ADMINISTRATION OF MEDICATION FUNCTIONS OF THE NURSE 8 Dependent – Nursing Action carried out at the instruction or order of the Physician

. 9 Independent – Nursing Action carried out within the legal scope of Nursing’s independent domain. 10 Interdependent – Nursing action performed by the Nurse in collaboration with other members of the Health Care Team. PHARMACOLOGY 11 Study of actions of chemicals on Living Organisms. 12 Study of drugs & the effects to the Person. IMPORTANT THINGS TO NOTE BEFORE ADMINISTERING DRUGS  Name of the Patient  Name of the Drug ο Generic Name – the name assigned by the manufacturer that 1st developed the drug. ο Trade/Brand Name – selected by the drug company that sells the drug & is copyrighted.  Dose  Route (Drug Preparation)  Timing & Frequency  Doctor’s Orders/Signature  Date FIVE RIGHTS The Right Drug with The Right Dose through The Right Route at The Right Time to The Right Patient 1. The Right Drug  Name ο Generic Name ο Trade Name  Preparation ο Solid  Capsule – powder or gel form of an active drug enclosed in a gelatinous container, may also be called liquigel.  Pill – Mixture of a powdered drug with a cohesive

material; may be round or oval.  Tablet – small, solid dose of medication, compressed or molded; may be any color, size or shape.  Lozenge/Troche – small oval, round or oblong preparation containing a drug in a flavored or sweetened base, which dissolves in the mouth & releases the medication.  Trans-Dermal Patch – unit dose of medication applied directly to the skin for diffusion through skin & absorption into the bloodstream. ο Liquid  Elixir – medication in a clear liquid containing water, alcohol, sweeteners & flavor.  Syrup – medication combined in a water & sugar solution.  Suspension – finely divided, undissolved particles in a liquid medium that needs to be shaken before use.  Solution – a drug dissolved in another substance. ο Semi-Solid  Ointment – semi-solid preparation containing a drug to be applied externally.  Liniment – medication mixed with alcohol, oil or soap, which is rubbed on skin.  Lotion – drug particles in a solution for topical use.  Suppository – easily melted medication preparation in a firm base such as gelatin that is inserted in the body. Effects ο Primary (Therapeutic)  Intended Effect of the drug. ο Secondary (Side-Effect)  Not intended effect of the drug  Allergy → rapidly-developing reaction. → Signs & Symptoms may appear on the skin, respiratory system or the GIT. → Anaphylactic Reaction – life-threatening reaction that may result in respiratory distress, severe bronchospasm, tachycardia, hypotension & cardiovascular collapse. May be treated by epinephrine, bronchodilators & antihistamines.  Toxicity → Overdose – taking in a lethal dose of medication. → Cumulative Effect ♦ The body cannot metabolize one dose of the

drug before another dose is administered. ♦ The drug is taken in more frequently than it is excreted & each new dose increases the total quantity in the body. ♦ May cause permanent damage to the kidneys or liver. Ingestion of Drugs for External Use

DRUG NOMENCLATURE 1. Chemical Name  Precise description of the drug’s chemical composition. 2. Generic Name  The name assigned by the manufacturer that first develops the drug.  Often derived from the Chemical Name. 3. Official Name  The name by which the drug is identified in the official publication. 4. Trade Name  Also referred to as the Brand Name or Proprietary Name.  Selected by the drug company that sells the drug & is copyrighted.  A drug can have several Trade Names but the same Generic Name.

DRUG PREPARATIONS 1. Oral  Capsule, Pills, Tablets, Extended Release, Elixir, Suspension, Syrup. 2. Topical  Drug is applied directly to the body site, usually, the skin or

mucous membranes. Liniment, Lotions, Ointment, Suppository, Transdermal Patch.

