PRINCIPLES OF DRUG ADMINISTRATION Flashcards by Althea Caryll Lebeco

Right client
Right medication
Right dose
Right route of administration
Right time and frequency of delivery
Right to refuse medication
Right to receive drug education/health teaching
Right preparation
Right documentation
Right drug evaluation

RIGHTS OF DRUG ADMINISTRATION

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Checking the drug with the MAR or the medication information system when removing it from the medication drawer, refrigerator, or controlled substance locker

3 CHECKS OF DRUG ADMINISTRATION

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Checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag

3 CHECKS OF DRUG ADMINISTRATION

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Checking the drug before administering it to the client

3 CHECKS OF DRUG ADMINISTRATION

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Taking in medication in the manner prescribed by the practitioner or in the case of OTC drugs, following the instruction in the label.

COMPLIANCE

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1.Enteral
2. Topical
3. Parenteral

ROUTES OF DRUG ADMINISTRATION

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Drugs given orally and those administered through nasogastric or gastronomy tube.

Enteral

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most, most convenient, and usually the least costly of all routes

ORAL DRUG ADMINISTRATION

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safest route because the skin barrier is not compromised

ORAL DRUG ADMINISTRATION

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ENTERAL
TOPICAL

ROUTE AND FORMS OF MEDICATION

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 Oral solids
 Tablets
 Score tablets
 Enteric Coated Tablets
 Capsules
 Caplets
 Lozenges, pastilles, troches

ENTERAL

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Tablets
Capsules
Caplets
Power and granules
Troches, lozenges, and pastilles

Oral solids

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Compressed or molded substances to be swallowed whole, chewed before swallowing, or placed in the buccal pocket or under the tongue

Tablets

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Tablets which can be divided

Score tablets

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Tablets are designed to dissolve in the alkaline environment of the intestines

Enteric Coated Tablets

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Substances encased in either a hard or a soft soluble container or gelatin shell that dissolves in the stomach

Capsules

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Gelatin coated tablets that dissolve in the stomach

Caplets

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Similar preparations of drugs designed to dissolve in the mouth.

Ex: Strepsils

Lozenges, pastilles, troches

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Enemas
Douches
Suspensions
Emulsion
Syrups
Gargles
Mouthwashes
Nasal solutions
Optic and otic solutions
Elixirs

SOLUTIONS

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Aqueous solution for rectal instillation

Enemas

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Aqueous solution that functions as a cleansing or antiseptic agent that may be dispensed in a form of powder with directions for dissolving in a

Douches

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specific quantity of warm water

Douches

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Particle or powder substances that must be dissolved in a liquid (shaken vigorously) before administration

Suspensions

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A two-phase system in which one liquid is dispersed in the form of small droplets throughout another liquid

Emulsion

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Substances dissolved in a sugar liquid

Syrup

Non-aqueous solution that contain water varying alcohol content and glycerin or other sweeteners

Elixirs

Aqueous solution that may contain alcohol, glycerin and synthetic sweeteners and surface-active flavoring and color agents

Gargles/Mouthwashes

1. Patches 2. Ointments 3. Pastes 4. Suppositories

TOPICAL

Semi-solid substance for topical use

Ointments

semi-solid substance, thicker than an ointment, absorbed slowly

Pastes

Gelatin substance designed to dissolve when inserted in the rectum, urethra, or vagina

Suppositories

 Vials  Ampules

Injectables

Drugs or dilution of drugs administered by the nasal or oral respiratory route for local or systemic effect

Inhalants

1. Sublingual route 2. Buccal route 3. Oral route

ROUTES OF ADMINISTERING DRUGS

medication is placed under the tongue and allowed to dissolve slowly

Sublingual route

rapid onset of action may occur because of the rich blood supply in this area.

