Medication Aide Chapters 6-9

Generic

Universal name based on chemical ingredients Name starts with a small letter-is longer in

length & is more difficult to pronounce Trade Name

Name is given by Co. that develops it Name starts with a capitol letter-is shorter in

length & is easier to pronounce

Drug Names

Body system Therapeutic use or clinical indication Physiological or chemical action Prescription or non-prescription Illegal drugs

Drug Classification

Drugs act in the human body in the following ways:

Change physiological activity within the body Drugs form a chemical bond within specific sites Drugs that interact with a receptor to cause a response

are agonists Drugs that attach to a receptor but do not cause a

response are antagonists Drugs that interact with a receptor to cause a response

but prevent other responses are partial agonists Once given, all drugs go through stages

Absorption, distribution, metabolism, and excretion

Basic Principles

Factors that affect drug absorption

Absorption Age and weight of consumer Dry or wrinkled skin Decreased number of hair follicles Condition of consumer i.e. decreased cardiac

output, pain, fever Inability to chew tablets for chewable drugs Less saliva production GI absorption affected by disease processes,

presence of other drugs

Cont….

Distribution Amount of body water Decreased levels of plasma proteins

Metabolism Decreased liver function Genetics, smoking, diet, gender, liver disease,

other drugs Excretion

Decreased kidney function

Is the process by which a drug is transferred

from its site of body entry to circulating body fluids for distribution. The rate depends on: The route Blood flow through the tissue where the drugs

was given How well the drug can dissolve

Absorption

Give oral drugs with enough fluid Reconstitute and dilute drugs as

recommended by the manufacturer Give drugs into the correct tissue

To promote absorption

Enteral (oral, rectal, or naso-gastric) Parenteral (bypass GI tract)

Subcutaneous Intramuscular Intravenous percutaneous

Drugs are given

Refers to the ways drugs are transported by

circulating body fluids to the sites of action. Once absorbed into the blood, a drug’s

distribution is determined by: Chemical properties How it is affected by the blood and tissues it

contacts

Distribution

Is the process by which the body in-activates

drugs. The liver is the primary site for drug

metabolism.

Metabolism

Is the elimination of a drug from the body. Urine and feces are the primary routes of

excretion.

Excretion

No drug has a single action. When a drug is absorbed and distributed, the

desired action (expected response) usually occurs.

All drugs can affect more than one body system, therefore side effects and adverse drug reactions can occur.

Drug Action

An unintended reaction to a drug given in a

normal dosage. Nausea Dry mouth Dizziness Blurred vision Ringing in ears

Side effects

Unintended effect on the body from using a

legal drug, illegal drug, or two or more drugs. Rash, itching, high blood sugar

(hyperglycemia) and a reduced number of platelets (thrombocytopenia) are common ADRs.

Drug reactions/adverse

drug reaction

Is an unfavorable response to a substance that

causes a hyper-sensitivity reaction. Most common reaction is

Uticaria (hives) Most severe reaction is

Anaphylaxis Severe, life threatening. Sweating, SOB, hypotension, irregular pulse,

respiratory distress, and swelling of larynx First exposure- mild reaction Second exposure- severe reaction

Allergic reaction

Is something unusual or abnormal that

happens when a drug is first given. Can be considered an over –reaction to a drug Related to the body’s inability to metabolize the

drug

Idiosyncratic Reaction

Age Body weight Metabolic rate Illness Willingness to take drugs Placebo effect Tolerance Dependence Cumulative effect

Factors Influencing Drug Action

Occurs when the action of one drug is altered

by the action of another drug Increase the action of the other (potentiation) Decrease the action of the other (antagonist)

Drug Interactions

American Hospital Formulary Service Drug

Information Drug Interaction Facts Drug Facts and Comparison Handbook of Nonprescription Drugs Natural Medicines Comprehensive Database Physician’s Desk Reference Package Inserts Drugs.com

Drug Information

Classification Brand Name Generic Name Therapeutic Use Dose Side Effects Anything unusual Any Nsg. Precautions

Drug Activity

Physician Physician’s assistant/ nurse practitioner Pharmacist Director of nurses Supervisory nurse Medication aide

