Test 2

Question 1

Drugs are administered for

Answer 1

• Local effects

* Systemic effects

Question 2

Local drugs:

Answer 2

Applied to skin, tissues, or mucous membranes

Question 3

Systemic drugs:

Answer 3

Administered by routes that allow the drug to be absorbed and distributed in the bloodstream throughout the body.

Question 4

What needs to be considered before choosing the route of administration?

Answer 4

1. drug’s mechanism of action
2. drug’s characteristics
3. cost
4. availability
5. patient’s physical and emotional state

Question 5

Dose and Route in Drug Administration:

Answer 5

• give extreme care to dose and route
• frequently check and recheck the ordered form of the drug (tablet or capsule)
• there are many forms of a specific drug available so there is a high risk of error in choosing the correct form
• route of administration can determine how much drug is delivered in one dose
• ensure that the ordered dose is appropriate for the patient’s age and weight
• check that the patient has no swelling or injury at the administration site
• check that there are no contraindications

Question 6

General Rules for Drug Administration

Answer 6

1. Give only the drugs the physician ordered; written orders are better than oral; if unfamiliar with the orders, ask doctor or consult a drug reference book
2. Wash hands before handling the drug
3. Prepare the drug in a well-lit area
4. Focus on what you are doing; don’t get distracted
5. Calculate the dose if this is necessary
6. Avoid leaving a prepared drug unattended
7. Never administer a drug that someone else has prepared
8. Identify the patient by asking him/her name; also ask patient about any possible drug allergies (be aware that he/she may have new allergies, not only the ones that were on the chart)
9. Be sure that doctor is in the room when you administer the drug
10. If there is an anaphylactic reaction, the doctor must be present to administer epinephrine
11. After administering the drug, watch for any unexpected effects
12. Give patient specific instructions about the effects of the drug as well as general information about drug use
13. If the patient refuses to take the drug, flush it down the toilet. Do not put it back into the container
14. Be sure to document the refusal in the patient’s record and tell the physician
15. If you make an error in drug administration, tell the physician immediately
16. Document immediately the drug and dose administration; never document before giving the medicine
17. The most important is: FOLLOW THE SEVEN RIGHTS

Question 7

THE SEVEN RIGHTS

Answer 7

1. right patient
2. right drug
3. right documentation
4. right dose
5. right time
6. right route
7. right technique

Question 8

Routes of Administration

1. Buccal: Tablets

Answer 8

Place drug between patient’s gum and cheek. Tell patient to leave tablet there until it dissolves and not to chew or swallow it; this is to insure absorption. No eating, drinking, or smoking until tablet is completely dissolved.

Question 9

2. Intradermal administration:

Answer 9

Solutions & Powders for reconstitution

Drug is administered by injection into upper layers of patient’s skin.

Question 10

3. Intramuscular administration:

Answer 10

Solutions & Powders for reconstitution

Administer the drug by injection into muscle.

Question 11

4. Intravenous:

Answer 11

Solutions (often in bags of 250, 500, or 1000ml), Powders for reconstitution, blood and blood products
Administer drug by injection or infusion into vein.

Question 12

5. Inhalation therapy (nasal or oral):

Answer 12

Aerosols, sprays, mists or steam

Administer drug by inhalation to reach respiratory tract.

Question 13

6. Oral:

Answer 13

Tablets, capsules, liquids, lozenges

Give drug to patient to swallow.

Question 14

7. Ophthalmic (eye) or otic (ear):

Answer 14

Solutions, Ointments

Apply drug, usually as drops, in patient’s eye or ear.

Question 15

8. Rectal:

Answer 15

Suppositories, Solutions

Insert suppository into rectum. Administer solution as enema, using tube and nozzle.

Question 16

9. Subcutaneous:

Answer 16

Solutions, powders for reconstitution

Administer drug by injection into subcutaneous layer of skin.

