Six rights of medication administration:

1. Right medication
2. Right dose
3. Right patient
4. Right route
5. Right time
6. Right document

Chemical vs. Generic vs. Trade

o Chemical: provides the exact description of the medication
o Generic: the manufacture who first develops the drug can assigns the name and it is then listed (ex.
Acedimedifin)
o Trade: also known as the brand or proletary name. This is the name under which a manufacturer
markets the medication (ex. Tylenol)

 If a patient uses herbal supplements they need to tell us what they are taking because it can interact with
medications.

Types of orders:
o Standing: waiting if you need it later or not.
o PRN: as needed
o One-Time: one time only
o STAT: asap
o Now: within 90 minutes or as soon as you can

Types of injections (parenteral)

1. Intradermal- Between layers of the skin into dermis; 15 degree angle; 1ml syringe
o Inner forearm and upper back
o Skin testing (TB, or allergy testing)
2. Subcutaneous- Into connective tissue under the dermis, slow acting; 45-90 degree angle; 1ml
syringe (insulin- tb syringe)
o Posterior upper arm, abdomen (heparin), anterior thigh
o Alternative- scapular of upper back, upper ventral or dorsal gluteal
o Free of skin lesions, bony prominences and large underlying muscles or nerves
3. Intramuscular- Into muscle tissue, fastest route; 90 degree angle; 1-3ml syringe; aspirate before
o Ventrogluteal (volumes greater than 2ml) perfered, vastus lateralis (biologicals) thigh,
deltoid (2ml or less, immunizations)
o Hep b, tetanus, diphtheria and tdap
o Children and older adults 2ml, small children 1ml and small infants .5ml
4. Intravenous- Directly into blood stream, drug begins immediately
o Large volume- safest and easiest
o Bolus- most dangerous
o Piggyback- connects to upper y port of primary infusion line; bag is higher than primary
infusion bag. Only ONE runs at a time
o Home IV’s- CVC
5. Epidural- Epidural space; analgesia
6. Intrathecal- Subarachnoid space or ventricles of brain; long term treatment
7. Intraosseous- Bone marrow; usually infants or toddlers
8. Intraperitoneal- Peritoneal cavity, absorbed in circulation; chemotherapeutic agents, insulin,
antibiotics
9. Intrapleural- Needle or chest tube into pleural space; chemotherapeutic agents, pleurodesis
10. Intraarterial- Arteries, pts who have arterial clots and receiving clot dissolving factors
  Ampule- Glass, 1ml-10 ml or more. Neck snaps off to allow access to medication, use a filter needle to
draw medication than replace with an appropriate sized needle
 Vial- Single or multi use; inject air into it prior to drawing up medication
 Insulin
o Correction insulin (sliding scale) based on pt. blood glucose level
o Short acting
o Long acting
o Regular insulin reaches its peak in 2-4 hr. after admin and that’s when you look for hypoglycemia
o Intermediate acting- NPH; peaks in 6-12 hours

Z track- For IM; minimize local skin irritation by sealing medication in muscle tissue. Usually ventrogluteal muscle,
pull skin laterally or downward, needle remains inserted for 10 seconds and release skin while removing needle
Nasal
 Before; blow or clear nose prior
o Pharynx- head tilt
o Ethmoid or sphenoid- head back over edge of bed and back
o Front or maxillary- head over edge of bed and to the side

Instilling Ear Drops for Adult and Child

o Proper technique: Use sterile solution, can put cotton ball in ear but don’t push it in. Drops need to be
room temp. Do not force the medication in the ear.
o Side lying position 2-3 minutes, apply gentle pressure on tragus
a) Adult: up and out
b) Child: down and back

Eye Drops
o Proper technique: In the white part of the eye only. Don’t touch the tip of the dropper to the pts eye.
Never use another pts to another patient. Drops at room temp or specific temp.

Types of Medication Actions

o Therapeutic Effect: expected or prediction physiological response
o Why are we giving this medication
o Side Effect: unavoidable secondary effect
o Gets put together with adverse effect
o Adverse Effect: unintended, undesirable, often predictable.
o Stomachache with meds can mean allergic reaction
o Toxic Effect: accumulation of medication in the bloodstream
o Too much was given
o Idiosyncratic Reaction: over or under reaction or different than normal reaction
o Gave patient Narcan and now you are completely out of it
o Allergic Reaction: unpredictable response to medication
o Hives
Inhalers
o Types: aerosol spray, mist, powder.
o Used for respiratory rescue and maintenance
o Pressurized Metered-Dose Inhalers (pMDIs): need sufficiency hand strength for use.
o Breath-Actuated Metered-Dose Inhalers (BAIs): release depends on the strength of breath
o Dry Powder Inhalers (DPIs): activated by patients breath; have patient rinse mouth after inhaler

Medications you can NOT crush/cut

 Capsules (liquid, beadlets)
  Potassium (K+)
 SR (sustained release)
 TR (timed-release)
 EC (enteric coated)
Bowel Important Terms
o Laxative/ Cathartics - Drugs that act to promote bowel evacuation
o FOBT-  Measures microscopic amounts of blood in the feces
o gFOBT- most commonly used fecal test
o FIT- no test prep, most sensitive test but more expensive

Bowel Elimination Problems

o Constipation- Condition characterized by difficulty in passing stool or an infrequent passage of hard stool
o Impaction- Accumulation of hardened fecal material in the rectum or sigmoid colon
o Diarrhea- Increase in the number of stools and the passage of liquid, unformed feces
o Incontinence- Inability to control passage of feces and gas from the anus
o Flatulence- Gas;  common cause of abdominal fullness, pain, and cramping
o Hemorrhoids- Permanent dilation and engorgement of veins within the lining of the rectum
Bowel Diversions
o Surgical procedure in which an opening is made into the abdominal wall to allow the passage of intestinal
contents from the bowel (colostomy) or urine from the bladder (urostomy)
Enema’s
1. Cleansing
2. Tap water
3. Normal Saline
4. Hypertonic
5. Soapsuds
6. Oil retention
Enema Fluid Amount
o Infant- 150-250ml
o Toddler- 250-350ml
o School age- 300-500ml
o Adolescent- 500-750ml
Types of Catheterizations
1. Straight catheter
2. Indwelling- one drains urine, one inflate balloon; urine drained from a special port
3. Triple lumen- one drains urine, one inflates balloon and one is for irrigation

Types of Incontinence
o Stress: loss of urine with increased intraabdominal pressure
o Urge: loss of urine immediately after urge to void
o Mixed: combination of stress and urge
o Reflex: involuntary loss of urine without the sensation or need to void
o Hyperactive/Overactive Bladder (OAB): sudden involuntary contraction of the muscles of the urinary
bladder resulting in an urge to go.

Urine collection
o Midstream: catch middle of urination
o Clean Catch: from catheter
o Children: device that has tape that goes around the hole to go into the bag

Medical terminology
 ac = before meals
 bid = twice daily (not same as q12°)
 HS = at bedtime
 NOC = nighttime
 pc = after meals
 PRN = as needed
 q or Q = every
 q AM = every morning
 q hr = every hour
 QD = everyday
 QID = 4x a day
 QOD = every other day
 TID = 3 times days (not same as q 8°)