NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
Iatrogenic Disease: Caused by the drug that is given to PT
• Ex. When a patient is given a Broad Antibiotic, it will kill ALL the Flora (Bacteria) in the body Including
the GOOD bacteria and patient can get Thrush, or C dif etc.
Drugs
• Nomenclature (Name):
o Chemical name: precise description of chem makeup
o Generic name: The name of the Drug that refers to the CHEMICAL MAKEUP of the Drug
o Official name: How it is listed in publications
o Trade Name: Listed by Manufacturer, the Trademarked Name of a Drug
• Preparation: Pill, Capsule, Tablet, IV, Injection, or Transdermal etc.
• Therapeutic Effect: How the drug works on the body
o Ex. Insulin will lower the blood sugar
• Pharmacologic Effect: Effect drugs have on the Organs & Systems of the Body
• Classification: How the drug works on the body
o Therapeutic Class: What condition the drug will Treat
§ According to the symptoms of the drug
o Ex. Antipyrexia (Anti Fever) Medication
§ According to clinical condition: What effect the drug will have on the body
o Ex. Antihypertensive, Anticonvulsive, Antidiabetic
o Pharmacologic Class: What effect the drug will have on the body
§ Ex. Active Factor X Inhibitor: Will prevent blood clots by blocking the activity of clotting factor X
Mechanics of drug action
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Pharmacodynamics: What the
body does with the medication
Pharmacokinetics: What does
the patient body do to the drug
o Absorption: Process of which the drug is
absorbed from the entry site to the
§ Route of administration:
o PO: By mouth
o IM: Injection into Muscle
§ Given with 2.5” – 3” Needle at 90⁰
o IV: Most dangerous and fastest acting route
§ Cannot be reversed or stopped
§ Most dependable dosage
§ Drug solubility: How quickly the drug is absorbed
o Liquid will absorb quicker than a solid drug
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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o Capsules must deteriorate first and pass through the GI Tract to be absorbed
o Can be placed in oil or solid protein will
o Clear insulin is FAST ACTING, cloudy insulin has Solid protein in it and slows it
down
Distribution: The drug will act on a
specific organ or spot in the body
o Drugs for the liver, will go the
liver and treat the issue
Metabolism (AKA:
Biotransformation, Detoxification):
The break down of the drug to an
active form
o Primary site for drug metabolism
is the LIVER!
Excretion: Once it is broken down,
the body will excrete the Drug
o Most of the drugs we take are excreted by the Kidneys
o Where the drug is administered, it can be excreted. Ex the Lungs
o Routs of Excretion of Drugs:
§ Kidneys
§ Lungs are the route inhalation & excretion of anastatic
drugs
§ Intestine
§ GI is used too to excrete drugs
§ Salvatory Glands
§ Sweat Glands will also excrete the drugs we take
§ Mammary Glands will excrete drugs too
Factors Affecting Drug Action:
• Developmental:
o Child dose will always be different than an adult’s dose
o Elderly dose may be adjusted due to GFR at a slower rate
§ Zyrtec is a 10mg pill, PT over 65 doses must be 5mg. their kidney cannot process the
drug
• Weight: Therapeutic affect = Dose is based on Healthy man 18-65 weighting 165lbs
o If they are heaver, they will need a larger dose
• Psychological: Patients expectations of the effects of a drug will affect the response of the medication
o Feeling of the medication will influence the effect of the medication
o Placebo: Pharmacological inactive substance
§ Can be given because they are expecting an outcome from the drug
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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Pathology: Presence of a Disease
o Any disease that will affect how and when the drug will be absorbed and/or excreted
o Examples:
§ Kidney Disease: Drug cannot be excreted properly
§ Liver Disease: Drug cannot be metabolized properly
§ GI Disease: Drug cannot be absorbed properly
Time of Administration:
