Medication Administration Routes

Medication Administration Routes

• Oral (PO): Medications swallowed.

  • Split or crush unit dose pills, except enteric-coated or sustained-release tablets.
  • Administer liquid medications at eye level.
  • Employ oral syringes for precise small doses.
  • Use pudding, jello, or applesauce for patients with swallowing difficulties.

• Intramuscular (IM): Injection into muscle tissue.

  • Needle length/gauge depends on patient age (adults = longer needle).
  • Ventrogluteal site is preferred for adults, vastus lateralis for infants/children.
  • Inject at a 90-degree angle.
  • Use a syringe ½ cc larger than the dose.
  • Avoid the deltoid, abdomen, and dorsogluteal in infants.
  • Employ the Z-track method (retract tissue before injecting, allow tissue to return to original position).
  • Do NOT massage the injection site.

• Intravenous (IV): Injection directly into a vein.

  • Unfractionated heparin commonly given IV for DVT-related pulmonary emboli.
  • Usual dose: 50,000 units/liter of IV fluid.
  • Administered as a drip infusion.

• Intradermal (ID): Injection just beneath the skin surface.

  • Max volume: 0.5 - 1.0 cc.
  • Needle bevel should face upward, just below the skin.
  • Used for skin tests (e.g., PPD, allergy).
  • Evaluate for induration (hardened area) response.

• Subcutaneous (SC): Injection into the fatty tissue beneath the skin.

  • Slow, sustained release of medication.
  • Short needle, small gauge.
  • Typical dose: 0.5 - 1.0 ml.
  • 90-degree angle for adults, 45-degree angle for children/emaciated adults.
  • Common medications include insulin, heparin, vaccines, and pre-operative meds.
  • Sites: lateral upper arms, abdomen, front mid-thigh, and buttocks (fatty areas).
  • Insulin dosing: units and cc are NOT interchangeable.
  • Example: 30 units = 0.3 cc; 100 units = 1 cc.
  • Draw up regular insulin before NPH insulin when mixing.
  • Ensure no air bubbles before administering NPH.
  • Rotate injection sites to prevent tissue damage.
  • Hypoglycemia assessment and protocol: if patient uses insulin.
    • Signs: sweaty, rapid heart beat, dizziness, trembling.

• Sublingual (SL): Placing the medication under the tongue.

  • Dissolved, absorbed through mucous membrane.
  • Example: Nitroglycerin.

• Buccal: Placing medication inside the cheek.

  • Absorbed through mucous membrane.
  • Example: Nystatin.

• Topical: Local effect applied to the skin or mucous membranes.

  • Examples: creams, Preparation H, cortisone.

• Transdermal: Adhesive patch delivering medication through the skin.

  • Examples: hormones, blood pressure medications.

• Inhaled: Aerosol medication delivered to the respiratory system.

  • Example: Albuterol inhaler.

• Otic: Liquid medication administered into the ear.

  • Pull the ear down and back to straighten the ear canal.
  • Example: ear drops for an infection.

Medication Safety and Administration

• Six Rights: Right patient, right medication, right dose, right time, right route, right documentation.
• Medication Verification: 3 times (pyxis, preparation, administration).
• High-Risk Medications: Narcotics, insulin, heparin, potassium.
• Error Prevention Measures: Barcode scanning, redesigned delivery systems, safety culture, communication.
• Medication Orders: Contain medication name, dosage, route, and purpose signed by provider.
• Medication Assessment: Before administration, assess patient's ability to swallow, GI motility, IV access, and vital signs.

Elimination Notes

• Normal Urine Output: 250-400 ml/ void (adult); 30 ml/hour minimum; 1200-1500 cc/24 hours (adult).
• Factors Affecting Urination: Fluid intake, nutrition, irritants (caffeine, carbonation), diuretics, salt, body position, cognition, disease, medications.
• Altered Urination: Dysuria, polyuria, oliguria, anuria, nocturia, hematuria, pyuria, urgency, frequency, urinary retention.
• Urinary Health Promotion: Adequate fluid intake, good hygiene, muscle tone (Kegels).
• Types of Incontinence: Stress, functional, total.

Diagnostics and Catheters

• Urine Specimens: Random, clean catch, 24-hour, catheter.
• Urinalysis Tests: Specific gravity, reagent strips, pH, glucose, proteins, bacteria, ketones, RBCs, WBCs.
• Urine Culture and Sensitivity: Identifies and tests for bacteria.
• Urinary Catheters: Straight, indwelling (Foley), triple lumen, indications, risks, types (use based on patient need).

Bowel Elimination

• Factors Affecting Bowel Elimination: Nutrition, fiber, fluid intake, medications, disease.
• Altered Bowel Function: Constipation, fecal impaction, diarrhea, incontinence, distention.
• Specimen Collection: Stool sample/culture, O&P, occult blood.
• Diagnostic Tests: Upper GI (barium swallow), lower GI (barium enema), ERCP, EGD, colonoscopy, enema (various types).
• Fecal Diversion: Ileostomy, colostomy, continent diversions.

Patient Safety and Communication

• Normalization of Deviance: Deviance from a standard becomes accepted.
• Swiss Cheese Model: System failures arise from multiple points of vulnerability.
• Communication Principles: Closed-loop communication, active listening, timeliness.
• Teamwork Tools: Staff safety assessment, TeamSTEPPS, timeouts, briefings, shadowing.
• Comprehensive Unit-Based Safety Program (CUSP): Learning from mistakes to improve safety culture.
• Safe Patient Handling: Manual lifting restrictions, use of assistive devices (e.g. hoists).