Administration of Drug

Administration of Drug

Introduction

Medication is a process of entering the medicines into the body. It is any pharmacological intervention used to treat, prevent, or reduce signs and symptoms of diseases, disorders, and/or traumatic injuries. The patients with acute or chronic health problems restore or maintain their health using a variety of strategies. One of these strategies is medication, a substance used in the diagnosis, treatment, cure, relief or prevention of health problems. Nurses play an essential role in safe medication preparation, administration, and evaluation of medication effects. Healthcare providers are trained in how to give you medication safely. Administration of medication requires thorough understanding the drug including:

• How it moves through body
• When it needs to be administered
• Possible side effects and dangerous reactions
• Proper storage, handling, and disposal

Drugs

Drugs are chemical substances derived from different sources (living or non-living things) which are used to alter or change the function of cells, organs for organisms by reacting with them. It may be defined as a substance used to promote health, to prevent, to diagnose, and to care disease. Drugs can be dangerous, though, even when they're meant to improve our health. Taking them correctly and understanding the right way to administer them can reduce the risks.

Purposes of Medication

• To diagnose disease
• To treat disease
• To promote health status
• To prevent heath alterations
• To relieve pain and discomfort

Abbreviations Used in Medication Orders

Time and Frequency of Medication Administration

AC- Before Meal

PC- After Meal

AM- In the Morning

PM- Afternoon / Evening

OD- Once a day

HS- At bed time

OM- Each Morning

ON- Each Night

P.R.N- When required

SOS- If Necessary

BID/BD- Twice a day

TDS/TID- Three times a day, 8 hourly

QID- Four times a day, 6 hourly

Stat- Immediately (at once)

QH- Hourly

NPO- Nothing per oral

Abbreviations Regarding Route

PO-Per Oral

IM- Intra Muscular

IV- Intra Vascular

ID- Intra Dermal

SC- Subcutaneous

PV- Per Vaginal

PR- Per Rectum

NG- Naso Gastric

Abbreviations Regarding the Preparation of Drugs

Mist- Mixture

Tr./Tinct- Tincture

Syp- Syrup

Sp- sprit

Lot- lotion

Liq- Liquid

Inf- infusion

Fl- fluid

Abbreviation Regarding the Amounts

grg- Gargle

kg- Kilogram

0- Pint

mg- Miligram

O2- Ounce

gm- Gram

MI- Mililiter

Tab- Tablet

Cap- Capsule

Tsf- Tea spoon

Tbs- Tablespoonful

Gtt- drops

Mcg- microgram

Types of Medication Action

Therapeutic Effect: Medication's desired and intentional effects are called therapeutic effects. These effects vary with the nature of medicine, length of time the client has been receiving it and the client's physical condition.

Adverse Effect: An effect other than the therapeutic effects is an adverse effect. These are generally considered severe responses to medication. For example, a client may become comatose when a drug is ingested.

Side Effect: Minor adverse effects are side effects. These are predictable and unavoidable secondary effects. Many side effects are harmless and can be ignored. Some are harmful and undesirable.

Toxic Effect: Medication toxicity results from overdose or abnormal accumulation of drug in the blood because of impaired metabolism or excretion. Toxicity can affect and permanently damage the functions of organs e.g. liver and kidney.

Hyper Sensitivity Reaction: It occurs when a client is unusually sensitive to a medication therapeutic effect or secondary effect. An estimated therapeutics dosage of medication may be too large for the client and may result in degree of action greater than desired.

Tolerance: It occurs when a client develops a decreased response to it, requiring an increased dose to achieve the therapeutic effects.

Sign and Symptoms: Sign is any abnormality or phenomena about the patient which can be observed by other people e.g. cyanosis, paler, edema etc. Symptom is abnormal sensation experienced by the patient himself. Symptom cannot be observed by anyone except the patient himself e.g. headache, pain, burning micturition.

Idiosyncratic Reaction: Medicine may cause an idiosyncratic effect. This occurs when a patient over reacts or under reacts to a drug or has a reaction different from the normal.

