Week 2

Non-
Parenteral
Medications

NSE 211 2023

VIDEOS

Using Automated Medication Dispen

sing System
Administering Oral Medications
Documenting Medication Administra
tion
Handing medication variations
Preventing Medication Error

** The Mosby’s videos are quite

outdated, please follow P&P: 10
Right of Medication (p. 746)

NSE 211 2023

New CNO Medication Standards (2019)
Medication Standards

3 Principles That
Promote Public
Protection:

authority competence safety

3 Decision
Making Trees:

Is prescription
deciding about deciding about
clear, complete
administration dispensing
and appropriate?

NSE 211 2023

Components Of A Physician’s Prescription/Order

• Client’s full name

• Date and time the order was written
• Medication name
• Dosage
• Route
• Frequency
• Length of time to administer (if applicable)
• Purpose of medication (if prn but not always stated)
• Prescriber’s signature
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Rights of Medication Administration: Potter & Perry (2019) Pg. 746
1. Right medication
2. Right client
3. Right ______________
4. Right route
5. Right time & frequency
6. Right ______________
7. Right reason
8. Right ______________
9. Right education
10. Right ______________
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Match Correct One to Left Side
• Give immediately • Given one time only for a specific reason
• Hour • Hs
• • Q2h
At bedtime
• Qid
• Whenever needed
• pc
• Every day
• BID
• Every hour
• STAT
• Every 2 hrs
• daily
• Every 4 hrs
• Medication to be taken outside of the hospital
• Twice a day
• Hr
• Three times a day
• TID
• Four times a day • Q2d
• Every other day • PRN
• Before meals • ac
• After meals • Q4h
• Routine • Qh
• One time • X1
• prescription • Administered until the dosage is changed or another medication is prescribed
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Common Adverse/Side Effects
CJM while administering medications

Incorporate clinical judgement model when administering medications

Adverse Effects (usually bold or italics in med books)

• Hypersensitivity: rash, anaphylaxis, profound hypotension
• Respiratory depression - opioid analgesics
• Nephrotoxicity - decreases drug excretion
• Fluid/Electrolytes imbalances
• Endocrine dysfunction

Side Effects
• GI distress: nausea, constipation, diarrhea
• Skin irritations
• Slowed GI motility (constipation)

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 • ase, plase: thrombolytic agent (alteplase)
• azole: antifung, antimicrobial (fluconazole)
• cef, ceph: cephalosporin antibiotic (ceftriazone)
• cillin: penicillin antibiotic (penicillin, piperacillin)
• cycline: antibiotic (doxycycline)
Memory aid – • dipine: Ca+ Channel blocker (amlodipine)
Generics by prefix, • dronate: bone resorcliention inhibitor (alendronate)
root or suffix • floxacin: fluroquinolone antibiotic (ciprofloxacin)
• micin, mycin: aminoglycoside antibiotic
(gentamicin)
• nitro: nitrate vasodilator antianginal (nitroglycerin)
• olol: beta blocker antihypertensive (propranolol)
• pril: ACE inhibitor, antihypertensive (caclientopril)
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 • statin: lipid lowering agent (atorvastatin)
• parin: anticoagulant, heparin (enoxaparin)
• prazole: GI proton pump inhibitor antiulcer
(omeprazole)
• sone: corticosteroid (prednisone)
Memory aid – • sulfa: sufonamide antibiotic (sulfamethoxazole)
• terol: bronchodilator (albuterol)
Generics by prefix,
• phylline: bronchodilator (aminophylline)
root or suffix
• tidine: histamine 2 antagonize antiulcer
(cimetidine)
• vir: antiviral anti-infective (acyclovir)
• zepam, zolam: antianxiety (diazepam)
• zosin: periph acting antihypertensive (prazosin)
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 Desired Dose (mcg, mg, g, units) / Dose on Hand (mcg,
mg, g, units) x Amount on Hand (per tablet or ml) =
Amount to Administer
DD/DH X AH= AA

Dose Calculations
Examples:
Formula Client to receive Keflex 500 mg PO. Available in 250 mg
(see P&P Pg 738 ) tablets.
• How many tablet(s) are required?

