Transcript NUR104ModC_000

Module C- Administering
Medications
By Brenda D. Rigsby,
MSN, RN, CRNP
Safety Issues
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Standard Precautions
Equipment disposal
Needleless systems
Personal protection equipment
Reporting needle sticks
Reporting medication errors
Behaviors to avoid during medication
administration
Standard Precautions
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Guidelines recommended by the Centers
for Disease Control and Prevention to
reduce the risk of the spread of infection
in hospitals.
Standard Precautions, cont.
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These Precautions (e.g., handwashing,
and wearing personal protective
equipment such as gloves, mask, eye
protections, gown) apply to blood, all
body fluids, secretions, excretions (except
sweat), nonintact skin, and mucous
membranes of all pts. And are the primary
strategy for successful nosocomial
infection control.
Personal protection equipment
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Protective equipment, including personal protective
equipment for eyes, face, head, and extremities,
protective clothing, respiratory devices, and protective
shields and barriers, shall be provided, used, and
maintained in a sanitary and reliable condition wherever
it is necessary by reason of hazards of processes or
environment, chemical hazards, radiological hazards, or
mechanical irritants encountered in a manner capable of
causing injury or impairment in the function of any part
of the body through absorption, inhalation or physical
contact.
Equipment disposal
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Put the syringe and
needle into the sharps
container
Needless system
Reporting needle sticks
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What are the steps involved in reporting a
needle stick?
Elements leading to Medication
Errors
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Misinterpretation
Miscalculations
Misadministration
Difficulty in
interpretation
handwritten orders
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Misunderstanding of
verbal orders
Drug name confusion
Lack of
employee/patient
knowledge
Reporting medication errors
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What steps should be
taken when a medication
error has occurred?
USPMERP- United States
Pharmacopeia Medication
Errors Reporting
Program- healthcare
professions report
MedWatch- public
reports
Institute for Safe
Medication Practices
(ISMP)
JCAHO
Medication Orders
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Reading and
interpreting
medication orders
Parts of a medication
order
Types
Essential Order Components
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Client name
Date/Time
Medication name
Dose
Route
Time & Frequency
Signature
Medication administration
record: example
Medication orders &
documentation
Reading and interpreting
medication orders
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See the provided handout.
Types
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STAT
Routine
Standing
PRN
One time dosing
Written vs. Verbal/phone
Reading and interpreting labels
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Common abbreviations
No longer approved abbreviations
Drug packaging
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Mix-O-Vials
Cartridges/Tubex
Dose Packs
Vials
Ampules
Pre-filled syringes
Drug Administration
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equipment/adaptive equipment
Systems of distribution
Computerized system
Unit Dose
Stock
Narcotic Control Systems
Reconstitution of medications
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Diluent
Labeling
Calculating dosages
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Use of approved formulas
Compare order to safe dose
Preparing dosages for
administration
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Read physician’s orders accurately
Compare to medication administration record
Check medication at least 3 times
Check expiration date on medication
Accurately measure medication dose
Check for patient allergies Check for patient
allergies
Review nursing implications
Behaviors to avoid during
medication administration
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What are some
behaviors to avoid
during medication
administration?
Drug information preparation
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Classification
Mechanism of action
Side effects
Adverse/toxic reactions
Contraindications/cautions
Drug/food interactions
Nursing implications
Routes for administering
medications
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Enteral
Parenteral
Intradermal
Subcutaneous
Intramuscular
Z-track
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IV
Percutaneous
Enteral Medication Route
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The enteral route refers to those drugs
administered directly into the GI tract by
oral, rectal, or nasogastric routes.
Dosage forms
- capsules
- elixirs
- lozenges or troches
- emulsions
- pills
suspensions
- tablets
- syrups
Dosage Forms
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Capsules- small, cylindrical gelatin containers that hold dry powder or
liquid medicinal agents. Convenient way of administering drugs with an
unpleasant odor or taste.
- Time-released capsules- provide a gradual but continuous release of drug
b/c the granules w/in the cap. Dissolves at a different rate. It reduces the #
of doses/day.
Lozenges- are flat disks containing a medicinal agent in a suitably flavored
base. They are held in the mouth to dissolve slowly.
Tablets- are dried, powdered drugs that have been compressed into small
disks. Scored tablets- the indentation maybe used to divide the dose.
Enteric-coated tablets- has a special coating that resists dissolution in the
acidic pH of the stomach but is dissolved in the alkaline pH of the
intestines.
Elixirs- clear liquids made up of drugs dissolved in alcohol and H2O. They
are primarily used when the drug will not dissolve in water alone.
