Ch 53 math medication administration and ch 16

Needles

A needles gauge is expressed with numbers. The smaller the number the larger the diameter. Choose the correct needle length based on the type of injection as well as the patients size, fatty tissue, and injection site.

Subcutaneous

A subcutaneous injection provides a slow sustained release of a medication and a relatively long duration of action. Generally 1 mL or less of a medication can be delivered by a subcut injection. Various drugs such as high risk drugs insulin and heparin are commonly administered by a subcut injection. Common subcutaneous injection sites include an area on the back between the shoulder blades, outer sides of upper arms, thighs, and abdomen. When patients need regular subcut injections remember to rotate injection sites systematically. Rotating sites promotes drug absorption and prevents hard lumps from forming. At the injection site ensure you can pinch at least 1in of skin for the injection.

Charting

All chart entries must be factual, accurate, complete, current, organized, and confidential. Be specific. Chart what the patient said or did and not what you think. Before you begin make sure you have the right chart and right location in the chart. Chart medications directly from the physicians order. Be specific. If using paper charts don't leave gaps or skip lines. If you make an error don't erase it. Never use ditto marks. Write neatly in longhand or carefully enter into the electronic chart and check your note before submitting it. Use abbreviations and correct symbols. If you're unsure about charting check with your supervising licensed practitioner.

Right to know

All patients have the right to be educated about the medication they are receiving. This should include the reason, effect, and side effects.

Right patient

Always check the name and dob on the order for a medication or vaccine. Have an attending caregiver or family member state the name and dob if the patient is unable to.

Right technique

Always use the proper administration technique. If you haven't given a medication or vaccine by the ordered route recently review the technique before administering the drug.

Intradermal

An intradermal injection is administered between the upper layers of skin at an angle almost parallel to the skin. Common sites for intradermal injections are the forearm and back. Intradermal injections are usually used to administer a skin test such as allergy or TB test. The drug is injected under the top skin layer and a little bubble or wheal is raised. If the body reacts to the drug redness and hardening occur. This reaction generally takes place 15-20 minutes after an allergy test and from 48-72 hours after a TB test.

Right time

Be sure to give the medication at the right time. If it must be given after meals make sure the patient has eaten. For certain medications you must ensure that it's the correct time of day and correct time in a series of doses.

Patient condition

Before administering observe the patient for any condition that might interfere with the medication you will be administering. Review the patients drug list to ensure that any medications already being taken won't interfere with the ordered drug or route of administration. Double check the order and ensure that it's appropriate for the patients age and weight.

Prescription drugs

Before patients begin drug therapy they should be informed of certain considerations like when and how to take the medication and medication safety precautions. First you must check a credible drug information resource about any medication with which your are not familiar. As part of your patient education provide instructions orally and in writing. An important aspect of this kind of information is teaching the patient how to read a prescription medication label. Instruct the patient to be particularly alert for special instructions and warning labels.

Buccal and sublingual administration

Buccal and sublingual medications are placed in the mouth, they don't continue to the GI tract. The dissolve and are absorbed in the buccal area between the cheek and gum or the sublingual area under the tongue. The medication and is absorbed thru tissue that's rich in capillaries and the medication enters the bloodstream directly. Bc it doesn't pass thru the GI tract it produces a therapeutic effect more quickly than oral medications.

Rectal administration

Certain medications such as drugs used to treat constipation, nausea, and vomiting may be administered by the rectal route. These medications may be given in the form of suppositories or enemas and may produce local or systemic effects.

Right dose

Compare the dose on the order in the chart with the dose you prepare. To obtain the right dose read the label closely and calculate accurately. Don't confuse the dose contained in one tablet with the number of tablets in the container.

Right drug

Compare the name of the prescribed medication or vaccine in the patients chart with the label on the medication container. Look at the expiration date. Never use a medication that has passed this date. If you're unfamiliar with the medication look it up. Always perform the triple check every time you prepare a medication.

Right documentation

Document the procedures immediately after administering the medication or vaccine to the patient. Don't wait until later and don't document before administering.

