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Medication or Drug is a chemical substance intended for use in
the diagnosis, treatment, cure, mitigation, or prevention of a
disease. When a drug is given to a client, there is an intended
specific effect. An assumption made by nurses before administration
of any medication is that the drug will be safe for the client to
consume if the dose, frequency, and route are within the
therapeutic range for that drug.
Slide 3
The written direction for the preparation and administration of
a drug. Prescription:
Slide 4
Medication Names Official name: name under which drug is listed
in official government publications of drug standards( US
Pharmacopeia). Chemical name: name that describes the chemical
composition of the drug. Generic name: shortened name given to the
drug by the developer; generic names are not capitalized before
become official.
Slide 5
Brand name, trade name, or proprietary name: name given to and
registered by the manufacturer The brand name is always capitalized
and may have a trademark symbol ( or ) A drug has only one generic
name but may have many trade names, depending on how many companies
manufacture it
Slide 6
Drug Action A drugs ability to combine with a cellular drug
receptor. Depending on the location of the cellular receptor, the
drug can have a local effect, a systemic effect, or both.
Slide 7
Medication Management Its purpose is to produce the desired
drug action by maintaining a constant drug level. Drug action is
based on the drugs half-life (the time it takes the body to
eliminate half of the blood concentration level of the original
drug dose).
Slide 8
Terms Relating to Drug Action Onset of action (the time it
takes for the body to respond to a drug after administration). Peak
plasma level (the highest blood concentration of a single drug dose
before the elimination rate equals the rate of absorption). Plateau
(maintenance of a certain level).
Slide 9
The 4 Properties of Drug Action Absorption (passage of a drug
from the site of administration into the bloodstream). Distribution
(the movement of drugs from the blood into body fluids and
tissues). Metabolism (the physical and chemical processing of a
drug by the body). Excretion (the elimination of drugs from the
body.
Slide 10
Dissolution: is the rate at which a drug becomes a solution.
After ingestion, a pill, capsule, or caplet must disintegrate
before it can be dissolved and then absorbed by the body for
therapeutic use. The more rapid the rate of dissolution, the more
quickly the drug can be absorbed. Drug Interaction The effect one
drug can have on another drug.
Slide 11
Side Effects and Adverse Reactions Drug Allergy. Drug
Tolerance. Toxic Effect. Idiosyncratic Reaction.
Medication Orders All medication orders should contain: Clients
name Date & Time Name of Drug to be administered Doasage Route
of administration Time & frequency signature of person
ordering
Slide 14
Ahmad Ali -------------12\3\2009----7pm (1) (2) (1) (2) Demerol
100 mg IM q 4 hrs (3) (4) (5) (6) (3) (4) (5) (6) Dr. Saeed
Mohammed Ahmad Ali -------------12\3\2009----7pm (1) (2) (1) (2)
Demerol 100 mg IM q 4 hrs (3) (4) (5) (6) (3) (4) (5) (6) Dr. Saeed
Mohammed Example: Example:
Slide 15
Types of Orders Stat (those that should be administered
immediately). Single-Dose (one-time medications). Scheduled
(administered routinely until order is canceled by another order).
PRN (on as-needed basis).
Slide 16
Standing Example: Synthroid 0.1mg po qd Standing PRN Example:
Tylenol i or ii po q 4 hr for H/A Short-series order Example:
Prednisone 5 mg po tid x 3 days, then 5 mg bid x 2 days then 5 mg
qd x 5 days Standing Example: Synthroid 0.1mg po qd Standing PRN
Example: Tylenol i or ii po q 4 hr for H/A Short-series order
Example: Prednisone 5 mg po tid x 3 days, then 5 mg bid x 2 days
then 5 mg qd x 5 days Examples of Medication Orders
Slide 17
One time Example: Demerol 50 mg IM @ 0800 in am Stat Example:
Valium 5 mg IV now One time Example: Demerol 50 mg IM @ 0800 in am
Stat Example: Valium 5 mg IV now Categories of Medication
Orders,
Slide 18
Five Rights of Safe Drug Administration Right drug. Right dose.
Right client. Right route. Right time.