• Client to receive erythromycin suspension 250 mg PO.

Available in 100 ml bottles with label stating 125mg
erythromycin/5 ml.
• How many mls are required?
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The physician has prescribed the following – Amoxicillin 0.5g po x 1
stat
1. What is the prescription dose in mg?

Available concentration of the medication, as supplied is 125mg per 5

ml
2. How much volume (ml) will the nurse administer?

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 • Client name, medication, time, dose, route, frequency
• Pre-administration assessment data (e.g. – pain
assessment, BP)
Principles of • Scan during or sign right after giving – NOT BEFORE
Documentation • Note time if different than prescribed, with rationale
• Observe client swallow med, check mouth
• If client did not take, document per agency policy
with rationale
• Post-administration assessment data (e.g.
effectiveness of analgesic, BP)
• Note any side or adverse effects

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 • Follow P&P’s 10 rights to prevent errors
Safe Administration • Utilize informatics (computerized MAR) & distribution
systems (unit dose, automated systems) as available
Medication Errors and Risk M within the institution e.g. ADU, PIXUS
anagement in Hospitals
• Always read labels 3 times before administering to the
client. For example, compare MAR & label when:
~ taking med out of the cupboard
~ placing it in the medication cup
~ prior to returning the bottle to the cupboard
or giving the medication to the client

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 • Check client armband using at least 2 identifiers (name,
birthday, hospital ID number)
Safe Administration • Do not allow distractions when administering medication
cont’d • Double check all calculations, verify with another nurse,
calculator
Medication Errors and Risk M • Ensure high risk medications are verified (e.g. insulins,
anagement in Hospitals anticoagulants see ISMP for complete list)
• Clarify illegible handwriting with prescriber
• Question unusual prescriptions (need to know the
acceptable dose range)
• Document at time of (electronic) or immediately after
(paper) giving

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 • Omission
• Wrong time*
• Wrong dose
• Extra dose
Most common reasons
• Wrong client
for Student Med Errors
• Misinterpreting abbreviation
Preventing Medication Incid • Making mental slip when distracted (especially
ents narcotics)
• Duality of client assignments & communication
breakdown
• who will administer, (RN or student?)
• which meds have been administered
• which meds should be held (i.e., anti-diabetic
agent when it is the RN, not the student, doing the
BSNSEreading)
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 • Students not aware that V/S and / or lab values should be
checked
• Administering unfamiliar medications
Most common • Missing dose pharmacy notified but then the issue was
reasons for forgotten (i.e. forgot to check for new med arrival on the unit
& administer it once it arrived)
Student Med • INSULIN - most frequent drug in student related error
Errors • omitting a dose
• selecting wrong type
• wrong sliding-scale
• wrong client
• ALWAYS double (triple) check!

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Identify Steps In Incident Reporting

Practice questions:
You have missed the 0900 dose of Metoprolol for Mr. Tutu. You are
administering your 1200 meds with your instructor & notice - His HR is
100 and BP150/90.

1. What is the student role and responsibility following this incident?

2. What is the instructor role and responsibility following this

incident?

3. What is the primary nurse’s role and responsibility following this

incident?

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 What is included in your assessment prior to
administering oral form of medication?
• Oral Administration

Sublingual - under tongue

Buccal - in cheek
What are the benefits to oral administration of
medications?

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Medication Cards
(to help you learn the basics
about main drug
classifications)
• Drug name (generic and trade)
• Classification
• Main pharmacologic action
• Main uses, use for client
• Main adverse and side effects
• Main contraindications
• Main nursing implications, assessments
and decision making required before and
after
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For This Week’s Lab
Review and Bring:

• Performance checklist SKILL 34-1 Administering oral medications

• Week 2 – Lab MAR/Case Study – Chart for Student

NSE 211 2023