Study sets, textbooks, questions
Upgrade to remove ads
Medication Administration Chapter 31
Terms in this set (177)
Considerations prior to Med Admin in Nursing Assessment:
•Past Medical History
•Patient's current condition
Considerations Post Med Admin Nursing Assessment:
Considerations Post Med Admin Patient Education:
•Efficacy of medication
•Adverse effects & side effects
Routes of Administration oral:
sublingual and buccal
Routes of Administration Topical:
-Body Cavity(otic, ophthalmic)
Routes of Administration Parenteral:
Routes of Administration Intraocular*
-Inserting med similar to a contact lens into patient's eye
-The eye med disk has 2 soft outer layers that have medication enclosed in them
-Can remain there up to a week
Routes of Administration Inhalation
Injection into the dermis just under the epidermis
Injection into tissues just below the dermis of the skin
Injection into the muscle
Injection into a vein
Oral route Solid Forms
powdered medication that's compressed in hard cylinder. Usually have scoring if breakage is needed.
medication encased in a gelatin shell, can be opened.
Shaped like a capsule and coated for ease of swallowing
coated tablet that does not dissolve in stomach, coatings dissolve in intestines where it is absorbed
Will be released a varying amount of time to dissolve
Liquid forms of oral route
Clear fluid containing water/ and or alcohol , often sweetened
Other forms of oral route
aqueous medications sprayed and absorbed in mouth or upper airway, not meant for ingestion
Flat around tablets that dissolve in mouth to release medication, not meant for ingestion
•Food, fluid or medication that is intended for gastrointestinal tract inadvertently enters the respiratory tract
What are complications with aspiration?
What do you do if patient has aspiration?
Use another route if there's significant risk for aspiration!!!
What do you asses for aspiration?
•Gag reflex, cough reflex
•Swallowing abilities: chin to chest (sit up 90 degrees)
Prevention methods for aspiration:
•Give medicine on stronger side of mouth (unilateral weakness)
•Administer one pill at a time
•Thicken liquids (nectar consistency)
•Have pt hold and drink from cup independently
•Place in upright or side lying after admin
Where are Sublingual and Buccal medications absorbed through?
The mucous membranes of the mouth for rapid systemic effects
What happens is your patient is in NPO?
-Check your agency's policy
-In most cases you can still give sublingual and buccal medications
How do you administer a sublingual medication?
Underneath the tongue
Sublingual medication should not be?
Sublingual medication precautions
No eating or drinking anything until medication is fully dissolved
Where is the buccal oral medication placed?
Against mucous membranes of the cheek
Why do you alternate cheeks with buccal administration?
To avoid mucosal irritation
Buccal medication precautions
•Do not chew or swallow medication
•Do not take with any liquids
If medications are not packaged, how do you administer it?
When do you remove wrapper of medication?
DO NOT remove wrapper until in patient's room
When do you administer medications on time?
Administer 30 minutes, before or after scheduled time
What needs to be done if medication falls on the floor?
Discard it and repeat preparation
How do you make sure that patient has swallowed medications?
•Stay at pt's bedside
•DO NOT leave it at bedside for pt to take late
What medications do you not crush?
How do you crush tablets?
•Mixing with food/beverages
•Use smallest amount possible
•Avoid pt's favorite foods/beverage
Oral medication through an enteral tube temporary tubes:
•Nasogastric tube (NG)
•Small Bore Feeding Tube
•i.e. Dobhoff (weighted)
Oral medication through an Enteral tube Permanent Tubes:
•PEG or G-tube
How do you verify the location of the tube (stomach or jejunum)?
•X-ray, pH strips for NGT and NJT
Compatibility of location with medication:
•i.e. Fe dissolves in the stomach and absorbed in the duoden
How do you flush tube?
Flush tube with at least 15 mL of sterile water BEFORE and AFTER giving medicine
When do you clamp enteral tube?
For at least 30-60 minutes after giving the medication
What do you do if liquid preparation is NOT available?
•Crush tablets or simple open gelatin capsules an dilute in sterile water
•DO NOT use tap water
Why do you not use tap water through an Enteral Tube?
-Heavy metals that can interact with medication & bioavailability
Topical Route Direct to skin service:
i.e nitro cream or transdermal patches
Topical Route Body Cavity:
What do you always wear with local & systemic effects of topical medications?
