Unit 13  Administration of Medications

A www.med126.com/rencai/medication or a drug is a substance used to prevent diseases, to aid in the diagnosis and treatment of diseases, and to restore or maintain function in body tissues. In the health care context, the words medication and drug are generally used interchangeably. The preparation and administration of medications are vital nursing functions. In order that the medications are reasonable, safe and effective to patients, nurses must know the medication condition of the patients as well as the pharmacology of the medication well. Nurses must also be skilled at administering medications, evaluate the effects of medications, and instruct the patients to take medicine correctly.

Chapter 1  Basic Knowledge of Medications

Principles of Drug Administration

When administering any drug, regardless of the route of administration, the nurse should identificate the patient first, then administrate the drug, provide adjunctive nursing care as indicated, record and evaluate the patient’s response to the drug last.

When giving medications, the nurse is guided by a number of principles. Hospital policies vary, but the medication policies encompass many of the following general principles.

●  Medications are prescribed only by physicians and dentists, and are to be in writing. In an emergency, oral or telephone orders may be carried out, but the order must be written and signed as soon as possible; this is important because a written order protects the physician, the patient, and the nurse. It is a permanent record that cannot be disputed and is always available for reference. The nurse is responsible for carrying out an order as it is written; she is never permitted to make the slightest change. If you have any reason to question an order or do not understand it, you must consult the head nurse or the physician before proceeding.

●  Medications are given by the person who prepared them. If not given, the drug should not be returned to the drug cabinet or cart unless it is still in the labeled unit dose package.

●  Medications are not to be left at the bedside because they may not be taken correctly. Exceptions for drugs such as antacids or nitroglycerin may be made when so ordered in writing by the doctor.

●  Narcotics and other controlled drugs are kept in locked cabinets. The nurse is responsible for its security and must account for each dose used.

Principles for administering medications safely

It is essential that the nurse administer medications safely and competently, according to the following principles:

●  Check medication orders before giving drugs. Routinely compare medicine cards or medication records with those listed on the Kardex nursing care card to see that there are no errors or omissions. If there is a question about the accuracy, refer to the original order on the doctor’s order sheet.

●  Know about the drugs you are giving. Look up information on unfamiliar drugs concerning their action, dosage, and any precautions to be followed.

●  Observe the “five rights” when administering drugs. Make sure to check three times: before administration, at the time of administration, and after administration.

a. Give the drug to the right patient. Be sure that you give each medication to the right patient. Check the patient’s identity by referring to the identification band, if used, rather than by stating the name, since owing to their condition some patients may 医.学全在线www.med126.comanswer to names other than their own. If you are not sure of the patient’s identity, ask him his name. The patient must state his name, and not only answer “yes” or “no". Stay with the patient until he has swallowed an oral medicine. If left alone with a medication, the patient may dispose of it.

b. Give the right drug. Check the label of the drug carefully with the order; they should be the same. Listen when a patient questions the correctness of a medication. If a patient has been getting a red pill and is offered a white one instead, it is not surprising if he suspects a mistake. Recheck the order, the label, and the medication card.

c. Give the right dose. If the dose differs from the amount shown on the label, verify your calculations with another person if possible.

d. Give the drug at the right time. It is important to give it as scheduled in order to maintain a therapeutic level of the medication in the blood stream. Check the time for giving a drug with the Kardex and the medication card. Follow the routine of the hospital as to intervals or routine times when medications are given. You must know which types of medications are usually given four times a day, during waking hours, or every 6 hours, around the clock. You must also know which medications must be given before meals or after. Be sure you know the abbreviations for times, such as t.i.d, and b.i.d., and ask if you are not sure.

e. Give the drug by the right method. Many drugs come in various forms and can be given by oral, IM, or IV. If a drug is specified for IM use, do not give it intravenously. Solutions designated for IV must not be given by other routes. Check the physician’s orders and the Kardex to verify the method by which the medication should be given. Remember, some drugs can cause death if given by the wrong method. You should be aware of the usual route for certain medications. Some hospitals color code medications by route of administration. Know the color codes of the medication cards followed by your hospital.

a. Do not place different types of drugs together in a cup. For example, do not place a PRN medication with a regularly given medication, and do not place digitalis with other medications. Why? Because the patient might not get one medication and you would not be able to identify for certain which drug was which in the cup.

b. Never leave a medicine tray within reach of patients. If you must leave the room or the ward, take the tray with you. Lock it up if necessary.

c. Always chart medications as soon as you have given them. Never chart a medication before you give it.

d. Record the time, name of the drug, dosage, and method. Add your name so the physician will know who gave the drug.

e. Record and report immediately any unusual patient reaction, such as vomiting, an unfavorable change in the patient’s condition, his refusal to take the medicine, or his inability to take all of it. If you find that you have forgotten to give a medication, you must report this promptly. This is a medication error.

f. Discard an unused dose of a medication－never return it to the stock container. Medications, which are discarded should be poured down the sink or flushed down the hopper. You must have a witness cosign with you if you discard a narcotic.

