medication administration Flashcards
how many times should you check medication labels against provider’s order
minimum of 3 times before administering
safety checks to prevent errors
- right medication
- right form
- right dose
- right route
- right time
- right patient
- right technique
- right education
- right documentation
what should be asked of regarding reactions to medication?
ask if the patient is allergic to latex/adhesive bandages/skin preparations
how do you assess patient reactions to medications?
- have patient wait 20-30 min after administering
- tell them to call if they experience any side effects (fever/rash/chills) within 48 hr of injection
what are the types of oral medications?
- tablets
- capsules
- liquids
what should you do prior to administering any type of medication?
- check patient’s EHR (reason of visit/orders/drug allergies)
- is this specific medication in your scope of practice?
- compare med. order to the drug label 3x
- hand hygiene
steps to prepare tablets/caplets
- label cups (if more than one med is needed)
- perform label check
- remove cap from bottle (don’t touch inner surfaces)
- transfer pills -> cap -> cup (pills cannot go back in once in cup)
- replace cap securely
- place unopened blister pack in med cup
why is a blister pack important for medication administration?
so that if the patient refuses the medication, it is still sterile + intact
steps to prepare liquid medications
- label med cups
- shake suspensions to mix contents
- loosen + remove cap (don’t touch inside)
- pour medication at eye level to volume ordered
- replace cap w/o contamination
what if too much liquid is poured while preparing?
discard according to facility guidelines + do NOT pour it back into the med bottle
steps to administer oral medication
- check med label against order
- place med + water on tray to deliver to pt’s room
- greet patient
- verify patient identity (2 identifiers)
- hand hygiene + disposable gloves
- explain medication (purpose/side effects/etc.)
- administer med + observe pt for entire dosage entire time
- dispose of trash + hand hygiene
- document medication administration in EHR
what is important when documenting medication administration in EHR?
- name of med
- dosage
- route of administration
- who ordered it
- what education was given
- confirmation of patient’s understanding
- possibly exp dates/log number/initials of MA
steps for injectable medication preparation
- check EHR
- hand hygiene
- med label check + exp date
- confirm scope of practice
- calculate dosage
- assemble supplies
what supplies are needed for an injectable medication?
- tray
- medication vial
- syringe
- needle for syringe
- antiseptic wipes
- gauze for bleeding
- disposable gloves
- sharps container
- waste container
steps to withdraw medication from vial
- place all supplies on a tray onto counter
- remove syringe from wrapper w/o contaminating
- break syringe seal by pulling barrel back + forth a couple times
- attach needle to syringe
- med label check
- roll syringe between hands to mix suspension
- remove seal on vial + cleanse the stopper w/ alcohol
- pressurize vial
- inject air at 90 degree angle needle insertion into air space of vial
- invert vial + draw up medication gently
- return to upright position + engage safety needle
- label syringe + place on tray w/ other supplies
how to prevent air bubbles in syringe when withdrawing medication from a vial
- invert the vial + keeping needle below the fluid
- keep needle in the center of rubber stopper
- gently tap/flick syringe
- slowly push plunger forward after drawing up medication to remove air
how to prevent needle-stick injury when withdrawing medication from a vial
- recap needle using one-handed scoop technique
- engage safety device + replace needle with a new one (b/c old one is duller)
needle lengths and gauge for intradermal (ID) injection
- tuberculin syringe (no more than 0.2 mL)
- 25 to 28-gauge
- 1/4th to 5/8th inch needle length
important steps for selecting injection site for an intradermal injection
- mid-anterior forearm for allergy + TB test
- 4 inches below bend of elbow + palm faces up
- skin of upper chest
- upper back
steps to administering intradermal injection
- loosen needle cap + open alcohol pads
- cleanse site w/ alcohol pad in concentric circles
- grasp sides of syringe w/ thumb + index finger
- bevel must face up
- pull skin taut using nondominant hand
- insert needle at 5-15 degree angle about 1/8th inch under skin
- inject med slowly until a wheal/bleb appears on skin (do NOT aspirate)
- withdraw needle steadily at same angle to minimize discomfort
- activate safety device + remove label on syringe
- discard syringe in sharps container
- apply loose bandage if needed (do NOT apply pressure)
what should be checked for after intradermal injection
after 20-30 min wait, reactions can include hives/swelling/reddening/cyanosis/shock/itching/etc
syringe and needle sizes for subcutaneous injection
- 1 to 3 mL syringe
- 23-26 needle gauge
- 1/2 inch needle length for 90 degree angle entry
- 3/8th to 5/8th inch length for 45 degree angle entry
what are the most common types of subcutaneous medications?
