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Mosby items and derived items © 2005 by Mosby, Inc.
Chapter 34
Medication Administration
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacological Concepts
• Drug names
• Classification
• Medication forms or preparations
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Legislation and Standards
• Federal regulations
• State and local regulations
• Health care institutions and medication laws
• Nursing practice
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Pharmacokinetics
• Absorption– Route of administration– Ability to dissolve– Blood flow to administration site– Body surface area– Lipid solubility
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Pharmacokinetics (cont’d)
• Distribution– Circulation– Membrane permeability– Protein binding
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Pharmacokinetics (cont’d)
• Metabolism– Biotransformation– Detoxification
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Pharmacokinetics (cont’d)
• Excretion– Kidneys– Liver– Bowel– Lungs– Exocrine glands
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Actions
• Therapeutic effects
• Side effects
• Adverse effects
• Toxic effects
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Actions (cont’d)
• Idiosyncratic reactions
• Allergic reactions
• Interactions
• Medication dose responses
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Routes of Administration
• Oral: sublingual, buccal
• Parenteral: intradermal, subcutaneous, intramuscular, intravenous
• Topical
• Inhalation
• Intraocular
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Systems of Measurement
• Metric
• Apothecary (grains)
• Household
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Metric System
• Grams (g), milligrams (mg), kilograms (kg)
• Liters (L), milliliters (ml)
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Household Measurements
• Tablespoons
• Teaspoons
• Ounces
• Cups
• Pints
• Quarts
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Clinical Calculations
• Conversions within systems
• Conversions between systems
• Formula:
Dose ordered x Amount
Dose on hand on hand
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Prescriber’s Role
• Types of orders– Standing orders– prn orders– Single orders– Stat orders
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Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
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Nurse’s Role
• Six rights
• Triple-check before administration
• Client assessment
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Six Rights
• Right medication
• Right dose
• Right client
• Right route
• Right time
• Right documentation
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Client’s Rights
• Information
• Refusal
• Careful assessment
• Informed consent
• Safe administration
• Supportive therapy
• No unnecessary medications
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Assessment
• Medical history
• History of allergies
• Medication data
• Diet history
• Perceptual or coordination problems
• Current condition
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Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
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Nursing Diagnoses
• Deficient knowledge (medications)
• Noncompliance (medications)
• Disturbed sensory perception
• Impaired swallowing
• Ineffective therapeutic regimen management
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Planning
• Goals and outcomes– Example:
Client will verbalize therapeutic and adverse effects of medications
• Setting priorities
• Continuity of care
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Implementation
• Client and family teaching
• Medication orders: receipt, transcription, communication
• Calculation and measurement
• Correct administration technique
• Recording
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Special Considerations
• Infants and children
• Older adults– Polypharmacy– Self-prescribing– Over-the-counter medications– Misuse– Noncompliance
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Evaluation
• Client response to medications
• Client and family ability to administer medications
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Oral Administration
• Presence of GI alterations
• Ability to swallow
• Use of gastric suction
• Positioning
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Topical Administration
• Skin applications– Use of gloves or applicators– Preparation of skin– Thickness of application
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Nasal Instillation
• Assessment of nares
• Client instruction and self-administration
• Positioning
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Eye Instillation
• Drops, ointments, disks
• Assessment of eyes
• Asepsis
• Positioning
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Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children and adults
• Positioning
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Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Client positioning, comfort, and hygiene
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Rectal Instillation
• Suppositories
• Use of gloves
• Client positioning, comfort, and hygiene
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Inhalation
• Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister
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Irrigation
• Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic)
• Asepsis
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Parenteral Administration
• Equipment– Syringes: sizes (volume), types– Needles: length, gauge– Disposable units: Tubex, Carpuject– Ampules– Vials
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Parenteral Administration (cont’d)
• Mixing medications– Determine compatibility of the
medications– Do not contaminate one medication with
another– Ensure the final dose is accurate– Maintain aseptic technique
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Parenteral Administration (cont’d)
• Insulin– Syringes and needle sizes– Types of insulin– Mixing of insulins– Rotation of vials before withdrawal of
solution
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Administration of Injections
• Minimize discomfort– Use smallest suitable needle– Position client comfortably– Select proper site– Divert client’s attention– Insert the needle quickly and smoothly– Hold the syringe steady– Inject the medication slowly and steadily
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Administration of Injections (cont’d)
• Subcutaneous injections– Sites: condition of area, rotation of use– Amount of solution– Length and gauge of needle– Pinch or spread skin– Angle of insertion
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Administration of Injections (cont’d)
• Intramuscular injections– Sites: landmarks, condition of area– Amount of solution– Length and gauge of needle– Angle of insertion– Aspiration– Air-lock method– Z-track technique
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Administration of Injections (cont’d)
• Sites– Ventrogluteal– Vastus lateralis– Deltoid
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Administration of Injections (cont’d)
• Intradermal injections– Skin testing– Sites– Length and gauge of needle– Angle of insertion– Formation of small bleb
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Prevention of Needle Sticks
• Needleless devices
• Sharps disposal
• One-handed recapping technique
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Intravenous Administration
• Large volume infusions
• Bolus injection
• Volume-controlled infusionsPiggyback– Tandem– Volume-control set– Mini-infusor pump