Transcript University of Tabuk Faculty of Applied Medical Sciences Department

Advanced Fundamentals of Nursing
1st Year Bridging,
Academic Year (AY) 1435—1436 H
Mylin G. Abalus, MSN
Lecturer
Classroom Rules
1. All students must arrive in the classroom before
the scheduled lecture.
2. Students should wear the prescribed dress and lab
coat in class.
3. All students are encouraged to come prepared for
class. Participation is necessary.
4. All mobile device should be turned off or put into
silent mode.
Policies
1. Sick leave reports or any certification for absence
should be given within three days. No special
return demo or quiz or exam will be given if
absence/s is/are not excused.
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Grading System
Assessment method
Midterm Exam
Weight
20% (5% Written exam
+15% return demo)
40% (10% Written exam
+ 15% return demo)
Final Exam
Quizzes, Requirements
(assignment)
Weekly return demo
Total
15%
25%
100
Course Objectives
1. Describe the purposes of the different basic nursing
skills.
2. Explain the principles and rationale of the steps of the
basic nursing skills.
3. Demonstrate strict adherence to aseptic technique
principles and universal precaution.
4. Analyze the importance of doing appropriate nursing
responsibilities such as assessment, evaluation, and
proper documentation when performing basic nursing
skills.
Course Objectives
5. Demonstrate therapeutic communication
skills when performing basic nursing care.
6. Perform a systematic approach when
performing basic nursing skills.
7. Safely administer medications.
8. Demonstrate good documentation skills.
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Text Book
• Kozier, et.al., Kozier's Fundamentals of
Nursing: Concepts, Process, and Practice,
10th ed. New Jersey: Pearson Education, Inc.
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Medication Administration
This chapter will help you
develop the skills needed to
safely administer
medications.
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Topic Outline
1. Terminologies, routes of medication
administration
2. 10 rights of medication administration
3. 3 checks for safe medication administration
4. Steps to follow in medication administration
regardless of route.
5. Steps in administering oral medications
6. Nursing considerations when administering oral
medications
Learning Objectives
At the end of lecture-demonstration, you
will be able to:
Enumerate the different routes of medication administration
Discuss the advantages and disadvantages of each route
Perform steps to follow for all medications, regardless of
type or route
Administer oral medications
Routes of Administration
 Oral (by mouth )
 Sublingual (under the tongue )
 Buccal ( between gums and cheeks )
 Topical (applied to the skin)
 Inhalation ( aerosol sprays )
 Instillation ( nose, eyes, ears )
 Suppository ( rectal, vaginal )
 Parenteral routes ( intradermal,
subcutaneous, intramuscular, and
intravenous )
ORAL MEDICATION
- has systemic effects or local
effects on GIT or both
-Most common, least expensive,
most convenient, safe method
Forms:
- capsule, time-release pill,
sprinkle, enteric coated, liquid
suspension, syrups, elixir
ORAL MEDICATION
DISADVANTAGES:
1- Unpleasant test
2-Irritation of gastric mucosa
3-Irregular absorption from GIT
4- Slow absorption and more prolonged
effect
5-Harm to patient’s teeth in some cases
6-Less potent
ORAL MEDICATION
CONTRAINDICATIONS:
• Patient with vomiting episodes
• Gastric or intestinal suction
• Unconscious and unable to swallow
SUBLINGUAL MEDICATIONS
placed under the tongue; good in
emergencies; absorbed directly
into the blood
BUCCAL
placed between the cheeks and
gums
NOTE :
Instruct the patient not to swallow these medications,
but instead to hold them in place until they are
dissolved completely.
