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Chapter 30
Medication Administration
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Standards and Legislation
• Standards:
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Ensure uniformity
Predict effects
United States Pharmacopeia (USP)
National Formulary (NF)
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Standards and Legislation
• Federal legislation:
– Pure Food and Drug Act of 1906
• USP and NF establish drug standards
• State and local legislation
• Health care institution regulations
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pharmacokinetics
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Absorption
Distribution
Metabolism
Excretion
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Nomenclature
• Chemical name
– Precise description of composition
• Generic name
– Given by U.S. Adopted Names Council
• Trade or brand name
– Given by pharmaceutical companies
– Used during marketing
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Action
• Pharmacology
– Medication management
– Classification
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Action
• Pharmacology
– Preparation and route
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Oral
Parenteral
Topical
Inhalants
Intraocular route
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Drug Interaction
• Effect of one drug on another
• Deliberate combining
• Not all drug combinations therapeutic
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Side Effects and Adverse
Reactions
• Side effects
– Mild
– Predictable
– Nontherapeutic
• Adverse reactions
– Unexpected
– Potentially hazardous
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Side Effects and Adverse
Reactions
• Food and drug interactions
– Drug effects on nutritional status
– Food effects on drug absorption
– Food effects on drug utilization
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Factors Influencing Drug Action
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Genetics
Age
Height
Weight
Physical conditions
Mental conditions
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Professional Roles in
Medication Administration
• Health care providers
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Orders
Administration of drugs
Teaching
Observation
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Professional Roles in
Medication Administration
• Types of orders:
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Stat
Single-dose
Standing
PRN
• As needed
• Parts of drug order
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Systems of Weight and Measure
• Metric
• Apothecary
• Household
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Approximate Dose Equivalents
• Converting units of weight and volume
– Measurement conversions within metric system
– Measurement conversions between systems
• Drug dose calculations
– Pediatric dosages
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safe Drug Administration
• Guidelines for medication:
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Right drug
Right dose
Right client
Right route
Right time
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safe Drug Administration
• Document:
– Critical element
– Only after client has taken drug
• Drug supply and storage
– Unit dose form
– Stock supplied drugs
– Narcotics and controlled substances
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safe Drug Administration
• Drug abuse
– Addiction
• Physiological or psychological dependence on substance
or behavior
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safe Drug Administration
• Drug abuse
– Dependence
• Reliance on or need to take drug
• Physiological
• Psychological
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Compliance
• Compliance
– Taking medication as prescribed
– Improved through client understanding
• Noncompliance
– Inconsistent use as prescribed
– Self-adjusted dosing or scheduling
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Legal Aspects of
Administering Medications
• Questioning medication order
– Responsible
– Accountable
• Preventing medication errors
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Assessment
– Medical history
– Drug history
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Allergies
Prescription drugs
Over-the-counter drugs
Complementary therapy
– Herbal supplements
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Assessment
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Biographical data
Cultural diversity
Lifestyle and beliefs
Sensory and cognitive status
Physical exam
Diagnostic and laboratory data
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Diagnosis
– NANDA statements
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Deficient knowledge
Ineffective health maintenance
Impaired physical mobility
Disturbed sensory perception
Readiness for enhanced knowledge
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Planning and outcome identification
– NOC for medication administration:
• Knowledge
– Medication
• Medication response
• Self-care
– Nonparenteral medication
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Assessment
– Administration
– Teaching
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Oral medication administration
• Most common route
– Gag reflex
– Consciousness
– Nausea or vomiting
• Medication administration
– Sublingual and buccal
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Enteral medication administration
• Delivery through gastrointestinal tube
• Equipment
• Risk for aspiration
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Parenteral medication administration
• Routes
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Intradermal
Subcutaneous
Intramuscular
Intravenous
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Parenteral medication administration
• Equipment
– Syringes
– Needles
– Ampules and vials
• Angle of injection
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Intradermal medication administration
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Purposes
Slow absorption
Small quantity of solution
Procedure
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Subcutaneous medication administration
• Purposes
– Heparin
– Insulin
• Sites
• Procedure
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Intramuscular medication administration
• Purposes
• Sites
• Procedure
– Z-track injection
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Intravenous medication administration
• Purposes
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Intravenous medication administration
• Procedure
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Infusion pump
Adding drugs to volume-control administration set
Administering by intermittent infusion
Intermittent infusion devices
Administering intravenous push medications
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Implementation
– Topical medication administration
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Eye
Ear
Nasal
Rectal
Vaginal
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medication Administration
and the Nursing Process
• Evaluation
– Ongoing responsibility of nurse
• Client’s response to medications
• Changes in client’s condition
• Client’s ability to self-manage
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.