The Nursing Process and Medication Administration

Assessing the patient is the first step in administering medication. This might seem unusual because the prescriber—prior to writing the prescription for the medication—has already assessed the patient. However, the patient's condition can change between the prescriber's assessment and the time the medication is administered. Assessing the patient also provides a baseline from which you can compare the patient's reaction to the medication after administering the medication.

The assessment is divided into two areas. First is a general assessment that is necessary for every medication. Then there is an assessment that is required for specific drugs. The general assessment must determine:

• Is the therapeutic action of the drug proper for the patient?

This, too, appears unusual since the prescriber has already made this determination. However, the nurse is responsible to independently verify that the drug is proper for the patient. You do this by reading the patient's diagnosis in the patient's chart and looking up the medication in the drug manual where it will state the approved use of the drug.

If the drug isn't used for the patient's condition, then the nurse should contact the prescriber. Nurses may not administer drugs that are being used for purposes other than those approved by the FDA. It is important to realize that in some situations, the prescriber will be using the drug for a secondary therapeutic effect that addresses the patient's condition which is acceptable if that purpose is FDA approved.

• Is the route proper for the patient?

Some drugs can be administered using more than one route. Although the prescriber specifies a route in the medication order, the patient's current condition might indicate a different route is appropriate.

For example, the prescriber might order antibiotics PO. However, the patient might have a very high fever that needs immediate relief by administering antibiotics IV. In another situation, the patient might be experiencing stomach pains and vomiting, which is a clear indication that PO isn't the desired route. If the route is no longer appropriate, then the nurse should contact the prescriber and obtain an order to use an alternate route that is appropriate for the patient's condition.

• What is the proper dose for the patient?

The prescriber will specify the dose in the medication order. Sometimes the dose doesn't match the prepared dose that the nurse has on hand requiring the nurse to calculate the dose. For example, the prescriber might write a medication order for 800 mg of ibuprofen. The nurse might have on hand 200 mg tablets and will have to calculate that the patient must be administered 4 tablets of 200 mg of ibuprofen.

With some drugs the prescriber will order a dose based on the weight of the patient. It is the nurse's responsibility to calculate the actual dose after weighing the patient. For example, the prescriber orders Depakote 10 mg/kg. The patient weights 176 lbs. The nurse has 200 mg/5 mL on hand and calculates that the correct dose for the patient is 20 mL. (You'll learn how to perform this calculation in Chapter 7).

• Assess for contraindications.

The patient might have developed a condition since being assessed by the prescriber that makes it inappropriate to receive the medication. The nurse must review the drug's profile in the drug manual to determine the drug's contraindications and then determine if they apply to the patient. If so, then the nurse must contact the prescriber to advise of the patient's condition. This is particularly important since different healthcare professionals might prescribe the patient drugs.

For example, the patient might be scheduled for an angiogram in 24 hours and the prescriber has a standing medication order for Glucophage. Gluco-phage reacts with contrast dyes and therefore cannot be administered to the patient within 24 hours of any dye procedures such as an angiogram. However, withholding medications should only be done after the healthcare provider has been notified.

• Assess for side effects and adverse reactions to the drug.

Drugs can have known side effects—some of which the patient can tolerate and others that result in an adverse reaction. The nurse must review the profile of the drug in the drug manual to determine any side effects and adverse reactions that it might cause and monitor the patient for such signs and symptoms. The nurse should alert the patient to the possible side effects before administering the medication. In addition, the nurse can prepare to deal with a possible adverse reaction the patient might have to a medication.

For example, some opioids such as morphine sulfate can cause respiratory depression. Narcan (naxalone) can reverse the effects of opioids. Keeping nar-

can available when administering morphine sulfate in high doses or to a patient who has never had morphine might avoid an adverse reaction.

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