Med Admin Flashcards
Define: Medication administration
preparing, giving and evaluating the effectiveness of prescription and non-prescription drugs
Role of the RPN: Med Admin
Be knowledgeable about your practice standards (BCCNM)
Educate yourself on the drug you are administering
what it does, how it works, normal dosage and why it was ordered?
Educate yourself on what could go wrong once you give it
potential side effects and contraindications for use
Identify any barriers to medication compliance
be aware of why people may want to discontinue their meds
Carry out the Nursing Process
BCCNM Medication Administration
- RPNs are responsible for administering medications within their scope of practice.
- RPNs are knowledgeable about the effects, side effects and interactions of medications and take action as necessary.
- RPN’s adhere to the “7 rights” of medication administration.
- RPNs administer only medications they themselves or a pharmacist have prepared, except in an emergency.
- RPNs do not pre-pour medication because it increases the likelihood of errors.
- RPNs take appropriate steps to resolve and report any medication administration error or near miss in a timely manner.
7 Rights of Medication Administration:
Right Medication
Right Client or Patient
Right Dose
Right Time
Right Route
Right Reason
Right Documentation
You may encounter practice settings that use ‘10 Rights’. The additional three are:
Right to refuse
Right patient education
Right evaluation
Define pharmacology
The study or science of drugs
The psychiatric nurse needs to know about pharmacological principles so they can understand how each drug given will affect the patient (both beneficial and adverse effects).
Drug names:
- generic name
- trade name
- chemical name
generic name of drug
the name given to the drug by the developer of the medication
Becomes the official name and is used in all formal publications
E.g. acetaminophen, ibuprofen, dimenhydrinate
trade name of drug
Also known as the brand name, this is the commercial name given to a drug by the manufacturer, can vary in different countries
E.g. Tylenol, Advil, Gravol
chemical name of drug
Describes the medication’s molecular structure
E.g. N-acetyl-para-aminophenol is acetaminophen (generic name)
or Tylenol (brand name)
drug classification
Indicates the desired effect on the body system.
Tells you what type of drug it is.
- E.g. Antipsychotic, antihypertensive
medication forms
The form of the med indicates the route of administration. Nurses must ensure they use the correct form of medication as this affects absorption and metabolization.
E.g. tablet, ointment, suppository
Pharmacodyamics:
The study of what the drug does to the body:
therapeutic effect
side effect
adverse effect
toxic effect
contraindication
Pharmaceutics:
How various medication forms/routes influence the way in which the body metabolizes a drug and the way in which the drug effects the body
Therapeutic Effect
intended or expected effect on the body
E.g. Tylenol will relieve a headache.
side effect
unintended secondary effects
adverse effect
serious, negative effects
toxic effect
a build-up or accumulation of medication in the body, to the point where it is poisonous.
Contraindication
any characteristic of the patient (disease state, other medication, pregnancy) which makes the use of the medication dangerous for them.
Pharmacokinetics:
How the medication moves into, through and out of the body (absorption, distribution, metabolism and excretion)
Absorption:
The movement of the drug from the site of administration to the bloodstream
Distribution:
Transport of a drug in the body by the bloodstream to its site of action
metabolism
The biological transformation or metabolic breakdown of a drug in the body (most commonly done in the liver)
excretion
The elimination of drugs from the body
- The kidneys are the primary way that drugs are eliminated from the body; to a lesser extent the bowel and liver are also responsible for elimination
Different ways we get medications into the body:
parenteral
IV, IM, subcutaneous
Different ways we get medications into the body:
inhalation
nebulizers, nasal sprays
Different ways we get medications into the body:
transmucosal
sublingual
Different ways we get medications into the body:
gastrointestinal
PO, suppositories
Different ways we get medications into the body:
transdermal / topical
patches, creams, ointments
onset of action
Time it takes for the drug to elicit a therapeutic response
peak effect
Time needed for a drug to reach its maximum therapeutic response
duration of action
The length of time that the concentration is sufficient to elicit a therapeutic response (time it lasts before it wears off)
half-life
The time it takes for one half of the drug in the body to be removed (eliminated from the body)
drug schedule
Health Canada determines whether or not a drug requires a prescription in order to regulate access to the drug
Drug Scheduling Act & Controlled Drugs and Substances Act
Health Canada classifies a drug based on it’s medicinal ingredients and puts the drug on the Prescription Drug List
If a drug has been given non-prescription status by Health Canada, the regulation and sale of that drug is left up to the individual provinces and territories
Schedule l, lA, ll, lll & lV must all be sold from licensed pharmacies
schedule 1
Need a prescription in order to sell
e.g. amoxicillin, sertraline
schedule 2
no prescription required but pharmacist supervises the sale (medications are kept behind the counter)
e.g. Tylenol # 1 - 8 mg of codeine, cough syrup with codeine
schedule 3
Drugs that can be sold without a prescription by a pharmacist (medications are locked in grocery stores after pharmacy closes. If no pharmacist on duty, cannot sell the medications)
-e.g. hydrocortisone topical cream, Pepcid AC
schedule 4
prescription by pharmacist
unscheduled
no restriction on sale of this drug
e.g. Tylenol, Tums – available at 7/11, etc.
