Enteral & Parenteral medication administration

Question 1

What is the most common method to administer medication?

Answer 1

by mouth :Oral

Question 2

What is percutaneous medication administration?

Answer 2

medication is applied to the skin or mucous membranes.

This includes topical application of ointments, creams, etc. to the skin and the instillation of medication to the eyes or ears, and the inhalation of aerosols or powder to the lungs.

Question 3

Compare local and systemic effect

Answer 3

A Local effect refers to an adverse health effect that takes place at the point or area of contact. The site may be skin, mucous membranes, the respiratory tract, gastrointestinal system, eyes, etc. Absorption does not necessarily occur. Examples: strong acids or alkalis.

Systemic effect refers to an adverse health effect that takes place at a location distant from the body’s initial point of contact and presupposes absorption has taken place. Examples: arsenic effects to the blood, nervous system, liver, kidneys and skin; benzene effects to the bone marrow.

Question 4

Define Insertion

Answer 4

Inserting drug into a body cavity (rectal or vaginal suppositories, vaginal creams, or foams)

Question 5

Define Instillation

Answer 5

Instillation of fluid into body cavity, fluid is retained. (ear drops, nose drops, bladder and rectal instillation

Question 6

Define Irrigation

Answer 6

Irrigation of body cavity, fluid is NOT retained ( flushing eye, ear, vagina, bladder, or rectum with medicated fluid.

Question 7

Define Inhalation

Answer 7

Aerosol Spray: distributes medication throughout the nasal passages and the tracheobronchial airway (nebulizers, inhalers)

Question 8

Define dry powder

Answer 8

Distributes medication in powder form throughout the tracheobronchial airway (dry powder inhaler)

Question 9

What does “ Per Os” mean?

Answer 9

By mouth

Question 10

How do you administer medication by Buccal?

Answer 10

Medication placed between the upper and lower molar teeth and cheek area; is dissolvable

Question 11

What is Sublingual administration of medication?

Answer 11

Under the tongue ( shouldn’t be swallowed)

Question 12

List the advantages of administering drugs by oral route

Answer 12

• Easy
  
  • Comfortable to administer
  • convenient
  • economical
  • may produce local or systemic effects
  • rarely causes anxiety for patient

Question 13

List the disadvantages of administering drugs by oral route?

Answer 13

• Avoided when pt has alterations in GI function
○ nausea, vomiting,
○ with reduced GI motility (after surgery)
• Gastric secretions destroy some meds. Oral admin is contraindicated in pt who are NPO and unable to swallow
• Do not give organ meds when pt has gastric suction, before certain diagnostic tests or surgery
• An unconscious or confused pt is unable or unwilling to swallow or hold sublingual meds under the tongue of buccal meds in cheek
Oral medications irritate the lining of the GI tract, discolour teeth, or have an unpleasant taste

Question 14

List measures that can be taken to reduce the risk of aspiration.

Answer 14

• Assess patient’s ability to swallow and cough and check for presence of gag reflex
  
  • Prepare oral medication in form that is easiest to swallow
  • Allow patient to self-administer medication if possible
  • If patient has unilateral (one sided) weakness, place medication in stronger side of mouth
  • Thicken regular liquids or offer fruit nectars if patients cannot tolerate thin liquids
  • Avoid straws because they decrease control patient has over volume intake, which increases risk of aspiration
  • Have patient hold and drink from a cup if possible
  • Time medications to coincide with mealtimes or when patient is well rested and awake if possible
  • Administer medications using another route if risk of aspiration is severe

Question 15

Explain how the preparation and administration of medication differs when
administering to infants and children.

Answer 15

• Pediatric:
○ Liquid forms of medication are safer to swallow to
avoid aspiration of small pills
○ Children refuse bitter or distasteful oral preparations.
Mix the drug with a small amouth of a sweet tasting
substance ex: jam
○ Measure small amount of liquid medications using a
plastic calibrated oral dosing syringe or a hollow-
handed medicine spoon.

