Скачать презентацию Medication Administration By Diana Blum MSN NURS 1510 Скачать презентацию Medication Administration By Diana Blum MSN NURS 1510

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Medication Administration By: Diana Blum MSN NURS 1510 Medication Administration By: Diana Blum MSN NURS 1510

History • Definition: Substance administered for diagnosis, cure, treatment, or relief of a symptom History • Definition: Substance administered for diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. • Opium, castor oil, vinegar used in ancient times

Names • Generic – Given before drug officially approved • Official – Name under Names • Generic – Given before drug officially approved • Official – Name under which it is listed in publications • Brand/TRADE – Given my manufacturer – Several names if several manufacturers • Chemical – Name by which the chemists know it

Legal Aspects • U. S. drug legislation • Sets official drug standards • Defines Legal Aspects • U. S. drug legislation • Sets official drug standards • Defines prescription drugs • Regulates controlled substances • Improves safety • Requires proof of efficacy • Nurse Practice Acts • Identify nursing responsibilities for administration and client monitoring

Standards • • Vary in strengths and activities Controlled by law NURSES can be Standards • • Vary in strengths and activities Controlled by law NURSES can be punished if error made Controlled substances locked up in hospital

Effects of Drugs • Therapeutic/Desired: what is intended or reason it was prescribed • Effects of Drugs • Therapeutic/Desired: what is intended or reason it was prescribed • SE: secondary effect: effect that is not intended – May be harmful or harmless • Adverse Effects: more serious side effects or a reaction to the drug • Drug toxicity: related to overdose, ingestion when meant to be external in use, or build up in blood. • Allergic Reaction: immune response to drug • Anaphylactic Reaction: severe allergy to drug that could become fatal

Tolerance • Person requires increase dose to maintain effectiveness (opiates, tobacco, etc) • Cumulative Tolerance • Person requires increase dose to maintain effectiveness (opiates, tobacco, etc) • Cumulative effect: increased response to repeated doses. Toxic symptoms may occur. • Idiosyncratic effect: unexpected result. Under response or over response • Interaction: response to 2 drugs at once

Drug Misuse • Improper use of common meds • Abuse: inappropriate intake of drug Drug Misuse • Improper use of common meds • Abuse: inappropriate intake of drug • Dependence: reliance of a drug may be physiologic or psychologic • Habituation: feels better after taking drug • Illicit: street drug

Actions of Drugs on the Body • Half life: the time it takes for Actions of Drugs on the Body • Half life: the time it takes for half of the drug to be excreted from the body • If you don’t receive steady amount of the drug it concentration decreases. • Onset of action: time it takes for the body to respond to drug • Peak plasma level: the highest level achieved by a single dose • Plateau: maintained level during a series of scheduled doses • Agonist acts to respond to a substance • Antagonist acts to inhibit a response to a substance

Pharmacokinetics • Process by which drug is excreted absorbed distributed or biotransformed. • Absorption: Pharmacokinetics • Process by which drug is excreted absorbed distributed or biotransformed. • Absorption: process of passing in the blood stream • Distribution: transportation from site of absorption to site of action. • Biotransformation: process that converts the drug to a less active form by way of a detox or metabolism • Excretion: leaves the body

Factors that affect med action • • Developmental factors Gender Genetics/culture Diet Environment Psychologic Factors that affect med action • • Developmental factors Gender Genetics/culture Diet Environment Psychologic Illness/disease Time of administration

Medication Systems Stock Supply: Unit Dose: • Bulk quantity • Central location • Not Medication Systems Stock Supply: Unit Dose: • Bulk quantity • Central location • Not client-specific • Individually packaged • Client-specific drawers • 24 -hour supply

Medication Systems Automated Dispenser: • Password-accessible locked cart • Computerized tracking • Can combine Medication Systems Automated Dispenser: • Password-accessible locked cart • Computerized tracking • Can combine stock and unit doses Self-Administration: • Individual containers • Kept at client’s bedside

Orders • Types – – STAT Standing PRN Single • Parts of the Order Orders • Types – – STAT Standing PRN Single • Parts of the Order – – – – Name Date and time Name of drug Dose Frequency Route why signature • • TORB VORB Handwritten preprinted

Nursing Considerations: Medication Administration Safety Three checks: • Before you pour: • Check the Nursing Considerations: Medication Administration Safety Three checks: • Before you pour: • Check the medication label against the MAR • After you pour: • Verify the label against the MAR • At the bedside: • Check the medication again

Nursing Considerations: Medication Administration Safety Six Rights: • • • Right drug Right client Nursing Considerations: Medication Administration Safety Six Rights: • • • Right drug Right client Right dose Right time Right route Right documentation Other Rights: • Right reason • Right to know • Right to refuse

Routes • • • PO SL Buccal Parenteral: SQ, IM, IV, intrdermal Topical Routes • • • PO SL Buccal Parenteral: SQ, IM, IV, intrdermal Topical

