Chapter 31 Medication AdministrationSaturday, December 12, 202010:10 PM

Chapter 31 Medication Administration

Saturday, December 12, 2020

10:10 PM

Chapter 31 Medication Administration

       Scientific knowledge base

#Medication legislation and standards 허용 범위 실행 규칙

*federal regulations

FDA

United States Pharmacopeia

National Formulary

MedWatch program

*state and local regulation of medication

*health care institutions and medication laws

*medication regulations and nursing practice

Nurse Practice Acts

#pharmacological concepts

*medication names

chemical

generic (United States adopted names council)

proprietary

*classification

*medication forms

solid : caplet, capsule, tablet, enteric coated tablet

liquid: elixir, extract, aqueous solution, aqueous suspension, syrup

other oral: troche(lozenge), aerosol, sustained release

Topical: ointment(salve or cream), lotion, liniment, paste, transdermal patch or disk

parenteral:  solution, powder

instillation into body cavities : intraocular disk, suppository

#Pharmacokinetics as the basis of medication actions

*absorption

-route of administration

-ability of the medications to dissolve

liquid dissolves faster. acidic meds absorbs fast through gastric mucosa and basic meds through the intestines

-blood flow to the site of administration

-body surface area : more meds are absorbed in the intestines rather than stomach

-lipid solubility

consult and collaborate with the prescriber to achieve the therapeutic effects of all meds a pt is taking

*distribution

-circulation

vascularity affects the speed of a med substance delivery

pt with heart problems might delay or alter the med effects

-membrane permeability

blood brain barrier

placenta

-protein binding

the degree to which the meds binds to blood protein, liver problems : aging(has decreased albumin) or disease

*metabolism

liver problem - toxicity slow metabolism

*excretion

liver problem, kidney problem   

#types of medication action

Patients do not always respond in the same way to each successive dose of a medication

*therapeutic effects

*side effects/adverse effects

Every medication has a potential to harm a patient.

when the nurse observes or the patient notes these effects, they must be notified to the prescriber immediately

that were not indicated as intended therapeutic effects to the patient

bad effects override the positive effects. Must be discontinued.

specified side effect/adverse effects and unspecified side effects/adverse effects  - must be aware of both

 

-toxic effects

when med is accumulated in the body and cause bad effects

it means that there are too much of the med substance in the body.

must detox? must stop the meds, must do something to lower the level in the body

time might be a factor but must be reported to the physician

were therapeutic ?

might become more sensitive to the drug after the toxic event?

but does not mean necessarily discontinue

-idiosyncratic reactions

when a particular person shows nontypical response to a med

It is not always possible to predict if a patient will have an idiosyncratic response to a medication.

different effect rather than the intended therapeutic effect

-allergic reactions

Medication or chemical acts as an antigen, triggering the release of the antibodies in the body

medication allergy symptoms vary according to the individual and the medication

antibiotics cause a high incidence of allergic reactions

anaphylactic reactions - life threatening allergic reactions

-> sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, severe wheezing and shortness of breath

-> need a med identification bracelet or medal so when unalert, med staff would know

#medication interactions

synergistic effect - could be beneficial

beneficial effects

side effects are contradicted - a beneficial effect

diminished effect

works for the worst

worsens the side effects of both or one

create another type of side adverse effects by co-usage

#timing of medication dose responses

after an initial medication dose, the pt receives each successive dose when the previous dose reaches its half-life

#routes of administration

*oral routes

-sublingual administration

-buccal administraion

*parenteral routes

-epidural

-intrathecal

-intraosseous

-intraperitoneal

-intrapleural

-intraarterial

-intracardiac

-intraarticular

*topical administration

1. Directly applying a liquid or ointment
2. Inserting a med into a body cavity
3. Instilling fluid into a body cavity
4. Irrigating a body cavity
5. Spraying a med into a body cavity

*inhalation route

*intraocular route

#systems of medication measurement

*metric system

*household measurements

*solutions

 

      nursing knowledge base

#clinical calculations

*conversions within one system

*conversion between systems

*dose calculations

-the ratio and proportion method

-dimensional analysis

#prescriber's role

#types of orders in acute care agencies

*standing orders or routine medication orders

Carried out until the prescriber cancels it by another order or a prescribed number of days elapse.