• Gerontologic:
○ Give medication with a full glass of water to aid
passage of the drug
Give patient time to swallow

Question 16

List the indications and contraindications for administering medication via the rectal route

Answer 16

• Indications:
• mucous membranes provide route of administration
when oral medications are not possible
• Contraindications:
○ Mucous membranes are highly sensitive to
some medication concentrations
○ Insertion of rectal medications often causes
embarrassment

Rectal suppositories are contraindicated it pt’s have had rectal surgery or have rectal bleeding

Question 17

Describe the correct technique for the administration of medication per rectum

Answer 17

1. Prepare suppository for administration. Check label for medication against MAR 2 times
   
   2. Take medication (s) to patient at correct time
   3. Identify patient using two identifiers
   4. At patient’s bedside again compare MAR or computer printout with names of medications on medication labels and patient name. Ask patient if they have allergies
   5. Discuss purpose of each medication, action, and possible adverse effects. Explain procedure and allow patient to ask questions
   6. Perform hand hygiene, arrange supplies at bedside, and apply clean gloves. Close room curtains and or door
   7. Help patient assume left side-lying Sims’ position with upper leg flexed upward
   8. If patient has mobility impairment, help into lateral position. Obtain assistance to turn patient and use pillow under upper arm and leg
   9. Keep patient draped with only anal area exposed
   10. Examine condition of anus externally
       a. Option: palpate rectal walls as needed
   11. Remove suppository from foil wrapper and lubricate rounded end with water-soluble lubricant. Lubricate gloved index finger of dominant hand. If patient has hemorrhoids, use liberal amount of lubricant and touch area gently
   12. Ask patient to take a slow deep breath, and relax anal sphincter
   13. Retract patient’s buttock with non-dominant hand. Which gloved index finger of dominant hand, insert suppository gently through anus, past internal sphincter and against rectal wall (10cm-4 inches) in adults and (5cm-2 in) in infants and children. You should feel rectal sphincter close around your finger

Question 18

Explain how the patient should be positioned when receiving a suppository

Answer 18

• Left Lateral Position, Natural curve of the sigmoid colon

Question 19

Define Enema

Answer 19

a procedure involving introduction of a solution into the rectum for cleansing or therapeutic purposes

Question 20

Define cleansing enema

Answer 20

an enema, usually soapsuds, administered repeatedly until the colon is free of all formed fecal material

Question 21

Define retention enema

Answer 21

oile retention enemas lubricate the rectum and colon; the feces absorb the oil and become softer and pass easier

Question 22

Define Fleet enema

Answer 22

a saline-based enema which helps produce a bowel movement and is also ideal for bowel cleansing before undergoing a rectal examination

Question 23

Define Suppository

Answer 23

a solid form of medication inserted into a body cavity (eg. rectum or vagina). The drug is absorbed after it dissolves in the cavity

Question 24

List the indications for an enema

Answer 24

• Come in a pre-mixed container
○ Bottle with a spout at the end of it
○ Pt. lays on side ( left lateral) because that is the
way the bowel is shaped.
○ Have the patients try to “hold it” for a few
minutes. Have a bed pan readily available.
○ Retention enema : used for treating an infection. The medication is retained and then absorbed into the bloodstream
○ Fleet and Soap Suds enemas are used for
constipation.

Question 25

Describe the correct volumes to be given to adults, children, and infants ( enema)

Answer 25

Correct volume of warmed solution (enema bag):
Adult	750mL-1000mL
Adolescent	500mL-700mL
School-age child	300mL-500mL
Toddler	250mL-350mL
Infant	150mL-250mL

Question 26

Discuss unexpected outcomes in the administration of an enema

Answer 26

• If pt. has poor sphincter control, position the pt on the bedpan in comfortable dorsal recumbent position, never on top of the toilet
• If pain occurs or you feel resistance at any time during procedure, stop and discuss with prescriber.
• If tube does not pass easily, do not force
• Lower container or clamp tubing it pt. complains of cramping or if fluid escapes around rectal tube.
• Have pt. breathe slowly in through nose and out through mouth
• Abdomen becomes rigid and distended, stop enema immediately & obtain vital signs
• Bleeding occurs, stop immediately and obtain vital signs

Question 27

What is topical route of administration?

Answer 27

• Topical:are applied locally to skin, mucous membranes, or tissue membranes.
○ Local effect
○ Ointments for rashes, etc.
○ Lotions: thinner
○ Creams and Ointments are thicker. Ointments
are oil based.

Question 28

What is transdermal route of administration?