o Circadian cycles can affect how the drug reacts to the body
o Some drugs need to be taken with food
§ Empty stomach will increase the absorption rate
§ Some medications need to be given with food in the stomach, some may cause issues in
the stomach and GI tract
§ Some medications need to be given on an empty stomach; Best given at 0700
§ Food will delay the absorption of medication
o Some need to be given at certain times
Adverse drug effects:
• Side effects: Predictable and unavoidable
o Produced at a usual therapeutic dose
§ Percocet: PT will be Sleepy
• Adverse effects: Unintentional, Undesirable, Unpredictable
o Can occur in Minutes to Hours
o Iatrogenic Disease: Caused by the drug that is given to PT
o Drug allergy: Caused in PT’s who have had previously
administrated and created an allergy
o Can range from Mild to Serious
o Rash, Nausea, Diarrhea
o Drug tolerance: Body becomes accustom to particular drug
over a period of time
o Higher doses may be needed if PT has been taking
the Drug for a long period of time
o Cumulative effect: When the body cannot metabolize or
detoxify the drug before the second dose is given
o Previous drug is still present in body when Second dose is Given
o Will happen when PT has a Liver of Kidney Problem
o Interaction: How one drug will affect another drug
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Antagonistic (1+1=1):
o When you give two drugs, and one neutralized the other one
o Maalox & Tetracycline when given together they both will not work
o Narcan & Morphine: Narcan will neutralize the effect of Morphine
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
§ Synergistic (1+1=3):
o Alcohol & Barbiturates
o Aspirin & Coumadin
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Idiosyncratic: When PT reaction is different than desired affect
o Patients take benzodiazepine and gets hyper
o Patient drinks coffee and is very tired
Anaphylactic: Life threating allergic reaction
o Signs of:
§ Constriction of bronchial
§ Edema of Pharynx, Wheezing, Short of Breathing
Medication Orders: Dr. NP, or PA will write the Order
• NO DRUG CAN BE GIVEN WITHOUT AN ORDER
• Written on a specific form: either electronic or handwritten
o Will become part of the permeant record of the PT
• All drugs that Patient takes at home WILL be discontinued when the Patient comes into the Hospital
• When Patient brings Medications to the hospital, we must send the medication home
o If PT has no family: We will send it to security, and they will place it in a safe and PT can pick up
on the way home
o If Drug is expensive, we will send it to the pharmacy, and it will be place in a pyxis
• Types of Orders:
o Standing: Carried out as specified until it is CANCLED by another Order
§ Ex. PT gets medication for 7 days, carry out for 7 days
§ O2 can be ordered Standing and up to RN Discretion to administer when needed
§ Can be cancelled when order runs out
o PRN: As Needed
§ Only receives when PT
asks for drug or if the PT
needs it
§ Requires a judgment by
the nurse if PT looks like
he/she is in pain? Offer
pain medication
o Single: Only given 1 time
§ Examples:
• Pre-Op
medication
• Potassium is Low?
Given just once
o STAT: Single order given IMMEDITALY
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
Parts of the Order that MUST BE on THE ORDER: MAY BE MISSING ON EXAM….
• Patient name
• Date and time
• Drug Name: What drug is to be given
• Drug Dosage: Tabs, mL, g, gr, L
• Route: PO, IV, IM, Liquid, Rectal,
• Frequency: q4hr, PRN, qd, tid, Pre-Op, STAT, etc.
o drugs can be given 30 min BEFORE & 30 min AFTER time that drug is ordered
• Signature: Who wrote the script must sign
o If order is TO, or VO. Write TORB or VORB and provider must be signed withing 24 hours
Problems with Orders: Any drug order that has a suspected error, WE Must Bring it up
• Dose: is the dose more than the recommended dose?
• Allergies: Patient allergies must be considered
• If you cannot read the order, CALL THE PHYSICAN WHO WROTE THE ORDER!