Often indicates a final date or number of treatments or doses

Many agencies have policies for automatically discontinuing standing orders

*prn orders

To be given only when a pt requires it

Use objective and subjective assessment and discretion is determining whether a pt needs it or not

When administering the prn med, document the assessment of why the patient needed it and when the med was administered.

*single (one-time) orders

One time order usually for preoperative meds or meds to be given before a diagnostic procedure

*stat oreders

Urgent immediate one time order

*now orders

More specific than a one time order and is used when a pt needs a med quickly but not right away. Within 90 minutes of order

*prescriptions

#pharmacist's role

#distribution systems

*unit dose

*automated medication dispensing systems

#nurse's role

Assess the pt's ability to self administer medications, determine

Whether a patient should receive a medication at a given time,

Administer meds correctly

And closely monitor their effects.

Pt and family education is important

#medication errors

When an error occurs, the pt's safety and well-being become the top priority.

The nurse must first assess and examines the pt's condition and notify the

Health care provider as soon as possilbe.

Once the pt is stable, the nurse reports the incident and  makes an incident report

That usually must be filed within 24 hours.

It is not put in the med record of the pt.

Medication reconciliation - comparing the med orders from previous unit or facility or before discharge to the current order of meds

 

critical thinking

#knowledge

#experience

#attitudes

Every step of safe med administration requires a disciplined attitude and a comprehensive, systemic approach.

Accept full accountability and responsibility surrounding all actions of medication administration.

Do not assume that an ordered med and dosage is the correct med and dosage.

Be responsible for knowing that the ordered meds and dosage are correct and appropriate.

I am accountable is I give an ordered med that is knowingly inappropriate for the pt.

Therefore, be familiar with each therapeutic effect, usual dosage, anticipated changes in lab data, and side effects of a drug.

I am also responsible for ensuring that pts and caregivers who self-administer meds have been properly informed about all aspects of self-administration.

#standards

*right medication

*right dose

*right patient

*right route

*right time

*right documentation

*maintaining patient's rights

 

 

Nursing Process

 

!assessment

 

#through the patient's eyes

Putting pts in the center of their care helps you to see the situation through their eyes and contributes to safe medication administration.

Begin your assessment by asking a variety of questions that help you better understand pt's current medication management routine, the ability to afford meds and beliefs and expectations about meds.

#history

Before administering meds, obtain or review the pt's medical history.

A pt's medical history provides indications and contraindications for medication therapy. Gastric ulcer - aspirin a problem, long term health problems such as diabetes or arthritis require meds, having had certain surgeries requires meds such as thyroidectomy indicates that the pt takes thyroid hormone replacement.

*allergies

Inform the other members of the health care team if the pt has a history of allergies to meds and foods.

*medications

Assess information about each medication that the pt takes, including length of time the med has been taken, the current dosage, and whether or not the pt experiences side effects of has had adverse effects from the med.

In addition, review the action, purpose, normal dosage, routes, side effects, and nursing implications for administering and monitoring each med.

*diet history

A diet history reveals a pt's normal eating patterns and food preferences. An effective dosage schedule is planned around them.

*patient's perceptual or coordination problems

There might need be management for pt with problems that inhibit self medication

#Patient's current condition

Assess a patient carefully before giving any medication.

Check bp for antihypertensive meds, avoid oral meds of nauseated pts.

Notify.

Assessment findings serve as a baseline in evaluating the effects of med therapy

#patient's attitude about medication use

Observe the pt's behavior for evidence of dependence or avoidance.

Cultural factors might predispose the pt against taking western meds.

#patient's understanding of and adherence to medication therapy

When a pt has a poor adherence to med history, check if he or she is able to afford the meds.

