1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 30 Medication Administration

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Standards and Legislation Standards: –Ensure uniformity –Predict effects –United States Pharmacopeia (USP) –National Formulary (NF) (continued)

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Standards and Legislation Federal legislation: –Pure Food and Drug Act of 1906 USP and NF establish drug standards State and local legislation Health care institution regulations

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacokinetics Absorption Distribution Metabolism Excretion

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Nomenclature Chemical name –Precise description of composition Generic name –Given by U.S. Adopted Names Council Trade or brand name –Given by pharmaceutical companies –Used during marketing

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Action Pharmacology –Medication management –Classification (continued)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Action Pharmacology –Preparation and route Oral Parenteral Topical Inhalants Intraocular route

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Interaction Effect of one drug on another Deliberate combining Not all drug combinations therapeutic

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Side Effects and Adverse Reactions Side effects –Mild –Predictable –Nontherapeutic Adverse reactions –Unexpected –Potentially hazardous (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Side Effects and Adverse Reactions Food and drug interactions –Drug effects on nutritional status –Food effects on drug absorption –Food effects on drug utilization

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Influencing Drug Action Genetics Age Height Weight Physical conditions Mental conditions

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Professional Roles in Medication Administration Health care providers –Orders –Administration of drugs –Teaching –Observation (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Professional Roles in Medication Administration Types of orders: –Stat –Single-dose –Standing –PRN As needed Parts of drug order

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Systems of Weight and Measure Metric Apothecary Household

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Approximate Dose Equivalents Converting units of weight and volume –Measurement conversions within metric system –Measurement conversions between systems Drug dose calculations –Pediatric dosages

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safe Drug Administration Guidelines for medication: –Right drug –Right dose –Right client –Right route –Right time (continued)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safe Drug Administration Document: –Critical element –Only after client has taken drug Drug supply and storage –Unit dose form –Stock supplied drugs –Narcotics and controlled substances (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safe Drug Administration Drug abuse –Addiction Physiological or psychological dependence on substance or behavior (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safe Drug Administration Drug abuse –Dependence Reliance on or need to take drug Physiological Psychological

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Compliance Compliance –Taking medication as prescribed –Improved through client understanding Noncompliance –Inconsistent use as prescribed –Self-adjusted dosing or scheduling

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Aspects of Administering Medications Questioning medication order –Responsible –Accountable Preventing medication errors

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Assessment –Medical history –Drug history Allergies Prescription drugs Over-the-counter drugs Complementary therapy –Herbal supplements (continued)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Assessment –Biographical data –Cultural diversity –Lifestyle and beliefs –Sensory and cognitive status –Physical exam –Diagnostic and laboratory data (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Diagnosis –NANDA statements Deficient knowledge Ineffective health maintenance Impaired physical mobility Disturbed sensory perception Readiness for enhanced knowledge (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Planning and outcome identification –NOC for medication administration: Knowledge –Medication Medication response Self-care –Nonparenteral medication (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Assessment –Administration –Teaching (continued)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Oral medication administration Most common route –Gag reflex –Consciousness –Nausea or vomiting Medication administration –Sublingual and buccal (continued)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Enteral medication administration Delivery through gastrointestinal tube Equipment Risk for aspiration (continued)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Parenteral medication administration Routes –Intradermal –Subcutaneous –Intramuscular –Intravenous (continued)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Parenteral medication administration Equipment –Syringes –Needles –Ampules and vials Angle of injection (continued)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Intradermal medication administration Purposes Slow absorption Small quantity of solution Procedure (continued)

32. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Subcutaneous medication administration Purposes –Heparin –Insulin Sites Procedure (continued)

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Intramuscular medication administration Purposes Sites Procedure –Z-track injection (continued)

34. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Intravenous medication administration Purposes (continued)

35. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Intravenous medication administration Procedure –Infusion pump –Adding drugs to volume-control administration set –Administering by intermittent infusion –Intermittent infusion devices –Administering intravenous push medications (continued)

36. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Implementation –Topical medication administration Eye Ear Nasal Rectal Vaginal (continued)

37. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Medication Administration and the Nursing Process Evaluation –Ongoing responsibility of nurse Client’s response to medications Changes in client’s condition Client’s ability to self-manage