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Administration of Meds

Administration of Meds

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Terms and Definitions a.

Medication administration requires the soldier medic to be familiar with the terms and definitions of medication administration b. Drug effects-mechanism of action (1) Predictable chemical reaction-how the drug works (2) Changes the physiological activity of the body as the drug bonds chemically at a specific site called a receptor site (3) Mechanism of actions of drugs include (a) Drugs that fit the receptor sites well with a good chemical response are called "agonists³ (b) Drugs that attach at a receptor site and become chemically inactive with no drug response is called an "antagonist³ (c) Drugs that attach at a receptor site and produce a slight chemical reaction are called "partial agonists³ c. Drug actions (1) Therapeutic effects (a) Expected positive effect of drug (b) Single medication may have many therapeutic effects such as aspirin which is an analgesic, reduces inflammation, reduces fever and reduces clot formation (c) Some drugs have very specific effects such as antihypertensive medications have a therapeutic effect of controlling high blood pressure. Antibiotics treat bacterial infections. (2) Side effects (a) Unintended secondary effects (b) May or may not be harmful to the patient (c) Side effects of a drug may outweigh the benefits (d) Patients may stop taking a drug because of unpleasant side effects, i.e. codeine prescribed to control coughing but causes constipation. (3) Toxic effects (a) Caused by intake of high doses of medications, ingestion of drugs not intended to be ingested, such as topical medications, or when a drug accumulates in the system due to impaired metabolism or excretion

(b) May be lethal, depending on the action of the drug (c) Usually seen in accidental poisonings and intentional drug overdoses i.e., intentional ingestion or accidental administration of a large amount of a narcotic may cause severe respiratory depression and death. (4) Allergic Reactions (a) Unpredictable response to a drug (b) May be mild or severe (c) Mild allergic reactions include hives, rash, pruritus (itching of the skin), rhinitis (stuffy, runny nose) and wheezing. (d) Severe or anaphylactic reactions are characterized by sudden constriction of the bronchiolar muscles, swelling the throat, severe wheezing and shortness of breath. Without immediate life saving measures, this reaction progresses rapidly and death can occur within minutes. (e) Always ask patient about allergies to medications. Check unconscious patients for a medical alert bracelet or medal indicating a medication allergy prior to administering medications (5) Drug tolerance and dependence (a) Occurs when the patient receives the same drug for long periods of time and requires higher doses to produce the same effect. (b) For example, patients who take pain medications over a long period of time may develop a tolerance for the drug and require higher doses to achieve the same effect. (6) Drug interactions (a) One drug modifies the action of another drug. Drug interactions are common in patients who take many medications (b) A drug may potentiate or diminish the action of other drugs (c) May alter the way a drug is absorbed, metabolized or eliminated from the body (d) Drug interactions may or may not be desirable. For example, combining alcohol with other central nervous system depressants is not desirable. Combining diuretics and vasodilators act together to lower blood pressure in a desirable way.
An adverse drug reaction is defined as ³an undesirable response associated with use of a drug that either compromises therapeutic efficacy, enhances toxicity, or both.´10 ADRs can be manifested as diarrhea or constipation, rash, headache, or other nonspecific symptoms.

Routes of Drug Administration

and suspensions (c) Disadvantages include 1) Inability of some patients to swallow 2) Slow absorption 3) Partial or complete destruction by the digestive system (d) Other routes associated closely with oral administration 1) Sublingual a) The drug is placed under the tongue and rapidly absorbed directly into the blood stream b) Example . liquids. Non-parenteral medication administration (1) Drugs are introduced into the body by different routes.the drug is changed from a liquid or solid to a gas or vapor by the use of heat.almost entirely restricted to anesthesia .a. such as steam inhalation 2) Gas inhalation.Nitroglycerin sublingual tablets 2) Buccal . capsules. or powder (b) Divided into three major types 1) Vaporization . each serving a specific purpose (2) Oral administration of medications is the most common method (a) Advantages 1) Convenience 2) Economy 3) The drug need not be absolutely pure or sterile 4) A wide variety of dosage forms are available (b) Oral medications include tablets. vapor.The drug is placed between the cheek and gum and is quickly absorbed directly into the blood stream (3) Inhalation (a) The introduction of medications through the respiratory system in the form of a gas.

Nitroglycerin paste (5) Suppositories (a) Rectal is preferred to the oral route when patient is 1) Nauseated or vomiting 2) Unconscious.3) Nebulization . or mentally incapable (b) Vaginal suppositories. or other skin conditions without being absorbed into the bloodstream and 2) Systemic effect-the drug is absorbed through the skin into the bloodstream. burning. or tablets are examples of vaginal preparations that are inserted into the vagina to produce a local effect b. 3) Example .the drug is nebulized into minute droplets by the use of compressed gas or oxygen (4) Topical ointments (a) Examples of topical preparations 1) Creams 2) Lotions 3) Shampoos (b) Topical application serves two purposes 1) Local effect-the drug is intended to relieve itching. creams. uncooperative. Parenteral medications are those introduced by injection (1) All drugs used by this route must be (a) Pure (b) Sterile (c) Pyrogen-free (pyrogens are products of the growth of microorganisms) (d) Liquid state (2) Several types of parenteral administration (a) Subcutaneous 1) The agent is injected just below the skin's cutaneous layers .

