Week 4 Chapter 8 routes of drug admistration

Question 1

anesthetic

TOPICAL ROUTE

applied for the following effects

Answer 1

Anesthetic: to remove the sensation of pain (e.g., benzocaine).

Question 2

antecubital space

Answer 2

The most common IV injection sites are the basilic or cephalic veins on the back of the hand, the basilic vein on the medial, anterior forearm and elbow or the cephalic vein on the lateral, anterior forearm and elbow (Fig. 8-6). The anterior recess of the elbow where these veins are located is often referred to as the antecubital space

Question 3

antihistamine

TOPICAL ROUTE

applied for the following effects

Answer 3

Antihistamine : for manifestations caused by allergic reactions (e.g., Benadryl cream).

Question 4

antiseptic

TOPICAL ROUTE

applied for the following effects

Answer 4

Antiseptic or bacteriostatic: to inhibit growth and development of microorganisms (e.g., Betadine, Bactroban).

Question 5

aqueous solution

Answer 5

A drug may be given intramuscularly in an aqueous solution , an aqueous suspension, or a solution or suspension of oil. Suspensions form a supply of drug in the tissue and result in slow, gradual absorption. Two disadvantages sometimes encountered when preparations in oil are used are that the patient may be sensitive to the oil and the oil may not be absorbed. In the latter case, incision and drainage of the oil may be necessary. Fortunately, few drugs are formulated in oil.

Question 6

aspiration

Answer 6

For the IM injection, the needle and syringe assembly is held as if it were a dart while the other hand stretches the skin of the injection site taut. If the muscle mass underlying the injection site is inadequate to accommodate the length of the needle, the flesh may instead be pinched up before needle insertion. The injection should be made perpendicular to the skin surface, from a distance of about 2 inches, in one quick motion. If possible, the needle should not be inserted to its full depth, and a small portion of needle should be left accessible above the skin so that the needle might be retrieved should it break, a very rare occurrence. As in SC injection, it is necessary to make certain that the needle is not in a blood vessel, thus causing the unintended deposit of medication into the bloodstream instead of muscle tissue. This is ascertained by pulling out the plunger slightly after the needle is in place in the tissue (aspiration). A slight pinkish tinge to the medication may be seen close to the needle hub, or a small amount of blood may enter the barrel of the syringe, if the needle is in a blood vessel rather than in tissue.

Question 7

aqueous suspension

Answer 7

A drug may be given intramuscularly in an aqueous solution, an aqueous suspension , or a solution or suspension of oil. Suspensions form a supply of drug in the tissue and result in slow, gradual absorption. Two disadvantages sometimes encountered when preparations in oil are used are that the patient may be sensitive to the oil and the oil may not be absorbed. In the latter case, incision and drainage of the oil may be necessary. Fortunately, few drugs are formulated in oil.

Question 8

astringent

TOPICAL ROUTE

applied for the following effects

Answer 8

Astringent: resulting in vasoconstriction, tissue contraction, and decreased secretions and sensitivity, thereby counteracting inflammatory effects.

Question 9

bacteriostatic

TOPICAL ROUTE

applied for the following effects

Answer 9

Antiseptic or bacteriostatic: to inhibit growth and development of microorganisms (e.g., Betadine, Bactroban).

Question 10

buccal

Answer 10

Sublingual administration is performed by placing the drug under the tongue for dissolution and absorption. The thin epithelium and network of capillaries on the underside of the tongue permit drug absorption. Drugs administered by this route will gain access to the general circulation without traversing the liver or being affected by gastric and intestinal enzymes. Thus, the drug potency may be enhanced. This also applies to buccal administration, in which a tablet is held in the mouth in the pocket between gums and cheek for local dissolution and absorption. Nitroglycerin tablets and morphine sulfate solution are two examples of drugs commonly administered by the sublingual and buccal routes.

Question 11

butterfly set

Answer 11

The winged-tip or butterfly set is the most common IV needle used by imaging technologists for the introduction of contrast. These needles vary from ¼ to 1¼ inches in length and 18 to 27 gauge in diameter. Most have 6 to 12 inches of tubing attached, extending from the needle to the syringe hub

Question 12

central venous line

Answer 12

Central venous (CV) lines, also known as central venous catheters and venous access devices, are catheters inserted into a large vein to administer drugs, manage fluid volume, transfuse and analyze blood, and monitor pressures within the heart.

CV catheters vary in size and composition and are used in both short-term and long-term patient care. They are available as percutaneous catheters (subclavian insertion), totally implanted access ports (Infusa Port, Port-a-Cath, Mediport), peripherally inserted central catheters (PICC lines), and externally tunneled catheters. Implantable ports are desired when access is required intermittently over a long period.

