93
Medications PREPARED BY : MS. AILEEN S. ADRALES, RN
Medications
PREPARED BY :
MS. AILEEN S. ADRALES,RN
Pretest
A client tells the nurse, “This pill is
a different color than the one that I
usually take at home.” Which is
the best response by the nurse?
1. “Go ahead and take your
medicine.”
2. “I will recheck your medication
orders.”
3. “Maybe the doctor ordered a
different medication.”
4. “I’ll leave the pill here while I
check with the doctor.”
Question 2
If the following medications are listed
on a client’s medication
administration record (MAR), which
one should the nurse question?
1. Lasix 40 mg, po, STAT
2. Ampicillin 500 mg, q6 hr, IVPB
3. Humulin L (Lente) insulin 36 u, sc, q
am, ac
4. Codeine q 4-6 hr, po. Prn for pain
Question 3The primary care provider prescribed
5 mL of a medication to be given deep
IM for a 40-year old female who is
5’7” tall and weighs 135 pounds.
Which of the following is the most
appropriate method of
administration?
1. A tuberculin syringe, #25-#27 gauge,
¼ -5/8 inch needle.
2. Two 3-mL syringes, #20-#23 gauge, 1
½ inch needle.
3. Two 2-mL syringes, #25 gauge, 5/8-
inch needle.
4. Two 2-mL syringes, #20-#23 gauge, 1-
inch needle.
Question 4
An elderly client with renal
insufficiency is to receive a cardiac
medication. The nurse is most likely
to administer which of the following?
1. A decreased dosage.
2. The standard dosage.
3. An increased dosage.
4. A divided dosage.
Question 5
Proper administration of an otic
medication to a two-year-old client
includes which of the following?
1. Pull the ear straight back.
2. Pull the ear down and back.
3. Pull the ear up and back.
4. Pull the ear straight upward.
Administration of Medications
• Medication: substance
administered for the
diagnosis, cure,
treatment, or relief of a
symptom or for
prevention of disease
• Drug: same as
medication – but also
refers to illicitly
obtained substance
Administration of Medications
• Prescription: The written direction for
the preparation and administration of a
drug
• Generic name: name given before drug
becomes officially approved
• Official name: name which drug is
listed in official publications
Administration of Medications
• Chemical name: name that
describes the constituents of the
drug
• Trade name: name given to drug by
manufacturer (brand name)
• Pharmacology: study of the effect of
drugs on living organisms
• Pharmacy: Art of preparing,
compounding, and dispensing drugs
•Curative
•Supportive
•Substitutive
•Chemotherapeutic
•Restorative
Legal Aspects of
Administering
Medications
• Nursing practice acts
• Responsibility for actions
• Question any order that appears
unreasonable
• Refuse to give the medication until the
order is clarified
Controlled Substances
• Kept under lock
• Special inventory forms
• Documentation requirements
• Counts of controlled
substances
• Procedures for discarding
Effects of Drugs
1. Therapeutic effect = desired effect
• Reason drug is prescribed
2. Side effect = secondary effect
• Unintended, usually predictable
• May be harmless or harmful
3. Drug toxicity
• Result from overdose, ingestion of
external use drug
• Buildup of drug in blood
Effects of Drugs
4. Drug allergy
• Immunologic reaction to drug
• Mild to severe reactions (anaphylaxis)
5. Drug tolerance
• Need increasing doses to maintain
therapeutic effect
6. Drug interaction
• One drug affecting effect of another
Effects of Drugs
7. Potentiating effect
• Effect of one or both drugs is
increased
8. Inhibiting effect
• Effect of one or both drugs is
decreased
9. Synergistic effect
• When two drugs increase the action
of one or another drug
Drug Misuse
• Improper use of medications
• Drug abuse
• Drug dependence
• Physiologic dependence
• Psychologic dependence
• Drug habituation
• Illicit drugs
Actions of Drug on Body
• Pharmacodynamics
• Process by which drug changes body
• Pharmacokinetics
• Study of absorption, distribution,
biotransformation, and excretion of
drugs
Factors Affecting Medication
Action
1. Developmental
2. Gender
3. Cultural, ethnic, and genetic
4. Diet
5. Environment
6. Psychologic
7. Illness and disease
8. Time of administration
Routes of Medication
Administration
1. Oral
2. Sublingual
3. Buccal
4. Parenteral
oSubcutaneous
oIntramuscular
oIntradermal
oIntravenous
Routes of Medication
Administration
5. Topical
― Rectal
― Vaginal
― Transdermal
― Inhalation
Copyright 2008 by
Pearson Education, Inc.