Mode of Action of Drugs

Anesthetics: Drugs which cause loss of sensation are anesthetics.

General Anesthesia: It depresses cerebral function, induces unconsciousness and depresses all sensation.

Local Anesthesia: It interferes with the function of a nerve or nerve ending and depresses all sensation from a localized area without interfering with consciousness.

Analgesics: Drugs which relieve pain are analgesics. Analgesic drugs are narcotic and non- narcotic.

Narcotic Analgesic Drugs relieve pain probably by selectively acting on receptors situated both in the higher centre and the spinal cord. 901

Non-narcotic Analgesic Drug relives pain without producing hypnosis or marked impairment or mental activity by central as well as peripheral action.

Aperients: These are those drugs which are mild purgatives that loosen the bowels.

Carminatives: These are drugs which cause expulsion of gas from the stomach and intestine. It produces mild irritation to the gastrointestinal tract leading to more motility and causing relaxation of sphincters.

Chemotherapeutic Agents: It destroys parasites or organisms without damaging the host tissue.

Diaphoretics: These are drugs which increase the action of sweat glands and induce sweating (perspiration).

Diuretics: These are drugs which increase the flow of urine e.g. Frusemide.

Antipyretics: Antipyretics reduce body temperature when it is raised above normal. e.g. Paracetamol

Emetics: Emetics are those drugs which initiate vomiting by irritating the mucous membrane of stomach or by stimulating the centre of medulla which controls the act of vomiting.

Antiemetic: These are drugs preventing nausea and vomiting.

Expectorants: The drugs which increase the bronchial secretion and help to cough of sputum are expectorants.

Hypnotics: Hypnotics are those drugs which induce sleep.

Sedatives: Sedatives are those drugs which depress CNS and allow sleep.

Tranquilizers: They calm an anxious patient without impairing his consciousness.

Tonics: Tonics produce and restore the normal tone of health.

Histamine: It causes smooth muscle contraction, including bronchiolar and small vessel constriction, increased vascular permeability and secretion of nasal and bronchial glands.

Anti-histamine: It blocks the effect of histamine. They effectively block the histamine included broncho-constriction, contraction of intestinal and other smooth muscle and triple responses especially wheal, flora and itch.

Anti-helminthic: They are drugs which destroy and expel worms e.g. albendazole.

Anti-inflammatory: Helps to reduce inflammation e.g. Ibrufen.

Antibiotics: Destroys or inhibits the growth of microorganism e.g. penicillin

Antacid: Neutralizes the activities of gastric secretion.

Antidote: Counteracts the effects of poison.

Anti-coagulant: Inhibits or decreases the blood clotting process.blogs

Anti-mycotic: Prevents growth of fungus or destroys.

Myotics: Contract the pupil of the eye.

Narcotics: Drugs which produce stupor or complete insensibility.

Stimulants: Increase the functional activity of an organ e.g. caffeine.

Nurse's Rights for Safe Medication Administration

• The right to complete and clearly written order
• The right to have the correct drug route and dose dispensed
• The right to have access to information
• The right to have policies on medication administration
• The right to administer medications safely and to identify problems in the system
• The right to stop think and be vigilant when administering medications.

Patient's Right for Safe Medication

• To be informed of the medication's name, purpose, action and potential undesired effects
• To refuse a medication regardless of the consequences.
• To have qualified nurses or physician's assess a medication history including allergies
• To be properly advised of the experimental nature of medication therapy and to give written consent for its use
• To receive appropriate supportive therapy in relation to medication therapy.

Rules for Drugs Administration

Medication orders should clearly state the patient's first and last name, the name of the drug ordered, the dose, the route, the time the drug is to be administered, and the signature of the prescriber. If any of this information is missing, notify the prescriber before giving the medication. Learning to prepare and administer medications safely and accurately is an essential component of nursing practice. The six rights ensure safety in giving drugs. For safe administration of drugs, give the right dose of the right drugs to the right patient in the right route at right time and keep proper documentation.

