Download Pharmacology

Medication
Administration
Presented by Denise Auttonberry,
Ph.D., MSN, RN
Outline developed by Glenda Moore, MSN, RN
A.D.Nursing Faculty
Regulation of Medicines

1906 – Pure Food and Drug Act

1914 – Harrison Act

1932 – State Narcotic Act

1970 – Controlled Substances Act

US Food and Drug Administration
Pharmacology

Study or science of drugs
Common Terms, Symbols and
Abbreviations

Review from study sheet.

Small groups.
JCAHO DO NOT USE LIST Examples
U, IU – Unit, International Unit
 QD, QOD – (Write it out) daily, every day,
every other day.
 Trailing Zero – 1.2500
 MS, MSO4, MgSO4 –

 morphine,
sulfate
morphine sulfate, magnesium
Who can order medications?

A licensed practitioner – always be familiar with
the state practice act and agency policy.
 Physician
 Nurse
– MD or DO
Practitioner – NP
 Physician
 Dentist
Assistant - PA
– DDS or DMD
 Podiatrist
- DPM
Who can dispense
medications?

licensed pharmacist –
R.Ph. or Pharm.D.
Who can give medications?
Registered Nurse – RN
 Licensed Practical Nurse – LPN
 Respiratory Therapist – CRT, RRT
 Paramedic – prehospital only

Who regulates nursing practice?

Professional Regulation
Standards
 Accreditation
 Certification


Legal Regulation
The Board of Nursing - State Agency
 Nurse Practice Act
 Scope of Practice
 Voted by State Legislature

Resources for Medication
Administration
Nursing & Pharmacology Textbooks
 Nursing Drug Guides
 Preprinted Drug Cards
 Physician Desk Reference (PDR)
 Hospital Formulary
 Pharmacy
 Internet Resources

Nursing Responsibilities for
Administering Drugs
Assessing the client and understanding
the need for medication.
 Ensuring the rights of medication
administration.
 Preparing the medication to be
administered using accurate dosage
calculation.

Nursing Responsibilities for
Administering Drugs – con’t
Administering medication and
documenting it was given.
 Monitoring client response.
 Educating client regarding medication
regimen.

Safety Considerations in
Medication Administration
Knowledge about the medication.
 The five/six rights.
 Three checks.
 Safe dosage.
 Safe environment.

Knowledge Needed to
Administer Drugs Safely
Drug name, preparations, and
classifications.
 Mode of action and purpose of medication.
 Side effects and contraindications for
medication.
 Antagonist of medication.

Knowledge Needed to
Administer Drugs Safely – con’t
Safe dosage range for medication.
 Interactions with other medications.
 Precautions to take prior to medication.
 Proper administration technique.

What are the five rights?
Right patient
 Right medication
 Right dosage
 Right route
 Right time
 Right documentation
 Right reason med is given

What are the six rights?
Who?
 What?
 When?
 Where?
 How much?

 Write

Why?
it down
Client Rights

Remember –
Clients always have
the Right to Refuse.
What are the three checks?
Container or unit dose package compared
with MAR
 Compare with MAR immediately before
removing from package or multi-dose
container.
 Returning container to shelf or before
giving the unit dose to the client
compared with MAR.

How do we know the dosage
ordered is safe?

Knowledge of the drug

Accurate calculations
To maintain safe patient dosage
Monitor blood levels
 Safe dosage levels

 May
be ordered as:
Loading dose
 Maintenance dose
 Example – blood thinners, some antibiotics

What is a safe environment?
Well lighted
 Quiet, minimal distractions
 Work alone when possible, except as
students
 NEVER leave meds unattended.

Legal/Ethical Factors
Nursing Responsibility
 Documentation
 Physician’s Prescriptions
 Medication Errors
 Agency Policies
 Narcotic/Control Drugs

Nursing Responsibility
 To
properly and correctly prepare,
administer, document medication
administration, observation, and
teaching of client.
Nursing Responsibility
PATIENT EDUCATION
IS A MAJOR
NURSING
INTERVENTION
Medical Record Documentation

MAR – Medication Administration Record
 Legal
document
 Chart each dose of medication ASAP
 Never chart ahead of time
 CMAR – computerized

User ID/password
Medical Record Documentation
Intentional or inadvertently omitted drugs
 Refused drugs
 Medication errors

