Nurses Role in Medication Administration

• administration
  
• effects
  
• side effects of drugs
  

• Dependent practice - by Prescription
  
• Interdependent practice - MD and RN consult
  
• Independent practice - nurse prepares and administers monitors for side effects patient teaching
  

• Nurse is responsible for what, how, when, and how much is given
  
• Must question orders that seem incorrect or inappropriate
  

• Responsible for understanding:
  
• expected effects
  
• untoward effects
  
• dosages and protocol to give
  
• actions to take in event of untoward reaction
  

• DRUGS ARE LETHAL WEAPONS
  
• THERE IS A FINE LINE BETWEEN CORRECT DOSES AND LETHAL OR TOXIC EFFECTS
  

• Pharmacokinetics-
  
• What the body does to the drug
  
• Pharmacodynamics-
  
• What the drug does to the body
  

• Prescription from M.D.
  
• sometimes nurse practitioner (CRNP) or physician’s assistant (PA) both may need to be co-signed by MD
  

• standing - until cancelled or d/c by agency policy or for particular symptoms
  
• prn - as needed (e.g. for pain)
  
• single order - once, at a certain time
  
• stat - immediately; once only
  

• client name
  
• date/time order written
  
• name of drug (generic or brand)
  
• dosage (metric or apothecary)
  
  
  
  • amount
    
  • frequency
    
  
  
• route
  
• signature
  

• oral
  
• sublingual
  
• buccal
  
• rectal
  
• topical
  
• transdermal
  
• inhalation
  
• Parenteral
  
• subcutaneous
  
• intramuscular
  
• intradermal
  
• intravenous
  
• intraarterial
  

• client
  
• medication
  
• dosage
  
• route
  
• time
  

  
  

  
  

  
  
  • within 1/2 hour
    

• 5 "rights"
  
• 3 checks
  
  
  
  • reach for container or unit dose packet
    
  • right before pouring or opening
    
  • as return container - BEFORE administering
    

• You prepare, you give.
  
• give within 30 minutes of time ordered
  
• identify client (check name band)
  
• explain to client
  
• if client questions drug or dose - STOP
  
• observe client take med
  
  
  
  • per agency policy
    
  • antacids, lozenges
    
  
  
• document after giving (or refused)
  
• monitor and evaluate client response
  

• check if NPO, intact gag and swallow reflex
  
• position patient properly
  
• provide straw as needed
  
• crush or mix in food (e.g. applesauce) prn
  

• Select appropriate size (guage) and length of needle
  
  
  
  • guage - 18 thru 27
    
  • length - 1/2 to 2 inches
    
  
  
• Select appropriate size syringe
  
  
  
  • 1 - 3 ml
    
  
  
• Use aseptic technique
  
• Select appropriate site - IM, SQ, ID
  

• Don disposable gloves
  
• Cleanse site
  
• Inject quickly - 90⁰
  
• Aspirate (not heparin, intradermal)
  
• Inject medication
  
• Dispose in puncture-resistant container without recapping
  
• Record
  
• Evaluate
  

• Dorsogluteal (buttock)
  
• Ventrogluteal (hip)
  
• Vastus lateralis (lateral thigh)
  
• Rectus femoris (anterior thigh)
  
• Deltoid (arm)
  

• recessed IV connectors
  
• blunt cannulas
  
• needles sheathed in plastic guard
  
• retractable needles
  

• Apothecary
  
  
  
  • Basic unit weight - grain (gr)
    
  • Basic unit volume - minim (m) (@ drop)
    
  • 1 gr = 1 m = 1 drop
    
  • written with Roman numeral gr ii
    
  • Others: dram (z ) ounce pint, quart, gallon
    

• Household
  
  
  
  • drop (gtt) 1 minim
    
  • tsp (t) 4-5 ml (z ) @ 60 gtts
    
  • 3 tsp = T (15 ml)
    
  • 2 T = 1 oz (30 ml)
    
  • 1 c = 8 oz
    

• Metric
  
  
  
  • based on units of ten (decimal system)
    
  • 3 basic units measurement
    
  • length - meter (m or M; cm; mm)
    
  • volume - liter (l or L; ml)
    
  • weight - gram (g or Gm; mg)
    

• Roman numerals i, ii, iii, iv, v, x gr i, gr v 1/2 = ss
  
• Fractions
  
• Decimals based on tenths
  
  
  
  • R of . < 1.0 (0.78)
    
  • L of . > 1.0 (12.0)
    
