Drug Administration: ENs, Legislations, Pharmacology, and Medication Errors

This article covers drug administration by ENs, relevant legislations, pharmacology concepts, and medication errors. It also discusses the 6 Rights of Medication and medication administration techniques for various drugs. The article is relevant for nursing students and professionals.

Running head: DRUG ADMINISTRATION.
Drug Administration
Name of Student
Institutional Affiliation

DRUG ADMINISTRATION.
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1 a. when ENs can and cannot administer drugs
ENs can administer drugs after finishing a course on medication and administration. Enrolled
nurses have an act that prohibits them from practising drug administration. The act is
overcome by attending and completing a training on drug administration. Before the
completion of the course, the nurse cannot administer drugs.
b. Under what circumstance can an EN nurse administer IV medication?
An EN nurse can administer IV medication only the nurse does not have a notation and has
completed a training on IV medication administration.
c. Other relevant legislations to the administration and handling medicine
drugs and poisons act
proper drug storage act
2. How do the following relate to my role as an EN.
a. Health (drugs and poisons) regulations
The regulations state on the proper handling and use of medicines. In relevance to my role of
patient care, I should be able to have knowledge on drug use and the side effects and how to
handle the adverse reactions.
b. State/ Territory drugs and poisons act
this act states the regulations on where consumers should purchase medicine and how they
should be packed and labelled, in relevance to my role as an EN nurse, the act enables the
nurses to understand the state recommendations and the drugs to be used hence advice
patients correctly on the drugs to purchase.
c. State/Territory nurse regulatory authority codes and guidelines
explains the codes of drug administration according to a particular state, an EN nurse should
be well conversant with the guidelines.
d. National Safety and Quality Health Standards(NSQHS) preventing and controlling Health
Care Associated Infections.
Specifies the health standards that an EN nurse should adhere to

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e. Visual Infusion Phlebitis Score
specifies the rules in bleeding patients and the sites of IV line insertion
f. scheduled medication and interpretation of scheduling of medications- schedule 2, schedule
3, 4 and 8
Medications prescription interpretation scheduling. The medication should be administered
according to the scheduled dosages and time.
3. Define;
a. pharmacodynamics
This is an aspect of pharmacology that explains the effect of a drug to the organism. It
explains the molecular, functional and chemical effect of the drug. This involve receptor
affinity, the chemical effect and the effects beyond receptors. Pharmacodynamics can be
affected by the interaction with other drugs, the age and some conditions (Chen, Zhou and
Palmisano, 2017).
b. pharmacokinetics
Pharmacokinetics is defined as the effect of the body metabolism to the drug. It defines how a
drug is taken op, processed and removed from the body. This involves processes of
absorption, breakdown and excretion. Its efficiency depends on the individual organ function
and the chemical composition of the drug. This aspect enables clinicians to regulate dosage to
avoid adverse drug reactions (Shargal, Andrew and Pong, 2015).
c. Pharmacotherapeutics
This is an aspect of pharmacology that explains the medical uses of a drug as well as its
adverse reactions. It explains the synergistic advantage of combining drugs and the drug
interactions in the human body.
d. toxicology
Toxicology is an aspect that explains the unfavourable effects of a drug towards an organism.
This effects may arise from decreased excretion of the drug due to impaired organ function or
due to overdose. They can also result from drug interaction inside the organism. This branch
explains the pathophysiology of the effects and how they can be managed.

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e. Anaphylactic reaction
Anaphylactic reaction is an acute allergic response that emerges rapidly and requires prompt
action. It is an urgent reaction and arises as a result of drugs, insect bites or food. It presents
as certain swelling, shortness of breath, rash, bronchospasm, vomiting or falling in blood
pressure (Dispenza, Regan and Bouchner, 2017).
f. adverse reaction
an adverse reaction is an unfavourable response as a result of chemical ingestion. It may be
due to drug overdose, drug interaction or failure of organs of excretion. It’s a toxicity and
differs in degree of urgency. The adverse reaction can be immediate or can come to way later.
Drugs have antidotes that are used to manage the effects (Tylor, Blau and Rother, 2015).
g. contraindication
This is a situation in which a therapeutic procedure or drug should not be conducted to an
individual because performing the procedure may cause more harm than curative benefits.
There are two types; relative contraindication means that the procedure or drug may be
administered since it might be curative than harmful. Absolute contraindication describes a
situation where under no circumstance the procedure should never be done.
h. precautions
precautions are standards and practices adopted to prevent occurrence of a dangerous,
harmful, damaging or injurious situations.
i.Side effects
side effect is an advantageous or adverse effect of a drug that is next in order to the planned
effect
4. the 6 Rights of Medication
Right patient- this is the obligation to ensure the medication is administered to the correct
patient of which the drug was prescribed for.
Right drug- after confirming the patient, there is need to confirm whether the drug is the
correct brand prescribed for that particular patients. Different patients can have same
prescription, and drugs may have almost similar names hence the need to confirm.

