basic pharmacology for nurses 01
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NUrsingTRANSCRIPT
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2NUR 106: Course ScheduleNUR 106: Course Schedule 1/24: Ch: 1,2 1/31: Ch: 3,7,8 2/7: Ch: 9, 10 2/14: Exam 1 2/21: Ch: 11,12, 142/21: Ch: 11,12, 14 2/28: Ch: 16,20,23 3/7: Ch: 25,29 3/14: Exam 2
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NUR 106: Course Schedule ContdNUR 106: Course Schedule Contd
3/21: Ch: 30,33 3/28: Ch: 34,35 4/4: No Classes 4/11: 27,36 4/18: Exam 34/18: Exam 3 4/25: Ch: 42, 46 5/2: Ch: 48 5/9: Last Day of Class- Exam 4
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Chapter 1Chapter 1Definitions, Names, Standards, and Informational Sources
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Foundations of Pharmacology
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3Types of Drug Names:Types of Drug Names:
Chemical
Generic
Official
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Trademark (brand)
Proprietary
CHEMICAL NAMECHEMICAL NAME
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Sources of Drug InformationSources of Drug Information American Drug Index American Hospital Formulary Service Drug Interaction Facts Drug Facts and Comparisons Handbook on Injectable Drugs
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Handbook on Injectable Drugs Handbook of Nonprescription Drugs MartindaleThe Complete Drug Reference Package inserts Natural Medicines Comprehensive Database Physicians Desk Reference (PDR) Nursing journals
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4Sources of Patient Sources of Patient InformationInformation
United States Pharmacopeia Dispensing Information (USPDI)
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Therapeutic Choices
U.S. Drug LegislationU.S. Drug Legislation
Federal Food, Drug, and Cosmetic Act (1938, 1952, 1962)
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Controlled Substances Act (1970)
Foundations of Pharmacology Foundations of Pharmacology
Drug review process
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5Chapter 2Chapter 2Principles of Drug Action and Drug Interactions
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Basic principlesBasic principles
A strong understanding of the human bodys processes are important to grasp drug actions and drug interactions in the body
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Examples:Examples:
Antagonistbeta blockers
Agonistepinephrine
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Partial agonistpentazocine
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6Drug Stages After AdministrationDrug Stages After Administration
Absorption
Distribution
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Metabolism
Excretion
Categories of Drug Administration
Enteral route: PO, Rectal, NG
Parenteral route: subQ, IM, IV
Percutaneous route: inhalation, sublingual,Percutaneous route: inhalation, sublingual, topical
HalfHalf--life of Drugslife of Drugs
Factors modifying the quantity of drug reaching a site of action after a single oral dose
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7Terms used in relationship to Terms used in relationship to medicationsmedications
Desired action
Side effects/ Adverse effects
Allergic reactions: i.e. hives, urticaria
Idiosyncratic reactions
Carcinogenicity
TeratogenSlide 19
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Principles of Drug Action and Principles of Drug Action and Drug InteractionsDrug Interactions
Desired effect: when a drug enters a patient, is absorbed and distributed, and produces the expected response
Adverse effect: Any noxious, unintended and d i d ff t f d hi h t
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undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis or therapy (World Health Organization)
Principles of Drug Action and Principles of Drug Action and Drug Interactions (contd)Drug Interactions (contd)
Drug interaction
Drug interactions represent 3% to 6% of preventable in-hospital adverse drug reaction cases
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cases
Drug interactions are a major component of the number of hospital emergency department visits and admissions
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8Factors Influencing Drug Action
Age Body weight Metabolic rate Illness Psycological aspectsPsycological aspects Tolerance Drug dependence Cumulative effect
Chapter 3 Chapter 3 Drug Action Across the Life Span
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Drug Action Across the Life SpanDrug Action Across the Life Span
Age and gender affect drug therapy
Gender-specific medicine
A d l i i th t t di th
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A developing science that studies the differences in the normal function of men and women and how people of each sex perceive and experience disease
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9Across The Life SpanAge
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Drug Absorption: Age ConsiderationsDrug Absorption: Age Considerations
Topical administration in infants is effective because:
Outer layer of skin (stratum corneum) not fully de eloped
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developed
Skin more fully hydrated; plastic diaper increases skin hydration
Inflammation (diaper rash) increases absorption
Drug Absorption: Age ConsiderationsDrug Absorption: Age Considerations
Difficult to predict in geriatric patients
Dermal thickness decreases with age and may enhance absorption
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Drying, wrinkling, and decreased hair follicles decrease absorption
Decreased cardiac output and diminishing tissue perfusion also affect absorption
Drug Absorption: Age ConsiderationsDrug Absorption: Age Considerations
Gastrointestinal absorption influenced by:
Gastric pH
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Gastric emptying time
Enzymatic activity