large quantity of drug from which individual medication dose is removed (3) Storage guidelines (a) Once individual dosage is removed. can be returned to medication cart/storage . liquid.Insulin (b) Intradermal 1) The drug is injected within the dermis 2) Example .single dose of a drug in a tablet.The drug is introduced into the subarachnoid space of the spinal column. Bulk and Unit Dose Medications a. it can NEVER be returned to bulk container (b) Individual dosage drawn from bulk drug container will be disposed of IAW local SOP (c) Some medications require controlled temperature storage ranges b.Purified Protein Derivative (PPD) (c) Intramuscular 1) The drug is injected into the muscle 2) Example .2) Example . Bulk drugs (1) Commonly called floor stock or clinic stock (2) Description .Intravenous fluids/antibiotics (e) Intrathecal/intraspinal . or injectable form that is prepackaged by the pharmaceutical company or pharmacy (2) Storage guidelines (a) Normally found in medication cart (b) If still in original wrapper/unused condition. Unit dose (1) Description .Procaine penicillin G (d) Intravenous 1) The drug is introduced directly into the vein 2) Example . capsule.

and physician.c. Principle 3: Everything should be done to avoid ³no-shows. It is important to act as soon as the error is discovered. and tablets are stored on separate shelves d.) Principle 7: If there is an error or medication incident. Internal and topical (external) medications must be stored separately to prevent accidental use of the inappropriate medication. ointments. administration (within 24 hours).injectable.´ especially for seizure medications and antibiotics. Do not use one student¶s medication for another. Complete documentation.1 Principles That Influence Medication Administration Procedures It is important that these principles of medication administration be known and followed by anyone (nursing and non-nursing personnel) who is administering medications.g. Principle 5: Keep individual student information private. For detailed information about what to do in the case of medication administration errors. Principle 4: Prevent errors! Do not allow yourself to be distracted. Monitoring. The school administrator or supervisor should evaluate errors by all persons administering medications. Example . diazepam (Valium) (3) All pre-filled hypodermic needles and syringes Guidelines and Principles of medication aministration GUIDELINE #5: GENERAL PROCEDURES FOR MEDICATION ADMINISTRATION 5. the student¶s parent/legal guardian.g. . and Assessment.. Specific medications kept in secured (limited access) area (1) All narcotics (2) All medications with abuse potential.. Principle 1: Guarantee that medication administration is a clean procedure by washing hands. Follow district procedure for notifying your school nurse. Principle 6: Apply child development principles when working with students (e. e. students do not want to be considered unique. see section 9 of the Minnesota Guidelines: Quality Assurance. Principle 2: Give medication exactly as ordered by the health care provider or indicated on manufacturer¶s instructions. it must be reported.

and route while preparing the correct dose.. Procedure 2: Verify authorization from parent and/or prescriber. Procedure 3: Gather necessary items. medical pharmacopoeia) to verify the accuracy of the physician¶s order. Seek help when questions arise. Take measures to maintain data privacy. time. and route before returning the container to the locked cabinet. If an adverse reaction is evident. Procedure 9: Do not leave medication unattended. dose.g. Procedure 7: Check the label and/or manufacturer¶s instructions for name. dedicated area. Watch for typical adverse medication reactions. Remove medication from locked cabinet.2 Step-by-Step Procedures When medications are administered by any school personnel.5. and route. if possible. medication. Use current resources (e. Nonverbal students may need third party assistance with identification. dose. Procedure 11: Identify the student. unless otherwise specified. Ask the student to say his or her name. medication cups and alcohol wipes) as needed. Also verify contraindications to medicine. medication. time. dose. Procedure 8: Check the label and/or manufacturer¶s instructions for name.. Procedure 4: Prepare and give medications in a well-lit. Procedure 5: Check the label for name. or licensed prescriber. procedures such as the following should be in place: Procedure 1: Wash hands. . contact the supervisor.g. Procedure 12: Verify the student¶s allergies verbally by asking the student and by checking the student health records. medication. according to school policy. check the label and/or manufacturer¶s instructions. parent/legal guardian. Procedure 10: Provide equipment and supplies (e. time. Administration of medication is a clean (not sterile) procedure. Procedure 6: Prepare the correct dosage of medication without touching medication.

3 The Six Rights of Medication Administration The six rights can be used as a mental checklist to assist those administering medication to remember and clarify the critical elements of the process. 5. intramuscular. and right documentation). medication. Promptly and accurately document the medication administration. Procedure 18: Record name. Procedure 14: Explain procedure to student. dose.. Procedure 20: Clean. pumps. inhaled. Check three times. Procedure 16: Administer medication according to the six rights (right student. Procedure 17: Discuss administration procedure and carefully observe the student as medication is administered. route. return. or ear and eye. ³Are you Jane Doe?´ before administering the medication. This set of medication administration procedures is modified as needed. Right route. Properly identify the student (e. and any unusual observations. Administer the correct medication. right time. Right time. person administering the medication.Procedure 13: If the student questions whether it is the right medication. rectal. General guidelines (1) Check the physician's/PA orders . right route. based on routine or emergency administration and the route of administration: oral. Right medicine. Procedure 21: Wash hands. Procedure 19: Ensure accurate documentation of all medications. time. stop and verify the medication against records. subcutaneous. or with registered pharmacist. intravenous. This can usually be within 30 minutes earlier or later than the designated time unless otherwise specified by the provider or the pharmacist. Procedure 15: Position the student properly for medication administration. Right dose. They are the: y y y y y y Right student. Right documentation. including the witnessed disposal of medications. ask the student to state his or her name). right dose.g. gastrostomy-tube. Administer the right amount of medication. a. and/or dispose of equipment as appropriate. prior to administration. with parent/legal guardian. Use the prescribed method of medication administration. Administer medication at the prescribed time. right medicine. topical. rather than asking the student.

