Module C Part 1 Medication Administration Flashcards
Rights of Medication Administration
Right Client Right Drug Right Dose Right Route Right Time Right Documentation (Right to Refuse)
Personal Protective Equipment
Eyes (goggles) Face (mask) Head (cap) Extremities (gloves) Protective Clothing (gown) Respiratory devices: Protective Shields Barriers
Reasons for PPE use
hazards of the process
environmental chemical hazards
radiological hazards
mechanical irritants
*ex: hand moisturizer - facility approved
(can make gloves more permeable and infection can get through)
Systems of Distribution
Computerized (pharmacy provides meds)
Unit Dose
Stock Supply (draw 1mL out of 10mL vial)
Drug Packaging (types)
Mix-O-Vials Cartridges/Tubex Dose Packs Vials Ampules Pre-filled Syringes
powder in vial, mix with solution
Mix-O-Vials
plastic syringe with plunger to push through tubing
Cartridges/Tubex
glass; break top with alcohol swab, draw medication up with filtered needle & administer medication with a different needle
Ampules
Made with medication already in the syringe
Pre-filled Syringes
Safe & effective medication administration
Careful evaluation of technique (are you protecting the patient)
Clients response to therapy is positive
Client has ability to assume responsibility for self-care
Goals of Medication Administration
MAR
Medication Administration Record
refer to for identification of the patient, dose, medication, route, etc. according to MD order
Medication Administration Record (MAR)
Reading & interpreting medication orders
Parts of a medication order
Compare to medication administration record
Types -STAT, Now, Routine/Standing, PRN, One time dosing, Written, Verbal/Phone
Medication Orders
STAT
single dose one time IMMEDIATELY
Now
first dose: 60-90 minutes now, but may give more than once
Standing
done until discontinued
PRN
only when patient requires, as needed or requested, as occasion arises
One Time Dosing
pre-op situations, one time dose
Verbal/Phone
written down but they have to sign, then put into computer record
(strict because RNs give w/o order & errors happen & used to practice medications without license
Essential Order Components
Client name Date/Time Medication name Dose Route Time & Frequency Signature *if one is missing- Not Valid, send back, do not fill it or give it.
Reading & Interpreting Orders
Common Abbreviations No longer approved abbreviations Likely to be discontinued or unapproved in the future *do not use-joint commission list *ISMP list -higher risk of errors *Special instructions -read whole order
Essential Label Components
Name of manufacturer Drug name (trade/generic) Form Supplied dosage Total Volume Route intended Directions for mixing Label alerts/special precautions Expiration date Lot/control number National drug code Bar code U.S. Pharmacopeia & National Formulary Unit dose Any combination of drugs
What to do incase of bad reaction?
Do Not Throw Anything Away
Remember: What? When? Where?
(what med, when it was administered, where was it administered)
Preparing Dosages for Administration
Check medication at least 3 times
Check expiration date on medication
Accurately measure medication dose
Check for patient allergies
Measuring a Liquid Medication
Hold the bottle with the LABEL in the palm of hand
Hold at eye level to make sure its at right amount
Use cups that came with the medication
Classification Mechanism of action (therapeutic effect, idiosyncratic reactions) Side Effects Adverse Effects Toxic Effects Contraindications/cautions Drug/Food interactions (synergistic effect) Nursing Implications
Drug Information Preparation
The expected response the patient will have to the medication
*benadryl to child - causing drowsiness
Therapeutic Effect
unpredictable adverse drug effects that are seen less frequently than predictable ones.
(it doesn’t make sense, unexpected, not dose dependent)
*may be considerably more serious
*occur rarely but can occur
Idiosyncratic Reaction
Not wanted reactions but somewhat predictable
Side Effect
negative side effect, unwanted, undesirable effects
(much more severe than side effect)
stop medication immediately, report to FDA and MD
Adverse Effect
very narrow therapeutic ranges which means that the dose that you need to take to prevent a certain condition or treat condition is very close to the dose that is toxic to you.
ex: Lithium - dehydration
Toxic Effect
something (as a symptom or condition) that makes a particular treatment or procedure inadvisable
*reason you don’t give medication
Contraindications
Monitor more closely
Cautions
The effect produced when some drugs and certain foods or beverages are taken at the same time
*ex: grapefruit juice blocks metabolism of some drugs in the GI tract, a reaction that can cause normal dosages of a drug to reach a toxic level in the plasma
**could be positive or negative
(synergistic effect)
Drug/Food Interaction
Information Needed to Safely Administer Meds
V/S
Monitor Pt’s Response
Effective?
**Prepare Meds for ONE PATIENT at a time
Enternal Medication Route
drugs administered directly into the GI tract
oral
rectal
nasogastric
Why Enternal Medication Route?
slow onset of action, longer lasting effect, preferred by patient over other routes, be able to assess for contraindication
*ex: phenergan- do not give if pt cant keep down due to N/V
check allergies, if pt vomits 10 mins later-Call MD
Oral Medication Routes
Sublingual
Buccal
medication that is intended to dissolve and be readily absorbed under the tongue
*do not eat/drink until completely dissolved
Sublingual
medication in solid form placed against mucous membranes of cheek to dissolve
*do not eat/drink until completely dissolved
Buccal
Dosage Forms
Capsule/Pill/Tablet Tablets Elixir Syrup Lozenge Suspension Emulsion Suppository
gelatin container that holds dry powder or granule
*great if medication has bad taste or odor
Capsule
gradual, continuous release of drug
- reduces number of doses taken per day
- especially in elderly
Time-Released Capsule (TR)
dry powder meds compressed in small disk
- scored - can cut in half
- if not scored - ask about cutting
Tablet
special coating to get past stomach & broken down by pH in small intestines
*never cut or crush
Enteric-coated
clear liquids made up of medications dissolved in water and small amounts of alcohol
*take medication that is not water-soluble and mix with little alcohol (to dissolve drug) and then put in bigger amount of water
Elixir
concentrated solution of sugar (sucrose) to make it taste better due to medication being bitter
Syrup
flat disk with medication usually flavored dissolve in mouth
ex: cough drops
Lozenge
liquid dose with solid particles in liquid solution
- drug particles will settle at bottom
- Shake Well before dispensing
Suspension
small droplets of either oil with water base or tiny drops in water with oil base
ex: vitamins containing iron
* Try to hide taste of medications
Emulsion
Per Rectum (PR), some have local effect, some stimulating effect (absorbed)
- can be vaginal
- sometimes pt can give to themselves, sometimes you have to do it for the pt
Suppository
When Giving Multiple Medications..
give the most important medication first
Oral Pediatric Administration
Don’t shove in mouth; ask if they want to do it
Check ID bracelet on the pt., not the ID on the bedside or in the bed.
Check level of orient-ness, coo, looking around
Never dilute medication for child unless there is an order for it
Never leave medication at bedside or if baby is sleeping do not leave with parents
*you see them take it or you take it with you, unless physician order.
Five Behavioral Patterns of Medication Use Characteristic of Older Adults
Polypharmacy Self-prescribing of meds OTC meds Misuse of meds Noncompliance
take a lot of medications, to treat increasing number of diseases or disorders
*greatly increases risk of adverse effects
Polypharmacy
pain, constipation, insomnia
*may take IBU or OTC
Self-Prescribing of Meds
*75% of adults take these types of meds (it can hurt a pt.)
Need to know if they take these types of meds due to reactions
Over The Counter (OTC) Meds
Overused, underused, save old RX from DR
Misuse of Meds
deliberate misuse of meds
- taking meds other than the way they are prescribed
- sometimes pt. forgets to take medication and doubles up on that medication
Noncompliance
Medication Rules for Older Adult
Usually need lower dose than the recommended adult dose Special delivery (big labels, caps not childproof)
Organs That Decline With Age
Kidney & Liver Function
Meds Administered Through Skin & Mucous Membranes
Instillations:
Eye, Ear, Vaginal, Nasal, Inhalation (delivered to lungs)
eye drops
if pt has cervical injury- do not hyperextend the neck
Ophthalmic
ear drops
Otic
Less Common Abbreviations of Eye
OD-right eye
OS-left eye
OU-both eyes
Putting Eye Drops In
If applying to open wound -sterile technique
Putting Ear Drops In
Side Lying, ear canals little crooked, pull auricle down and back (child) or pull auricle up and back (adult) to straighten canal. Massage tragus and have patient lay in position for 2 to 3 minutes
Vaginal Meds
usually in the fridge
usually pt can self-administer
Nasal Meds
usually written for both nostrils
positioning is specific
on turbulance
Using Nasal Medication
breath through mouth, gently blow nose (unless nose bleed or sinus surgery) before giving med
Do not allow patient to inhale through nose while giving med because it pulls deep in passage and goes down the throat.
Teach to use with spacer (spacer teaching)
9% of the med get in lungs & 81% of med gets on mouth & throat (oral pharynx) w/o a spacer
Meter-Dose Inhaler (MDI)
Why are inhalers considered topical medications?
Because you are putting the medication on the Lung surface
Example of MDI
Ventolin
slows velocity down so medication gets down to the lungs
Spacer
Proper Technique with MDI
Spacer
If patient does not have the muscle coordination to use an inhaler, what do you do for the patient?
Allow patient to use a nebulizer with a mask
Requires less coordination, turn one-click to put powder in opening & inhale.
Dry Powder Inhaler (DPI)
Causes of Clumping in the Inhaler
Exhaling into the inhaler (powder gets wet)
Humidity
Spacer is not required for this type of inhaler
DPI
Applied using gloved hand, applied to intact skin
Topical Medications
Types of Topical Medications (applied locally to skin)
Lotions, Pastes, Ointments, Patches
If there is open skin wound, and you need to apply topical medication, what technique do you use?
Sterile Technique
What do you do before applying a patch?
Look for another patch that may be on
Concerns about Patches
A lot of the medication is left on the patch when its taken off therefore there is concern with the drug on patch being broken down to cook (make illegal drugs)
Documentation of Patches
When it came off, Where it came from, When it was reapplied (or put on), & where you reapplied (or put on)
What can you do to help others find the patch you applied?
Mark around the patch or label it
Syringe Functions
Transfers med from storage container to patient Useful for maintaining sterility Measures meds that we give Safety device to prevent needle sticks Useful device to deliver med with
Syringe Parts
Barrel, Plunger, Tip
Main body of syringe, medicine receptacle usually calibrated with scale
Barrel
Generates negative pressure to pull medication in barrel, positive pressure to push medication out
Plunger
Needle connects to this
Tip
Needle Parts
Beveled Tip
Shaft
Hub
Sharp cutting edge; the longer it is, the sharper it is
Beveled Tip
Length in inches, diameter in gauge
the bigger the gauge number the smaller the needle size
Shaft
Factors Affecting Needle Choice
General Principle: use smallest appropriate gauge to get to the target tissue
Viscosity: thickness, flowability of medication; takes more pressure, thicker the med, lower the gauge # (larger needle size)
Target Tissue: we want to hit the target tissue with the least amount of trauma; depending on what type of shot (ID, SQ, IV, IM) depends on needle size
Volume of Medication Intradermal (ID)
0.1 mL
Volume of Medication Subcutaneous (SQ)
0.3 mL - 1 mL
Volume of Medication Intramuscular (IM)
0.5 mL - 3 mL
Volume of Medication Intravenous (IV)
5 mL - 1000 mL
IM for Infant
0.5 mL - 1 mL
IM for child
0.5 mL - 2 mL
IM for adult
0.5 mL - 3 mL
a lot of volume for a single shot
3 mL in adult
What do you do if you have to give an IM shot to an adult for 5 mL of Antibiotics? WHY?
give 2.5 mL then give another shot of 2.5 mL, because if you give 3 mL and 2 mL the muscle may not be mature enough to handle 3 mL
How can IV Meds be administered? WHY?
Continuously, because volume is greater because its going directly into vessel so you can regulate how quickly it flows.
Used to delivered as small as 5 mL total volume of IV meds.
Syringe Pump
Has to be drawn up with a filter needle due to glass particles
Ampule
Advantages of Ampules
cost effective, sterile, small volumes, single dose or multi-dose
Preparing Injections from Ampules
- Must break the neck with alcohol pad to access medication
- When you break the neck there is an air bubble so medicine doesn’t run out, you can get medication by needle (there is a technique)
Preparing Injections from Vials
- Glass or plastic rubber cap protected by metal or plastic cover.
