Fundamental Fundamental NursingNursing

Chapter 32Chapter 32

Oral MedicationsOral Medications

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Medication OrdersMedication Orders

A A medication ordermedication order lists the drug name and lists the drug name and

directions for its administration. Usually directions for its administration. Usually

physicians or dentists write a medication physicians or dentists write a medication

order.order.

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Components of a Medication Components of a Medication OrderOrder

All medication orders must have seven All medication orders must have seven components:components:

1.1. Client's nameClient's name2.2. Date and time the order is writtenDate and time the order is written3.3. Drug nameDrug name4.4. Dose to be administeredDose to be administered5.5. Route of administrationRoute of administration6.6. Frequency of administrationFrequency of administration7.7. Signature of the person ordering the drugSignature of the person ordering the drug

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If any one of these components is absent, the If any one of these components is absent, the nurse must withhold the drug until he or she nurse must withhold the drug until he or she has obtained the missing information. has obtained the missing information. Medication errors are serious. Medication errors are serious.

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Drug NameDrug Name

Each drug has a Each drug has a trade nametrade name (name that the (name that the pharmaceutical company who made the drug pharmaceutical company who made the drug uses). uses).

Drugs also have a Drugs also have a generic namegeneric name (chemical (chemical name not protected by a company's name not protected by a company's trademark), trademark),

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Drug DoseDrug Dose

The The dosedose means the amount of drug to means the amount of drug to

administer.administer.

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Route of AdministrationRoute of Administration

The The route of administrationroute of administration means how the means how the

drug is given, which may be by the oral, drug is given, which may be by the oral,

topical, inhalant, or parenteral route. topical, inhalant, or parenteral route.

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The The oral routeoral route (administration of drugs by (administration of drugs by swallowing or instillation through an enteral swallowing or instillation through an enteral tube) facilitates drug absorption through the tube) facilitates drug absorption through the gastrointestinal tract. It is the most common gastrointestinal tract. It is the most common route for medication administration because it route for medication administration because it is safer, more economical, and more is safer, more economical, and more comfortable than others. Medications comfortable than others. Medications administered by the oral route come in both administered by the oral route come in both solid and liquid forms.solid and liquid forms.

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Frequency of AdministrationFrequency of Administration

The frequency of drug administration refers to The frequency of drug administration refers to how often and how regularly the medication is how often and how regularly the medication is to be given. Frequency of administration is to be given. Frequency of administration is written using standard abbreviations of Latin written using standard abbreviations of Latin origin. Some common examples include the origin. Some common examples include the following:following:

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Stat—immediatelyStat—immediately b.i.d.—twice a dayb.i.d.—twice a day t.i.d.—three times a dayt.i.d.—three times a day q.i.d.—four times a dayq.i.d.—four times a day q.h.—hourlyq.h.—hourly q4h—every 4 hoursq4h—every 4 hours

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Verbal and Telephone OrdersVerbal and Telephone Orders

Verbal orders are instructions for client care that are Verbal orders are instructions for client care that are given during face-to-face conversations. Telephone given during face-to-face conversations. Telephone orders are obtained from a physician during a orders are obtained from a physician during a telephone conversation.telephone conversation.

When obtaining phone orders, it is important to When obtaining phone orders, it is important to repeat the dosages of drugs and to spell drug names repeat the dosages of drugs and to spell drug names for confirmation of accuracy. Some nurses ask a for confirmation of accuracy. Some nurses ask a second nurse to listen to a telephone order on an second nurse to listen to a telephone order on an extension. extension.

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Storing MedicationsStoring Medications

Each health agency has one area for storing Each health agency has one area for storing drugs. Some agencies keep medications in a drugs. Some agencies keep medications in a mobile cart; others store them in a medication mobile cart; others store them in a medication room.room.

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Accounting for NarcoticsAccounting for Narcotics

Health agencies keep narcotics in a double-Health agencies keep narcotics in a double-locked drawer, box, or room on the nursing locked drawer, box, or room on the nursing unit. Because narcotics usually are delivered unit. Because narcotics usually are delivered by stock supply, nurses are responsible for an by stock supply, nurses are responsible for an accurate account of their use.accurate account of their use.

Nurses count narcotics at each change of shift. Nurses count narcotics at each change of shift.

