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For handouts log on: www.dyci_sirglennhandouts@ yahoogroups.com
Drug Administration By: MYLA KISON, RN, MAN For handouts log on: yahoogroups.com
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Drug Nomenclature Chemical name — identifies drug’s atomic and molecular structure Generic name — assigned by the manufacturer that first develops the drug Official name — name by which it is identified in official publications USP and NF Trade name — brand name copyrighted by the company that sells the drug
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Drug Preparations Oral Topical Injectable
Capsule, pill, tablet, extended release, elixir, suspension, syrup Topical Liniment, lotion, ointment, suppository, transdermal patch Injectable
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Drug Classifications Body system Symptoms relieved Clinical indication
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Mechanisms of Drug Actions
Drug-receptor interaction — drug interacts with one of more cellular structures to alter cell function Drug-enzyme interaction — combines with enzymes to achieve desired effect Acting on cell membrane or altering cellular environment
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Pharmacokinetics Absorption — drug is transferred from site of entry into bloodstream Distribution — drug is distributed throughout the body Metabolism — drug is broken down into an inactive form Excretion — drug is excreted from the body
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Factors Affecting Drug Absorption
Route of administration Drug solubility pH Local conditions at site of administration Drug dosage Serum drug levels
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Adverse Effect of Medications
Iatrogenic disease Allergic effects Toxic effects Idiosyncratic effects Drug interactions
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Signs and Symptoms of Drug Allergy
Rash Uticaria Fever Diarrhea Nausea Vomiting Anaphylactic reaction
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Variables Influencing Effect of Medications
Developmental considerations Weight Sex Genetic and cultural factors Psychological factors Pathology Environment, timing of administration
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Types of Medication Orders
Standing order — carried out until cancelled by another order Prn order — as needed Stat order — carried out immediately
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Parts of the Medication Order
Patient’s name Date and time order is written Name of drug to be administered Dosage of drug Route by which drug is to be administered Frequency of administration of the drug Signature of person writing the order
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Medication Supply Systems
Stock supply Individual supply Medication cart Computerized medication system Bar coded medication cart
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Systems of Measurement
Metric — meter (linear), liter (volume), gram (weight) Apothecary — less convenient and concise; basic unit or weight is grain Household — least accurate system; teaspoons, tablespoons, teacup and glass used
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Metric System Conversions
To convert larger unit to smaller unit, move decimal point to right. To convert smaller unit to larger unit, move decimal point to left. 1 kilogram = 1000 grams 1 gram = 1000 milligrams 1 milligram = 1000 micrograms
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Three Checks of Medication Administration
Read the label: When the nurse reaches for the container or unit dose package Immediately before pouring or opening medication When replacing the container to the drawer or shelf
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Five Rights of Medication Administration
The nurse should give: The right medication To the right person In the right dosage Through the right route At the right time
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Controlled Substances Required Information
Name of patient receiving narcotic Amount of narcotic used The hour narcotic was given The name of physician prescribing narcotic Name of the nurse administering narcotic
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Oral Medications Solid form — tablets, capsules, pills
Liquid form — elixirs, spirits, suspensions, syrups
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Administration of Oral Medications
Oral Route — having patient swallow drug Enteral route — administering drug through an enteral tube Sublingual administration — placing drug under tongue Buccal administration — placing drug between tongue and cheek
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Administration of Parenteral Medications
Subcutaneous injection — subcutaneous tissue Intramuscular injection — muscle tissue Intradermal injection — corium (under epidermis) Intravenous injection — vein Intraarterial injection — artery Intracardial injection — heart tissue Intraperitoneal injection — peritoneal cavity Intraspinal injection — spinal canal Intraosseous injection — bone
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Sites for Intramuscular Injections
Ventrogluteal site Vastus lateralis site Deltoid muscle site Dorsogluteal site
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Criteria for Choosing Equipment for Injections
Route of administration Viscosity of the solution Quantity to be administered Body size Type of medication
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Preparing Medications for Injection
Ampules Vials Prefilled cartridges
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Topical Administration of Medications
