Chapter 5
Medications
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Copyright Wolters
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Knowledge Needed to Administer Drugs
Safely
Drug name, preparations, and classifications
Mode of action and purpose of medication
Adverse effects and contraindications for medication
Antagonist of medication
Safe dosage range for medication
Interactions with other medications
Precautions to take before administrating medication
Proper administration technique
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Three Checks of Medication
Administration
The label on the medication package or container should be checked
three times during medication preparation and administration.
1. Read the eMAR/MAR and select the proper medication from the
patient's medication drawer or medication supply system. This is the
first check of the medication label.
2. After retrieving the medication from the drawer, compare the
medication label with the eMAR/MAR. Note: Compare with the
eMAR/MAR immediately before pouring from a multidose container.
This is the second check of the medication label.
3. The third check can be performed in one of two ways, depending on
facility policy:
• Most commonly, at the bedside, recheck the labels with the
eMAR/MAR after identifying the patient and before administration.
• When all medications for one patient have been prepared, recheck
the labels with the eMAR/MAR before taking the medication to the
patient.
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Question #1
The nurse is administering medications to patients on a
medical-surgical ward. What is the second check the nurse
would make to ensure the correct medication is given?
[Link] nurse reads the eMAR and selects the proper
medication from the unit stock.
[Link] nurse rechecks the labels with the eMAR before
taking the medication to the patient.
C. After retrieving the medication from the drawer, the
nurse compares the label with the eMAR.
D. At the bedside, the nurse rechecks the label with the
eMAR.
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Answer to Question #1
A. After retrieving the medication from the drawer, the
nurse compares the label with the eMAR.
Rationale: After retrieving the medication from the drawer,
the nurse compares the label with the eMAR, which is
the second check of the label. The first check is option
A, and the third checks are options B and D.
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Rights of Medication Administration
To prevent medication errors, always ensure that the:
1. Right medication is given 1. Right response by the
to the patient.
2. Right patient in the Additional rights have been
3. Right dosage (in the right suggested to include (10) the
form) through the right to education, ensuring
patients receive accurate and
4. Right route at the
thorough information about the
5. Right time for the medication, and (11) the right
6. Right reason based on the to refuse, acknowledging that
patients can and do refuse to
7. Right (appropriate) take a medication.
assessment data using the
8. Right documentation and
monitoring for the
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Nursing Responsibilities for Administering
Drugs
Assessing the patient and understanding clearly why the
patient is receiving a particular medication
Preparing the medication, using asepsis
Calculating accurate dosage calculations
Validating medication calculations with another nurse
Administering medication and documenting it has been
given
Monitoring patient reaction and evaluating response
Educating patients regarding their medication regimen
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Needle/Syringe Selection
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Factors Altering Drug Response in Older
Patients
Decreased gastric motility; increased gastric pH
Decreased muscle mass; decreased total body water
Decreased adipose tissue
Decreased number of protein-binding sites
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Question #2
A nurse administering mediations to older patients must
consider what age-related alteration that may affect the
drug action?
A. Decreased gastric motility
B. Increased lean body mass
C. Decreased adipose tissue
D. Increased lipid content in skin
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Answer to Question #2
A. Decreased gastric motility
Rationale: Decreased gastric motility may cause stomach
irritation, nausea, vomiting, and gastric ulceration. Older
patients also have decreased lean body mass leading to
increased possibility of drug toxicity; increased adipose
tissue, which may delay elimination of the drug; and
decreased lipid content in the skin, which may decrease
absorption of transdermal medications.
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Administering Oral Medications
Most commonly used route of administration
Usually most convenient and comfortable route for the
patient
Intended for absorption in the stomach and small
intestine
Drug action has slower onset and a more prolonged, but
less potent, effect than other routes
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Home Care Considerations for Oral
Medications
Encourage patient to discard outdated prescription
medications.
Discuss safe storage when children and pets are in the
home.
Discuss with parents difference in over-the-counter
medications for infants and children.
Encourage patients to carry a card listing all medications,
dosage, and frequency in case of emergency.
Discuss importance of using an appropriate measuring
device for liquid medications.
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Administering Medications via a Gastric
Tube
Types of tubes:
o Nasogastric, nasointestinal, percutaneous endoscopic
gastrostomy [PEG], or jejunostomy [J] tube.
Medications:
o Use liquid medications when possible because they
are readily absorbed and less likely to clog tube.
o Crush each pill one at a time to a fine powder and
mix with 15 to 30 mL of water before delivery
through the tube.
Not all medications can be crushed or altered.
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Procedures for Preparing Medications for
Injection
Removing medication from an ampule
Removing medication from a vial
Mixing medications from two vials in one syringe
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Administering an Intradermal Injection
Medication is administered into the dermis just below the
epidermis.
The intradermal route has the longest absorption time of
all parenteral routes.
o Used for sensitivity tests
o Body’s reaction to substances is easily visible
Sites used:
o Inner surface of forearm and upper back, under the
scapula
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Intramuscular Site Selection
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Administering a Subcutaneous Injection
Administered into the adipose tissue layer at a 45- to 90-
degree angle just below the epidermis and dermis
o Generally, insert the shorter, ⅜-inch needle at a 90-
degree angle and the longer, ⅝-inch needle at a 45-
degree angle.
o Because there are few blood vessels here, there is a
slow, sustained rate of absorption into the capillaries.