Slide 19
REALLYTHERE ARE 2 MORE! RIGHT TO KNOW must explain each drug to
patient RIGHT TO REFUSE cannot make patient take meds
Slide 20
Three Systems of Weight and Measure Metric (simple system based
on units of 10). Apothecary (based on the weight of one grain of
wheat). Household (drops, teaspoons, tablespoons, etc.).
Slide 21
Weight gram (g) Volume liter (L) Length meter (M) Smaller and
larger units in the metric system can be indicated by attaching
prefixes to the basic units Kilo- is used to enlarge the basic unit
1000 times Weight gram (g) Volume liter (L) Length meter (M)
Smaller and larger units in the metric system can be indicated by
attaching prefixes to the basic units Kilo- is used to enlarge the
basic unit 1000 times Metric System
Slide 22
centi (cm) is used to diminish the basic unit by 100 milli
(mm), (mL), and (mg) diminishes the basic unit by 1000 The symbol
micro (micrometer or 0.001 millimeter) The terms milliliter (ML)
and cubic centimeter (CC) are used interchangeably centi (cm) is
used to diminish the basic unit by 100 milli (mm), (mL), and (mg)
diminishes the basic unit by 1000 The symbol micro (micrometer or
0.001 millimeter) The terms milliliter (ML) and cubic centimeter
(CC) are used interchangeably Metric System, continued
Slide 23
The metric system uses the Arabic numerals that we all know,
e.g., 1, 2, 3 Abbreviations are placed after the number, as in 50
mg or 500 mL Quantities less than 1 and fractions are written in
decimal form as in 0.25 mg, 1.25 mg, and 1.5 g The metric system
uses the Arabic numerals that we all know, e.g., 1, 2, 3
Abbreviations are placed after the number, as in 50 mg or 500 mL
Quantities less than 1 and fractions are written in decimal form as
in 0.25 mg, 1.25 mg, and 1.5 g Metric System, continued
Slide 24
Basic Dimensional Analysis Review The doctor ordered Rocephin
750 mg IM x 1 dose. You have available a 5 mL vial labeled Rocephin
1 gram/2.5 mL How many mL will you administer? _________ We are
looking for (calculating) mL The order is 750 mg Available
concentration is 1 gram/2.5 mL (Conversion) 1 gram = 1000 mg (the
question doesnt tell us this; we have to know it) The 5 mL tells us
the size of vial (Extra info)
Slide 25
Basic Dimensional Analysis Review The doctor ordered Rocephin
750 mg IM x 1 dose. You have available a 5 mL vial labeled Rocephin
1 gram/2.5 mL How many mL will you administer? _________ 2.5 mL 1
gram 750 mg mL = ---------- X ------------ X ----------- = 1 gram
1000 mg
Slide 26
Basic Dimensional Analysis Review 1 st, reduce commons 2.5 mL 1
gram 750 mg mL = ---------- X ------------ X ----------- = 1 gram
1000 mg 3 4
Slide 27
Basic Dimensional Analysis Review 2 nd, do the math (follow
UAMS rounding rules) 2.5 mL 1 gram 750 mg 7.5 mL = ---------- X
------------ X ----------- = ------ = 1.875 = 1.9 1 gram 1000 mg 4
3 4 So, you would administer 1.9 mL
Slide 28
mL/hr Calculation IVF: 1000 mL D5 NS at 24 hour rate 1 st, what
are we looking for? We do have an infusion pump, so it is mL/hr.