Always wear gloves!!
How do you assess sites where previous medication was applied?
•Irritation or skin breakdown
•Rotate sites to prevent skin irritation
Prepping skin for Intact skin:
Clean Technique (soap and water)
Prepping skin for Non intact skin:
Prepping skin purpose:
•Use sterile technique for open wounds.
•Remove old patch before applying new.
•Document new location and removal of old patch
•Ask about patches during the medication history.
•Apply a label to the patch with date/time and your initials
Topical Medications with Age Related changes
•Skin is thinner
•Remove patches slowly, to avoid tearing skin!
Topical Medications Absorption considerations with older adults
•Absorption is more rapid!
•Patient Teaching: toxicity
How can you avoid bruising with Topical Medication for Older Adults?
Apply lotions & creams gently to avoid bruising
Nasal drops before administration:
Blow nose gently to clear mucus and secretions
How do you position a patient for nasal drops?
Supine position with head tilted back
How can you avoid contamination with nasal drops?
Keep dropper away from the nares
•Upright position with head slightly hyperextended
•Spray during inhalation
Opthalmic medication forms
Eye drops, ointments, and intraocular disks
Ophthalmic medication is considered?
-Avoid touching tip of bottle/tube
Before ophthalmic medication of administration what do you do?
-Wipe away from drainage
-Wipe from inner to outer canthus
What does ointment expose?
Conjunctival sac (pull eyelid downward)
What do you apply for ointment?
•Apply 1 cm ribbon in the pocket formed
•Apply gentle pressure to nasolacriminal duct for 30-60 seconds
What do you not do with ointment?
DO NOT push on the eyeball or touch the eye
How do you apply drops?
Apply medication above conjuctival sac
What do you avoid with drops?
When do you repeat drops?
-If drops lands on the outer lid
With drops, How long do you wait before administrating next ophthalmic medication?
What do you use prior to otic medication?
How do you position ear canal for otic medication?
•Upward and outward (ages >3 yrs.)
•Down and back (<3 yrs.)
How do you instill holding dropper with otic medication?
1 cm above ear canal
What do you do after otic medication instillation?
Massage the tragus
What position do you place patient while administering otic medication?
◦Place in side lying position for 2-3 minutes
◦Cotton balls to external ear only if needed
Topical route: rectal suppository you want to provide for?
For topical route rectal suppository you want to communicate by?
•Explain procedure to client
•Encourage client to relax , deep breathe
Which position do you place a patient when administrating a topical route in the rectal suppository?
•Remain at least 5 minutes after admin
For topical route rectal suppository you want to appluy?
•Lubricate tip, round end inserted first
•Insert past sphincter, towards umbilicus
What are inhalation routes?
-Dry powder inhaler
How are medications administered with handheld inhalers dispersed?
Through an aerosol spray, mist, or powder that penetrates lung airways
With inhalation route what absorbs medications rapidly?
How do you shake canister for metered dose or dry poweder?
Shake canister vigorously 5-6 times
Which hand do you place the inhaler?
How do you position a metered dose or dry powder inhaler for administration?
•a) Close mouth around mouth piece with opening towards back of throat and lips held tight around (top)
b) Position mouthpiece 1-2 inches in front of mouth (bottom)
How does a patient inhale for a metered dose or dry powder inhalers?
Have patient inhale slowly and deeply through mouth for 3-5 seconds while depressing canister
How long does a patient need to hold their breath for a metered dose or dry powder inhaler?
•Twist onto design onto the tip and lock themselves in place
•Prevents inadvertent removal of needle
Syringes: Non-Luer lock
Needles slip onto the tip
Ranges for 0.5 mL to 60 mL
Types of syringes
C.Tuberculin syringe (marked 0.01)
D.Insulin syringe (marked 50 units)
When are tuberculin syringes useful?
When small, precise doses are prepared for infants or young children
When do you use a tuberculin syringe?
To prepare small amounts of medications such as:
How is tuberculin syringe calibrated?
In sixteenths of a minim and hundredths of a milliliter and has a capacity of 1 mL
What sizes are insulin syringes available in?
Sizes that hold 0.3 to 1 mL
How are insulin syringes calibrated?
How are most insulin syringes?
How are insulin syringes designed?
Designed to be used with U-100 strength insulin
Each milliliter of U-100 insulin contains?
