Basic Nursing:
Foundations of
Skills & Concepts
MEDICATION
ADMINISTRATION
Chapter 24
Medication Management
Requires the collaborative efforts
of many health care providers.
Nurses are responsible for
administering medications.
Medication administration
requires specialized knowledge,
judgment, and nursing skills.
Drug Standards and
Legislation
A drug is a chemical substance
intended to elicit a specific effect.
Standards are set to ensure drug
uniformity in:
Strength.
Purity.
Efficacy.
Safety.
Bioavailability (readiness to produce a drug
effect).
Standards
The United States Pharmacopeia
and the National Formulary (USP
and NF) are books of drug
standards for use in the United
States.
Legislation: The FDA
The Food and Drug Administration
(FDA) tests all drugs for toxicity
before granting a company the
right to market a drug.
Drug Nomenclature
Drugs are usually referred to by
their generic name (not
capitalized) or by their trade
name (always capitalized).
Drug Action
A drugs ability to combine with a
cellular drug receptor.
Depending on the location of the
cellular receptor, the drug can
have a local effect, a systemic
effect, or both.
Pharmacology
The study of the effects of drugs
on living organisms.
Medication Management
Its purpose is to produce the desired
drug action by maintaining a constant
drug level.
Drug action is based on the drugs half-
life (the time it takes the body to
eliminate half of the blood
concentration level of the original drug
dose).
Terms Relating to Drug
Action
Onset of action (the time it takes for the
body to respond to a drug after
administration).
Peak plasma level (the highest blood
concentration of a single drug dose
before the elimination rate equals the
rate of absorption).
Plateau (maintenance of a certain level).
Routes of Drug
Absorption
Oral.
Topical.
Inhalants.
Parenteral (injectable).
Intradermal (into the dermis).
Subcutaneous (into the subcutaneous tissue).
Intramuscular (into the muscle).
Intravenous (into a vein).
Pharmokinetics
The study of the absorption,
distribution, metabolism, and
excretion of drugs to determine
the relationship between the
dose of a drug and the drugs
concentration in biological fluids.
The 4 Properties of Drug
Action
Absorption (passage of a drug from the site of
administration into the bloodstream).
Distribution (the movement of drugs from the
blood into body fluids and tissues).
Metabolism (the physical and chemical
processing of a drug by the body).
Excretion (the elimination of drugs from the
body.
Drug Interaction
The effect one drug can have on
another drug.
Side Effects and Adverse
Reactions
Drug Allergy.
Drug Tolerance.
Toxic Effect.
Idiosyncratic Reaction.
Food and Drug
Interactions
Certain drugs may interfere with
the absorption, excretion, or use in
the body of one or more nutrients.
Certain foods may increase or
decrease the absorption of a drug
into the body.
Other foods may alter the chemical
actions of drugs, preventing their
therapeutic effect on the body.
Factors Influencing Drug
Action
Genetic Weight.
factors. Physical
Age. conditions.
Height. Mental
conditions.
Medication Orders
All medication orders should contain:
Clients name
Date & Time
Name of Drug to be administered
Doasage
Route of administration
Time & frequency
signature of person ordering
Types of Orders
Stat (those that should be
administered immediately).
Single-Dose (one-time medications).
Scheduled (administered routinely
until order is canceled by another
order).
PRN (on as-needed basis).
Three Systems
of Weight and Measure
Metric (simple system based on
units of 10).
Apothecary (based on the weight
of one grain of wheat).
Household (drops, teaspoons,
tablespoons, etc.).
Five Rights of
Safe Drug Administration
Right drug.
Right dose.
Right client.
Right route.
Right time.
Documentation of Drug
Administration
A critical element of drug
administration is documentation.
The standard is if it was not
documented it was not done.
The nurse should document that
a drug has been given after the
client has received the drug.
Drug Supply and Storage
Scheduled drugs for each client are usually
dispensed in a unit dose form.
Certain drugs may be stock supplied
(dispensed and labeled in large quantities)
and stored in the medication room.
Narcotics and controlled substances must
be administered in accordance with
federal regulations.
Medication Compliance
The clients understanding of why a
medication was ordered and how a
medication can decrease the likelihood
of getting a disease or how it can lessen
the effects of an existing disease.
Clients refusing medication or adjusting
the scheduling or dose are
noncompliant.
Responsibilities of Nurses
Regarding Drug
Administration
Nurses are both legally and
morally responsible for correct
administration of
[Link] must:
Follow institutional policy.
Consider clients desires and abilities.
Foster compliance.
Correctly document all actions related to
medication administration and medication
errors.
Assessment
Drug History (Allergies,
Prescription Drugs taken, Over-
the-Counter Drugs used).
Medical History (Biographical
data, Lifestyle and beliefs,
Sensory and cognitive status).
Physical Examination.
Diagnostic and Laboratory Data.
Nursing Diagnosis
Health Maintenance, Altered.
Knowledge Deficit.
Management of Therapeutic
Regimen, Ineffective.
Physical Mobility, Impaired.
Sensory/Perceptual Alterations.
Swallowing, Impaired.
Nursing Interventions
Primary nursing interventions
related to medication
management are:
Assessment.
Administration.
Teaching.
Oral Drugs
Oral medications should be
poured and measured at eye level
to ensure accuracy.
Parenteral Drugs
Although the physician will
determine the dose and route of a
parenteral drug, the nurse is
responsible for choosing the
correct gauge and length of the
needle to be used.
Equipment to Administer
Parenteral Drugs
Syringes (three basic parts: the hub,
the barrel, the plunger).
Needles (three basic parts: the hub,
the cannula, or shaft, and the bevel).
Ampules (glass containers of single-
dose drugs).
Vials (glass, single- or multiple-dose
rubber-capped drug containers).
Intradermal Injection
Injections typically used to
diagnose tuberculosis, identify
allergens, and administer local
anesthetics.
Subcutaneous Injection
Injections into the subcutaneous
tissue, between the dermis and
the muscle.
Commonly used in the
administration of medications
such as insulin and heparin.
Intramuscular Injection
Used to promote rapid drug
absorption and to provide an
alternate route when the drug is
irritating the subcutaneous
tissue.
Intravenous Therapy
Requires parenteral fluids
(hypotonic fluid, isotonic fluid,
hypertonic fluid)
Special equipment needed:
Administration set.
IV pole.
Filter.
Regulators to control IV flow rate.
Established venous route.
Blood Transfusion
To replace blood loss (deficit) with
whole blood or blood components.
Special equipment needed:
Administration set.
IV pole.
Filter.
Regulators to control IV flow rate.
Established venous route.
The Importance of
Monitoring
The nurse must always carefully monitor
client reactions to medications and
ensure that clients are appropriately
educated as to the actions, side effects,
and contraindications of all medications
they are receiving.
Clients receiving IV therapy or blood
transfusions require constant
monitoring for complications.
Topical Medications
Eye Respiratory
medications. inhalants.
Ear Rectal
medications. instillations.
Nasal Vaginal
instillations. instillations.
