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clinical skills JM > administering medications > Flashcards

administering medications Flashcards

1
Q

types of routes

A

Systemic
- enteral
- parenteral

Local

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2
Q

why so many routes?

A
  • Properties of the drug
  • Chemical properties
  • Absorption
  • Breakdown
  • Onset/activation
  • Convenience
  • Cost
  • Patient factors
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3
Q

The “Six Rights” of administration

A
    1. Right patient
    1. Right medication
    1. Right dosage
    1. Right time
    1. Right route
    1. Right documentation
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4
Q

means the administration of drug via alimentary tract (2 ends)

A

enteral route

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5
Q

Enteral routes include:

A
  • Oral administration (swallow)
  • Sublingual administration
  • Buccal administration
  • Nasogastric route
  • Rectal administration
  • Colonic administration
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6
Q

hepatic metabolism of a pharmacological agent when it is absorbed from the gut and delivered to the liver via the portal circulation

A

first pass effect

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7
Q

effect of a greater first pass effect

A

the greater the first pass effect, the less the agent will reach the systemic circulation when the agent is administered orally.

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8
Q

when do you use rectal route

A

when oral ingestion is precluded by vomiting or when the patient is unconscious. About 50% of the drug passes through the liver, thus this way is even better than orally. however absorption is often irregular and incomplete.

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9
Q
  • Drugs are well absorbed across mucosal membranes.
  • Mucous membranes are highly selective and differ in absorptive
    activity and sensitivity.
  • Avoids gut breakdown and irritation
  • Allows for drugs w/short ½ lives
  • Reduces multiple dosing
  • Improvement in patient compliance
A

transmucosal administration

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10
Q

Buccal cavity
* Sublingual tablets
* Rapid absorption
* Usually systemic unlike other mucosal absorption routes

A

sublingual and buccal administration

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11
Q
  • Some drugs (in the form suppository, tablet, cream, jelly, or
    pessary) are administered into the vagina for the treatment of local
    infection.
  • Spermicidal agents
  • Radioactive needle (caesium) implantation for the treatment of
    carcinoma cervix
  • Normal saline to test the patency of fallopian tube
A

vaginal administration

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12
Q

Alprostadil urethral suppository is used to treat men who have
erectile dysfunction

A

urethral administration

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13
Q

routes other than enteral

A

parenteral

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14
Q
  • Means outside the intestine
  • Delivery medication via a route other than the digestive tract
  • Most common Parenteral route is injection
  • Other routes include:
  • Intravenous (vein)
  • Trandermal (through the skin)
  • Transmucosal (mucous membrane)
  • Topical (on the skin)
A

parenteral

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15
Q

This injection places
medication/solution the loose connective tissue just under the dermis.

A

subcutaneous (SC)

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16
Q

This injection places the
medication into the dermis just under the epidermis.

A

intradermal (ID)

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17
Q

This injection places the
medication into the body of a muscle.

A

intramuscular (IM)

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18
Q

This injection places the
medication/solution into a vein through an existing IV line or a short venous access device (saline lock)

A

intravenous (IV)

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19
Q

angle of subcutaneous injection

A

45

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20
Q

angle of intradermal injection

A

10-15

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21
Q

angle of intravenous injection

A

25

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22
Q

angle of intramuscular injection

A

90

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23
Q
  • Can deliver if the patient is unconscious, unresponsive, irrational, agitated, dysphagia, NPO, trauma, wired jaws, postsurgery, ileus, GI irritation
  • No GI irritation
  • Not altered by gastric acids
  • Exact dose can be delivered directly to the site
  • EMERGENCY SITUATIONS - provide rapid effect
  • DRUG CHARACTERISTICS -
  • drugs rendered ineffective by GI tract pH or digestive enzymes such as insulin.
  • drugs not absorbed well by other routes.
  • drugs too toxic or too irritating by other routes
A

advantages of parenteral

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24
Q

disadvantages of parenteral

A
  • Infection
  • Allergic reactions may occur more rapidly and be more severe
  • Feared by adults and children unpleasant, danger, sign of serious illness, loss of privacy/control.
  • Risk of irritation/pain/necrosis at site, damage to large vessels/nerves/bones, ecchymosis or soreness, and infection that is serious/hard to cure.
  • EXPENSIVE
  • Irretrievable more difficult to deal with errors and allergy
  • LEGAL REQUIREMENTS & ETHICAL CONSIDERATIONS:
  • legal rights to refuse vs court orders for children, elderly, incompetent patients.
  • right to information - about drug and consent in experiments.
  • right to administration by qualified person (drug knowledge, safe technique).
  • right to proper assessment - history, allergy, disease, current condition and body sit
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25
Q