100 units of insulin
Each unit of insulin syringe is?
One-hundredth of a milliliter (0.01 mL or 0.01 cc)
On an insulin syringe what does each black mark equal to?
When Needle gauge ↓, the needle diameter?
What things need to be considered when choosing needle sizes?
•Viscosity of fluid to be injected or infused
•SQ (3/8 - 5/8 in.)
•IM (1 - 1 ½ in.)
•Patient's size and weight
A 19 gauge needle is how many inches?
1 1/2-inch length
A 20 gauge needle is how many inches?
A 21 inch gauge is how many inches?
A 23 gauge needle is how many inches?
A 25 gauge needle is how many inches?
5/8 -inch length
Bevel is always?
What does bevel create?
•a narrow slit when injected into tissue that quickly closes when the needle is removed to prevent leakage of medication, blood, or serum.
Why are long beveled tips sharper and narrower?
To minimize discomfort when entering tissue used for SQ or IM injection
What are the medication administrations for parenteral?
Ampules & Vials
What kind of container is a vial?
Single-dose or multi-dose container with a rubber seal at the top
What kind of medication forms are contained in vials?
Liquid or dry form
Vial medications that are unstable are in what form of solution?
What does the vial label specify?
-specifies the solvent or diluent used to dissolve the medication
-and the amount of diluent needed to prepare a desired medication concentration
What is commonly used to dissolve vial medications?
-Sterile distilled water
What kind of system is a vial?
What needs to be injected into the vial?
Air to permit easy withdrawal of the solution
What happens if you don't inject air when withdrawing?
Creates a vacuum within the vial that makes withdrawal difficult
What needs to be done after mixing multi-dose vials?
Make a label that includes:
-Time of mixing
-Concentration of med per milliliter
When do some multi-dose vials require to be refrigerated?
After the contents are reconstituted
Removing medications Vials:
•Single-dose or Multi-dose
•Dry forms need to be reconstitute with solvent or diluent (NS or sterile water)
•Air needs to be injected into vial to remove
•Inject air with the same amount of volume to be removed
Removing medications: Ampules
•Glass; single doses (liquid)
•Range: 1 mL to 10 mL
•Carefully aspirate the medication into a syringe with a filter needle.
•REMEMBER TO REPLACE NEEDLE FOR ADMINISTRATION
•No addition of air is needed in the ampule
What do you need to know before injecting?
•Volume and viscosity of medication
•Locating appropriate anatomical site
•Failure: Nerve and bone damage
What can happen if you inject to large of a volume of medication?
•Local tissue damage
How can you minimize patient discomfort using a sharp-beveled needle?
In the smallest suitable length and gauge
What needs to be selected properly to minimize patient discomfort?
Injection site, using anatomical landmarks
What can you apply before injection to minimize patient discomfort?
-Apply a vapocoolant spray
How can diverting a patient's attention help with minimizing patient discomfort?
By conversing using open ended questions
What can you do to minimize tissue pulling to minimize patient''s discomfort?
Insert needle quickly and smoothly
How do you hold syringe to minimize patient discomfort?
Hold the syringe steady while the needle remains in tissue
What rate do you inject the medication to minimize patient discomofort?
Slowly and steadily
Where is the SQ medication placed?
In loose connective tissue under the dermis:
•Minimal vascular supply
•Increased pain receptors
How is the SQ injection compared to the IM injections?
Where are the best SQ injection sites?
•Outer posterior aspect of the upper arms
•Abdomen from below the costal margins to iliac crests
•Anterior aspect of thighs
Which site most frequently recommended for heparin injection?
Alternative SQ sites
•Scapular areas of the upper back
•Upper ventral or dorsal gluteal areas
Subcutaneous Injections Rules:
A patient's body weight indicates the depth of SQ layer
•Length: 5/8 in or 1/2 in (children)
If you can grasp 2 inches (5 cm) of tissue, insert the needle at a 90-degree angle
If you can grasp 1 inch (2.5 cm) of tissue, insert the needle at a 45-degree angle.
•Use upper abdomen
how do you administer low molecular weight heparin (Lovenox)
•Abdomen (2 inches from umbilicus) and pinch the injection site as you insert
•DO NOT expel the air bubble in syringe
what is an insulin needle like?
