MEDICATION ADMINISTRATION LAB

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MEDICATION ADMINISTRATION LAB
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OBJECTIVES...

• DESCRIBE 5 RIGHTS OF ADMINISTRATION
• LIST SAFETY GUIDELINES
• DESCRIBE ROUTES OF ADMINISTRATION
• EXPLAIN EQUIPMENT TECHNIQUE
• DISCUSS CHARTING METHODS
• DISCUSS ASSOCIATED NURSING INTERVENTIONS

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TYPES OF MEDICATION ORDERS

• STANDING routine orders for certain procedures
  with no unusual complications
• PRN orders to be carried out as needed
• SINGLE (ONE-TIME ONLY) only 1 dose
• STAT give immediately

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COMPONENTS OF A DRUG ORDER

• PATIENT NAME (A)
• ALLERGIES (B)
• DATE TIME ORDER IS WRITTEN (C)
• DRUG NAME (USUALLY GENERIC) (D)
• DRUG DOSAGE (E)
• ROUTE (F)
• FREQUENCY DURATION (G)
• ANY SPECIFIC INSTRUCTIONS (G)
• SIGNATURE nurse must sign if verbal order MD
  must sign within 24 hours (H)

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DELIVERY SYSTEMS

• UNIT DOSE
• COMPUTERIZED MEDICATION SYSTEMS

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PYXIS computerized system used at PH
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Unit dose system
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5 RIGHTS

• RIGHT CLIENT
• RIGHT DOSE
• RIGHT DRUG
• RIGHT TIME
• RIGHT ROUTE

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REALLYTHERE ARE 2 MORE!

• RIGHT TO KNOW must explain each drug to patient
• RIGHT TO REFUSE cannot make patient take meds

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BEHAVIORS TO AVOID DURING MEDICATION
ADMINISTRATION

• DO NOT BE DISTRACTED
• DO NOT GIVE OR HOLD MEDS DISPENSED BY OTHERS
• DO NOT POUR FROM CONTAINERS WITHOUT LABELS OR
  DIFFICULT TO READ LABELS
• DO NOT GIVE EXPIRED DRUGS
• DO NOT GUESS ABOUT DOSAGES OR DRUGS
• DO NOT LEAVE BY THE BEDSIDE, OR UNATTENDED
  ANYWHERE
• DO NOT GIVE IF THE CLIENT STATES ALLERGIES OR HAS
  CONCERNS ABOUT THE DRUG
• DO NOT MIX WITH FOOD OR LIQUIDS IF CONTRAINDICATED

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YOUR RESPONSIBILITIES AS A STUDENT NURSE

• PROPER TECHNIQUE SEE SYLLABUS
• RESEARCH MUST LOOK UP ALL DRUGS PRIOR TO GIVING
  TO PATIENT
• SOURCES OF INFORMATION DRUG HANDBOOK, DRUG
  CARDS, PHARM BOOK, MICROMEDIX (on hospital
  intranet)

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ROUTES

• ORAL OR PO
• DO NOT GIVE TO PATIENTS WHO
• ARE VOMITING
• ARE COMATOSE
• LACK A GAG REFLEX
• ARE NPO
• HAVE FEEDING TUBES
• HAVE NG TUBES (UNLESS NG TUBE CAN BE CLAMPED)

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LIQUIDS

• MENISCUS IS THE LINE OF THE DESIRED DOSE

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TRANSDERMAL PATCHES

• PROVIDE CONSISTENT BLOOD LEVELS
• DO NOT CAUSE GI IRRITATION

• PUT DATE, TIME INITIALS ON PATCH
• REMOVE OLD PATCH CLEAN SKIN
• WEAR GOVES!!!!

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TOPICALS

• CAN APPLY TO SKIN WITH GLOVE, TONGUE BLADE OR
  COTTON TIP APPLICATOR
• BE CAREFUL NOT TO CONTAMINATE MEDICATION (NO
  DOUBLE DIPPING!!)

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INSTILLATIONS

• EYE DROPS
• EYE OINTMENT
• EAR DROPS
• NOSE DROPS / SPRAYS

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pull outer ear to straighten ear canal
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Eye Drops or Ointments

• wear gloves
• steady hand holding applicator by resting heel of
  hand on patients forehead
• intill medicine inside lower lid not directly
  on cornea
• after instillation of drops lightly press inner
  canthus to prevent drop from entering tear duct

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Inhaler without Inhaler withspacer spacer
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SUPPOSITORIES (RECTAL OR VAGINAL)

• remove foil
• apply lubricant
• insert with gloved finger
• must push beyond sphincter ridge

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PARENTERAL(OUTSIDE THE GI TRACT)
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• INSULIN SYRINGES CAN ONLY BE USED TO ADMINSTER
  INSULIN
• INSULIN CAN ONLY BE ADMINISTERED IN AN INSULIN
  SYRINGE

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NEEDLE SIZES

• THE LARGER THE GAUGE NUMBER, THE SMALLER THE
  DIAMETER OF THE LUMEN
• THE SMALLER THE GAUGE NUMBER, THE LARGER THE
  DIAMETER OF THE NEEDLE
• COMMON RANGE 18 TO 26
• ALSO VARIOUS NEEDLE LENGTHS IM injections must
  be given with longer needles to put medicine into
  the muscle

