Medication Administration PDF

ADMINISTERING MEDICATIONS Vienna Eloisa C. Batara, RN CONTENT 10 Rights of Medication Administration Non-Parenteral Routes Parenteral Routes  COMMON MEDICATION ERRORS Wrong medication Incorrect dose Wrong Client Route Time Administering medication the patient...

ADMINISTERING MEDICATIONS Vienna Eloisa C. Batara, RN CONTENT 10 Rights of Medication Administration Non-Parenteral Routes Parenteral Routes  COMMON MEDICATION ERRORS Wrong medication Incorrect dose Wrong Client Route Time Administering medication the patient is allergic to Incorrect discontinuation of medication Inaccurate prescribing NONPARENTERAL ADMINISTRATION ORAL/ENTERAL Administering medications via mouth (per orem) Can be administered orally as liquids, capsules, tablets, or chewable tablets. Most convenient and usually the safest and least expensive, it is the one most often used Contraindicated to patients with problems of swallowing, decreased level of consciousness or no gag reflex. Have patient sit at a 90 degree angle NEVER crush enteric-coated or time release medications Break or cut scored tablets only NONPARENTERAL ADMINISTRATION TRANSDERMAL Delivered bodywide through a patch on the skin. Sometimes mixed with a chemical that enhances penetration through the skin into the bloodstream without any injection. Place the patch on a dry and clean area of skin (free of hair) Rotate the sites of the patch to prevent skin irritation Always take off the old patch before placing a new one NONPARENTERAL ADMINISTRATION INHALATION Administered by inhalation through the mouth; atomized into smaller droplets than those administered by the nasal route, so that the drugs can pass through the windpipe (trachea) and into the lungs Rinse mouth after the use of steroid inhalations 20-30 seconds between puffs 2-5 minutes between different medications Use spacer if possible to prevent thrush NONPARENTERAL ADMINISTRATION SUBLINGUAL AND BUCCAL Sublingual: under the tongue Buccal: Between the cheek and the gum Absorbed directly into the small blood vessels that lie beneath the tongue Keep the tablet in place until it has completely absorbed DO NOT eat or drink until the tablet has completely dissolved. NONPARENTERAL ADMINISTRATION SUPPOSITORIES Rectal: drug is mixed with a waxy substance that dissolves or liquefies after it is inserted into the rectum Lateral or sim’s position Uses lubricants Insert beyond internal sphincter Leave it in for 5 minutes Vaginal: administered vaginally to women as a solution, tablet, cream, gel, suppository, or ring Supine with knees bent and feet flat on the bed, close to hips Insert the suppository along the posterior wall of the vagina (3-4 inches deep) Stay supine for at least 5 minutes NONPARENTERAL ADMINISTRATION INSTILLATION Eyes Have patient tilt their head back slightly Hold the dropper 1-2 cm above the conjunctiva sac and drop medication directly into the sac Apply gentle pressure on the nasolacrimal duct for 30-60 seconds. Ear Tilt head Warm solution before giving Adult: pull ear upward and outward below 3 years of age: pull ear down and back Nose Patient will lay supine. Do not blow nose 5 mins after instilling PARENTERAL ADMINISTRATION SUBCUTANEOUS Administration of drug in the fatty layer of the body ADVANTAGE: Safer and less painful Suitable for small amount of delicate drugs that needs to be absorbed slowly and steadily Provides longer effect of drug (heparin and insulin) SITES: Upper arm Anterior aspect of the thighs Abdomen Scapular area of the upper back Buttocks Rotate sites of injection to minimize tissue damage Gauge 25, 5/8 inch needle is used for adults of normal weight and is injected at 45 degree angle 3/8 inch needle is used at 90 degree angle for obese patients For children, 1/2 inch needle is used and is inserted at 45 degree angle For insulin injection, do not massage to prevent rapid absorption PARENTERAL ADMINISTRATION INTRAVENOUS Medication enters the client's bloodstream directly by way of vein It is appropriate when medications are too irritating to tissues It can be given through the following method: Large volume infusions of IV fluids Intermittent IV infusion (piggyback) Volume controlled infusion IV push or bolus IV fluid therapy is essential when clients are unable to take food, medicines and fluid orally.  