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MEDICATION ADMINISTRATION Chapter 35. 6 Rights of Medication. Right Patient Right Drug Right Dose Right Route Right Time Right Documentation – if it wasn’t documented, it wasn’t done #7 -THE RIGHT To REFUSE. The RIGHT Medication. As the physician prescribed? Trade name or generic?
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MEDICATION ADMINISTRATIONChapter 35 NRS105 2011
6 Rights of Medication • Right Patient • Right Drug • Right Dose • Right Route • Right Time • Right Documentation – if it wasn’t documented, it wasn’t done • #7 -THE RIGHT To REFUSE NRS105 2011
The RIGHT Medication • As the physician prescribed? • Trade name or generic? • Does the drug match the MAR (medication administration record)? • Is the drug appropriate for the patient? • Does it make sense? NRS105 2011
The RIGHT Dose • Does the dose of medication in your hand agree with the dose on the MAR? • Are the mg, mcg, mL the same? • Is your math correct? • Double check!! NRS105 2011
The RIGHT Patient • Have you checked using two patient identifiers? • Patient states…..verifies DOB • Patient armband – compare to information on MAR • What if there is no arm band? NRS105 2011
The RIGHT Time • AM or PM • Q4 • Tid • Bid • Qid • Qd • HS NRS105 2011
The RIGHT Route • PO • IV • SC (SQ) • TRANSDERMAL • RECTAL • IM • Does it make sense? NRS105 2011
RIGHT Documentation 8/27/2014 NRS 105.320 W2009 8 NRS105 2011
MOD – Medication on Demand • The Radio Frequency Identification (RFID) based wrist band • The first of its kind to be implemented successfully • Assists nurses by automating the process of administering patient medication NRS105 2011
PO – Per Os/ by mouth SL – Sublingual Buccal Inhaled Intranasal AD/AS/AU - Ears OD/OS/OU –Intraocular [eyes] Topical - Skin IO - intraosseous PR – per rectum Vaginal IM - Intramuscular IV – Intravenous SC - Subcutaneous ROUTES OF ADMINISTRATION NRS105 2011
SYSTEMS OF MEDICATION MEASUREMENT METRIC SYSTEM ml, mg, mcg, gm HOUSEHOLD MEASUREMENTS Tsp, gtts APOTHECARY Drams, grains Know conversions/ carry table NRS105 2011
ORAL ADMINISTRATION OF MEDICATION • SOLID FORMS • CAPLET • CAPSULE • TABLET • GELCAP • ENTERIC COATED NRS105 2011
ORAL ADMINISTRATION OF MEDICATION • LIQUID FORMS • ELIXIR • CONTAINS ALCOHOL EITHER AS INGREDIANT OR FLAVORING • EXTRACT • SEPARATE FROM BASE INGREDIENT • (VANILLA EXTRACT) • AQUEOUS SOLUTION/ SUSPENSION • PARTICLES MIXED WITH BUT NOT DISSOLVED IN WATER • SYRUP • MIXED WITH SUGAR AND WATER • TINCTURE • MEDICINE IN ALCOHOL BASE NRS105 2011
ORAL ADMINISTRATION OF MEDICATION • OTHER ORAL FORMS • TROCHE / LOZENGE • NOT MEANT TO BE SWALLOWED • AEROSOL • TOPICAL • SUSTAINED RELEASE NRS105 2011
ORAL ADMINISTRATION NRS105 2011
BUCCAL ADMINISTRATION OF MEDICATION • BETWEEN THE CHEEK AND GUMS • TABLET • SEMI-SOLID • PASTE • THICK LIQUID NRS105 2011
SUBLINGUAL NRS105 2011
TOPICAL APPLICATION • SPRAYS • ORAL • TOPICAL • NASAL • INHALED • Creams/ Ointments • VAGINAL/RECTAL • SUPPOSITORIES • EAR DROPS • POSITION EAR • EYE DROPS NRS105 2011
PARENTERAL ADMINISTRATION INTRAMUSCULAR IM SUBCUTANEOUS SC INTRADERMAL [like TB test] INTRAVENOUS IV INTRAOSEOUS IO EPIDURAL INTRATHECAL (SUBARACHNOID SPACE) INTRAPERITONEAL INTRAPLEURAL INTRARTERIAL INTRARTICULAR [in a joint] NRS105 2011
INTRAMUSCULAR • PAIN MEDICATION • ANTIBIOTICS • VACCINATIONS • SUPPLEMENTS • IRON • B12 NRS105 2011
IM Injection Sites Ventrogluteal NRS105 2011
Vastus Lateralis NRS105 2011
Deltoid Injection NRS 105.320 W2009 NRS105 2011
INJECTION ANGLES NRS105 2011
Subcutaneous injection NRS105 2011
Sub Q administration sites NRS105 2011
Intradermal Injection NRS105 2011
Syringes – NOT interchangeable NRS105 2011
Sizes of Needles • Length 3/8” to 3” • Gauge 30 – 19 • 20-22G, 1-1.5” for IM • 25-30G, 3/8-1/2” for SQ NRS105 2011
