Kozier Ch 35 Medications

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

• 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

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

• 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

• 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

• Improves safety
• Prescription drugs
• Controlled Substances Act- categorizes drugs
• & limits frequency of refill
• FDA- labels must be accurate & drugs be
• tested

• Identify nursing responsibilities for
• administration and patient monitoring

• 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

• 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

• Client’s full name
• Date and time order written
• Name of medication
• Dosage
• Frequency, number of doses
• Route of administration
• Signature of prescriber

• 1. Look in drug book
• 2. Discuss with pharmacist
• 3. Contact prescriber
• 4. Report to nursing supervisor
• 5. Refuse to administer if order incorrect

• 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

• Knowledge deficit
• Ineffective management of therapeutic regimen
• Noncompliance
• Risk for injury

• Before you pour
• *Check medication label against MAR

• After you pour
• *Verify label against MAR

• At bedside
• *Check medication again

• 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

• Most commonly used route
• Medication swallowed
• Types:
• Tablets, pills, capsules, liquids

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

• ORAL
• CONTRAINDICATIONS
• •Vomiting, gastric/intestinal suctioning, unconscious/unable to swallow

• 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

• Applied locally to skin, mucous membranes
• (Nasal, eye, ear, bladder, vagina, rectal)
• Types
• Lotions, creams, ointments
• Transdermal patches
• Instillations & irrigations
• Inhalations

• MOST NOT ABSORBED WELL, COMPLETELY, OR PREDICTABLY DUE TO SKIN ACTING AS BARRIER TO DRUG DIFFUSION
• •Rate of absorption increased if laceration, burn, nonintact skin

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

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

• OTIC
• •Infections, soften cerumen

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

• VAGINAL
• •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

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

• By needle
• Intradermal- dermis (TB screening)
• Subcutaneous (hypodermic) subcutaneous tissue
• (Insulin, heparin)
• Intramuscular- muscle
• Intravenous- vein

• •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

•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

•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

• •Diluents: sterile saline or sterile water
• •Read powder vial label for amount of diluent to be added
• •Roll between palms to mix solution

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

• 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

• 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

• 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

• 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

• 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

• Patient response to drug
• Intended action
• Side effects
• Understanding of drug teaching