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Medications

Definitions:

  Medication: is a substance administered for diagnosis, cure, treatment, mitigation or prevention.

  Prescription: the written direction for the preparation and the administration of the drug.

   One drug have multiple name

• The generic name: is given for the drug to being official name.
  
•    The trade mark or brand name: is name given by the drug manufacture.
  
•             Lasix      =    furosemide  

The therapeutic action of drug

•   Palliative: relieve symptom of a disease but does not affect on a disease it self as morphine.
  
•    Curative: cure a disease or condition as penicillin.
  
•    Supportive: support body function until treatment or body response can take over as aspirin.
  
•    Substitutive: replace body fluids or substance insulin.
  
•    Chemotherapeutic: destroy malignant cell as busulfan for leukemia.
  
•    Restorative: return body health as vitamin.

Affect of drugs

• The therapeutic effect: is the primary effect intended that is the reason the drug is prescribed such as morphine sulfate is analgesia.
  
•  Side effect: secondary effect of the drug is one that unintended, side effects are usually predictable and may be either harmless Example digitalis increase the strength of myocardial contraction but it can have side effect inducing vomiting and nausea.
  
•  Drug toxicity: deleterious effect of the drug on an organism or tissue, results from overdose or external use.
  
•  Drug allergy: is immunological reaction to a drug.
  
•  Drug interaction: occur when administration of one drug before or after alter effect of one or both drug.
  
•  Drug misuse:  Is the improper use of common medications in way that lead to acute and chronic toxicity for example laxative, antacid and vitamins.
  
•  Drug abuse: is an appropriate intake of substance either continually or periodically.
  
•  Drug dependence: is a persons reliance on or need to take drug or substance there are two type of dependence: physiological and psychological.
  
•  Physiological dependence: is due to biochemical changes in the body tissue these tissue come to require substance for normal function.
  
•  Psychological dependence: is emotional reliance on a drug to maintain a since of wellbeing accompanied feeling of need.
  
•  Drug habituation: denotes a mild form of psychological dependence.
  
•  Illicit drug: also called street drug are those sold illegally.

 Common mild allergic response

•  Skin rash.
•  Rhinitis.
•  Nausea and vomiting.
•  Wheezing.
•  Diarrhea.

 Rout of drugs administration 

 1- Oral: is the most common

Advantage:

•    Least expensive and most convenient route for most clients.
•    Safe, does not break the skin.

Disadvantage:

•  Inappropriate for client with nausea and vomiting.
•  Drug may have unpleasant taste.
•  May cause irritation of gastrointestinal tract.
•  Drug may discolor teeth.
•  Drug can be aspirated by ill client.

2- Sublingual

Sublingual: a drug placed under the tongue, where it dissolved.

Advantage:

•  Same as oral plus followings:
•  Drug may administered for local effect.
•  Drug rapidly absorbed into blood stream.
•  More potent than oral.

Disadvantage:

•  If swallowed drug may be inactive.
•  Drug must remain under the tongue until dissolved.

3- Rectal:

can  be used when drug objectionable taste

4- Parenteral :

1) Subcutaneous (SC)

2) Intramuscular (IM)

3) Intravenous (IV)

4) Intradermal (ID)

1) Subcutaneous (SC)

hypodermic into subcutaneous tissue, just below the skin.

 Advantage:

onset drug action faster than oral.

 Disadvantage:

• Must involve sterile technique because breaks skin barrier.
•  More expensive than oral.
•  Can administer only small doses.
•  Slower than intramuscular injection.
•  Some drug can irritate tissue and can cause pain.

Sc injection site

•  lateral upper arms.
•  Anterior and lateral thighs.
•  The abdomen.
•  Under scapula.

2) Intramuscular (IM)

  Intramuscular (IM): into in the muscle.

Characteristics :

   2 to 5 ml syringe, 21 or 22 gauge and 1.1/5 inches.

- Several factors can effect of needle:

•   The muscle site.
•   the type of solution.
•   the amount of adipose tissue that covered of area.
•    the age of the client.

Advantage:

•  Pain from irritating drugs is minimized.
•  Can administer large volume of drug.
•  Drug rapidly absorbed.

Disadvantage:

•  breaks skin barrier.
•  Can be anxiety producing.