check with supervisor.e. provider's orders. or pharmacist. syringe.(2) Wash hands prior to touching any medication (3) Five patient rights (a) Right patient .administer medication via the route specified in the provider's order (i. physician. number of tablets. allergy bands. (3) Administration route and time will be followed IAW provider's orders WARNING: NEVER alter medication dosage ordered by physician/PA! (4) If in doubt about medication dose. Physicians Desk Reference (PDR) or RN's Drug Book CAUTION: If there is any doubt about administering a medication..ensure amount of medication ordered by the provider is measured correctly (i. return to pharmacy or follow local SOP (5) Check all medications label 3 times to ensure that the correct medication is being prepared for administration . nurse. PA or pharmacist (a) MD/PA's order and medication label DO NOT match exactly (b) Illegible medication label. physician.compare provider's orders. check with supervisor.administer medications at the prescribed time as per provider's orders (e) Right route . medic-alert tags and ask patient for medication allergies b. both therapeutic and non-therapeutic. PO. Principles of Medication Administration (1) Only administer medication that you have prepared or received from the pharmacy as unit dose (2) Be familiar with all potential medication effects. This information can be found in the (a) Manufacturer's medication insert that accompanies prepackaged medications (b) Local SOP (c) If available. number of milligrams. IM.) (4) Check medical records.verify patient's identity by comparing the patient's medical record. nurse. and the medical bracelet (hospital) or ask patient to state full name (b) Right medication . and medication label (c) Right dose . administration route. PA. IV. or if a medication is missing. graduated medicine cup. time.e. etc..) (d) Right time . etc. medication sheet.

transfer the prescribed dose of tablets or capsules to the medicine cup or if unit dose. CAUTION: prior to administering medication. dressing changes) (9) Prepare the prescribed dose of medication (a) Tablet or capsules .pour the correct dose of powdered or granulated medication into the medicine cup 1) Pour the required amount of water or juice into a paper cup 2) Reconstitute the medication at the patient's bedside WARNING: Never directly touch oral medications. (10) Patient Identification (a) Patient identification (Hospital) 1) Be sure the patient has received and wears an identification band 2) Check the information on the band to see that it is correct 3) Check the tag on the bed or wall and door. Small amounts of liquid medication should be drawn up in a syringe (c) Powders .(a) When removing the medication or container from the storage area (b) When preparing the medication dose (c) When returning the container to the storage area (6) Check the expiration date of the medication (7) Handle only one medication at a time (8) While administering medication. also the medication will become contaminated.pour the prescribed dose of liquid medication into the medicine cup.open the package and give directly to the patient (b) Liquids . obtain vital signs. do not perform other duties (i. Check with supervisor for instructions. Some medications can be absorbed through the skin.e. and make sure the patient is properly identified Positive patient ID required .. 3) The medic may assist the patient in taking the medication if the patient is physically unable WARNING: DO NOT administer oral medications to patients with a decreased level of consciousness.

Dosage (1) A dose is the amount of medication to be administered (2) Dosology is the study of dosage and the criteria that influence it (3) United States Pharmacopeia and National Formulary (USP-NF) states the doses given are the average therapeutic doses or "usual adult doses" . cups. Systems of drug measurement (definitions) (1) Metric system (a) Decimal system.4) Ask the patient to state his/her name 5) Check patient ID band for medication allergies and other pertinent information 6) In a hospital environment. have patients return to their bedside to receive medication (b) Patient identification (Clinic) 1) Have patient state name 2) Ask patient if he/she has any allergies to medications Dosage a. the liter (volume). and glass for volume. and the gram (weight) (c) Small or large letters are used to designate the basic units 1) Gram = g or GM 2) Liter = l or L (d) Small letters are abbreviations for subdivisions of major units 1) Milligram = mg 2) Milliliter = ml (2) Household measurements (a) Familiar to most people (b) Used when more accurate systems of measure are unnecessary (c) Basic units of measure include drops. teaspoons. each basic unit of measure is organized into units of 10 (b) Basic units of measure are the meter (length). tablespoons. and ounces and pounds for weight b.

(4) The following terms are used in connection with doses (a) Therapeutic dose 1) Amount needed to produce the desired therapeutic effect 2) Also referred to as "usual adult dose" 3) Calculated on an average adult about 24 years old. method of administration. and frequency of the dose (2) Although a physician prescribes the amount to be given. weighing approximately 150 pounds (b) Dosage range 1) The range between the MINIMUM amount of drug and the MAXIMUM amount of drug required to produce the desired effect 2) Many drugs. the least amount of drug required to produce a therapeutic effect 4) MAXIMUM dose. require large initial doses that are later tapered to smaller amounts 3) MINIMUM dose.The genetic structure of the individual may cause peculiar reactions to medications in some patients .The least amount of drug than can produce death c. Factors affecting dosage (1) Many factors that affect the dose. especially in the calculation of pediatric doses (6) Other factors that influence dosage are (a) Genetic make-up . the largest amount of drug that can be given without reaching the toxic effect 5) TOXIC dose. the least amount of drug that will produce symptoms of poisoning 6) Minimum lethal dose . you need to know how and why these quantities are determined (3) Two primary factors that determine or influence the dose are age and weight (4) Age is the most common factor that influences the amount of drug to be given (a) An infant would require much less than an adult (b) Elderly patients may require more or less than the average dose. depending upon the action of the drug and the condition of the patient (5) Weight has a more direct bearing on the dose than any other factor. such as antibiotics.