Parts of a Medication Order
1.Full name of the client
2.Date and time the order written
3.Name of drug to be administered
4.Dosage
5.Frequency of administration
6.Route of administration
7.Signature of person writing the order
Prescription
Types of Medication
Orders
1. Stat order
• Demerol 100mg IM stat
2. Single Order
• Seconal 100mg hs before surgery
3. Standing order
• Demerol 100 mg IM q4h x 5 days
4. PRN order
Amphojel 15 mL prn
MAR
Administering Medications
1. Identify the client
2. Inform the client
3. Administer the drug
4. Provide adjunctive interventions as
indicated
5. Record the drug administered
6. Evaluate the client’s response to the
drug
Ten “Rights” of Accurate
Medication
Administration
1. Right
medication
2. Right dose
3. Right time
4. Right route
5. Right client
6. Right client
education
7. Right
documentation
8. Right to refuse
9. Right assessment
10.Right evaluation
The six rights OF Medication Pass
D Drug
R Route
P Patient
A Amount
T Time
S Scribe/ Documentation
Helps prevent medication
errors
1. Right patient:
– identify the patient you are
going to give
the medicine
Look at the patient’s ID
band too!!!
• Is this the appropriate
drug for the
condition of the patient?
• Is this the correct drug?
2. Right Drug
Is this the right dose
based on the patients
size
and age?
Right
Dosage:
Does the patient’s condition
need the quick acting route
– or can I use the longer
acting route?
• Is the medication made to
be given by that route?
– Not all IV meds can be
given IM and vise versa
Right
Route:
Is the timing between the
dosages correct?
• Is it every 3 minutes?
• Or every 5 minutes?
• Can I give this medication
only once
Right Time:
• Documentation of what you
have done
D – Drug
A – Amount
R – Route
T – Time
Right
Scribe/Documentation
• Correct medication
• Correct concentration
• Expiration date
• Seals intact
• Color
• No precipitate (floaters)
Medication exam:
Medications Administration
Packaging:
1.Prefilled
Syringe
2.Ampule
3.Vial
4.Tubex
Prefilled syringe
• two pieces that
screw together
and medication
is quickly
administered
• • Most
emergency
• meds are in
prefilled syringes
Tubex:
• A type of
prefilled
Syringe
• Need an adapter for administration
Non prefilled syringes
• Pick the right size
for the job
• Need to know how
much medication
you will be
drawing up
– 1cc or tuberculin
– 3cc
– 5cc
– 10cc
Non Prefilled
• Luer lock
needle
screws onto
the tip most
syringes• Slip Lock needle slips onto the tip push then twist
LUER LOCK SLIP
LOCK
Ampule
– breakable
glass container
that
can be used
only once
• Self-sealing
rubber
stopper in
the top
• Single dose vial
• Multidose vial
Vial
Parenteral Medications
• Common nursing procedure
• Absorbed more quickly than oral
• Careful and accurate administration
• Aseptic technique
Copyright 2008 by
Pearson Education, Inc.
