Module 9: Medication administration Flashcards
What is the therapeutic objective of drug therapy?
“The objective of drug therapy is to provide maximum benefit with minimum harm”
What does the nurses role include in therapeutic objective of drug admin?
- acquiring and using a scientific knowledge base,
- a clear orientation toward safety,
- awareness of legislation and current medication administration standards,
- excellent assessment and monitoring competence.
What is pharmacology?
the study of the effect of drugs on living organisms.
What is pharmacy?
the art of preparing, compounding, and dispensing drugs.
what does a liscensed pharmacist do?
o prepares and dispenses drugs as ordered by the physician, dentist, nurse practitioner, and other health care professionals on the basis of provincial or territorial legislation.
what is a drug?
is any chemical that affects physiological processes.
What is a medication?
is a substance administered or the prevention, diagnosis, cure, treatment, or relief of a symptom or disease. In the health care context, the words medication and drug are used interchangeably.
Medications are a primary treatment that patients associate with restoration of health
What is involved in the “teaching” for client and drug admin?
- And their adverse drug events
- Promoting patient adherence to the medication regimen
- Evaluating the patients technique for all routes of medication delivery
What is a prescription?
The written direction for the preparation and administration of a drug
How many different names can one drug have?
- generic name,
- official name,
- chemical name,
- trademark or brand name.
What is a “generic” name and give examples
It is assigned before a drug becomes official. It is approved by Health Canada under the Food and Drug Regulations Act.
ex.
Acetominphen is the generic name for tylenol
Ibupropen is the generic name for advil
dimenhydrinate is the trade name for Gravol TM, Dramamine
Aspirin is the trade names for ASA , Entrophen
what is the “official” name?
- the name under which a drug is listed in one of the official publications.
what is the “chemical” name?
the name by which a chemist knows it; it describes the chemical constituents and molecular structure of the drug
what is a DIN and where is it found?
• Each drug is evaluated by Health Canada Therapeutic Products Directorate and approved for sale in Canada receives an eight-digit Drug Identification Name (DIN). This number is found on the label of all prescriptions and over the counter drugs (OTCS) as well as natural health products.
Why are drug standards developed?
to ensure uniform quality
What are official drugs?
those designated by the Canadian Federal Food, Drug, and Cosmetic Act
what is the nurses role in the legal aspects of drug admin?
a) know how nursing practice acts in their jurisdictions define and limit their fxns
b) Be able to recognize the limits of their own knowledge and skills
who is responsible for incorrectly administering a written incorrect dosage?
The nurse, and the prescribing health care provider
what is a high alert medication?
medications that carry a high risk of harming the patient when they are used in error), including controlled substances, which require the verification of two registered nurses
What is necessary for any portion or all of a controlled substance that is discarded?
must be witnessed and documented by both nurses
How are children’s medications computed?
Children’s medication doses are computed on the basis of body surface area and weight
What should each medication order include?
- patient’s name
- order date
- medication name
- dosage
- route
- time of administration and indication
- prescriber’s signature.
What are the 10 “rights” of medication administration?
- right medication,
- right dose
- right patient
- right route
- right time and frequency
- right documentation
- right reason
- right evaluation (or assessment)
- right patient education
- right to refuse.
who can administer medications?
The nurse should administer only the medications that they prepared; prepared medications must never be left unattended.
What is nurse responsible for?
- evaluating the effects of the medications
- teaching patients about their medications and possible adverse drug events
- promoting adherence
- and evaluating the patient’s technique for medication delivery.
What is clinical pharmacology?
Clinical Pharmacology: the study of drugs in humans.
Therapeutics or pharmacothera-peutics:
Therapeutics or pharmacothera-peutics: the use of drugs to diagnose, prevent or treat disease or to prevent pregnancy
What are the properties of an ideal drug?
Effectiveness
Safety
Selectivity
What are the factors that determine the intensity of drug responses for administered drug dosages?
Drug
Dosage
Route
Timing
What are the factors that affect how much of the drugs gets to its site of action? (Pharmacokinetics)
Drug absorption
Drug distribution
Drug metabolism
Drug excretion
What is pharmacokinetics?
The study of how medications 1) Enter the body 2) Are absorbed and distributed into cells, tissues, or organs 3) Alter physiological functions 4) Exit the body
What are the factors that affect absorption?