Blood flow of mucous lining and intestines
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Drug Absorption: Gender ConsiderationsDrug Absorption: Gender Considerations
Increased potential for toxicity and slower absorption times in women
Empty solids more slowly
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Have greater gastric acidity
Have lower gastric levels of alcohol dehydrogenase needed to metabolize alcohols
Drug DistributionDrug Distribution Depends on pH, body water concentrations,
presence and quantity of fat tissue, protein binding, cardiac output, and regional blood flow
I f t h l l f t t t
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Infants have larger volume of water content and require higher dose
With age, total body water decreases and fat increases
Drug DistributionDrug Distribution
Highly fat-soluble drugs take longer to act and accumulate in fat tissues, increasing potential for toxicity
P i bi di
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Protein binding Drugs that are relatively insoluble are
transported in circulation by binding to plasma proteins
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Drug DistributionDrug Distribution
Age considerations Some drugs have lower protein binding in
neonates and require larger loading dose Albumin levels decrease with age
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Gender considerations Some differences between men and
women in globulin proteins
Drug MetabolismDrug Metabolism Drug metabolism
Process by which the body inactivates medicine
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Affected by genes, diet, age & maturity of enzyme systems
Liver weight and hepatic blood flow decrease with age
Routes of Medication Excretion Routes of Medication Excretion
Primary Routes Renal tubules: into the urine GI tract: through feces
Minor RoutesMinor Routes Evaporation: through skin Exhalation: from the lungs Secretion: in saliva & breast milk
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Drug ExcretionDrug Excretion
Metabolites of drugs (and sometimes the drug itself) eventually excreted
Preterm infant has 15% of adult renal
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capacity; fully functional by 9 to 12 months
Drug Excretion (contd)Drug Excretion (contd)
Decreased renal function with age
No prediction of renal function can be based solely on age because of wide individual
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y gvariation in changes
Percentages of Body WaterPercentages of Body Water
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Therapeutic Drug MonitoringTherapeutic Drug Monitoring
Entails measurement of a drugs concentration in biologic fluids to correlate the dosage administered and the level of medicine in the body with the pharmacologic response
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Timing of drugs administration and collection of specimen are crucial to accurate interpretation
Use of Monitoring ParametersUse of Monitoring Parameters
Before administering medicine, assess expected therapeutic actions, side effects, reportable adverse effects, probable drug interactions
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Monitoring parameters related to patients age
Monitoring Parameters:Monitoring Parameters:Pediatric PatientsPediatric Patients
Infants and young children more susceptible to dehydration
Weight variation affects dosage
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g g
Aspirin never to be administered to children
Allergic reactions occur rapidly in children, most commonly to antibiotics
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Monitoring Parameters: Older Adult PatientsMonitoring Parameters: Older Adult Patients
Factors that place older patient at risk:
Reduced renal and hepatic function
Chronic illness
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Polypharmacymultiple-drug therapy required by chronic illness
A greater likelihood of malnourishment due to polypharmacy
Monitoring Parameters: Older Adult PatientsMonitoring Parameters: Older Adult Patients
Drug therapy
Take thorough drug history and nutritional assessment Determine whether new symptoms have
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y pbeen induced by existing medicines Gradually taper dosage when discontinuing
drug Start at one third to one half normal dosage
when initiating therapy; gradually increase Review regimen periodically
Potentially Inappropriate Medications Potentially Inappropriate Medications for Older Adult Patientsfor Older Adult Patients
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Use of Monitoring Use of Monitoring Parameters: Pregnant WomenParameters: Pregnant Women
Avoid drugs if at all possible
When taking womans history, be alert to possibility of pregnancy
I i id d l h l
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Instruct patient to avoid drugs, alcohol, tobacco
Try nonpharmacologic treatments before using medicines
Avoid herbal medicines
Drugs Known to Be Drugs Known to Be TeratogenicTeratogenic
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Use of Monitoring Parameters: Use of Monitoring Parameters: BreastBreast--Feeding PatientsFeeding Patients
Some drugs are known to enter breast milk and harm nursing infant
Discuss all medications with physician
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Take medicine immediately after breast-feeding or just before infants longest sleeping period
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Chapter 7 Chapter 7 Principles of Medication Administration
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Legal and Ethical Legal and Ethical ConsiderationsConsiderations
Standards of care: developed by the states nurse practice act, state and federal law, JCAHO, professional organizations
Before administering medication, nurse must have:
C t li t ti
