Medication Administration

INTRODUCTION

Medication PHARMACOLOGY

 Is a substance administered for the  Is the study of the effect of drugs on

diagnosis, cure, treatment or relief of living organisms
a symptom or for prevention of
PHARMACY
disease.
 Is the art of preparing, compounding
Drug
and dispensing drug
 Has the connotation of an illicitly
PHARMACIST
obtained substance
 In health care context, medication and  a person licensed to prepare and
drug are generally used dispense drugs and to make up
interchangeably prescriptions
 CLINICAL PHARMACIST - is a
Prescription
specialist who often guides the
 The written direction for the physician in prescribing drugs
preparation and administration of a  PHARMACY TECHNICIAN - is a
drug member of the health team who in
some states administers drugs to
FOUR KINDS OF NAMES OF A DRUG:
clients
GENERIC NAME
DRUG STANDARDS
 Is a name given before a drug
 Drugs can be made from plants,
becomes officially an approved
minerals, or animals, or be produced
medication.
synthetically.
OFFICIAL NAME  Standards ensure drugs are pure and
of uniform strength, uniform quality.
 Is the name under which it is listed in
 U.S. Pharmacopeia describes drugs
one of the official publications
sources, properties, tests done,
CHEMICAL NAME storage methods, assay category,
 This name describes the constituents normal dosages.
of the drug precisely

BRAND NAME/TRADE NAME

 Is the name given by the drug

manufacturer


 containers that are sectioned and
numbered.

EFFECTS OF DRUGS

THERAPEUTIC EFFECT/DESIRED
EFFECT

 is the primary effect intended, that is,

the reason the drug is prescribed

Therapeutic Actions of Drugs

LEGAL ASPECTS OF DRUGS
DRUG TYPE
ADMINISTARTION
PALLIATIVE - Relieves the symptoms of a
 Nursing practice acts disease but does not affect the disease
 Recognizing limits of own knowledge itself
and skill
 Take responsibility for actions CURATIVE - Cures a disease or condition
 Question any order that appears SUPPORTIVE - Supports body function until
unreasonable other treatments or the body's response
 Refuse to give medication until order is can take over
clarified
 Controlled substances SUBSTITUTIVE - Replaces body fluids or
o Kept under lock substances
o Special inventory forms CHEMOTHERAPEUTIC - Destroys
o Documentation requirements malignant cells
o Procedures for discarding
RESTORATIVE - Returns the body to
o End-of-shift counts of controlled
health
substances
SIDE EFFECT

 or secondary effect, of a drug is one

that is unintended
 are usually predictable and may be
either harmless or potentially harmful
 ADVERSE EFFECT - more severe
side effects or reactions

DRUG TOXICITY

 results from overdosage

Figure 35-1 Some narcotics are kept in

specially designed packages or plastic


DRUG ALLERGY  IATROGENIC DISEASE -disease
caused unintentionally by medical
 is an immunologic reaction to a drug
therapy
 skin rash, pruritus, angioedema, rhinitis,
lacrimal tearing, nausea, vomiting, DRUG MISUSE
wheezing and dyspnea, diarrhea
 Improper use of common medications
 ANAPHYLACTIC REACTION - severe
 Drug abuse
allergic reaction usually occurs
 Drug dependence
immediately after the administration of
o Physiological dependence
the drug
o Psychological dependence
DRUG TOLERANCE  Drug habituation
 Illicit drugs
 exists in a person who has unusually
low physiologic response to a drug and ACTIONS OF DRUGS ON THE BODY
who requires increase in the dosage to
maintain a given therapeutic effect
 CUMULATIVE EFFECT - is the
increasing response to repeated doses
of a drug that occurs when the rate of
administration exceeds the rate of
metabolism or excretion
 IDIOSYNCRATIC EFFECT -
underresponse and overresponse to a
drug

DRUG INTERACTION

 occurs when the administration of one

drug before, at the same time as, or
after another drug alters the effect of
one or both drugs
 POTENTIATING EFFECT -increases
the effect
 INHIBITING EFFECT -decreases the
effect
 ADDITIVE -Two of same types of
drugs increase action of each other
 SYNERGISTIC -when two different Onset of action
drugs increase the action of one or
 the time after administration when the
another drug
body initially responds to the drug


Peak plasma level  Distribution
o Transportation of a drug from its
 the highest plasma level achieved by a
site of absorption to its site of
single dose when the elimination rate of
action
a drug equals the absorption rate
 Biotransformation
Drug half-life o Also called detoxification or
metabolism
 the time required for the elimination
o Process by which a drug is
process to reduce the concentration of
converted to a less active form
the drug to one half
o Metabolites
Plateau  Products of this process
 Excretion
 a maintained concentration of a drug
o Process by which metabolites
in the plasma during a series of
eliminated
scheduled doses
o Mostly through urine
PHARMACODYNAMICS
FACTORS AFFECTING MEDICATION
 Mechanism of drug action and ACTION
relationships between drug
 Developmental factors
concentration and the body's
responses  Gender
 Receptor  Cultural, ethnic, and generic factors
o Drug's target  Diet
 Agonist  Environment
o Same response as endogenous  Psychological factors
substance  Illness and disease
 Antagonist  Time of administration

PHARMACOKINETICS Routes of Administration

 Study of absorption, distribution, Oral

biotransformation, and excretion of
drugs
 Absorption
o Process by which drug passes into
bloodstream
o Rate is variable
 Depends on food, acid medium
o Drug bypasses if injected
 The most common, least expensive
and most convenient route for most
clients.
Sublingual
 A drug is placed under the tongue,
where it dissolves


 o Intraarticular

Buccal

 Means “pertaining to the cheek”