Route of administration Ability of the medication to dissolve Blood flow to site of administration Body surface area Lipid solubility of medication
What does distribution depend on?
Circulation
Membrane permeability
Protein binding
How are medications metabolized?
into a less potent or an inactive form
What is biotransformation and where does it occur?
Biotransformation occurs when enzymes detoxify, degrade, and remove active chemicals
Occurs in the liver
How are medications excreted?
Kidneys Liver Bowel Lungs Exocrine glands
What are the factors that determine the intensity of drug responses?
- pharmacodynamics
- Sources of inidividual variations
What are factors included in pharmacodynamics?
Binding of the drug to its receptor
Patient’s functional state
Placebo effects
What are the factors in individual variations?
Drug interactions
Physiologic variables – age, gender, weight
Pathologic variables – effectiveness of the liver and kidneys
Genetic variables
To safely and accurately administer medications, nurses need knowledge related to…?
Pharmacology Pharmacokinetics Growth and development Human anatomy Pathophysiology Psychology Nutrition Mathematics
How are medications classified?
- Effects on body system
- which symptoms relieved
- desired effect
What are the different types of medication forms?
Solid - Caplet, capsule, tablet, enteric-coated tablet, Pill
Liquid - Elixir, extract, aqueous solution, aqueous suspension, syrup, tincture
Other oral forms
Topical - Ointment, liniment, lotion, paste,
Parenteral - solution , powder
Instillation into body cavities - Solution, intraocular disc, suppository
What does parenteral mean?
administration of medication in any other non-oral form usually relating to injection
What is the difference between therapeutic classification of medication? give an example
Therapeutic classification: a way or organizing drugs based on their therapeutic usefulness in treating particular diseases;
e.g. Cardiac Care Drugs affect cardiovascular function
Pharmacological classification: addresses a drug’s mechanism of action, or how a drug produces its effect in the body.
e.g. Pharmacotherapy for hypertension
Some medications are part of more than one class of drugs;
e.g. aspirin is an analgesic, antipyretic and anti-inflammatory
What are considerations for medication actions?
- A patient does not always respond in the same way to each successive dose of a medication
- Sometimes the same medication causes very different responses in different patients
- Therefore, nurses need to understand all the effects that medications can have on patients.
what are the four different types of medication actions?
1) Therapeutic affects - Expected or predictable
2) Side affects - Unintended secondary effect
3) Adverse affects - Severe, negative response to medication
4) Toxic affects - Medication accumulation in the bloodstream
What is a idiosyncratic reaction?
Overreaction or underreaction to a medication
What is the difference between side affects and severe adverse affects of medication action?
Side effect - It is PREDICTABLE: Unintended, unavoidable secondary effects that a medication predictably will cause.
e.g. Narcotics may cause nausea or constipation
Severe adverse effect - UNPREDICTABLE and UNDESIRABLE: Severe adverse effects or adverse drug events (ADE) are unintended, undesirable and often unpredictable.
Can be intolerable, negative responses that justify immediately discontinuation of the medication
e.g. Kidney failure
What is a contraindiction?
Many medications should not be taken by some patients due to unwanted, dangerous reactions.
Prescribing aspirin to children and teenagers is contraindicated due to risk of Reye’s Syndrome
What is a medication “interaction”?
Interactions are events in which one medication modifies the action of another.
what is a “syngistic” effect?
A synergistic effect occurs when the combined effect of two medications is greater than the effect of the medications given separately
What are the different medication dosage responses?
- Goal of prescribing medication
- Onset
- Constant therapeutic concentration.
- Peak concentration
What is the goal of prescribing medication?
to achieve a constant blood level of the medication within a safe therapeutic range.
What is the “onset”?
- time it takes for a medication to produce a response
What is the “peak concentration”?
the highest effective concentration reached after medication is administered.
What is “trough” concentration?
minimum blood serum concentration before next scheduled dose
peak level is drawn whenever the drug is expected to reach its peak concentration.
What is “serum half-life”?
time for serum medication concentration to be halved
- the length of time required for a medication to decrease concentration in the plasma by one-half after administration.
- Some drugs have a half-life of only a few minutes, while others have a half-life of several hours or days. The greater the half-life the longer it takes a medication to be excreted
What is “duration”?
time medication takes to produce greatest result
What is “plateau”?
blood serum concentration reached and maintained
What should happen when a medication admin error occurs?
