Professional Documents
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Medications
Medications
Fundamentals of Nursing
Concepts, Process, and Practice
TENTH EDITION, GLOBAL EDITION
CHAPTER 35
Medications
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Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
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Audrey Berman | Shirlee Snyder | Geralyn Frandsen
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Learning Outcomes
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Introduction
• Medication
▪ Substance administered for diagnosis,
cure, treatment, or relief of symptom or
for prevention of disease
• Drug
▪ Same as medication but also refers to
illicitly obtained substance
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Introduction
• Prescription
▪ Written direction for preparation and
administration of a drug
• Generic name
▪ Name used throughout the drug's
lifetime
• Trade (brand) name
▪ Given by drug manufacturer
▪ Identifies it as property of that company
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Introduction
• Official name
▪ Name by which drug is listed in official
publications
• Chemical name
▪ Name by which a chemist knows it
▪ Describes constituents of the drug
precisely
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Introduction
• Pharmacology
▪ Study of effect of drugs on living
organisms
• Pharmacy
▪ Prepares, makes, and dispenses drugs
as ordered
• Pharmacist
▪ Person who prepares, makes, and
dispenses drugs as ordered
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Drug Standards
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Legal Aspects of Administering
Medications
• Nursing practice acts
• Recognizing limits of own knowledge
and skill
• Take responsibility for actions
• Question any order that appears
unreasonable
• Refuse to give medication until order is
clarified
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Legal Aspects of Administering
Medications
• Controlled substances
▪ Kept under lock
▪ Special inventory forms
▪ Documentation requirements
▪ Procedures for discarding
▪ End-of-shift counts of controlled
substances
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Figure 35–1 Some narcotics are kept in specially designed packages or plastic containers that are sectioned
and numbered.
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Effects of Drugs
• Therapeutic effect
▪ Desired effect
▪ Reason drug is prescribed
• Side effect
▪ Secondary effect
▪ Unintended, usually predictable
▪ May be harmless or harmful
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Effects of Drugs
• Adverse effect
▪ More severe side effect
▪ May justify discontinuation of a drug
• Drug toxicity
▪ Results from overdose, ingestion of
external-use drug, or buildup of drug in
blood
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Effects of Drugs
• Drug allergy
▪ Immunologic reaction to drug
▪ Mild to severe reactions
• Anaphylactic reaction, anaphylaxis
• Drug tolerance
▪ Unusually low physiological response
▪ Requires increases in the dosage to
maintain a given therapeutic effect
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Effects of Drugs
• Drug tolerance
▪ Cumulative effect
• Increased effect resulting from rate of
dosage being higher than rate of
excretion
▪ Idiosyncratic effect
• Unexpected; may be individual to client
• Drug interaction
▪ One drug alters effect of other drug(s).
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Effects of Drugs
• Potentiating effect
▪ One or both drugs is increased.
▪ Additive
• Two of same types of drugs increase
action of each other.
▪ Synergistic
• Two different drugs increase action of
one or another.
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Effects of Drugs
• Inhibiting effect
▪ Effect of one or both drugs is decreased.
• Iatrogenic disease
▪ Disease unintentionally caused by
medical or drug therapy
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Drug Misuse
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Actions of Drugs on the Body
• Half-life
▪ Time interval required for body's
elimination processes to reduce the
concentration of the drug in the body by
one-half
• Onset of action
• Peak plasm level
• Drug half-life (elimination half-life)
• Plateau
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Figure 35–2 A graphic plot of drug concentration in the blood plasma following a single dose.
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Pharmacodynamics
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Pharmacodynamics
• Agonist
▪ Same response as endogenous
substance
• Antagonist
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Pharmacokinetics
• Distribution
▪ Transportation of a drug from its site of
absorption to its site of action
• Biotransformation
▪ Also called detoxification or metabolism
▪ Process by which a drug is converted to
a less active form
▪ Metabolites
• Products of this process
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Pharmacokinetics
• Excretion
▪ Process by which metabolites eliminated
▪ Mostly through urine
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Factors Affecting Medication
Action
• Developmental factors
▪ Risks during pregnancy
▪ Infants require smaller dosages.
