Transcript new med administrationx

MEDICATION
ADMINISTRATION
N116
WHAT IS MEDICATION?

Substance used in diagnosis, treatment, cure,
relief, or prevention of health alterations
NURSES’ ROLE IN MEDICATION
Prepare, administer, teach, and evaluate
response to medication
 Evaluate side effects
 Ensure adherence to prescribed regimen
 Evaluate client’s ability to self-administer
 Follow legal provision when administering
controlled substances
 Assume ultimate responsibility for the 6 “rights”

PHARMACOLOGICAL CONCEPTS
Drug names

chemical, generic, brand
 Classification

indicates effect on a body system
 Medication form

tablet, capsule, elixir, suppository, soln

PHARMAKOKINETICS
How do meds enter the body, reach their site of
action, metabolize, and exit the body
 Absorption- passage of meds from site into blood
 Distribution-within body and tissues ultimately
to site of action
 Metabolism-after reaching site of action, med
becomes inactive or less active- easier to excrete
 Excretion- exit body through kidneys, intestine,
liver, lungs, exocrine glands

MEDICATION ACTIONS
Therapeutic effects- intended or desired, expected
physiologic response
 Side /Adverse effects- SE are predictable, often
unavoidable. AE or unintended, undesirable,
unpredicted, severe
 Toxic effects- prolonged intake, accumulates in
blood or tissue
 Idiosyncratic effects- different from normal/under
or over reacts
 Allergic reactions- med triggers release of
antibodies. Anaphylactic reactions
 Med interactions

ROUTES OF ADMINISTRATION
Oral buccal, sublingual
 Parenteral intradermal, subcutaneous,
intramuscular, intravenous, intraosseous,
intraperitoneal, intralpleural, intraarterial
 Topical
discs, baths, patch, ointment
 Inhalation
 Intra ocular

CALCULATING DOSES
Meds are not always dispensed in the unit of
measurement in which they were ordered.
 Double check calculations with another nurse for
high risk meds (insulin, heparin)
 Double check if the answer seems unreasonable

50 tablets? 10cc IM?

TYPES OF ORDERS
Routine medication orders “tetracycline 500 mg
po q 6 h”
 PRN orders “morphine sulfate 2 mg IVP q 2 h
prn incisional pain”
 One-time order “Ativan 1 mg IV x 1 prior to MRI”
 STAT order: “Apresoline 10 mg IV STAT”
 Now order: give within 90 minutes, only once
 Prescriptions:

RECEIVING ORDERS
Verbal or telephone orders
 Read back “TORB”
 Nursing students MAY NOT take telephone
orders
 Hand write or computer entry
 Send order to pharmacy for review

ABBREVIATIONS
NO
YES
Ug
 Cc
 hs
 SC, SQ
 QD
 iu
 MS
 HCl, KCl


Microgram or mcg
 mL
 Bedtime
 Subcut
 Daily
 International unit
 Morphine sulfate
 Hydrochloride,
potassium chloride
THE SIX RIGHTS
Right medication
 Right dose
 Right client
 Right route
 Right time
 Right documentation

PATIENT RIGHTS








To be informed of med’s name, purpose, action,
potential side effects
To refuse any medication regardless of consequences
To have qualified nurse or physician assess a
medication history
To be advised and give consent for any experimental
therapy
To receive labeled medication comfortably
To receive supportive therapy in addition to
medication
To not receive unnecessary medication
To be informed if medications are part of a research
study
NEVER
Guess about the route if not specified
 Document before giving a medication
 Withhold information about a medication
 Give a medication to a patient you are unable to
identify
 Give a medication before assessing the client’s
condition
 Force or threaten clients to take medication

MEDICATION ADMINISTRATION RECORD
“MAR”
 Compare list on MAR to original orders
 Name, dose, route, and exact time med given
 Recording immediately after giving reduces
duplication errors
 Document site of injections
 Circle, yellow or in some way indicate that dose
was deliberately not given, not just ”missed”
 Becomes part of the care chart, is a legal
document