Right Drugs

A nurse must need to administer a correct medication. In order to be sure that you are giving the right medication, you must:

• Read the physician's order. If the order is not clear, consult the physician or other seniors.
• Read the medication order carefully. Make sure that the medication name on the order matches the medication name on the label.
• Select the right drugs from the cupboard.
• When administering a drug, the nurse should Determine that he/she has the right drug involves checking the medication label against the medication administration record (MAR) at least three times before administer the drug.
  • Before remove each drug from the storage area
  • Before prepare each drug
  • Before administer each drug.
• Look for the colour, odour and consistency of the drug.
• Administer medicine only from a clearly labeled container.
• Avoid conversation or anything that distracts the mind.
• Know abbreviations of drugs.
• Be familiar with the trade name of the drugs.
• Do not accept verbal orders.
• Correctly identify the patient before administration.
• Be sure about the changing of orders.

Right Dose

The right dose is how much of the medication you are supposed to give the individual at one time. To determine the dose, you need to know the strength of each medication. In the case of liquid medications, you need to know the strength of the medication in each liquid measure. The nurse needs to know the doses of the drugs which are safe to administer.

• Read the physician's orders to know the correct dose.
• Check the age and weight of the patient.
• Calculate the doses correctly.
• Ensure accuracy in measuring.
• Use dry medicine glasses for pouring liquid medicines.
• Hold the ounce glass at the eye level, keep the thumb at the desired level and pour the medicine.
• Know abbreviation and symbols of amounts.
• Help the patient to take all the medicine.

Sometimes, the pharmacy gives out drugs in grams when the order specifies milligrams. You need to convert these.

e.g. 1000 mg = 1gm

       1000 g = 1 kg

       1000 ml = 1 litre.

Liquid medicines are given in a vial or an ampule. Sometimes, the vial may contain more than the dose you need to give. You need then to work out how much of the solution to give in order to have the correct dose. Formula,

Dose ordered/Dose available× Quantity in hand= volume to be given

Right Patient

Before giving a medication, make sure that you are giving it to the right patient. You must use two identifiers. For example, check the patient's medical record number on the medication administration record against the patient's identification band and ask the patient to state his or her full name. In some facilities, an electronic scanner will be used to match the patient's medication administration record with the identification band. If the patient is confused or unresponsive, your two identifiers can consist of comparing the medical record number and the birth date on the MAR with the information on the patient's identification band. If your patient is a child, ask the parents or legal guardian to identify the patient, in addition to comparing the information on the MAR with the information on the patient's identification band. No matter how long you have been caring for the patient or how well you know the patient, each time you enter the room to administer a medication, you must use a minimum of two identifiers to confirm that you have the right patient.

• Check the medication card/record against the patient's name, bed and other patient's identification.
• Ask the patient to tell you his/her name.
• For unconscious patients or children, use an identification tag and ask the patients relatives.
• Prepare medication for one individual at a time.
• Give the medication to the individual as soon as you prepare it.
• Do not talk to others and ask them not to talk to you when you are giving medication.

Right Time

Medications are usually ordered to be given at certain frequencies, intervals, or times of day such as "hour of sleep". Insulin, for example, is normally given before meals. Antibiotics are usually ordered every 6, 8 or 12 hours throughout the day and night. Diuretics are usually given in the morning rather than in the evening so that the patient's sleep is not disturbed by frequent urination. For routinely ordered medications, such as antibiotics, 30 minutes before or after the scheduled time is commonly acceptable.

• Read the physicians' order.
• Know the hospital routines for intervals.
• Give near the time ordered, fifteen minutes before or after the designated time.
• Know abbreviations for time as AC, PC, and BD.

Right Route

The route means how and where the medication goes into the body. Most medication is taken into the mouth and swallowed, but others enter the body through the skin, rectum, vagina, eyes, ears, nose, and lungs, through a g-tube or by injection.

