1. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Chapter 35 Researching and Preparing Medications

2. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Terminology Related to Effect of Medications  Desired effect: the reason medication is prescribed  Adverse effect: unintended harmful effects  Side effect: an unintended outcome  Therapeutic level: amount of medication in blood it takes to reach desired effect  Toxicity: too much medication in the body

3. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Names of Medications  Chemical name: name of the exact ingredients of the medication  Generic name: assigned by the USANC; shorthand version of chemical name  Brand name (trade or proprietary name): shorter, easier to remember name owned by the pharmaceutical company

4. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Two Types of Medications  Prescription  Available with a written direction from a health- care provider with prescriptive authority  Over the counter  Available without a prescription; can be purchased by the consumer for use at recommended dosages

5. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Routes of Medication Administration  Oral  Mucosal  Topical  Parenteral

6. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Scheduled (Controlled) Drugs  Schedule I: highly addictive; have no medical purpose; street drugs  Schedule II: have high potential for abuse and do have accepted medical use  Schedule III: have some potential for abuse, are at less risk to be abused than those in schedule I and II  Schedule IV: have a lower potential for abuse than schedule I, II, and III medications  Schedule V: have the lowest potential for abuse.

7. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Multiple Choice Question A nurse is administering methadone to a recovering drug addict. What schedule drug is methodone? A. Schedule I B. Schedule II C. Schedule III D. Schedule IV E. Schedule V

8. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Answer B. Schedule II Rationale: Schedule II drugs have great potential for abuse and do have accepted medical use. Examples include morphine, codeine, fentamyl, oxycodone, methadone, meperidene, amphetamines, and short-acting barbiturates.

9. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Reason Adverse Effects May Occur  Chronic illness affecting metabolism  Drug allergies  Liver or renal impairment  History of previous drug reactions

10. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Effects of Anaphylaxis  Swelling of airways  Shortness of breath  Respiratory arrest  Decreased blood pressure  Circulatory collapse

11. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Categories of Medications Causing Allergic Reactions  Antibiotics, especially penicillin and sulfa drugs  Iodine and dyes injected for procedures  Vaccines  Anticonvulsants (seizure medications)

12. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Resources Providing Information on Specific Drugs  Pharmacist  Physicians’ Desk Reference  Nursing drug handbooks  Pharmacology textbooks

13. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Sections of the Physicians’ Desk Reference  Manufacturer’s index  Brand and generic name index  Product category index  Product identification section

14. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Common Drugs That May Cause Toxicity  Digoxin  Aminophylline  Gentamicin  Imipramine  Phenobarbital  Procainamide  Valproic acid

15. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Classifications of Medications  Cardiovascular  Gastrointestinal  Endocrine  Immune system  Nervous system  Respiratory

16. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Multiple Choice Question An antibiotic is an example of which of the following categories of medications? A. Respiratory B. Cardiovascular C. Endocrine D. Immune system

17. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Answer D. Immune system Rationale: An antibiotic is considered an immune system drug. It is used to treat infections caused by bacteria by interfering with the way bacteria live and reproduce.

18. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Information Included in Medication Orders  Date and time of the order  Name of medication, either generic or brand  Dosage of medication  Frequency for taking the medication  Route of administration  Patient’s name  Signature of the prescriber

19. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Converting Between Units of Measurement in the Metric System To change between units of measurement in the metric system, move the decimal three places to the right to convert to a smaller unit; move the decimal three places to the left to convert to a larger unit.

20. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company True/False Question A nurse accurately converts a medication dosage from 0.5 grams to 500 milligrams. A. True B. False

21. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Answer A. True Rationale: The nurse moves the decimal point three places to the right to convert from grams to milligrams.

22. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Formula for Calculating Medication Dosages H = D V X HX = VD X = VD H

23. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Methods of Dispensing Medications  Computerized cabinets  Medication cart  Locked bins in patient rooms

24. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company 6 Rights of Medication Administration 1.Right medication 2.Right dose 3.Right route 4.Right patient 5.Right date and time 6.Right documentation

25. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Preparing Medications  Check orders for discrepancies  Look up unfamiliar medications  Wash or sanitize hands  Obtain ordered medications; verify six rights and any allergies  Perform first two safety checks  Perform any necessary drug calculations

26. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines for Preparing Medications (cont.)  Place unopened medication in medicine cup  Close and lock the cart or bin  Immediately take medication to patient’s bedside  Perform third safety check  Assess any required vital signs  Administer medication and ensure it is swallowed

27. Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Avoiding Medication Errors  Be extremely careful during preparation  Question anything that does not seem correct about the order  Know what you are giving, the expected effects, and the potential side effects