NCM 103 RLE

FAR EASTERN UNIVERSITY - NICANOR REYES MEDICAL FOUNDATION

Second Semester - S.Y. 2021-2022
Midterms

✓ 1 ml
WEEK 1: PARENTAL ADMINISTRATION ✓ 3 ml
✓ 5 ml
Parental medication – medication absorbed quickly than oral medication ✓ 10 ml
- given through a route ✓ 20 ml
o Intradermal – under the skin Insulin – specially designed for the use with the ordered dose of insulin
o Intramuscular – into the muscle Tuberculin – narrow syringe use to administer small or precise doses such
o Subcutaneous – into the skin as pediatric dosages
o Intravenous – vein - should be uses 0.5 ml or less
- patient cannot take medication orally Pre-filled single-dose syringes – may laman na then throw after used

NURSING RESPONSIBILITIES PARTS OF A SYRINGE

Assessment: do not just follow the doctor’s orders. Assess what the patient
needs.
✓ Injection site (give betamethasone 2x Intramuscularly. If given at
the left side, the second dose should be on the right deltoid)
✓ Drug allergies (drug test/skin test by getting a sample of the drug
and if any itchiness happens the patient has an allergy)
✓ Patient condition – be alert to changes that can affect drug
therapy
✓ Consent form

TECHNIQUES FOR DRUG ADMINISTRATION Plunger – which fits the inside the barrel and has a rubber tip
Barrel – outside part, which contains measurement calibrations
1. Intradermal – into upper layer of the skin Tip – connects the needle
- used for skin tests
2. Intramuscular – more rapid absorption PARENTERAL DRUG PACKAGING
- less irritation of tissue
- larger amount of drug
3. Subcutaneous – provides slow, sustained release and longer duration
of action
- rotate sites
4. Intravenous – through the vein
- not to be given by medical assistant who did not undergone
training

MATERIALS NEEDED FOR PARENTERAL ADMINISTRATION

✓ Medicine tray (with white linen)

✓ Appropriate syringe with needle
✓ Cotton balls with alcohol Ampule – glass or plastic container that is sealed and sterile (open with
✓ Dry cotton balls care)
✓ Band aid
✓ Medication needed
Note: If you are not the one who prepared the medicine, you should not
administer the medication.

PARTS OF A NEEDLE

A needle has three parts the hub, the shaft, the bevel
Hub – where you attach or detach the needle from the syringe
Shaft – long slender stem of the needle that is beveled at one end to form a
point
Bevel – slant shape of tip of the needle
Lumen – hollow bore of the needle shaft
Note: the SMALLER the number, the LARGER the gauge (inside diameter) Vial – small bottle with rubber diaphragm and can be punctured by needle

PREPARING TO ADMINISTER A DRUG

✓ Give drugs with doctor’s order (compared against the MAR)

✓ Wash hands
✓ Calculate the dose carefully
✓ Do not leave prepared drug unattended
✓ Identify patient properly (with 2 identifiers)
✓ Observe the patient following and after administration of drug
✓ Discard any ungiven medication properly
✓ Report any untoward reaction and error to the head nurse / physician
TYPES OF SYRINGES
immediately
✓ Document properly
Standard (depends on the amount needed for the patient)
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 NCM 103 RLE
FAR EASTERN UNIVERSITY - NICANOR REYES MEDICAL FOUNDATION
Second Semester - S.Y. 2021-2022
Midterms

SITES OF INJECTION
Intradermal – skin test for tuberculosis
- typical site is in the upper forearm
Allergy skin testing – small number of various allergens are administered to
identify
- usually at the back (then observe)
- 0.9 sodium chloride, 0.9 distilled water, 0.1 medication. Insert 0.1
of medication and if it forms a wheal, you encircle the area. After
30 mins the wheal grows more than the circle. That means the
client has an allergy to that specific medication
Subcutaneous – administer medication under the skin into the
subcutaneous fat
Sample 1: Physician orders 500mg of Ibuprofen (Desired Dose) for a
patient and you have 250mg (Stock on hand) tablets (Quantity of solution
on hand)
Solution: D/S x Q = X 500mg / 250 mg x 1 tablet
Answer: 2 tablets
Sample 2: Physician orders 1500mg of liquid Ibuprofen for a patient.
Quantity of Ibuprofen is 500mg in 1cc, how much will you administer?
Solution: D/S x Q = X 1500mg / 500mg x 1cc
Answer: 3cc
Sample 3: You have available Lorazepam (Ativan) 0.5 tablets, and you
need to administer 1mg per orem. How many tablet(s) will you administer?
Solution: 1 / 0.5 x 1 tablet
Answer: 2 tablets

