ROUTES OF MEDICATION ADMINISTRATION (1).pdf

Module 1 - LAB Routes of Medication Administration GERMAINE ANNE A.BAGUIO RN Instructor PRE ASSESSMENT MEDICATION THERAPY Age Health problems and current reason for seeking care All medications currently taken adverse or side effects Any Use of herbal or natural products for m...

Module 1 - LAB Routes of Medication Administration GERMAINE ANNE A.BAGUIO RN Instructor PRE ASSESSMENT MEDICATION THERAPY Age Health problems and current reason for seeking care All medications currently taken adverse or side effects Any Use of herbal or natural products for medicinal purposes Use of caffeine, tobacco, alcohol, and street drugs Clients’ understanding of the purpose of the medications along with the client’s beliefs, feelings and concerns All medication and food allergies Routes of Administration 1. Oral most convenient, usually less expensive, does not break skin barrier, and administration does not cause stress inappropriate for patients with nausea and vomiting, with reduced GIT motility, and to those who cannot swallow or are unconscious some have unpleasant taste or odor and/or may discolor teeth or harm tooth enamel cannot be used before certain diagnostic tests or surgical procedures can be aspirated by seriously ill patients Routes of Administration Oral Forms Solid – tablet, capsule, pill, powder Liquid – syrup, suspension, elixir, etc. Reminders enteric-coated tablets should not be crushed before administration and do not administer together with antacids, milk or other alkaline substances if the patient vomits within 20-30 minutes after taking the drug, notify the physician; never re-administer the drug without the physician’s order  NURSING ACTIONS Contraindications: vomiting, decreased GI motility, absence of gag reflex, difficulty swallowing, and a decreased level of consciousness. Position: upright at a 90° angle Irritating medication: administered a with small amounts of food. Administration: an empty stomach (30 min to 1 hr before meals, 2 hr after meals).  NURSING ACTION Do not mix with large amounts of food or beverages incase clients cannot consume the entire quantity. Avoid administration with interacting foods or beverages, such as grapefruit juice Follow the manufacturer’s directions for crushing, cutting, and diluting medications. Break or cut scored tablets only. Make sure clients swallow enteric‐coated or time‐release medications whole. Use a liquid form of the medication to facilitate swallowing whenever possible ADVANTAGES & DISADVANTAGES ADVANTAGES DISADVANTAGES Safe Oral medications have highly variable Inexpensive absorption. Easy and Inactivation can occur in the GI tract convenient or byfirst‐pass effect. Clients must be cooperative and conscious. Contraindications include nausea and vomiting. Routes of Administration 2. Sublingual the drug is placed under the tongue where it dissolves the drug can be administered for local effect and is rapidly absorbed in the bloodstream ensures greater potency because the drug directly enters the blood and bypasses the liver the drug must remain under the tongue until dissolved and absorbed; If swallowed, it may be inactivated by the gastric juice Routes of Administration 3. Buccal the drug is held in the mouth against the mucous membranes of the cheek until it is dissolved the drug can be administered for local effect and is rapidly absorbed in the bloodstream ensures greater potency because the drug directly enters the blood and bypasses the liver the drug must remain in the mouth against the mucous membranes until it is dissolved and absorbed; If swallowed, it may be inactivated by the gastric juice  Routes of Administration 4. Topical application of a drug to a circumscribed area of the body includes dermatological medications, irrigations and instillations dermatologic ophthalmic otic nasal NURSING ACTIONS Apply with a glove, tongue blade, or cotton‐tipped applicator. Do not apply with a bare hand INSTILLATION (DROPS, OINTMENTS, SPRAYS) - Generally used for eyes, ears, and nose  Routes of Administration 5. Inhalation - Administered through metered dose inhalers (MDI) or dry‐powder inhalers (DPI) *Dry- Powder Inhalers (DPI) *Metered Dose Inhalers -is a breath-actuated device that delivers the drug in the form of particles contained in a (MDI) capsule or blister that is punctured prior to - is a device that sprays a pre-set use. amount of medicine through the mouth to the airways. METERED DOSE INHALER Dry- Powder Inhalers (DPI) Routes of Administration 6. Nasogastric and Gastrostomy Tubes GENERAL CONSIDERATION: Use liquid forms of medications; if not available, consider crushing medications if appropriate guidelines allow. Do not administer sublingual medications through the NG tube (may give sublingual medications under the tongue). Do not crush specifically prepared oral medications (extended/time‐release, fluid‐filled, enteric‐coated). Administer each medication separately. Do not mix medications with enteral feedings. Completely dissolve crushed tablets and capsule contents in 15 to 30 mL of sterile water prior to administration. Nasogastric and Gastrostomy Tubes NURSING ACTIONS Verify proper tube placement. Use a syringe and allow the medication to flow in by gravity or push it in with the plunger of the syringe. To prevent clogging, flush