MEDICATION ADMINISTRATION General Medication Information

KEY POINTS A formula for computing drug dosage: Dose ordered Dose on hand amount on hand = amount to administer The primary care provider prescribes, the pharmacist prepares , and the nurse administers to the client. The nurse should question any order suspected of being in error. Effects of a medication are influenced by weight, sex, biological factors, physiological factors, pathology, environment, and timing of administration. The Five Rights are the right: Medications, Client, Dosage, Route, and Time To identify a client, check the ID bracelet and ask the client to state his/her name. Do not administer medications prepared by another nurse. Return the medication to the pharmacy if the label is missing or illegible.

Clinical Overview: A drug or medication is a substance that modifies body functions. The primary care provider is legally responsible for prescribing medications; the pharmacist prepares them; the nurse determines them to clients. The generic name (e.g acetaminophen) of a drug is the name assigned by the manufacturer that first develops the drug; the trade name (e.g. Tylenol, Tempra, Liquiprin) is the brand name chosen by the company that sells the drug. 1. Absorption is the process by which a drug gets from its site of entry into the bloodstream. 2. Distribution is the movement of the drug, via the bloodstream, to the specific tissues for its action, here it accumulates. 3. Metabolism (biotransformation) is the breakdown of the drug into an inactive form. Usually this occurs in the liver. 4. Excretion occurs after the drug is metabolized. Most drugs leave the body via the kidneys, but excretion also occurs through the sweat, salivary, and mammary glands, the lungs and the intestines. Factors Influencing the Effects of Medication 1. Weight 2. Sex (because of the distribution of body fat and fluids) 3. Genetic and biological factors (e.g. placebo effect) 4. Psychological factors(e.g. placebo effect) 5. Pathology (e.g. liver disease slows drug metablosim) 6. Environment (e.g. quiet environment enhances effect of pain medication) 7. Timing of administration (e.g. some drugs are best absorbed from an empty stomach) Adverse Effect The therapeutic effect is the desired effect of the drug (e.g. the therapeutic effect of morphine is pain relief). Adverse effects are those that are neither intended nor desired. 1. Drug allergy occurs if the person has previously had the drug and has developed antibodies. Allergic reactions range from minor to serious (e.g. rash, hives, diarrhea) 2. Anaphylactic reactions is a life-threatening immediate allergic reaction that causes respiratory distress , severe bronchospasm, and cardiovascular collapse. It is treated with epinephrine, bronchodilators, and antihistamines. 3. Drug tolerance occurs when the body becomes accustomed to a drug over a period of time, so that larger and larger doses must be given to the client to produce the same effects. 4. A cumulative effect occurs when the body cannot metabolize one dose of the drug before another is administered; so each new dose adds to the total quantity in the body. 5. An idiosyncratic effect is an abnormal or peculiar response. It may be an over response, an under response, or simply an unexpected response. They may be the result of genetic enzyme deficiencies. Older clients, for example, often have erratic responses to medications. 6. A drug interaction occurs when the combined effect of two or more drugs produces a different effect that that of each alone. An agonistic effect is greater than that of each drug alone (e.g. alcohol and barbiturates are synergistic). An antagonistic effect is less than that of each drug alone. Medication Orders

The nurse is legally responsible for drugs administered; any order suspected of being in error should be questioned. A medication order consists of 7 parts: 1. Clients name 2. Date and time order is written 3. Name of drug to be given 4. Dosage of the drug 5. Route of administration 6. Signature of the person writing the order. Safety Measures for Preparing and Administer Drugs 1. Check the label on the medication container 3 times: (1) when reaching for package/container, (2) immediately before pouring or opening the package, and (3) when replacing the container or giving the unit dose to the client. 2. Return medications to the pharmacy if the label is missing or illegible. 3. Follow agency procedures for accounting for controlled substances (e.g. narcotics) 4. Notify the nurse manager if there appears to be tampering with any medication. 5. Never administer medications prepared by another nurse. 6. Observe the five right a. Right medication b. Right client c. Right dosage d. Right route e. Right time 7. To identify a client, check his/her identification bracelet and ask the client to state his/her name. It is not safe to just call the client by name. 8. Remain at the bedside until the medication is taken. 9. Administer scheduled medications within 30 minutes of scheduled time. 10. Recheck medications if the client questions their appearance or time of administration. 11. Monitor the effect of the medication. Computing Drug Dosages One formula is as follow: 1. Dose ordered Dose on hand amount on hand = amount to administer Age Related Changes-Gerontological Considerations 1. Older adults have a decline in liver function and enzyme production needed for drug metabolism. 2. Decreased kidney function results in diminished filtration and excretion. 3. The older adult has altered peripheral venous tone important if client is talking antihypertensive medications. 4. Older adults often take multiple drugs that interact with each other. 5. Because of sensory deficits such as hearing and sight, the older adult may not comprehend medication instructions or be able to see and read labels. 6. Older adults are dehydrated which effects distribution of medication. Dosages should be reevaluated frequently because of changes in weight.

Oral Medication Preparations

KEY POINTS The oral (PO) route is the most common method of drug administration. Oral medication may be pills, capsules, tablets, or liquid preparations. Usually the safest route. Some clients have difficulty swallowing oral medications Some clients are at risk for choking and aspiration. Ensure that the client has adequate swallowing and gag reflexes. Pour liquid medications into a medicine cup at eye level to measure. Remember that older adults have special needs related to medication administration and metabolism.