  • Multiply by 10s, 100s, 1000s - move decimal point
    
  • Add or subtract keep decimals lined up
    

• Ratio and Proportion
  
• ratio - express relationship by division 1/3 or 1:3
  
• proportion - 2 equal ratios 1/3 = 3/9 or 1:3::3:9
  
• Product of means always = product of extremes
  
• use to solve for x
  

• 2 = 8 2:4::8:x 4 x
  

• 2 x = 32
  
• x =
  

• What you KNOW What you NEED
  

• DOSE HAVE :: DESIRED DOSE Quantity on hand Quantity to give
  

• Rx: Demerol 75 mg IM stat
  
• Have: Demerol 100mg/ml in vial
  

• DOSE HAVE :: DESIRED DOSE Quantity on hand Quantity to give
  

• 100 mg :1ml :: 75 mg : x ml ( 100 = 75 ) 1 x
  
• 100 x = 75
  
• x = ml
  

• Rx: Cardizem 90 mg po qd
  
• Have: 60 mg / tab
  

• DOSE HAVE :: DESIRED DOSE Quantity on hand Quantity to give
  

• 60 mg :1 tab :: 90 mg : x tabs ( 60 = 90 ) 1 x
  
• 60 x = 90
  
• x = tabs
  

• Rx: Lasix 40 mg IV push stat
  
• Have: 10 mg / ml
  

• DOSE HAVE :: DESIRED DOSE Quantity on hand Quantity to give
  

• 10 mg :1ml :: 40 mg : x ml ( 10 = 40 ) 1 x
  
• 10 x = 40
  
• x = ml
  

• Rx: Amoxicillin 250 mg po q 6h
  
• Have: 500 mg/5cc
  
• DOSE HAVE :: DESIRED DOSE Quantity on hand Quantity to give
  

• 500 mg : 5 ml :: 250 mg : x ml ( 500 = 250 ) 5 x
  
• 500 x = 1250
  
• x = ml
  

• Rx: ASA gr v po qd
  
• Have: ASA 325 mg tabs
  
• How many tablets will you give?
  
• Use conversion factor - gr and mg
  
• Conversion factor?
  
• 1 gr = 65 mg (KNOW)
  
• What you KNOW What you NEED
  
• UNKNOWN/NEED ?
  
• 5 gr = x mg
  

• What you KNOW What NEED TO KNOW
  
• 1 gr = 65 mg :: 5 gr = x mg
  
• (1) x = (65) (5)
  
• x = 325 mg (There are 325 mg in 5 gr)
  
• How many tablets will you give?
  
• 325 mg = 325 mg (5 gr) 1 tab x tabs
  
• 325 x = 325
  
• x =
  

• Rx: Lithium gr x po t.i.d.
  
• Have: Lithium 300 mg/capsule
  
• How many caps will you give?
  
• Conversion factor: 60 mg = 1 gr
  
• 60 mg : 1 gr :: x mg : 10 gr x = 600 mg (not caps)
  
• NOW 300 mg : 1 cap :: 600 mg : x caps 300 x = 600 x = 2 caps
  

• Insulin 100U/ml
  

• Heparin 10-20,000U/ml
  

• Penicillin 400-800,000U/ml
  

• Rx: 5,000U Heparin sq q 12h
  
• Have: 20,000 U/ml
  
• Can use Desired X Amount Have
  

5,000U X 1ml = 20,000U
Give = 1 or .25 ml 4

• Rx: 40U NPH Insulin sq q AM
  
• Have: 100U/ml in vial (U-100; U-50)
  
• Use U-100 syringe
  
• D X Amt 40U X 1ml = 0.4 ml H 100U
  
• OR ratio/proportion 100U:1ml :: 40U: x ml
  

100 x = 40
x = 0.4 ml

• Must be reconstituted for injection
  
• Rx: aqueous penicillin G 500,000 U IM Have: 5,000,000 U in dry powder in vial
  
• How many ml will you give?
  
• TRICK QUESTION!!
  
• You need to reconstitute - add diluent.
  
• Follow manufacturer directions.
  

• Reconstitution instructions:
  

Add for U/ml 18 ml 250,000 8 ml 500,000 3 ml 1,000,000

• How much diluent will you add?
  

(sterile water,NaCl)
You want to give 500,000U per dose.

• Add 8 ml diluent = 500,000 U/ml
  

• KNOW = UNKNOWN/NEED
  
• 500,000 U = 500,000 U 1 ml x ml
  
• 500,000 x = 500,000
  
• x = ml
  

• MD orders type solution amount " time of infusion
  

medications to be added
to continuous infusion
to intermittent infusion
(IVPB)
as bolus dose

• Rx: 1000 ml NSS to run over 6 hours
  
• total volume = ml/hour total time in hours
  
• 1000 = 166.6 ml/hr 6
  
• Round off to 167 ml/hr
  

• Rx: Administer 1000 ml D5W every 8 hr. Drop factor is 15 gtt/min
  
• total volume x drop factor = gtt/min total time (in minutes)
  
• 1000 ml x 15 = 15000 8 x 60 480
  

= 31.25 gtt/min
Round to 31 gtt/min

• Macrodrip 10gtt/ml 15 gtt/ml 20 gtt/ml
  

• Microdrip 60 gtt/ml
  

Rx: Kefzol 1 g IVPB q 6 h
(Mix in 50 ml D5W. Infuse over 20 min.)
Drop factor is 20 gtt/ml
Kefzol supplied as 500mg/ml.

