Unit 4: Medication Administration Fundamental of Nursing Unit 4: Medication Administration: Medication: Is a substance administered for the diagnosis, cure, treatment, relief, or prevention of disease. Six Rights of Medication Administration After paramedics have received the medication or fluid order, they should then administer the drug in question. In performing drug administration, pre-hospital care providers adhere to the six rights of medication administration: 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation Basic principle of nurse on drugs administration 1. The nurse must know the drug's prescribed dose, method of administration, actions, expected therapeutic effect, possible interactions with other drugs, and adverse effects. 2. The nurse must know the institution's administration procedures for the client's welfare and the nurse's legal protection. 3. The nurse must Review physician's order for completeness the client's name, date of the order, name of the drug, dose, rout, time of administration, and the physician's signature. 1 Unit 4: Medication Administration Fundamental of Nursing 4. The nurse discusses the medication and its actions with the client; recheck the medication order if the client disagrees with the dose or the physician's order. 5. The nurse must check the physician's order against the client's medication administration record for accuracy. 6. The nurse gives the patient the right to know about the medication he is receiving and the right to refuse it. Routes of Administration A: Enteral Tract Routes The common enteral routes of administration used in general medical practice are as follows: 1. Oral: The best, and most convenient, way of administering drugs is by mouth. The effects of oral administration are often not seen until 30 to 45 minutes after administration. 2. Orogastric/nasogstric tube (OG/NG): This route is generally used for oral medications when the patient already has the tube in place for other reasons. 3. Sublingual (SL): Some drugs can be administered sublingually, the drug is placed under the tongue, where it quickly dissolves. The drug is then absorbed into the vast capillary network present in the mucous membranes. 4. Buccal: Absorption through this route between the cheek and gum is similar to sublingual absorption. 5. Rectal (PR): Rectal administration may have both local and systemic effects. It may be necessary to administer some medications rectally, especially if the patient is nauseated. The rectal route is frequently used in infants and children, who may not be able to swallow oral medications. 2 Unit 4: Medication Administration Fundamental of Nursing Absorption of rectally administered drugs is generally somewhat slower than by the oral route. B: Parenteral Routes Any method of administration that does not involve passage through the digestive tract is termed parenteral. Parenteral routes include the following: 1. Topical: Certain drugs can be placed on the skin, where they are slowly absorbed into the capillary network underneath the skin. 2. Intradermal: Drugs can be injected into the dermal layer of the skin. 3. Intranasal: The drug is aerosolized and instilled in the nose, whereby the drug is rapidly absorbed through the massive vascular network in the nasal tissues. 4. Subcutaneous:. With subcutaneous administration, medications are injected into fatty, subcutaneous tissue under the skin and overlying the muscle. 5. Intramuscular:. The most commonly used route of parenteral medication administration is the intramuscular route. 6. Intravenous. Most medications used in emergency medicine are designed to be administered intravenously. 7. Endotracheal: Sometimes it is possible to administer emergency medications down an endotracheal tube, which permits absorption into the capillaries of the lungs. 8. Sublingual injection: Certain drugs can be injected into the vast capillary network immediately under the tongue. Lidocaine is the agent most frequently given by this route. 3 Unit 4: Medication Administration Fundamental of Nursing 9. Intracardiac: Injection of a medication directly into the ventricle of the heart is referred to as intracardiac administration. 10. Intraosseous: When an IV line cannot be started in children under 6 years of age, many emergency medications can be administered intraosseously. A needle can be placed in the anterior aspect of the proximal tibia, through which medications and fluids can be administered. 11. Inhalational: Medications can be administered directly into the respiratory tree in cases of respiratory distress resulting from reversible airway disease including asthma and certain types of chronic obstructive pulmonary disease. These medications are usually nebulized into a water vapor and breathed with normal respiration. 