Principles of Medication Administration Notes

8/18/2019 Principles of Medication Administration Notes

http://slidepdf.com/reader/full/principles-of-medication-administration-notes 1/19

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-



( 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



• 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



• ?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-



( 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



&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



• 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



• 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



• 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



• 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



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



+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



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@@@



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



;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



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



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



• 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



• 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

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Principles of Medication Administration Notes