- heparin
- insulin
- epinephrine
- allergy extracts
administration sites for subcutaneous injections
- outer posterior part of the arm (fatty part)
- thigh (middle part)
- abdomen (2 inches away from umbilicus)
- upper back (between shoulder blades)
steps to administering subcutaneous injection
- cleanse site w/ alcohol pad
- gently pinch loose fatty tissue
- don’t aspirate injection + insert needle at 45 degree angle
- after insertion, release pinched skin + push med slowly
- withdraw needle at same angle + activate safety device
- remove label from syringe + discard in sharps
- apply loose bandage + do not massage for heparin/insulin
syringe and needle sizes for intramuscular injection
- 5 mL syringe
- 18 to 25 gauge needle
- 5/8th inch to 1/2 inch needle length for 90 degree angle
- longer needle lengths can be used for obese patients (1-3 inches)
what are the most common types of intramuscular injections?
- vaccines
- contraceptives
- vitamin preps
- corticosteroids
- antibiotics
administration sites for IM injections
- deltoid (vaccines + small volume meds)
- vastus lateralis (side of middle anterior thigh) for infants/children
- ventrogluteal (oil-based meds)
steps to administer IM injection
- cleanse site w/ alcohol pad
- syringe in dominant hand + pull skin taut w/ nondominant
- quickly insert needle at 90 degree angle (dart-like motion)
- stabilize syringe + slowly push medication
- withdraw needle at the same angle
- activate safety device
- apply bandage + light pressure/massage
- dispose of syringe in sharps
- ask pt to wait 20-30 min
how do you aspirate a medication in a syringe?
- insert needle
- pull back on plunger + wait 5-10 seconds
- if blood enters syringe, remove needle + start again b/c you’ve entered a blood vessel
transdermal administration
- continuous slow diffusion of drug through intact skin
- patches used for therapy (ex. fentanyl/nicotine/nitroglycerine)
- rotate sites
which type of medication has the quickest action?
intravenous (IV) injects drug directly into the bloodstream to reach the brain (<1 min)
mucosal route
- absorption into/through mucous membranes
- can be administered in vagina/rectum/eye/ear
- can cause irritation to mucosa
topical route
- reacts locally w/ minimal absorption
- can treat local condition (ex. acne) or serve as barrier from irritants
- oil or water based
inhalation route
- targeted areas like bronchial passages
- inhalers/nebulizers (coach on proper breathing techniques)
- pt must hold medication in the lungs as long as possible for effectiveness
sublingual route
- commonly used: nitroglycerin tablets/spray
- smaller doses required
- tablets melt + enter bloodstream rapidly under tongue
- eat/drink/smoke can influence absorption
buccal route
- rapid absorption between cheek + gums
- smaller doses required
- no chewing/swallowing medication as it should be melted
- eat/drink/smoke can influence absorption
eye/ear medications
- medication must be at room temperature
- solution should not flow down the tear duct
which parenteral routes can NOT be administered by CCMA?
- epidural
- intra-arterial
- intra-articular (within joint space)
- intraosseous (bone marrow)
- intraperitoneal (abdomen)
- intrapleural
- intrathecal (brain)
enteral vs. parenteral
enteral: medication absorbed through digestive system
parenteral: entered through bloodstream
instillation route of medication
delivered by drops (gtt) for eyes/ears/nose
vaginal route of medication
delivered in form of suppositories/pills/creams/contraception
