can available when administering morphine sulfate in high doses or to a patient
who has never had morphine might avoid an adverse reaction.Assessment Required for Specific Drugs
Besides contraindications for a drug, the drug’s profile in the drug manual also
provides the nurse with the pharmacologic response of the drug (see Chapter 2)—
how the drug works in the body. Knowing this, the nurse can assess the patient
to determine if the patient’s body will be able to metabolize and eliminate
the medication.
Here are the areas that the nurse needs to consider:- Absorption
The patient must be able to absorb the medication. For example, PO
medication is absorbed in the GI tract (stomach and small intestine). A patient
with GI disturbances such as vomiting or diarrhea will not be able to absorb
the medication. - Distribution
Once absorbed, the medication must be distributed throughout the body.
In order for this to occur, some drugs must bind to protein, which carries drug
particles through the veins and arteries. If the patient has low protein levels,
some drug particles are unable to bind to the protein and the unbound drug par-
ticles are free drug which can possibly result in a toxic effect.
For example, Dilantin binds to albumin. If the patient has a low albumin
level, there will be less Dilantin bound to protein. The patient will be receiving
the proper therapeutic dose but because much of it is not bound to protein, the
serum levels of free drug will be too high—causing toxicity. - Metabolism
The liver breaks down drugs so they can be excreted from the body. If the
patient’s liver isn’t functioning properly, then the drug particles are not metabo-
lized and cannot be excreted from the body. This results in a buildup of the drug
and can possibly cause toxicity in the patient. It is important to remember that
inadequate liver function is not always caused by liver disease. Age influences
(^84) CHAPTER 5 Medication Administration