▪ Older adults experience decreased
gastric motility
• Gender
▪ More drug research done on men
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Factors Affecting Medication
Action
• Cultural, ethnic, and genetic factors
▪ Pharmacogenetics
▪ Ethnopharmacology
• Study of the effect of racial, ethnic
responses to prescribed medication
• Diet
▪ Nutrients can affect action of a
medication
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Factors Affecting Medication
Action
• Environment
▪ Especially affects drugs used to alter
behavior and mood
• Psychological factors
▪ Expectations
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Factors Affecting Medication
Action
• Illness and disease
▪ Action altered in clients with circulatory,
liver, or kidney dysfunction
• Time of administration
▪ Some drugs absorbed more quickly if
stomach is empty, some when stomach
is full
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Routes of Administration
• Oral
▪ Most common, least expensive, most
convenient
• Sublingual
▪ Not to be swallowed, but dissolved
• Buccal
▪ Cheek
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Figure 35–3 Sublingual administration of a tablet.
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Figure 35–4 Buccal administration of a tablet.
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Routes of Administration
• Parenteral
▪ Subcutaneous (hypodermic)
▪ Intramuscular (IM)
▪ Intradermal (ID)
▪ Intravenous (IV)
▪ Less common
• Intrathecal/intraspinal
• Epidural
• Intracardiac
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Routes of Administration
• Topical
▪ Dermatologic
▪ Installations and irrigations
▪ Inhalations
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Medication Orders
• Ordered by physicians
▪ Sometimes nurse practitioners,
physician assistants depending on state
laws and agency policies
• Verbal and telephone orders
• Abbreviations, acronyms, and symbols
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Types of Medication Orders
• Stat order
▪ Such as morphine sulfate 10 milligrams
IV stat
• Single order
▪ Such as Seconal 100 mg hs before
surgery
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Types of Medication Orders
• Standing order
▪ Indefinitely, such as multiple vitamins
daily
▪ Specified number, such as KCl twice
daily × 2 days
• PRN order
▪ Such as Amphojel 15 mL prn
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Essential Parts of a Medication
Order
• Full name of client
• Date and time order is written
• Name of drug to be administered
• Dosage of drug
• Frequency of administration
• Route of administration
• Signature of person writing the order
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Figure 35–5 A prescription filled out by a primary care provider.
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Box 35–2 Parts of a Prescription
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Communicating Medication Orders
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Systems of Measurement
• Metric system
▪ Devised by the French
▪ Logically organized into units of 10
▪ Meter, liter, gram basic units
• Apothecaries' system
▪ Older than metric system
▪ Grain, minim basic units
▪ Do not use; unfamiliar to many
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Figure 35–7 Basic metric measurements of volume and weight.
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Systems of Measurement
• Household system
▪ May be used when more accurate
systems not required
▪ Drops, teaspoons, tablespoons, cups,
and glasses
▪ Pints and quarts defined as
apothecaries' measures
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Converting Units of Weight and
Measure
• Converting weights within the metric
system
▪ Gram (g), milligram (mg), and
microgram (mcg) only units used for
dosages
▪ Divide or multiply and move decimal
points
▪ Put a 0 in front of decimal point if less
than 1 (0.5 g)
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Converting Units of Weight and
Measure
• Converting weights and measures
between systems
▪ Nurse may need to convert from
systems used by pharmacies
• Converting units of volume
▪ Fluid drams, ounces used in liquid
medications
▪ Liters, milliliters used for enemas,
irrigations, and solutions for wounds
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Converting Units of Weight and
Measure
• Converting units of weight
▪ Milligrams to grains
• Milligram is smaller than a grain
• 1 grain = 60 mg
▪ Pounds to kilograms
• 2.2 lb = 1 kg
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Table 35–7 Approximate Volume Equivalents:
Metric, Apothecaries', and Household Systems
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Methods of Calculating Dosages
• Basic formula
▪ (D × V) / H
▪ D (desired dose)
▪ H (dose on hand)
▪ V (vehicle or form of drug)
• Ratio and proportion method
▪ H : V :: D : x
▪ Considered to be the oldest method
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Methods of Calculating Dosages
• Dimensional analysis
4. Set up equation
5. Cancel units that appear in numerator
and denominator
6. Multiply numerator; multiply
denominator; divide the products
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Methods of Calculating Dosages
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Administering Medications Safely
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Medication Reconciliation
• Medication cart
▪ Mobile
• Medication cabinet
▪ Locked, in client's room
• Medication room
▪ Accessed by key, code
• Automated dispensing cabinet
▪ Reduces risk of error, theft
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Figure 35–11 The medication cart is kept locked when not in use. The nurse is using a key to access client
medications.