Syringes
Types of Syringes
Syringe Tips
Luer-Lok syringe (note threaded tip)
non-Luer-Lok syringe (note the smooth graduated tip)
Prefilled Syringes
The cartridge slides into syringe barrel, turns, and locks at needle end. The plunger then screws into cartridge end
Needles
• Stainless steel
• Most disposable
• Parts
• Hub
• Cannula or shaft
• Bevel
Needles
• Characteristics
• Slant or length of bevel
• Length of the shaft
• Gauge
Elder Considerations
• Altered memory
• Decreased visual acuity
• Decrease in renal function
• Less complete and slower absorption
from the gastrointestinal tract
Elder Considerations
• Increased proportion of fat to lean body
mass
• Decreased liver function
• Decreased organ sensitivity
• Altered quality of organ responsiveness
• Decrease in manual dexterity
Administering Oral Medications
Skill 35-1
Copyright 2008 by
Pearson Education, Inc.
Compare the medication label to the MAR A cutting device can be used to divide tablets
Pouring a liquid medication from a bottle
The bottom of the meniscus is the measuring guide
Things to Consider
What are the life span considerations for administering oral medications?
What are the home care considerations for administering oral medications?
Nasogastric/Gastrostomy
Tube Medication
Administration
• 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
Nasogastric/Gastrostomy
Tube Medication
Administration
• Do not administer whole or undissolved
medications
• Assess tube placement
• Aspirate stomach contents and measure
the residual volume
Nasogastric/Gastrostomy
Tube Medication
Administration• 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
Nasogastric/Gastrostomy
Tube Medication
Administration
• Administer each medication separately
and flush in between
• After administration of all medications,
flush again
• If the tube is connected to suction,
disconnect the suction and keep the
tube clamped to enhance absorption
Preparing Medications From
Ampules
Breaking the neck of an ampule
Withdrawing a medication from an ampule
Preparing Medications From Vials –
Withdrawing a medication from a vial that is held with the base down
Withdrawing a medication from an inverted vial
Mixing Medications Using One
Syringe – Skill 35-4
Mixing two types of insulin
Intradermal Injections
Administering Intradermal
Injections- Skill 35-5
Subcutaneous Injections
Administering a Subcutaneous
Injection - Skill 35-6
Injections (Intramuscular)
Video
Back to Directory
Intramuscular Injections
• Ventrogluteal
• Vastus lateralis
• Dorsogluteal
• Deltoid
• Rectus femoris
Ventrogluteal Site
Vastus Lateralis Site
Copyright 2008 by
Pearson Education, Inc.
infant
adult
Dorsogluteal Site
Copyright 2008 by
Pearson Education, Inc.
Deltoid Site
Rectus Femoris Site
Administering IV Medications
Using IV Push – Skill 35-9
Administering Ophthalmic
Instillations – Skill 35-10
Copyright 2008 by
Pearson Education, Inc.
Administering Otic Instillations –
Skill 35-11
Copyright 2008 by
Pearson Education, Inc.
Nasal Medications
Administering Vaginal
Instillations – Skill 35-12
Copyright 2008 by
Pearson Education, Inc.
Inserting Rectal Suppository
Copyright 2008 by
Pearson Education, Inc.
Proper Use of a Metered
Dose Inhaler (MDI) Video
Click here to view a video on using a metered dose inhaler.Back to Directory
Respiratory Inhalation
Copyright 2008 by
Pearson Education, Inc.
Post Test
A client tells the nurse, “This pill is
a different color than the one that I
usually take at home.” Which is
the best response by the nurse?
1. “Go ahead and take your
medicine.”
2. “I will recheck your medication
orders.”
3. “Maybe the doctor ordered a
different medication.”
4. “I’ll leave the pill here while I
check with the doctor.”
Rationales 1
1. Do not administer the medication if
there is any doubt.
2. Correct. If there is any doubt, the
medication administration process
should be interrupted until the
question is clarified.
3. Do not administer the medication if
there is any doubt.
4. Never leave medication unattended.
Copyright 2008 by
Pearson Education, Inc.
Question 2
If the following medications are
listed on a client’s medication
administration record (MAR),
which one should the nurse
question?
