MEDICATION ADMINISTRATION

Ms. Sheila M. Tolentino , RN MAN

 a substance administration
for the diagnosis, treatment, relief or prevention of disease.

Types of Doctors Order

Standing order
it is carried out until the specified period of time, or until it is discontinued by another order.

Single order
it is carried out for one time only

STAT order
it is carried out at once or immediately

PRN order
it is carried out as the patient requires.

PART OF LEGAL DOCTORs ORDER

Name of patient Data and time Name of drug Dose of drug Route of administration Time or frequency Signature of the physician

Observe the 10 RIGHTS of drug administration.

Right drug Right dose Right client Right route Right time Right documentation Right advice Complete drug history Drug allergies Drug-drug interaction

Administer the right drug. Administer the drug to the right patient. Administer the right dose. Administer the drug at the right time. Administer the drug by the right route. Document each drug you administer. Teach your patient about the drug hes receiving. Take a complete patient drug history. Find out if the patient has any drug allergies. Be aware of potential drug-drug or drug-food interactions

Practice asepsis. Nurses who administer medications are responsible for their own actions. Question any order you consider incorrect. Be knowledgeable about medications that you administer. Keep narcotics and barbiturates in locked place. Use only medications that are in clearly labeled containers. Return liquid that are cloudy or have changed in color to the pharmacy. Before administering a medication, identify the client correctly. Do not leave the medication at the bedside. If the client vomits after taking an oral medication, report this to the nurse in charge and or physician. Preoperative medications are usually discontinued during the postoperative period unless ordered to be continued. When a medication is omitted for any reason, record the fact together with the reason. When a medication error in made, report it immediately to the nurse in charge/ physician.

Advantages Most convenient Usually less expensive Safe, does not break skin barrier Administration usually does not cause stress.

Disadvantages Inappropriate for client with nausea and vomiting Drugs may have unpleasant taste or odor Inappropriate if client cannot swallow or is unconscious. Cannot be used before certain diagnostic test or surgical procedures.

Types of Oral Medications

Solid preparations are: tablets, capsules and pills and powder. Liquid preparations are: syrup, suspension, emulsion, milk or other alkaline substances. Enteric coated tablets should not be crushed before administration. Do not administer enteric coated with antacids, mild or other alkaline substance If the patient vomits within 20-30 minutes of taking the drugs, notify physician. Do not readminister the drug without a physicians order.

Therapeutic Nursing Interventions for oral preparations

Assess to be sure that the client has adequate swallowing and gag reflex. Pour liquid medication into medicine cup eye level. For medications with objectionable taste, offer oral hygiene immediately after administering. Never put any of your clean items which are used in administering medications directly on the surface of the counter or medication cart/tray.

 application of medications to a circumscribed area of the body. Includes dermatological medications, irrigations and instillations.

OTIC Instillations: To soften earwax, to relieve pain To reduce inflammation and to treat infection Irrigation: To remove cerumen or pus, to apply heat To remove a foreign object

NASAL

Have the client blow the nose nasal instillations (nose prior to instillation drops) usually are Assume back-lying instilled for their position astringent effect ( to Elevate the nares slightly shrink the theswollen by pressing thumb mucous membranes) against the clients tip to of loosen the nose.secretions and facilitate head drainagetilted or Keep treat infections of the backward for 5 minutes nasalinstillations cavity or sinuses. after of nasal drops

INHALATION

Semi or high fowlers position If bronchodilator a maximum of 2 puffs, for at least 30 seconds interval

VAGINAL

Advantage: provides Empty bladder before Irrigating container local effect thetherapeutic procedure be 30 cm. (12 should Disadvantage: has Position and drape inches) above. the client: limited use Instillation: backDrug forms: Ask client to tablet, remain in lying position with cream, jelly, foam, bed for 5-10minutes knees flexed and suppository following hips rotated Vaginal irrigation laterally administration of (douche) : is the Irrigation: backvagina suppository, lying with washing of position the vagina cream, foam, jelly or hips higher than by a liquid at low irrigation the shoulders (use pressure. bedpan)

Rectal Suppository

 Dose absorbed is unpredictable Suppositories tend to soften at room temperature, need to be refrigerated Use glove for insertion of suppositories Lie on left side and breath through the mouth to relax the anal sphincter Have the remain on side for 20 minutes after insertion

 Intradermal under the epidermis (into the dermis) Subcutaneous into the subcutaneous tissue (also hypodermic) Intramuscular into the muscle Intravenous into a vein Intraarterial into an artery Intraosseous into the bone

 Check doctors order Support the tissues with General Principle Introduce the needle in Identify the client aproperly quick thrust. in Parenteral cotton swabs before Administration of withdrawal Either spread or pinch Practice ASEPSIS of needle introducing needle the Medications: when Use appropriate Massage the site of size needle. Plot the to injection hasten injection Minimize discomfort by properly. cold compress applying absorption. Use separate needles for over the injection site aspiration and injection of Apply pressure at the before the introduction medications. of medication to numb for fewair minutes. site Introduce into the vial the nerve ending; apply before aspiration. Evaluate of warm compress to Allow a effectiveness small air bubble improve bloodto supply in procedure the syringe push the the and make medication thatbefore may relevant Aspirate remain documentation. in the hub and

introduction. lumen of the needle.

