Kozier & Erb's
Fundamentals of
Nursing Concepts, Process, and
Practice
TENTH EDITION, GLOBAL EDITION
CHAPTER
35
Medications
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Introduction
• Medication
▪ Substance administered for diagnosis,
cure, treatment, or relief of symptom or
for prevention of disease
• Drug
▪ Same as medication but also refers to
illicitly obtained substance
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Introduction
• Prescription
▪ Written direction for preparation and
administration of a drug
• Generic name
▪ Name used throughout the drug's
lifetime
• Trade (brand) name
▪ Given by drug manufacturer
▪ Identifies it as property of that company
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Introduction
• Official name
▪ Name by which drug is listed in official
publications
• Chemical name
▪ Name by which a chemist knows it
▪ Describes constituents of the drug
precisely
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Introduction
• Pharmacology
▪ Study of effect of drugs on living
organisms
• Pharmacy
▪ Prepares, makes, and dispenses drugs
as ordered
• Pharmacist
▪ Person who prepares, makes, and
dispenses drugs as ordered
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Drug Standards
• Drugs can be made from plants,
minerals, or animals, or be produced
synthetically.
• Standards ensure drugs are pure and of
uniform strength, uniform quality. • U.S.
Pharmacopeia describes drug sources,
properties, tests done, storage methods,
assay category, normal dosages.
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Table 35–2 U.S. Drug Legislation
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Figure 35–1 Some narcotics are kept in specially designed packages or plastic containers that are
sectioned and numbered.
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Effects of Drugs
• Therapeutic effect
▪ Desired effect
▪ Reason drug is prescribed
• Side effect
▪ Secondary effect
▪ Unintended, usually predictable
▪ May be harmless or harmful
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Effects of Drugs
• Adverse effect
▪ More severe side effect
▪ May justify discontinuation of a drug
• Drug toxicity
▪ Results from overdose, ingestion of
external-use drug, or buildup of drug in
blood
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Effects of Drugs
• Drug allergy
▪ Immunologic reaction to drug
▪ Mild to severe reactions
• Anaphylactic reaction, anaphylaxis
• Drug tolerance
▪ Unusually low physiological response
▪ Requires increases in the dosage to
maintain a given therapeutic effect
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Effects of Drugs
• Drug tolerance
▪ Cumulative effect
• Increased effect resulting from rate of
dosage being higher than rate of
excretion
▪ Idiosyncratic effect
• Unexpected; may be individual to client
• Drug interaction
▪ One drug alters effect of other drug(s).
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Effects of Drugs
• Potentiating effect
▪ One or both drugs is increased.
▪ Additive
• Two of same types of drugs increase
action of each other.
▪ Synergistic
• Two different drugs increase action of
one or another.
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Effects of Drugs
• Inhibiting effect
▪ Effect of one or both drugs is decreased.
• Iatrogenic disease
▪ Disease unintentionally caused by
medical or drug therapy
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Factors Affecting
Medication Action
• Developmental factors
▪ Risks during pregnancy
▪ Infants require smaller dosages. ▪
Older adults experience decreased
gastric motility
• Gender
▪ More drug research done on men
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Factors Affecting
Medication Action
• Cultural, ethnic, and genetic factors
▪ Pharmacogenetics
▪ Ethnopharmacology
• Study of the effect of racial, ethnic
responses to prescribed medication •
Diet
▪ Nutrients can affect action of a
medication
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Factors Affecting
Medication Action
• Environment
▪ Especially affects drugs used to alter
behavior and mood
• Psychological factors
▪ Expectations
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Factors Affecting
Medication Action
• Illness and disease
▪ Action altered in clients with circulatory,
liver, or kidney dysfunction
• Time of administration
▪ Some drugs absorbed more quickly if
stomach is empty, some when stomach
is full
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Routes of Administration
• Oral
▪ Most common, least expensive, most
convenient
• Sublingual
▪ Not to be swallowed, but dissolved
• Buccal
▪ Cheek
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Figure 35–3 Sublingual administration of a tablet.
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Figure 35–4 Buccal administration of a tablet.
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Routes of Administration
• Parenteral
▪ Subcutaneous (hypodermic)
▪ Intramuscular (IM)
▪ Intradermal (ID)
▪ Intravenous (IV)
▪ Less common
• Intrathecal/intraspinal
• Epidural
• Intracardiac
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Routes of Administration
• Topical
▪ Dermatologic
▪ Installations and irrigations
▪ Inhalations
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Medication Orders
• Ordered by physicians
▪ Sometimes nurse practitioners,
physician assistants depending on state
laws and agency policies
• Verbal and telephone orders
• Abbreviations, acronyms, and symbols
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Types of Medication Orders
• Stat order
▪ Such as morphine sulfate 10 milligrams
IV stat
• Single order
▪ Such as Seconal 100 mg hs before
surgery
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Types of Medication Orders
• Standing order
▪ Indefinitely, such as multiple vitamins
daily
▪ Specified number, such as KCl twice
daily × 2 days
• PRN order
▪ Such as Amphojel 15 mL prn
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Essential Parts of a Medication
Order
• Full name of client
• Date and time order is written •
Name of drug to be administered •
Dosage of drug
• Frequency of administration
• Route of administration
• Signature of person writing the order
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Figure 35–5 A prescription filled out by a primary care provider.
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Box 35–2 Parts of a Prescription
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Communicating Medication Orders
• Written on chart, provided by phone or
verbally
• Copied to Kardex or MAR, or on
computer printout
• If an order seems inappropriate
▪ Contact primary care provider
▪ Document in notes when PCP called,
what was communicated, how PCP
responded
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Communicating Medication Orders
• If an order seems inappropriate
▪ Or, document attempts to reach PCP
and reason for withholding drug
▪ If medication given, document client
condition before and after dose
▪ If needed, document factual information
on incident report
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Systems of Measurement
• Metric system
▪ Devised by the French
▪ Logically organized into units of 10
▪ Meter, liter, gram basic units •
Apothecaries' system
▪ Older than metric system
▪ Grain, minim basic units
▪ Do not use; unfamiliar to many
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Figure 35–7 Basic metric measurements of volume and weight.
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Systems of Measurement
• Household system
▪ May be used when more accurate
systems not required
▪ Drops, teaspoons, tablespoons, cups,
and glasses
▪ Pints and quarts defined as
apothecaries' measures
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Converting Units of Weight and
Measure
• Converting weights within the metric
system
▪ Gram (g), milligram (mg), and
microgram (mcg) only units used for
dosages
▪ Divide or multiply and move decimal
points
▪ Put a 0 in front of decimal point if less
than 1 (0.5 g)
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Converting Units of Weight and
Measure
• Converting weights and measures
between systems
▪ Nurse may need to convert from
systems used by pharmacies
• Converting units of volume
▪ Fluid drams, ounces used in liquid
medications
▪ Liters, milliliters used for enemas,
irrigations, and solutions for
wounds
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Converting Units of Weight and
Measure
• Converting units of weight
▪ Milligrams to grains
• Milligram is smaller than a grain
• 1 grain = 60 mg
▪ Pounds to kilograms
• 2.2 lb = 1 kg
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Table 35–7 Approximate Volume
Equivalents:
Metric, Apothecaries', and Household
Systems
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Methods of Calculating Dosages
• Basic formula
▪ (D × V) / H
▪ D (desired dose)
▪ H (dose on hand)
▪ V (vehicle or form of drug)
• Ratio and proportion method
▪ H : V :: D : x
▪ Considered to be the oldest method
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Methods of Calculating Dosages
• Fractional equation method
▪ (H / V) = (D / x)
▪ Cross multiply and solve for x
• Dimensional analysis
1.Identify dose on hand
2.Identify desired dose
3.Write down conversion factor
continued on next slide
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Methods of Calculating Dosages
• Dimensional analysis
4. Set up equation
5. Cancel units that appear in numerator
and denominator
6. Multiply numerator; multiply
denominator; divide the products
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Methods of Calculating Dosages
• Calculating for individualized drug
dosage
▪ Clients receiving chemotherapy,
critically ill clients required
individualized dosages
▪ Body weight
• Convert pounds to kilograms.
• Determine drug dose per body weight by
multiplying drug dose × body weight ×
frequency
continued on next slide
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Methods of Calculating Dosages
• Calculating for individualized drug
dosage
▪ Body weight
• Choose method of drug calculation to
determine amount to administer
▪ Body surface area
• Ratio of child's body surface area to that
of an average adult
• (Surface area of child (m2) / 1.7m2) ×
normal adult dose
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Administering Medications Safely
• Always assess health status
• Take medication history
▪ Include OTC drugs and supplements,
allergies, normal eating habits
• Include client's illness or current
condition, intended drug and
route
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Administering Medications Safely
• Assess ability to self-administer
• Assess socioeconomic factors
▪ Transportation
▪ Money for medication
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Medication Dispensing Systems
• Medication cart
▪ Mobile
• Medication cabinet
▪ Locked, in client's room
• Medication room
▪ Accessed by key, code
• Automated dispensing cabinet
▪ Reduces risk of error, theft
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Figure 35–11 The medication cart is kept locked when not in use. The nurse is using a key to access
client medications.
