1. Mosby items and derived items © 2005 by Mosby, Inc. Chapter 34 Medication Administration

2. Mosby items and derived items © 2005 by Mosby, Inc. Pharmacological Concepts Drug names Classification Medication forms or preparations

3. Mosby items and derived items © 2005 by Mosby, Inc. Legislation and Standards Federal regulations State and local regulations Health care institutions and medication laws Nursing practice

4. Mosby items and derived items © 2005 by Mosby, Inc. Pharmacokinetics Absorption –Route of administration –Ability to dissolve –Blood flow to administration site –Body surface area –Lipid solubility

5. Mosby items and derived items © 2005 by Mosby, Inc. Pharmacokinetics (cont’d) Distribution –Circulation –Membrane permeability –Protein binding

6. Mosby items and derived items © 2005 by Mosby, Inc. Pharmacokinetics (cont’d) Metabolism –Biotransformation –Detoxification

7. Mosby items and derived items © 2005 by Mosby, Inc. Pharmacokinetics (cont’d) Excretion –Kidneys –Liver –Bowel –Lungs –Exocrine glands

8. Mosby items and derived items © 2005 by Mosby, Inc. Actions Therapeutic effects Side effects Adverse effects Toxic effects

9. Mosby items and derived items © 2005 by Mosby, Inc. Actions (cont’d) Idiosyncratic reactions Allergic reactions Interactions Medication dose responses

10. Mosby items and derived items © 2005 by Mosby, Inc. Routes of Administration Oral: sublingual, buccal Parenteral: intradermal, subcutaneous, intramuscular, intravenous Topical Inhalation Intraocular

11. Mosby items and derived items © 2005 by Mosby, Inc. Systems of Measurement Metric Apothecary (grains) Household

12. Mosby items and derived items © 2005 by Mosby, Inc. Metric System Grams (g), milligrams (mg), kilograms (kg) Liters (L), milliliters (ml)

13. Mosby items and derived items © 2005 by Mosby, Inc. Household Measurements Tablespoons Teaspoons Ounces Cups Pints Quarts

14. Mosby items and derived items © 2005 by Mosby, Inc. Clinical Calculations Conversions within systems Conversions between systems Formula: Dose ordered x Amount Dose on hand on hand

15. Mosby items and derived items © 2005 by Mosby, Inc. Prescriber’s Role Types of orders –Standing orders –prn orders –Single orders –Stat orders

16. Mosby items and derived items © 2005 by Mosby, Inc. Distribution Systems Stock supply Unit dose Computer controlled

17. Mosby items and derived items © 2005 by Mosby, Inc. Nurse’s Role Six rights Triple-check before administration Client assessment

18. Mosby items and derived items © 2005 by Mosby, Inc. Six Rights Right medication Right dose Right client Right route Right time Right documentation

19. Mosby items and derived items © 2005 by Mosby, Inc. Client’s Rights Information Refusal Careful assessment Informed consent Safe administration Supportive therapy No unnecessary medications

20. Mosby items and derived items © 2005 by Mosby, Inc. Assessment Medical history History of allergies Medication data Diet history Perceptual or coordination problems Current condition

21. Mosby items and derived items © 2005 by Mosby, Inc. Assessment (cont’d) Attitude about medication use Knowledge of therapy Learning needs

22. Mosby items and derived items © 2005 by Mosby, Inc. Nursing Diagnoses Deficient knowledge (medications) Noncompliance (medications) Disturbed sensory perception Impaired swallowing Ineffective therapeutic regimen management

23. Mosby items and derived items © 2005 by Mosby, Inc. Planning Goals and outcomes – Example: Client will verbalize therapeutic and adverse effects of medications Setting priorities Continuity of care

24. Mosby items and derived items © 2005 by Mosby, Inc. Implementation Client and family teaching Medication orders: receipt, transcription, communication Calculation and measurement Correct administration technique Recording