Sublingual route

Tablet or capsule is placed in the oral cavity between the gum and cheek

Buccal route

Provides slower absorption

Buccal route

Safest, most convenient and least expensive method

Oral route

Slower acting than the other routes

Oral route

 Not given to clients who are vomiting, lacks gag reflex, or who are comatose  Do not mix with large amount of food  Do not mix with infant formula

GUIDELINES IN ADMINISTERING DRUGS THROUGH THE ORAL ROUTE

 Enteric coated and time released capsules must be swallowed whole to be effective  Administer irritating drugs with food  Administer on empty stomach if food interferes with absorption

GUIDELINES IN ADMINISTERING DRUGS THROUGH THE ORAL ROUTE

 Drugs given sublingually or buccally must remain in place until fully absorbed  Encourage use of child resistant cap

GUIDELINES IN ADMINISTERING DRUGS THROUGH THE ORAL ROUTE

 Drugs directly applied to the skin are absorbed through the epidermal layer into the dermis where they create local effects or absorbed into the bloodstream  Can be applied to the skin with a glove, tongue blade or cotton tipped applicator

GUIDELINES IN ADMINISTERING TOPICAL DRUGS

 Nurse must protect her own skin  Do not contaminate the medication in a container  Do not double dip

GUIDELINES IN ADMINISTERING TOPICAL DRUGS

Delivered into the alveoli of the lungs

Inhalants

 Permeability of the alveolar and vascular epithelium  An abundant blood flows  A very large surface area for absorption

Delivered into the alveoli of the lungs that promotes fast absorption due to

Medication is stored in a patch placed on the skin and absorbed through the skin, having a systemic effect

Transdermal

Are liquid medications usually administered as drops, ointment, or spray

Instillation

Used to treat local conditions of the eye and surrounding structures

Ophthalmic Administration

Used to treat local conditions of the ear, including infections and soft blockages of the auditory canal

Otic Administration

Used to deliver medications for treating local infections and to relieve vaginal pain and itching

Vaginal Administration

Refers to the dispensing of medications by routes other than oral or topical

Parenteral Drug Administration

Delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles or veins

PARENTERAL ROUTE

* Intradermal * Subcutaneous * Intramuscular * Intravenous

PARENTERAL ROUTES

Injection administered into the dermis layer of the skin

Intradermal route

Sterile 1ml with gauge 26-27 needle

Intradermal route

- lightly pigmented - thinly keratinized and hairless

Preferred intradermal route Sites for injection

Intradermal route Sites for injection

ventral mid-forearm Clavicular area of the chest scapular area of the back

delivered for the deepest layer of the skin

Subcutaneous injection

Outer part of the upper arms, in the area above the triceps muscle

Sites for injection of Subcutaneous Injection

Middle 2/3 of the anterior thigh area

Sites for injection of Subcutaneous Injection

Subscapular areas of the upper back

Sites for injection of Subcutaneous Injection

Upper dorsogluteal and ventrogluteal areas

Sites for injection of Subcutaneous Injection

Abdominal areas, above the iliac crest and below the diaphragm, 1.5 – 2inches out from the umbilicus

Sites for injection of Subcutaneous Injection

delivers medication into specific muscles

Intramuscular injection

1. Ventrogluteal site 2. Deltoid site 3. Dorsogluteal site 4. Vastus lateralis

Sites for Intramuscular Injection:

most preferred site for IM injections. Slightly angle the needle toward the iliac crest

Ventrogluteal site

Used in well-developed teens and adults for volumes of medication not to exceed 1ml

Deltoid site

Place the needle at a 90degree angle to the skin or slightly toward the acromion.

Deltoid site

Used for adults and for children who have been walking for at least 6months

Dorsogluteal site

This site is safe as long as the nurse approximately locates the injection landmarks to avoid puncture or irritation of the sciatic nerve and blood vessels

Dorsogluteal site

Place the needle at a 90degree angle to the skin in prone position

Dorsogluteal site

Usually thick and well developed in both adults

Vastus lateralis

Medications and fluids are administered directly into the bloodstream and are immediately available for use by the body

Intravenous (IV) Administration

This is used when a very RAPID onset of action is desired

Intravenous (IV) Administration

IV medications bypass the enzymatic process of the digestive system and first pass effect of the liver just like the other parenteral routes

