Medication

• Drug or medication is any substance that modifies body functions when taken into the body
• A substance administered for diagnosis, cure, treatment, relief, or prevention of disease
• Types of doctor's orders:

  • Standing order: carried out as specified until cancelled by another order, a specified set of standing orders for all hospitalized patients, may include PRN orders
  • P.R.N. order ("as needed"): the patient receives medication when requested or needed, commonly written for post-operative pain medications
  • Single order: the directive is carried out only once, at a time specified by the physician
• Parts of the medication order include the patient's name, date and time the order is written, name of drug to be administered, dosage of the drug, route by which the drug is to be administered, frequency of administration of the drug, and signature of the person writing the order
• Common abbreviations used in medication orders:

  • ac = before meals, ID = intradermal
  • ad lib = freely as desired, IM = intramuscular
  • aq = water, IV = intravenous
  • bid = twice a day, OD = right eye
• 10 Rights of Drug Administration:

  • Right medication, dose, time, route, patient, to educate, documentation, to refuse, assessment, evaluation
• Principles in administering medications:

  • Observe the ten rights of drug administration
  • Practice asepsis
  • Nurses who administer medications are responsible for their own actions
  • Be knowledgeable about the medication being administered
  • Keep narcotics in a locked place
• Guidelines for correct administration of medications:

  • Wash hands before preparing medications
  • Check for drug allergies and verify doses with another nurse
  • Recheck drug calculation of drug dose with another nurse
  • Administer only those drugs that you have prepared
• Common types of medication errors:

  • Inappropriate prescribing of the drug
  • Extra, omitted, or wrong doses
  • Administration of a medication to a patient that was not ordered for them
  • Incorrect route or rate of administration
  • Failure to give medication at prescribed time and interval
• The medication is taken orally every 8 hours at 8am, 8pm, and 9pm

  
• Routes for drug administration include oral, sublingual, buccal, skin application, ophthalmic, otic, nasal, vaginal, rectal, respiratory inhalation, and intravenous
• Oral medications are not given to clients who are vomiting, lack a gag reflex, or are comatose
• Sublingual route involves placing a drug under the tongue where it dissolves for rapid absorption into the bloodstream
• Buccal route involves holding a medication in the mouth against the mucous membranes of the cheek until it dissolves
• Topical skin or dermatologic preparations include ointments, pastes, creams, lotions, powders, sprays, and patches
• Intradermal injections are administered into the dermal layer of the skin beneath the epidermis for local effects
• Subcutaneous injections are administered into the subcutaneous tissue for systemic effects, often used for insulin and immunizations
• Intramuscular injections are administered into the muscle for systemic effects, used for drugs that are irritating or need rapid absorption
• Intravenous injections have an immediate effect and are used in emergency situations when immediate absorption is required
• Fundamentals of Nursing: Medication objectives include defining medication, enumerating different routes of medication administration, identifying different types of Doctor’s medication orders, observing the 10 Rights in Medication Administration, and performing procedures in administering oral medication, intradermal injection, subcutaneous injection, and intramuscular injection
• Types of Doctor’s Orders:

  • Standing Order
  • P.R.N. Order (“as needed”)
  • Stat Order
• Common Abbreviations used in Medication Order:

  • BMC
  • Color
  • Frequency
  • Time
• Guidelines for Correct Administration of Medications:

  • Preparations
  • Administration
  • Storage
  • Recording
• Behaviors to avoid during medication administration:

  • Common types of medication errors
• Types of Drug Preparation:

  • Aerosol spray or foam
  • Aqueous solution
  • Aqueous suspension
  • Caplet
• Routes for Drug Administration:

  • Oral Route
  • Enteral Route
  • Sublingual Route
  • Buccal Route
• Procedure for Oral Medication:

  • Perform hand washing before starting the procedure
  • Assemble all necessary articles to avoid waste of time
  • Prepare the medical cards correctly
  • Read and check the medicine cards 3 times
• Parts of a Needle:

  • Bevel
  • Shaft
  • Gauge
• Parts of a Syringe:

  • Tip
  • Barrel
  • Plunger
• Recommended Needle Sizes:

  • Hypodermic Syringe
  • Insulin Syringe
  • Tuberculin syringe
• Classification of Syringe Tip:

  • Luer-Lok
  • Non Luer-lok
• Intradermal Injection (ID) Procedure:

  • Read Physicians order carefully
  • Prepare the right medicine card observing format, color & shape
• Intradermal injection sites include the forearm and upper back
• Intradermal injection procedure:

  • Read physician's order carefully
  • Prepare the right medicine card observing format, color & shape
  • Wash and dry hands thoroughly
  • Gather all necessary materials to avoid waste of time
  • Read the label upon first contact with the drug
  • Prepare the drug by dissolving the solute with its corresponding solvent
• Intradermal injection procedure:

  • Observe aseptic techniques
  • Use sterile forceps to pick up cotton balls
  • Disinfect the rubber cap of the vial with alcohol
  • Open sterile packs without touching sterile portions
• Intradermal injection procedure:

  • Read the drug label and check it with the medicine card
  • Prepare the drug accurately without distractions
  • Aspirate distilled water and the drug to be tested
  • Ensure the medicine is evenly distributed by pulling down the plunger and tilting the syringe
• Intradermal injection procedure:

  • Change the aspirating needle with a gauge 25 needle
  • Remove excess air bubbles from the syringe
  • Carry the medicine and medicine card to the patient's room
  • Identify the client and explain the procedure
• Intradermal injection procedure:

  • Cleanse the area using circular motion
  • Hold the skin taut and insert the needle at a 10-15 degrees angle
  • Inject medication slowly to form a wheel
  • Remove the needle slowly and do not massage the area
• Intradermal injection procedure:

  • Instruct the client not to massage the area
  • Encircle the injection site with black or blue ink
  • Instruct the client about signs and symptoms to be observed within 30 minutes
  • Write the time checking sensitivity results on the patient's medicine card
• Intradermal injection procedure:

  • Return materials and discard used disposable materials properly
  • Return after 30 minutes to evaluate results