| Term | Definition |
|---|
| Ampule | Contain one dose of medication in a small breakable glass container |
| Bevel | Slanted surface of a needle |
| Cartridge | Prefilled device that is placed into a special syringe for IM injection |
| Computer Controlled dispensing system | System of inventory control that allows nurses to access medications from a central locked unit by utilizing a password. |
| Hub | Part of a needle that fits into a syringe. |
| Instillation | Done drop by drop |
| Intradermal | Injected under the top layer of the skin |
| Luerlok | A specialized device for applying needles to syringes. |
| MAR | Form used to tract and document medication administration |
| Profile | Total of all medications for a specific patient |
| Stat Order | One time order to be given immediately |
| Wheal | Round elevation of the skin |
| Z Track | Injection technique to prevent seepage of irritating medicine into the tissue |
| Written Drug Order should include | Patient's name. Date and time of the order. Name of the drug. Dosage of the drug. Route. Time the drug may be given. Frequency of the drug. Signature of physician. Any special instructions – Example -Hold medication if BP is between so and so, Take with meals. We should be able to look at an order and be able to tell what is missing |
| Types of Medication Orders | Standing Orders, Verbal Orders, Stat order, Single order, PRN Order |
| Standing Orders | Order that is already written by a physician for all patients in a particular unit or area. They can be carried out without calling the physician. It is usually typed up. Example: Angina Pectoris - Example: Amoxicillin trihydrate 500 mg PO X10 days |
| Verbal Orders | May be given in the presence of a LPN or RN. Can be given directly in their presence, or over the phone. It should be written in a chart and signed by a physician as soon as possible. This is how it should be written - Order should be written, Name of the physician, Your Name, Your Title. The doctor will sign it as soon as they come in |
| Stat order | One time order to be given immediately. Example - Lidocaine 50 mg IV push stat |
| Single order | One time order to be given at a specified time. Example - Demerol 100 mg IM preoperatively |
| PRN Order | Given as needed based on nurses' judgment of safety and patient need. Example - Docusate calcium 100 mg PO at bedtime prn constipation |
| Standard times for giving medication | Qd, bid, tid, qid, q4h, q6h |
| Qd | Usually in the morning 0900 or 1000 |
| Bid | 1000 and 1800 or 0900 and 2100 |
| Tid | 1000, 1400, and 1800 or 0900, 1300, 1700 |
| Qid | 1000, 1400, 1800 and 2200 or 0900, 1300, 1700, 2100 |
| Q4h | Start at 1000 and count |
| Q6h | Start at 1000 and count |
| Common Abbreviations | Nurse has to know the various abbreviations in order to give medications. Study the abbreviations and know it. It is in my quizlet page. Look for it |
| Identify "Six Rights" of administering medications | Right patient, Right medication, Right dosage/amount, Right route, Right time, Right documentation |
| How to remember the six rights | TRAMP |
| Right patient | Identify the patient with their ID band. Name on their chart. Match the chart name with the medication card or sheet. Compare the number in the MAR with their ID bracelet. Ask the patient to state their full name |
| Right medication | Check the medication label three times – Before, During, After . Verify the order to make sure that is the medication that is going to be given |
| Right dosage/Right Amount | Check the order, Make sure you check for the form of the medication. Is it a tablet? Does it come in ml? Do we have to calculate it, for example lovenox? For Lovenox it is usually 40 mg. Is the dosage reasonable? Is the person getting to little or too much |
| Right route | Check the order |
| Right time | Check order for frequency. Time frame is 30 minutes to an hour before if it is on the hour. If it is one minutes after, you are marked late |
| Right documentation | Document all administration after the medication has been administered |
| Oral Route Advantages | Convenient for the patient. Patient feels more comfortable. If we make an error it can be corrected more quickly because other dosages can be stopped. We cannot do that with certain other routes. Less expensive, very economical |
| Oral Route Disadvantage | Slower onset of absorption and action. Rate and degree of absorption will depend on the GI contents and motility. Not good route to use if patient is complaining of nausea and vomiting. Not good to use in patients who have possible aspiration, dysphagia. Cannot use it on patients who are unconscious. Cannot use it on patients who are NPO. |
| Some drugs cannot be given orally | Heparin and Insulin. They are not given orally because they are destroyed by the digestive fluids because of which they must be given in an injection form |
