Download ADMINISTRATION OF MEDICATIONS

ADMINISTRATION OF
MEDICATIONS
MODULE 6
Administering
drugs is one of most
critical nursing
responsibilities.
• Smallest margin for error
•
Medication Administration
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Avoiding errors:
o know
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how to read & correctly
interpret drug orders
o have a sound understanding of
pharmacology.
Pharmacology is the study of
drugs & their action on living
organisms
Drug chemical, generic & trade names
•
The chemical name (p-Acetaminophenol,
Paracetamol, p-Hydroxyacetanilide:N-acetylp-aminophenol) provides an exact chemical
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description of the drug’s composition.
The manufacturer who first develops the
drug gives the generic name
(acetaminophen) before it receives
official approval
Drug chemical, generic & trade names
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Federal legislation in 1962 mandated that there is
one official name (acetaminophen) for each drug.
A drug’s generic name often becomes its official
name
The trade name (Tylenol), brand name, or
proprietary name is the name under which a
manufacturer markets a drug.
•
A generic drug may have many different
trade names (Tylenol, Atasol, Tempra are
all trade names of acetaminophen products)
Acts/laws regulating drugs in Canada
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Laws govern all aspects of drug production,
distribution, advertising, and sale.
The Canadian drug laws
• Food and Drugs Act of 1953
• Narcotic Control Act of 1961 (p.1116).
• Both laws under the Health Protection Branch of
Health Canada.
• Enforcement of Narcotic Control Act delegated
to the RCMP
Nurses responsible for their own
actions regardless of whether there
is a written order.
• If physician writes incorrect
order, nurse who administers
•
written incorrect dosage is
responsible for the error.
Pharmacokinetics
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Pharmacokinetics is the study of
the
absorption,
• distribution,
• biotransformation, and
• excretion of drugs.
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Absorption
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Process by which a drug passes into bloodstream.
1st step in movement of drug through body (Unless
drug is administered directly into bloodstream)
For absorption to occur, correct form of drug
must be given by route intended.
Rate of absorption of in stomach variable & depends
on:
• food,
• acidity of stomach,
• application of heat or cold.
Distribution
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The transportation of drug from its site of
absorption to site of action.
When a drug enters bloodstream, it is carried
to most vascular organs – liver, kidneys &
brain
Body areas with lower blood supply – skin and
muscles – receive the drug later.
Chemical & physical properties of drug
largely determine area of body to which drug
will be attracted
Biotransformation
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Called detoxification or metabolism
Process = drug is converted to a less active form.
Most biotransformation takes place in liver
Products of process called metabolites.
Types of metabolites: active and inactive.
• active metabolite has a pharmacological action
itself, whereas an inactive metabolite does not.
May be impaired if a person has an unhealthy
liver.
Excretion
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Process by which metabolites & drugs
eliminated from body.
Most eliminated by kidneys in urine
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some excreted in feces, breath,
perspiration, saliva & breast milk.
Efficiency of kidneys to excrete
drugs and metabolites diminishes with
age
Effects of drugs
• The
therapeutic effect of a
drug, also referred to as
desired effect, is primary
effect intended, that is the
reason the drug was
prescribed
Effects of drugs
•
A side effect, or secondary effect, of a
drug is one that is unintended.
• Usually predictable & may be either
harmless or potentially harmful.
• Some tolerated for drug’s therapeutic
effect
• More severe, also called adverse
effects, may justify the discontinuation
of a drug
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Drug toxicity (harmful effects of a drug
on an organism or tissue) results from
• overdosage,
• ingestion of drug intended for external
use
• buildup of drug in blood because of
impaired metabolism or excretion.
Some toxic effects apparent immediately,
some not be apparent for weeks or
months.
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A drug allergy is immunologic reaction to a drug.
• When a client is 1st exposed to foreign substance
(antigen), body may react by producing
antibodies.
• Client can react to a drug as to an antigen &
develop symptoms of an allergic reaction.
• Allergic reactions
• can be mild or severe; from a mild rash to an
anaphylactic reaction.
• Can occur anytime from few minutes to 2 weeks
after the administration of drug.
•
Drug tolerance exists in person who has
unusually low physiologic activity in
response to a drug & who requires
increases in dosage to maintain therapeutic
effect.
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Drugs that commonly produce tolerance are
• opiates,
• barbiturates,
• ethyl alcohol
• tobacco
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A drug interaction occurs when
the administration of one drug
before, at the same time as, or after
another drug alters the effect of one
or both drugs.
Effect of one or both drugs may be
either increased or decreased.
