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Taylor Nursing Chapter 28: Medications
Terms in this set (59)
- identifies drug's atomic and molecular structure
- assigned by the manufacturer that first develops the drug, usually lowercase letter
- name by which the drug is identified in official publications United States Pharmacopeia (USP) and National Formulary (NF)
- brand name copyrighted by the company that sells the drug
- is protected by trademark.
- Upper case letter
Classified by effect on body systems, chem compositions, or by the clinical indication for the drug or therapeutic action.
- Capsule, pill, tablet, extended release, elixir, suspension, syrup
- Liniment, lotion, ointment, suppository, transdermal patch
Common Type of Drug Preparations (Table 28-1)
Capsule / liquigel
powder or gel form of an active enclosed in a
medication in a
containing water, alcohol, sweeteners, and flavor
a tablet or pill coated to
prevent stomach irritation
preparation of a medication that allows for slow and continuous release over a predetermined period; may also be referred to as
CR or CRT
(sustained or slow release),
Never chew or crush!
mixed with alcohol, oil , or soap
, which is rubbed in the skin
drug particles in a solution of
Small oval, round, or oblong preparation containing a drug in a flavored or sweetened base, which
dissolves in the mouth
releases the medication
Ointment / unction
preparation containing a drug to be applied externally
mixture of a powdered drug with a cohesive material, may be round or oval
single or mixture of finely ground drugs
in another substance (e.g. in an aqueous solution)
an easily melted medication preparation in a firm base such a gelatin that is
inserted into the body
undissolved particles in a liquid
, medium, should be shaken before use
medication combined in a
water and sugar
small, solid dose of medication, compressed of molded, may be any color, size, or shape;
tablets are coated with a substance that is
insoluble in gastric acids to reduce gastric irritation
be the drug
unit dose of medication applied directly to skin for
diffusion through skin
and absorption into the bloodstream
achievement of the desired
therapeutic goal from drug therapy.
effect of the body
on the drug, once the drug enters the body; in relation to:
The process by which a drug is transferred from its site of entry into the body to the bloodstream; in relation to:
- Route of administration
- Lipid solubility
- Blood flow
- Local conditions at the site of administration
- Drug dosage
Occurs after a drug has been absorbed into the bloodstream and the drug is distributed throughout the body, becoming available to body fluids and body tissues.
Biotransformation, is the change of a drug from its original form to a new form.
The process of removing a drug, or its metabolites from the body.
The process by which drugs
alter cell physiology
and affect the body.
turn on, turn off, promote, or block responses
that are part of the body's processes.
Drug-receptor interaction occurs when the drug interacts with one or more cellular structures to alter cell function.
Drugs may also combine with other molecules in the body to achieve their effect.
Other drugs act on the cell membrane or alter the cellular environment to achieve their effect.
Adverse Drug Effects
Undesirable effects other than the intended therapeutic effect of a drug.
- An immune system response that occurs when the body interprets the administered drug as a foreign substance and forms antibodies against the drug.
- most serious allergic effect. Severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse.
Occurs when the body becomes accustomed to the effects of a particular drug over a period of time.
- Specific groups of symptoms related to drug therapy that carry risk for permanent damage or death.
- condition that occurs when the body cannot metabolize a drub before additional doses are administered.
Any unusual or peculiar response to a drug that may manifest itself by over response, under response, or even the opposite of the expected response.
- Combined effect of two or more drugs that produces
than the effect of each drug alone.
- Combined effect of two or more drugs is
than the effect of each drug alone.
Factors Affecting Drug Action
- Developmental considerations
- Genetic and cultural factors
- Psychological factors
- Timing of administration
Drugs known to have the potential to cause
developmental defects in the embryo or fetus
and are definitely contraindicated.
The study of the effect of ethnicity on responses to prescribed medication, escpiecally drug absorption, metabolism, distribution, and excretion.
Pharmacologically inactive substance.
Drug Dose and Serum Drug Levels
: concentration of drug in the blood serum that produces the desired effect without causing toxicity
: highest plasma concentration
: the point when the drug is at its lowest concentration, indicating the rate of elimination
: amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body
Standing Order (Routine Order)
- Carried out as specified until it is canceled by another order.
- As Needed
- Carried out only once, at a time specified by the prescriber.
- Single Order, to be carried out
Questioning the Medication Order
Nurses have the right to refuse to administer any medication that, based on their knowledge and experience, may be harmful to the patient.