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Current license to practice Clear policy statement authorizing the act Signed medication order Understanding of rationale for drug use Understanding of drug action, dosing, dilution,
route and rate of administration, side effects, adverse effects to report, contraindications
Contents of Patient ChartsContents of Patient Charts
Summary sheet Consent forms Physicians order form History and physical exam form
P t
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Progress notes Critical pathways Nurses notes Laboratory tests record
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Contents of Patient ChartsContents of Patient Charts Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or
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Medication administration record (MAR) or medication profile
PRN or unscheduled medication record Case management Patient education record
Legal and Ethical Legal and Ethical ConsiderationsConsiderations
Standards of care: developed by the states nurse practice act, state and federal law, JCAHO, professional organizations
Before administering medication, nurse must have:
C t li t ti
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Current license to practice Clear policy statement authorizing the act Signed medication order Understanding of rationale for drug use Understanding of drug action, dosing, dilution,
route and rate of administration, side effects, adverse effects to report, contraindications
Contents of Patient ChartsContents of Patient Charts Summary sheet Consent forms Physicians order form History and physical exam form Progress notes
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Progress notes Critical pathways Nurses notes Laboratory tests record
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Contents of Patient Charts Contents of Patient Charts (contd)(contd)
Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or
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Medication administration record (MAR) or medication profile
PRN or unscheduled medication record Case management Patient education record
The KardexThe Kardex
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Drug Distribution SystemsDrug Distribution Systems
Floor or ward stock system
Individual prescription order system
C t t ll d di i t
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Computer-controlled dispensing system
Unit dose system
Long-term care unit dose system
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Narcotic Control SystemsNarcotic Control Systems
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The Drug OrderThe Drug Order Stat order
Standing order
Renewal order
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PRN order
Verbal orders
Electronic transmission of patient orders
Medication ErrorsMedication Errors Prescribing errors
Transcription errors
Dispensing errors
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Dispensing errors
Administration errors
Monitoring errors
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Nurse ResponsibilitiesNurse Responsibilities Verification Nurse makes professional judgment regarding
acceptability and safety of the drug order, including type of drug, dose and dose preparation, therapeutic intent, route, potential allergic reactions, or contraindications
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allergic reactions, or contraindications
Transcription Nurse is responsible for verification of orders
transcribed by others
The Six RightsThe Six Rights 1. Right drug Compare exact spelling and concentration of
drug with medication card and drug container; drug label should be read three times
2. Right time
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g Standard abbreviations Standardized administration times Maintenance of consistent blood levels Maximum drug absorption Diagnostic testing PRN medications
The Six Rights (contd)The Six Rights (contd) 3. Right dose Abnormal hepatic or renal function Nausea and vomiting Accurate dose forms Accurate calculations Correct measuring devices
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Correct measuring devices
4. Right patient Bracelet checking Pediatric and older adult patients
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The Six RightsThe Six Rights 5. Right route IV route Intramuscular route Intravenous route Subcutaneous route Oral route
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Oral route
6. Right documentation Safety/ethical considerations Legal considerations Always include date/time, drug name, dose,
route, site of administration
Special Documentation Special Documentation CircumstancesCircumstances
Patient refuses medication Thoroughly record incident and reason for
refusal in nurses notes Notify physician
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Medication error occurs Notify physician Complete incident report
Chapter 8Chapter 8Percutaneous Administration
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Percutaneous AdministrationPercutaneous Administration Application of medications to the skin or
mucous membranes for absorption
Includes: Topical application of ointments, creams,
lotions or powders to the skin
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lotions, or powders to the skin Inhalation of aerosolized liquids or gases Installation of solutions into the mucous
membranes of the mouth, eye, ear, nose, or vagina
Always follow the six rights of drug administration
PercutaneousPercutaneous AdministrationAdministration
Premedication assessment and explanation Patient teaching Hygiene requirements Proper application techniques and timing
Cautions particular to drug or drug
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Cautions particular to drug or drug administration Side effects When to contact physician
PercutaneousPercutaneous AdministrationAdministration
Documentation
Date, time, drug, dosage, route
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Record ongoing assessment data, including signs of adverse drug effects