When an error occurs, the nurse should assess the patient’s condition and notify the physician or prescriber of the medication ASAP
May need to take measures to counteract the error. After the patient’s condition has stabilized, the incident should be reported to the appropriate person in the institution
The nurse is responsible for preparing a written occurrence or incident report, which usually needs to be filed within 24 hours of the error
When do medication errors usually occur?
Medication errors often occur when a patient is transferred to a different unit within a hospital or to another health care agency
What is the difference between potentiating vs inhibiting effect?
o The effect of one or both drugs may be either…
- potentiating effect = increased
- inhibiting effect = decreased
What does the route prescribed depend on?
- medication route depends on the medications properties, the medications desired effect, and the patients physical and mental condition
What is the most common and easiest route for drug admin?
Oral
Why should sublingual meds never be swallowed?
because the medication will not have the desired effect.
What is buccal drug administration?
administration of a medication by the buccal route involves placing solid medication in the mouth and against the mucous membranes of the cheek until the medication dissolves
How would you teach a patient to avoid buccal irritation?
To avoid mucosal irritation, teach patients to alternate cheeks with each subsequent dose
What are the four major sites of injection?
1) Intradermal (ID): injection into the dermis just under the epidermis
2) Subcutaneous (subcu): injection into tissues just below the dermis
3) Intramuscular (IM): injection into the muscle
4) Intravenous (IV): injection into a vein
What are the other sites for parenteral injection?
- epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intra-arterial routes
What is the Intrathecal route?
administered through a catheter that has been placed into the subarachnoid space or into one of the ventricles of the brain
What is the intraosseous route?
infusion of medication directly into the bone marrow
What is the intraperitoneal route?
peritoneal cavity, where they are absorbed into the circulation system
What is the intrapleural route?
an injection or a chest tube is used to administer intrapleural medications directly into the pleural space
What is the Intra-arterial route?
directly into the arteries and are commonly used to deliver tissue plasminogen activators in patients who have arterial clots
Often administered through indwelling catheters
What percautions should the nurse take when administering topical medication?
Gloves should be worn to prevent absorbing medications through the appliers skin
What are the different methods of topical administration?
- painting or spreading the medication over the skin, applying moist dressings, soaking body parts in a solution, or giving medicated baths
What are the different ways of inhalation route?
nasal passages, the oral passage, or endotracheal or tracheostomy tubes
What is the difference between endotracheal tubes vs tracheostomy?
Endotracheal tubes are inserted into the patient’s mouth and extend to the trachea.
Whereas, tracheostomy tubes directly enter the trachea through an incision in the patient’s neck
What is the intraocular route?
a medication in a form similar to a contact lens in inserted directly into the patient’s eye.
What should the nurse do when they receive a verbal drug admin order?
When the nurse receives a verbal order, he or she must read it back and receive confirmation from the prescriber to ensure accuracy
The nurse then immediately enters the order into the patient’s medical record and records the time and the name of the prescriber who gave the order
AC:
Before meals
BID
Twice a day
IM
Intramuscular
IV
Intravenous
PC
(post cibum) after meals
PO
(per os) By mouth
PRN
When needed
Q2H
Every two hrs
STAT
Immediately
What is a unit dose system?
- the unit dose system uses portable carts containing a drawer with a 24 hour supply of medications for each patient
Each drawer is labelled with the name of a patient
The unit dose is the ordered dose of medication the patient receives at one time
Each tablet or capsule is wrapped in a foil or paper container
At a designated time each day, the pharmacist or a pharmacy technician refills the drawers in the cart with a fresh supply
What is an AMDS?
Automatic dispensing system
- Computerized controls to dispense narcotics and unit dose medication
- Each nurse accesses the system by entering a security code
- All procedures connected to an AMDS are controlled electronically via a patient’s profile
- The patient’s name and drug profile must be accessed before the AMDS will dispense a medication
- The nurse enters the patient’s identification number into the computer and selects the desired medication
- The system opens the drawer containing the medication and records the transaction. Nurses may also scan bar codes to identify the patient, medication (name, dose, route) and the nurse administering the medication. This information is then automatically recorded in a computerized database
What is the difference between an agonist vs antagonist?