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Right dose- due to the sensitivity and side effects of drugs, the nurse ought to confirm
whether the dose she is administering is the correct one. Underdose leads to no action of drug
and overdose can lead to toxicity.
Right route – different drugs have different route of administration to ensure efficiency.
Right documentation- proper record keeping is key for reference and drug tracking.
Right time- the concentration of a drug should be maintained at peak for effectiveness.
Other rights
Right to refuse
Right history taking and physical assessment
Right education and information
Right drug interaction assessment.
5. a. common anti-emetics administered IM
Metoclopramide
Domperidone
b. what dose can you give?
For metoclopramide; 5mg/ml
For Domperidone; 10mg
c. what size of syringe should you use
the preferred size of syringe is a 2ml 25-27 gauge
d. preferred site
the preferred site of injection is the gluteal muscle, the upper outer quadrant of the gluteal
muscle. Site is located by dividing the gluteal region to four quadrants then using the upper
outer one.
e. how long do you expect the medication to start action
The medication takes effect after two hours and the effect lasts up to 8 hours.

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6. I will check the tablets and confirm the prescription, then I will check the documentation to
confirm the time patient was given the medication. This is to avoid overdosing the patient or
giving the wrong medication.
7. a. in case a patient has been given wrong medication, I would inform other clinicians for
collaborative action. I will clearly monitor patients progress then ensure the correct
medication is administered.
b. in case 2 tablets are missing, I will have to do a background check among all clinicians and
confirm in case they administered drugs without documentation.
c. in case an incorrect dosage is administered to the right patient, I will inform the primary
nurse and monitor patient for any adverse reactions. I will also be prepared with the
management strategies
8. Define
a. acidifiers
these are chemical substances of which when ingested, they multiply the quantity of acid in
the stomach hence reducing the pH. Acidifies of the urinary system dictate the urine pH
(Barr, 2016).
b. alkalinizers
they are chemical agents that when ingested they correct low pH disorders. This may be
acidity in the body caused by reduced kidney function, or acidity due to excessive ingestion
of acidifiers.
c. Diuretics
these are drugs or substances that are taken to increase salt and water elimination from the
body. They are used to correct acute fluid overload (Danman et al., 2015).
d. Electrolytes
these are substances that break down into ions in solution in order to conduct electricity
e. Replacement solutions
these are solutions that are ingested to replenish fluid lost from the body. They correct acute
hypovolemia

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9. I will explain to my patient that Diabetes is a chronic condition and he needs to take the
medication for a long time. Metformin enables maintain blood sugar level that if not
maintained, they may cause complications. The patient ought to take the medication as
prescribed and keep an account of the glucose levels. Side effects include drowsiness,
abdominal discomfort and constipation.
10.
Proper documentation
Label the drug stores correctly
Proper storage in relevant atmospheric conditions
11.
orders written as required are recorded in the PRN section while regular medication ordered
should be charted in the Regular medication section. In case the patient has passed stool twice
and does not want to take the laxative I will respect his request and document properly on the
number of bowel movements and the patients request. If a patient asks for paracetamol, yes I
will administer the inform the doctor to prescribe.
12. part 1
First, I would position the patient correctly, either lie on the side to relieve pain. Second I
would assess the level of pain in a scale of 1-10 and assessing the facial expression and
listening to his verbal statements. Then check the prescribed analgesic and administer the
right dose. I would then advise the patient to voice out in case the pain return and use
distractions to divert the concentration. The medication includes opioids like tramadol and
NSAIDS
Part 2
In relevance to the scenario I would apply the ISBAR criteria to assess and manage my
patient.
1. Introduction- I will start by recording the patients name, the diagnosis and the
procedures that have been performed to get a correct baseline of the condition
2. Situation- this is by analysing the symptoms and the current complaint, in this
scenario is pain. Also identify the stability of the patient.

