ppt chapter002

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 02-Administration of Drugs


IntroductionIntroduction

• Drug administration

• Understand basic concepts

• Nurse’s role:

– Monitor the therapeutic response

– Report adverse reactions

– Teach the patient and family members


The Five +1 Rights of Drug AdministrationThe Five +1 Rights of Drug Administration

• Right patient: Check patient’s wristband; ask patient to identify himself

• Right drug: Compare medication; container label; medication record

• Right dose

• Right route : Obtain written order

• Right time

• Right documentation: Record immediately


Considerations in Drug Administrations Considerations in Drug Administrations

• General principles of drug administration

– Factual knowledge of each drug given: Reasons for use; general action; common adverse reactions; special precautions in administration; normal dose ranges

– Check current and approved references for all drug information

– Consider before administering a drug: Patient’s allergy history; previous adverse reactions; patient comments; change in patient condition


Considerations in Drug Administrations (cont’d) Considerations in Drug Administrations (cont’d)

• The medication order: To administer medication a physician’s order is essential

– Common orders: Standing; single; PRN; STAT

• Once-a-Week drug: Doses designed to replace daily doses of drugs; beneficial for those experiencing mild adverse reactions

– Example: Alendronate (Fosamax) - Treat osteoporosis


Considerations in Drug Administrations (cont’d)Considerations in Drug Administrations (cont’d)

• Guidelines for preparing a drug for administration

– Check health care provider’s written orders and compare label of the drug with MAR

– Wash hands and do not let hands touch capsules or tablets


Considerations in Drug Administrations (cont’d)Considerations in Drug Administrations (cont’d)• Guidelines for preparing a drug for

administration (cont’d)

– Never remove a drug from: An unlabeled container; a package with an illegible label

– Never crush tablets or open capsules or administer a drug prepared by someone else

– Alert: Drugs with similar names



• Guidelines for preparing a drug for administration (cont’d)

– Return drugs requiring special storage to the storage area immediately after they are prepared for administration

– Unit dose: Remove wrappings when the drug reaches the patient; chart immediately after administering the drug


Considerations in Drug Administrations (cont’d)Considerations in Drug Administrations (cont’d)• Each time a drug is prepared and

administered: Follow the 5+1 rights

• Precautions taken by the nurse: Confirm any questionable orders; verify calculations with another nurse; listen to the patient; concentrate on only one task at a time

• Most common occurrence of errors: Insulin and heparin


Considerations in Drug Administrations (cont’d)Considerations in Drug Administrations (cont’d)• Drug Errors - patient receives:

– The wrong dose

– The wrong drug

– An incorrect dosage of the drug

– A drug by the wrong route

– A drug given at the incorrect time

• Nurses: Last defense against detecting drug errors; if error occurs, report immediately



• National Patient Safety Goals

-Accrediting body for hospitals: JCAHO

-Approve National Patient Safety Goals yearly

• Institute for Safe Medication Practices

-Medication Errors Reporting Program



• Drug dispensing system

– Computerized Dispensing System

– Unit Dose System

– Bar Code Scanner


Administration of Drugs by Oral RouteAdministration of Drugs by Oral Route

• Most frequent route of drug administration

• Oral Drug Forms: Tablets; capsules; liquids

• Sustained-release drugs

• Nursing responsibilities: Verify the drug; identify the patient; assess; keep water readily available; instruct; never leave a drug at the patient’s bedside to be taken later


Administration of Drugs by Parenteral RouteAdministration of Drugs by Parenteral Route

• Parenteral drug administration routes: Subcutaneous (SC); intramuscular (IM); intravenous (IV); intradermal route; intralesional; intra-arterial; intracardiac; intra-articular

• Nursing responsibilities: Wear gloves; use standard precautions; cleanse skin


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Administration of drugs by subcutaneous

route: Places the drug into the tissues between the skin and the muscle

• Nursing responsibilities:

