Medical surgical nursing - Administration of medications

Administration of medications(Medical surgical nursing):

 

Medication :

 

Medication is any substance administered to promote health, to prevent, diagnose, treat, or cure a disease. It is also known as medicine.

 

Medicine:

 

Medicine is a term also used to designate the science of preventing or treating diseases or injury.

 

Drug :

 

Drug is any substance, which helps to cure the disease

 

Pharmacology :

 

It is the study of drugs including their origin, chemical, structure, preparation, action, administration, metabolism and excretion.

 

Drug therapy:

 

Drug therapy is the application of the drug and other measures in the treatment of disease.

 

Administration of drug:

 

Drugs are given in many ways and as this is often the duty of nurses. The route used to administer drugs has a profound effect on drug absorption, distribution, metabolism and elimination.

 

Methods of administration [routes]

 

1. By Oral: (refer practicals)

 

The easier and very usual way to give drugs is by mouth and there are many formulations for this purpose.

 

Tablets: They are prepared by mixing a drug with base, which binds it together. They are usually coated and may be coloured.

1.     Capsules: Capsules are made of gelatin and contain a drug, which is liberated when the wall of the capsule is digested in the stomach or intestine.

 

2.     Mixtures: These are liquids, which contain several ingredients dissolved or diffused in water or some other solvent.

 

3.     Emulsion: Is a mixture of two liquids in which one is dispensed through the other in a finely divided state.

 

4.     Linctus: Is a liquid, which contains some sweet syrupy substances, used for its soothing effect or cough.

 

2. By injection: (refer practicals)

 

It defined as the forcing of a fluid into a cavity, a blood vessel or to body tissue through a hollow tube or needle. They are called as:

 

1.     intravenous,

 

2.     intra muscular,

 

3.     subcutaneous

 

4.     intraspinal or intrathecal,

 

5.     intraperitoneal etc.

 

3. By inhalation :

 

Drugs may be inhaled either to produce a local action on the respiratory tract. As they are absorbed through the lungs, they produce a general effect.

 

For eg. Anaesthetic drug.

 

4. By rectum :

 

Administration of drug through the rectum. Certain drugs are absorbed by the mucus memebranes of the rectum eg. Rectal suppository.

 

5.  By sublingual :

 

Certain drugs are placed under tongue  for rapid absorption.

 

6. By topical application :

 

Drugs are applied to the skin, mucus membrane and wound surfaces to produce their action at the site of application.

7. By transdermal application :

 

The drug is applied to the skin as a medicated patch. It releases the medication at a constant rate and the medication is absorbed through the skin.

 

Eg.  Glycerine trinitrate for treatment of angina pectoris,

 

 

Principles of administration of medication :

 

1.     Drugs are administrated under the written medical prescription.

 

2.     In emergencies drugs may be given under oral instruction but the written order must be obtained immediately

 

3.     Before administering drug, the nurse must check whether the right drug is given, in the right dose, in the right form, in the right route and to the right patient in the right time

 

4.     Norcotic drugs must be kept under lock. The balance must be verified daily and to be handed over to the next shift nurse.

 

5.     Before administering medication obtain history of drug allergy. If the patient is having allergy to specific drugs, it must be noted in the patient record.

 

6.  When administering drugs watch for any side effect, allergic reaction or adverse side effects.

 

7.     When administering injections do not mix two drugs.

 

Sources of drugs:

 

The main sources of drugs are from herbs and chemicals.

 

 

Law regulating drugs:

 

Both central and state government have taken steps to regulate the process of manufacturing and issue of drugs. Drug controller is the officer who periodically will check the drugs formulation, process and date of manufacturing, expiry and permission for keeping of narcotic drugs.

 

 

 

Weights and measures :

 

There are several system of measuring medicines The apothecary, imperial, metric and household measures.

 

i. Combination of apthecary and imperial system :

 

Table of weights Table of measures

60 grains = 1 dram 3 drams  = 1 ounce

8 dram = 1 ounce 20 ounce  = 1 pint

16ounce = 1 pound 2 pint  = 1  quart

    4 quart  = 1 gallon

ii. metric system : Table of weights : Table of measures

10 milligrams = 1 centigram 10 millitre  = 1 centilitre

10 centigram = 1 decigram 10 centilitre = 1 decilitre

10 deci gram = 1 gram 10 decilitre = 1 litre

10 gram = 1 decagram 10 litre  = 1  decalitre

10 hectogram = 1 kilogram 10 hectolitre = 1 kilolitre

iii. House hold measures:   

60 drops  = 1 teaspoon   

2 teaspoon = 1dessertspoon  

 

2 dessertspoon = 1 table spoon

 

12 tablespoon = 1 drinking glass

 

 

Instruction for administration of drugs :

 

1.     Read the patient full name from the prescription sheet.

 

2.     Read the prescription, checking the validity and time of last administration

 

3.     Read the name of drug from the label when removing the container from the shelf.

 

4.     Check the label of the container for the name, strength, and dose of the drug, the route of administration and the expiry date against the prescription.