Infusion pumps always run in mL/hr!! mL 1000 mL ------ =
------------ = 41.66666 = 42 mL/hr hr 24 hr Total Volume Ordered
Time to infuse total volume over Remember to use UAMS rounding
rules mL/hr round to whole number
Slide 29
mL/hr Calculation Now, what happens if the doctor orders an
amount of fluid to run over minutes rather than 1 hour? Remember,
the pumps are calibrated for mL/hr so you will need to plug the
conversion for hours/minutes into your formula 60 min = 1 hour
Slide 30
mL/hr Calculation The doctor orders 100 mL IVPB to infuse over
30 minutes. How many mL/hr do you set the pump? mL 100 mL 60 min
------ = ---------- X --------- = hr 30 min 1 hr Total Volume to
Infuse Time to infuse total volume over Conversion factor
Slide 31
mL/hr Calculation The doctor orders 100 mL IVPB to infuse over
30 minutes. How many mL/hr do you set the pump? mL 100 mL 60 min
200 ------ = ---------- X --------- = ----- = 200 mL/hr hr 30 min 1
hr 1 2 1
Slide 32
gtt/min Calculation You will use this formula when you dont
have a pump to infuse the ordered IV fluids!! You will have to
locate the drop factor (found on the IV tubing package) Drop factor
= how many drops does it take to equal 1 mL
Slide 33
gtt/min Calculation Standard macrodrip calibration 10, 15, or
20 gtt/mL Used for most adult IV sets Microdrip calibration set 60
gtt/mL Used in pediatrics or critical medication drips Remember,
the drop factor tells you how many drops needed to equal 1 mL
Slide 34
gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse
over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per
minute will be given? We calculate drops/minute because we dont
have a pump and it doesnt make sense for the nurse to stand at the
bedside and count drops for one hour; the nurse counts drops for 1
minute and then a second minute to verify that the correct drops
are infusing to deliver the ordered amount over 1 hour
Slide 35
gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse
over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per
minute will be given? gtt 10 gtt1000 mL 1 hr ----- = -------- X
------------ X ---------- = min 1 mL 12 hr 60 min What were looking
for 10 gtt/mL is the tubing that we have on hand Doctors Order
Conversion Factor Remember, this is not in the question, we have to
know it
Slide 36
gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse
over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per
minute will be given? gtt 10 gtt 1000 mL 1 hr 500 ----- = --------
X ------------ X ---------- = ------- = 13.888 = 14 min 1 mL 12
hr60 min 36 5 6 100 6 Use UAMS rounding rules; round gtt/min to
nearest whole number
Slide 37
gtt/min Calculation The doctor orders furosemide (Lasix) 20 mg
in 50 mL of NS. Infusion time is 30 minutes. Drop factor is 60
gtt/mL. How many gtt/min will you give? gtt 60 gtt 50 mL ----- =
-------- X --------- = min 1 mL30 min What were looking for 60
gtt/mL is the tubing that we have on hand Doctors Order Note that
the 20 mg dose doesnt matter and we dont need the hour/minute
conversion factor
Slide 38
gtt/min Calculation The doctor orders furosemide (Lasix) 20 mg
in 50 mL of NS. Infusion time is 30 minutes. Drop factor is 60
gtt/mL. How many gtt/min will you give? gtt 60 gtt 50 mL 100 -----
= -------- X --------- = ----- = 100 gtt/min min 1 mL30 min 1 2
1
Slide 39
gtt/min Calculation 250 mL D5W is to infuse at 10 mL/hr. The IV
drop factor is 60 drops per mL. How many drops per minute will this
IV run? gtt 60 gtt 10 mL 1 hr 10 ----- = -------- X -------- X
--------- = ---- = 10 gtt/min min 1 mL 1 hr 60 min 1 1 1
Slide 40
mL/hr Calculation The doctor ordered 1000 mL D5NS to infuse
over 8 hours. The drop factor is 15 drops per mL. How many mL/hr
will the IV run? mL 1000 mL ---- = ------------ = 125 mL/hr hr 8 hr
Note that we did not need the drop factor or hour/minute conversion
This is what the question ask us to calculate This is what the
doctor ordered
Slide 41
Unit Calculation The doctor ordered Heparin 4000 units SQ.
Available is Heparin 5000 units per mL. How many mL will the nurse
administer? Use basic calculations to do this problem; Heparin is
ordered in units but is available in mL, so we will calculate mL 1
mL 4000 units mL = -------------- X ------------- = 5000 units
Note: you must spell out the word unit, it is no longer acceptable
to use the abbreviation u
Slide 42
Unit Calculation The doctor ordered Heparin 4000 units SQ.
Available is Heparin 5000 units per mL. How many mL will the nurse
administer? 1 mL 4000 units 4 mL = -------------- X ------------- =
----- = 0.8 mL 5000 units 5 What type of syringe will you use to
administer the Heparin? 4 5
Slide 43
UnitsHeparin The doctor ordered Heparin 2000 units SC NOW.