Pulmonary (into lungs)
Medications
 ADVANTAGES
Absorbed quickly
Local and systemic effect
Good in emergencies
 DISADVANTAGES
Can increase HR and cause tremors
Can cause hyperactivity and restlessness
Can have an unpleasant taste and can irritate the
mouth
MDI- difficult to administer correct dose
Ear Medication Administration
OTIC MEDICATIONS:
Instillation: a clean procedure except if
tympanic membrane is not intact , in this
case sterile technique is used
PURPOSE:
To soften wax
To relieve pain
To treat infection or inflammation
Ear Medication Administration
• ADVANTAGES:
– Local effect
• DISADVANTAGES:
– Dose is measured in number of drops
– Use care to slowly squeeze the bottle to
administer accurately
– Person must remain with treated ear up for 35 minutes
Ophthalmic Medications
Administration
• Soothe irritated tissue, dilate or constrict
the pupil, treat eye diseases
• You must be certain you are medicating the
“right” eye
• When verifying the medication order,
identify whether the medication is to be
given in the right eye (OD), left eye
(OS), or both eyes (OU)
Ophthalmic Medications
Administration
• ADVANTAGES:
– Produces local effect
• DISADVANTAGES
– Cooperation of the person is often hard to get
– Some meds may burn
Nasal Medication
Administration
• PURPOSES:
– To treat allergies
– To treat sinus infections
– To treat nasal congestion
Nasal Medication
Administration
ADVANTAGES:
Acts in minutes
Local effect
Quick relief of symptoms
DISADVANTAGES:
Prolonged use may cause rebound congestion
Can lead to chronic swelling of nasal passages
Difficult to obtain pt’s cooperation
Topical (to skin) Medications
- to decrease pruritus, to lubricate or
soften the skin, to cause local
vasoconstriction or vasodilation, to
treat or prevent infection
FORMS:
 OINTMENTS – semisolid preparation of a medication in a
base
 LOTIONS – suspension or emulsion of a medication in a
water or oil base
 LINIMENTS
 CREAMS- semi-solid emulsion in water or oil base
 POWDERS – fine particles
Topical Medications
 Acts within minutes for local effect; one hour for systemic
effect
 ADVANTAGES:
Usually easy to apply
Produces local effect but can be absorbed systematically
over time
 DISADVANTAGES:
Accurate dose can not be specified
May be toxic if swallowed
Powder particles may be inhaled
Transdermal (through skin)
 Acts over a period of time hours to days
 ADVANTAGES:
Systemic effect
Specific dose contained on patch
 DISADVANTAGES:
Not effective in an emergency
May irritate the skin
Absorption of dose may be affected by skin condition
and circulation
RECTAL/VAGINAL
MEDICATIONS
ADVANTAGES:
Can be used to administer medication if person is
unconscious or vomiting
DISADVANTAGES:
Difficult to administer
Embarrassing
Patient must be able to retain
Can not be used if person has lower GI disease
Can be messy
PARENTERAL MEDICATIONS
• - It is the administration of medication rather than
through alimentary or respiratory tract; that is by
needle.
• ROUTES:
Subcutaneous- into a subcutaneous tissue, just
below the skin
Intramuscular – into a muscle
Intradermal – under the epidermis
Intravenous – into a vein
10 GOLDEN RULES FOR ADMINSTERING
DRUGS SAFELY
1. RIGHT CLIENT – medication is given to the right client
2. RIGHT DRUG –medication given was the medication
ordered. The components of the drug order are:
date and time the order was written
drug name or generic name
drug dose
route of administration
frequency and duration of administration
3. RIGHT DOSE – is the dose prescribed for a
particular patient
4. RIGHT TIME – time at which the prescribed
medication should be administered
5. RIGHT ROUTE – necessary for adequate or
appropriate absorption
6.
RIGHT DOCUMENTATION – requires that the nurse
immediately record the appropriate information about
the drug administered. This includes the name of the
drug, dose, route, time and date and the nurses
signature
7. RIGHT ASSESSMENT – requires that appropriate data are
collected prior to administration of the drug.
8. RIGHT TO EDUCATION – requires that the client receive
accurate and thorough information about the
medication and how it relates to his or her particular
situation.
9. RIGHT EVALUATION – requires that the
effectiveness of the medication be
determined by the client’s response to the
medication.
10. RIGHT TO REFUSE THE MEDICATION – clients
can refuse to take a medication
MEDICATION
ADMINISTRATION
RECORD (MAR)
Card - the oldest type of record used for medication
administration
- contains the patients name, room number,
medication, dosage and route
Computer Generated MAR (CMAR)
Inpatient Medication Administration Record
(IMR)
THREE CHECKS:
1. At the time of contact with the drug bottle or
container.
2. Before pouring the drug.
3. After pouring the drug and before returning
to the packaged label.
STEPS TO FOLLOW FOR ALL
MEDICATIONS, REGARDLESS OF TYPE
OR ROUTE
• 1. Checks medication order on MAR
against physician’s order (patient
name, identification number,
medication, dose, route, time, and
allergies).
• 2. Follows agency policies for medication
administration, including the time frame
for medication administration. Most
agencies allow medications to be given 30
minutes before or 30 minutes after the
time indicated in the MAR.
• 3. Knows drug information, including drug
action, purpose, recommended dosage,
time of onset and peak action, common
side effects, contraindications, drug
interactions, and nursing implications.
• 4. Determines if medication dosage is
appropriate for patient’s age and weight.
• 5. Identifies any special considerations for
medication preparation and
administration, such as can the
medication be crushed or a capsule
opened, or should medication be
administered with food or on an empty
stomach.
• 6. Checks expiration date of medication.
• 7. When preparing medication, verifies
correct medication, dose, time, route, and
expiration date.
