Ch.63 Administration of Noninjectable Medications (BN)

Question 1

Review and describe how medications are stored and supplied in healthcare facilitates.

Answer 1

Healthcare facilities must have a secure medication storage area.

• This may be a locked mobile cart, allowing medication setup close to the clients’ rooms.
• Some medications require refrigeration to preserve their potency; these are kept in a designated refrigerator, which cannot be used for anything else.
• All narcotics and other controlled substances (schedule medications) are kept double-locked.
• Many acute care facilities use a computerized dispensing machine.

Stock Supply: Usually, only OTC medications are supplied in this manner. Even then, in a healthcare facility, these medications are kept locked until they are needed.

Unit-Dose Systems: Acute care facilities and most skilled long-term nursing facilities use unit-dose medications (packaged in single-dose units) because they provide greater safety.

Automated Systems: Many facilities use a computerized system to dispense medications. The pharmacy often sends medications via conveyor, pneumatic tube, or courier or may program the medication dispensing unit so medications can be removed by nurses.

Self-administered Medications: Clients at home or in an assisted living facility may manage their own medication administration. Often these are set up weekly by staff or the visiting nurse.

Question 2

Discuss the importance of accurate documentation of medication administration.

Answer 2

Documentation is vital in medication administration.

Actions not documented are considered not to have been done.

Proper documentation communicates to other members of the healthcare team which medications were administered and when.

If a medication is PRN or a first-time administration, documentation must include the medication’s effects.

Question 3

Differentiate between STAT, PRN, and bedtime medications.

Answer 3

Stat:

• A STAT order means that a medication must be administered immediately.
• First, check the order against the original provider’s order.
• Then, make sure the order appears on the MAR.

PRN:

• Evaluating a client’s need for PRN ( as needed or on request ) medication is an important nursing responsibility that is learned with experience.
• If a client requests a PRN medication, first gather information about the client’s symptoms.

Bedtime Medications:

• Providers often order sedatives and hypnotics, “sleeping pills,” on a PRN basis.
• Technically, the client should request these but may be unaware that these are ordered.
• Thus, it is appropriate to offer HS medications to the client and to inform the client to ask for this medication in the future, if needed. Bedtime sleep medications should be given as close to the time the client will be retiring as possible.

Question 4

Discuss the importance of the “Five Rights, Plus Two”, of medication administration, including steps to observe before administering medications.

Answer 4

The purpose of following the 5 Rights of Medication Administration are:

• To help to ensure the right drug, right dose, right route, and right patient, at the right time.
• The sixth right is “Right Documentation”
• The seventh right is accpliate when administering pump medication.

Steps to observe before administering medications are:

• Standard Precautions
• The “Five Rights, Plus Two” of medication administration

Question 5

State the approved means of identifying a client before giving medications.

Answer 5

• The best way to identify a client is to check the wrist band.
• After checking the client’s identification band, if the client is conscious and oriented, ask the client to state their name.
• Most clients are able to tell you their birth date. This is very good identification, but not foolproof.
• Verification by another responsible person should be the last resort for identifying a client.

Question 6

Differentiate between desired and undesired effects, and local and systemic medication effects.

Answer 6

• Therapeutic effect
  
  • The medications desired effect; the medication produces the result for which it was given.
• Adverse effect
  
  • A response that is not intended or desired.
  • Some adverse effects are minor ( side effects ) and, although bothersome, can be ignored or treated easily.
  • Constipation is an example of a side effect.
• Serious adverse effect
  
  • Some side effects, such as respiratory depression or neurologic damage, are disabling or potentially fatal.
• Anaphylaxis
  
  • The medication causes the client to experience a severe, immediately life threatening, allergic reaction ( anaphylaxis ) manifested by vasodilation, low blood pressure, and shock.
  • Anaphylaxis is a medical emergency; it must be recognized and treated immediately.
• Medication toxicity
  
  • A harmful, undesired effect resulting from an increased blood level of medication beyond its therapeutic level.
  • Administering a medication in too large a dose or via the wrong route can lead to drug toxicity.
  • In some cases, the client can also build up toxicity as a result of a disorder, such as inadequately functioning kidneys.
• Paradoxical effect
  
  • This client’s response is opposite to that which is desired.
  • For example, a client may become extremely agitated and restless in response to a sedative given for sleep.
  • Paradoxical responses are most common in very young and elderly clients.
• Potentiation
  
  • Two drugs may potentiate each other.
  • The effects of the two medications together are greater than would be the two individually.
  • Potentiation multiplies or enhances the effects of the drugs.
  • This can become a very dangerous situation.
• Local effects of a medication are restricted to the area in which they are administered.
  
  • Topical application (applied directly to the skin or mucous membranes) can cause a local effect .
  • These may be applied to mucous membranes of the eye, mouth, nose, throat, or vagina by instillation, irrigation, swabbing, or spraying.
• Systemic effects spread throughout the body.
  