3. Injectable  Introduction of medication into the body by a syringe.  Vials, Ampules, Pre-Filled Syringes. DRUG CLASSIFICATIONS 1. Body Systems  Drugs that affect the bodily systems, such as the Digestive System, Cardiovascular System, etc. 2. Symptoms Relieved  Ex: Fever, Colds, Cough, etc. 3. Clinical Indication of the Drug  Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive. PHARMACOKINETICS 13 Study of the movement of drug molecules in the body. 1. Absorption  The process by which a drug is transferred from its site of entry into the body to the bloodstream. 2. Distribution  After a drug has been absorbed into the bloodstream, it is distributed throughout the body.  Drug accumulates in specific tissues for its action to take place.  Distribution depends on the rate of perfusion and capillary permeability to the drug. 3. Metabolism  Also called Biotransformation.  The breakdown of the drug to an inactive form.  The liver is the primary site for drug metabolism.  Physiologic changes or presence of a Liver disease may complicate the process. 4. Excretion  After the drug is broken down to an inactive form, excretion of the drug from the body occurs.  The Kidneys excrete most of the drugs.  The Lungs excrete gaseous substances such as inhaled anesthesia.  Many drugs are also excreted through the intestines. FACTORS AFFECTING DRUG ABSORPTION 1. Route of Administration  Injected medications are usually absorbed more rapidly than

oral medications. 2. Drug Solubility  Liquid medications are absorbed more rapidly than solid preparations, as liquid medications do not have to be dissolved by the gastric juices. 3. pH  Acidic drugs are well absorbed in the stomach.  Basic drugs remain ionized or insoluble in an acid environment. They can only be dissolved in the Small Intestines. 4. Local Conditions at the Site of Administration  The more extensive the absorbing surface, the greater the absorption of the drug, thus, a more rapid effect will occur.  Food in the stomach can delay the absorption of some medications or enhance the rate of absorption of other drugs. 5. Drug Dosage  A higher dose than the normal is usually given when a patient is in acute distress and the maximum therapeutic effect is desired as quickly as possible.  A maintenance dose is a lower dosage that becomes the usual or daily dosage. 6. Serum Drug Levels  After a drug has been absorbed, its serum level can be monitored by drawing blood and measuring the drug’s peak & trough levels. ADVERSE EFFECTS OF MEDICATION 1. Allergic Effect  A drug allergy occurs when a person who has been previously exposed to the drug develops antibodies.  Can be manifested in a variety of symptoms which can range from minor to serious.  Reaction may occur immediately after the patient receives the medication or be delayed for hours or days.  Life-threatening immediate reaction is called Anaphylactic Reaction and results in respiratory distress, sudden severe bronchospasm, and cardiovascular collapse. Can be treated with epinephrine, bronchodilators and antihistamines.  Symptoms & signs of allergy to drugs: ο Fever ο Diarrhea – GIT ο Urticaria – Local Effect ο Rash– Local Effect ο Nausea – GIT

ο Vomiting – GIT 2. Cumulative Effect  Also called Drug Tolerance  Occurs when the body becomes accustomed to a particular drug over a period of time.  Larger doses are given to produce the same effects as the initial dose.  Occurs when the body cannot metabolize one dose of the drug before another dose is administered.  The drug is taken in more frequently than it is excreted.  If allowed to reach toxic levels, it may cause permanent damage to the body organs. 3. Idiosyncratic Effect  Any abnormal or peculiar response to a drug that may manifest itself by over-response, under-response, or response different from the expected outcome. 4. Drug Interaction  The combined effect of 2 or more drugs acting simultaneously produces an effect either less than that of each drug alone (Antagonist Effect), or greater than that of each drug alone (Synergistic Effect).  Drug A can inhibit the effect of Drug B.  Ingestion of a drug with alcohol may create a synergistic effect.

5. Iatrogenic Effect  The drug produces a disease condition.  Examples: ο Chloramphenicol, which is taken for Typhoid Fever, may cause Depression of the Bone Marrow functions, such as Anemia, Thrombocytopenia, Neutropenia, Pancytopenia. ο Augmentin, causes Diarrhea. 6. Drug Resistance  When microorganisms would no longer respond to the drug. 7. Drug Dependence  Abuse of regulated drugs.  Physical Effects: Change in Biochemical make-up of the body & experiences withdrawal symptoms.  Psychological Effects: Feeling of Well-Being when taking the drugs.