the nurse should have another qualified nurse check the calculated dose 3. To receive appropriate supportive therapy in relation to medication therapy g. Medication that must act at certain times are given priority (e. Before removing the container from the drawer or shelf b. Right Client ± an important step in administering medication safely is being sure the medication is given to the right client. if the specified route is not recommended.Injections Medication Administration PRINCIPLES OF MEDICATION ADMINISTRATION I . each institution has are commended time schedule for medications ordered at frequent interval c.Some patients must take medications chronically. the nurse compares the label of the medication container with medication form.(b) Habitual use . To be properly advised of the experimental nature of medication therapy and to give written consent for its use e. III ± Nurse who administer the medications are responsible for their own action. and potential undesired effects. Example . RIGHT TIME a. route and frequency b. the nurse must know why a medication is ordered for certain times of the day and whether the time schedule can be altered b. a. To not receive unnecessary medications II ± Practice Asepsis ± wash hand before and after preparing the medication to reduce transfer of microorganisms. RIGHT DOCUMENTATION ±Documentation is an important part of safe medication administration a. purpose. the nurse consult the prescriber. causing their bodies to build up tolerance to the drug.Before or after meals. Before returning the container to the storage 2. including allergies d. Sign medication sheet immediately after administration of the drug CLIENT¶S RIGHT RELATED TO MEDICATION ADMINISTRATION A client has the following rights: a. 5. Likewise. The nurse does this 3 times: a. the nurse should alert the prescriber immediately. To identify the client correctly: b. This tolerance may require larger doses than their initial doses to obtain the same therapeutic effect. As the amount of medication ordered is removed from the container c.the time. dose. The nurse check the medication administration form against the client¶s identification bracelet and asks the client to state his or her name to ensure the client¶s identification bracelet has the correct information. The documentation for the medication should clearly reflect the client¶s name.³Six Rights´ of drug administration 1. (c) Time of administration . To received labeled medications safely without discomfort in accordance with the six rights of medication administration f. action. b. Question any order that you considered incorrect (may be unclear or appropriate) IV ± Be knowledgeable about the medication that you administer . the name of the ordered medication.Therapeutic effect may be altered depending upon time of administration. To refuse a medication regardless of the consequences c. The Right Medication ± when administering medications. 4. Right Dose ±when performing medication calculation or conversions. To be informed of the medication¶s name.g insulin should be given at a precise interval before a meal ) 6. (d) Mode of administration . Example . RIGHT ROUTE ± if a prescriber¶s order does nor designate a route of administration.This has a definite impact on the dose. To have a qualified nurses or physicians assess medication history.

This may prevent any adverse effects of the drug. the fluid must be aspirated from the capsule and placed under the tongue. Syrup: sugar-based liquid medication d. Elixir: alcohol-based liquid medication. capsule. e. This allows maximum absorption of the medication. or desire effects will not be achieved Advantages: a. Medication Administration 1. A drug that is placed under the tongue. A medication given by the sublingual route should not be swallowed. Emulsion: oil-based liquid medication f. Stay with the client until he actually takes the medications. XI ± If the client vomits after taking the medication. Same as oral b. Drug may be aspirated by seriously ill patient. identify the client correctly IX ± Do not leave the medication at the bedside. suspension. . c. Crushing sustained-released medication ± allows all the medication to be absorbed at the same time. Do not accept endorsement of medication. VI± Use only medications that are in clearly labeled containers. If swallowed. Drug Forms for Oral Administration a. SUBLINGUAL a. resulting in a higher than expected initial level of medication and a shorter than expected duration of action 2. report it immediately to the nurse in-charge or physician. To implement necessary measures immediately. where it dissolves. Safe. elixir. report this to the nurse in-charge or physician. pill. Solid: tablet. VII ± Return liquid that are cloudy in color to the pharmacy. After administration of elixir. Only the nurse prepares the drug knows what the drug is. Shake bottle before use of medication to properly mix it. Drug may discolor the teeth e. b. Drug is rapidly absorbed in the bloodstream Disadvantages a. XIV ± When the medication error is made. resulting in mucositis or gastric irritation. XIII.³A FUNDAMENTAL RULE OF SAFE DRUG ADMINISTRATION IS: ³NEVER ADMINISTER AN UNFAMILIAR MEDICATION´ V ± Keep the Narcotics in locked place. milk. powder b.When a medication is omitted for any reason. Usually less expensive Disadvantages a. Suspension: water-based liquid medication. ³NEVER CRUSH ENTERIC-COATED OR SUSTAINED RELEASE TABLET´ Crushing enteric-coated tablets ± allows the irrigating medication to come in contact with the oral or gastric mucosa.. Relabelling of drugs are the responsibility of the pharmacist. Drug may have unpleasant taste d. or other alkaline substances. allow 30 minutes to elapse before giving water. The easiest and most desirable way to administer medication b. XII ± Preoperative medications are usually discontinued during the postoperative period unless ordered to be continued. Liquid: syrup. record the fact together with the reason. VIII ± Before administering medication. emulsion. c. does nor break skin barrier d. Inappropriate for client with nausea and vomiting c. X ± The nurse who prepares the drug administers it. When the medication is in capsule and ordered sublingually. Drug may irritate the gastric mucosa f. drug may be inactivated by gastric juices. Oral administration Advantages a. Most convenient c. Inappropriate if client cannot swallow and if GIT has reduced motility b.

