NUR 51/45A Non-Parenteral Medication Administration Charlene Gagliardi, RN, MSN

Drug Names Generic or Nonproprietary Name Name assigned when a drug is first manufactured i.e. acetaminophen Trade Name, Brand Name, or Proprietary Name Copyrighted name given by manufacturer of medication Medication may have several trade names i.e. Tylenol

Four Parts of Pharmacokinetics Absorption Transference of blood molecules from the point of entry in the body into the bloodstream Distribution Begins with absorption of the drug into the circulation and ends when the drug arrives at its site of action

Four Parts of Pharmacokinetics Metabolism Process of inactivating and breaking down a medication Excretion Movement of a drug from its site of metabolism back into circulation and its transport to the site of exit from the body

Drug Actions Idiosyncratic Responses Drug Tolerance Drug Interactions Therapeutic Effect Side Effects Adverse Effects Allergic Responses

Adverse Drug Effects

Components of a Medication Order Date and Time of Order Medication Name Dose of Medication Route of Administration Frequency of Administration Signature of Prescriber

Types of Medication Orders Standing Orders PRN Orders Single Orders STAT Orders

Routes of Administration Oral: given by mouth –Oral (PO) –Sublingual –Buccal Parenteral: given by injection –Intradermal (ID) –Subcutaneous (SC or SQ) –Intramuscular (IM) –Intravenous (IV)

Routes of Administration Topical Route: given directly to a body site Inhalation: given into the respiratory tract via the nose or throat Rectal or vaginal – suppository/cream Nasogastric / G-Tube / J-Tube

Comparison of Onset, Peak and Duration of an Oral & IV Drug

Distribution Systems Stock supply Unit dose Computer controlled

Pyxis Medication cart

It is vitally important for the nurse to elicit information about known drug and food allergies before the patient receives a medication for the first time. The Six Rights of Medication Administration Right Drug Right Dose Right Patient Right Route Right Time Right Documentation

Assessment Medical history History of allergies Medication data Diet history Perceptual or coordination problems Current condition

Assessment (cont’d) Attitude about medication use Knowledge of therapy Learning needs

Prevention of Medication Errors Know agency policies and procedures Question over 3 tablets Be aware of drugs with similar names Check you math; check the decimal point Question abrupt/ excessive > or < in dose Don’t guess with illegible handwriting Always check orders against the MAR Know pt’s history and allergies (food/drug)

Prevention of Medication Errors Know your medications – never give a med that you are unfamiliar with Do all necessary pt assessments – VS, labs. etc. Always perform the six rights Do your patient teaching with all meds Do not leave medications at the bedside Always administer NG or GT meds one at a time with a water flush before, between and after Report any med errors

Assessment of Apical Pulse

Procedure Perform all checks and assessments Have water, cups, straws at bedside Wash hands Using MAR, remove meds in order, checking med name, dose, expiration date Keep meds in unit dose packaging and place in med cups Take MAR and meds to pt room

Comparison to MAR

Procedure Perform all ID checks Assist pt to comfortable position Pt teaching with each med administered Remove meds from packaging one at a time Make sure pt swallows the medication Reposition patient / discard trash Document

Nursing Diagnoses Deficient knowledge (medications) Noncompliance (medications) Disturbed sensory perception Impaired swallowing Ineffective therapeutic regimen management

Planning Goals and outcomes – Example: Patient will verbalize therapeutic and adverse effects of medications Setting priorities Continuity of care

Implementation Patient and family teaching Medication orders: receipt, transcription, communication Calculation and measurement Correct administration technique Recording

Evaluation Patient response to medications Patient and family ability to administer medications

Oral Administration Presence of GI alterations Ability to swallow Use of gastric suction Positioning

Solid Oral Medications

Scored Tablet

Enteric Coated/Extended Release

Pouring Liquid Medications

Sublingual Placement

Buccal Administration

NG/G Tube Medications Make sure the medications can be crushed or are in liquid form Check for proper placement of NG tube prior to giving meds and check for residual for all tubes Each medication is administered separately by gravity syringe method followed by a small water flush Water flush at the end of administration of medication

Individual Preparation of NG/G Tube Medications

Checking Residual before NG/G Tube Medications

Gravity Administration of NG/G Tube Medications

Topical Administration Skin applications –Use of gloves or applicators –Preparation of skin –Thickness of application

Transdermal Patch

Nitroglycerine Ointment

Medicated Cream

Nasal Instillation Assessment of nares Patient instruction and self- administration Positioning

Nasal Medications

Application of Nose Drops

Nasal Spray

Eye Instillation Drops, ointments, disks Assessment of eyes Asepsis Positioning

Eye Drops

Applying Pressure to Prevent Systemic Absorption

Applying Eye Ointment

Ear Instillation Assessment of ear canal Warming of solution Straightening of canal for children and adults Positioning

Ear Drops

Vaginal Instillation Suppositories, foams, creams Use of gloves and applicator Patient positioning, comfort, and hygiene

Vaginal Creams/Suppositories

Angle of Insertion for Vaginal Medications

Rectal Instillation Suppositories Use of gloves Patient positioning, comfort, and hygiene

Always Use Water Soluble Lubricant

Insertion of a Rectal Suppository

Inhalation Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) Patient assessment and instruction Use of spacer Determination of doses in canister

Types of Inhalers

Using a Metered Dose Inhaler

Irrigation Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic) Asepsis

Reading a Drug Label

Medication Math Metric System - - mL, L, gram Apothecary System – grain, minim, dram, ounce, pint, quart, gallon, pound Apothecary metric conversion - clock Household – tsp, tbsp, ounce, pint, qt, gallon Solutions - %, 1:100 vs. 1:10 Converting Measurement Units Dosage Calculation Formulas

Calculation Formulas Ratio / Proportion: shows relationship between two ratio’s – The order is for 10 mg and we have 8 mg per mL. 8 mg/ 1 mL = 10 mg / X mL 8X=10 X=10/8 X = 1.25 mL

Calculation Formulas D/H X Q (Dose, Have, Quantity) Dose ordered 10 mg; have 5 mg per ml 10/5 X 1 = 2 mL Solid medication – Q is always one Liquid medication – Q will vary. If there is 5 mg in 10 mL, the Q is 10 10/5 X 10 = 20 mL

Drug Measure Rules Use Arabic Fractions most often stated as decimals Use zero rules!!! Space goes between number and unit of measurement i.e. 1 mg Symbol follows the number with the exception of gr, oz and dr Use correct abbreviations