Alternate Routes of Medication Administration PDF

ALTERNATE ROUTES OF MEDICATION ADMINISTRATION All references to Pearson are Volume III TOPICAL RECTAL EYE VAGINAL EAR NASAL NEBULIZERS Before Administering Medication Check physician’s order & allergies Hand Hygiene Identify self, identify...

ALTERNATE ROUTES OF MEDICATION ADMINISTRATION All references to Pearson are Volume III TOPICAL RECTAL EYE VAGINAL EAR NASAL NEBULIZERS Before Administering Medication Check physician’s order & allergies Hand Hygiene Identify self, identify patient and explain procedure Focused assessment as it relates to the medication Before Administering Medication Compare the three checks to the MAR Six Rights and Three Always check expiration date Checks; of medications Apply gloves (Medical Asepsis) Safety, Body Mechanics, Privacy Position patient – know positions for each type of administration  Medication Safety Checks Six Rights Right Patient Right Drug/Medication Right Dose Right Route Right Time Right Documentation  Medication safety checks are performed three (3) times during medication preparation Medication Safety The information being checked are the first five (5) rights (not documentation) Checks The medication safety checks are being compared to the MAR Medication safety checks: 2 occur at the preparation area and the final check occurs at the bedside  Administer medication according to procedure Military time is used in most facilities: Example: Administer 0000 – 12:00AM; 0600 – 6:00 AM 1500 – 3:00 PM; 2200 – 10:00 PM Remove Remove gloves Dispose Dispose of Equipment Wash Wash hands Document (sixth right) - MAR Document Site where medication was applied Patient’s response Common Abbreviations prn - as needed or as necessary stat – immediately po - by mouth IV – intravenous IM - intramuscular Quick Review: Contraindications for Oral Meds Gastrointestinal alterations Nausea, vomiting, obstruction, bleeding Inability to swallow Unresponsive or comatose Order for NPO  Actions of the Medication: Local Local Action – The action of the drug is limited to a certain location – Examples Anti-inflammatory ointment applied to a rash Antibiotic cream applied to a skin infection  Actions of the Medication: Systemic Systemic Action – The action of the drug causes changes within a system – Example: nitroglycerin patch – dilates coronary arteries to increase circulation acetaminophen suppository – reduction in body temperature  TOPICAL MEDICATIONS Applied to skin, tissue or mucous membranes Assess skin for: Come in different – Circulation forms: – Drainage – Powder – Color – Ointment – Scars – Cream – Rashes – Lotion – Temperature – Transdermal – Altered skin patch integrity  SKIN APPLICATIONS Assess and Thoroughly assess and cleanse area where medication will be cleanse applied Wear gloves for administration Wear To protect YOU from effects of the medication Use sterile technique when an open wound is present Use Use sterile tongue depressor/sterile gauze/sterile applicator to apply medications  Skin Application: Special considerations with transdermal patches and ointments **Always remove old patch/ointment before applying new patch/ointment—Why is this important? Rotate sites, apply to hairless, clean & dry skin, cleanse area where patch removed, wear gloves for own protection Date, time and initial the patch Always read manufacturer’s directions – Areas of the body for application may differ with each med NEVER cut a transdermal patch – all the medication is released at once – Overdose and accidental death can occur  Topical Administration Considerations for the Older Adult Be aware of the many changes associated with aging skin; take into consideration when applying topical medications: – Apply lotions and creams gently to avoid bruising or damaging the skin – When removing a patch, do so slowly and carefully to avoid tearing or removing skin – Because skin becomes thinner with age, older patients tend to absorb topical medication more rapidly than younger patients  Topical Administration Considerations for the Older Adult It is important when teaching older patients about their medications to make sure they are aware of the signs of toxicity For those who use transdermal patches, emphasize the importance of removing the used patch before applying a new one  INSTILLATIONS & IRRIGATIONS INSTILLATION IRRIGATION Insertion of a Lavage - Washing medication into a Out A Body Cavity body cavity By A Stream Of Nasal, eye, ear, Water Or Other Fluid vaginal, rectal To clean the area Drops ex: eye, vagina Ointments Remove foreign object Apply heat or cold Disks Apply medication Prepare area for surgery EYE Medications – (Ophthalmic) Positioning Supine or sitting position