Pharmacy sends a vial labeled, Heparin 5000 units per mL. How many
mL do you administer? 1 mL 2000 units 2 mL = -------------- X
--------------- = ---- = 0.4 mL 5000 units 5 2 5
Slide 44
UnitsInsulin Use Insulin syringes to administer insulin Do not
use tuberculin syringes Insulin syringes 1 mL in size Some are mL
in size (if the dose of insulin is less than 50 units) This makes
it easier to see the small lines Calibrated in units (1 unit) =
hundredths (0.01 mL) Marked U-100 This means there are 100 units of
insulin in each mL of the medicine Make sure that the bottle of
insulin is also marked U-100 Insulin is available in a 10 mL vial
That means there are 1000 units of insulin in the entire
bottle
Slide 45
UnitsInsulin Note the large numbers (20, 30, 40 and so on)
These represent units, not mL You have to rotate the syringe to its
side to see the small lines. Each line represents 1 unit. There are
a total of 100 units or 1 mL in this syringe The doctor will order
insulin doses in units, not mL The orange cap covers the needle;
the white cap on the other end must be taken off in order to expose
the plunger
Slide 46
Unit Calculation You have Humulin -R insulin available in a
bottle labeled U-100. The doctor orders Humulin-R insulin 16 units.
How many units will you administer? 16 units, (thats what the
doctor ordered) Now, what if the question asked, how many mL will
you administer?
Slide 47
Unit Calculation You have Humulin -R insulin available in a
bottle labeled U-100. The doctor orders Humulin-R insulin 16 units.
How many mL will you administer? 1 mL 16 units 16 mL = ------------
X ----------- = ----- = 0.16 mL 100 units 100 less than 1 mL, round
to the nearest hundredth
Slide 48
Medication Forms
Slide 49
Routes for Administering Medication PO Sub-ling - SL Topical
Inhalants PO Sub-ling - SL Topical Inhalants Oral Under the tongue
Sprays, creams, suppositories Nebulizers
ROUTES ORAL OR PO DO NOT GIVE TO PATIENTS WHO: ARE VOMITING ARE
COMATOSE LACK A GAG REFLEX ARE NPO HAVE FEEDING TUBES HAVE NG TUBES
(UNLESS NG TUBE CAN BE CLAMPED)
Slide 52
INTRADERMAL SITES USUALLY CHOSEN SO THAT LOCAL REACTION CAN BE
OBSERVED LIGHTLY PIGMENTED HAIRLESS USUALLY FOREARM THINK TB
TESTING
Slide 53
INTRAMUSCULAR INJECTIONS NO MORE THAN 4ml IN SINGLE INJECTION
SITE (ADULT WITH WELL DEVELOPED MUSCLES) CHILDREN & ELDERLY MAY
LIMIT TO 1 2ml USUALLY 1&1/2 INCH, 21 TO 23 GAUGE NEEDLE
Slide 54
Peripheral IV Access - Hand veins Superficial dorsal Basilic
Cephalic Arm veins Radial (wrist) Cephalic Basilic Median cubital
Median
Slide 55
Common IV Sites Metacarpal, cephalic, basilic, and median veins
and their branches More distal sites should be used first, with
more proximal sites used subsequently. Feet / leg sites require MD
order Avoid arm on mastectomy side
Slide 56
Selecting the Site Consider Condition of the vein Type of fluid
or medication to be infused Duration of therapy Patients age and
size Whether patient is left or right handed Patients medical
history and current health status Skill of the person performing
the venipuncture
Slide 57
Selecting the Site Avoid areas that are painful to palpation
where the vein is hard or lumpy below an infiltrated IV site Veins
too small for the selected IV catheter That interfere with ability
to perform ADLs
Slide 58
Choosing the correct size catheter Smaller the gauge*
(diameter) = less trauma Catheters that are too big invite
complications Gauge must match the type of fluid to be administered
* the larger the #, the smaller the diameter (gauge)
Slide 59
Tips for Success Having difficulty finding a good vein? Apply
warm moist soaks Apply warm towel or washcloth (DO NOT microwave)
Let gravity help you! Have patient hang arm over side of bed.
