chapter 35: medication administration (part 2) bonnie m. wivell, ms, rn, cns
TRANSCRIPT
Chapter 35: Medication Administration (Part 2)
Bonnie M. Wivell, MS, RN, CNS
Routes Of Administration• PO – Oral• SL – Sublingual• Buccal• Inhalation• Nasal• Ears, Ears• Topical / Skin
Application• Rectal• Vaginal
• IM - Intramuscular• IV – Intravenous• SC – Subcutaneous • ID - Intradermal
Process of AdministrationProcess of Administration
• Identify the client
• Inform the client
• Administer the drug
• Provide adjunctive interventions as indicated
• Record the drug administered
• Evaluate the client’s response to the drug
Types Oral of Medications
• SOLID FORMS– Caplets– Capsules– Tablets
• Scored
– Gel Caps– Enteric Coated– Extended Release
• LIQUID FORMS– Elixir– Extract– Acqueous Solution/
Suspension– Syrup– Tincture
Oral Administration Of Medication Cont’d.
• Other Oral Forms– Troche/ Lozenge
• Not meant to be swallowed
– Aerosol• Topical
Oral Administration
• Swallowed• Dissolved in Liquid• Crushed and put in applesauce/pudding• Crushed and given via tube (pg. 718)
– Gastric Tube (G-tube or PEG)– Enteral Feeding Tube– Nasogastric Tube (NG)
• Always refer to drug book or check with pharmacist before crushing a medication
Oral Administration Cont’d.• Cutting and Crushing Tablets
• Do not crush:• Enteric Coated• Capsules • Beads from capsules
– Cut only “scored” tablets
• Do not swallow or chew sublingual tabs unless directed to do so
Buccal and Sublingual Administration
• Buccal – between the cheek and gums– Tablet– Semi-Solid– Paste– Thick Liquid
• Sublingual – under the tongue
Topical and Transdermal Application
• Types of meds given topically– Anti-arthritis (Heat)– Cardiac Meds (NTG Paste)– Pain Med (Patch)
• Fentanyl (Duragesic)
– Other Patches• Nicotine• Estrogen• Scopolamine
• What is the prescribed length of time for application?
Topical Application
• Sprays– Oral– Topical– Nasal– Inhaled
• MDI• DPI
• Vaginal / Rectal– Suppositories– Creams
• Ear Drops– Position ear
• Eye Drops
• Irrigations
Parenteral Administration
• Intramuscular
• Subcutaneous
• Intradermal
• Intraosseous
• Intravenous
EquipmentEquipment
• Syringes– Insulin– TB– Hypodermic
Luer Lok vs Non Luer LokLuer Lok vs Non Luer Lok
Types of Insulin PensTypes of Insulin Pens
Parts of NeedleParts of Needle
Sizes of NeedlesSizes of Needles
• Length 3/8” to 3”• Gauge 30 – 19• 20-22G, 1-1.5” for IM• 25-30G, 3/8-1/2” for
SQ
Filter Needle
Single Dose Ampule
Single Dose Vial
Multi-dose Vial
Insulin Preparation
• Rapid, short, intermediate, and long acting• Know onset, peak and duration• ONLY regular insulin can be given IV• Sliding scale based on blood glucose • Gently roll cloudy• DO NOT SHAKE• Prepare last and administer first if mixed
because regular can become “contaminated” and action can be affected
• CLEAR to CLOUDY
Injection Angles
Intradermal InjectionIntradermal Injection
Intramuscular• PAIN MEDICATION
• ANTIBIOTICS
• VACCINATIONS
• SUPPLEMENTS– IRON– B12
IM Injection SitesIM Injection Sites
Deltoid IM Injection SiteDeltoid IM Injection Site
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Carpuject
Tubex
Where Do You Get IV and Injectable Medications?
• IV Solutions are standard, mixed for the patient in the pharmacy or ordered from the outside– IVPB (IV Piggyback) meds are mixed in the
pharmacy– Pre-mixed– Add-Vantage
• Injectable Medication– Unit dose
• Carpuject• Ampules• Vials
NEEDLELESS SYSTEMS
3ml Luer Lock Syringe + Clave Adapter
Where do Drugs Come From in LTC FACILITY?
• MEDICATIONS ARE DELIVERED FROM AN OUTSIDE PHARMACY– ORDERS ARE FAXED TO PHARMACY– MEDICATIONS ARE DELIVERED BY THE
PHARMACY
• SOME STOCK DRUGS AND NARCOTICS ARE ON SITE FOR PRN USE
Medication Safety
““SIX”SIX”(OR SEVEN) (OR SEVEN) RIGHTSRIGHTS
RIGHT MEDICATIONRIGHT MEDICATIONRIGHT DOSERIGHT DOSE
RIGHT PATIENTRIGHT PATIENTRIGHT TIMERIGHT TIME
RIGHT ROUTERIGHT ROUTERIGHT DOCUMENTATIONRIGHT DOCUMENTATION
THE RIGHT OF THE PATIENT THE RIGHT OF THE PATIENT TO REFUSETO REFUSE
The RIGHT Medication • As the physician prescribed?
• Trade name or generic?
• Does the drug match the MAR? (medication administration record)
• Is the drug appropriate for the patient?
• Does it make sense??
The RIGHT Dose • DOES THE DOSE OF MEDICATION IN
YOUR HAND AGREE THE DOSE ON THE MAR?
• ARE THE MG, MCG, ML THE SAME?
• IS THIS THE TIME TO DO MATH OR GO ON A BREAK!?
The RIGHT Patient
– HAVE YOU CHECKED USING TWO PATIENT IDENTIFIERS?
– PATIENT STATES…VERIFIES BD– PATIENT ARMBAND– COMPARE PT. ID NUMBER TO MAR– WHAT IF THERE IS NO ARM BAND?
The RIGHT Time • AM or PM
• Q4
• Tid
• Bid
• Qid
• qd
The RIGHT Route• PO
• IV
• SC (SQ)
• TRANSDERMAL
• RECTAL
• IM
• DOES IT MAKE SENSE??
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Patient Controlled Anelgesia
PCA PUMP
MOD – Medication on Demand
•The Radio Frequency Identification (RFID) based wrist band, the first of its kind to be implemented successfully, assist nurses by automating the process of administering patient medication.