Medical Administration

a nursing function that involves skillful techniques and consideration of the patient’s developmental health status and safety.

Chemical name—identifies drug’s atomic and molecular structure (rarely used)

Generic name—assigned by the manufacturer that first develops the drug
(e.g. acetaminophen)

Official name—name by which the drug is identified in official publications USP and NF

Trade name—brand name copyrighted by the company that sells the drug
(e.g. Tylenol)

-Oral
Capsule, pill, tablet, extended release, elixir, suspension, syrup
- Topical
Liniment, lotion, ointment, suppository, transdermal patch
-Injectable
-Instilled drops (opthalmic and otic)

Standing order—carried out until cancelled by another order
PRN order—as needed
Stat order—carried out immediately

Others:
Standard
PRN: Must record in nurse's progress notes
One Time
Verbal or telephone
automatic stop orders

-Patient’s name
-Date and time order is written
-Name of drug to be administered
-Dosage of drug
-Route by which drug is to be administered
-Frequency of administration of the drug
-Signature of person writing the order

-Body system (e.g. drugs that affect the respiratory system, drugs that affect the cardiovascular system)
-Symptoms relieved
-Clinical indication (or therapeutic action) - e.g. analgesic, antibiotic

Drug-receptor interaction

Drug-enzyme interaction

Acting on cell membrane or altering cellular environment

-Route of administration
-Drug solubility
-pH
-Local conditions at site of administration
-Drug dosage
-Serum drug levels

-Iatrogenic disease --occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by the patient during the course of treatment.
-Drug interactions

-Allergic effects (e.g. anaphylactic rxn)
-Toxic effects
-Idiosyncratic effects --any unusual or peculiar response to a drug that may manifest itself by over, under response, or even the opposite of the expected response
-Drug tolerance --occurs when the body becomes accustomed to the effects of a particular drug over a period of time.

Rash
Uticaria (hives)
Fever
Diarrhea
Nausea
Vomiting
Anaphylactic reaction

-Developmental considerations
-Weight
-Sex
-Genetic and cultural factors
-Psychological factors
-Pathology
-Environment, timing of administration

Metric—meter (linear), liter (volume), gram (weight)
Apothecary—less convenient and concise; basic unit or weight is grain
Household—least accurate system; teaspoons, tablespoons, teacup, and glass used

Document
--Each dose of medication—as soon as possible after it is given
--Intentional or inadvertently omitted drugs (w/ rationale given)
--Refused drugs (w/ rationale given)
--Medication errors

False - Medication errors are to be documented in the "incidence report" and NOT the patient's chart

-Inappropriate prescribing of the drug
-Extra, omitted, or wrong doses
-Administration of drug to wrong patient
-Administration of drug by wrong route or rate
-Failure to give medication within prescribed time
-Incorrect preparation of a drug
-Improper technique when administering drug
-Giving a drug that has deteriorated

-Check patient’s condition immediately; observe for adverse effects
-Notify nurse manager and physician
-Write description of error and remedial steps taken on medical record
-Complete special form for reporting errors

(These may vary. Be sure to check your hospital's protocols.)

Any drug suspected in error
Ask: How do you know it is a safe dose?

Does this medication order make sense for this patient based on their
Condition?
Symptoms?
Health Status?

The nurse is responsible for all the meds they administer!

Nurses have the right to refuse giving any medication that may be harmful to the patient based on their knowledge and experience

-Abide by “DO NO HARM”
-Cover yourself w/ everything you do. Be careful when you approach or correct a physician
-Must be assertive when need be:
“Medication held due to….Physician notified…”

Stock supply
Individual supply
Medication cart
Computerized medication system (e.g. Pixi chart?)
Bar coded medication cart

1. When the nurse reaches for the container or unit dose package,
2. After retrieval from the drawer and compared w/ the MAR, or compared w/ the MAR immediately before pouring from a multidose container, and
3. When replacing the container to the drawer or shelf or before giving the unit dose medication to the pt.

Right
1. Medication
2. Patient
3. Dosage
4. Route
5. Time
6. Reason
7. Documentation
8. Right to Refuse!

-Name of patient receiving narcotic
-Amount of narcotic used
-The hour narcotic was given
-The name of physician prescribing narcotic
-Name of the nurse administering narcotic

-Solid form — tablets, capsules, pills
-Liquid form — elixirs, spirits, suspensions, syrups

-Selecting the appropriate container: souffle cup, plastic med cup
-One medication per container; Do not combine liquids
-Keep medications in wrappers until you get to the bedside
-Demonstrate pouring tablets
-Demonstrate pouring liquid med.