TOPICAL ± Application of medication to a circumscribed area of the body. (e. Drug can be administered for local effect c. Apply only thin layer of medication to prevent systemic absorption.g large area of burns) e.Do not press cotton into the canal. Use surgical asepsis when open wound is present c. or placed under the tongue (e. nausea and pain. The medication should not be chewed. Ask the client to remain in side lying position for about 5 minutes h. failure to do so may cause vertigo. Have the client assume a side-lying position ( if not contraindicated) with ear to be treated facing up. g. Press gently bur firmly a few times on the tragus of the ear to assist the flow of medication into the ear canal. g. . Remove previous application before the next application d. c. Client should be taught to alternate the cheeks with each subsequent dose to avoid mucosal irritation Advantages: a. At times the MD will order insertion of cotton puff into outermost part of the canal. h. For liquid eye medication. clean the skin thoroughly by washing the area gently with soap and water. Shutting the eyes tightly causes spillage of the medication. b. Wait for 5 minutes if additional drops need to be administered. Nasal ± Nasal instillations usually are instilled for their astringent effects (to shrink swollen mucous membrane). 1. Use sterile technique e. Otic Instillation ± to remove cerumen or pus or to remove foreign body a. a. Have the client blow the nose prior to nasal instillation b. Drug must remain under the tongue until dissolved and absorbed 3. Irrigation ± To clear the eye of noxious or other foreign materials. calcitonin. liniment and ointments. Straighten the ear canal: 0-3 years old: pull the pinna downward and backwardš Older than 3 years old: pull the pinna upward and backwardš e. d. swallowed. b. Decongestants. Instillation ± to provide an eye medication that the client requires. d. or locally debriding tissue. Elevate the nares slightly by pressing the thumb against the client¶s tip of the nose. Before application. tranquilizer. Clean the eyelid and eyelashes with sterile cotton balls moistened with sterile normal saline from the inner to the outer canthus f. drug may be inactivated by gastric juiceš 4. soaking an involved site. A medication is held in the mouth against the mucous membranes of the cheek until the drug dissolves. Use gloves when applying the medication over a large surface. Warm the solution at room temperature or body temperature. Apply gloves if drainage is present. BUCCAL a.antiemetics. powder. i. Assume a back lying position. c. 4. Instruct the client to close the eyes gently. Opthalmic .b. b. While the client inhales. Ensures greater potency because drug directly enters the blood and bypass the liver Disadvantages: If swallowed. steroids. opiates. b.g sustained release nitroglycerine. press firmly on the nasolacrimal duct (inner cantus) for at least 30 seconds to prevent systemic absorption of the medication. Position the client either sitting or lying. Dermatologic ± includes lotions. a. sedatives) c. dizziness. Instill eye drops into lower conjunctival sac. because it causes discomfort. Same as oral b. This is for proper absorption of the medication.includes instillation and irrigation a. j. Instill a maximum of 2 drops at a time. 2. Avoid dropping a solution onto the cornea directly. or sit up and lean head back. squeeze the bottle. Instill eardrops on the side of the auditory canal to allow the drops to flow in and continue to adjust to body temperature f. Remove cotton after 15 minutes. Perform hand hygiene. c. to loosen secretions and facilitate drainage or to treat infections of the nasal cavity or sinuses. 3.

c. Administer bronchodilator before other inhaled medication. foam and suppository. Inhalation ± use of nebulizer. Vaginal ± drug forms: tablet liquid (douches). c. For obese patient: 90 degree angle of needle . for at least 30 second interval. Ask the client to remain in bed for 5-10 minute following administration of vaginal suppository. Instruct the client to hold breath for 10 seconds. Empty the bladder before the procedure b. 10 cm (4 inches) in adults. It is also called douche. b. To prevent irritation of the site. preoperative medication. metered-dose inhaler a. f. e. 7. e. alternate nares to prevent irritations 5. a. c. Apply disposable gloves. bevel up. If bronchodilator. 8. Use applicator or sterile gloves for vaginal administration of medications. also allows suppository to dissolve without escaping through orifice. To enhance complete absorption of the medication. b. Intradermal ± under the epidermis. 26. upper chest and back. b. Use the needle gauge 25. Inject a small amount of drug slowly over 3 to 5 seconds to form a wheal or bleb. e. Indicated for allergy and tuberculin testing and for vaccinations. May need to apply gentle pressure to hold buttocks together momentarily. a. Position the mouthpiece 1 to 2 inches from the client¶s open mouth. jelly or irrigation. Have the client lie on left side and ask to take slow deep breaths through mouth and relax anal sphincter. Wait at least 1 minute before administration of the second dose or inhalation of a different medication by MDI g. PARENTERAL. Irrigating container should be 30 cm (12 inches) above d. Needle length and gauge are the same as for ID injections d. RECTAL ± can be use when the drug has objectionable taste or odor. insulin. To enhance full chest expansion allowing deeper inhalation of the medication b.administration of medication by needle. 5 cm (2 in) in children and infants. Do not massage the site of injection. administer a maximum of 2 puffs. To mix the medication and ensure uniform dosage delivery c. Keep head tilted backward for 5 minutes after instillation of nasal drops. Rotate site of injection to minimize tissue damage. When the medication is used on a daily basis. 27: needle length 3/8´. f. Position the client on her back with the hips higher than the shoulder (use bedpan) c. foam. f. 5/8´ or ½´ d. and to prevent absorption of the drug into the subcutaneous. Only small doses of medication should be injected via SC route. The site: outer aspect of the upper armsš anterior aspect of the thighsš Abdomenš Scapular areas of the upper backš Ventroglutealš Dorsoglutealš a. Subcutaneous ± vaccines. Retract buttocks gently through the anus. Close room or curtain to provide privacy. press the canister down to release one dose of the medication. Vaginal Irrigation ± is the washing of the vagina by a liquid at low pressure. Assist client to lie in dorsal recumbent position to provide easy access and good exposure of vaginal canal. c. 6. a. and beneath the scapula.d. Discard gloves to proper receptacle and perform hand washing. narcotics. past internal sphincter and against rectal wall. The site are the inner lower arm. d. Simi or high-fowler¶s position or standing position. ½ is use at a 90 degree angle. Client must remain on side for 20 minute after insertion to promote adequate absorption of the medication. if steroid had been administered. For thin patients: 45 degree angle of needle f. Shake the canister several times. As the client starts inhaling. Use 5/8 needle for adults when the injection is to administer at 45 degree angle. a. Needle at 10±15 degree angle. This allows delivery of the medication more accurately into the bronchial tree rather than being trapped in the oropharynx then swallowed d. This opens airway and promotes greater absorption of the medication. Jelly. e. Need to be refrigerated so as not to soften. heparin. This is to prevent fungal infection. Instruct client to rinse mouth. b. cream. e.

