You are on page 1of 10

NURSES’ DUTIES AND RESPONSIBILITIES: “PHARMACOLOGY: CALCULATION OF RATES AND DOSAGE OF DRUGS”

LEILA R. RAMOS, R.N. IVT NURSE PRECEPTOR CARD No: 08-015535

30 (c) Art. effective nursing care. 6.21 Art.VII or administratively under Sec. LEGAL AND ETHICAL ASPECT OF IV THERAPY AND DRUG ADMINISTRATION  R.8 Sec. 5. Describe the roles and responsibilities of the nurse regarding medication administration.  RA 9173 – Philippine Nursing Law of 2002 have stated that parenteral injection is in the scope of nursing practice.  R. amending for the purpose Republic Act No. 6425. 3. otherwise known as the Dangerous Drugs Act of 1972. 4. Republic Act No. Explain how the “ten rights” of medication administration affect patient sa fety. 5921 or the Pharmacy Law. and Republic Act No. and for other purposes . 2.III – states that any registered nurse without training and who administers IV injections to patients shall be held liable. repealing republic act no. # 9165 Dangerous Drug Act of 2002 .An act providing for cheaper and quality medicines. either criminally whether causing or not an injury or death to the patient. Compare and contrast the advantages and disadvantages of each route of drug administration.A. providing funds therefore and for other purposes.A. # 9502 .An Act Instituting the Comprehensive Dangerous Drugs Act of 2002. 8293 or the Intellectual Property Code. Give specific examples of the nurse can increase patient compliance in taking medications. Discuss the ethical and legal issues related to medication administration and IV therapy. .  Board of Nursing Resolution No. 6675 or the Generics Acts of 1988. as amended. Discuss medication administration as a component of safe.OBJECTIVES 1.

Slows excretion e. Passive glomerular filtration ii. Sweat . ABSORPTION . distributed. metabolized. and eliminated by the body. DISTRIBUTION  Rate of perfusion  Plasma protein (albumin) binding  Accumulation in tissues  Ability to cross membranes o Blood-brain barrier o Placental barrier 4. Exhaled air i. tablet. Mechanisms dependent upon: i. Feces h. METABOLISM  Two effects o Transformation to less active metabolite o Enhancement of solubility  Liver = primary site  Liver disease o Slows metabolism o Prolongs effects 5. PHARMACOKINETIC PROCESSES 1. Prolongs effects  Other sources f. EXCRETION (ELIMINATION)  Kidneys = primary site a. Active tubular transport b.applies to drugs given orally  Components o Release of drug from pill. LIBERATION . Partial reabsorption c.movement from administration site into circulation 3. Breast milk g.PHARMACOKINETICS  Is the process by which a drug is absorbed. Hemodialysis  Renal disease d. capsule o Dissolving of active drug in GI fluids 2.

epinephrine  Inhalation  Bronchodilators via nebulizers  Transmucosal  Rectal or sublingual  Intramuscular  Depends on perfusion quality  Subcutaneous  Depends on perfusion quality  Oral   Slow. unpredictable Little pre-hospital use  An I. atropine. narcan.V. medications may be ordered when: o Rapid therapeutic effect is needed o Oral meds can’t be absorbed by the G. tract .I.PHARMACODYNAMICS  It is the biochemical and physiologic mechanisms of drug action USES:      Symptomatic Curative Restorative Preventive Diagnostic ADMINISTRATION ROUTES  Intravenous  Fastest. Most dangerous  Endotracheal  Lidocaine.

If peripheral venous access isn’t possible. An incompatibility results when two or more substances react or interact so as to change the normal activity of one or more components. inaccessible veins from repeated venipunctures or infusion of irritating drugs.V. POOR VASCULAR ACCESS – Clients who require frequent or prolonged I. diagnosis or therapy of disease. The following are some adverse drug reactions that you might notice. the doctor may use a central vein. commonly by the subclavian route. ADVERSE DRUG REACTION – A response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis. Incompatibility may result in the loss of therapeutic effects and may occur when: o Several drugs are added to large volume of fluid to produce an admixture. MEDICATIONS – Mixing of two incompatible drugs in a solution can cause an adverse interaction. medication may be given by: o Drug injection o Intermittent infusion o Continuous infusion  Benefits o Rapid response o Effective absorption o Accurate titration o Less discomfort  Risks o Solution and drug incompatibility o Poor vascular access in some clients o Immediate adverse reactions INCOMPATIBILITY  Drug and diluents must be compatible. or for modification of physiological function (WHO). The more complex the solution the greater the risk of incompatibility.o The client may receive nothing by mouth o For controlled administration rate  I.V.V. scarred. o Drugs in separate solutions are administered concurrently or in close succession via the same IV line o A single drug is reconstituted or diluted with the wrong solution o One drug reacts with another drug’s preservative HAZARDS OF I. therapy may develop small. o o o Skin rash Easy bruising Bleeding .