Right route

Double check to make sure the administration route you're preparing to use matches the route ordered. Also check that the medication you're using can be administered by the route ordered. Check that the patient can receive the medication by this route and that it seems appropriate.

Administration site

Drugs that have local effects are applied directly to the skin, tissues, or mucous membranes. Drugs that produce systemic effects are administered by routes that allow the drug to be absorbed and distributed in the blood stream throughout the body. Before you administer medication you must check the site of administration.

Right to refuse

Every patient has the right to refuse medication. If a patient does refuse a medication or vaccine you should report this to the physician. A refusal of medication should be documented in the patients chart.

General rules for medication administration

Give only the medications the physician ordered. Wash your hands before handling the medication. Perform a triple check by checking the medication 3 times. Calculate the dose if necessary. Avoid leaving a prepared medication unattended and never administer medication someone else prepared. Ask the patient to state their name and dob to ensure correct identification. Be sure the physician is in the office when your administer a medication or vaccine. After administering the medication ask the patient to remain in the facility for 10-20 minutes to observe for unexpected side effects. If the patient refuses to take the medication discard it according to office policy. If you make a error in medication administration tell the physician immediately. Document the medication and dose immediately after administration.

Inhalation therapies

Inhalation Theraphy is medication that's delivered into the respiratory system during inhalation. This medication can be administered thru the mouth or nose. Always read the inserts for inhaled drugs for a detailed description of the exact procedure for the type of inhalation you will be administering.

Drug food interactions

Interactions between a medication and food can alter the medications therapeutic effect. A food that may interact with drugs is grapefruit and grapefruit juice. Some drug food interactions can affect the body's use of nutrients. When teaching a patient about drug food interactions specify exactly which foods to avoid and when. Explain what to expect if a interaction occurs and how to deal with it.

Elimination

Is the process in which the drugs leaves the body. Most drugs are eliminated thru the urine although they can also be eliminated in the air that we exhale, sweat, feces, breast milk, or any other body secretions.

Distribution

Is the process that moves a drug from the bloodstream into other body tissues and fluids. The target site is the site where the drug produces its desired effect.

Absorption

Is the process that moves a drug from the site where it's given into the bloodstream. Intravenous medications bypass the absorption process bc they are administered directly into the bloodstream. Oral medications are absorbed thru the digestive system while topical medications are absorbed thru the skin.

Pharmacokinetics

Is the study of what happens to a drug after it's administered to a patient. There's four processes that affect a drug after it's administered: absorbed, distribution, metabolism, and elimination.

Pregnant patients

It's extremely important to double check the medication in a credible drug reference for toxicology or pregnancy warnings. If the physician orders a medication for a pregnant patient double check the order against the pregnancy drug risk categories.

Creatinine clearance

Many package inserts discuss safe dosage levels based on creatinine clearance. Creatinine is a by product of muscle metabolism and is found in the blood. The kidneys filter creatinine from the blood and the rate at which creatinine is excreted thru the urine is called creatinine clearance. A persons creatinine clearance is considered an indicator of the rate at which the kidneys filter the blood. Creatinine clearance often decreases with age as a normal part of aging process. If a patient has decreased kidney function the creatinine clearance will decrease beyond the normal effect of aging. At the same time the amount of creatinine in the blood may increase.

Patient consent form

Many physicians require that a patient sign a consent form before receiving an injection. This form provides general information regarding the medication or vaccine and lists the possible side effects or adverse effects. If a consent form is needed make sure the patient signs the form and that you have answered any questions prior to giving the injection.

Medications by injection

Medications given by injection are called parenteral medications. Parenteral administration is the administration of a substance such as medication by muscle, vein, or any means other than thru the GI tract. Parenteral administration poses more safety risks for the patient bc after the medication has been injected it can't be retrieved. Parenteral administration also increases your risk of potential exposure to bloodborne pathogens when you perform injections and dispose of used needles. After using a needle, lancet, or syringe engage the safety mechanism then immediately place it in the sharps container.