Does the pt understand the purpose for the med?

Without adequate knowledge and motivation, adherence to medication schedules is unlikely

#patient's learning needs

 

!nursing diagnosis

 

!planning

 

# goals an outcomes

#setting priorities

#teamwork and collaboration

 

!implementation

 

유진이가 지시에 따라 사진을 적절한 곳에 넣는 것이 아니라

내가 지목해주는 곳에 지목해준 글이 아닌 지목해주는 사진을 내가 찾아 주면 본뜨는 것 copy하는 것은 자기가 하여 넣는 것이니 오해 말라.

onenote의 글도 거부하는 것 외에는 내가 올리는 것이니 그것도 오해 말라.

오늘 글은 준수한 글들이라.

잘 읽고 유념하여야 할 것이라.

레오 진 스 사이트 잊지 마라.

하 나 님.

 

내가 꼭 사진은 올린다.

내가 모조리 올린다고 보아도 좋을 듯 하다.

잘 유념하라.

 

하 나 님.

 

내가 바라지 않는 글을 유진이 올리지 않으므로 그것도 역시 유념하라.

하 나 님.

 

#Health promotion

*patient and family teaching

Patients cope better with problems caused by medication if they understand how and when to act

#acute care

*receiving, transcribing, and communicating medication orders

*accurate dose calculation and measurement

*correct administration

Carefully monitor the pt's response to the med esp when he or she receives the first dose of a new medication

*recording medication administration

Record the name of med, dose, route, and exact time of administration and the site of injection when pertinent immediately on the appropriate record form

When a dose is missed document the reason for not giving the dose

#Restorative care

#special considerations for administering medications to specific age- groups

*infants and children

*older adults

*polypharmacy

#Evaluation

*Through the patient's eyes

*patient outcomes

 

Medication Administration

 

#oral administration

#topical medication applications

*skin applications

*nasal instillation

*eye instillation

*intraocular administration

*ear instillations

*vaginal instillation

*rectal instillation

 

#administering medications by inhalation

#administering medications by irrigation

 

#parenteral administration of medications

*equipment

-syringes

-needles

-disposable injection units

*preparing an injection from an ampule

*preparing an injection from a vial

*mixing medications

-mixing medications from a vial and an ampule

-mixing medications from two vials

*insulin preparation

 

#administering injections

*subcutaneous injections

*intramuscular injections

-sites

• Ventrogluteal
• vastus lateralis
• deltoid

-use of the z-track method in intramuscular injections

*Intradermal injections

*safety in administering medications by injection

-needleless devices

*intravenous administration

-large volume infusions

-intravenous bolus

-volume-controlled infusions

• Piggyback
• Volume-control administration
• Mini-infusion pump

*intermittent venous access

*administration of intravenous therapy in the home

1mL = 15 drops

5mL = 1 teaspoon

15mL = 1 tablesppon

30mL = 2 tablespoon = 1 fl. Oz

240 mL = 1 cup = 8 fl oz

960 mL = 1 quart

3840 mL = 1 gallon

@Verbal orders for antineoplastic agents should not be permitted under any circumstances.

These meds are not administered in emergency or urgent situations and they have a narrow margin of safely.

 

Elements that should be included in a verbal order

1. Name of pt
2. Age and wt of pt when appropriate
3. Drug name
4. Dosage form
5. Exact strength or concentration
6. Dose, frequency and route
7. Quantity and or duration
8. Purpose or indication unless disclosure considered inappropriate by prescriber
9. Specific instructions for use
10. Name of prescriber and telephone # when appropriate
11. Name of individual transmitting the order if different from prescriber

 

The content of verbal order should be clearly communicated

1. The name of the drug should be confirmed by

Spelling, providing both the brand and generic name, or providing indication for use

1. Spell out the number in dosages 50 then five zero mililiter
2. For drug name modifiers use spelling assistant methods such as x as in x ray
3. No abbreviations
4. Write the order down then read it back.