bones. For insulin injection: k. Use appropriate needle size. Vastus Lateralis a. c. Deltoid site a. The triangle formed by the index finger. Recommended site of injection for infant b. GENERAL PRINCIPLES IN PARENTERAL ADMINISTRATION OF MEDICATIONS 1. This is approximately 5 cm (2 in) or 2 to 3 fingerbreadths below the acromion process. For heparin injection: h. b. Adjust the length of the needle depending on the size of the client. Apply disposable gloves. c. anterior aspect of thigh. Plot the site of injection properly. so it less contaminated.client may have anxiety. b. Rectus femoris site ±located at the middle third. 2´ to reach the muscle layer b. inject the medication slowly. If blood appears on pulling back of the plunger of the syringe. which can increase the pain. Retract the skin laterally. Inject the medication slowly to allow the tissue to accommodate volume. point the index finger toward the anterior superior iliac spine. The injection site id lateral and superior to this line. l. Used for parenteral iron preparation. aspirate before injection of medication to check if the blood vessel had been hit. To prevent hitting nerves. palpate the lower edge of the acromion process and the midpoint on the lateral aspect of the arm that is in line with the axilla. 6. Another method of locating this site is to imaginary divide the buttock into four quadrants. To locate the site. the third finger and the crest of the ilium is the site. m. Hold retraction of skin until the needle is withdrawn c. Position the client similar to the ventrogluteal site b. place the heel of the hand over the greater trochanter. Not used often for IM injection because it is relatively small muscle and is very close to the radial nerve and radial artery. Dorsogluteal site a. c. e. These ensure relaxation of gluteus muscles and minimize discomfort during injection. Do not massage the site of injection to prevent leakage into the subcutaneous. flex the knee and hip. To minimize tissue injury. It is farther from the rectal area. To locate the site. 3. d. Avoid hitting the sciatic nerve. Located at the middle third of the anterior lateral aspect of the thigh. or blood vessels and less fat. curl the toes inward. Check doctor¶s order. 2. Observe verbal and non-verbal responses toward receiving injection. e. The area contains no large nerves. Practice asepsis to prevent infection. i. major blood vessel or bone by locating the site properly. 4. Position the client in prone or side-lying. c. 1 ½´. remove the needle and discard the medication and equipment. the nursedraw an imaginary line from the greater trochanter to the posterior superior iliac spine. Do not massage the injection site to prevent hematoma formation j. then abduct the middle (third) finger. Do not massage to prevent rapid absorption which may result to hypoglycemic reaction. Palpate the crest of the ilium to ensure that the site is high enough. Sites: Ventrogluteal site a. To seal the drug deep into the muscles and prevent permanent staining of the skin. Assume back-lying or sitting position. 5. To locate the site. Injection can be painful. Intramuscular a. blood vessels. IM injection ± Z tract injection a. Check the expiration for medication ± drug potency may increase or decrease if outdated. . Needle length is 1´. b. When in prone position.g. For other medications. Always inject insulin at 90 degrees angle to administer the medication in the pocket between the subcutaneous and muscle layer. The upper most quadrant is the site of injection. d. Clean the injection site with alcoholized cotton ball to reduce microorganisms in the area. When side-lying position. The site should not be use in infant under 3 years because the gluteal muscles are not well developed yet. do not aspirate.

Apply pressure at the site for few minutes. during and after infusion. Introduce the needle in quick thrust to lessen discomfort. e. Aspirate before the introduction of medication. D50W c. Practice strict asepsis. Predictable. plainRinger¶s lactate d. Observe for potential complications. or medication through an existing intravenous infusion line or intermittent venous access (heparin or saline lock) 3. a. it must be available during administration. Introduce air into the vial before aspiration. or small volume. a. NaCl 0. amount. a. Prime IV tubing to expel air. When administering potent medications. To ensure administration of proper volume of IV fluid as ordered. 16. The nurse should double-check the six rights of safe medication. Verify the doctor¶s order b. Inform the client and explain the purpose of IV therapy to alleviate client¶s anxiety. 10. c. To prevent bleeding. Most rapid route of absorption of medications. g. the nurse assesses vital signs before. 8. As mixture within large volumes of IV fluids. Either spread or pinch muscle when introducing the medication. To check if blood vessel had been hit. e. To prevent contamination. Types of IV Fluids Isotonic solution ± has the same concentration as the body fluid a. Plain Normosol M Hypotonic ± has lower concentration than the body fluids. i. b. D5NM . 17.7. Change IV needle insertion site every 72 hours to prevent thrombophlebitis. To create a positive pressure within the vial and allow easy withdrawal of the medication. Shave the area of needle insertion if hairy. If the medication has an antidote. Na Cl 0. Minimized discomfort by applying cold compress over the injection site before introduction of medicati0n to numb nerve endings. h. and indication of IV therapy. j. c. 12. Regulate IV every 15-20 minutes.9% c. Intravenous The nurse administers medication intravenously by the following method: 1. Nursing Interventions in IV Infusion a. therapeutic blood levels of medication can be obtained. 13.2 ml) in the syringe to push the medication that may remain. By ³piggyback´ infusion of solution containing the prescribed medication and a small volume of IV fluid through an existing IV line. D10W b. D5LR d. Know the type. f. D5 W b. Clean the insertion site of IV needle from center to the periphery with alcoholized cotton ball to prevent infection. f. Support the tissue with cotton swabs before withdrawal of needle. Large dose of medications can be administered by this route. By injection of a bolus. Evaluate effectiveness of the procedure and make relevant documentation. d. k. Use separate needles for aspiration and injection of medications to prevent tissue irritation. Depending on the size of the client. 14. h. 9. Massage the site of injection to haste absorption. The route can be used for clients with compromised gastrointestinal function or peripheral circulation. This will prevent air embolism. Change the IV tubing every 72 hours. The nurse must closely observe the client for symptoms of adverse reactions. To prevent discomfort of pulling tissues as needle is withdrawn.3% Hypertonic ± has higher concentration than the body fluids. 11. 15. g. 2. d. Allow a small air bubble (0.

