Medication Administration

1
Medication Administration

• Part 1
• Keith Rischer, RN, MA, CEN, CCRN

2
Todays Objectives

• State the primary use and nursing implications
  for drugs in each major classification
• Describe the characteristics of any drug that the
  nurse is responsible for administering
• Onset, peak, duration and half-life
• Mechanism of actiongtSEgtNsg Implications
• Calculate fractional dosages of drugs
• Using drug reference text correctly fill out
  clinical paperwork related to medication
  administration

3
Nurses Responsibility

• How many patients die each year because of
  medication errors in US hospitals?
• 500
• 5000
• 7000
• 25,000
• How many patients are injured as a result of
  medication errors annually?
• 100,000
• 500,000
• 1,000,000
• 1,500,000

4
Pharmacological Concepts

• Drug Names
• Chemical name
• name of a drug as the chemist knows it.
• Describes the constituents of the drug
• Ex
• N-acetyl-para-aminophenol (Tylenol)
• 2-(acetyloxy)benzoic acid. (Aspirin)

5
Pharmacological Concepts

• Drug names
• Generic names
• Name given to a drug before it becomes official.
• Name is often listed in the USP as the official
  name
• Ex Furosemide, Acetaminophen, Atorvastatin
• Brand name
• Trademark or name given by drug manufacturer.
• More that one manufacturer may make the same drug
• EX Lasix, Tylenol, Lipitor

6
Reading Medication Labels
7
Nursing implications

• Implications related to administration and
  assessment/monitoring
• RN responsible for
• V/S
• Timing with meals
• Labs
• IO
• Dilute? Crush?

8
Classifications/Nursing Implications

• Anti-hypertensive
• Beta Blockers
• Atenolol
• Metoprolol
• Propranolol
• Calcium channel blockers
• Diltiazem
• Nifedipine
• ACE Inhibitors
• Captopril
• Enalapril
• Lisinopril
• Diuretics
• Loop of Henle (Furosemide)
• Distal tubule-(Hydrochlorothiazide-HCTZ)

9
Classifications/Nursing Implications

• Analgesics
• Mild-NSAIDS
• Tylenol, Ibuprofen, Aspirin
• Moderate-Opiod Narcotics po
• Tylenol 3, Vicodin, Percocet
• Severe-Opiod Narcotics IV
• Morphine, Dilaudid, Fentanyl
• Anti-bacterial
• Penicillins
• Amoxicillin
• Cephalosporins
• Keflex
• Sulfa
• Bactrim DS

10
Classifications/Nursing Implications

• Anti-inflammatory
• NSAIDS
• Prednisone
• Anti-coagulant
• Heparin
• Coumadin
• Anti-platelet
• Aspirin
• Plavix
• Laxative
• Sennakot, Metamucil

11
Routes of Administration

• Oral
• Capsules/tablets
• Syrup/solution
• Inhalation
• Rectal
• suppository
• Topical
• Patch
• ointment
• Parenteral
• IV (intravenous)
• Sub-q (sub-cutaneous)
• IM (intra-muscular)
• ID (intra-dermal)

12
Medication Administration

• Oral
• 60-100 mL of fluid
• Contraindications
• NPO
• GI
• CVA
• Prevent aspiration (Table 35-16 p.717 PP)

13
Medication Administration

• Topical
• Remove old patch before applying new
• Date and time new patch
• Use gloves
• Make sure skin is clean and dry
• Examples
• Fentanyl
• Nitroglycerin
• Nicoderm

14
Medication Administration

• Nasal
• Eye
• Ear

15
Medication Administration

• Inhalers
• Albuterol/Advair
• Spacer
• Vaginal
• Rectal

16
Types of Medication Action

• Therapeutic/Mechanism of action
• Side effects
• Adverse reactions
• Allergic reactions
• Idiosyncratic reactions
• Toxic effects
• Amiodarone
• Tolerance
• Opiate narcotics

17
Time/Action Profile

• Onset
• Peak
• Duration
• Trough
• Serum Half life
• Morphine IV
• Vicodin po

18
Interpreting Drug Orders

• Abbreviations - Pickar
• Do not use of abbreviations list Pickar
• MS 2 mg IV q4 hours p.r.n for pain
• Lantus insulin 20u qd
• Maalox 15cc q6 hours prn

19
Formula Method

• D X Q X
• H
• Desired X Quantity Amount
• Have

20
Formula Method

• Heparin subq order for 12,000u due. This
  injection comes in a vial of 20,000u/cc. What
  will be the amount you will administer?
• Dilaudid 0.25mg IV for pain. The pharmacy
  dispenses a carpuject/vial of Dilaudid 1mg/cc.
  What is the amount you will administer?
• Solumedrol 25mg IV. It is dispensed as a 40mg/cc
  vial. What is the amount you will administer?
• Plavix 300mg to be given now. It only comes in
  75mg tablets. How many tabs will you administer
  to give the correct dose?

21
This is your patient

• MB, 75 yo, admitted to the step down unit with
  exacerbation of heart failure. She complained
  of SOB, 3 pitting edema in lower legs and a
  weight gain of 8 lbs in 3 days. Her K was 3.4
  mEq/L in the ED.
• Furosemide 40mg IV was given in the ED with 800cc
  urine out
• P-96 R-32-BP 160/90 initially in ED
• P-86-R-24 BP 122/78 after Lasix
• Physician has ordered
• KCL 30 mEq po bid
• Pharmacy has dispensed KCL 20 meq/15cc elixir
  unit dose tubs x2. What will be the amount (cc)
  you will administer?