contraindications of IM’s

A
  • when SERUM ENZYMES will be required to determine diagnosis
    and treatment as with myocardial infarction.**
  • muscular/developmental status results in INADEQUATE
    MUSCLE MASS. Some examples: extreme muscle wasting as with
    paralysis from: CVA (stroke), spinal cord injury, bed rest or lack of use,
    contractures, elderly, those with no exercise.
  • when needle CAN’T REACH PROPER DEPTH, extreme edema and extreme obesity.
  • No IM’s or subcutaneous injections when ABSORPTION IMPAIRED/decreased circulation as: paralysis, edema, clots, etc
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26
Q

components of syringe

A
  • Primarily plastic
  • Range from 1ml to 60ml
  • Selection based on amt. of medication to be delivered.
    Components:
  • Calibrated barrel
  • Plunger
  • Flange
  • Tip
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27
Q

generally used for injections requiring a secure connection of the syringe to another device. the tip is threaded for a ‘locking’ fit, and is compatible with a variety of needles, catheters, and other devices

A

BD Luer-Lok tip

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28
Q

a friction fit connection that requires the clinician to insert the tip of the syringe into the needle hub or other attaching device in a push-and-twist manner. this will ensure a connection that is less likely to detach. simply sliding the attaching device onto the syringe tip will not ensure a secure fitting

A

luer slip tip

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29
Q

allows for work requiring closer proximity to the skin. generally used for venipuncture and aspiration of fluids

A

eccentric luer slip tip

30
Q

used for flushing (cleaning) catheters, gastrostomy tubes and other devices. insert catheter tip securely into catheter or gastrostomy tube

A

catheter tip

31
Q

refers to the diameter
of the needle

A

gauge

32
Q

how is the needle chosen

A
  • Often chosen by the viscosity or
    thickness of the medication &
    location to be delivered
  • The larger the gauge, the
    smaller the diameter of the
    needle
  • A 20 G < 18 G
33
Q

how to recap needles

A

“scoop method,” in which the fingers do not touch the needle, is no longer recommended, because of the danger of an accidental needle stick.

34
Q

how to withdraw medications

A
  • Verify the PATIENT, name of the MEDICATION, exp. date, dosage, and allergies
  • In order to withdraw medication you must insert air
  • 1.5ml of air, to withdraw 1.5ml of solution
  • The vial has an air pressure vacuum inside. If you do not inject the correct amount of air it will be very
    difficult to pull back on the plunger.
  • Once the medication is drawn you must move the plunger forward to expel the air within the syringe.
    You may also need to flick the end of the syringe to remove the bubbles
35
Q

what are ampules

A
  • many pre-packed procedure sets come with an ampule of lidocaine.
  • The glass ampule is hermetically sealed, meaning the dose is completely enclosed in glass and the neck is scored so it will break easily when opened.
  • Depending upon the situation you may either need sterile or non-sterile gloves.
  • When separating the neck:
  • Wear gloves
  • Use a piece of gauze, wrap around the neck and break
36
Q

how to use an ampule

A
  • Medication is withdrawn using a
    syringe and a filter needle.
  • A blunt fill needle with filter must be
    used when withdrawing medication
    to prevent glass particles from being
    drawn up into the syringe.
  • Never use a filter needle to inject
    medication
37
Q

when to check for allergies

A

before: always check the chart and with the patient prior to administering the medication

after: observation for 20-30 minutes. most reactions happen during this time

38
Q

are administered into the adipose tissue layer just below the epidermis and dermis

Tissue has few blood vessels, - this route has a slow, sustained rate of absorption

A

Subcutaneous (SC) injections

39
Q

Sites for SC injection

A

include the outer aspect of the upper arm, the abdomen within one inch of the belly button, anterior aspects of the thighs, upper back, and upper ventral gluteal area

40
Q
  • are injections administered into the dermis, just below the
    epidermis.
  • ID injection route has the longest
    absorption time of all parenteral routes.
  • Examples: TB and allergy
A

intradermal injections

41
Q

Intradermal Injections
* Safety Considerations

A
  • Do not aspirate. It is not necessary to aspirate because the dermis is
    relatively without vessels.
  • Always take steps to eliminate interruptions and distractions during
    medication preparation.
  • If the patient expresses concerns about the medication or procedure,
    stop and explore the concerns. Re-verify order with physician if
    appropriate.
42
Q

deposit medications into the muscle fascia, which has a rich blood supply.
* used for medications that require a quick absorption rate but also a reasonably prolonged action.
* Due to their rich blood supply, they can absorb larger volumes of solution, which means a range of medications, such as sedatives, anti-emetics, hormonal therapies, analgesics, and immunizations, can be administered
intramuscularly in the community and acute care setting.
* Muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications.

