Chapter 29 Medication Administration Fundamentals of Nursing: Standards & Practices, 2E.

Chapter 29

Medication Administration

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 29-2

Drug Standards and Legislation

Standards• Standards have been developed to

ensure drug uniformity so that effects are predictable.

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


Federal Legislation• The Pure Food and Drug Act of 1906

designated the USP and the NF as official bodies to establish drug standards.

• State and Local Legislation• Health Care Institution Regulations


Drug Nomenclature

Drugs may be used as an aid in the diagnosis, treatment, or prevention of disease, in other abnormal conditions for the relief of pain or suffering, or to improve any physiological or pathologic condition.


Drug Action

Pharmacology• Medication Management• Classification• Preparation and Route


Pharmacokinetics

Absorption Distribution Metabolism Excretion Drug Interaction Side Effects and Adverse Reactions Food and Drug Interactions


Factors Influencing Drug Action

Individual client characteristics, such as genetic factors, age, height and weight, and physical and mental conditions can influence the action of drugs on the body.


Professional Roles in Medication Administration

Health Care ProvidersTypes of Medication Orders

• Stat Orders• Single-Dose Orders• Standing Orders• PRN Orders

Parts of the Drug Order


System of Weight and Measure

Metric SystemApothecary SystemHousehold System


Approximate Dose Equivalents

Converting Units of Weight and Volume• Measurement Conversions within the

Metric System• Measurement Conversions between

SystemsDrug Dose Calculations

• Pediatric Dosages


Safe Drug Administration

Guidelines for Medication • Right Drug• Right Dose• Right Client• Right Route• Right Time


Documentation of Drug Administration• Documentation is a critical element of

drug administration.• Nurse should document that a drug

has been given after the client has taken the drug.


Drug Supply and Storage• Unit dose form is used to dispense

scheduled drugs for each client.• Stock supplied drugs (dispensed and

labeled in large quantities) are stored in the medication room or other area on the nursing unit.

• Narcotics and Controlled Substances


Drug Abuse• Addiction is a physiological or

psychological dependence on a substance.

• Dependence is the reliance on, or need to take a drug.


Medication Compliance

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

Noncompliance is when clients do not consistently take prescribed medications, or when they adjust the scheduling or dose of the medication.


Legal Aspects of Administering Medications

Negligence exists any time the nurse fails to do something that a reasonable nurse would do under similar circumstances or does something that a reasonable nurse would not do.

Malpractice is any professional misconduct or unreasonable lack of skill in professional duties.

Questioning the Medication Order


Assessment

Drug History• Allergies• Prescription Drugs• Over-the-Counter Drugs• Biographical Data• Lifestyle and Beliefs• Sensory and Cognitive Status


Physical ExaminationDiagnostic and Laboratory Data


Nursing Diagnosis

Nursing Diagnoses related to medication administration are• Deficient Knowledge• Ineffective Therapeutic Regimen

Management• Ineffective Health Maintenance• Impaired Physical Mobility


Nursing Diagnosis

• Disturbed Sensory Perception• Impaired Swallowing

Nursing Diagnoses related to the addicted client are• Imbalanced Nutrition• Impaired Verbal Communication• Interrupted Family Processes


• Impaired Social Interaction• Social Isolation• Spiritual Distress• Readiness for Enhanced Spiritual Well-

Being• Ineffective Coping


Outcome Identification

Nurse develops goals and plans care on the basis of nursing diagnosis.

Client teaching based on medications prescribed is inherent in the plan of care.

Nursing interventions are identified and incorporated into the plan of care to promote the attainment of goals and to assist the client in achieving expected outcomes.


Planning

The nurse needs to carefully plan nursing care activities to ensure safe administration of medications.

Adequate planning provides for questions and discussion by the client and demonstration of skills learned.


Implementation

Administer Oral Drugs• Sublingual and Buccal Drug

Administration• Review Procedure 29-1 on

administering an oral medication.• Enteral Instillation of Drugs


Administer Parenteral Drugs• Equipment• Review Procedure 29-2 on withdrawing

medication from an ampule.• Review Procedure 29-3 on withdrawing

medication from a vial.• Intradermal Injection• Subcutaneous Injection


• Review Procedure 29-4 on mixing insulins in one syringe.

• Review Procedure 29-5 on administering an intradermal injection.

• Review Procedure 29-6 on administering a subcutaneous injection.

• Intramuscular Injection


• Review Procedure 29-7 on administering an intramuscular injection.

• Intravenous Injections• Review Procedure 29-8 on

administering medications by IV Piggyback to an existing IV.


Administer Topical Medications• Eye Medications• Review Procedure 29-9 on

administering an eye medication.• Ear Medications• Review Procedure 29-10 on instilling

an ear medication.


• Nasal Instillations• Review Procedure 29-11 on instilling nose

drops.• Respiratory Inhalants • Review Procedure 29-12 on teaching self-

administration with a metered-dose.


• Rectal Instillations• Review Procedure 29-13 on administering

a rectal suppository.• Vaginal Instillations• Review Procedure 29-14 on administering

a vaginal suppository.Complementary Therapy


Evaluation

The nurse is responsible for ongoing evaluation of client’s response to medication.

Nurses in the community setting need to evaluate the client’s ongoing ability to manage his or her medication regime.

Chapter 29 Medication Administration Fundamentals of Nursing: Standards & Practices, 2E.

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