Clinical Overview: The oral (PO) route (through the mouth) is the most common because it is usually the most convenient, comfortable, and safe. Oral medications are intended for absorption in the gastrointestinal tract. Some are administered via gastric or intestinal tube. Compared to other routes, medications have a slower onset and a more prolonged but less potent effect. Sublingual drugs (e.g. nitroglycerin) are placed under the tongue to dissolve and are readily absorbed. Drugs given by the buccal route are placed against buccal membranes of the cheek until the drug dissolves. They act local on the mucosa or systematically when swallowed in the saliva. The desired effect is not achieved if these drugs are swallowed or if the client drinks liquids before the drug is dissolved. Types of Oral Medications 1. Oral medications may be solid or liquid a. Solid preparations are: tablets, capsules, and pills. Enteric-coated tablets have a coating that delays absorption until after the tablet leaves the stomach. Because the active ingredient irritates stomach mucosa, enteric-coated tablets should not be crushed or chewed. Extended release capsules also should not be crushed or chewed. b. Liquid preparations include elixirs, spirits, suspensions, and syrups. They may be water or alcohol-based. They are administered in a special calibrated, disposable cup. Safety Factors for Oral Drug Administration 1. Oral medications can be difficult, and even dangerous, to give in some situations. The following are examples: a. Children under age 5 years find it difficult to swallow tablets and capsules. 2. Clients who are NPO cannot take oral medications. 3. Clients with dysphagia or altered level of consciousness are at risk for choking and aspiration. 4. Clients who have experienced oral trauma or surgery cannot usually take PO medications. Therapeutic Nursing Intervention for Oral Preparations 1. Assess to be sure that the client has adequate swallowing and gag reflexes. 2. Consult with the primary care provider about substituting liquid drugs for solid medications that must be instilled via gastric or intestinal tube. 3. Pour liquid medication into medicine cup eye level. 4. Clients that may have trouble swallowing whole capsules or tablets may need to have the medication crushed and mixed with food or put down the feeding tube (e.g. nasogastric or NG tube). Not all tablets and capsules can be crushed. Medications that are slow release, long acting, or sustained release are coated to control the release of the drug. This coating must remain intact to prevent uncontrolled release or dumping of the dose tablets should not be crushed of they have been coated; capsules generally can be opened but the beads cannot be crushed because the beads are generally the part that have been coated to control release of the medications with food or via the tube. Note: Before administering medications via a nasogastric tube, confirm proper positioning of the tube. 5. For medications with objectionable taste, offer oral hygiene immediately after administering. 6. Never put any of your clean items which are used in administering medications directly on the surface of the counter or medication cart/tray. Always provide a clean barrier to prevent contamination of clean items from age unknown material on a surface. Age Related Changes - Gerontological Considerations 1. Older adults have decreased gastric emptying time, decreased gastric motility, and an increase in stomach pH. 2. Older adults, because of arthritis, may have difficult removing childhood caps.

3. Aging causes a decrease in saliva production, which makes swallowing medication more difficult (increased risk of choking) 4. Older adults need extra time to take medications related to slower reflexes and a decreased understanding of treatment.

COMPUTATION EXERCISES 1. The physician ordered 1000ml dextrose in water in 8hrs.The available D5W is 1000ml.What is the IV flow rate if the drop factor is 15gtts/ml. 2. The physician order reads administer D5LR 1L for 8 hrs. How many gtts/min. will the nurse regulate the IVF? Drop factor is 20gtts/ml. 3. Dr. Cruz ordered 1L of D5LR to be given to an adult patient for a span of 12 hrs. How many ml/hr. will be infused? Drop factor is 20gtts/ml. 4. In the Pediatric ward, the doctor ordered PNSS 500ml for 12 hrs. How many gtts. per minute should the nurse regulate? 5. How many drops /min. should nurse Ana give to a 2 yr. old patient if an IV infusion of 100ml. is to be given for 8 hrs. via soluset? 6. Sheila is a 3 yr. old patient, his doctor administered D5LR 500ml.for 18hrs.What is the flow rate will the nurse regulate via microset. 7. The doctor order Clarythtomycin (Klaricid) 500mg. tab. The stock dose is 250mg./tab. How many tablets should be given to the client? 8. The physician ordered Prednisone (Prednicort) 7.5 mg. The stock dose is 5mg./tab. How many tablets should you give to the client. 9. The doctor ordered Amoxicillin (Amoxil) 500mg/cap. TID. The nurse went to the pharmacy and found out that the available stock dose is 250mg/cap. How many capsule should the nurse will give to the patient? 10. The physician ordered Ampicillin 125mg via IV push to an 8 yr. old patient with URTI. The stock dose is 250mg./ml. and the diluent is 5ml.of distilled water. How much should be given to the patient? 11. The physician in the Pediatric ward prescribed the patient with Gentamycin 20mg IV push 8 hrs. The available stock dose is 40 mg./2ml. How much should be given to the patient? 12. A physician prescribed Acetaminophen(Dolanex) to a 4yr.old girl who weighs 30 lbs. The normal adult dose is 325mg.every 4-6hrs. Acetaminophen is available as 325mg per 5 ml. What is the drug dose for the client and how much should be given? (Clarks rule) 13. How many ounces are there in 2 glasses of H2O? 14. How many table spoons are there in 15ml? 15. How many microdrops in 1 drop, if the drop factor of the macroset is 15gtts/ml?

Topical and Inhalation Medications What is the drug dose for the ches

KEY POINTS Topical medications are given for their local effects; inhalation medications are given for both local and systemic effects. Wear gloves when applying topical medications. Methods of inhalation: nasal inhalation, oral inhalation, endotracheal or tracheal administration (requires special training)