with head slightly hyperextended Minimizes drainage of medication through the tear duct Have patient look up to the ceiling less likely to blink Risk of transmitting infection from one eye to the other is high Avoid touching the eyelids or other eye structures with eye droppers or ointment tubes  Forbidden Abbreviations Related to the Eye DO NOT USE OD – RIGHT OS – LEFT OU – BOTH EYE EYE EYES EYE Medication Administration Instilling Eye Drops or Ointment Place medication into the lower conjunctival sac (so cornea is not harmed) Approach eye from the side Hold eye dropper 1-2 cm (0.4-0.8 in.) above conjunctival sac If eye drop medication is NOT to be absorbed into the body systems (systemic): – Apply firm pressure on nasolacrimal duct for at least 30 seconds  Assessment for Eye Medication Administration Systemic Local Assessments Assessments - – example example Change in BP and Skin Pulse irritation from Change in topical medication respiratory rate Tearing, redness, Change in mental swelling of eyes status after otic medication. Instilling eyedrop into lower conjunctival sac  EYE IRRIGATION Expose lower conjunctival sac Separate the lids – Prevents blinking Hold the syringe about 1” above eye Direct solution into lower conjunctival sac from inner to outer canthus  EAR (Otic) Medication Administration: Indications Instillation Irrigation – to soften earwax – to clean canal – to provide local – to apply heat therapy to – to remove a foreign decrease object inflammation or destroy organisms – to relieve pain  EAR DROPS Position – Place on side with the affected ear facing up – Straighten the ear canal by pulling the pinna upward and backward (see next slide) – Instill correct number of drops along side of the ear canal – Ask patient to remain on their side for approximately 5 minutes to allow for distribution of the medication (then, may loosely apply cotton for 15-20 min; then remove).  Ear Irrigation (Pearson p. 139) Pt. may experience feeling Direct solution gently of fullness, warmth, &/or upward against the top discomfort as fluid comes of the canal in contact with the Loosely place cotton in tympanic membrane auditory canal to absorb Position pt. with head excess fluid turned toward affected ear so fluid can flow from canal Straighten ear canal as previously described Insert tip of syringe into the auditory meatus (opening) Nasal Medication Administration Nose drops or sprays: Indications for use: – Astringent effect - to shrink swollen mucous membranes – Loosen secretions – Facilitate drainage – Treat infections Over The Counter nasal decongestants - use with caution because of rebound effect… this means overuse may increase nasal congestion or swelling  Nasal Medications Position Comfortable position – With sprays, usually upright position – With drops, position on back with pillow under shoulders to allow head to rest back (tilt head backward) Local effects of medication burning, tingling, dripping into throat  Nasal Medication Administration When administering medication: – Ask patient to breathe through their mouth – Hold dropper just above nostril and direct solution into opening and toward the side This method prevents solution from draining into the Eustachian tube – Remain on back for at least 5 minutes to allow solution to come in contact with all nasal surfaces; breath through mouth – Reassess patient after 15-30 minutes Nebulized Medications: Non-Pressurized Aerosol (NPA) Non-pressurized aerosol – solid or liquid particles (medication) suspended in a gas that is distributed as a cloud or mist Non-Pressurized Aerosol Portable In Hospital  Nebulized Medications: Non-Pressurized Aerosol (NPA) Deliver respiratory medications quickly and directly into the airways with each inhalation for quick absorption Available to the body within minutes Assess patient before and after inhalation therapy – Respirations - rate, quality – Breath sounds – Heart rate – Oxygen Saturation Inhaler: Methods of Delivery Hand-held Metered-dose Inhaler/Dry Powder inhalers (MDI): Inhaler (DPI): delivers a specific delivers medication amount of in the form of dry medication in a powder aerosol form Inhaler: Hand-held (dry) Position Position – upright position is best Open and insert Open and insert the capsule (medication) into center of chamber Have Have patient: Exhale completely Place lips tightly around mouthpiece Breathe slowly and deeply for 2-3 seconds Take inhaler out of mouth Hold breath as long as comfortable Repeat Procedure – Metered-Dose Inhaler (MDI) Position – upright position is Position best Standing or sitting Insert canister firmly into the Insert inhaler Hold upright and shake inhaler Hold vigorously for 3-5 seconds To mix medication Have