Nurses' Duties and Responsibilities: "Pharmacology: Calculation of Rates and Dosage of Drugs"
Nurses' Duties and Responsibilities: "Pharmacology: Calculation of Rates and Dosage of Drugs"
Nurses' Duties and Responsibilities: "Pharmacology: Calculation of Rates and Dosage of Drugs"
OBJECTIVES 1. Discuss the ethical and legal issues related to medication administration and IV therapy. 2. Discuss medication administration as a component of safe, effective nursing care. 3. Describe the roles and responsibilities of the nurse regarding medication administration. 4. Explain how the ten rights of medication administration affect patient sa fety. 5. Give specific examples of the nurse can increase patient compliance in taking medications. 6. Compare and contrast the advantages and disadvantages of each route of drug administration.
PHARMACOKINETICS
Is the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body. PHARMACOKINETIC PROCESSES 1. LIBERATION - applies to drugs given orally Components o Release of drug from pill, tablet, capsule o Dissolving of active drug in GI fluids 2. ABSORPTION - movement from administration site into circulation 3. DISTRIBUTION Rate of perfusion Plasma protein (albumin) binding Accumulation in tissues Ability to cross membranes o Blood-brain barrier o Placental barrier 4. METABOLISM Two effects o Transformation to less active metabolite o Enhancement of solubility Liver = primary site Liver disease o Slows metabolism o Prolongs effects 5. EXCRETION (ELIMINATION) Kidneys = primary site a. Mechanisms dependent upon: i. Passive glomerular filtration ii. Active tubular transport b. Partial reabsorption c. Hemodialysis Renal disease d. Slows excretion e. Prolongs effects Other sources f. Feces h. Breast milk g. Exhaled air i. Sweat
PHARMACODYNAMICS
It is the biochemical and physiologic mechanisms of drug action USES: Symptomatic Curative Restorative Preventive Diagnostic
An I.V. medications may be ordered when: o Rapid therapeutic effect is needed o Oral meds cant be absorbed by the G.I. tract
o The client may receive nothing by mouth o For controlled administration rate I.V. medication may be given by: o Drug injection o Intermittent infusion o Continuous infusion Benefits o Rapid response o Effective absorption o Accurate titration o Less discomfort Risks o Solution and drug incompatibility o Poor vascular access in some clients o Immediate adverse reactions
INCOMPATIBILITY Drug and diluents must be compatible. The more complex the solution the greater the risk of incompatibility. An incompatibility results when two or more substances react or interact so as to change the normal activity of one or more components. Incompatibility may result in the loss of therapeutic effects and may occur when: o Several drugs are added to large volume of fluid to produce an admixture. o Drugs in separate solutions are administered concurrently or in close succession via the same IV line o A single drug is reconstituted or diluted with the wrong solution o One drug reacts with another drugs preservative HAZARDS OF I.V. MEDICATIONS Mixing of two incompatible drugs in a solution can cause an adverse interaction. POOR VASCULAR ACCESS Clients who require frequent or prolonged I.V. therapy may develop small, scarred, inaccessible veins from repeated venipunctures or infusion of irritating drugs. If peripheral venous access isnt possible, the doctor may use a central vein, commonly by the subclavian route. ADVERSE DRUG REACTION A response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function (WHO). The following are some adverse drug reactions that you might notice. o o o Skin rash Easy bruising Bleeding
o o o o o
What should you do if you suspect an ADR? o o o o Stop the medication immediately Report the incident to the physician Monitor the client Document
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Administer the right drug Administer the right drug to the right patient Administer the right dose Administer the drug by the right route Administer the drug at the right time Document each drug you administer Teach your patient about the drug he is receiving Take a complete patient drug history Find out if the patient has any drug allergies Be aware of patient drug-drug or drug-food interactions
COMMON MEDICATION ERRORS 1. 2. 3. 4. 5. 6. Wrong dose (overdose, under dose, missed dose) Wrong medication to wrong patient Wrong medication to right patient Wrong medication due to wrong dispensing Wong interpretation of doctors prescriptions for drugs Wrong infusion rate (over infusion, under infusion, missed order)
INTERPRETATION OF DOCTORS ORDER FOR DRUGS The nurse must understand the order perfectly before acting on it (the drug, the dose, the route, the frequency). If any of this is unclear or open for interpretations, it is the responsibility of the nurse to clarify the order with the physician. DEFINITION OF TERMS Transcription of medical orders is the act of writing out medical orders. Kardex is the summarize written presentation of all the care and treatment of the patient. Medication/Treatment Sheet is the legal documents in the patients chart were medicines and treatments administered to the patient are written, acknowledged and administered by nurses. Physicians Order Sheet is a legal document wherein medical orders are written and use as reference of nurses in the transcription and executing nursing care. The registered nurse indicates that he/she has checked and completely transcribes the medical order by signing his/her name with the date and time directly right after the doctors order. As a general rule, telephone orders are received and carried out only in emergency cases by nurses. Nurses receive telephone orders only from consultants. RNs will review all orders immediately after the physician writes. All medication and treatment orders must be written legibly and must contain the following: a. Generic name and brand name of medicines b. Dosage of the medicines c. Frequency of administration d. Route of administration e. Signature over printed name of attending physician or authorized representative f. Date and time order was written PATIENT/FAMILY TEACHING o o o Inform the client about the medication you are about to administer. Reason why the medication is to be give Adverse effect he may experience (pain, redness, swelling)
DOCUMENTATION o o o o o o Type and amount of drug given Date and time given Confirmation that I.V. line was patent Patients response to the medication Condition of the insertion site Ongoing monitoring that you provided
WHERE TO DOCUMENT o o o o o Nurses Progress Notes Medication Sheet Infusion Sheet Vital Signs Monitoring Sheet Input and Output Monitoring Sheet
COMPUTATION
INOTROPES Used to maintain cardiac output and hemodynamic parameters at stable levels. (Cardiogenic shock, Septic shock, Decrease urine output, Severe CHF) PRIMARY ACTION 0.5-2.0 ug/kg/min increased renal blood flow, dieresis 2.0-7.5 ug/kg/min increased cardiac output, increased renal blood flow 7.5-20 ug/kg/min - increased afterload (vasoconstriction); may decreased output > 20.0 ug/kg/min increased afterload; decreased cardiac output; increased myocardial contractility through stimulation of beta receptors in the heart
FORMULA Desired Dose (ug/kg/min) x BW (kg)/Concentration Single Concentration Dopamine Dobutamine 13.3 (200mg/250ml) 16.6 (250mg/250ml) Double Concentration 26.6 (400mg/250ml) 33.2 (500mg/250ml)
CALCULATING ADMINISTRATION RATES One must know two key components before using the formula: Drop factor of the I.V. administration set Amount of the solution to be infused over one hour RATE CALCULATIONS Macrodrip set 10 drops = 1 ml 15 drops = 1 ml 20 drops = 1 ml Microdrip set 60 drops = 1 ml
FORMULA Drip Rates: Drops per minute = No. of ml to be infused x Drop Factor 60 mins
OTHER FACTORS AFFECTING FLOW RATE 1. 2. 3. 4. 5. Gauge of the catheter Viscosity of the infusate Height of the I.V. stand Conditions of the veins Condition of the patient