Medication Administration (1).pdf

Medication Administration N010 Kim Stiles, PhD, RN Copyright © 2021, Elsevier Inc. All Rights Reserved. Monday Content Review 1. You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may...

Medication Administration N010 Kim Stiles, PhD, RN Copyright © 2021, Elsevier Inc. All Rights Reserved. Monday Content Review 1. You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may experience problems with: A. absorption. B. biotransformation. C. distribution. D. excretion. Copyright © 2021, Elsevier 2 Inc. All Rights Reserved. Systems of Medication Measurement Metric system Most logically organized Meter, liter, gram Never use a trailing zero Household system Most familiar to individuals Disadvantage: inaccuracy Solutions When a solid is dissolved in fluid, concentration is expressed as Units of mass per units of volume (g/L, mg/mL) Percentage (10% solution) Proportions (1/1000) Copyright © 2021, Elsevier 3 Inc. All Rights Reserved. Which of the following numbers is written unsafely? 0.25 mg 25.0 mg 25 U.25 mg QD Types of Orders Standing PRN STAT Now Range One Time Hold Medication Administration Distribution systems Unit dose systems Automatic medication dispensing system [AMDS]) Copyright © 2021, Elsevier 6 Inc. All Rights Reserved. Medication Question 3. If a nurse experiences a problem reading a physician s medication order, the most appropriate action will be to: A. call the physician to verify order. B. call the pharmacist to verify order. C. consult with other nursing staff to verify. D. withhold the medication until physician makes rounds. ’ Copyright © 2021, Elsevier 7 Inc. All Rights Reserved. Medication Question 4. Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following? A. Medication before administering it. B. Medication after administering it. C. Rationale for administering it. D. Prescriber rationale for prescribing it. Copyright © 2021, Elsevier 8 Inc. All Rights Reserved. Effects of Aging on Medication Metabolism Copyright © 2021, Elsevier 9 Inc. All Rights Reserved. Critical Thinking Seven rights Right medication Right dose Right patient Right route Right time Right documentation Right indication Maintaining patients rights ’ Copyright © 2021, Elsevier 10Inc. All Rights Reserved. Routes of Administration Oral routes Sublingual administration Buccal administration Copyright © 2021, Elsevier 11Inc. All Rights Reserved. Routes of Administration Parenteral routes Four major sites of injection Intradermal Subcutaneous Intramuscular Intravenous Other routes Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intraarterial Routes usually limited to physicians Intracardiac and intraarticular Copyright © 2021, Elsevier 12Inc. All Rights Reserved. Routes of Administration Topical administration Skin Mucous membranes Inhalation route Intraocular route Copyright © 2021, Elsevier 13Inc. All Rights Reserved. Oral Administration Easiest and most desirable route. Food sometimes affects absorption. Protect patients from aspiration. Follow special precautions when administering medications to patients with enteral or small-bore feeding tubes Follow tubing connection standards Verify tube is compatible with medication absorption Use liquid medications when possible Flush before, bet ween, and after medications Copyright © 2021, Elsevier 14Inc. All Rights Reserved. Topical Medication Applications Skin applications Ask patients if they take any topical medications. When applying a transdermal patch, ask the patient whether he or she has an existing patch. Wear disposable clean gloves when removing and applying transdermal patches. If the dressing or patch is difficult to see (e.g., clear), apply a noticeable label to the patch. Document patch or medication location on the MAR Document patch or medication removal on the MAR Copyright © 2021, Elsevier 15Inc. All Rights Reserved. Nasal Instillation Methods Spray Drops Tampons Decongestant spray or drops most common Caution patients to avoid the rebound effect Serious systemic effects also develop if excess decongestant solution is swallowed, especially in children Copyright © 2021, Elsevier 16Inc. All Rights Reserved. Eye Instillation Instillation Avoid the cornea. Avoid touching eye or eyelid with droppers or tubes. Use only on the affected eye. Never