Medication Administration

By: Diana Blum MSN

NURS 1510

History

• Definition: Substance administered for diagnosis, cure, treatment, or relief of a symptom or for prevention of disease.

• Opium, castor oil, vinegar used in ancient times

Names

• Generic– Given before drug officially approved

• Official– Name under which it is listed in publications

• Brand/TRADE– Given my manufacturer– Several names if several manufacturers

• Chemical– Name by which the chemists know it

Legal Aspects

• U.S. drug legislation• Sets official drug standards• Defines prescription drugs• Regulates controlled

substances• Improves safety• Requires proof of efficacy

• Nurse Practice Acts• Identify nursing

responsibilities for administration and client monitoring

Standards

• Vary in strengths and activities• Controlled by law• NURSES can be punished if error made• Controlled substances locked up in hospital

Effects of Drugs

• Therapeutic/Desired: what is intended or reason it was prescribed

• SE: secondary effect: effect that is not intended– May be harmful or harmless

• Adverse Effects: more serious side effects or a reaction to the drug

• Drug toxicity: related to overdose, ingestion when meant to be external in use, or build up in blood.

• Allergic Reaction: immune response to drug• Anaphylactic Reaction: severe allergy to drug that

could become fatal

Tolerance

• Person requires increase dose to maintain effectiveness (opiates, tobacco, etc)

• Cumulative effect: increased response to repeated doses. Toxic symptoms may occur.

• Idiosyncratic effect: unexpected result. Under response or over response

• Interaction: response to 2 drugs at once

Drug Misuse

• Improper use of common meds• Abuse: inappropriate intake of drug• Dependence: reliance of a drug may be physiologic

or psychologic

• Habituation: feels better after taking drug• Illicit: street drug

Actions of Drugs on the Body

• Half life: the time it takes for half of the drug to be excreted from the body

• If you don’t receive steady amount of the drug it concentration decreases.

• Onset of action: time it takes for the body to respond to drug

• Peak plasma level: the highest level achieved by a single dose

• Plateau: maintained level during a series of scheduled doses

• Agonist acts to respond to a substance• Antagonist acts to inhibit a response to a substance

Pharmacokinetics

• Process by which drug is excreted absorbed distributed or biotransformed.

• Absorption: process of passing in the blood stream• Distribution: transportation from site of absorption to

site of action.• Biotransformation: process that converts the drug to

a less active form by way of a detox or metabolism• Excretion: leaves the body

Factors that affect med action

• Developmental factors• Gender• Genetics/culture• Diet• Environment• Psychologic • Illness/disease• Time of administration

Stock Supply:

• Bulk quantity

• Central location

• Not client-specific

Unit Dose:

• Individually packaged

• Client-specific drawers

• 24-hour supply

Medication Systems

Automated Dispenser:• Password-accessible locked cart• Computerized tracking• Can combine stock and unit doses

Self-Administration:• Individual containers• Kept at client’s bedside

Medication Systems

Orders

• Types– STAT– Standing– PRN– Single

• Parts of the Order– Name– Date and time– Name of drug– Dose– Frequency– Route– why– signature

• TORB• VORB• Handwritten• preprinted

Three checks:

• Before you pour:• Check the medication label against the MAR

• After you pour:• Verify the label against the MAR

• At the bedside:• Check the medication again

Nursing Considerations: Medication Administration Safety

Six Rights:• Right drug• Right client• Right dose• Right time• Right route• Right documentation

Other Rights:• Right reason• Right to know• Right to refuse

Nursing Considerations: Medication Administration Safety

Routes

• PO• SL• Buccal• Parenteral: SQ, IM, IV, intrdermal• Topical

Equipment Preparation:

• Syringe/needle (size, gauge)

Medication Preparation:

• Vials and ampules• Reconstituting from powder• Two medications in one syringe• Never recap dirty needle

• Use the correct site• Wrong site could mean wrong route

• Be familiar with the technique required for the medication (e.g., heparin, insulin)

Parenteral Medication Administration

• Use the six rights

• Calculate doses carefully; double-check with a second RN

• Watch for drugs with similar names

• Watch for clients with same last names• Clarify illegible orders

• Know and use your resources

• Keep up with changes in medication orders

Avoiding Medication Errors

•Conversions

Systems of measurement

Metric

Ordered by units of 10

Decimal system

Liter and gram are basic units

kilogram

milligram

microgram

milliliter

Apothecaries

• Older than metric• Grain• Minum• Pound• Pints• quarts

Household

• Drops• Teaspoons• Tablespoons• Cups• Glasses

Metric: decimal system, most logically organized.

Each unit is organized into units of 10. In X the decimal moves to the “R”; in division it moves “L”

Basic measurement=meter(L), liter(volume), gram(weight)

Equivalents of Measurements

• Basic units:– Deci 1/10 or 0.1– Centi 1/100 or 0.01– Milli 1/1000 or 0.001

• 500mg or 0.5g, not 1/2g• 10ml or 0.01L, not 1/100L

– With fractions the zero is always place in front of the decimal to prevent error

• In metric system, division or multiplication are used, ie, to change mg to g. divide by 1000 or move the decimal 3 points to the left

• To convert liters to ml, multiply by 1000 or move the decimal 3 points to the right

Conversion in One System

• To convert units of measurement within the apothecary or household system, must know the equivalent.

• Example: To convert ounces to quarts must know 32 oz is = to 1 quart

• To convert 8 oz to a quart measurement, divide 8 by 32 to get the equivalent, ¼ or 0.25 quart

• When looking at a medication order, ask yourself 3 questions:

What did the MD order? (desired quantity)

What do I have on hand? (dose available)

What conversion factor (conversion

do I need? factor)

Setting Up the Calculations

• The desired quantity is the MD order, (10mg, v gr)• The dose available is found on the drug label,

(tablet, number of capsules, ml)• *Remember, the quantity of tablets, capsules, or ml

is always the numerator of the dose available; the amount (or dosage) is in the denominator

• To decide which equivalent measure should be in the numerator and which should be in the denominator, look at the units of measure in the desired quantity.

• The units of measure in the desired quantity should be in the denominator of the conversion factor (i.e.,if the desired quantity is 100 mg and the equivalent conversion factor is 1000 mg = 1 g, then the conversion factor in fraction form should be 1 g / 1000mg

Desired quantity x Dose available X Conversion (if factor needed) = Amount to Administer

This is a simple formula that uses ratio and proportions which will help you both correctly set up and solve dosage calculation problems

Formula

• MD order: ASA 300 mg q4h prn pain• Drug label: ASA 1 tab = v gr • Conversion factor: 1 gr = 60 mg

• 5gr x 1 tab x 60 mg = x• 300mg 1 gr

• 5 x 1 tab x 60 = 300 tab = x• 300 300

• 300 tab = x• 300• x = 1 tab

continued

• Another basic formula that can be used when preparing solid or liquid forms:

Desire dose X Amt on hand = Amt to give

dose Have

Demerol 50 mg ordered comes in 100 mg vial in I cc

More Formulas

• Amount in cc’s X drip factor = gtt/min• time in minutes

Rate of infusions

• 1 gram (G) = 1000 milligrams (mg)• 1000 micrograms (mcg) = 1 mg• 60-65 mg = 1 grain (gr)• 1 fluid ounce = 30 ml or 2 tablespoons• 1 teaspoon = 5 ml• 1000 ml = 1 quart or 1 liter• 1 kg = 2.2 pounds (lb)• 1 inch = 2.54 cm• 1 mL=15 gtts• 30mL=1 ounce• 1 tbsp= 15mL

Conversions to know