Kozier Ch 35 Medications

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Kozier Ch 35 Medications
2011-09-26 10:29:14
Kozier 35 Medications

Kozier Ch 35 Medications
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  1. Medication
    Generic name
    Brand name
    Pharmacology, pharmacy, pharmacist
    Medication - substnace adminsitered for the diagnosis, cure, treatment, or relief of symptoms or for prevention of disease

    Drug - used interchangebly with the word medication or to indicate illegal substances

    Prescription - written direction for the preparation and administration of a drug

    Generic name - given before a drug becomes officially an approved medication

    Brand name - trade name - name given by the drugs manufacturer

    Pharmacology - study of the effects of drugs on living organisms

    pharmacy - art of preparing, compounding, and dispensing drugs

    pharmacist - person licensed to prepare and dispense drugs and to make up prescriptions
  2. Drug Effects
    Therapeutic effect
    Side effect
    Adverse effects
    Drug toxicity
    Drug allergy
    Anaphylactic reaction
    Drug tolerance
    Cumulative effect
    Drug interaction
    • Therapeutic effect - desired effect
    • Side effect - unintended effect
    • Adverse effects - more severe side effects
    • Drug toxicity - determental effects of a drug on an organism or tissue - caused by overdose, buildup, incorrect route
    • Drug allergy - immunologic reaction to a drug
    • Anaphylactic reaction - severe allergic reaction
    • Drug tolerance - person who has low physiologic response to a drug who may requre an increaded dosage to get desired effect
    • Cumulative effect - increasing response to drug that occurs when the rate of administration exceeds the rate of metabolism or excretion
    • Drug interaction - administration of one drug alters the effects of another drug
    • Synergistic -when two different drugs increade the action of one another
  3. Drug Misuse
    Drug abuse
    Drug dependence
    Drug habituation
    Drug abuse - inappropriate intake of a substance, either continually or periodically

    Drug dependence - reliance on or need to take a drug or substance

    Drug habituation - mild form of psychologic dependence - individual develops a habit of taking the substance and feels better after takign it
  4. Pharmacodynamics
    Onset of action
    Peak plasma level
    Half life
    • Pharmacodynamics - process by which a drug changes the body
    • Actions -
    • Onset of action - time after administration when the body initially responds to the drug
    • Peak plasma level - Highest level achieved by a single dose when the elimination rate of a drug equals the absorption rate
    • Half life - Time required for one-half of the drug to be eliminated
    • Plateau - maintained concentration of a drug in the plasma during a series of scheduled doses
    • Agonist - drug that produces the same type of response as the physiologic or endogenous substance
    • antagonist - drig that inhibits cell finction by occupying receptor sites
  5. Pharmacokinetics
    • Pharmacokinetics - study of absorption, distribution, biotransformation, and excretion of drugs (what the body does to the drug)
    • Absorption - how the drug passes into the blood
    • Distribution - transportation from site of absorption to site of action
    • Detoxification/metabolism - biotransformation - process by which drug is converted to less active form - most often in liver
    • Excretion - how drug is removed from the body - urine, feces, breath, perspiration, saliva and breast milk
  6. U.S. drug standards
    • Improves safety
    • Prescription drugs
    • Controlled Substances Act- categorizes drugs
    • & limits frequency of refill
    • FDA- labels must be accurate & drugs be
    • tested
  7. Nurse Practice Acts
    • Identify nursing responsibilities for
    • administration and patient monitoring
  8. Medication Systems
    • Stock Supply:
    • Bulk quantity
    • Central location
    • Not patient-specific
    • Cost-effective
    • Measure dose

    • Unit Dose:
    • Bulk quantity
    • Central location
    • Not patient-specific
    • Cost-effective
    • Measure dose

    • Automated Dispenser
    • Password-accessible locked cart
    • Computerized tracking
    • Stock and unit doses