  • To achieve systemic effects , medications often are administered by transdermal application, mouth, or injection, although other methods, such as nasal inhalation, can also produce systemic effects

Question 7

Differentiate between enteral and parenteral administration.

Answer 7

• Enteral administration means through the gastrointestinal (GI) system (most commonly, this is PO or via NG tube).
• Parenteral administration is administration by any other method; it most commonly refers to administration by injection.

Question 8

Describe and demonstrate methods of enteral medications administration: oral administrating (including translingual, sublingual, buccal), and administration via NG tube and rectally.

Answer 8

• Oral Administration:
  
  • The oral route of medication administration is used most frequently.
  • A PO medication can be in many forms, including tablets, capsules, caplets, sprinkles, or in liquid or gel form to be swallowed or sprayed on the tongue or applied to the mucous membranes of the mouth.
• Sublingual Administration:
  
  • Sublingual ( SL ) medications (e.g., nitroglycerin) are placed under the tongue, where they are dissolved and absorbed.
  • Clients should not chew or swallow SL medications.
• Translingual Administration:
  
  • Translingual (TL) medications are placed on the tongue, where they are absorbed or dissolve.
  • These medications may be in the form of a spray or may be a troche, which dissolves slowly.
  • The medication is absorbed through the tongue or is swallowed with saliva.
• Buccal Administration
  
  • Buccal administration involves placing medication between the client’s cheek and gum.
  • Clients should not chew or swallow buccal medications but should leave them between the cheek and gum until they dissolve or are discarded, as in the case of Nicorette gum.
• Administration through a Gastric Tube
  
  • Clients with nasogastric (NG) tubes or other types of GI tubes generally receive their medications through the tube.
  • Medications administered by this route should be in liquid form, although they can be quite thick.
• Rectal Administration
  
  • Typically, medications given rectally are in the form of a suppository, a bullet-shaped semi solid medication designed to melt at body temperature.

Question 9

Describe procedures for administration of transdermal, vaginal, eye/ear, and aerosolized medications.

Answer 9

• Vaginal Administration
  
  • Vaginal medications are supplied in the form of suppositories, foams, creams, and tablets that usually involve the use of an applicator, to ensure that the medication is placed correctly.
• Eye (Ophthalmic) Administration
  
  • Medications instilled or administered directly into the eye ( ophthalmic medications) include liquids, ointments, and medication-impregnated disks that resemble contact lens.
• Ear (Otic) Administration
  
  • Ear ( otic ) medications may be given by instillation from a squeeze bottle or dropper. Occasionally, ear suppositories are used.
• Nasal or Respiratory Administration
  
  • Drugs may be given by drops, inhalation, or through nebulizer delivery systems for disorders of the respiratory tract.
  • Inhaled medications have a very rapid rate of absorption and onset of action. They may be delivered by inhaler or nebulizer delivery system.
  • Nebulizer treatments are based on the use of compressed air or oxygen, which forces a mist of medication through tubing to a mouthpiece or mask.
• Transdermal Administration
  
  • Several types of TD patches are:
    
    • The reservoir membrane-modulated system
    • The micro reservoir system
    • The drug-in-adhesive layer system
    • The matrix system
  • As a general rule, it can be very dangerous to cut a TD patch.

Question 10

__________ supply medications usually are those that can be sold over the counter.

Answer 10

Stock

Question 11

A/An __________ effect of medication is seen when the client’s response is opposite to that which is desired.

Answer 11

Paradoxical

Question 12

Clients usually prefer __________ administration, which is used most frequently.

Answer 12

Oral

Question 13

A disadvantage of drugs administered orally is the __________ absorption rate.

Answer 13

Slow

Question 14

__________ medications are placed on the tongue, where they are absorbed or dissolved.

Answer 14

Translingual (TL)

Question 15

An inhaler or nebulizer setup is used for __________ client(s) only.

Answer 15

One

Question 16

Identify the procedure shown in the figure.

Answer 16

The figure indicates administration of a nebulizer treatment or aerosol therapy.

Question 17

State the basis for this procedure, and list some of the medications commonly administered by this procedure.

Answer 17

• Nebulizer treatments are based on the use of compressed air or oxygen, which forces a mist of medication through tubing to a mouthpiece or mask.
• The client then inhales the medication.
• Medications commonly used for nebulizer treatment include albuterol, cromolyn, levalbuterol, and metaproterenol.
• These agents have bronchodilating effects and may be administered by respiratory therapy personnel.

Question 18

Which important precautions should the nurse consider during nebulaizer treatments?

Answer 18

The nurse should consider the following important precautions during nebulizer treatments:

• Set up a nebulizer treatment for one client only.
• Keep the nebulizer in a sealed bag in the client’s medication drawer or other designated place.
• Teach the client how to use the device.
• Avoid giving treatments immediately before or after meals.
• Never leave a client alone during a nebulizer
• treatment.
• Encourage the client to breathe deeply, but not rapidly. (Rapid breathing may cause dizziness or tetany due to hyperventilation.)
• The client needs to be in upright position.