Tablets
Dosage Forms
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Emulsions- are dispersions of small droplets of waterin-oil or oil-in-water. They are used to mask bitter tastes
or provide better solubility to certain drugs.
Suspensions- are liquid dose forms that contain solid,
insoluble drug particles dispersed in a liquid base. They
should be all shaken well before administration to ensure
thorough mixing of the particles.
Syrups- contain medicinal agents dissolved in a
concentrated solution of sugar, usually sucrose. They are
effective in masking the bitterness of the drug and for
use in pediatrics b/c they tend to prefer the taste.
Equipment
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Unit Dose or Single Dose
Soufflé’ Cup
Medicine Cup
Medicine Dropper
Teaspoon
Oral Syringe
Nipple
Enteral Administration
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Administering oral medications: liquid
- Adult or child-Give the most important drug 1st.
-Never dilute a liquid med. Unless specifically ordered.
- Always remain w/ the pt while the med is taken. Never leave meds
at BS, unless orders state this.
- Infant
- Check the I.D. bracelet
- assess alertness
- position with head slightly elevated
- Administer using oral syringe or dropper or nipple.
Enteral Administration
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Administering medications via nasogastric tube
Liquid forms of drug should be utilized whenever
possible for NG administration.
When using tablets(crush) and capsules(pull
apart) and mix w/ 30cc of H20. Not enteric –
coated or sustained release caps.
When more than one drug is used flush w/ 5-10
cc of H2O.
Enteral Administration
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Administering rectal suppositories
Administering disposable enemas
See textbook
Parenteral Administration
Preparing parenteral medications
- Syringes
Syringe has several functions
*Device for transfer of medication
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* From storage container
* To administration container
* To patient
System for maintenance of sterility
System for measuring medication
System for delivering medication
System for prevention of needle sticks
Syringe parts
Syringe
(Syringe has 3 parts)
1. barrel
* Main body of syringe
* Acts as receptacle for medication
* Has measuring scale on side
2. plunger
* Used to pull or push medication into or out of barrel
3.tip
* Provides connecting site for needle
Syringe calibration
1. Metric Scale- measures in mL (cc) & fractions of cc’s
2. Apothecary Scale- measures in minims ( 15 minims =
1ml), &
3.Insulin scale- measures in units (U-100 Insulin: 100 U =
1cc)
th
Syringe
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Factors Affecting Syringe Choice
* Volume of Medication
* 1cc or less = ID
SQ
IM
IV
* 1 – 3cc
=
IM
IV
* >3cc
=
IV
Needle: parts
Needles- has several parts
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* Hub
* Provides attachment device to syringe tip
* Shaft
* Length
* Varies from 3/8” to 3”
* Diameter
* Expressed as “ Gauge (ga. or #)”
* Bevel
* Provides sharp point and cutting edge
* Varies from “short”(very dull) to “long”(more
sharp
Needles
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Factors Affecting Needle Choice
* General Principle
* Use smallest gauge of appropriate length
* Goal is to deliver to “target” tissue with least trauma
* Viscosity of Medication
* Thicker meds need bigger needle (lower gauge)
* Target Tissue
* Intradermal and Subcutaneous
* 3/8”- 5/8”, 25 ga- 30 g
* Intramuscular
* 1 – 1 ½” , 20 ga- 22 ga
Giving an Intramuscular
Injection
Parenteral Administration
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Preparing injections from ampule
Glass with “hour glass” neck
Must break the neck to access med
Single dose
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Preparing injections from vial
Glass or plastic with rubber cap protected by metal or
plastic cover
Rubber cap must be pierced to access medication
Maybe liquid or powder (must be diluted)
Maybe single or multidose
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Preparing injections in one syringe by mixing
two vials
Parenteral Administration
Route
Volume
Gauge
Length
Intradermal
0.01- 0.1ml
26-29ga
3/8 – ½”
Subcutaneous
0.5 –2ml
25-27ga
3/8-5/8”
Intramuscular
0.5- 3ml-adult
1-2ml-child
18-23 ga-adult 1-11/2”-adult
25-27ga-child ½ - 1”-child
5/8 - newborn
Intravenous
1- 2000ml
20-22ga(sol)
15- 19 ga(bld)
½ -1¼” (butterfly)
½ - 2” (reg needle
IM injection: needle length
selection
Parenteral Administration
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Administering intradermal (ID) injections
are made into the dermal layer of the skin just
below the epidermis. Usually 0.1ml, are injected
to produce a wheal.