• Read the physician's order carefully to ensure the route of administration.
• Know abbreviation for methods e.g. I/V, I/M, P/O.
• If this information is missing or the specified route is not the recommended route, notify and ask for clarification.
• Most drug manufacturers label parenteral medications "for injectable use only" to help To errors, so check the label carefully.
• If any error occurs, it should be immediately reported to the ward sister and the physician.

Right Assessment

• Check the patient actual need of medication
• Properly assess the patient and tests to determine if medication is safe and appropriate If supposed to unsafe or inappropriate, notify to the senior/doctor.

Right Evaluation

• Assess the patient for effectiveness of medication.
• Remind the patients prior status of the medication and compare the with
• Determine the patient for any adverse side effects. the post medication.

Right Reason

Administer the medicine for the right reason. It means confirming the rationale for the ordered medication, what is it treating? For example an antibiotic is ordered when the person has a bacterial infection.

Right response

Right response Once a medication is administered, the nurse should monitor the patient to it medication has the desired effect or response. This right of medication administration involves an evaluation of the effectiveness of the medication's intended purpose which is crucial for some high-risk medications such as anticoagulants, anti-arrhythmics and insulin. Monitoring for the right response for example could involve assessment of the patient's blood glucose level, vital signs or other physiologic parameters such as urine output. This 'right' could thus be labelled the 'right observations'.

Right Education

• Inform patient of medication being administered.
• Explain the patientof desired effect and side effect of the medication.
• Make them aware they should contact a health care personal if they experience side effects.

Right Documentation

Accurate documentation must be available before and after a drug is administered to ensure that it is prepared and administered safely. Documentation of medication administration must be done at the time that you give the medication. After administering a medication, document it on patient's cardex. Be sure to document name of drugs, dose, route, time and signature of nurse providing the medicine and any effect of medicine. Failure to document or incorrect documentation can be considered a medication error in itself and can cause an error as well.

Routes of Administration of Drug

The path taken by the drug to get into the body is known as the route of drug administration. The route used to give a drug depends on the part of the body being treated, the way the drug works within the body, patient's physical and mental condition and the formula of the drug. Medicine can be given through various routes.

Classification

• Enteral route
• Parenteral route
• Inhalation
• Topical

Enteral Route

Enteral administration involves the esophagus, stomach, and small and large intestines (i.e., the gastrointestinal tract). Methods of administration include oral, sublingual (dissolving the drug under the tongue), and rectal.

Oral route: Medication that is given by mouth is designed to be swallowed which is absorbed in stomach and intestined.

Sublingual: The drug is placed under the tongue and letting it slowly dissolve e.g. nitroglycerine.

Buccal: Hold inside of mouth until they dissolve e.g. Lozenges.

Administration through tubes. Delivered directly into the stomach or intestine (with a G-tube or J-tube) obstructor

Parenteral Administration

It means giving of therapeutic agents outside the alimentary tract.

Intra-dermal: Into the dermis

Intra-muscular: Into the muscle

Intra-venous: Into the vein

Intra-thecal: Into the spinal cavity, involves the subarachnoid space. Injection may be applied for the lumbar puncture, for spinal anesthesia and for diagnostic purposes. This technique requires special precautions.

Intra-peritoneal: Into the peritoneal cavity. Intraperitoneal route may be used for peritoneal dialysis.

Intrapleural Route: Penicillin may be injected in cases of lung empyma by intrapleural route.

Intracardiac Route: Injection can be applied to the left ventricle in case of cardiac arrest.

Intra-osseous: into the bone marrow. This route may be used for diagnostic or therapeutic purposes.

Subcutaneous: Into the subcutaneous tissue

Intra-articular Route: Intra-articular route involves injection into the joint cavity. Corticosteroids may be injected by this route in acute arthritis.

Topical Application

Drugs may be applied to the external surfaces, the skin and the mucous membranes. Topical route includes:

Enepidermic Route: When the drug is applied to the outer skin, it is called enepidermic route of drug administration. Examples include poultices, plasters, creams and ointments.