 A medication is held in the mouth

against the mucous membranes of the
cheek until the drug dissolves

Parenteral

 By needle

 Subcutaneous (hypodermic) – into Topical

the subcutaneous tissue, just below
 Are those applied to a circumscribed
the skin
surface area of the body
 Intramuscular – into the muscle
 Dermatologic preparations –
 Intradermal – under the epidermis applied to the skin
(into the dermis)
 Instillations and Irrigations – applied
 Intravenous – into a vein into body cavities or orifices
 Less common  Inhalations – administered into the
respiratory tract by a nebulizer
o Intrathecal/intraspinal

o Epidural


Medication Order

 Ordered by physicians

o Sometimes nurse practitioners,

physician assistants depending on
state laws and agency policies

 Verbal and telephone orders

 Abbreviations, acronyms, and symbols

Types of Medication Order

Communicating Medication Orders
STAT ORDER
 Written on chart, provided by phone or
 indicates that the medication is to be verbally
given immediately and only once
 Copied to Kardex or MAR, or on
SINGLE ORDER / ONE-TIME ORDER computer printout

 is for medication to be given once at a  If an order seems inappropriate

specified time
o Contact primary care provider
STANDING ORDER
o Document in notes when PCP
 may or may not have a termination called, what was communicated,
date how PCP responded

PRN ORDER / AS-NEEDED ORDER  If an order seems inappropriate

 permits the nurse to give a medication o Or, document attempts to reach

when, in the nurses’ judgment, the client PCP and reason for withholding
requires it drug

Essential Parts of Medication Order o If medication given, document client

condition before and after dose
 Full name of client
o If needed, document factual
 Date and time order is written
information on incident report
 Name of drug to be administered
Systems of Measurements
 Dosage of drug
Metric system
 Frequency of administration
 Devised by the French
 Route of administration
 Logically organized into units of 10
 Signature of person writing the order
 Meter, liter, gram basic units


Apothecaries' system
 Older than metric system
 Grain, minim basic units
 Do not use; unfamiliar to many
Household system
 May be used when more accurate
systems not required
 Drops, teaspoons, tablespoons, cups,
and glasses
Converting Units of Weight and Measure
 Converting weights within the metric
system
o Gram (g), milligram (mg), and
microgram (mcg) only units used
for dosages
o Divide or multiply and move decimal
points
o Put a 0 in front of decimal point if
less than 1 (0.5 g)
 Converting weights and measures
between systems
o Nurse may need to convert from
systems used by pharmacies
 Converting units of volume
o Fluid drams, ounces used in liquid
medications

o Liters, milliliters used for enemas,
irrigations, and solutions for
wounds
 Converting units of weight
o Milligrams to grains
 Milligram is smaller than a
grain
 1 grain = 60 mg
o Pounds to kilograms
 2.2 lb = 1 kg
Methods of Calculating Dosages
 Basic formula
o (D × V) / H
o D (desired dose)
o H (dose on hand)
o V (vehicle or form of drug)
 Ratio and proportion method
o H : V :: D : x
o Considered to be the oldest method
 Fractional equation method
o (H / V) = (D / x)
o Cross multiply and solve for x
 Dimensional analysis
1. Identify dose on hand
2. Identify desired dose
3. Write down conversion factor
4. Set up equation
5. Cancel units that appear in
numerator and denominator
 6. Multiply numerator; multiply o Transportation
denominator; divide the products
o Money for medication
 Calculating for individualized drug
Medication Reconciliation
dosage
o Clients receiving chemotherapy,  Most accurate list possible of all drugs
critically ill clients required taken compared to primary care
individualized dosages provider's orders to provide continuity
o Body weight of care
 Convert pounds to kilograms.
 Inadequate communication during
 Determine drug dose per body
transitions accounts 50% of med
weight by multiplying drug dose
errors and 20% of adverse drug
× body weight × frequency
events
 Calculating for individualized drug
 Completed list provided to client and
dosage
next health care provider
o Body weight
Medication Dispensing Systems
 Choose method of drug
 Medication cart
calculation to determine
amount to administer o Mobile

o Body surface area  Medication cabinet

 Ratio of child's body surface o Locked, in client's room

area to that of an average
 Medication room
adult
o Accessed by key, code
 (Surface area of child (m2)
/ 1.7m2) × normal adult dose  Automated dispensing cabinet

Administering Medications Safely o Reduces risk of error, theft

 Always assess health status

 Take medication history

o Include OTC drugs and

supplements, allergies, normal
eating habits

 Include client's illness or current

condition, intended drug and route Process of Administering Medications

 Assess ability to self-administer  Identify the client

 Assess socioeconomic factors  Inform the client


 Administer the drug  Record the drug administered

 Provide adjunctive interventions as  Evaluate the client's response to the

indicated drug

Developmental Considerations

 Growth and development especially

important in administering medication
to very young and very old

 Infants and children

o Most often provided in sweetened

liquid form

o Do not mix into milk or orange juice

o Be honest about injections hurting

 Older adults

o Altered memory

o Decreased visual acuity

o Decrease in renal function

o Less complete and slower

absorption from gastrointestinal
tract

o Increased proportion of fat to lean

body mass

o Decreased liver function

o Decreased organ sensitivity

o Altered quality of organ

responsiveness

o Decrease in manual dexterity