Pre-attached needles: 25-31 gauge
for insulin what are the quickest absorption sites
abdomen has the quickest absorption followed by arms thighs and buttocks
what is something to keep in mind with insulin when rotating sites?
No injection site should be used again for at least 1 month
At least 1 inch away from previous site
intramuscular injection sites?
Dorso gluteal is no longer an acceptable site
things to keep in mind with intramuscular injections?
•Faster absorption than SQ
•Muscle is less sensitive to irritating and viscous medications
at what angle do you administer an intramuscular injection?
how do you assess an intramuscular injection
•Properly identify the site by palpating bony landmarks
•Needs to be free of tenderness
•Patient must be relaxed
•Rule out any hardened lesions
how much do you administer to adults during intramuscular injections?
•Adults: 2 to 5 mL (varies by site)
how much do you administer to pediatrics/older adults/ thin patients during intramuscular injections?
Pediatrics, older adults, thin patients: up to 2 mL
Small children and older infants: up to 1 mL
Smaller infants: up to 0.5 mL
what are the intramuscular needle sizes for children?
• 22 - 25 gauge
7/8 to 1 ¼ inches in length
what are the intramuscular needle sizes for adults?
•19 - 25 gauge
•1 to 1 ½ inches (standard)
•3 inches for large adults
what are potential complications with intramuscular injections?
fibrosis, nerve damage, abscess, tissue necrosis, muscle contraction, gangrene, and pain are associated with all common IM sites EXCEPT the ventrogluteal site
what is preferred and safest site for all adults, children, and infants?
(Volume >2 mL)
most commonly used intramuscular site for children?
vastus lateralis (Volume <2mL)
how to administer IM injection in vastus lateralis?
Relax the muscle: patient to lie flat with the knee slightly flexed or in a sitting position
Use the middle third of the muscle for injection
With young children or cachectic patients
•Grasp the body of the muscle during injection to be sure that the medication is deposited in muscle tissue.
who can you give IM injections in the deltoid to?
DO NOT USE IN CHILDREN <3years old
what injuries are you at risk for with IM deltoid injections?
Potential for injury to axillary, radial, brachial, and ulnar nerves, and brachial artery
things to keep in mind when administering an IM deltoid injection
Fully expose the patient's upper arm and shoulder.
•DO NOT roll up a tight-fitting sleeve
•Patient to relax arm at the side & flex elbow
Palpate the lower edge of the acromion process
•The injection site is in the center of the triangle
•about 3 to 5 cm (1 to 2 inches) below the acromion process
what is the Z track method best recommended for?
reasons why Z track method is beneficial?
•Zigzag path that seals the needle track
•Displaces the SQ tissue
•Medication cannot escape from muscle tissue
•Protects SQ tissue from irritating and discoloring medications
how to perform the Z track method
•Place the ulnar side of the nondominant hand just below the site
•Pull the overlying skin and subcutaneous tissues
•2.5 to 3.5 cm (1 to 1 1/2 inches) laterally or downward.
•Leave needle in place for 10 seconds to allow medication to disburse
(Hold the skin in this position until you administer the injection)
what are intradermal injections used for?
skin testing (TB, allergy testing)
why are intradermal injections beneficial?
•Slow absorption from dermis
•Useful for potent medications
•Decreases risk for severe anaphylaxis reactions
what kind of syringe do you use for skin testing?
a tuberculin or small hypodermic syringe
at what angle do you administer an intradermal injection
5 to 15 degrees with bevel up
where do you administer an intradermal injection
inner forearm and upper back (a small bleb should form if not, it's in SQ)
what can orders can nursing students NOT take?
prohibited from transcribing or receiving verbal or telephone orders
what are the 6 rights?
1. Right medication
2. Right dose
3. Right patient
4. Right route
5. Right time
6. Right documentation
Steps to Prevent Medication Errors
•ONLY prepare medications for one patient at a time
•Do not allow distractions or interruptions
•Administer only medications you prepare
•Never leave prepared medications unattended
•Check for allergies
•Read labels 3 TIMES and compare with MAR orders.
•Double check all drug calculations (esp. high risk meds)
•Unusually large or small doses
Sets found in the same folder
Pain Management Chapter 44
Mobility Chapter 28
Patient Safety Chapter 27
Other sets by this creator
Death & Grief Chapter 36
Stress & Coping