– Volume of injection: Single/multiple sites

– SC injection sites: Upper arms; upper abdomen; upper back

– Needle length and angle of insertion: Obese/thin patients


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Administration of drugs by intramuscular

route: Administration into a muscle

• Nursing responsibilities: 22-gauge needle

– Volume of injection: Single/multiple sites

– Injection sites, needle length and angle of insertion: Deltoid muscle; ventrogluteal or dorsogluteal sites; vastus lateralis

• Z-Track technique: Prevents backflow of drug into the SC tissue


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Drug administration- intravenous route: Directly

into blood; needle inserted into a vein

• Methods of administration: Slow; rapid; piggyback infusions; existing IV line; using intermittent venous access device; added to an IV solution; venipuncture

• Intravenous infusion controllers, pumps: Detectors, alarms alert the nurse

– Possible problems: Air in line; occlusion; low battery; completion of infusion; inability to deliver preset rate


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Administration of drugs by intravenous route

(cont’d)


– Record type of IV fluid and drug added to the IV solution after start of infusion; check infusion rate and inspect needle site

– Swelling around the needle: Extravasation or infiltration


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Drug administration- intradermal route:

Sensitivity tests - Tuberculin; skin allergy


– Injection sites: Inner part of forearm; upper back; hairless; avoid areas near moles, scars, or pigmented skin

– 1-mL syringe; 25- to 27-gauge needle; 1⁄4 to 5⁄8 inch

– Needle insertion: 15-degree angle; do not aspirate syringe or massage the area


Administration of Drugs by Parenteral Route (cont’d)Administration of Drugs by Parenteral Route (cont’d)• Other parenteral routes of drug

administration: Intracardial; intralesional; intra-arterial; intra-articular


– Prepare drug for administration; Ask primary care provider

– Venous access ports: For chemotherapy or long-term therapy


Administration of Drugs Through the Skin and Mucous MembranesAdministration of Drugs Through the Skin and Mucous Membranes• Application to the skin and mucous

membranes

• Several routes

– Topical

– Transdermal

– Inhaled through the membranes of the upper respiratory tract


Administration of Drugs Through the Skin and Mucous Membranes (cont’d)Administration of Drugs Through the Skin and Mucous Membranes (cont’d)• Administration of drugs by the topical route

– Act on the skin; not absorbed through the skin


– Follow special instructions: Drug action may depend on correct administration of the drug


Administration of Drugs Through the Skin and Mucous Membranes (cont’d)Administration of Drugs Through the Skin and Mucous Membranes (cont’d)• Administration of drugs by the transdermal

route

– Readily absorbed from the skin

– Drug dosages: Implanted in a small patch-type bandage

– Drug system maintains: Constant blood concentration; reduces the possibility of toxicity


Administration of Drugs Through the Skin and Mucous Membranes (cont’d)Administration of Drugs Through the Skin and Mucous Membranes (cont’d)• Administration of drugs by the transdermal

route (cont’d)


– Wear gloves; apply patch on clean, dry, nonhairy areas of intact skin; apply next dose to new site: Remove old patch

– Commonly used sites: Chest, flank, and upper arm


Administration of Drugs Through the Skin and Mucous Membranes (cont’d)Administration of Drugs Through the Skin and Mucous Membranes (cont’d)• Administration of drugs through inhalation

– Drug droplets, vapor, or gas: Through mucous membranes of the respiratory tract

– Use face mask, nebulizer, or positive-pressure breathing machine


– Provide proper instructions


Nursing Responsibilities after Drug AdministrationNursing Responsibilities after Drug Administration• Record: Administration of the drug; IV flow

rate, site used for parenteral administration; problems with administration; vital signs taken immediately before administration

• Evaluate and record: Patient’s response to the drug

• Observe and record: Adverse reactions and frequency


Administration of Drugs in the HomeAdministration of Drugs in the Home• Home setting caregivers: Patient or family

members

• Ensure: Patient or caregiver understands the treatment regimen

• Home care checklist: For administering drugs safely in the home


End of Presentation

ppt chapter002

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