Chapter 31: Medication Administration

🧾 Medication Legislation & Standards

⚖️ Federal Regulations

• Pure Food and Drug Act (1906):
• First law to ensure drugs are pure and labeled correctly.
• Food and Drug Administration (FDA):
• The main federal agency that tests, approves, and monitors all drugs sold in the U.S.
• Makes sure medications are safe and effective before being sold.
• Regulates prescription drugs, over-the-counter meds, and supplements.
• MedWatch Program:
• A voluntary reporting system by the FDA. Nurses, doctors, or patients can report adverse reactions or medication errors. This helps the FDA detect and fix safety issues faster.

🏛️ State & Local Regulations

• State Laws:
• Control drugs not covered by federal laws.
• Create and enforce Nurse Practice Acts (NPA) — rules that define what nurses can and can’t do with medications.

Nurse Practice Acts (NPA):

• Define the scope of nursing practice for each state. Tell nurses which medications they can administer and under what conditions. Violating these acts can result in loss of license or legal action.
• Local Laws:
• Often regulate alcohol and tobacco use and sales.

🏥 Health Care Institutions

• Each hospital or facility has its own medication policies to follow the law.

Medication names

• Chemical—We don’t use this.
• Generic—The name we use in school.
• Trade-Brand name

Medications are classified by their type (like analgesics for pain or anti-inflammatories for swelling), the body system they affect (such as cardiovascular or respiratory), the symptoms they relieve (like fever or anxiety), and their desired effect (for example, lowering blood pressure).

They come in different forms: oral (tablets, capsules, syrups), parenteral (injections), topical (creams, patches), and instillation (drops or body cavities like the eye, ear, nasal, rectal, or vaginal).

🧬 Pharmacokinetics — How the Body Handles Medication

💉 1. Absorption

The medication moves from where it’s given into the bloodstream.

⚙️ Influenced by:

• Route of administration (oral, IV, topical, etc.)
• How easily it dissolves
• Blood flow to the site
• Body surface area-Like medication on the skin.
• Lipid solubility (fat-soluble drugs absorb faster)

🧠 Think: “How fast and how much of the drug gets in.”

🩸 2. Distribution

Once in the blood, the medication travels to body tissues and organs.

⚙️ Depends on:

• Circulation: good blood flow = faster delivery
• Protein binding: some drugs attach to proteins, slowing their effect
• Membrane permeability: like a "gate" controlling how easily the medication can pass through

🧠 Think: “Where the drug goes.”

⚗️ 3. Metabolism

The body breaks down the drug into a less active or inactive form, mainly in the liver.

⚙️ Happens through:

• Enzymes that detoxify and transform the drug (biotransformation)

🧠 Think: “How the body changes the drug.”

🚽 4. Excretion

The type of drug determines the organ of excretion. The body eliminates the medication through several routes:

• Kidneys (urine) 🧻
• Liver (bile) → Goes to intestines → feces
• Bowels (feces)
• Lungs (exhaled gases) 🌬️
• Exocrine glands (sweat, breast milk) 💧

🧠 Think: “How the drug leaves the body.”

💊 Types of Medication Actions

⚠️ Adverse Effect

An unintended, harmful, or unpredictable reaction to a drug.

🧠 Think: “Bad reaction that wasn’t expected.”

🔒 Medication Dependence -Like and addiction.

The body or mind relies on the drug to function or feel normal.

• Physical dependence: body needs it to avoid withdrawal.
• Psychological dependence: emotional craving or desire. - This is what we know as addiction.

🧠 Think: “Can’t function or feel okay without it.”

A postoperative patient is receiving morphine sulfate via patient-controlled analgesia (PCA). The nurse assesses that the patient’s respirations are depressed. The effects of the morphine sulfate can be classified as: A. allergic. B. idiosyncratic. C. therapeutic. D. toxic.✅

⏰ Timing of Medication Dose Responses

🎯 Therapeutic Range

The level of drug in the blood that produces the desired effect without being toxic.

🧠 Think: “Safe and effective zone.”

📈 Peak

The highest concentration of the drug in the blood — when the effect is strongest.

📉 Trough

The lowest concentration in the blood — usually measured right before the next dose to make sure levels stay safe.

⏳ Biological Half-Life

The time it takes for half of the drug to leave the body.

🧠 Think: “How long it stays active.”

🩺 Plateau ——

Occurs when drug intake equals drug elimination, keeping a steady level in the bloodstream.

⏱️ Time-Critical Medications

Drugs that must be given exactly on schedule (like insulin or antibiotics) to work safely and effectively.

👩‍🏫 Patient Teaching

Explain why timing matters, encourage taking medications at the same time daily, and never skipping doses.

