Ch. 3 Principles of Drug Administration Notes PDF

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Ch. 3 Principles of Drug Administration 3.1 Medication Knowledge & Understanding  Nurses are expected to understand the pharmacotherapeutic principles of all medications given to each patient o What drug is ordered o Name and classification of drug o Intended use for this patient o Effects on the body o Contraindications/Side effects o Special considerations o How the med comes from the pharmacy o How the medication is to be administered  Adverse event (AE)  any undesirable experience associated with the use of a medical product in a patient, and may warrant lowering the dose or discontinuing the drug o Usually described in terms of severity (mild, moderate, severe, life threatening) o Serious Adverse Event (SAE): used to define threat of death or immediate risk of death  Side effects  describes nontherapeutic reaction to a drug o Usually transient and perceived as tolerable o May require nursing intervention  Allergic reaction  hyper-response of body’s defenses to a foreign substance (allergen) o Skin rash (may itch) o Edema o Reddened eyes / runny nose  Anaphylaxis  Severe allergic reaction involving massive systemic release of histamine& inflammation mediators o Hypotension o Dyspnea o Tachycardia 3.2 The Rights of Drug Administration  Five right of drug administration form the operational basis for the safe delivery of medications o Right patient o Right medication o Right dose o Right route o Right time o Right documentation  Three checks of drug administration o Checking drug with MAR/medication information system when removing it from med drawer, refrigerator or controlled substance locker. o Checking drug when preparing, pouring, taking out of unit-dose container or connecting IV tubing to bag.

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o Checking the drug before administering. Common causes of medication errors o Incomplete patient data o Unavailable drug information o Miscommunication of drug orders o Lack of appropriate labeling when a drug is prepared & repackaged in smaller unit o Distracting environmental factors

3.3 Patient Adherence & Successful Pharmacotherapy  Adherence  taking a medication in the manner prescribed by the healthcare provider or, with OTC, following the instructions on the label  Before administering the drug, the nurse must: o Formulate a personalized care plan that involves the patient.  Allow them to accept or reject the course of treatment o Address essential information.  Name of drug, why it is ordered, expected actions, side effects, interactions with other substances. o Identify factors that may influence compliance.  Cost, coverage by insurance, frequency of dosing, annoying side effects, self-adjustment of doses.  Non-compliance should be considered when medications fails to produce the expected outcomes 3.4 Drug Order & Time Schedules  Drug orders o STAT  give once within 5 minutes o ASAP  give within 30 minutes o Single order  give only once at a specified time o PRN  give as required by patient’s condition o Routine  any order other than above  Drug orders must be reviewed by the attending physician within specific time frames or at least every seven days  Drugs may need administration during or between meals, depending on interaction with food  Central nervous system drugs and antihypertensives are often best administered at bedtime  Nurses must document carefully the details of medications given to patient—after they have been given o Refusal or omission of medication must be documented

Table 3.1 Drug Administration Abbreviations Abbreviation

Meaning

ac

before meals

ad lib

as desired/as directed

AM

Morning

bid

twice a day

cap

capsule

gtt

drop

h or hr

hour

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

every 2 hours (even or when first given)

q4h

every 4 hours (even)

q6h

every 6 hours (even)

q8h

every 8 hours (even)

q12h

every 12 hours

Rx

take

STAT

immediately; at once

tab

tablet

tid

three times a day

3.5 Systems of Measurement  Three systems of measurement

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o Metric  most common o Household  common for home use o Apothecary  not used in accredited settings Do not need to know grains or dram Ice chips are half the amount (8 ounces given in a cup means that they really consumed 4 ounces of ice chips)

Table 3.2 Metric, Apothecary, & Household Equivalents

Metric 5 mL 15 mL 30 mL 240 mL 480 mL 1 Liter 1 mg 60 mg 300 mg 1 kg

Household 1 teaspoon 1 tablespoon/3 tsp 2 TBSP/6 tsp 1 cup 2 cups 4 cups/1 quart

Apothecary 1 fluid dram 4 fluid drams 1 ounce 8 ounces (1/2 pint) 16 oz (1 pint) 32 ounces 1/60 grain 1 grain 5 grains

2.2 pounds

Routes of Drug Administration  Guidelines: o Verify the med order & check for allergy. o Wash hands and glove if indicated. o Use aseptic technique when preparing & giving meds. o ID the patient by asking full name, looking at patient armband, asking date of birth and checking against med computer. o Give the pt. info about what you are giving, how they will take it, side effects and what the med is for. o Position the patient for the route of administration. o If unit dose, remove med from package at bedside. o Do not leave meds at bedside unless order to do so. o Document the med administration and any necessary patient responses on medication record (MAR). 3.6 Enteral Drug Administration  Enteral route  Drugs given orally by mouth or through nasogastric or gastrostomy tube. o Most common, usually less costly. o Safest route because skin barrier is not compromised. o Comes in tablets, capsules and liquid forms. o Absorbed by the oral mucosa, stomach or small intestine.

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Tablets & Capsules o Enteric-coated tablets  designed to dissolve in the alkaline environment of the small intestine

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o Enteric coated tabs may NOT be crushed or chewed o Sustained-released (SR) tablets or capsules  designed to dissolve very slowly o Disadvantages:  Pt. must be conscious and able to swallow  First-pass metabolism  Variation in GI tract may affect ability to absorb Sublingual & Buccal Drug Administration o Medication given by this route are not subjected to the digestive enzymes o Buccal  Placed between the gum and cheek  Slower absorption than sublingual  Avoids first-pass metabolism o Sublingual  Under the tongue  Rich blood supply allows rapid onset of action  Tablet must dissolve completely  Avoids first-pass metabolism  Give after other oral medications have been swallowed Rapid Dissolving Tablets & Films o Orally disintegrating tablets (ODTs) and oral soluble films allow for quick dissolving of medications without the need for an external source of water Nasogastric & Gastrostomy Drug Administration o Usually in liquid form. o Tablet should be finely crushed & mixed with warm water and then the tube cleansed with water. o Sustained-release drugs cannot be crushed. o Head of the bed up one hour after administering.

3.7 Topical Drug Administration  Used for a local or systemic effect  Applied to the skin or membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina and rectum. o Dermatologic- creams, lotions, gels, powders, sprays o Instillations & irrigations- into body cavities such as eyes, ears, nose, bladder, vagina, rectum o Inhalations- into the lungs such as inhaler, nebulizers or positive pressure breathing apparatuses 3.8 Parenteral Drug Administration  Parenteral route  delivers medications through a needle into the skin layers, subcutaneous tissue, muscles, veins  More advanced methods- arteries, into body cavities & organs  Follows a strict aseptic technique  Intradermal & Subcutaneous Administration o Intradermal  given in the dermis layer; limited to 0.1 to 0.2 ml o Subcutaneous given into the deeper layer of the skin; limit to 0.5 to 1 ml  Intramuscular Administration o Give into specific muscle (ventrogluteal, deltoid, dorsogluteal, vastus lateralis) o Limit 2-3 ml (1 ml in deltoid)  Intravenous Administration o Given directly into the bloodstream-rapid onset of action o Large volume infusion, intermittent infusion, IV bolus...