Medication Management.ppt

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Medication Management

Dina Dewi S L I



• Drug management : merupakan tindakan

kolaboratif yang dilakukan oleh perawat

dengan melibatkan Dr, Drg, Rn( pd negaratertentu), Apoteker, Dietetion.

• Drug (substansi kimia) memiliki efek

khusus dalam tubuh perawat harus yakinobat yang akan diberikan harus benar :

dosis, frekwensi & rute terapeutik thd efek

obat.



Strandard & Legislasi

• Standard :

dibuat untuk memastikan keseragaman

(uniformity) obat agar efek obat dapatdiketahui

• Legeslasi :

aturan yang dibuat untuk mengontrol penggunaan obat. Contoh schedule yangdigunakan untuk obat yang dapat dikonsumsiatau dikontrol sendiri.



Schedule I

• High abuse potential, tdkdigunakandalam

pengobatan

• Heroin,marijuana

Schedule II

• Hi abuse potential forseveredependence

• Narcotik,amphetamin,gol barbirturatlain

Schedule III

• Less abuse potential, formoderatedependence

• Nonbaebituratsedativ,

Schedule IV

• Lower abuse potential,limiteddependence

• Sedativ. Antianxiety agent,nonnarcoticanalgesic

Schedule V

• Limited abuse potential

• codein



Nomenclature

Trade Name Drug name

aspirin Acetylsalisilic acid

Benadril DiphenhydramineHydrochloride

Zovirax acyclovir

Trade name

generic

chemical



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 (cont’d)

Distribution

– Circulation

– Membrane permeability

– Protein binding




Metabolism ( in liver)

– Biotransformation

– Detoxification

•




• Excretion

– Kidneys

– Liver

– Bowel

– Lungs – Exocrine glands



Actions

• Therapeutic effects

• Side effects

• Adverse effects

• Toxic effects



Actions (cont’d) • Idiosyncratic reactions

• Allergic reactions

• Interactions : food & drug interaction

abuse antasid

Vit D deficiencyExcessive diureticloss of electrolite

Ca milk or milk product decrease antibiotic absorbtion

• 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 =1teaspoonful

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



Prescriber’s Role

Types of orders

– Standing orders routine

– prn orders as needed

– Single ordersone time (diagnostic test)

– Stat ordersimmediately



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

http://www.achilljournal.com/wp-content/uploads/2007/09/pharmacy-010sa.jpg



Nurse’s Role

• Six rights

• Triple-check before administration

• Client assessment



Six Rights

• Right medication

• Right dose

• Right client

• Right route

• Right time

• Right documentation



Client’s 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 (cont’d)

• 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

l Ad i i i




(cont’d)

• Mixing medications

– Determine compatibility of the medications

– Do not contaminate one medication with

another

– Ensure the final dose is accurate

– Maintain aseptic technique

P l Ad i i i




(cont’d)

• 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 client’s attention

– Insert the needle quickly and smoothly

– Hold the syringe steady

– Inject the medication slowly and steadily



Administration of Injections (cont’d)

• 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




• Sites

– Ventrogluteal

– Vastus lateralis

– Deltoid




• 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



Prevention of Needle Sticks

• Needleless devices

• Sharps disposal

• One-handed recapping technique



Documentation

Medication Management.ppt

Documents

Transcript of Medication Management.ppt