MOD 4: Medication Administration

Transcription

1 NSE22 Page 1 1. MOD 4: Medication Administration October1310 8:12 PM The CNO identifies eight rights of medication administration. Identify the eight rights and the rationale for each Right Client give medication to the right client Right Medication give the correct medication ordered by the doctor/np Right Dose dosage is appropriate for the client (child/adult) Right Time medication is given for maximum effect Right Method of application ensure medication is administered correctly Right Documentation ensure effects of medication is therapeutic Right Reason ensure medication is used for correct diagnosis Right Frequency ensure medication is used correctly 2. Name the various routes of medication administration Oral, ophthalmic, ototic, intramuscular, subcutaneous, intradermal, intravenous, sublingual, topical, rectal, vaginal, nasal, inhalation, transdermal. Oral Routes: o Given by mouth and swallowed with fluid. o Sublingual Medication placed under the tongue to dissolve; no fluid required e.g. nitroglycerine o Buccal placing medication in the mouth and against the mucous membranes of the cheek until medication dissolves Parenteral Routes: o Involves injecting a medication into body tissues o Intradermal (ID) injection into the dermis just under the epidermis o Subcutaneous (SubQ) Injection into tissues just below the dermis of the skin o Intramuscular (IM) Injection into a muscle o Intravenous (IV) Injection into a vein Skin: o Topical applied onto skin e.g. creams Inhaled: o Deeper passages of the respiratory trat provide a larger surface area for medication absorption o Drug is changed from solid to a liquid to gas e.g. inhalers for asthma or lung problems Vaginal/Rectal: o Drugs inserted into the cavity as a suppository e.g. enemas, creams, douches o Rectal preferred is pt at risk for vomiting. 3. Define the common terms used in pharmacology Absorption o Refers to passage of medication molecules into he blood from is site of administration. Its influenced by route or administration, ability of the medication to dissovlve, blood flow to the site of administration, body surface area, and lipid solubility of medication. Onset o Time it takes after a medication is administered for it to produce a response. Duration o Time during which the medication is present in concentration great enough to produce a response Peak effect o Time it take for a medication to reach its highest effective concentration Excretion o After medications are metabolized, they exit the body through the kidneys, liver, bowel, lungs and exocrine

2 NSE22 Page 2 glands. Distribution o How the medication is distributed within the body to tissues and organs and to its specific site of action. Half life o Time is takes for excretion processes to lower the serum medication concentration by half. Mechanism of action o The way the medication is suppose to act or do. Adverse Effects o Generally considered o be severe, negative responses to medication 4. Identify and describe standard medication abbreviations Q = every Bid = twice a day Tid = three times a day Qid = four times a day PC = before food AC =After food OS = Left eye OD = Right eye OU = Both eyes PO = by mouth SL = sublingually gtt = drops HS = bed time Ins = instill Stat = now Prn = when needed State the formula for performing medication calculations Desired dose/ unit dose on hand x volume on hand = amount to administer Discuss the principles of documentation related to medication administration and responses Write the name of the medication, dose, route, exact time of administration, assessment parameters (before and after), site of injections. If client refuses medications, or a dose is missed, also record Explain what is involved in recording a medication that has been; held, unavailable, refused, vomited, or wasted Held: o Record why the drug was withheld on client s chart and MAR and notify doctor Unavailable: o Notify pharmacy to request more Refused: o Record the client s refusal, document and notify the doctor Vomited: o Record that the pt aspirated after taking medication, what was observed in the vomit, document and notify doctor Waste: o Document, notify doctor Identify the major three major routes of drug elimination

3 NSE22 Page 3 Kidneys Liver Bowel 9. Identify the factors the determine the action and effects of any medication Age Infants lack many of the enzymes necessary for normal drug metabolism. A # of physiological changes accompanying the aging process influence the response to drug therapy Weight Sex People who are heavier than the average person may be able to take greater doses of a drug. Lighter people may be adversely affected by the same amount. Hormonal differences between men and women alter the metabolism of certain drugs. Hormones and drugs compete with each other in biotransformation because they are degraded by the same metabolic processes. Diurnal variation in estrogen secretion may be responsible for cyclic fluctuation in drug reaction experienced by women. Genetic factors Psychological factors When a person takes a drug, his/her psychological expectations have an influence on the effects of the drug. The emotional state of the user can also affect the reactions he/she has, especially with hallucinogens. Disease state Any disease state that impairs the function of organs that are responsible for normal pharmacokinetics also impairs drug action. Time of administration Environment If two medications are ordered at the same time, they could interact with each other and influence the action and the chemical reactions of the medication. This is why some medications are taken at intervals, which gives allowance for other medications to be taken in between those intervals of time. Also the life of the drug must also be taken into consideration when planning the time of administration. The environment in which a person takes a drug has substantial influence on its effects. The user s feelings of discomfort, the temperature, and the altitude of the surroundings can affect the drug in the body and they way a person reacts physically to the chemical Identify the components of a doctor's order for a medication Clients name Date of order Name of drug Dosage Route of administration Time of administration Frequency of medication Signature What knowledge is required prior to the administration of any medication Classification nurses must learn to categorize medications with similar characteristic by their class. Classification indicates the effect if the medication on a body system, the symptoms the medication relieves or the medication desired effect. Generic name (Acetaminophen) is the nonproprietary name given by the manufacturer who first develops the medication and is protected by law, trade name/ brand name (Tylenol ) has the symbol at the upper right of the

