34.2 - Medication Administration

Question 1

Oral Administration pro’s

Answer 1

Advantages: Easiest, cheap, considered the safest as there can be time to recover medication from the stomach. Most should be swallowed with 60-100mls fluid

Increased or decreased gastric motility
Client must be conscious and able to swallow
Prevent aspiration. Don’t give meds with pt laying down in bed. Have sitting upright, chin down. See Box 34-18 for more suggestions to prevent aspiration

Question 2

Enteral feeding considerations

Answer 2

• wear gloves
• may need to check placement or assess gastric residual volume according to facility policy
• Pt must be in semi-Fowler’s or high Fowler’s position
• must stay elevated for at least 30 minutes following administration
• Some medications such as phenytoin (Dilantin) or carbidopa-levodopa (Sinemet) are not compatible with an enteral feed
• meds must be liquid or crushed, mixed with 15-39mL of eater
• meds must be pre and post flushed

Question 3

Topical administration

Formulations

Answer 3

Dermatologic – creams, lotions, gels, powders, sprays
Inhalations for respiratory tract – inhalers, nebulizers, positive pressure devices
Instillations and irrigations

Question 4

Skin Applications

Answer 4

• wear gloves
• Skin must be cleansed and dried, no open areas. Unless it’s specified
• Assess the skin prior to administration.

Question 5

Why is it important to clean the skin before applying topical medication?

Answer 5

Skin encrustations and dead tissue harbour micro-organisms and block contact of medications with the affected tissue or membrane. Applying new medication over a previously applied medication does little to prevent infection or provide therapeutic benefit to a patient.

Question 6

What would cause a systemic effect to be more likely to occur?

Answer 6

Systemic effects are more likely to occur if the skin is thin, medication concentration is high, contact with the skin is prolonged, or the medication is applied to skin that is not intact.

Question 7

Application; Lotion and Cream

Answer 7

• Use gloves to apply topical skin preparations

* Spread the lotion on the skin with long, smooth, gentle strokes

Question 8

Application: Transdermal Patch

Answer 8

• Opening a transdermal patch medication
• Ensure that the edges of the transdermal patch are secure after applying
• Should have date, time and initials
• Transdermal patches stay in place for a period (nitroglycerin 12 hours, fentanyl 72 hours), many are clear.
• Often remove the old before putting on a new and have to sign for it in the MAR.
• Always document location patch was applied.
• Patch should have the date, time and the initials

Question 9

Documentation for cream/lotion

Answer 9

• Document time that each medication was administered, type of agent applied, strength, and site of application in • MAR immediately after administration, NOT BEFORE. Include initials or signature.
• Document patient teaching and validation of understanding on flow sheet or nurses’ notes in EHR or chart.
• Describe condition of skin before each application on flow sheet or nurses’ notes in EHR or chart.
• Report adverse effects/patient response and/or withheld medications to nurse in charge or health care provider.

Question 10

Administer: Nasal instillation

Answer 10

• Check the nares for irritation in pts who use frequent nasal sprays. Use a penlight. If pt has nasal discharge, wear gloves
• Because with nasal sprays we try to get the timing of the spray on an inhale, it may be easier for pts to administer a spray themselves
• Gently blow nose prior to administration if not contraindicated
• Nasal spray is administered with pt in the sitting position
• Always explain what to expect to patient. May feel burning, or maybe a choking sensation
• occlude one nostril and inhale while depressing medication.
• 2 puffs for each side

Question 11

Documentation for nasal spray

Answer 11

• Document medication name, concentration, number of drops, nares into which medication was instilled, and actual time of administration on MAR immediately after administration, NOT BEFORE. Include initials or signature.
• Document in nurses’ notes patient teaching and validation of understanding.
• Report any unusual systemic or adverse effects/patient response and/or withheld medications to nurse in charge or health care provider.