| Oral Route Rules | Always check patient records for allergies. Prioritize the medication. Give the most important first. Do not open a unit dose until the patient is ready to take it. Elevate the head of the patient's bed when you are giving them the medication only if not contraindicated. Stay with the patient until all the medications are swallowed. Do not leave medication at bedside. Do not leave medication on the possession of the patient unless there is an MD order. Administer oral medications with water unless there is a contraindication. Do not give the medications with the following - Fruit juices, Milk, Soft drink, Or any other liquids unless otherwise indicated. Do not open or crush time release capsule or the enteric coated capsules. All tablets are considered scored so if we have a tablet and need to break it use a pill cutter to break it. If we cannot find a pill cutter, put it in a paper towel and break it. Do not touch the tablet. You can use a needle to put in the middle of the score and break the tablet. Never break tablets with hands. If you are just taking certain amount of medications from a certain bottle, pour it into the lid and use a graduated medication cup to put the tablets or capsule. If a patient is NPO, if a patient refuses the medication, if a patient vomits the medication it has to be reported. MD needs to be notified. MD may need to change the medication. Documentation of the emesis must be done. If a patient refuses a medication write down the reason why they refused, report the reason behind refusal to someone in charge, document it. Tablets unless they are enteric coated, may be crushed using mortar and pestle. Use some sort of can to crush the medication if you cannot find the mortar. Any capsules except time release may be opened and the contents of it can be mixed with apple sauce or ice-cream. This is for patients who cannot swallow. When administering liquid medication remove the cap, place it upside down, hold the medication at eye level and then pour it. Label should be towards the palm as you pour. Type of medication cup to use here is the graduated medicine cup. The lowest level of meniscus |
| Sublingual/Buccal | Any medication whose action depends on the mucous membrane should not be administered with fluid or food. Instruct patient not to chew, sallow, or touch the medication with their mouth. Instruct patient not to smoke until the medication is dissolved. |
| Rectal | They are receiving it rectally because they cannot tolerate it PO. It can also be because they are unconscious, dysphagia, or aspiration problems |
| Rectal Route Advantages | Bypasses action of digestive enzymes. Avoids irritation of upper GI tract. Useful in people who suffer from dysphagia |
| Rectal Route Disadvantages | Some meds are unavailable in suppository, Some people have difficulty retaining it. Example - Elderly, children. Prolong use can cause rectal irritation Example – Aminophylline. Absorption may become irregular or incomplete due to feces being present |
| How to insert a suppository rectally | Lubricate suppository, Put on gloves, Have patient in sims position ( left side lying), Have pt. take deep breath and bear down slightly, Push suppository in approx 1", Use pointed side of suppository for insertion, Use 4th finger for children. Hold buttocks together so they don't release the medication. Pt. should remain on side for 20 minutes (maintain position). Avoid holding suppository because it will melt. |
| Vaginal | Explain the procedure to the patient. Empty bladder before administration. Patient needs to be in a lithotomy position. After the medication is administered they need to lay in the position for 10 minutes. They should have a perineal pad for discharge. Maintain privacy and dignity of the patient |
| Topical | Gloves must be worn when we are applying any skin medications. Remove old topical medication before applying new topical medication otherwise they will get a double dose. Lotion medication should be padded not rubbed. Do not use gauge to cover the medicated area because it can cause irritation. Use sterile techniques and sterile gloves when applying medication to burns. Follow doctor's order to cover the area or to leave it open to air. If unaware of what must be done, check with charge nurse and called doctor to verify. |
| Eye | Look at the label it should say ophthalmic use. Read the label carefully because it may look similar to ear medications. Know abbreviations for eyes (OD, OS, OU). Get patients medications. They should have their own bottle or tube. Administer at room temp. Explain the procedure to patient. Use gloves. Remove exudate before applying the medication. Wipe from the nasal side out. Start from inner canthus to the outer canthus. Drop medication in the conjunctiva sac and not the eye ball. Medications are used for only one patient and are not shared |
| Ear | Make sure ear canal is not blocked, if blocked get an order to unblock it. Read the label to make sure it is an ear medication. Otic must be on the label. Administer the medication at room temperature. Position the patient with the affected side upwards. Instill the correct prescribed amount of drops without touching any part of the ear with the dropper. Children 3 and under pull ear back and down. Adults pull the ear up and back. The patient should lie on the side with the affected ear up. The patient is to remain in the same position for 5 minutes to allow the medication to coat the surface of the inner canal. Insert cotton ball which helps the medication stay in the canal. It has to be prescribed. |