1. Lasix 40 mg, po, STAT
2. Ampicillin 500 mg, q6 hr, IVPB
3. Humulin L (Lente) insulin 36 u,
sc, q am, ac
4. Codeine q 4-6 hr, po. Prn for pain
Copyright 2008 by
Pearson Education, Inc.
Rationales 2
1. Order is okay.
2. Order is okay.
3. Order is okay.
4. Correct. The dosage is missing
from this order.
Copyright 2008 by
Pearson Education, Inc.
Question 3
The primary care provider prescribed 5 mL
of a medication to be given deep IM for a 40-
year old female who is 5’7” tall and weighs
135 pounds. Which of the following is the
most appropriate method of administration?
1. A tuberculin syringe, #25-#27 gauge, ¼ -5/8
inch needle.
2. Two 3-mL syringes, #20-#23 gauge, 1 ½ inch
needle.
3. Two 2-mL syringes, #25 gauge, 5/8-inch
needle.
4. Two 2-mL syringes, #20-#23 gauge, 1-inch
needle.Copyright 2008 by
Pearson Education, Inc.
Rationales 3
1. This syringe would be too
small to give two 2.5 mL
doses.
2. Correct. 5 mL is too much
to inject into one site and
needs to be divided into two
2.5 mL doses. Therefore a 3-
mL syringe can be used.
3. This syringe would be too
small to give two 2.5 mL
doses.
4. This syringe would be too
Copyright 2008 by
Pearson Education, Inc.
Question 4
An elderly client with renal
insufficiency is to receive a
cardiac medication. The nurse is
most likely to administer which
of the following?
1. A decreased dosage.
2. The standard dosage.
3. An increased dosage.
4. A divided dosage.
Copyright 2008 by
Pearson Education, Inc.
Rationales 4
1. Correct. Due to renal
insufficiency, the dose of the
medication would need to be
decreased in order to avoid
accumulation of the medication
and the risk of toxicity.
2. Incorrect.
3. Incorrect.
4. Incorrect.
Copyright 2008 by
Pearson Education, Inc.
Question 5
Proper administration of an otic
medication to a two-year-old
client includes which of the
following?
1. Pull the ear straight back.
2. Pull the ear down and back.
3. Pull the ear up and back.
4. Pull the ear straight upward.
Copyright 2008 by
Pearson Education, Inc.
Rationales 5
1. Incorrect.
2. Correct. In clients less than 3
years of age, the ear must be
pulled down and back.
3. This method is only used in
individuals over 3 years of age.
4. Incorrect.
Copyright 2008 by
Pearson Education, Inc.
Rationales 1
1. Do not administer the
medication if there is any doubt.
2. Correct. If there is any doubt,
the medication administration
process should be interrupted
until the question is clarified.
3. Do not administer the
medication if there is any doubt.
4. Never leave medication
unattended.
Copyright 2008 by
Pearson Education, Inc.
Rationales 2
1. Order is okay.
2. Order is okay.
3. Order is okay.
4. Correct. The dosage is missing
from this order.
Copyright 2008 by
Pearson Education, Inc.
Rationales 3
1. This syringe would be too
small to give two 2.5 mL
doses.
2. Correct. 5 mL is too much
to inject into one site and
needs to be divided into two
2.5 mL doses. Therefore a 3-
mL syringe can be used.
3. This syringe would be too
small to give two 2.5 mL
doses.
4. This syringe would be too
Copyright 2008 by
Pearson Education, Inc.
Rationales 4
1. Correct. Due to renal
insufficiency, the dose of the
medication would need to be
decreased in order to avoid
accumulation of the medication
and the risk of toxicity.
2. Incorrect.
3. Incorrect.
4. Incorrect.
Copyright 2008 by
Pearson Education, Inc.
Rationales 5
1. Incorrect.
2. Correct. In clients less than 3
years of age, the ear must be
pulled down and back.
3. This method is only used in
individuals over 3 years of age.
4. Incorrect.
Copyright 2008 by
Pearson Education, Inc.
