Medication Administration Actions Therapeutic effects Side effects Adverse

Medication Administration

Actions • • Therapeutic effects Side effects Adverse effects Toxic effects Mosby items and derived items © 2005 by Mosby, Inc.

Routes of Administration • Oral: sublingual, buccal • Parenteral: intradermal, subcutaneous, intramuscular, intravenous • Topical • Inhalation • Intraocular Mosby items and derived items © 2005 by Mosby, Inc.

Classification Routes of administration can broadly be divided into: • Topical: Drugs are applied topically to the skin or mucous membranes, mainly for local action. • Oral: used for systemic (non-local) effect, substance is given via the digestive tract. • Parenteral: A drug administered parenterally is one injected via a hollow needle into the body at various sites and to varying depth. • Rectal: Drugs given through the rectum by suppositories or enema. • Inhalation: The lungs provide an excellent surface for absorption when the drug is delivered in gaseous, aerosol or ultrafine solid particle form.

Routes of administration

1 - Topical route: I Skin A-Dermal – cream, ointment (local action) B- Transdermal- absorption of drug through skin (i. e systemic action) I. stable blood levels(controlled drug delivery system) II. No first pass metabolism III. Drug must be potent or patch becomes too large II Mucosal membranes • eye drops (onto the conjunctiva) • ear drops • intranasal route (into the nose)

2 -Oral route (Cont. ) Advantages: 1 - Convenient - portable, no pain, easy to take. 2 - Cheap - no need to sterilize, compact, multi-dose bottles, automated machines produce tablets in large quantities. 3 - Variety - tablets, capsules, suspensions, mixtures.

3 - Buccal/Sublingual route: • Some drugs are taken as smaller tablets which are held in the mouth (buccal tablet) or under the tongue (sublingual tablet). • Buccal tablets are often harder tablets [4 hour disintegration time], designed to dissolve slowly. • E. g Nitroglycerin, as a softer sublingual tablet [2 min disintegration time], may be used for the rapid relief of angina.

3 - Buccal/Sublingual route (Cont. ) Disadvantages 1 - Holding the dose in the mouth is inconvenient. 2 - Small doses only can be accommodated easily.

4 - Parenteral route:

4 - Parenteral route (Cont. ) A- Intravascular (IV): - placing a drug directly into blood stream. -May be - Intravenous (into a vein) or - intraarterial (into an artery). Advantages 1 - precise, accurate and immediate onset of action, 100% bioavailability. Disadvantages 1 - risk of embolism. 2 - high concentrations attained rapidly leading to greater risk of adverse effects.

4 - Parenteral route (Cont) B-Intramuscular : (into the skeletal muscle). Advantages 1 - suitable for injection of drug in aqueous solution (rapid action) and drug in suspension or emulsion (sustained release). Disadvantages 1 - Pain at injection sites for certain drugs.

4 - Parenteral route (Cont) C- Subcutaneous (under the skin), e. g. insulin. D- Intradermal, (into the skin itself) is used for skin testing some allergens. E- Intrathecal (into the spinal canal) is most commonly used for spinal anesthesia. F- Intraperitoneal, (infusion or injection into the peritoneum) e. g. peritoneal dialysis in case of renal insuffeciency.

5 -Rectal route: Most commonly by suppository or enema. Advantages 1 - By-pass liver - Some of the veins draining the rectum lead directly to the general circulation, thus by-passing the liver. Reduced first-pass effect. 2 - Useful - This route may be most useful for patients unable to take drugs orally (unconscious patients) or with younger children. - if patient is nauseous or vomiting

5 - Rectal route (Cont. ) Disadvantages 1 - Erratic absorption - Absorption is often incomplete and erratic. 2 - Not well accepted.

6 - Inhalation route: - Used for gaseous and volatile agents and aerosols. - solids and liquids are excluded if larger than 20 micron. the particles impact in the mouth and throat. Smaller than 0. 5 micron , they aren't retained. Advantages A- Large surface area B- thin membranes separate alveoli from circulation C- high blood flow - As result of that a rapid onset of action due to rapid access to circulation.

6 - Inhalation route (Cont. ) Disadvantages 1 - Most addictive route of administration because it hits the brain so quickly. 2 - Difficulties in regulating the exact amount of dosage. 3 - Sometimes patient having difficulties in giving themselves a drug by inhaler.

Metric System • Grams (g), milligrams (mg), kilograms (kg) • Liters (L), milliliters (ml) Mosby items and derived items © 2005 by Mosby, Inc.