ADMINISTERING MEDICATIONS
Oral
 Easiest and most desirable method
 Most need 60-100 mL of water to be swallowed
 Seated or 90 degree angle upright
 Fully awake
 Tablets may be crushed or capsules opened to
mix with carrier or make solution (some
exceptions)
 One at a time

ADMINISTERING MEDICATIONS
Topical
 Use gloves or applicators
 Cleanse skin with soap and water before
applying
 Spread evenly
 Apply dressing or cover if indicated
 Remove old patch before applying new

INTRANASAL
Best if client self-administers
 Control spray and inhale at same time
 Check nares for irritation

EYE INSTILLATION
 Poor vision, hand tremor, difficulty grasping add
to difficulty with administration
 Cornea is sensitive!\
 Avoid touching eyelids or eye structure
 Use only on affected eye
 Hold lower lid with cotton ball, client looks at
ceiling, dispense into conjunctival sac

RECTAL ADMINISTRATION
Bullet shaped suppositories-rounded end gets
inserted to avoid rectal trauma
 Store suppositories in fridge
 Place past the internal and external sphincter,
against rectal mucosa

INJECTIONS
“parenteral”
 Luer-lock or non luer-lock syringes
 Choose right type and right size of syringe
 Choose right site for injections

INJECTIONS
Subcutaneous –into loose connective tissue under
the dermis.

not as vascular as muscle, absorption is
slower. Contains pain receptors.

back of arm, abdomen, upper leg

27-25 gauge needle, 1-3 mL syringe

3/8-5/8 inch needle

pinch OR spread skin

45-90 degree angle

no aspiration is necessary
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SUBCUTANEOUS INJECTIONS
SUBCUTANEOUS INJECTIONS
Used for small volumes of medication

children up to 0.5 mL, adults up to 1.5 mL
 Insulin

abdomen has quickest absorption, followed by
arms, thighs.

“Intrasite rotation” provides consistent
absorption.
 Heparin, Lovenox (LMWH)

2 inches from umbilicus, “love handles”

do not expel air bubble from prefilled
Lovenox syringe
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INJECTIONS
Intramuscular—into large muscles

fast absorption, due to muscles’ vascularity

risky—verify need and justification

90 degrees

½-3 inch needle dependent on client’s
subcutaneous fat depth

may tolerate 0.5 mL (infant), 1mL
(children), 2 mL(thin or older adults), 3mL(well
muscled adults)

ventrogluteal, vastus lateralis, deltoid

must aspirate

INTRAMUSCULAR INJECTIONS
CHOOSING THE RIGHT NEEDLE FOR IM
1-1 ½ inches long for adult
 ½-1 inch for children or very thin adults
 3 inches for very obese adults
 As the needle gauge gets bigger, the needle
diameter gets smaller. 27 g is very fine needle, 20
g is wider
 Gauge is chosen based on viscosity of injectable
product. Thick, sticky medication is difficult to
inject through a fine needle.
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INTRAMUSCULAR INJECTIONS


Complications such as fibrosis, nerve damage,
abcesses, tissue necrosis, muscle contraction,
gangrene and pain are associated with all IM
injection sites EXCEPT the ventrogluteal site.
Z-track method minimizes local skin irritation by
sealing the medication in muscle tissue. Pull
overlying skin and subcutaneous tissue 1-1/2
inches to the side. Inject needle deeply, aspirate,
inject medication, wait 10 seconds, release skin
after withdrawing needle.
Z TRACK
MINIMIZING DISCOMFORT IN IM
INJECTIONS
Use a sharp-beveled needle in the smallest
suitable length and gauge
 Position the patient to reduce muscular tension
 Select injection site using anatomical landmarks
 Apply topical anesthetic spray or EMLA if
available
 Divert pt’s attention with conversation
 Insert needle quickly and smoothly (DART!)
 Hold syringe steady with needle remains in
tissue
 Inject medicine slowly and steadily

