Lakhasly

INTRODUCTION
A medication is a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. The term drug also has the connotation of an illicitly obtained substance such as heroin, cocaine, or amphetamines. Medications have been known and used since antiquity. Crude drugs, such as opium, castor oil, and vinegar, were used in ancient times. Over the centuries the number of drugs available has increased greatly, and knowledge about these drugs has become correspondingly more accurate and detailed.
medications are usually dispensed on the order of primary care providers and dentists. In some U.S. states, specially qualified nurse practitioners or other advanced practice nurses and physician assistants may prescribe drugs. The written direction for the preparation and administration of a drug is called a prescription.
One drug can have two kinds of names:
• Generic name
• Chemical name.
Purpose of medication administration:
✓ diagnostic purpose (e.g. barium for x ray)
✓ treatment of diseases (relief symptoms, restore normal functions or supply the body with deficient substances)
✓ prevention of disease as vaccines
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Types of drug preparations
LEGAL ASPECTS OF DRUG ADMINISTRATION
(1) Nurses need to:
(a) know how nursing practice acts in their areas define and limit their functions
(b) be able to recognize the limits of their own knowledge and skill.
(2) Under the law, nurses are responsible for their own actions regardless of whether
there is a written order.
Example: If a primary care provider writes an incorrect order (e.g., morphine 100 mg instead of morphine 10 mg), a nurse who administers the written incorrect dosage is responsible for the error as well as the primary care provider.
Therefore, nurses should question any order that appears unreasonable and refuse to give the medication until the order is clarified.
(3) controlled substances. In hospitals, controlled substances are kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system.
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(4) Agencies may have special inventory forms for recording the use of controlled substances. The information required usually includes:

• Name of the client - the date and time of administration


• the name of the drug - the dosage


• the signature of the person who prepared and gave the drug.


• The name of the primary care provider who ordered the drug
  EFFECTS OF DRUGS

1. The therapeutic effect


2. A side effect, or secondary effect,


3. Drug toxicity


4. A drug allergy


5. Drug tolerance


6. A cumulative effect


7. An idiosyncratic effect


8. A drug interaction


9. A synergistic effect


10. Iatrogenic disease
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1. The therapeutic effect of a drug, also referred to as the desired effect, is the primary effect intended, that is, the reason the drug is prescribed.
   For example, the therapeutic effect of morphine sulfate is analgesia, and the therapeutic effect of diazepam is relief of anxiety.


2. A side effect, or secondary effect, of a drug is one that is unintended.
   ✓ Side effects are usually predictable and may be either harmless or potentially harmful.
   For example, digitalis increases the strength of myocardial contractions (desired effect), but it can have the side effect of inducing nausea and vomiting.
   ✓ Some side effects are tolerated for the drug’s therapeutic effect
   ✓ more severe side effects, also called adverse effects or reactions, may justify the discontinuation of a drug.
   ✓ The nurse should monitor for dose-related side or adverse effects and report these to the health care provider (physician) to discontinue the medication or change the dosage.


3. Drug toxicity (harmful effects of a drug on an organism or tissue) results from overdosage, ingestion of a drug intended for external use
   ✓ buildup of the drug in the blood because of impaired metabolism or excretion (cumulative effect) causing toxicity.
   ✓ Some toxic effects are apparent immediately; some are not apparent for weeks or months.
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   ✓ Fortunately, most drug toxicity is avoidable if careful attention is paid to dosage and monitoring for toxicity.
   An example of a toxic effect is respiratory depression due to the cumulative effect of morphine sulfate in the body.


4. A drug allergy is an immunologic reaction to a drug.
   ✓ When a client is first exposed to a foreign substance (antigen), the body may react by producing antibodies and thus develop symptoms of an allergic reaction.
   ✓ Allergic reactions can be either mild or severe. A mild reaction has a variety of symptoms, from skin rashes to diarrhea.
   ✓ A severe allergic reaction usually occurs immediately after the administration of the drug and is called an anaphylactic reaction.
   ✓ An allergic reaction can occur anytime from a few minutes to 2 weeks after the administration of the drug.


5. Drug tolerance exists in a person who requires increases in the dosage to maintain a given therapeutic effect.


6. A cumulative effect occurs when the rate of administration exceeds the rate of metabolism or excretion.
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7. An idiosyncratic effect is one that is unexpected and may be individual to a client.