Oral administration

Medications that are swallowed are absorbed relatively slowly as they travel along the gastrointestinal GI tract. Medications for oral administration include tablets, capsules, lozenges, and liquids. One special type of tablet you should be aware of is a scored tablet. Oral administration is contraindicated in patients who have nausea, are comatose, or can't swallow.

Metabolism

Or bio transformation of a medication is the process that chemically changes a drug either before or after it performs its intended task. These changes occur primarily in the liver.

Complete medication list

Patients must inform the doctor of all substances they use regularly or periodically. This includes prescription and OTC drugs plus herbals and supplements. It also includes past and present use of alcohol and recreational drugs. When patients have more than one doctor tell them to inform each doctor about all medications they are taking. Encourage them the keep up to date medication lists with dosages.

Over the counter drugs

Patients shouldn't treat themselves with OTC drugs as a way to avoid medical care. Patients should know that OTC drugs may not produce enough therapeutic benefit in some cases or be dangerous when used in combination with other substances. Some OTC drugs may mask symptoms or aggravate a problem. Many OTC drugs contain more than one active ingredient.

Vaginal administration

Physicians usually prescribe vaginal medications to treat local fungal or bacterial infections. They are usually packaged as suppositories, solutions, creams, ointments, and foams. The liquid form of vaginal medication is administered by performing a douche.

Pediatric patients

Physiological differences between children and adults make children more susceptible to the effects and adverse reactions of medications. Not only the difference in body size and composition but also the immaturity of organ systems contribute to increased risks associated with pediatric medication administration. Bc children have an increased metabolism and higher percentage of water per kilogram of body weight the pharmacokinetic processes absorption, distribution, metabolism, and excretion are different in children than they are in adults.

Adverse reactions

Reported adverse reactions associated with a drug are somewhat predictable and range from mild side effects such as stomach upset, to severe or life threatening allergic responses. Elderly patients and patients with liver or kidney disease are more susceptible than others to adverse reactions bc these conditions affect drug metabolism and excretion. When drugs aren't metabolized properly or excreted from the body quickly enough drugs can reach toxic levels even with normal doses. Teach the patient to take the drug at the right time in the right amount and under the right circumstances. Also teach patients to recognize significant adverse effects and to call the office if any of them occur. The patient also should report any change in overall health bc that change could be drug related. Tell patients to inform each of their doctors of any adverse reactions they've had to drugs.

Restraining methods

Sometimes a pediatric patient will need to be restrained in order for you to administer an injection.

Syringes

The barrel is the calibrated cylinder that holds the drug. The plunger forces the drug thru the barrel and out the needle. All syringes must include a needle stick prevention safety device.

Right reason

The person who administers the medication should know the reason the medication is being given.

Drugs and drug allergies

The physician needs to know everything the patient is taking before ordering a medication. The medical assistant is responsible for ensuring that a complete and accurate medication list is maintained on the patients chart. This medication list must be updated every time the patient comes for an appointment. While asking about medications you must also ask about any drug allergies. Even though you see the patient regularly be in the habit of asking about drugs and drug allergies at every patient visit.

Polypharmacy

The practice of taking many medications at one time is called polypharmacy. Many geriatric patients take several medications. They may take more than a dozen prescription medications as well as OTC medications or natural supplements. They often have more than one physician and one or more specialists who treat specific diseases and ailments.

Urethral administration

The urethral route is used when antibiotics and antifungal drugs are needed locally at the site of infection for some urinary tract infections. Urethral medication administration requires passing a small diameter urinary catheter into the bladder instilling a drug thru it and clamping the catheter to let the drug bath the bladder wall.

Pediatric injection sites

The vastus lateralis and ventrogluteal sites are recommended for infants and children. The gauge and length vary based on the size of the patient.