    • Self-Adminsitration
    • Individual containers
    • At patient bedside
    • Check with patient for time drug taken
  9. Types of Medication Orders
    • Stat- immediately & once
    • Single- one-time order
    • Standing- Used with patients having identified condition or in certain circumstances
    • PRN- as needed
    • Automatic “stop” date -
    • •Narcs 7 days, may need to be rewritten; antibiotics 5, 7, 10, 14 days
  10. Components of a Medical Order
    • Client’s full name
    • Date and time order written
    • Name of medication
    • Dosage
    • Frequency, number of doses
    • Route of administration
    • Signature of prescriber
  11. What to do with a possible incorrect order?
    • 1. Look in drug book
    • 2. Discuss with pharmacist
    • 3. Contact prescriber
    • 4. Report to nursing supervisor
    • 5. Refuse to administer if order incorrect
  12. Nursing Process: Assessment
    • Before administration
    • Check your knowledge of the med
    • Is the ct condition appropriate for med (history and physical?
    • NPO for test or surgery?
    • Check lab values
    • Muscle mass - enough for injection?
    • Venous- make sure IV is patent

    • During administration -Patient perceptions, thought processes, coordination, swallowing, ability to
    • self-administer

    After administration - Effectiveness of drug, side effects, adverse effects, allergic reactions, toxic effects
  13. Nursing Diagnosis Related to Medicaiton
    • Knowledge deficit
    • Ineffective management of therapeutic regimen
    • Noncompliance
    • Risk for injury
  14. Three Safety Checks
    • Before you pour
    • *Check medication label against MAR

    • After you pour
    • *Verify label against MAR

    • At bedside
    • *Check medication again
  15. Right of Medication Administration
    7 + 3
    • 1. Right client
    • 2. Right drug
    • 3. Right dose
    • 4. Right time
    • 5. Right route
    • 6. Right documentation
    • 7. Right to refuse

    • Book:
    • Right education
    • Right assessment
    • Right evaluation
  16. Oral Route
    • Most commonly used route
    • Medication swallowed
    • Types:
    • Tablets, pills, capsules, liquids

    • Oral disadvantages
    • Gastric irritation
    • Poor GI absorption
    • Harmful to teeth

    • ORAL
    • •Vomiting, gastric/intestinal suctioning, unconscious/unable to swallow
  17. Sublingual & Buccal Route
    • Sublingual:
    • Under tongue
    • Dissolved into blood vessels under tongue
    • Not swallowed

    • Buccal Route:
    • Cheek
    • Dissolved by oral mucosa or into saliva where it may become swallowed
  18. Topical Route
    • Applied locally to skin, mucous membranes
    • (Nasal, eye, ear, bladder, vagina, rectal)
    • Types
    • Lotions, creams, ointments
    • Transdermal patches
    • Instillations & irrigations
    • Inhalations

    • •Rate of absorption increased if laceration, burn, nonintact skin

    • •Sustained release (nitroglycerin, estrogen, nicotine, fentanyl)

    • •Must state for opthalmic use only
    • •Infections, glaucoma, artificial tears, anesthetic

    • OTIC
    • •Infections, soften cerumen

    • NASAL
    • •Loosen secretions, infections of nose/sinuses,
    • decongestant

    • •Infection, pruritis, pain

    • •RECTAL- anti nausea
    • suppositories (phenergan)

    • Assess skin or mucous membranes for redness
    • Change applications to prevent irritation
    • Change application site (patches)
    • Don’t contaminate self with medication
    • Remove medication residue from transdermal
    • patches before placing on another
  19. Inhalation Route
    Nebulization- production of particles such as spray or mist from a liquid