FACTORS THAT DETERMINE THE SIZE OR SYRINGE TO BE USED:

Type of medication Amount of medicine to be injected Method of dispensing the medication

FACTORS THAT DETERMINE THE SIZE OF NEEDLE TO BE USED:

Route of administration Medication to be administered Size of the patient.

 MOST COMMONLY USED SIZE OF NEEDLES: ID G27, G26, G25 SC G25, G23 IM G23, G22, G21

REMOVING MEDICATION FROm AN AMPULE:

Tap the stem of the ampule to remove medication Wrap the stem of the ampule with cotton Break the neck along the pre-scored line. Insert the needle into the ampule and remove the medication. Remove the needle from the ampule

REMOVING MEDICATION FROM A VIAL

Load the syringe with air at equal amount of solution to be removed Cleanse the rubber stopper of the vial. Insert the needle into vial and inject the air. Remove the prescribed amount of the solution Remove the needle from the vial and store the vial properly.

Intradermal injection administration of a drug into the dermal layer of the skin just beneath the epidermis. Indicated for allergy and tuberculin testing and for vaccinations.

 Sites: Epidermis Needle length: 3/8 5/8 , Angle: 10 - 15

Administration of Intradermal Injection

Re-check the patients the dose, route, Position the syringe withname, the bevel ofdrug, the needle pointing against doctors and medication card. upward, so that order, the needle is almost flat against the Check patients readiness/ explains procedure to clients skin. patient. Insert the needle through the epidermis so that the point of the needle visible through the skin. at The needle Arrange your is equipment conveniently patients should be advanced until it is approximately 1/8 inch bedside (3mm) below the skin surface provides privacy and washes hands Gradually inject a small amount of drug to form a wheal position the patient or bleb. Identify injection site When the the injection wheal appears, withdraw the needle. Never Clean site with an antiseptic (alcohol) massage the area or apply pressure to the site asthe this may using circular motion working from site outward. interfere with the test result. Remove the protective needle cup. Encircle the side of the wheal using black or blue ink and Holding the clients forearm in one hand, stretch the label site. skin.

Subcutaneous injection drug administered subcutaneously are: vaccines, preoperative medication, narcotics, insulin, heparin. Needle length: 45 - 5/8, 90 - Sites

 Only small doses (0.5-1.5 ml) of medication should be injected via s.c. route Rotate sites of s.c. injections to minimize tissue damage, aid absorption and avoid discomfort Needle length and gauge are the same as for intradermal injections Use 5/8 needle for adults when the injection is administered at 45 degree angle of needle. For obese patients: 90 degree angle ( also use for administering heparin and insulin) For heparin: do not aspirate Do not massage the site to prevent hematoma formation For insulin injection: do not massage the site to prevent rapid absorption which may result to hypoglycemic reaction. If blood appears on pulling back the plunger of the syringe, remove the needle And discard the medication and equipment.

Administration of Subcutaneous Injection:

Follow steps #1-8 of ID injection Grasp the firmly between the thumb and fore finger to elevate the subcutaneous tissue. Holding the syringe firmly at 45 degree angle to the skin thrust the needle into the tissue.

Intramuscular Injection
Purpose:
Rapid absorption because of rich blood supply Muscles can take a greater volume of fluid without discomfort. Adult ( can tolerate up to 3ml) Medications that are irritating may safely be given by IM injection

 Danger: Damaging nerves and blood vessels Common Complications: Abscess, necrosis, nerve injuries. Needle length: 1, , 2 ( 3 needle may be used if the patient is obese) Use the needle G 20,21,22,23 ( depending on the viscosity of the drug) Clean site with alcoholized cotton ball. Inject the medication slowly (20 seconds) to allow the tissues to accommodate volume. Sites:

Ventrogluteal site Uses gluteus minimus muscles Area contains no large nerves or blood vessels and less fat Farther from the rectal area: less contaminated

Dorsogluteal site

Uses gluteus medius muscle Not to be used for children under 3 years unless child has been walking for 1 year Avoid hitting the sciatic nerve, major blood vessel

Vastus lateralis site

Recommended site of injection for infants Assume back lying or sitting position.