the tubing before and after each medication with 15 to 30 mL of warm sterile water. Flush with another 15 to 30 mL of warm sterile water after instilling all the medications. Routes of Administration 7. Suppositories Can be used when drug has objectionable taste or odor Absorption is unpredictable Suppositories which are administered via this route tend to soften at room temperature; hence, need to be refrigerated Can either be Rectal/ Vaginal NURSING ACTIONS VAGINAL SUPPOSITORIES RECTAL SUPPOSITORIES Position client's supine with their knees bent and their feet flat on the bed and close to their hips (modified lithotomy or Use glove(s) when admi dorsal recumbent position). nistering/ inserting supp Use the applicator, if available. ositories Insert the suppository along the posterior Patient should lie on the lef wall of the vagina 7.5 to 10 cm (3 to 4 in). t side and Instruct clients to remain supine for at least 5 min after insertion to retain the breathe through the mo suppository. uth a little bit deeper If using an applicator, wash it with soap and water. (If it is disposable, discard it.) Patient should remain o n side lying for 20 minu tes after the insertion Routes of Administration 8. Intradermal Use for tuberculin testing or checking for medication or allergy sensitivities. Use small amounts of solution (0.01 to 0.1 mL) in a tuberculin syringe with a fine‐gauge needle (26‐ to 27‐gauge) in lightly pigmented, thin‐skinned, hairless sites (the inner surface of the mid‐forearm or scapular area of the back) at a 10° to 15° angle. Insert the needle with the bevel up. A small bleb should appear. Do not massage the site after injection. Routes of Administration 9. Subcutaneous Use for small doses of nonirritating, water‐soluble medications, such as insulin and heparin. Use a 3/8‐ to 5/8‐inch, 25‐ to 27‐gauge needle or a28‐ to 31‐gauge insulin syringe. Inject no more than1.5 mL of solution. Select sites that have an adequate fat‐pad size (abdomen, upper hips, lateral upper arms, thighs). For average‐size clients, pinch up the skin and inject at a 45° to 90° angle. For clients who are obese, use a 90° angle Routes of Administration 10. Intramuscular Use for irritating medications, solutions in oils, and aqueous suspensions. The most common sites are ventrogluteal, dorsogluteal, deltoid, and vastus lateralis (pediatric). Use a needle size 18‐ to 27‐gauge (usually 22‐ to25‐gauge), 1‐ to 1.5‐inch long, and inject at a 90° angle. Solution volume is usually 1 to 3 ml. Divide larger volumes into two syringes and use two different sites. Use this technique for because it is less painful and it prevents medication from leaking back into subcutaneous tissue. Use for medications that cause visible or permanent skin stains, such as iron preparations. ADVANTAGES & DISADVANTAGES ADVANTAGES Use for poorly soluble medications. DISADVANTAGES Use for administering IM injections are more costly. medications that have slow absorption for an extended IM injections are inconvenient. period of time(depot preparations). There can be pain with the risk for local tissue damage and nerve damage. There is a risk for infection at the injection site. Z‐TRACK Routes of Administration 11. Intravenous Use for administering medications, fluid, and blood products. Vascular access devices can be for short‐term use(catheters) or long‐term use (infusion ports). Peripheral veins in the arm or hand are preferable. For newborns, use veins in the head, lower legs, and feet. 16‐gauge devices for clients who have trauma 18‐gauge during surgery and for blood administration, 22‐ to24‐gauge for children, older adults, and clients who have medical issues or are stable postoperatively.  Routes of Administration 12. Epidural Use for IV opioid analgesia (morphine or fentanyl). The clinician advances the catheter through the needle into the epidural space at the level of the fourth or fifth vertebra. Use an infusion pump to administer medication. Drug Preparations Tablet preparation of powdered drugs that are compressed or molded into small disks* types enteric-coated: has a special coating that resists dissolution in the acidic pH of the stomach but is dissolved in the alkaline pH of the intestines layered: formed in layers to allow incompatible medications to be administered at the same time scored: indented or grooved that may be used to divide the dose Drug Preparations Capsule a small cylindrical soluble container enclosing a dose of medicine, or the container itself Lozenge a flat, round or oval preparation that dissolves and releases a drug when held in the mouth Syrup a thick sweet liquid used to convey oral medicines; aqueous solution of sugar Elixir a solution of a drug in alcohol and water Drug Preparations Cream non-greasy, semi solid preparation used on the skin Ointment smooth greasy substance used on the skin to soothe soreness or itchiness* Transderm Patch medicated patch applied to the skin** Suppository a medicated mass that melts at body temperature; designed to be inserted into the rectum, vagina, or urethra Drug Preparations Ampule a small sealed glass container that holds a measured amount of medicinal substance to be injected; usually contains one dose of the drug Vial glass or plastic container with rubber stopper and usually contains a number of doses of the drug