12. Umbilical: Both the umbilical vein and umbilical artery can provide an alternative to IV administration in newborns. 13. Vaginal: Medications can be placed into the vagina, where they are absorbed into surrounding tissues. Most vaginal medications are supplied in creams or vaginal suppositories. The onset of action is slow, and the effects are generally limited to the lower female genital tract. Non-parenteral Rout Medication Administration Oral medication administration Definition: is the most common and convenient type for most clients by which the drug is swallowed to the stomach, or administrated under the tongue for slow action. Purpose 1. To provide safe, effective drug therapy with minimal complications and discomfort. 2. To provide a convenient route for drug therapy. 4 Unit 4: Medication Administration Fundamental of Nursing Advantages 1. It's the easiest, least expensive, safe, and most desirable type of drug to administration. 2. Has the slowest onset of action because it is absorbed through the gastric mucosa into the bloodstream for a systemic effect. 3. Can have a local effect (for example, anti-acids) 4. Is supplied in the form of tablets, capsules, enteric-coated tablets, liquids, syrups, and suspensions Disadvantage 1. Unpleasant taste of the drugs. 2. Irritation of the gastric mucosa. 3. Irregular absorption from the gastrointestinal tract. 4. Slow absorption. 5. Harm to the client's teeth. 6. Is contraindicated in a client who is vomiting or cannot swallow food or fluids, who is having gastric suctioning, or who lacks mental awareness. Topical Administering Skin Application Definition: is the applied of substance to a circumscribed surface area of the body. Purpose 1. To facilitate absorption through the skin or mucous membranes. 2. Provide local anesthetic effect 3. To stop slow, or prevent microbial growth. 5 Unit 4: Medication Administration Fundamental of Nursing Advantages 1. Is applied externally to the skin or mucous membranes. 2. The pharmaceuticals forms used in topical and skin administration are including (lotions, liniments, ointments, pastes, powders, patches, creams, gels, jellies, foams, Aerosol spray). 3. It requires use of sterile supplies and sterile techniques when applied on open skin lesion such as sterile applicators. 4. Can create systemic and local effects if absorbed through the skin. 5. Can be applied into body cavities or orifices, such as the urinary bladder, eyes, ear, nose, rectum, or vagina. 6. Can be administered by inhalation into the respiratory tract by a nebulizer. Disadvantage: Not absorbed well (completely) Administration of vaginal and rectal instillations Purpose 1. To provide an alternative route of administration. 2. To promote bowel elimination. 3. To treat vaginal infection, pain, or itching (local effect). 4. To treat rectal hemorrhoid and fissure (local effect). Characteristics 1. It's a safe, alternative method of medication administration. 6 Unit 4: Medication Administration Fundamental of Nursing 2. It's usually supplied as a solid cone- or oval shaped mass of medication dissolved in a wax like substance; body heat melts the wax and release the medication to be absorbed. 3. Provide a local or systemic effect. 4. Rectal suppository is contraindicated with cases of rectal surgery or active rectal bleeding. Administration of Eye(ophthalmic) medication. Definition: medications that instilled in the form of liquid or ointment and indicated for ophthalmic use. Purpose 1. To provide local anesthetic effect. 2. To decrease intraocular pressure. 3. To dilate the pupil for eye examination. 4. To treat ophthalmic infection. Characteristics of Eye medication administration: 1. It's instilled the medication as a sterile liquid, drops, or an ointment. 2. Sterile preparation and sterile technique are indicated. Administration of Ear (otic) medication. Purpose 1. To relive ear pain. 2. To provide local therapy to reduce inflammation by otic antibiotic medication. 3. To soften ear wax for removed at later time. 7 Unit 4: Medication Administration Fundamental of Nursing Characteristics of Ear medication administration 1. It's supplied as drops in plastic or glass container with dropper. 2. Requires a sterile technique to instill medication special if tympanic membrane is damaged. Administration of nasal medication Definition: medications that instilled for shrink swollen mucous membranes, loosen secretion and facilitate drainage or to treat infection of sinuses. Characteristics of nasal medication administration: 1. Nasal drops are used to treat sinus infection. 2. Small doses are needed. 3. Nebulizer bronchodilator medication can be administrated in emergency cases. Parenteral Rout Medication Administration: