Alternate Routes of Med Admin

Medication Safety Checks

• Six rights and three checks: right patient, right medication, right dose, right route, right time, right documentation
• Safety checks are compared to the MAR (medication administration record)
• Three checks: first five rights are checked at preparation, second check at preparation area, final check at bedside

Administration Guidelines

• Use military time: 0000 - 12:00 AM, 0600 - 6:00 AM, 1500 - 3:00 PM, 2200 - 10:00 PM
• Remove gloves after administration
• Dispose of equipment safely
• Wash hands
• Document on MAR: site of application, patient's response

Topical Medications

• Applied to skin, tissue, or mucous membranes
• Assess skin for: circulation, drainage, color, scars, rashes, temperature, altered skin integrity
• Topical medications come in various forms: powder, ointment, cream, lotion, transdermal patch
• Cleanse the area thoroughly before application
• Wear gloves to protect oneself from medication effects
• Use sterile technique when an open wound is present

Ear Medications

• Instill medications into the ear canal
• Head positioned with affected ear up
• Straighten the ear canal
• Insert tip of syringe into the auditory meatus

Nasal Medications

• Indications for use: astringent effect, loosen secretions, facilitate drainage, treat infections
• Over the counter nasal decongestants should be used cautiously due to rebound effect
• Position: comfortable position, upright for sprays, back with pillow under shoulders for drops
• Local effects: burning, tingling, dripping into throat
• Ask patient to breathe through their mouth
• Hold dropper above nostril and direct solution into opening
• Remain on back for at least 5 minutes
• Reassess patient after 15-30 minutes

Nebulized Medications

• Non-pressurized aerosol (NPA): solid or liquid particles suspended in a gas that is distributed as a cloud or mist
• Deliver respiratory medications quickly and directly into the airways
• Available to the body within minutes
• Assess patient before and after inhalation therapy: respirations, breath sounds, heart rate, oxygen saturation

Inhalers

• Hand-held inhaler/dry powder inhaler (DPI): delivers medication in the form of dry powder
• Metered-dose inhaler (MDI): delivers a specific amount of medication in aerosol form
• Inhaler position: upright
• Exhale completely before inhaling
• Place lips tightly around mouthpiece
• Breathe slowly and deeply for 2-3 seconds
• Hold breath as long as comfortable
• Repeat

Vaginal Medications

• Instilled into vagina
• Forms: suppository, cream, jelly, foam
• Irrigation (douche): washes vagina with liquid at low pressure
• Instillation: medications instilled into vagina to relieve infection, discomfort, itching, pain
• Position: dorsal-recumbent or Sims' position
• Lubricate suppositories before insertion
• Insert 2-4 inches with lubricated gloved finger or applicator
• Insert applicator 2-4 inches for cream or foam
• Remain flat for 5-10 minutes after insertion
• May need to apply a peri-pad

Older Adults and Topical Medications

• Many older adults can instill these medications independently.
• If they cannot, teach family members or caregivers how to administer safely and correctly.

Infection Control in Vaginal Medication Administration

• Hand hygiene is crucial to minimize infection risk.

Timing for Vaginal Medication Administration

• Before bedtime is recommended to maximize medication absorption and minimize leakage.

Patient Positioning for Vaginal Medication Administration

• Lithotomy position with knees bent and feet flat on the bed facilitates proper administration.

Administration of Vaginal Cream or Foam

• Use an applicator to deposit the cream or foam into the vagina.

Common Misconception About Vaginal Suppositories

• Patients might believe they must lie flat for an extended period after inserting a suppository.

Caregiver Education for Older Adults

• If older adults cannot administer medications independently, caregivers should be trained in proper medication administration techniques.

Action After Inserting a Vaginal Suppository

• It is recommended to remain lying down for at least 15 minutes after insertion.

Essential Education for Infection Control

• Teaching proper hand hygiene is crucial for patients receiving vaginal medications.

Patient Position for Ear Medication Administration

• Side-lying position with the affected ear facing upwards promotes fluid drainage.

Notable Caution With Over-the-Counter Nasal Decongestants

• Prolonged use can lead to rebound congestion.

Preferred Position for Administering Nasal Drops

• Head tilted back allows the drops to reach the nasal mucosa effectively.

Assessment Before Inhalation Therapy

• Assess respiratory rate, effort, and oxygen saturation to gauge the need for the medication.

Ensuring Effective Medication Delivery With a Metered-Dose Inhaler (MDI)

• Use a spacer to improve medication delivery and reduce side effects.

Holding Breath After Inhaling From an MDI

• Hold breath for 10 seconds to enhance medication absorption in the lungs.

Effective Administration of Nasal Sprays

• Tilt the head slightly forward while spraying to target the nasal passages effectively.

Repeating MDI Administration

• Wait 1-2 minutes before administering a second dose.

Purpose of a Spacer With an Inhaler

• Spacers help reduce the deposition of medication in the mouth and throat, increasing lung delivery.

Local Effects of Nasal Medication

• Systemic effects are possible, especially with prolonged use.

Purpose of Wearing Gloves During Medication Administration

• Wearing gloves is a universal safety precaution to prevent the spread of germs and protect healthcare workers.

Recommended Positions for Administering Ear Medication

• Supine position with the affected ear facing upwards is generally recommended

Focused Assessment in Medication Administration

• Assess patient history, allergies, and current medications before administering medication.

Abbreviation Indicating Immediate Medication Administration

• STAT

Critical Step for Ophthalmic Medication Effectiveness

• Ensure proper instillation technique to maximize medication absorption.

Action Before Applying a Transdermal Patch

• Clean and dry the application site to ensure proper adhesion.

One of the Six Rights of Medication Administration

• Right route

Essential Assessment Before Administering Topical Medications

• Assess the skin condition and integrity of the application site.

Abbreviation NOT to Use When Prescribing Medications

• U

Patient Positioning for Medication Administration

• Comfort and safety are essential considerations when positioning a patient.

Order of Administration for Bronchodilator and Another Medication

• Administer the bronchodilator first, followed by the other medication.

Rationale for Administering Bronchodilator Before Other Medications

• Bronchodilators open the airways, facilitating the delivery and effectiveness of other medications.

Possible Consequence of Not Administering the Bronchodilator First

• Other medications may be less effective or trapped in the constricted airways.

True Statement Regarding Administration of Bronchodilators and Other Medications

• Patients should hold their breath for 10 seconds after inhaling a bronchodilator to ensure proper medication delivery.

Possible Consequence of Administering Medications in the Wrong Order

• Reduced effectiveness of the medications or adverse reactions may occur.