RLENCM103 – FUNDA (MIDTERM

REVIEWER)
MEDICATION PRINCIPLES IN
ADMINISTERING
a MEDICATION is a substance MEDICATIONS:
administered for the diagnosis, cure,
treatment, or relief of a symptom or  observe the “12 rights” of the
for prevention of disease. drug administration.
 practice asepsis.
PRESCRIPTION - written direction
 nurses who administer
for the preparation and administration
medications are responsible for
of a drug
their actions. question any order
PHARMACOLOGY is the study of that you consider incorrect.
the effect of drugs on living  Be knowledgeable about the
organisms. medications that you administer.
 Keep narcotics and barbiturates in
ALL DRUG ORDERS AND a locked place.
PRESCRIPTIONS REQUIRE  Use only medications that are
SPECIFIC PARTS: clearly labeled in containers.
1. PERSON’S FULL NAME  Return liquids that are cloudy or
2. DATE have changed in color to the
3. DRUG NAME (BRAND & pharmacy.
GENERIC)  Before administering a
4. ROUTE OF ADMINISTRATION medication, identify the client
5. DOSE correctly.
6. FREQUENCY  Do not leave the medications at
7. DURATION OF ORDER the bedside.
8. DOCTOR’S SIGNATURE  if the client vomits after taking
oral medication, report this to the
TYPES of DOCTOR’S ORDERS: nurse in charge and/or physician.
STANDING ORDER 12 RIGHTS OF DRUG
it is carried out until the specified ADMINISTRATIONS
period of time or until it is
discontinued by another order.  Right client
 Right drug
SINGLE ORDER  Right dose
it is carried out for one time only.  Right route
STAT ORDER  Right time
it is carried out at once or immediately.  Right assessment
 Right motivation approach
PRN ORDER  Right of the client to refuse
it is carried out as the patient requires.  Right of the client to educate
 Right evaluation
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 Right documentation administration of medications by
 Right drug preparation NEEDLE.

ROUTES OF DRUG a. INTRADERMAL (ID)- under the

ADMINISTRATION epidermis (into the dermis).
b. SUBCUTANEOUS (SC)- in the
ORAL ROUTE subcutaneous tissue (also,
hypodermic)
Oral Route Forms:
c. INTRAMUSCULAR (IM)- into
a) SOLID: tablet, capsule, pill,
the muscle.
powder.
d. INTRAVENOUS (IV)- into a vein.
- Enteric-coated tablets should not be
e. INTRAARTERIAL- into an artery.
crushed before administration.
f. INTRAOSSEOUS- into the bone.
b) LIQUID: syrup, suspension,
emulsion
- Suspensions are never administered
intravenously. If the patient vomits
within 20 – 30 minutes of taking the
drugs, notify the physician. Do not re-
administer the drug without a
physician's order.
SUBLINGUAL- drug placed under
the tongue, where it dissolves.
BUCCAL- medication is held in the
mouth against the mucous membranes
of the cheek until the drug dissolves.
TOPICAL
a. Dermatologic - lotions, liniments,
ointment, pastes and powders.
b. Ophthalmic- instillations and
irrigations.
c. Otic
d. Nasal DRUG MEDICATION: AMPOULE
e. Inhalation
 Tap the top of the ampoule.
f. Vaginal - tablet, cream, jelly, foam,
 Use gauze or an alcohol swab to
suppository
protect your fingers.
g. Rectal – suppository
 Break the neck of the ampoule
PARENTERAL ROUTE away from your body.
 Use a filter needle if available.
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 Insert your needle into the
solution.
 Invert the ampoule (or leave on
the surface).
 With your needle in the solution,
pull back on the plunger to the
appropriate dose.
DRUG MEDICATION: VIAL
• Remove the metal or plastic
protective covering.
• Swab the top with an alcohol
swab.
• Fill the syringe with air equivalent
to the amount you want to
withdraw from the vial.
• Insert the needle into the center of
the rubber stopper.
• Instill the air from the syringe.
• Invert the vial.
• While holding the vial and the
syringe:
- pull back on the plunger to
the desired amount.
- make sure the needle tip is in
the fluid.
- remove the needle/syringe
from the vial once the desired
amount is reached.
- use the “scoop” technique to
recap the needle.
- change the needle before
administration.
INTRADERMAL (ID)
 Are administered into the
DERMIS just below the
EPIDERMIS.
 Have the longest absorption time
of all parenteral routes because
there are fewer blood vessels and
no muscle tissue.
 Used for sensitivity testing
because the patient’s reaction is
easy to visualize, and the degree
of reaction can be assessed. (EX:
tuberculosis (TB) and allergy
testing)
 SITES: the inner surface of the
forearm and the upper back below
the scapula. it should be free from
lesions, rashes, moles, or scars
that may alter the visual
inspection of the test results.
 The angle of administration for an
id injection is 5 to 15 degrees.
 After the id injection is
completed, a BLEB (small blister)
should appear under the skin. the
presence of the bleb indicates that
the medication has been correctly
placed in the dermis.
SUBCUTANEOUS (SQ)
 Are administered into the adipose
tissue layer called “SUBCUTIS”
below the dermis. Medications
injected into the subcutaneous
layer are absorbed at a slow and
steady rate.
 SITES: outer lateral aspect of the
upper arm, the abdomen (from
below the costal margin to the
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iliac crest and more than two
inches from the umbilicus), the
anterior upper thighs, the upper
back, and the upper ventral gluteal
area.
 A 45- or 90-degree angle is used
for a subcutaneous injection. a 90-
degree angle is used for normal-
sized adult patients or obese
patients, and a 45-degree angle is
used for patients who are thin or
have less adipose tissue at the
injection site.
 Insert the needle quickly at a 90-
degree angle.
 Aspirate for blood if needed.
 Inject the medication slowly if no
blood. discard and prepare again
if there’s a blood.
 Remove the needle at the same
angle.
 Cover with sterile gauze and
band-aid if necessary.
INTRAMUSCULAR (IM) SITES
VENTROGLUTEAL