Rectus femoris
Located at the anterior aspect of the thigh

Deltoid site
Not used for often for IM injection because it is relatively small muscle and is very close to the radial nerve and radial artery. Rapid absorption

Administration of IM Injection:
Follow steps #1-8 of ID injection Holding the syringe firmly and perpendicularly to the skin, thrust the needle into the muscle. Do not insert the needle up to the hub, but leave 1/8-1/4 inch to allow identification in case the needle should break.

Holding the syringe with the left hand, aspirate by pulling back on the plunger with right hand. If blood appears in the syringe, remove the needle, discard the medication and equipment and begin the procedure from step 1. If no blood appears in the syringe, slowly introduce the medication. Smoothly and quickly withdraw the needle. Immediately place pressure over the puncture site with a new swab unless contraindicated, massage the injection site to facilitate the absorption of medication. Position the client comfortably Dispose the needle and syringe properly in container and remove gloves. Chart date, time, route and site of injection and name and the dosage of the medication sheet and progress notes.

Z tract Injection
For parenteral iron preparation (to seal the drug deep into the muscle and prevent permanent staining of the skin.)

Administration of Z- tract or Zigzag injection

aspirate for blood with the thumb and index finger and if there is not blood, push the plunger with thumb to inject the solution Withdraw the needle Release the skin and underlying tissues to return to normal position. Use light, steady pressure over the site

 PURPOSE:
Maintain or replace body stores of water electrolytes, vitamins, proteins, fats and calories in the patient who cannot maintain an adequate intake by mouth. Restore acid-base balance Restore volume of blood components Provides avenues for the administration of medications. Monitor central venous pressure.

Hypotonic solutions- Solutions containing lesser concentration number of solutes as compared with blood plasma. EXAMPLES: 0.33 NSS ; 0.45 NSS ; 2.5 dextrose Isotonic Solutions-Solutions having the sane concentration of solutes with blood plasma. EXAMPLES: 0.9 NSS; D5W ; LRS Hypertonic solutions -- Solutions containing greater concentration/ number of solutes with blood plasma Examples: 5% dextrose in 4.5 NSS, 0.9 NSS in LR Crystalloids a. Solutions contain electrolytes. b. Crystalloids may be used for fluid volume replacement. Colloids a. Colloids also are called plasma expanders. b. Colloids pull fluid from the interstitial compartment into the vascular compartment. c. Colloids are used to increase the vascular volume rapidly, such as in hemorrhage or severe hypovolemia.

Solution 0.9% saline (NS) 5% dextrose in water (D5W) 5% dextrose in 0.225% saline (5% D/ NS) Lactated Ringers (RL) solution 0.45% saline (1/2 NS) 0.225% saline (14 NS) 0.33% saline (1/3 NS) 3% saline (3% N5) 5% saline (5% NS) 10% dextrose in water (D10W) 5% dextrose in 0.9% saline (5% D/NS) 5% dextrose in 0.45% saline (5% D/NS) 5% dextrose in lactated Ringers solution Dextran Albumin

Tonicity isotonic Isotonic Isotonic Isotonic Hypotonic Hypotonic Hypotonic Hypertonic Hypertonic Hypertonic Hypertonic Hypertonic Hypertonic Colloid Colloid

Nursing Interventions in IV infusion

Check for doctors order. Assembles all the necessary equipment to start on IV. IV cannula, catheter IV set the solution to be infused tourniquet alcohol sponge micropore tape IV pole/stand IV splint or armboard.

Selection of site.

using veins Avoid Use distal veins of that are: in areas of the arm first flexion, highly visible Use the because clients nonthey dominant arm tend to roll away whenever possible from the needle, damage Select vein that is: by previous easily palpable and use, continually feel soft and full, distended with naturally and splinted blood in by bone and large surgically enough to allow compromised or adequate circulation injured extremity. around the catheter.

Anchor the catheter with micropore tape Apply a splint or an armboard to splint the joint. Regulate the flow rate as indicated and prescribed. Mark on the infusion bottle the time started, time to consume, medicine added and flow rate per minute. .

COMPLICATIO N

POSSIBLE CAUSES

SIGNS AND SYMPTOMS

NURSING CONSIDERATIO NS
discontinue the infusion, remove the needle catheter if the infiltrations caught within hr. and the swelling small, apply ice, or otherwise apply warm wet compress to encourage absorption restart IV in another limb document what youve done

PREVENTION TIPS

Infiltration

Needle or catheter displacement Leakage of blood around needle or catheter

Coolness of skin around site Swelling around site, which may or may not be painful Absence of blood backflow. Sluggish flow rate discomfort

use a splint to stabilize the needle or catheter when the sites over a joint or the patients active hand palpate occasionally to confirm proper needle position