Epidermic Route (Innunition): When the drug is rubbed into the skin, it is known as epidermic route. Examples include different oils.

Insufflations: When drug in finely powdered form is blown into the body cavities or spaces with special nebulizer, the method is known as insufflations.

Instillation: Liquids may be poured into the body by a dropper into the conjunctival sac, ear, nose and wounds. Solids may also be administered.

Irrigation or Douching: This method is used for washing a cavity e.g. urinary bladder, uterus, vagina and urethra. It is also used for application of antiseptic drugs.

Painting/Swabbing: Drugs are simply applied in the form of lotion on cutaneous or mucosal surfaces of buccal, nasal cavity and other internal organs.

Insertion: It means introducing solid forms of drugs into the body orifices e.g. rectal and vaginal suppositories.

Inhalations

Drugs introduced into the body in the form of vapour are called inhalation. Inhalation may be the route of choice to avoid the systemic effects. In this way drugs can pass directly to the lungs. Such as O2 inhalation, stem inhalation etc. dom to sbient

Oral Medication

Oral medications are defined as the administration of medication by mouth and ensuring that the patient swallows the medicine. Oral route is the most common route of drug administration. It is mostly used for the neutral drugs. It may be in the form of tablets, capsules, syrup, emulsions or powders.

Purposes

• To provide a medicine that has systemic or local effect on the gastrointestinal tract.

Advantages

• This method is safe and convenient.
• It is an effective method.
• There is no pain while giving drugs.
• Few and mild allergic reactions.
• No need of a trained person.
• Cheap.
• Easy to administer.

Disadvantages

• Sometimes, a patient may not swallow the medicine.
• The drug may only be partially absorbed.
• It may irritate the gastric mucosa and can cause vomiting or diarrhoea and the effects are lost.
• Unpleasant taste.
• Drug may absorb slowly.

Contraindications

• Alteration in gastrointestinal tract like vomiting.
• Surgical resection of a portion of gastrointestinal tract.
• The patients with gastric suction / aspiration.
• Prior to certain tests / surgeries.
• Patients on NPO status.
• The patients with poor gag reflex.
• Unconscious/confused patient.
• The patients who are unable to swallow e.g. the patientwith neuromuscular disorder.
• When drugs are destroyed in the stomach by the action of digestive juice e.g. insulin.

Forms of Oral Medications

Solid forms of medication: It includes tablets, capsules and powders.

Tablets: they are powdered medication compressed in to hard disk or cylinder.

Interic coated tablet: Medication with hard surface that impedes absorption until the medication reaches the small intestine.

Sustained release tablet: Especially formulated for gradual absorption.

Lozenge: Tablets that dissolve in mouth.

Capsule: Capsules are oral preparation in which one or more medicinal substances, powder or liquid are placed inside the shell.

Powder: Dry particles, a mass of very small fine dry pieces.

Liquid form of medication: It includes syrup, suspension and elixir, emulsion.

Syrup: Medication dissolved in concentrated sugar solution, may contain flavoring to make medication more testable.

Suspension: Finely divided drug particles dispersed in liquid medium. It must be shaken before administration.

Elixir: Liquid preparations of medication with alcohol base e.g. cough syrup.

Emulsion: Suspension within an oily base.

Articles Required

• Medication card/patient's file
• Medication tray
• Medicine
• Measuring cup/dropper/plastic cup; spoon, medicine cup
• Kidney tray/paper bag
• Glass of water
• Mortar and pestle
• Scissors
• Towel, or sponge cloth, cotton to dry the measuring cup, glass or spoon
• Jug of water
• Bowl

Procedure

Special Consideration

• Administer medications which can irritate the stomach mucosa with a light snacks or following meal e.g. Asprin, Brufen.
• Do not administer water after giving cough syrup. If the tablet/Capsule falls to the floor, discard it and repeat tablet preparation.
• Medicines that need pre-administration assessment should be placed separately.