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Claire Boyd. Medicine Management Skills for Nurses
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Student Survival Skills Series
MEDICINE MANAGEMENT SKILLS FOR NURSES
Preface
Introduction
Acknowledgements
The 24‐Hour Clock
Chapter 1 DRUG ADMINISTRATION: GENERAL PRINCIPLES
LEARNING OUTCOMES
PROFESSIONALISM
Professionalism in nursing
PROFESSIONAL JUDGEMENT
Question 1.1
MEDICATION ERRORS
Drug Errors and Adverse Reactions
Question 1.2
Question 1.3
Worldwide Facts and Figures
LATIN ABBREVIATIONS
Activity 1.1
MEDICAL ABBREVIATIONS
Activity 1.2
DID YOU KNOW?
DRUG WASTAGE
MEDICATION PROCESS
COMPLEMENTARY MEDICATION
Complementary medicine
Alternative medicine
Drug Administration Routes
Activity 1.3
Keeping Updated
Single‐Nurse Administration
PAEDIATRIC PATIENTS
Paediatric patients
Question 1.4
Older Adults
Postural hypotension
ADMINISTERING DRUGS SAFELY. Drug Administration Competence
Calculations Competence
Activity 1.4
Reports and Safety Alerts
Department of Health
Venous thromboembolism (VTE)
Improving Medication Safety
Question 1.5
Patient Self‐Administration of Medication
Focus on the Task in Hand: Do Not Get Distracted
Vicarious Liability. Question 1.6
Procedure for Administering Medication
Commonly Used Medicine Name Suffixes
Finally
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
REFERENCE
Chapter 2 PHARMACOKINETICS AND PHARMACODYNAMICS
LEARNING OUTCOMES
Activity 2.1
ABSORPTION
Routes of Absorption
Sublingual
Mesenteric blood flow
Bioavailability
DRUG DISTRIBUTION
DRUG METABOLISM
Placenta
DRUG EXCRETION
Therapeutic Serum Levels
DRUG INTERACTIONS
Activity 2.2
Synergy and Antagonism
Drug Interaction: Underlying Factors
Drug–Food Beverage Interaction
Drug interaction
Drug–Medical Condition Interaction
The Pharmacist. Activity 2.3
Adverse Drug Reactions
Reporting Adverse Drug Reactions
ANAPHYLAXIS. DID YOU KNOW?
The Patient Information Leaflet
Exemestane, 25 mg Coated Tablets
Very Common Side Effects
Common Side Effects
Uncommon Side Effects
The BNF Side Effects Grading Scheme
Examples of Some Adverse Effects
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 3 DRUGS AND MEDICINES
LEARNING OUTCOMES
WHAT'S THE DIFFERENCE BETWEEN A DRUG AND A MEDICINE?
CATEGORIES OF MEDICINE
Prescription Only Medications‐Community
MEDICATION DIRECTIONS
PRESCRIPTIONS
More Labelling
Question 3.1
Question 3.2
GENERIC PRESCRIBING
Activity 3.1
TYPES OF MEDICINE
Question 3.3
Pessary
MEDICINE STORAGE
VACCINES
Question 3.4
LEGISLATION
Medicines Act 1968
Misuse of Drugs Act 1971
Barbiturates
The Misuse of Drugs Regulations 2001
Misuse of Drugs (Supply to Addicts) Regulations 1997
Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2018
EC Directive 92/27/EEC
The Health Act 2006
The Human Medicines Regulations 2012
Health and Safety Act 1974
ADMINISTRATION OF DRUGS TO PATIENTS WHO REFUSE TREATMENT
DID YOU KNOW?
Nursing Standards for Administration of Medicines
WHAT IS ARE PATIENT SPECIFIC AND PATIENT GROUP DIRECTIONS?
