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Online Companion: Fundamentals of Nursing Standards and Practice 2E
Medications are prescribed by health
care providers to help in treatment, cure or prevention of health problems.
Nurses have an important role in administering medications, teaching clients
about their medication regimen and evaluating the effects of the ordered drugs.
Chapter 29 offers the background knowledge the nurse needs for preparing, administering
and documenting effects of prescribed medications. Medications, their manufacture,
sales and distribution, are regulated by the federal government through the
Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA). Each
state's nurse practice act sets boundaries on the actions of nurses within that
state. Pharmacokinetics is the study of ways drugs react in the human body.
Four properties are involved in drug action: absorption, distribution, metabolism
and excretion of drugs. Health care providers use knowledge about these properties
when determining the dose, the route, the appropriate dosage interval of a specific
drug. Drugs are prepared in different ways for administration. The oral route
is the safest, most convenient, and least expensive way to take a drug. Drugs
are also prepared to be applies topically, inhaled, given as a solution to the
eye, or to be injected into body tissue. The nurse collaborates with physicians,
other health care providers and pharmacists and the client to provide accurate
and therapeutic drug administration. Communication among these professionals
begins with the medication order that specifies the drug to be given, the dose,
the frequency and route of administration. The physician or advance practice
registered nurse who writes the order must sign it. The nurse who administers
the drug from this order must have knowledge of the terms and abbreviations
that are used in the drug order and must be able to calculate drug dosages.
Nurses use the "five rights" of drug administration to protect the
client from medication errors: right drug, right dose, right patient, right
time and right route. There are additional guidelines for the storage, preparation,
and documentation of controlled substances administration. The nursing process
is used in the drug administration procedure. The nurse begins by assessing
the client's allergies, use of prescription and over the counter drugs, his
sensory and cognitive status and lifestyle and beliefs that may affect his response
to drug therapy. The nurse also assesses the client's physical functioning and
laboratory values as these impact responses to drugs. The nursing diagnoses
that are pertinent to the client and drug administration are presented in Chapter
29 along with related nursing process steps. When discussing the implementation
step, the authors present detailed description of drug administration procedures
for oral drugs, enteral instillations, sublingual drugs, use of syringes and
vials to prepare parenteral drugs, IM, sc, and IV drug administration and all
types of topical drug administration. Chapter 20 concludes with a case study
for Mrs. Landry, a client with deep vein thrombosis. The case study is a good
example of the nurse's role in caring for a client receiving drug therapy.
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