Basic Nursing: Foundations of

Skills & Concepts Chapter 24

MEDICATION ADMINISTRATION

Medication Management

Requires the collaborative efforts of many health care providers.

Nurses are responsible for administering medications.

Medication administration requires specialized knowledge, judgment, and nursing skills.

Drug Standards and Legislation

A drug is a chemical substance intended to elicit a specific effect.

Standards are set to ensure drug uniformity in: Strength. Purity. Efficacy. Safety. Bioavailability (readiness to produce a drug effect).

Standards

The United States Pharmacopeia and the National Formulary (USP and NF) are books of drug standards for use in the United States.

Legislation: The FDA

The Food and Drug Administration (FDA) tests all drugs for toxicity before granting a company the right to market a drug.

Drug Nomenclature

Drugs are usually referred to by their generic name (not capitalized) or by their trade name (always capitalized).

Drug Action

A drug’s ability to combine with a cellular drug receptor.

Depending on the location of the cellular receptor, the drug can have a local effect, a systemic effect, or both.

Pharmacology

The study of the effects of drugs on living organisms.

Medication Management

Its purpose is to produce the desired drug action by maintaining a constant drug level.

Drug action is based on the drug’s half-life (the time it takes the body to eliminate half of the blood concentration level of the original drug dose).

Terms Relating to Drug Action

Onset of action (the time it takes for the body to respond to a drug after administration).

Peak plasma level (the highest blood concentration of a single drug dose before the elimination rate equals the rate of absorption).

Plateau (maintenance of a certain level).

Routes of Drug Absorption

Oral. Topical. Inhalants. Parenteral (injectable).

Intradermal (into the dermis). Subcutaneous (into the subcutaneous tissue). Intramuscular (into the muscle). Intravenous (into a vein).

Pharmokinetics

The study of the absorption, distribution, metabolism, and excretion of drugs to determine the relationship between the dose of a drug and the drug’s concentration in biological fluids.

The 4 Properties of Drug Action

Absorption (passage of a drug from the site of administration into the bloodstream).

Distribution (the movement of drugs from the blood into body fluids and tissues).

Metabolism (the physical and chemical processing of a drug by the body).

Excretion (the elimination of drugs from the body.

Drug Interaction

The effect one drug can have on another drug.

Side Effects and Adverse Reactions

Drug Allergy. Drug Tolerance. Toxic Effect. Idiosyncratic Reaction.

Food and Drug Interactions

Certain drugs may interfere with the absorption, excretion, or use in the body of one or more nutrients.

Certain foods may increase or decrease the absorption of a drug into the body.

Other foods may alter the chemical actions of drugs, preventing their therapeutic effect on the body.

Factors Influencing Drug Action

Genetic factors. Age. Height.

Weight. Physical

conditions. Mental conditions.

Medication Orders

All medication orders should contain: Client’s name Date & Time Name of Drug to be administered Doasage Route of administration Time & frequency signature of person ordering

Types of Orders

Stat (those that should be administered immediately).

Single-Dose (one-time medications). Scheduled (administered routinely until

order is canceled by another order). PRN (on as-needed basis).

Three Systems of Weight and Measure

Metric (simple system based on units of 10).

Apothecary (based on the weight of one grain of wheat).

Household (drops, teaspoons, tablespoons, etc.).

Five “Rights” of Safe Drug Administration

Right drug. Right dose. Right client. Right route. Right time.

Documentation of Drug Administration

A critical element of drug administration is documentation.

The standard is “if it was not documented it was not done.”

The nurse should document that a drug has been given after the client has received the drug.

Drug Supply and Storage

Scheduled drugs for each client are usually dispensed in a unit dose form.

Certain drugs may be stock supplied (dispensed and labeled in large quantities) and stored in the medication room.

Narcotics and controlled substances must be administered in accordance with federal regulations.

Medication Compliance

The client’s understanding of why a medication was ordered and how a medication can decrease the likelihood of getting a disease or how it can lessen the effects of an existing disease.

Clients refusing medication or adjusting the scheduling or dose are noncompliant.

Responsibilities of Nurses Regarding Drug Administration

Nurses are both legally and morally responsible for correct administration of medications.They must: Follow institutional policy. Consider clients’ desires and abilities. Foster compliance. Correctly document all actions related to medication

administration and medication errors.

Assessment

Drug History (Allergies, Prescription Drugs taken, Over-the-Counter Drugs used).

Medical History (Biographical data, Lifestyle and beliefs, Sensory and cognitive status).

Physical Examination. Diagnostic and Laboratory Data.

Nursing Diagnosis

Health Maintenance, Altered. Knowledge Deficit. Management of Therapeutic Regimen,

Ineffective. Physical Mobility, Impaired. Sensory/Perceptual Alterations. Swallowing, Impaired.

Nursing Interventions

Assessment.

Administration.

Teaching.

Primary nursing interventions related to medication management are:

Oral Drugs

Oral medications should be poured and measured at eye level to ensure accuracy.

Parenteral Drugs

Although the physician will determine the dose and route of a parenteral drug, the nurse is responsible for choosing the correct gauge and length of the needle to be used.

Equipment to Administer Parenteral Drugs

Syringes (three basic parts: the hub, the barrel, the plunger).

Needles (three basic parts: the hub, the cannula, or shaft, and the bevel).

Ampules (glass containers of single-dose drugs).

Vials (glass, single- or multiple-dose rubber-capped drug containers).

Intradermal Injection

Injections typically used to diagnose tuberculosis, identify allergens, and administer local anesthetics.

Subcutaneous Injection

Injections into the subcutaneous tissue, between the dermis and the muscle.

Commonly used in the administration of medications such as insulin and heparin.

Intramuscular Injection

Used to promote rapid drug absorption and to provide an alternate route when the drug is irritating the subcutaneous tissue.

Intravenous Therapy

Requires parenteral fluids (hypotonic fluid, isotonic fluid, hypertonic fluid)

Special equipment needed: Administration set. IV pole. Filter. Regulators to control IV flow rate. Established venous route.

Blood Transfusion

To replace blood loss (deficit) with whole blood or blood components.

Special equipment needed: Administration set. IV pole. Filter. Regulators to control IV flow rate. Established venous route.

The Importance of Monitoring

The nurse must always carefully monitor client reactions to medications and ensure that clients are appropriately educated as to the actions, side effects, and contraindications of all medications they are receiving.

Clients receiving IV therapy or blood transfusions require constant monitoring for complications.

Topical Medications

Eye medications. Ear medications. Nasal instillations.

Respiratory inhalants.

Rectal instillations. Vaginal

instillations.