Question 17

10. Sublingual:

Answer 17

Tablets, Sprays
Place drug under patient’s tongue. Tell patient to leave tablet under tongue until it dissolves and not to chew or swallow it. No eating, drinking, or smoking until tablet is completely dissolved.

Question 18

11. Topical:

Answer 18

Ointments, Lotions, Creams, tinctures, powders, sprays, solutions
Apply drug to patient’s skin or rub into skin.

Question 19

12. Transdermal:

Answer 19

Patches

Apply drug to clean, dry, nonhairy area of skin.

Question 20

13. Urethral:

Answer 20

Solutions

Administer drug by instilling in bladder, using catheter.

Question 21

14. Vaginal:

Answer 21

Solutions, suppositories, ointments, foams, creams
Administer solution as douche, using tube and nozzle. Administer any other form by inserting into vagina with applicator.

Question 22

Syringe Preparation

Answer 22

Drawing drug from ampule & from injection

Question 23

Guidelines BEFORE preparing syringe

Answer 23

• Read labels on all medications to be certain the correct injection technique is being used (ex: intramuscular)
• Make sure you have the correct dose
• Check expiration dates
• Always wash your hands and wear gloves

Question 24

Preparing the syringe:

Answer 24

• Know what kind of equipment you will be using
• How medications are packaged
• Follow disinfection or aseptic procedure
• Use an alcohol swab to clean the rubber stopper on vials before preparing the injection
• Always inspect the needle for burrs, bends, or other defects before use
• Never allow the needle to touch a contaminated surface
• If you prepare the injection, you carry it to the patient and recap the needle before you take it to the patient…DO NOT carry an uncapped needle around the office

Question 25

Choosing equipment:

Answer 25

• Choose right size and type of syringe and needle

Question 26

Parts of a syringe:

Answer 26

• Barrel (holds the medication)
• Plunger (inside the barrel; used to withdraw medication from the container, and to inject medication into the body)
• Flange (flared part of the barrel)
• Tip (where the needle attaches)
• Luer-lock mechanism (allows needle to screw onto the syringe)
• Calibrations: markings outside

Question 27

Types of Syringes:

Answer 27

• They vary in size from 1mL (or 1cc) to 60mL (or 60cc). Size depends on the volume needed
• All hypodermic syringes are marked with calibrations showing milliliters or smaller divisions depending on the size of the syringe.
• Two special types are: Tuberculin and Insulin syringe

Question 28

o Tuberculin syringe

Answer 28

• Are narrow and have a total capacity of 1mL. Each TB syringe has 100 calibration lines.
• Used for: newborn doses, pediatric doses, intradermal skin tests, small doses in adults, injections just beneath the skin

Question 29

o Insulin Syringe:

Answer 29

• Used only for administering insulin to diabetic patients.
• Has total capacity of 1mL
• 1mL volume is marked as units (U)= strength of the insulin per milliliter; most of the insulin that is used today is U-100, which means that it has 100 units of insulin per milliliter; on the syringe, large lines mark each group of ten units; five smaller lines divide the ten units into groups of two; each small line represents 2 units

Question 30

Parts of a needle:

Answer 30

• Hub (part that attaches to the syringe; may be color-coded according to its size)
• Shaft (long portion of the needle)
• Hilt (where the shaft attaches to the hub)
• Bevel (at other end of the shaft; the point is angled)
• Lumen (bore or opening down the middle of the shaft where the medication travels)
• Gauge (is determined by the size of the lumen; the larger the gauge, the smaller the lumen; a 16g or gauge has the largest lumen, and a 28g has the smallest lumen), although insulin needles are as small as 30 gauge.
• Needle sizes are chosen by length and gauge
• The type of injection determines length of the needle being given and the size of the body part chosen.
• Example: a 1-inch needle is sufficient for IM in deltoid muscle, but it may not be long enough for gluteal muscles
• The gauge of the needle is determined by the thickness of the medication
• Example: it is easier to inject a thick medication (Depo-Estradiol) through a larger lumen than it would be through a smaller lumen
• If a very long needle is required, a larger gauge can be chosen to avoid needle bending during the procedure