Parenteral Medication Administration Equipment Preparation: • Syringe/needle (size, gauge) Medication Preparation: • Vials and Parenteral Medication Administration Equipment Preparation: • Syringe/needle (size, gauge) Medication Preparation: • Vials and ampules • Reconstituting from powder • Two medications in one syringe • Never recap dirty needle • Use the correct site • Wrong site could mean wrong route • Be familiar with the technique required for the medication (e. g. , heparin, insulin)

Avoiding Medication Errors • Use the six rights • Calculate doses carefully; double-check with Avoiding Medication Errors • Use the six rights • Calculate doses carefully; double-check with a second RN • Watch for drugs with similar names • Watch for clients with same last names • Clarify illegible orders • Know and use your resources • Keep up with changes in medication orders

 • Conversions • Conversions

Systems of measurement Metric Ordered by units of 10 Decimal system Liter and gram Systems of measurement Metric Ordered by units of 10 Decimal system Liter and gram are basic units kilogram milligram microgram milliliter

Apothecaries • • • Older than metric Grain Minum Pound Pints quarts Apothecaries • • • Older than metric Grain Minum Pound Pints quarts

Household • • • Drops Teaspoons Tablespoons Cups Glasses Household • • • Drops Teaspoons Tablespoons Cups Glasses

Equivalents of Measurements Metric: decimal system, most logically organized. Each unit is organized into Equivalents of Measurements Metric: decimal system, most logically organized. Each unit is organized into units of 10. In X the decimal moves to the “R”; in division it moves “L” Basic measurement=meter(L), liter(volume), gram(weight)

 • Basic units: – Deci 1/10 or 0. 1 – Centi 1/100 or • Basic units: – Deci 1/10 or 0. 1 – Centi 1/100 or 0. 01 – Milli 1/1000 or 0. 001 • 500 mg or 0. 5 g, not 1/2 g • 10 ml or 0. 01 L, not 1/100 L – With fractions the zero is always place in front of the decimal to prevent error

Conversion in One System • In metric system, division or multiplication are used, ie, Conversion in One System • In metric system, division or multiplication are used, ie, to change mg to g. divide by 1000 or move the decimal 3 points to the left • To convert liters to ml, multiply by 1000 or move the decimal 3 points to the right

 • To convert units of measurement within the apothecary or household system, must • To convert units of measurement within the apothecary or household system, must know the equivalent. • Example: To convert ounces to quarts must know 32 oz is = to 1 quart • To convert 8 oz to a quart measurement, divide 8 by 32 to get the equivalent, ¼ or 0. 25 quart

Setting Up the Calculations • When looking at a medication order, ask yourself 3 Setting Up the Calculations • When looking at a medication order, ask yourself 3 questions: What did the MD order? (desired quantity) What do I have on hand? (dose available) What conversion factor (conversion do I need? factor)

 • The desired quantity is the MD order, (10 mg, v gr) • • The desired quantity is the MD order, (10 mg, v gr) • The dose available is found on the drug label, (tablet, number of capsules, ml) • *Remember, the quantity of tablets, capsules, or ml is always the numerator of the dose available; the amount (or dosage) is in the denominator

 • To decide which equivalent measure should be in the numerator and which • To decide which equivalent measure should be in the numerator and which should be in the denominator, look at the units of measure in the desired quantity. • The units of measure in the desired quantity should be in the denominator of the conversion factor (i. e. , if the desired quantity is 100 mg and the equivalent conversion factor is 1000 mg = 1 g, then the conversion factor in fraction form should be 1 g / 1000 mg

Formula Desired quantity x Dose available X Conversion (if factor needed) = Amount to Formula Desired quantity x Dose available X Conversion (if factor needed) = Amount to Administer This is a simple formula that uses ratio and proportions which will help you both correctly set up and solve dosage calculation problems

 • MD order: ASA 300 mg q 4 h prn pain • Drug • MD order: ASA 300 mg q 4 h prn pain • Drug label: ASA 1 tab = v gr • Conversion factor: 1 gr = 60 mg • 5 gr x 1 tab x 60 mg = x • 300 mg 1 gr • 5 x 1 tab x 60 = 300 tab = x • 300

continued • • • 300 tab = x 300 x = 1 tab continued • • • 300 tab = x 300 x = 1 tab

More Formulas • Another basic formula that can be used when preparing solid or More Formulas • Another basic formula that can be used when preparing solid or liquid forms: Desire dose X Amt on hand = Amt to give dose Have Demerol 50 mg ordered comes in 100 mg vial in I cc

Rate of infusions • Amount in cc’s X drip factor = gtt/min • time Rate of infusions • Amount in cc’s X drip factor = gtt/min • time in minutes

Conversions to know • • • 1 gram (G) = 1000 milligrams (mg) 1000 Conversions to know • • • 1 gram (G) = 1000 milligrams (mg) 1000 micrograms (mcg) = 1 mg 60 -65 mg = 1 grain (gr) 1 fluid ounce = 30 ml or 2 tablespoons 1 teaspoon = 5 ml 1000 ml = 1 quart or 1 liter 1 kg = 2. 2 pounds (lb) 1 inch = 2. 54 cm 1 m. L=15 gtts 30 m. L=1 ounce 1 tbsp= 15 m. L