Principles of Medication Administration Notes

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Principles of Medication Administration Lecture NotesMonday 1/11/16

Learning Objectives• Identify types of medication orders and how to read them

• Describe safety measures in preparing drugs

• Describe principles used to prepare and administer oral, parenteral, topical, and inhalation

medications.

• Describe measures for safe administration of medications

• Understand and Implement guidelines for nursing actions to assess and administer

medications to patients.

• Understand and demonstrate interventions to enhance patient care for patients with a

tracheostomy, to include daily care and suctioning.

• Understand and demonstrate interventions to maintain uid balance, to include assessment

and initiation of an I, administering I uids, maintaining I lines using sterile techni!ue.

• Understand and demonstrate interventions to obtain blood samples.

"urses• always responsible for their own actions

• must know state laws regarding nursing practice and medication administration• Never re-cap used needle

• Remember Standard Precautions

Drug Information• not possible to #now or memori$e all drug info

• best way to #now how to administer the medication is to %&'D the pac#age insert

• read nursing implications ( Drug )andboo# * +D% * )ospital +harmacy websites

echanism of Drug 'ction• 'bsorption-

  ( from site of entry to bloodstream

• etabolism-

  ( changing drug to dierent form

• Distribution-

  ( blood ow to the tissues

• &/cretion-

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  ( lungs, #idneys, 0I

• +harmacodynamics-

  ( achieving desired eects

'dverse Drug &ects• "1'

• 'llergic %eaction

• Drug 2olerance

( build up immunity

•  2o/ic eect

( e.g. 2ylenol over 3444 mg e/tremely to/ic to #idneys• 5ide eects

• Drug Interactions

Drug 'ction and the +atient• weight

• gender

• cultural

• religious

( e.g. birth control pharmacist doesnt believe in can refuse to 6ll prescription• genetic factors

• pyschological factors 7 placebos8

• timing of medications

edication Orders 7 "&&D 2O 1"O9 8

• 5tat order : now

• 5ingle order or One;time order- needed for that time period

( e.g. u shot• 5tanding order

• +%" order-

( as needed you and or patient ma#e that decision( e. g. pain medication

+arts of edication Order : ust )ave 'LL +arts

• "ame of +atient

•

Date < 2ime order is written• "ame of Drug

• Dose < =re!uency

• %oute

• 5ignature of +rovider

>>>>>>If 5omething is issing from +rescription : ?all and 's#@>>>>>>>>>>

&/ample of an Order- )ospital• Jane Doe

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•  February 14, 2016

• 000

•  Flucona!ole 1"0mg #$ one%time only

• &his '( please

•  

• John )mith (D

*hat is wrong with the abo+e order

+rescriptions• must have Date of Airth

+rescription &/ample• Jane Doe

• D$-. 4%%1/

• January 10th, 2016

• Flucona!ole 1"0mg #$ one%time only

• Dispense 1•  o refills

• John )mith (D

'% or &'%

+atient Identity•

must have B identi6ers•  C?')Os "ational +atient 5afety 0oals : %e!uired by Coint ?ommission

• "ame

• ID "umber often on ID )and

• +hoto ID

e.g. patient isnt awa#e : picture• Or other person;speci6c ID

• "O2 room number

%ights of edication 'dministration EU52 1"O9F

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• ?hec#ing the medication orders for transcription errors, allergies, interactions

e.g. if you see med listed patient is allergic to ma#e sure to call doctor and have itremoved

• 'fter preparing medications "&&% leave the medications in the room for the patient to

ta#e later

•  Gou U52 9I2"&55 the patient ta#ing the medications to document they were given

• Do "O2 give medication I have not pulled myself 

H ?hec#s Aefore 0iving a edication

. 9hen reaching*pic#ing up medicationB. ?ompare to the &'% : be sure it is right@H. Aefore giving to the patient; be sure it is right

5IJ %ights of edications E 1"O9 F

13 ight (edication

23 ight #atient

53 ight Dosage43 ight oute

"3 ight time

63 ight eason

3 ight Documentation

Oral edications

. 'ssess-• 'llergies

• 5wallowing

• ital 5igns, lab results

e.g. Alood +ressure edicine ( always chec# blood pressure before giving and if on the edge and I am

worried wait and hour and rechec# blood pressure againB. +atient #nowledge and needed educationH. &!uipment- cups, spoons, pill cutters, water to drin#, crushing tool