Nursing Roles • Legal and Ethical implications • Know your meds • Pharmacokinetics: • Because food, other drugs, disease, age affect absorption, distribution, metabolism, excretion • Actions • Interactions • Routes • Measurement and Calculation, conversions • Documentation NRS105 2011
Responsibilities • Prescribe – APN • Correct drug and dose [range] • Effects and implications • Why med is ordered for pt • Monitor effects – intended and other • Reactions • Education NRS105 2011
Critical Thinking • Knowledge: understand why you are giving a med; if you don’t know, look it up • Experience: skills become more refined • Attitudes: take adequate time to prepare and administer • Standards: ensure safe practice • 6 Rights NRS105 2011
Components of Medication Orders • Client’s full name • Date and time that the order is written • Medication name • Dose • Route • Time and frequency of administration • PRN orders must have a reason • Signature NRS105 2011
Test Your Knowledge • The nurse is transcribing the physician’s orders for the newly admitted client’s medications. For which of the following orders would the nurse need clarification prior to administering the medication? A) Digoxin 0.125 mg po daily B) Lasix 40 mg. po bid C) Tylenol 650 mg. po PRN D) Lipitor 20 mg. po at bedtime NRS105 2011
Types of Medication Action NRS105 2011
Medication Interactions • Occur when one medication modifies the action of another • A synergistic effect occurs when the combined effect of two medications is greater than the effect of the medications given separately. • Can be beneficial: Tylenol and Codeine • ETOH and antihistimines, antidepressants, or narcotics (all CNS depressants) • HTN may be treated with diuretic and vasodilator NRS105 2011
Medication Dose Responses NRS105 2011
Effects of Nutrition on Drugs NRS105 2011
Systems of Medication Measurement Requires the ability to compute medication doses accurately and correctly Metric system: organized in units of 10 Apothecaries: older than metric Household system: least accurate Solution NRS105 2011
Insulin Preparation • Rapid, short, intermediate, and long acting • Know onset, peak and duration (see page 743) • ONLY regular insulin can be given IV • Sliding scale based on blood glucose • Gently roll cloudy • DO NOT SHAKE • Prepare last and administer first if mixed because regular can become “contaminated” and action can be affected • CLEAR to CLOUDY NRS105 2011
Drug Calculations Dose Ordered X amount = amount to dose on hand on hand administer • Look at order + available concentration • Ballpark estimate • Calculate – paper + calculator • Check math, compare to estimate Convert to same units [mcg, mg] NRS105 2011
Examples • Order: Digoxin 12.5mg PO daily • On hand: 25 mg tablets • Change to same units if needed [mg= mg] • Put in formula: 12.5 X 1 tab = ? 25 amount to give • Estimate: 12.5 is about ½ of 25 • Solve: ½ X 1 = ½ tab • Check estimate – ½ = ½ NRS105 2011
Wait! • You’re not done yet: • Nursing implications for Digoxin: • Assess and record apical HR and B/P • Hold for systolic B/P < 90, HR <60 • Know WHY • Know action of Digoxin • Document HR, B/P, dose given or held, time NRS105 2011
Example 2 • Order: APAP gtts 5mg/kg q 4° PO fever/pain • Available: 80mg/0.8ml [= 100mg/1ml] • Wt is 3 kg • 5 mg X 3 kg = 15 mg dose • Estimate: 100 mg in 1 ml, dose is 15 mg; will be very small dose - < 1 ml NRS105 2011
Solve 15ml [ordered] X 1ml = ? amount 100mg [on hand] to give 15mg/100mg X 1 ml = 0.15ml Check – close to estimate? [if I mess up my math and get 1.5 ml, estimate will catch me] Administer and document NRS105 2011
PRACTICE • You CANNOT Practice medication calculations too much • KEY skill for success in school & practice • PRACTICE, PRACTICE, PRACTICE • Know conversions, abbreviations NRS105 2011