NSAIDS
(Non-steroidal anti-inflammatory drugs)
ASA (Aspirin)
Advil (Ibuprofen)
OTC
Non-opioid Analgesics
pain relief:Acetaminophen (Tylenol)
anti-emetics
Dimenhydrinate (Gravol)
Antihistamines
Diphenhydramine (Benadryl)
Natural Health Products (NHPs)
Complementary medicines or traditional remedies based on premise that plants contain natural substances that can promote and alleviate illness.
- E.g. Marijuana, St. John’s Wort, Melatonin
- NHP Advantages:
Adjunct therapy to support conventional pharmaceutical therapies. - NHP Disadvantages:
Drug-drug interactions
E.g. Evening primrose interferes with antipsychotic drugs
Allergic reactions
Adverse side effects
People believe they are safe due to “Natural” label
med admin: assessment
Gather a comprehensive medication profile including:
All medications your patient takes on a regular basis
History of allergies
Use of OTC and Natural Health Products
Intake of alcohol, tobacco, caffeine
Illicit drug use
Past/ present health/ medication history
Family history
Client’s beliefs about their medications and their effectiveness
med admin: nursing diagnosis
Developed from the assessment data through critical thought, analysis, creativity and accurate data collection.
Nursing diagnoses related to medication therapy may include:
Variance in Knowledge Base (knowledge deficit)
Variance in Protection (risk of injury from over-medicating)
Variance in Health Beliefs (non-adherence)
med admin: planning
Goals are patient focused
They include a time frame
GOAL: Patient will take medication as prescribed on a daily basis, starting immediately.
med admin: interventions
Interventions are based on evidenced based practice
Interventions are done as independent nursing functions or as collaborative interdisciplinary care
Nurse to discuss with patient the risks of not taking meds as prescribed
Have pharmacist discuss side effect profile with patient and how to manage each side effect (this is often done by the nurse)
Provide education on long term consequences of stopping medications abruptly
med admin: evaluation
Includes monitoring whether or not the patient goal has been met or not
Includes observing for therapeutic effects and adverse effects/toxicity of a medication
If the goal is not met then nursing care plan will need to be revised
general rules for med admin
- Read the Dr.’s orders and check it against the MAR (Medication Administration record) to ensure they match
- Dr.’s orders are transcribed onto the MAR by either the nurse or a unit clerk (primary nurse must always double check the order)
- Contact the doctor or the pharmacy to clarify any unclear or questionable orders prior to administering
- Never leave poured medications unattended
- Plan your time wisely so that the medication is given within 30 min of the ordered time
- Don’t let yourself multi task or be distracted while pouring or administering medications – this is when many med errors occur
- Provide adjunctive interventions as indicated
E.g. Take patient’s BP pre/post med - Ensure you do 3 medication checks
- Identify the client by name and check wrist band against MAR.
Inform the client about what medication you are giving, listen to them if they express a concern - Don’t forget to ask about allergies prior to giving the medication
- Administer the drug
- Record the drug administered on MAR and if prn then also record in nurses notes -NEVER sign off a medication prior to giving it !!!
- Evaluate and document the client’s response to the drug in nurses notes
medication adherence
Clients are often misinformed about their medication. Providing accurate education to your clients about their medications is a large part of your role as psychiatric nurses
As psychiatric nurses, DO be collaborative and curious
DON’T be chastising
