Page 2 - Pharmacological Therapies Study Guide for the NCLEX-PN Exam
Prior to administering a medication, the LPN may be responsible for tasks related to medication preparation.
When preparing a medication, it may require using clinical decision making and performing medication calculations as needed. This may include using the concentration of a drug to determine the amount to be delivered to achieve the ordered dosage. The LPN may also need to calculate and monitor an IV medication flow rate.
Working with Medication
When physically working with medications, the LPN should be able to do the following tasks.
In some cases, medications may need to be mixed. A common medication that may need to be mixed is insulin. There are also times where medications from two vials will need to be mixed. Further, there may be medications that need to be reconstituted prior to administration.
Many safety practices must be followed when preparing medications. Medications should always be stored appropriately and expiration dates should be checked frequently. Also, the LPN should dispose of any unused medications according to the facility’s policy.
When preparing, administering, and disposing of controlled substances, there may be additional tasks. These may include the counting of narcotics, witnessed waste and disposal of medication, and additional documentation of these substances.
The LPN will also need to reconcile and maintain both client home medication lists and the medication administration record. The LPN should be sure that these lists encompass not only prescribed medications but also over-the-counter medications and/or herbal supplements.
There are additional tasks that are required when administering medications to the client. These may depend on the type of medication and the delivery method.
Rights of Medication Administration
All healthcare providers, including the LPN, should be aware of the Five Rights of Medication Administration. These Five Rights are the right client, the right drug, the right dose, the right route, and the right time. Prior to any medication administration, the LPN should mentally review the Five Rights to double-check accuracy.
There are certain data elements that the LPN may need to collect prior to medication administration. For example, the LPN may need to test the client’s blood glucose level to determine the insulin dose to prepare and administer. Further, client vital signs may determine if certain medications should be administered or withheld.
There are a variety of methods for administering medications. When a medication is prescribed or ordered, the delivery method should be specified by the healthcare provider.
Administration by Various Routes
There are a number of different routes by which medications may be administered. The route may also determine the form of the drug that should be administered (e.g., tablet vs. solution).
Oral route— Medications that are given orally are given by mouth, typically with sips of water.
Intravenous piggyback (secondary) medications— If a client has an intravenous line, a medication may be given as a secondary piggyback.
Gastrointestinal tube— If a client has a gastrointestinal tube (G-tube, NG tube, G-button, or J-tube), medications may be given using this route. Medications given via this route are traditionally considered oral medications and consist of liquids and/or crushed and dissolved solid medications, such as tablets and capsules.
Subcutaneous, intradermal, or intramuscular— A medication given by injection may be given subcutaneously, intradermally, or intramuscularly.
By ear, eye, nose, inhalation, rectum, vagina, or skin— Other medications may be given by ear, eye, nose, inhalation, rectum, vagina, or skin. The LPN should ensure the correct form of the medication is used for these routes.
There are drugs that will be given by transfusion. For example, blood products are typically given by transfusion. During a blood transfusion, the client should be monitored closely and vital signs taken more regularly to ensure any adverse effects of the transfusion are detected early.
One of the LPN’s roles will be to reinforce teaching and alleviating client concerns about medications and their frequency.
Some medications may be ordered PRN, which means these medications are only given as needed. The LPN will need to be familiar with the medication and the instructions for monitoring to determine if the client needs this PRN medication. For example, pain medications may be ordered as needed for a client who reported pain over a certain level.
When clients are prescribed medications to administer themselves, they tend to be oral medications that require little teaching. However, there are medications that may require additional instruction, such as insulin dose calculations, subcutaneous insulin pump maintenance, and injectable drugs.
Helping clients manage any pain associated with their condition is an important part of nursing and you’ll need to know several principles involved.
Identify Client Need
For clients experiencing pain, there may be medications prescribed or ordered to aid in managing pain. When caring for these clients, the LPN will be instrumental in identifying the client’s need for these medications, as they may be prescribed on a PRN, or as needed, basis. These medications should only be administered when indicated.
Monitor and Document
Clients being treated for pain management pharmacologically need to be monitored for the need for medication administration and re-administration. The LPN should use pain rating scales and/or verbal reports to determine if the client requires pharmacological interventions. All of these pain assessments and medication administration events should be documented appropriately.
Pain Control Devices
For some clients, pain management may require devices in addition to or in place of oral or intravenous medication. These devices include, but are not limited to, epidurals, patient-controlled analgesia devices (PCAs), and peripheral nerve catheters. The LPN may be responsible for maintaining these devices and ensuring they are functioning properly.