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Creams, Lotions, OintmentsCreams, Lotions, Ointments Wash hands, put on gloves, position patient
Clean area
Wear gloves
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Shake lotion bottle; use tongue blade to remove desired amount of ointment or cream from container
Use dressings according to orders
Patch TestingPatch Testing Method to identify sensitivity to contact
materials (soaps, pollen, dyes)
Allergens on patch placed in contact with back, arms, or thighs
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Patch left in place for 48 hours
Site aired for 15 minutes, then read
Emergency equipment must be available in case of anaphylactic response
Patch TestingPatch Testing Wash hands, put on gloves,position patient
Clean the area
Wear gloves
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g
Apply dose-measuring applicator paper
Do not rub in ointment
Cover area with plastic wrap
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Transdermal Drug DeliveryTransdermal Drug Delivery Disk or patch providing controlled release of
medication
Wash hands,put on gloves,position patient
Apply topical disk or patch
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Apply topical disk or patch
Application frequency depends on drug
Wash hands after application
Label disk with time, date, nurse initials
Topical PowdersTopical Powders Particles of medication in a talc base
Wash hands, put on gloves
Position the patient
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Position the patient
Wash and thoroughly dry area
Apply powder, smooth over area for even coverage
Sublingual and Buccal Sublingual and Buccal TabletsTablets
Sublingual tablets: placed under the tongue
Buccal tablets: held in the buccal cavity
Advantage: rapid absorption and onset of
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Advantage: rapid absorption and onset of action
Action is usually systemic, rather than localized to the mouth
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Eye Drops, Ointments, and Eye Drops, Ointments, and DisksDisks
OD (right eye), OS (left eye), OU (both eyes)
Wash hands, put on gloves,position patient
Inspect affected eye
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Inspect affected eye
Expose lower conjunctival sac
Approach eye from below
Never touch eye with dropper, tube
Ear DropsEar Drops Ensure ear is clear of wax
Warm medication to room temperature
Younger than age 3: pull earlobe downward and back
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and back
Older than age 3 and adults: pull earlobe upward and back
Patient should remain on side for a few minutes
Nose Drops, Nasal SprayNose Drops, Nasal Spray Patient should blow nose gently Nose drops Position patient lying down with head hanging
back Nose spray
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Patient is upright Block one nostril Shake bottle and insert tip into nostril Spray while patient inhales
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Nebulizers and InhalersNebulizers and Inhalers Nebulizers Prepare medication and fill nebulizer Patient exhales Put nebulizer in mouth; do not seal completely Patient inhales
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Metered-dose inhalers Follow instructions on inhaler
Dry powder inhalers Follow instructions on inhaler
Vaginal MedicationsVaginal Medications Wash hands, put on gloves Fill applicator Place patient in lithotomy position, elevate
hips with pillow Spread labia and insert applicator or
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p ppsuppository
Chapter 9Chapter 9Enteral Administration
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Administration of Oral Administration of Oral MedicationsMedications
Enteral is direct administration to the GI tract Most drugs are available in oral dose forms: Capsulessmall, cylindrical gelatin containers
used to administer unpleasant tasting medications; timed-release capsules (provides a gradual and continuous release of the drug);
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gradual and continuous release of the drug); lozenges or trochesflat disks in a flavored base
Tablets (powdered drugs that have been compressed)
Elixirsdrugs dissolved in water and alcohol Emulsions of water-in-oil or oil-in-water Liquid suspensions and syrups
Administration of Oral Administration of Oral MedicationsMedications
Common methods used to administer oral medications
Unit dose packaging providing a single dose Souffl cups Medicine cups
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Medicine cups Medicine droppers Teaspoons Oral syringes: plastic syringes calibrated and used
to measure liquid medications Nipples with additional holes, used for infants
Administration of SolidAdministration of Solid--Form Form Oral MedicationsOral Medications
Two techniques for administering medications: the medication card and unit dose distribution
Perform premedication assessment in all cases
All techniques follow FIVE RIGHTS procedure:
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All techniques follow FIVE RIGHTS procedure: RIGHT patient RIGHT drug RIGHT route of administration RIGHT dose RIGHT time of administration
ALWAYS check or recheck the FIVE RIGHTS
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Administration of SolidAdministration of Solid--Form Form Oral MedicationsOral Medications
General principles apply to all distribution systems Give the most important medications first Do not touch the medication with your hands Encourage liquid intake to ensure swallowing
Remain with patient while medication is taken; DO
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Remain with patient while medication is taken; DO NOT leave the medication at bedside unless an order to do so exists
Discard the medication container
Provide complete documentation of administration and responses to therapy