• Steps to Take if you think the order is not correct or can harm the patient
1) Drug book: Check order and make sure your information is correct
2) Supervisor or Charge Nurse: You can ask them what your question is & what your concern is
3) Pharmacist: Call pharmacy and see what they think
4) Physician: Last STEP, call the physician and let them know what your concern is
• If you refuse to give an order
1) Must notify Supervisor of Charge Nurse know what an alternative is
2) Notify the Doctor
3) Make sure you document what you did
Medication Supply Systems
• Stock: Large quantities are stored and used for patients
• Unit dose: Packaged and labeled for Single use
• Ampules are SINGLE USES, draw what you need and throw away the rest
• Pyxis: Has medications in individual drawers for each medication
Drug Administration
• 3 checks when you do not have a Pyxis
1) Obtaining the container: Confirm the medication is correct
2) Removing the med: Check the Medication when taking it out
3) Replacing the container: Check med when you put the container back
• 3 Checks when you do have a Pyxis
1) When pulling the medication: Checked when looking up in the Pyxis
2) After taking out the medication: Once the medication is taken out of the machine
3) Before administering the medication at bedside (Bedside Verification Reaffirmation): Done at the
BEDSIDE before administrating the Medication to the Patient
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
6 Rights: Must KNOW for the RETURN DEMO!!!!
• Patients Do Drugs Round The Day
Patient: Not the Roommate…
2) Drug: Do not confuse Drugs
3) Dose: Correct dose
4) Route: PO, IV, IM, Rectal, etc.
5) Time
6) Documentation
1)
Avoiding Errors
• Prepare drugs alone
o Prevent distractions
• Do not leave drugs alone
o Do not leave drugs unattended
• Prepare and administer
o RN Who PREPARES the Medication MUST Administer the Medication
• Lock med cart: Lock the Cart when your done with it
• Supervise swallowing: Confirm that the patient has taken the medication and swallowed it
o If PT is in bathroom, take medication with you and bring it back, do not leave the medication at the
bedside for them
• Do not open the medication BEFORE Administrating it to the Patient, Always open the
medication INFRONT of the Patient
Steps in Administration
• 3 checks
o Without Pyxis:
1) Check Container when Pulling off Shelf
2) Check when taking medication out of Bottle
3) Check when putting the Bottle Back in the Cabinet
o With Pyxis:
1) When pulling the medication: Checked when looking up in the Pyxis
2) After taking out the medication: Once the medication is taken out of the machine
3) Before administering the medication at bedside (Bedside Verification Reaffirmation): Done at
the BEDSIDE before administrating the Medication to the Patient
• 6 rights: Patient, Drug, Dose, Route, Time, & Documentation
• Assessment:
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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o Beta Blocker? Check HR and BP
o Patient position:
o PO? Have patient sit up unless contraindicated
o Fluids: PO? Patient needs water to swallow them
Keep meds in wrappers: DO NOT OPEN THE PILL BEFORE ADMINISTRATING!!!
Offer separately
Administering Narcotics: Controlled Drugs
• Definition
• Record
o Patient name
o Amount
o Time
o Physician
o Nurse signature
o Waste/witness
• Count: Pyxis will keep count of doses left in Pyxis, count before and after taking a medication out of
machine
• Discrepancies: Is anything missing from the pyxis or the supply?
Documentation
• Legal record: Med record is legal and cannot be destroyed
• Record After medication is administrated, do not do before: Patient may Refuse the medication or
medication may fall on floor etc.
• Information
o Medication Name
o Dose
o Route
§ IV: Pic Line? CVC? IM? PO?
o Time
o Nurse Initials
o Nurse signature
o Site of Injection
o Other Information
• Omitted drugs: Some drugs can be omitted
o Circle the time that the Med was supposed to be administered
o Reason: Lab Values are not within drug
§ Coumadin? Check INR
o Accidental: You forgot to give drug…
§ Notify MD
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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Refused drugs: Educate them and let them know what the consequences are from refusing the drug.
Let them know that taking the drug will help them.
