Medication Administration- PPT Content Module 2

Medication Administration Guidelines: Follow the 8 Medication rights What are your 8 RIGHTS? 1. Right Client 2. Right medication 3. Right reason 4. Right dose 5. Right frequency 6. Right Route 7. Right Site 8. Right Time Follow and document according to employer policy Infection control Follow standard precautions. Always wash your hands. Hand washing is the most effective precaution to prevent the spread of illness or infection. Environment Work in a well-lit environment and away from avoidable distractions Care plan o Check the care plan in MAR. Review the care plan with your supervisor before assisting the client with medications. o Read the labels carefully and compare container labels with the care plan and the MAR. o Store medications o Store where the client can easily access o Clients medication should be stored separately from other clients. o In a cool dry place not in the bathroom medicine cabinet o Out of reach of children and of adults with dementia o In the original labeled container o With lids tightly closed In the original labeled container With lids tightly closed According to any special storage directions. E.g. fridge If you notice medication is running low, tell the client and family and your supervisor so that the client will not run out of medications. Labeled/Unlabeled containers - do not remove labels from containers - never use medications in containers that is unlabeled or that has an unreadable label. Do not leave medications at the clients bedside. Do not assume that the client will take them correctly. Remain with the client until he or she has finished taking the medications. Give a glass of water (or other liquid) with oral medication as ordered.

Listen to the client. If they have questions about the medication, STOP! Do not assist with self medication and call your supervisor immediately Help steady the pts hand when pouring out medication into the container especially those with hand tremor.

Report to supervisor Before discarding unused medication Client does not take medication correctly Do not understand why the medication should be taken and does not know the dosage or the schedule Client refuses to take the medication or forgets or omits a dose to take. The client should not take a double if one is omitted. Shows any side effects. E.g. vomiting rash, SOB, urticaria, diarrhea. Client want to take medication including OTC medications or alternative remedies) that are not listed on the MAR and care plan. Report and record if a medication is not taken or is omitted. Explain why.

Limitations

UCPs and PSWs should never: Offer advice about taking or not taking a drug Share information about clients personal medication Administer a med when they are not authorized Fail to advise the appropriate person of concern they have about a clients medication use. Filling in pill boxes or dosettes of the pt; this is the nurses responsibility or family member

Standard Precaution

Hand hygiene is the most essential technique in preventing transmission of infections. According to Health Canada (1998). The components of good hand washing are: adequate of soap and create friction, and rinsing under a stream of warm water. In fact decreased nosocomial infection rates have been reported with improved hand washing compliance.

Medication Error the failure to complete a planned action as intended or when an incorrect plan is used at any point in providing medication to the intended recipient. If you believe that you have committed a drug error or noticed a drug error, report this to your supervisor immediately! It is the responsibility of the supervisor to assess the situation and decide what to do.

Adverse Drug Reactions

Type A: Predictable dose related

Type B: Unpredictable not dose related.

Type A Side effects: excessive but characteristic pharmacology effect from usual dose of a drug. For example B blockers causing bradycardia. Overdose/toxicity: exaggerated but characteristic pharmacological effect from supratherapeutic dose Teratogen: drug may produce developmental defects in fetus

Characteristics: Account for more than 80% of ADRs Extension of pharmacological effects Dose related and generally not severe Usually do not require discontinuation Dose reduction or titration may help minimize effect Idiosyncratic: uncharacteristic response to drug, unrelated to pharmacology. E.g. Sulfacontaining medications (Sulfonamides). Pseudoallergenics: mimics immune mediated reaction Allergic / immune-mediated

Characteristics:

Usually more severe Usually require discontinuation Not dose-related

Drug Classifications

Alzheimer's Medication:

Action: E.g. Donepezil HCL (Aricept) Treat mild to moderate symptoms of Alzheimers Disease

Observations and Responsibilities Report any nausea, diarrhea, and vomiting and muscle cramp. Client may be fatigued easily Donezepil Blocks AChE (Acetyl cholinesterase) Alzheimers associated with decreased ACH (acetylcholine) levels in the brain. Increases ACH level in brain.

