Module 4: Nonparenteral Meds

Question 1

Enhanced nebulizer designs

Answer 1

Breath-enhanced nebulizers minimize waste and produce more aerosolized medication during inhalation.
 Advantages of breath-enhanced nebulizers include:
* Production of smaller particles in the aerosol.
* Faster nebulization rate.
* Less medication waste.
 Newer technology uses a storage bag with a one-way valve in the mouthpiece, so during the expiratory phase, aerosol collects in the bag and is delivered to the patient on the next inhalation.
 This design reduces waste of the medication
 A breath-actuated valve that triggers aerosol production only during inhalation eliminates the need for a storage bag, which benefits pediatric patients compared with a jet nebulizer.

Question 2

Oral med absorption/ingestion

Answer 2

Liquids are absorbed faster than tablets or capsules
and are usually absorbed in the stomach.
 Some oral medications are absorbed in the intestinal
tract. The enteric coating protects the stomach lining
from irritation by the medication.
* Never crush or split an enteric-coated medication.

Question 3

If patient experiences adverse effects

Answer 3

Patient exhibits adverse effects.
* Notify health care provider and pharmacy immediately.
* Withhold further doses.
* Assess vital signs.
* Symptoms such as urticaria, rash, pruritus, rhinitis, and wheezing may indicate an allergic reaction and need for emergency medications.
* Add allergy information to patient’s medical record.

Question 4

If patient refuses medication

Answer 4

Assess why patient is refusing medication.
* Provide further instruction.
* Do not force patient to take medications.
* Notify health care provider

Question 5

Feeding Tube Administration

Answer 5

Medications should be in liquid form; consult a pharmacist before crushing or dissolving tablets
 Verify correct placement of tube before medication
administration

Keep the head of the bed elevated a minimum of 30 degrees (preferably 45 degrees) for 1 hour after medication administration; follow agency policy.

Question 6

Aspiration with feeding tube

Answer 6

Patient exhibits signs of aspiration, including
respiratory distress, changes in vital signs, or
changes in oxygen saturation.
* Stop all medications/fluids through feeding tube.
* Elevate head of bed and stay with patient.
* Assess vital signs and breath sounds while another staff member notifies health care provider

Question 7

Patient does not receive medication because of
blocked enteral tube

Answer 7

• For newly inserted tube, notify health care provider and obtain x-ray film confirmation of placement.
• Requires interventions to unclog tube to ensure drug delivery

Question 8

Tube patient exhibits adverse effects

Answer 8

Withhold further doses.
* Notify health care provider and pharmacy immediately.
* Symptoms such as urticaria, rash, pruritus, rhinitis, and wheezing indicate allergic reaction.
* Enter patient allergy in medical record.

Question 9

Applying topical meds

Answer 9

Medications applied locally to skin, mucous
membranes, or tissues.
 Lotions, patches, pastes, and ointments primarily
produce local effects, but can create systemic effects
if absorbed through the skin.
 Never apply new medication over a previously applied
medication.
 Always clean the skin or wound thoroughly before
applying a new dose of a topical medication

Question 10

Unexpected outcomes w topical meds

Answer 10

• Skin site appears inflamed and edematous with
  blistering and oozing of fluid from lesions. These
  signs indicate subacute inflammation or eczema that
  can develop if skin lesions are getting worse.
• Hold medication.
• Notify health care provider; alternative therapies may be needed.

Question 11

Ophthalmic Meds unexpected outcome - Patient complains of burning or pain or experiences
local side effects.

Answer 11

Dim room lights to reduce glare and associated discomfort.
* Notify health care provider for possible adjustment in
medication type and dosage

Question 12

Ophthalmic Meds unexpected outcome - Patient experiences systemic effects from drops

Answer 12

Notify health care provider immediately.
* Remain with patient. Assess vital signs.
* Withhold further doses

Question 13

Otic Meds unexpected outcome - Ear canal remains inflamed, swollen, tender to palpation. Drainage is present

Answer 13

Hold next dose.
* Notify health care provider for possible adjustment in
medication type and dosage.

Question 14

Otic Meds unexpected outcome - Patient’s hearing acuity does not improve

Answer 14

Notify health care provider.
* Cerumen may be impacted, requiring ear irrigation

Question 15

Using Metered-Dose
Inhalers (MDIs

Answer 15

Pressurized metered-dose inhalers (pMDIs)
 Breath-actuated metered-dose inhalers (BAIs)
 Dry powder inhalers (DPIs)

MDI
 Small, handheld device
 Disperses medication into the airways through an
aerosol spray or mist by activation of a propellant
 Requires coordination during the breathing cycle
* Patient with poor coordination may need to use a spacer device or a BAI

Question 16

MDIs Unexpected Outcomes - Patient’s respirations are rapid and shallow; breath sounds indicate wheezing

Answer 16

• Evaluate vital signs and respiratory status.
• Notify health care provider.
• Reassess type of medication and/or delivery method

Question 17

MDIs Unexpected Outcomes - Patient needs bronchodilator more than every 4 hours
(may indicate respiratory problem)

Answer 17

• Reassess type of medication and delivery methods needed.
• Notify health care provider.

Question 18

MDIs Unexpected Outcomes - Patient experiences cardiac dysrhythmias (light-headedness, syncope), especially if receiving beta-adrenergic medication

Answer 18

• Withhold all further doses of medication.
• Evaluate cardiac and pulmonary status.
• Notify health care provider for reassessment of type of
  medication and delivery method

Question 19

Using Dry Powder–
Inhaled (DPI) Medications

Answer 19

Dry powder inhaler (DPI)
 Holds dry powder medication
 Creates an aerosol when the patient inhales through
a reservoir that contains the medication
 Contains no propellant
 Does not require a spacer

Question 20

Nebulization

Answer 20

Process of adding medications or moisture to inspired
air by mixing particles of various sizes with air
 Small-volume nebulizers convert a drug solution into
a mist that is then inhaled by a patient into his or her
tracheobronchial tree.
 Effects are designed to be local, but can be systemic
if absorbed into the bloodstream by the alveoli

Question 21

Nebulization Unexpected Outcomes - Patient’s respirations are rapid and shallow; breath
sounds indicate wheezing and peak flow reading is
below target

Answer 21

Reassess type of medication and/or delivery method.
* Notify health care provider.

Question 22

Nebulization unexpected outcomes - Patient experiences paroxysms of coughing.
Aerosolized particles can irritate posterior pharynx

Answer 22

Reassess type of medication and/or delivery method.
* Notify health care provider.

Question 23

Patient experiences cardiac dysrhythmias (light-
headedness, syncope), especially if receiving a beta-
adrenergic.