Medication Management Dina Dewi S L I
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Medication Management
Dina Dewi S L I
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• Drug management : merupakan tindakan
kolaboratif yang dilakukan oleh perawat
dengan melibatkan Dr, Drg, Rn( pd negaratertentu), Apoteker, Dietetion.
• Drug (substansi kimia) memiliki efek
khusus dalam tubuh perawat harus yakinobat yang akan diberikan harus benar :
dosis, frekwensi & rute terapeutik thd efek
obat.
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Strandard & Legislasi
• Standard :
dibuat untuk memastikan keseragaman
(uniformity) obat agar efek obat dapatdiketahui
• Legeslasi :
aturan yang dibuat untuk mengontrol penggunaan obat. Contoh schedule yangdigunakan untuk obat yang dapat dikonsumsiatau dikontrol sendiri.
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Schedule I
• High abuse potential, tdkdigunakandalam
pengobatan
• Heroin,marijuana
Schedule II
• Hi abuse potential forseveredependence
• Narcotik,amphetamin,gol barbirturatlain
Schedule III
• Less abuse potential, formoderatedependence
• Nonbaebituratsedativ,
Schedule IV
• Lower abuse potential,limiteddependence
• Sedativ. Antianxiety agent,nonnarcoticanalgesic
Schedule V
• Limited abuse potential
• codein
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Nomenclature
Trade Name Drug name
aspirin Acetylsalisilic acid
Benadril DiphenhydramineHydrochloride
Zovirax acyclovir
Trade name
generic
chemical
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Pharmacokinetics
• Absorption :is themovement of the drug from its site
of administration into the blood stream
– Route of administration – Ability to dissolve
– Administration site to Blood flow
– Body surface area
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Pharmacokinetics (cont’d)
Distribution
– Circulation
– Membrane permeability
– Protein binding
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Pharmacokinetics (cont’d)
Metabolism ( in liver)
– Biotransformation
– Detoxification
•
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Pharmacokinetics (cont’d)
• Excretion
– Kidneys
– Liver
– Bowel
– Lungs – Exocrine glands
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Actions
• Therapeutic effects
• Side effects
• Adverse effects
• Toxic effects
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Actions (cont’d) • Idiosyncratic reactions
• Allergic reactions
• Interactions : food & drug interaction
abuse antasid
Vit D deficiencyExcessive diureticloss of electrolite
Ca milk or milk product decrease antibiotic absorbtion
• Medication dose responses
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Routes of Administration
• Oral: sublingual, buccal
• Parenteral: intradermal, subcutaneous,
intramuscular, intravenous
• Topical
• Inhalation
• Intraocular
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Systems of Measurement
• Metric :Grams (g), milligrams (mg),
kilograms (kg), Liters (L), milliliters (ml)
• Apothecary : grains, dram, ounce, pounds
• Household : Tablespoons, Teaspoons,
Ounces, Cups, Pints, Quartss
• Contoh : 1mg = 1/60 grain, 5 ml=1 fluid dram =1teaspoonful
Catt: lihat converting unit
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Clinical Calculations
• Conversions within systems
• Conversions between systems
• Formula:
Dose ordered x Amount
Dose on hand on hand
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contoh
Order : nitroglycerin 1/150gr PO,…..mg???
1 gr=60 mg
X =1/50 gr x 60 mg/gr
X =60/150
X= 0,4 mg
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Dose calculation
• Dose on hand
• Dose desired
Contoh : cephalexin 500 mg PO QID( four
time every day), dose on hand 250mg/5
ml…??
250 mg/5=500mg/X
X =5x500/250
X = 10 ml
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Order : anticoagulant 10.000unit, dose on
hand 40.000unit/ml,….???
