Medication Administration

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Medication Administration
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Automated Medication Administration Equipment

• Pyxis
• SureMed
• MedServe

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Essential Components of a Medication Order

• Clients Name
• Medical Record Number, Room/Bed
• Date time of order
• Name of Medication
• Dosage of Medication
• Route
• Frequency of administration
• MDs signature

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Six Rights of Medication Administration

• Right Patient (check name band, ask client their
  name)
• Right Medication
• Right Dose
• Right Route
• Right Time (frequency)
• Right Documentation
• Clients also have the right to refuse (say no)
  to medication

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The Nurses Responsibility for Medication
Administration

• Assess whether the client can tolerate the meds
• Administer meds accurately timely
• Monitor for side-effects
• Know contraindications
• Client teaching
• Practice the Six Rights(stressed in clinical)
• Evaluation (effectiveness client response)

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Types of Oral Medications

• Tablets
• Capsules
• Sublingual
• Buccal
• Elixirs
• Enteric Coated

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Precise Safe Medication Administration
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Rectal Medications

• Provide for privacy
• Explain procedure to client
• Place client in Sims position
• Apply clean gloves
• Lubricate tip, round end inserted first
• Encourage client to relax , deep breathe
• Insert past sphincter, towards umbilicus
• Have client remain on side at least five mins.
  (hold buttocks together etc.)

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Rectal Medication Administration
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Ophthalmic Medications

• Place HOB down or low Fowlers
• Provide Kleenex for client
• Have client look towards ceiling
• Instill meds in conjunctiva (if gtts)
• If ointment, apply ribbon from inner to outer
  canthus
• Know od, os, ou routes

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Topical Inhalation Medications

• Ointments (absorbed via mucous membranes, skin)
• Inserted (vaginal)
• Instilled (ear/nose gtts)
• Lotions
• Sprays (nasal)
• Pastes (absorbed through skin)
• Inhalation (nebulized treatments, MDI)

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Topical Ointments
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Otic Medications
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MDI Medications
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Medications via NGT/EFT

• Determine whether med comes in elixir form
• Crush all except for EC meds and mix with water
  or other liquid medications
• Stop feedings, clamp tube, apply syringe, unclamp
  tube, flush tube with approx. 30cc water
• Clamp tube, remove syringe, pull plunger from
  barrel, reattach barrel, pour meds through barrel
• Add water as necessary to keep things flowing
  smoothly
• After all meds have been given, flush with 30cc
  water, clamp tube, remove syringe, start feedings

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Documentation

• Always record
• Date, time your initials or signature, title
  (R. Otten, SN,CSUF )
• Medication, route (site) and actual time given
• Reason why med was omitted (ie. refused)
• Clients response to the medication

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Medication Administration Records (MARs)
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Nursing Considerations for Injection Sites

• Assess for adequate tissue muscle
  availability/client body wt.
• Assess where previous injections have been
  administered
• Assess client restrictions
• Assess for quantity quality of medication to
  be administered

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Parts of a Needle Syringe

• Syringe
• Barrel
• Plunger
• Tip
• Needle
• Bevel
• Shaft
• Hub

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Types of Syringes
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Tips of Syringes
Luer-Lok
Non Luer-Lok
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Pre-Filled Systems
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Assembling the Device
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Scoop Method
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Safety Devices
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Needless Systems
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Three Types of Injections

• Intradermal
• - Injected into dermal skin layers
  (Allergy tests, PPDs, etc.)
• Subcutaneous
• - Injected into subcutaneous tissues
  (Heparin, Insulin)
• Intramuscular
• - Injected into deep muscles
• (narcotic analgesics, iron)

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Intradermal Injections

• Given in small doses (i.e.. 0.1cc)
• Common sites include RFA, LFA
• Use 1cc syringe with 26-27 gauge needle, 1/4 -
  5/8 inch long
• Administer with needle at 5-15 degree angle
  with bevel of needle up
• Check for bleb or wheal
• Document site in medication book/nurses notes

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Intradermal Injections
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Subcutaneous Injections

• Given in doses of 0.5cc - 1.5 cc
• Common sites include deltoid, abdomen
• Deltoid landmarks Find Acromium Process and go
  4 to 6 finger-lengths below
• Rotate sites to minimize tissue damage
• Use Insulin/TB syringe for these meds
• For other SQ meds use 1-3 cc syringe,
• 25-27 gauge needle, 3/8-5/8 inch length
• Insert needle 45-90 degrees

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Deltoid Injections
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Vastus Lateralis Injections

• Site well-developed in both adults children,
  lacks major blood vessels/nerves
• Landmark Find Greater Trochanter Knee, divide
  thigh up into three equal quadrants with hand,
  middle 1/3 is the site for injection (lateral
  aspect).
• Good for clients with position restrictions

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Intramuscular Injections
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Vastus Lateralis
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Dorsogluteal Injections

• Rarely used due to Sciatic nerve risk
• Less accessible than other sites (i.e. requires
  side-lying or turned further)
• Landmark Find Greater Trochanter Iliac Crest,
  draw quadrants and administer in upper two
  quadrants

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Dorsogluteal Injections
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What other site is used for IMs?
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Ventrogluteal

• Good for deep injections
• Away from blood vessels and nerves
• Z-track
• Thick, viscous meds
• Antibiotics
• Large volume
• Irritating

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What if

• when giving an IM injection, the aspirate comes
  back with blood.
• What is the correct procedure and why?

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Preparing NPH Regular Insulin

• Swab tops of both vials
• Inject desired units of air into NPH vial, remove
  needle and then inject desired units of air into
  Regular vial
• Invert Regular vial and withdraw desired units of
  insulin (no bubbles)
• Insert needle into NPH vial, invert and withdraw
  desired units of insulin

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Regular NPH Insulins
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Mixing Insulins
NPH Insulin
Regular Insulin
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Remember !!!

• If an IM injection requires the administration of
  gt 3cc of medication, divide the medication up
  into two equal doses and administer in different
  sites.

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Remember !!!

• Always double-check Insulin Heparin
  amounts/doses with another licensed person
• (RN/LVN/INSTRUCTOR)