Medication Errors
• Reasons for Occurrence:
o Tired
o Forget to check the 6 Rights
o Short Staffed or Overwhelmed
o Inaccurately Read the Label
o Incorrectly Calculate the Dosage
o Leave Medication Unattended
• Steps if error takes place:
1) Check the Patient Condition IMMEDITALY!!
§ Check Vital Signs
§ Call code if necessary
2) Notify the physician to discuss the next action
3) Write a description of what happened
§ The Incident Report
Oral medications: PO, Intended for absorption in the stomach or Small Intestines
• Easiest route for administrating drugs
• Safest route if an error occurs the catabolism is slow
• Most convent
• Most prolonged effects
• Systemic and local actions
• Forms
o Solids:
§ Can be Tables or Capsules
o Enteric Coated: Covered with HARD Surface which will break down AFTER it has left the stomach
§ Medication will be absorbed when it reached the Small Intestine
§ Active Ingredient can Irritate the Stomach
o Example: Aspirin
o Cannot be Chewed or Crushed because it will be absorbed in the stomach
o Liquids:
When pouring liquids, hold label in palm of hand and measure in cup with lines and cup
sitting on a FLAT surface
§ Elixirs: Alcohol Based
o Don’t give to an Alcoholic
§ Syrups: Sugar Based
o Don’t give to a Diabetic
o Used for children
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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Suspension: Crushed up Drug that is placed in a something (Like Applesauce)
Sublingual: Allows drug to be absorbed quickly into blood stream
• Never Be Swelled or Chewed
• Systemic effects
• Under tongue
• Buccal
o Cheek and Gum
Topical: When Drug is Applied
directly to a Body Site
• Intended for Direct Action of
a specific site of the body
• If skin is not clean,
abstriction may not be
absorbed at the normal rate
• WEAR GLOVES WHEN
ADMINISTRATING TOPICAL DRUGS
• Systemic and local effects
• Skin
o Technique
o Transdermal drug patches
§ Do not use the same site in less
§ Upper back, Upper Arms
§ Avoid places where friction will occur,
§ Wash skin before placing patch
§ Use mild soap if necessary, water is fine
§ Do not have to shave PT
§ WEAR GLOVES!!
§ Make sure you remove the old patches
• Eye instillation
o Sclera is the White around the Eye
o Rarely place Medication onto Eyeball, Place in the Conjunctival Sac
o Drops
o Lower conjunctival sac
o Ointments:
§ After administration have patient close eyes and heat will warm ointment and distribute
§ Place ointment into Conjunctival Sac
o Offer Tissue to dry excess
o Have PT look at ceiling and look UP
o Medication sound does not touch Eyelid or Eyelashes
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NUR 1210 Medication Administration Basic Principles 1, Chapt. 31
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o Apply gentle pressure on inner campus to prevent eyedrops from going where they are not
intended
Ear instillations
o Make sure fluid is at Room Temperature
o Clean Ear and excess Cerumen
o Place patient in correct position
o Straighten canal
§ Adult: Up and Back
§ Under 3: Down and Back
o Place Drop on side and then apply pressure on Tragus
o DO NOT PLACE DROPS DIRECTLY ON EAR DRUM!!
o If applying to both ears: Wait 5 min between each side
Nasal instillations:
o Must use Sterile Technique
o Position:
§ Place Patient
o 1/3 of applicator will be placed into nostril
o Have Patient keep position for 3 min to keep solution in Nasal
Vaginal applications
o Have PT Void Prior to giving Medication
o Spread Labia and Clean area
o Technique
§ Have Patient stay supine for 5 to 10 Min to allow medication to stay inside
o Give Patient a Peri Pad after administrating
Rectal instillations
o Will have a systemic Effect
o B & O: Will go
o If PT is puking a lot, Rectal is best route
o Have Patient lay in SIMS Position
o Use LUBE….. On finger and Suppository
o Push drug PAST Internal Anal Sphincter
§ Adult 4 inches
§ Child 2 inches
Inhalation
• Frequently used to Types of drugs
o Puff Medications
• Technique
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