- outside of the upper arm
- top of the thigh
- lower portion of each side of the abdomen
- often have a longer onset of action and longer duration of action
(compared with IM or IV injection)
- to be given at a 45-degree angle in the abdomen
- rotation of area of administration
Intramuscular injection – promote rapid drug adsorption
Sample 4: A patient with heart failure has a daily order for Digoxin
(Lanozin) 0.25 mg per orem. Digoxin 0.125mg tablets are available. How
many tablets should you give?
Solution: 0.25mg / 0.125mg x 1 tablet
Answer: 2 tablets
Sample 5: The physician orders Alprazolam (Xanax) 0.5mg per orem. You
have on hand Xanax 0.25mg tablets. How many tablets will you give?
Solution: 0.5mg / 0.25mg x 1 table
Answer: 2 tablets
Sample 6: You have an order to administer 40mg of Methadone
(Dolophine) Subcutaneously for opioid detoxification. You have on hand
30mg/mL. How much should you draw into the syringe?
Solution: 40mg / 30mg x 1mL
Answer: 1.3 mL

Sample 7: Order: Erythromycin 750mg on hand: Erythromycin

250mg/capsule How many capsules should you give?
Solution: 750mg / 250mg x 1 capsule
Answer: 3 capsules

- provide an alternate route when the drug is irritating to Sample 8: Order: Acetaminophen 500mg on hand: Acetaminophen 250mg
subcutaneous tissue in 5mL How many mL should you give?
- for unconscious patients Solution: 500mg / 250mg x 5mL
- use to administer: antibiotics, vitamins, iron, vaccines Answer: 10m
- care must be taken with deep IM injection to avoid hitting a vein,
artery or nerve Sample 9: The physician writes a ‘now’ order for codeine 45mg
- adults – given into upper outer portion of the gluteus maximus intramuscular for a patient with a vertebral compression fracture. You have
(butt area) or deltoid (upper arm on shoulders) muscles on hand codeine 60mg / 2mL. How many milliliters should you give?
Solution: 45/ 60mg x 2 mL
SITES OF INTRAMSCULAR INJECTION Answers: 1.5mL

Dorsolateral WEEK 2: SAFETY MEASURES, TRANSFER, AND POSITIONING

Ventrogluteal - form an imaginary triangle sa balakang ng patient then in
the middle, you inject POSITIONING

INTRAVENOUS MEDICATIONS - positioning a client in a good body alignment and changing the
position regularly are essential aspects of nursing practice. When the
✓ Large volume infusion of intravenous fluid body is aligned, whether standing, sitting or lying, no excessive strain
✓ Intermittent intravenous infusion is placed on these structures
✓ Volume-controlled infusion (often used for children)
✓ Intravenous push PURPOSES
✓ Intermittent injection ports (device)
✓ To prevent muscle discomfort, undue pressure resulting in pressure
MEDICAL CALCULATION ulcers, damage to superficial nerves, and blood vessels and
contractures
Formula: D/S * Q = X ✓ To maintain muscle tone and stimulate postural reflexes
D=Desired Dose
S=Stock on Hand CONSIDERATIONS
Q=Quantity of Solution
X=Unknown Quantity of Drug ✓ It is important to assess the skin and provide skin care before and
after a position change
Examples:

