Responsibilites of the nurse when administering medication
-what drug is ordered
-name (generic and trade) and drug classification
-intended or proposed use
-effects on the body
-contradictions
-special considerations (e.g., how age, weight, body fat distribution, and individual pathophysiologic states affect pha
Allergic Reaction
-an acquired hyperresponse of body defesnes to a foreign substance (allergen)
-signs of allergic reactions vary in severity and include skin rash with or without itching, edema, runny nose, or reddened eyes with tearing
Anaphylaxis
-a sever type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock
-symptoms such as acute dyspnea (difficulty breathing), and the sudden appeara
The Five Rights of Drug Administration
-together, they form the operational basis for the safe delivery of medications
-offer simple and practical guidance for nurses to use during drug preparation, delivery, and administration, and focus on individual performance
1. right patient
2. right med
The Three Checks of Drug Administration
-used in conjuction with the five rights help to ensure patient safety and drug effectiveness
1. checking the drug with the MAR or the medication information system when removing it from the medication drawer, refrigerator, or controlled substance locker
Compliance
-taking a medication in the manner prescribed by the health care provider, or in the case of OTC drugs, following the instructions on the label
-patient noncompliance ranges from not taking the medication at all to taking it at the wrong time or in the wr
Reasons for noncompliance
-drug may be too expensive
-the drug may not be approved by the patient's health insurance plan
-patients forget doses of medications, especially when they must be taken three or four times per day
-annoying side effects such as; headache, dizziness, naus
STAT order
-refers to any medication that is needed immediately and is to be given only once
-often associated with emergency medications that are needed for life-threatening situations
-comes from the latin word "statim" meaning immediately
-should be administered
ASAP order
-not as urgent as STAT
-as soon as possible
-should be avaliable for administration to the patient with 30 minutes of the written order
Single order
-for a drug that is to be given only once, and at a specific time, such as a preoperative order
PRN order
-latin "pro re nata"
-administered as required by the patient's condition
-the nurse makes the judgement, based on patient assessment, as to when such a medication is to be administered
Routine orders
-orders not written as STAT, ASAP, NOW or PRN
-these are usually carried out within 2 hours of the time the order is written by the physician
Standing order
-written in advance of a situation that is to be carried out under specific circumstances
-example: set of postoperative PRN prescriptions that are written for all patients who have undergone a specific surgical procedure "Tylenol elixir 325mg PO every 6
ac
-before meals
ad lib
-as desired, as directed
AM
-morning
bid
-twice per day
cap
-capsule
gtt
-drops
h or hr
-hours
IM
-intramuscular
IV
-intravenous
no
-number
pc
-after meals, after eating
PO
-by mouth
PM
-afternoon
PRN
-when needed/necessary
qid
-four times per day
q2h, q4h, q6h, q8h, q12h
-every __ hours
Rx
-take
STAT
-immediately, at once
tab
-tablet
tid
-three times per day
Enteral Drug Administration
-includes drugs given orally and those administered through the nasogastric or gastrostomy tubes
-take advantage of the vast absorptive surfaces of the oral mucosa, stomach, and small intestine
Oral Drug Administration
-oral dugs administration is the most common, most convienient, and usually the least costly of all routes
-considered the safest route because the skin barrier is not compromised
-avaliable in tablet, capsule, and liquid forms
Tablets and Capsules
-the most common forms of drugs
-patients prefer tablets or capsules over other routes and forms because of their ease of use
-some patients, especially children, have difficulty swallowing tablets and capsules
-crushing tablets or openings capsules and s
Enteric Coated Drugs
-the strongly acidic contents within the stomach present a destructive obstacle to the absorption of some medications
-tablets may have hard, waxy coatings that enables them to resist the acidity
-enteric coated tablets are designed to dissolve in the alk
Sustained Release Drugs
-compliance declines as the number of doses per day increases
-sustained release tablets or capsules are designed to dissolve very slowly
-this releases the medication over an extended time and results in longer duration of action for the medication
-also
Disadvantages to Oral Medication
-patient must be conscious and able to swallow properly
-certain drugs, such as proteins, are inactivated by digestive enzymes in the stomach and small intestine
-first pass metabolism=medications absorbed form the stomach and small intestine first travel
Sublingual and Buccal Drugs
-tablet is not swallowed but kept in the mouth
-the mucosa of the oral cavity contains a rich blood supply that provides an excellent absorptive surface for certain drugs
-medications given by this route are not subjected to destructive digestive enzymes
Sublingual Route
-the medication is placed under the tongue and allowed to dissolve slowly
-because of the rich blood supply in this region, the sublingual route results in a rapid onset of action
-sublingual dosage forms are most often formulated as rapidly disintegratin
Buccal Route
-the tablet or capsule is placed in the oral cavity between the gum and the cheek