VARIABLES INFLUENCING THE EFFECT OF A MEDICATION 1. Developmental Considerations  During pregnancy, most medications are contraindicated due to its possible adverse effects on the fetus.  Certain drugs have a Teratogenic Effect, which are known to have a potential to cause developmental defects in the embryo or fetus.  Breastfed infants are also at a risk for adverse effects from the drugs in the mother’s body.  Children are given smaller doses of medication because the immaturity of their organs are responsive to the medication.  Older Adults are also responsive to medication because their bodies have experienced physiologic changes associated with the aging process.  Small body size, reduced weight & reduced body water also alter distribution.  Drugs are excreted more slowly from the body as a result of changes in kidney functions of Older people. 2. Weight  Expected responses to drugs are based largely on those reactions that occur when the drugs are given to healthy adults (18-65 years old, 150 lb.)  Drug doses for children are calculated by weight or Body Surface Area. 3. Sex  The difference in the distribution of body fat & fluids in men & women is a minor factor affecting the action of some drugs. 4. Genetic & Cultural Factors  Asian patients may require smaller doses of a drug because they metabolize it at a slower rate.  African Americans appear to require larger doses of some medications that are used to lower blood pressure.  Herbal treatments that are popular in some cultures may interfere with or counteract the action of prescribed medication. 5. Psychological Factors  The patient’s expectations of the medication affects the response to the medication.  Placebo is a pharmacologically inactive substance.  Some patients appear to have the same response with the placebo as with an active drug. 6. Pathology  The presence of a disease may affect the drug action.  Pathologic conditions that involve the Liver may slow the metabolism & alter the dosage of the drug needed to reach a

therapeutic level.

7. Environment  Sensory deprivation and overload may affect drug responses.  Nutritional state may also affect the body’s reaction to certain drugs. 8. Timing of Administration  The presence of food in the stomach delays the absorption of orally administered medications. TYPES OF MEDICATION ORDERS 1. Standard Order  Carried out until cancelled by another order.  The Physician specifies that a certain order is to be carried out for a stated number of days or times. Once the stated period has passed, the order is cancelled automatically. 2. PRN Order  As needed, or only when necessary.  Commonly written for post-operative pain medication. 3. Stat Order  Carried out immediately and for one time only. 4. Single Order  The medication is only ordered once, at a time specified by the Physician. 5. Self-Terminating PARTS OF A MEDICATION ORDER 1. Patient’s Name 2. Date & Time when the Order was written. 3. Name of the Drug to be administered. 4. Dosage of the Drug 5. Route by which the Drug is to be administered. 6. Frequency of administration of the Drug. 7. Signature of the Person/Physician writing the Order. TRANSCRIPTION OF MEDICATION ORDERS 14 Kardex 15 Medication Sheet or Medication Administration Record 16 Medication Card ROUTES FOR ADMINISTERING DRUGS 1. Oral Route – Having the Patient Swallow the medication  Enteral Route – Administering the drug through an Enteral Tube.

Sublingual Administration – Placing the drug under the tongue. Buccal Administration – Placing the drug between the cheek & gum. 2. Parenteral Route – Injecting the Drug  Subcutaneous Injection – Injecting the drug into the Subcutaneous Tissue.  Intramuscular Injection – Injecting the drug into the Muscle tissue.  Intradermal Injection – Injecting the drug into the Corium, under the Epidermis.  Intravenous Injection – Injecting the drug into the Vein.  Intraarterial Injection – Injecting the drug into the Artery.  Intracardial Injection – Injecting the drug into the Heart Tissue.  Intraperitoneal Injection – Injecting the drug into the Peritoneal (Abdominal) Cavity.  Intraspinal Injection – Injecting the drug into the Spinal Canal.  Intraosseous Injection – Injecting the drug into the Bone.  