Assessment: Pain.š Arm feels warmer than the other armš Nursing Intervention: Change IV site every 72 hoursš Use large veins for irritating fluids. Assessment: Dizzinessš Shockš Faintingš Nursing Intervention Slow infusion to KVO.Complication of IV Infusion 1. Air Embolism ± Air manages to get into the circulatory system. clot formation.š Apply cold compress immediately to relieve pain and inflammation. or backpainš Hypotensionš .š Take vital signsš Notify physicianš 4. irritating solution or drugs.š Stabilize venipuncture at area of flexion. Drug Overload ± the patient receives an excessive amount of fluid containing drugs.š Nursing Intervention: Change the site of needleš Apply warm compress.š ³Do not irrigate the IV because this could push clot into the systemic circulation¶š 5. and fluids accumulate in the subcutaneous tissues.š 2. large bore catheters. Infiltration ± the needle is out of nein. flow rate has decreases or stops. 5 ml of air or more causes air embolism. Circulatory Overload -Results from administration of excessive volume of IV fluids. Superficial Thrombophlebitis ± it is due to o0veruse of a vein. To enhance breathing Administer diuretic. shoulder. swelling. This will absorb edema fluids and reduce swelling. pallor of the site. Assessment: Pain along the course of veinš Vein may feel hard and cordlikeš Edema and redness at needle insertion site. Assessment: Headacheš Flushed skinš Rapid pulseš Increase BPš Weight gainš Syncope and faintnessš Pulmonary edemaš Increase volume pressureš SOBš Coughingš Tachypneaš shockš Nursing Interventions: Slow infusion to KVOš Placeš patient in high fowler¶s position. Assessment: Chest. bronchodilator as orderedš 3. skin is cold at needle site. later with warm compress to stimulate circulation and promotion absorption.

which reacts with recipient antigen. give most IV push medication over 3 to 5 minutes. Altered vital signs indicate adverse reaction. k. j. Identify client properly. Check for cross matching and typing. For plasma. h. Never administer IV fluids with dextrose. Administer 0. and possible cardiac arrest. Complications of Blood Transfusion 1. Warm blood at room temperature before transfusion to prevent chills. To allow air to rise in the right side of the heart. To prevent adverse effectsš Do not incorporate medication into the blood transfusionš Do not use blood transfusion line for IV push of medication. safe from transfusion. albumin) Nursing Interventions: a.Use BT set with special micron mesh filter. b.š Turn patient to left side in the trendelenburg position. HBsAg. during or after BT. To prevent administration of blood clots and particles. At least 2 licensed nurse check the label of the blood transfusion Check the following: Serial number¾ Blood component¾ Blood type¾ Rh factor¾ Expiration date¾ Screening test (VDRL. Inform the client and explain the purpose of the procedure. To provide selected cellular components as replacements therapy (e. Monitor vital signs. packed rbc).g clotting factors. To increase the number of RBCs and to maintain hemoglobin levels in clients with severe anemia 3. Obtain and record baseline vital signs d.š m. To ensure compatibility c. cryoprecipitate. Allergic Reaction ± it is caused by sensitivity to plasma protein of donor antibody.š Physical therapy may be requiredš Note: apply splint with the fingers free to move. transfuse quickly (20 minutes) clotting factor can easily be destroyed. Dextrose causes hemolysis. platelets. Start infusion slowly at 10 gtts/min. Speed Shock ± may result from administration of IV push medication rapidly. trauma. Nerve Damage ± may result from tying the arm too tightly to the splint. To avoid speed shock. Adverse reaction usually occurs during the first 15 to 20 minutes. Practice strict Asepsis e. 7. Administer BT for 4 hours (whole blood. g. Do not mixed medications with blood transfusion.Dyspneaš Cyanosisš Tachycardiaš Increase venous pressureš Loss of consciousnessš Nursing Intervention Do not allow IV bottle to ³run dry´š ³Prime´ IV tubing before starting infusion. To increase circulating blood volume after surgery. malarial smear)¾ .9% NaCl before. . l. f. Remain at bedside for 15 to 30 minutes. This allows easy flow of blood. This prevent pulmonary embolism. n.this is to ensure that the blood is free from blood-carried diseases and therefore.š 6. or hemorrhage 2. Use needle gauge 18 to 19. platelets.š BLOOD TRANSFUSION THERAPY Objectives: 1. Two Nurses check the client¶s identification. Assessment Numbness of fingers and handsš Nursing Interventions Massage the are and move shoulder through its ROMš Instruct the patient to open and close hand several times each hour. Verify doctor¶s order.