Sites used:
o Outer aspect of the upper arm, abdomen, anterior
aspects of the thigh, upper back, and upper ventral
or dorsogluteal area
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Angles of Insertions for Intramuscular,
Subcutaneous, and Intradermal Injections
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Administering an Intramuscular Injection
Delivers medications through the skin and subcutaneous
tissues into certain muscles
o Muscles have a larger and a greater number of blood
vessels than subcutaneous tissue, allowing faster
onset of action than with subcutaneous injections.
o The deposit of medication creates a depot at the
injection site, designed to deliver slow, sustained
release over hours, days, or weeks.
Consider age of patient, medication type, and volume
when selecting a site.
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Administering Continuous Subcutaneous
Infusion: Applying Insulin Pump
Allows for multiple preset rates of insulin delivery
Utilizes a small, computerized reservoir to deliver insulin
via tubing by a needle inserted into subcutaneous tissue
Sites should be changed every 2 to 3 days to prevent
tissue damage or absorption problems.
Advantages include longer rate of absorption and
convenience for the patient.
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Administering Medications by Intravenous
Bolus or Push Through an IV
Administration involves a single injection of a
concentrated solution directly into an IV line.
Drugs given by IV push are used for intermittent dosing
or to treat emergencies.
The drug is administered at the rate recommended by the
manufacturer, biomedical literature, or according to
institutional guidelines.
Done manually or by use of a venous access device being
used for continuous infusion of fluid.
Confirm exact administration times by consulting a
pharmacist, package insert, or drug reference.
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Question #3
Is the following statement true or false?
The deposit of medication administered intravenously
creates a depot at the site of injection, designed to deliver
slow, sustained release over hours, days, or weeks.
A. True
B. False
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Answer to Question #3
B. False
Rationale: Drugs given by IV push are used for intermittent
dosing or to treat emergencies. The drug is administered
very slowly over at least 1 minute. The deposit of
medication via an intramuscular injection creates a depot
at the site of injection, designed to deliver slow, sustained
release over hours, days, or weeks
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Administering an Intermittent IV Infusion
of Medication via a Mini-infusion Pump
The drug is mixed with a small amount of the IV solution,
and administered over a short period at the prescribed
interval.
The mini-infusion pump (syringe pump) for intermittent
infusion is battery or electrically operated and allows
medication mixed in a syringe to be connected to the
primary line and delivered by mechanical pressure
applied to the syringe plunger.
“Smart (computerized) pumps” are being used by many
facilities for IV infusions, including intermittent infusions.
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Administering an Intermittent IV Infusion
via a Volume-Control Administration Set
With intermittent IV infusion, the drug is mixed with a
small amount of the IV solution (e.g., 50 to 100 mL) and
administered over a short period at the prescribed
interval (e.g., every 8 hours).
The administration is most often performed using an
electronic infusion device (IV or infusion pump), which
requires the nurse to program the infusion rate into the
pump.
Administration may also be achieved by gravity infusion,
which requires the nurse to calculate the infusion rate in
drops per minute.
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Introducing Drugs Through a Medication
or Drug-Infusion Lock with Saline Flush
A medication or drug-infusion lock, also known as an
intermittent peripheral venous access device or saline
lock, is used for patients who require intermittent IV
medication, but not a continuous IV infusion.
This device consists of a needle or catheter connected to
a short length of tubing capped with a sealed injection
port.
After the catheter is in place in the patient’s vein, the
catheter and tubing are anchored to the patient’s arm so
that the catheter remains in place until the patient no
longer requires the repeated medication intravenously.
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Applying a Transdermal Patch
Involves applying a disk or patch containing medication
to the skin
Commonly used to deliver hormones, opioid analgesics,
cardiac medications, and nicotine
Medication errors have occurred when patients apply
multiple patches at once or fail to remove the overlay on
the patch that exposes the skin to the medication.
Opioid analgesic patches are associated with the most
adverse drug effects
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Administering Eye Drops into Conjunctival
Sac
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Instilling Ear Drops (Pulling Pinna up and
Back)
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Administering a Nasal Spray
Nasal spray is used to treat allergies, sinus infections, and
nasal congestion.
Medications with a systemic effect may also be prepared
as a nasal instillation.
Medical asepsis should be observed when administering a
nasal spray.
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Administering a Vaginal Cream
Creams, foams, tablets, and suppositories melted by
body heat can be applied intravaginally.
Uses a narrow tubular applicator with an attached
plunger
Time administration to allow the patient to lie down
afterward to retain the medicine.
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Administering Medication via Metered-
Dose Inhaler (MDI)
Hand-held inhaler that uses an aerosol spray or mist
Delivers a controlled dose of medication with each
compression of the canister
Medication is absorbed rapidly through lung tissue.
Results in local and systemic effects
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Methods of Administering Inhaled
Medications
Metered-dose inhaler (MDI)
Small-volume nebulizer
Dry power inhaler
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Administering a Rectal Suppository
Must be placed past the internal anal sphincter and
against the rectal musosa
Used primarily for local action
o Laxatives
o Fecal softeners
Systemic effects also achieved
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Inserting the Suppository Round End First
Along the Rectal Wall
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