⚖️ Systems of Medication Measurement (Metric, Household, Solutions)

📏 Metric System

• Most accurate and organized.
• Uses meter (length), liter (volume), gram (weight).
• ⚠️ Never use a trailing zero (e.g., write 5 mg, not 5.0 mg).

🏠 Household System

• Most familiar to patients.
• Uses teaspoon, tablespoon, cup.
• ❌ Less accurate — not ideal for precise dosing.

💧 Solutions

• A solid dissolved in a liquid.
• Expressed as:
• Mass per volume: g/L, mg/mL
• Percentage: 10% solution = 10 g per 100 mL
• Proportion: 1:1000 (1 part drug per 1000 parts solution)

🩺 Prescribers and Medication Orders

👨‍⚕️ Who Can Prescribe

• Physicians, Nurse Practitioners (NPs), and Physician Assistants (PAs) can legally prescribe medications.

📝 Types of Orders

• Written: handwritten or electronic (most common).
• Verbal: given in person — nurse must read back in the system for confirmation or call the provider by phone after.
• Telephone: taken over the phone — must be documented and verified.

⚠️ Abbreviations

• Abbreviations can cause medication errors.
• Always use caution and know which are prohibited or error-prone (e.g., “U” for units, “QD” for daily).

🏥 Types of Medication Orders in Acute Care

📋 Standing (Routine) Orders

Given regularly until the provider changes or stops it.

🧠 Example: “Take 1 tablet daily.”

💊 PRN (As Needed) Orders

Given only when needed for specific symptoms.

🧠 Example: “Give acetaminophen 650 mg every 6 hours PRN for pain.”

🕐 Single (One-Time) Order

Given once only for a specific reason.

🧠 Example: “Give pre-op antibiotic before surgery.”

⚡ STAT Order

Given immediately — emergency use, once only.

🧠 Example: “Give epinephrine STAT for anaphylaxis.”

⏱️ Now Order

Given as soon as possible, but not as urgent as STAT (usually within 90 min).

🧠 Example: “Give pain med now.”

🏠 Prescription

Used outside the hospital — taken to a pharmacy to fill.

🧠 Example: “Amoxicillin 500 mg PO three times daily for 7 days.”

💊 Medication Administration

🧪 Pharmacist’s Role

• Prepares, packages, and distributes medications.
• Checks for drug compatibility and safety before sending to the nurse.

🗂️ Distribution Systems

• Unit Dose System: each dose packaged and labeled individually for one patient.

• AMDS (Automatic Medication Dispensing System): computerized cabinet that stores and tracks medications.

⚠️ Medication Errors

• A medication error is any preventable mistake that can cause harm or inappropriate use.

🧠 Examples: wrong dose, wrong patient, wrong time.

✅ Seven Rights of Medication Administration

1. 💊 Right Medication — Give the correct drug as prescribed.
2. ⚖️ Right Dose — Give the correct amount; check calculations carefully.
3. 🧍‍♂️ Right Patient — Verify using two identifiers (name, DOB, ID band).
4. 🩸 Right Route — Use the correct method (oral, IV, IM, etc.).
5. ⏰ Right Time — Give it at the right schedule (consider peak/trough times).
6. 📝 Right Documentation — Record immediately after giving the medication.
7. 🎯 Right Indication — Know why the patient is receiving the medication.

🧠 Tip: Double-check all 7 rights every time to prevent medication errors.

🧠 Implementation in Medication Administration

🌿 Health Promotion a and Teach patients and caregivers

👩‍🏫 Patient & Family Teaching

Dose calculations and measurements.

🏥 Acute Care Responsibilities

• Receive, transcribe, and communicate medication orders correctly.
• Ensure accurate dose calculations and measurements.
• Avoid distractions while preparing or giving meds.
• Administer correctly using the 7 rights.
• Document immediately after administration.

💊 Oral Administration (Feeding Tube Care)

• Check that the tube type and medication are compatible.
• Use liquid meds when possible.
• Flush the tube before and between medications.
• Follow tubing connection standards to prevent errors.

🌿 Topical Administration (Patches & Creams)

• Document patch location and removal in the MAR.
• Always check for existing patches before applying a new one.
• Rotate sites to avoid skin irritation.

👃 Nasal Instillation

• Can be given as spray, drops, or tampon.
• Decongestants are most common.
• Warn patients not to overuse — it can cause rebound congestion.
• Avoid swallowing the solution, especially in children.

👁️ Eye Instillation

• Avoid touching the cornea, eye, or eyelid with dropper.
• Intraocular disks (like contact lenses): teach how to insert/remove and watch for side effects.

👂 Ear Instillation

Use room-temperature, sterile drops. If there’s ear drainage, check for eardrum rupture before giving. Never block the ear canal. Irrigation removes wax only when needed for hearing, discomfort, or inspection.