Analgesics (non-opiod) Action: E.g. Acetaminophen (Tylenol) Treat mild to moderate pain

Observation and Responsibilities Might cause nausea vomiting Do not take with alcohol

Analgesics (Opiods) Action: Relieve severe pain

E.g. Acetaminophen 325mg; Codeine 30mg (Tylenol #3)

Observation and Responsibilities Report excessive drowsiness and constipation

Opiod Analgesics Blocks pain receptor sites Mu, Kappa, sigma, delta, epsilon Psychological dependence (addiction) Physical dependence Tolerance

Adverse Effects Cardiovascular: Hypotension, palpitations, flushing Central Nervous System: Sedation, disorientation, euphoria. Gastrointenstinal: Nausea, vomiting, constipation Genitourinary: Urinary retention Integumentary: Itching, rash Respiratory: resp depression, aggravation of asthma

Antacids Action: E.g. Calcium carbonate (TUMS) Relieves heartburn hyperacidity

Observations and Responsibilities Should not be taken within 2 hours of another medication as it might interfere with the absorption of the drug Ancient Greeks used crushed coral (calcium carbonate) for indigestion Stimulates mucus to protect from HCL (Hydrochloric acid)

Anti-anginal Action: E.g. Nitroglycerin (Nitrostat) Relieve angina chest pain

Observations and Responsibilities May cause dizziness in client. Wear gloves in handling the medication as it may cause headache to the person administering drugs.

Anti-anginal Lowers BP Goal is to increase blood flow to ischemic myocardium. Prevent or delay MI. SL, q 5 minutes. X3.

Anti-anxiety Action: E.g. Lorazepam (Ativan) Reduce anxiety

Observations and Responsibilities Might cause drowsiness and sleepiness. Client must be careful in driving. Benzodiazepines depresses activity in the brain -> produces anxiolytic effect as well as sedation and muscle relaxation -azepam suffix drugs e.g. Lorazepam, Diazepam, Oxazepam

Adverse Effects CNS: Drowziness, sedation, loss of coordination, GI: N&V, constipation, dry mouth, abdominal Integumentary: Pruritis, skin rash blurred vision, dizziness, HA. cramping

Antibiotics Action: E.g. Ampicillin (Novo-ampicillin) Eliminate or reduce harmful bacteria

Observations and Responsibilities Check for diarrhea and vomiting Bitter after taste Ensure clients finish the entire course prescribed, unless told by the doctor or pharmacist.

Anticoagulants Action: E.g. Dalteparin Sodium (fragmin) Coumadin (warfarin) Heparin Reduce blood clotting

Observations and Responsibilities May make client more prone to bruising and bleeding Use care when brushing teeth or shaving Report bruises on body, blood in urine

Adverse Effects GI: N&V, vomiting, diarrhea, abdominal cramps, ulcerations, bleeding

Hematological: Other: Osteoporosis, skin necrosis, anaphylactic reactions Bleeding, thrombocytopenia,

Anticonvulsant Action:

 E.g.

Reduce seizures

Phenytoin Sodium (Dilantin)

Observations and Responsibilities Make sure the client hast good mouth care to eliminate mouth sores and a bad taste in mouth. Prevent or control seizure Contraindicated to allergy and pregnancy Exact mechanism not known Make it more difficult for a nerve to be excited.

Adverse Effects CNS: drowsiness, dizziness, lethargy GI: N&V Other: Rash, urticaria Hematological: Bone marrow supression Heart: Dysrhythmias, Heart Failure Antiemetics Action: E.g. Bismuth subsalicylate (Pepto-Bismol) Dimenhydrinate (Gravol) Reduce nausea, motion sickness

Observations and Responsibilities Make sure client has good mouth care to eliminate mouth sores and bad taste.

Adverse Effects CNS: GI: Difficult urination, constipation dizziness, drowsiness, disorientation, blurred vision, dilated pupils, dry mouth

Integumentary:

 CV:

rash, erythema

Orthostatic Hypotension, ECG changes, tachycardia

Anti-hypertensives Action: E.g. Ramipril (Altace) Reduce blood pressure

Observations and Responsibilities Client should get up slowly to avoid dizziness or lightheadedness.

