Chapter 12 Administering Medication
Medication or drugs are given to exert specific physiologic effects on the body. Since they play such an important role in preventing, treating, and curing illness, their administration has become one of the most important, complex, and risk-laden aspects of nursing care. While medications are administered for an intended therapeutic effect, they can also have side effects, adverse effects, or even toxic effects. The nurse is responsible for understanding a drug’s expected and unexpected effects, administering the drug correctly, monitoring the response, and helping the client self-administer drugs correctly.
In addition to knowing about a specific drugs’ action, the nurse must also understand the client’s previous and current health problems to determine whether a particular medication is safe to give. The nurse’s judgment is critical for proper drug administration.
Section 1 Basic Knowledge about Medication Administration
Drug Forms, Distribution System and Medication Storage
Medications are available in a variety of forms or preparations. The form of the drug determines its route of administrations.
The composition of a drug is designed to enhance its absorption and metabolism. Many drugs are made in several forms such as tablets, capsules, elixirs, and suppositories. When administering a medication, the nurse must be certain to use the proper form. Table 12-1 lists common forms of medications.
In addition, medications are classified as the four kinds that are medications to be taken orally, externally, for injection, and new preparations in terms of routes of administration.
Extended/ sustained release
Transdermal disk or patch
Liquid, powder, or foam deposited in a thin layer on the skin or mucous membrane by air pressure
Liquid preparation that may be used orally, parenterally, or externally; can also be instilled into body organ and cavity (e.g., bladder irrigations); contains water with one or more medications dissolved compounds; must be sterile for parenteral use or when instilled into body cavity
Finely divided drug particles dispersed in liquid medium; when suspension left standing, particles settle to bottom of container; commonly is oral medication and is not given parenterally
Semisolid preparation, thicker and stiffer than ointment; absorbed through skin more slowly than ointment
One or more medications mixed with a cohesive material, in oval, round, or flattened shapes
Finely ground loose or molded drugs; given with or without liquids
Solid dosage form mixed with gelatin and shaped in the form of pellet for insertion into a body cavity (rectum or vagina); melts when it reaches body temperature, releasing the drug for absorption
Medication dissolved in concentrated sugar solution; may contain flavoring to make drug more palatable
Powdered dosage form compressed into hard disks or cylinders; in addition to primary drug, contains binders (adhesive to allow powder to stick together), disintegrators (to promote tablet dissolution), lubricants (for ease of manufacturing), and fillers (for convenient tablet size)
Alcohol or water-alcohol drug solution
Medication contained within semipermeable membrane disk or patch; allows medications to be absorbed through skin slowly over a longer period
In clinical settings, administering medication includes order management, medication supply and storing medications. Not only the nurses are responsible for medication administration, but also are other related people, such as the physician, and pharmacist also help to ensure the right medication to the right client.
Stock Supply System
Large quantities of medications and multidose containers are in nursing unit. One nurse is assigned to get and replenish the medications based on physician’s orders. This system is time consuming because a nurse must dispense each medicine separately for a client every day, and it has been associated with a high rate of medication errors and is not commonly used today.
There is a portable carts to contain a drawer with a 24-hour supply of medications for each client. The nurse sends the portable cart to center dispensary system, at a designated time each day, and the pharmacist simplifies medication preparation by packaging and labeling each dosage for 24-hour period. After that, nurses offer the medication for every client at right time. The cart also contains limited amounts of prn and stock medications for special situations. The unit-dose system can reduce the number of medication errors and saves steps in dispensing medication. Special medication rooms, portable locked carts, computerized medication cabinets are some of the facilities used in nursing unit.
Computer-controlled Dispensing System
These systems are used more and more successfully. They are especially useful for the delivery and control of narcotics. Each nurse has a security code allowing access to the system. Then the client’s identification number is entered. In these systems, the nurse is then allowed to select desired medication, dosage, route. The system delivers the medication to the nurse, records it, and charges it to the client.
Some special medications, e.g. toxicant, narcotic, and expensive medications, should be managed by special system.
Medication distribution systems are different in various institution, nurses should follow the policies of their institution to ensure the supply of medication to the clients.