1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 02- Administration of Drugs

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Drug administration Understand basic concepts Nurse’s role: –Monitor the therapeutic response –Report adverse reactions –Teach the patient and family members

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins *The Five +1 Rights of Drug Administration Right patient: Check patient’s wristband; ask patient to identify himself, DOB, pictures Right drug: Compare medication; container label; medication record Right dose Right route : Obtain written order Right time Right documentation: Record immediately*

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 –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

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Considerations in Drug Administrations (cont’d) 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

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Considerations in Drug Administrations (cont’d) * Precautions taken by the nurse: – Confirm any questionable orders –verify calculations with another nurse – listen to the patient –Never administer a drug until you answer the patients questions – concentrate on only one task at a time Most common occurrence of errors: Insulin and heparin

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Considerations in Drug Administrations (cont’d) Drug dispensing system –Computerized Dispensing System –Unit Dose System –Bar Code Scanner –Bar codes are used to identify the patient and to record and charge routing and PRN drugs –Provider identification badges are scanned during the procedure, identifying the nurse giving the medication

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration 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

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins NGT or g-tubes* Always check for placement Dilute and flush liquid drugs through the tube Crush tablets and dissolve them in water before administering them through the tube Flush tube with water after the drugs are placed in the tube to clear the tubing completely

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration 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

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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-ROTATE sites –Needle length and angle of insertion: Obese/thin patients-23-25 gauge needle

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs by Parenteral Route (cont’d) Administration of drugs by intramuscular route: Administration into a muscle Nursing responsibilities: 20-22 gauge needle –Volume of injection: Single/multiple sites; 1-3 mls –Injection sites, needle length and angle of insertion: Deltoid muscle; ventrogluteal or dorsogluteal sites; *vastus lateralis-infants and small children Z-Track technique: Prevents backflow of drug into the SC tissue

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins IM route Wash hands Don gloves Verify drug allergies Aspirate 5-10 seconds Place pressure on area after removing needle

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs by Parenteral Route (cont’d) Administration of drugs by intravenous route (cont’d) Nursing responsibilities: –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

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs by Parenteral Route (cont’d) Drug administration- intradermal route: Sensitivity tests - Tuberculin; skin allergy Nursing responsibilities: –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

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs by Parenteral Route (cont’d) Other parenteral routes of drug administration: Intracardial; intralesional; intra-arterial; intra-articular Nursing responsibilities: –Prepare drug for administration; Ask primary care provider –Venous access ports: For chemotherapy or long-term therapy

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs Through the Skin and Mucous Membranes Application to the skin and mucous membranes Several routes –Topical –Transdermal Rotate patch sites –Inhaled through the membranes of the upper respiratory tract

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Nursing responsibilities: –Follow special instructions: Drug action may depend on correct administration of the drug

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration of Drugs Through the Skin and Mucous Membranes (cont’d) Administration of drugs by the transdermal route (cont’d) Nursing responsibilities: –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

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Nursing responsibilities: –Provide proper instructions

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing 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

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Administration 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