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Pediatric dose
Body surface area child/ BSA adult X dose
adult = child dose
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Prescriber’s Role
Types of orders
– Standing orders routine
– prn orders as needed
– Single ordersone time (diagnostic test)
– Stat ordersimmediately
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Abbreviation
• a. c = before meal
• ad lib = as desired
• hrly = hourly
• SC = subcutan
Lihat di buku FN
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Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
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Nurse’s Role
• Six rights
• Triple-check before administration
• Client assessment
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Six Rights
• Right medication
• Right dose
• Right client
• Right route
• Right time
• Right documentation
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Client’s Rights
• Information
• Refusal
• Careful assessment
• Informed consent
• Safe administration
• Supportive therapy
• No unnecessary medications
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Assessment
• Medical history
• History of allergies
• Medication data
• Diet history
• Perceptual or coordination problems
• Current condition
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Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
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Nursing Diagnoses
• Deficient knowledge (medications)
• Noncompliance (medications)
• Disturbed sensory perception
• Impaired swallowing
• Ineffective therapeutic regimen management
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Planning
• Goals and outcomes
Example:
• Client will verbalize therapeutic
• and adverse effects of
• medications
– Setting priorities
– Continuity of care
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Implementation
• Client and family teaching
• Medication orders: receipt, transcription,
communication
• Calculation and measurement
• Correct administration technique
• Recording
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Special Considerations
• Infants and children
• Older adults
– Polypharmacy
– Self-prescribing
– Over-the-counter medications
– Misuse
– Noncompliance
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Evaluation
• Client response to medications
• Client and family ability to administer
medications
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Oral Administration
• Presence of GI alterations
• Ability to swallow
• Use of gastric suction
• Positioning
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Topical Administration
Skin applications
– Use of gloves or applicators
– Preparation of skin
– Thickness of application
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Nasal Instillation
• Assessment of nares
• Client instruction and selfadministration
• Positioning
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Eye Instillation
• Drops, ointments, disks
• Assessment of eyes
• Asepsis
• Positioning
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• Ear Instillation
• • Assessment of ear canal
• • Warming of solution
• • Straightening of canal for children
• and adults
• • Positioning
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• Vaginal Instillation
• • Suppositories, foams, creams
• • Use of gloves and applicator
• • Client positioning, comfort, and
• hygiene
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• Rectal Instillation
• • Suppositories
• • Use of gloves
• • Client positioning, comfort, and
• hygiene
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Inhalation
• Metered-dose inhalers (MDIs) and dry
powder inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister
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Irrigation
• Medications used to wash out a body
cavity delivered with a stream of solution
(sterile water, saline, or antiseptic)
• Asepsis
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Parenteral Administration
• Equipment
– Syringes: sizes (volume), types
– Needles: length, gauge
– Disposable units: Tubex, Carpuject
– Ampules
– Vials
l Ad i i i
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Parenteral Administration
(cont’d)
• Mixing medications
– Determine compatibility of the medications
– Do not contaminate one medication with
another
– Ensure the final dose is accurate
– Maintain aseptic technique
P l Ad i i i
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Parenteral Administration
(cont’d)
• Insulin
– Syringes and needle sizes
– Types of insulin
– Mixing of insulins
– Rotation of vials before withdrawal of
solution
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Administration of Injections
• Minimize discomfort
– Use smallest suitable needle (>gauge=<
needle)
– Position client comfortably
– Select proper site
– Divert client’s attention
– Insert the needle quickly and smoothly
– Hold the syringe steady
– Inject the medication slowly and steadily
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Administration of Injections (cont’d)
• Intramuscular injections – Sites: landmarks, condition of area
– Amount of solution
– Length 1-2 inc and gauge of needle 20-22 – Angle of insertion (90°)
– Aspiration
– Air-lock method
– Z-track technique
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Administration of Injections (cont’d)
• Sites
– Ventrogluteal
– Vastus lateralis
– Deltoid
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Administration of Injections (cont’d)
• Subcutaneous injections – Sites: abdomen, lateral upperarm, lateral
tigh, scapular, upper ventrodorso gluteal
condition of area, rotation of use – Amount of solution
– Length 5/8 inc and gauge of needle
– Pinch or spread skin
– Angle of insertion (45°)
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Intravenous Administration
• 25°
• Large volume infusions
• Bolus injection
• Volume-controlled infusions
– Tandem (piggyback)
– Volume-control set
– Mini-infusor pump
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Prevention of Needle Sticks
• Needleless devices
• Sharps disposal
• One-handed recapping technique
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Documentation