Pediatric patients

Their physiology and immature body systems make medication effects less predictable bc drugs are absorbed, distributed, metabolized, and excreted differently in children than in adults. These factors require dosage adjustments and careful measurement of small doses. Administration sites and techniques for a child may differ from those for an adult. When dealing with a infant or young child teach the parents not the patient about the medication. With an older child include parents and patient in the teaching session.

Patient compliance

To help ensure that patients comply with instructions confirm that they completely understand the name, dosage, and purpose of each drug prescribed for them. Explain how and when to take each drug to ensure it's safety and effectiveness. Tell patients how long to take each drug. Explain how to identify possible adverse reactions of each drug and safety measures related to adverse reactions. Tell patients not to save medications that are over 1 year old or share them with anyone else. Suggest that patients avoid alcohol when taking certain drugs. Tell patients to ask their pharmacists where to store each medication. Tell patients to take their drugs in a well lit area so that they can read each drug label carefully before taking each dose. Instruct patients to call the licensed practitioner if they have any questions about their drug therapy.

Topical application

Topical application is the direct application of a medication on the skin. Topical medications can take the form of creams, lotions, ointments, tinctures, powders, sprays, and solutions which are used for their local effects. To apply a cream, lotion, or ointment use long even strokes with a cotton tipped applicator and a gloves finger when rubbing it into the skin. A specialized type of topical administration that produces a systemic effect is the transdermal system or patch. A medication administered thru the transdermal patch is absorbed thru the skin directly into the bloodstream.

Intramuscular

When a patient requires rapid medication absorption you may be asked to administer an intramuscular injection. An IM injection usually irritates a patients tissues less than a subcut injection and allows administration of a larger amount of medication. Common IM injection sites include the ventrogluteal, vastus lateralis, and deltoid muscles. Take into consideration the patients layer of fat when choosing an IM injection site. When injecting an IM drug that can irritate subcutaneous tissues use the z track method. To do this pull the skin and subcutaneous tissue to the side before inserting the needle at the site. After the drug is injected release the tissue. This creates a zigzag path in the tissue layers which prevents drug from leaking into the subcutaneous tissue and causing irritation.

Drug drug interactions

When two drugs are taken at the same time there are several possible interactions. In some cases the effects of both drugs are increased causing either a toxic or beneficial effect. In other cases the effects of both drugs are decreased or one drug cancels out the effect of the other. In some other cases the effect of one drug is increased by the other. Drug interactions can lead to adverse reactions. To help prevent unintentional drug interactions thoroughly check the patients medication use. Question the patient about past and present use of alcohol and recreational drugs as well as herbal remedies.

Geriatric patients

When your work with geriatric patients show them respect. Listen to their concerns. Recommend that they use the same pharmacy to fill all prescriptions. Encourage them to have one doctor as their primary physician to monitor and approve all medications. Remind them to keep a list of all their medications including vitamins, herbals, and alternative medications. Geriatric patients may have decreased manual dexterity that can interfere with their ability to inject medications, administer eye drops, or open bottles. Patients with difficulty swallowing will need information about which medications may be crushed and mixed with applesauce or pudding. They need information about which medications may not be broken or crushed. Many patients can't read small print. Medications may need labels that can easily be read and will clearly describe the purpose of each medication. Geriatric patients often have some form of hearing loss. They may also have short term memory loss. Liver and kidney functions are often reduced in geriatric patients. Decreased liver function results in slower metabolism of certain drugs delaying or prolonging the desired effect. It can also lead to higher level of drug in the blood system producing more intense results. Decreased kidney function along with decreased cardiac output slows the excretion of medications from the body. The effects of slower excretion and reduced metabolism may combine causing medications to accumulate in the body. This may cause increased side effects or toxicity. Many chronic diseases in the elderly can damage the kidneys. Commonly used drugs such as lasix and antibiotics can impair kidney function. Patients who have these diseases or are taking these medications must be monitored especially closely for their kidney functions.

Patients who are breastfeeding

Whenever a medication is ordered for a patient who is breastfeeding check a drug reference to see whether the medication is contraindicated during lactation. If a mother must take a medication that affects lactation advise her to supplement with infant formula.