5pecial 5ituations• ?rushing-

( only way to #now if you can crush loo# it up( slip into pudding

• 5yringe or Dropper-

( ma#e certain the syringe is oral syringe and not I syringe

• ?hildren-

( tiny amounts

• Auccal-

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( putting medication in the chee#

• 5ublingual-

( give medication under the tongue

=eeding 2ubes and edications

  ( Li!uid edication K

. Loo# to see if you can crush medication and if you cant call pharmacy and see if can getli!uid

B. ?hec# +lacement of the 2ube( pull bac# on syringe and see if patient is gagging and if so it may be in patients

lungs

H. ?rush edicine and i/ it with 9ater

3. =lush-adultM;H4 ml

  childM;4 ml

M. 0ive meds separately < =lush between

 2opical edications

Dermatologic-• lotions : use cotton balls

• patches

( do not put estrogen patches on someones breast not cause it but trigger it( ta#e old patch o

( new patch put a sharpie dot on it if patient is in hospital• spray

• powder

( use caution to not sha#e and inhale( dont sha#e in front of patients face they may breathe it

• transdermal

&ye 'dministration• wear gloves and ma#e sure eye med

• place in lower conjunctival sac

• place pressure over inner canthus to prevent systematic absorption

• allow to absorb before rubbing

• &ye Irrigation- ( ushing w* water

• 'dministering &ye ed into ?onjunctival 5ac

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&ar edicines• ear drops-

• ma#e certain to have right temperature

• submerge into warm water to get it room temperature

•dont put hot or cold into ear

• 9ait M minutes before changing sides > important>

• assage tragus to encourage movement of medicine

• ?otton ball used to #eep medicine from rolling down nec#

• Irrigation

"asal edications• gloves

• #leene/

• =owlers, sitting with head up and slightly tilted bac#

• depress bottle* dropper to administer

• hold position for a few minutes

• provide #leene/

aginal 'pplication• gloves and hand hygiene

• creams, foams, tablets

• vaginal applicator

• remain supine for M;4 minutes to absorb

• peri pad

%ectal 'pplication• suppositories and enema

• use inde/ 6nger to insert H;3 inches

• lubrication• encourage to remain on side for M or greater minutes may have to tell patient to hold the

medicine in• retain as directed

'sthma edications

• read instructions for appliance

• add spacer, prn

• sha#e med if needed

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• 9'"2 to I")'L& not swallow >>>> I+O%2'"2>>>>

• 'dminister with inta#e of breath

• place ;B inches from open mouth

• If steriod : rinse mouth after medication

+arenteral edications 7 shots 8

• I : intramuscular( into muscles( N4; degree angle

• 5; subcutaneous

  ( into fat of the body( 3M;degree angle

• Intradermal

( into s#in( 4;M degree angle

• I : going into the vein

• 9ear clean gloves when administering the medication

• ?lean site with alcohol

• Length of y "eedle is "U%5I"0 Decision >>>>

▪ loo# at patient and assess

5hots• 6rst apply gloves and clean site

• use a swift dart li#e motion

• do not bounce or hesitate

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• inject the medicine and remove the needle

• use safety features of needle*syringe

• dispose of in sharps

5yringes < "eedles

+arts of the syringe• tip

• barrel

• plunger

luer loc# 7 screw on8 or non;luer loc#pre6lled syringe e.g. u shotinsulin syringe >>> ( measured in units

only use syringes with units on side for insulin>>>>>"eedles are classi6ed by 0'U0& PQ;PH4the larger the P 7 H48 the smaller the needle diameter

&.0. gauge P H4 is so tiny it used for "I?U not strong enough to go into muscle the needlewould bend if used on adult

Drawing Up edications

• 'mpule-

▪ glass : be careful

• "eed a =ilter "eedle which will be changed A&=O%& injecting the patient

• ial- clean the top with alcohol

• ?hec# Order and inject air 7 in the amount of medication you will ta#e out8 into the vial