Drug interactions may be beneficial
or harmful
Routes of administration of drugs:
Oral, s.l., buccal
• Topical
• Transdermal
• Parenteral (IM, IV, ID sc)
• Inhalation
• Rectal
• Vaginal
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The route of administration is
chosen according to the
• speed
of absorption
desired
• site of action of
medication
Some medications are
formulated for a specific route
only and must be given in
that manner.
• It is important that medicines
be administered as directed by
the manufacturer.
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Oral and enteral administration
require by medication not be destroyed
by environment of stomach & digestive
enzymes.
• Oral too slow if rapid absorption
required,
• Cannot be used if patient is vomiting.
•
Rectal administration in form of liquids or
suppositories circumvents this problem
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Mucosal routes of administration include
absorption through
Nasal mucosa
• Buccal mucosa,
• Sublingually,
• Bronchioles (usually achieved
through inhalation of an aerosol)
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Vaginal or rectal administration
also mucosal routes of medication
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Percutaneous
administration is
most often used by
direct absorption
through skin
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Parenteral administration is used when
a drug cannot be given by mouth.
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speed of absorption varies
greatly with the specific route
used, which may be subcutaneous,
intravenous, intramuscular, intraarterial, intraperitoneal, intrathecal,
intracardiac, or intrasternal.
Copyright 1997 by F.A.Davis Company
Factors that influence drug action
• Developmental
factors
such as pregnancy and age
• Gender due to
distribution of body fat
and fluid and hormonal
differences
Factors that influence drug action
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Cultural, ethnic & genetic
factors
Genetic factors may contribute to
toxic effects because of being
unable to eliminate a drug or
metabolizing it too fast.
• The use of herbal remedies may
counteract prescribed medications
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Factors that influence drug action
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Nutrients can affect the action of a
medication
Environment. The client’s exposure to
severe physical and emotional stress
triggers a hormonal response that
eventually may interfere with drug
metabolism.
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Exposure to heat and cold can affect
responses to drugs (vasodilation and
vasoconstriction)
Factors that influence drug action
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Psychological factors: a client's
expectations about what a drug can
do could affect the response to
medications
Illness and disease can also affect
the action of a drug. Drug action is
altered in clients with circulatory,
liver, or kidney dysfunction
Factors that influence drug action
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Time of administration of oral
medications affects the relative
speed with which they act.
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Orally administered medications
are absorbed more quickly on an
empty stomach. Thus oral
medication given 2 hours prior to
meals work faster than those taken
after meals.
The Drug order
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Drug order sheet usually stamped with pt’s
addressograph to contain all relevant demographic
info of client
Orders for drugs usually in this sequence:
• Drug name
• Dosage
• Administration route
• Time & frequency of administration
Tylenol 500 mg, ii tabs po qid x 10 days
Various components of a drug order
1.
2.
3.
4.
5.
6.
7.
Full name of client
Date and time the order is written
Name of the drug to be
administered
Dosage of the drug
Route of administration
Frequency of administration
Signature of the person writing
the order
Example of
written
prescription in
community
setting
Types of medication orders
• stat
order
• single order
• standing order
• prn
order
Types of medication orders
• stat
order indicates that
the medication is to be
given immediately and
only once
Minipress 4mg po stat
Types of medication orders …
order or “one-time
order” is for medication to
be given once at a specified
time
• single
Minipress 4mg po @ 1600h
today
Types of medication orders …
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standing order may or may not have
a termination date.
May be carried out indefinitely until
an order is written to cancel it, or may
be carried out for a specified number
of days
Minipress 4mg po q6h
Minipress 4 mg po q6h if systolic BP
>140
Types of medication orders …
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prn order, “as needed order,”
permits nurse to give a medication
when, in the nurse’s judgment, the
medication is needed and when it
can be safely administered
Tylenol 500 mg, ii tabs for pain as
required q4h
Dealing with drug orders
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Once you determine the order contains all the
necessary info, you begin to
• Interpret it (if any info missing or writing is
illegible, clarify with doctor before transcribing)
• Transcribe it to a medication sheet record.
(MAR = medication administration record). You
will need to initial the order sheet & med record
to indicate it was you who correctly transcribed
the order
• Direct a copy to pharmacy for prep of medicine
to be delivered to unit
Differentiate between prescribing,
dispensing & administering medications.
Who is responsible for each of these roles?
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The physician prescribes medications (unless there
is a nurse practitioners act).
