- 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 med-
ication 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 con-
traindications 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 toler-
ate and others that result in an adverse reaction. The nurse must review the pro-
file 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 symp-
toms. The nurse should alert the patient to the possible side effects before admin-
istering 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-
CHAPTER 5 Medication Administration^83