  Common site of intramuscular injections:

1) Ventrogluteal site:

 also known as von Hochseter’s site which lies over the gluteus minimus.
   The clients position: On back, prone and side lying position.
   Suitable for children over 7 months and adults.
   Is preferred site because the area contains no large nerve or blood vessels, contain less fat than buttock area, and provides the greatest thickness of gluteus muscle, consisting gluteus medius and gluteus minimus.

2) Vastus latralis site:

 is usually thicker and well developed in adult and children. And
 Suitable for infant 7 months and older because no major blood vessels and nerves in the area.
 It established by dividing the area between the greater trochanter of the femur and the lateral femoral condyle into third and selects the middle third.
 Patient may in supine position or sitting position.

3) Dorsogluteal site:

 Is composed of the thick gluteal muscle of the buttocks, Because the site developed by walking, the site not be used or children under three years.
 The nurse must choose the injection site carefully to avoid striking the sciatic nerve and blood vessels.
 The nurse palpates the posterior iliac spine, and then draws an imaginary line to the greater trochenter femur.

 4) Deltoid muscle:

  is found on the lateral aspect of the upper arm its not used frequently because it is relatively small and very close to the radial nerve and radial artery. But no more 1ml can be administered for example: hepatitis B vaccine.
 The method of establishing the deltoid site is to place four fingers across the deltoid muscle, with first finger on the acromion process, the site is three finger breadths below the acromion process.  

5) Rectus femoris site:

 Which belongs to the quadriceps muscle group. It’s situated on the anterior aspect of the thigh

3) Intradermal (ID):

is the administrating of a drug into the dermal layer of the skin just beneath the epidermis, usually small amount of liquid is used for example 0.1ml.


 characteristic of needle may use:
 short and fine, 25,26 and 27 gauge. ¼ to 5/8 inch long.
Common sites:

•  Inner lower arm.
•  Upper chest.
•  On the back beneath the scapula.

 Notes: Intradermal injection are absorbed slowly through blood capillaries, the area not massaged because the medication may disperse.
 
Advantage:

•  absorption is slow (this advantage test for allergy).

Disadvantage:

•   amount of drug administered must be small.
  
•  Breaks skin barrier.

4) Intravenous (IV):

  Intravenous (IV): in to the vein.

Advantage:

•   rapid effect.
•   Large amount of drug can be administered.

Disadvantage:

•   limited to highly soluble drug.
•   Break skin barrier.
•   Drug distribution inhibited by poor circulation.

5) Inhalation: 

introduce drug through respiratory tract.

6) Otic: to ear.
7) Ophthalmic: to eye.
8) Nose
 9) Topical:

  Topical applications are those applied to circumscribed surface area of the body. They effect only the area to which they are applied.

Types of medication order:

1) A stat order: indicates that the medication is to be given immediately and only once.
  Example: volterin 75mg IM state.
2) The single order dose: is for medication to be given once at the specified time.
   Example 100mg hs before surgery.
3) The standing order: may or may not have a termination date.
Example volterin 75mg IM q4h * 5 days.
4) A PRN order: as needed order permits the nurse to give a medication when in the nurse judgment, the client requires it. Example: panadol 500mg PRN.

The drug order has seven essential parts:

 1- Full name of the client
 2- Date &time the order is written
 3- Name of the drug to be administered
 4- Dosage of the drug
 5- Method of administration.
 6- Frequency of drug.

 7- Signature.

Five 'Rights' of drug administration

 1- Right drug
 2- Right dose
 3- Right time
 4- Right route
 5- Right client.

Right Medication.

Read the medication record, and take the appropriate medication from the shelf, drawer, or refrigerator.
   Compare the label of the medication container against the order.  If these are not identical, recheck the client’s record.  If there is still a discrepancy, check with the charge nurse.

Right Time.  Give the medication at the right time.

Right Route.  Give the medication by the ordered route – oral, IV, IM SC, Nose,….etc.

Right Dose.
 Checking medication data is essential to prevent a medication error.  Check the drug for the name and strength and concentration.

Right Client.

  Identify the client by name.
   Explain to the client it is time for their medication administration.
   Explain the technique to the client.

  Common abbreviations

  Ac: before meals
  Pc: after meals
  PO: by mouth.
  PRN: as needed (sos).
  Q: every
  Q2h: every 2 hours.
  Hs: at bed time.
  Stat: once.
  OD: once a day.
  BID: two times a day.
  TID: three times a day(TDS).
  QID: four times a day.
  Rx: treatment.
  G, gm: gram.
  Mg: milligram.
  L: liter.