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3. Background- this is understanding the main complaint and the primary diagnosis.
Identifying the date of admission and relevant past medical history.
4. Assessment and action. This is the assessment of the patient, the procedures that have
been performed and the medication that have been administered. Assess the vital
signs and the fluctuations.
5. Recommendations- this is the plan of action; what u want to be done. After assessing
my patient, I will assess the priorities and make a plan of action.
13. match the drugs with the route of administration
Oral

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14. reasons for medication administration errors
The reasons for medication errors are due to lack of knowledge, wrong prescription, lack
of proper documentation, lack of patient identity, lack of proper patient assessment and
poor communication. Failure to document medication given to patients and the time can
lead to error of omission or overdosing of a patient. Documentation is key in handing
over since it gives the next shift nurse to have a picture of what the patient has been given
and what he is due. Lack of knowledge in drug administration leads to errors such as
using the wrong route of administration or wrong drug reconstitution. Using wrong route
of administration or not properly identifying the proper site reduces the efficiency of the
drug. Wrong prescriptions from doctors leads to wrong drug administration. Prescription
can be wrong in terms of time, dosage or route. This can clearly lead to wrong
medication. Lack of proper patient assessment can lead to underrating of the symptoms
and at times under dose then, this mostly occurs when administering analgesics. Lack of
proper communication with other clinician and consulting areas of weakness leads to
application of substandard techniques.
15. how do you administer the following medication
Paracetamol- paracetamol is prescribed as 1mg tds or Qid depending on the severity os
pain. It is administered PRN through the oral route, before administering, wash hands and
ensure right dose.
Ondansetron- first prepare the patient by explaining the procedure and obtain consent.
The wash hands and administer the drug below the tongue.
Ventolin- explain the patient the procedure and the inhalation techniques. Then wash
hands and help the patient puff in the correct technique.
Neo-B12- prepare patient and explain the procedure, provide privacy, confirm again if it
is the right medication. Locate the injection site and give a deep IM.
Timolol- explain the procedure to the patient. Obtain consent. Perform hand hygiene and
instruct patient to cooperate. Administer 1 drop in the eye affected.
Morphine sulphate- explain the procedure to the patient. Check the patency of the IV line.
Then administer the drug slowly.
GROUP CONDITION INTENDED POTENTIAL SIDE MEDICATION

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EFFECTS EFFECTS EXAMPLES
Anaesthetics Analgesic,
amnesia, muscle
relaxants
Reduce pain
during surgery
and relax
muscles
Respiratory
depression
Drowsiness
nausea
Halothane
Isoflurane
propofol
analgesics Management of
acute or chronic
pain
Reduce pain
sensation of
nerve endings
Dizziness
Respiratory
depression
Diarrhoea
Diclofenac
Asprin
tramadol
antacids Management of
stomach acids like
acid indigestion,
upset and heartburn
Reducing the
acid refluxes and
gastric
neutralization
Constipation
Headache
Diarrhoea
Nausea
Pantoprazole
Gaviscon
Antianginals angina Reduces cardiac
muscle oxygen
demand
Edema in the limbs
Increased heart rate
Amlodipine
nifedipine
Antianxiety anxiety Prevents
dissociation of
serotonin.
Insomnia
sweating
Diazepam
lorazepam
Antiarrythmics Treat cardiac
arrythmias
Inhibit abnormal
cardiac rhythms
Low heart rate
rashes
Amiodarone
lidocaine
Antibiotics Prevention and
management of
bacterial infection
Kill or prevent
cell division in
bacteria
Vomiting,
Diarrhoea
Cefuroxime,
Erythromycin
Anticholinergics Poisoning
COPD
Blocks binding
of acetylcholine
to the receptors
Slurred speech
hallucination
Atropine
propantheline
Anticoagulants Prevent formation
of blood clots
Prevent clots
formation in
major vessels
and major organs
e.g. the heart and
Excessive bleeding Heparin,
warfarin

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brain
Anticonvulsants Angina disease
treatment
Makes it easy for
oxygen and
blood to reach
the heart
Palpitation
Swelling of body
parts e.g. legs,
ankles and feet
Phenorbarbitone
diazepam
Antidepressants depression Corrects
chemical
imbalances in the
brain hence
reducing
symptoms of
depression
Insomnia
Hyponatremia
confusion
Citalopram
duloxetine
Antidiarrheal diarrhoea Reduces gastric
motility
Constipation
Weakness
Loperamide
Antiemetic Management of
nausea and
vomiting
Reduce gastric
motility
Act on CNS to
prevent nausea
and vomiting
Constipation Domperidone
Promethazine
Antifungals Kill fungus Management of
fungal infections
Abdominal cramps
Constipation
Ketoconazole
Miconazole
Antihistamines Allergic reactions Inhibits effect of
histamine
Low tear
production
irritability
benadryl
Antihypertensive Lowering of blood
pressure
Causes
vasodilation
Increase urine
excretion
Drowsiness
Cough
Dehydration
Clonidine
Nifedipine
Anti-inflammatory Inflammation
pain
Regulates the
inflammatory
mediators
Heart burn
Hyperacidity
tinnitus
Ibuprofen
aspirin