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Process of Administering
Medications
• Identify the client
• Inform the client
• Administer the drug
• Provide adjunctive interventions as
indicated
• Record the drug administered
• Evaluate the client's response to the
drug
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Box 35–6 Ten “Rights” of Medication
Administration
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Figure 35–13A A sample bar code.
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Developmental Considerations
• Older adults
▪ Altered memory
▪ Decreased visual acuity
▪ Decrease in renal function
▪ Less complete and slower absorption
from gastrointestinal tract
▪ Increased proportion of fat to lean body
mass
• Older adults
▪ Decreased liver function
▪ Decreased organ sensitivity
▪ Altered quality of organ responsiveness
▪ Decrease in manual dexterity
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Oral Medications
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Skill 35–1 Administering Oral Medications
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Nasogastric and Gastrostomy
Medications
• Nasogastric tube, gastrostomy tube
• Practice guidelines
▪ Check with pharmacist a liquid form
▪ Check to see if medication can be
crushed
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Nasogastric and Gastrostomy
Medications
• Practice guidelines
▪ Crush tablet into fine powder and
dissolve in at least 30 mL of warm water
▪ Open capsules and mix contents with
water only if pharmacist says it is safe
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Figure 35–14 The three parts of a syringe.
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Equipment
• Syringes
▪ Parts
• Tip, which connects with needle
• Barrel
• Plunger
▪ Hypodermic
• Syringes vary
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Equipment
• Syringes
▪ Insulin
• Common problems with insulin pen
• Needlestick injuries
• Errors in technique
• Using the pen like a vial
• Using the pen for more than one client
▪ Tuberculin
• Narrow
continued on next slide
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Equipment
• Syringes
▪ Luer-Lok syringe
• Requires needle to be twisted onto it
▪ Non-Luer-Lok syringe
• Has smooth graduated tip
• Needles are slipped onto it
A B
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Figure 35–19 A 60-mL non–Luer-Lok syringe, which can be used for irrigation of tubes or wounds.
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Equipment
• Syringes
▪ Prefilled unit-dose systems
• Prefilled syringes ready for use
• Prefilled sterile cartridges and needles
that require attachment of reusable
holder before use
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Equipment
• Needles
▪ Stainless steel
▪ Most disposable
▪ Parts
• Hub
• Cannula or shaft
• Bevel
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Equipment
• Needles
▪ Characteristics
• Slant or length of bevel
• Length of shaft
• Gauge (diameter) of shaft
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Figure 35–22 The parts of a needle.
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Equipment
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Figure 35–26 Passive safety device. The needle retracts immediately into the barrel after injection.
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Figure 35–27 Active safety device. The nurse manually pulls the sheath or guard over the needle after
injection.
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Figure 35–28 A needleless system can extract medication from a vial.
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Box 35–8 Avoiding Puncture Injuries
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Preparing Injectable Medications
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Skill 35–2 Preparing Medications from Ampules
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Preparing Injectable Medications
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Skill 35–4 Mixing Medications Using One Syringe
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Intradermal Injections
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Figure 35–32 Body sites commonly used for intradermal injections.
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Skill 35–5 Administering an Intradermal Injection
for Skin Tests
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Subcutaneous Injections
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Figure 35–33 Body sites commonly used for subcutaneous injections.
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Skill 35–6 Administering a Subcutaneous Injection
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Intramuscular Injections
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Intramuscular Injections
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Intramuscular Injections
• Ventrogluteal site
▪ Preferred
• No large nerves, vessels
• Sealed off by bone
▪ Side-lying position most accessible
• Vastus lateralis site
▪ Best for infants, young children
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Figure 35–35 Landmarks for the ventrogluteal site for an intramuscular injection.