A

IM injections

43
Q

IM injection sites

A
  • deltoid
  • ventrogluteal
  • vastus lateralis
  • dorsogluteal (avoid sciatic nerve)
44
Q

refers to the action of pulling back on the plunger for 5 seconds
prior to injecting medication

A

aspiration

45
Q

what to do if you aspirate and there is lack of blood in the syringe

A

confirms needle placement is in the muscle

46
Q

what to do if you aspirate and there is blood present

A

remove the needle, discard it appropriately, and re- prepare and administer the medications.

47
Q

are Vaccinations and immunizations given by IM injections aspirated

A

no

48
Q

z track method

A
49
Q

IM complications

A
  • Muscle atrophy
  • Injury to bone
  • Cellulitis Sterile abscesses
  • Pain Nerve injury
  • Factors that impair blood flow to the local tissue will affect the rate and extent of drug absorption.
  • There is an increased risk of injecting the medication directly into the patient’s bloodstream
50
Q

used for infusions under six days
and for solutions that are iso-osmotic or near iso- osmotic.
* They are easy to monitor and can be inserted at the bedside.
* are to be replaced every 72 to 96 hours to prevent infection and phlebitis in adults

A

peripheral IVs

51
Q

peripheral IV complications

A

Complications
* Phlebitis
* Infiltration
* Extravasation
* Hemorrhage
* Infection

52
Q

also known as fluid overload or circulatory overload, is a condition caused by excess fluid accumulation in the lungs, due to excessive fluid in the circulatory system.Characterized
by decreased oxygen saturation, increased respiratory rate, fine or coarse crackles at lung bases,
restlessness, breathlessness, dyspnea, and coughing up pinky frothy sputum. If suspected, raise the head of the bed, apply oxygen, take vital signs, complete a cardiovascular assessment, and notify the physician.

A

pulmonary edema

53
Q

air is introduced into the venous system and travels to the right ventricle and/or pulmonary circulation. More frequently during catheter removal. 10 ml of air is
associated with serious and fatal effects. Small air bubbles are tolerated by most patients.
S/S include sudden SOB, continued coughing, shoulder/neck pain, agitation, feeling of impending
doom, lightheadedness, hypotension, wheezing, increased HR, altered mental status, and jugular venous distension.

Treatment: Occlude source of air entry. Place patient in a Trendelenburg position on the left side (if not contraindicated), apply oxygen at 100%, obtain vital signs, and notify physician promptly.
To avoid air embolisms, ensure drip chamber is onethird to onehalf filled, ensure all IV connections
are tight, ensure clamps are used when IV system is not in use, and remove all air from IV tubing by
priming prior to attaching to patient

A

air embolism

54
Q

occurs when a small part of the cannula breaks off and flows into the vascular system. When removing a peripheral IV cannula, inspect tip to ensure end is intact.

A

catheter embolism

55
Q

is caused by microorganisms that are introduced into the blood through the puncture site, the hub, or contaminated IV tubing or IV solution, leading to bacteremia or sepsis. A CR-BSI is a nosocomial preventable infection and an adverse event.

A

Catheter-related bloodstream infection (CR-BSI)

56
Q

how to inspect IV solution bags

A

IV solution bags should have the date, time, and initials of the health care provider marked on them to be valid. Add-on devices (e.g., extension tubing or dead-enders) should be changed every 96 hours, if contaminated when administration set is replaced, or as per agency policy.