3. Topical Route – Inserting or rubbing drug onto the Skin or Mucous Membrane.  Vaginal Administration – Inserting drug into the Vagina.  Rectal Administration – Inserting drug into the Rectum.  Inunction – Rubbing drug into the Skin.  Instillation – Placing drug into direct contact with the Mucous Membrane.  Irrigation – Flushing the Mucous Membrane with drug in a Solution.  Skin Application – Applying Transdermal Patch. 4. Pulmonary Route – Having the Patient inhale the drug. ADMINISTRATION OF ORAL MEDICATION 17 Intended for absorption in the Stomach & Small Intestines. 18 Most commonly used route of administration, most comfortable & convenient for the Patient, also the safest. 19 Oral medications should not be administered to Patients who have difficulty swallowing, unconscious, under NPO order, or is vomiting. 20 Available in solid & liquid forms. 21 Some tablets are scored for easy breaking for partial quantity dosage. 22 Enteric-coated tablets are covered with a hard surface to impede its

absorption until it has left the Stomach. It should not be chewed or crushed. 23 Other forms of oral medication that should not be chewed or crushed: o SR – Sustained Release o XL – Extended Release o CR/CRT – Controlled Release o SA – Sustained Action o LA – Long Acting 24 Liquid preparations are administered using calibrated cups or using a plastic syringe without a needle (placed between the gum & cheek). ADMINISTRATION OF PARENTERAL MEDICATION 25 Injecting the medication into those body tissues outside of the intestines or alimentary canal. 26 Absorption occurs more rapidly with an injection than when other routes are used. 27 Intravenous injections are absorbed more rapidly than intramuscular ones, but the effects of intramuscular injections usually last longer due to the increased absorption time. 28 Results are more predictable, and the desired dosage can be determined with greater accuracy. 29 Used for patients who are unconscious, who have gastrointestinal disturbances, or who are uncooperative. 30 Also used in emergencies because absorption and desired results occur rapidly.

TYPES OF SYRINGES 1. Hypodermic Syringe

 Comes in 2-, 2.5-, and 3 mL sizes.  Usually has 2 scales marked with minim & milliliter.  Milliliter scale is normally used.  Minim scale is used for very small dosages. 2. Insulin Syringe  Similar to a Hypodermic Syringe but the scale is especially designed for Insulin.  Several low-dose Insulin Syringes are also available, frequently with non-removable needles.  All Insulin Syringes are calibrated on the 100-unit scale. 3. Tuberculin Syringe  Originally designed to administer Tuberculin.  It is a narrow syringe calibrated in tenths and hundredths of a milliliter (up to 1 mL) on one scale and in sixteenths of a minim (up to 1 minim) on another.  Can also be useful in administering other drugs, particularly when small or precise measurement is indicated. 4. Pre-Filled Syringes  Syringes that are already filled with a medication and usually have their own needle attached.  Available as pre-filled syringes ready for use or pre-filled sterile cartridges and needles that require attachment of a reusable holder (injection system) before use.  Provides a single dose of medication. TYPES OF SYRINGE TIPS 1. Luer-Lok Syringe  Has a tip that requires the needle to be twisted onto it to avoid accidental removal of the needle. 2. Non-Luer-Lok Syringe  Has a smooth graduated tip onto which needles are slipped.  Often used for irrigation purposes. PARTS OF THE SYRINGE 1. Plunger – Used to push the medication out of the Syringe. 2. Barrel PARTS OF THE NEEDLE 1. Needle Hit or Hub – Where the needle is connected to the Syringe. 2. Shaft 3. Bevel – Sloped edge of the needle, designed to make a narrow, slitlike opening that closes quickly. PREPARING MEDICATION FOR INJECTION

1. Ampule  An ampule is a glass flask that contains a single dose of medication for parenteral administration.  Before breaking the neck of the ampule, flick the tip or the stem of the ampule to make sure that all the medication is returned to the body of the ampule. DO NOT SHAKE.

  

If the neck of the ampule has perforations to make breaking it easier, no need to file the neck. The ampule can be inverted or placed on a flat surface to draw solution into the syringe. Make sure that the needle does not touch the rim of the ampule as it may contaminate the needle.