share eye medications. Intraocular instillation Disk resembles a contact lens. Teach patients how to insert and remove the disk. Teach about adverse effects. Copyright © 2021, Elsevier 17Inc. All Rights Reserved. Ear instillation Eardrops Instill eardrops at room temperature. Use sterile solutions. Check with the health care provider for eardrum rupture if patient has ear drainage. Never occlude the ear canal. Irrigation Performed to remove cerumen that cannot be removed with wax softeners Performed only in cases of hearing deficit, ear discomfort, or to visualize the tympanic membrane Copyright © 2021, Elsevier 18Inc. All Rights Reserved. Vaginal Instillation Vaginal medications Inserted with a gloved hand Suppositories Administered with an applicator inserter Foam Jellies Creams Copyright © 2021, Elsevier 19Inc. All Rights Reserved. Rectal Instillation Rectal suppositories Thinner and more bullet-shaped than vaginal suppositories Rounded end prevents anal trauma during insertion Contain medications that exert local effects A small cleansing enema may be required before inserting a suppository Copyright © 2021, Elsevier 20Inc. All Rights Reserved. Administering Medications By Inhalation Pressurized metered-dose inhalers (pMDIs) Require hand strength and hand-breath coordination May be used with a spacer Breath-actuated metered-dose inhalers (BAIs) Release depends on strength of patient s breath on inspiration Dry powder inhalers (DPIs) Activated by patient s breath Deliver more medication to the lungs ’ ’ Copyright © 2021, Elsevier 21Inc. All Rights Reserved. Administering Medications by Irrigations Irrigations most commonly use sterile water, saline, or antiseptic solutions on the eye, ear, throat, vagina, or urinary tract. Use aseptic technique if there is a break in the skin or mucosa. Use clean technique when the cavity to be irrigated is not sterile, as in the case of the ear canal or vagina. Irrigations cleanse an area, instill a medication, or apply hot or cold to injured tissue. Copyright © 2021, Elsevier 22Inc. All Rights Reserved. Parenteral Administration of Medications Equipment Syringes Luer-Lok Non–Luer-Lok Needles Hub Shaft Bevel Disposable injection units Copyright © 2021, Elsevier 23Inc. All Rights Reserved. Parenteral Administration of Medications Copyright © 2021, Elsevier 24Inc. All Rights Reserved. Parenteral Administration of Medications Preparing an injection from an ampule Snap off ampule neck Aspirate medication into syringe using filter needle Replace filter needle with an appropriate size needle or needless device Administer injection Copyright © 2021, Elsevier 25Inc. All Rights Reserved. Parenteral Administration of Medications Preparing an injection from a vial If dry, use solvent or diluent as needed Inject air into vial Label multidose vials after mixing Refrigerate remaining doses if needed Copyright © 2021, Elsevier 26Inc. All Rights Reserved. Parenteral Administration of Medications Mixing medications Mixing medications from a vial and an ampule Prepare medication from the vial first. Use the same syringe and filter needle to withdraw medication from the ampule. Mixing medications from t wo vials Do not contaminate one medication with another. Ensure that the final dose is accurate. Maintain aseptic technique. Copyright © 2021, Elsevier 27Inc. All Rights Reserved. Parenteral Administration of Medications Copyright © 2021, Elsevier 28Inc. All Rights Reserved. Parenteral Administration of Medications Insulin preparation Insulin is the hormone used to treat diabetes. It is administered by injection because the GI tract breaks down and destroys an oral form of insulin. Use the correct syringe: 100-Unit insulin syringe or an insulin pen to prepare U-100 insulin Insulin is classified by rate of action: Rapid-, short-, intermediate-, and long-acting Know the onset, peak, and duration for each of your patients ordered insulin doses. ’ Copyright © 2021, Elsevier 29Inc. All Rights Reserved. Parenteral Administration of Medications Mixing insulins Patients whose blood glucose levels are well controlled on a mixed-insulin dose need to maintain their individual routine when preparing and administering their insulin. Do not mix insulin with any other medications or diluents unless approved by the health care provider. Never mix insulin glargine or insulin detemir with other types of insulin. Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal. Verify insulin doses with another nurse while you are preparing the injection. Copyright © 2021, Elsevier 30Inc. All Rights Reserved. Parenteral Administration of Medications Administering Injections Each injection route differs based on the types of tissues the medication enters. Before injecting, know: The volume of medication to administer The characteristics and viscosity of the medication The location of anatomical structures underlying the injection site Minimize patient discomfort Copyright © 2021, Elsevier 31Inc. All Rights Reserved. Parenteral Administration of Medications Subcutaneous injections Medications placed into loose connective tissue under dermis Exercise and hot or cold compresses influence rate of absorption Administration of low-molecular-weight heparin requires special considerations. Copyright © 2021, Elsevier 32Inc. All Rights Reserved. Parenteral Administration of Medications Copyright © 2021, Elsevier 33Inc. All Rights Reserved. Parenteral Administration of Medications New technologies for administration of subcutaneous injections Injection pens Needleless jet injection systems Subcutaneous injection devices Copyright © 2021, Elsevier 34Inc. All Rights Reserved. Parenteral Administration of Medications Intramuscular Injections Faster absorption than subcutaneous route Angle of administration: 90 degrees Needle length and site tailored to patient Amounts: Adults: 2 to 5 mL (4 to 5 mL unlikely to be absorbed properly) Children, older adults, thin patients: up to 2 mL Small children and older infants: up to 1 mL Smaller infants: up to 0.5 mL Z-Track method Copyright © 2021, Elsevier 35Inc. All Rights Reserved. Parenteral Administration of Medications Copyright © 2021, Elsevier 36Inc. All Rights Reserved. Parenteral Administration of Medications Ventrogluteal site Gluteus medius Preferred and safest site for all adults, children, and infants V method G method Copyright © 2021, Elsevier 37Inc. All Rights Reserved. Parenteral Administration of Medications Vastus lateralis Used for adults and children Use middle third of muscle for injection Often used for infants, toddlers, and children receiving biologicals Copyright © 2021, Elsevier 38Inc. All Rights Reserved. Parenteral Administration of Medications Deltoid Not well developed in many adults Proximity to ner ves and artery create potential for injury Volume: less than 2 mL Site is three finger widths below the acromion process Copyright © 2021, Elsevier 39Inc. All Rights Reserved. Parenteral Administration of Medications Intradermal injections Used for skin testing (tuberculosis [TB], allergies) Blood supply in the dermis is reduced and medication absorption occurs slowly. Skin testing requires the nurse to be able to clearly see the injection site for changes Use a tuberculin or small hypodermic syringe for skin testing Angle of insertion is 5 to 15 degrees with bevel up A small bleb will form Copyright © 2021, Elsevier 40Inc. All Rights Reserved. Parenteral Administration of Medications Safety in administering medications by injection Needleless devices Needlestick Safety and Prevention Act Safety syringes Dispose of needles and other instruments considered sharps into clearly marked, appropriate containers Copyright © 2021, Elsevier 41Inc. All Rights Reserved. Safety Guidelines For Nursing Skills Be vigilant during medication administration. Verify that medications have not expired by checking labels. Use at least t wo identifiers before administering medications, and check against the medication administration record (MAR). Before administering medication, check for accuracy three times. Clarify unclear medication orders and ask for help if needed. Copyright © 2021, Elsevier 42Inc. All Rights Reserved. Safety Guidelines For Nursing Skills Use the technology available in your agency when preparing and giving medications. Use strict aseptic technique during parenteral medication preparation and administration. Educate patients about each medication. Most of the time you cannot delegate medication administration. Follow safety guidelines to prevent needlestick injuries. Copyright © 2021, Elsevier 43Inc. All Rights Reserved.