25. Mosby items and derived items © 2005 by Mosby, Inc. Special Considerations Infants and children Older adults –Polypharmacy –Self-prescribing –Over-the-counter medications –Misuse –Noncompliance

26. Mosby items and derived items © 2005 by Mosby, Inc. Evaluation Client response to medications Client and family ability to administer medications

27. Mosby items and derived items © 2005 by Mosby, Inc. Oral Administration Presence of GI alterations Ability to swallow Use of gastric suction Positioning

28. Mosby items and derived items © 2005 by Mosby, Inc. Topical Administration Skin applications –Use of gloves or applicators –Preparation of skin –Thickness of application

29. Mosby items and derived items © 2005 by Mosby, Inc. Nasal Instillation Assessment of nares Client instruction and self- administration Positioning

30. Mosby items and derived items © 2005 by Mosby, Inc. Eye Instillation Drops, ointments, disks Assessment of eyes Asepsis Positioning

31. Mosby items and derived items © 2005 by Mosby, Inc. Ear Instillation Assessment of ear canal Warming of solution Straightening of canal for children and adults Positioning

32. Mosby items and derived items © 2005 by Mosby, Inc. Vaginal Instillation Suppositories, foams, creams Use of gloves and applicator Client positioning, comfort, and hygiene

33. Mosby items and derived items © 2005 by Mosby, Inc. Rectal Instillation Suppositories Use of gloves Client positioning, comfort, and hygiene

34. Mosby items and derived items © 2005 by Mosby, Inc. Inhalation Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) Client assessment and instruction Use of spacer Determination of doses in canister

35. Mosby items and derived items © 2005 by Mosby, Inc. Irrigation Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic) Asepsis

36. Mosby items and derived items © 2005 by Mosby, Inc. Parenteral Administration Equipment –Syringes: sizes (volume), types –Needles: length, gauge –Disposable units: Tubex, Carpuject –Ampules –Vials

37. Mosby items and derived items © 2005 by Mosby, Inc. Parenteral Administration (cont’d) Mixing medications –Determine compatibility of the medications –Do not contaminate one medication with another –Ensure the final dose is accurate –Maintain aseptic technique

38. Mosby items and derived items © 2005 by Mosby, Inc. Parenteral Administration (cont’d) Insulin –Syringes and needle sizes –Types of insulin –Mixing of insulins –Rotation of vials before withdrawal of solution

39. Mosby items and derived items © 2005 by Mosby, Inc. Administration of Injections Minimize discomfort –Use smallest suitable needle –Position client comfortably –Select proper site –Divert client’s attention –Insert the needle quickly and smoothly –Hold the syringe steady –Inject the medication slowly and steadily

40. Mosby items and derived items © 2005 by Mosby, Inc. Administration of Injections (cont’d) Subcutaneous injections –Sites: condition of area, rotation of use –Amount of solution –Length and gauge of needle –Pinch or spread skin –Angle of insertion

41. Mosby items and derived items © 2005 by Mosby, Inc. Administration of Injections (cont’d) Intramuscular injections –Sites: landmarks, condition of area –Amount of solution –Length and gauge of needle –Angle of insertion –Aspiration –Air-lock method –Z-track technique

42. Mosby items and derived items © 2005 by Mosby, Inc. Administration of Injections (cont’d) Sites –Ventrogluteal –Vastus lateralis –Deltoid

43. Mosby items and derived items © 2005 by Mosby, Inc. Administration of Injections (cont’d) Intradermal injections –Skin testing –Sites –Length and gauge of needle –Angle of insertion –Formation of small bleb

44. Mosby items and derived items © 2005 by Mosby, Inc. Prevention of Needle Sticks Needleless devices Sharps disposal One-handed recapping technique

45. Mosby items and derived items © 2005 by Mosby, Inc. Intravenous Administration Large volume infusions Bolus injection Volume-controlled infusions Piggyback –Tandem –Volume-control set –Mini-infusor pump