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Medications Chapter 35 60 Minutes- The wrong medicine
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How are drugs named and classified
Prescriptive drugs Nonprescriptive drugs Generic name Trade or Brand name
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Legal Aspects Nurse Practice Acts Controlled Substances US legislation
State laws
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Effects of Drugs Side effects Adverse effects Drug toxicity Allergy
Anaphylactic reaction Drug interaction
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Actions of Drugs on the Body
Half life Onset Peak plasma level
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Pharmacokinetics Absorption Distribution Biotransformation Excretion
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Factors Affecting Medication Action
Developmental Sex Cultural, ethnic, and genetic Diet Environment Psychological Illness and disease Time of administration
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Oral Tablets, capsules, liquids Sublingual Buccal Enteral medications
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Figure 35-3 Sublingual administration of a tablet.
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Figure 35-4 Buccal administration of a tablet.
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Transdermal Applied to the skin Local (and sometimes systemic) effects
Skin lotions, creams, ointments Transdermal patches
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Parenteral Medications
Injected via Intradermal Subcutaneous Intramuscular Intravenous
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Topical Applied to skin or in a body cavity
Eye, ear, vagina, rectum, nose
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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.
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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
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Communicating Orders Telephone/verbal orders
Order placed on Medication Administration Record (MAR)
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Write the order you receive over the phone from Dr. Jones.
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Figure 35-6 Sample medication administration record (MAR).
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Administering Medications Safety
Assessment Suitable route Medication history (hx) Drug allergies Specifics to drug Self administration problems
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Administering Medications: Practice Guidelines
Pg. 860
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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
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Medication Dispensing Systems
Medication Cart Unit dosing Automated dispensing system
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Process of Administering Medications
Identify the client Inform the client Administer the drug After completion of 3 checks
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Process of Administering Medications (cont.)
Provide adjunctive interventions as indicated Record the drug administered Evaluate the client’s response to the drug
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Three Checks Rule (Box 35-4 pg. 863)
Check the medication label against MAR Upon removal When preparing med At the bedside
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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
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Compare the medication label to the MAR.
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Medication Errors Practice safe medication administration !!!!
Common errors How can they be avoided? Practice safe medication administration !!!!
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What To Do If I Make A Medication Error?
Assess VS and physical status Notify primary care provider Notify charge nurse Complete incident report
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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?
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Oral Med. Administration
Pg per Lab discussion
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Parental Medications (pg. 872)
Intradermal Subcutaneous (SubQ) Intramuscular Intravenously
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Preparing injectable medications
Ampule Vial Reconstituting medications
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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
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Administering an Intradermal Injection ; the medication forms a bleb or wheal under the epidermis.
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Figure 35-32 Body sites commonly used for intradermal injections.
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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
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Sub Q injections (cont.)
Pinch or spread skin Insulin Heparin Skill 35-6 pg. 885
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SQ Injection Sites
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Administering a Subcutaneous Injection Inserting a needle into the subcutaneous tissue using 90- and 45-degree angles. 40
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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
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IM injections (cont.) 1-4 ml for larger leg muscles Angle- 90 degrees
Aspirate Skill 35-7 pg. 891
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Ventrogluteal Site
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Vastus Lateralis Site
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Dorsogluteal Site Not recommended
Injection site close to sciatic nerve
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Rectus Femoris Site Located in anterior thigh Used only occasionally
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Deltoid 47
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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
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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
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Discussed in Lab (pg. 902-915) Skin Ophthalmic (eye) Otic (ear) Nasal
Vaginal Rectal Inhaled
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Let’s put it into practice!
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