Medication Medication AdministrationAdministrationWe must get it right the first and We must get it right the first and

every time!every time!

Five Rights of AdministrationFive Rights of Administration

Right patientRight patientRight Right

medicationmedicationRight dosageRight dosageRight route Right route Right timeRight time

Oral MedicationsOral Medications Most commonly used route. Absorption Most commonly used route. Absorption

through stomach and small intestine. through stomach and small intestine. Must first determine client’s ability to Must first determine client’s ability to

swallow medication, and aspiration risk.swallow medication, and aspiration risk. Anxiety, knowledge deficits, and non-Anxiety, knowledge deficits, and non-

compliance in taking medications should compliance in taking medications should all be assessed. all be assessed.

A few tips when preparing oral A few tips when preparing oral medications:medications:

Prepare medications for Prepare medications for one patient at a time. one patient at a time.

Do not open wrapper until Do not open wrapper until at the bedside.at the bedside.

Recheck each medication Recheck each medication package or preparation package or preparation with the order as it is with the order as it is poured.poured.

After medications are After medications are prepared, recheck them prepared, recheck them once again with order once again with order before taking to client. before taking to client.

More tips for oral medications:More tips for oral medications: See that the client receives the See that the client receives the

medications at the correct medications at the correct time. time.

Identify the patient carefully—Identify the patient carefully—especially if they are verbally especially if they are verbally compromised!compromised!

Remain with the patient until Remain with the patient until each medication is swallowed. each medication is swallowed. NEVER leave the medication NEVER leave the medication at the patient’s bedside. at the patient’s bedside.

Check patient within 30 Check patient within 30 minutes to verify response to minutes to verify response to medication! medication!

Know your medications!Know your medications!Before administering any unfamiliar Before administering any unfamiliar

medications, know the following:medications, know the following: Mode of action and purpose of medicationMode of action and purpose of medication Side effects of and contraindications Side effects of and contraindications Antagonist of medicationAntagonist of medication Safe dosage range for medicationSafe dosage range for medication Interactions with other medicationsInteractions with other medications Precautions to take prior to administrationPrecautions to take prior to administration Proper administration techniqueProper administration technique

Calculating Dosage:Calculating Dosage: You have a client who is to have 400mg of You have a client who is to have 400mg of

antibiotic, and you have 200mg tablets.antibiotic, and you have 200mg tablets. Formula is the following:Formula is the following:

Dose on handDose on hand = = Dose desiredDose desired

Quantity on hand XQuantity on hand X

Cross you heart you will never forget!Cross you heart you will never forget!

200 mg200 mg = = 400mg400mg 200X=400 X=2 tablets 200X=400 X=2 tablets

1 tablet1 tablet X X

When using the needle/syringe When using the needle/syringe technique:technique:

Note the needle gauge Note the needle gauge (e.g. 18,20). The bigger (e.g. 18,20). The bigger the number, the the number, the SMALLER the bore size.SMALLER the bore size.

Note the need length Note the need length (e.g. 1, 11/2). Determine (e.g. 1, 11/2). Determine length needed by what length needed by what type of tissue you are type of tissue you are trying to reach. trying to reach.

Size of syringe is Size of syringe is determined by amount of determined by amount of medication.medication.

Angles of different types of Angles of different types of injectionsinjections

Sites for subcutaneous injectionSites for subcutaneous injection

Subcutaneous injectionsSubcutaneous injections Should contain no more than 1 ml of fluidShould contain no more than 1 ml of fluid Give at 45-90 degree angle.Give at 45-90 degree angle. Sites are as follows:Sites are as follows:

Outer aspect of upper armOuter aspect of upper arm AbdomenAbdomen Anterior aspects of thighAnterior aspects of thigh Upper backUpper back Upper ventral or dorsogluteal area.Upper ventral or dorsogluteal area.

Insertion site depends on patient’s preference, Insertion site depends on patient’s preference, nurses preference, and type of medication.nurses preference, and type of medication.

Intramuscular InjectionsIntramuscular Injections Should contain nor more than 3-5ml of Should contain nor more than 3-5ml of

fluidfluid Normal angle of insertion is 72-90 Normal angle of insertion is 72-90

degrees.degrees. Injections sites include:Injections sites include:

Vastus lateralisVastus lateralis VentroglutealVentrogluteal DeltoidDeltoid DorsoglutealDorsogluteal

Sites for intramuscular injectionsSites for intramuscular injections

Insulin and working with vials:Insulin and working with vials: A vial is a glass A vial is a glass

bottle, with a self-bottle, with a self-sealing stopper.sealing stopper.

Swab top with Swab top with antimicrobial swab antimicrobial swab before entering before entering with a needle. with a needle. Inject air.Inject air.

Inject air into the Inject air into the vials to allow fluid vials to allow fluid to be pulled out.to be pulled out.

InsulinsInsulins If insulin is a suspension If insulin is a suspension

(NPH, Lente) roll and (NPH, Lente) roll and agitate the vial to mix it agitate the vial to mix it well. well.

Regular (Actrapid) insulin Regular (Actrapid) insulin should never be should never be contaminated with NPH or contaminated with NPH or any insulin modified with any insulin modified with added protein (medium and added protein (medium and long-acting insulins). long-acting insulins).

Inject air into both vials Inject air into both vials when they are sitting flat, so when they are sitting flat, so that the insulin doesn’t that the insulin doesn’t touch the needle tip. touch the needle tip.

Insulin preparationInsulin preparation Draw up the Regular Draw up the Regular

(Actrapid) insulin first, (Actrapid) insulin first, and make sure it is and make sure it is not contaminated with not contaminated with the other types of the other types of insulin.insulin.

Roll the cloudy insulin Roll the cloudy insulin between your hands between your hands to mix, and then draw to mix, and then draw up without over-up without over-drawing (have drawing (have another R.N. observe another R.N. observe you doing this).you doing this).

Tap while upside down to Tap while upside down to remove bubblesremove bubbles

Clean area, and bunch up skin Clean area, and bunch up skin to injectto inject

Inject the insulinInject the insulin

Massage site after subcutaneous—Massage site after subcutaneous—but not with clexane or heparinsbut not with clexane or heparins

For lab this week:For lab this week: You will need to work through You will need to work through

worksheets on pages 23, 26, 27, 28, worksheets on pages 23, 26, 27, 28, 30, 31, 32-33.30, 31, 32-33.

Have your lab partner/peer sign you Have your lab partner/peer sign you off for each of the above sheets. off for each of the above sheets.

You may also be able to get some You may also be able to get some worksheets signed off when you are worksheets signed off when you are in clinical. in clinical.