Vaginal Rectal Inunction Instillation Irrigation Skin application
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Medical Record Documentation
Each dose of medication, give as soon as possible after it is given Intentional or inadvertent omitted drugs Refused drugs Medication errors
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THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR MAKING MISTAKES” high volume patients high volume prescription illegible, unclear orders MD high volume MD orders highly sensitive impatient patients high variety, myriad cases, symptoms high turnover medical staff high stress, overworked medical staff high speed emergencies
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Type of Medication Errors
Inappropriate prescribing of the drug Extra, omitted, or wrong doses Administration of drug to wrong patient Administration of drug by wrong route or rate Failure to give medication within prescribed time Incorrect preparation of a drug Improper technique when administering drug Giving a drug that has deteriorated
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LOOK-ALIKE SOUND-ALIKE PRODUCT NAMES
LOSEC LASIX HYDROXYZINE HYDRALAZINE FORADIL TORADOL PLAVIX PAXIL ACCUPRIL MONOPRIL ULTRACET ULTRACEF SERZONE SEROUEL ZYRTEC ZYPREXA CELEBREX CEREBYX ACTRAPID ACTRAPHANE SINECOD SINEMET
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DANGEROUS ABBREVIATIONS-
INSTRUCTIONS 10U 100 0.01 mg 0.001 mg .5 mg 5 mg 5.0 mg 50 mg D/C (discharge) D/C (discontinue) µg mg HCl KCl every Monday every morning 1:10,000 mg/mL 1:1,000 mg/mL X (yes) X (no)
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LOOK-ALIKE PRODUCTS AND PACKAGING
suppository oral capsule HEPARIN 10ml INSULIN 10ml water alcohol cephalexin dolfenal A B KCl distilled water
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SIMILAR-LOOKING CONTAINERS FOR DRUGS AND NON-DRUGS
poison drug fixative soap
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THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR MAKING MISTAKES” high risk, irreversible procedures dangerous equipment potent chemicals KCl use of invasive devices potent drugs infectious environment look-alike, sound-alike drugs, chemicals, fluids potent body fluids
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Medication Errors Check patient’s condition immediately; observe for adverse effects. Notify nurse manager and physician. Write description of error on medical record and remedial steps taken. Complete special form for reporting errors.
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THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR HIDING MISTAKES” incoherent, inarticulate patients disease can mask medical error collegial silence punitive culture IR incomplete, error-prone documentation multiple handoffs hierarchical culture dual management most errors are near misses, slight effects
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1 million hospitalized patients in the U.S.
16 doses of medication daily each 16 million doses per day 2% medication rate 320,000 medication errors daily
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A Medication Error Story
HIS for ordering medications is broken Nurse gives the patient a medication to which he is allergic Nurse borrows medication from another patient Tube system for obtaining medications is broken Patient arrests and dies Reason
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Patient Teaching Review techniques of medication administration.
Remind patient to take the medication as prescribed for as long as prescribed. Instruct patient not to alter dosages without consulting physician. Caution patient not to share medications.
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11 Golden Rule’s in giving medications
Administer the right Drug Administer right drug to right patient Administer with right dose Administer Right drug with right route Administer right drug at right time Document each drug you administer Teach your patient about the drug he is receiving. Take a patient complete pt. drug history Find out if the patient has any drug allergies Be aware of potential drug to drug , and Drug to food reactions, The right of the patient to refuse medications.
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Clarifying Orders Illegible Incomplete Incorrect Route or dosage
Not expected of patients current diagnosis.
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Know your Medications Mode of action & the purpose of medication
Side effects or contraindication of medication Antagonist of medication Safe dosage range of medication Interaction with other medication Proper administration technique
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Principle in Size of Needle
The higher the number the smaller the gauge of the needle. The smaller the number the bigger the size of the lumen.
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Degrees of Insertion Intramuscular – 72 to 90 degrees
Subcutaneous – 45 degrees Intradermal- 10 to 15 degrees
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Subcutaneous Subcutaneous injection should not contain no more that 1 ml in an insertion site . The normal angle of insertion is 45 to 90 degrees Subcutaneous injection sites: Abdomen, scapula, thigh, upper back, upper dorso gluteal region.
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Intramuscular Intramuscular injection should not contain no more than 3 to 5ml,the smaller the muscle being injected ,the smaller the amount should be. Injection sites: Vastus lateralis, Ventrogluteal, deltoid , dorso gluteal. Insertion site selection depends on: Amount of medication/ Viscosity of medication/ Age of pt & Development of muscle tissue , preference of pt. or nurse.
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