medication administration Flashcards
what nursing actions support safe medication administration
- Review patient allergies.
- Review and reconcile prescribed medications.
- Identify possible adverse effects of medications.
- Identify potential interactions with other medications.
- Determine route of administration.
- Determine time of administration.
- Develop patient education regarding medication administration.
what actions can help reduce the risk of medication errors
making sure to check all of the 10 rights of medication administration
compare and contrast the various routes by which medication can be administered
oral (PO)
Sublingual (SL)
rectal (PR)
Intravenous (IV)
Buccal
Inhalation
Intramuscular (IM)
subcutaneous (Subcut)
transdermal
otic
opthalmic
nasal
what role does the nurse play in relation to educating the clients about their medications
A nurse plays a critical role in educating clients about their medications by providing clear, understandable information about the purpose, dosage, administration method, potential side effects, and interactions of each prescription
The six rights of medication administration
- Right client: Verify the client’s identity using two client identifiers. (DOB and name)
- Right medication: Confirm the name and form of the medication is correct. (transcribing and read back, MRS)
- Right dose: Check the medication you have against the order in the medical record.
- Right route of administration: Confirm the route (IV, IM, SC, etc.).
- Right time of delivery: Confirm the time the drug is to be given and the last time the drug was administered.
- Right documentation: Document the time the drug was given and any pertinent remarks.
Right to refuse
Client has the right to refuse the medication
Right assessment
Confirm that the medication is appropriate for the clients condition
- make sure to check the medication and double check for allergies
Right education
Provide adequate education addressing
what medication the client is taking, expected benefits, and side effects.
- make sure they know what to expect when taking it
Right response/evaluation
Observe the client’s response to the rug
- check for adverse reactions and if it is working
Additional safety strategies for medication administration
- checking the medication against the Medication administration Record or medication information device upon removal of the drug from the dispensing device
- checking the drug upon preparation
- checking the drug just prior to administration
Medication reconciliation
- performed anytime the care of the client is transferred from one health care professional to another, such as when a client returns or from one physical location to another
- involves reviewing the client’s current medications, then addressing omissions and duplications
- ensure continuity of care (make sure all medications are correct)
Pharmacodynamics
The study of how a drug works, its relationship to drug concentrations, and how the body responds to
Examples of pharmacodynamics
Therapeutic range
Peek blood level (highest)
Trough blood level (lowest)
Half-life (half of duration)
Onset of action (when it starts working)
Peek effect
Duration of action (how long it stays in the body)
Drug-drug interactions
The effect that two or more drugs that the client is administered have on each other
- enhance actions or block actions, increase or decrease ADR, etc).
Drug-food interactions
Effects of nutrients on the absorption, distribution, metabolism, or excretion of medications
- iron and orange juice
- warfarin and diflucin
Serious adverse drug event (ADE)
- a life-threatening reaction that requires medical intervention to prevent death or permanent disability, or congenital anomaly.
- must be reported to the FDA to improve safety outcomes, revising drug labels and warnings, and, when needed, to withdraw drugs from the market
What is a black box warning
A warning issues on medications that may produce lethal and iatrogenic results
Allergic reactions
- allergic or hypersensitivity reaction develops when the body perceived a foreign substance (medication) as an allergen, producing antibodies to counteract the allergen
- the adverse reaction produces histamines in response to tissues injury
Anaphylaxis
A severe, life-threatening reaction resulting from histamine release producing dyspnea, hypotension, and tachycardia
Steven’s-Johnson syndrome
A potentially fatal drug reaction
- develops 1-14 days following drug administration. SJS is manifested by respiratory distress, fever, chills, a diffuse fine rash, and then blisters
What is a pharmacokinetic
The study of the absorption, metabolism, distribution, and excretion of drugs in the human body
The parts to pharmacokinetics
- the dissolution of a medication is dependent upon its initial state and route of administration
- most medications are administered by the oral or enteral route, which provides for a much slower rate of absorption
- distribution is the process of drug delivery to the target organ or tissues that occurs before metabolism and excretion
Metabolism defined
Metabolism or bio transformation is the process of converting a medication to a form that is easily excreted from the body
Examples of how metabolism works
Most drugs are metabolized by the liver.
• Kidneys and sections of the small intestines may also be responsible for drug
metabolism.
• Prodrugs are inactive chemicals that are transformed through metabolism to become
active before they have therapeutic effect.
• Oral medications pass from the small intestine to the hepatic circulation via the
mesenteric vein and portal vein flowing into the liver. This is the first-pass effect,
resulting in a lower concentration of the medication in the systemic circulation.
Define excretion
Is the process of removing drugs from the body
The primary parts of excretion
The kidneys are the primary organ responsible for drug excretion.
• The skin, lungs, exocrine glands, mammary glands, and intestines excrete
medications to a lesser extent.
• Drug toxicity develops when the body is unable to metabolize and excrete
a drug.
Teratogenic medications
Known to cause fetal defects, pregnancy loss, developmental disabilities, or prematurity
Examples of teratogenic medications
o Cocaine
o Alcohol
o Angiotensin-converting enzyme inhibitors (ACE)
o Gentamycin
o Lithium
o NSAIDs
o Tetracycline
Medication order
The order must have the client’s name, DOB, date and time the order was written, and the providers name and title
A medication order written by the provides must include
o The name of the drug,
o The amount to be given
o The route of administration
o The frequency of administration
What are high alert medications
Drugs that are associated with an increased risk of causing considerable client harm when they are administered in error
Parts and types of high-alert medications
Insulin, opiates, narcotics, intravenous
heparin, and injectable potassium
chloride are high-alert medications.
• One strategy to reduce the risk of
harm is manual independent double
checks with two nurses verifying
identical information before these
drugs are administered.
Oral or enteral route
via mouth, stomach or
intestine – absorbed in GI tract first, then to
the circulatory system
Subcutaneous
Delivered into the fat layer under the dermis - usually slower absorption than IM due to small blood vessel size
Intramuscular
Faster absorption due to
larger blood vessels in muscle tissue
Intravenous
Most rapid absorption –
directly administered into the circulatory
system
Topical and transdermal
Applied directly to the area being treated – absorbed through mucus membranes or skin into capillaries and then to the bloodstream
Time
- Time-critical medications are those
that when administered either 30 minutes before or after the scheduled administration time can cause harm to client or substandard pharmacological effect. - Non-time critical medications are defined as medications that can be administered between one and two hours early or late without causing harm or substandard pharmacological effects to the client.
The formula method
Dose ordered or desired X quantity (tablet or ml) / available dose or what is available
examples of medications with black bow warnings
loop diuretics
estrogen
iron supplements
naproxen
birth control
aspirin
