So that they do not dissolve in stomach. Certain medications can cause ulcers in the stomach because of how strong they are. They dissolve in the small intestine instead.
When can you divide unscored tablets, enteric-coated tablets, time released tablets, and capsules?
What are the 4 types of liquid drug forms?
syrups (sugar solution), suspensions (water, or suitable liquid medium), Tinctures (alcohol), and Elixirs (sweetened alcohol).
If a concentrated liquid medication can irritate the gastric mucosa, what should a nurse do with it first?
Dilute it in 4 ounces of fluid.
If a liquid medication can discolor the teeth, how should the nurse administer it? Example?
dilute the medication and give it through a straw. Ex: Tetracycline
What kind of liquid medication comes in a pre-filled syringe?
Who stocks the pyxis?
When using a pyxis, how do you retrieve the meds?
by clicking on the patient's name and his or her meds on the screen.
How else can the nursing unit access information about what medications a patient is taking and the times they are to take them without using the MAR?
Getting a computer printout from the pharmacy.
If a medication is to be given twice a day, what times would it be given?
9am and 5pm.
What would happen if 2 nurses were counting the narcotics and a narcotic is missing?
No one leaves the unit until the narcotic is found.
What are 2 advantages of oral administration?
a. drug does not need to be completely pure or sterile. b. there is a wide variety of dosage forms.
What are 3 disadvantages of oral administration?
a. hard to swallow for some patients. b. slow absorption c. may only be partially absorbed by digestive system
How should a nurse prepare solid oral medications?
first, pour meds into lid of container. then, into a paper cup. (the medication is NOT touched).
Can several solids be combined in the cup?
What step would a nurse take if a patient has an oral medication but is NPO?
ask the physician if oral med can be administered with a small amount of water.
What should a nurse do next once a patient refuses a medication?
a. find out why. b. then chart the reason. c. then initiate action to correct the situation.
How should a nurse pour a medication?
at "eye level". Never pour over the label. Pour over the clear side. -label should be up so it will not be stained.
If a patient has difficulty swallowing solid medications, what can a nurse do to make it easier?
a. try liquid form. b. crush the medication and mix it in jello, pudding, etc. c. sit in an upright position.
What kind of form are medications always prescribed in when given to infants or toddlers?
Why is it important to have the head of a toddler properly aligned when administering medication?
they can aspirate.
Why is it important to administer medication in the pocket between the cheek & gum of a toddler?
So that they do not aspirate and it isn't forced down their esophagus.
Can you put medications for a young child in a bottle/formula?
When administering NG tube medication, you as a nurse are responsible for PRP. What is PRP?
Placement, drug Residual, and Patency (opening of tube).
How should medications via NG tube be administered?
crushed or in a liquid form. (wax tabs and sustained-release capsules should NOT be crushed).
What position should a patient receiving meds via NG tube be in?
When should the NG Tube be flushed with water when giving meds?
30 ml of water before and after administering medication.
When administering medication via NG tube, should a nurse push the meds down the tube?
NO. allow fluid to flow via GRAVITY in the NG tube.
Are parenterally administered meds given via GI tract?
no. -administered via injection for systemic effect.
Do parenterally administered meds have to be sterile?
Why do parenterally administered meds have lower doses than oral doses?
because 100% of an injected dose is ultimately absorbed.
The larger the number of the gauge, the _______ the diameter of the needle.
Why does the length of the needle matter when giving an injection?
Length matters depending on injection site and patient's body (fat? dermis? muscle? etc)
What size syringe is the most common?
How many ml's can a muscle hold?
2-2.5 ml's. No more than 2.5 ml's.
What size needle does an IM injection usually require?
1 1/2 to 2 inches in length.
What kind of needle do viscous substances require?
large diameter (usually 20 or 18 gauge).
What size gauge of a needle is usually used for intradermal injections?
How much air should be injected into vile before drawing out medication?
Inject air into vile equal to the amount of the dose to be drawn from the vile. then, draw medication.
What kind of measurements are used in a 1ml syringe?
measurements of 1/100 (hundredths).
a. How are insuline syringes measured? b. How are insulin syringes identified?
a. measured by "units". b. orange cap.
Before performing any injections, what should the nurse assess?
assess the condition of the site for evidence of tissue damage or poor circulation.
It is important to always __________ injections sites.
How are powdered medications administered?
powdered medications are reconstituted with the proper diluent.
Before mixing drugs within a syringe, what should the nurse check?
the nurse should check the compatibility of the medications (Restoril and Demerol).
What is the most preferred IM injection site? Why?
Ventrogluteal (gluteus minimus). - it is the furthest away from the sciatic nerve.
Where is a vastus lateralis IM injection given?
side of thigh.
Where is a rectus femoris IM injection given?
middle of thigh.
What are the steps in giving a ventrogluteal IM?
1. Use hand opposite of the patient's leg. 2. Place your palm of your hand on the greater trochanter. 3. point index finger toward anterior superior iliac spine and middle finger toward the iliac crest. 4. Injection site is between index and middle finger.
where is the site for a Dorsogluteal IM injection?
Upper-outer quadrant of buttock.
Where is a vastus lateralis IM injection given?
lateral thigh (side). one hand's width below the greater trochanter and one hand's width above the knee. Give the injection in the lateral thigh.