6. 10.o o o o o Severe nausea and vomiting Diarrhea Constipation Confusion Breathing difficulties What should you do if you suspect an ADR? o o o o Stop the medication immediately Report the incident to the physician Monitor the client Document TEN GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY 1. 4. 5. 2. missed dose) Wrong medication to wrong patient Wrong medication to right patient Wrong medication due to wrong dispensing Wong interpretation of doctors prescriptions for drugs Wrong infusion rate (over infusion. 4. under dose. 2. Wrong dose (overdose. Administer the right drug Administer the right drug to the right patient Administer the right dose Administer the drug by the right route Administer the drug at the right time Document each drug you administer Teach your patient about the drug he is receiving Take a complete patient drug history Find out if the patient has any drug allergies Be aware of patient drug-drug or drug-food interactions COMMON MEDICATION ERRORS 1. 6. 3. missed order) . 5. 7. 3. 9. under infusion. 8.

The registered nurse indicates that he/she has checked and completely transcribes the medical order by signing his/her name with the date and time directly right after the doctor’s order.TRANSCRIPTION OF MEDICATION AND TREATMENT ORDERS INTERPRETATION OF DOCTOR’S ORDER FOR DRUGS – The nurse must understand the order perfectly before acting on it (the drug. Dosage of the medicines c. telephone orders are received and carried out only in emergency cases by nurses. RN’s will review all orders immediately after the physician writes. the dose.  Physician’s Order Sheet – is a legal document wherein medical orders are written and use as reference of nurses in the transcription and executing nursing care. swelling) DOCUMENTATION o o o o o o Type and amount of drug given Date and time given Confirmation that I. As a general rule.  Medication/Treatment Sheet – is the legal documents in the patient’s chart were medicines and treatments administered to the patient are written. If any of this is unclear or open for interpretations.V. Route of administration e. redness. Reason why the medication is to be give Adverse effect he may experience (pain. line was patent Patient’s response to the medication Condition of the insertion site Ongoing monitoring that you provided .  All medication and treatment orders must be written legibly and must contain the following: a. DEFINITION OF TERMS  Transcription of medical orders – is the act of writing out medical orders. Nurses receive telephone orders only from consultants. acknowledged and administered by nurses. the route. Frequency of administration d. Generic name and brand name of medicines b.  Kardex – is the summarize written presentation of all the care and treatment of the patient. it is the responsibility of the nurse to clarify the order with the physician. Signature over printed name of attending physician or authorized representative f. the frequency). Date and time order was written PATIENT/FAMILY TEACHING o o o Inform the client about the medication you are about to administer.

0 ug/kg/min – increased afterload. may decreased output > 20.0-7. (Cardiogenic shock. increased renal blood flow 7.used for other medications Desired Dose x Quantity/Stock .WHERE TO DOCUMENT o o o o o Nurses’ Progress Notes Medication Sheet Infusion Sheet Vital Signs Monitoring Sheet Input and Output Monitoring Sheet COMPUTATION INOTROPES  Used to maintain cardiac output and hemodynamic parameters at stable levels.6 (400mg/250ml) 33.5-20 ug/kg/min .0 ug/kg/min – increased renal blood flow.5-2.increased afterload (vasoconstriction). dieresis 2.3 (200mg/250ml) 16.2 (500mg/250ml) Desired Dose (ug/kg/min) x BW (kg) x 60 min/hr/Concentration Noradrenaline 8 (2mg/250ml) 16 (4mg/250ml) GENERAL FORMULA . increased myocardial contractility through stimulation of beta receptors in the heart FORMULA Desired Dose (ug/kg/min) x BW (kg)/Concentration Single Concentration Dopamine Dobutamine 13.5 ug/kg/min – increased cardiac output. Severe CHF) PRIMARY ACTION     0. Decrease urine output. decreased cardiac output. Septic shock.6 (250mg/250ml) Double Concentration 26.

to be infused x ml per hour or ugtts/min = Total No. 4. of hrs. administration set  Amount of the solution to be infused over one hour RATE CALCULATIONS Macrodrip set  10 drops = 1 ml  15 drops = 1 ml  20 drops = 1 ml Microdrip set  60 drops = 1 ml FORMULA Drip Rates: Drops per minute = No. 3. 5. of hours OTHER FACTORS AFFECTING FLOW RATE 1. stand Conditions of the veins Condition of the patient .V.V. of ml to be infused x Drop Factor 60 mins No. 2. Gauge of the catheter Viscosity of the infusate Height of the I. of ml/total No.CALCULATING ADMINISTRATION RATES  One must know two key components before using the formula:  Drop factor of the I.