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Transcript
Drug Administration By: MYLA KISON, RN, MAN For handouts log on: www.dyci_sirglennhandouts@ yahoogroups.com Drug Nomenclature • Chemical name — identifies drug’s atomic and molecular structure • Generic name — assigned by the manufacturer that first develops the drug • Official name — name by which it is identified in official publications USP and NF • Trade name — brand name copyrighted by the company that sells the drug Drug Preparations • Oral – Capsule, pill, tablet, extended release, elixir, suspension, syrup • Topical – Liniment, lotion, ointment, suppository, transdermal patch • Injectable Drug Classifications • Body system • Symptoms relieved • Clinical indication Mechanisms of Drug Actions • Drug-receptor interaction — drug interacts with one of more cellular structures to alter cell function • Drug-enzyme interaction — combines with enzymes to achieve desired effect • Acting on cell membrane or altering cellular environment 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 Factors Affecting Drug Absorption • • • • • • Route of administration Drug solubility pH Local conditions at site of administration Drug dosage Serum drug levels Adverse Effect of Medications • • • • • Iatrogenic disease Allergic effects Toxic effects Idiosyncratic effects Drug interactions Signs and Symptoms of Drug Allergy • • • • • • • Rash Uticaria Fever Diarrhea Nausea Vomiting Anaphylactic reaction Variables Influencing Effect of Medications • • • • • • • Developmental considerations Weight Sex Genetic and cultural factors Psychological factors Pathology Environment, timing of administration Types of Medication Orders • Standing order — carried out until cancelled by another order • Prn order — as needed • Stat order — carried out immediately Parts of the Medication Order • • • • • • • Patient’s name Date and time order is written Name of drug to be administered Dosage of drug Route by which drug is to be administered Frequency of administration of the drug Signature of person writing the order Medication Supply Systems • • • • • Stock supply Individual supply Medication cart Computerized medication system Bar coded medication cart Systems of Measurement • Metric — meter (linear), liter (volume), gram (weight) • Apothecary — less convenient and concise; basic unit or weight is grain • Household — least accurate system; teaspoons, tablespoons, teacup and glass used Metric System Conversions • To convert larger unit to smaller unit, move decimal point to right. • To convert smaller unit to larger unit, move decimal point to left. – 1 kilogram = 1000 grams – 1 gram = 1000 milligrams – 1 milligram = 1000 micrograms Three Checks of Medication Administration • Read the label: – When the nurse reaches for the container or unit dose package – Immediately before pouring or opening medication – When replacing the container to the drawer or shelf Five Rights of Medication Administration • The nurse should give: – – – – – The right medication To the right person In the right dosage Through the right route At the right time Controlled Substances Required Information • • • • • Name of patient receiving narcotic Amount of narcotic used The hour narcotic was given The name of physician prescribing narcotic Name of the nurse administering narcotic Oral Medications • Solid form — tablets, capsules, pills • Liquid form — elixirs, spirits, suspensions, syrups Administration of Oral Medications • Oral Route — having patient swallow drug • Enteral route — administering drug through an enteral tube • Sublingual administration — placing drug under tongue • Buccal administration — placing drug between tongue and cheek Administration of Parenteral Medications • • • • • • • • • Subcutaneous injection — subcutaneous tissue Intramuscular injection — muscle tissue Intradermal injection — corium (under epidermis) Intravenous injection — vein Intraarterial injection — artery Intracardial injection — heart tissue Intraperitoneal injection — peritoneal cavity Intraspinal injection — spinal canal Intraosseous injection — bone Sites for Intramuscular Injections • • • • Ventrogluteal site Vastus lateralis site Deltoid muscle site Dorsogluteal site Criteria for Choosing Equipment for Injections • • • • • Route of administration Viscosity of the solution Quantity to be administered Body size Type of medication Preparing Medications for Injection • Ampules • Vials • Prefilled cartridges Topical Administration of Medications • • • • • • Vaginal Rectal Inunction Instillation Irrigation Skin application Medical Record Documentation • Each dose of medication, give as soon as possible after it is given • Intentional or inadvertent omitted drugs • Refused