 

5.     Measure or count the correct dose

 

6.     Re-check the label before returning the container to the shelf

 

7.     Both nurses must verify the patient, identify by checking the details in the prescription sheet.

 

8.     Ensure the patient is in a fit state to receive the drug.

9.     Give the dose and see that  it has been swallowed

 

10.                        Record the time of administration Also record if a drug is not given and the reason.

 

 

Form of drugs :

1. Liquid  : a. Oils  b. Mixtures

2. Solids a.  Tablets b.  Pills  c. Capsules

3. Gases eg.  Oxygen,  anesthetic gases.

 

 

Drugs are classified according to their action:

1 Analgesic : Drugs which cause loss of sensation. Eg Aspirin   

2 Anaesthetics : Drugs which cause loss of sensation or insensibility to patient eg. Ethen  

3 Antipyretics : Drugs which reduce fever ef. Crocin.      

4 Antihelmintics : Drugs which destroy and expell worms eg. Mebendazole.    

5 Antidotes : Substances  used  to  counteract  the effect of poison. eg large quantity of diluted  alkali  is  given  to  neutralize acid poisoning.    

6 Antacids : A substance which counteracts acidity or neutralizes acid eg Gelusil.  

7 Antiemetics : Drugs that prevent or relieve nausea and /or vomiting.     

8 Antihistamines : Drugs used in the  treatment   of allergic conditions.       

9 Anticoagulant : Drugs used to prevent or inhibit coagulation of blood    

10 Coagulant : Drugs used to hasten blood coagulation ( clotting).  

11 Carminatives : Drugs which cause expulsion of gas.

12 Cathartics : Drugs which cause intestinal evacuation.  They are subdivided as. 1a.  laxatives b. purgatives  

13 Diuretics : Drugs which increase the secretion of urine. Eg.  lasix.  

14 Emetics : Drugs which produce vomiting    

15 Hypnotics : Drug which produce sleep  

16 Mydriates : Drugs  which  dilate  pupil of the  eye eg. Atrophine   

17 Myotics : Drugs which contract the pupils.  

18 Expectorants : Drugs  which  increase  the  bronchial secretion  and  help  in  expulsion  of mucus.  

19 Sedatives : Drugs which exerts a smoothening or tranquilizing effect.  They may be general or local. eg. Opium.  

20 Stimulants : Drugs which increases the functional activity of an organ eg. Amphetamine stimulates central nervous system.

21 Narcotics : Drugs which produce   sleep and relieve pain eg. Injection morphine.

 

 

Care of medicine cabinet and drugs :

1.     To give proper care of drugs, each ward should be provided with a medicine cabinet.

 

2.     It should be large enough to accommodate all drugs and should have separate compartments for mixtures tablets, powders and ointments.

3.     As far as possible the medicine cabinet should be kept in a separate room near the nurses room with a sink, with running water and the cupboard should be locked at all times. Keys should be kept where only doctors and nurses have access to it.

4.     The bottles should have proper label and adequate lighting should be provided within the cabinet to read the labels clearly.

 

5.    Bottles should be arranged alphabetically.

 

6.    Poisonous drugs should be kept in a separate cupboard, which must have separate lock and key. The senior sister is entirely responsible for the cupboard.

 

7.    A register should be maintained to keep the account of poisonous drugs.

 

8.    Drugs that are unusual in colour, odour and consistency should be returned to the pharmacy to be discarded.

9.    Oils such as castrol oil, serum, vaccines and antibiotics such as penicillin should be kept in refrigerators.

 

10.                        Emergency drugs such as stimulants should be kept in a box or tray where they are readily obtainable

11.                        When indenting for drugs, indent only the required quantity.

 

12.                        The medicine cabinet should always be kept neat & clean.

 

13.                        All equipments should be cleaned and returned to its proper place after use.

The side effects of drugs:

1 Dermatological reaction : Purities

2 Blood dyscrasias : hemolytic anemia    

3 Hepatotoxicity : Biliary obstruction, Hepatic Necrosis   

4 Nephrotoxicity : Kidney damage    

5 Ototoxicity  : Vestibular damage    

6 Central nervous : Toxicit, Poor  motor  coordiantion,  system convulsion

7 Gastro intestinal disturbances : Diarrhea, nausea, vomiting etc.  

8 Drug Dependence : Psychological dependence