| Nasal | The patient should gently blow the nose. Position the patient with the head tilted back. The patient should remain in that position for 2 to 3 minutes after the drops are instilled. One nostril must be blocked. Medication should be shaken and administered |
| PEG (Percutaneous Endoscopy Gastrotomy) and NGT (Naso Gastric Tube) | Must check for placement. Patient should be in a semi fowlers or high fowlers position. They should be in that position 30 minutes after the medication has been administered. Inject 5 to 10 ml of air in to the tube. When we inject the air we are listening for swoosh sound. Aspirate contents is another technique. Prior to putting the first medication we need to put 10 ml of water. Each medication must be mixed with water. If we are going to give 8 medications we need to mix all 8 of them separately. We need 30 ml of regular warm tap water for each medication. Tip of the syringe or a spoon can be used to stir each medication. Follow with 5 ml of water between each medication. When we get to the last medication, the entire system should be flushed with 30 to 60 ml of water (The teacher says she leans towards 60 ml of water). |
| Nursing care for PEG and NGT | If the person has an NG tube or a PEG tube make sure that you monitor these tubes frequently. Always check the placement prior to feeding the patient or administering the medication. Go by gravity. Up is faster, low is slower. If we infuse things too quickly it will agitate the stomach of the patient and food will come back. Flushing is the same thing for both PEG and NG tube. Normal saline or water can be used to flush. Large flushing always occurs after the last medication. |
| Safety guidelines when preparing medication | Plan ahead. Do not rush. Avoid distractions. Remember six rights. Anything that you can't read, clarify it before you even attempt to give medication. Do not give any drug if it is not clear or not correctly labeled. Any questionable order, call the pharmacist. If you have to calculate any medication get it done before you even get in to the room. Double check everything, specially – Potassium, Heparin, Insulin, Cardiac drugs. Be familiar with every drug that you administer and look it up if you cannot remember or do not understand. Check expiration date. Check each drug at the bedside with the patient's MAR prior to administering. Do not leave any medications at the bedside. |
| If family members are in the room | You cannot leave the medication with them. You have to make sure that the patient takes the medication in your presence. |
| Always check to assess | The patient's response to medications. |
| If a patient refuses a medication | Do not force them to take it. Document as follows, "Patient refused medication because of _______________ " |
| If you elect to omit a dose of medication based on your nursing judgment | You need to discuss the situation with another nurse. If there is an agreement, document the omitted dose and report to the physician as to why the dose was omitted. |
| Medication Routes/Drug Form | Enteral, Percutaneous, Parenteral, Syringe |
| Enteral | Via the GI Tract |
| Examples of Enteral Medications | Powders, Pills, Tablets, Any liquid medication or suspension, Suppositories |
| Percutaneous | Via or through the skin or mucous membranes |
| Examples of Percutaneous | Anything topical, Anything that you instill, Anything that you inhale |
| Parenteral | Methods other than the GI tract. Usually a needle route |
| Things that fall under Parenteral | Ampules, Vial, IM, Subq, Intradermal, IV |
| Parts of a Syringe | Barrel, Plunger, Tip |
| Barrel | The container for the medication. Calibrations are printed numbers |
| Plunger | Is the inner solid rod that fits snugly into the barrel. |
| Tip | portion that holds the needle. Some of the tip has a metal to it. |
| Parts of syringe that must be kept sterile | Inside part of the barrel or the very tip of the syringe. The shaft of the plunger which is the needle shaft. Needle/bevel |
| Parts of a Needle | Hub, Shaft, Bevel |
| Hub | The bottom part that attaches to the syringe. |
| Shaft | The hollow part through which the medication passes. (The shaft is the length between the point and the hub). The shaft is what gives us the needle length |
| Two parts to Shaft | Gauge, Lumen or Hollow |
| Gauge | The diameter of the needle. The larger the number, the smaller the needle (the hole becomes smaller) Example: 27 is a small hole, 21 is a large hole |
| Lumen or Hollow | The opening or the interior diameter that goes down the center of the shaft. |
| Bevel | The slanted tip of the needle. This is the part that pierces the skin. Usually it has to be up when we are giving an injection. |
| Types of syringes | Standard, Tuberculin, Insulin |
| Standard | Most frequent used for the following – Subcutaneous, IM, Calibrated - Calibrations will either be in cc or ml |
| When dealing with a standard syringe | We need to know what each line means. For example looking at a 3 ml syringe each line is 0.1. |
