Chapter 16: Administering Medications

Chapter 16: Administering
Medications
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 1
Scientific Knowledge Base
 Pharmacological concepts
 Medication names
• Chemical name
• Generic name
• Trade or brand name
 Classification
 Medication forms
Medication Legislation
and Standards
 Government regulation
 Health care institutions and medication laws
 Medication regulations and nursing practice
 Nontherapeutic medication use
Pharmacokinetics as the Basis
of Medication Actions
 The study of how medications
 Enter the body
 Reach the site of action
 Metabolize
 Exit the body
Absorption
 The passage of medications into the blood
from the site of administration
 Five factors that influence absorption
 Route of administration
 Ability of the medication to dissolve
 Blood flow from the area of absorption
 Body surface area
 Lipid solubility of the medication
Distribution
 The rate and extent of distribution depend on
the physical and chemical properties of
medications and patient’s physiology
 Three factors influence distribution
 Circulation
 Membrane permeability
 Protein binding
Metabolism
 Occurs after the medication reaches the site
of action
 Biotransformation occurs when enzymes
detoxify, degrade, and remove active
chemicals
 Occurs in liver, lungs, kidneys, blood, and
intestines
Excretion
 After metabolism, excretion occurs through
 Kidneys, liver, bowel, lungs, and exocrine glands
 Chemical structure of medication determines

where excretion occurs
Types of Medication Action
Therapeutic Effects Side Effects
Adverse Effects Toxic Effects
Idiosyncratic Reactions Allergic Reactions
Medication Interactions Medication Dose

Responses
Routes of Administration
 Oral
 Parenteral
 Topical
 Inhalation
 Intraocular
Systems of Medication
Administration
 Metric system
 A decimal system organized into units of 10
 Household measurements
 Drops, teaspoons, tablespoons, cups, pints, quarts
 Solutions
 Concentrations in units of mass per units of
volume
Clinical Calculations
 Conversions within one system
 Conversions between systems
 Dosage calculations
 Pediatric dosages
Administering Medications
 Prescriber’s role
 Types of orders
 Standing
 prn
 Single one time
 STAT
 Now
 Prescriptions
 Pharmacist’s role
Distribution Systems
 Unit dose
 Automated medication dispensing systems
 Nurse’s role
 Administer medication correctly
 Monitor side effects
 Assess ability for patient self medication
 Patient and family education
Medication Errors
 Errors include
 Inaccurate prescribing
 Wrong medication, route, and time
 Extra doses or failing to administer
 Reporting procedures
 Written report within 24 hours of occurrence
 Medication reconciliation
 Comparison of medications taken at home and
prescribed when in the health care setting
Critical Thinking and Medication
Administration
 Standards
 1. Right medication
 2. Right dose
 3. Right patient
 4. Right route
 5. Right time
 6. Right documentation
 Maintaining patient’s rights
Nursing Process and Medication
Administration: Assessment
 History
 Allergies, medication, diet
 Patient’s perspectives
 Current condition
 Attitudes about medication use
 Knowledge and understanding of medication use
 Learning needs
 Expectations
Diagnoses and Planning
 NANDA-I list
 Setting goals
 Establishing outcomes
Implementation
 Patient and family teaching
 Receiving, transcribing, and communicating
medication orders
 Accurate dosage calculation and
measurement
 Correct administration
 Recording medication administration
Special Considerations for
Administering Medications
 Infants and children
 Age, weight, surface area
 Ability to absorb, metabolize, and excrete
 Older adults
 Polypharmacy
 Swallowing
 Reading
 Arthritis
Evaluation
 Change in patient’s condition
 Desired effect
 Adverse reactions
 Observation of physiological measures
 Changes in laboratory values

Chapter 16: Administering Medications

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Chapter 16: Administering

 Chemical structure of medication determines

Adverse Effects Toxic Effects

Idiosyncratic Reactions Allergic Reactions

Medication Interactions Medication Dose

 Automated medication dispensing systems

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