Answer 28

• Transdermal:supplying a medication in a form for absorption through the skin into the bloodstream
○ Systemic Effect, nitro patches, nicotine patches…
slow release into the general circulation

Nitrol patch: to be measured with the nitral apli-ruler and then applied to the pt’s skin and taped in place.

Question 29

Describe advantages and disadvantages of the percutaneous route of Administration

Answer 29

• Advantages:
○ Non-invasive

• Disadvantages:
○ Can create systemic effects if skin is thin, drug concentration is high, contact with the skin is prolonged, or the drug is applied to skin that is not intact

Question 30

List appropriate sites for the application of transdermal patches. Explain why nitroglycerin patches are to be removed after 10 – 12 hours.

Answer 30

• Date and initial outer side of new patch before applying it and note time of administration. Use soft-tip or felt-tip pen
• Choose a new site that is clean, dry and free of hair. Some patches have specific instructions for placement locations. Do not apply patch on skin that is oily, burned, cut, or irritated in any way
• After 10-12 hours, it is no longer effective

Question 31

Explain how the administration of ear drops differs in adults and children ( Ear drops)

Answer 31

• Adult: pull the ear up
• Children: 3 and under, pull the ear down

It straightens out the ear canal)
• After the drop has been instilled, ask the patient to stay in the same position to make sure the medication stays in place. Gently presson the tragus to ensure absorption. Do not use cotton because it will absorb the medication away form the patient.

Question 32

Describe the indications and demonstrate the correct technique in the administration of medication by ophthalmic (optic)

Answer 32

• Eye drops: (local effect)
○ Have the pt look up
○ Remove contacts
○ Pull up on the conjunctival sacs and instill the proper amount of drops in the lower conjunctival sac
○ Gently press on the inner canthus area to allow the medication to enter the eye and prevents the medication to go into the nasal effect and leaking out of the eye.
○ With eye ointment: same process, but put a thin ribbon on the lower conjunctival sac.

Do not touch the face with the tip of the medication tube.

○ If there patient has an infection, make sure to remove all the drainage before putting drops or ointment.

Clean with a warm cloth and or saline

Question 33

Describe the benefit of extenders or spacers used in conjunction wit metered dose inhalers.

Answer 33

• Ensures that the medication will be inhaled properly.

* Increases the accuracy

Question 34

What is parenteral drug administration?

Answer 34

The parenteral administration of drugs requires specialized knowledge and manual skill to ensure safety and therapeutic effectiveness. Injection of drugs is an invasive procedure resulting in trauma to the injection site, and carrying potential risks such as infection, nerve injuries, and necrosis. It is critical that medication is administered accurately and carefully.

Question 35

Describe the disadvantages of drug administration by intradermal, subcutaneous, and intramuscular routes.

Answer 35

• Trauma to the injected site
• Risk of infection, nerve damage and necrosis
• Some IV meds are expensive
• Some patients experience pain from repeated needle sticks
• IM and ID routes are avoided in patients who have bleeding tendencies
• Risk of tissue damage with subQ injections
• IM and IV routes have higher absorption rates, which places the patient at higher risk for reaction
• Anxiety is caused in many patients, especially children

Question 36

Describe the advantages and of drug administration by intradermal, subcutaneous, and intramuscular routes.

Answer 36

• An alternative means of administration when oral medication are contraindicated
• More rapid absorption than with topical or oral routes IV infusion provides medication delivery when patient is critically ill or when long-term therapy is required
• If peripheral perfusion is poor, IV route is preferred over injection

Question 37

Explain intradermal injection site and the rate of absorption

Answer 37

• Intradermal (ID): Injection into the dermal just under the epidermis
○ Medication absorb slowly through the skin

Question 38

Explain subcutaneous injection site and the rate of absorption

Answer 38

• Subcutaneous: Injection into tissues just below the dermis

Question 39

Explain intramuscular injection site and the rate of absorption

Answer 39

• Intramuscular (IM): Injection into a muscle

○ Absorbs quickly

Question 40

Define drug incompatibility.

Answer 40

• Medication interactions are common in patients who take several
  
  • Some medications increase or diminish the action of other medications or may alter the way another medication is absorbed, metabolized, or eliminated from the body.
  • If two medications are compatible, they can be mixed in one injection if the total dose is within accepted limits.