Agonist: when the drug produces the same type of response as the physiological substance
Antagonist: prevents natural body substances or other drugs from activating the fxns of the cell by occupying the receptor sites.
What is first-pass effect?
occurs when oral drugs first pass through the liver and are partially metabolized prior to reaching the target origin. This requires higher oral doses to achieve the appropriate effect or administration by other routes than the gastrointestinal tract
How can the rate of of absorption be accelerated?
by the application of heat or slowed by the application of cold.
What determines the distribution of the drug?
The chemical and physical properties of a drug largely determine the area of the body to which the drug will be attracted.
What is metabolism and where does it take place and what are the products created called?
• also called detoxification or biotransformation, is a process by which a drug is altered by enzymes.
o Most metabolism takes place in the liver.
o Drug metabolism can result in: increased excretion by the kidneys, drug inactivation, increased therapeutic action, and increased toxicity.
o The products of metabolism are called metabolites.
Where are drug metabolites eliminated?
by the kidneys through the urine; however, some are excreted in feces, breath, sweat, saliva
What are the two systems of measurement used in Canada?
• the metric system and the household system
What is the official system used in Canada and how does it measure?
• The metric system is the official system of measurement in Canada and is logically organized into units of 10; it is a decimal system.
o Basic units of measurements are the metre, litre, and gram.
What is the household measurement?
• Household measures may be used when more accurate systems of measure are not required and includes teaspoons (tsp) and tablespoons (tbsp)
What is the relative metric conversion for household measures?
♣ 1 tsp = ~5ml
♣ 1 tbsp = ~15ml
1000mg =
1g
1000000mcg =
1g
1mg =
0.001g
1 mcg =
0.000001
1 mg =
1000mcg
What is the basic formula for calculating dosages?
D x V / H = amount to administer (x)
D = desired dosage H = dose on hand (i.e dose on label of bottle/vial) V = vehicle (form the drug comes in)
What is dimensional analysis?
Dimensional Analysis is a calculation method known as units conversion
Dimensional analysis is a practical approach to drug calculations. It can be used for all medication problems.
o Used when a quantity in one unit of measurement is converted to an equivalent quantity in a different unit of measurement and is done by cancelling matching units of measurement
How do you determine the drug dose by body weight?
Body weight:
- Determine the drug dose per body weight by multiplying drug dose x body weight x frequency
- Choose a method of drug calculation to determine the amount of medication to administer
How do you determine the drug dose by body surface area?
♣ Considered the most accurate method of calculating a pediatric dose.
♣ Determined by using a nomogram and the child’s height and weight.
What is the guidelines for rounding numbers in Drug Calculations?
- Rounding numbers is performed only AFTER all calculations have been completed.
What is the guidelines for rounding numbers in intravenous drug Calculations?
o Gravity infusion: Round to the nearest whole number
o Infusion by intravenous pump:
♣ If the pump uses only whole numbers, then round to the nearest whole number.
Some pumps in critical care settings can be set to a tenth of a rate
What is the guidelines for rounding numbers in oral drug Calculations?
o Capsules, enteric-coated and extended-release formations cannot be divided.
o Tablets that are scored (a line marked on the table) can be divided, generally into halves. A tablet must be scored by the manufacturer to be divided properly.
o For tablets that are not scored and for capsules, it may not be realistic to administer the exact amount as calculated.
o For liquid medications, check to see if it is possible to administer the accurate dosage. Syringes, such as a 1ml medication syringe, include markings for hundredths of a milliliter.
What is the guidelines for rounding numbers for parenteral drug Calculations?
o Medications with volumes 1ml or less are rounded to the nearest 100th, that is, 2 decimals. These medications are drawn up using a 1ml syringe.
o Medications with volumes greater than 1ml are rounded to the nearest 10th, 1 decimal.
o High-alert medications (e.g. insulin) are rounded to the hundredth and specially calibrated syringes are used.
What is the guidelines for rounding numbers DOWN for drug Calculations?
o Rounding down may be used in pediatric clients or when administering high-alert medications to adults so as to avoid the danger of overdose.
o To round down to hundredths, drop all of the numbers after the hundredth place. For tenths, drop all of the numbers after the tenth place, and for whole numbers, all of the numbers after the decimal are dropped.
What are the two different methods for drug calculations?
1) Dimensional analysis
2) Formula D / H x X = Amount to give
what are the rules around dimensional analysis?