Circulatory too much fluid overload fluid delivered too fast

rise in blood pressure and CVP dilation of veins with neck veins sometimes visibly engorged rapid breathing, shortness of breath rates wide variance between liquid input and output

slow the infusion to KVO rate raise patients head in semi-fowlers keep warm to promote peripheral circulation and to ease the stress on the central veins monitor vital signs administer oxygen if permitted ]notify doctor document what you've done

be aware of the patients cardiovascular status and history tell the doctor if the fluid volume flow rate may be more than patient can tolerate monitor urine output

container Air embolism allowed to run dry air in tubing loose connectio ns

blood pressure drop rise in CVP weak, rapid pulse cyanosis loss of consciousne ss

turn patient on his left side, lower the head of the bed check system for leaks give O2 if allowed notify doctor immediately document what youve done

clear all air from the tubing before attaching it to the patient change containers before theyre empty make sure all connections are secure

Catheter embolism

withdrawin g catheter before the needle or attempting to rethread a catheter with a needle failure to secure the catheter to the skin adequately

discomfort along the vein in which the catheter fragments lodge BP drop Rise CVP Cyanosis Loss of consciousness

Discontinue IV Apply tourniquet above site. Have the patient x-rayed to confirm embolism Document what youve done

Remember to withdraw needle and catheter together after unsuccessful venipuncture attempt Take special care when taping or withdrawing.

Infection Poor of aseptic venipunc technique ture site

Swelling and soreness at site Foul smelling discharge

Discontinue IV improve aseptic technique infusion, and remove needle and wash your hands catheter immediately. Send IV equipment to lab for bacterial analysis Clean site, apply microbial ointment and cover with sterile gauze pad Restart IV in another limb Document what youve done

Thrombo injury to phlebitis the vein irritation to the vein caused by: long term therapy, irritating/ incompatibl e additives, use of vein thats too small to handle the amount

sluggish flow rate edema in limb vein: cord-like, sore warm to touch. It may look like a red line above the venipuncture site.

Discontinue IV and remove Apply warm wet compress Notify doctor Restart IV in another site Document what youve done

If irritating additive find a vein large enough to dilute it. Dilute irritating additives if possible Make sure drug additives are compatible Keep infusion flowing at the prescribed rate Stabilize the needle with a splint if necessary.

Nerve Damage

Tying arm too tightly to the splint

Numbne ss of fingers and hands

Massage area and move shoulder through its ROM Instruct patient to open and close hand several times each hour

BLOOD TRANSFUSION

Definition of terms
Antigens complex proteins on the red cells surface. May stimulate the formation of anti-bodies Antibody protein circulating in the plasma produced in response to an antigen that the individual is lacking Agglutination clumping of blood cells Hemolysis destruction of RBC Cross matching compatibility testing, accompanied by incubating a sample of the patients plasma with the donor red cell to detect sign of incompatibility.

Purposes:
To restore circulating blood volume To stop bleeding due to platelet deficiencies/defects and coagulation factor deficiencies. To increase oxygen carrying capacity of the blood To combat infection due to decreased WBC or antibodies.

NURSING RESPONSIBLITIES DURING BLOOD TRANSFUSIONS:

Check and verify doctors order. Inform the client and explain the purpose of the procedure. Check for cross-matching and blood typing

 Dont mix medication with BT Administer 0.9% NaCl before, during or after BT. Never administer with dextrose.

Administer BT for 4 hours blood should be transfused 30 minutes after it is taken from the blood bank. Observed for complications or reactions. Documentation.

COMPLICATIONS

CAUSES

ASSESSMENT

Allergic reaction

Sensitivity to plasma protein or donor antibody Hypersensitivity to donor white cell, platelets or plasma proteins Transfusion of blood or components contaminated by bacteria

Flushing, rash, hives, laryngeals edema, itching, urticaria, wheezing, anaphylaxis Sudden chills and fever, flushing, headache, anxiety

Febrile, Nonhemolytic

Septic reaction

Rapid onset of chills, vomiting, high fever, diarrhea

Circulatory Administration of overload blood volume at a rate greater than the circulatory system can accommodate. Leads to increase blood in the pulmonary vessels and decreased lung compliance.

Rise in venous pressure, dyspnea, rales or crackles, distended neck veins, cough

Hemolytic reaction

It is caused by infusion of incompatible blood products

Chills, feeling of head fullness, tachycardia, low back pain, flushing, tachypnea, hypotension, hemoglobinuria, bleeding, vascular collapse, hemeglobinemia, acute renal failure, DEATH

NURSING INTERVENTIONS: if any sign and symptoms of complications of BT occurs:

Stop blood transfusion. Start an IV line (0.9% NaCl) Collect urine specimen Monitor VS Send unused blood and BT set to the blood bank

 Administer the following drugs as ordered: antihistamine, Diuretics, Bronchodilators Make relevant documentation.

Blood Transfusion Set

THE END.