Medications Chapter 35 60 Minutes- The wrong medicine

How are drugs named and classified Prescriptive drugs Nonprescriptive drugs Generic name Trade or Brand name

Legal Aspects Nurse Practice Acts Controlled Substances US legislation State laws

Effects of Drugs Side effects Adverse effects Drug toxicity Allergy Anaphylactic reaction Drug interaction

Actions of Drugs on the Body Half life Onset Peak plasma level

Pharmacokinetics Absorption Distribution Biotransformation Excretion

Factors Affecting Medication Action Developmental Sex Cultural, ethnic, and genetic Diet Environment Psychological Illness and disease Time of administration

Oral Tablets, capsules, liquids Sublingual Buccal Enteral medications

Figure 35-3 Sublingual administration of a tablet. 9

Figure 35-4 Buccal administration of a tablet. 10

Transdermal Applied to the skin Local (and sometimes systemic) effects Skin lotions, creams, ointments Transdermal patches

Parenteral Medications Injected via Intradermal Subcutaneous Intramuscular Intravenous

Topical Applied to skin or in a body cavity Eye, ear, vagina, rectum, nose

Types of Medication Orders STAT orders Single order Standing orders PRN orders If written by the nurse (phone or verbal order) must read back to verify accuracy of the order.

Essential Parts of a Drug Order Full name of client Date and time the order is written Name of the drug Dosage Frequency of administration Route of administration Signature of the person writing the order

Communicating Orders Telephone/verbal orders Order placed on Medication Administration Record (MAR)

Write the order you receive over the phone from Dr. Jones.

Figure 35-6 Sample medication administration record (MAR). 18

Administering Medications Safety Assessment Suitable route Medication history (hx) Drug allergies Specifics to drug Self administration problems

Administering Medications: Practice Guidelines Pg. 860

Medication Reconciliation Ensure clients receive meds as they move or transfer through or out of a facility Compare complete list of meds to the physician’s orders

Medication Dispensing Systems Medication Cart Unit dosing Automated dispensing system

Process of Administering Medications Identify the client Inform the client Administer the drug After completion of 3 checks

Process of Administering Medications (cont.) Provide adjunctive interventions as indicated Record the drug administered Evaluate the client’s response to the drug

Three Checks Rule (Box 35-4 pg. 863) Check the medication label against MAR Upon removal When preparing med At the bedside

5 Rights + 5 (p. 864) Right Documentation (the 6th right) Right Patient Right Drug Right Route Right Time Right Dose Right Documentation (the 6th right) Client education Right to refuse Right assessment Right evaluation

Compare the medication label to the MAR. 27

Medication Errors Practice safe medication administration !!!! Common errors How can they be avoided? Practice safe medication administration !!!!

What To Do If I Make A Medication Error? Assess VS and physical status Notify primary care provider Notify charge nurse Complete incident report

The nurse is taking an oral tablet of Tylenol to a client who is in a private room. He is in the bathroom and says, “just leave it on the table and I will take it when I come out.” You are very familiar with this client and have cared for him all weekend long. What would you do? Why?

Oral Med. Administration Pg. 865-871 per Lab discussion

Parental Medications (pg. 872) Intradermal Subcutaneous (SubQ) Intramuscular Intravenously

Preparing injectable medications Ampule Vial Reconstituting medications

Intradermal Injections Are given in the dermis Use 1 ml. syringe 25-27 gauge needle, ¼ to 5/8 in. Dose 0.01 to 0.1 ml Angle 5-15 degrees Produces a wheal or bleb See Skill 35-5 pg. 882

Administering an Intradermal Injection ; the medication forms a bleb or wheal under the epidermis. 35

Figure 35-32 Body sites commonly used for intradermal injections. 36

Sub Q injections Sites Maximum of 25 gauge needle, 3/8 to 5/8 length Dose no more than 1 ml. Angle 45 degrees for avg. or thin client Angle 90 degrees for obese client

Sub Q injections (cont.) Pinch or spread skin Insulin Heparin Skill 35-6 pg. 885

SQ Injection Sites

Administering a Subcutaneous Injection Inserting a needle into the subcutaneous tissue using 90- and 45-degree angles. 40

IM injections IM sites 23-25 gauge needle, larger for thick solutions; 1 – 1 ½ in. ½-1 ml for deltoid 1-4 ml for larger leg muscles

IM injections (cont.) 1-4 ml for larger leg muscles Angle- 90 degrees Aspirate Skill 35-7 pg. 891

Ventrogluteal Site

Vastus Lateralis Site

Dorsogluteal Site Not recommended Injection site close to sciatic nerve

Rectus Femoris Site Located in anterior thigh Used only occasionally

Deltoid 47

IM Injection Technique: Z-Track Seals needle track Displace or pull skin to the side Insert needle Aspirate Inject (wait 5-10 sec.) Withdraw Release skin Skill 35-7 pg. 892

Considerations A safe distance from nerves, large blood vessels, and bones Free from injury, abscesses, tenderness, necrosis Large enough to accommodate the volume of medication to be given

Discussed in Lab (pg. 902-915) Skin Ophthalmic (eye) Otic (ear) Nasal Vaginal Rectal Inhaled

Let’s put it into practice!