chapter 9: Drug Administration

Question 1

Preparing for Drug Administration

Answer 1

• Check the “Nine Rights.”
• Standard precautions: perform hand hygiene!
• Check for drug allergies.
• Prepare drugs for one patient at a time.
• Check the label three times.
• Check expiration dates.
• Check patient’s identification; two identifiers required.
• Give medications on time.
• Explain medications to the patient.
• Open medications at the bedside.
• Try not to touch the medications. If you need to, then wear gloves.
• Document medications given before going to the next patient.
• Discard any medications that fall to the floor or become contaminated.
• Stay with the patient while the patient takes the drug(s).
• Do not leave the drug(s) in the patient’s room to take at another time.
• Assess and document the patient’s response to the drug(s) administered.

Question 2

Enteral Drugs: Oral

Answer 2

• Oral medications
  Assess for dysphagia.
  Crushing pills
  Aspiration precautions
  Age considerations
  Remain with the patient until all medications have been swallowed.
  Document medication administration and patient response.

Question 3

Enteral Drugs: Sublingual and buccal medications

Answer 3

Sublingual tablets are placed under the tongue.
Buccal tablets are placed between the upper or lower molar teeth and the cheek.
These drug forms are not taken with fluids.
Instruct the patient not to drink anything until the tablet has dissolved completely.
When using the buccal route, alternate sides
with each dose to reduce risk of oral mucosa irritation.
Document medication administration and patient response.

Question 4

Enteral Drugs: Liquid medications

Answer 4

Ensure proper dose.
Discard excess medication in the sink.
Use calibrated oral syringes for small amounts.
Document medication administration and patient response.
Special considerations for infants and children

Question 5

Enteral Drugs: Gastric tube

Answer 5

• Hand hygiene
• Position patient
• Semi-fowlers, fowlers
• Leave HOB elevated for 30 minute after
• Check compatibility with feedings if applicable.
• Follow agency P&P for checking placement and residual.
• Use liquid form of medications if possible
• If not, crush those medications that are crushable into a fine powder then dissolve in 15
  to 30 ml of water
• Administer each med separately, flushing in-between
• Flush with 30 ml after last med.
• Document including fluid intake
• Assess if fluid restriction or overload concerns apply

Question 6

Enteral Drugs: Administering rectal drugs

Answer 6

Hand hygiene, standard precautions, gloves
Assess patient for active rectal bleeding or diarrhea.
Position patient on left side unless contraindicated (Sims’ position).
Do not insert suppository into stool.
Follow insertion procedure.
Retention enemas
Have the patient remain lying on the left side for 15 to 20 minutes to allow absorption of the medication.
Age-related considerations

Question 7

Parenteral Drugs

Answer 7

• Never recap a used needle!
• May recap an unused needle with the “scoop method”
• Prevention of needlesticks
• “Needleless” systems
• Filter needles
• Use a filter needle when withdrawing medication from an ampule. Filter needles
  help to remove tiny glass particles that may result from the ampule breakage. Do
  not use a filter needle for injection into a patient! Some facilities may also require
  the use of a filter needle to withdraw medications from a vial.
• Removing medications from ampules
• Removing medications from vials

Question 8

Parenteral Drugs: Insulin Syringes

Answer 8

• Always use an insulin syringe to administer insulin.
• Types of insulin syringes
• 100-unit syringe (U 100)
• Low dose syringes (50 units) available for smaller unit doses
• 500-unit syringe (U 500)
• Each calibration mark is 5 units.
• Only use U 500 insulin with this syringe.
• Teaching the patient self-administration of insulin
• Check compatibility before mixing
• Draw up rapid/fast acting insulin first (clear)
• Then draw up intermediate insulin (cloudy)

Question 9

Parenteral Drugs: Injections

Answer 9

• Needle angles for various injections
• Intramuscular (IM)
• Subcutaneous (subcut)
• Intradermal (ID)
• Air-lock technique
• Intradermal injections
• Subcutaneous injections
• Insulin administration
• Heparin administration

Question 10

Parenteral Drugs: IM Injections

Answer 10

• Sites
• Ventrogluteal site (preferred)
• Vastus lateralis site
• Deltoid site
• The dorsogluteal site is no longer recommended
• Z-track technique

Question 11

Parenteral Drugs: Intravenous medications

Answer 11

• Needleless systems
• Compatibility issues
• Check expiration dates
• Age-related considerations
• Infusion of intravenous piggyback (IVPB) medications
• Labeling intravenous (IV) infusion bags when adding medications
• Adding medications to a primary infusion bag
• Should be done in controlled setting (Pharmacy)
• Always add to a new bag, not an existing infusion
• IVPB medications (secondary line)
• IV push medications (bolus)
• Through an IV lock
• Through an existing IV infusion

Question 12

Topical Drugs

Answer 12

• Lotions, creams, ointments, powders
• Transdermal patches
• Eye Medications
• Ear Medications
• Age-related considerations

Question 13

Eye medications

Answer 13

• Drops
• Ointments
• Age-related considerations
• Cleanse eye of any debris or drainage before instilling medications

Question 14

• Eardrops

Answer 14

• Adults
• Infant or child younger than 3 years of age

Question 15

Inhaled drugs

Answer 15

• Metered-dose inhalers
• Dry powder inhalers
• Small-volume nebulizers

Question 16

Administering medications to the skin

Answer 16

• Lotions, creams, ointments, powders
• Transdermal patches
• Age-related considerations