Medication Administration: Oral, Rectal, Topical, Ophthalmic ...

Medication Administration: Oral, Rectal, Topical, Ophthalmic ...

Medication Administration Automated Medication Administratio n Equipment Pyxis

SureMed MedServe 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

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 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) Types of Oral Medications Tablets Capsules Sublingual Buccal Elixirs

Enteric Coated Precise & Safe Medication Administration 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.) Rectal Medication Administratio n 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 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)

Topical Ointments Otic Medication s MDI

Medications 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

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 Medication Administration Records (MARs) 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 Parts of a Needle & Syringe Syringe: Barrel

Plunger Tip Needle: Bevel Shaft Hub Types of Syringes

Tips of Syringes Luer-Lok Non Luer-Lok Pre-Filled Systems

Assembling the Device Scoop Method Safety Devices Needless Systems

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) 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

Intradermal Injections 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

Deltoid Injections 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 Intramuscular Injections Vastus Lateralis 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 Dorsogluteal Injections What other site is used for IMs?

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

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

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

Regular & NPH Insulins Mixing Insulins NPH Insulin

Regular Insulin Remember !!! If an IM injection requires the administration of > 3cc of medication, divide

the medication up into two equal doses and administer in different sites. Remember !!! Always double-check

Insulin & Heparin amounts/doses with another licensed person (RN/LVN/INSTRUCTOR)

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