Module 4: Nonparenteral Meds Flashcards
Enhanced nebulizer designs
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.
Oral med absorption/ingestion
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.
If patient experiences adverse effects
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.
If patient refuses medication
Assess why patient is refusing medication.
* Provide further instruction.
* Do not force patient to take medications.
* Notify health care provider
Feeding Tube Administration
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.
Aspiration with feeding tube
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
Patient does not receive medication because of
blocked enteral tube
- 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
Tube patient exhibits adverse effects
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.
Applying topical meds
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
Unexpected outcomes w topical meds
- 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.
Ophthalmic Meds unexpected outcome - Patient complains of burning or pain or experiences
local side effects.
Dim room lights to reduce glare and associated discomfort.
* Notify health care provider for possible adjustment in
medication type and dosage
Ophthalmic Meds unexpected outcome - Patient experiences systemic effects from drops
Notify health care provider immediately.
* Remain with patient. Assess vital signs.
* Withhold further doses
Otic Meds unexpected outcome - Ear canal remains inflamed, swollen, tender to palpation. Drainage is present
Hold next dose.
* Notify health care provider for possible adjustment in
medication type and dosage.
Otic Meds unexpected outcome - Patient’s hearing acuity does not improve
Notify health care provider.
* Cerumen may be impacted, requiring ear irrigation
Using Metered-Dose
Inhalers (MDIs
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
MDIs Unexpected Outcomes - Patient’s respirations are rapid and shallow; breath sounds indicate wheezing
- Evaluate vital signs and respiratory status.
- Notify health care provider.
- Reassess type of medication and/or delivery method
MDIs Unexpected Outcomes - Patient needs bronchodilator more than every 4 hours
(may indicate respiratory problem)
- Reassess type of medication and delivery methods needed.
- Notify health care provider.
MDIs Unexpected Outcomes - Patient experiences cardiac dysrhythmias (light-headedness, syncope), especially if receiving beta-adrenergic medication
- Withhold all further doses of medication.
- Evaluate cardiac and pulmonary status.
- Notify health care provider for reassessment of type of
medication and delivery method
Using Dry Powder–
Inhaled (DPI) Medications
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
Nebulization
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
Nebulization Unexpected Outcomes - Patient’s respirations are rapid and shallow; breath
sounds indicate wheezing and peak flow reading is
below target
Reassess type of medication and/or delivery method.
* Notify health care provider.
Nebulization unexpected outcomes - Patient experiences paroxysms of coughing.
Aerosolized particles can irritate posterior pharynx
Reassess type of medication and/or delivery method.
* Notify health care provider.
Patient experiences cardiac dysrhythmias (light-
headedness, syncope), especially if receiving a beta-
adrenergic.