Where is a Rectus Femoris IM injection given?
Anterior thigh (front). One hand's width below the greater trochanter and one hand's width above the knee. Give injection in the middle of thigh.
What IM injection site is best for a baby?
What are the boundaries for a Deltoid IM injection site?
lower edge of the acromian process and the axilla. Should be given 2-3 inches below the acromian process.
What is the highest dose that can be administered when giving a deltoid IM injection?
2 ml. NO HIGHER.
1. What size gauge of a needle is used on an adult? 2. What length of a needle should be used on an adult?
1. 18 - 23 gauge. 2. 1- 1 1/2 inch needle.
1. What size gauge of a needle is used on a child? 2. What length of a needle is used on a child? 3. length for a newborn?
1. 25-27 gauge. 2. 1/2 - 1 inch needle. 3. 5/8 inch for newborn.
Amount of IM injection is normally up to _______ ml, but may be up to ______ ml for certain drugs.
3 ml; 5 ml
Syringe size depends on the size of the _________.
For very thin patients, squeeze the skin at the injection site and insert needle at ________ degrees when giving an IM.
When giving an IM injection, the nurse is to use a ________ motion at 90 degrees.
darting motion. Start from a farther position opposed to up close near the skin.
When giving an IM, why is it important to aspirate gently before injecting the medication?
to confirm that the placement is correct. If blood appears, withdraw the needle and prepare another dose fro an alternative site.
What kind of injection is given if the medication can irritate or stain the skin?
How is a Z-track injection given?
1. Stretch the skin and hold it. 2. Inject needle at a 90 degree angle. 3. Count 10 seconds after giving the medication, then release needle and hand at the same time.
Do you a massage the site where a z-track injection is given?
NO!! you do NOT want the medication mixing with the skin.
What kinds of meds would be given via z-track?
vistaril, iron, and vitamin k.
What size gauge of a needle would be used to give an intradermal injection? What size length of a needle?
25-27 gauge; 3/8 to 5/8 inch in length.
Where is the most common site for an Intradermal injection?
What are the steps for giving an intradermal injection?
1. clean site with an alcohol swab. 2. insert needle at 15 degree angle & with bevel UP. 3. Med is injected to form a small pocket. 4. Do NOT massage.
Why are subcutaneous injections used?
What types of medication are typically given subcutaneously?
insulin and anticoagulants (heparin, for clotting).
What length and gauge of a needle is used when giving a SQ injection?
25-27 gauge; 3/8 to 5/8 inch in length.
What angle are SQ injections given at?
45 or 90 degree angle & bevel up.
When giving an SQ injection, gently massage the injection site to stimulate circulation except for _______ and _________!
HEPARIN and INSULIN.
Where is heparin injected?
abdomen, at least 2 inches from the umbilicus.
What kind of injections do we not massage?
Z-track and when giving heparin and insulin SQ's.
When administering heparin and insulin, what do we not do?
aspirate and massage.
What are the steps for mixing regular insulin and NPH insulin? ex: 5 units of regular and 10 units of NPH insulin.
1. put 10 units of air in NPH vile, then pull out. 2. Then, put 5 units of air in regular vile, then draw out 5 units of regular from vile. 3. Then, draw 10 units of NPH in same syringe so that the marker is at 15 units.
Where is sublingual administration given? Example?
Under the tongue. Wait until it dissolves. Ex: Nitroglycerin.
Where is Buccal administration given?
between the gum and cheek. Wait until it dissolves.
What is an advantage of using sublingual and buccal administrations?
rapid absorption into blood stream due to lots of blood vessels.
How is a suppository given?
Rectal administration. 1. Place patient on left side and lift right leg towards the chest. (sims position) 2. Insert lubricated suppository approx. 2 inches. 3. Encourage to retain for 10-20 mins.
When administering opthalmic (eye) drops, the drops must be ________ and the label should read ___________________.
sterile; "for ophthalmic use only"
When administering ophthalmic drop, they should be given in the __________ of the eye. Then apply pressure to the patient's _________ for 30-60 secs to prevent ____________.
How are otic (ear) drops administered for an adult?
lie on the unaffected side, then pull the auricle up and back.
How are otic (ear) drops administered for a child?
lie on the unaffected side, then pull the auricle down and back.
What is done first before administering nose drops?
blow the nose gently to clear nasal pathway.
How should nasal drops be administered?
head tilted back and maintained that way for 1 to 2 minutes.
When administering a respiratory inhaler without a spacer to a patient, what should be done?
First, exhale a deep breath. Then, hold inhaler 1-2 inches in front of mouth without touching the mouthpiece. Then, press the canister down into the mouthpiece to release meds and inhale slowly. Hold breath for 10 seconds then breathe out slowly.
When giving Nitroglycerin via dermal (skin), what should you do?
Select non-hairy spot. Squeeze ointment 2 inches and apply on skin. Do NOT Rub. Cover area with plastic wrap and tape. Then write date and time of when it was given.
How is vaginal administration done?
-place patient in dorsal recumbent position. -insert applicator 2 inches in. -angled downward and back into vagina.
Before administering medication, what should the nurse determine? (5 things)
- safety and need of med. -Risk factors - drug relates to pt condition. - dose is within safe range. - pt allergic history.
During evaluation during the nursing process, the nurse should be aware of all ________ taken by the patient.