INTRAMUSCULAR (IM)

 USED TO PLACE
MEDICATION IN MUSCLE
TISSUE. muscle has an abundant
blood supply that allows
medications to be absorbed faster
than the subcutaneous route.
WHEN ADMINISTERING AN
INTRAMUSCULAR INJECTION:

 Stabilize skin with nondominant

hand.
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VASTUS LATERALIS

Z-TRACK METHOD FOR IM

INJECTIONS

 This method prevents the

medication from leaking into the
subcutaneous tissue, allows the
medication to stay in the muscles,
and can minimize irritation.

DRUG CALCULATION
DELTOID
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LIQUID MEASUREMENTS 3. EXPRESS 300ML IN LITERS
CONVERSIONS • Solution:
QUANTITY CONVERSION 300ML = 300 ÷ 1000 = 0.3 L
½ teaspoon (tsp) 2.5 milliliter (ml) DRUG DOSAGE CALCULATION
1teaspoon (tsp) 5 ml
2 tsp 10 ml are required when the amount of
½ tablespoon (tbsp) 7.5 ml medication ordered (or desired) is
1 tbsp 15 ml different from what is available on
3 tsp 1 tbsp hand for the nurse to administer.
1 liter (L) 1000 ml AMOUNT DESIRED (D)
1 fluid ounce (fl oz) 30 ml X QUANTITY (Q)
AMOUNT ON HAND (H)
=Y
1 pint (pt) 473 ml
1 gram (g) 3785 ml DRUG DOSAGE CALCULATION
BASED ON BODY WEIGHT
body weights are required when the
SOLID MEASUREMENT dosage ordered and administered is
CONVERSIONS dependent on the weight of the patient
QUANTITY CONVERSION STEP 1: using the formula, calculate
1000 micrograms (μg) 1 milligram (mg) the total required dosage based on the
1000 mg 1g given body weight
1000 g 1 kilogram (kg)
1 kg 2.2 pounds (£) WEIGHT (KG) x DOSAGE
1 oz 28,300 mg ORDER (PER KG) = Y
1oz 28.3 g (REQUIRED DOSAGE)
1£ 16 oz STEP 2: apply the formula below to
1£ 454 g calculate he amount of medication to
1£ 0.45 kg be administered
D
H
x Q
EXAMPLES
IV FLUID COMPUTAION
1. EXPRESS 5MG IN
MICROGRAMS. MACRODRIP tubing delivers 10-
•Solution: 20gtt/ml and is used to infuse large
5 mg = 5 × 1000 = 5000 mcg volumes or to infuse fluids quickly.
MICRODRIP tubing delivers 60
2. EXPRESS 0.5G TO MG gtt/ml and is used for small or very
•Solution: precise amounts of fluids,
0.5 G = 0.5 × 1000 = 500 MG IV Drip rate = (Volume/Time) x Drop Factor
(gtt/ml) (mL) (minutes) (gtt/ml)
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HYGIENE AND COMFORT
HYGIENE
• According to the World Health
Organization (WHO), “Hygiene refers
to conditions and practices that help
to maintain health and prevent the
spread of diseases.”
• Practice related to lifestyle,
cleanliness, health and medicine.
• Series of practices performed to
preserve health.
• Hygiene in a variety of settings plays
an important role in preventing the
spread of infectious diseases.
FACTOR INFLUENCING
INDIVIDUAL HYGIENIC
PRACTICES
• Hygiene activities and practices can
protect health and prevent disease.
However, hygiene practices vary
widely among groups and people.
• It is important to respect differences
in patient hygiene practices and
provide care and information in non-
judgemental manner.
CULTURE
• Cleanliness is highly valued in
North American culture. Many
North Americans bathe or shower once
or twice a day, whereas some other
cultures bathe only once a week.
• Some cultures believe that bathing
requires privacy, whereas others
practice communal bathing. Body
odor is considered offensive in some
cultures but normal in others.
SOCIO-ECONOMIC
• A person's socioeconomic class and
financial resources often define the
hygiene options available to that
person.
• For example: Some people may
have limited finances to buy soap,
shampoo, shaving cream and
deodorant.
• Homeless people may have no or
limited access to the water and soap.
SPIRITUAL PRACTICES
• Spiritual practices including religious
beliefs may include ceremonial
washings and purifications such as
before prayer, eating
• For e.g. in the Jewish tradition,
ritual baths are required for women
after childbirth and menstruation.
• In some religion of Nepal, contact
with a deceased person may make a
person unclean.
HEALTH AND ENERGY
• People may not have the motivation
or energy to attend to hygiene. Some
clients who have neuromuscular
impairments may be unable to
perform hygienic care.
SKIN CARE
GENERAL GUIDELINES FOR
SKIN CARE:
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1. The body's first line of defense is an bed.
intact, healthy skin. 4. Use two or more people for
2. The amount of subcutaneous tissue assistance