🌸 Vaginal Instillation

Suppositories use an applicator; other forms include foams, jellies, and creams.

🍑 Rectal Instillation

• Bullet-shaped suppository for easy insertion and less trauma.
• May act locally or systemically.
• Give cleansing enema first if stool is present.

💧 Irrigations

• Use sterile water, saline, or antiseptic on eye, ear, throat, vagina, or urinary tract.
• Clean technique for non-sterile areas (ear canal, vagina).
• Purpose: cleanse, deliver meds, or apply hot/cold therapy.

💉 Insulin Preparation

• Always use a U-100 insulin syringe or insulin pen for U-100 insulin — this ensures accurate dosing.
• When mixing rapid-acting and NPH insulin, inject within 15 minutes before a meal to prevent hypoglycemia.
• We only mixed Regular and NPH.
• Double-check doses with another nurse before giving the injection for patient safety.

🧠 Tip: Remember “Clear before Cloudy” — draw up the rapid-acting (clear) insulin first, then the NPH (cloudy).

💉 Subcutaneous (SubQ) Injections

• Medication is injected into the fatty tissue under the skin (below the dermis).
• Absorption rate depends on blood flow, exercise, and temperature (heat ↑ absorption, cold ↓ it).
• Low-molecular-weight heparin (LMWH) (e.g., enoxaparin) needs special care — inject into the abdomen, avoid massaging the site, and don’t expel the air bubble in the syringe.
• Common sites: abdomen, thigh, upper arm.

🧠 Tip: Rotate injection sites to prevent tissue damage and improve absorption consistency.

💉 Parenteral Administration of Medications

• Amounts:
• Infants: 0.5 mL
• Small children/older infants: 1 mL
• Adults: 2–5 mL (best ≤3 mL)
• Elderly/thin/adolescents: up to 2 mL
• Use the Z-Track method to seal the medication and prevent irritation or leakage.

🍑 IM Injection Sites

1. Ventrogluteal

• Safest & preferred site for all ages.
• Muscle: gluteus medius.
• Use V or G method to locate the area.

2. Vastus Lateralis

• Middle third of thigh muscle.
• Common for infants and young children receiving vaccines.

3. Deltoid

• For small volumes (<2 mL) only.
• Site: three finger-widths below the acromion process.
• Avoid major nerves and arteries.

🧪 Intradermal (ID) Injections

• Used for skin testing (e.g., TB, allergy tests).
• Angle: 5–15° with bevel up.
• Small bleb should form.
• Absorption is slow due to low blood flow.
• Use tuberculin syringe for accuracy.

🧷 Injection Safety

• Follow the Needlestick Safety and Prevention Act.
• Dispose of all sharps in labeled sharps containers.

💧 Intravenous (IV) Administration

💼 Methods

1. Large-volume infusion — pharmacy-prepared IV bags (500–1000 mL).
• Safest method but monitor for fluid overload.
• Nurses only mix in emergencies; never high-alert meds.
2. IV Bolus (Push) — direct, concentrated dose into bloodstream.
• Fastest and riskiest method (no time to correct errors).
• Confirm IV patency and calculate correct rate.
3. Piggyback (Secondary Infusion) — small IV bag with medication attached to main line.

⚙️ Volume-Controlled Infusions

• Use 50–100 mL of fluid via mini-chambers, piggyback sets, or syringe pumps.
• Advantages:
• Prevents rapid-dose errors.
• Keeps medications stable.
• Controls total IV intake precisely.

💧 Parenteral Administration of Medications (IV Methods)

🧩 Piggyback

• Small IV bag (25–250 mL) connected to a Y-port on the main IV line or saline lock.
• Used for intermittent medications (e.g., antibiotics).

🧠 Think: “small bag riding on the main line.”

⚙️ Volume-Control Administration

• Small 150 mL chamber attached below the main IV bag.
• Allows precise dosing of small medication volumes.
• Prevents rapid-infusion errors.

🪡 Syringe Pump:

• Battery-operated; infuses 5–60 mL at a controlled rate.
• Ideal for small doses or pediatric patients.

🔄 Intermittent Venous Access (Saline Lock)

• Provides IV access without continuous fluids.
• 💰 Advantages:
• Saves cost and nurse time.
• Increases patient mobility and comfort.
• 🩸 Before use: check patency and site condition.
• 💧 After use: flush with saline to keep line patent.

🏠 IV Therapy at Home

• Patients usually have central venous catheters.
• Home-care nurses monitor for complications.
• Teach patients and families:
• Signs of infection or occlusion.
• When to call the nurse or provider.
• Proper care and maintenance of IV equipment.

🛡️ Safety Guidelines for Nursing Skills

• Perform the three medication checks (before preparing, before giving, and before discarding).
• Use technology (bar-code scanners, AMDS) when available.