Administration of SolidAdministration of Solid--Form Form Oral MedicationsOral Medications
Documentation of medication administration and responses to drug therapy is called the Sixth Right
General principles apply to all medication administration Chart date, time, drug name, dosage, and route of
d i i t ti
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administration Regularly record patient assessments to evaluate
therapeutic effectiveness Chart and report any sign of adverse drug effects
Perform and validate essential education about drug therapy and other aspects of intervention for the individual
Administration of LiquidAdministration of Liquid--Form Form Oral MedicationsOral Medications
General procedures are the same as with solid-form oral medications
Perform premedication assessment in all cases
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All techniques follow the FIVE RIGHTS procedure
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Administration of LiquidAdministration of Liquid--Form Form Oral Medications (contd)Oral Medications (contd)
General principles for infants, children, and adults Give adults and children the most important
medications first NEVER dilute medications without specific
orders. DO NOT leave a medication at the
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bedside without an order to do so Check an infants ID and be certain the infant
is alert
Provide complete documentation of administration and responses to therapy
Administration of LiquidAdministration of Liquid--Form Form Oral MedicationsOral Medications
Measuring techniques vary according to receptacle used
With a measuring cup: Cover label to prevent smearing; place
fingernail at exact level on measuring cup;
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fingernail at exact level on measuring cup; read the volume at the level of meniscussee Figure 9-13. Recheck FIVE RIGHTS.
With an oral syringe: Select syringe of appropriate size. Draw up
prescribed volume of medication from bottle or medicine cup
Administration of Medications Administration of Medications by Nasogastric Tubeby Nasogastric Tube
Drugs are administered via NG tube for specific patients, using a liquid form whenever possible. Remember: Always flush the tube before and after
administration Perform premedication assessment
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p Assemble equipment before administration
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Administration of Medications Administration of Medications by Nasogastric Tube (contd)by Nasogastric Tube (contd)
Prepare doses as for administration of solid-form or liquid-liquid form oral medications
Three methods for checking NG tube location Follow procedure for administering
di i
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medication DO NOT attach suction for 30+ minutes Provide complete documentation of
administration and responses to therapy
Administration of Enteral Feedings via Administration of Enteral Feedings via Gastrostomy of Jejunostomy TubeGastrostomy of Jejunostomy Tube
Enteral formulas are in several mixtures to meet individual needs
Assemble equipment beforehand Prescribed enteral formula should be
checked
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Administration of Enteral Feedings Via Administration of Enteral Feedings Via Gastrostomy or Jejunostomy Tube (contd)Gastrostomy or Jejunostomy Tube (contd)
Formula should be fully labeled Discard unused formula every 24 hours Follow the guidelines specific for patients
receiving general nutrition via intermittent or
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continuous feedings Follow FIVE RIGHTS RIGHT patient, RIGHT drug (formula), RIGHT
route of administration, RIGHT dose (amount, dilution, strength), RIGHT time
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Administration of Enteral Feedings via Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube (contd)Gastrostomy or Jejunostomy Tube (contd)
Verify tube placement and initiate feeding Flush, then clamp tube Proceed with tube feeding technique Intermittent: use Toomey syringe
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y y g Continuous: use disposable feeding container
and enough formula for a 4-hour period Provide complete documentation of
administration and responses to therapy
Administration of Rectal Administration of Rectal SuppositoriesSuppositories
Suppositories are solid medication designed to dissolve inside a body orifice
Equipment is simple: Finger cot or disposable glove Water-soluble lubricant
P ib d it
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Prescribed suppository Perform standard premedication assessment
Administration of Rectal Administration of Rectal Suppositories (contd)Suppositories (contd)
Technique begins with FIVE RIGHTS Explain procedure and check pertinent
parameters Patient bends uppermost leg
A l l b i t t ti f it Pl
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Apply lubricant to tip of suppository. Place suppository about 1 inch beyond orifice, past internal sphincter
Provide complete documentation of administration and responses to therapy
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Administration of a Disposable Administration of a Disposable EnemaEnema
The dose form will be a prepackaged, disposable-type enema solution
Equipment is simple Perform standard premedication assessment
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Administration of a Disposable Administration of a Disposable Enema (contd)Enema (contd)
Technique begins with FIVE RIGHTS Explain procedure and check pertinent
parameters Time of last defecation
P ti t b d t l
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Patient bends uppermost leg Apply lubricant to rectal tube Insert lubricated tube and insert solution
Provide complete documentation of administration and responses to therapy
Parenteral AdministrationParenteral Administration Parenteral means drug administration by any
