给 药 (二) 中国医科大学护理学院 王健

Medications (two)

FACTORS AFFECTING MEDICATION ACTION A number of factors other than the drug itself can affect its action. A person may not respond in the same manner to successive doses of a drug. In addition, the identical drug and dosage may affect different clients differently.

1.Developmental Factors ·During pregnancy women must be very careful about taking medications. ·Infants usually require small dosages because of their body size and the immaturity of their organs, especially the liver and kidneys. ·Older adults have different responses to medications due to physiologic changes that accompany aging.

2.Gender Differences in the way men and women respond to drugs are chiefly related to the distribution of body fat and fluid and hormonal differences. 3.Cultural, Ethnic, and Genetic Factors Recent research has indicated ethnicity and culture may contribute to differences in responses to medications.

4. Diet Nutrients can affect the action of a medication. 5 4.Diet Nutrients can affect the action of a medication. 5.Environment The client’s environment can affect the action of drugs, particularly those used to alter behavior and mood.

6.Psychologic Factors A client’s expectations about what a drug can do can affect the response to the medication. 7.Illness and disease Illness and disease can also affect the action of drugs. 8.Time of Administration The time of administration of oral medications affects the relative speed with which they act.

ROUTES OF ADMINISTRATION Pharmaceutical preparations are generally designed for one or two specific routes of administration. The route of administration should be indicated when the drug is ordered. When administering a drug, the nurse should ensure that the pharmaceutical preparation is appropriate for the route specified.

1.Oral Oral administration is the most common, least expensive, and most convenient route for most clients. In oral administration, the drug is swallowed. Because the skin is not broken as it is for an injection, oral administration is also a safe method.

The major disadvantages are possibly unpleasant taste of the drugs, irritation of the gastric mucosa, irregular absorption from the gastrointestinal tract, slow absorption, and in some cases, harm to the client’s teeth.

2.Sublingual In sublingual administration a drug is placed under the tongue, where it dissolves (Figure 33-2). In a relatively short time, the drug is largely absorbed into the blood vessels on the underside of the tongue. The medication should not be swallowed. Nitroglycerin is one example of a drug commonly given in this manner.

3. Buccal Buccal means “pertaining to the cheek 3.Buccal Buccal means “pertaining to the cheek.” In buccal administration, a medication (eg, a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves (Figure 33-3). The drug may act locally on the mucous membranes of the mouth or systemically when it is swallowed in the saliva.

4.Parenteral Parenteral administration is administration other than through the alimentary tract; that is, by needle. The following are some of the more common routes for parenteral administration:

·Subcutaneous (hypodermic): into the subcutaneous tissue, just below the skin ·Intramuscular: into a muscle ·Intradermal: under the epidermis (into the dermis) ·Intravenous: into a vein

5.Topical Topical applications are those applied to a circumscribed surface area of the body. They affect only the area to which they are applied. Topical applications include the following:

•Dermatologic preparations: applied to the skin •Instillations and irrigations: applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina •Inhalations: administered into the respiratory tract by a nebulizer or positive pressure breathing apparatus. Air, oxygen, and vapor are generally used to carry the drug into the lungs. See Chapter 47.

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

ADMINISTERING MEDICATIONS SAFELY The nurse should always assess a client’s health status and obtain a medication history prior to giving any medication.

•The medication history includes information about the drugs the client is taking currently or has taken recently. •An important part of the history is clients’ knowledge of their drug allergies. •Also included in the history are the client’s normal eating habits. •Any problems the client may have in self-administering a medication must also be identified.

Clinical guidelines for administering medications 1 Clinical guidelines for administering medications 1.Nurses who administer medications are responsible for their own actions. Question any order that you consider incorrect. 2.Be knowledgeable about medications you administer. 3.Federal laws govern the uses of narcotics and barbiturates. Keep these medications in a locked place.

4. Use only medications that are in a clearly labeled place. 5 4.Use only medications that are in a clearly labeled place. 5.Do not use liquid medications that are cloudy or have changed color. 6.Before administering a medication, identify the client correctly using the appropriate means of identification, such as checking the identification bracelet or asking clients to state their name or both.

7.Do not leave medications at the bedside, with certain exceptions (eg, nitroglycerin, cough syrup). Determine agency policy. 8.If a client vomits after taking an oral medication, report this to the nurse in charge or the physician or both. 9.Take special precautions when administering certain medications, for example, have another nurse check the dosages of anticoagulant, insulin,and certain IV preparation.

10.Most hospital policies require new orders from the physician for the client’s postsurgery care. 11.When a medication is omitted for any reason, record the fact together with the reason. 12.When a medication error is made, report it immediately to the nurse in charge or the physician or both.

Process of Administering Medications 1. Identify the client. 2 Process of Administering Medications 1.Identify the client. 2.Inform the client. 3.Administer the drug. 4.Provide adjunctive interventions as indicated. 5.Record the drug administered. 6.Evaluate the client’s response to the drug.

Five “Rights” of Drug Administration • Right drug • Right dose • Right time • Right route • Right client

ORAL MEDICATIONS 1. Organize the supplies. 2 ORAL MEDICATIONS 1.Organize the supplies. 2.Verify the client’s ability to take medication orally. 3.Verify the order for accuracy. 4.Obtain appropriate medication.

5. Prepare the medication 5.Prepare the medication. •tablets or capsules (Figure 33-8,9,10) •liquid medication (Figure 33-11,12)

6. Administer the medication at the correct time. 7 6.Administer the medication at the correct time. 7.Document each medication given. 8.Dispose of all supplies appropriately. 9.Evaluate the effects of the medication.

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