| Tuberculin (TB) | Used when we want to measure very small, minute amounts of substances. For example if we want to test for TB or allergies. It can be used for subq injections when it is in small amounts. Intradermal, Very small amounts, Calibrated in tenths |
| TB syringe can only hold up to | 1 cc. |
| When we use a TB syringe | We should see a bleb. |
| Insulin | Is calibrated in units. Example U – 100 = 1 cc, U – 50 = ½ cc. |
| Prefilled Cartridges | Medication is already pulled for you. It comes in a premeasured amount. Medication fills into a device called a Tubex. |
| Examples of medications that comes in prefilled cartridges | Narcotics – Demerol, Morphine, Epi-Pen, Chloride |
| Selecting Needle | Several characteristics we need to determine Route - Subq, IM, Intradermal, Patient - Size of the patient, Type of injection - What type of injection is it? What kind of medication is it? Example penicillin is thick where as rosafrin is thin. Where is this injection is being given? Amount of medication? Viscosity of the medication, skin condition. (Do not inject in a tattoo). Age of the patient, children do not get injected in certain sites. |
| Choosing a gauge determined by | Route, Medication that we want to use. Use a large gauge for viscous medications, Type of injection |
| Selecting a syringe | Most will be 3 ml or less, The most common size is 3 ml and 1 ml |
| Cartridge syringe | We must ensure that the medication cartridge is securely held in the syringe. Turn the cartridge so that you can read the calibrations. |
| Ampules | It contains medication through out. Before attempting to break the neck, tap it so that the medication on top goes to the bottom of the bottle. |
| To break an ampule | Break away from you. Hold the neck with a gauge. Some slivers of glass may go in to the medication so use a filter needle when withdrawing the medication. After the medication has been withdrawn discard the ampule. Clear the filter of the needle by pulling the plunger back. Replace the filter needle with the appropriate gauge that you are going to use to give the medication. Once the filter needle is replaced with the appropriate gauge, push the plunger up until you see a drop of medication come up. Then you can see that you are ready to give the medication. |
| Vials | Contains multi dosage of medication. Always check the date on the bottle. |
| To open a vial | When it is not opened, on the top it has a metal band which is a protective covering. It protects the rubber portion. Remove the metal band before working with it. Clean the stopper with alcohol. Clean it in one circular swipe. Allow it to dry. Then touch the barrel of the needle. Take off the needle cap. Pull back the plunger to what you want (5 cc example). Insert that amount into the syringe. That will puncture the vial. Pull the plunger back. When you turn the vial upside down, the needle should be below the level of the fluid that we want other we will aspirate air. Keep the label and the calibrations towards you so that we can read it. If we obtain air bubbles we need to get rid of it by flicking the syringe to move air to the top of the syringe. Then we need to push the air out. This method of trying to get rid of air can become stubborn. We can go back to the vial and get more medication out and push the medication out. |
| Reasons why we should handle air bubbles | Air bubbles when giving injections helps push the medication in to the needle shaft which will help it to go into the muscle. Helps prevent leakage of solution into the subcutaneous tissue. Air bubbles are only needed when we are giving an IM injections. |
| Airlock | Is a medication that needs air bubble. It is an IM injection. |
| Airlock technique is utilized | When we are giving IM injection. It is used to clear the needle of medication and seal the track so that the medication does not flow back into the subcutaneous tissue. |
| To use an airlock | We must draw up the exact amount of medication that is ordered for example 5 cc. To do an airlock draw up 2 tenths more which will provide the air lock. (it will be 5.2 now) Give the medication in a 90 degree angle. |
| To clean a site to give any injection | Use an alcohol swap to clean the site. Go in to the inner aspect and use circular motion to clean from in to out. Let the skin air dry. Clean 2 inches around the area. |
| Administration by Injection | Intradermal, Subcutaneous, Intramuscular, Intravascular |
| Intradermal | Administered into the skin onto the inner surface. |
| Intradermal is usually given | To the lower arm. It can also be given in the upper chest, upper back. |
| Intradermal is used for | Allergy testing or TB testing.. |
| Volume of medication used for intradermal | A small amount of medication is used for this kind of medication usually 0.01 to 0.1. Usually we will see a bleb or a wheal when we give this medication correctly. Recommended for very small amounts of medication. |
| Type of syringe used for Intradermal | Tuberculin syringe is recommended for this kind of medication because it utilizes small amount of medication. |
