Principles of Drug Administration

Nurse Responsibilities Know classifications, actions and side effects of drug Know patient details and why drug was prescribed Know how drug is acquired and pharmacy procedures Know how to prepare and administer drug safely

Nurse Responsibilities (cont'd) Before drug administered, nurse must know all variables of the client’s condition Be prepared to recognize and react to adverse effects

Allergy versus Anaphylaxis Allergic Reactions Allergic reaction - an acquired hyperresponse of body defenses to a foreign substance If discovered, nurse responsible for labeling charts, informing all personnel, and placing alert bracelet on patient Anaphylaxis A severe allergic reaction involving the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock Requires immediate treatment

Five Most Common Medication Errors Incomplete patient information Unavailable drug information Miscommunication of drug orders Lack of appropriate drug labeling Environmental distractions

Five Rights of Drug Administration Five Rights used as the basis of safe delivery of medications. They are: Right client Right medication Right dose Right route of administration Right time of delivery

Three Checks of Drug Administration Checking the drug with the MAR or the medication information system when pulling it from storage Checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag Checking the drug before administering it to the patient

Mistakes and Liability Despite five rights and three checks, mistakes still occur Nurses are held accountable for correct administration of drugs, but responsibility also rests on other positions like physician and pharmacist

Drug Compliance Compliance is taking a medication in the manner prescribed by the health care provider Patient has active role in ensuring compliance Factors that can cause a patient to deviate from compliance Cost of drug Forgetting doses Annoying side effects Self-adjustment of doses Fear of dependency

Special Drug-Administration Abbreviations STAT – medication is to be given immediately, and only once ASAP – drug should be available for administration within 30 minutes of the written order PRN – drug administered as required by the patient’s condition

Drug-Administration Written Orders Single order – drug to be given only once at at a specific time Orders not written as STAT, ASAP, NOW, or PRN are called routine orders Standing order - written in advance of a situation that is to be carried out under specific circumstances

Drug-Administration Procedures Drug orders must be reviewed by the attending physician within specific time frames, at least every 7 days Drugs may need administration during or between meals, depending on interaction with food Central nervous system drugs and antihypertensives are often best administered at bedtime

Drug-Administration Procedures (cont'd) Nurse must educate patients carefully about timing of taking medications Nurses must document carefully the details of medications given to patient – after they have been given Refusal or omission of medication must be documented

Three Systems of Measurement Used in Pharmacology Metric—most common Apothecary—oldest Household

Common Protocols and Techniques for All Routes of Administration Review medication order Wash hands and apply gloves, if indicated. Identify client, check for allergies Inform client Position client, remove drug from prepackaging if necessary; do not leave drugs at bedside unless so instructed Document

Routes of Administration Three broad routes are enteral, topical, and parenteral Subsets within each See short video on webcampus

Enteral Route Includes Drugs Given By mouth: tablets, capsules, sublingual and buccal Via nasogastric tube or gastrostomy tube Tablets and capsules most common form of drugs Can be crushed or opened only if manufacturer instructed; enteric-coated tablets must remain intact

Sublingual Buccal

Enteral Drug Administration Advantages Advantages Convenient Least costly of three routes Overdose can be countered by retrieval of undigested medicines through vomiting Safest route because skin barrier not compromised Uses vast absorptive surfaces of the oral mucosa, stomach, or small intestine

Enteral Drug Administration Disadvantages Disadvantages Difficulty swallowing by some clients May be inactivated if tablets or capsules crushed or opened Can be inactivated by enzymes Depends on client gastrointestinal motility and mobility First-pass metabolism: inactivation of drug by processing in the liver

Figure 3.2 (cont'd) Transdermal patch administration: (b) patch immediately applied to clean, dry, hairless skin and labeled with date, time, and initials Source: Pearson Education/PH College

Topical Drugs Are Applied to Skin or Mucous Membranes Applications: Dermatologic preparations: applied to skin – most common Instillations and irrigations: applied into body cavities and orifices Inhalations: applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing Systemic vs. local effect is important distinction for a nurse

Parenteral Drugs Are Administered via Needle Types: intradermal, subcutaneous, intramuscular, intravenous Require aseptic technique Nurse must have knowledge of anatomical locations Nurse must know correct equipment to use Nurse must know procedure for disposing of hazardous equipment

Parenteral Locations Intradermal: dermal layer of skin Subcutaneous: deepest layers of the skin Intramuscular: specific muscles Intravenous: directly into bloodstream Advanced parenteral delivery may be directly into body cavities or organs

Intradermal and Subcutaneous Administrations Avoid the hepatic first-pass effect and digestive enzymes; offer method for those who cannot take medicine orally Only small volumes can be administered; injections can cause pain and swelling Intradermal (ID) injection administered into the dermis layer of the skin More easily absorbed than in subcutaneous Small amount of drug

Intradermal and Subcutaneous Administrations (cont'd) Subcutaneous injection is delivered to the deepest layers of the skin Used for easy access and rapid absorption Important to rotate injections sites Aspiration not usually necessary, but depends on drug

Intramuscular Administration Delivers medication into specific muscles More rapid onset of action than with oral, ID, or subcutaneous administration Can accept larger volume of medication than subcutaneous Injection site very important; must avoid bone, blood vessels, and nerves

Four Common Intramuscular Injection Sites Ventrogluteal Deltoid Dorsogluteal Vastus Lateralis

Figure 3.9 (cont'd) Intramuscular drug administration: (c) the needle is inserted at a 90° angle: Source: Pearson Education/PH College.

Intravenous Administration (IV) Medications and fluids administered directly into bloodstream and are immediately available for use by the body Fastest drug onset action, but also most dangerous method Contaminations Swift adverse reactions

Three Types Intravenous Administration Large volume infusion: for fluid maintenance, replacement, or supplementation Intermittent infusion: small amount of IV solution arranged tandem with primary large-volume infusion; used to instill adjunct medications IV bolus (push) administration: concentrated dose delivered directly to circulation via syringe to administer single-dose medications

Figure 3.12 (cont'd) IV bolus administration. (b) the drug is administered through the port using a needleless syringe

Parenteral Advantages and Disadvantages Advantages: Bypasses first-pass effect and enzymes Available to patients unable to take medication orally Disadvantages Only small doses can be used Pain and swelling at injection site