and the skin's dryness determine how
well the skin protects the underlying EXCESSIVE DRYNESS
tissues from injury. • Skin can appear flaky and rough.
3. Moisture in contact with the skin
can promote bacterial growth and
cause irritation.
4. Body odors are caused by skin
bacteria that live on the skin and act
on body secretions. Cleanliness is the
most effective deodorant.
5. Individuals' skin sensitivity to NURSING IMPLICATION
irritation and injury varies according 1. Prone to infection if the skin cracks;
to their health. therefore, provide alcohol-free lotions
6. Skin care agents have specific to moisturize the skin and prevent
actions and purposes. Soap, detergent, cracking.
bath oil, cream, lotion, powder, 2. Bathe client less frequently; use no
deodorant, and antiperspirant are some soap, or use nonirritating soap and
examples. limit its use. Rinse skin thoroughly
COMMON SKIN PROBLEMS: because soap can be irritating and
drying.
ABRASION: 3. Encourage increased fluid intake if
• Superficial layers of the skin are health permits to prevent dehydration.
scraped or rubbed away. Area is
reddened and may have localized ACNE
bleeding or serous weeping. • inflammatory condition with papules
and pastules.
TYPES OF ACNE:
1. BLACKHEADS
2. WHITEHEADS
3. NODULES
4. PAPULES
NURSING IMPLICATION
5. PASTULES
1. Prone to infection; therefore, wound
should be kept clean and dry. NURSING IMPLICATION
2. Do not wear rings or jewelry when 1.Keep the skin clean to prevent
providing care to avoid causing secondary infection.
abrasions to clients. 2.Treatment varies widely
3. Lift and do not pull a client across a
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ERYTHEMA
• redness associated with a variety of
conditions, such as rashes, exposure to
sun, elevated body temperature.
NURSING IMPLICATION:
1. Wash area carefully to remove
excess microorganisms.
2. Apply antiseptic spray or lotion to
prevent itching, promote healing, and
prevent skin breakdown.
BATHING
• It removes accumulated oil,
perspiration, dead skin cells, and
some bacteria.
• It stimulates circulation
• It offers an excellent opportunity for
the nurse to assess all clients
• Excessive bathing, can interfere with
the intended lubricating effect of
sebum, causing dryness of the skin.
CLEAN BATHING
Given chiefly for hygiene purposes
and include these types:
• COMPLETE BED BATH. The
nurse washes the entire body of a
dependent client in bed.
• SELF-HELP BED BATH. Clients
confined to bed are able to bathe
themselves with help from the nurse
for washing the back and perhaps the
feet.
• PARTIAL BATH
(ABBREVIATED BATH). Only the
parts of the client's body that might
cause discomfort or odor, if neglected,
are washed: the face, hands, axillae,
perineal area and back.
• BAG BATH. This bath is a
commercially prepared product that
contains 10 to 12 presoaked disposable
washcloths that contain no rinse
cleanser solution.
•TUB BATH. Tub baths are frequently
preferred over bed baths because they
are easier to wash and rinse in.
• SHOWER. Many ambulatory clients
can use shower facilities with only
minor assistance from the nurse.
EAR CARE
NURSING INTERVENTIONS:
• Cleanse the pinna with moist
washcloth.
• Remove visible cerumen by
retracting the ears downward. If this is
ineffective, irrigate the ear as ordered.
• Do not use bobby pins or cotton-
tipped applicators to remove cerumen.
These can rupture the tympanic
membrane or traumatize the ear canal.
Cotton- tipped applicators can push
wax into the ear canal, which can
cause blockage.
EYE CARE
NURSING INTERVENTIONS
• Cleanse your eyes from the inner to
the outer canthus. For each wipe, use a
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fresh cotton ball. To avoid
nasolacrimal duct contamination.
• If the patient is unconscious, apply
sterile moist compresses to the eyes.
To avoid corneal dryness and
irritation.
• Warm water and soap should be used
to clean eyeglasses, and soft tissue
should be used to dry them.
•Clean contact lenses according to the
manufacturer's instructions. Wear
clean gloves and depress the client's
lower eyelid to remove artificial eyes.
With your thumb and index finger,
grasp the artificial eye.
•Place the artificial eye in a container
with water or saline solution after
cleaning it with warm normal saline. |
• Avoid rubbing the eye
• When reading, make sure to have
enough light.