Question 12

Administer eye medicaition

Answer 12

• Avoid instilling medication directly onto the cornea
• Can spread infection from eye to eye, avoid touching eye dropper or ointment tube to eye
• Each pt should have their own container of eye medication. Do not share
• If patient is to have medication applied to both eyes, use separate tissue for each eye
• Administer eye drops before ointment
• Lie supine or sit back in chair with head slightly hyperextended
• Assess the eyes to see if they need to be cleaned prior to med administration and to get a baseline to see if there is a response. Always cleanse from inner canthus to the outer canthus
• Gently roll container, do not shake as it may cause bubbles
• Hold cotton ball or tissue in non-dominant and gently press downward on boney orbit with thumb and forefinger and ask pt to look up
• Instill eye drops by resting dominant hand on pts forehead and holding eye dropper 1-2cm above conjunctival sac
• Unstill the number of drops prescribed
• Repeat if patient blinks or drop misses
• Ask pt to close eye gently, do not squeeze shut
• If a medication may cause systemic effects, apply pressure to the nasolacrimal duct for 30-60 seconds

Question 13

Administer eye ointment

Answer 13

• Ask pt to look up
• Apply a thin strip along the inner edge of the lower lid from inner to outer canthus
• Close eye and use cotton ball to gently rub lid in a circular motion if not contraindicated

Question 14

Administer intraocculat disc

Answer 14

• resemble a contact lens, but the disc is placed in the conjunctival sac, not on the cornea, and it remains in place for up to 1 week. Usually sits between lower lid and eye,
• To remove grasp with forefinger and thumb and pinch
• If extra medication wipe from inner to outer canthus
• May apply an eye patch if necessary

Question 15

Documentation of eye medication

Answer 15

• Document medication, concentration, dose or strength, number of drops, site of application (left, right, or both eyes), and time of administration on MAR immediately after administration, NOT BEFORE.
• Document objective data related to tissues involved (e.g., redness, drainage, irritation), any subjective data (e.g., pain, itching, altered vision), and patient’s response to medications.
• Report adverse effects/patient response and/or withheld medications to nurse in charge or health care provider.

Question 16

Application: Ear Medication

Answer 16

• Always want to inspect the ear and visible structures for discharge - If drainage assess for ruptured ear drum. Cleanse outer ear if cerumen present or drainage.
• The ear canal is very sensitive to temperature. Warm solution if possible, room temperature may cause vertigo and nausea
• Ear canal must be straightened for solution to reach the deepest parts of the ears external structure. For children under 3 we straighten the ear canal by pulling the auricle down and back
• For adults we pull the auricle upward and outward.

• Pt should be positioned side lying with ear to be treated facing up.

• Ear medications are usually in a solution and instilled by drops.
• Although structures of the outer ear are not sterile, use sterile drops and solutions in case the eardrum is ruptured.
• Don gloves if discharge or drainage
• Do not administer cold drops.
• Avoid forcing any solution into the ear. Do not occlude the ear canal with a medicine dropper because this can cause pressure within the canal during instillation and subsequent injury to the eardrum
• After ear drops given gently massage tragus and have pt stay in position for 2-3 mins
• If needed, place cotton ball into outermost part of ear and remove after 15 mins

Question 17

Documentation of Ear Mediation

Answer 17

• Document medication, concentration, dose or strength, number of drops, site of application (left, right, or both ears), and time of administration on MAR immediately after administration, NOT BEFORE. Include initials or signature.
• Document objective data related to tissues involved (e.g., drainage, tenderness, irritation), any subjective data (e.g., ear pain, ringing in ears, change in hearing acuity), and patient’s response to medications.
• Report adverse effects/patient response and/or withheld medications to nurse in charge or health care provider.

Question 18

Administation Vaginal Meds

Answer 18

• Gloves must be worn
• As mentioned already, vaginal supps are larger and more oval than rectal
• Have patient empty bladder and if able perform peri care prior to administration
• After suppositories inserted, body temperature will melt, and then it can be absorbed, may need to wear a perineal pad
• Patients may be more comfortable with self administration – just be sure to explain procedure well and ensure patient can manipulate applicator
• Keep in mind pts need for privacy and comfort. Use a drape or sheet to cover. Often if pt is prescribed a vaginal medication it will be for an infection. May have foul discharge. May require a perineal pad or require more frequent perineal hygiene.
• dorsal recumbent position
• Administer at bed time to allow medication to stay in place as long as possible. If not at bedtime pt must lie still for at least 10 minutes to facilitate absorption

Question 19

Administration: Vaginal Suppository

Answer 19

Supository
• For a suppository (gloved hand or applicator)
• Remove suppository from foil wrapper and apply sterile water-based lubricant

Creams Foams or Gels are administered with applicator
• Fit the applicator to tube of the medication, and gently squeeze tube to fill applicator with correct amount of medication.
• Lubricate the tip of the applicator with a water-soluble lubricant.