-the patient must be instructed not to manipulate the medication with the tongue; it could get displaced to the sublingual area where it would be more rapidly absorbed, or t
Nasogastric and Gastostomy Drug Administration
-patients with a nasogastric tube (NG Tube) or enteral feeding mechanism such as a gastostomy tube (G Tube) may have their medications administered through these devices
-NG tubes are used for short-term treatment
-G tubes are inserted for patient's requi
Topical Drug Administration
-those applied locally to the skin or the membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina, and rectum
-some drugs are applied topically to produce a local effect
---example: antibiotics applied to the skin to treat skin
Dermatologic Preparations
-drugs applied to the skin
-the most common topical route
-includes creams, lotions, gels, powders, and sprays
Instillations and Irrigations
-drugs applied into the body cavitied or orifices
-includes the eyes, ears, nose, urinary bladder, rectum and vagina
Inhalations
-drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses
-most common indication for inhaled drugs is bronchoconstriction due to bronchitis or asthma
-illegal, abused drugs are taken by thise route becaus
Transdermal Delivery System
-provides an effective means of delivering certain medications
---examples: nitroglycerin for angina pectoris and scopolamine for motion sickness
-although transdermal patches contain a specific amount of the drug, the rate of delivery and the actual dose
Ophthalmic Administration
-used to treat local conditions of the eye and surrounding structures
-common indications include excessive dryness, infections, glaucoma, and dilation of the pupil during eye examinations
-avaliable in the form of eye irrigations, drops, ointments, and m
Otic Administration
-used to treat local conditions of the ear, including infections and soft blockages of the auditory canal
-otic medications include eardrops and irrigations which are usually ordered for cleaning purposes
Nasal Administration
-used for both local and systemic drug administratio
-nasal muscosa provides an excellent absorptive surface for certain medications
-advantages include ease of use and avoidance of the first-pass metabolism and digestive enzymes
-nasal sprays formulation
Vaginal Administration
-used to deliver medications for treating local infections and to relieve vaginal pain and itching
-vaginal medications are inserted as suppositories, creams, jellies, or foams
-provide for privacy and patient dignity
-offer a perineal pad following admin
Rectal Administration
-the rectal route may be used for either local or systemic drug administration
-it is a safe and effective means of delivering drugs to patients who are comatose or who are experiencing nausea or vomiting
-normally in suppository form, although a few laxa
Parenteral Drug Administration
-refers to the dispensing of medications by routes other than oral or topical
-delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins
-can also include administration into arteries, body cavities (such as intrathecal), an
Intradermal and Subcutaneous Administration
-injection into the skin delivers drugs to the blood vessels that supply the various layers of the skin
-the major difference between intradermal and subcutaneous methods is the depth of injection
-advantages:
---they offer a means of administering drugs
Intradermal (ID) Injection
- administered into the dermis layer of the skin
-because the dermis contains more blood vessels than the deeper subcutaneous layer, drugs are more easily absorbed
-usually employed for allergy and disease screening or for local anesthetic delivery prior
Subcutaneous Injection
-delivered to the deepest layers of the skin
-insulin, heparin, vitamins, some vaccines, and other medications are given in this areas because the sites are easily accessible and provide rapid absorption
-body sites that are ideal for subcutaneous injecti
Intramuscular Administration
-delivers medication into specific muscles
-because muscle tissue has a rich blood supply, medication moves quickly into blood vessels to produce a more rapid onset of action than with oral, intradermal, or subcutaneous administration
-the anatomical stru
Four Commone sites for intramuscular injections
1. ventrogluteal site
---this is the preferred site for IM injections
---provides the greatest thickness of gluteal muscle, contains no large blood vessels or nerves, is sealed off by bone, and contains less fat than the buttock area thus eliminating the
Intravenous (IV)Administration
-medications and fluids are administered directly into the bloodstream and are immediately avaliable for use by the body
-the IV route is used when a very rapid onset of action is desired
-IV medications bypass the enzymatic process of the digestive syste
The 3 basic types of IV administration
1. Large volume infusion
2. Intermittent infusion
3. IV bolus (push) administration
Large volume infusion
-this type of IV administration of for fluid maitenance, replacement, or supplementation
-compatible drugs may be mixed into a large-volume IV container with fluids such as normal saline or Ringer's lactate
Intermittent infusion
-this is a small amount of IV solution that is arranged tandem with or piggybacked to the primary large-volume infusion
-used to instill adjunct medications, such as antibiotics or analgesics over a short period of time
IV bolus (push) administration
-this is a concentrated dose delivered directly to the circulation via syringe to administer single-dose medications
-bolus injections may be given through an intermittent injection port or a direct IV push
First pass metabolism
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