-Record immediately AFTER giving medication, not before
-Record on MAR & nurse's notes; insulin chart etc.
-Initial w/ exact time
-Record pt. response to drug therapy, esp. w/ pain medication
-Parenteral: record SQ or IM site
-IV: Record condition of IV site
-Initial & circle medications not given
-Med error: Can be a late med; Write incident report

-Oral Route—having patient swallow drug
-Enteral route—administering drug through an enteral tube
-Sublingual administration—placing drug under tongue
-Buccal administration—placing drug between tongue and cheek

Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
Client assessment and instruction
Use of spacer
Determination of doses in canister

Vaginal
Rectal
Inunction - rubbing the med into the skin
Instillation
Irrigation
Skin application

-Subcutaneous injection—subcutaneous tissue
-Intramuscular injection—muscle tissue
-Intradermal injection—corium (under epidermis)
-Intravenous injection—vein
-Intraarterial injection—artery
-Intracardial injection—heart tissue
-Intraperitoneal injection—peritoneal cavity
-Intraspinal injection—spinal canal
-Intraosseous injection—bone

-Route of administration
-Viscosity of the solution
-Quantity to be administered
-Body size
-Type of medication

Intramuscular:
-Faster absorption
-Use longer needles (0.5-3”)
-Insertion angle 90 degrees
-Viscosity and irritation better tol.
-Vol 3ml IM

Subcutaneous:
-Slower absorption than IM
-Uses shorter needle 5/8 to 1/2in
-Insertion angle 45 (up to 90) degrees
-“Thin” liquids-water soluble
-Vol 0.5-1ml SQ

Ventrogluteal site - located by placing the palm on the greater trochanter & the index finger toward the anterosuperior iliac spine

Vastus lateralis site - identified by dividing the thigh into 3rds, horizontally and vertically

Deltoid muscle site - located by palpating the lower edge of the acromion process

Dorsogluteal site

= outside the intestines or alimentary canal.

administering medication by this route involve injecting the medication into those body tissues outside of the intestines or alimentary canal and into the circulatory system.

a method of injecting medication into a large muscle using a needle and syringe. This method seals the medication deeply within the muscle and allows no exit path back into the subcutaneous tissue and skin. This is accomplished by displacing (pull back) the skin and subcutaneous tissue 1–1.5 inches (2.5–3.75 cm), laterally, prior to injection and releasing the tissue immediately after the injection.

Ampules (single dose)
Vials (multiple dose)
Prefilled cartridges (single dose)

-Medications added to large volumes as part of continuous infusion
-Piggyback infusions in a small volume through an existing line
-IV push (IVP) small volume via syringe directly into IV line or other venous access (Heparin or Saline lock)

-Medical history
-History of allergies
-Medication data-drug action, purpose, dose, SE, nursing implications
-Perceptual or coordination problems-arthritis, tremors
-Current condition that may affect meds actions or administration
-Attitude about medication use
-->Avoidance or Dependency issues
-Knowledge of therapy
-Learning needs usually pertain to:
-->Time & Dose to take
-->Purpose
-->Possible side effects & what to do
-->Correct self-administration technique

-Deficient knowledge (medications)
-Noncompliance (medications)
-Disturbed sensory perception
-Impaired swallowing
-Ineffective therapeutic regimen management

-Goals and outcomes
– Example:
Client will verbalize therapeutic and adverse effects of medications
-Setting priorities
-Continuity of care

Client and family teaching. Learning needs usually pertain to:
----Time & Dose to take
----Purpose
----Possible side effects & what to do
----Correct self-administration technique
-Medication orders: receipt, t-ranscription, communication
----Verbal Order Readback (JCAHO 2004)
-Calculation and measurement
-Correct administration technique:
---->Includes never leaving medication unattended in the med room. Major source of med error (JCAHO 2004).
-Recording/Documentation
---->Never chart med is given on MAR before it actually is!!
---->Chart sites of injections
---->Chart response to p.r.n. esp. pain med

-Review techniques of medication administration
-Remind patient to take the medication as prescribed for as long as prescribed
-Instruct patient not to alter dosages without consulting physician
-Caution patient not to share medications

-Infants and children
Offer realistic choices

-Older adults
Polypharmacy
Self-prescribing
Over-the-counter medications (75%)
Misuse
Noncompliance

-Client response to medications
----Especially to p.r.n. meds, pain meds, insulin administration
-Client and family ability to administer medications
-Long term safe and appropriate use by elderly who may have forgotten or become confused about proper regimen