observing signs and symptoms and monitoring vital signs as often as every 5 minutes. and steroids as per physician¶s order or protocol. Assessment Rise in venous pressure¾ Dyspnea¾ Crackles or rales¾ Distended neck vein¾ Cough¾ Elevated BP¾ 5.Assessments Flushing¾ Rush. attached label. Circulatory Overload ± it is caused by administration of blood volume at a rate greater than the circulatory system can accommodate. This is the most symptomatic complication of blood transfusion Assessments: Sudden chills and fever¾ Flushing¾ Headache¾ Anxiety¾ 3. It is caused by infusion of incompatible blood products. Patient observation . Septic Reaction ± it is caused by the transfusion of blood or components contaminated with bacteria. The nurse remains with the client. hives¾ Pruritus¾ Laryngeal edema. vasopressor. tubing. 8. The nurse prepares to administer emergency drugs such as antihistamines. platelets or plasma proteins. STOP THE TRANSFUSION. Hemolytic reaction. 2. Blood container. Notify the physician immediately. 7. Principles of Patient Observation and Medication Documentation a. difficulty of breathing¾ 2. Assessment Low back pain (first sign). Place the client in fowlers position if with SOB and administer O2 therapy. 4. and transfusion record are saved and returned to the laboratory for analysis. Non-Hemolytic ± it is caused by hypersensitivity to donor white cells. 6.9% Na Cl) 3. Start IV line (0. fluids. If blood transfusion reaction occurs. Obtain a urine specimen and send to the laboratory to determine presence of hemoglobin as a result of RBC hemolysis. 5. Febrile.¾ Chills¾ Feeling of fullness¾ Tachycardia¾ Flushing¾ Tachypnea¾ Hypotension¾ Bleeding¾ Vascular collapse¾ Acute renal failure¾ Nursing Interventions when complications occurs in Blood transfusion 1. This is due to inflammatory response of the kidneys to incompatible blood. Assessment: Rapid onset of chills¾ Vomiting¾ Marked Hypotension¾ High fever¾ 4.

purpose. injected. or applied topically (2) If patient refuses medication (a) Remove medication from the patient's room (b) Report the patient refusal to the nurse/supervisor (c) Offer the medication again in five minutes (d) If refused a second time. (Rash. side effects and nursing implications for administration and monitoring (4) If the patient has an adverse reaction. CAUTION: DO NOT leave medications in the patient's possession without a specific physician's order to do so. and nausea/vomiting/diarrhea are common examples of adverse reactions. . itching.(1) Remain with patient until medication is swallowed completely. they may be sensitive to any product containing iodine such as Betadine or dyes used in radiological testing (c) Medication history 1) Length of time drug has been taken 2) Current dosage schedule 3) Any ill effects experienced 4) Drug data . (3) Observe for medication effects and/or side effects (a) Medical history 1) Before administering medications.action. normal dosage.) WARNING: Anaphylaxis is the most severe form of adverse reaction to a medication. record the omission per SOP and document the reason for the omission in the nursing notes. Report patient refusal to direct supervisor. routes. review the patient¶s medical history for possible indications or contraindications for medication therapy 2) Disease or illness may place patient at risk for adverse medication effects 3) Long-term health problems or surgical history may require medications (b) History of allergies 1) Allergic to medication 2) Food allergies should be documented 3) If patient is allergic to shellfish.

opiates. Strict adherence to the five "rights³ of medication administration helps to prevent errors d. Any event that causes the patient to receive inappropriate drug therapy (medications) or failing to receive appropriate drug therapy (medications) b.(a) Stop dosage immediately (b) Assess patient's airway. 91W) c. breathing. antibiotics. RN. preparing and dispensing (pharmacist. Professional and ethical obligations to your patients mandate that you report all medication errors Some of the factors associated with medication errors include the following: y y y Medications with similar names or similar packaging Medications that are not commonly used or prescribed Commonly used medications to which many patients are allergic (e. and nonsteroidal anti-inflammatory drugs) . LPN. Minimum information needed is (a) Name of medication given (b) Dosage of medication (c) Time given (d) Route of administration (e) Patient's reaction (effects/side effects) (f) Name of person who administered medication (2) Record the omission of a medication on the appropriate medical forms whenever a scheduled medication is not administered IAW local SOP Medication Errors a. circulation (c) Inform nurse/physician on duty immediately b. transcribing of the order.g. 91W) or administering the medication (RN. Can be made by anyone involved in the prescribing (MD/PA). Medical documentation (1) Record administration of medication IAW SOP.. Errors should be acknowledged as soon as they are discovered or known to have happened and reported immediately to the appropriate people for patient follow-up e.

wrong frequency. names that look or sound alike). theophylline. failure to act on test. and known allergy. inadequate monitoring.. wrong drug. similar or misleading container labeling.e.) Medication errors occur in all settings5 and may or may not cause an adverse drug event (ADE). Types of Medication Errors Leape and colleagues27 reported more than 15 types of medication errors: wrong dose.6 Phillips and colleagues7 found that deaths (the most severe ADE) associated with medication errors involved central nervous system agents. (This list is available at www. known allergy. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. wrong time. Misreading medication names that look similar is a common mistake.9 percent). Each type of error was found to occur at various stages.. and diagnostic and interventional areas) are associated with increased risk of ADEs. .5 percent). wrong technique. extra dose. name confusion (e.. and digoxin) Look-alike/sound-alike medication names can result in medication errors.org/NR/rdonlyres/C92AAB3F-A9BD-431C-8628-11DD2D1D53CC/0/lasa.g. Among the 126 nursing administration errors. The Joint Commission publishes a list of look-alike/sound-alike drugs that are considered the most problematic medication names across settings. preparation error. wrong route.. Most of the common types of errors resulting in patient death involved the wrong dose (40. and cardiovascular drugs. performance or knowledge deficits. the majority were associated with wrong dose. and other. and the wrong route of administration (9.g. wrong technique. emergency departments. drug-drug interaction. nontoxic) therapeutic levels are maintained (e. antineoplastics. and inappropriate packaging or device design. intensive care units. wrong choice of drug. the wrong drug (16 percent). lithium. and wrong drug. warfarin.jointcommission. though some more often during the ordering and administration stages. Medications with complex dosing regimens and those given in specialty areas (e. missed dose.g. The causes of these deaths were categorized as oral and written miscommunication. Of the 130 errors for physicians. equipment failure.y Medications that require testing to ensure proper (i. the majority were wrong dose.pdf. wrong choice.

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