Routes of Administration of Drugs

Pharmaceutical preparations are designed for a specific route of administration. Normally, the route of administration is specified when the drug is ordered. When a nurse is administering the drug, it is essential that the pharmaceutical preparation be appropriate to the route ordered. The main routes of administration are oral administration, parenteral administration, and topical administration.

The method chosen to administer a drug depends on the nature and the amount of the drug to be given, the speed of its action, and the patient’s condition. There may be a local effect at the point where the drug is applied or a systemic effect, whereby the drug is absorbed into the circulation and carried to body cells.

Local effects may be obtained by applying drugs to the skin or mucous membranes. Antiseptics such as alcohol on a cut or scratch, or soothing drugs such as a lotion on a rash are applied directly to the skin. Drug preparations are applied to the mucous membranes of the eye, mouth, nose, throat, and genitourinary tract by swabbing, spraying, instillation, or irrigation. They are applied to the vagina and rectum in the form of suppositories. There are several methods for introducing drugs into the circulation and obtaining systemic effects. These methods of administration include oral, intramuscular injection, and intravenous injection.

Oral administration  

Most commonly, drugs are administered orally. Oral administration is usually least expensive and most convenient for most patients. It is also a safe method of administration in that the skin is not broken as it is for an injection.

The major disadvantages of oral administration are that the drugs may have an unpleasant taste or be difficult to swallow, irritate the gastric mucosa, be absorbed irregularly from the gastrointestinal tract, be absorbed slowly, and in some cases harm the teeth. Patients who are nauseated or vomiting cannot take drugs by mouth and some drugs irritate the lining of the stomach, causing nausea and vomiting. Digestive enzymes destroy the effectiveness of certain drugs. In some instances patients may also be uncooperative and refuse to swallow the medication. Furthermore, there is the danger of a semi-comatose or partially unconscious patient aspirating a medication into his lung.

Sublingual administration 

Sublingual drug is placed under the patient's tongue where it dissolves and is absorbed. The patient must be able to understand the instructions and keep the drug under the tongue and not swallow it. He should not take a drink until it is absorbed. Nitroglycerine in tablet form is one of the few drugs given sublingually.

Buccal administration

Buccal administration involves placing the solid medication in the mouth and against the mucous membranes of the cheeks until the drug dissolves. Patients should be taught to alternate cheeks with each subsequent dose to avoid mucosal irritation. The drug may act locally on the mucous membranes of the mouth or systematically when it is swallowed in the saliva.

Parenteral administeration

Parenteral administration is a method of administering a drug other than through the digestive tract. Drugs are injected into body fluids or tissues through a needle.

The medications must be soluble, absorbable, sterile, and not irritating or injurious to the tissues. Injection has the advantage of rapid action, but can be dangerous if there is an error in dosage or technique. Repeated insertions of a needle may also make the tissues tender and sore, and there is always the possibility of infection when the skin is pierced.

The scratch test  The scratch test is a series of tests primarily designed to detect the causative agent in inhalant allergies, such as dusts, dander, molds, and pollens. Scratch test kits are in different sizes, with varying numbers of antigens. Some physicians maintain multiple dose vials of antigens for the common local allergies rather than the test kits, which often include antigens that are not needed. Complete or partial testing may be done, as indicated by the patient’s history.

Intradermal injection  A small amount of a drug is injected just beneath the outer layer of the skin, making a bump, or wheal, where it is absorbed slowly. This method is used when testing for allergies and tuberculosis.

Subcutaneous injection  A small amount of a drug is injected into the subcutaneous tissues (hypodermically). This method is used to give drugs that are soluble and nonirritating.

Intramuscular injection  A drug is injected into the muscle beneath the subcutaneous tissue. This method is used when giving irritating drugs or large amounts of a drug, because deep muscle tissue has fewer nerve fibers. Also, absorption of the drug is faster because muscle tissue has a great number of blood vessels. The injection is most commonly given in the gluteal or deltoid muscle, because these muscles are large enough to absorb a substantial amount of a drug.

Intravenous injection, or infusion  A drug is injected directly into a vein if it is given intravenously. This method is used when it is necessary to obtain the needed effect quickly or when it is impossible to inject a drug into other tissues. If a large quantity of solution is given it is called an infusion. The procedure requires technical skill and sometimes must be done by physician. In some hospitals, registered nurses regularly perform this procedure. Intravenous injection is commonly given for dehydration and excessive loss of blood to dilute poisons in the blood and other body fluids, or to provide electrolytes, drugs, and nutrients. If blood is given, this intravenous route is called a transfusion.

Topical administration

Topical applications are those applied to a circumscribed surface area of the body. They are designed to affect only the area to which they are applied, but some systematic absorption may occur. Topical applications include:

●  Dermatologic preparations  Medications applied to the skin

●  Instillations  Medications applied into body cavities or orifices, such as the eyes, ears, nose, rectum, or vaginal.

●  Inhalations  Drugs that can be vaporized may be given through the respiratory tract. So much absorbing surface is available in the lungs and the bronchi that the drug is rapidly absorbed and quickly effective. This is very important in an emergency, as in the administration of oxygen or bronchodilators.