8. A drug interaction occurs when the administration of one drug before, or after another drug alters the effect of one or both drugs.


9. A synergistic effect occurs when two different drugs increase the action of another drug.


10. Iatrogenic disease is a disease caused unintentionally by medical therapy
    DRUG MISUSE
    Drug misuse is the improper use of common medications in ways that lead to acute and chronic toxicity (e.g. Laxatives, antacids, vitamins).
    Drug misuse may result in drug abuse, drug dependence or drug habituation.
    Drug abuse is the inappropriate intake of a substance, either continually or periodically.
    Drug dependence is a person’s reliance on or need to take a drug or substance.
    Drug habituation the individual develops the habit of taking the substance and feels better after taking it.
    Key terms related to drug actions are as follows:
    • Onset of action: the time after administration when the body initially responds to the drug
    • Peak plasma level: the highest plasma level
    • Plateau: a maintained concentration of a drug in the plasma during a series of scheduled doses.
    FACTORS AFFECTING MEDICATION ACTION
    Developmental Factors
    ✓ Infants usually require small dosages because of their body size and the immaturity of their organs, especially the liver and kidneys.
    ✓ Older adults have different responses to medications due to physiological changes that accompany aging.
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    Gender
    ✓ Differences in the way men and women respond to drugs are chiefly related to the distribution of body fat and fluid and hormonal differences.
    Cultural, Ethnic, and Genetic Factors
    ✓ A client’s response to a drug is influenced by genetic variations such as gender, size, and body composition.
    ✓ Ethnicity racial and ethnic differences/responses to prescribed medication.
    ✓ For example, certain medications may work well at usual therapeutic dosages for certain ethnic groups but be toxic for others.
    ✓ Cultural factors and practices (e.g., values and beliefs) can also affect a drug’s action.
    ✓ For example, an herbal remedy (e.g., the Chinese herb ginseng) may speed up or slow down the metabolism of prescribed medications.
    Diet
    ✓ Nutrients can affect the action of a medication.
    ✓ For example, Vitamin K, found in green leafy vegetables, can counteract the effect of an anticoagulant such as warfarin.
    Environment
    ✓ The client’s environment can affect the action of drugs, particularly those used to alter behavior and mood.
    ✓ Environmental temperature may also affect drug activity. When environmental temperature is high, the peripheral blood vessels dilate, thus intensifying the action of vasodilators.
    Psychological Factors
    ✓ A client’s expectations about what a drug can do can affect the response to the medication.
    ✓ For example, a client who believes that codeine is ineffective as an analgesic may experience no relief from pain after it is given.
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    Illness and Disease
    ✓ Illness and disease can also affect the action of drugs.
    For example, Drug action is altered in clients with circulatory, liver, or kidney dysfunction.
    Time of Administration
    ✓ Some orally administered medications are absorbed more quickly if the stomach is empty, whereas other medications have a more rapid absorption when administered with food.
    ROUTES OF ADMINISTRATION
    Oral
    ✓ Oral administration is the most common, least expensive, and most convenient route for most clients.
    ✓ In oral administration, the drug is swallowed. It considered a safe method.
    The major disadvantages can include:


11. an unpleasant taste of the drugs


12. irritation of the gastric mucosa


13. irregular absorption from the GI tract


14. slow absorption


15. in some cases, harm to the client’s teeth.
    Sublingual
    ✓ In sublingual administration a drug is placed under the tongue, where it dissolves in a relatively short time
    ✓ The drug is largely absorbed into the blood vessels on the underside of the tongue.
    ✓ The medication should not be swallowed.
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    Buccal
    Buccal means “pertaining to the cheek.” In buccal administration, a medication is held in the mouth
    against the mucous membranes of the cheek until the drug dissolves.
    The drug may act locally on the mucous membranes of the mouth or systemically when it is
    swallowed in the saliva.
    Parenteral
    The parenteral route is defined as other than through the alimentary or respiratory tract; that is, by
    needle.
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    more common routes for parenteral administration:
    • Subcutaneous (hypodermic) into the subcutaneous tissue, just below the skin
    • Intramuscular (IM) into a muscle
    • Intradermal (ID) under the epidermis (into the dermis)
    • Intravenous (IV) into a vein.
    Topical
    Topical applications are those applied to a circumscribed surface area of the body. They affect only the area to which they are applied.
    Topical applications include the following:
    • Dermatologic preparations applied to the skin
    • Instillations and irrigations applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina
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    MEDICATION ORDERS
    A physician usually determines the client’s medication needs and orders medications.
    Types of Medication Orders
    Four types of medication orders are commonly used:

1. A stat order indicates that the medication is to be given immediately and only once (e.g., morphine sulfate 10 milligrams IV stat).