Parts of Medication Order
1. Patient's name
2. Date and Time the order is written
3. Name of drug to be administered
4. Dosage of the drug
5. Route by which the drug is to be administered
6. Frequency of administration of the drug
7. Signature of person writing the order.
- Body surface area
Pediatric doses are calculated according to the child's weight or BSA.
The BSA formula provides the most accuracy in calculating pediatric dosages because it considers both weight and height.
Routes for Administering Drugs (Tab 28-2)
O̲R̲A̲L̲ ̲R̲O̲U̲T̲E̲ - having patient swallowing drug
through an enteral tube
between the cheek and gum
P̲A̲R̲E̲N̲T̲E̲R̲A̲L̲ ̲R̲O̲U̲T̲E̲ - outside the intestines or alimentary canal; injecting drug into:
corium (under epidermis)
T̲O̲P̲I̲C̲A̲L̲ ̲R̲O̲U̲T̲E̲ - applying drug onto skin or mucous membrane
applying drug to vagina
applying drug to rectum
rubbing drug into skin
placing drug into direct contact with mucous membrane
flushing mucous membrane with drug in solution
P̲U̲L̲M̲O̲N̲A̲R̲Y̲ ̲R̲O̲U̲T̲E̲ - having a patient inhale drug
Drug schedules abbreviation
- bis in die - 2x/d
- ter in die - 3x/d
- quater in die - 4x/d
ante cibum - before a meal or
ante cibos - before meals.
post cibum - after meals
hora somni - before sleep, at bedtime
every four hours
3 Checks of Medication Administration
Read the label:
1. When the nurse reaches for the container or unit dose package
2. After retrieval from the drawer and compared with the CMAR, or compared with the CMAR immediately before pouring from a multidose container
3. Before giving the unit dose medication to the patient or when replacing the multi-dose container in the drawer or shelf
1. MAR matched to drug label when removing drug from automated dispensing system
2. MAR matched to drug label
3. MAR matched to drug label and patient ID
11 Rights of Medication Administration
*Right ASSESSMENT DATE
*Right EDUCATION of the patient
*Patient's RIGHT TO REFUSE
Parts of a Needle and Syringe
Needle part that fits on the syringe tip
Length of the needle inserted into body tissue; the needle's outer portion
Sharp end of needle shaft
Slant of needle point of the needle
Inside diameter of the needle
The smaller that gauge of the needle, the larger the lumen or inside diameter of the needle. Gauges may vary from 13 G to 27 G
part of syringe that hold medication
covers the needle
pushes medication through syringe
designed for index an middle finger to hold while thumb plunger is pushed
devaice to prevent accidental injury; activated immediately after injection
the needle twists or screws onto the syringe as opposed to sliding on.
and Sizes* of Needles
to draw up medications (a.k.a. a "blunt" needle)
25, 26, and 28 gauge
5/8-7/8 inches long
22 or 23 gauge
1-3 inches long
IM injections to children or emaciated patients
25, 26, and 28 gauge
26 gauge or other fine needle
3/8-5/8 inches long
Use a needle with a small lumen
Oily or thick solutions
Use a needle with a large lumen
Use a 1 to 1.5 inch needle
Use a 1.5 to 2 inch needle
Pediatric and thin Patients
Use a 0.5 to 1 inch needle
- inserted just below the epidermis
- most common site is 1) the inner aspect of forearm, 2) back, and 3) upper chest
has the longest absorption time of all parenteral routes
- used for diagnostic purposes / sensitivity test (TB, allergy, local anesthesia)
small volumes, usually 0.01 to 0.05 mL, are injected because of the small tissue space
- A wheal or blister indicates that the medication has been injected into the dermis.
- If the wheal or blister does not appear, the medication has most likely been given into the subcutaneous tissue and must be
into another site.
- The primary care provider needs to be notified that the skin test needs to be administered again so that an order can be obtained.
- administered into the adipose tissue layer below epidermis and dermis.
- tissue here has few blood vessels
- drugs have slow sustained rate of absorption into the capillaries
i.e. Drugs- Insulin, Heparin
no more than 1 ml is given SQ
sites: upper arm, abdomen, anterior thigh, upper back, upper ventral or dorsogluteal area
-abdomen is absorbed most rapid
-arms absorbed slowly
-thighs, ventral gluteal are the slowest
- pinching is advised for thinner pts.
