Medication AdministrationSlide 2Medication Legislation and StandardsDrug NamesPharmacokineticsSlide 6Slide 7Pharmacokinetics (cont’d)Medication ActionSlide 10Slide 11Medication Action (cont’d)Types of OrdersRoutes of AdministrationParts of the Medication OrderResourcesLegal IssuesNursing Responsibilities for Administering DrugsNursing Responsibilities for Administering Drugs (cont’d)Dosage CalculationsSlide 21Dosage CalculationSlide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Slide 31Slide 32Slide 33Slide 34Principles of Safe Medication AdministrationMedication SafetyMedication Safety (cont’d)JCAHO 2011 Patient Safety Goals: Use Medicines safelyPrinciples of Safe Medication Administration (cont’d)Slide 40Slide 41Slide 42Slide 43High Alert MedicationsMedication Safety Initiatives ReviewMedication Safety Initiatives Review (cont’d)Principles of Safe Medication Administration-SummaryPrinciples of Safe Medication Administration-SummaryKey Points: Oral RouteSlide 50Key Points: Enteral Feeding TubesKey Points: Enteral Feeding Tubes (cont’d)Slide 53Key Points: Topical Medications (cont’d)Slide 55Key Points: Nasal InstillationsKey Points: Nasal Instillations (cont’d)Key Points: Opthalmic InstillationKey Points: Otic InstillationKey Points: Metered-dose InhalersKey Points: Parenteral MedicationsSlide 62Slide 63Slide 64Slide 65Key Points: Parenteral Medications (cont’d)Slide 67Slide 68Slide 69Slide 70Slide 71Slide 72Key Points: Parenteral Medications IV (cont’d)Slide 74Key Points: Parenteral Medications IVReferencesSTEPHANIE TURRISE, PHD(C), RN, BC, APRN, CNEMEDICATION ADMINISTRATIONMEDICATION ADMINISTRATION•Nurses spend a great deal of time administering medications to clients.•Medications are used to prevent, diagnose, or treat disease.•Nurses need to have knowledge about the actions and effects of medications but also an understanding of pharmacokinetics, growth and development, human anatomy, nutrition, and mathematics.MEDICATION LEGISLATION AND STANDARDS•The US government regulates the pharmaceutical industry to protect the health of people•The Federal Drug Administration requires vigorous testing of medications before they are release on the market•Read more in P & P chapter 35DRUG NAMES•Medications have chemical names, trade names, and generic names. You must know trade names and generic names.•It is helpful for you to learn drug classes and the suffix of the class i.e. metoprolol, atenolol, are beta-blockers. Cimetidine, ranitidine, famotidine are all H-2 receptor blockers.PHARMACOKINETICS•Absorption•Route: Injected medications are absorbed more rapidly than oral or topical medications with IV injection being the fastest. YOU WILL NOT ADMINISTER IV PUSH MEDS IN SCHOOL•Solubility: Liquids are absorbed more rapidly than solids.•pH: Acidic drugs are well absorbed in the stomach but basic drugs are not absorbed before the small intestine.PHARMACOKINETICS•Absorption•Local conditions at site of administration: •The larger or more extensive the absorbing surface the greater the absorption and the more rapid the effect•Food in the stomach can either speed or slow the rate of absorption depending on the drug•Sustained release or enteric coated preparations also affect the rate of absorptionPHARMACOKINETICS•Absorption•Drug dosage: Loading doses may be given if client is in distress and the maximum therapeutic effect is desired quickly (digoxin, phenobarbital)PHARMACOKINETICS (CONT’D)•Serum drug levels:•Therapeutic range- concentration of drug in the blood that produces the desired effect without toxicity•Peak level- highest plasma concentration and is measured when absorption is complete•Trough level- point when the drug is at its lowest concentration- usually drawn 30 minutes before the next doseMEDICATION ACTION•Side effects vs. Adverse effects vs. Allergic Effects•Drug Interactions:•Antagonist effect•Synergistic effect: sometimes this is useful for example in the treatment of hypertension but can also be detrimental.**very important to assess for use of herbals.MEDICATION ACTION•Developmental considerations•Pregnancy•Breastfeeding•Infants •Children•ElderlyMEDICATION ACTION•Genetic and Cultural Factors•Pharmacoanthropology- the study of drug responses in various ethnic and racial groups•Asian patients may require smaller doses of a drug because they metabolize it more slowly•Example: BiDilMEDICATION ACTION (CONT’D)•African Americans need larger doses of medications to treat hypertension•Cultural health beliefs may affect compliance and response to medication regimenTYPES OF ORDERS•Standing or routine orders:Decadron 10 mg PO daily x 5 days•PRN orders: as neededTylenol 650mg PO q6h prn temp greater than 101.•Single order: one time orderAtivan 1mg IV on call to MRI•Stat orders: a single order that needs to be given immediatelyLasix 100 mg IV STATROUTES OF ADMINISTRATION•Topical Routes•Vaginal•Rectal•Skin•Inhalation•Oral Routes•Sublingual•Buccal•Parenteral Routes•Intradermal•Subcutaneous•Intramuscular•IntravenousPARTS OF THE MEDICATION ORDER•Patient’s name•Date and time order is written•Name of the drug to be administered•Dosage of the drug•Route by which it is to be administered•Frequency of administration•Signature of person writing the orderRESOURCES •Pharmacist•Drug books•Physician Drug Reference•Institutional Policy•Online resources (MicroMedex, etc.)LEGAL ISSUES•Nurses are legally responsible for the drugs they administer.•Any drug order suspected to be in error should be questioned.•Leading zeroes are always used for clarity (0.5 mg) but trailing zeroes should be left off (1.0 mg vs 1 mg)NURSING RESPONSIBILITIES FOR ADMINISTERING DRUGS•Assess the patient and have a clear understanding of why this patient is receiving this drug•Ensure the six rights plus “2”•Preparation of the medication•Accurate dosage calculationsNURSING RESPONSIBILITIES FOR ADMINISTERING DRUGS (CONT’D)•Administration of the medication•Documentation of medications administered•Monitoring patient reaction and evaluating patient response•Educating the patient regarding medications and regimenDOSAGE CALCULATIONS•Metric System •Weight•1 kilogram (kg) = 1000 grams (g)•1 g = 1000 milligrams (mg)•1 mg = 1000 micrograms (mcg)•Length•1 inch = 2.54 cm•Volume•1 liter (L) = 1000 milliliters (mLs) = 1