Ch23

F. A. Davis’s Fundamentals of Nursing, Second EditionF. A. Davis’s Fundamentals of Nursing, Second Edition

Copyright © 2011. F.A. Davis Company

Chapter 23: Administering Medications



Legal Considerations

U.S. Drug Legislation• Sets official drug standards• Defines prescription drugs• Regulates controlled

substances• Improves safety• Requires proof of efficacy

Nurse Practice Acts• Identify nursing

responsibilities for administration and client monitoring



Medication Systems

Stock Supply

Bulk quantity Central location Not client-specific

Unit Dose

Individually packaged Client-specific drawers 24-hour supply



Automated Dispenser Password-accessible locked cart Computerized tracking Can combine stock and unit doses

Self-Administration Individual containers Kept at client’s bedside

Medication Systems (Cont’d)



Pharmacological Considerations

Pharmacokinetics What happens to the drug in the body

Pharmacodynamics How the drug affects the body



Pharmacokinetics

Four processes Absorption Distribution Metabolism Excretion



Absorption

Movement of drug into the bloodstream Factors affecting absorption

• Route of administration

• Drug solubility

• pH/ionization

• Blood flow



Distribution

Drug transport to tissues and organs Factors affecting distribution

• Local blood flow

• Membrane permeability

• Protein-binding capacity



Metabolism

Biotransformation: chemical conversion of drug Factors affecting metabolism

• Liver function

• Health/disease status

• First-pass effect



Excretion

Elimination of the drug Factors affecting excretion

• Organ function, especially the kidneys, liver, and lungs

• Exocrine glands



ClickerCheck

The client has been on a low-protein diet. This will most likely affect which pharmacokinetic process?

a. Absorption

b. Excretion

c. Distribution

d. Metabolism



Correct answer: C

A low-protein diet may lead to an inadequate level of plasma proteins, which will affect availability of “free” drug.



Concepts Related to Pharmacokinetics Time until onset and peak Therapeutic range

• Peak level

• Trough level

• Therapeutic level Half-life Concentration of active drug



Pharmacodynamics: Effects of Drugs

Primary Effects

Therapeutic effects Predicted Intended Desired Why the drug was prescribed



Pharmacodynamics: Effects of Drugs (Cont’d)

Secondary Effects

Unintended Nontherapeutic Can be

• Predictable• Harmless• Harmful



Pharmacodynamics: Effects of Drugs (Cont’d)

Types of Secondary Effects

Side effects Adverse reactions Toxic reactions Allergic reactions Idiosyncratic reactions Cumulative effect



Drug Interactions

Antagonistic Synergistic Incompatibilities



Nursing Considerations: The Medication Order

Types of Medication Orders

Written order Automatic “stop” date STAT order Standing order PRN order



Nursing Considerations: The Medication Order (Cont’d)

Communication of Orders

Handwritten Preprinted Orally Telephone



ClickerCheck

The primary provider has written a medication prescription. The nurse is having difficulty deciphering what has been written. The best strategy to clarify the information is

a. Ask the patient what medication the provider prescribed.

b. Call the pharmacist and ask her to read the

prescription.

c. Ask the nurse who knows the provider’s handwriting to read the prescription.

d. Call the provider and ask him to clarify the prescription.



Correct answer: D

All other answers increase the risk of a medication error.



Components of the Medication Order/Prescription Client’s full name (some locales require address) Date and time Name of medication Dosage size, frequency, number of doses Route of administration Printed name and signature of prescriber, including

relevant credentials and legal registration number



Nursing Considerations: Medication Administration Safety

Three Checks

Before you pour• Check the medication label against the MAR

After you pour• Verify the label against the MAR

At the bedside• Check the medication again



Nursing Considerations: Medication Administration Safety (Cont’d)

Six Rights Right drug Right client Right dose Right time Right route Right documentation

Other Rights Right reason Right to know Right to refuse



Routes of Administration

• Tablets, pills, capsules• Liquids• Buccal• Sublingual• Enteral medications

Oral Medications Most commonly used route Includes



Overview of Medication Administration, by Routes

• Lotions, creams, ointments• Transdermal patches• Eye and ear

• Nasal• Vaginal • Rectal

Topical Medications

Applied directly to body surface/body cavities Local (and sometimes systemic) effects



Routes of Administration

Respiratory Inhalations

Use concept of nebulization Absorption via alveoli and blood supply

• Atomizers• Aerosol• Metered dose inhaler



Routes of Administration (Cont’d)

Parenteral Medications

Intradermal Transdermal Subcutaneous Intramuscular Intravenous



Parenteral Medication Administration

Equipment Preparation Syringe/needle (size, gauge)

Medication Preparation Vials and ampules Reconstituting from powder Two medications in one syringe



Parenteral Medication Administration (Cont’d)

Safety Issues

Use sharps containers Avoid recapping a dirty needle




Use the correct site• Wrong site could mean wrong route

Be familiar with the technique required for the medication (e.g., heparin, insulin)




Intravenous Medications

IV push IV piggyback Medicated drips



ClickerCheck

When administering a drug via a parenteral routes, the drug would be absorbed fastest if given per the IM route.

a. True

b. False



Correct answer: B, false

Absorption refers to the “movement” of the drug from the site of administration into the blood stream. Therefore, the intravenous, parenteral route leads to “instant” absorption.



Avoiding Medication Errors

Arrive to work well rested and undistracted. Use the six rights.

Calculate doses carefully; double-check with a second RN.

Watch for drugs with similar names.

Watch for clients with the same last names.



Avoiding Medication Errors (Cont’d)

Clarify unfamiliar drug names and dosages or illegible orders.

Avoid abbreviations.

Know and use your resources.

Keep up with changes in medication orders.



What Should I Do If I Commit a Medication Error?

Immediately assess the patient’s vital signs and physical status.

Report findings to the primary care provider. Notify the nurse manager of your unit and report

the event surrounding the event. Check with your institution for agency-specific policy regarding incident reporting.



Critical Thinking

You have checked the medication record (MAR) for Margaret Marks (“Meet Your Patients,” in Volume 1) and prepared her next dose of antibiotic for intravenous administration. The MAR also indicates that she is receiving morphine for pain and that her last dose was given 1 hour ago. When you enter the room, you find her apparently sleeping. You are not able to awaken her to verify her identity. What do you suspect is happening, and how should you respond?

Health & Medicine

Ch23