• Avoid using eye drops on a regular
basis.
• As an emergency treatment, if dirt or
foreign bodies get into your eyes, rinse
them thoroughly with clean, tepid
water
NOSE CARE
NURSING INTERVENTIONS
• Clean nasal secretions by gently
blowing the nose into the soft tissue.
• When blowing the nose, keep both
nares open to avoid forcing debris into
the middle ear via the Eustachian tube.
• To remove encrusted, dried
secretions, use a cotton-tipped
applicator moistened with saline or
water. Only insert up to the cotton tip.
ORAL CAVITY CARE
Measures to Prevent Tooth Decay
• Brush the teeth thoroughly after
meals and before going to bed.
• Floss your teeth at least once a day.
|• Ensure adequate calcium,
phosphorus, and vitamin D intake.
Fluoride, vitamins A, C, and D. Avoid
sweet foods and beverages between
meals. Consume fibrous, coarse foods
(cleansing foods), such as fresh fruits
and raw vegetables.
• Have the teeth checked every six
months.
• Use topical fluoride applications as
directed by the dentist.
BRUSHING AND FLOSSING THE
TEETH
PURPOSES
1. To remove food particles from
between and around the teeth.
2. To get rid of dental plaque.
3. Ro improve the client's sense of
well-being.
4. To keep mouth sores and infections
at bay.
NURSING INTERVENTIONS
WHEN PROVIDING ORAL CARE
FOR CONSCIOUS PATIENT
• Inform the client and explain the
procedure's purpose.
• Provide privacy
• Help in a sitting or side-lying
position.
• Place a towel beneath the client's
chin.
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• Dentifrice should be applied to the
bristles of the toothbrush.
• Hold the kidney basin under the chin.
If possible, allow the client to brush
his teeth.
• Use downward strokes on the upper
front teeth, upward strokes on the
lower front teeth, back and forth
strokes on the biting surfaces of the
teeth and hold the brush against the
teeth at a 45-degree angle to penetrate
and clean beneath the gingival
margins. Rinse the mouth thoroughly
with water. Floss the teeth.
• Maintain the client’s comfort.
• Perform equipment and article
maintenance.
• Document any relevant data.
FOR UNCONSCIOUS CLIENT
• To avoid aspiration, place in a side-
lying position.
• Suction apparatus should be readily
available.
• To open the mouth, use a padded
tongue blade.
• Brush the teeth and gums with a
toothbrush or a soft sponge-ended
swab.
• Apply a thin layer of petroleum jelly
to your lips to prevent them from
drying out or cracking.
CARE OF ARTIFICIAL
DENTURES
• When handling and cleaning
dentures, use gloves.
• When brushing dentures, place a
washcloth in a basin or bowl of sink to
prevent damage if the dentures are
dropped.
• Keep the dentures in a watertight
container.
COMMON PROBLEMS OF THE
MOUTH
1. PLAQUE - An invisible soft film of
bacteria, saliva, epithelial cells and
leukocytes that adhere to the enamel
surface of the teeth.
2. TARTAR - A visible, hard deposit
of plaque and bacteria that forms at the
gum lines.
3. HALITOSIS - Bad breath.
4. GLOSSITIS -Inflammation of the
tongue.
5. GINGIVITIS -Inflammation of the
gums.
6. STOMATITIS - Inflammation and
dryness of oral mucosa.
7. PAROTITIS - Inflammation of the
parotid salivary glands (mumps).
8. SORDES - Accumulation of foul
matter (food, microorganisms, and
epithelial elements) on the gums and
teeth.
9. PERIODONTAL - disease. Gums
appear spongy and bleeding
(pyorrhea). If you’re noticing some
issues with your teeth and gums, you
might have to get some dental
implants. This is a painless process
however you should do everything you
can to avoid having to have a dental
procedure.
10. CHEILOSIS - Cracking of the
lips.
11. DENTAL CARIES - Teeth have
darkened area, may be painful
(cavities).
HAIR CARE
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• The appearance of the hair may hair cleansing.
reflect a person’s sense of well-being • Rinse hair thoroughly. Soap residue
and health status. in hair can irritate the scalp and cause
• Brushing and combing the hair hair to dry out.
stimulate circulation of blood in the • Thoroughly dry the hair.
scalp; distribute the oil along the hair • Maintain the client’s comfort.
shaft; help to arrange the hair. • Perform equipment and article
maintenance.
HAIR SHAMPOO • Make necessary documentation.
PURPOSES
1. Massage is used to increase blood
circulation in the scalp.
2. To clean the client's hair and make
them feel better.