2. Vial  A vial is a glass bottle with a self-sealing stopper through which the medication is removed.  A vial usually contains several doses of medication.  Before drawing the medication from the vial, wipe the rubber stopper with alcohol.  To facilitate the removal of medication, inject air into the vial in the same amount as the quantity of medication to be administered, while it is standing on a flat surface.  Invert the vial and withdraw the needle tip slightly so that is below the fluid level. This is to prevent air from being aspirated into the syringe.  Draw the prescribed amount of the medication while holding the syringe at eye level, vertically, for accurate reading.  After withdrawing the medication from the vial, carefully replace the cap of the needle using the Scooping Method. ADMINISTERING MEDICATIONS INTRADERMALLY 31 Intradermal Injections have the longest absorption time of all parenteral routes. 32 Only used for diagnostic purposes. 33 Intradermal injections are placed just below the epidermis. 34 Usually only a small amount of the medication is administered. 35 Usual Sites for Intradermal Injections: o Inner surface of the Forearm o Dorsal Aspect of the Upper Arm

o Upper Chest o Upper Back 36 Cleanse the area of the injection site by using an alcohol swab or cotton ball going on circular motions moving outward from the site. 37 Allow skin to dry. 38 Use your non-dominant hand to tauten the skin over the injection site. This will facilitate an easier entrance into the intradermal tissue. 39 Place the needle almost flat against the Patient’s skin with the Bevel Side up, and insert the needle into the skin so that the point of the needle can be seen through the skin. 40 Once the needle is inserted at about 1/8 of an inch, slowly inject the medication while watching for a small wheal or bleb to appear. If none appears, withdraw the needle slightly. 41 Withdraw the needle quickly at the same angle it was inserted to minimize tissue damage & discomfort for the patient. 42 Do not massage the area of the injection so that it will not interfere with the test results.

ADMINISTERING MEDICATIONS INTRAMUSCULARLY 43 Often used to administer drugs that are irritating, because there are a few nerve endings in deep muscle tissues. 44 Absorption occurs more rapidly because of the greater vascularity of muscle tissues. 45 Intramuscular Injection Sites: o Deltoid – 3 finger-breadths below the Acromion Process. o Ventrogluteal – Hips, right below the Iliac Crest o Vastus Lateralis  Found on the Antero-Lateral middle third of the Thigh.  Usually used for Patients below 1 year old. o Dorsogluteal – Upper Outer Quadrant of the Buttocks (to avoid piercing the Sciatic Nerve) 46 Z-Track Technique o This method prevents seepage of the medication into the needle track and reduces pain and discomfort. o Suggested for elderly patients with decreased muscle mass. o The skin is pulled down or to one side about 1 in and held in this position with the non-dominant hand, while the needle & medication is injected. o Steadily withdraw the needle and release the displaced tissue to return to its normal position. o Do not massage the site as it may cause the seepage of the medication back to the needle track.

47 Clean the injection site with an alcohol swab using friction & allow to dry. 48 Hold the syringe with your dominant hand between the thumb & forefinger. 49 Quickly dart the needle into the tissue at a 90-degree angle to facilitate the entry into the muscle tissue. 50 As soon as the needle is in place, use your non-dominant hand to hold the lower end of the syringe, to steady the syringe as you aspirate. 51 Aspirate by slowly pulling back on the plunger to determine whether the needle is in a blood vessel. If blood is aspirated, discard the needle, syringe & medication, and start over on another site. 52 If no blood is aspirated, inject the solution slowly (10 seconds per mL of medication). This will reduce discomfort of the patient as it allows the medication to disperse in the tissues. 53 Remover the needle slowly and steadily. 54 Apply gentle pressure at the site as this will cause less trauma and irritation to the tissues. ADMINISTERING TOPICAL MEDICATIONS 55 Drug is applied directly to the body site. 56 Usually intended for direct action at a particular site. IRRIGATION 57 Washing and allowing the solution to come out 58 Used for the eyes, ears, nose, rectum & vagina. EYE INSTILLATIONS & IRRIGATIONS 1. Eyedrops  Eyedrops are instilled for their local effects, such as pupil dilation or constriction, for treating an infection, etc.  Tilt the Patient’s head back, if sitting, the head may be turned to the affected side to prevent the solution from flowing to the other eye.  Have the Patient look up.  Place 2 fingers of your non-dominant on the lower eyelid, just below the eyelashes and slightly pull down to expose the lower conjuctival sac.

