Medication Administration Part 1 Keith Rischer RN MA

Medication Administration Part 1 Keith Rischer, RN, MA, CEN, CCRN

Today’s Objectives ü State the primary use and nursing implications for drugs in each major classification ü Describe the characteristics of any drug that the nurse is responsible for administering – Onset, peak, duration and half-life – Mechanism of action>SE>Nsg Implications ü Calculate fractional dosages of drugs ü Using drug reference text correctly fill out clinical paperwork related to medication administration

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

Pharmacological Concepts Ø Drug Names q Chemical name – ü name of a drug as the chemist knows it. ü Describes the constituents of the drug ü Ex: – N-acetyl-para-aminophenol (Tylenol) – 2 -(acetyloxy)benzoic acid. (Aspirin)

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

Reading Medication Labels

Nursing implications Ø Implications related to administration and assessment/monitoring q RN responsible for ü V/S ü Timing with meals ü Labs ü I&O ü Dilute? Crush?

Classifications/Nursing Implications Ø Anti-hypertensive q Beta Blockers ü ü ü q Calcium channel blockers ü ü q Diltiazem Nifedipine ACE Inhibitors ü ü ü Ø Atenolol Metoprolol Propranolol Captopril Enalapril Lisinopril Diuretics q q Loop of Henle (Furosemide) Distal tubule-(Hydrochlorothiazide-HCTZ)

Classifications/Nursing Implications Ø Analgesics q Mild-NSAIDS ü q Moderate-Opiod Narcotics po ü q Tylenol #3, Vicodin, Percocet Severe-Opiod Narcotics IV ü Ø Tylenol, Ibuprofen, Aspirin Morphine, Dilaudid, Fentanyl Anti-bacterial q Penicillins ü q Cephalosporins ü q Amoxicillin Keflex Sulfa ü Bactrim DS

Classifications/Nursing Implications Ø Anti-inflammatory q q Ø Anti-coagulant q q Ø Heparin Coumadin Anti-platelet q q Ø NSAIDS Prednisone Aspirin Plavix Laxative q Sennakot, Metamucil

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

Medication Administration Ø Oral 60 -100 m. L of fluid q Contraindications q ü ü ü q NPO GI CVA Prevent aspiration (Table 35 -16 p. 717 P&P)

Medication Administration Ø Topical Remove old patch before applying new q Date and time new patch q Use gloves q Make sure skin is clean and dry q Ø Examples: Fentanyl q Nitroglycerin q Nicoderm q

Medication Administration Ø Nasal Ø Eye Ø Ear

Medication Administration Ø Inhalers Albuterol/Advair q Spacer q Ø Ø Vaginal Rectal

Types of Medication Action Therapeutic/Mechanism of action q Side effects q ü q Allergic reactions ü q Idiosyncratic reactions Toxic effects ü q Adverse reactions Amiodarone Tolerance ü Opiate narcotics

Time/Action Profile Onset q Peak q Duration q Trough q Serum Half life q Morphine IV q Vicodin po q

Interpreting Drug Orders Abbreviations - Pickar Ø “Do not use” of abbreviations list – Pickar Ø q MS 2 mg IV q 4 hours p. r. n for pain q Lantus insulin 20 u qd q Maalox 15 cc q 6 hours prn

Formula Method D X Q = X H Desired Have X Quantity = Amount

Formula Method Ø Ø Heparin subq order for 12, 000 u due. This injection comes in a vial of 20, 000 u/cc. What will be the amount you will administer? Dilaudid 0. 25 mg IV for pain. The pharmacy dispenses a carpuject/vial of Dilaudid 1 mg/cc. What is the amount you will administer? Solumedrol 25 mg IV. It is dispensed as a 40 mg/cc vial. What is the amount you will administer? Plavix 300 mg to be given now. It only comes in 75 mg tablets. How many tabs will you administer to give the correct dose?

This is your patient… Ø Ø 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 m. Eq/L in the ED. Furosemide 40 mg IV was given in the ED with 800 cc urine out P-96 R-32 -BP 160/90 initially in ED q P-86 -R-24 BP 122/78 after Lasix q q Physician q has ordered: KCL 30 m. Eq po bid ü Pharmacy has dispensed KCL 20 meq/15 cc elixir