Slide 60
Patient Education Explain the procedure PRIOR to venipuncture
Have patient report: Burning, bleeding, swelling at site IV
dressing becomes wet or leaks Pump alarms
IV Push: method of giving concentrated doses of medication
directly into the vein( is administered over 1 to 5 minutes) IV
Bolus: concentrated dose of medication or fluid, frequently given
intravenously Admixture: The result of adding a medication to a
container of intravenous fluid IV Push: method of giving
concentrated doses of medication directly into the vein( is
administered over 1 to 5 minutes) IV Bolus: concentrated dose of
medication or fluid, frequently given intravenously Admixture: The
result of adding a medication to a container of intravenous fluid
IV Push and IV Bolus
Slide 63
Speed Shock Rapid infusion of medication of fluid into the
circulation causes toxic concentrations to accumulate Drugs can
cause a shock-like syndrome
Slide 64
Slower-than-ordered Infusion Rates Deprives the patient of
fluids and medications Always check infusion rates against orders
at beginning of shift, and after secondary infusions (I.e.,
antibiotics) to insure proper rate is maintained
Each hospital maintains a schedule of hours for administration
of medications that is set up by the hospital nursing service You
are required to learn the hours that are standard for your hospital
Note: Standard prn orders are never assigned a time, because the
drugs are administered as they are needed by the patient Each
hospital maintains a schedule of hours for administration of
medications that is set up by the hospital nursing service You are
required to learn the hours that are standard for your hospital
Note: Standard prn orders are never assigned a time, because the
drugs are administered as they are needed by the patient Frequency
of Administration
Slide 69
When a doctor wishes a drug to be administered only for
specific conditions, a qualifying phrase will be part of the
medication order Not all orders contain qualifying phrases Examples
of commonly used phrases: For severe pain For stomach spasms For
N/V While awake For insomnia When a doctor wishes a drug to be
administered only for specific conditions, a qualifying phrase will
be part of the medication order Not all orders contain qualifying
phrases Examples of commonly used phrases: For severe pain For
stomach spasms For N/V While awake For insomnia Qualifying
Phrases
Slide 70
The Importance of Monitoring The nurse must always carefully
monitor client reactions to medications and ensure that clients are
appropriately educated as to the actions, side effects, and
contraindications of all medications they are receiving. Clients
receiving IV therapy or blood transfusions require constant
monitoring for complications.
Slide 71
Responsibilities of Nurses Regarding Drug Administration Nurses
are both legally and morally responsible for correct administration
of medications.They must: Follow institutional policy. Consider
clients desires and abilities. Foster compliance. Correctly
document all actions related to medication administration and
medication errors.
Slide 72
BEHAVIORS TO AVOID DURING MEDICATION ADMINISTRATION DO NOT BE
DISTRACTED DO NOT GIVE OR HOLD MEDS DISPENSED BY OTHERS DO NOT POUR
FROM CONTAINERS WITHOUT LABELS OR DIFFICULT TO READ LABELS DO NOT
GIVE EXPIRED DRUGS DO NOT GUESS ABOUT DOSAGES OR DRUGS DO NOT LEAVE
BY THE BEDSIDE, OR UNATTENDED ANYWHERE DO NOT GIVE IF THE CLIENT
STATES ALLERGIES OR HAS CONCERNS ABOUT THE DRUG DO NOT MIX WITH
FOOD OR LIQUIDS IF CONTRAINDICATED
Slide 73
YOUR RESPONSIBILITIES AS A STUDENT NURSE PROPER TECHNIQUE SEE
SYLLABUS RESEARCH MUST LOOK UP ALL DRUGS PRIOR TO GIVING TO PATIENT
SOURCES OF INFORMATION: DRUG HANDBOOK, DRUG CARDS, PHARM BOOK,
MICROMEDIX (on hospital intranet)
Slide 74
Documentation of Drug Administration A critical element of drug
administration is documentation. The standard is if it was not
documented it was not done. The nurse should document that a drug
has been given after the client has received the drug. Never sign a
medication out before you give it.
Slide 75
Serious Medication Errors: EXAMPLES: Overdose Medication given
to the wrong client Medication given via the wrong route Inform
your supervisor Call the doctor as soon as possible. Strictly
observe the client Document what happen, actions and interventions
taken
Slide 76
Remember a few important points: Always wash your hands before
giving medication. NO ORDERS = DO NOT GIVE MEDICINE Medication is
ALWAYS to be kept in a locked area.