Proper Signature on MAR

Agency will have specific policy
 Signing
when medications are administered
 Signing when medications are held
 Where to put signature and corresponding
initials

Approved HCC signature
Signature
A. Showers, Hinds NS
Initials
AS
CAREFUL DOCUMENTATION
--THE KEY TO
COMPETENT
PRACTICE
Military/Computer Time
24 hour clock
 Midnight – 12:00 AM = 2400 (0000)
 Noon – 12:00 PM = 1200
 Convert AM time: remove colon, place
zero in front
9:15 AM =0915
 Convert PM time: remove colon, add
1200
5:30 PM - 1730

Physician’s Prescriptions
Who can??
 CPOE – Computer Prescriber Order Entry
 Written
 Verbal/telephone

 Never
students
 Agency Policy
Executing HCP Prescriptions
Nurse is legally liable for administering
medications.
 Nurse Practice Act
 Agency/institution policy
 Get written orders when possible

Executing HCP Prescriptions
Double check any order that client
questions
 Question any order that is:

 Ambiguous
 Contraindicated
by-
Normal practice
 Client’s present condition

Types of Medication Orders
Standing order
 PRN order
 One-time order
 Stat order
 Telephone/verbal order
 Stop order
 Automatic stop order

Parts of the Medication Order
Client’s Name
 Date and time order written
 Drug name
 Dosage
 Route
 Frequency
 Signature of person writing order

Medication Supply System
Stock supply
 Individual supply
 Medication cart
 Computerized/automated medication
system
 Bar coded medication cart

Computerized Medication
Dispensing System
Drugs from Home
What can we do?
 Self administered medications
 Use of meds from home

 Must
have order for self administration and to
have meds at bedside
 Document given by client
Systems of Measurement
Metric – meter (linear), liter (volume), gram
(weight)
 Apothecary – les convenient and concise;
basic unit or weight is grain
 Household – least acurate system;
teaspoons, tablespoons, teacup, glasses
used

Conversions

Conversions between Systems –
See Calculate With Confidence
Conversions

Medications not usually ordered in
household measurements


(Home oral med for children may be ordered in tsp.
Must use measuring device with that med)
Some still may be ordered in apothecary—
grains
 Acetaminophen
& aspirin
 Morphine, Nitroglycerin, & Phenobarbital
Signs & Symptoms of Drug
Allergy








Rash
Uticaria
Pain
Fever
Diarhea
Nausea/Vomiting
Angioedema
Anaphylactic reaction- involves 2 or more body
systems
Anaphylactic reactions
Local Urticaria (hives)
 Edema
 Warmth
 Erythema
Systemic
Urticaria
Angioedema
flushing,
Wheezing
Dyspnea
Increased mucous
production
N&V
Feeling of generalized
anxiety
Anaphylactic reaction
Local reaction
Anaphylactic reaction
systemic
Types of Medication Errors








Inappropriate prescribing of the drug
Extra, omitted, or wrong doses
Wrong patient
Wrong route or rate
Failure to give drug within prescribed time
Incorrect preparation of a drug
Improper technique when administering drug
Giving a drug that has deteriorated
Narcotic/Control Drugs


Controlled /substance Act
Schedule I-V
 C-I – no aceptable medical use (heroin)
 C-II – high abuse potential (morphine)
 C-III – intermediate abuse potential (hydrocodone,
valium)
 C-IV – less abuse potential (benzodiazepines)
 C-V – limited abuse potential, recorded as transaction
(cough syrup with codeine)
Which agency has control?

Which governmental Agency has jurisdiction?
 Drug Enforcement Agency
Medication Administration

Nursing Process
 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
Assessment


Health history
 Previous and current drug use
 Ask about OTC/herbal preparations
 Schedule
 Response
 Attitude
 Compliance
 Storage
Always assess before, during, and after administration
Planning - Nursing Diagnosis

Varies with abnormal data found/problems
identified

Planning- goal-outcome for that diagnosis

Interventions and rationales

Evaluate the stated outcome
Implementation
Utilizing the “6 Rights”



Preparing
Right drug
Right reason
Right dose and preparation
Before
Right client (2 methods of ID—not room number according to
The Joint Commission National Patient Safety Goals)
Right medication
Right dose, route, time
After
Right documentation
Right response
Implementation
Stay with client
 Give each drug separately
 Never leave medications
 Document promptly

