Medication Management

Dina Dewi S L I

 Drug management : merupakan tindakan kolaboratif yang dilakukan oleh perawat dengan melibatkan Dr, Drg, Rn( pd negara tertentu), Apoteker, Dietetion. Drug (substansi kimia) memiliki efek khusus dalam tubuh perawat harus yakin obat yang akan diberikan harus benar : dosis, frekwensi & rute terapeutik thd efek obat.

Strandard & Legislasi

Standard : dibuat untuk memastikan keseragaman (uniformity) obat agar efek obat dapat diketahui Legeslasi : aturan yang dibuat untuk mengontrol penggunaan obat. Contoh schedule yang digunakan untuk obat yang dapat dikonsumsi atau dikontrol sendiri.

Schedule I
High abuse potential, tdk digunakan dalam pengobatan Heroin, marijuana

Schedule II
Hi abuse potential for severe dependence Narcotik, amphetamin, gol barbirturat lain

Schedule III
Less abuse potential, for moderate dependence Nonbaebiturat sedativ,

Schedule IV
Lower abuse potential, limited dependence Sedativ. Anti anxiety agent, nonnarcotic analgesic

Schedule V
Limited abuse potential codein

Nomenclature
chemical

generic Trade name

Trade Name

Drug name

aspirin

Acetylsalisilic acid

Benadril

Diphenhydramine Hydrochloride acyclovir

Zovirax

Pharmacokinetics
Absorption :is themovement of the drug from its site
of administration into the blood stream

Route of administration Ability to dissolve Administration site to Blood flow Body surface area

Pharmacokinetics (contd)
Distribution Circulation Membrane permeability Protein binding

Pharmacokinetics (contd)
Metabolism ( in liver) Biotransformation Detoxification

Pharmacokinetics (contd)
Excretion Kidneys Liver Bowel Lungs Exocrine glands

Actions
Therapeutic effects Side effects Adverse effects Toxic effects

 Idiosyncratic reactions Allergic reactions Interactions : food & drug interaction

abuse antasid Vit D deficiency Excessive diureticloss of electrolite Ca milk or milk product decrease antibiotic absorbtion

Actions (contd)

Medication dose responses

Routes of Administration
Oral: sublingual, buccal Parenteral: intradermal, subcutaneous, intramuscular, intravenous Topical Inhalation Intraocular

Systems of Measurement
Metric :Grams (g), milligrams (mg), kilograms (kg), Liters (L), milliliters (ml) Apothecary : grains, dram, ounce, pounds Household : Tablespoons, Teaspoons, Ounces, Cups, Pints, Quartss
Contoh : 1mg = 1/60 grain, 5 ml=1 fluid dram =1 teaspoonful Catt: lihat converting unit

Clinical Calculations
Conversions within systems Conversions between systems Formula: Dose ordered x Amount Dose on hand on hand

contoh
Order : nitroglycerin 1/150gr PO,..mg??? 1 gr=60 mg X =1/50 gr x 60 mg/gr X =60/150 X= 0,4 mg

Dose calculation
Dose on hand Dose desired Contoh : cephalexin 500 mg PO QID( four time every day), dose on hand 250mg/5 ml?? 250 mg/5=500mg/X X =5x500/250 X = 10 ml

Order : anticoagulant 10.000unit, dose on hand 40.000unit/ml,.???

Pediatric dose
Body surface area child/ BSA adult X dose adult = child dose

Prescribers Role
Types of orders Standing orders routine prn orders as needed Single ordersone time (diagnostic test) Stat orders immediately

Abbreviation
a. c = before meal ad lib = as desired hrly = hourly SC = subcutan Lihat di buku FN

Distribution Systems
Stock supply Unit dose Computer controlled

Nurses Role
Six rights Triple-check before administration Client assessment

Six Rights
Right medication Right dose Right client Right route Right time Right documentation

Clients Rights
Information Refusal Careful assessment Informed consent Safe administration Supportive therapy No unnecessary medications

Assessment
Medical history History of allergies Medication data Diet history Perceptual or coordination problems Current condition

Assessment (contd)
Attitude about medication use Knowledge of therapy Learning needs

Nursing Diagnoses
Deficient knowledge (medications) Noncompliance (medications) Disturbed sensory perception Impaired swallowing Ineffective therapeutic regimen management

Planning
Goals and outcomes Example: Client will verbalize therapeutic and adverse effects of medications
Setting priorities Continuity of care

Implementation
Client and family teaching Medication orders: receipt, transcription, communication Calculation and measurement Correct administration technique Recording

Special Considerations
Infants and children Older adults Polypharmacy Self-prescribing Over-the-counter medications Misuse Noncompliance

Evaluation
Client response to medications Client and family ability to administer medications

Oral Administration
Presence of GI alterations Ability to swallow Use of gastric suction Positioning

Topical Administration
Skin applications Use of gloves or applicators Preparation of skin Thickness of application

Nasal Instillation
Assessment of nares Client instruction and selfadministration Positioning

Eye Instillation
Drops, ointments, disks Assessment of eyes Asepsis Positioning

Ear Instillation Assessment of ear canal Warming of solution Straightening of canal for children and adults Positioning

Vaginal Instillation Suppositories, foams, creams Use of gloves and applicator Client positioning, comfort, and hygiene

Rectal Instillation Suppositories Use of gloves Client positioning, comfort, and hygiene

Inhalation
Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) Client assessment and instruction Use of spacer Determination of doses in canister

Irrigation
Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic) Asepsis

Parenteral Administration
Equipment Syringes: sizes (volume), types Needles: length, gauge Disposable units: Tubex, Carpuject Ampules Vials

Parenteral Administration (contd)

Mixing medications Determine compatibility of the medications Do not contaminate one medication with another Ensure the final dose is accurate Maintain aseptic technique

Parenteral Administration (contd)

Insulin Syringes and needle sizes Types of insulin Mixing of insulins Rotation of vials before withdrawal of solution

Administration of Injections
Minimize discomfort Use smallest suitable needle (>gauge=< needle) Position client comfortably Select proper site Divert clients attention Insert the needle quickly and smoothly Hold the syringe steady Inject the medication slowly and steadily

Administration of Injections (contd)

Intramuscular injections Sites: landmarks, condition of area Amount of solution Length 1-2 inc and gauge of needle 20-22 Angle of insertion (90) Aspiration Air-lock method Z-track technique

Administration of Injections (contd)

Sites Ventrogluteal Vastus lateralis Deltoid

Administration of Injections (contd)

Subcutaneous injections Sites: abdomen, lateral upperarm, lateral tigh, scapular, upper ventrodorso gluteal condition of area, rotation of use Amount of solution Length 5/8 inc and gauge of needle Pinch or spread skin Angle of insertion (45)

Intravenous Administration
25 Large volume infusions Bolus injection Volume-controlled infusions Tandem (piggyback) Volume-control set Mini-infusor pump

Administration of Injections (contd)

Intradermal injections Skin testing Sites : forearm, upper chest/back Length 3/8-1/2 inc and gauge of needle (2527) Angle of insertion (10-15) Formation of small bleb

Prevention of Needle Sticks

Needleless devices Sharps disposal One-handed recapping technique

Documentation