• Rules:
1. Identify the desired answer unit and write it to the left of the equal sign.
2. Identify the given quantity in the problem and desired quantity and write them to the right of the equal sign so that the desired quantity is a numerator and the given quantity is written to allow cancellation of units.
3. Establish the unit path from the given quantity to the wanted quantity using equivalents as “conversion factors.” Make sure that the unit of the desired quantity is the numerator of either the given quantity or in the unit path.
4. Carefully check each conversion factor and ensure that it is correctly placed in the numerator or denominator portion of the problem to allow the unwanted units to be cancelled from the problem.
5. Cancel the terms as per fraction multiplication. The remaining units should match the units on the left of the equal sign and be the units desired. If all the units except the answer units are not eliminated, recheck the equation.
6. Reduce the fractions to their lowest terms; multiple the numerators and denominators and divide the denominator into the numerator to provide the numerical value of the wanted quantity.
• The dimensional analysis method requires three elements: given quantity, desired quantity, and unit path, using equivalent “conversion factors” when necessary to convert from one unit to another.
What does dimension refer to?
o a unit of mass, volume, length, rime, and so on. Examples are milligram (mg), litre (L), metre (m), and minute (min).
What are the rules around the formula method?
• Rules:
- Memorize the formula, or verify the formula from a resource
- Place the information from the problem into the formula in the correct position, with all terms in the formula labelled correctly.
- Make sure all measurements are in the same units and systems of measurement, or a conversion must be done before calculating the formula.
- Think logically and consider what a reasonable amount to administer would be.
- Calculate the answer.
- Label all answers with the correct units.
- Double-check the math of the calculation.
What are the different tools used for dosage calculations?
- The medicine cup: Normally 30 mL with both the household system and the SI system are calibrated on the cup.
- The calibrated doppler: Used to administer some small quantities.
When is a dropper used?
o A dropper is used when giving medicine to children and older adults, and when adding small amounts of liquid to water or juice. Eye and ear medications are also dispensed from a calibrated medicine dropper or squeeze drop bottle.
Why should you never interchange packaged droppers?
o a properly calibrated dropper usually accompanies the medicine. It is calibrated according to the way that a drug is prescribed. The calibrations are usually given in milliliters, cubic centimeters (cc), or drops.
To be safe, never interchange packaged droppers between medications because drop size varies from one dropper to another
How do you distinguish between oral syringes and parenteral syringes?
- syringes intended for oral use typically do not have a Luer-Lok hub, and the tip is too large to accommodate a needle. They also usually have a cap on the tip that must be removed before administering the medication
- Syringes intended for parenteral use have a Luer-Lok that allows a needle to be secured tightly
what are the guidelines around the 3ml parental syringe?
o The nurse pulls back on the plunger to withdraw the medicine from the storage container.
o The calibrations are read from the top black ring, not the raised middle section and not the bottom ring.
o Each ½ (or 0.5) millilitre is marker up to the maximum volume of 3 mL.
o Dosages are standardized to the syringe calibrations. Standard drug doses of 1 mL or greater can be rounded to the nearest tenth (o.1) of a mL and measured on the mL scale.
What should the nurse do when an abbr is not clearly written?
- it is the responsibility of the nurse to contact the writer of the order containing the abbreviation to obtain clarification and avoid any potential safety incidents
what are the 7 parts of a drug order?
- Name of the patient
- Name of the drug to be administered
- Dose of the drug
- Route by which the drug is to be administered
- Frequency, time, and special instructions related to administration
- Date and time when the order was written
- Signature of the person writing the order
What happens when any of the 7 parts of the drug order are missing?
• If any of the seven parts of the drug order is missing or unclear, the order is considered incomplete and is, therefore, not a legal patient care order. The nurse must obtain clarification of the order from the writer.
What are the rights of safe and accurate medication administration?
The right patient must receive the right drug for the right reason in the right amount by the right route in the right site at the right time and right frequency, with the right to refuse, followed by the right documentation.
What is the specific sequence for each patient care order?
o The name of the drug is written first, followed by the dosage, route, and frequency.
o he order may be written using generic or brand names, or both.
♣ Combinations and over-the counter drugs are often identified by brand name.
♣ When correctly written the trade name of the drug begins with a capital or upper-case letter.
♣ The generic name begins with a lower-case letter.