ISOTONIC SOLUTIONS 0.9 NaCL (normal Lactated Ringer’s 5% Dextrose in Sterofundin saline) Water  HYPOTONIC SOLUTION 0.45 NaCl 0.33 NaCl  HYPERTONIC SOLUTION 5% Dextrose in 5% Dextrose in 5% Dextrose in Lactated Ringers 0.45 NaCl Normal Saline  VOLUME EXPANDERS Dextran Plasma Albumin GUIDE VENIPUNCTURE SITE Site chosen for venipuncture varies with the client's age, length of time of infusion, type of solution, and the condition of the veins For adults, veins in the arm and hand are commonly used For infants, veins in the scalp and dorsal foot are often used Larger veins are preferred for infusions that need to be given rapidly Metacarpal, basilic and cephalic veins are commonly used for intermittent or continuous solutions. GUIDE VEIN SELECTION Use distal veins of the arms first Use client's nondominant hand/arm whenever possible Select a vein that is Easily palpated and feels soft and full Natural splinted by bone Large enough to allow adequate circulation Avoid veins that are In areas of flexion Highly visible Damaged by previous use Continually distended Surgically compromised or injured extremities GUIDE CANNULAS Should be sterile. EXAMPLES OF INTRAVENOUS CANNULA GUIDE CANNULAS CANNULA WITH SAFETY DEVICES WATCHOUT INFILTRATION Needle is out of the vein and fluids accumulate in the surrounding tissues Swelling Coldness Pallor Pain around the infusion site Disconnect the IV infusion and restart at different site Limit the movement of the extremity WATCHOUT EXTRAVASATION Needle is out and irritating fluids starts to accumulate in the surrounding tissues Redness Swelling Blanching Cool skin temperature Stop infusion immediately Report to physician Apply thermal therapy Antidote according to protocol WATCHOUT SUPERFICIAL THROMBOPHLEBITIS Due to overuse of a vein, irritating solutions or drugs, clot formation or large bore catheters Local tenderness Acute tenderness Slight edema of the vein Discontinue the infusion immediately Apply warm, moist compress to the affected site Avoid further use of the vein Restart infusion at different site WATCHOUT AIR EMBOLISM Air manages to get into the circulatory system Low BP Fast breathing Dizziness Cyanosis Position the patient on left side lying Notify the MD, especially if patient complains of sudden pain or DOB WATCHOUT SPEED SHOCK May result from administration of IV push medications rapidly Pounding headache Fainting, chills Rapid pulse rate, back pains Refer to the physician and monitor V/S and rate of infusion Use proper tubing, especially to all pediatric clients WATCHOUT INFECTION Invasion of pathogenic organisms into the body Fever Swelling at the IV site Discharge at the IV site Ensure aseptic technique when starting an infusion Change dressing regularly Always wash hands before handling the tubing Administer antibiotics as ordered WATCHOUT CIRCULATORY OVERLOAD Results from administration of excessive volume of IV fluids Engorged neck veins Hypertension Dyspnea Slow rate of infusion Notify the doctor Monitor v/s and rate of IV fluid GUIDE NEEDLE/SYRINGE SELECTION When looking at a needle package, the first number is the gauge or diameter and the second number is the length As the gauge number becomes larger, the size of the needle becomes smaller. The length of the needle is directed by the size of the patient, the selected insertion site and the tissue you are to reach. The size of the syringe is directed by the amount of medication to be given. PARENTERAL ADMINISTRATION INTRADERMAL Administration of a drug into the dermal layer of the skin beneath the epidermis. Has the longest absorption time of all parenteral routes ADVANTAGE: the body’s reaction to the substances is easily visible It provides a local and very little systemic effect SITES: Inner lower arm Upper chest Back - beneath the scapula Buttocks PARENTERAL ADMINISTRATION INTRADERMAL PURPOSE: For skin testing of antibiotics, NSAIDS, opioids and other medications that requires skin testing. Allergy testing TB screening Vaccinations Needle gauge used is #25-27 and 1/4 to 5/8 inch long Needle at 10-15 degree angle level up Inject slowly the small amount of drug to form a wheal or a bleb Do not massage the site of injection PERFORM PERFORM PERFORM PERFORM PARENTERAL ADMINISTRATION INTRAMUSCULAR Administration of drug into the muscle ADVANTAGE: faster absorption of drug and improved bioavailability SITES: Deltoid Not used often for IM injection because it is relatively small muscle and is very close to the radial nerve and radial artery Volume is 0.5-1cc but not more than 3 cc 23 gauge, 1 in needle Client may be positioned sitting, standing, supine or prone PARENTERAL ADMINISTRATION INTRAMUSCULAR Dorsogluteal Use if volume is 1-3 cc, but less than 5 cc. Use a 20-23 gauge, 1 - 1/2 inch needle. The site should not be used for infants under 3 years, because the gluteal muscle are not well developed yet. Position client in side-lying or supine position, with kneed flexed on injection side, or prone with toes pointed inward to rotate femur. PARENTERAL ADMINISTRATION INTRAMUSCULAR Ventrogluteal Uses the gluteus medius which lies over the gluteus minimus muscle Used if volume is 1-3 cc Use a gauge 20-23 needle Position the client in supine lateral position PARENTERAL ADMINISTRATION INTRAMUSCULAR Vastus Lateralis Recommended site of injection for infants Use 22-25 gauge with 5/8-1 inch needle Position the client in supine or sitting position Needle length is 1 or 1 1/2 inches Use needle gauge 20,21,22,23 depending on what type of muscle and age the client have Do not inject on injured tissues Avoid hitting major blood vessels, bone or sciatic nerve PERFORM PERFORM PERFORM PERFORM PERFORM