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ASSOCIATION OF NURSING SERVICEASSOCIATION OF NURSING SERVICE
ADMINISTRATORS OF THEADMINISTRATORS OF THE
PHILIPPINES, INC. (ANSAP)PHILIPPINES, INC. (ANSAP)
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R.A. # 9502 - An act providing forcheaper and quality medicines,amending for the purposeRepublic Act No. 8293 or the
Intellectual Property Code,Republic Act No. 6675 or theGenerics Acts of 1988, and
Republic Act No. 5921 or thePharmacy Law, and for other
purposes
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R.A. # 9165 DangerousDrug Act of 2002 - An ActInstituting the Comprehensive
Dangerous Drugs Act of 2002,repealing republic act no.6425, otherwise known as the
Dangerous Drugs Act of 1972,as amended, providing fundstherefor and for other
purposes
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RA 9173 PhilippineNursing Law of 2002 have
stated that parenteralinjection is in the scope ofnursing practice.
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Board of Nursing Resolution
No.8 Sec.30 (c) Art.VII oradministratively under Sec.21Art.III states that any
registered nurse withouttraining and who administersIV injections to patients shall
be held liable, eithercriminally whether causing ornot an injury or death to the
patient.
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PharmacokineticsPharmacokinetics
- The process by which a drug isabsorbed, distributed, metabolized,and eliminated by the body.
PHARMACOKINETICSPHARMACOKINETICS - what theBODY does to the DRUG
(PROCESSES)
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PharmacokineticPROCESSES
Absorption
Distribution
Metabolism
Excretion
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PharmacodynamicsPharmacodynamics
The study of the action oreffects of drugs on livingorganisms.
PHARMACODYNAMICSPHARMACODYNAMICS - what the
DRUG does to the BODY(EFFECTS)
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PharmacodynamicsPharmacodynamics
Symptomatic
Curative
Restorative
Preventive
Diagnostic
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An I.V. Medications mayAn I.V. Medications may
be ordered when:be ordered when:
rapid therapeutic effect.rapid therapeutic effect.
cant be absorbed by the GIcant be absorbed by the GI
tracttract..
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An I.V. Medications mayAn I.V. Medications may
be ordered when:be ordered when:
The client may receiveThe client may receive
nothing by mouth.nothing by mouth.
controlled administration ratecontrolled administration rate
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I.V. Medication may beI.V. Medication may be
given by:given by:Drug injectionDrug injection
Intermittent infusionIntermittent infusion
Continuous infusionContinuous infusion
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BenefitsBenefits
Rapid ResponseRapid Response
Effective AbsorptionEffective Absorption
Accurate TitrationAccurate Titration
Less DiscomfortLess Discomfort
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RisksRisks
Solution and drugincompatibilities.
Poor vascular access in someclients.
Immediate adversereactions.
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IncompatibilityIncompatibility
Drug + DiluentDrug + Diluent == must bemust becompatiblecompatible
--The more complex the solution,The more complex the solution,the greater the risk ofthe greater the risk of
incompatibilityincompatibility
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An incompatibility results whenAn incompatibility results when
two or more substances react ortwo or more substances react or
interact so as to change theinteract so as to change the
normal activity of one or morenormal activity of one or more
components.components.
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Incompatibility may resultIncompatibility may result
in the loss of therapeuticin the loss of therapeutic
effects and may occureffects and may occurwhen:when:
Several drugs are added to largevolume of fluid to produce anadmixture.
Drugs in separate solutions areadministered concurrently or in closesuccession via the same IV line
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Incompatibility may resultIncompatibility may result
in the loss of therapeuticin the loss of therapeutic
effects and may occureffects and may occurwhen:when:
A single drug is reconstituted orA single drug is reconstituted or
diluted with the wrong solutiondiluted with the wrong solution
One drug reacts with anotherOne drug reacts with another
drugs preservativedrugs preservative
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Hazards of intravenousHazards of intravenous
medicationsmedications
Mixing of two incompatibleMixing of two incompatible
drugs in a solution can causedrugs in a solution can cause
an adverse interactionan adverse interaction
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Poor Vascular AccessPoor Vascular Access
Clients who require frequentor prolonged I.V. therapy may
developed small, scarred,inaccessible veins fromrepeated venipunctures or
infusion of irritating drugs.
