CHAP 9, 10, 11, 13

• About 40% of the nurse’s time is spent on drug administration; knowledge of these drugs is essential to patient safety.
• Concepts focus on the patient-centered model of care instead of a disease-centered model of health care.
• The nurse gathers cues (information) from many sources and uses them to plan care.During the Recognize Cues/Assessment phase, the nurse is gathering information from the patient about the patient’s health and lifestyle. Assessment includes both subjective and objective data.
• Subjective data


  include information provided verbally by the patient, family members, friends, or other sources.
• Objective data


  are what the nurse directly observes about the patient’s health status. It involves collecting the patient’s health information by using the senses: seeing, hearing, smelling, and touching.
• Subjective data are symptoms described by and apparent to the patient. Objective data are signs that are measured and detected by another person.
• During the Generate Solutions/Planning phase, the nurse uses the data collected to develop interventions that created effective outcomes.
• The Take Action/Implementation phase is the part of the nursing process in which the nurse provides education, drug administration, patient care, and other interventions necessary to assist the patient in accomplishing the established medication goals.
• In the Evaluate Outcomes/Evaluation phase of the nursing process, the nurse determines whether the goals and teaching objectives are being met. The nurse continues to use ongoing assessment data to evaluate the successful attainment of the patient’s objectives and goals.
• Six rights of medication

  right patient, right drug, right dose, right route, sight time, right documentation
• medication error


  may be defined as “any preventable event that may cause or lead to inappropriate medication use or harm to a patient.”
• Most organizations have a risk management department staffed with nurse managers and risk managers who conduct root cause analysis (RCA), a method of problem solving used to identify potential workplace errors. Such analysis presents opportunities for learning and focuses on strategies that can be put in place to correct problems.
• If a patient dies as the result of a drug error, it is called a sentinel event.
• The National Patient Safety Goals (NPSGs) focus on problems in health care safety and how to solve them.
• When a prescription drug is known to be effective for some patients but may cause serious side effects in others, the FDA will require the drug’s printed materials to carry a warning about the adverse effects surrounded by a black box.
• Drug reconciliation


  is an important component of the culture of safety. It is defined as the process of identifying the most accurate list of all medications that the patient is taking at transitions in care, which includes admissions and discharges from a hospital to another health care setting such as long-term care.
• The Secure and Responsible Disposal Act


  encourages both public and private entities to develop secure, convenient, and responsible methods for collecting and destroying medications and controlled substances.
• Needlestick Safety and Prevention Act (NSPA)


  requires that employers implement safer medical devices for their employees, provide a safe and secure workplace environment with educational opportunities, and develop written policies to help prevent sharps injuries.
• Most medication errors occur in the transcription stage (56%), followed by the nurse administration stage (41%), and finally the doctor prescribing stage (39%).
• High-alert drugs


  can cause significant harm to the patient. If a high-alert medication is given in error, it can have a major effect on the patient’s organs.
• The FDA Pregnancy Categories & Subsection Labeling System


  provides a broader explanation based on current available information of the benefits and risks medications can have to the mother, the fetus, and the breastfeeding child.
• Nurses share their knowledge about the many aspects of drug administration including drug interactions, safety practices, side effects, and dosage calculations.
• A variety of forms and routes are used for the administration of drugs, including sublingual, buccal, oral (tablets, capsules, liquids, suspensions, elixirs), transdermal, topical, instillation (drops and sprays), inhalation, nasogastric and gastrostomy tubes, suppositories, and parenteral.
• Oral medications


  are not given to patients who are vomiting, lack a gag reflex, or to those who are comatose.
• Enteric-coated and timed-release capsules


  must be swallowed whole to maintain a therapeutic drug level, so the drug is released gradually. If crushed, the initial excessive drug release poses a risk of toxicity such that it could lead to a potentially fatal overdose.
• Administer irritating drugs with food to decrease gastrointestinal (GI) discomfort.
• Drugs given via sublingual (under the tongue) or buccal (between the cheek and gum) routes remain in place until fully absorbed; therefore, no food or fluid should be taken while the medication is in place.
• Elixirs


  are sweetened, hydro-alcoholic liquids used in the preparation of oral liquid medications.
• Emulsions


  are a mixture of two liquids that are not mutually soluble.
• Suspensions


  are liquids in which particles are mixed but not dissolved.
• Transdermal medication


  is stored in a patch placed on the skin and absorbed through skin, having a systemic effect.
• Topical medications


  are most frequently applied to the skin by painting or spreading the medication over an area and applying a moist dressing or leaving the area exposed to air.
• Instillations


  are liquid medications usually administered as drops, ointment, or sprays.
• Metered-dose inhalers (MDIs)


  are handheld devices used to deliver a number of commonly prescribed asthma and bronchitis drugs to the lower respiratory tract via inhalation.
• Spacers


  are devices used to enhance the delivery of medications from the MDI.
• nebulizer


  is a device that changes a liquid medication into a fine mist or aerosol and has the ability to reach the lower, smaller airways.
• Check for proper tube placement before administering medications via nasogastric and gastrostomy tubes.
• Proper placement of NGT and OGT


  • Place patient in a high Fowler position or elevate the head of bed at least 30 degrees to avoid aspiration.
  • Make sure the drug is crushable. If it is a capsule, assess whether it can be opened to be administered through the tube.
  • The crushed drug should be placed into a plastic dosing cup. A small amount of water is added to liquify the dry medication.
• Medications administered as suppositories or enemas can be given rectally for local and systemic absorption.
• Vaginal drugs are available as suppositories, foams, jellies, or creams.

  ○ Advise patients to remain lying for a time sufficient to allow medication absorption; times vary depending on the medication.