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Chapter 3 - Principles of Drug Administration
Terms in this set (59)
What nurse responsibilities are required in terms of drugs?
what drug is ordered, name (generic and trade) and drug classifcation, intended purpose or use, effects on body, contraindication, special considerations (ex. how age affects response), side effects, why the medication was prescribed, how med is supplied by pharmacy, how med is administered including dosages ranges, all variables of the patients condition, be prepared to recognize and react to adverse effects
What is an allergic reaction?
an acquired hyperresponse of body defenses to a foreign substance
If an allergic reaction is discovered, what is the nurse's responsiblities?
labelling charts, informing all personnel, and placing alert bracelet on patient
What is anaphylaxis?
a severe allergic reaction involving the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock
What are the Five Rights of Drug Administration and what are they used for?
Used as the basis of safe delivery of medications; include right patient, right medication, right dose, right route of administration, right time of delivery
What are the Three Checks of Drug Administration?
Checking drug with MAR or medication information system when removing it from storage; checking drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing bag; checking drug before administering it to the patient
What are the Four Most Common Medication Errors?
errors in patient assessment (aka inadequate med history); errors in prescribing (ex. wrong drug, incorrect dose); administration errors (ex. route or time of administration); distracting environmental factors (ex. interruptions during preparation)
What are the factors that cause a patient to deviate from compliance?
cost of drug, forgetting doses, annoying side effects, self-adjustment doses, fear of dependency
STAT stands for
medication is to be given immediately, and only once
drug should be available for administration within 30 minutes of the written order
drug is administered as required by the patients condition
Which abbreviations can lead to medication errors?
q, qh, qd, qhs, qod
In terms of written orders for drug administration, what is a single order?
drug is to be given only once at a specific time
In terms of written orders for drug administration, what is a routine order?
orders not written as STAT, ASAP, NOW, or PRN
In terms of written orders for drug administration, what is a standing order?
written in advance of a situation that is to carried out under specific circumstances
What is drug compliance?
taking a medication in the manner prescribed by the health care provider
What are the drug administration procedures?
drug orders must be reviewed; drugs may need administration during or between meals; CNS and antihypertensives often best administered at bedtime; nurses must educate patients about timing of taking meds; nurses must document details of meds given to patient after they have been given
What are the three systems of measurement used in pharmacology?
metric, apothecary, household
What are the three broad routes of drug administration?
enteral, topical, and parenteral
What is the enteral route of drug administration?
Via mouth so tablets, capsules, sublingual, and buccal; via nasogastric tube or gastrostomy tube
What are the common drugs taken through the enteral route?
tablets and capsules, enteric-coated tablets; sustained-release tablets or capsules
What is sublingual drug administration?
Medication is placed under the tongue and allowed to dissolve slowly; Rich blood supply causes rapid onset; Used only after oral medications have been swallowed, if multiple drugs are ordered; No food or drink until completely dissolved
What is buccal drug administration?
Tablet or capsule placed in oral cavity
between the gum and the cheek; Preferred for sustained delivery; Generally does not cause irritation; Like sublingual drugs, buccal drugs are formulated to bypass first-pass metabolism
What are Orally distintegrating tablets (ODTs) or oral dissolving films?
Medication that is placed on the tongue; Dissolves in less than 30 seconds; Eliminates need for external source of water and aids compliance
What is nasogastric drug administration?
a soft, flexible tube inserted by way of the nasopharynx with the tip lying in the stomach; Generally for short-term treatment; method generally uses liquid drugs
What is gastronomy drug administration?
surgically placed directly into the patient's stomach; Longer-term treatment; method generally uses liquid drugs
Advantages of enteral drug administration?
Convenient; Overdose can be countered by retrieval of undigested medicines through vomiting; Safest route because skin barrier not compromised; Uses vast absorptive surfaces of the oral mucosa, stomach, or small intestine
Disadvantages of enteral drug administration?