Apprenticeship Standard for Nursing Associates
Unlicensed Medicines
Let me show you an example
Crushing Tablets
Top 100 Most Prescribed Medications in UK Hospitals
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 4 CALCULATIONS FOR WORKING OUT DOSAGES
LEARNING OUTCOMES
DRUG DOSAGES FOR TABLETS AND CAPSULES
Let me show you an example…
Enteric coating
Activity 4.1
Let me show you an example:
DRUG DOSAGES FOR INJECTION (AND ANY LIQUID MEDICATION)
Let me show you an example…
Activity 4.2
Oramorph
Opiate
INFUSION DEVICES
SYRINGE DRIVERS
Let me show you an example…
Diamorphine
Activity 4.3
Ambulatory
AMBULATORY SYRINGE DRIVERS
Let me show you an example…
Activity 4.4
GRAVITY‐FEED DRIP RATES (DROPS PER MINUTE)
Let me show you an example…
Activity 4.5
DURATION OF INFUSION
Duration of Infusion
Let me show you an example…
Activity 4.6
DRUGS ACCORDING TO BODY WEIGHT
Let me show you an example…
Activity 4.7
SETTING PUMPS TO RUN AT MILLILITRES PER HOUR
Let me show you an example…
Activity 4.8
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 5 ORAL DRUG ADMINISTRATION
LEARNING OUTCOMES
THE PRESCRIPTION CHART
Allergic reaction
Electronic Prescription Charts – Bar‐Coding
Community Medication Administration Sheet (MAR)
Care Home Homely Remedy
ORAL ROUTES
Modified‐Release Medications
Medications with an Enteric Coating
Question 5.1
How to Calculate Oral Drug Dosages
SOLID ORAL MEDICINES. Using a Tablet Cutter
Crushing of Solid Oral Medicines
Question 5.2
Swallowing Difficulties
LIQUID MEDICATIONS
What's A Meniscus?
SERVICE USERS. Activity 5.1
SELF‐ADMINISTRATION OF DRUGS
Controlled drugs
DID YOU KNOW?
CONTROLLED DRUGS
CHECKING MEDICATIONS FOR CHILDREN
Children Who Refuse Their Medication
Administration to Children by a Parent/Guardian
ADMINISTRATION. Procedure for Oral Drug Administration
Procedure for Administering Medication to Children and Babies using an Oral Syringe
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 6 ADMINISTRATION OF INJECTIONS
LEARNING OUTCOMES
REASONS FOR ADMINISTERING MEDICATION BY INJECTION
Activity 6.1
PARENTERAL DRUG ADMINISTRATION. Routes
Disadvantages of Parental Drug Administration
DEPOT INJECTIONS
Depot injection
SYRINGES
The Syringe
Types of Syringe. Luer‐lock
Eccentric Luer‐slip
Concentric Luer‐slip
Insulin
Insulin
Heparin
Question 6.1
NEEDLES
Needles for Injection
INJECTIONS
Aseptic Technique
Sites on the Body for IM Injections. Gluteus Muscles
Muscle atrophy
Deltoid Muscle
Vastus Lateralis Muscle
Aspirate
IM Injection Technique
Z‐Track Technique
Sites on the Body for Subcutaneous Injections
SC Injection Technique
Preparation of a Patient Prior to the Injection
Disposal of Sharps
Sharps
Intradermal Injections
Vaccines
Adenovirus
Influenza
Coronovirus
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES. Government Publications
REFERENCES
Chapter 7 ADMINISTRATION OF RECTAL AND VAGINAL PREPARATIONS
LEARNING OUTCOMES
INSERTION OF VAGINAL PESSARIES
INSERTION OF RECTAL MEDICINES
Laxative
Digital Rectal Examination
Constipation
Administration of Enemas and Suppositories
Autonomic Dysreflexia
Enema
DID YOU KNOW?