Question 31

Needles:

Answer 31

• Observe universal precautions and aseptic technique to prevent contamination
• Never walk around the office with an exposed needle
• Never recap a needle once an injection has been given
• Place used syringe, with the needle still attached, into a sharps container
• Always wear gloves when giving an injection

Question 32

Administering medications:

Answer 32

• Before withdrawing medication, a volume of air equal to the amount of medication should be injected to prevent a vacuum from developing in a multiple-dose vial
• Air bubble give the patient discomfort and interfere with medication absorption
• Bubbles can be reduced by injecting this air into air gap at the top of the vial before inverting it to aspirate the medication
• Bubbles can be eliminated by flicking the syringe with your finger until the bubbles rise to the top, then ejecting them through the needle until one drop of medication escapes (while doing this, keep the needle capped or in the vial to avoid contamination or needle-stick injury
• Check label three times
• Once injection is prepared, do not let it out of your sight; keep it with you at all times
• Only give injections that you prepare yourself
• Disinfect the injection site by using an alcohol swab to scrub the site, and then use a second swab to clean in a circular motion inward to outward; never drag a swab from the edges of the disinfected area toward the center because this will drag bacteria with it
• For patient comfort, allow the site to air dry-never blow or fan it
• Choosing the injection site is important; there are localized conditions which make a site unsuitable
• Aspirate by drawing back the plunger and looking for a clear air bubble (this means you have not terminated or ended with the needle in a blood vessel)
• If you see blood, do not inject the medication; withdrawing the syringe and preparing a new injection is the safest thing to do
• Never take your eyes off the needle once it has penetrated the patient’s body
• Stabilize the needle to prevent it from bending or breaking; it should not move while in the patient
• Once an injection has been given, a charting entry must be made
• In the chart indicate: date, medication, dose, method, site, and your initials
• Example: 10/04/00, Demerol, 75mgIM, L gluteus ML.

Question 33

Medication Packaging:

Answer 33

• Injectable medications are packaged in different types of containers
• Vial = multiple-dose glass bottle, with a self-sealing rubber stopper to protect sterility of the medication
• Ampule = single-dose glass container with a small neck which must be broken to prepare the injection; be careful not to get cut or contaminate the contents with glass; tiny shards of glass may mix in with the contents. A filter needle or straw can be used to extract these.
• Tubex or Carpujet = single-dose; closed-injection systems because they are already prepared; some cartridges have the needle attached, but others require needle selection and attachment

Question 34

Oral drug administration:

Answer 34

• Tablets should not be broken unless they are scored (breaking may result in an incorrect dose, affect absorption or cause gastric irritation)
• Tablets are solid
• Capsules may be plastic or solid on the outside and powder, liquid or granules on the inside
• Only crush tablets if already consulted with the pharmacist

Question 35

What to have at hand when administrating oral drug:

Answer 35

• Chart
• Container of oral drug
• Small paper cup (for tablets, capsules, caplets)
• Plastic calibrated medicine cup (for liquids)
• Glass of water or juice
• Package insert or drug information sheet
Method:
1. Wash hands
2. Select ordered drug
3. Check 7 rights
4. Be familiar with the drug
5. Ask patient about drug or food allergies, if not allergic, proceed
6. Calculate dose, if needed

Question 36

Administering Tablets:

Answer 36

1. Open container
2. Tap correct number into cap
3. Tap tablets or capsules from cap into paper cup
4. Re-cap container
5. Give patient cup along with glass of water (if patient has trouble swallowing, give water/juice before the tablet)

Question 37

Administering a liquid:

Answer 37

1. If it’s a suspension, shake it well
2. Locate mark on medicine cup for prescribed dose
3. Keep thumbnail on mark, hold cup at eye level and pour correct amount of drug
4. Label side of bottle should be up
5. After pouring, place cup on flat surface, check level again
6. Give cup to patient with instructions
7. Offer water/juice if appropriate

Question 38

After giving an oral drug:

Answer 38

1. Wash hands
2. Give patient information sheet about the drug, discuss this with patient, answer questions
3. Document drug administration with date, time, drug name, dosage, route, site, and significant patient reactions in the patient’s chart
4. Document patient education about the drug also in the chart

Question 39

Administering Sublingual and buccal (cheeks):

Answer 39

• No chewing or swallowing the medication
• Sublingual goes under the tongue until dissolved
• Buccal goes between the cheek and the gum until dissolved
• There is rapid absorption since these areas have a rich blood supply
• Patient should not drink, smoke or eat anything until tablet completely dissolves
• Remain with patient until tablet dissolves to monitor any adverse reactions

Question 40

Parenteral Administration:

Answer 40

This is administration of a substance by muscle, vein, or any means other than through the GI tract.
Risks: after injected, drug cannot be retrieved; there is a risk of exposure to blood-borne pathogens

Question 41

Methods of injections:

Answer 41

1. Intradermal (ID)- within the upper layers of the skin
2. Subcutaneous (SC)- beneath the skin
3. Intramuscular (IM)- within a muscle
4. Intravenous (IV)- directly into a vein

Question 42

Intradermal Injections:

Answer 42

• Administered into the upper layer of skin at an angle almost parallel to the skin
• Common sites are forearm (ventral aspect- inner aspect), rest patient’s arm on a table with the palm up; measure 2-3 finger-widths below the antecubital space and a hand-width above the wrist- the space between is available for the injection and back (below the scapula)
• Use a 25-27 gauge, 3/8 – ½ inch needle
• Use a tuberculin syringe
• Used for skin tests, such as allergy test or TB test
• Dose is usually less than 0.5ml
• Drug is injected under top skin layer (into dermis, immediately below the epidermal layer), and a little bubble or wheal is raised
• Position patient sitting or lying down
• Position the patient; ensure privacy; expose site to be injected; wash visibly soiled skin with soap and water or prepare skin with alcohol swab, moving in a circle from the center out and dry before administering injection
• Using fingers of your non-dominant hand, hold the middle of the patient’s forearm from the posterior side; pull the anterior skin taut between your thumb and index finger
• With the bevel of the needle facing upward, insert the needle under the outer layer of the skin, just below the epidermis, almost flat against the patient’s skin;
• Needle should be inserted at an angle of 10-15 degrees
• Do NOT aspirate
• Lower the syringe barrel and advance the needle, using slight pressure to elevate it under the skin
• Administer the injection slowly by depressing the plunger; you should see the needle through the skin (You should see a wheal)
• When a bump appears on the skin surface, withdraw the needle carefully
• Wipe the skin gently with dry gauze, ensuring no pressure is applied over the injection site
• Do NOT massage
• If body reacts to the drug, erythema (redness) and induration (hardening) occur
• Document injection date, time, drug name, dosage, route, site and significant reactions
• This takes place 15-20 minutes after an allergy test and 48-72 hours after a TB test
• Dose for TB test is 0.3mL
• If not wheal form you need to let the physician know because you went in too deep

Question 43

Subcutaneous Injections:

Answer 43

• Used for drugs that need to be absorbed steadily and slowly
• Used for insulin and heparin
• Do NOT inject more than 1.0ml in one site
• Patient position can be sitting or lying down
• Wash hands
• Check seven rights
• Prepare drug, pull plunger back an additional 0.2-0.3ml to create an air bubble (this helps seal the subcutaneous tissue
• Clean site
• Pinch skin
• Administered beneath the epidermis into the fat and connective tissue underlying the dermis; make sure the fold contains fat tissue
• Injection sites include: deltoid, abdomen (except a 2-inch area around umbilicus), thighs, beneath scapula, select a site away from bones and blood vessels
• Rotate injection sites systematically, this promotes drug absorption and prevents hard subcutaneous lumps from forming
• At injection site, ensure that you can pinch at least a 1-inch skin fold for the injection
• Use 23-27 gauge, ½-3/4 inch needles
• Insert needle at angle of 45 degrees when it is longer than ½ inch
• Insert needle at angle of 90 degrees when it is less than ½ inch or ½ inch
• Insert needle in one quick motion
• Release skin, aspirate by pulling back slightly on plunger to check needle placement (don’t pull back if it’s insulin or heparin); if you see blood, begin again with new syringe; if not, inject drug slowly
• After injected, place alcohol swab over site, withdraw needle at same angle you inserted it
• Apply pressure at puncture site with alcohol swab
• Massage site gently to help distribute drug
• Dispose of needle, etc.
• Remove gloves, wash hands
• Stay with patient for reactions
• Document on chart

Question 44

Intramuscular Injections:

Answer 44

• Used for rapid drug absorption
• Deposits drug into muscle layer beneath subcutaneous tissue
• Used for wide range of soluble, non-irritant drugs
• 3-5ml of drug can be administered
• May be contraindicated for patients with blood clotting disorders
• Wash hands
• Gloves
• 7 rights
• Clean site
• Position patient
• Identify site (use vastus lateralis (outside of the thigh) muscle for infant or toddler); you can also tap the site to stimulate the nerve endings and reduce pain caused by the needle insertion
• Use 18-23 gauge, 1-3 inch needle
• Sites: gluteal muscles (upper outer quadrant (UOQ) of buttock-avoids sciatic nerve and superior gluteal arteries), vastus lateralis and rectus femoris muscles in the thigh (divide the upper leg into thirds and inject into the middle third or the area central to a hands breadth above the knee joint), deltoid muscles
• Take consideration of the layers of fat the patient has when choosing a site
• The injection has to penetrate beyond the fat layer to muscle
• Stretch skin to one side around the injection site; inject at an angle of 90 degrees; insert needle with a quick, dartlike thrust, holding the barrel of the syringe firmly between thumb and index finger, plunge it into the skin leaving a third of the needle exposed
• Steady the barrel and pull back gently on plunger to observe if blood is aspirated
• Inject drug by pushing plunger of syringe using thumb, with a slow, continuous movement
• Injecting slowly allows time for the tissue to be displaced and is less painful; it also allows diffusion through the muscle
• Withdraw needle and apply pressure to site as necessary
• Remove gloves, wash hands
• Monitor patient
• Document on chart

Question 45

Intramuscular- Z-track method Injection:

Answer 45

• Used for drugs that can irritate subcutaneous tissues
• Pull the skin and subcutaneous tissue to the side before inserting the needle at the site
• After drug is injected, release the tissue
• This creates a zig-zag path in the tissue layers, which prevents drug from leaking into the subcutaneous tissue and causing irritation

Question 46

Intravenous Injection Usage:

Answer 46

• Powerful antibiotics, chemotherapeutic drugs, emergency drugs and electrolytes
• Introduced directly into bloodstream
• Produce almost immediate effect
• Can cause sudden adverse reactions
• Supplies: drug, tourniquet, bedsaver pad, gloves, iodine, alcohol swabs, venipuncture device, tape, gauze pad

Question 47

Inhalation therapy administration:

Answer 47

• Administered through mouth or nose
• Examples: nasal or oral inhalers
• 7 rights
• Check labels and follow directions

Question 48

Topical administration:

Answer 48

• Direct application on skin
• Creams, lotions, ointments
• Follow directions

Question 49

Transdermal administration:

Answer 49

• Absorbed through skin directly into bloodstream
• Nitroglycerin, estrogen
• Patient receives a timed-release dose
• Follow directions