INJECTIONS
Intradermal –into the dermis (skin layer)

usually for testing (allergy or TB)

inner forearm or back

“TB” syringe

5-15 degrees

bevel up, don’t aspirate

“bleb” or wheal

INTRAVENOUS MEDICATION
Mixtures within large volumes of IV fluids

d5 ½ NS with 20K+ @ 150/hour

Small bolus or injection through existing IV
infusion line, or in IV access (“hep lock or saline
lock”)

Morphine 2 mg IVP q 2 hours prn pain

“piggyback” solution of medication mixed with IV
fluids and running through an existing line of
fluids

Ancef 1 g in 500 mL NS IVPB q 8 hours

INTRAVENOUS THERAPY
May be used to give medications
 May be for fluid replacement
 May be used to supply electrolytes or nutrition

THE MOST RAPID means of medication
administration
 The medication enters the bloodstream
immediately
 Any adverse effects, errors in dosing or
preparation will affect the patient immediately

WHY IV THERAPY
Usually the route in “stat” orders
 Can maintain constant therapeutic levels
 Alkaline or irritant medications may damage
muscle and SQ tissue
 Only one “poke” instead of multiple injections

IV MEDICATIONS
Administer at prescribed rate. Nurse is
responsible for verifying rate.
 Observe closely for adverse reactions
 Label all bags
 Check for compatibility between solutions
 Monitor for extravasation, phlebitis, infiltration,
pain at IV insertion site

INFILTRATION V EXTRAVASATION
PIGGYBACK/PUSH
CONTROLLING IV FLOW RATE
SAFETY GUIDELINES
Be vigilant during entire process of preparing
and administering
 Know why each med is ordered for your patient
 Do not allow distractions during preparation
 Verify expiration dates of medications
 Use at least two patient identifiers
 Use identifier technology when available
 Clarify all unclear orders
 Educate patients re adverse reactions or side
effects
 Know your limits and delegation laws.

QUESTIONS


NS is provided in 1 Liter bags. The physician
orders NS IV at 100 mL/hour. How long will the
bag last?
The patient is dehydrated, and his potassium test
revealed K+ level 0f 3.0. The physician orders
“add 20 mEq of Potassium to each liter IV fluids.”
Rather than waste the current bag, the nurse
injects 20 mEq of potassium into the bag and
continues the rate of 100 mL/hour. Discuss
QUESTIONS


A 5 year old child, Tess, needs a DPT booster.
What size needle should the nurse select for this
IM injection?
The nurse can’t find insulin needles and his
patient, Bob, needs insulin before meals. Can the
nurse use a very small syringe with a TB needle
instead?
QUESTIONS
Nancy is a resident at a care center. On Tuesday
she “pocketed” her pills and spat them out into
her breakfast oatmeal and stated she would not
take her pills any more. On Wednesday,

a. the nurse crushes the pills and mixes them
into Nancy’s juice without telling her

b. doesn’t bother with the pills since she knows
Nancy wont take them

tells Nancy she can’t go to Wii Bowling until
she takes her pills

other

QUESTIONS
The surgeon wrote “Morphine 5.0 mg IV q 2
hours prn pain.”
 The pharmacist transcribed this as Morphine 50
mg IV”
 The nurse gave Morphine 50 mg IV because
that’s what it said on the MAR.
 The patient stopped breathing


Who is responsible for this outcome?
QUESTIONS



What do you need to assess before giving PO
meds?
What do you assess before giving injectable
meds?
What do you assess before giving IV meds?
QUESTIONS

Why do we aspirate when giving IM injections?
QUESTIONS
Which age range might have increased
medication toxicity due to slow excretion by the
kidneys
 Infants
 Middle aged adults
 Elderly adults
 Teen agers

QUESTIONS

What medication class is aspirin?
QUESTIONS





Place in order of fastest absorption
subcutaneous
intravenous
intramuscular
intradermal
QUESTIONS

Why would a nurse choose a Z-track method for
an IM injection?