Difficulty swallowing by some patients; May be inactivated if tablets or capsules crushed or opened; Can be inactivated by enzymes; Depends on patient gastrointestinal
motility and mobility; First-pass metabolism: inactivation of drug by processing in the liver
Applications of topical drugs applied to the skin or mucous membranes?
Dermatologic Preparations (applied to skin); Instillations and Irrigations (applied into body cavities and orifices); Inhalations (applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing)
What is the purpose of topical drugs?
Many intended for local effect—for example antibiotics to treat a skin infection; Fewer side effects because generally absorbed very slowly; Some given for slow absorption into general circulation, designed for their systemic effects
What is transdermal delivery of drugs and what route of administration are they a part of?
medication patch; topical
What are the advantages of transdermal delivery?
provide effective means of delivering some medications; Rate of delivery and dose may vary with drug; Avoids first-pass effect of liver and enzymes
What is ophthalmic administration and what are common indications of problems?
used to treat local conditions of the eye and surrounding structures; Common indications is excessive dryness, infections, glaucoma, and dilation of the pupil during eye examinations; ex. eye ointment
What is otic administration?
Used to treat local conditions of the ear, including infections and soft blockages of the auditory canal; Eardrops, irrigations; Usually used for cleaning purposes
What is nasal administration?
For both local and systemic
administration; Ease of use, avoids first-pass effect and digestive enzymes; Mucosal irritation common; potential for damage; Often used for local astringent effect
What is a local astringent effect?
shrink swollen mucous membranes or loosen secretions and facilitate drainage; effect made by nasal administrated drugs
What is vaginal administration?
Suppositories, creams, jellies, or foams; For treating local infections and to relieve vaginal pain and itching
What is rectal administration?
Usually suppository form, but sometimes administered as enema; Local or systemic administration; First-pass effect and digestive enzymes avoided
What types of parenteral administration is used for drugs?
intradermal, subcutaneous, intramuscular, intravenous
What does intradermal mean?
dermis layer of skin
What does subcutaneous mean?
deepest layers of the skin
What does intramuscular mean?
What does intravenous mean?
directly into the bloodstream
What is the advantage of intradermal and subcutaneous administrations? What must be monitored?
Avoid the hepatic first-pass effect and digestive enzymes; offer method for those who cannot take medicine orally; Only small volumes can be administered; injections can cause pain and swelling
What route of administration allows the drug to be better absorbed? Intradermal or subcutaneous?
intradermal bc administered into the dermis layer of the skin
What degree should the needle be entering the skin at for intradermal administrations?
What is the specific advantage of subcutaneous administrations?
used for easy access and rapid absorption
What degree should the needle be entering the skin at for a subcutaneous administration?
What has the most rapid onset of action in terms of drug administration? Put them in order: Intramuscular, subcutaneous, intravenous or intradermal?
intravenous, intramuscular, intradermis, subcutaneous
What must be avoided during intramuscular administrations of drugs?
bone, blood vessels and nerves
What degree should the needle be entering the skin at for an intramuscular administration?
What are four common intramuscular injection sites?
ventrogluteal, deltoid, dorsogluteal, vastus lateralis
What is intravenous (IV) administration?
Medications and fluids are administered directly into the bloodstream and are immediately available for use by the body; Fastest drug onset action, but also most dangerous method
What are three types of intravenous administration?
large volume infusion; intermittent infusion; IV bolus (push) administration
What is large volume IV infusion?
for fluid maintenance, replacement, or supplementation; ex. if dehydrated give saline solution
What is IV intermittent infusion?
small amount of IV solution arranged tandem with or piggybacked to primary large- volume infusion; used to instill adjunct medications; ex. antibiotics
What is IV bolus (push) administration?
concentrated dose delivered directly to circulation via syringe to administer single-dose medications; ex. pain medications
Advantages of parenteral drug administration?
Bypasses first-pass effect and enzymes; Available to patients unable to take medication orally
Disadvantages of parenteral drug administration?
Only small doses can be used; Possible pain and swelling at injection site
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