Question 41

True or False

If you are mixing 2 medications, draw from your vial first, and then from your ampule.

Answer 41

True

Question 42

Explain why injection sites are rotated

Answer 42

• Area should be free of abnormalities
  
  • Injection sites that are used repeatedly can become hardened from lipohypertrophy (increased growth in fatty tissue)
  • Now they recommend that the person sticks to 1 anatomical site, but to rotate around this site.

Question 43

Identify appropriate products to be used to cleanse injection site.

Answer 43

Clean the injection site with antiseptic swab

Touch the swab to the centre of the site and rotate outward in a circular direction for about 5cm

Question 44

Describe procedures to be implemented in the event of a needle-stick injury

Answer 44

• Report injury immediately
○ Location of the incident
○ Type of brand of device involved in the incident
○ Description of the incidint
○ Protec the privacy for the the employee and patient involved in the needle-stick injury

Question 45

What is the max for intradermal injection?

Answer 45

0.1

Question 46

Describe sites used for intradermal injections

Answer 46

○ Inner forearm

○ Upper back

Question 47

State the size of needle and syringe used for intradermal injection

Answer 47

• Tuberculin or small hypodermic syringe

Question 48

Describe the angle and depth of penetration when administering
intradermal injections

Answer 48

• Insert it slowly with the bevel pointed up at a 5- to 15-degree angle until resistance is felt
  
  • Advance the needle through the epidermis to approximately 3 mm below the skin surface.
  • Needle tip can be seen through skin

Question 49

Describe sites used for subcutaneous injections

Answer 49

• Abdomen from below the costal margins
  
  • Iliac crest
  • Anterior aspects of the thighs
  • Outer posterior aspect of the upper arms

Question 50

State the correct sizes of needle and syringes used for subcutaneous injection

Answer 50

• U-100 insulin: (0.3, 0.5 or 1 mL) with preattached needle (28-31 gauge)
  
  • A 1-3 mL syringe is usually adequate for a subQ or IM injection

Question 51

State the angle used to administer subcutaneous injections

Answer 51

• Medication can be injected in the subcutaneous tissue of normal-sized patient using a 25-gauge 1.5 cm needle inserted at a 45 degree angle or a 1.3 cm needle inserted at a 90 degree angle
  
  • A child may only require a 1.3 cm needle
  • The preferred needle length is one-half the width of the skinfold and the angle of insertion may be between 45 and 90 degree

Question 52

List the indications for intramuscular injections

Answer 52

• Use a longer and heavier-gauge needle to pass through the subQ tissue and penetrate the deep muscle tissue
• The angle of insertion for an intramuscular injection is 90 degrees

Question 53

Describe sites used for intramuscular injections

• Vastus Lateralis Muscle:

Answer 53

• Lacks major nerves and blood vessels
  
  • Facilitates rapid drug absorption
  • Used frequently with infants receiving immunization
  • May also be used in older children and toddles receiving immunization

Question 54

• Describe sites used for intramuscular injections:

Ventroglutal muscle

Answer 54

• Offers a deep site, situated away from major nerves and blood vessels
  
  • Offers less chance of contamination in incontinent patients and infants
  • Identified easily and prominent body landmarks
  • Is preferred side for medications that are larger in volume, more viscous and irritating for patients

Question 55

Describe sites used for intramuscular injections;

• Deltoid Muscle

Answer 55

• Is easily accessible but the muscle is not well developed in most patients
  
  • May be used for small amounts of meds
  • Not used in infants or children with underdeveloped muscles
  • Use of the muscle involves opotential for injury to the brachial artery and to the radial and ulnar nerves
  • May be used for immunizations
  • Recommended site for hepatitis B vaccine and rabies injections

Question 56

List complications associated with intramuscular injections

Answer 56

• Pain
  
  • Nerve Damage
  • Injury
  • Hitting the bone

Question 57

What is “ Z” tract during an injection? And how is it done?

Answer 57

Recommended for IM injections

It prevents leakage of medication into subcutaneous tissues, seals medication in the muscle, and minimizes irritation

i. Pull the overlying skin and subq tissues approx 2.5 to 3.5 cm laterally to the side with the unar side of the nondominant hand. Hold the skin in this position until you have administered the injection.