57
Q

Intravenous solution and IV tubing should be changed if

A
  • IV tubing is disconnected or becomes contaminated by touching a non-sterile surface
  • Less than 100 ml is left in the IV solution bag
  • Cloudiness or precipitate is found in the IV solution
  • Equipment (date and time) is outdated
  • IV solution is outdated (24 hours since opened)
58
Q

an undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products; cells, tissues, and organs; disinfectants; and radiopharmaceuticals. An adverse
reaction may occur under normal use and conditions of the product

A

Adverse reaction, also known as an adverse event

59
Q

what to do if you have IV complications

A

Immediately stop the injection (or infusion) of the medication. Keep
syringe of medication for further investigation of the reaction

60
Q

Injection of medication
into a vein may cause inflammation or roughening of the endothelial lining, which can result in thrombus formation. Medication may also be inadvertently injected into surrounding tissue, resulting in tenderness, pain, tissue necrosis, or nerve damage

A

IV site shows signs of phlebitis or irritation

61
Q

can result from poor aseptic technique

A

Septic thrombophlebitis

62
Q

are typically inserted for patients requiring more than six days of intravenous therapy or who:
* Require antineoplastic medications
* Are seriously or chronically ill
* Require vesicant or irritant medications
* Require toxic medications or multiple medications
* Require central venous pressure monitoring
* Require long-term venous access or dialysis
* Require total parenteral nutrition
* Require medications with a pH greater than 9 or less than 5, or osmolality of greater than
600mOsm/L
* Have poor vasculature
* Have had multiple PIV insertions/attempts (e.g., two attempts by two different IV therapy
practitioners)

A

central venous catheters

63
Q

Benefits is that medication is delivered locally without the
secondary trauma of an injection; transdermal drug delivery
through ionto and phonophoresis can assist with:
* decreasing inflammation
* decreasing pain
* decreasing size of calcium deposits in soft tissue
* promote wound healing
* decrease edema

A

transdermal medications

64
Q

disadvantages of transdermal medications

A
  • Cannot deliver drugs that require high blood levels. Daily dose of
    10mg or less
  • Is not meant for rapid bolus
  • Skin irritation, dermatitis
  • May fall off
  • Uncomfortable
  • Cost
65
Q

sites of transdermal medications

A
  • Dose released depends upon the disk in the contact with the skin.
  • Several hours to weeks
  • Any area without hair. Or the hair may need to be clipped.
  • Most people prefer the chest, flank, or upper arm.
  • Rotate sites.
  • Examples: NTG, clonidine, estrogen, nicotine, scopolamine, fentanyl
66
Q

routes of transdermal medications

A
  • Drugs may be painted, swabbed, or irrigated on the surface
  • Nose
  • Eyes, Ears
  • Oral
  • Vagina
  • Urethra
67
Q
  • Sterile
  • Easily administered
  • Usually does not interfere
    with vision
  • Warm to room temperature
    before administration
A

ophthalmic drugs

68
Q
  • Absorption of lipid soluble drug is rapid from this route because
    very large surface area is provided by the alveoli which are also
    associated with rich blood supply. The rapidity may be compared
    with intravenous administration.
  • Apart from volatile anesthetics, sympathomimetic amines, steroids
    are commonly administered through this route to relieve acute
    bronchospasm
A

inhalation

69
Q

The major barrier to non-lipid soluble or ionized drug for crossing the skin is

A

stratum corneum
Pores through sweat glands and hair follicles are the routes through which these drugs can pass, although the surface area of the pores is pretty small.

70
Q

how can The rate of transfer be increased

A

electricity and this phenomenon is known as iontophoresis or electrotransport. There are
bright prospects for drugs like lignocaine, NSAIDs for local use and opioid for systemic use.

71
Q

means the application of drug on to
the surface of keratinized epithelium.

  • The drugs in the form of ointment, lotion, cream, liniment, paste, paint,
    patch, jelly and aerosol are used.
  • The purpose is to get local effect. Thus a high concentration of drug is to be delivered at its site of action.
  • Epidermal administration may cause irritation, sensitization, and undesired systemic effect (dermatological steroidal preparation). Prolonged use of
    corticosteroid cream may give rise to adrenocortical suppression in adult
    and growth retardation in children. Overuse and unregulated use of
    antibacterial agents may cause bacterial resistance.
A

Epidermal (Topical)

72
Q
  • Medications for nasal congestion, Opioids, histamine antagonists, propranolol, vitamin Bl2 (vasopressin tannate, conoba snuff, and cocaine) are taken as snuff
    (fine powder) for desired systemic effects.
  • The common cold, sinusitis, and hay fever affect absorption adversely.
  • Hypothalamic and pituitary peptides are given through
    this route as they are destroyed in the gut.
  • In order to reach cerebrospinal fluid this route has a great advantage as the contact with the subarachnoid space of the olfactory lobes.
A

nasal route

clinical skills JM (2 decks)

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