Lab week 2

• Pharmacokinetics


  The study of how medications enter the body, reach the site of action, metabolize, and exit the body
• Nursing Process and Medication Administration: Assessment includes medical history, history of allergies, medication data, diet history, patient’s perceptual or coordination problems, patient’s attitude toward medication use, patient’s knowledge and understanding of medication therapy, patient’s learning needs
• Critical Thinking and Medication Administration: Critical thinking is essential to safe administration of medications. It allows the nurse to think before doing, involves basing decisions on knowledge of patient and medication, and evaluation of patient, and medication effects. The nurse administering medication is accountable for any medication error, regardless of the reason for the error. You are responsible for your own actions
• Nursing Process and Medication Administration: Diagnosis includes nursing diagnoses such as Anxiety, Deficient knowledge of medications, Nonadherence to prescribed medications, Disturbed visual sensory perception, Impaired swallowing, Ineffective therapeutic regimen management
• Nursing Process and Medication Administration: Implementation includes health promotion, acute care involving receiving medication orders, correct transcription & communication of orders, accurate dose calculation & measurement, correct administration, and recording medication administration
• Nurse responsibilities related to medication administration include determining whether the correct medication was ordered, not assuming all medications in the patient’s pill box are to be given, determining correct time, administration route, and evaluation of effects, assessing the patient’s ability to self-administer medication, patient and family education
• Pharmacological Concepts

  • Chemical, generic, trade, Drug Identification Number (DIN), Drug names, Effects on body system, which symptoms relieved, desired effect, Classification, Solid, liquid, other oral forms, topical, parenteral, instillation into body cavities
• A medication is a substance used in the prevention, diagnosis, relief, treatment, or cure of health alterations
• Types of Medication Action

  • Therapeutic effects, Side effects, Adverse effects, Toxic effects, Idiosyncratic reactions, Allergic reactions
• Medication Dose Responses: Therapeutic concentration - the goal is to achieve a constant blood level of the medication within a safe therapeutic range. Peak concentration - The highest serum concentration of a medication usually occurs just before the body absorbs the last of the medication. Trough concentration - The point at which the lowest amount of drug is detected in the serum (Potter and Perry pg. 732)
• Routes of Administration (Non-Parenteral)

  • Oral (PO), Enteral, Rectal (PR), Topical, Inhalation, Intraocular, Otic, Vaginal
• Patient Rights: To be educated regarding medication’s name, purpose, action, & potential side effects, to refuse a medication, regardless of the consequences, to have qualified nurses or physicians assess a medication history, including allergies & use of herbal & OTC medications, to be properly advised of the experimental nature of medication therapy & to give consent prior to administration
• Patients with Special Considerations

  • Infants & children, Older persons, Polypharmacy, Non-adherence
• Nursing Process and Medication Administration: Planning involves organizing care activities to ensure the safe administration of meds, setting priorities based on assessment of the patient, and determining whether the administration of medications is appropriate
• Preventing Medication Errors


  1. Follow 10 rights of medication administration

  2. Read drug labels (comparing MAR with label) x3

  3. Use 2 patient identifiers

  4. No interruptions during medication administration

  5. Double check calculations (verify with another nurse)

  6. Illegible handwriting > clarify order

  7. Question unusual orders

  8. Document asap

  9. Medication error > reflect on what occurred and why and evaluate situation
• Common causes for errors

  • Lack of pediatric formulations, dosage forms, and guidelines
  • Confusion between adult and pediatric formulations
  • Confusion among concentrations (dosage strengths)
  • Calculation errors
  • Errors with measuring devices
  • Preparing medication for more than one pt at a time
  • Distraction
• Oral Medication Administration: 3 Safety Checks


  • When preparing medications, compare the label of the medication packaging with the order/MAR THREE TIMES:
  • For unit-dose prepackaged medications:
  • Outside pt room: Check the package label against the MAR when taking meds out of the dispensing system/ drawer. Is this the right patient?
  • Outside pt room: Check the package label against the MAR in preparation for administering the med. Is this the right medication, dose, route, time, frequency, check expiration date?
  • At pt bedside: Verify all medication labels against the MAR at the patient’s bedside before opening the packages and delivering the medication to the patient. Is this the right medication, dose, route, time, frequency, right reason, client education, right to refuse
• Strategies to Prevent Aspiration

  • Assess patient abilities
  • Determine best timing
  • Prepare in most suitable form (i.e. pill, thickened fluid, liquid)
  • Patient positioning
  • Pace administration to patient response
• Common Errors

  • Omission
  • Improper dose
  • Wrong time
  • Wrong patient
• Steps to Take During Medication Errors

  1. Take accountability and responsibility when medication errors occur by acknowledging and reporting errors according to hospital policy

  2. Notify patient of medication error (and/or family members) & appropriate team members

  3. Reflect on how and why medication error occurred to prevent future medication errors
• Nursing Process and Medication Administration: Evaluation


  1. Nurses monitor patient responses to medications on an ongoing basis

  2. Nurses require knowledge of the desired effect, the therapeutic action, & the common SE

  3. A change in a patient’s condition can be physiologically r/t health status, medications, or both
• Oral Medication Administration: Steps 7 – Preparing Meds


  1. Prepare medications

  2. Perform hand hygiene

  3. If using medcart, place outside patient room

  4. Unlock cart

  5. Prepare meds one at a time

  6. Select medication, compare med label to MAR and check expiry

  7. Calculate medication dose

  8. If controlled substance: check last dose timing and perform medication count

  9. If using stock bottle, remove only what is needed, break scored medications if needed

  10. If using unit-dose tablets, do not remove wrapper, place directly in medcup with

  11. Place all meds to be given in one medcup with the patient ID label attached, except those that require preadministration assessments

  12. If needed, use a pill crushing device and mix the ground tablet into small amount of soft food

  13. To prepare liquids – gently shake, pour in medcup at eye level, use PO syringe if <10ml

  14. Compare MAR with prepared medication and container

  15. Return stock containers to drawer and read labels again as you do so

  16. Do not leave medications unattended
• Med Errors and High Alert Medications

  • Potassium chloride and concentrated electrolytes
  • Heparin
  • Insulin
  • Neuromuscular medications
  • Chemotherapy medications
  • Opioids, such as morphine
• Oral Medication Administration: Steps 8 -10 – Administering Meds

  1. Administering medications

  2. Take meds to patient at correct time

  3. ID patient – compare patient ID bracelet to MAR

  4. Use two patient identifiers

  5. At the bedside: compare labels of medications

  6. Explain purpose of medications, action, allow questions

  7. Sit up patient

  8. Administer meds

  9. If patient is unable to hold, give one at a time with med cup

  10. If medication falls on floor – discard it, repeat preparation

  11. Ensure all meds are swallowed

  12. For acidic meds offer nonfat snack (crackers)

  13. Assist patient to comfortable position

  14. Replenish stock, clean work area

  15. Evaluate patient response

  16. Assess patient/family knowledge acquisition

  17. Recording and Reporting

  18. Record administration on MAR immediately after administering

  19. If drug withheld, record and report following agency policy

  20. Record/Report evaluation of medication effect if required
• Oral Medication Administration: Steps 1-6 – Pre-Assessment


  1. Check accuracy and completeness

  2. Assess for contraindications

  3. Assess Medical History

  4. Gather necessary assessment and lab info that may influence med admin

  5. Assess patient’s knowledge

  6. Assess fluid preferences