nur 51/45a non-parenteral medication administration charlene gagliardi, rn, msn
TRANSCRIPT
NUR 51/45A
Non-Parenteral Medication Administration
Charlene Gagliardi, RN, MSN
Drug Names
Generic or Nonproprietary Name
• Name assigned when a drug is first manufactured
i.e. acetaminophenTrade Name, Brand Name, or Proprietary Name
• Copyrighted name given by manufacturer of medication
• Medication may have several trade names
i.e. Tylenol
Four Parts of Pharmacokinetics
Absorption
• Transference of blood molecules from the point of entry in the body into the bloodstream
Distribution
• Begins with absorption of the drug into the circulation and ends when the drug arrives at its site of action
Four Parts of Pharmacokinetics
Metabolism• Process of inactivating and breaking
down a medication
Excretion • Movement of a drug from its site of
metabolism back into circulation and its transport to the site of exit from the body
Drug Actions
• Idiosyncratic Responses
• Drug Tolerance
• Drug Interactions
• Therapeutic Effect
• Side Effects
• Adverse Effects
• Allergic Responses
Adverse Drug Effects
Components of a Medication Order
• Date and Time of Order
• Medication Name
• Dose of Medication
• Route of Administration
• Frequency of Administration
• Signature of Prescriber
Types of Medication Orders
• Standing Orders
• PRN Orders
• Single Orders
• STAT Orders
Routes of Administration
• Oral: given by mouth – Oral (PO) – Sublingual– Buccal
• Parenteral: given by injection– Intradermal (ID)– Subcutaneous (SC or SQ) – Intramuscular (IM)– Intravenous (IV)
Routes of Administration
• Topical Route: given directly to a body site
• Inhalation: given into the respiratory tract via the nose or throat
• Rectal or vaginal – suppository/cream
• Nasogastric / G-Tube / J-Tube
Comparison of Onset, Peak and Duration of an Oral & IV Drug
Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
Pyxis Medication cart
It is vitally important for the nurse to elicit information about known drug and food allergies before the patient receives a medication for the first time.
The Six Rights of Medication Administration
• Right Drug
• Right Dose
• Right Patient
• Right Route
• Right Time
• Right Documentation
Assessment
• Medical history• History of allergies• Medication data• Diet history• Perceptual or
coordination problems• Current condition
Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
Prevention of Medication Errors
• Know agency policies and procedures• Question over 3 tablets • Be aware of drugs with similar names• Check you math; check the decimal point• Question abrupt/ excessive > or < in dose• Don’t guess with illegible handwriting• Always check orders against the MAR • Know pt’s history and allergies (food/drug)
Prevention of Medication Errors
• Know your medications – never give a med that you are unfamiliar with
• Do all necessary pt assessments – VS, labs. etc.• Always perform the six rights• Do your patient teaching with all meds• Do not leave medications at the bedside• Always administer NG or GT meds one at a time
with a water flush before, between and after• Report any med errors
Assessment of Apical Pulse
Procedure
• Perform all checks and assessments
• Have water, cups, straws at bedside
• Wash hands
• Using MAR, remove meds in order, checking med name, dose, expiration date
• Keep meds in unit dose packaging and place in med cups
• Take MAR and meds to pt room
Comparison to MAR
Procedure
• Perform all ID checks• Assist pt to comfortable position• Pt teaching with each med administered• Remove meds from packaging one at a time• Make sure pt swallows the medication• Reposition patient / discard trash• Document
Nursing Diagnoses
• Deficient knowledge (medications)
• Noncompliance (medications)
• Disturbed sensory perception
• Impaired swallowing
• Ineffective therapeutic regimen management
Planning
• Goals and outcomes– Example:
Patient will verbalize therapeutic and adverse effects of medications
• Setting priorities
• Continuity of care
Implementation
• Patient and family teaching
• Medication orders: receipt, transcription, communication
• Calculation and measurement
• Correct administration technique
• Recording
Evaluation
• Patient response to medications
• Patient and family ability to administer medications
Oral Administration
• Presence of GI alterations
• Ability to swallow• Use of gastric suction• Positioning
Solid Oral Medications
Scored Tablet
Enteric Coated/Extended Release
Pouring Liquid Medications
Sublingual Placement
Buccal Administration
NG/G Tube Medications
• Make sure the medications can be crushed or are in liquid form
• Check for proper placement of NG tube prior to giving meds and check for residual for all tubes
• Each medication is administered separately by gravity syringe method followed by a small water flush
• Water flush at the end of administration of medication
Individual Preparation of NG/G Tube Medications
Checking Residual before NG/G Tube Medications
Gravity Administration of NG/G Tube Medications
Topical Administration
• Skin applications– Use of gloves or applicators– Preparation of skin– Thickness of application
Transdermal Patch
Nitroglycerine Ointment
Medicated Cream
Medicated Cream
Nasal Instillation
• Assessment of nares
• Patient instruction and self-administration
• Positioning
Nasal Medications
Application of Nose Drops
Nasal Spray
Eye Instillation
• Drops, ointments, disks
• Assessment of eyes
• Asepsis
• Positioning
Eye Drops
Applying Pressure to Prevent Systemic Absorption
Applying Eye Ointment
Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children and adults
• Positioning
Ear Drops
Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Patient positioning, comfort, and hygiene
Vaginal Creams/Suppositories
Angle of Insertion for Vaginal Medications
Rectal Instillation
• Suppositories
• Use of gloves
• Patient positioning, comfort, and hygiene
Always Use Water Soluble Lubricant
Insertion of a Rectal Suppository
Inhalation
• Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
• Patient assessment and instruction
• Use of spacer
• Determination of doses in canister
Types of Inhalers
Using a Metered Dose Inhaler
Irrigation
• Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic)
• Asepsis
Reading a Drug Label
Medication Math
• Metric System - - mL, L, gram• Apothecary System – grain, minim, dram, ounce,
pint, quart, gallon, pound• Apothecary metric conversion - clock• Household – tsp, tbsp, ounce, pint, qt, gallon• Solutions - %, 1:100 vs. 1:10• Converting Measurement Units• Dosage Calculation Formulas
Calculation Formulas
• Ratio / Proportion: shows relationship between two ratio’s – The order is for 10 mg and we have 8 mg per mL.
8 mg/ 1 mL = 10 mg / X mL 8X=10
X=10/8 X = 1.25 mL
Calculation Formulas
• D/H X Q (Dose, Have, Quantity)• Dose ordered 10 mg; have 5 mg per ml
10/5 X 1 = 2 mL
• Solid medication – Q is always one
• Liquid medication – Q will vary. If there is 5 mg in 10 mL, the Q is 10
10/5 X 10 = 20 mL
Drug Measure Rules
• Use Arabic
• Fractions most often stated as decimals
• Use zero rules!!!
• Space goes between number and unit of measurement i.e. 1 mg
• Symbol follows the number with the exception of gr, oz and dr
• Use correct abbreviations