chapter 034
DESCRIPTION
mTRANSCRIPT
![Page 1: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/1.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Chapter 34
Medication Administration
![Page 2: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/2.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacological Concepts
• Drug names
• Classification
• Medication forms or preparations
![Page 3: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/3.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Legislation and Standards
• Federal regulations
• State and local regulations
• Health care institutions and medication laws
• Nursing practice
![Page 4: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/4.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacokinetics
• Absorption– Route of administration– Ability to dissolve– Blood flow to administration site– Body surface area– Lipid solubility
![Page 5: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/5.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacokinetics (cont’d)
• Distribution– Circulation– Membrane permeability– Protein binding
![Page 6: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/6.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacokinetics (cont’d)
• Metabolism– Biotransformation– Detoxification
![Page 7: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/7.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Pharmacokinetics (cont’d)
• Excretion– Kidneys– Liver– Bowel– Lungs– Exocrine glands
![Page 8: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/8.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Actions
• Therapeutic effects
• Side effects
• Adverse effects
• Toxic effects
![Page 9: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/9.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Actions (cont’d)
• Idiosyncratic reactions
• Allergic reactions
• Interactions
• Medication dose responses
![Page 10: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/10.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Routes of Administration
• Oral: sublingual, buccal
• Parenteral: intradermal, subcutaneous, intramuscular, intravenous
• Topical
• Inhalation
• Intraocular
![Page 11: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/11.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Systems of Measurement
• Metric
• Apothecary (grains)
• Household
![Page 12: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/12.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Metric System
• Grams (g), milligrams (mg), kilograms (kg)
• Liters (L), milliliters (ml)
![Page 13: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/13.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Household Measurements
• Tablespoons
• Teaspoons
• Ounces
• Cups
• Pints
• Quarts
![Page 14: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/14.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Clinical Calculations
• Conversions within systems
• Conversions between systems
• Formula:
Dose ordered x Amount
Dose on hand on hand
![Page 15: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/15.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Prescriber’s Role
• Types of orders– Standing orders– prn orders– Single orders– Stat orders
![Page 16: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/16.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
![Page 17: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/17.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Nurse’s Role
• Six rights
• Triple-check before administration
• Client assessment
![Page 18: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/18.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Six Rights
• Right medication
• Right dose
• Right client
• Right route
• Right time
• Right documentation
![Page 19: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/19.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Client’s Rights
• Information
• Refusal
• Careful assessment
• Informed consent
• Safe administration
• Supportive therapy
• No unnecessary medications
![Page 20: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/20.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Assessment
• Medical history
• History of allergies
• Medication data
• Diet history
• Perceptual or coordination problems
• Current condition
![Page 21: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/21.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
![Page 22: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/22.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Nursing Diagnoses
• Deficient knowledge (medications)
• Noncompliance (medications)
• Disturbed sensory perception
• Impaired swallowing
• Ineffective therapeutic regimen management
![Page 23: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/23.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Planning
• Goals and outcomes– Example:
Client will verbalize therapeutic and adverse effects of medications
• Setting priorities
• Continuity of care
![Page 24: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/24.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Implementation
• Client and family teaching
• Medication orders: receipt, transcription, communication
• Calculation and measurement
• Correct administration technique
• Recording
![Page 25: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/25.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Special Considerations
• Infants and children
• Older adults– Polypharmacy– Self-prescribing– Over-the-counter medications– Misuse– Noncompliance
![Page 26: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/26.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Evaluation
• Client response to medications
• Client and family ability to administer medications
![Page 27: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/27.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Oral Administration
• Presence of GI alterations
• Ability to swallow
• Use of gastric suction
• Positioning
![Page 28: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/28.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Topical Administration
• Skin applications– Use of gloves or applicators– Preparation of skin– Thickness of application
![Page 29: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/29.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Nasal Instillation
• Assessment of nares
• Client instruction and self-administration
• Positioning
![Page 30: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/30.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Eye Instillation
• Drops, ointments, disks
• Assessment of eyes
• Asepsis
• Positioning
![Page 31: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/31.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children and adults
• Positioning
![Page 32: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/32.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Client positioning, comfort, and hygiene
![Page 33: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/33.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Rectal Instillation
• Suppositories
• Use of gloves
• Client positioning, comfort, and hygiene
![Page 34: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/34.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Inhalation
• Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister
![Page 35: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/35.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Irrigation
• Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic)
• Asepsis
![Page 36: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/36.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Parenteral Administration
• Equipment– Syringes: sizes (volume), types– Needles: length, gauge– Disposable units: Tubex, Carpuject– Ampules– Vials
![Page 37: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/37.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Parenteral Administration (cont’d)
• Mixing medications– Determine compatibility of the
medications– Do not contaminate one medication with
another– Ensure the final dose is accurate– Maintain aseptic technique
![Page 38: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/38.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Parenteral Administration (cont’d)
• Insulin– Syringes and needle sizes– Types of insulin– Mixing of insulins– Rotation of vials before withdrawal of
solution
![Page 39: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/39.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Administration of Injections
• Minimize discomfort– Use smallest suitable needle– Position client comfortably– Select proper site– Divert client’s attention– Insert the needle quickly and smoothly– Hold the syringe steady– Inject the medication slowly and steadily
![Page 40: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/40.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Administration of Injections (cont’d)
• Subcutaneous injections– Sites: condition of area, rotation of use– Amount of solution– Length and gauge of needle– Pinch or spread skin– Angle of insertion
![Page 41: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/41.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Administration of Injections (cont’d)
• Intramuscular injections– Sites: landmarks, condition of area– Amount of solution– Length and gauge of needle– Angle of insertion– Aspiration– Air-lock method– Z-track technique
![Page 42: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/42.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Administration of Injections (cont’d)
• Sites– Ventrogluteal– Vastus lateralis– Deltoid
![Page 43: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/43.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Administration of Injections (cont’d)
• Intradermal injections– Skin testing– Sites– Length and gauge of needle– Angle of insertion– Formation of small bleb
![Page 44: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/44.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Prevention of Needle Sticks
• Needleless devices
• Sharps disposal
• One-handed recapping technique
![Page 45: Chapter 034](https://reader033.vdocuments.site/reader033/viewer/2022042603/55cf92b2550346f57b98d173/html5/thumbnails/45.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
Intravenous Administration
• Large volume infusions
• Bolus injection
• Volume-controlled infusionsPiggyback– Tandem– Volume-control set– Mini-infusor pump