Medication Administration Flashcards
Pharmokinetics definition
How medications travel through the body. Medications undergo a variety of biochemical process that result in absorption, distribution, metabolism, and excretion.
Routes of Absorption
Oral
Barriers: layer of epithelial cells that line the GI tract
Subcutaneous and intramuscular
Barriers: no significant barrier
Intravenous
Barriers: None
Factors influencing Distribution
Circulation: peripheral vascular problems or cardiac disease can delay medication distribution
Permeability of the cell membrane : Medication must be able to pass through tissue
Plasma protein binding : medications compete for protein binding sites within the bloodstream, primarily albumin.
Factors influencing medication metabolism rate
Age : infants have a limited medication-metabolism capacity. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
An increase in some medication metabolizing enzymes : can require an increase in dosage of that medication to maintain therapeutic level
First pass effect :the liver inactivates some medications on their first pass through the liver. Thus they require a non enteral route (sublingual, IV because of their high first-pass effect.
Similar metabolic pathways : When the same pathway metabolizes two mediations, it can alter the metabolism of one or both of them.
Nutritional status : Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes thus impairing medication metabolism
Excretion
The elimination of medications through the body are primarily through the kidney.
Also, the lungs, liver, intestines, and exocrine glands (in breast milk).
Therapeutic Index
Medications with high therapeutic index has a wide safety margin
Medications with low therapeutic index require close monitoring of medication levels.
Nurses should consider the route of administration when monitoring for peak levels (highest plasma level when elimination=absorption).
Pharmacodynamics (Mechanism of Action)
The interactions between medications and target cells, body systems, and organs to produce effects.
Examples:
Agonist- mimic receptor activity
Antagonist - block the usual receptor activity
Partial agonists - act as an agonist and antagonist
Sublingual and bucal
Sublingual: under the tongue
bypasses the liver, goes directly in bloodstream
Bucal: between the cheek and gum
Keep medication in place until complete absorption occurs
Topical medication
Do not apply with a bare hand
For skin applications, wash the skin with soap and water. Pat dry before application
Transdermal medication
Apply patches as prescribed to ensure proper dosing
Wash the skin with soap and water, and dry it thoroughly before applying a new patch
Place the patch on a hairless are and rotate sites to prevent skin irritation
Eye drop medication
Hold dropper above the conjunctival sac about 1 to 2 cm, AVOID PLACING IT DIRECTLY ON CORNEA, and have them close the eye gently. If they blink repeat the procedure
Apply gentle pressure with finger and clean facial tissue on the nasolacrimal duct for 30 to 60 seconds
Wait 5 min in between medications in same ye.
IF APPLYING OINTMENT, APPLY THIN RIBBON FROM THE INNER TO OUTER CANTHUS
Ear medication
Have clients sit upright or lie on their side.
Hold the dropper 1 cm above the ear canal, instill medication, and then gently apply pressure with finger to the tragues of the ear.
Have clients remain in the side-lying position if possible for 2-3 min after installation of ear drops
Nasal medication
Have clients lie supine
Use dominant hand to instill the drops, supporting head with other.
Instruct clients to breathe through mouth and do not blow nose for 5 min after
Spray med into nose while client inhales
Metered Dose Inhalers (MDI)
Shaker the inhaler vigorously five or six times
Hold the inhaler about 2 to 4 cm (1-2 inches) away from mount with the opening pointing toward the back of the throat
Take a deep breath, and then exhale
Tilt head back then begin o press the inhaler then inhale slowly and deeply for 3 to 5 seconds to facilitate delivery to air passages
Hold breath for 10 seconds to allow medication to deposit in airways
Resume normal breathing
Dry powdered inhalers
Do not shake the device
Exhale completely
Place mouthpiece between your lips and take a deep inhalation breath through mouth
Hold your breath for 5 to 10 seconds
Exhale through pursed lips after removing inhaler from mouth.
Clients who need more than one puff should wait the length of time the provider specifies before second puff
RINSE MOUTH WITH WATER OR BRUSH YOUR TEETH IF USING CORTICOSTEROID INHALER TO REDUCE RISK OF FUNGAL INFECTIONS
Nasogastric and gastrostomy tubes nursing action
Verify proper tube placement
Use a syringe and allow the medication to flow in by gravity or push it in with the plunger of the syringe
administer each medication separately.
Completely dissolve crushed tablets and capsule contents in 15 to 30 mL of tepid water prior to administration
To prevent clogging flush the tubing before and after each medication with 15 to 30 mL of water. Flush with another 30 -60 mL of water after all medications
WITH ENTERAL FEEDINGS: KEEP BED ELEVATED AT A MINIMUM OF 30 DEGREES. ( PREFERABLY 45 DEGREES) FOR ABOUT AN HOUR AFTER MEDICATION
Parenteral examples
Intradermal
Subcutaneous
Intramuscular
Intravenous
Parenteral nursing actions
Vastus lateralis is best for infants 1 year and younger
Ventrogluteal site for IM injections and injecting volumes exceeding 2 mL
Deltoid site can only accommodate up to 1 mL of fluid
Tuberculin syringe for solution less than 0.5 mL
DO NOT USE INJECTION SITES THAT ARE EDEMATOUS, INFLAMED, OR HAVE MOLES, BIRTHMARKS, OR SCARS
Intradermal nursing actions
Use for tuberculin testing or checking for medication or allergy sensitivities
Use 1 mL tb syringe
Use 0.001 - 0.1 mL solution in syringe
1/4 to 5/8 inch needle size
25-27 gauge
inner surface of the mid-forearm or scapular area of the back
10-15 degree angle
Bevel should be up
DO NOT MASSAGE SITE AFTER INJECTION
Subcutaneous nursing actions
Use small doses for non irritating, water soluble medications
SubQ gauge 25-27
Example: insulin and heparin
Use 3/8 to 5/8 inch needle
25-31 gauge for insulin
Use insulin syringe for insulin. No more than 1.5 mL of solution.
Select sites with adequate fat-pad size
abdomen, upper hips, lateral upper arms, thighs
For average size clients, pinch the skin and inject at 45 - 90 degree angle. For obese, use a 90 degree angle.
Intramuscular nursing action
Use for irritating medications, solutions in oils, and aqueous suspensions
Common sites: ventrogluteal, deltoid, and vastus lateralis (pediatric)
use 5/8 to 1 1/2 inch needle
18 to 25 gauge (usually 22-25 gauge) syringe
Inject at 90 degree angle
solution is usually 1-3 mL
Divide larger volumes in two different syringes and different sites
Use Z-track method for IM injections of irritating fluids or fluids that can stain the skin
Example : iron preparations
(Prevents medication from leaking back into subQ tissue
Intravenous nursing actions
Use for administering medications fluid and blood products
16 gauge for clients who have trauma 18 gauge during surgery and blood admin
Use 22 to 24 gauge for children, older adults, and clients who have medical issues or are stable post op
Sites: peripheral veins in the arm or hand are preferable.
NEWBORNS : use veins in the head, lower legs, and feet
Routine or standing prescriptions
Medications nurses give on a regular schedule with or without a termination date (prescription will be in effect until provider discontinues or discharges the client)
Providers must re-prescribe some medications within a specific amount of time or they automatically discontinue
Single or one time prescriptions
Common for pre operative or pre procedural medications
Example: a one time prescription instructs the nurse to administer warfarin 5 mg PO at 1700