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If peripheral venous access isntIf peripheral venous access isnt
possible, the doctor may use apossible, the doctor may use a
central vein, commonly by thecentral vein, commonly by thesubclavian route.subclavian route.
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Adverse Drug ReactionAdverse Drug Reaction
A response to a drug that isA response to a drug that isnoxiousnoxious andand unintendedunintendedand occurs atand occurs at dosesdoses
normallynormallyused in man for theused in man for the
prophylaxis, diagnosisprophylaxis, diagnosis oror
therapytherapyof disease, or forof disease, or formodification of physiologicalmodification of physiological
function (WHO).function (WHO).
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The following are someThe following are some
adverse drug reactionsadverse drug reactions
that you might notice:that you might notice:
Skin rashSkin rash
Easy bruisingEasy bruising
BleedingBleeding
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Severe nausea and vomitingSevere nausea and vomiting
DiarrheaDiarrhea
ConstipationConstipation
ConfusionConfusion
Breathing difficultiesBreathing difficulties
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What should you do if youWhat should you do if you
suspect an ADR?suspect an ADR?
Stop the medication immediately.Stop the medication immediately.
Report the incident to theReport the incident to the
physician.physician.
Monitor the client.Monitor the client.
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10 GOLDEN RULES FOR10 GOLDEN RULES FOR
ADMINISTERING DRUGSADMINISTERING DRUGS
SAFELYSAFELY
Administer the right drug.
Administer the right drug to the
right patient.
Administer the right dose.
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Administer the drug by the rightroute.
Administer the drug at the righttime.
Document each drug youadminister.
Teach your patient about the drughe is receiving.
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Take a complete patient drughistory.
Find out if the patient has any
drug allergies.
Be aware of patient drug drug
or drug-food interactions.
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Common Medication Errors
Wrong dose (overdose, underdose,
missed dose)Wrong medication to wrong patient
Wrong medication to right patient
Wrong medication due to wrongdispensing
Wrong interpretation of doctors
prescriptions for drugsWrong infusion rate ( over infusion,
under infusion, missed order )
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Transcription ofTranscription of
medication and treatmentmedication and treatment
ordersorders
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Interpretation of DoctorsInterpretation of Doctors
Order for DrugsOrder for Drugs The nurse must understand the order
perfectly before acting on it
> The Drug
> The Dose
> The Route
> The Frequency
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If any of the above are unclear oropen for interpretations, it is theResponsibility of the nurse to clarify
the order with the physician.
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Definition of Terms:Definition of Terms:
Transcription of medicalTranscription of medical
orders-orders- is the act of writing outmedical orders.
Kardex-Kardex- is the summarize
written presentation of all thecare and treatment of the patient.
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Medication/TreatmentMedication/Treatment
sheet-sheet- is the legal
documents in the patientschart were medicines and
treatments administered tothe patient are written,acknowledged and
administered by nurses.
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Physicians Order Sheet-Physicians Order Sheet-is a legal document wherein
medical orders are writtenand use as reference of
nurses in the transcriptionand executing nursing care.
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All medication and treatment orders mustbe written legibly and must contain thefollowing:
a. generic name and brand name ofmedicines
b. Dosage of the medicines
c. Frequency of administrationd. Route of administration
e. Signature over printed name of
attending physician or authorizedrepresentative
f. Date and time order was written
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The registered nurseindicates that he/she has
checked and completelytranscribe the medical order
by signing his/her name withthe date and time directlyright after the doctors order.
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As a general rule, telephoneorders are received and carried
out only in emergency cases bynurses. Nurses receive telephoneorders only from consultants.