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 NCM 103 RLE
FAR EASTERN UNIVERSITY - NICANOR REYES MEDICAL FOUNDATION
Second Semester - S.Y. 2021-2022
Midterms
✓ Clients who can move easily automatically reposition themselves for
comfort, however, people who are weak, frail, in pain, paralyzed or
unconscious rely on nurses to provide or assist with position changes
✓ Make sure that the mattress is firm and level yet has enough given to
fill in and support natural body curvatures
✓ Ensure that the bed is clean and dry
✓ Any position corrects or incorrect can be detrimental if maintained for
a prolonged period
PROCEDURE
A. Erect or standing – maintains body alignment in relation to body’s
normal center of gravity
1. Head is erect and midline
2. Shoulders and hips are straight and parallel
3. Arms are comfortably positioned at each side
4. Feet are placed slightly apart, with toes pointed forward
B. Sitting – sitting upright provides full expansion of lungs and provides
better visualization of symmetry of upper body parts
1. Head is erect and vertebrae are in straight alignment
2. Body weight is evenly distributed on buttocks and thighs
3. Both feet are supported on floor and ankles are comfortably
flexed
4. A 1-to-2-inch space is maintained between edge of seat and
popliteal space on posterior surface of knee
5. Forearms should be supported on armrest, in lap, or on table
in front of chair
C. Horizontal Recumbent or Dorsal Position – position is used to provide
comfort and facilitate healing following surgeries or anesthetics
1. Assist client to lie flat on his/her back with legs together,
extended or slightly flexed
2. Place one pillow under the head (other conditions do not
elevate of head and shoulders) and a smaller one may be
placed under the knees
3. Place arms along the side of the body or comfortably flexed
on the sides
D. Dorsal Recumbent – position is used for abdominal assessment
because it promotes relaxation of abdominal muscles
1. Assist the client to lie on his/her back
2. Separate the legs, flex the knees so that the soles of the feet
are flat on the bed
3. Place the arms either above the head or flex with the hands
on the chest
4. Place one pillow under the head
E. Lithotomy Position – this position provides maximal exposure of
genitalia and facilitates insertion of vaginal speculum
1. Assist client to lie on his back
2. Separate the legs and flex the thighs deeply towards the
abdomen. Elevate the lower legs and support them with
stirrups
3. Raise the arms above the head or flex them with the hands on
the chest
F. Sim’s or Lateral – flexion of hips and knee improves exposure of rectal
area
1. Assist the client to lie on either side
2. Extend the left arm behind the back and flex the elbow of the
right arm forward
3. Flex the right thigh towards the abdomen with the knee drawn
up higher than the left knee that is only slightly flexed
G. Prone – this position is used to assess posterior thorax and extension
of hip joint
1. Help the client assume the horizontal recumbent position
2. Assist him to turn over unto the abdomen
3. Turn the head to one side
4. Place the arms at the side or flex or extend upwards
5. Allow the feet to hang over the edge of the mattress or
support on a pillow high enough to keep the toes from
touching the bed
H. Fowler’s Position – promotes lung expansion for client with respiratory
problem
1. Place the client in a horizontal recumbent position
2. Elevate the head of the bed to approximately 45 degrees
angle
3. Flex the knees slightly and support them with knee rolls
I. Trendelenburg (Shock Position) – promotes venous circulation in
certain clients. Provides postural drainage of basal lung lobes
1. Assist the client to a horizontal recumbent position
2. Elevate the foot of the bed so that the lower truck is higher
than the head and shoulders
3. Support the shoulders and knees
J. Knee Chest (Genupectoral) – this position provides maximal exposure
of rectal area
1. Place the client on a prone position
2. Assist to kneel with the knees slightly separated
3. Bend forward so that the chest is resting on the bed and the
thighs are perpendicular to the legs
4. Turn the head to one side and place the arms either above
head or flex at the elbow and rest along the side of the head
TRANSFERRING
- is a nursing skill that helps the dependent client or the client with
restricted mobility attain positions to regain optimal independence as
quickly as possible?
EQUIPMENT
✓ Transfer belt
✓ Blanket, Draw sheet
✓ Wheelchair
✓ Stretcher
PROCEDURE
1. Assess for tubes, IV lines, incisions, or equipment that may alter the
positioning procedure. Identify any movement limitations. Estimates
ability to participate in transfer
2. Wash hands. Reduces transfer of microorganisms
3. Explain the procedure to the client. Promotes understanding and
cooperation
A. Transferring from Bed to a Stretcher
1. Adjust the head of the bed to a flat position. Raise the bed to a
height that is slightly higher than the transport stretcher. Lower
the side rails, if in place. The client must be positioned
correctly prior to the transfer to avoid straining and
reaching.
2. Two nurses should stand on the stretcher side of the bed. A third
nurse should stand on the side of the bed without the stretcher.
Three to four health care providers are required for the
transfer. Prepares client to move to side of bed and protects
from falling.
3. Cross client‘s arm on chest. Prevents injury to client’s arms.
4. Moves the client to the side of the bed where the stretcher will be
placed by rolling up the draw sheet close to the client‘s body and
pulling.
5. Positions stretcher next to the bed. Lock stretcher. Helps
stabilize stretcher and is shortest distance for the client to
turn. Wheel locks prevent from moving.
6. Nurse on the side of the bed opposite the stretcher uses draw
sheet to turn the client away from the stretcher; the other nurse
places the transfer board across the space between the stretcher
and the bed, partially under the patient. Roll the client onto his or
her back, so that the patient is partially on the transfer board.
The transfer board must be positioned as a bridge between