    Nebulizer- apparatus to deliver a fine spray or mist of a medication

    Absorption via alveoli and blood supply

    • Atomizer- produces large drops
    • Aerosol-drops suspended in a gas
    • Large-volume- can heat or cool mist
    • Ultrasonic- 100% humidity & small particles
    • Metered-dose inhaler (MDI)- hand held
  20. Parenteral Route
    • By needle
    • Intradermal- dermis (TB screening)
    • Subcutaneous (hypodermic) subcutaneous tissue
    • (Insulin, heparin)
    • Intramuscular- muscle
    • Intravenous- vein
  21. Syringes
    • •Tip, barrel, plunger; touch only outside of barrel and end of plunger
    • •0.5-60 ml syringes
    • •TB syringe: tenths and hundredths of one ml
    • •Insulin: 100 unit scale, use with U-100 insulin
    • •10,20,50-60 ml syringes: adding meds to IV solutions, enteral meds, irrigating wounds or urinary catheters
    • •Tip: Luer-lock or non-Luer lock
    • •Most plastic, single use, disposable
  22. Needles
    •Bevel, shaft, hub

    • •Bevel: long or short;
    • longest=sharpest: IM, SQ; shortest ID, IV

    • •Shaft: 3/8-3 inches;
    • length determined by route, muscle mass, weight

    •Gauge: diameter of needle; 14-30; larger the gauge, the smaller the diameter; small gauge=decrease tissue trauma; large gauge=viscous solution
  23. Vials
    •Vial: closed system, inject air equal to amount to be withdraw; glass or plastic, single or multidose; sealed rubber cap

    •Ampule: glass, open system, don’t inject air, use filter needle to withdraw med
  24. Reconstituting Medications
    • •Diluents: sterile saline or sterile water
    • •Read powder vial label for amount of diluent to be added
    • •Roll between palms to mix solution
  25. Nursing Intervention: Site Selection
    Use correct site: wrong site could mean wrong route (bone or nerve injury)

    Be familiar with technique for med

    Invasive: tissue trauma, portal of entry

    Too large a volume for site: pain, trauma

    Wrong tissue: rate of absorption, tissue injury
  26. Intervention: Minimizing Discomfort
    • Smallest needle possible
    • Change needles
    • Split large volumes: 2 injections
    • Position: muscle relaxation (IMs)
    • Z-track for IMs
    • Skin taut, insert needle quickly, inject slowly
    • Steady syringe
    • Apply gentle pressure unless contraindicated
  27. Intervention: Safety Precautions
    • Use sharps container
    • Never recap dirty needle
    • Never bend/break needle
    • Use integrated safety device
    • Use one-handed scoop technique
    • Never put in your pocket
    • Never leave at bedside
  28. Nasogastric/Gastrostomy Tube Medication Administration
    • Check with pharmacist for a liquid form
    • Check to see if medication can be crushed
    • Crush a tablet into a fine powder and dissolve in at least 30 mL of warm water
    • Open capsules and mix the contents with water only with the pharmacists advice
    • Do not administer whole or undissolved medications

    • Assess tube placement
    • Aspirate GI content
    • Test pH of aspirated fluids (gastric >4)
    • Listen for air in stomach
    • Measure length of tube from insertion site
    • Aspirate stomach contents and measure the residual volume
    • Remove the plunger from the syringe
    • Connect syringe to a pinched or kinked tube
    • Put 15 - 30 mL (5 - 10 mL for children) of water into the syringe barrel to flush the tube
    • Pour liquid or dissolved medication into the syringe barrel and allow to flow by gravity into the enteral tube
    • Administer each medication separately and
    • flush in between with 15 to 30 mL (5 for children)
    • After administration of all medications,
    • flush again with 15 to 30 mL of water
    • If the tube is connected to suction, disconnect the suction and keep the tube clamped to enhance absorption
  29. Intervention: Avoiding Medication Errors
    • Always use the “rights”
    • Calculate dosage carefully; recheck with another RN
    • Watch for drugs with similar names
    • Watch for patients with same last name
    • Clarify illegible orders
    • Use your resources
    • Check for changes in drug orders
  30. Intervention: Medication Errors
    • Assess patient: VS, physical exam related to drug action, side effects
    • Notify instructor, RN, and nurse manager
    • Notify physician; get orders for f/u tx
    • Document med as given, but not in error
    • Complete incident (Variance) report
    • Critically review why error occurred
  31. Evaluation
    • Patient response to drug
    • Intended action
    • Side effects
    • Understanding of drug teaching