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Figure 35-37 The vastus lateralis muscle of an infant's upper thigh, used for intramuscular injections.
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Figure 35–40 Landmarks for the rectus femoris muscle of the upper right thigh, used for intramuscular
injections.
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Intramuscular Injections
• Dorsogluteal site
▪ Not preferred, should be avoided
▪ Close to sciatic nerve and superior
gluteal nerve
• Complications have occurred.
• Numbness
• Pain
• Paralysis
▪ Subcutaneous tissue
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Intramuscular Injections
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Intramuscular Injection Technique
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Skill 35–7 Administering an Intramuscular
Injection
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Intravenous Medications
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Skill 35–8 Adding Medications to Intravenous Fluid
Containers
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Intravenous Medications
• Volume-controlled infusions
▪ Set such as Buretrol, Soluset, Volutrol,
and Pediatrol
▪ Often used with children, older clients
when volume administered is critical
and must be carefully monitored
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Intravenous Medications
• Intravenous push
▪ Or bolus
▪ Undiluted and used in emergency
▪ Errors may not be corrected and drug
may irritate lining of blood vessels
• Intermittent infusion devices
▪ For clients receiving long-term therapy
▪ SASH flushing procedure
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Skill 35–9 Administering Intravenous Medications
Using IV Push
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Topical Medications
• Percutaneous
• Transdermal patch
• Skin applications
▪ Clean skin before applying
▪ Wear gloves
▪ Use surgical asepsis in presence of open
wound
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Topical Medications
• Ophthalmic medications
▪ Liquid or ointment medication into eye
• Irrigation
• Instillation
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Skill 35–10 (continued) Administering
Ophthalmic Instillations
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Topical Medications
• Otic medications
▪ Administer medication to external
auditory canal
• Irrigation
• Instillation
▪ Position of canal varies with age.
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Skill 35–11 Administering Otic Instillations
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Topical Medications
• Nasal medications
▪ Shrink swollen mucus membranes
▪ Loosen secretions and facilitate drainage
▪ Treat infections of nasal cavity and
sinuses
• Nasal medications
▪ For self-administration:
• Suggest that client should blow nose first
• Client in seated position with head tilted
back
• Client holds tip of container just inside
the nares
• Inhales as spray enters the nasal passage
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Figure 35–51 Position of the head to instill drops into the ethmoid and sphenoid sinuses.
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Figure 35–52 Position of the head to instill drops into the maxillary and frontal sinuses.
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Topical Medications
• Vaginal medications
▪ Creams, jellies, foams, or suppositories
▪ Infections or discomfort
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Skill 35–12 Administering Vaginal Instillations
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Topical Medications
• Rectal medications
▪ Inserting a rectal suppository
• Assist client to left lateral or left Sims
position
• Upper leg flexed
• Expose buttocks
• Put glove on hand used to insert the
suppository
• Unwrap suppository
• Rectal medications
▪ Inserting a rectal suppository
• Lubricate smooth rounded end
• Lubricate gloved index finger
• Encourage client to relax by breathing
through the mouth
• Insert suppository gently into the anal
canal
• Rectal medications
▪ Inserting a rectal suppository
• Avoid embedding in feces
• Press buttocks together for a few minutes
• Ask client to remain in left lateral or
supine position for at least 5 minutes
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Figure 35–53 Inserting a rectal suppository beyond the internal sphincter and along the rectal wall.
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Inhaled Medications
• Nebulizers
▪ Fine spray (fog or mist)
• Metered-dose inhaler
▪ Extender, extender spacer
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Figure 35-55 Delivery of medication to the lungs using a metered-dose inhaler extender.
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Inhaled Medications
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Irrigations
• Irrigation (lavage)
• Stream of water or other fluid
▪ Clean body cavity
▪ Remove foreign object, secretions
▪ Apply heat/cold
▪ Apply antiseptic
▪ Reduce inflammation
▪ Relieve discomfort
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Figure 35–59 Four types of syringes used for irrigations: A, Asepto; B, rubber bulb; C, piston syringe; D,
Pomeroy.
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