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MEDICATION VIAL

• A SMALL GLASS/ PLASTIC CONTAINER WITH A SELF
  SEALING RUBBER TOP

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WITHDRAWING FROM VIAL

• SELECT APPROPRIATE SYRINGE SIZE ATTACH NEEDLE
• CLEAN TOP OF VIAL
• LEAVE VIAL UPRIGHT
• INJECT AIR INTO VIAL EQUAL TO AMOUNT YOU WILL
  GIVE CLIENT (2CC OR 2 MLS) ML CC
• INVERT VIAL AND REMOVE PRESCRIBED AMOUNT OF
  MEDICATION

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AMPULES

• A GLASS CONTAINER WITH A TAPERED NECK FOR
  SNAPPING OPEN AND USING ONLY ONCE

A FILTER NEEDLE MUST BE USED WHEN WITHDRAWING
FROM AN AMPULE. A NEW NEEDLE MUST BE ATTACHED FOR
INJECTION.
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• SELECT APPROPRIATE SYRINGE ATTACH FILTER NEEDLE
• TAP STEM OF AMPULE
• WRAP ALCOHOL PAD AROUND NECK AND SNAP AWAY FROM
  YOUR BODY
• WITHDRAW MEDICATION WITHOUT TOUCHING RIM OF
  AMPULE (CAN TURN UPSIDE DOWN !!!!)
• REPLACE FILTER NEEDLE WITH ADMINISTRATION NEEDLE

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IMPORTANT

• NEVER, EVER RECAP A USED NEEDLE !!!!
• SCOOP CAP BACK ON STERILE NEEDLES ONLY

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ANGLES FOR INJECTION
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INTRADERMAL SITES

• USUALLY CHOSEN SO THAT LOCAL REACTION CAN BE
  OBSERVED
• LIGHTLY PIGMENTED
• HAIRLESS
• USUALLY FOREARM
• THINK TB TESTING

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INTRADERMAL TECHNIQUE

• 26 TO 27 GAUGE NEEDLE
• SYRINGE 1 ML (CALIBRATED IN 0.01 ML INCREMENTS)

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• BEVEL UP
• CLEANSE IN CIRCULAR MOTION
• SKIN TAUT
• 10 TO 15 DEGREE ANGLE
• INJECT MEDICATION SLOWLY TO FORM A BLISTER OR
  BLEB
• DO NOT MASSAGE THE AREA

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SUBCUTANEOUS ROUTE

• SYSTEMIC EFFECT
• SMALLER DOSES
• SITES ABDOMEN, UPPER HIPS, UPPER BACK, LATER
  UPPER ARMS AND THIGHS
• NEEDLE SIZE 25 TO 27 GAUGE
• USUALLY 1/2 TO 5/8 IN LENGTH

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TO ASPIRATE OR NOT ? ! ? !

• ASPIRATION IS DRAWING PLUNGER OF SYRINGE BACK
  BY SUCTION
• (OBSERVING FOR BLOOD BEFORE INJECTION)
• HELPS DETERMINE NEEDLE IN TISSUE OR MUSCLE AND
  THAT MEDICATION WILL NOT BE INJECTED INTO VESSEL
• ASPIRATION CONTRAINDICATED WITH CERTAIN
  MEDICATIONS (HEPARIN AND INSULIN) CONSULT DRUG
  HANDBOOK!!!

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SQ injections

• Choose appropriate site equipment angle 45
  degrees
• Draw medication from vial or ampule
• Pinch up skin between fingers and thumb of
  non-dominant hand
• Insert needle
• Steady syringe use non dominant hand to hold
  barrel
• Use dominant hand to push plunger
• Inject medication

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INTRAMUSCULAR INJECTIONS

• NO MORE THAN 4ml IN SINGLE INJECTION SITE (ADULT
  WITH WELL DEVELOPED MUSCLES)
• CHILDREN ELDERLY MAY LIMIT TO 1 2ml
• USUALLY 11/2 INCH, 21 TO 23 GAUGE NEEDLE

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DELTOID MUSCLE ONLY FOR ADULTS, USUALLY LIMITED
TO 1ml
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VASTUS LATERALIS SITE

• THICK MUSCLE
• NO LARGE VESSELS NEAR
• DOES NOT COVER A JOINT
• DESIRABLE FOR INFANTS CHILDREN (GLUTEAL MUSCLES
  NOT FULLY DEVELOPED)

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LANDMARKS FOR VASTUS LATERALIS SITE
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VENTROGLUTEAL SITE

• RECOMMENDED FOR BOTH ADULTS CHILDREN OVER 7
  MONTHS
• NO LARGE VESSELS OR NERVES
• ACCESSIBLE WITH CLIENT ON SIDE, BACK OR ABDOMEN

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VENTROGLUTEAL SITE
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DORSOGLUTEAL SITE

• COMMON SITE
• SCIATIC NERVE MAJOR BLOOD VESSELS LIE BELOW
  LANDMARKS
• DONT USE FOR CHILDREN UNDER AGE 3 (GLUTEAL
  MUSCLES TOO SMALL)

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DORSOGLUTEAL SITE
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IM injections

• Choose appropriate site equipment angle 90
  degrees
• Draw medication from vial or ampule
• Spread skin somewhat taut using non-dominant hand
• Insert needle
• Steady syringe use non dominant hand to hold
  barrel
• Use dominant hand to aspirate (pull back on
  plunger)
• Inject medication if no blood is aspirated. If
  blood is aspirated, withdraw syringe and start
  over.