- once needle is inserted release the skin to avoid injecting into tissue
- delivered into certain muscles, muscles have larger /greater number of blood vessels allowing
faster onset of action
than SQ injections
designed for slow, sustained release over hours, days or weeks
i.e antibiotics, hormones, vaccines (Pneumococcal/Hepatitis)
- IM injection is 1-4 ml range, no more than 1 ml at Deltoid site
- consider age of pt, medication type, med volume when selecting site for IM injection
i.e Ventrogluteal site, vastus lateralis (desired for infants), deltoid muscle (vaccines ages 1-18)
With injection of the deltoid site, there can occur damage to the radial nerve and artery
To check whether the needle is in the client's blood vessel, perform aspirating for a blood return.
-skin or mucous membranes including eyes, ears, nose, rectum, vagina, and lungs
-rubbing the medication in is called "inunction"
-these drugs are
absorbed into the lining of the sebaceous gland
-cleaning skin with soap and water OR/AND applying heat will increase absorption
- usually intended for direct action at a particular site, although some can have systemic effects and are given for systemic effect.
Transdermal route for topical medications
- involves applying a disk or patch that contains medication intended for daily use or longer intervals
hormones, narcotic analgesics, cardiac medications, and nicotine
- transdermal patches that contain estrogen
be applied to the breast tissue (assoc. with Breast Cancer)
-slow onset of drug action
-delivers drug directly into the bloodstream,
- most dangerous route of administration, cannot be recalled or actions slowed.
-effect of medication is immediate
-used in emergency situations
-aseptic technique when administering IV route to prevent introduction of organisms
Preparing to administer medication via
- locate port nearest to the IV insertion site,
- swab port with an alcohol swab,
- piece port with the needless adaptor,
- administer medication over the specified time,
- pinch IV tubing above the access port,
- pull back plunger to observe for blood return.
- relatively large amount of medication given all at once;
- bolus administration sometimes is described as a drug given by IV push, or rapid intravenous administration
- peripheral inserted central catheter
- nontunneled percutaneous catheter that is inserted into a peripheral vein with the distal end terminating in the axillary vein, subclavian vein, or superior vena cava.
- appropriate for clients who are to receive
short term fluid or medication therapy
- flushed with normal saline and/or heparin in order to maintain patency by preventing clot formation in the line.
- Sterile technique should be used for dressing changes for at least 24 hours after insertion and 3 to 7 days thereafter.
- The external part of the catheter should be kept under the dressing to prevent the introduction of microorganisms, leading to infection.
- Catheter caps should be changed every 3 to 7 days
Central Vs. Peripheral IV RISKS
Clot formation, pneumothorax, and bacteremia risks are higher with a central line. As a result, the risks associated with central line placement are higher than those associated with a peripheral IV.
Glass container - single dose of a drug
Clear glass, prescored/constricted neck
1ml to 10ml or more
Ampule must be carefully broken at the neck
FILTER NEEDLE REQUIRED
Do not touch rim of ampule when using needle to remove medication
Small glass bottle with a self-sealing rubber cap
Single dose to multiple dose
Metal or plastic cap protects
the rubber seal
Rubber cap must be wiped with
alcohol before use
Cap is pierced with a needle
AIR MUST BE INJECTED TO DISPLACE DRUG REMOVED DUE TO CLOSED SYSTEM
EXPIRES IN 24 HOURS IF OPENED
process of adding liquid, known as diluent, to a powered substance.
- skin is pulled about 1 inch away from an
injection site while medication is being administered and then replaced after the needle is removed.
- ensures that the medication doesn't leak back along the needle track and into subcutaneous tissue.
- minimize irritation by sealing medication in muscle tissue; staggering the needle pathway.
- using a 1 ½ to 2 in. long needle
Advanced Injection Techniques
any injection into:
usually performed by a physician or advanced practitioner
provides a single dose of medication
-most are overfilled, inject excess medication to give an exact dose
i.e. Tubex and Carpuject
come with excess air, air should not be expelled or injected with air
i.e. Enoxaparin (Lovenox)
in 1 syringe
1. ensure that two drugs are compatible
* i.e. diazepam (Valium) is incompatible with other drugs.
Incompatible drugs may become
cloudy or form precipitate
* Mixing more than 2 drugs is not recommended
2. Inject air into both vials and draw medication in multi dose vial first then single-dose vial
3. If preparing from ampule, prepare medication in vial 1st then draw up medication in the ampule
-Hormone produced by the pancreas, enables cells to use carbohydrates.
