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Medication Administration

Medication Administration. Part 1 Keith Rischer, RN, MA, CEN, CCRN. Today’s Objectives. State the primary use and nursing implications for drugs in each major classification Describe the characteristics of any drug that the nurse is responsible for administering

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Medication Administration

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  1. Medication Administration Part 1 Keith Rischer, RN, MA, CEN, CCRN

  2. Today’s Objectives • State the primary use and nursing implications for drugs in each major classification • Describe the characteristics of any drug that the nurse is responsible for administering • Onset, peak, duration and half-life • Mechanism of action>SE>Nsg Implications • Calculate fractional dosages of drugs • Using drug reference text correctly fill out clinical paperwork related to medication administration

  3. Nurse’s Responsibility • How many patients die each year because of medication errors in US hospitals? • 500 • 5000 • 7000 • 25,000 • How many patients are injured as a result of medication errors annually? • 100,000 • 500,000 • 1,000,000 • 1,500,000

  4. Pharmacological Concepts Drug Names Chemical name – name of a drug as the chemist knows it. Describes the constituents of the drug Ex: N-acetyl-para-aminophenol (Tylenol) 2-(acetyloxy)benzoic acid. (Aspirin)

  5. Pharmacological Concepts Drug names Generic names Name given to a drug before it becomes official. Name is often listed in the USP as the official name Ex: Furosemide, Acetaminophen, Atorvastatin Brand name Trademark or name given by drug manufacturer. More that one manufacturer may make the same drug EX: Lasix, Tylenol, Lipitor

  6. Reading Medication Labels

  7. Nursing implications • Implications related to administration and assessment/monitoring • RN responsible for • V/S • Timing with meals • Labs • I&O • Dilute? Crush?

  8. Classifications/Nursing Implications • Anti-hypertensive • Beta Blockers • Atenolol • Metoprolol • Propranolol • Calcium channel blockers • Diltiazem • Nifedipine • ACE Inhibitors • Captopril • Enalapril • Lisinopril • Diuretics • Loop of Henle (Furosemide) • Distal tubule-(Hydrochlorothiazide-HCTZ)

  9. Classifications/Nursing Implications Analgesics Mild-NSAIDS Tylenol, Ibuprofen, Aspirin Moderate-Opiod Narcotics po Tylenol #3, Vicodin, Percocet Severe-Opiod Narcotics IV Morphine, Dilaudid, Fentanyl Anti-bacterial Penicillins Amoxicillin Cephalosporins Keflex Sulfa Bactrim DS

  10. Classifications/Nursing Implications • Anti-inflammatory • NSAIDS • Prednisone • Anti-coagulant • Heparin • Coumadin • Anti-platelet • Aspirin • Plavix • Laxative • Sennakot, Metamucil

  11. Routes of Administration • Oral • Capsules/tablets • Syrup/solution • Inhalation • Rectal • suppository • Topical • Patch • ointment • Parenteral • IV (intravenous) • Sub-q (sub-cutaneous) • IM (intra-muscular) • ID (intra-dermal)

  12. Medication Administration • Oral • 60-100 mL of fluid • Contraindications • NPO • GI • CVA • Prevent aspiration (Table 35-16 p.717 P&P)

  13. Medication Administration • Topical • Remove old patch before applying new • Date and time new patch • Use gloves • Make sure skin is clean and dry • Examples: • Fentanyl • Nitroglycerin • Nicoderm

  14. Medication Administration • Nasal • Eye • Ear

  15. Medication Administration • Inhalers • Albuterol/Advair • Spacer • Vaginal • Rectal

  16. Types of Medication Action • Therapeutic/Mechanism of action • Side effects • Adverse reactions • Allergic reactions • Idiosyncratic reactions • Toxic effects • Amiodarone • Tolerance • Opiate narcotics

  17. Time/Action Profile • Onset • Peak • Duration • Trough • Serum Half life • Morphine IV • Vicodin po

  18. Interpreting Drug Orders • Abbreviations - Pickar • “Do not use” of abbreviations list – Pickar • MS 2 mg IV q4 hours p.r.n for pain • Lantus insulin 20u qd • Maalox 15cc q6 hours prn

  19. Formula Method D X Q = X H Desired X Quantity = Amount Have

  20. Formula Method Heparin subq order for 12,000u due. This injection comes in a vial of 20,000u/cc. What will be the amount you will administer? Dilaudid 0.25mg IV for pain. The pharmacy dispenses a carpuject/vial of Dilaudid 1mg/cc. What is the amount you will administer? Solumedrol 25mg IV. It is dispensed as a 40mg/cc vial. What is the amount you will administer? Plavix 300mg to be given now. It only comes in 75mg tablets. How many tabs will you administer to give the correct dose?

  21. This is your patient… • MB, 75 yo, admitted to the step down unit with exacerbation of heart failure. She complained of SOB, 3+ pitting edema in lower legs and a weight gain of 8 lbs in 3 days. Her K+ was 3.4 mEq/L in the ED. • Furosemide 40mg IV was given in the ED with 800cc urine out • P-96 R-32-BP 160/90 initially in ED • P-86-R-24 BP 122/78 after Lasix • Physician has ordered: • KCL 30 mEqpo bid • Pharmacy has dispensed KCL 20 meq/15cc elixir unit dose tubs x2. What will be the amount (cc) you will administer?

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