Intravenous (IV) Administration

1. Large-Volume Infusion 2. Intermittent Infusion 3. IV Bolus (push) Administration

3 BASIC TYPES OF IV ADMINISTRATION

For fluid maintenance, replacement or supplementation

Large-Volume Infusion

Compatible drugs maybe mixed into a large volume IV container with fluids like normal saline or ringer’s lactate

Large-Volume Infusion

Small amount of IV solution that is arranged tandem with a piggybacked to the primary large-volume infusion

Intermittent Infusion

Used to instill adjunct medications, such as antibiotics or analgesics over a short period of time

Intermittent Infusion

Concentrated dose delivered directly to the circulation via syringe to administer single-dose medications

IV Bolus (push) Administration

This can be given through an intermittent injection port or by direct IV push

IV Bolus (push) Administration

offers the fastest onset of drug action, it is also the most dangerous.

IV route

these pxs must be closely monitored for adverse reaction that may occur immediately, or it takes hours or days to appear. Antidote of the drugs must be readily available.

Patient receiving IV injections

What drug is ordered

MEDICATION KNOWLEDGE, UNDERSTANDING, AND RESPONSIBILITIES OF THE NURSE

* STAT order * Single order * Standing order * PRN order

DRUG ORDERS AND TIME SCHEDULES

Indicates that the medication is to be given immediately and only once

STAT order

It is often associated with emergency medications that are needed for life threatening situations

STAT order

Examples: Morphine sulfate 10mg IV STAT

STAT order

Should be available for administration to the client within 30minutes of the written order

ASAP (as soon as possible) order

A drug that is to be given only once and at a specific time, such as pre-operative order

Single order

Example: Secosonal 100mg at bedtime before surgery

Single order

May or may not have a termination date

Standing order

May be carried out indefinitely until an order is written to cancel

Standing order

* Example: Multiple vitamins, 1 tab daily * Or maybe carried out for a specified number of days; KCI 1 tablet, 2x per day X 2 days

Standing order

Or as needed order

PRN order

Administered as required by the client condition

PRN order

Example: Mefenamic acid 500mg Q6 for pain

PRN order

Usually carried out within 2hrs of the time the order is written by the physician

Routine orders

This are the order not written as STAT, ASAP, NOW, or PRN

Routine orders

* Full name of the client * Date and time the order is written * Name of the drug to be administered * Dosage of the drug * Frequency of administration * Route of administration * Signature of the person writing the order

ESSENTIAL PARTS OF A MEDICATION ORDER

A drug is written on the client’s chart by a primary care provider

COMMUNICATING A MEDICATION ORDER

medication order

copied by the nurse in the medication administration record (MAR) and in most institutions in the country in the medication card and other sheet in the client’s chart

* Descriptive information about the client * Date on which the prescription was written * The RX symbol (take thou) * Medication, name, dosage, strength * Route of administration

PARTS OF A PRESCRIPTION

* Dispensing instructions for the pharmacist * Direction for administration to be given to the client “one table with meals” * Refill and/or special labelling * Prescribers signature

PARTS OF A PRESCRIPTION

1. Drug Administration during Pregnancy and Lactation 2. Drug Administration among Pediatric Clients 3. Drug Administration among Older Adults

CONSIDERATIONS IN DRUG ADMINISTRATIONS ON SPECIAL AGE GROUP

Exercise great caution when initiating pharmacotherapy during pregnancy

Drug Administration during Pregnancy and Lactation

In all cases, healthcare practitioners evaluate the therapeutic benefits of a given medication against its potential adverse effects

Drug Administration during Pregnancy and Lactation

Knowledge of growth and development Is essential

2. Drug Administration among Pediatric Clients

Oral medications are usually prepared sweetened or flavored in liquid form to make it more palatable

2. Drug Administration among Pediatric Clients

Parents may provide which method is best for their child

2. Drug Administration among Pediatric Clients

The nurse should need to acknowledge that pain sensation may be felt

2. Drug Administration among Pediatric Clients

Accurate computation is necessary

2. Drug Administration among Pediatric Clients

May have physiological changes associated with aging that influence medication administration or effectiveness