ments could be misleading and provide false information about the effective-
ness of the drug.
The nurse must suspend administering further doses of the medication if the
patient shows the signs and symptoms indicating an adverse reaction to the medi-
cation. The prescriber must be immediately notified of the patient’s condition.
The nurse must also note any side effect of the medication experienced by the
patient and how well the patient tolerates the side effect. If the patient has a low
tolerance to the side effect, then the nurse needs to notify the prescriber. The pre-
scriber might substitute a different medication or prescribe other medication to
alleviate the side effect.
The nurse must determine if the patient is receiving the therapeutic effect
from the medication. This is critical when giving pain medication. Doses are
often ordered for the average-weight patient. Patients who are very thin or obese
may be receiving too much or too little medication. Prescribers are also con-
cerned about patients developing tolerance to or dependency on pain medication
and may underprescribe the dose or how often it may be given. If the nurse accu-
rately assesses the patient’s response to the drug, the dose or frequency may be
adjusted to provide appropriate relief from pain.
Controlling Narcotics
Special precautions are necessary for storing and handling narcotics because
the manufacture, sale, and use of narcotics are controlled by federal legislation.
Here are the steps that must be taken to secure narcotics.
- Keep narcotics in a double-locked drawer or a closet.
- One nurse per shift must keep the keys to the narcotic drawer on his/her
person. - A sign-out sheet must be used to control the inventory of narcotics.
- Document on the MAR or similar records when a patient is given a
narcotic.
Controlled substances (narcotics) are generally counted at least once per shift.
The amount of the drug available is compared with the numbers that have been
used for patients and signed for on the narcotics form. Each agency has a policy
to govern this activity and to determine what action should be followed if the
count is not accurate.
CHAPTER 5 Medication Administration^93