5ubcutaneous 5hot +icture: super s#inny patiente.g.RAunchingS

5 5ites

• bac# of arm

• side of the arm

• within the stomach : B inches from umbilicus

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• thighs last resort

Insulin• given in very small amounts

• usually given 5

• can be given I or inhaled or 5 with a pump

• oral medication; dont worry about this however

Insulin B "urses erify

• dierent types of insulin mi/ed in one syringe

• ?lear before ?loudy >>>>>

• %egular Insulin clear

•

"+) cloudy due to added proteins 7 proteins added to slow down absorption long acting8• Order-

  T units %egular T units "+)• 5tart with "+) ( 'dd 'ir ( 0o to % add air

• Draw up % then add "+)

Intradermal

• administer medication into the dermal layer of the s#in just below the epidermis

• M degrees, bevel up

• the hole of the needle a#a bevel

• forms a wheal or bleb 7 loo#s li#e a blister8

• e.g. allergy shots , 2A shots

Intramuscular- I

• injection into the muscle

• need a needle that will reach the muscle

• >> U5?L&, "O2 vein, so aspirate

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• aspirate

( pull bac# the plunger to ma#e certain needle not in veinif you see blood in syringe ta#e the needle out

• 5ites Used for Intramuscular Injections

• entrogluteal ( adults ( right on hip not on butt 6nd top of trochanter and 6nd top

of hip bone it is in triangle >> preferred site of I shots>>>> DO "O2 U5& DO%5O0LU2U&L DO "O2 0O A'?1 2)&%&>>

• astus Lateralis ( in pediatrics give most of the time the muscle running up thigh

• Deltoid ( in patients arm

;trac#• purpose is to #eep medicine inside the s#in so it will not come out

• certain medications

• can stain the s#in

%&&A&%

5afetyDo not %ecapUse 5harps ?ontainer

Intravenous !erapy

5olutions

I tubing- drop factor and length

Drop =actor

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how many drops mldierent droppings have dierent factors : read the pac#age

VR"AS#NS # $A%" %"N#&S A''"SS

V 2o balance uids in the body

V 2o administer medications

V 2o have access to the circulatory system

+repare the 5olution

. ?hec# orders to verify solutionB. Obtain bag if I uids, compare to orderH. ?hec# contents for e/piration date3. Obtain correct I tubing, note drip factor and length of tubingM. %emove caps 7 sterile8 o bag and tubing

T. 5pi#e the bag, R+rime the lineS and let uid run through tubingW. ?lamp

If giving blood use big enough for cells to get through ( Q gauge

9ho decides needle si$e and how longX ; "urse

I ?atheters

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+I??peripherally inserted central cathetermedication goes directly into the hearteverything push through goes into the heartbig deal

+I?? Linese.g. picture of R+ower +I??Son used for drawing labsone for pushing meds

nurse practioners and doctors insert +I?? lines+I?? line changes are sterile procedure and done using sterile techni!ue%emoval of a +I?? line re!uires special care to limit air embolism>>>"&&% U5& +I?? LI"& 9I2)OU2 +%O=&55O% +%&5&"2>>

I 5ite +reparation;clean the s#in

=inding an I 5itelocate vein : put tourna!itlower e/tremity

apply warmth : circulation and dilationtap veinopen and close 6stuse of vein 6nder

Intravenous 5ites for 'dult'rm'lways 2owards the )eart

I 5ite on Infant

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into s#ull

5tarting an I

@@@@@@ 'L9'G5 start an I in the direction of the heart@@@@

. 'pply tourni!uet

() 'lean s*in at site for +, seconds or accordin to policy) Allo. to dry

H. )old s#in taught below sight with non;dominant hand

3. Insert I catheter at a 4;M degree angle

M. Loo# for blood return in the ash;bac# chamber

Vedications can be added to an I line

V>>>>>>U52 use 4cc syringe >>>>>>

VI medications are administered I piggybac# or direct I push

V'L9'G5 must #now the rate the medication is to be infused over

 ( ma#e certain medication does not stay in line

V"&&% guess the I rate on a medication, loo# it up.@@@'L9'G5@@@

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Va#e sure medications are compatible