ACE-I: vasodilator; blocks ACE -pril drugs e.g. Catopril, ramipril, Beta Blockers: decreases force and rate of heart contractions -> lowers BP reduction in peripheral resistance. Block beta receptors found on heart muscles -olol drugs e.g. metropolol, Calcium Channel Blockers: decrease Ca movement -> decreases smooth muscle contraction and electrical conductivity -> relaxes blood vessels and lowers BP -ines drugs e.g. Nifedipine Adverse effects Orthostatic hypotension Dry mouth, drowsiness, sedation, constipation, HA, N&V, sleep disturbances, rash Hyperkalemia, anemia,

Anti-parkinsonian

Action: E.g. Levodo-carbidopa Reduce symptoms of Parkinson's disease

Observations and Responsibilities Report dizziness, pain

Adverse effects Hematological: CV: CNS: Agitation, anxiety, psychotic and suicidal episodes, choreiform, dystonic and other involuntary movements, HA, blurred vision palpitations, orthostatic hypotension agranulocytosis (low WBCs), hemolytic anemia

Anti-psychotics Action: E.g. Haloperidol (Haldol) Reduce psychosis, severe agitation, severe vomiting

Observations and Responsibilities Watch for hand tremors and dizziness. Notify the nurse if you see grimacing For serious mental illness such as depressive psychoses and schizophrenia. Extreme mania Tourettes syndrome

Adverse Effects Agranulocytosis, anemia Tardive dyskinesia, extrapyramidal symptoms

Antitussive Action: E.g. Dextromethorphan (Robitussin DM) Liquefy phlegm making it easier to cough

Observations and Responsibilities Should be taken after any drugs. Clients must not drink fluids 10-15 minutes to give chance for the drug to be absorbed into throat tissues Suppresses cough reflex Beneficial for unproductive cough (dry cough) Post surgery

Anti-Virals Action: E.g. Acyclovir (Zovirax) Reduce virus reproductions

Observations and Responsibilities Report headache and nausea and skin reactions Blocks polymerase enzyme which normally catalyzes the synthesis of new viral genomes Results in impaired viral genomes

Adverse Effects Nausea, vomiting, diarrhea, HA, Rash, insomnia, nervousness, fatigue, seizures, bone marrow toxicity, anemia, Mostly tolerated Bronchodilators Action: E.g. Salbutamol (Ventolin) Reduce spasms in breathing passages

Observations and Responsibilities Watch for dry mouth. May cause shakiness and tremor in hands and increase heart rate in clients. Relax bronchial smooth muscle and dilates the bronchi and bronchioles that are narrowed as a result from disease process.

Adverse Effects Insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, hypokalemia, tremor, headache, hypertension, hypotension, tremors.

Decongestants Action: E.g. Pseudoephedrine (Sudafed) Reduce nasal congestion

Observations and Responsibilities May cause dry mucous membranes and rebound congestion (gets worse after drug wears off) Decongestants help reduce swelling in the nasal passages, which relieves the feeling of pressure and improves airflow through your nose. In response to an allergen or the cold virus, the tissues in your nose swell and increase their production of fluid and mucus. As a result, you might feel fullness or pressure in your nose and head.

Diuretics Action: E.g. Furosemide (Lasix) Lowers BP and body swelling by increasing urine output

Observations and Responsibilities Depending on the drug, some clients must eat more potassium rich foods (banana, potatoes

Adverse Effects Drowsiness, anorexia, paresthesia, hearing disturbances, tinnitus, urticaria, photosensitivity, hematuria, melena

Hypoglycemic agents Action:

 E.g.

Improved insulin production in the body

Glyberide (Diabeta) Metformin

Observations and Responsibilities Insulin Action: E.g. Insulin regular Human biosynthetic (Humulin-R) Makes for lack of natural insulin Report any nausea, vomiting, dizziness or weakness

Observations and Responsibilities Report any blurred vision, dry mouth, extreme hunger and chest palpitations

Adverse Effects Hypoglycemia from overdose can result in shock and possibly death

Signs of hypoglycemia Laxatives Action: E.g. Bisacodyl (Dulcolax) Lactulose Docusate sodium Help with bowel movement

Observations and Responsibilities May cause diarrhea; encourage fluids and high fiber to reduce need of laxative

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Action: Reduces pain;swelling

E.g. Ibuprofen (Advil) Aspirin

Observations and Responsibilities NSAIDs Gout Arthritis Painful shoulder Fever Pain Tendinitis inflammation of tendon May cause upset stomach, so should never be taken on an empty stomach

Thyroid Replacement Action: E.g. Levothyroxine Sodium (Eltroxin) Makes up for lack of natural thyroid

Observations and Responsibilities Reporting menstrual irregularities, nausea or vomiting

Adverse Effects Most significant is cardiac dysrhythmias

Common ones: HTN, insomnia, HA, anxiety, diarrhea, decreased appetite, weight loss, sweating, fever.