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Medication Administration (Definitions (ampule - glass flask containing a…

- - - - a^- = before
      - ad lib = as desired
      - noc = night
      - NPO = nothing by mouth
      - p^- = after
      - PRN = as needed
      - BID = twice a day
      - q = every
      - wa = while awake
  - - - Label on medication container is checked 3 times:
      - When you reach for container
      - Before pouring
      - Upon replacing container or at bedside
    - - Right Patient
      - Right Dosage
      - Right Route
      - Right Medication
      - Right Time
      - Right Reason
      - Right Assessment Data
      - Right Documentation
      - Right Response
      - Right to education
      - Right to refuse
  - - - usually the form determines the route of administration, available for oral, topical, and parenteral
      - capsule - powder or gell form of an active drug enclosed in gelatinous container (AKA liquigel)
      - elixir - medication in a clear liquid containing water, alcohol, sweeteners, and flavor
      - Pill - mixture of a powdered drug with a cohesive material (round or oval)
      - Enteric coated - tablet or pill coated to prevent stomach irritation
      - Extended release - preparation of a medication that allows for slow anf continuous release (Controlled Release CR, Sustained/Slow Release SR, Sustained Action SA, Long Acting LA, or Timed Release TR
      - Lotion/Ointment - drug or particles in solution/semisolid preparation for topical use
      - Lozenge - small oval, round, or oblong preparation containing a drug in a flavored or sweet base that dissolves in the mouth and release meds
      - Powder - single or mixture of finely ground dugs
      - Tablet - small, solid dose of meds compressed or molded; elongated/oval and often coated
      - Transdermal patch - unit dose of meds applied directly to skin for diffusion through skin and absorption into the bloodstream
    - - based on abuse potential and likelihood of causing dependency
      - Schedule 1 - highest potential for abuse
        
        research purposes only, no accepted medical treatment or prescriptions allowed
        
        Heroin, LSD, ecstasy
      - Schedule 2 - high potential
        
        Must be a written prescription, label required to say "Federal law prohibits use by any person other than patient"
        
        Morphine, methadone, ritalin, delaten
      - Schedule 3-5 - moderate to low physical dependence
        
        Rewritten every 6 months
        
        Vicaden (3), Valium (4), Phenylhistine (5)
  - - - influenced by route, lipid solubility, pH, blood flow, local conditions, and dosage
    - - depends on adequacy of blood circulation to tissues, ability to leave the bloodstream, ability to enter cells
        
        barriers include blood brain barrier and placenta
    - - biotransofrmation - change of active drug from original form to inactive/new form
        
        depends on health of liver, kidney, lungs, GI and on Age, genetic differences, other drugs, hepatic first pass
        
        Hepatic First Pass - what happens when drug is circulated to liver
    - - kidneys excrete most drugs through urine, renal function is most important. Lungs excrete inhalants, Exocrine glands through saliva, sweat, milk, Some through Bile
        
        decreased ability to excrete with age requires smaller doses
  - - - identifies the drug's active ingredient, assigned by the manufacturer that first develops the drug
      - derived from the chemical name
      - universally accepted
      - acetaminophen (usually lowercased)
    - - selected by the pharmaceutical company that sells the drug and is protected by trademark
      - one drug can have several names
      - Tylenol, Liquiprin, Tempra (usually uppercased)
    - - precise description of the drug's chemical composition that identifies the drug's atomic and molecular structure using exact chemical language and terminology
  - - - time until 50% is eliminated
    - - time to produce a reponse
    - - highest plasma concentration when absorption is complete
      - typically 1 hour after dose given
    - - time of minimal concentration
      - Blood taken 30 minutes before next dose
- - - - more lipid soluble = absorbed more readily and pass more easily through membrane
    - - absorption increase with more blood flow
    - - acidic drugs well absorbed in stomach
      - basic drugs not absorbed before reaching small intestine
    - - more extensive a surface = greater absorption
    - - oral takes longest
      - intravenous = directly into blood therefore take effect most quickly
  - - - Pregnancy
        