Care and Management of Autonomic Dysreflexia
Procedural Steps for DRE
Procedural Steps for Administration of Enemas and Suppositories
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 8 ADMINISTRATION OF TOPICAL PREPARATIONS
LEARNING OUTCOMES
Systemic
APPLYING CREAMS AND OINTMENTS
Fingertip Units
Skin Condition
Oedema/oedematous
Applying Creams and Ointments (Table 8.4)
TRANSDERMAL PATCHES
Applying a Transdermal Patch
EYE DROPS
Eye Conditions
Lacrimal
Glaucoma
Applying Eye Drops (Table 8.5)
EYE OINTMENT
Applying Eye Ointment
EAR DROPS
Ear Conditions
Applying Ear Drops (Table 8.6)
NOSE DROPS
Nose Conditions
Rhinitis
Applying Nose Drops or Sprays (Table 8.7)
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 9 ADMINISTRATION OF INHALATION MEDICATIONS AND NEBULISERS
LEARNING OUTCOMES
Palliative care
NEBULISATION
AEROSOLISATION
Exubera: Inhalable Insulin
Asthma and COPD
Reliever Inhalers
Preventer Inhalers
Combined Treatment with Reliever and Preventer
Inhaler Devices
Spacer Devices
Prescriptions
Question 9.1
Common Mistakes in Inhaler Administration
How to Administer Medications with Inhaler Devices
Turbohaler
Metered‐Dose Inhaler
Easi‐Breathe
HandiHaler
Accuhaler
Other Treatments for asthma
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 10 ADMINISTRATION OF INTRAVENOUS FLUIDS
LEARNING OUTCOMES
Activity 10.1
TYPES OF FLUID REPLACEMENT
Crystalloids
Activity 10.2
Blood Products are Hypertonic
Osmolarity
Activity 10.3
DEHYDRATION
Hypovolaemic shock
Electrolyte
RISK TO THE PATIENT
Vesicant
COMPLICATIONS OF IV THERAPY
Question 10.1
ADDING MEDICATIONS TO BAGS OF FLUID
EQUIPMENT
BLOOD PRODUCTS
INFUSION DEVICES
Calculating the Drip Rate
PRESCRIPTIONS
PREPARATION OF INTRAVENOUS FLUIDS
PROCEDURE FOR DISCONNECTION OF INTRAVENOUS INFUSION
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
REFERENCE
Chapter 11 ADMINISTRATION OF INTRAVENOUS BOLUS MEDICATIONS
LEARNING OUTCOMES
ADVANTAGES OF IV BOLUS INJECTIONS
SALINE FLUSHES
DISADVANTAGES OF IV BOLUS INJECTIONS
Let me show you an example… with amoxicillin
Adults and Children
Neonates
Phlebitis
Chemical phlebitis
Mechanical phlebitis
Bacterial phlebitis
AMOXICILLIN ADMINISTRATION IN NEONATES
DISPLACEMENT
Let me show you an example…
SPEED SHOCK
Activity 11.1
Infiltration V Extravasation
DID YOU KNOW?
GROUP A DRUGS
GROUP B DRUGS
Managing Extravasation
DID YOU KNOW
DID YOU KNOW
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
REFERENCE
Chapter 12 ADMINISTRATION OF CONTINUOUS INTRAVENOUS INFUSIONS
LEARNING OUTCOMES
ADVANTAGES OF CONTINUOUS INTRAVENOUS INFUSION
DISADVANTAGES OF CONTINUOUS INTRAVENOUS INFUSION
CALCULATING THE RATE
Heparin
Let me show you an example… with insulin
DIABETIC EMERGENCIES
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 13 ADMINISTRATION VIA PERCUTANEOUS ENDOSCOPIC GASTROSTOMY, PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY, OR NASOGASTRIC TUBE
LEARNING OUTCOMES
Enteral
MEDICATION
ADVICE FROM THE NPSA
Activity 13.1
PLACEMENT OF TUBES
PARENTERAL NUTRITION
ENTERAL FEEDING REGIMES
Methods of Administering Enteral Feeds
Procedure for Nasogastric Intubation
Xiphisternum
Procedure for Securing the Tube
NASOGASTRIC CARE PLAN
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
RESOURCES
Chapter 14 OXYGEN THERAPY
LEARNING OUTCOMES
RESPIRATION
Cell Metabolism
What Happens When We Breath?
What Is Proning?
What Makes Us Breath?
Who Is at Risk of Respiratory Failure
Kyphoscoliosis
Ankylosing Spondylitis
What Are the Physical Symptoms of Low Oxygen (Hypoxaemia) or High Carbon Dioxide (Hypercapnoea)?
ADMINISTERING THE OXYGEN
Nasal Cannula
Simple Masks
Non ‐ rebreathe Masks
Venturi Mask Valves
Titrating Oxygen Therapy
DETERIORATING PATIENTS
SIGNS OF RESPIRATORY DETERIORATION
OXYGEN CYLINDERS
Hospital Patients
APPROACH TO MONITORING
CASE STUDY
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 15 DRUGS AND SPECIFIC MEDICAL CONDITIONS
LEARNING OUTCOMES
Prostaglandins
ASPIRIN AND NSAIDs
How Does Aspirin Work to Prevent Blood Clots?