Regardless of the style used, the goal is to position the catheter tip in a central vein, usually the superior vena cava, 2 to 3 cm above the right atrial junction. Because of its size, the superior vena cava reacts less to infusions of caustic IV fluids.

The most common insertion site for CV catheters is the subclavian vein. Other common sites include the internal jugular and femoral veins.

Question 13

dorsogluteal

Answer 13

The technologist can best locate the dorsogluteal site (the muscle underneath is the gluteus medius) by asking the patient to lie facedown and exposing the entire area so that the landmarks and the injection site can be clearly located. The proper site for this injection is outlined by an imaginary diagonal line drawn from the area of the greater trochanter of the femur to the posterior iliac spine. The injection should be given at any point between that imaginary straight line and below the curve of the iliac crest

Question 14

emollient

TOPICAL ROUTE

applied for the following effects

Answer 14

Emollient: for a soothing and softening effect to overcome dryness and hardness (e.g., lanolin).

Question 15

extravasation (infiltration)

Answer 15

During and after venipuncture, it is important to watch carefully for drug and blood leakage into the tissues surrounding the vein. This infiltration or extravasation can be very painful and is often quite serious for the patient. If extravasation does occur, remove the needle immediately, apply pressure to the injection site, and apply a warm, moist cloth to relieve the pain. Important: Do not continue to inject the drug! If the drug was potentially corrosive or caustic, a physician should be contacted immediately. Hospital or clinic policy may dictate that an “incident report” be filed for extravasations, especially those involving contrast media or corrosive drugs.

Question 15

endotracheal tube

Answer 15

Endotracheal (ET) tubes are used primarily to assist the patient through a number of respiratory problems. Indications for use of ET tubes include the following:

*Mechanical ventilation and oxygen delivery necessitated by oxygen debt (e.g., airway obstruction, shock, poor gas exchange in lungs)

*Concerns about aspiration of stomach contents

*Upper airway obstruction

*Administration of epinephrine during advanced cardiac life support (ACLS)

The inhaled air must be adequately humidified because the normal humidifying function of the upper respiratory tract is bypassed. Inhaled air must also be protected from contamination as much as possible. Suctioning of secretions through the tube is required because normal expulsion of these secretions is impossible. Since a patient with an ET tube in place cannot talk, means must be arranged to assist with communication.

Question 16

lipodystrophy

Answer 16

arenteral administration of drugs includes all forms of drug injection into body tissues or fluids using a syringe and needle or catheter and container. Drugs given parenterally must be sterile, readily soluble and absorbable, and relatively nonirritating. Parenteral administration can be the most hazardous route by which to give a drug. Administering medication by this route requires specialized knowledge, aseptic technique, and manual skill to ensure safety and therapeutic effectiveness. Aseptic technique, accurate drug dosage, and proper technique and rate of injection at the proper site of injection are all essential to avoiding harm, such as lipodystrophy (atrophy or hypertrophy of subcutaneous fat tissue), abscess, necrosis, skin sloughing, nerve injuries, prolonged pain, and periostitis. An injected drug acts rapidly and is irretrievable. Thus, an error in dosage, method, or site is not easily corrected.

Question 16

intradermal

Answer 16

Intradermal or intracutaneous injection means that the injection is made into the upper layers of the skin almost parallel to the skin surface.

The term parenteral means to be administered by injection. The four most common methods by which drugs are administered parenterally are intradermal, subcutaneous, intramuscular, and intravenous (Table 8-1).The medical imaging technologist may also witness intraarterial injections with certain medical procedures.

Question 17

gauge (needle)

Answer 17

The type of needle used for IM injection depends on the site of the injection, the condition of the tissues, the size of the patient, and the nature of the drug to be injected. Needles from 1 to 1½ inches in length are common. The usual gauge is 21 to 23; the larger the number, the finer the needle (Fig. 8-4). Fine needles can be used for thin solutions and heavier needles for suspensions and oils. Needles for injection into the deltoid area should be ⅝ to 1 inch in length, the gauge again depending on the material to be injected.

Question 17

intramuscular

Answer 17

Deeper injections are made into muscular tissue, through the skin and subcutaneous tissue, when a drug is too irritating to be given subcutaneously, although irritation may also occur with some drugs given intramuscularly. Larger doses can be given by IM injection (up to 5 ml) than by SC injection. In cases of circulatory collapse (i.e., shock), intravenous (IV) injection is preferred over the delayed absorption through the SC, IM, or ID route.

