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Routes of Administration—
Easiest, most common
Most preferred route
Routes of Administration—
Has a slower onset of action and a more prolonged effect than parenteral
Placing the medication under the tongue
Should NOT be swallowed, chewed
Ex: Nitroglycerin (NTG)—Pt. should NOT eat, drink, or chew gum until the medication is completely dissolved
Placing solid medication against the mucous membranes against the cheek until dissolved
Acts locally on the mucosa or systemically as it is swallowed in the saliva
Oral Route-Patient Education
Alternate cheeks with each dose to avoid irritation
Do not chew, swallow the medication
No intake of liquids
Occurs when food, fluid, or medication intended for the GI route enters the respiratory tract.
Always evaluate your patient’s ability to swallow
Fowler’s position or seated position
Lateral position (when swallow, gag, and cough reflexes are intact)
if pt has trouble swallowing?
- May need consult (Speech therapy)
- Use other routes, (IV, SC) if possible
- May administer through NG or feeding tube
Routes of Administration—
Injecting a medication into body tissue
what are the routes for parenteral administration
- Subcutaneous (SQ)
- Intramuscular (IM)
- Intravenous (IV)
- Intradermal (ID)
injection into tissues just below the skin
injection into a muscle
injection into a vein
injection into the dermis, just under the epidermis
Routes of Administration
Meds that are applied to the skin, mucous and respiratory membranes
Routes of Administration—Topical
holds the medicated ointment to the skin—application of dosage varies (hours to week)
Types of Ophthalmic Meds (eye meds)
what are problems older adults have installing eye meds?
- Hand tremors
- Poor vision
- Poor grasping
Avoid instilling any form of eye medication directly onto ?
Avoid touching the eyelids or other eye structures with ?
droppers or ointment tubes
Use eye medication only for the patient’s
what kind of applications do nasal installations come in
Caution patients to avoid abuse of nose drops or sprays—
can lead to rebound nasal congestion
Topical Medication ApplicationEar Instillation
- Internal ear structures are very sensitive to temperature extremes
- Use sterile ear drops
- Do not occlude the ear with the dropper or irrigating syringe
- Straighten ear canal according to age of patient.
what type of medical applications are used with vaginal instillation?
Foams, Jellies, Creams, Suppositories
what is the purpose of irrigation
- Cleanse an area
- -Instill a medication
- -Apply hot or cold to injured tissue
Examples of irrigation are
normal saline, sterile water, antiseptic solutions
if there is a break in the skin or mucosa or a sterile cavity, use?
Non-sterile cavity use ?
Irrigation may be required as part of caring for the?
eye, ear, throat, vagina, or urinary tract.
administration of meds by injection are considered an invasive procedure - always use?
types of syringes -
Require special needles that twist on and “lock” themselves in place
The design of this syringe prevents accidental removal of the needle
types of syringes -
Also may be referred to as “slip tip”
Requires special needles to slip onto the tip of the syringe
Long thin barrel with preattached thin needle
Syringe is calibrated in sixteenths of a minim and hundredths of a milliliter
Capacity is 1 milliliter
Used primarily for ID
Can be used for SC
what are the 3 parts of a needle
- -Hub (fits on tip of syringe)
- -Shaft (connects to the hub)
- -Bevel (slanted tip) has narrow slit that quickly closes after removing the needle to prevent leakage of med.
what length needle do you need for IM injection
1 to 1 1/2 inch
what length needle do you need for SQ (SC) injection
3/8 to 5/8
what determines what length needle will be used
- Size of patient
- Route of administration
needles can vary in lenth from what sizes?
1/4" to 3"
Selection of gauge dependent upon
- Patient comfort
- Viscosity of fluid
- Speed of administration
ampules only contain how much medication?
a single dose
when drawing up medication from am ampule, what kind of needle do you use?
single or multi-dose container that has a rubber seal at the top
Air needs to be injected into a vial before drawing up because it is?
a closed system
vials can be what types of medications
liquid or powder
Medications that are unstable in solution are ?
what specifies the solvent or diluent needed to prepare a desired medication concentration
the vial label
what are common diluents for vials of medication?
sterile distilled water
Mixing one med from vial and other from ampule?
vial first, then ampule
Mixing meds from two vials?
- Do not contaminate one medication with another
- Ensure the final dose is accurate
- Maintain aseptic technique
When preparing U-100 insulin, what kind of syringe do you use?
use a U-100-unit-scaled syringe.
Always have a second nurse double-check insulin for right?
drug, dose, etc.
how do you mix two types of insulin in a syringe?
- roll long acting or cloudy insulin between palm of hands, do not shake
- put air in long acting
put air in short acting
draw short acting
draw long acting
Prior to administration of an injection, you must know…
- The volume to be injected
- Characteristics and viscosity of the med
- Anatomical structures that underlie the site being injected
Failure to select an injection site in relation to anatomical landmarks will result in
bone or nerve damage during needle insertion
If you do not aspirate, the med may go directly
into an artery or vein
Too large of volume of medication causes
extreme pain and results in local tissue damage
Use a sharp-beveled needle in the smallest suitable length and gauge
Position the patient so that muscle tension is decreased.
Select the proper injection site, using anatomical landmarks
these ways to ?
Divert patient’s attention—talk to the patient
Insert the needle QUICKLY and SMOOTHLY to minimize tissue pulling
Hold the syringe steady while the needle remains in tissues
Inject the medication SLOWLY and STEADY.
these are ways to?
minimize discomfort when giving injections
Injection of medication into the loose connective tissue under the dermis
Has slower absorption rate than IM
Subcutaneous or SC/SQ
Outer posterior aspect of the upper arms
Abdomen below the costal margins to the iliac crest 2” in. from the umbilicus
Anterior aspects of the thighs
-Recommended site for heparin injections is the abdomen.
Low molecular weight heparin - right or left side of the abdomen. Give 2” from the umbilicus
Fastest to slowest absorption sites for SC/SQ injections
abdomen→ arms→ thighs→buttocks
what guage needles are insulin needles
26 - 31 guage
If you are able to grasp 2 inches of tissue, insert ?
if you are able to grasp 1 inch then insert needle at ?
these are for SQ/SC injections
90 degree angle
45 degree angle
Provides faster absorption than SC
needle legnths & guages for IM injections
legnths - 1/2" to 1 1/2"
guages - 21 to 25
when administering an IM injection, what angle does the needle need to be?
never give IM injections in sites with ?
infection or necrosis
bruising or abrasions
underlying nerves, bones, major blood vessels
what are the sites for IM injections
Most frequent route of exposure to blood-borne diseases is from