COMMON HAIR AND SCALP

NURSING INTERVENTIONS PROBLEMS
DURING HAIR SHAMPOO
• DANDRUFF. Is a chronic diffuse
• Determine whether the institution scaling of the scalp, with pruritus
requires a doctor's prescription for hair (seborrheic dermatitis)
shampoo.
• Place the client in bed diagonally.
• Remove the hair pins. Brush and
comb hair thoroughly. This is to get rid
of tangles.
• With the neck hyperextended, place
the Kelly pad under the head.
• The Kelly pad's trough should be
directed to a pail. To keep water from
spilling on the floor •ALOPECIA. Hair loss or baldness.
• Cover eyes with a washcloth. To
keep them from becoming irritated.
• Cotton balls should be used to plug
the ears. To prevent water from
entering the external auditory canal.
• Use a small amount of shampoo.
• Make a rich lather by massaging the
scalp with the fat pads of your fingers.
• Massage increases circulation to the
scalp. A rich lather ensures thorough
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•PEDICULOSIS. Infestation with
lice.
Pediculosis capitis is head louse
Pediculosis corporis is body louse
Pediculosis pubis is crab louse

COMMON HAIR AND SCALP

PROBLEMS
The usual treatment for pediculosis is
gamma benzene hexachloride (Kwell),
which comes in lotion, cream and
shampoo. Pubic lice are difficult to
remove, so the shampoo may be • HIRSUTISM.is a condition in those
applied and left on 12 to 24 assigned female at birth, that results in
hours.Linens and clothing used by excess hair growth in androgen-
clients should be washed in hot water. dependent areas of the body, including
the chin, upper lip, chest, and back.