drugs • Medication errors THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR MAKING MISTAKES” MD high volume patients illegible, unclear orders high volume MD orders high volume prescription high variety, myriad cases, symptoms high turnover medical staff high stress, overworked medical staff highly sensitive impatient patients high speed emergencies Type of Medication Errors • • • • • • • • Inappropriate prescribing of the drug Extra, omitted, or wrong doses Administration of drug to wrong patient Administration of drug by wrong route or rate Failure to give medication within prescribed time Incorrect preparation of a drug Improper technique when administering drug Giving a drug that has deteriorated LOOK-ALIKE SOUND-ALIKE PRODUCT NAMES HYDROXYZINE HYDRALAZINE ULTRACET ULTRACEF SERZONE SEROUEL ACTRAPID ACTRAPHANE FORADIL TORADOL PLAVIX PAXIL ZYRTEC ZYPREXA LOSEC LASIX ACCUPRIL MONOPRIL CELEBREX CEREBYX SINECOD SINEMET DANGEROUS ABBREVIATIONSINSTRUCTIONS .5 mg 5 mg µg mg 1:10,000 mg/mL 1:1,000 mg/mL 5.0 mg 50 mg HCl KCl X (yes) X (no) 0.01 mg 0.001 mg 10U 100 D/C (discharge) D/C (discontinue) every Monday every morning LOOK-ALIKE PRODUCTS AND PACKAGING 10ml 10ml HEPARIN suppository oral capsule INSULIN water A alcohol B cephalexin dolfenal KCl distilled water SIMILAR-LOOKING CONTAINERS FOR DRUGS AND NON-DRUGS drug soap fixative poison THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR MAKING MISTAKES” dangerous equipment use of invasive devices potent chemicals high risk, irreversible KCl procedures potent body fluids look-alike, sound-alike drugs, chemicals, fluids potent drugs infectious environment Medication Errors • Check patient’s condition immediately; observe for adverse effects. • Notify nurse manager and physician. • Write description of error on medical record and remedial steps taken. • Complete special form for reporting errors. THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR HIDING MISTAKES” disease can mask medical error collegial silence incoherent, inarticulate patients IR punitive culture ADMINISTRATOR hierarchical culture MED. DIRECTOR MANAGER MANAGER multiple handoffs MANAGER MANAGER incomplete, error-prone documentation dual management most errors are near misses, slight effects 1 million hospitalized patients in the U.S. 16 doses of medication daily each 16 million doses per day 2% medication rate 320,000 medication errors daily A Medication Error Story Nurse gives the patient a medication to which he is allergic Patient arrests and dies HIS for ordering medications is broken Tube system for obtaining medications is broken Nurse borrows medication from another patient Reason Patient Teaching • Review techniques of medication administration. • Remind patient to take the medication as prescribed for as long as prescribed. • Instruct patient not to alter dosages without consulting physician. • Caution patient not to share medications. 11 Golden Rule’s in giving medications suppository oral capsule 1. Administer the right Drug 2. Administer right drug to right patient 3. Administer with right dose 4. Administer Right drug with right route 5. Administer right drug at right time 6. Document each drug you administer potent drugs 7. Teach your patient about the drug he is receiving. 8. Take a patient complete pt. drug history 9. Find out if the patient has any drug allergies 10.Be aware of potential drug to drug , and Drug to food reactions, 11.The right of the patient to refuse medications. Clarifying Orders • • • • Illegible Incomplete Incorrect Route or dosage Not expected of patients current diagnosis. Know your Medications • Mode of action & the purpose of medication • Side effects or contraindication of medication • Antagonist of medication • Safe dosage range of medication • Interaction with other medication • Proper administration technique Principle in Size of Needle • The higher the number the smaller the gauge of the needle. • The smaller the number the bigger the size of the lumen. Degrees of Insertion • Intramuscular – 72 to 90 degrees • Subcutaneous – 45 degrees • Intradermal- 10 to 15 degrees Subcutaneous • Subcutaneous injection should not contain no more that 1 ml in an insertion site . • The normal angle of insertion is 45 to 90 degrees • Subcutaneous injection sites: Abdomen, scapula, thigh, upper back, upper dorso gluteal region. Intramuscular • Intramuscular injection should not contain no more than 3 to 5ml,the smaller the muscle being injected ,the smaller the amount should be. • Injection sites: Vastus lateralis, Ventrogluteal, deltoid , dorso gluteal. • Insertion site selection depends on: • Amount of medication/ Viscosity of medication/ Age of pt & Development of muscle tissue , preference of pt. or nurse.