| Gauge used for Intradermal | 24 to 27 gauge and 29. Most common gauge is 25. |
| Needle length for intradermal | 3/8 inch to ½ inch. |
| Angle for intradermal injection | 10 to 15 degrees |
| Subcutaneous Commonly used sites | Abdominal area, lower lateral aspect of upper arm (below deltoid muscle), anterior thigh, upper back. It basically goes into fatty tissue areas. |
| Gauge used for Subcutaneous | 25, 26, and 27. |
| Angle used for Subcutaneous | 45 degree or 90 degrees. Recommendation is 45 degrees. |
| Needle length for Subcutaneous | ½ inch to 1 inch. |
| How much medication can we put in one site for Subcutaneous | 0.5 to 1 ml. |
| Syringe sizes for Subcutaneous | 1 ml to 3 ml. |
| Subcutaneous is used for | Allergies, immunizations, insulin and lovenox |
| Z Track method Purpose | Medications can be irritating to the tissues. Use the Z track technique for these medications. Some examples - Iron dextran, Hydroxine, Cephazolin. |
| Z Track method steps | Skin has to be pulled very tight and in one direction laterally. Inject deep into the muscle at a 90 degree because it is an IM injection. Aspirate for blood and then slowly inject medication. Wait 5 seconds before withdrawing the needle. Release tissue. Wipe the area gently. Do not massage. |
| Intramuscular | It is used to give large amounts of medications. Absorption is rapid because it goes into muscle tissue. The needle has to be long enough to go into the muscle. |
| Angle for Intramuscular | 90 degrees. |
| Needle length for Intramuscular | 1 to 1 ½ inches or 1 to 2 inches. |
| Needle Gauge for Intramuscular | 20 to 22. Most common is 22. |
| Syringes for Intramuscular | 3 ml. |
| Medication in a site for Intramuscular | 0.5 to 2 ml. |
| Intramuscular is used for | Antibiotic, analgesics, anti-inflammatory. |
| Sites for Intramuscular | Deltoid, Dorsogluteal, Rectus Femoris, Vastus lateralis, Ventrogluteal. |
| Dorsogluteal Muscle | Recommended mostly for adults. Not recommended for children under 3 |
| Dorsogluteal Position | Position patient flat on the stomach (prone) or on the side (lateral) with upper leg flexed. |
| Landmarks we need to know for Dorsogluteal | Greater trochanter and posterior superior iliac spine. We want the upper outer quadrant. Buttock should be divided into four quadrants. Use upper outer quadrant of the buttock. Divide it again into four quadrants. |
| Ventrogluteal Muscle | Make a V with fingers. The patient has to be in a lateral position. Place the palm over the greater trochanter. Put the index finger on the anterior superior iliac spine. The middle fingers are going to spread towards the posterior iliac. If you are a right hander put your hand on the left hip, if you are a left hander put your hand on the right hip. Always inject with your dominant hand. |
| Deltoid Muscle | Be careful to avoid several areas – clavical, humerus, Acromion, brachial vein and artery and the radial nerve. Draw an imaginary line across the arm in the level of the armpit. Make a square below the Acromion process and above the axillary line |
| Deltoid landmarks | Acromion process and axillary line. |
| Vastus Lateralis Muscle | Located on the anterior lateral thigh. It is a preferred site for infants |
| Area that we want to utilize for Vastus Lateralis | Mid portion of the side of the leg. One hand breadth above the knee and one hand breadth below the greater trochanter. |
| Landmarks for Vastus Lateralis | Anterior lateral thigh between greater trochanter and patella |
| Rectus Femoris Muscle | Located on the anterior aspect of the thigh and is utilized mostly in children |
| Intravenous | Can be used for blood administration |
| Gauge for Intravenous | 15 to 22. 15 and18 is the most common |
| Needle length for Intravenous | 1 in to 2 in |
| Syringe for Intravenous | 5 cc syringe |
| Volume to be injected for Intravenous | Unlimited |
| Reducing IM Injection Discomfort | Utilize the smallest gauge. Change needle prior to giving drug that is irritating to tissue. Choose a site that is not irritated. Rotation of injection sites. Insert the needle and draw it out without hesitation. Instill the medication slowly and steadily to decrease discomfort. Z track method can be used for irritating medications as well as for various IM injections. Apply pressure after you withdraw the needle except for those medications that you should not massage. Massage afterward if not contraindicated. Encourage patient to relax. Wait till the alcohol dries during prepping the site |
| Site for Heparin | Abdomen, or below the deltoid |
| Heparin | Do not aspirate. Just give the medication. Inject entire length of needle at a 45 or 90 degree angle into skin fold held between thumb and forefinger. Hold skin fold throughout the injection in a taut position. When the needle comes out of the skin fold, release the skin fold. If you let go prior to the needle coming out, it will cause bleeding. Do not massage |
| Insulin Sites | Abdomen, thigh, below the deltoid |
| Insulin | Given subcutaneously. Do not aspirate. Inject at 45 or 90 degree angle. Insert the amount. Take the needle. Do not massage. You can dab. |
Combine with other sets
Share on Facebook
Share on MySpace