PARACETAMOL
MONOAMINE OXIDASE INHIBITORS
THE CO‐DRUGS
DRUGS USED IN SPECIFIC MEDICAL CONDITIONS. Cerebrovascular Accident: Stroke
Ischaemia
Treatment
Myocardial Infarction
Activity 15.1
Acid Reflux: H2 Blockers
How Do They Work?
Possible Side Effects
Drugs Used in a Cardiac Arrest Response
Adrenaline
Amiodarone
Lidocaine
Atropine
Additional Drugs
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 16 PAIN MANAGEMENT
LEARNING OUTCOMES
EFFECTS OF PAIN
Myelin
NOW FOR THE SCIENCE BIT
PAIN GATE THEORY
CLASSIFICATIONS OF PAIN
ASSESSMENT OF PAIN
Sedation
Activity 16.1
STRATEGIES TO MANAGE PAIN
ANALGESIC LADDER
MORPHINE
Correct Dilution for IV Morphine
Complications/Side Effects of Opiates
Observations
Antidote to Most Opiates
Predictors of Dose
Activity 16.2
BALANCED ANALGESIA
Why is Paracetamol Usually Prescribed with Morphine?
PALLIATIVE CARE
Palliative care
Palliative medicine
TEST YOUR KNOWLEDGE. Case Study
KEY POINTS
WEB RESOURCES
REFERENCES
Chapter 17 CASE STUDY
LEARNING OUTCOMES
NOTES ON PATIENTS' MEDICAL CONDITIONS, MEDICATION, AND POSSIBLE SIDE‐EFFECTS
TEST YOUR KNOWLEDGE
KEY POINTS
WEB RESOURCES
Chapter 18 KNOWLEDGE TEST
LEARNING OUTCOMES
Answers to Activities, Questions, and ‘Test Your Knowledge’ CHAPTER 1. Activity 1.1
Activity 1.2
Activity 1.3
Activity 1.4
Chapter 1 Questions
Chapter 1 Test Your Knowledge
CHAPTER 2. Activity 2.1
Activity 2.2
Activity 2.3
Chapter 2 Test Your Knowledge
CHAPTER 3. Activity 3.1
Chapter 3 Questions
Chapter 3 Test Your Knowledge
CHAPTER 4. Activity 4.1
Activity 4.2
Activity 4.3
Activity 4.4
Activity 4.5
Activity 4.6
Activity 4.7
Activity 4.8
Chapter 4 Test Your Knowledge
CHAPTER 5. Activity 5.1
Chapter 5 Questions
Chapter 5 Test Your Knowledge
CHAPTER 6. Activity 6.1
Chapter 6 Question
Chapter 6 Test Your Knowledge
CHAPTER 7. Chapter 7 Test Your Knowledge
CHAPTER 8. Chapter 8 Test Your Knowledge
CHAPTER 9. Chapter 9 Question
Chapter 9 Test Your Knowledge
CHAPTER 10. Activity 10.1
Activity 10.2
Activity 10.3
Chapter 10 Question
Chapter 10 Test Your Knowledge
CHAPTER 11. Activity 11.1
Chapter 11 Test Your Knowledge
CHAPTER 12. Chapter 12 Test Your Knowledge
CHAPTER 13. Activity 13.1
Chapter 13 Test Your Knowledge
CHAPTER 14
CHAPTER 15. Activity 15.1
Chapter 15 Test Your Knowledge
CHAPTER 16. Activity 16.1
Activity 16.2
Chapter 16 Test Your Knowledge
Chapter 17 Case Studies Test Your Knowledge
CHAPTER 18 KNOWLEDGE TEST
Note
Appendix 1 SPECIFIC COMPETENCIES: MEDICINES MANAGEMENT
KNOWLEDGE
ADMINISTRATION
HANDLING OF CONTROLLED DRUGS (FOR FIRST LEVEL REGISTERED NURSES). THIS SECTION DOES NOT APPLY TO NURSING ASSOCIATES
RAPID TRANQUILLISATION (FOR FIRST LEVEL REGISTERED NURSES) – THIS SECTION DOES NOT APPLY TO NURSING ASSOCIATES
Appendix 2 A TYPICAL PRESCRIPTION CHART
Index
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