both surfaces.
7. The nurse on the side of the bed without the stretcher should
grasp the friction-reducing sheet at the head and chest area.
One nurse on the stretcher side of the bed should grasp the
friction-reducing sheet at the head and chest, and the other
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FAR EASTERN UNIVERSITY - NICANOR REYES MEDICAL FOUNDATION
Second Semester - S.Y. 2021-2022
Midterms
nurse at the chest and leg areas of the client. The sheet must
be between the client and the transfer board to decrease
friction between client and board.
8. At a signal given by one of the nurses, have the nurses standing
on the stretcher side of the bed pull the friction reducing sheet. At
the same time, the nurse (or nurses) on the other side push,
transferring the client‘s weight toward the transfer board, and
pushing from the bed to the stretcher. Coordinating the move
between health care providers prevents injury while
transferring clients.
9. Use draw sheet to slide across the transfer board onto the
stretcher. Allows the client to lie flat on the bed.
10. Turn the client away from the bed and remove the board and
transfer roller sheet.
11. Reposition on the stretcher for comfort and alignment; provide a
blanket if needed. Promotes comfort.
12. 15. Fasten safety belts and raise stretcher side rails. Prevents
harm to client
B. Transferring from Bed to a Chair
1. Place the bed in the lowest position. Raise the head of the
bed to a sitting position, or as high as the client can tolerate.
Provides the client with an opportunity to ask questions
and help with the positioning.
2. Put the chair next to the bed.
3. Assist to a sitting position, allow to sit before transfer. At the
same time, pivot on your back leg to lift the client‘s trunk and
shoulders. Keep your back straight; avoid twisting.
4. Stand in front of the client, and assess for any balance
problems or complaints of dizziness. Allow the client‘s legs to
dangle a few minutes before continuing. Allows client to
adjust to position change.
5. Assist the client to sit up on the side of the bed; And ask to
swing his or her legs over the side of the bed.
6. Stand facing the client. Spread your feet about shoulder width
apart and flex your hips and knees. Stay close to your client
during the transfer to keep the patient’s weight close to
your center of gravity
7. Have the client scoot to the edge of the bed.
8. Put your arms around the chest, and clasp your hands behind
the back. Or, you may also use a transfer belt to provide a
firm handhold. Gait belts reduce strain on your back and
provides for security for the client.
9. Supporting the leg farthest from the wheelchair between your
legs, lean back, shift your weight, and lift. Improves your
base of support and allows space for client to turn.
10. Pivot on your back foot and assist to turn until the client feels
the chair against his or her legs. Allows the client to be
properly positioned in the chair and prevents back injury
to health care providers.
11. Ask to use an arm to steady him- or herself on the arm of the
chair while slowly lowering to a sitting position. Increases
client stability.
12. Assess alignment in the chair. Ensure feet is in proper
position. Assist to a comfortable position. Prevents injury to
client from poor body alignment.
BODY MECHANICS
- is the term used to describe the efficient, coordinated and safe use of
the body to move objects and carry out the activities of daily living
PURPOSE
To facilitate the safe and efficient use of appropriate muscle groups to
maintain balance, reduce the energy required, reduce fatigue and decrease
the risk of injury
PRINCIPLES AND GUIDELINES
1. Keep weight balance above base of support. Enlarge base of support
as necessary to increase the body‘s stability. Body balance is
achieved when a wide base of support exists, the center of
gravity falls within the support
2. Lowers center of gravity towards base of support in the direction in
which force is applied. When the person moves, the center of
gravity shifts continuously in the direction of the moving body
parts. Balance depends on the interrelationship of the center of
gravity, the line of gravity and the base of support.
3. Enlarge base of support in the direction in which force is applied. The
broader the base of support, the greater the stability and balance.
4. Tighten abdominal and gluteal muscles in preparation for all activities.
The greater the preparatory isometric tensing, or contraction of
muscles, before moving an object, the less the energy required
to move it, and the less the likelihood of musculoskeletal strain
and injury.
5. Faces in the direction of task and turns body in one plane. Ineffective
use of major muscle groups occurs when the spine is rotated or
twisted.
6. Bend hips and knees (rather than back) when lifting. This helps to
maintain the nurse’s center of gravity and lets the strong
muscles of the legs do the lifting.
7. Move objects on level surface when possible. Slides (rather than lift)
objects on smooth surface when possible. Moving an object along a
level surface requires less energy than moving an object up an
inclined surface or lifting it against the force of gravity.
8. Hold objects close to body and stand close to objects to be moved.
This action places the weight in the same plane as the lifter and
close to the center of gravity for balance.
9. Use body‘s weight to assist lifting or moving when possible. When a
person lifts or carries an object, the weight of the object
becomes part of the person’s body weight. Body weight adds
force to counteract the weight of the object and reduces the
amount of strain on the arms and back.
10. Use smooth motions and reasonable speed when carrying out task.
11. When moving clients, use a pulling motion whenever possible. It is
easier and safer to pull an object toward one’s own center of
gravity than to push it away, because a person can exert more
control of the object’s movement when pulling it.
12. Raise the working surface to waist level when possible. Objects that
are close to the center of gravity are moved with least effort.
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