• How many ml will you add to 50 ml bag?
  

500 mg = 1g
1 ml x ml
500 mg = 1000 mg
1 ml x ml
500 x = 1000
x = ml

• How many drops per minute will you run the Kefzol so it is absorbed in 20 minutes?
  

50 ml X 20 (drop factor) =20 (time in minutes)
1000 =20Run at 50 gtts/min

• Write out units of measurement; must appear in same order
  

e.g. 60 mg = 90 mg (60mg:1tab::90mg:x tabs)1 tab x tabs

• line up decimals
  
• Re-check if odd answer e.g. 25 tablets !!
  
• Calculator only as good as your set-up
  

• Generic - assigned
  
• Official - as listed
  

USP, NF

• Chemical - describes composition
  
• Trade or brand name
  
• Hydrochlorthiazide
  
• aspirin
  

• acetylsalicylic acid
  

• Bayer
  

Hydrodiuril

According to:

• body system - cardiac
  
• clinical indication/effect - antibiotic
  
• composition - chemical
  
• symptom relieved/purpose - relieve pain
  

• Therapeutic effect - desired
  
• Side effect - secondary or unintended
  

therapeutic should outweigh side effect

Adverse effects (FDA MEDWATCH)
Iatrogenic disease

• cumulative - drug level builds up
  
• drug tolerance- larger doses needed for same effect
  
• idiosyncratic - unexpected, peculiar
  

(e.g. elderly)

• drug allergy - minor to serious immune reaction
  

anaphylactic reaction - sudden, life-threatening

Combined effect of 2 or more drugs alters effect of one or both:

• antagonistic/inhibiting effect - lesser
  
  
  
  • antacids/milk with Tetracycline
    
  
  
• synergistic/potentiating effect - greater
  
  
  
  • e.g. alcohol and barbiturates
    

Demerol and Phenergan

To predict effect based on consistency,
uniform quality

• Pure Food and Drug Act (1906) - must be listed in
  
  
  
  • US Pharmacopeia (USP)
    
  • National Formulary (NF)
    

• Federal Food, Drug, Cosmetic Act (1938)
  
  
  
  • extensive testing of new drugs
    
  
  
• Comprehensive Drug Abuse Prevention
  

and Control Act (1970) (Controlled Substances Act)

• must have prescription for controlled substances:
  

narcotics, amphetamines, barbiturates, tranquilizer

• Harrison Narcotic Act
  
  
  
  • controlled substances must be kept in double-lock system
    

• Prescriptive rights for NPs
  
• Administering drugs IV push
  
• Question and/or refuse to give incorrect or contraindicated order
  

• Rx: dexamethasone .10 mg IV q 12h x 72 h
  
• Transcribed as 10 mg
  
• Avoid error by:
  
• writing as dexamethasone 0.1 mg don’t use "0" after decimal point
  
• if 1.0 mg - write "1 mg" instead
  

• Weight
  
• usually based on 70 KG person
  
• sometimes BSA- especially children
  
• sometimes on time mcg/kg/min
  
• Gender
  
• generally based on amount of body fat & H2O
  
• fewer studies done on women - hormonal effects
  

• Genetic factors
  
• variations in enzymes to process meds
  
• variations in amounts needed for therapeutic effects
  
• Cultural factors
  
• health beliefs can affect use of medications
  

• Psychologic factors
  
• expected response to medication
  

• Clinical trials/research
  
• compare effects of active drug vs placebos
  
• only ethical place for placebos
  
• Signed informed consent
  

• Pathology
  
• illness states or disease affects drug absorption
  
• especially true in organs that metabolize drugs
  
  
  
  • renal failure
    
  • hepatic failure
    
  
  
• Cachexia
  
  
  
  • altered albumin levels
    

• Environment
  
• Surroundings may enhance or diminish expected effects of medications
  

• Used for irritating medications
  
• Prevents "tracking" through layers of tissue
  
• Make sure needle is free of medication
  

(change needle or wipe off)

THE SPIDER كتب:

بس يا ريت تتم جميلك
وتحط مثلا nursing role before and after giving drug
زي مثلا دورك لما تدي antibotic or anti hemorrhagic or antacid or diuretics..........etc
اولا حضرتك نورتى المنتدى
ثانيا فى حاجة موجوده على المنتدى اسمه قاموس الادوية ده فيه كل دواء وما يخصه وكل شىء يجب فعله عند اعطاء الدواء