2. The single order or one-time order is for medication to be given once at a specified time (e.g., Seconal 100 milligrams at bedtime before surgery).


3. The standing order may or may not have a termination date.
   A standing order may be carried out indefinitely (e.g., multiple vitamins daily) until an order is written to cancel it, or it may be carried out for a specified number of days (e.g., KCl twice daily × 2 days).


4. A PRn order, or as-needed order, permits the nurse to give a medication when, in the nurse’s judgment, the client requires it (e.g., Amphojel 15 mL prn).


5. BID: Twice a day 6. TID: Three times a day


6. QID: Four times a day 8. EOD: Every other day


7. ABT: At bed time 10. AM: At morning


8. PM: At night
   Essential Parts of a Medication Order
   • Full name of the client • Date and time the order is written
   • Name of the drug to be administered • Dosage of the drug
   • Frequency of administration • Route of administration
   • Signature of the person writing the order
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   Parts of a Prescription
   Communicating a Medication Order
   ✓ A drug order is written on the client’s chart by a primary care provider or by a nurse receiving a telephone or verbal order from a primary care provider.
   ✓ Most acute care agencies have a specified time frame (e.g., 24 or 48 hours) in which the primary care provider issuing the telephone or verbal order must cosign the order written by the nurse.
   ✓ The nurse or clerk then copies the medication order to a Kardex include the client’s name, drug name and dose; and times and method of administration.
   ✓ In some agencies, the date the order was prescribed and the date the order expires are also included.
   ✓ The nurse should always question the primary care provider about any order that is ambiguous, unusual (e.g., an abnormally high dosage of a medication), or contraindicated by the client’s condition
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   When the nurse judges a primary care provider–ordered medication inappropriate, the
   following actions are required:
   • Contact the primary care provider and discuss the rationale.
   • Document in notes
   • If the primary care provider cannot be reached, document all attempts to contact
   • If someone else gives the medication, document data about the client’s condition before and after
   the medication.
   • If an incident report is indicated, clearly document factual information.
   SYSTEMS OF MEASUREMENT
   ✓ Two systems of measurement are used: the metric system and the household system.
   Metric System
   ✓ The metric system, is logically organized into units of 10; it is a decimal system.
   ✓ Basic units of measurement are the meter, the liter, and the gram.
   Household System
   ✓ Household measures may be used when more accurate systems of measure are not required.
   ✓ Included in household measures are drops, teaspoons, tablespoons, cups, and glasses.
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   ADMINISTERING MEDICATIONS SAFELY
   ✓ The nurse should always assess a client’s health status and obtain a medication history prior to giving any medication.
   ✓ The extent of the assessment depends on the client’s illness or current condition, the intended drug, and the route of administration.
   ✓ The medication history includes information about the drugs the client is taking currently or has taken recently.
   Medication Administration Errors
   a medication error is “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
   Four main types of medication errors that occur with hospitalized clients are:
   (1) prescription errors (e.g., wrong drug or dose);
   (2) transcription/ interpretation error (e.g., misinterpretation of abbreviations);
   (3) preparation errors (e.g., calculation error)
   (4) administration errors (e.g., wrong dose, wrong time, omission, or additional
   dose).
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   Medication Dispensing Systems
   Medical facilities vary in their medication dispensing systems. The systems can include the
   following:
   • Medication cart. The medication cart is on wheels, allowing the nurse to move the cart to outside
   the client’s room.
   • Medication cabinet. Some facilities have a locked cabinet in the client’s room. This cabinet
   holds the client’s unit-dose medications
   • Medication room. Depending on the facility, a medication room may be used as a central
   location for stock medications, controlled medications, and/or drugs used for emergencies.
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   Process of Administering Medications
   When administering any drug, regardless of the route of administration, the nurse must do the
   following:


9. Identify the client. 2. Inform the client. 3. Administer the drug.


10. Provide adjunctive interventions as indicated.


11. Record the drug administered


12. Evaluate the client’s response to the drug.