WEEK7- Drug administration Flashcards
what are the 6d’s of drug administration
drug - the name of drug, allergies
dose - check dose (grams, milligrams, micrograms) and quality/volume
date- check expiry date
duration(timing)- how often can the drug be given, patient’s history of drugs, w the time now
distance(route)- how should drug be taken, are you competent of the route
documentation- document drug,dose,date time and route
what are the routes of admin that a first year can conduct
inhaled, oral, nebulised, sublingual (tongue) buccal (check) rectal, intranasal, intramuscular and subcutaneous
which drugs are parental and which drugs are non-parental
non parenteral:
inhaled
oral
nebulised
sublingual
buccal
rectal
intra nasal
parenteral:
subcutaneous
intraosseous
intravenous
how do you conduct nebuliser
- add medication to chamber of nebuliser
- attach chamber to the oxygen mask
connect the mask using some tubing to 6-8 litres of oxygen. fine mist should be generated - place mask over face
- get patient to breath in slowly and deeply over 3-5 seconds
how do you conduct intranasal
- draw up liquid drug from container.
- check 6d’s and that equipment is intact
- attach drawing up needle to a syringe- 4. use ampoule breaker to open drug.
- draw up drug, insert syringe to exposed liquid and pull back on plunger of the syringe.
REMEMBER: extra 0.1ml of liquid should be drawn up to allow dead space in device - remove any air in syringe
- place blunt needle in sharps bin immediately
- attach to atomiser device to the syringe
- hold head back and insert tip of device into one nostril. Aim device up and out towards ear
- briskly press plunger to administer half syringe of medication
- swap to other nostril and deliver other half of medication
what is the recommended needle depth for IM
5/8 inches to 1.5 inches.
depends on adipose (fat) tissue on the arm
most adults over 60kg will need a 1inch needle
what are the 2 most common places to conduct IM
deltoid muscle
anterolateral thigh
how to conduct IM
- draw up drug from ampoule
- check 6d’s and ensure drugs are intact
- attach blunt (drawing up) needle to a syringe- used to filter any glass which may have entered liquid
- use ampoule breaker to open drug
- draw up drug, insert blunt needle/syringe into exposed liquid and pull back on the plunger of the syringe.
- remove any air in syringe
- place blunt needle in the sharps bin immediately.
- select current site, prepare skin with alcohol wipe
- select appropriately sized intramuscular needle and attach to the syringe.
- verbalise you have removed cap from needle
- pull skin and subcutaneous tissue downwards and sideways with one hand
- insert the needle at 90 degrees angle into the skin until muscle is reached
- draw back the plunger on the syringe. if no blood is seen then no vein has been entered
- push drug in
- wait 10 seconds then remove needle
- push against an object to engage the safety cap on the needle and put in sharps bin
how do you conduct subcutaneous
- use same technique to draw up the medication using blunt needle
- smaller depth syringe (3/8 to 5/8 of an inch)
- check needle is correct size by pinching tissue with thumb and finger. needle should be half of the depth of the fold
- select correct site, wipe skin with alcohol wipe with a circular motion
- verbalise that cap is removed from needle
- pinch skin together using index finger and thumb
- inject needle between 45-to-90-degree angle then remove needle and release skin
what considerations must be conducted before administering drugs
presentation
indications
actions
contraindications
cautions
side effects
dose and admin
indications and contraindications of aspirin
given to query MI or ischemia
or suspected TIA (when symptoms fully resolved, isn’t being conveyed to hospital, referred into a local TIA pathway
known allergies/ sensitivity to drug
children under 16
active gastrointestinal bleeding
haemophilia or other known clotting disorders
severe hepatic failures with jaundice
what’s the route of admin for aspirin
oral- to be chewed
indications and contraindications of gtn
cardiac chest pain due to angina/ myocardial infarction
when the systolic blood pressure is more than 90mmHg
breathlessness due to pulmonary oedema in acute heart failure when systolic blood is greater than 110mmHg
patient with cocaine toxicity with chest pain
hypotension
head trauma
hypovolemia
cerebral haemorrhage
unconscious patient
know severe aortic. mitral stenosis
if Viagra has been taken in past 24 hours
whats the route of admin for gtn
sublingual (under the tongue)
indications and contraindications of adrenaline
anaphylaxis
life threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy
no indications
1:1000
whats the route of admin for adrenaline
intramuscular (IM)
indications and contraindications of chlorpenamine
allergic reactions falling short of anaphylaxis but causing the patient distress
alleviating distressing cutaneous symptoms in anaphylaxis only after emergency treatment with adrenaline and patient is stable
known hypersensitivity
treatment with MAOI’s- old style of anti-depressants
whats the route of admin for chlorpenamine
intramuscular (IM) or oral
indications and contraindications for hydrocortisone
severe/life threatening asthma
acute exacerbation of COPD
adrenal crisis- long term steroid therapy.
