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Medication AdministrationLegal AspectsBefore you can legally administer a med:Prescriber and nurse must be licensedIs the medication order valid?Pharmacist validates (double checks)Know purpose, action, side effects, and teaching related to medicationYou are responsible for your actionsQuestion & clarify incomplete, incorrect, inappropriate, or invalid ordersAsk or look it upControlled substances (2 nurse check if wasting narcotic meds)Lewis Blackman Act= badges must be labelled w/ attending, resident, student, etc.Attending= person responsible for patient’s careResident= under umbrella of attending, also see patient but ultimately, attending is still responsibleAnytime patient requests attending, the nurse must pass along concern to attendingMechanism must be available for patient to get prompt assistance if necessary (patient advocate)Pharmacist is collaborative expert within hospital.Variables Affecting Drug ActionDevelopment factorsInfant: smaller dossImmature liver, kidneys, digestive system, increased body water, decreased body fatOlder adult: smaller dosesDecreased/impaired renal and liver function, decreased motility (time it takes from mouth to excretion) so meds stay in system longer, decreased muscle mass, decreased body water, increased body fatPregnancy: some meds can interfere with fetal developmentWatch for meds that are contraindicated in breastfeedingBody weightIncreased body mass= larger dosesGenderHormone levels can affect toleration of medsResearch done on men, but may affect women differentlyGenetic & cultural factorsAfrican Americans- certain HTN meds don’t work as well as others (beta blockers)Herbal remedies can affect metabolism of other medsDietVitamin K- avoid on Coumadin bc they can reverse affectGrapefruit can intensify medsEnvironmentTemperature- cold vasoconstriction (esp. if taking meds that are supposed to do this, might not work as well)Psychological statePlacebo affectIllness & diseaseTime of administrationSome have to be given AM, some PM, some AC, etc.Recommended Guidelines for AdministrationRoute depends on desired effect and patient’s conditionEnteral- via GI tract:Oral (PO)- by mouth (swallow)Easiest, least expensiveSafest, as long as they can swallow (not breaking skin or at risk of infection like with IV)Sublingual (SL)- under tongue and dissolvesAvoid food or drink bc this washes awayCapillaries/vascular system under tongue quick absorption into bloodstreamCan swallow, but won’t work as wellBuccal- against checkRotate side bc it can eat away/irritate cheekNGT/PEG- via tube (PT is NPO)Flush before, after, and between meds & check placement beforeCan put meds in for a temporary amount of timePatient NPO most of the time (probably reason they have tube in)Can’t crush EC or XR (call doctor & see if there is a different form)Topical- via skin or mucous membranesSkinTransdermalPatches, creams, ointmentsDeliver meds over 12 or 24 hoursPain patches, one for memory/dementiaNever cut a patchWhen applying, write date & time so others know when patch was appliedLook for skin irritation, maybe put in a place they can’t pick atUse gloves with creams, ointments, and patches (can get into your skin too)Instillations & irrigationsOtic/ophthalmic/nasalVaginal/rectalInhalantsNebulizer treatmentProbably will be respiratory therapist in hospital, but nurse in long-term care settingParenteral- via needle injectionIntradermal (ID)- below dermis (right up under skin)PPDSubcutaneous (SubQ)- into subcutaneous tissue (a little deeper than ID)Insulin, heparinIntramuscular (IM)- into muscleFlu shot, antibiotics (rosefarin)Intravenous (IV)- into veinSteroid injections, fluidsParenteral ConsiderationsAseptic techniqueUse new, capped needle every timeUse good techniqueWhen openingClean skin w/ alcoholSyringe, needle, angle dependent on patient, route, type of med (oil vs. water based)Size of patient is importantThe larger the gauge number- the smaller to diameter of needle shaftSame with IVs18/18= large bolus of fluid/blood product in emergency23= IV fluid maintenanceintradermal: 25-27 gauge? to 5/8” needle5-15 degreessmall and shortalmost parallel with skinsubcutaneous- 25-30 gauge3/8 to 5/8” needle45-90 degrees depending on how much SubQ fat patient hassometimes pinch up skin so you can get into fat (behind arm, love handle area, etc.)intramuscular- 21-25 gauge1-1.5” needle90 degreesneedle needs to be longer and larger & go in at 90 degrees to get past dermis and SubQ to get into muscle never re-cap a needle after injectiondispose via sharps container:needlesblades and lancetsrazorsbroken glass (ampules)any sharp instrument!!Whenever drawing up meds w/ needle, you can’t walk around with exposed needle, so you can recap (just can’t recap after it has been in patient)Ampule: glass containerMust be broken- CAUTION!!Use filter needle to withdraw med from ampule in case there is broken glassWear gloves & break ampule away from you at weak pointVial: glass or plastic container with rubber seal for closed systemCan have single use vials or multi use vialsAirlock method: air injected behind medication to prevent tracking into SubQ tissueSeals medication into tissueZ-track method: for irritating medsPull back top layer of skin, so that when injected into muscle it won’t leak outMedication OrdersStat order (give immediately, one time order)Should still go through pharmacy first to verifyCode order= exceptionSinge order (one time dose)Maybe contrast before test or pre-surgeryStanding orderProtocol in placeGive Tylenol for temp. greater than 101 degreesGives nurse authority to write order w/o calling doctorNo definite time framePRN order (as needed)If someone is nauseated, then you can give them thisDiscretion of nurse, not patientEssential components of medication orderPatient’s full nameDateName of drugDosageRoute of administrationFrequencySignature Patient AssessmentObtain on admission: (part of medication reconciliation)Medication historyIncluding herbal supplementsWhy they take medicationsWhen they take medicationsAllergiesIs it a true allergy?Could be side effect of medication, not actual allergyMedical historySurgical historyPregnant? Or lactating?Some meds are contraindicated in pregnancySomeone might not look pregnant, but if in childbearing years, this is importantNot if patient uses drugs or alcohol (could be withdrawing)Before administration:Check medication administration record (MAR)Diet & fluid ordersMight be NPO except medicationsLaboratory valuesLook at INR levels before administering CoumadinPhysical assessmentAbility to swallowGastrointestinal motilityOutputAdequate muscle massAdequate venous accessVital signsBody system assessmentAdministering medications:Stay with patient until completely swallowedNever leave medication unattendedDon’t touch medication with bare handsNever administer med that falls on floor/sinkIntroduce selfIdentify patient (2 identifiers)Name and date of birthHand hygieneInform patientWhat med is and what it doesAdminister drugRecent changes in 30-minute policyDocument administrationEvaluate responseIf medication worked or notSeven Rights of Drug AdministrationRight patientRight drugRight doseRight routeRight timeRight documentationRight to refuseAvoiding ErrorsMedication checks- triple checkOnly give meds you pull or draw upBe sure med has drug labelKnow generic/trade nameReason patient is getting med?Assessment parameters for administration?Listen to patient!!If patient says something doesn’t look or sound right, look into this! ................
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