• 8. Calculates dosage accurately.
• 9. Locks medication cart after removing
medication.
• 10. At the bedside, verifies correct patient
(using two methods of identification,
including armband), medication, expiration
date, dose, route, time, and presence of
drug allergies.
• 11. Remains with the patient until sure
he has taken the medication.
• 12. Does not leave medication unattended
at bedside.
• 13. Reassesses for therapeutic and side
effects.
• 14. Teaches patient about the medication
as needed.
• 15. Document the administration of medication
immediately after administration.
8/6/12 1320 Percocet, 1 tablet given PO.
—K. Sanders, RN
• 16. Evaluate the patient’s response to
medication within appropriate time frame.
ADMINISTERING ORAL
MEDICATIONS
A- assess appropriateness of drug to patient
- review medical history, allergy
assessment, lab data
- assess pt’s ability to swallow
- assess pt’s knowledge of the med
- verify the pt’s name, dose, route, and
time of administration
- assess pt’s vital signs
ADMINISTERING ORAL
MEDICATIONS
• Nursing Diagnoses
– Impaired swallowing
– Deficient knowledge
– Noncompliance
– Risk for aspiration
– Anxiety
ADMINISTERING ORAL
MEDICATIONS
• Goal/Expected outcome:
– Patient will swallow medication
– Patient will experience the desired effect from
the medication
– Patient will not aspirate
– The patient does not experience adverse
effects
– Patient understands and complies with the
medication regimen
ADMINISTERING ORAL
MEDICATIONS
• 1. Prepares and administers medications
according to “Medication Guidelines:
Steps to Follow for All Medications.”
Tablets and Capsules
• 2. If pouring from a multi-dose container,
do not touch the medication. Pour the
tablet into the cap of the bottle, then into
the medication cup.
3. Pour correct number
into medication cup.
4. If necessary to give
less than a whole tablet,
break scored tablet with
hands; use a pill cutter if
necessary. Does not
break unscored tablet.
• 5. If drug is unit-dose, do not open
package; place entire package in paper
(soufflé) cup.
• 6. If patient has difficulty swallowing,
checks to see if the pill can be crushed. If
so, mixes with soft food, such as
applesauce.
• 7. Pours all medications scheduled at the
same time into the same cup, except uses
separate cup for any medications
requiring pre-administration assessment
(e.g., digoxin).
• 8. If patient is able to hold it, places tablet
or medication cup in her hand. If unable to
hold it, place medication cup to her lips
and tip the pill(s) into her mouth.
• 9. Provide liquid to swallow the pills.
Sublingual Medications
• 10. Place or have patient place the tablet
under the tongue and hold there until
completely dissolved.
Buccal Medications
• 11. Place or have patient place the tablet
between cheek and teeth and hold there
until completely dissolved.
Liquids
• 12. Shake the liquid, if necessary, before
opening the container.
• 13. Place bottle lid upside down on the
counter.
• 14. Hold bottle with label in palm of the
hand.
• 15. Pour medication, slightly twists bottle
when finished to prevent dripping.
• 16. If medication drips over bottle lip when
pouring, wipe with a clean tissue or paper
towel—only the outside lip of the bottle.
• 17. Holds medication cup at eye level to
measure dosage.
• 18. Positions patient in high Fowler’s
position if possible; or raises head of bed
as much as allowed; or uses side-lying
position.
• When giving small amounts of liquids (e.g.
<5ml), prepare the medication in a sterile
syringe without the needle or in a specially
designed oral syringe. Label the syringe with
the name of the medication and the route
(PO). Rationale: Any oral solution removed
from the original container and placed into a
syringe should be labeled to avoid medications
being given by the wrong route (e.g.IV). This
practice facilitates client safety and avoids
tragic errors.
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NURSING CONSIDERATIONS ADMINISTERING ORAL MEDS
INFANTS :
1. Oral medications can be effectively
administered in several ways:
• Use a syringe or a dropper
• A medication nipple which allows the infant
to suck the medication
• A spoon or medication cup, for older
children.
2. Never mix medications into food that are
essential. Rationale: Infant may
associate the food with an
unpleasant taste and refuse the
food in the future. Never mix
medications with formula.
3. Place a small amount of liquid medication
along the side of the baby’s cheek and
wait for the infant to swallow before giving
more. Rationale: To prevent
aspiration or spitting out.
4. When using a spoon, retrieve and refeed
medication that is thrust outward by the
infant’s tongue.
Thanks for listening.
Any questions?
Post-lecture Evaluation
What are the three checks before giving
medication?
What are the things to document after giving oral
medications.
Topic for the Next Session
1. Parenteral medication administration
2. Preparation of meds from vials and
ampules