Medications AdministrationDated September 16,2008

Prepared and delivered bySuleman Shah

Clinical Instructor RAK College of Nursing

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.

Drug Preparations

• Oral – Capsule, pill, tablet, extended release, elixir,

suspension, syrup• Topical

– Liniment, lotion, ointment, suppository, transdermal patch

• Inject able

Drug Classifications

• Body system• Symptoms relieved• Clinical indication

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

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

Factors Affecting Drug Absorption

• Route of administration• Drug solubility• pH• Local conditions at site of

administration(blood flow)• Body surface area• Lipid solubility• Food

factor affecting Distribution

• Circulation• Membrane permeability• Protein binding

factor affecting metabolism

• Age• Function of liver

Factor affecting exretion

• Kidney function• Liver function• Bowel function• etc

Effect of Medications

• Therapeutic effects• Side effects• Adverse effects• Toxic effects• Idiosyncratic reaction• Allergic reaction• Synergistic effects.

Signs and Symptoms of Drug Allergy

• Rash• Uticaria• Fever• Diarrhea• Nausea• Vomiting• Anaphylactic reaction

Variables Influencing Effect of Medications

• Developmental considerations• Weight• Sex• Genetic and cultural factors• Psychological factors• Pathology• Environment, timing of administration

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

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

Medication Supply Systems

• Stock supply• Unite dose-portable cart with 24 hours supply

for each patient.• Computerized medication system.• Individual supply.

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

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

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

Rights of Medication Administration

• The nurse should give:1. The right medication 2. To the right person3. In the right dosage4. Through the right route5. At the right time6. Right documentation

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

Oral Medications

• Solid form — tablets, capsules.• Liquid form — elixirs, spirits, suspensions,

syrups

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

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

Sites for Intramuscular Injections

• Gluteal site• Vastus lateralis site• Deltoid muscle site

Criteria for Choosing Equipment for Injections

• Route of administration• Viscosity of the solution• Quantity to be administered• Body size• Type of medication

Preparing Medications for Injection

• Ampules• Vials• Prefilled cartridges

Topical Administration of Medications

• Vaginal• Rectal• Instillation• Irrigation• Skin application

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

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

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

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Nasal Medication Administration

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

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Small volume nebulizer

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

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Metered dose inhaler

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Confirm proper tube placement.

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.

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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Gently inject the saline.

Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clamp off the distal tube.

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

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

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

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.

Common dosage Administration 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 morning Qam

Every hourly QH

Every two hourly q2h

4 time a day QID, qid

Give immediately state

3 time a day TID,tidS

Dangerous abbreviation used in medication administration

Abbreviation malpractice Preferred term

U (unit) Mistaken as zero, four, cc unit

IU(for international unit) Mistaken as IV or 10 International unite

Q.D(once daily)Q.O.D(every other day)

Mistaken for each other day Write it as daily. and every other day

MS.MSU4(morphine sulphate) MgSo4

Mistaken for one another Write it as morphine sulphate, magnesium sulphate.

ug Mistaken for mg mcg

H.S Mistaken 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 discontinue Write as discharge.

Reference

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