Nursing and Medications

Medications

Drug Nomenclature

• Chemical name – identifies drug’s atomic and molecular structure
• Generic name – assigned by the manufacturer that first develops the drug
• Official name – name by which it is identified in official publications USP and NF
• Trade name – brand name copyrighted by the company that sells the drug

Drug Preparations

• Oral
– Capsule, pill, tablet, extended release, elixir, suspension, syrup
• Topical
– Liniment, lotion, ointment, suppository, transdermal patch
• Injectable

Drug Classifications

• Body system
• Symptoms relieved
• Clinical indication

 

Mechanisms of Drug Actions

• Drug-receptor interaction — drug interacts with one of more cellular structures to alter cell function
• Drug-enzyme interaction — combines with enzymes to achieve desired effect
• Acting on cell membrane or altering cellular environment

 

Pharmacokinetics

• Absorption -  drug is transferred from site of entry into bloodstream
• Distribution – drug is distributed throughout the body
• Metabolism – drug is broken down into an inactive form

• Excretion – drug is excreted from the body

 

Factors Affecting Drug Absorption

• Route of administration
• Drug solubility
• pH
• Local conditions at site of administration
• Drug dosage
• Serum drug levels

 

Adverse Effect of Medications

• Iatrogenic disease
• Allergic effects
• Toxic effects
• Idiosyncratic effects
• Drug interactions

 

Signs and Symptoms of Drug Allergy

• Rash
• Uticaria
• Fever
• Diarrhea
• Nausea
• Vomiting
• Anaphylactic reaction

 

Variables Influencing Effect of Medications

• Developmental considerations
• Weight
• Sex
• Genetic and cultural factors
• Psychological factors
• Pathology
• Environment, timing of administration

 

Types of Medication Orders

• Standing order – carried out until cancelled by another order
• Prn order – as needed
• Stat order – carried out immediately

 

Parts of the Medication Order

• Patient’s name
• Date and time order is written
• Name of drug to be administered
• Dosage of drug
• Route by which drug is to be administered
• Frequency of administration of the drug
• Signature of person writing the order

 

Medication Supply Systems

• Stock supply
• Individual supply
• Medication cart
• Computerized medication system
• Bar coded medication cart

 

Systems of Measurement

• Metric – meter (linear), liter (volume), gram (weight)
• Apothecary – less convenient and concise; basic unit or weight is grain
• Household – least accurate system; teaspoons, tablespoons, teacup and glass used

 

Metric System Conversions

• To convert larger unit to smaller unit, move decimal point to right.
• To convert smaller unit to larger unit, move decimal point to left.
– 1 kilogram = 1000 grams
– 1 gram = 1000 milligrams
– 1 milligram = 1000 micrograms

 

Three Checks of Medication Administration

• Read the label:
– When the nurse reaches for the container or unit dose package
– Immediately before pouring or opening medication
– When replacing the container to the drawer or shelf

 

Five Rights of Medication Administration

• The nurse should give:
– The right medication
– To the right person
– In the right dosage
– Through the right route
– At the right time

 

Controlled Substances Required Information

• Name of patient receiving narcotic
• Amount of narcotic used
• The hour narcotic was given
• The name of physician prescribing narcotic
• Name of the nurse administering narcotic

 

Oral Medications

• Solid form – tablets, capsules, pills
• Liquid form – elixirs, spirits, suspensions, syrups

 

Administration of Oral Medications

• Oral Route – having patient swallow drug
• Enteral route – administering drug through an enteral tube
• Sublingual administration – placing drug under tongue
• Buccal administration – placing drug between tongue and cheek

 

Administration of Parenteral Medications

• Subcutaneous injection — subcutaneous tissue
• Intramuscular injection — muscle tissue
• Intradermal injection — corium (under epidermis)
• Intravenous injection — vein
• Intraarterial injection — artery
• Intracardial injection — heart tissue
• Intraperitoneal injection — peritoneal cavity
• Intraspinal injection — spinal canal
• Intraosseous injection — bone

 

Sites for Intramuscular Injections

• Ventrogluteal site
• Vastus lateralis site
• Deltoid muscle site
• Dorsogluteal site

 

Criteria for Choosing Equipment for Injections

• Route of administration
• Viscosity of the solution
• Quantity to be administered
• Body size
• Type of medication

Preparing Medications for Injection

• Ampules
• Vials
• Prefilled cartridges

 

Topical Administration of Medications

• Vaginal
• Rectal
• Inunction
• Instillation
• Irrigation
• Skin application

 

Medical Record Documentation

• Each dose of medication, give as soon as possible after it is given
• Intentional or inadvertent omitted drugs
• Refused drugs
• Medication errors

 

Type of Medication Errors

• Inappropriate prescribing of the drug
• Extra, omitted, or wrong doses
• Administration of drug to wrong patient
• Administration of drug by wrong route or rate
• Failure to give medication within prescribed time
• Incorrect preparation of a drug
• Improper technique when administering drug
• Giving a drug that has deteriorated

 

Medication Errors

• Check patient’s condition immediately; observe for adverse effects.
• Notify nurse manager and physician.
• Write description of error on medical record and remedial steps taken.
• Complete special form for reporting errors.

 

Medication and Patient Teaching

• Review techniques of medication administration.
• Remind patient to take the medication as prescribed for as long as prescribed.
• Instruct patient not to alter dosages without consulting physician.
• Caution patient not to share medications.

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