Question 19

Applying medications directly to the skin or mucous membrane

Answer 19

Topical Method

Question 20

Administering medication into body parts by other ways other than digestive tract

Answer 20

Parenteral Route

Question 21

Medication administration by way of the digestive tract

Answer 21

Enteral Route

Question 22

Placing the medication between the client’s cheek and gum.

Answer 22

Buccal Administration

Question 23

Write the correct sequence that the nurse needs to follow to assist a client during the
application of a nicotine patch.

1. Place the patch on a clean, dry, hairless area and press on all parts of the patch.
2. Take the patch from the package and remove the backing from the patch.
3. Wear gloves during the entire procedure, including the preparation of the patch.
4. Use a permanent marker to indicate the date and time the patch was applied.

Answer 23

• 3. Wear gloves during the entire procedure, including the preparation of the patch.
• 2. Take the patch from the package and remove the backing from the patch.
• 1. Place the patch on a clean, dry, hairless area and press on all parts of the patch.
• 4. Use a permanent marker to indicate the date and time the patch was applied.

Question 24

What are the advantages of storing medications in unit-dose systems?

Answer 24

The advantages of storing medications in unit-dose systems include the following:

• Greater safety in administering medications, because each dose is individually labeled.
• Prevention of duplication, because most unit-dose systems provide only a 24-hour supply of medication for each client.
• Easier identification, because each dose is marked with the generic and trade names.

Question 25

What are self-administered medications? Give
examples.

Answer 25

Self-administered medications are those that a client is allowed to keep at her bedside and administer herself.

Examples of these medications include creams and ointments, vaginal creams, nicotine chewing gum, throat lozenges, and inhalers.

Question 26

When are the three checks done to
compare and confirm the medication’s
name and dosage with the client’s medical
administration record?

Answer 26

The three checks to compare and confirm the medication’s name and dosage with the client’s medical administration record are done at the following times:

• The first check: when removing the medication from storage.
• The second check: when scanning it and placing it in the medication cup or envelope.
• The third check: when opening the unit-dose package at the client’s bedside.

Question 27

What are the common errors that occur
during medication administration? How are
they prevented?

Answer 27

• The most common medication errors include
  
  • Administering medication to the wrong client,
  • Administering the wrong medication or dose
  • Administering at the wrong time
  • Administering by the wrong route.
• Failure to document a medication or incorrect documentation is also considered a medication error.
• Consulting a drug reference or asking the team leader before administration can prevent medication error.
• If the possibility of a medication error exists, the nurse should not hesitate to report it.

Question 28

What is meant by potentiation of drugs?

Answer 28

Two drugs are said to potentiate each other when the effects of the two medications added together are greater than what they should be (i.e., the effects of the drugs are multiplied).

Potentiation can become a very dangerous situation.

Question 29

Describe the purpose of instilling eye drops
and eye ointments.

Answer 29

Eye drops and eye ointments are instilled for various

reasons:

• *•** To contract or dilate the pupils
• *•** To treat an infection
• *•** To provide lubrication
• *•** To produce a local effect (e.g., anesthesia)

Question 30

A 50-year-old client who underwent surgery
for cervical spondylitis at a healthcare facility
requests that the nurse provide the necessary
medications that he must take after being discharged from the healthcare facility.
On obtaining the prescribed medications, the client reports to the nurse that the shape of the medication provided by the nurse is different from the tablets that were given to them during their hospital stay.

Which important teaching should the nurse
provide the client before administering any
medication?

Answer 30

The nurse should provide the following information before administering any medication to clients:

• What medications are being given (generic and trade names)
• Why the client is taking them
• Dosage and frequency
• How to administer or take them at home
• Expected effects
• Possible undesirable side effects
• How long the client will need to take the medications
• What to do if a dose is missed
• Signs and symptoms that the client should report to the healthcare provider

Question 31

What are the important assessments a nurse
should make when a client asks for PRN medication?

Answer 31

• The nurse should make the following assessments when a client asks for a PRN medication:
• First, assess what symptoms have prompted the client’s request. If the client is complaining of pain, determine the pain’s location and discomfort level on a pain scale of 0 to 10.
• Next, consult the medication administration record to determine when the client last received the PRN or a regularly scheduled pain medication.
• Observe the client’s reaction to illness and hospitalization, because nursing care is based on the client’s unique responses to the stress of illness and hospitalization.
• If the prescribed period has elapsed, administer the medication as soon as possible. If the prescribed period has not elapsed, inform the client when he or she can receive the next dose.
• If the pain is extreme, consult the primary provider to determine whether an additional dose or another medication can be given.

Question 32

How will the nurse reassure the client regarding the shape change of the medication?

Answer 32

• The nurse should explain to the client that the differences in shape and color of a medication may be due to a change in manufacturer or because the client is now receiving a generic form of the medication.
• Also, the nurse should explain to the client that the differences do not necessarily mean that the medication is incorrect.
• The nurse should check the medication if she is not sure.