Chapter 29 Medication Administration Fundamentals of Nursing: Standards & Practices, 2E Chapter 29 Medication Administration

Drug Standards and Legislation Standards have been developed to ensure drug uniformity so that effects are predictable. The United States Pharmacopeia and National Formulary (USP and NF) are books of drug standards for usage in the United States. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Federal Legislation The Pure Food and Drug Act of 1906 designated the USP and the NF as official bodies to establish drug standards. State and Local Legislation Health Care Institution Regulations Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Drug Nomenclature Drugs may be used as an aid in the diagnosis, treatment, or prevention of disease, in other abnormal conditions for the relief of pain or suffering, or to improve any physiological or pathologic condition. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Drug Action Pharmacology Medication Management Classification Preparation and Route Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Pharmacokinetics Absorption Distribution Metabolism Excretion Drug Interaction Side Effects and Adverse Reactions Food and Drug Interactions Copyright 2002 by Delmar, a division of Thomson Learning

Factors Influencing Drug Action Individual client characteristics, such as genetic factors, age, height and weight, and physical and mental conditions can influence the action of drugs on the body. Copyright 2002 by Delmar, a division of Thomson Learning

Professional Roles in Medication Administration Health Care Providers Types of Medication Orders Stat Orders Single-Dose Orders Standing Orders PRN Orders Parts of the Drug Order Copyright 2002 by Delmar, a division of Thomson Learning

System of Weight and Measure Metric System Apothecary System Household System Copyright 2002 by Delmar, a division of Thomson Learning

Approximate Dose Equivalents Converting Units of Weight and Volume Measurement Conversions within the Metric System Measurement Conversions between Systems Drug Dose Calculations Pediatric Dosages Copyright 2002 by Delmar, a division of Thomson Learning

Safe Drug Administration Guidelines for Medication Right Drug Right Dose Right Client Right Route Right Time Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Documentation of Drug Administration Documentation is a critical element of drug administration. Nurse should document that a drug has been given after the client has taken the drug. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Drug Supply and Storage Unit dose form is used to dispense scheduled drugs for each client. Stock supplied drugs (dispensed and labeled in large quantities) are stored in the medication room or other area on the nursing unit. Narcotics and Controlled Substances Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Drug Abuse Addiction is a physiological or psychological dependence on a substance. Dependence is the reliance on, or need to take a drug. Copyright 2002 by Delmar, a division of Thomson Learning

Medication Compliance Compliance can be associated with the client’s understanding of why medication was ordered, and how medication can decrease the likelihood of getting a disease or how it can lessen the effects of an existing disease. Noncompliance is when clients do not consistently take prescribed medications, or when they adjust the scheduling or dose of the medication. Copyright 2002 by Delmar, a division of Thomson Learning

Legal Aspects of Administering Medications Negligence exists any time the nurse fails to do something that a reasonable nurse would do under similar circumstances or does something that a reasonable nurse would not do. Malpractice is any professional misconduct or unreasonable lack of skill in professional duties. Questioning the Medication Order Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Assessment Drug History Allergies Prescription Drugs Over-the-Counter Drugs Biographical Data Lifestyle and Beliefs Sensory and Cognitive Status Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Physical Examination Diagnostic and Laboratory Data Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Nursing Diagnosis Nursing Diagnoses related to medication administration are Deficient Knowledge Ineffective Therapeutic Regimen Management Ineffective Health Maintenance Impaired Physical Mobility Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Nursing Diagnosis Disturbed Sensory Perception Impaired Swallowing Nursing Diagnoses related to the addicted client are Imbalanced Nutrition Impaired Verbal Communication Interrupted Family Processes Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Impaired Social Interaction Social Isolation Spiritual Distress Readiness for Enhanced Spiritual Well-Being Ineffective Coping Copyright 2002 by Delmar, a division of Thomson Learning

Outcome Identification Nurse develops goals and plans care on the basis of nursing diagnosis. Client teaching based on medications prescribed is inherent in the plan of care. Nursing interventions are identified and incorporated into the plan of care to promote the attainment of goals and to assist the client in achieving expected outcomes. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Planning The nurse needs to carefully plan nursing care activities to ensure safe administration of medications. Adequate planning provides for questions and discussion by the client and demonstration of skills learned. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Implementation Administer Oral Drugs Sublingual and Buccal Drug Administration Review Procedure 29-1 on administering an oral medication. Enteral Instillation of Drugs Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Administer Parenteral Drugs Equipment Review Procedure 29-2 on withdrawing medication from an ampule. Review Procedure 29-3 on withdrawing medication from a vial. Intradermal Injection Subcutaneous Injection Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Review Procedure 29-4 on mixing insulins in one syringe. Review Procedure 29-5 on administering an intradermal injection. Review Procedure 29-6 on administering a subcutaneous injection. Intramuscular Injection Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Review Procedure 29-7 on administering an intramuscular injection. Intravenous Injections Review Procedure 29-8 on administering medications by IV Piggyback to an existing IV. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Administer Topical Medications Eye Medications Review Procedure 29-9 on administering an eye medication. Ear Medications Review Procedure 29-10 on instilling an ear medication. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Nasal Instillations Review Procedure 29-11 on instilling nose drops. Respiratory Inhalants Review Procedure 29-12 on teaching self-administration with a metered-dose. Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Rectal Instillations Review Procedure 29-13 on administering a rectal suppository. Vaginal Instillations Review Procedure 29-14 on administering a vaginal suppository. Complementary Therapy Copyright 2002 by Delmar, a division of Thomson Learning

Copyright 2002 by Delmar, a division of Thomson Learning Evaluation The nurse is responsible for ongoing evaluation of client’s response to medication. Nurses in the community setting need to evaluate the client’s ongoing ability to manage his or her medication regime. Copyright 2002 by Delmar, a division of Thomson Learning