 

Holding the dropper, place your dominant hand on the Patient’s forehead. Hold the dropper close to the eye, while avoiding to touch the

eyelashes, eyelid & eyeball, slowly squeeze the container to allow the prescribed number of drops to fall onto the lower conjuctival sac.  Release the lower lid once the medication is instilled & ask the Patient to slowly close the eyes.  Apply gentle pressure on the inner canthus to prevent the medication from flowing into the tear duct. 2. Ointments  Used for local infection or irritation.  A small amount of ointment is distributed along the exposed lower conjustival sac from the inner cathus to the outer canthus. 3. Eye Irrigation  Performed to remove secretions or foreign bodies or to cleanse and soothe the eyes.  Irrigation should continue for 15 minutes, and then professional help should be sought.  Usually, tap water is used to irrigate and remove chemicals from the eyes. EAR INSTILLATIONS & IRRIGATIONS • Drugs or irrigations are instilled in the auditory canal for local effect. • If the tympanic membrane is ruptured or opened through surgical means, instillation & irrigations have to be performed with the greatest of care to prevent forcing materials from the outer ear into the middle & inner ear. 1. Ear Drops  Ear drops should be warmed to body temperature to minimize the discomfort of the Patient.  Tilt the Patient’s head towards the unaffected area, so that the affected ear is exposed. This will prevent the medication from spilling outside of the ear.  Children below 3 years old: Straighten the auditory canal by pulling the Pinna down and back.  3 years old & Above: Straighten the auditory canal by pulling the Pinna up & back.  Allow the Eardrops to fall on the side of the auditory canal as it may be uncomfortable for the Patient if the medication drops directly on the Tympanic Membrane.  Release the Pinna after instilling the medication.  Gently press on the Tragus to help move the medication from the canal towards the Tympanic Membrane. 2. Ear Irrigations

   

Irrigations of the external auditory canal are ordinarily done for cleaning purposes, or applying heat. Typically, Normal Saline Solution is used. To prevent pain, the solution should be warmed to Room Temperature. An Irrigation Syringe is typically used in most cases.

NASAL INSTILLATIONS 59 Used to treat allergies, sinus infections and nasal congestion. 60 Nasal Sprays may also be used to apply medication to the nasal mucous membrane. 61 Instilling Medication to the Ethmoidal or Sphenoidal Sinuses: o Place the Patient on a Proetz Position, by letting the head hang straight back on the edge of the bed. o The patient may also slightly tilt head to the affected side. o Instill prescribed medication on the nares. o Let Patient remain in the same position for a few minutes to prevent the solution from escaping. 62 Instilling Medication to the Maxillary & Frontal Sinuses: o Place the Patient on a Parkinson’s Position, by placing the head slightly over the edge of the bed & turn to the affected side. o Instill prescribed medication on the nares. o Let Patient remain in the same position for a few minutes to prevent the solution from escaping. SUPPOSITORIES 63 Medication that is inserted into a body cavity & that melts at body temperature. 64 Has to be frozen or refrigerated before use. 65 Rectal Insertion: o Place the Patient on Sims Position. o Push the suppository into the Rectal Mucosa up to 2 inches. 66 Vaginal Insertion: o Have the Patient lie on a Dorsal Recumbent Position. o Push the suppository approximately 1-2 inches into the Vaginal