A drug may be given intramuscularly in an aqueous solution, an aqueous suspension, or a solution or suspension of oil. Suspensions form a supply of drug in the tissue and result in slow, gradual absorption. Two disadvantages sometimes encountered when preparations in oil are used are that the patient may be sensitive to the oil and the oil may not be absorbed. In the latter case, incision and drainage of the oil may be necessary. Fortunately, few drugs are formulated in oil.

Criteria for selection of a safe IM injection site include distance from large, vulnerable nerves, bones, and blood vessels and from bruised, scarred, or swollen previous injection or infusion sites. The type of needle used for IM injection depends on the site of the injection, the condition of the tissues, the size of the patient, and the nature of the drug to be injected. Needles from 1 to 1½ inches in length are common. The usual gauge is 21 to 23; the larger the number, the finer the needle (Fig. 8-4). Fine needles can be used for thin solutions and heavier needles for suspensions and oils. Needles for injection into the deltoid area should be ⅝ to 1 inch in length, the gauge again depending on the material to be injected. The deltoid can readily absorb up to 2 ml of drug. For many IM injections, the gluteal muscles are preferred because of fewer nerve endings and less discomfort. The needle must be long enough to avoid depositing the solution of drug into the subcutaneous or fatty tissue. The depth of insertion depends on the amount of subcutaneous tissue and will vary with the weight of the patient.

Question 18

intravenous

Answer 18

**Intravenous (IV) Method **Direct injection into a vein (intravenously) is warranted when “immediate” effects of a drug or fluid are desired. Most emergency drugs, sterile saline and dextrose solutions (dehydration), chemotherapy drugs, and radiopaque contrast media (ROCM; imaging examinations) are introduced through the IV route.

Intravenous injection sites.
The most common IV injection sites are the basilic or cephalic veins on the back of the hand, the basilic vein on the medial, anterior forearm and elbow or the cephalic vein on the lateral, anterior forearm and elbow (Fig. 8-6). The anterior recess of the elbow where these veins are located is often referred to as the antecubital space.

Question 19

keratinized

Answer 19

Topical medications may be applied in the form of a lotion, tincture (alcoholic solution), ointment or cream, foam, spray, gel, wet dressing, tampon, bath, or soak. The effectiveness of medicinals applied to the skin for local effect is limited by the fact that highly specialized layers of skin resist penetration of many (not all) foreign substances to protect the internal body environment. Topical absorption is increased when the skin is thin or macerated, when there is increased drug concentration, when there is prolonged contact of the drug with the skin, or when the drug is combined with a solvent-penetrant. The mucous membranes absorb drugs much more readily because they are not keratinized. Keratin is a scleroprotein that is the principal constituent of the epidermis, hair, nails, and the organic matrix of the enamel of the teeth.

Question 20

oral

Answer 20

ORAL ROUTE
The oral route is the most common method of drug administration. Oral administration is the safest, most economical, and most convenient way of giving medication. Therefore, it is the preferred route unless some distinct advantage is to be gained by using another route or a contraindication to oral administration is present. Most drugs undergo absorption in the small intestine; few are absorbed in the stomach and colon (see Chapter 3). Drug effects are generally slower and less efficient when a drug is given orally rather than parenterally. When receiving drugs by the oral route, the patient must be conscious and the head should be elevated to aid in swallowing.

Question 21

parenteral

Answer 21

PARENTERAL ROUTE
The term parenteral means to be administered by injection. The four most common methods by which drugs are administered parenterally are intradermal, subcutaneous, intramuscular, and intravenous (Table 8-1).The medical imaging technologist may also witness intraarterial injections with certain medical procedures.

Question 22

Pulmonary Arterial Lines

Answer 22

Pulmonary Arterial Lines
Pulmonary arterial (PA) lines are commonly called Swan-Ganz catheters, after their inventors. PA lines are actually specialized CV lines that incorporate a small electrode at the distal end used to monitor pulmonary arterial pressures. PA lines are used to estimate left ventricular end-diastolic pressure (LVEDP). Because catheter placement in the left ventricle creates major physiologic consequences, the safest way to assess left-sided heart pressure is to estimate its value by monitoring right-sided heart and pulmonary pressures.

Question 23

rectal

Answer 23

RECTAL ROUTE
Rectal administration of certain preparations can be used advantageously when the stomach is nonretentive or traumatized, when the medicine has an objectionable taste or odor, or when it can be changed by digestive enzymes. This route is also a reasonably convenient and safe method of giving drugs when the oral method is unsuitable, as when the patient is a small child or is unconscious.

