ASSOCIATION OF NURSING SERVICE ADMINISTRATORS OF THE PHILIPPINES, INC.

(ANSAP)

R.A. # 9502 - An act providing for

cheaper and quality medicines, amending for the purpose Republic Act No. 8293 or the Intellectual Property Code, Republic Act No.6675 or the Generics Acts of 1988, and Republic Act No. 5921 or the Pharmacy Law,and for other purposes

R.A. # 9165 Dangerous Drug Act of 2002 - An Act

Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

RA 9173 Philippine Nursing Law of 2002 have stated that parenteral injection is in the scope of nursing practice.

Board of Nursing Resolution No.8 Sec.30 (c) Art.VII or administratively under Sec.21 Art.III states that any registered nurse without training and who administers IV injections to patients shall be held liable, either criminally whether causing or not an injury or death to the patient.

Pharmacokinetics
- The process by which a drug is absorbed, distributed, metabolized, and eliminated by the body. PHARMACOKINETICS - what the BODY does to the DRUG (PROCESSES)

Pharmacokinetic PROCESSES
Absorption Distribution Metabolism Excretion

Pharmacodynamics
The study of the action or effects of drugs on living organisms. PHARMACODYNAMICS - what the DRUG does to the BODY (EFFECTS)

Pharmacodynamics
Symptomatic Curative Restorative Preventive Diagnostic

An I.V. Medications may be ordered when:

rapid therapeutic effect. cant be absorbed by the GI tract.

An I.V. Medications may be ordered when:

The client may receive nothing by mouth. controlled administration rate

I.V. Medication may be given by:

Drug injection

Intermittent infusion Continuous infusion

Benefits
Rapid Response Effective Absorption Accurate Titration Less Discomfort

Risks
Solution and drug incompatibilities. Poor vascular access in some clients. Immediate adverse reactions.

Incompatibility

Drug + Diluent = must be compatible -The more complex the solution, the greater the risk of incompatibility

An incompatibility results when two or more substances react or interact so as to change the normal activity of one or more components.

Incompatibility may result in the loss of therapeutic effects and may occur when:
Several drugs are added to large volume of fluid to produce an admixture. Drugs in separate solutions are administered concurrently or in close succession via the same IV line

Incompatibility may result in the loss of therapeutic effects and may occur when:
A single drug is reconstituted or diluted with the wrong solution One drug reacts with another drugs preservative

Hazards of intravenous medications

Mixing of two incompatible drugs in a solution can cause an adverse interaction

Poor Vascular Access

Clients who require frequent or prolonged I.V. therapy may developed small, scarred, inaccessible veins from repeated venipunctures or infusion of irritating drugs.

If peripheral venous access isnt possible, the doctor may use a central vein, commonly by the subclavian route.

Adverse Drug Reaction

A response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function (WHO).

The following are some adverse drug reactions that you might notice:
Skin rash Easy bruising Bleeding

Severe nausea and vomiting Diarrhea Constipation Confusion Breathing difficulties

What should you do if you suspect an ADR?

Stop the medication immediately. Report the incident to the physician. Monitor the client.

10 GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY Administer the right drug. Administer the right drug to the right patient. Administer the right dose.

 Administer the drug by the right route. Administer the drug at the right time. Document each drug you administer. Teach your patient about the drug he is receiving.

 Take a complete patient drug history. Find out if the patient has any drug allergies. Be aware of patient drug drug or drug-food interactions.

Common Medication Errors

Wrong dose (overdose, underdose, missed dose) Wrong medication to wrong patient Wrong medication to right patient Wrong medication due to wrong dispensing Wrong interpretation of doctors prescriptions for drugs Wrong infusion rate ( over infusion, under infusion, missed order )

Transcription of medication and treatment orders

Interpretation of Doctors Order for Drugs

The nurse must understand the order perfectly before acting on it
> > > > The The The The Drug Dose Route Frequency

 If any of the above are unclear or open for interpretations, it is the Responsibility of the nurse to clarify the order with the physician.

Definition of Terms: Transcription of medical orders- is the act of writing out medical orders. Kardex- is the summarize written presentation of all the care and treatment of the patient.

Medication/Treatment sheet- is the legal documents in the patients chart were medicines and treatments administered to the patient are written, acknowledged and administered by nurses.

Physicians Order Sheetis a legal document wherein medical orders are written and use as reference of nurses in the transcription and executing nursing care.

 All medication and treatment orders must be written legibly and must contain the following: a. generic name and brand name of medicines b. Dosage of the medicines c. Frequency of administration d. Route of administration e. Signature over printed name of attending physician or authorized representative f. Date and time order was written

The registered nurse indicates that he/she has checked and completely transcribe the medical order by signing his/her name with the date and time directly right after the doctors order.

As a general rule, telephone orders are received and carried out only in emergency cases by nurses. Nurses receive telephone orders only from consultants. RNs will review all orders immediately after the physician writes.

Patient / Family Teaching

Inform the client about the medication you are about to administer. Reason why the medication is to be give. Adverse effect he may experience Pain Redness swelling

Documentation
Type and amount of drug given Date and time given Confirmation that the I.V. line was patent Patients response to the medication Condition of the insertion site Ongoing monitoring that you provided

Where to Document
Nurses Progress Notes Medication Sheet Infusion Sheet Vital Signs Monitoring Sheet Input and Output Monitoring Sheet

Weighing In
Remember!!! 2.2 lb. = 1 kg

Coming to the Surface

Remember!!!

Body Surface Area use NOMOGRAM

Nomogram
Find your weight in the right column and your height in the left column. Place a straightedge on the nomogram so the weight and height are connected. The point where the straightedge crosses the center column denotes your body's surface area in square meters.

Coming to the Surface

Basal Surface Area Childs Dose = Childs BSA X average 173 m2 adult dose (average adult BSA)

GENERAL FORMULA FOR DRUG CALCULATION

1.

desired strength x total ml of solution strength on hand

2. Calculation by Ratio : Proportion 8 mg : x = 16 mg : 1 tab

(works for any computation of Dosage if you have a given and a need to determine the unknown). Rule :
1. Units for each ratio must be the same. 2. Units for each ratio must be placed in the same order.

Calculating Administration Rates

One must know two key components before using the formula: Drop factor of the IV administration set Amount of solution to be infused over one hour

Rate Calculations
Macrodrip Set 10 drops = 1 ml 15 drops = 1 ml 20 drops = 1 ml Microdrip Set 60 drops = 1 ml Blood Set 10 drops = 1 ml

FORMULA

Drip Rate (gtts or mgtts/min) =

Total no. of ml x Drip Factor Total no. of min.

FORMULA

ml per hour =
Total no. of ml Total no of hours

Other factors affecting Flow Rate:

1. Gauge of the catheter 2. Viscosity of the infusate 3. Height of the IV stand 4. Condition of the veins 5. Condition of the patient