unit 4 learning objectives Flashcards
Identify equipment required for parenteral medications.
syringes and needles,
is required to prepare and administer parenteral medications. The selection of the syringe and needle is based on the type and location of injection; amount, quality, and type of medication; and the body size of the patient
Discuss pediatric and geriatric considerations with administration of medications through ultrasonic nebulizer or MDI.
both go by weight of individual- scone both weights are vastly differing from each other. its important to go by weight
Determine 2 ways to maintain clean equipment with use of an MDI/nebulizer in the long term setting or in the home setting.
Soak the mouthpiece or mask, top piece, and medicine cup in a white vinegar and water solution for 30 minutes
Describe procedure for administrating medications through an ultrasonic nebulizer.
Hold the nebulizer in an upright position to prevent spilling and to ensure the medication is correctly distributed. Take normal regular breaths in through your mouth so that the medicine can go deep into your lungs. Continue until all of the medicine is gone from the cup.
Review appropriate abbreviations for medication administration including eye and ear.
do not crush
CD
TR
LA
ER
XT
SR
XL
SA
CR
DR
E
CC
XR
hs-hours of sleep
ac/pc=before/after meals
qd-daily
bid-2x
tid-3x
qid-4x
Identify how to determine how much medication is left in the MDI.
count how many puffs you take each day. Then look at the label on your MDI and see how many doses (puffs) are in the canister.
Identify which clients would benefit from using a spacer to receive medications through a MDI.
help the medication get straight to where it’s needed in your lungs, with less medication ending up in your mouth and throat where it can lead to irritation or mild infections.
Discuss how to teach a client proper use of a metered dose inhaler (MDI) to receive the recommended dose and avoid excessive inhalations.
Remove the cap and hold the inhaler upright.
Stand or sit up straight.
Shake the inhaler.
Tilt your head back slightly and breathe out all the way.
Put the inhaler in your mouth
.
Press down on the inhaler quickly to release the medicine as you start to breathe in slowly.
Breathe in slowly for 3 to 5 seconds.
Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.
Breathe out slowly.
Repeat puffs as directed by your doctor. Wait 1 minute before taking the second puff.
Discuss the advantages and of administering medications via the eye, ear, inhalation, vaginal, and topical routes, across the lifespan.
relative simplicity to formulate, minimal storage limitations and ease of drug instillation by most patients
A vastly higher concentration of antibiotic can be delivered to the site of infection
Suitable for infants and people too sick or physically unable to use other devices
dosage reduction, continuity of drug delivery, longer durations between doses, reduced side effects
Easy to Administer and fewer risk of gi difficulties
Discuss the and disadvantages of administering medications via the eye, ear, inhalation, vaginal, and topical routes, across the lifespan.
limited drug concentration for lipophilic agents, precorneal losses and the barrier function of the cornea
barriers to absorption
Contents easily contaminated
Relatively expensive
Poor delivery efficiency
Drug wastage
can be very awkward for patients and nurse and can also lead to potential mistakes in giving
They can be time-consuming to apply. At times, the regimen can be complicated,
Describe the procedure for medication administration via the eye, ear, inhalation, vaginal, and topical routes across the lifespan.
Squeeze the bottle or tube gently to instil the eye drop without touhcing-place pressure on lacrimal sac to absorb
ear-admister ear drop on side-wait 5 minutes and do next side
inhalation - spray medication while patient is breathing in allows mediation to go to lungs
top-puts medications on skin
vaginal-stick it al the way ip there
Describe techniques for safe administration of injections across the lifespan.
Prepare injections using aseptic technique in a clean area.
Do not use needles or syringes for more than one patien
Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle
Use single-dose vials for parenteral medications when possible.
Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
Do not combine the leftover contents of single-use vials for later use.
Identify appropriate injection sites across the lifespan.
deltoid, ventrogluteal, and thigh
ventrogluteal is considered best
Identify techniques for preparing drugs to administer via the intradermal, subcutaneous and intramuscular routes.
od-spread skin apart-take slight angle into skin to create wheal
subcutaneous- pinch skin- needle at 45-90 degree, stick needle in
intramsualrar-nsert needle at a 90o angle to the skin with a quick thrust. Retain pressure on skin around injection site with thumb and index finger while needle is inserted
identify clinical situations in which a nasogastric (NG) tube with suction is indicated.
Toxic ingestion (poisoning).
Gastroparesis or gastric outlet obstruction.
Small bowel obstruction or pseudo-obstruction.
Intractable nausea and vomiting.
Upper GI bleeding.
Gastrointestinal surgery.
Describe techniques for effective delivery of medication through a feeding tube.
ach medication should be given separately through the feeding tube. A clean 30-mL or larger oral (non-Luer tip) syringe should be used. Flush the tube again. The tube should be flushed again with at least 15 mL of purified water to ensure that the drug has been delivered and the tube is clear.
Recognize, through the use of medication resources, pertinent laboratory tests related to medication administration.
laboratory tests can tell you how the patents busy id responding. If the patients body is responding a certain way, that can lead you to administer or stop administering certain medications
Identify patient and clinical contraindications to administering oral, rectal, and feeding tube medications.
those who have altered mental status or have nausea or vomiting that hinder them from safely ingesting the drug orally.
rectal bleeding, diarrhea, recent prostate or rectal surgery, local trauma, undiagnosed GI disturbances, cardiac arrhythmias.
some drugs cannot be admisntered with a feeding tube- also might get caught and cause problems
Describe the advantages and disadvantages to the oral/feeding tube/rectal route of medication administration.
afety, good patient compliance, ease of ingestion, pain avoidance, and versatility to accommodate various types of drugs
o maintain adequate hydration.
