Chapter 35Chapter 35Medication Medication

AdministrationAdministration

Scientific Knowledge BaseScientific Knowledge Base

To safely and accurately administer medications you need knowledge related to: ◦Pharmacology◦Pharmacokinetics◦Life sciences◦Human anatomy◦Mathematics

Medication Legislation Medication Legislation and Standardsand Standards

Federal regulationsState and local regulation of

medicationHealth care institutions and

medication lawsMedication regulations and nursing

practice

Pharmacological ConceptsPharmacological Concepts

Drug names:◦Chemical, generic, trade

ClassificationMedication forms:

◦Solid, liquid, other oral forms, topical, parenteral, instillation into body cavities

PharmacokineticsPharmacokinetics

The study of how medications:◦Enter the body◦Are absorbed and distributed into cells,

tissues, or organs◦Alter physiological functions

AbsorptionAbsorptionThe passage of medication molecules

into the blood from the site of administration

Factors that influence absorption:◦Route of administration◦Ability to dissolve◦Blood flow to site of administration◦Body surface area◦Lipid solubility of medication

DistributionDistributionAfter absorption, distribution occurs

within the body to tissues, organs, and to specific sites of action.

Distribution depends on:◦Circulation◦Membrane permeability◦Protein binding

MetabolismMetabolismMedications are metabolized into a

less potent or an inactive form.Biotransformation occurs under the

influence of enzymes that detoxify, degrade, and remove active chemicals.

Most biotransformation occurs in the liver.

ExcretionExcretionMedications are excreted through:

◦Kidney◦Liver◦Bowel◦Lungs◦Exocrine glands

Types of Medication ActionTypes of Medication Action

Therapeutic effect:Therapeutic effect:Expected or predictableExpected or predictable

Side effect:Side effect:Unintended, secondary Unintended, secondary effecteffect

Adverse effect:Adverse effect:Severe response to medSevere response to med

Toxic effect:Toxic effect:Medication Medication accumulates in the accumulates in the blood streamblood stream

Idiosyncratic reaction:Idiosyncratic reaction:Over- or under-reaction to Over- or under-reaction to a medicationa medication

Allergic reaction:Allergic reaction:Unpredictable response Unpredictable response to a medicationto a medication

Medication InteractionsMedication InteractionsOccur when one medication modifies

the action of anotherA synergistic effect occurs when the

combined effect of two medications is greater than the effect of the medications given separately.

Medication Dose Medication Dose ResponsesResponsesSerum half-life:Serum half-life:Time for serum medication Time for serum medication concentration to be halvedconcentration to be halved

Onset:Onset:Time it takes for a medication Time it takes for a medication to produce a responseto produce a response

Peak:Peak:Time at which a medication Time at which a medication reaches its highest effective reaches its highest effective concentrationconcentration

Trough:Trough:Minimum blood serum Minimum blood serum concentration before next concentration before next scheduled dosescheduled dose

Duration:Duration:Time medication takes to produce Time medication takes to produce greatest resultgreatest result

Plateau:Plateau:Blood serum concentration is Blood serum concentration is reached and maintainedreached and maintained

Routes of AdministrationRoutes of AdministrationOralOral

Sublingual, buccalSublingual, buccal

ParenteralParenteral

ID, Sub-Q, IM, IVID, Sub-Q, IM, IV

Epidural, Intrathecal, Epidural, Intrathecal, Intraosseous, Intraosseous, Intraperitoneal, Intraperitoneal, Intrapleural, IntraarterialIntrapleural, Intraarterial

TopicalTopical

InhalationInhalation IntraocularIntraocular

Systems of Medication Systems of Medication MeasurementMeasurement

Requires the ability to compute medication doses accurately and correctly

Metric systemHousehold systemSolution

Nursing Knowledge BaseNursing Knowledge BaseSafe administration is imperative.Nursing process provides a

framework for medication administration.

Clinical calculations must be handled without error.◦Conversions in and between systems◦Dose calculations◦Pediatric and elderly calculations

Prescriber’s Role Prescriber’s Role Prescriber can be physician, nurse

practitioner, or physician’s assistant.Prescribers must document the

diagnosis, condition, or need for each medication.

Orders can be written, verbal, or by telephone.

Types of Orders in Acute Care Types of Orders in Acute Care AgenciesAgencies

Standing or Routine:Standing or Routine:Administered until the dosage Administered until the dosage is changed or another is changed or another medication is prescribedmedication is prescribed

PRN:PRN:Given when the client requires Given when the client requires itit

Single one-time:Single one-time:Given one time only for a Given one time only for a specific reasonspecific reason

STAT:STAT:Given immediately in an Given immediately in an

emergencyemergency

Now:Now:When a medication is needed When a medication is needed right away, but not STATright away, but not STAT

Prescriptions:Prescriptions:Medication to be taken outside Medication to be taken outside of the hospitalof the hospital

Medication AdministrationMedication AdministrationPharmacist’s roleDistribution systemNurse’s roleMedication error

Critical Thinking and Critical Thinking and Medication AdministrationMedication Administration

KnowledgeExperienceAttitudesStandards

Nursing Process and Nursing Process and Medication AdministrationMedication Administration

AssessmentDiagnosisPlanning Implementation Evaluation

Medication AdministrationMedication AdministrationOralTopicalInhalationIrrigationParenteralInjections