Household Measurements • • Tablespoons Teaspoons Ounces Cups Mosby items and derived items © 2005 by Mosby, Inc.

Prescriber’s Role • Types of orders – Single orders – Stat orders Mosby items and derived items © 2005 by Mosby, Inc.

Distribution Systems • Stock supply • Unit dose • Computer controlled Mosby items and derived items © 2005 by Mosby, Inc.

Parts of the Order • • Patient name Date and time Drug name Drug dosage • Route • Frequency • Signature

Problems with Orders • Allergies • Steps – Drug book – Pharmacist – Physician – Supervisor

Drug Administration • 3 checks – obtaining the container – removing the med – replacing the container

Nurse’s Role • Six rights • Triple-check before administration • Client assessment

Six Rights • • • Right medication Right dose Right client Right route Right time Right documentation

Client’s Rights • • Information Refusal Careful assessment Informed consent Safe administration Supportive therapy No unnecessary medications

Assessment • • • Medical history History of allergies Medication data Diet history Perceptual or coordination problems Current condition

Assessment (cont’d) • Attitude about medication use • Knowledge of therapy • Learning needs

Nursing Diagnoses • • Deficient knowledge (medications) Disturbed sensory perception Impaired swallowing Ineffective therapeutic regimen management

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

Implementation • Client and family teaching • Medication orders: receipt, communication • Calculation and measurement • Correct administration technique • Recording

Special Considerations • Infants and children • Older adults – Self-prescribing – Over-the-counter medications – Misuse – Noncompliance

Evaluation • Client response to medications • Client and family ability to administer medications

Oral Administration • Presence of GI alterations • Ability to swallow • Positioning

Topical Administration • Skin applications – Use of gloves or applicators – Preparation of skin – Thickness of application

Nasal Instillation • Assessment of nares • Client instruction and selfadministration • Positioning

Eye Instillation • • Drops, ointments, disks Assessment of eyes Asepsis Positioning

Ear Instillation • Assessment of ear canal • Warming of solution • Straightening of canal for children and adults • Positioning

Vaginal Instillation • Suppositories, foams, creams • Use of gloves and applicator • Client positioning, comfort, and hygiene

Rectal Instillation • Suppositories • Use of gloves • Client positioning, comfort, and hygiene

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

Irrigation • Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic) • Asepsis

Parenteral Administration • Equipment – Syringes: sizes (volume), types – Needles: length, gauge – Disposable units: Tubex, Carpuject – Ampules – Vials

Parenteral Administration (cont’d) • Mixing medications – Determine compatibility of the medications – Do not contaminate one medication with another – Ensure the final dose is accurate – Maintain aseptic technique

Parenteral Administration (cont’d) • Insulin – Syringes and needle sizes – Types of insulin – Mixing of insulins – Rotation of vials before withdrawal of solution

Administration of Injections • Minimize discomfort – Use smallest suitable needle – Position client comfortably – Select proper site – Divert client’s attention – Insert the needle quickly and smoothly – Hold the syringe steady – Inject the medication slowly and steadily

Administration of Injections (cont’d) • Subcutaneous injections – Sites: condition of area, rotation of use – Amount of solution – Length and gauge of needle – Pinch or spread skin – Angle of insertion

Administration of Injections (cont’d) • Intramuscular injections – Sites: landmarks, condition of area – Amount of solution – Length and gauge of needle – Angle of insertion – Aspiration – Air-lock method – Z-track technique

Administration of Injections (cont’d) • Sites – Ventrogluteal – Vastus lateralis – Deltoid

Administration of Injections (cont’d) • Intradermal injections – Skin testing – Sites – Length and gauge of needle – Angle of insertion – Formation of small bleb

Prevention of Needle Sticks • Needleless devices • Sharps disposal • One-handed recapping technique

Intravenous Administration • Large volume infusions • Bolus injection • Volume-controlled infusions – Mini-infusor pump

Avoiding Errors • • • Prepare drugs alone Don’t leave drugs alone Prepare and administer Lock med cart Supervise swallowing

Steps in Administration • • 3 checks 6 rights Assessment Patient position • Fluids • Keep meds in wrappers • Offer separately

Administering Narcotics • Definition • Record – Patient name – Amount – Time – Physician – Nurse signature – Waste/witness • Count • Discrepancies

Documentation • Legal record • When to record • Information – – med name dosage route time – – nurse initials nurse signature site of injection other information • Omitted drugs – reason – notify MD • Refused drugs 57

Medication Errors • Reasons for occurrence • Steps if error takes place