4 NSE22 Page 4 name indicating that the manufacturer has marked the medication name Pharmacological action the action of a drug on a receptor, or enzyme. The cellular process involved in the drug and cell interaction. (e.g. what does the medication do for the client. Does it blocks, stimulate, and increases, lower the condition). Indication for use what conditions a specific medication can be use to treat Contraindications any condition, including any current or recent drug therapy, especially related to disease states or other client characteristics that renders a particular form of treatment improper or undesirable. Interactions what other drug or medication can this one interact with safely or unsafely. The alteration of the action of one drug by another that can either increases or decrease another drug and can either be harmful or beneficial. Safe maximum dosage the largest amount of a drug or physical procedure that an adult can take with safety or can produce a therapeutic effect. Side effects undesirable effect of a medication that is expected or anticipated in a predictable percentage of clients who receive a given medication. Side effects can range from mild to severe client responses but usually resolve with completion of drug therapy. Nursing interventions/implications treatment that nurses perform in all setting to meet the needs of clients and promote better health. Base on the client conditions and what work in the best interest of that client. Teaching providing information and instruction to clients, family and care givers to maintain or improve knowledge and skills to assist client Evaluation determining whether expected outcome were met by assessing effectiveness of the medication. Client s full name, date and time order is written, medication name, dose, route of administration, time and frequency, signature of prescriber. 12. Describe the legal implications when administrating an opiod or controlled substance. Include in your discussion the responsibilities of RNs/ RPNs and student nurses; the Controlled Drug and Substances Act (CDSA) and Narcotic Control Regulations; and filling out the narcotic control sheet Responsibility of RN's, RPN s and student nurses when administering narcotic drugs: Store all narcotics in a locked, secured cabinet or container. Nurses in charge must carry a set of keys for the narcotics in the cabinet. At the changing of the shift, the nurse going off duty must count all the narcotics with the nurse coming on duty. Both nurses must sign the narcotic record to indicate that the count is correct. Discrepancies in narcotic counts are to be reported immediately. A special inventory is then recorded each time a narcotic is dispensed. The record is used to document the client's name, date, time of medication administration, name of medication, dose and signature of the nurse dispensing the medication. The form must provide an accurate ongoing count of narcotics used and remaining. If only one part of a premeasured dose of a controlled substance is given, a second nurse witnesses the disposal of the unused portion and documents such on the record form (Perry and Potter, 2001 p. 888). The nurse is responsible for following legal provisions when administrating controlled substances (drugs that affect the mind and behaviour), which can be dispensed only with a prescription. Violations of the Narcotic Control Act are punishable by fines, imprisonment, and loss of nurse licensure or registration. See pg. 836 (Box 301) for narcotics guidelines. The Controlled Drug and Substances Act (CDSA) was passed in 1997, replacing the Narcotic Control Act and parts III and IV of the Food and Drugs Act. The regulations that address the possession, sale, manufacture, disposal, production, import, export, and distribution of certain drugs, their precursors, and other substances classified as controlled are covered in the CDSA. Interestingly, not all possession and use of illicit drugs is prohibited. For example, the regulations of the CDSA allow the use of methadone, heroin, and marijuana for medical purposes.

5 NSE22 Page 5 The first Narcotic Control Act, passed in 1961, was enacted in response to the growing use and misuse of drugs in the middle and late 1960s. It replaced the previous act, the Canadian Opium and Narcotic Act of The Narcotic Control Act and parts III and IV of the Food and Drugs Act prohibited activities such as possession; possession for the purpose of trafficking; trafficking; importing and exporting; and cultivation of narcotics, controlled, and restricted drugs.