- Rubber cap must be pierced to access med
- When sticking needle into vial it dulls needle so another needle to stick patient.
- If Multi-dose vial make sure you shake before use b/c meds may settle at bottom
How Vials Come Packaged
Multi-dose or single dose, liquid or powder (must be diluted), glass or plastic bottle
The Injection Site We DO NOT Inject In
Dorsal Gluteal
Reason we DO NOT Inject in Dorsal Gluteal
Sciatic Nerve varies from person to person (you have a bigger chance hitting that nerve), very painful could cause foot drop and/or long term complications
Always do with IM injections
ASPIRATE for Blood Return before injecting medication
How do you Aspirate for Blood Return?
Pull Back on Plunger just a little bit
You are giving an IM injection, you aspirate for blood return & you get blood return. What do you do in this situation?
Take the needle out, get all new equipment (needle, medication, etc.) and go to another site.
ALWAYS DOCUMENT -even doc. how many attempts it takes
What happens if you get blood return and don’t change sites & you just push the med in the site?
You will shoot medication into vein and cause complications
What is the first 3 things you do when Drawing Up Medication? (3 Checks)
- Check Label (on med)
- Check Expiration Date (on med)
- Check (inspect) for Discoloration & Precipitation (of the med)
After 3 Checks, What do you do with vial/bottle?
- Clean the top of the bottle each time with an alcohol pad (firm swipe of the swab)
- Do not touch the top of the bottle after it is cleaned with alcohol
After cleaning the top of the bottle/vial, what do you do with needle and syringe?
- Attach &/or tighten the needle onto the syringe
2. Take the needle cap off the needle
When carefully selecting the site for injection what do you want to avoid?
Major blood vessels and nerves.
We use different sites giving injections to prevent..
repeated injections in the same area
If different sites are used, what can happen?
Patient can get lipodystrophy
If you have more than one injection, you will..? Especially with what kind of injection & why?
change sites with each injection.
Especially with steroid injections because you can cause Skin Breakdown
Areas you DO NOT use when selecting the site of an injection
areas that are bruised, tender, scarred from surgeries or injury, or swollen
What do you need to know when giving an injection to a patient..
What injection you gave and what body part.
Administering Intradermal (ID) Injections are made into what area? How do you measure?
Injection is made into Dermal Layer of the Skin just below the epidermis.
-Hand breath from radial and hand breath from bend of arm (AC), if you were giving injection on the forearm
When Administering ID Injections, how much do you inject and what are you producing?
Usually 0.1 mL is injected to produce a bleb
An irregularly shaped elevation of the epidermis; blister-like
Bleb
Reasons you give Intradermal Injections?
Allergy Sensitive Tests
Desensitization Injections (severe allergy in controlled environment)
Local Anesthetics
Vaccinations (TB test)
Angle of Syringe with giving Intradermal Injection
5 to 15 degree angle
How long do you have to wait before you can read a TB test?
48 to 72 hours
What do you look for when checking the TB Skin Test?
Raised indurated area you feel from the bleb
If Positive TB Skin Test, what does the patient have to do next? How often?
Chest X-Rays; Annually
Patient from a Foreign Country has had BCG vaccine (TB vaccine), we do not give this in the United States, what does the patient have to do? Why?
Patient has to get a Chest X-Ray because they will test positive every time due to the BCG (TB) Vaccine
What is Desensitization Injections?
When a person has a severe allergy, allergy specialist/doctor will give a very small amount of concentrated allergen in a controlled environment incase of anaphylaxis, so they can reverse the anaphylaxis if it happens.
Subcutaneous (SubQ) Injections are made into what area? How much is normally deposited at a SC site?
Injections are made into the loose connective tissue between the dermis and muscle layer.
No more than 1 mL can ordinarily be deposited at a SC site
Reasons you give SubQ Injections
For Drugs like Insulin & Heparin
*also Lovenox (blood thinner)
Why do you NOT aspirate with SubQ Injections?