• SCABIES. Contagious skin

infestation by the itch mite. The
characteristic of the lesion is the
burrow produced by the female mite
as it penetrates the skin. The burrows
are short, wavy, brown, or black
threadlike lesions.
FOOT CARE
• Wash and dry the feet on a daily
basis, paying special attention to the
interdigital spaces.
• To soften the nails and loosen debris
under them, soak the feet in warm
water. Soaking diabetic clients' feet is
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no longer recommended because
excessive moisture can contribute to
skin breakdown.
• To soften calluses, apply cream or
lotion to the skin
• To prevent or control unpleasant
odors, use deodorant sprays or foot 3. UNPLEASANT ODORS. This
powder. results from perspiration and its
• Toenails should be filed straight interaction with microorganisms.
across. To avoid nail splitting and
tissue damage around the nail.
• Change socks or stockings on a daily
basis.
• Wear shoes that are both comfortable
and well-fitting
• Do not walk barefoot
• Exercise feet to increase circulation.
• Avoid wearing constrictive clothing 4. PLANTAR WARTS. Caused by
or round garters, which can reduce virus papovaviral hominins. They
circulation. appear on the sole and are
• Avoid crossing your legs. moderately contagious. They are
• Avoid self-treatment for corns or painful and make walking difficult.
calluses.
COMMON FOOT PROBLEMS
1. CALLUS -Painless, flat, thickened
epidermis, a mass of keratotic
material. Often caused by pressure
from the shoe on bony prominence.

5. FISSURES -Caused by dryness and

cracking of the skin.

2. CORN - Keratosis caused by

friction and pressure from a shoe. It
commonly affects the fourth and fifth
toe. It appears circular and raised.
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6. TINEA PEDIS - Characterized by
scaling and cracking of the skin,
particularly between the toes, caused
by a fungus. There may be blisters.
(Also, Athlete’s foot, ringworm of the
foot.)
7. INGROWN TOENAIL - Inward
growth of the nail, causing trauma into
soft tissues. It is usually due to
trimming the lateral edges of the
toenails.
NAIL CARE
• Trim nails straight across or in the
shape of the fingers.
• Smooth the edges of your nails with
a file.
• To avoid ingrown nails, do not trim
them at the lateral corners.
• Diabetic clients are advised not to cut
their hangnails or cuticles.
• Ingrown is also known as unguis
incarnate.
• Onycholysis is the separation of the
nail from the nail bed.
• Paronychia is an inflammation of the
skin fold at the nail margin
PERINEAL- GENITAL CARE
PURPOSES OF PERINEAL-
GENITAL CARE
1. To remove normal perineal
secretions and odor.
2. To prevent infection.
3. To promote comfort.
NURSING INTERVENTION
DURING PERINEAL- GENITAL
CARE
• Inform the client and explain purpose
of the procedure.
• Provide privacy. To maintain client
dignity
Position and drape the client as
follows:
• Female: dorsal recumbent position;
drape the client diagonally.
• Male: supine position
• For female clients, use forceps to
hold cotton balls for cleansing the
perineum.
• For male clients, wear clean gloves.
FOR FEMALE CLIENTS
1. Use anterior to posterior (front to
back) stroke to prevent contamination
of urethral meatus and vagina with
microorganisms from the anus.
2. Use one cotton ball for each stroke.
3. Cleanse perineum with soap/
antiseptic solution. Include the inner
thigh.
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4. Rinse the area with copious amount
of water. To remove soap adequately
and prevent irritation of the perineal
area.
5. Dry perineum thoroughly. Moisture
supports microbial growth.

FOR MALE CLIENTS

1. Wash and dry penis using firm
strokes, to prevent erection of the
penis.
2. Use circular motion, from the tip of
glans penis towards the penile shaft.
3. If the client is uncircumcised,
retract the prepuce (foreskin). This is
to remove smegma that collects under
the foreskin and facilitates bacterial
growth.
4. Wash and dry the scrotum and
buttocks.
5. For post-delivery or menstruating
females, apply a perineal pad as
needed from front to back. This
prevents contamination of urethra and
vagina from anal area.
6. Keep the client comfortable
7. Do the after-care of equipment and
articles
8. Document relevant data