patients who have established adrenal crisis/ patients with suspected adrenal insuffiency on long term steroid therapy that have become unwell
pregnant woman with Addisons disease who are in labour
known allergies
whats the route of admin for hydrocortisone
intramuscular
indications and contraindications of ipratropium bromide
acute, severe or life-threatening asthma
asthma unreasonable to salbutamol
exacerbation of COPD unresponsive to salbutamol
expiratory wheezing
none in emergency situation
route of admin for ipratropium bromide
nebuliser
indications and contraindications of naloxone
reversal of acute opioid or opiate toxicity for respiratory arrest/respiratory depression
unconsciousness associated with respiratory depression of unknown cause where opioid overdose is a possibility
cardiac arrest where opioid toxicity is the likely cause
patients exposed to high patency anaesthesia if consciousness is impaired
neonates born to opioid addicted mothers
route admin for naloxone
intramuscular or intranasal
indications and contraindications of oxygen
critical illness required high levels of supplemental oxygen
serious illness requiring moderate levels of supplemental oxygen if hypoxaemic
explosive environments
route of admin for oxygen
inhaled
when administering oxygen when do you reduce it
administer oxygen dose until vital signs are normall then reduce oxygen dose to aim for target saturations
what is Fi02
the fraction of inspired oxygen. this is an estimation of the oxygen content a person inhales and is thus involved in gas exchange at the alveolar level
what are the different types of oxygen masks
simple mask (hudsons mask, flow 6- 10LPM, Fi02 35/50%)
face tent (flow 10-15LPM, Fi02 30/40%)
venturi mask (flow 2-15 LPM, Fi02 24/60%)
partial rebreather (flow 10-15LPM, Fi02 60/80%
non-rebreather (flow 10-15LPM, Fi02 80+)
when would u put 15 litres of oxygen on straight away
cardiac arrest/resuscitation (15 litres until vital signs are normal- through bag valve mask)
carbon monoxide poisoning (maximum dose ONLY don’t reduce 02 at all- through high concentration 02 mask)
Major trauma, anaphylaxis, decompression illness, major pulmonary haemorrhage, sepsis, shocking, drowsiness (15 litres per minute- high concentration mask)
active convulsion, hyperthermia (15 litres until reliable SP02 reading- high concentration 02 mask)
when would you put moderate oxygen on straight away
acute hypoxemia with SP02 reading below 85% (10-15 LPM- bag valve mask)
deterioration of lung fibrosis or acute asthma with SPO2 between 85-83 (2-6 LPM- high concentration 02 mask)
acute heart failure, pneumonia, lung cancer, pulmonary embolism, postoperative breathlessness, severe anaemia, sickle cell crisis (5-10 LPM high concentration 02 mask)
when to give low dose of oxygen straight away
copd, exacerbation of cystic fibrosis, chronic neuromuscular disorder, morbid obesity, chest wall disorders (4LPM- 28% venturi mask)
if oxygen saturation remains below 88% increase dose and change mask (5-10LPM- simple face mask
REMEMBER: critical illness and COPD- if copd develops a critical illness/injury then target saturations of 94-98% should be aimed.
Unless this causes decreased conscious level. decrease oxygen and aim for 88-92%
indications and contraindications of glucagon
hypoglycaemia clinically suspected hypoglycaemia or an unconscious patient where hypoglycaemia is considered a likely cause (below 4.0 millimoles per litre)
should be administered when oral glucose administration isn’t possible/ is ineffective and then iv administration of glucose isn’t possible
pheochromocytoma- type of neuroendocrine tumour that grown in adrenal gland
dont inject iv
route of admin for glucagon
intramuscular
glucose (40% oral gel) indications and contraindications
known or suspected hypoglycaemia in a conscious patient where there’s no risk of choking or aspiration
none
route of admin for glucose
buccal
indications and contraindications of paracetamol
relief of mild to moderate pain or high temperature with discomfort (not just high temp)
known allergy
don’t give if further paracetamol containing products have been taken in last 4 hours (6 hours in patients with renal impairment) or if the maximum cumulative daily dose has already been given
route of admin for paracetamol
oral-swallowed
aindications and contraindications of nitrous oxide
moderate to severe pain
labour pains
severe head injury with reduced LOC
chest injury and clinically suspected pneumothorax
abdominal pain where intestinal obstruction is suspected
violently disturbed psychiatric patients
if patient has had an intraocular injection of gas within the last 8 weeks
decompression sickness, consider anyone that has been diving in last 24 hours
route of admin for nitrous oxide
inhaled
drugs that i can’t physically administer but need to know
clopidogrel:- given as oral- swallowed. used for the treatment of an ST-elevation Myocardial infarction (STEMI)
dexamethasone:- given as oral solution- tablet. used for the treatment of moderate to severe croup
diazepam:- given rectally. used for the treatment of prolonged convulsions or symptomatic cocaine toxicity
midazolam:- given buccal. used for the treatment of prolonged convulsions
benzylpenicillin:- given as IM. used for suspected meningococcal disease in patients with a non-blanching rash or signs and symptoms
ondansetron;- given as IM, used for treating nausea and vomiting
morphine sulphate:- given as IM injection/orally. used for the treatment of severe pain management, pain associated with MI or ed of life are