Canal. PREPARING MEDICATION FOR INJECTION 1. Ampule  An ampule is a glass flask that contains a single dose of medication for parenteral administration.  Before breaking the neck of the ampule, flick the tip or the stem of the ampule to make sure that all the medication is returned to the body of the ampule. DO NOT SHAKE.  If the neck of the ampule has perforations to make breaking it easier, no need to file the neck.  The ampule can be inverted or placed on a flat surface to draw solution into the syringe.  Make sure that the needle does not touch the rim of the ampule as it may contaminate the needle. 2. Vial  A vial is a glass bottle with a self-sealing stopper through which the medication is removed.  A vial usually contains several doses of medication.  Before drawing the medication from the vial, wipe the rubber stopper with alcohol.  To facilitate the removal of medication, inject air into the vial in the same amount as the quantity of medication to be administered, while it is standing on a flat surface.  Invert the vial and withdraw the needle tip slightly so that is below the fluid level. This is to prevent air from being aspirated into the syringe.  Draw the prescribed amount of the medication while holding the syringe at eye level, vertically, for accurate reading.  After withdrawing the medication from the vial, carefully replace the cap of the needle using the Scooping Method. ADMINISTERING MEDICATIONS INTRADERMALLY 67 Intradermal Injections have the longest absorption time of all parenteral routes. 68 Only used for diagnostic purposes. 69 Intradermal injections are placed just below the epidermis. 70 Usually only a small amount of the medication is administered. 71 Usual Sites for Intradermal Injections: o Inner surface of the Forearm o Dorsal Aspect of the Upper Arm o Upper Chest o Upper Back 72 Cleanse the area of the injection site by using an alcohol swab or

cotton ball going on circular motions moving outward from the site. 73 Allow skin to dry. 74 Use your non-dominant hand to tauten the skin over the injection site. This will facilitate an easier entrance into the intradermal tissue. 75 Place the needle almost flat against the Patient’s skin with the Bevel Side up, and insert the needle into the skin so that the point of the needle can be seen through the skin. 76 Once the needle is inserted at about 1/8 of an inch, slowly inject the medication while watching for a small wheal or bleb to appear. If none appears, withdraw the needle slightly. 77 Withdraw the needle quickly at the same angle it was inserted to minimize tissue damage & discomfort for the patient. 78 Do not massage the area of the injection so that it will not interfere with the test results.

ADMINISTERING MEDICATIONS INTRAMUSCULARLY 79 Often used to administer drugs that are irritating, because there are a few nerve endings in deep muscle tissues. 80 Absorption occurs more rapidly because of the greater vascularity of muscle tissues. 81 Intramuscular Injection Sites: o Deltoid – 3 finger-breadths below the Acromion Process. o Ventrogluteal – Hips, right below the Iliac Crest o Vastus Lateralis  Found on the Antero-Lateral middle third of the Thigh.  Usually used for Patients below 1 year old. o Dorsogluteal – Upper Outer Quadrant of the Buttocks (to avoid piercing the Sciatic Nerve) 82 Z-Track Technique o This method prevents seepage of the medication into the needle track and reduces pain and discomfort. o Suggested for elderly patients with decreased muscle mass. o The skin is pulled down or to one side about 1 in and held in this position with the non-dominant hand, while the needle & medication is injected. o Steadily withdraw the needle and release the displaced tissue to return to its normal position. o Do not massage the site as it may cause the seepage of the medication back to the needle track. 83 Clean the injection site with an alcohol swab using friction & allow to dry.

84 Hold the syringe with your dominant hand between the thumb & forefinger. 85 Quickly dart the needle into the tissue at a 90-degree angle to facilitate the entry into the muscle tissue. 86 As soon as the needle is in place, use your non-dominant hand to hold the lower end of the syringe, to steady the syringe as you aspirate. 87 Aspirate by slowly pulling back on the plunger to determine whether the needle is in a blood vessel. If blood is aspirated, discard the needle, syringe & medication, and start over on another site. 88 If no blood is aspirated, inject the solution slowly (10 seconds per mL of medication). This will reduce discomfort of the patient as it allows the medication to disperse in the tissues. 89 Remover the needle slowly and steadily. 90 Apply gentle pressure at the site as this will cause less trauma and irritation to the tissues. ADMINISTERING TOPICAL MEDICATIONS 91 Drug is applied directly to the body site. 92 Usually intended for direct action at a particular site. IRRIGATION 93 Washing and allowing the solution to come out 94 Used for the eyes, ears, nose, rectum & vagina. EYE INSTILLATIONS & IRRIGATIONS 1. Eyedrops  Eyedrops are instilled for their local effects, such as pupil dilation or constriction, for treating an infection, etc.  Tilt the Patient’s head back, if sitting, the head may be turned to the affected side to prevent the solution from flowing to the other eye.  Have the Patient look up.  Place 2 fingers of your non-dominant on the lower eyelid, just below the eyelashes and slightly pull down to expose the lower conjuctival sac.

