Chapter 034

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Chapter 34
Medication
Administration
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Pharmacological Concepts
• Drug names
• Classification
• Medication forms or preparations
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Legislation and Standards
• Federal regulations
• State and local regulations
• Health care institutions and
medication laws
• Nursing practice
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Pharmacokinetics
• Absorption
– Route of administration
– Ability to dissolve
– Blood flow to administration site
– Body surface area
– Lipid solubility
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Pharmacokinetics (cont’d)
• Distribution
– Circulation
– Membrane permeability
– Protein binding
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Pharmacokinetics (cont’d)
• Metabolism
– Biotransformation
– Detoxification
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Pharmacokinetics (cont’d)
• Excretion
– Kidneys
– Liver
– Bowel
– Lungs
– Exocrine glands
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Actions
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Therapeutic effects
Side effects
Adverse effects
Toxic effects
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Actions (cont’d)
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Idiosyncratic reactions
Allergic reactions
Interactions
Medication dose responses
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Routes of Administration
• Oral: sublingual, buccal
• Parenteral: intradermal,
subcutaneous, intramuscular,
intravenous
• Topical
• Inhalation
• Intraocular
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Systems of Measurement
• Metric
• Apothecary (grains)
• Household
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Metric System
• Grams (g), milligrams (mg), kilograms
(kg)
• Liters (L), milliliters (ml)
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Household Measurements
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Tablespoons
Teaspoons
Ounces
Cups
Pints
Quarts
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Clinical Calculations
• Conversions within systems
• Conversions between systems
• Formula:
Dose ordered x Amount
Dose on hand
on hand
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Prescriber’s Role
• Types of orders
– Standing orders
– prn orders
– Single orders
– Stat orders
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Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
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Nurse’s Role
• Six rights
• Triple-check before administration
• Client assessment
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Six Rights
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Right medication
Right dose
Right client
Right route
Right time
Right documentation
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Client’s Rights
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Information
Refusal
Careful assessment
Informed consent
Safe administration
Supportive therapy
No unnecessary medications
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Assessment
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Medical history
History of allergies
Medication data
Diet history
Perceptual or coordination problems
Current condition
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Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
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Nursing Diagnoses
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Deficient knowledge (medications)
Noncompliance (medications)
Disturbed sensory perception
Impaired swallowing
Ineffective therapeutic regimen
management
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Planning
• Goals and outcomes
– Example:
Client will verbalize therapeutic
and adverse effects of
medications
• Setting priorities
• Continuity of care
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Implementation
• Client and family teaching
• Medication orders: receipt,
transcription, communication
• Calculation and measurement
• Correct administration technique
• Recording
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Special Considerations
• Infants and children
• Older adults
– Polypharmacy
– Self-prescribing
– Over-the-counter medications
– Misuse
– Noncompliance
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Evaluation
• Client response to medications
• Client and family ability to administer
medications
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Oral Administration
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Presence of GI alterations
Ability to swallow
Use of gastric suction
Positioning
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Topical Administration
• Skin applications
– Use of gloves or applicators
– Preparation of skin
– Thickness of application
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Nasal Instillation
• Assessment of nares
• Client instruction and selfadministration
• Positioning
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Eye Instillation
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Drops, ointments, disks
Assessment of eyes
Asepsis
Positioning
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Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children
and adults
• Positioning
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Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Client positioning, comfort, and
hygiene
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Rectal Instillation
• Suppositories
• Use of gloves
• Client positioning, comfort, and
hygiene
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Inhalation
• Metered-dose inhalers (MDIs) and
dry powder inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister
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Irrigation
• Medications used to wash out a body
cavity delivered with a stream of
solution (sterile water, saline, or
antiseptic)
• Asepsis
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Parenteral Administration
• Equipment
– Syringes: sizes (volume), types
– Needles: length, gauge
– Disposable units: Tubex, Carpuject
– Ampules
– Vials
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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
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Parenteral Administration (cont’d)
• Insulin
– Syringes and needle sizes
– Types of insulin
– Mixing of insulins
– Rotation of vials before withdrawal of
solution
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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
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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
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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
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Administration of Injections
(cont’d)
• Sites
– Ventrogluteal
– Vastus lateralis
– Deltoid
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Administration of Injections
(cont’d)
• Intradermal injections
– Skin testing
– Sites
– Length and gauge of needle
– Angle of insertion
– Formation of small bleb
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Prevention of Needle Sticks
• Needleless devices
• Sharps disposal
• One-handed recapping technique
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Intravenous Administration
• Large volume infusions
• Bolus injection
• Volume-controlled infusions
Piggyback
– Tandem
– Volume-control set
– Mini-infusor pump
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