1. Medications Administration Dated September 16,2008 Prepared and delivered by Suleman Shah Clinical Instructor RAK College of Nursing

2. Drug Nomenclature Chemical name — identifies drug’s atomic and molecular structure(Medication composition)rarely used in clinical practice.e.g acetyl –Para aminophenol Generic name — assigned by the manufacturer that first develops the drug Official name — name by which it is identified in official publications United state pharmacopeia. Trade name — brand name copyrighted by the company that sells the drug.

3. Drug Preparations Oral – Capsule, pill, tablet, extended release, elixir, suspension, syrup Topical – Liniment, lotion, ointment, suppository, transdermal patch Inject able

4. Drug Classifications Body system Symptoms relieved Clinical indication

5. 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

6. 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

7. Factors Affecting Drug Absorption Route of administration Drug solubility pH Local conditions at site of administration(blood flow) Body surface area Lipid solubility Food

8. factor affecting Distribution Circulation Membrane permeability Protein binding

9. factor affecting metabolism Age Function of liver

10. Factor affecting exretion Kidney function Liver function Bowel function etc

11. Effect of Medications Therapeutic effects Side effects Adverse effects Toxic effects Idiosyncratic reaction Allergic reaction Synergistic effects.

12. Signs and Symptoms of Drug Allergy Rash Uticaria Fever Diarrhea Nausea Vomiting Anaphylactic reaction

13. Variables Influencing Effect of Medications Developmental considerations Weight Sex Genetic and cultural factors Psychological factors Pathology Environment, timing of administration

14. Types of Medication Orders Standing order — carried out until cancelled by another order Prn order — as needed Stat order — carried out immediately Single order-one time

15. Parts of the Medication Order Patient’s full 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

16. Medication Supply Systems Stock supply Unite dose-portable cart with 24 hours supply for each patient. Computerized medication system. Individual supply.

17. 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

18. 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 – 1 ml=15 drops – 5ml=teaspoon – 15ml=tablespoon – 240ml=cup – 500ml=`pint – 1000ml=1lit

19. 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

20. Rights of Medication Administration The nurse should give: 1.The right medication 2.To the right person 3.In the right dosage 4.Through the right route 5.At the right time 6.Right documentation

21. 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

22. Oral Medications Solid form — tablets, capsules. Liquid form — elixirs, spirits, suspensions, syrups

23. 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

24. 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

25. Sites for Intramuscular Injections Gluteal site Vastus lateralis site Deltoid muscle site

26. Criteria for Choosing Equipment for Injections Route of administration Viscosity of the solution Quantity to be administered Body size Type of medication

27. Preparing Medications for Injection Ampules Vials Prefilled cartridges

28. Topical Administration of Medications Vaginal Rectal Instillation Irrigation Skin application

29. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity. Sublingual Medication Administration

30. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Place the medication between the patient’s cheek and gum. Buccal Medication Administration

31. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Use a medication dropper to place the prescribed dosage on the conjunctival sac. Eye Drop Administration

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nasal Medication Administration

33. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Manually open the ear canal and administer the appropriate dose. Aural Medication Administration

34. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Small volume nebulizer

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nebulizer with attached face mask, bag-valve mask, and endotracheal tube

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Metered dose inhaler

37. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Confirm proper tube placement.

38. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Withdraw the plunger while observing for the presence of gastric fluid or contents.

39. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Instill the medication into the gastric tube.

40. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gently inject the saline.

41. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Clamp off the distal tube.

42. 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

43. 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

44. 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

45. 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.

46. Common dosageAdministration scheduale Before meal-AC,ac Twice a day-BID,bid Hour-H At bed time after meal-PC,pc Whenever there is a need-prn Every morningQam Every hourlyQH Every two hourlyq2h 4 time a dayQID, qid Give immediatelystate 3 time a dayTID,tidS

47. Dangerous abbreviation used in medication administration AbbreviationmalpracticePreferred term U (unit)Mistaken as zero, four, ccunit IU(for international unit)Mistaken as IV or 10International unite Q.D(once daily)Q.O.D(every other day) Mistaken for each other dayWrite it as daily. and every other day MS.MSU4(morphine sulphate) MgSo4 Mistaken for one anotherWrite it as morphine sulphate, magnesium sulphate. ugMistaken for mgmcg H.SMistaken for half strength or hour of sleep Half strength or bed time. T.I.W (for three time a week)Mistaken for three time a day or twice weekly Write it three time weekly. D/C (discharge)Interpreted as discontinueWrite as discharge.

48. Reference Perry, A.G., & Potter, P.A (2005). Bowel Elimination in Clinical Nursing Skills and Techniques (6 th edition.). (pp. 823-890) St. Louis: Mosby.