        many drugs contraindicated b/c possible adverse affects on fetus
        
        teratogenic - known to have potential developmental defects in embryo/fetus (cocaine, alcohol, phenytoin, isotretinoin
        
        some cross into breast milk
      - Older adults
        
        more sensitive d/t decreased motility, muscle mass, acid production, and blood flow
      - Small children
        
        small body size, reduced weight, and reduced body water alter distribution, so children have smaller dose
    - - weight alters distribution, children prescribed by weight
    - - most research done on men -- women have different fluid levels and distribution of fat
    - - cultural beliefs and practices may affect compliance/religious restrictions
    - - placebo affect ~ expectations can affect response -- can also affect compliance
    - - presence of disease, especially in liver, or if GI disorder affects oral meds, can also create adverse affects
    - - sensory deprivation/overload affects response, nutritional state/dietary factors, oxygen deprivation at higher altitudes,
    - - taken w/ or w/o food, circadian rhythms may affect
- - - - immediately before surgery
      - stat order - carried out immediately (usually in emergency
  - - - Nursing history, medication history, allergies, assessment data, Lab results, religious beliefs/cultural practices
    - - identifies pt problem and suggests expected pt outcomes -- etiology directs nursing interventions
      - "Innefective health maintenance r/t lack of knowledge about anticoagulent medication regimen"
      - Constipation r/t use of an opioid
    - - remain w/ pt and make sure med is taken
      - offer drugs separately
      - Proper Administration
        
        ORAL- PO -- most common
        
        available in liquid or solid form -- intended for absorption in stomach and small intestine -- assess swallowing function (no NPOs)
        
        Using oral syringe - place b/w gum and cheek and give slowly
        
        know rules on crushing, only break if scored -- pour away from label w/ liquids
        
        Sublingual/Buccal - under tongue/on cheek
        
        not swallowed but held in place -- offer last of oral -- offer water or oral care before
        
        Enteral Feeding tubes (NG, PEG, J tube)
        
        liquid when possible, dilute thick suspensions -- some solid can be crushed and combined w/ liquid (grind to find powder and mix w/ 15-30mL)
        
        bring to room temperature, elevate HOB, remove clamp and check tube placement in stomach or intestine
        
        attach syringe, flush w/ 15-30 mL before and after giving meds
        
        give meds separately and flush w/ water b/w each drug
        
        if suction, leave unsunctioned and clamped 20-30 mins after
        
        PARENTERAL MEDS - outside intestines or alimentary canal -- involve injection using sterile technique
        
        Needle gauge = diameter... as diameter gets bigger, gauge number decreases
        
        STERILE = inside of barrel, part of plunger that enters barrel tip of barrel, and needle
        
        Needle considerations
        
        Route
        
        longer needle for intramuscular than intradermal/subcu
        
        Viscosity
        
        more viscous requires needle w/ large lumen
        
        Body size
        
        obese requires longer needle to reach muscle -- decreased muscle mass/thin person needs small needle
        
        INTRADERMAL
        
        just below epidermis into dermis - should be able to see -- Longest absorption time (skin allergy/sensitivity or TB test)
        
        Sites = inner forearm, upper arm, upper back
        
        1/4" to 1/2", 25- or 27-gauge needle -- dosage is small, <0.5mL -- Angle is 5-15 degrees
        
        SUBCUTANEOUS
        
        into adipose tissue layer just below epidermis and dermis -- slow, sustained rate of absorption (insulin or heparin)
        
        Sites = outer aspect of upper arm, abdomen (most rapid)(below costal margin to iliac crests), anterior aspects of thigh, upper back, upper ventral or dorsogluteal area (slowest absorption) -- Avoid bruised, tender, hard, swollen, inflamed, or scarred sites
        
        3/8"-1" needle (3/8" and 5/8" most common), 25- to 30-gauge (Based on amount of fat present based on body weight and build) -- no more than 1mL
        