Implementation





Oral medications- most common; convenient and
comfortable for client
Many forms
 To crush or not to crush-that is the question.
“Cheeking”
Special techniques
Special considerations
Children
Older adults
Enteral tubes
Administering Eye Drops into
Conjunctival
Sac
Instilling Ear Drops – Adults
Pulling Pinna up and Back
Instilling Ear Drops – Child
Pulling Pinna down and Back
Instilling Nose Drops/sprays
Used to treat allergies, sinus
infections, and nasal congestion
 Medications with a systemic affect
may also be instilled in the nose
 Medical asepsis should be observed
when instilling drops

Transdermal patch
Remove old patch, fold in half (adhesive
sides together and discard per agency
policy
Assess skin
 Clean with soap and water
 Wear gloves (don before opening/handling patch)
 Apply patch:
 Remove patch from packaging
 Write date, time, (initials) on patch
 Apply to site, use palm of hand to press firmly
for 10 seconds
Certain medications are to be applied to specific
sites.

Administering a Vaginal Medication
Creams, foams, tablets, and
suppositories melted by body heat can
be applied intravaginally
 May use a narrow tubular applicator
with an attached plunger
 Administration should be timed to
allow patient to sit down afterward to
retain medicine
 May need to lubricate tablet or
suppository to ease insertion

Administering a Vaginal
Medication
Administering a Rectal Suppository
Must be placed past the internal anal
sphincter and against rectal mucosa
 Positioning of client?
 Used primarily for local action

 Laxatives
 Fecal
softeners
Systemic effects also achieved
 Lubricate suppositories to ease
insertion

Inserting the Suppository Round End
First Along the Rectal Wall
Implementation

Pulmonary medications

MDI (metered dose inhaler)

With or without spacer
Small-volume nebulizer
 DPI (dry powder inhaler)

Inhalers
Implementation

Medications via a gastric tube
 How
would you administer through PEG
tube?
 What
if NG tube is to
Low Continuous Suction?
Implementation

Medication Administration Remember
 Reconcile
MAR with orders
 Prepare medication
 Administer medication
 Document administration
 Always assess
TEACHING

Educate about
 General
info—what
 How and when to administer
 Expected side effects and adverse effects
 When to follow up when to call/report
 Special instructions
Patient Teaching
Review techniques of medication
administration
 Remind client to take the medication
as prescribed for as long as
prescribed
 Instruct client not to alter dosages
without consulting physician
 Caution client not to share
medications

WHO DO WE TEACH?

Client

Family

Caregivers
How do we teach?

Teaching & Learning
 Chapter
22 in Taylor, Fundamentals.
Teaching Acronym
T – tune into the patient
 E – edit patient information
 A – act on every teaching moment
 C – clarify often
 H – honor the patient as partner in the
education process

Client Teaching
First determine what the client knows
 Identify learning needs
 Identify ethnic, socioeconomic, and
physiological factors that influence
medication usage
 Explain &/or demonstrate how to take
the medication
 Ask for a return demonstration

Evaluation

Effectiveness of drug
 Clinical
observation
 Subjective data
 Objective data
 Drug levels
 Monitoring devices
Pharmacodynamics
Therapeutic effect
 Mechanism of action

 Receptor

e.g., Beta blockers
 Enzyme

interactions
interactions
e.g., ACE inhibitors
 Nonselective
interactions
Pharmacokinetics
Absorption—drug is transferred from
site of entry into bloodstream
 Distribution—drug is distributed
throughout the body
 Metabolism—drug is broken down into
an inactive form
 Excretion—drug is excreted from the
body

Drug Classifications

Can be classified by
 Body
system
 Symptoms relieved
 Clinical indication

Davis’s Drug Guide for Nurses.
Philadelphia: F.A. Davis Company.
14th edition.
Davis Drug Guide
Quick References
 Useful tables
 Summaries of major drug
classifications

Drug Information You
MUST know










Name of drug
Classification
Expected therapeutic effect (action)
Reason medication given to client
Dosage, route, time of administration
Common Side Effects
Contraindications
Contingencies-common nursing actions
Expected therapeutic outcome
Patient education needs