-Diabetes mellitus includes no insulin production or insufficient production.
-rapid acting, short, intermediate, and long acting
-may receive more than one type of insulin
-Calculated in units (U100) "100 U/ 1 ml"
Lantus and Levemir cannot be mixed with other insulins!
- insulin with meal
- insulin before meal
- should be given an inch away from the previous injection
- site of administration must be recorded in pt's record
NEVER give other drugs with insulin syringe
- prefilled devices that combine insulin container and syringe.
- pt's attach a needle for each administration, dial a dose of insulin, and depress a plunger to administer dose.
Continuous subcutaneous insulin infusion (CSII or insulin pump)
- allows for multiple preset rates of insulin delivery.
- uses small computerized reservoir that delivers insulin via tubing through small plastic cannula or needle inserted into SQ tissue
- sites are changes every 2-3 days
administered SQ, common site is the abdomen
-avoid the area 2 inches around the umbilicus and belt line.
Hematoma formation (purple/black bruising) happens when giving Heparin due to aspirating (pulling back & checking for blood) before administering medication
aspirating is not recommended
Reconstituting powdered medications
Liquid or diluent must be added to the powder before its administered as solution.
-Act-O-Vial: have diluent and powder but are separated by rubber stopper
Eye installations /irrigations
Direct applications to the eyeball cannot be done as it could damage the cornea. Instead placed into the lower conjunctival sac (should be sterile)
Performed to remove secretions or foreign bodies or to cleanse and soothe the eye.
-can be used to remove chemicals from eye, tap water can be used to remove acid
-irrigation should continue for at least 15 mins then seek professional help
the ear contains receptors for hearing and equilibrium
-drugs are instilled into the auditory canal for local effect
used to soften wax, relieve pain, local anesthesia, destroy organisms, and insects lodged in canal
-Solutions should be at room temp.
- nurse first manipulates the client's ear to straighten the auditory canal.
- Tilting the client's head away, the nurse then administers the prescribed number of drops of medication.
- The client remains in this position briefly as the solution travels toward the eardrum.
- The nurse then places a cotton ball loosely in the ear to absorb the excess medication.
- The nurse then waits for at least 15 minutes before administering the medication in the opposite ear if prescribed.
used to treat allergies, sinus infections, and nasal congestion
-pt should blow their nose before instilling drops.
-have pt sit up with head tilted well back and maintain this position for a few minutes after administering
normal secretions in the vagina are acidic and further serve to protect the vagina from microbial invasion
-ask pt to void before inserting the medication with applicator or vag. suppository.
-usually for vaginitis or yeast infections
- suppositories are used primarily for their local action as laxatives, or fecal softeners.
- Acetaminophen suppositories are used as a antipyretic effect (fever reducer)
- used for antiemetics (relieves nausea and vomiting
- do not administer to pts who had rectal or prostate surgery, cardiac arrhythmias
- assess lab values WBS, Plt because pts who are thrombocytopenia or neutropenic should not receive.
- should remain in same position for 5 mins
Dry powder inhalers "DPI"
are breath activated, a quick breath from the pt activates the flow of medication
-used best for pts requiring inhalation of drug several times a day when the hand atomizer os fatigued.
-Infants and toddlers can also benefit
- propeller-driven device that spins and suspends a finely powdered medication.
- has a canister that contains medication under pressure
- aerosolized drug is released when the container is compressed
- maximize the absorption of the drug in a client who is having problems coordinating his breathing with the inhaler use.
- provides a reservoir for the aerosol medication. As the client takes additional breaths, he continues to inhale the medication held in the reservoir. This tends to maximize the drug's absorption because it prevents drug loss.
Drugs omitted (rejected) reasons
1. pts have diagnostic testing and need to fast
2. there no longer is a need for the drug, solution is met i.e pt had a BM and no longer needs the laxative
3. pt is suspected of having a allergy to the medication
Computerized automated dispensing system
"Pixis" fingerprint used, touch screen of medications that pt needs, and machine will dispense them
medication supply systems with large quantities of medication kept on the nursing unit making them immediately available to the nurse
If medication error occurs
1. check pt's condition immediately, observe for adverse effects
2. notify nurse manager and primary care provider
3. Write description of error and remedial steps taken on medical record
4. Complete form used for reporting errors, as dictated by the facility
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