LEC 6: Oral, Topical, Rectal, Vaginal, Eyes, Ears, Nasal, Inhalation Medication Administration Flashcards
What patient aspects need to be considered before administering an oral medication to them?
Can the patient swallow? Are they having difficulty swallowing?
- May not be able to give them medication orally
- May need to break the pill down
- Need to get patient in a sitting position
What are two things that need to be considered before breaking a pill down?
- Can only cut a pill in half if they have a score line
- Can only crush a pill if safe; need to check medication guidelines
What are the benefits of oral medication?
- Less painful
- Could potentially last longer
What are the risks of oral medication?
- Aspiration if trouble swallowing
- If they have nasal gastric tube; don’t want medication to get sucked out
What are medications that should NOT be crushed?
- SR: Sustained release
- XR: Extended release
- LA: Long acting
- DA: Delayed action
- ER: Enteric release
- EC: Enteric coated
- Medications that are irritants
- Medications that stain teeth
- Buccal or sublingual medication
How do you prepare liquid and oral syringe medication?
- Always measure with meniscus
- If liquid is less than 5 mL, will use oral syringe to draw up medication
- If you need to be precise, use a oral syringe
*Oral syringes are orange, safety mechanism; cannot attach to saline lock to pass medication through IV
Why do we give medication though sublingual or buccal administration?
- Absorbed quickly because we have large blood vessels in those areas
- No eating or drinking until the medication is fully absorbed
What are the four steps of oral administration?
- Assess
- Swallowing
- GI alteration
- Medical history
- Allergy history - Gather information
- Physical exam
- Lab work
- Vital signs - Verify
- 10 rights
- 3 checks - Administer medication
- Right to refuse
What are the 3 ways to administer inhalation medication?
- Metered-dose inhalers
- Dry powder inhaler
- With a holding chamber with mask
Metered Dose Inhaler
Need to coordinate the patients breathing when using the inhaler
- Administer a certain dose of medication with each inhalation
Dry Powder Inhaler
- Activated with patient breath, do not need to inhale
When do you want to do a “test spray” for inhalers?
Push a “test spray” into the air if not used for serval days or is a new inhaler
What are the three steps the patient needs to do when taking their inhaler?
- Instruct the patient to tilt their head back slightly and inhale slowly and deeply through the mouth for 3 to 5 seconds while depressing the canister fully
- Instructed the patient to hold the breath for approximately 10 seconds
- Instruct the patient to remove the MDI from the mouth and to exhale through pursed lips
How long should the patient wait between inhalations of medication?
The patient needs to wait at least 20 to 30 seconds between inhalations of medication
If two medications are given, what one needs to be administered first?
If two medications are to be administered give the bronchodilator first
Why do patients want to rise their mouths after using an inhaler or nebulizer?
To prevent getting thrush
Nebulizers
- Inhaled medication but delivered in droplet form and mixed with compressed air to create a mist
- Will add medication in recevoir
- Tubbing attaches to wall to create the mist; turn up to 6mL/min
- Always attach to medical air
- Patient needs to breath in and out nice and slow
Topical Administration
Applied to skin or mucous membranes to achieve local effect
What are types of topical administration?
- Transdermal patches
- Lotions, ointment, powders, pastes, and liniment
What are the steps to adminsitering topical medications?
After 10 rights and 3 checks:
- Hand hygiene
- Put on gloves
- Clean/ assess skin
- Want to remove any previous cream/ medications
- Want to assess skin to make sure the site is intact - Apply medication
- Document
- MAR
- Where you applies medication
- Condition of the skin
Transdermal Patches
- Want to asses site
- Do not apply patch to skin that has lesions/ open wounds
- Know the medication and were it needs to be applied
- Document where you placed the patch
- Remove patch when it says to remove it
- Rotate the patch, does not go in the same exact spot
Administering a Vaginal Medication: Suppositories
- Remove wrapper and apply lubricant to suppository and dominant index finder
- Retract labial fold
- Insert rounded end into canal 7.5 to 10cm or as far as it will go
- Withdraw and wipe away excess lubricant
- Patient needs to stay in position for 5 to 10 minutes
*Ensure privacy
Administering a Vaginal Medication: Foams, Jellies, Creams
- Fill applicator according to package directions
- Retract labial folds
- Insert applicator about 5 to 7.5 cm. Push applicator plunger
- Withdraw and wipe away excess medication
- Patient needs to stay in position for 5 to 10 minutes
Where are vaginal medications administered into?
Inserted into the body cavity and melt into the mucus membrane
Administering a Rectal Suppository and Enema
- Position the patient
- Want patient on left side due to the GI system - Remove wrap and apply lubricant
- Be sure to perform hand hygiene and to wear gloves - Help patient to relax
- Visualize the anus
- Can as patient to cough or bear down to help see anus - Insert suppository/ and administer enema
- Withdraw and wipe away excess lubricant
How to Administer Nasal Spray
- Assess the patient
- Get patient to blow nose before administering medication - Patient positioning
- Head up for spray - Coordinate patient’s inhalation with spraying action
- Observe effects
- Reassess
*Patient cannot blow their nose for 15 to 20 minutes after nasal spray or drops
How to Administer Nasal Drops (gtts)
- Assess the patient
- Get patient to blow nose before administering medication - Patient positioning
- Head down for drops - Wait a few minutes
- Help patient up from supine
- Observe effects
- Reassess
*Patient cannot blow their nose for 15 to 20 minutes after nasal spray or drops
How to Administer Eye Drops (gtts)
- Want to assess eye and area
- Make sure the area is clean and dry
- Clean in to out; avoid contamination of internal eye duct
- Don’t contaminate the dropper - Position the patient
- Head tilted back - Hold dropper 1 to 2 cm above eye
- Use dominant hand to administer drops
- Use non-dominant hand to pull eye skin back - Drop desired number of drops
- If patient blinks, re-administer - Have patient close eye(s) gently
* May need to push down on nasal lacrimal duct to ensure medications are not administered through the duct
How to Administer Eye Ointments
- Want to assess eye and area
- Make sure the area is clean and dry
- Clean in to out; avoid contamination of internal eye duct
- Don’t contaminate the dropper - Position the patient
- Head tilted back - Apply think stream to conjunctiva from inner to outer canthus
- Have patient close eye(s) gently
What medication do you administer first if you need to give eye drops and an eye ointment?
You would administer drops first and then the ointment
- Need to wait 10 minutes in between drops and ointment administration
- If administrating two different drops need to wait 5 minutes in between
How to Administer Ear Drops (gtts)
- Position patient
- Straighten ear canal
- Infected ear needs to be up - Instill drops
- Want drops to be room temperature - Have patient remain in position for 2 to 3 minutes
- Apply cotton for 15 minutes, if ordered
How to do Ear Irrigations
- Position patient
- Fill irrigating syringe
- Straighten ear canal
- Slowly instil solution allowing solution to drain out
What is ear irrigation used for?
Build up of wax, objects stuck in the ear etc.
How far do you need to insert the rectal suppository?
Insert the rectal suppository beyond the internal rectal sphincter
- 4 inches for adults
- 2 inches for infants and children
How long dose the patient need to hold the suppository in for?
Suppository needs to stay in for 20 to 30 minutes; let patient know they should not use the bathroom until then