 

Holding the dropper, place your dominant hand on the Patient’s forehead. Hold the dropper close to the eye, while avoiding to touch the eyelashes, eyelid & eyeball, slowly squeeze the container to allow the prescribed number of drops to fall onto the lower

conjuctival sac.  Release the lower lid once the medication is instilled & ask the Patient to slowly close the eyes.  Apply gentle pressure on the inner canthus to prevent the medication from flowing into the tear duct. 2. Ointments  Used for local infection or irritation.  A small amount of ointment is distributed along the exposed lower conjustival sac from the inner cathus to the outer canthus. 3. Eye Irrigation  Performed to remove secretions or foreign bodies or to cleanse and soothe the eyes.  Irrigation should continue for 15 minutes, and then professional help should be sought.  Usually, tap water is used to irrigate and remove chemicals from the eyes. EAR INSTILLATIONS & IRRIGATIONS • Drugs or irrigations are instilled in the auditory canal for local effect. • If the tympanic membrane is ruptured or opened through surgical means, instillation & irrigations have to be performed with the greatest of care to prevent forcing materials from the outer ear into the middle & inner ear. 1. Ear Drops  Ear drops should be warmed to body temperature to minimize the discomfort of the Patient.  Tilt the Patient’s head towards the unaffected area, so that the affected ear is exposed. This will prevent the medication from spilling outside of the ear.  Children below 3 years old: Straighten the auditory canal by pulling the Pinna down and back.  3 years old & Above: Straighten the auditory canal by pulling the Pinna up & back.  Allow the Eardrops to fall on the side of the auditory canal as it may be uncomfortable for the Patient if the medication drops directly on the Tympanic Membrane.  Release the Pinna after instilling the medication.  Gently press on the Tragus to help move the medication from the canal towards the Tympanic Membrane. 2. Ear Irrigations  Irrigations of the external auditory canal are ordinarily done for cleaning purposes, or applying heat.

  

Typically, Normal Saline Solution is used. To prevent pain, the solution should be warmed to Room Temperature. An Irrigation Syringe is typically used in most cases.

NASAL INSTILLATIONS 95 Used to treat allergies, sinus infections and nasal congestion. 96 Nasal Sprays may also be used to apply medication to the nasal mucous membrane. 97 Instilling Medication to the Ethmoidal or Sphenoidal Sinuses: o Place the Patient on a Proetz Position, by letting the head hang straight back on the edge of the bed. o The patient may also slightly tilt head to the affected side. o Instill prescribed medication on the nares. o Let Patient remain in the same position for a few minutes to prevent the solution from escaping. 98 Instilling Medication to the Maxillary & Frontal Sinuses: o Place the Patient on a Parkinson’s Position, by placing the head slightly over the edge of the bed & turn to the affected side. o Instill prescribed medication on the nares. o Let Patient remain in the same position for a few minutes to prevent the solution from escaping. SUPPOSITORIES 99 Medication that is inserted into a body cavity & that melts at body temperature. 100Has to be frozen or refrigerated before use. 101Rectal Insertion: o Place the Patient on Sims Position. o Push the suppository into the Rectal Mucosa up to 2 inches. 102Vaginal Insertion: o Have the Patient lie on a Dorsal Recumbent Position. o Push the suppository approximately 1-2 inches into the Vaginal Canal.

Sign up to vote on this title
UsefulNot useful