        45- to 90-degree angle -- 45-degree used only for small pts, angle based on amount of ft present and length of needle -- Short needle = larger angle
        
        Bunch skin to administer, do not massage
        
        INTRAMUSCULAR
        
        through skin and subcutaneous tissues into certain muscles, more blood vessels = faster action -- slow delivery and sustained release (antibiotics, hormones, and vaccines i.e. pneumococcal and hepatitis vaccine)
        
        Sites have various factors
        
        Ventrogluteal - gluteus medius and gluteus minimus muscles in hip area -- patient on back, side, or abdomen
        
        locate by placing palm over greater trochanter with fingers towards head, place index finger on anterosuperior iliac spine and extend middle finger dorsally, plapating iliac crest. Triangle is formed and injection is given at center of triangle
        
        Vastus lateralis - quadriceps femoris muscle along anterolateral aspect of thigh -- desirable for infants and children whose gluteal muscles are poorly developed
        
        locate by dividing thigh into thirds horizontally and vierticall and administer in outer middle third
        
        Deltoid muscle - lateral aspect of arm - recommended for vaccines for adults and children 3-18 - limited to 1 mL (sometimes up to 2mL)
        
        locate by palpating lower edge of acromion process. Triangle is formed at midpoint in line with axilla and later aspect of the upper arm, with base of triangle at acromion process
        
        Needle length depends on patients. 5/8" to 1 1/2" 18- to 15-gauge based on solution
        
        administer at 72- to 90-degrees, max of 4mL (besides 1mL at deltoid), inject slowly at 10 seconds per 1mL, do not massage
        
        INTRAVENOUS
        
        immediate affect -- most dangerous -- aseptic technique
        
        Intravenous solution - added to infusion solution, received slowly over relatively long period -- check for adverse affects every hour
        
        Bolus/Push - single injection of concentrated solution directly into IV line, rate varies but many over 2-min time frame
        
        Intermittent IV Infusion - mixed w/ small amount amount of IV solution (50-100mL) and administers short period of time at prescribed interval
        
        achieved through smart pump or gravity pump -- piggyback hang drug higher than primary IV -- mini-infusion pump
        
        TOPICAL - applied to skin or mucous membranes -- usually intended for direct action at site (some have systemic effects)
        
        Skin applicants
        
        transdermal route-- powder, oitnment, creams/oils, lotions, or patch -- clean -- do not massage -- heat helps absorption
        
        Eyes
        
        do not let tip touch eye - enter into conjunctival sac
        
        Use for local anesthetic, anti-inflammatory, anti-infection, irrigation, antihistamine
        
        Ears
        
        room temp - Use for anti-inflammatory, anethesia, irrigation
        
        Adults - ear lobe up and back. Kids - straight back.
        Under 3 - down and back
        
        Nasal Instillations
        
        blow nose before, sit up with head tilted back (maintain few mins after instillations) == do not touch nares with dropper
        
        Vaginal Applications
        
        foams, gels, creams, suppositories, irrigations
        
        void before insertion, position on back with knees flexed
        
        Rectal Insertions
        
        Suppositories
        
        lay on left side , lubricate, insert (deep breath), remain on side for 5 mins --- do not give to thrombocytopenia or neutropenic, or at risk for cardiac arrythmias, or recent rectal/prostate surgery
        
        Enemas
        
        INHALATION - aerosolized and breathed in - absorbed easily from lower respiratory tract
        
        A metered-dose inhaler is a canister that contains medication under pressure; the aerosolized drug is released when the container is compressed
        
        A turbo-inhaler is a propeller-driven device that spins and suspends a finely powdered medication.
        
        . An aerosol results after a liquid drug is forced through a narrow channel using pressurized air or an inert gas.
    - - Expected therapeutic effects will be demonstrated within specified time frame
      - expected change in symptoms
      - demonstrates knowledge regardin gmedication