RNs will review all ordersimmediately after the physicianwrites.
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Patient / Family TeachingPatient / Family Teaching
Inform the client about the medicationInform the client about the medication
you are about to administer.you are about to administer.
Reason why the medication is to beReason why the medication is to be
give.give. Adverse effect he may experienceAdverse effect he may experience
PainPain
RednessRednessswellingswelling
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DocumentationDocumentation
Type and amount of drug givenType and amount of drug given Date and time givenDate and time given
Confirmation that the I.V. line wasConfirmation that the I.V. line was
patentpatent Patients response to the medicationPatients response to the medication
Condition of the insertion siteCondition of the insertion site
Ongoing monitoring that youOngoing monitoring that you
providedprovided
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Where to DocumentWhere to Document
Nurses Progress NotesNurses Progress Notes Medication SheetMedication Sheet
Infusion SheetInfusion Sheet Vital Signs Monitoring SheetVital Signs Monitoring Sheet
Input and Output MonitoringInput and Output MonitoringSheetSheet
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Weighing InWeighing In
Remember!!!Remember!!!
2.2 lb. = 1 kg2.2 lb. = 1 kg
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Coming to the SurfaceComing to the Surface
Remember!!!
Body Surface Area useBody Surface Area use
NOMOGRAMNOMOGRAM
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NomogramNomogram
Find your weight in the rightFind your weight in the rightcolumn and your height in the leftcolumn and your height in the left
column. Place a straightedge oncolumn. Place a straightedge on
the nomogram so the weight andthe nomogram so the weight andheight are connected. The pointheight are connected. The point
where the straightedge crosseswhere the straightedge crosses
the center column denotes yourthe center column denotes yourbody's surface area in squarebody's surface area in square
meters.meters.
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Coming to the SurfaceComing to the Surface
Basal Surface AreaBasal Surface Area
Childs Dose =Childs Dose =
Childs BSAChilds BSA XX averageaverage
173 m2173 m2 adult doseadult dose
(average adult BSA)(average adult BSA)
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GENERAL FORMULA FOR DRUGGENERAL FORMULA FOR DRUG
CALCULATIONCALCULATION
1.1. desired strength x total ml ofsolution
strength on hand
22 C l l ti b R ti P tiCalculation by Ratio Proportion
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2.2. Calculation by Ratio : ProportionCalculation by Ratio : Proportion
8 mg : x = 16 mg : 1 tab8 mg : x = 16 mg : 1 tab
(works for any computation of Dosage if(works for any computation of Dosage ifyou have a given and a need to determineyou have a given and a need to determine
the unknown).the unknown).
Rule :Rule :
1. Units for each ratio must be the same.1. Units for each ratio must be the same.
2. Units for each ratio must be placed in the2. Units for each ratio must be placed in thesame order.same order.
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C l l i Ad i i i RC l l ti Ad i i t ti R t
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Calculating Administration RatesCalculating Administration Rates
One must know two key componentsOne must know two key componentsbefore using the formula:before using the formula:
Drop factor of the IV administrationDrop factor of the IV administration
setsetAmount of solution to be infused overAmount of solution to be infused over
one hourone hour
l l iR t C l l ti
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Rate CalculationsRate Calculations
Macrodrip SetMacrodrip Set10 drops = 1 ml10 drops = 1 ml
15 drops = 1 ml15 drops = 1 ml
20 drops = 1 ml20 drops = 1 mlMicrodrip SetMicrodrip Set
60 drops = 1 ml60 drops = 1 ml
Blood SetBlood Set10 drops = 1 ml10 drops = 1 ml
OFORMULA
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FORMULAFORMULA
Drip RateDrip Rate (gtts or mgtts/min)(gtts or mgtts/min) ==
Total no. of ml x Dripx Drip
Factor Total no. of min.Factor Total no. of min.
FORMULAFORMULA
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FORMULAFORMULA
ml per hour =ml per hour =
Total no. of mlTotal no. of ml
Total no of hoursTotal no of hours
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