Overview 3 Legislation Medication administration Essential info
you should know prior to administering a med Routes Side effects
Nursing implications 8 Rights to med administration
Slide 5
Introduction 4 Increased level of responsibility Preparation is
the key to success Knowledge re: Medication & how it works
Knowledge re: How to administer meds Knowledge of your client so
that you are able to make responsible judgments
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Introduction 5 Medication Drug Drug Misuse Substance Abuse
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I. Legislation 6 Administration of medications controlled by
law You are responsible for what you do or do not do Federal laws
Controlled Substance Act State laws Including Nurse Practice
Acts
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California Nurse Practice Act 7 Direct and indirect patient
care services, including, but not limited to, the administration of
medications and therapeutic agents, necessary to implement a
treatment, disease prevention, or rehabilitative regimen ordered by
and within the scope of licensure of a physician, dentist,
podiatrist, or clinical psychologist, as defined by Section 1316.5
of the Health and Safety Code
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II. Administration of Medication 8 Client Rights Information
Education Safety Right of refusal
Slide 10
III. Basic Nurses Knowledge 9 Generic, official, chemical, or
brand names Classification
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III. Basic Nurses Knowledge 10 Dosage Range Routes
What preparations would you need to make prior to administering
an oral mediacation ? 13
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Perry, Potter & Elkin 14 Prepare client Prepare equipment 3
checks 8 rights
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Topical / Skin 15 Patches & creams Intact skin Remove
previous application Medication absorbed via skin therefore you
will need to wear gloves Medication open areas Prepare area cleanse
if indicated Use applicator Use gloves
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Routes Eyes Treat as sterile Have client look up Use sterile 2
by 2 to put pressure on the inner canthus after administration to
prevent systemic effects Ointment from inner surface to outer
surface 16
Slide 18
Routes/ Ears Adult Pull pinea upward and back Make sure bottle
does not touch the side of the ear Have client lay on their side
and maintain that position after drops instilled 17
Slide 19
Routes / Ears Child Pull pinea down and back 18
Slide 20
Routes / Inhalation 19
Slide 21
Topical Rectal and vaginal suppositories considered topical
applications Be sure and remove wrappers 20
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Routes 21 Parenteral routes other then oral or topical
Injections (skills lab in a couple of weeks )
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Injections: 22 Injections and IV meds must be prepared using
surgical aseptic technique Syringe size and needle length selection
are based on type of medication, location of administration, and
route (SQ vs. IM) Site selection includes identification of
anatomical landmarks site conditions
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III. Basic Nurses Knowledge 23 Desired actions and therapeutic
effects How does this med work physiological effects within the
body
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III. Factors Affecting Medication Action 24 Developmental
factors Gender Cultural, Ethnic, Genetic factors Diet Environment
Psychological Factors Illness and diseases Time of
administration
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25
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III. Basic Nurses Knowledge 26 Side effects How do they disrupt
the body at times the side effects are what we give the meds for
Adverse reactions* Untoward effects*
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III. Basic Nurses Knowledge 27 Interaction with other meds or
with foods
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What Are Some Common Allergic Responses ? 28
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III. Basic Nurses Knowledge 29 Toxic and undesirable effects
Drug allergy anaphylactic reaction Drug tolerance Cumulative
effect
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III. Basic Nurses Knowledge 30 Nursing Implications What does
administering this medication do for or to the patient. What
assessments must you make prior to administering the med Or to
watch for after administering the medication
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IV. Application 31 Valid - medication order Clients name Date
Drug name Dosage Route MD signature
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Time for a Stretch Break 32
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V. Eight Rights 33 Right client -Check Id band Patient name
Medical Id number Have client state name Right medication - Check 3
times Pick up Pour Put away
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Check Three Times 34
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V. Eight Rights 35 Right dose Correct math Appropriate
preparation Time release medications Enteric coating do not crush
or break up Pre mix (Protonix + sodium bicarb) Interactions Do not
combine medications absorbed in the stomach with antacids (acidic
based meds)
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Time Release Medication Enteric coated pills Do not crush Time
release capsules do not take with hot water or chew otherwise may
result in overdose 36
Slide 38
V. Eight Rights (Dose) 37 Check MDs order MAR Your text books
24 hour max dose Why is this med being given i.e. baby ASA
prophylactic as anticoagulant vs. 600 mgm. for elevated
headache
Slide 39
V. Eight Rights 38 Time Before or after meals On an empty
stomach ? The MDs order will indicate the number of times a day but
may not specify before or after meals you need to know that
info
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V. Eight Rights 39 Right Route IM SQ PO Sublingual etc
Slide 41
V. Eight Rights 40 Right to information Expectation that
clients be informed re: what their medication is for Opportunity
for teaching Be sure an include side effects Ex. This med may make
you dizzy please put on call light if you wish to get up
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V. The Eight Rights 41 Right of refusal Documentation of
refusal
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42 Approach (#9) - Physiological effects of a medication may be
enhanced or diminished by how you present the medication - This
will help your pain vs. Try this it might help. V. The Eight
Rights
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43 Documentation MAR in timely fashion Time, Route if different
If medication is refused If medication is held If medication not in
cart
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Documentation Pixis Contains Narcotics Commonly prescribed meds
Maintains records but you still need to document in the MAR 44
Slide 46
EMAR 45 Follow 8 Rights Client Med Time Dose Route Know Refuse
Document http://www.hendricks.org/?id=374&sid=1#
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It is time for meds and your client is off the unit for x-ray
where would you document this? 46
Slide 48
Signing Out Narcotics 47 Students can not do this independently
When discarding a partial or complete dose must be witnessed by RN
or LVN Will need to sign for it on a special form or in Pixis
Narcotic count must be accurate before & end of shift Two RNs
count, if not correct unusual occurrence report
Slide 49
VI. Medication Errors 48 Should a medication error occur,
document it and report it. An unusual occurrence report may have to
be made Safety review check med 3 times, good communication with
LVNs and RNs
Slide 50
Med Errors 49 Following 8 rights and adhering to the hospital
polices and procedures is only the beginning You must use your
judgment with each medication you administer
Slide 51
Med Errors 50 Wrong client Wrong medication Wrong dose Wrong
time Wrong route Wrong information Incorrect assessment or failure
to obtain base lines Not taking into account interaction with other
meds or with foods Math miscalculation
Slide 52
Double Check Meds (Be sure and check with the hospital) 51
Insulin Heparin KCL IV Lasix IV Chemo All math Must be double
checked & cosigned - 2 licensed individuals
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Final Comments 52 A nurse that administers the written
incorrect order(e.g. Demerol 500 mgm.) is responsible for the error
as well as the physician. (Kozier p. 787) Medication administration
provides an opportunity to put pieces together Requires skills and
knowledge re meds as well as delivery methods
Slide 54
References 53 Adams, M.P. & Urban, C. Q. (2013)
Pharmacology: connections to practice (2 nd ed.) Boston: Pearson
California Nurse Practice Act (downloaded 10/9/2007)
Carpenito-Moyet, L., (2010) Handbook of nursing diagnosis (13ed.)
Philadelphia: Lippincott.
Slide 55
References Continued 54 Perry, A. G., Potter, P.A., Elkin, M.K.
(2012) Nursing interventions & clinical skills (5 th ed.).St
Louis, MO: Elsevier Potter, P.A., Perry, A. G. (2009) Fundamentals
of nursing (7 th ed. ). St. Louis, MO: Mosby.