The needle is short so you are not going low enough to get in tissue for bleeding
How do you hold the syringe when giving SubQ Injection? How fast do you inject medication?
Hold Syinge like a Dart
Inject medication at a controlled rate
Depending on how much extra tissue a patient has, what can you do to get to the subcutaneous layer?
you may pinch the skin up, this will hold the tissue up
Angle of Syringe when giving SubQ Injection
90 degrees with Larger People
45 degrees with Thin People (emaciated, frail)
What do you feel for first before giving SubQ injection?
Feel site for bony prominences, lesions, tenderness
What do you do after you give a SubQ injection? What do you NOT do?
Gentle pressure with cotton after needle
DO NOT MASSAGE SITE
With Insulin, what varies greatly from site to site?
How do you rotate sites?
Rate of Absorption varies greatly from site to site, and exercising before or after insulin shot.
Rotate sites Anatomically (R side of abd. to L side of abd.)
What happens if you give insulin injection in the abdomen then later give it in the thigh?
The injection in the thigh will act quicker than injection in the abdomen which causes faster absorption
IM Injection Sites
Ventrogluteal
Vastus lateralis
Deltoid
DO NOT USE DORSOGLUTEAL SITE!!!
Injection site you give for more viscous meds,
Preferred site for larger amounts of medicine, Can use in adults, children, and infants
Ventrogluteal
Injection site that has a large muscle, Less chance of hitting bony prominences due to being a deep site and well developed muscle (even if pt. is not walking), Less chance of contaminating site with incontinence, Preferred for Infants less than 12 mo old for immunizations
Vastus lateralis
Injection site that is easily used, do not use in children due to muscle not being well developed, potential to hit underlying nerve structures and arteries causing injury, easy to find, very small amounts of medications (hepB or rabies)
Deltoid
Angle of Syringe when giving Intramuscular (IM) Injection
90 degrees
IM injection Techniques
90 degree angle
muscle is less sensitive
well developed adult ^ to 3 mL volume
older, thin adults ^ to 2 mL or less depending on body type, and nutritional state
What does the Z-Track Method of IM injections do and what does it prevent?
it locks the medication into the muscle and prevents irritation to surrounding tissues and keeps medication from leaking to other tissues
When do you do a Z-Track Method IM Injection?
With Irritating Medications, or if packaging of drug recommends it. ex: Iron Injection (ferrous sulfate)
What do you tell the patient when explaining/teaching about their medications?
- Drug Information and how to take it
- Desired Effects
- If it requires skill, they have to return demonstration (Gold Standard -Required)
- How to dispose of needles (if getting them)
- Dietary Concerns
- Blood Sugar Checking with patients on Insulin
Procedures for Properly Handling or Disposing of Medication Administration Supplies
- Put needles in Sharps Box
- If Sharps Box isn’t available, try to do “one-handed recap method”
- Do not shove syringe/needle in full sharps box, drop into sharps box one-handed
- DO NOT RECAP A NEEDLE
- Whenever possible use needle-less devices
- Use Biohazard Containers (sharps box)
- Wasting Medications = follow facility protocol
- Wasting Medications that are controlled = always get another nurse to watch you (2 nurses)
Documenting Medication Administration Guidelines
- ASAP (not doc. not done)
- Date, Time, Name of Drug, Dose, Route, Site of Injection
- Add Fluids to I & O
- Right to Refuse (chart immediately) & Notify MD
- Report errors per protocol
Elements Leading to Medication Errors
- Misinterpretations (ex. Abbreviations)
- Miscalculations (ask for clarification)
- Misadministration
- Difficulty in Interpretation of Handwritten Orders
- Misunderstanding of Verbal Orders
- Drug Name Confusion (always look ^ & if you are late just chart why you were give med a little late)
- Lack of Employee/Patient Knowledge
Documenting Medication Administration
- School or Hospital Protocol
- Adjunct Assessment Data
- Evaluation of Patient’s Response to the Drug
Record.. in the chart
Date, Time, Name of Drug, Dose, Route, Site of Injection, Procedure, and How the Patient Tolerated
What do you always have to do after giving a medication?
ALWAYS REASSESS THE PATIENT
