Download Pharmacology Unit 2

Pharmacology
Unit 2
• Need to Know
• Chapter 10
Interpreting Physicians Orders
–Calculations text.
–Memorize abbreviations
• Need to know
• Chapter 11
Reading Med Labels
–Calculations book
–be able to identify
• Trade Name, Generic Name
• Manufacturer
• Dosage Strength
• Form
• Amount
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Medication Storage
• Med. Room
• Med cart - keep locked
• Med refrigerator
• Controlled Substance storage
Medication Records
•MAR
–Medication Administration Record
• Check Allergies
Unit Dose System
• Each dose of medication is packaged separately
• Marked with generic and/or brand name
• Marked with dose
• Remember
–DO
Administration of Medications
primary obligation as a nurse:
NO HARM !!!
• Need knowledge in Pharmacology
Code of Ethics
• Maintain individual competence in admin. of medications
• recognize/accept responsibility for actions and judgement
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Errors in Med Administration
• Report it immediately
–Charge nurse, instructor
• ALL errors need reporting
–complete variance
• If many, re-education
Medication Errors
• Reporting STAT may save pt. life and expense.
• Cover-up or neglect to report is as criminally liable
the error
How to avoid making med. errors:
• Know state nurse practice act
• Know facility policy and procedures
• Follow the 6 “rights”
The 6 Rights of Medication Administration
• Right Patient
• Right Med.
• Right Dose
• Right Time
• Right Route
• Right Document.
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as making
Right Patient
• Proper ID of pt (use 2 identifiers)
- compare MAR with wrist band
–then ask name
• Don’t call by name first
• Never leave med. at bedside
• Stay with pt until taken
• Never give unless absolutely certain you are giving to right pt
Right Medication
• Rule of three - look at med 3 times before
administering
Check 3 Times
• When removing med. from drawer
• When placing in med. cup / syringe
• When opening packages at bedside with MAR
Right Medication
• Make sure label legible
• CONCENTRATE!!!
• Know what med is, it’s intended effect and potential SE
• NEVER administer a medication that someone else has prepared
(unless it is still in it’s original container)
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Right Dose
• The correct amount
• Always listen to the client
• Know what usual dose should be - if unusual, don’t hesitate to
question the order
• Medicine cup
How to measure the
Right Dose
- use meniscus at eye level
- if pour excess,
discard extra amount
• Look carefully at syringe markings
• Insulin doses and syringes are different
- U-100 mostly
Unused Medication
• All prepared unused med should be discarded and NOT returned to
original container
• Administer at time ordered
• Know abbreviations
• Know set intervals
• Know when not to give
• STAT - immediately
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Right Time
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• PRN - as needed or on request.
–First assess symptoms
• HS - Hour of Sleep
Right Route
• Know what usual route is
• If not ordered, assumption is PO
• Check reference!!
Right Documentation
• Put on right pt’s chart, on right MAR
• Military time
• Nurse who gives it, charts it
• If STAT or PRN med:
–document time on MAR
–document time, focus, data, action and response in nurses notes
• When client refuses:
Documentation
–You are obligated to explain the med. and it’s importance
–If still refuses, circle the med. time and write “refused” and your
initials
–Explain in nurses notes
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Giving meds as Student Practical Nurse
• Give under instructor supervision - NO ONE ELSE until comps!!
• May not start IV’s or give IV meds
As students, you may:
• Observe IV sites
• Inc or Dec drip rates
• Hang new bags of plain
• DC IV’s
• Add meds to IV bags
IV’s if supervised
Students may not:
Questionable meds
• If you find a syringe - discard it
• If you find meds at bedside with no order - discard it
• What the drug is
• MD
• Patient condition
• Local
Routes of Administration
Determined by:
Type of Desired effect
• Systemic
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Enteral Routes
• Meds. Administered by way of digestive tract
• Oral, gastric tube, rectal
• Simple
• Convenient
• Safe
• Economical
Oral or PO
Advantages
Disadvantages
• Unpleasant taste, odor
• Some harmful to teeth, mucous membranes
• Cannot use with N & V
• Cautious with difficulty swallowing
• Peristaltic rate
What can influence PO absorption?
• Full stomach
• Dilution
• Food and drug may be incompatible
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Methods of giving
oral drugs
• Swallow via mouth
–Pill, tablet, caplet, capsule, liquid
• Med syringe
• NG-tube, Peg tube
Rectal
Rectal administration
•Local effects
•Systemic effects
3 different types:
•Suppository
•Ointment
•Liquid
Inserting suppository
• Explain procedure
• Sims position
– preferably left Sims
• Use gloves!!!!!!!
• Remove from wrapper
• Lubricate
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• Insert blunt side first
• Push toward umbilicus, past internal sphincter
• Press buttocks together
Rectal Ointments
• Same as suppositories but applicator is attached to tube
• inserted into anus
Percutaneous Routes
• Through the skin and mucous membranes
• Includes:
–Topical, Sublingual, Buccal, Eye, Ear, Nose, Vagina, Inhalation
Topical Meds
•Include:
–Ointments
–Creams
–Lotions
–Transdermal
Transdermal Meds.
• Absorbed through skin
• Patches / ointments
• Examples ???
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for systemic effects
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Transdermal Meds.