Health Professionals

Person’s full name Date Drug name Route of administration Dose Frequency of use Duration of order Doctor’s (prescriber’s) signature

Drug order

STAT order Single order Standing order PRN order Ordering methods

Written order Verbal order Telephone order Faxed order Electronic order

Drug orders

All have to be approved by

Joint Commission Institute for safe Medication Practice Facility

Commonly used Abbreviations

Weights

Metric system (microgram, milligram, centigram, gram, kilogram)

Apothecary system (grain, seldom used) Household system (pound)

Volume Metric (milliliter, centiliter, deciliter, liter) Apothecary (minim) Household system (tablespoon, teaspoon, cup,

ounce)

Measurements in drug orders

Addiction Adverse reaction Allergic reaction Anaphylactic shock Antagonist Contraindication Cumulative effect Drug abuse Habituation Idiosyncrasy Initial dose Maintenance dose Nursing precautions, interventions

Terms for describing drug interactions

Placebo Potentiate Side effect Therapeutic effect, desired effect Tolerance Toxic effect

Cont…

Person’s name, address, phone number Pharmacy’s name, address, phone number Prescription number Date prescription filled Original date of prescription Doctor’s name Brand name of drug Generic name of drug Manufacture’s name Drug dosage Amount in container How often to take Warnings Number of refills allowed Expiration date or when to discard

Information on the label

Person’s name, room number, identifying information Admission form Health history Physical examination results Doctor’s order form Doctor’s progress notes Nursing team progress notes (describes care given,

person’s response & progress) Graphic sheet (records, measurements/observations

made daily, every shift, or 3 or 4 times a day Flow sheet Laboratory & x-ray reports IV therapy record

Medical record

Respiratory therapy record Consultation reports Surgery & anesthesia reports Assessments/reports from social services,

dietary service, and physical, occupational, speech and recreational therapy

Consent forms PRN/unscheduled medication record

Continue

Medication administration record (MAR)

Scheduled medications Parental medications STAT medications Pre-operative medications PRN medications (date, time, drug given, dose

given, route, reason for giving, person’s response)

Time drug given and by whom

Cont….

Summarizes information in medical record Quick, easy source of information Updated regularly (usually in pencil) Not formal, legal part of medical record Destroyed when person leaves facility

Purpose of a Kardex

Nurse verifies and transcribes order Nurse decides is drug safe to give Nurse contacts physician if order deemed unsafe, physician may

cancel or rewrite order Transcribe (copied)

Copied to Kardex and MAR (secretary may copy) Nurse signs, dates, times transcription on original order Nurse sends order to pharmacy to fill

Order may New drug Discontinued drug Change an order STAT or one-time-only order

Transcribing drugs orders

Report

Person’s name, room number Time of observation Only what observed or did Changes from normal

Record What observed What you did Person’s response Record administration of medication as soon as given Sign per facility policy, date & time medication given Report medications refused, not given; not of medication record; discard

drug Record PRN medication immediately with reason given and results Report unusual reaction

How to accurately report and record

Four drug distribution systems

Floor or ward stock system Frequently used Avoids waiting or lag time Pros and cons

Individual prescription order system 3-5 day ordered drug Stored in patient bin Safe system Pharmacist/nurse review order before drug given Pharmacy monitors drug expiration date Fewer drugs for drug diversion (taking person’s drug for your

own use) STAT, PRN drugs available

Cont…

Computer-controlled dispensing system Pharmacy stocks drug cart for patients/residents on unit Accessed by security code/password Drug bar coded, patient ID bracelet also bar coded Patient’s ID scanned and drug scanned (provides check of

correct drug and automatically documents drug administration)

Unit dose system Single-unit dose package dispensed for each dose ordered 24 hour supply (refilled every day) in nursing centers may be

for week or month at a time Safe, cost, and time efficient Reduces risk of drug diversion May be color coded for different times of day

Cont…

Computer-controlled dispensing system Pharmacy stocks drug cart for patients/residents on unit Accessed by security code/password Drug bar coded, patient ID bracelet also coded Patient’s ID scanned and drug scanned (provides check of

correct drug and automatically documents drug administration)

Narcotic control systems Regulation of controlled substances Single-unit packages kept in locked cabinet in medication

room; or in a special container in the med cart- charge nurse has the key which cannot be given to anyone except the person giving the narcotic