patient: Exhale comfortably Administer Place mouthpiece in mouth with lips closed tightly around the mouthpiece Procedure – Metered-Dose Inhaler (MDI) Have patient (continued): – Press down once on the canister and – Inhale slowly (3-5 seconds) and deeply – Hold breath for 10 seconds – Remove inhaler and exhale slowly – If ordered to repeat Wait 1-2 minutes before repeating procedure Metered Dose Inhaler with Spacer: for use with children or adults The use of the spacer allows the patient to release the medication from the cannister and THEN inhale. After Inhaled Medication Administration: Nursing Considerations Have patient rinse mouth after medication administration Continually assess patient’s technique FYI: If 2 medications are supposed to be given, the Bronchodilator should be given before the other medications. Inhalation Medication Administration: Patient Teaching How to determine if MDI or DPI is empty – Some DPI’s have a mechanism showing how much med is left – Most accurate way: Divide the number of doses in the container by the number of doses the client takes per day – Ordered dose = 2 puffs 4 times/day The canister holds a total of 200 puffs; so…… 2 puffs x 4 x/day = 8 puffs/day » 200 puffs ÷ 8 puffs/day = 25 days – The canister should last ABOUT 25 days  Older Adult and Inhalation Medications Older adult patients often have problems using metered-dose inhalers properly because of the coordination required for depressing the canister at the right time during the breathing cycle. To help alleviate this problem, it is a good practice to teach how to use a spacer device.  Rectal Medication Administration: Insertion of medication into rectum for: – Local effect - usually laxatives – Systemic effect - nausea, fever, bladder spasms, patients unable to take meds orally – Administered by Suppository or Enema – Should not be used if recent history of: Rectal, bowel, or prostate gland surgery Rectal bleeding  Rectal Medication Administration If purpose is to stimulate evacuation (laxative) - should try to retain for as long as possible before expelling – Ex: Dulcolax as a laxative If purpose is to medicate systemically – allow suppository to dissolve – Ex: acetaminophen for fever Rectal Medication Administration Equipment/Supplies  Medication  Gloves  Water-soluble lubricant Position – Side-lying or Sim’s position – Left side preferable (descending colon is on the left side) – Upper leg drawn up toward chest – Visually assess the client’s external anus  Rectal Medication Administration Procedure – Have patient breath slowly through mouth To relax external sphincter muscle – Must place suppository past the internal anal/rectal sphincter muscle and against the rectal wall (about 4 inches) – Stay on side for at least 5 minutes  Older Adults and Rectal Medication Administration Older adult patients might have difficulty keeping the suppository in place due to a loss of sphincter control – The nurse may have to hold the buttocks together gently so that the medication can dissolve and be absorbed. – Teach patients who are self-administering suppositories about infection control techniques for avoiding contact with, and spreading of, fecal material. Vaginal Medication Administration Instilling Cleansing Instilling Cleansing the medications into vagina vagina in the Irrigation following forms: (douche) Suppository Cream Jelly Foam Vaginal Medication Administration IRRIGATION INSTILLATION Washing vagina Medications instilled with a liquid at a into vagina low pressure Relieve infection – Prevent infection Relieve vaginal – Remove an discomfort offensive odor or Itching discharge Pain – Reduce inflammation or Cream, foam, and prevent suppositories most hemorrhage by common  Vaginal Medication Administration Positioning – Dorsal-recumbent - on back with legs bent if possible (lithotomy position) OR – Sims - side-lying position Vaginal Medication Administration Suppository: Lubricate suppository for ease of insertion Insert 2-4” into the vagina with lubricated gloved finger OR may come supplied with an applicator Cream or Foam with applicator Insert applicator 2-4” into vagina Push applicator plunger to deposit medication Vaginal Medication Administration To prevent medication from flowing out of the vagina: Best to administer before bedtime - client will be lying flat for extended period of time. Otherwise, instruct client to remain flat for 5 to10 minutes after insertion May need to apply peri pad Older Adult and…. Eye, ear, nasal and vaginal administration: Many older adult patients can instill these medications independently. For those who cannot, be sure to teach family members or caregivers how to administer the medication safely and correctly