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Antineoplastic Metastatic cancer
management
Inhibits growth
of neoplastic
cells
Sores in the mouth
Bleeding
immunosuppression
Doxorubicin
vincristine
Antiparkinsonian parkinsonism Increases action
of dopamine
hence lowering
action of
acetylcholine
Running nose
sneezing
Anticholinergics
amantadine
Antipruritic pruritus Reduces
itchiness
Mouth sores
Burning sensation
chlophiniramine
Antipsychotics psychosis Block chemical
receptors in the
brain.
Tremors
Weight gain
Olanzapine
clozapine
Antiseptics Prevent surface
growth of
organisms
Kills growing
microorganisms
Inflammation of
skin
Itchiness of skin
Sodium hypochlor
Endozyme solutio
Antiulcer ulcer Coats stomach
mucosa to
prevent
corrosion
Diarrhoea
Nausea
Ranitidine
omeprazole
Antivirals Viral infection Kills virus in the
body preventing
viral infections
Dry lips
weakness
Amantadine
zidovudine
Anxiolytics anxiety Prevents
dissociation of
serotonin in the
CNS hence
reducing anxiety
symptoms
Fatigue
insomnia
Diazepam
clonazepam
Beta-blockers Heart disease Manage
arrhythmias and
prevent heart
Dry mouth
Dizziness
Atenolol
propranolol

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disease
Bronchodilators bronchoconstriction Decrease airway
hypersensitivity
and maintain
patency.
Nausea
Increased heart rate
headache
Salbutamol
Ipratropium bromi
Hormones homeostasis Affect body
function to
maintain balance
and normal
function
Weight gain
Mood swings
nausea
Insulin
Progesterone
aldosterone
Hypnotics,
Sedatives
insomnia Act centrally on
neurotransmitters
to induce sleep.
Memory loss
hallucination
Doral
ambien
Hypoglycaemics hyperglycemia Lowering blood
sugar
Hypoglycaemia
headaches
Metformin
glibenclamide
Insulin hyperglycemia Helps conversion
of glucose to a
storage form
Hypoglycaemia
dizziness
Human insulin
Rapid acting insul
Electrolyte
solutions
Electrolyte
imbalance
Regulate fluid
and electrolyte
balance
Constipation
diarrhea
Sodium
potassium
Laxatives/
aperients
constipation Promote gastric
motility
Diarrhea
Rectal bleeding
Lactulose
duclolax
Ophthalmic, otic Allergies and optic
infections
Management of
inflammatory of
the eye
Itchness
Tearing
Burning sensation
Dexasol ophthalm
Nasal medications Flu
Nasal congestion
Decongests the
nose
Nose dryness
Burning sensation
Ephedrine
Propythexedrine
naphazoline
Contraceptives Unwanted
pregnancy
Thicken cervical
mucus
Prevent
ovulation
Weight gain
Headaches
nausea
COCS
IUCD
Implants

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Corticosteroids Lupus
Asthma
rashes
Management of
asthma, lupus
and rashes
Weight gain
Immunosuppression
Dexamethasone
predinisolone
Diuretics Increase urine
excretion
Lower blood
pressure
vasodilation
Muscle pains
Dizziness
nausea
Lasix
spironolactone
Narcotic analgesia Chronic pain
Pain during
operation
Relief chronic
pain
Respiratory
depression
dizziness
Morphine
Codeine
Neuroleptics Bipolar disorder
schizophrenia
Management of
mood disorder
Management of
disorder
Weight gain
Nausea, vomiting
dizziness
Lurasidone
Clozapine
Caroprazine
Vitamins Assists in body
development and
growth
Boosts immunity
Helps in body
healing
Weak muscles
Confusion
Stomach bleeding
Riboflavin
Folic acid
Thiamine

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References
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PH acidifiers for the treatment and prevention of cancer. U.S. Patent 9,278,924.
Chen, N., Zhou, S. and Palmisano, M., 2017. Clinical pharmacokinetics and
pharmacodynamics of lenalidomide. Clinical pharmacokinetics, 56(2), pp.139-152.
Damman, K., Kjekshus, J., Wikstrand, J., Cleland, J.G., Komajda, M., Wedel, H., Waagstein,
F. and McMurray, J.J., 2016. Loop diuretics, renal function and clinical outcome in
patients with heart failure and reduced ejection fraction. European journal of heart
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Dispenza, M.C., Regan, J.A. and Bochner, B.S., 2017. Potential applications of Bruton’s
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Shargel, L., Andrew, B.C. and Wu-Pong, S., 2015. Applied biopharmaceutics &
pharmacokinetics (pp. 119-120). McGraw-Hill Medical Publishing Division.
Taylor, S.I., Blau, J.E. and Rother, K.I., 2015. Possible adverse effects of SGLT2 inhibitors
on bone. The lancet. Diabetes & endocrinology, 3(1), pp.8-10.