205: Oral meds and HTN day class notes

N205 ORAL MEDICATION ADMINISTRATION & HYPERTENSION

Medicine is the most regulated industry next to nuclear power.

At the completion of this class, the student will be able to:

1. describe the etiology, pathophysiology, risk factors, and consequences of HTN;

2. discuss nursing and medical management of HTN, including client education;

3. demonstrate safe administration of PO medications with specific techniques with tablets, liquids, and via NG or gastrostomy tubes;

4. accurately document medication administration using a MAR.

I. HYPERTENSION

A. Factors that affect blood pressure

1. cardiac output: myocardial contractility, blood volume, SNS

2. systemic vascular resistance: vessel diameter, vessel compliance

3. hormonal: renin, ANP, ADH, Aldosterone, adrenomedullin [vasodilator]

4. environmental: stress, lifestyle, high fat diet, inactivity, genetics

Brainstem damage can screw up mgmt of BP

B. Types of HTN

1. primary, essential HTN, no known cause

2. secondary: identifiable underlying process, most common is renal disease

silent killer; patient education is important.

C. Risk factors:

1. modifiable factors: stress, TOB, diet, exercise, salt

2. nonmodifiable factors: genetics, ethnicity, diabetes, ETOH increases rennin secretion

D. Pathophysiology:

1. excess SNS activity, with increased vasoconstriction and increased cardiac output. This is good when the building is coming down, but not day to day.

2. altered RAA system: too much Angiotensin 2

3. vascular endothelium: lots of factors are released in response to pressures

4. insulin resistance, hyperinsulinemia, endothelial factors

5. Obesity means hypermetabolic state; it’s a lot of work to get the blood throughout the body

6. Elderly: increased systolic due to arteriosclerosis; less elastin causes hardening. This is normal aging.

E. Manifestations/Complications

1. sx: early are asx [asymptomatic]; headache, large organ damage sx

2. complications: CVD, stroke, heart failure, cardiac dysrhythmias, renal insufficiency. Why heart failure; the heart has to push against greater systemic pressure

F. Management

1. diagnosis: this is why they’ve gotta go to the doc. White Coat hypertension. People have got to get their BP checked. People need to know what their BP is.

2. lifestyle changes

3. medications: they’re back from pharma! Expect to be tested on antiHTN meds; all those fucking categories.

4. complementary therapies: biofeedback, relaxation techniques [biofeedback is well documented as an intervention.]

5. nursing: health promotion

6. nursing diagnoses:

• Ineffective health maintenance
• Risk for noncompliance
• Imbalanced nutrition; more than body requirements
• Excess fluid volume

II. PREPARING ORAL MEDICATIONS

You can never be too good with med admin

Know which meds you need to give on empty stomach, full stomach, with food, etc.

A. Perform all steps of safe drug administration with tablets or capsules

B. What are they? READ LABEL THREE TIMES, when?

1. know where shit is in the Med Room
2. wash hands
3. check medication 3 times against MAR; check the med time, the dose, the route
4. Margi likes going top of the sheet to the bottom of the sheet with meds
5. Leave it in the package to go to bedside [you’ve got the name on the package, what if they refuse, what if they ask why that yellow one is in there?] You can do a 2^nd check at bedside when the labels are still attached.
6. Lock the meds back up or whatever.
7. If you have something to check before admin [pulse, BP] do it. If you’re suppose to hold for systolic of <110 hour="8" minute="0">8am vitals were 150/70, don’t hold it. If it was 115, retake their BP. Be smart.
8. Watch them swallow everything
9. Go straight home to the MAR to document that meds were given. You can’t document it if you didn’t see it taken.

Sometimes stock meds are in a bottle. Your professor will make you toss the meds and repour if she didn’t watch you pour it.

C. Liquid medications:

1. pour at eye level, [don’t break your back]

shake if necessary

Take a chaser of juice, water, or whatever.

2. read fluid dispensed at lowest pint of meniscus

3. return multidose bottle to storage area

D. Crushing medications techniques; mix in applesauce or dissolve in warm water if to be given via tube. Take a chaser of undrugged applesauce. Taking pills crushed always means people get less med, so its best if they can just take the whole thing.

E. Altering medications

1. scored tablets may be split. Risky b/c you might give the whole pill. If you washed your hands you can break it with your hands, or use a breaker. Dispose of unused half properly.

2. do not crush enteric coated or sustained release medications. If the doc has it ordered to be crushed, or they’re on a tube feed, you’ve gotta call the doc.

F. Patient preparation

1. check two identifiers against MAR

2. assist to a sitting position; why?

3. explain type and purpose of medication

4. determine if nursing action is needed before giving medication to patient; like what?

5. remove drug from packet and give to patient with water

6. stay with the patient and make sure the drug is swallowed

7. document drug on MAR

8. assess patient for adverse drug reactions or side effects

G. NG medications: why can’t they be PO? Well maybe b/c they have no gag reflex, they can’t swallow, whatever. NG tubes are evil little snakes that love to jump into the mouth, up to the esophagus.

1. Dissolve crushed medication in 30 ml water. NG tubes love to plug up.

2. verify NG tube placement with air bolus or stylet every time. Or check residual to confirm you’re in the stomach.

3. flush NG tube

4. administer medications

5. flush NG tube well

H. What can go wrong? What do you do?

1. patient refuses drugs

2. patient is allergic to drugs

3. patient is unable to swallow drugs

4. patient’s family takes medications when left at bedside

5. patient’s friends bring in recreational drugs

6. patient throws medications at you