Drug Administration Flashcards
What should be done before administering any drugs?
Informed consent should be given from the patient, an advocate or guardian
Key areas of risk when administering drugs
right patient
right drug
right route
right time
right dose
right documentation
How many presentations of paracetamol do ambulances carry?
3
When documenting administration of drugs what elements are essential?
batch number
time given
presentation of drug
how much was administered
expiry date
Parental Routes
Intramuscular
Intravenous
Subcutaneous
Non-Parental Routes
Passive absorption
oral administration
inhalation
nebulisation
sublingual
topical
buccal
transdermal
intranasal
rectal
Common Abbreviations: BD, IM, IV, NSAID
BD = twice daily
IM = Intramuscular
IV = Intravenous
NSAID = Non-steroidal anti-inflammatory drug
Common Abbreviations: PGD, POM, PR, SC
PGD = Patient Group Direction
POM = Prescription Only Medication
PR = Per Rectum
SC = Subcutaneous
Drug Abbreviations: ASP, ADM, ADX, PAR
ASP = Aspirin
ADM = Adrenaline 1:1000 (IM)
ADX = Adrenaline 1:10,000 (IV/IO)
PAR: Paracetamol
Drug Abbreviations: NOO, GLG, GLU, GLX
NOO = Nitrous Oxide
GLG = Glucose 40% Oral Gel
GLU = Glucagon
GLX = Glucose 10% solution (IV/IO)
When checking drugs, what do you check for?
medication type, expiry type, strength/concentration, package integrity, clarity of fluid
Onset of effect for different routes: IV, IO, Buccal, nebulisation, sublingual, rectal, IM Subcutaneous, oral, topical
IV/IO = Immediate
Buccal = 2/3 mins
Nebulised = 2/5 mins
Sublingual = Approx 3 mins
Rectal = 5-30 mins
IM = 10-20 mins
Subcutaneous = 15-30 mins
Oral = 30+ mins
Topical = hours
What can effect the effectiveness of nebulisation?
the number of droplets
particle size
rate & depth of patient breathing
Advantages of nebulisation
rapid onset utilising bronchial mucus
reduced systemic side effects
available in a variety of presentations
What does oxygen flow need to be to atomize the drugs in a nebuliser
6-8L/min
How to administer rectal medication
try and get a chaperone
1. separate buttocks to expose rectum
2. gently insert syringe tip into rectum
3. slowly count to 3 while gently pushing plunger in until it stops
4. Count to 3 before removing the syringe from the rectum
5. count to 3 whilst holding the buttocks together to prevent leakage
Key points when doing an IM injection
well perfused muscle
3-4ml
21 or 23 gauge needle
If injecting into to deltoid site where should the needle go?
2.5cm from acromial process and midpoint of the lateral aspect of the arm
How much can be injected into dorsogluteal site?
up to 4ml
How to draw up a drug for IM administration
Wash hands & PPE
Attach a blunt fill needle to the syringe
take the cover off of this fill needle and draw up the drug from its packaging
remove the drawing up needle from the syringe and place it in a sharps bin
Attach a 21 or 23 gauge needle to the syringe
expel any air and access medication and tap the syringe to ensure air is removed.
Potential complications of IM Injections
Infection
Pain from: needle, drug given, technique, volume of drug, speed of injection
Anaphylaxis
Nerve damage
Hitting a blood vessel
At what rate should IM injections be administered?
10 seconds per 1ml
Key points for subcutaneous injection
- medication goes into fat or connective tissue and not the muscle
- suitable for 1-2ml of medication
- 23 gauge needle
- elevate the subcutaneous skin by pinching the injection site
- with the needle bevel up, insert the needle at a 45 degree angle.
Risks with injections
Lipodystrophy
Cellulitis
Necrosis
Skin Sloughing
Nerve Injury
Prolonged Pain
How to reduce the risks associated with injections
Aseptic technique at all times
ensure correct dosage
use proper site of injection
use proper rate of injection
How to administer a pressurised metred dose inhaler (PMDI)
explain the procedure and ask for consent
remove the cap & shake
ask the patient to sit up straight and lift their chin
ensure breathing is in coordination with the administration of the medication
ensure there is a seal around the mouthpiece with the patient’s mouth
press canister and encourage patient to breathe in slowly until lungs feel full
take inhaler out of the mouth and hold breath for 10 seconds or as long as is comfortable
encourage them to breathe out slowly
wait at least 30 seconds before a second dose
wash mouth if medication has steroids
ENCOURAGE SELF ADMINISTRATION
Advantages of using a spacer device with a PMDI
Reduced Oropharyngeal deposition of the drug
improves lung deposition of the drug
Disadvantages of using a spacer device with a PMDI
Needs to be kept clean
Can be awkward to carry
What gauge are each needle used for cannulation?
RED - 14 gauge
GREY - 16 gauge
GREEN - 18 gauge
PINK - 20 gauge
BLUE - 22 gauge
YELLOW - 24 gauge
Things to check on IV giving set
packaging integrity, expiry date, roller clamp open and closing easily, covers on each side, tubing should be kink free
Things to check on IV fluid before administration
package integrity, expiry date, back number (write on PRF), clarity of fluid
Connection Technique - IV fluids
- ensure flow control is turned OFF and appropriately positioned
- Remove the protective covers from giving set and fluids
- insert the giving set cannula into the fluid port with a twisting/pushing motion
- prime drip the chamber by squeezing until half full
- slowly open flow control to allow fluid through
- raise the end of the line as fluid nears to prevent accidental leakage and clow off flow control