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Process of Administering
Medications
• Identify the client
• Inform the client
• Administer the drug
• Provide adjunctive interventions as
indicated
• Record the drug administered •
Evaluate the client's response to the
drug
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Box 35–6 Ten “Rights” of Medication
Administration
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Figure 35–13A A sample bar code.
continued on next
slide
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Figure 35–13B The nurse scans the bar code on the medication package.
continued on next
slide
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Figure 35–13C The nurse scans the the bar code on the client's wristband before administering the
medication.
continued on next
slide
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Developmental Considerations
• Growth and development especially
important in administering medication
to very young and very old
• Infants and children
▪ Most often provided in sweetened liquid
form
▪ Do not mix into milk or orange juice
▪ Be honest about injections hurting
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Developmental Considerations
• Older adults
▪ Altered memory
▪ Decreased visual acuity
▪ Decrease in renal function
▪ Less complete and slower absorption
from gastrointestinal tract
▪ Increased proportion of fat to lean body
mass
continued on next slide
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Developmental Considerations
• Older adults
▪ Decreased liver function
▪ Decreased organ sensitivity
▪ Altered quality of organ responsiveness
▪ Decrease in manual dexterity
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Oral Medications
• NPO “nothing by mouth” or Latin “nil
per os”
• Oral most common route
• Preferred unless digestive problem
(e.g., nausea and vomiting)
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Skill 35–1 Administering Oral Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering Oral
Medications
continued on next slide
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Skill 35–1 (continued) Administering
Oral
Medications
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Parenteral Medications
• Parenteral administration is a common
nursing procedure.
• Absorbed more quickly than oral route
▪ Careful and accurate administration •
Aseptic technique
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Figure 35–14 The three parts of a syringe.
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Equipment
• Syringes
▪ Parts
• Tip, which connects with needle
• Barrel
• Plunger
▪ Hypodermic
• Syringes vary
continued on next slide
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Figure 35–15 Three kinds of syringes: A, 3-mL syringe marked in tenths (0.1) of milliliters and in minims; B,
insulin syringe marked in 100 units; C, tuberculin syringe marked in tenths and hundredths (0.01) of 1 milliliter
(mL) and in minims.
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Equipment
• Syringes
▪ Insulin
• Common problems with insulin pen
• Needlestick injuries
• Errors in technique
• Using the pen like a vial
• Using the pen for more than one client
▪ Tuberculin
• Narrow
continued on next slide
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Equipment
• Syringes
▪ Luer-Lok syringe
• Requires needle to be twisted onto it
▪ Non-Luer-Lok syringe
• Has smooth graduated tip
• Needles are slipped onto it
continued on next slide
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Figure 35–18 Tips of syringes: A, Luer-Lok syringe (note threaded tip); B, non–Luer-Lok syringe (note the
smooth graduated tip).
A
B
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Figure 35–19 A 60-mL non–Luer-Lok syringe, which can be used for irrigation of tubes or wounds.
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Equipment
• Syringes
▪ Prefilled unit-dose systems
• Prefilled syringes ready for use
• Prefilled sterile cartridges and needles
that require attachment of reusable
holder before use
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Equipment
• Needles
▪ Stainless steel
▪ Most disposable
▪ Parts
• Hub
• Cannula or shaft
• Bevel
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Equipment
• Needles
▪ Characteristics
• Slant or length of
bevel • Length of
shaft
• Gauge (diameter)
of shaft
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Figure 35–22 The parts of a needle.
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Equipment
• Preventing needlestick injuries ▪
Needles and sharps present one of
greatest dangers to health care
workers.
▪ Passive devices
• Retracts immediately
▪ Active devices
• Requires nurse to activate safety feature
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Figure 35–26 Passive safety device. The needle retracts immediately into the barrel after injection.
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Figure 35–27 Active safety device. The nurse manually pulls the sheath or guard over the needle after
injection.
Kozier & Erb's Fundamentals of Nursing, Tenth
Edition, Global Edition Audrey Berman | Shirlee
Snyder | Geralyn Frandsen
Copyright © 2016
Pearson Education Limited All Rights Reserved