1. JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 26: Administering Medications

2. Copyright © 2016 F.A. Davis Company Legal Considerations (Pg 607-HF) U.S. drug legislation Sets official drug standards Defines prescription drugs Regulates controlled substances Improves safety Requires proof of efficacy Nurse practice acts Identify nursing responsibilities for administration and client monitoring

3. Copyright © 2016 F.A. Davis Company Medication Systems (Pg 608-HF) Stock Supply Bulk quantity Central location Not client specific Unit dose Individually packaged Client-specific drawers 24-hr supply

4. Copyright © 2016 F.A. Davis Company Medication Systems (cont’d) Automated dispenser Password-accessible locked cart Computerized tracking Can combine stock & unit doses Self-administration Individual containers Kept at client’s bedside

5. Copyright © 2016 F.A. Davis Company Pharmacological Considerations (Pg 609-HF) Pharmacokinetics What happens to the drug in the body? Pharmacodynamics How does the drug affect the body?

6. Copyright © 2016 F.A. Davis Company Pharmacokinetics Four processes Absorption Distribution Metabolism Excretion

7. Copyright © 2016 F.A. Davis Company Absorption Movement of drug into the bloodstream Factors affecting absorption – Route of administration – Drug solubility – pH/ionization – Blood flow

8. Copyright © 2016 F.A. Davis Company Distribution Drug transport to tissues and organs Factors affecting distribution – Local blood flow – Membrane permeability – Protein-binding capacity

9. Copyright © 2016 F.A. Davis Company Metabolism Biotransformation: chemical conversion of drug Factors affecting metabolism – Liver function – Health/disease status – First-pass effect

10. Copyright © 2016 F.A. Davis Company First Pass Effect Animation http://www.youtube.com/watch?v=DGROwxZotsQ

11. Copyright © 2016 F.A. Davis Company Excretion Elimination of the drug Factors affecting excretion – Organ function, especially the kidneys, liver, and lungs – Exocrine glands

12. Copyright © 2016 F.A. Davis Company Concepts Related to Pharmacokinetics (Pg 616-HF) Time until onset and peak Therapeutic range – Peak level – Trough level – Therapeutic level Half-life Concentration of active drug

13. Copyright © 2016 F.A. Davis Company Pharmacodynamics: Effects of Drugs Primary effects Therapeutic effects Predicted Intended Desired Why the drug was prescribed

14. Copyright © 2016 F.A. Davis Company Pharmacodynamics: Effects of Drugs (cont’d) Secondary effects Unintended Nontherapeutic Can be – Predictable – Harmless – Harmful

15. Copyright © 2016 F.A. Davis Company Pharmacodynamics: Effects of Drugs (cont’d) Types of secondary effects Side effects Adverse reactions Toxic reactions Allergic reactions Idiosyncratic reactions Cumulative effect

16. Copyright © 2016 F.A. Davis Company Drug Interactions (Pg 621-HF) Antagonistic Synergistic Incompatibilities

17. Copyright © 2016 F.A. Davis Company Nursing Considerations: The Medication Order Types of medication orders Written order Automatic “stop” date STAT order Standing order A prn order

18. Copyright © 2016 F.A. Davis Company Nursing Considerations: The Medication Order (cont’d) Communication of orders Handwritten Preprinted Oral By telephone

19. Copyright © 2016 F.A. Davis Company Components of the Medication Order/Prescription Client’s full name (some locales require address) Date and time Name of medication Dosage size, frequency, number of doses Route of administration Printed name and signature of prescriber, including relevant credentials and legal registration identifier or DEA # (written prescriptions)

20. Copyright © 2016 F.A. Davis Company Nursing Considerations: Medication Administration Safety Three checks Before you pour – Check the medication label against the medication administration record (MAR) After you pour – Verify the label against the MAR At the bedside – Check the medication again

21. Copyright © 2016 F.A. Davis Company Nursing Considerations: Medication Administration Safety (cont’d) Six rights Right drug Right client Right dose Right time Right route Right documentation Other rights Right reason Right to know Right to refuse

22. Copyright © 2016 F.A. Davis Company Routes of Administration Oral medications Pg. 414 – Vol 2 Pg. 634 – Vol 1 Most commonly used route Includes – Tablets, capsules – Liquids – Buccal – Sublingual – Enteral medications

23. Copyright © 2016 F.A. Davis Company Overview of Medication Administration, by Routes Topical medications Pg 419-432 Vol. 2 Pg 636-639 Vol. 1 Applied directly to body surface/body cavities Local (and sometimes systemic) effects – Lotions, creams, ointments – Transdermal patches – Eye and ear – Nasal – Vaginal – Rectal

24. Copyright © 2016 F.A. Davis Company Routes of Administration Respiratory inhalations Pg 432-434 Vol 2 Pg 639-640 Vol 1 Use concept of nebulization Absorption via alveoli and blood supply – Atomizers – Aerosol – Metered dose inhaler

25. Copyright © 2016 F.A. Davis Company Routes of Administration (cont’d) Parenteral medications Pg 435-456 Vol 2 Pg 640-652 Vol I Intradermal Transdermal Subcutaneous (subQ) Intramuscular (IM) Intravenous (IV) – No IV in Block I

26. Copyright © 2016 F.A. Davis Company Parenteral Medication Administration Equipment preparation Pg 435-456 Vol 2 Pg 640-652 Vol I Syringe/needle (size/length, gauge) Medication preparation Vials and ampules Reconstituting from powder Two medications in one syringe

27. Copyright © 2016 F.A. Davis Company Parenteral Medication Administration (cont’d) Safety issues Use sharps containers Avoid recapping a dirty needle

28. Copyright © 2016 F.A. Davis Company Parenteral Medication Administration (cont’d) Use the correct site. – Wrong site could mean wrong route. Be familiar with the technique required for the medication (e.g., heparin, insulin).

29. Copyright © 2016 F.A. Davis Company Parenteral Medication Administration (cont’d) Intravenous medications IV push IV piggyback Medicated drips Not discussed in Block I

30. Copyright © 2016 F.A. Davis Company Avoiding Medication Errors Pg 410-414 Vol 2 Pg 625-634 Vol 1 Arrive to work well rested and undistracted. Use the six rights. Calculate doses carefully; double-check with a second RN. Watch for drugs with similar names. Watch for clients with the same last names.

31. Copyright © 2016 F.A. Davis Company Avoiding Medication Errors (cont’d) Clarify unfamiliar drug names and dosages or illegible orders. Avoid abbreviations. Know and use your resources. Keep up with changes in medication orders.

32. Copyright © 2016 F.A. Davis Company What Should I Do if I Commit a Medication Error? Immediately assess the patient’s vital signs and physical status. Report findings to the primary care provider. Notify the nurse manager of your unit and report the events surrounding the event. Check with your institution for agency-specific policy regarding incident reporting.

33. Copyright © 2016 F.A. Davis Company Think Like a Nurse You have checked the medication record (MAR) for Margaret Marks (Meet Your Patients, in Volume 1) and are preparing her next dose of medications to administer. The MAR indicates that she is receiving morphine IM for pain and that her last dose was given 1 hr ago. When you enter the room, you find her apparently sleeping. You are not able to awaken her to verify her identity. What do you suspect is happening, and how should you respond?