• Use nondominant hand to spread labia and expose vagina. Gently insert the applicator as far as possible into the vagina (5-7.5cm)
• Push the plunger to deposit the medication. Remove the applicator and wrap it in a paper towel for cleaning.
Wipe away any remaining lubricant or medication.
• Stay in position for at least 10 mins

No Applicator
• lubricate your gloved index finger on your dominant hand to insert suppository about 7.5 to 10 cm into vagina. Withdraw finger and clean away extra lubricant for perineal area

Question 20

Why should ear medications be administered at room temperature?

Answer 20

Internal ear structures are very sensitive to temperature extremes; instilling cold drops can cause vertigo (severe dizziness) or nausea and debilitate a patient for several minutes.]

Question 21

Administer: Ear irrigation:

Answer 21

• Assess tympanic membrane. If ruptured ear irrigation is contraindicated
• Pt to be in sitting position with head tilted or side lying with affected ear up
• Use a kidney basin and a towel to catch fluid. Pt to hold kidney basin to ear being irrigated
• Fill with approx. 50ml solution, straighten ear canal and slowly instill irrigating solution by holding tip of syringe 1 cm above ear opening. Allow fluid to drain out. Continue until canal clean or all solution is used

Question 22

Administer: Rectal

Answer 22

• Pt to be in the Sim’s position (laying on left side with right hip and knee bent), drape, use a water-soluble lubricant,
• Complete a rectal check prior to administration to see if feces present. Then dispose of gloves and apply new ones
• Gently palpate rectal wall for feces, if possible have patient defecate prior to administration
• DO NOT PALPATE RECTUM IF PATIENT HAD RECTAL SURGERY
• Remove suppository from wrapper and lubricate rounded end with sterile water soluble lubricant
• Lubricate index finger of dominant hand as well
Insert suppository into rectum while patient takes slow deep breaths and exhales through mouth and ask pt to try to relax sphincter. Use gloved finger to quickly and gently insert the suppository into the rectum at least 2.5 cm beyond internal sphincter… about 10cm in adults and 5cm in children
• When inserting ensure you are against the rectal mucosa, not in the middle of stool where it will be ineffective. Ensure the suppository is placed past the internal anal sphincter and against the rectal mucosa. Improper placement can result in expulsion of the suppository before the medication dissolves and is absorbed into the mucosa.

Question 23

Administer Meter Dose Inhaler

Answer 23

• Insert cannister, remove mouthpiece
• Shake vigouroulsy 5 or 6 times
• Ask pt to take a deep breath and exhale
• Can be administered 2 ways:
• Pt places lips around mouthpiece with opening toward back of throat
• Device is placed 2-4cm in front of mouth (this is considered the best method)
• Depress cannister with index and middle finger on top and thumb at bottom (three-point or lateral hand position)
• Instruct pt to tilt head back slightly and inhale slowly and deeply through mouth for 3-5 seconds while depressing cannister
• Hold breath for 10 seconds
• Remove MDI and exhale through pursed lips

• Second method is the same but person puts lips around mouthpiece

Question 24

Adminiter: Areochamber inhaler

Answer 24

• Attach MDI to spacer and shake vigorously 5-6 times
• Pt to exhale completely before putting lips around mouthpiece of spacer
• Depress cannister spraying 1 puff
• Ask pt to inhale slowly and deeply for 3-5sec
• Hold breath for 10 sec
• Remove spacer from mouth before exhaling

Question 25

Document Inhaler

Answer 25

• Immediately after administration, not before, document on the MAR the medication administered, dose or strength, route, number of inhalations, and actual time administered. Include initials or signature .
• Document in nurses’ notes patient’s response to MDI, evidence of side effects, and patient’s ability to use MDI.
• Report adverse effects/patient response and/or withheld medications.

Question 26

Adminiter DPI

Answer 26

• Remove cover. Do not shake.
• Prepare as recommended from manufacturer
• Ask pt to Fully exhale then then inhale forcefully and deeply through the mouth
• Hold breath for 5-10 seconds
• Wait 20-30 seconds between inhalations of the same medication

• Should be cleansed once daily

Question 27

What is the purpose of adding moisture to the respiratory system?

Answer 27

Adding moisture to the respiratory system through nebulization improves clearance of pulmonary secretions.

Question 28

Nebulizer documentation

Answer 28

• Document medication, dose and strength, route, length of treatment, and time administered on MAR immediately after administration, NOT BEFORE. Include initials or signature. Document patient teaching and validation of understanding on flow sheet or nurses’ notes in EHR or chart.
• Document patient’s response to treatment on flow sheet or nurses’ notes in EHR or chart.
• Report adverse effects/patient response and/or withheld medications to nurse in charge or health care provider.