Inventoried at the end of each shift Must be counted by 2 qualified individuals If the count is not correct- MUST investigate Each narcotic has its own inventory sheet

which must match the count of that narcotic

Narcotic count

Drug storage

Drug cart (locked) as is the room that they’re stored in Drugs stored in original container or unit dose package in

person’s individual bin Some drugs may need to be stored in refrigerator; tight

containers- moisture & heat can destroy drug Assisted living residents may store own drugs if able to self

medicate-otherwise are stored in a locked room Controlled substances (narcotics) double locked –may be on

drug cart or separate cabinet Emergency medications may be stored in floor or stock system Medications for external use stored separate from those for

internal use

Disposal of drugs

Disposed of because Person refuses to take drug Drug dropped on the floor or bed You are to give only part of drug dispensed Drug becomes contaminated Person discharged Person died Doctor discontinued drug

Follow facility disposal policy Do not return to stock supply Document according to facility policy

Six rights

Right drug Read the label before removing from unit dose cart or shelf Read label before preparing or measuring prescribed dose Read label before returning drug to shelf or opening unit

dose packet Right time

By drug order Standard administration times Blood level Best drug absorption time Diagnostic tests One-time-only, PRN, STAT

Six rights cont…

Right dose Compare dose on label to MAR Use appropriate measuring devise Report nausea & vomiting Correct drug calculation (may need to be nurse)

Right person Compare person’s ID to MAR Two identifiers

Name Birthdate ID number

Check for allergies

Six rights cont…

Right route Drug order gives route Never change route Only give as allowed to give by prescribed route Routes

IV (most rapid onset action) IM (next fastest onset action) Sub-Q (probably next fastest) Intradermal (absorption slow)

What you can give Inhalation(fastest) Sublingual(next fastest) Suppository(next) Oral (slowest onset)

Right documentation Record as quickly as possible Follow documentation standards Right documentation

Drug errors

Prescribing errors Wrong drug for person’s diagnosis Drug person allergic to Wrong dose for person’s diagnosis

Transcription errors Misinterpreting/misunderstanding drug ordered or directions Interpreting hand-writing, not legible Using unapproved abbreviations Omitting a drug order Using wrong spelling Writing wrong dates or times

Drug errors cont….

Dispensing Sending wrong drug or dose to facility Using wrong formulation Using wrong dosage form

Giving drugs Giving wrong drug Giving wrong dose Giving an extra dose Giving drug not ordered for person Missing or skipping a dose Giving a drug at wrong time Giving drug in wrong way

Safety rules for drug

administration Follow the six rights of drug administration Store drugs properly Have good lighting to read Kardex, MAR Stay focused, don’t get distracted Keep working area clean, neat, orderly Check container label for drug name, dose, route Check person’s chart, Kardex, MAR, ID for allergies Check person’s chart, Kardex, MAR for rotation schedules for drugs applied

to skin Know why drug ordered, side effects, adverse reactions Calculate drug dosages accurately Identify person before giving drug Position person for route of administration Have correct fluids ready for person to swallow oral drugs Stay with person to make sure drugs have been swallowed Follow facility policy for self-administered drugs

Cont…

Never leave a drug in person’s room to take later Never leave a drug unattended Refer questions about person’s drug or treatment plan to nurse Do not prepare or give drug if container not properly labeled or unreadable Give only drugs you are allowed to administer Give drugs only prepared by pharmacist Check drug name, dose, frequency, route, against order Do not return unused drug to stock supply Do not mix liquid drug with water or other fluid unless directed to Ask nurse if you have any questions, concerns Practice good hand hygiene Never touch actual drug Check drug carefully (may look alike) Listen to patient – knows drugs best Observe for side effects Make sure drug cabinet/cart is locked

Infection is a disease state resulting from the

invasion and growth of microbes (pathogens)

Bacteria & viruses Medical asepsis (clean technique)

Hand washing!

Preventing Infection

Guidelines set by the CDC Prevent the transmission of infectious agents Blood borne Pathogen Standard

Isolation Precautions

Hand hygiene Gloves Gowns Masks

Standard Precautions