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Medication AdministrationMedication Administration

Safety is the main concern in medication Safety is the main concern in medication administration. Taking various precautions administration. Taking various precautions before, during, and after each administration before, during, and after each administration reduces the potential for medication errors. reduces the potential for medication errors. Some precautions include ensuring the five Some precautions include ensuring the five rights of medication administration, rights of medication administration, calculating drug dosages accurately, preparing calculating drug dosages accurately, preparing medications carefully, and recording their medications carefully, and recording their administration.administration.

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Applying the Five RightsApplying the Five Rights

To safeguard against medication errors, nurses To safeguard against medication errors, nurses

follow the five rights of medication follow the five rights of medication

administration: administration: the right patient, the right drug, the right patient, the right drug,

the right dose, the right route and the right the right dose, the right route and the right

timetime. Some nurses have added a sixth right, . Some nurses have added a sixth right,

the right to refuse.the right to refuse.

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Calculating DosagesCalculating Dosages

One of the major nursing responsibilities, and One of the major nursing responsibilities, and

one of the five rights, is preparing the dose one of the five rights, is preparing the dose

accurately.accurately.

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Box 32-1 • Drug Calculation Formula

EXAMPLE 1EXAMPLE 1

A client is ordered 150 mg soluble aspirin. A client is ordered 150 mg soluble aspirin.

‘Disprin’ tablets containing 300 mg aspirin are ‘Disprin’ tablets containing 300 mg aspirin are

available. How many tablets will you give?available. How many tablets will you give?

150mg / 300mg x 1tablet = 0.5 tablet150mg / 300mg x 1tablet = 0.5 tablet

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EXAMPLE 2EXAMPLE 2

You are required to give 6 mg morphine. In your You are required to give 6 mg morphine. In your

stock ampoule there is 15 mg per 1 mL. How stock ampoule there is 15 mg per 1 mL. How

much of the ampoule will you need?much of the ampoule will you need?

6 mg / 15 mg × 1 mL = 0.4 mL6 mg / 15 mg × 1 mL = 0.4 mL

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EXAMPLE 3EXAMPLE 3

You are required to give 30 units insulin. In your You are required to give 30 units insulin. In your

stock vial there is 100 units per 1 mL. How stock vial there is 100 units per 1 mL. How

much do you require?much do you require?

30 units / 100 units × 1 mL = 0.3 mL30 units / 100 units × 1 mL = 0.3 mL

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Administering Oral Administering Oral MedicationsMedications

Nurses prepare and bring oral medications to Nurses prepare and bring oral medications to

the client's bedside in a paper or plastic cup . the client's bedside in a paper or plastic cup .

The nurse administers only those medications The nurse administers only those medications

that he or she has personally prepared; never that he or she has personally prepared; never

administer medications prepared by another administer medications prepared by another

nurse.nurse.

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Administering Oral Medications by Administering Oral Medications by Enteral TubeEnteral Tube

When a client cannot swallow oral medications, they can When a client cannot swallow oral medications, they can be instilled by enteral tube.be instilled by enteral tube.

After administering the drug, the nurse clamps or plugs After administering the drug, the nurse clamps or plugs the tube for at least 30 minutes to prevent removing the the tube for at least 30 minutes to prevent removing the drug before it leaves the stomach. drug before it leaves the stomach.

Nurses can give medications while a client is receiving Nurses can give medications while a client is receiving tube feedings, but they instill the medications separatelytube feedings, but they instill the medications separately—that is, they do not add the medications to the formula. —that is, they do not add the medications to the formula.

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DocumentationDocumentation

Nurses document medication administration Nurses document medication administration

on the Medication Administration Record on the Medication Administration Record

(MAR), the client's chart, or both as soon as (MAR), the client's chart, or both as soon as

possible. Timely documentation prevents possible. Timely documentation prevents

medication errors.medication errors.

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Medication ErrorsMedication Errors

Medication errors happen.Medication errors happen.

As soon as he or she recognizes an error, the nurse As soon as he or she recognizes an error, the nurse

checks the client's condition and reports the checks the client's condition and reports the

mistake to the prescriber and supervising nurse mistake to the prescriber and supervising nurse

immediately. Health care agencies have a form for immediately. Health care agencies have a form for

reporting medication errors called an incident sheet reporting medication errors called an incident sheet

or accident sheet. or accident sheet.

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Nursing ImplicationsNursing Implications

Deficient KnowledgeDeficient Knowledge Risk for AspirationRisk for Aspiration Ineffective Therapeutic Regimen ManagementIneffective Therapeutic Regimen Management Ineffective Health MaintenanceIneffective Health Maintenance NoncomplianceNoncompliance