The pharmacist prepares & distributes prescribed
drugs. The pharmacist is responsible for filling
prescriptions accurately & for being sure that
prescriptions are valid
The nurse’s role extends beyond simply giving
drugs to a client. >>>>>>>>>>>>>>>>
Nurse’s role
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The nurse must
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determine whether a client should receive a drug
at a given time
assess the client’s ability to self-administer
drugs,
provide medications at the proper time,
monitor the effects of prescribed medications.
Client and family education about proper
drug administration and monitoring is also
the nurse’s role
The “five (plus one) rights” of drug
administration
1. Right drug
2. Right dose
3. Right time
4. Right route
5. Right client
And…
6.Right documentation
The 3 checks!
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When preparing to give a med, the label of a
drug is checked 3 times
1.
2.
3.
When the drug is taken from the
storage area
Immediately after removing the
drug from its container
Before returning the container back
to its storage area
Refusing to give a drug
You can legally refuse to administer a
drug under these circumstances
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If the dosage is too high
If the drug might interact
dangerously with other drugs taken
by the patient
If the pt’s physical condition
contraindicates the drug
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When you refuse to carry out a
drug order you:
• Notify
your immediate
supervisor
• Notify the doctor (if your
supervisor has not done so)
• Document medication not
given
Various medication systems
Stock supply, unit dose system or computer controlled
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Stock supply
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Medications are available in quantity in
stock containers.
Nurse prepares individual doses from
large stock supply container.
Time consuming and costly.
Narcotics are often provided in stock
supply
Various medication systems
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Unit-dose system
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Consist of a drawer with 24-hour supply of
medications for each client.
Is the ordered dose of medication client receives
at a prescribed hour.
At a designated time each day pharmacist refills
the drawers with a fresh supply of individually
wrapped medications.
This system
• reduces the number of medication errors
• saves steps in dispensing drugs
Various medication systems
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Computer-controlled dispensing systems
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Are especially useful for the delivery and
control of narcotics.
Each nurse has a security code that allows
access to the unit.
The client’s hospital number is then entered.
The nurse can select the desired drug, dose,
and route.
The system delivers the medication to the
nurse and records it.
Nurses responsibilities in med administration
Regardless of route of administration you will:
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Obtain MAR or order and verify order
Check for allergies
Identify the client
Inform the client
Administer the drug (5 + 1 rights & 3 checks)
Provide adjunctive interventions as indicated
Record the drug administered
Evaluate the client’s response to the drug
Variations in the way drugs affect
infants, children, and the elderly
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Infants
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Usually requires small dosages because of
their body size and the immaturity of their
organs, especially the liver and kidneys.
Dosages often calculated according to
weight
They often do not have all the enzymes
required for drug metabolism and therefore
may require different medications than
adults.
Variations in the way drugs affect infants, children & elderly
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Children
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Children vary in age, weight, body surface
area, and the ability to absorb, metabolize,
and excrete medications.
Children’s doses are lower than those of
adults, so special caution is needed in
preparing medications for them.
All children require special psychological
preparation before receiving mediations.
Variations in the way drugs affect infants, children & elderly
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Older adults
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Have different responses to medications due to
physiologic changes that accompany aging.
Changes include decreased liver and kidney function,
which can result in the accumulation of the drug in the
body.
May be on multiple drugs & incompatibilities may occur.
Older adults often experience decreased gastric mobility
and decreased gastric acid production and blood flow,
which can impair drug absorption.
Increased adipose tissue and decreased total body fluid
proportionate to body mass can increase the possibility of
drug toxicity.
Abbreviations commonly employed in
prescription orders
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See Table 30-3 p.840 and
30-8 p.847
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Each facility will have
a list of approved
abbreviations
accepted while
charting in that
facility.
24-hour clock
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24-hour clock system eliminates
need to specify a.m. or p.m.
Time is expressed as a 4-digit
number.
The first two digits indicate the
hour (1230h)
Second two digits represent the
minute. (1230h)
24-hour clock
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The hours are numbered consecutively
from 00 through 23, with midnight = 00.
Minutes are shown from 01 through 59.
The a.m. hours generally keep the same
number as in the 24-hour system, while
you need to add 12 to the p.m. hours to
obtain their 24-hour clock equivalent.
Midnight and noon are special cases.
Utilization of the 24-hour clock for
administration of medication
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Converting from am/pm to 24 hour clock:
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between 12:00 AM and 12:59 AM, subtract 12 hours:
12:59 AM = 0059h
between 1:00 AM and 12:59 PM, a straight conversion:
10:00 AM = 1000h
between 1:00 PM and 11:59 PM, add 12 hours:
10:59 PM = 2259h
Midnight = 2400h
1 min after midnight = 0001h
Times & med admin
• q6h
is not the
same as qid
• q8h is not the
same as tid