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Routes of Administration—
Easiest, most common
Most preferred route
Oral Route
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Routes of Administration—
Has a slower onset of action and a more prolonged effect than parenteral
oral route
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Oral Route
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
Sublingual (SL)
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Oral Route
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
Buccal
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Oral Route-Patient Education
Alternate cheeks with each dose to avoid irritation
Do not chew, swallow the medication
No intake of liquids
buccal
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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)
aspiration
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if pt has trouble swallowing?
- May need consult (Speech therapy)
- Use other routes, (IV, SC) if possible
- May administer through NG or feeding tube
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Routes of Administration—
Injecting a medication into body tissue
perenteral
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what are the routes for parenteral administration
- Subcutaneous (SQ)
- Intramuscular (IM)
- Intravenous (IV)
- Intradermal (ID)
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injection into tissues just below the skin
Subcutaneous (SQ)
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injection into a muscle
Intramuscular (IM)
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injection into a vein
Intravenous (IV)
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injection into the dermis, just under the epidermis
Intradermal (ID)
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Routes of Administration
Meds that are applied to the skin, mucous and respiratory membranes
topical
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Routes of Administration—Topical
holds the medicated ointment to the skin—application of dosage varies (hours to week)
transdermal disk
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Types of Ophthalmic Meds (eye meds)
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what are problems older adults have installing eye meds?
- Hand tremors
- Poor vision
- Poor grasping
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Avoid instilling any form of eye medication directly onto ?
the cornea
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Avoid touching the eyelids or other eye structures with ?
droppers or ointment tubes
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Use eye medication only for the patient’s
affected eye
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what kind of applications do nasal installations come in
spray
drops
tampons
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Caution patients to avoid abuse of nose drops or sprays—
can lead to rebound nasal congestion
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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.
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what type of medical applications are used with vaginal instillation?
Foams, Jellies, Creams, Suppositories
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what is the purpose of irrigation
- Cleanse an area
- -Instill a medication
- -Apply hot or cold to injured tissue
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Examples of irrigation are
normal saline, sterile water, antiseptic solutions
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if there is a break in the skin or mucosa or a sterile cavity, use?
aseptic technique
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Non-sterile cavity use ?
clean technique
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Irrigation may be required as part of caring for the?
eye, ear, throat, vagina, or urinary tract.
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administration of meds by injection are considered an invasive procedure - always use?
aseptic technique
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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
luer-lock
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types of syringes -
Also may be referred to as “slip tip”
Requires special needles to slip onto the tip of the syringe
non-luer-lock
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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
Tuberculin Syringe
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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.
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what length needle do you need for IM injection
1 to 1 1/2 inch
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what length needle do you need for SQ (SC) injection
3/8 to 5/8
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what determines what length needle will be used
- Size of patient
- Weight
- Route of administration
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needles can vary in lenth from what sizes?
1/4" to 3"
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Selection of gauge dependent upon
- Patient comfort
- Viscosity of fluid
- Speed of administration
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ampules only contain how much medication?
a single dose
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when drawing up medication from am ampule, what kind of needle do you use?
filter needle
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single or multi-dose container that has a rubber seal at the top
vials
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Air needs to be injected into a vial before drawing up because it is?
a closed system
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vials can be what types of medications
liquid or powder
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Medications that are unstable in solution are ?
packaged dry
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what specifies the solvent or diluent needed to prepare a desired medication concentration
the vial label
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what are common diluents for vials of medication?
normal saline
sterile distilled water
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Mixing one med from vial and other from ampule?
vial first, then ampule
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Mixing meds from two vials?
- Do not contaminate one medication with another
- Ensure the final dose is accurate
- Maintain aseptic technique
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When preparing U-100 insulin, what kind of syringe do you use?
use a U-100-unit-scaled syringe.
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Always have a second nurse double-check insulin for right?
drug, dose, etc.
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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
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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
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Failure to select an injection site in relation to anatomical landmarks will result in
bone or nerve damage during needle insertion
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If you do not aspirate, the med may go directly
into an artery or vein
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Too large of volume of medication causes
extreme pain and results in local tissue damage
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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 ?
minimize discomfort
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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
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Injection of medication into the loose connective tissue under the dermis
Has slower absorption rate than IM
Subcutaneous or SC/SQ
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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
Subcutaneous Sites
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Fastest to slowest absorption sites for SC/SQ injections
abdomen→ arms→ thighs→buttocks
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what guage needles are insulin needles
26 - 31 guage
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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
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Provides faster absorption than SC
IM injection
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needle legnths & guages for IM injections
legnths - 1/2" to 1 1/2"
guages - 21 to 25
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when administering an IM injection, what angle does the needle need to be?
90 degrees
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never give IM injections in sites with ?
infection or necrosis
bruising or abrasions
underlying nerves, bones, major blood vessels
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what are the sites for IM injections
ventrogluteal
dorsogluteal
deltoid
vastus lateralis
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Most frequent route of exposure to blood-borne diseases is from
needle-stick injuries
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