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Route of choice- for allergy sensitivity tests,
desensitization injections, local anesthetics, and
vaccinations
Intradermal injection technique
Parenteral Administration
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Subcutaneous (SC) injections
are made into the loose connective
tissue btw the dermis and muscle layer. No
more than 2ml can ordinarily be deposited
at a SC site.
Route of choice – for drugs such as insulin
& heparin. Do not aspirate
Giving the SC injection
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Prepare medication, gather supplies, wash
hands, don gloves, talk to Pt.
Select site(mark site with non-dominant
hand)
Cleanse site (circular motion, center->out,
using dominant hand
Put cleansing swab btw 3rd & 4th fingers of
non-dominant hand
Giving the SC injection
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Grasp skin to make site firm (non-dominant hand
Hold syringe as if it is a pencil
Insert needle quickly and smoothly at appropriate angle
* 45 degrees- thin people (emaciated)
* 90 degrees- larger people
Transfer non-dominant hand to hold hub of syringe
stable
Inject medication slowly but purposefully
W/d needle slowly but purposefully
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Apply gentle pressure w/swab (do not massage)
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SC injections: common sites
Subcutaneous injection
technique
Intramuscular(IM) injection
SITES & Max. Volume
1. Vastus Lateralis Muscle- vol. up to 2cc
2. Rectus Femoris Muscle- vol. up to 2cc
3. Gluteal Area- up to 4cc
* Ventrogluteal area
* Dorsogluteal area
4. Deltoid Muscle – vol up to 2cc
Intramuscular injection
technique
Supplies
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Medicine
Doctors Orders
Drug Card
MAR
Alcohol pads
Gloves
Patient chart
Getting Ready
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Wash your hands with
soap and water
Gather your needed
supplies
Drawing up the medication
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Check the label on the medicine
Check the expiration date
Inspect for discoloration of the medication
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Remove the cap from
the medicine bottle
Clean the top of the
bottle each time with
an alcohol pad.
Do not touch the top
of the bottle after it is
cleaned with alcohol
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Attach and / or tighten
the needle onto the
syringe
Take the needle cap off
the needle and place the
cap in the boat
Pull back on the end of
the plunger
Draw air into the syringe
equal to the amount of
medicine
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Place the bottle on
the table
Insert the needle into
the rubber stopper on
top of the bottle
Invert bottle with the
syringe attached
Pull the plunger down
allowing the
medication to fill the
syringe
Stop at the desired
amount
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Check for bubbles in the syringe
Remove the bubbles
Pull down the syringe again and fill the
syringe with the correct amount of
medicine
Check again for air bubbles if present
repeat the step above
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Remove the needle from the bottle
Carefully replace the needle cap
Change the needle
Selecting The Site
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Carefully select the site for the injection so
major blood vessels and nerves are
avoided
Use different sites to prevent repeated
injections in the same area
Change sites with each injection
Do not use areas that are bruised, tender,
scarred from surgeries or injury, or swollen
Let’s Take A Break!!!!!!!!!!!
Routes for administering
medications
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Instillations
Eye
 Ear
 Nose
 Rectal
 Vaginal
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Topical
Inhalation
Percutaneous Administration
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Instilling ophthalmic medications
- Administering ointment
- Instilling eye drops
Refer to the textbook
Percutaneous Administration
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Administering ear drops
Refer to the textbook
Percutaneous Administration
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Administering nasal drops and spray
Refer to the textbook
Percutaneous Administration
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Administering vaginal medications
Refer to the textbook
Administering medications via
metered-dose inhalers
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Administering
medications via
transdermal drug
delivery system
Intranasal Medications in the
Prehospital Setting
Insulin administration
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Syringes
Sliding scale
Types of insulin
Validation of dose by another licensed nurse
Sites
Lab data
Mixing insulins
12.0 Heparin administration
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Special technique for injection
Sites
Validation of dose by another licensed
nurse
Lab data
The six rights of Medication
Administration
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Patient
Medication
Dose
Route
Time
Documentation
Client/family teaching
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Drug information
Discharge planning
Return
demonstrations as
required
Properly Handling and Disposing of
Medication Administration Supplies
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Recapping Needles
Biohazard Containers
Wasting medications
Documenting medication
administration
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School or hospital
protocol
Adjunct assessment
data
Evaluation of patient’s
response to drug
Clean Up The Supplies
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Do not recap the
needle
Dispose of other
supplies in the trash
Record date time and
site of injection and
how the patient
tolerated
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Wash your hands
The End
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Questions?????????
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