To administer medications in a safe way.
To decrease the risk of aspiration pneumonia.
To decrease the risk of choking, chewing or swallowing problems when eating
in cases of nausea and vomiting.- there is no swallowing so its easier on patients who don’t have good throats
Indicate when oral/feeding tube medications can and/or should be crushed or dissolved in fluid.
before they are administered
di not do it if they are extended realease medications- only crush under physicians orders
Differentiate between oral, buccal, and sublingual routes.
oral-mouth
buccal-check
sublingual-under tongue
Describe techniques to enhance oral medication absorption.
physicochemical properties (e.g. solubility)
drug formulation (e.g. tablets, capsules, solutions)
the route of administration (e.g. oral, buccal, sublingual, rectal, parenteral, topical, or inhaled)
the rate of gastric emptying
Identify various preparations of drugs that can be administered orally, rectally, and through a feeding tube.
ost oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract-just given through mouth
ectal administration often comes in the form of a suppository or an enema- stick up butt
Never add meds directly to feeding tube. The nurse must stop the feed, flush first with 30 ml, flush with 15-30ml water between meds and flush again with 30-60 ml at end, before restarting feeding.
Identify complications of tube feedings and appropriate nursing interventions.
Constipation.
Dehydration.
Diarrhea.
Skin Issues (around the site of your tube)
Unintentional tears in your intestines (perforation)
Infection in your abdomen (peritonitis)
Identify techniques to maintain integrity of the skin and mucous membranes for patients with nasogastric or PEG tubes.
Keep the skin around the tube clean and dry.
Always wash hands with soap and water before checking the tube or giving nutrition or medicines.
At least once a day, look for changes in the appearance of the skin around the tube.
…
Limit pressure and movement of the tube against the skin.
offer plenty of water
proper nutrition
Compare and contrast techniques of intermittent and continuous feedings.
Continuous feeding involves hourly administration of EN over 24 hours assisted by a feeding pump
intermittent feeding involves administration of EN over 20-60 minutes
Identify long-term vs short-term situations in which enteral feedings are required.
Gastrointestinal dysfunction.
Head
neck cancers that make swallowing difficult or require throat surgery.
Gastrointestinal issues such as an obstructed bowel.
Neurological disorders including stroke and paralysis.
short
troke and now has difficulty swallowing- amyopne who will have lessened symptoms after certain amount of time
Differentiate between nasogastric and PEG (percutaneous enteral gastrostomy) feeding tubes.
used to feed babies and children who cannot take in enough calories by mouth. The NG tube is placed in the nose or mouth and slid into the stomach.
PEG is a surgery that takes place that places a tube into the stomach through abdomen
Contrast criteria that would be assessed to determine whether the NG tube is functioning properly.
suction out a small amount of fluid and test it for acid content. If the tube is placed correctly in your stomach, the aspirated fluid should have stomach acid in it, which will give it a lower pH
Identify the purpose of suction, the “blue pigtail,” and irrigation of a nasogastric tube.
suction out stomach contents to relieve pressure or remove poisons
llows atmospheric air to enter the patient’s stomach so the tube can flow freely, thus preventing the NGT from adhering to and damaging the gastric mucosa
irrigation cleans out the tube so no infections can occur
State the procedure to verify the amount/rate of an infusion.
take the total volume in mL, divided by the total time in hours that the medication is ordered to be infused over, to equal the rate in mL per hour.
Identify how often IV bags and tubing need to be changed
every 72 to 96 hours
IV tubing used for intermittent IV infusion (ie. antibiotics) is changed every 24 hours.
Describe why it is essential to maintain sterile technique when working with IV equipment.
to reduce the risk of vascular catheter–associated infection.
Discuss indications for mini-bag infusion therapy.
extracellular fluid replacement and in the management of metabolic alkalosis in the presence of fluid loss, and for restoring or maintaining the concentration of sodium and chloride ions.
Identify procedures to verify prescribed solutions and compatibility of secondary bags prior to infusion.
Secondary fluids should always be “piggybacked” into primary infusion lines to ensure that the correct amount of medication is infused. By piggybacking a medication, the solution from the primary fluid line is used to prime the secondary tubing.
State methods to assess patency of IV catheter and tubing.
flush 7-10 ml of NS. Place your fingers above the IV site (about an inch or 2) on the vein itself while flushing
Identify possible complications which may occur with IV sites/infusion and appropriate nursing interventions.
Infection: Skin-based bacteria may enter through insertion site. Local cellulitis or systemic bacteraemia are possible.
Phlebitis: Vein irritation. Due to the presence of the catheter/fluids or medication. Chronically ill patients requiring multiple and recurrent IV access.
infiltration, hematoma, an air embolism, phlebitis, extravascular drug administration, and intraarterial injection
Differentiate between intermittent and continuous infusions.
We defined “continuous infusion” as constant intravenous administration throughout a 24-hour period and “intermittent dosing” as administration of an intravenous infusion for less than or equal to 30 minutes
Describe factors influencing flow rates, both client and mechanical.
viscosity, density, and velocity of the fluid. Changes in the fluid temperature will change the viscosity & density of the fluid. The length, inner diameter, and in the case of turbulent flow, the internal roughness of the pipe.
Discuss use of IV infusion pumps to regulate IV therapy.
delivers fluids, such as nutrients and medications, into a patient’s body in controlled amounts.
