Medication Administration

Medication Administration

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Medication administration is a critical skill that nurses are responsible for. According to the National Council of State Boards of Nursing (NCSBN) and the NCLEXRN, there are several key considerations and steps that nurses should take to ensure safe and effective medication administration.

  1. Check the Medication Order: Before administering any medication, the nurse must ensure that the medication order is accurate, up to date, and appropriate for the patient. The nurse should double-check the medication order against the patient’s medical history, allergies, and other medications they are currently taking.
  2. Medication Preparation: Nurses must prepare medications in a clean, quiet, and well-lit area to minimize errors. This involves checking the medication label against the order, measuring the medication accurately, and preparing the medication in the appropriate form for administration (e.g., oral, topical, injectable).
  3. Medication Administration: The nurse must verify the patient’s identity before administering medication. The nurse should also explain the medication to the patient, including the medication name, dosage, frequency, and expected effects. The nurse should also check the patient’s vital signs before administering medication.
  4. Documentation: Accurate and timely documentation is a crucial part of medication administration. The nurse should document the medication given, the dosage, the time of administration, and the patient’s response to the medication. Any adverse reactions or medication errors must also be documented.
  5. Patient Education: Nurses must educate patients about their medications, including the medication name, dosage, and administration schedule. The nurse should also explain potential side effects and what to do if they occur. It is important to assess the patient’s understanding of their medication regimen and address any questions or concerns they may have.
  6. Safety Considerations: Nurses must be aware of safety considerations related to medication administration, including medication interactions, adverse reactions, and medication errors. Nurses should also be knowledgeable about proper medication storage and disposal, as well as the use of technology and automation in medication administration.

Medication Administration

Administering medications is a vital nursing responsibility that requires careful attention to detail and adherence to established protocols. Below are some key subtopics related to medication administration.

Six Rights of Medication Administration

To help prevent medication errors, nurses must ensure the six rights of medication administration are met:

  1. Right patient: Verify the patient’s identity using at least two patient identifiers (such as name and date of birth).
  2. Right medication: Check the medication label and compare it to the order.
  3. Right dose: Check the medication order and calculate the appropriate dose.
  4. Right route: Administer the medication via the correct route (such as oral, topical, intravenous, or intramuscular).
  5. Right time: Administer the medication at the correct time according to the order.
  6. Right documentation: Document the medication administration in the patient’s chart.

Needle Sizes and Uses

Needle size selection depends on the patient’s age, size, and the intended route of administration. For example, a larger gauge needle (18-22) is typically used for intramuscular injections, while a smaller gauge (25-27) is used for subcutaneous injections. In addition, insulin needles are specifically designed for insulin administration and are available in various sizes ranging from 28-32 gauge.

Peak and Trough

Peak and trough levels refer to the highest and lowest concentrations of medication in the bloodstream, respectively. These levels are important for drugs with a narrow therapeutic index, such as antibiotics, anticonvulsants, and antiarrhythmics. To monitor peak and trough levels, blood samples are usually drawn at specific times after medication administration.

Mixing NPH and Regular Insulin for Injection

Nurses may be responsible for mixing NPH and regular insulin for injection. The following steps should be taken:

  1. Verify the order with a second nurse.
  2. Roll NPH insulin between palms to mix (do not shake).
  3. Clean the rubber stopper of each insulin vial with an alcohol swab.
  4. Inject air into the NPH insulin (cloudy) vial and withdraw the ordered units.
  5. Inject air into the regular insulin (clear) vial and withdraw the ordered units.
  6. Verify the dose with a second nurse.
  7. Administer the injection.

Conversions: Pounds and Kilograms

Conversion between pounds and kilograms is necessary for medication dosage calculations. One kilogram equals 2.2 pounds. To convert pounds to kilograms, divide the weight in pounds by 2.2. To convert kilograms to pounds, multiply the weight in kilograms by 2.2.

Routes of Administration

Medications can be administered via enteral or parenteral routes.

Enteral routes include:

  • Oral (by mouth)
  • Sublingual (under the tongue)
  • Buccal (between the cheek and gum)
  • Rectal (into the rectum)

Parenteral routes include:

  • Intravenous (into a vein)
  • Intramuscular (into a muscle)
  • Subcutaneous (under the skin)
  • Intradermal (into the skin)
  • Intrathecal (into the spinal canal)

Overall, medication administration is a complex and critical nursing skill that requires attention to detail, effective communication, and a thorough understanding of medication safety and best practices. Nurses must be diligent in ensuring the safe and effective administration of medications to their patients.

Toxicities & Reversal Agents

  • Benzodiazepine – Flumazenil
  • Warfarin – Vitamin K and Fresh Frozen Plasma
  • Acetylcholinesterase Inhibitor – Atropine and Pralidoxime
  • Acetaminophen – N-Acetylcysteine
  • Antimuscarinic – Physostigmine Salicylate
  • Amphetamine – Ammonium Chloride (NH4Cl) and Acidify Urine
  • Beta Blocker – Glucagon
  • Iron – DeFEroxamine
  • Opioid – Naloxone
  • Tricyclic Antidepressant (TCA) – Sodium Bicarbonate (NaHCO3)

Arsenic, Gold and Copper Antidotes

Toxic Metals

  • Arsenic
  • Gold
  • Copper

Antidotes

  • Penicillamine
  • Dimercaprol (BAL)
  • Succimer

Lead Antidotes

  • Dimercaprol
  • CaEDTA
  • Succimer

Poisoning

  • Aspirin Poisoning (Salicylism) Assessment
    • Early Symptoms
      • Nausea and Vomiting
      • Tinnitus
      • Confusion
      • Hyperventilation
      • Respiratory Alkalosis
    • Late Symptoms
      • Metabolic Acidosis
      • Coma
      • Hyperthermia

Overall, medication administration is a crucial nursing responsibility that requires careful attention to detail and adherence to established protocols. By following the six rights of medication administration, selecting the appropriate needle size, monitoring peak and trough levels, and administering medications via the correct route, nurses can help ensure the safety and well-being of their patients.