Use of the rectal route avoids irritation of the upper gastrointestinal tract and may promote higher bloodstream drug titers because venous blood from the lower part of the rectum does not traverse the liver. The suppository drug vehicle is often superior to the retention enema vehicle because the drug is released at a slow but steady rate to ensure a prolonged effect. Disadvantages of the retention enema are unpredictable retention of drug and the possibility of fluid passing above the lower rectum to be absorbed into the portal circulation, where metabolism can be extensive.

Question 24

subcutaneous

Answer 24

Subcutaneous (SC) Method
Small amounts of drug in solution are given subcutaneously (beneath the layers of skin, yet above the muscle), usually by means of a 25-gauge (or thinner) needle and syringe. The needle is inserted through the skin with a quick movement, but the injection is made slowly and steadily (Fig. 8-3). The technologist should slightly withdraw the plunger of the syringe (aspirate) before injecting the drug to make sure that a blood vessel has not been entered. If a red streak is observed as the plunger is withdrawn, the operator should assume that a vessel has been tapped. It is then necessary to reposition or replace the needle and possibly the syringe and contents. If this simple precaution is not observed, an SC injection immediately turns into an intravenous or intraarterial injection; either of which can be extremely dangerous to the patient (e.g., air embolism, hematoma, extravasation).

Question 25

sublingual

Answer 25

SUBLINGUAL AND BUCCAL ROUTES
Sublingual administration is performed by placing the drug under the tongue for dissolution and absorption. The thin epithelium and network of capillaries on the underside of the tongue permit drug absorption. Drugs administered by this route will gain access to the general circulation without traversing the liver or being affected by gastric and intestinal enzymes. Thus, the drug potency may be enhanced. This also applies to buccal administration, in which a tablet is held in the mouth in the pocket between gums and cheek for local dissolution and absorption. Nitroglycerin tablets and morphine sulfate solution are two examples of drugs commonly administered by the sublingual and buccal routes.

The number of drugs that can be given sublingually or buccally is limited (e.g., nitroglycerin tablets). The drug must dissolve readily, and the patient must be able to cooperate. The patient must understand that the drug is not to be swallowed and that taking a drink must be avoided until the drug has been absorbed. However, usually little harm is done if a sublingual drug is inadvertently swallowed. It is unclear, in some cases, whether a drug is absorbed under the tongue or actually swallowed and absorbed in the intestinal tract.

Question 26

topical

Answer 26

TOPICAL ROUTE
The topical route of drug administration involves the application of a drug directly onto the skin or mucous membrane. The drug is diffused through the skin or membrane and absorbed into the bloodstream. These medications are applied for the following effects:

1.Astringent: resulting in vasoconstriction, tissue contraction, and decreased secretions and sensitivity, thereby counteracting inflammatory effects.

2.Antiseptic or bacteriostatic: to inhibit growth and development of microorganisms (e.g., Betadine, Bactroban).

3.Emollient: for a soothing and softening effect to overcome dryness and hardness (e.g., lanolin).

4.Cleansing: for the removal of dirt, debris, secretions, or crusts (e.g., Hibiclens).

5.Anesthetic: to remove the sensation of pain (e.g., benzocaine).

6.Antihistamine: for manifestations caused by allergic reactions (e.g., Benadryl cream).

Question 27

venipuncture

Answer 27

Venipuncture, also known as phlebotomy or a blood draw, is a medical procedure that involves using a needle to extract blood from a vein. It’s usually performed to obtain blood samples for laboratory testing, but can also be used to treat certain blood disorders by removing extra red blood cells.

Question 28

ventrogluteal

Answer 28

The ventrogluteal site can be made accessible with the patient lying in a supine or side-lying position. This site is used for IM injections in either children or adults and could be used more often. To locate it on the left side, the technologist should palpate for the left greater trochanter with the right palm, point the right index finger to the anterior superior iliac spine, and extend the middle finger toward the iliac crest. The injection should be made into the center of the V formed between the index and middle fingers (see Fig. 8-5, B). The left hand is used to detect landmarks in the right hip.

Question 29

2 Common Abbreviations and Symbols Related to Medication Administration

Answer 29

Question 29

1 Common Abbreviations and Symbols Related to Medication Administration

Answer 29

Question 30

five rights of drug administration

Answer 30

*Right patient

*Right drug

*Right amount

*Right time

*Right route

Question 31

3 Common Abbreviations and Symbols Related to Medication Administration

Answer 31

Question 32

4 Common Abbreviations and Symbols Related to Medication Administration

Answer 32