=lushing an I Line

V=lushing an I line provides access and assesses patency of the line and vein

VUse a 4 cc syringe and normal saline

V5ome hospitals use pre;6lled syringes

Valves on lines U52 be cleaned before use

5etting and I %ate

VUsing roller clamp, you will adjust the rate

V 2he rate will be in the doctors orders

V 2he rate is usually set on the I pump machine

V?an be hand calculated, using the D%O+ factor

V9ill practice in lab

+iggy bac# meds

( I meds that will be added to regular lines

 ( the )I0)&52 bag will ow 6rst

?hanging a dressing on an I site

• wear gloves

• #eep I stable

• remove old dressing and apply new

• re!uires a mas# for all in room

• +I?? re!uires special #it and sterile techni!ue

%emoving an I

'ssessing an I 5ite >>> U52 1"O9>>>>

• In6ltration

: needles has wiggled out of s#in : cannot save it : remove I

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 ;can be swollen or pale

• +hlebitis : see red line, redness

 : remove I•  2issue trauma at site ( it is torn or ripped

• Infection- ( indication of any pus on the scene if you see this let doctor

#now so pt can go onantibiotic . 5tart new I somewhere else

• 5eptic; same as infection in the bloodstream ( patient is sic# ( pull it out

and call .D

?aution for "ursesalways wear gloves when starting an Ialways dispose of needles in sharp bo/always chec# patients allergiesremember the medication is going into the patients heart you can get it bac#be accurate

rac!eostomy

partsobturator

inner cannula

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outer cannula

 2he obturator 6ts into the inner cannula which 6ts into the outer cannulaonly time you use this it is for insertion

 2racheostomytemporary or permanentcued or uncuedplaced in O% or I?U under sterile techni!uelocal anesthesia

>>> always over head of bed>>>if it comes bac# out ( put bac# in

0%U always have emergency trach bo/( so will have one of same si$e and one smaller si$e because it can close up before your eyes

?ued or ?uYess( how it is held into patient( depends on patients nec#( cued trach on ventilator patients( will downsi$e to cuYess before decanulate patient

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 2racheostomy ties or velcro fastener – change gau$e

 – change ties

0oal- aintain 'irway

•

suction e!uipment• o/gygen

• spare tracheostomy and obturator 7 insertion piece8

• call bell

• always get someone in there sooner than later

• this is N situation

5uctioning

done with sterile techni!ue

rac!eostomy 'are

Al.ays Sterile ec!niue• when suc#ing secretions also suc#ing air out>>>>

• tal# to patient

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• let them #now

• tell patient if it gets too much communicate with me

• set up communication system so you #now patient needs to catch breath

• provide safety

• provide airway

• provide sterile techni!ue

• provide communication to patient

0e .ill be c!ec*in o 

•  2rach ?are

• I starts

• )anging I bags

Robillard LR' '!ec* # ;giving medications

Adult $ealt! 1 Readin and S*ills Modules 0ee*

1 • %eadings in- 2oost3 'ra.ford 4 (,15) 7undamentals of Nursin 

Please read t!e follo.in information by LR' dates) !an*you)

• ?hapter HM edication 'dministration

• ?hapter HQ O/ygenation and 2issue +erfusion 72racheostomy cleaning and suctioning8

• ?hapter HN =luid, &lectrolyte and 'cid;Aase Aalance 7I starting and uid administration8

• &lsevier &ssential s#ills on &lsevier*&volve site-

• &volve 5#ills odules

• edication 'dministration

• 'dministering &ar edications

• 'dministering &ye edications

• 'dministering Intradermal Injections

• 'dministering Intramuscular Injections

• 'dministering Oral edications

• 'dministering 5 Injections

• 'pplying an &strogen +atch and "itroglycerin

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• Ointment

• 'pplying 2opical edications

• Documenting edication 'dministration

• Drawing up more than One 2ype of Insulin

• &nsuring the 5i/ %ights of edication

• 'dministration

• )andling edication ariations

• Inserting a %ectal 5uppository

• +reparing and 'dministering Insulin

• +reparing Injections from a ial

• +reparing Injections from an 'mpule

• Using a dry +owder Inhaler

• Using a etered Dose Inhaler

•

I 2herapy• 'dministering I edications by ini;Infusion

• +ump

• 'dministering edications by +iggybac#

• 'dministering edications Ay Intravenous

• Aolus 7+ush8

• Drawing blood and administering =luid

• Dressing the Infusion 5ite

• +erforming enipuncture

• +reparing an Infusion 5ite

• %egulating an Intravenous Infusion

•  2roubleshooting Intravenous Infusions

• +roviding 2racheostomy ?are