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

2. 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.
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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
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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.
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Drug Action
Pharmacology
Medication Management
Classification
Preparation and Route
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Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Drug Interaction
Side Effects and Adverse Reactions
Food and Drug Interactions
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7. 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.
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8. 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
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9. System of Weight and Measure
Metric System
Apothecary System
Household System
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10. Approximate Dose Equivalents
Converting Units of Weight and Volume
Measurement Conversions within the Metric System
Measurement Conversions between Systems
Drug Dose Calculations
Pediatric Dosages
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11. Safe Drug Administration
Guidelines for Medication
Right Drug
Right Dose
Right Client
Right Route
Right Time
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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.
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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
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Drug Abuse
Addiction is a physiological or psychological dependence on a substance.
Dependence is the reliance on, or need to take a drug.
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15. 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.
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16. 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
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Assessment
Drug History
Allergies
Prescription Drugs
Over-the-Counter Drugs
Biographical Data
Lifestyle and Beliefs
Sensory and Cognitive Status
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Physical Examination
Diagnostic and Laboratory Data
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Nursing Diagnosis
Nursing Diagnoses related to medication administration are
Deficient Knowledge
Ineffective Therapeutic Regimen Management
Ineffective Health Maintenance
Impaired Physical Mobility
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Nursing Diagnosis
Disturbed Sensory Perception
Impaired Swallowing
Nursing Diagnoses related to the addicted client are
Imbalanced Nutrition
Impaired Verbal Communication
Interrupted Family Processes
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Impaired Social Interaction
Social Isolation
Spiritual Distress
Readiness for Enhanced Spiritual Well-Being
Ineffective Coping
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22. 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.
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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.
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Implementation
Administer Oral Drugs
Sublingual and Buccal Drug Administration
Review Procedure 29-1 on administering an oral medication.
Enteral Instillation of Drugs
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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
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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
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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.
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Administer Topical Medications
Eye Medications
Review Procedure 29-9 on administering an eye medication.
Ear Medications
Review Procedure on instilling an ear medication.
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Nasal Instillations
Review Procedure on instilling nose drops.
Respiratory Inhalants
Review Procedure on teaching self-administration with a metered-dose.
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Rectal Instillations
Review Procedure on administering a rectal suppository.
Vaginal Instillations
Review Procedure on administering a vaginal suppository.
Complementary Therapy
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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.
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