route other than the gastrointestinal tract
Parenteral route Intradermal
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Subcutaneous Intramuscular (IM) Intravenous (IV)
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Chapter 10Chapter 10Parenteral Administration: Safe Preparation of Parenteral Medications
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Equipment Used in Parenteral Equipment Used in Parenteral AdministrationAdministration
The syringe has three parts: barrel, plunger, and tip
Syringes are calibrated in minims, milliliters, or cubic centimeters
Tuberculin syringes are used to measure ll l f di ti t l
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small volumes of medication accurately
Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)
The insulin syringe has a special scale for measuring insulin
In the United States, insulin is manufactured in U-100 concentration
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in U-100 concentration The U-100 syringe holds 100 units of insulin
per milliliter Low-dose insulin syringes are used for
patients receiving 50 units or less of U-100 insulin
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Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)
Prefilled syringes are disposable and have a premeasured amount of medication
Advantages: time saved in preparation, less h f t i ti
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chance of contamination
Disadvantages: additional expense, different holders for different cartridges, volume of second medication limited
Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)
The needle has three parts: Hub Shaft Beveled tip
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The needle gauge is the diameter of the hole through the needle
Needle selection depends on age of patient, and site (subcutaneous, IM, or IV)see Table 10-1
Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)
Major safety development: needleless systems
Provide an alternative to needles for routine
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Provide an alternative to needles for routine procedures, reducing the risk of needlesticks with contaminated sharps
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Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)
Other safety devices have been developed
BD Safety-Lok Syringe BD SafetyGlide Shielding Hypodermic Needle
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BD SafetyGlide Shielding Hypodermic Needle BD SafetyGlide Syringe Tiny Needle Technology BD Integra Syringe
Parenteral Dose FormsParenteral Dose Forms Ampules Glass containers usually containing a single
dose
Vials
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Glass containers that contain one or more doses
Mix-O-Vials Glass containers with one dose, two
compartments
Preparation of Parenteral Preparation of Parenteral MedicationMedication
Equipment needed for preparation of parenteral medications
Drug in sterile, sealed container
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Syringe of the correct volume Needles of the correct gauge and length Needleless access device Antiseptic swab MAR or medication profile
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Preparation of Preparation of ParenteralParenteralMedicationMedication
Techniques for preparing all parenteral medications
Use the five RIGHTS: Right Patient, Right D Ri ht R t f Ad i i t ti Ri ht
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Drug, Right Route of Administration, Right Dose (Amount and Concentration), Right Time of Administration
Check the drug dose form ordered against the source you are holding
Preparing a Medication from Preparing a Medication from an Ampulean Ampule
Move solution to the bottom of the ampule
Cover the ampule neck with a sterile gauze pledget or antiseptic swab while breaking off top
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top
Using an aspiration needle, withdraw medication from ampule
Preparing a Medication from Preparing a Medication from an an AmpuleAmpule
Remove the needle from the ampule and point the needle vertically
Pull back the plunger. Replace the aspiration needle with a new sterile needle
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needle with a new sterile needle
Push plunger until medication is at tip of needle
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Preparing a Medication from a Preparing a Medication from a VialVial
Cleanse the top of the vial of diluent
Pull plunger of syringe to fill with an amount of air equal to the volume of the solution to be withdrawn
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withdrawn
Insert the needle or needleless access device through the diaphragm, inject air
Withdraw the measured volume of diluent required to reconstitute the powdered drug
Preparing a Medication from a VialPreparing a Medication from a Vial
Tap the vial of powdered drug to break up caked powder; cleanse the rubber diaphragm with swab
Insert the needle or needleless access device i th di h d i j t th dil t i th
Slide 113Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
in the diaphragm and inject the diluent in the powder
Mix thoroughly to dissolve powder
Change needle to correct gauge and length to administer the medication to the patient
Preparing a Medication from a Preparing a Medication from a MixMix--OO--VialVial
Tap the container a few times to break up the caked powder
Remove the plastic lid protector
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Push firmly on the diaphragm-plunger
Mix thoroughly
Cleanse the rubber diaphragm and remove drug using syringe to administer to patient
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Special PreparationsSpecial Preparations
Occasionally two medications may be drawn into the same syringe for a single injection
M di ti d t b d f i
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Medications need to be prepared for use in the sterile field during a surgical procedure