• Chose clean, dry, hairless site
• Rotate sites
• Remove old patch or ointment
Eye Medication
(Opthalmic)
• Liquid drops
• Ointments
• Have look up and focus on specific object
Eye Drops
• Wash hands
• Apply gloves
• Retract lower conjunctival sac
• Place drop in center of everted lower lid
• Place gentle pressure on inner canthus
• Instruct pt. to close eyes
• Wipe off excess
• Wash hands
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Eye Ointments
• Squeeze thin ribbon along lower lid
• Start at inner canthus
• Wipe away excess
• Never touch applicator to eye
Ear Medications
(Otic)
• Adult = pull pinna up and back
• Child = down and back
• Do not touch ear with dropper
• Instill prescribed drops
• Direct against side of canal
• Remain on side for ~10 min to keep med in ear
Nasal / Respiratory Medications
• Have rapid absorption
• Inhalants
–Usually administered by hand held devices
–MDI - metered dose inhalant
•Aerosol
–Based on use of compressed air or oxygen forcing mist through
tubing to mouthpiece
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•Nasal sprays or drops
–High Fowlers
–Head tilted back
–Tip of bottle just inside nares
–Squeeze as pt. inhales
Sublingual
• Placed under the tongue
• Dissolve and are absorbed in mucous membranes
• Between cheek and gum
• Leave there until absorbed
Buccal
•How is a zydis administered?
Zydis
Vaginal Administration
• Douche
• Vag supp, creams, gels
• Use applicator
• Pt should lie down for 30 min after insertion
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Parenteral Routes
• Medication administered outside the digestive tract
• Medications administered by injections (needle)
Injection Routes
•Intradermal
•Subcutaneous
•Intramuscular
•Intravenous
• Syringes
Injection Equipment
– various sizes
• Needles
– various
• Barrel
–marked
• Plunger
gauges and lengths
Parts of syringe
with calibrations
–fits inside barrel
–rubber flange measures dose
• Tip
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Parts of Needle
•Hub
•Shaft
•Bevel
Sterile Parts??
• Ideas ???
Needles
• Various sizes
• Gauge and length vary with method of administration – need to know differences!
Gauge
• Needles inner diameter
• Larger number = smaller diameter
• 29-G to 14-G
• 3/8 inch to 2 inch
• SubQ - uses shorter needle
• IM - uses longer needle
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Length
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Medications for injection
• Liquid
• Reconstituted powder
• May come in:
- Ampules
- Vials
Cautions
• Injections are most hazardous method
• May damage nerves, tissue, blood vessels
• May lead to infections
Avoiding Complications
• Select site carefully
• Maintain sterility
• Choose proper needle
• Think: aspirate?
• Establish site rotation
When do we not aspirate?
• Intradermals
• SubQ heparin, Lovenox, or insulin
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Intradermal Meds
• Just beneath epidermis
• TB skin test / Allergy testing
• Dose very small
- usually 0.1 ml
Intradermal Equipment
• TB syringe (1 ml.) with fine gauge, short needle
• 3/8 - 5/8 inch length
• 25 - 27 G
Intradermal needle angle
• Almost flat against skin
• Bevel up
• Inserted ~ 1/8 inch
• Do not aspirate
(10-15º angle)
Skin prep
• Let alcohol dry before
• Do not massage after
• No bandaid/covering
• Almost always given in inner aspect of lower arm
Documentation
• Must include site, time
• Read in 24, 48, 72 hrs
• Can draw circle around site if no site map
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Subcutaneous (SubQ) Injections
• Hypodermic
• Under all layers of skin
• Given for slower systemic absorption
• Isotonic, watery, nonirritating
Used When:
• Med more effective in this route
• Pt can’t/won’t swallow
• Med. destroyed in GI tract or irritating
Not used when:
• Pt in shock
• Bad vascular system
• Gross adipose, edema, burns at usual sites
• Skin is diseased
Not used when:
• Skin tissue damaged by previous injection
• Drug not recommended for SubQ route
SubQ sites
• Most common: Arms abdomen, thighs
• Less common: Scapula
• Need fat fold of 1 inch
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SubQ equipment
• TB (1 ml) or 3 ml syringe
• Short, fine gauge
• 1/2 - 5/8 inch
• 25 - 27 G
• Most common is insulin
• Also see anticoags
• Dose usually < or = 1 ml
• Max. of 2 ml
• Needle angle 45º - 90º
SubQ meds
SubQ Do’s and Don’ts
• Do skin prep
• Do aspirate… UNLESS?
• Inject slowly
• Do massage…UNLESS?
• Document
Insulin
• Gently shake Intermediate or Long Acting
•NR = RN
• Air into N, air into R
• Draw up R, draw up N
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• Given when:
Intramuscular injections
- med not in oral form
- large dose
- Pt condition requires
- rapid effect desired
Risks of IM’s
• May damage blood vessels, nerves, bone
• Esp. dorsogluteal, sciatic nerve, large bl vessels
• Ventrogluteal
5 Basic sites:
• Deltoid
• Dorsogluteal
• Vastus lateralis
• Rectus femoris
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• 1 - 3 ml syringe
• 21 - 23 G
• 1 - 1.5 inch needle
• Need to get to muscle
IM equipment
IM med
• Many different meds
• Dose = 3 ml. max (deltoid – 2 ml max)
•
Angle of needle
90 degrees
• Choose site carefully
• Spread tissue before
• Always aspirate
• Withdraw quickly
• Massage after
IM Specifics
Z-track method
• Used for irritating drug
• Seals off needle tract
• Use 1.5 - 2 inch needle
• Discard needle used to draw up med
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Z-track
• Gluteal site only
• Pull skin laterally
• Insert needle, aspirate and inject
• Wait 10 sec, withdraw, allow skin to return
Z-track
•DO NOT MASSAGE!!
Intravenous Injections
• Advantages:
- delivers rapidly
- predictable effect
• Can irritate vein
• Inc risk of complication
• Expensive
• Inc risk of contaminate
• Constant monitoring
Disadvantages
Phlebitis
• Inflammation of vein
• Warmth, erythema
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IV infiltrate
• IV med / fluid passes out of vein into tissue
• cool, hard, tender, edema
• Microdrip = 60
• Macro = 10, 15 or 20
Review IV Formula
• What is the formula?
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