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What factors would you consider when you give an oral medication?
What are the different forms of liquid medications? Be able to define each.
- Elixirs: sweetened hydroalcoholic liquids
- Emulsions: mixture of 2 liquids that are mutually soluble
- Suspensions: liquids in which particles are mixed but not dissolved
How is a transdermal medication given?
Medication is stored in patch placed on skin and absorbed through skin, having systemic effect
What types of medications are given by this route?
- Neoplastic drugs
- Drugs to treat allergic reactions
- Insulin (in production)
Can transdermal patches be cut in half?
No they should not be cut since it will be hard to tell the dose the pt receives
How can a topical medication be applied? What should a nurse do before applying any topical medication?
Applied to skin using gloves, tongue blade or cotton-tipped applicator. ALWAYS use gloves.
What can a nurse do to prevent double dipping when applying topical medications?
Estimate the amount needed and remove from container or use fresh sterile applicator each time
What is meant by an instillation medication?
- Instillations are liquid medications usually administered as drops, ointments or sprays in the form of:
- Eye ointment
- Nose drops
What is the method used to administer:
- An eye drop (Box 13-1): Wash hands, don gloves, lie or sit looking at ceiling, remove discharge with separate cloth for each eye, draw skin down to expose sac, tell pt to avoid blinking, admin drops into center of the sac, gently press on lacrimal duct with a sterile cotton or tissue for 1-2 min to prevent absorption through lacrimal canal, have pt keep eyes closed for 1-2 min after.
- Eye ointment(Box 13-2): Eye ointment (Box 13-2)? Wash hands, don gloves, pt lie or sit facing ceiling, remove discharge, draw down skin to see sac, pt no blink, squeeze strip of ointment on sac, pt close eyes for 2-3 min, apply at bedtime if possible eyes may be blurry.
- Eardrop (Box 13-3): Wash hands, med at room temp, head tilted, for child under 3 pull down and back, for over 3 pull up and back, instill drops, don't allow them to fall on tympanic membrane, aim at side of ear so they can slide down, maintain position for 2-3 minutes
- Nose drop or spray (Box 13-4): Wash hands, wear gloves, pt blow nose, tilt head back for front sinus and tilt toward affected side to reach ethmoid sinus, if spray then tilt forward patient looking down at feet and spray tip aimed toward eye, advise pt to look down at feet and aim toward eye, adv pt to keep head tilted back for 5 min after instillation of drops.
What is an inhalation medication?
Metered-dose inhalers (MDIs) are handheld devices that deliver meds to lower respiratory tract
How is a spacer and MDI used to distribute an inhalation medication (Box 13-5)?
MDIS deliver meds to the lower respiratory tract, spacers enhance delivery of medication, shake inhaler well, breathe out open mouth wide, hold mouth piece 1-2 inches from mouth without spacer, take slow deep breath, hold for 10 seconds, exhale slowly through pursed lips, wait 1-2 minutes if second dose is needed, rinse mouth after, avoid smoking, clean equipment daily.
How is a medication delivered by nasogastric or gastric tube?
Check for placement, replace aspirated fluid, pour drug into syringe without plunger or bulb, release clamp, and allow medication to flow in properly, usually by gravity. Flush tubing with 50 ml of water or the prescribed amount, clamp tube remove syringe, wait 30 min to put suction back on.
Why would a medication be delivered rectally? How would the nurse deliver a medication by this route?
- Local and systemic absorption, small capillaries in the rectal area promote medication absorption.
- Medication should be retained (antipyretics and bronchodilators)
- Must refrigerate before use (tend to soften at room temp)
- Explain procedure to pt
- Don gloves
- Pt lies on left side and breathe through the mouth to relax anal sphincter
- Lubricate suppository
- Insert beyond the internal sphincter and they should stay in position for 20 minutes.
How would a vaginal suppository medication be delivered?
With an applicator, patient in lithotomy position, remain lying for a while for meds to absorb, provide patient a sanitary pad after.
What are the routes of parenteral medication administration?
- Delivered via injection and bypass the first pass of the liver.
- Routes include:
When would an intradermal mediation be utilized?
Local effect, allergic reaction tests (eg tuberculin test & drug and other allergic sensitivity tests), some immunotherapy for cancer.
What sites would be used for intradermal medication administration? What equipment?
- Sites include lightly pigmented, thinly keratinized and hairless areas like ventral mid-forearm, clavicular area of chest, or scapular area of back.
- Needle is 25-27 gauge,
- 3/8-5/8 long,
- 1ml calibrated syringe in 0.01 increments (usually 0.01-0.1 mL injected)
What technique would the nurse use to give an intradermal medication?
Cleanse skin, Hold skin taut, insert at 10-15 degree angle, the outline of the needle under the skin should be visible. Inject slowly to form a wheal/bleb, if no bleb then you have to use another site, do not massage, mark with pen, assess in 24-72 hours.
When would an intramuscular mediation be utilized?
For systemic effect, rapid, used for solutions in oils and deep IM for irritating drugs.
What sites would be used for intramuscular medication administration? * Dorsogluteal site is not utilized in the Valencia College Nursing Program and at most partnering clinical sites.
- Ventrogluteal, deltoid, vastus lateralis
- Adults and Toddlers -ventrogluteal
- Newborns- vastus lateralis
What equipment would be used for intramuscular medication administration?
- 20-23 gauge,
- 18 gauge for blood,
- 1-1 ½ inch needle.
- 1-3 ml syringe.
What technique would the nurse use to give an intramuscular medication?
- Ventrogluteal- 1-3ml, 20-23 g, 1 ¼ - 2 ½ inch. Angle needle toward iliac crest
- Deltoid- 0.5-1ml, 5/8-1 ½ inch. 90 degree angle with patient in prone
- Vastus lateralis- 0.5 ml in infants, 1 ml for children, 1-1.5 ml in adults max is 2ml direct at knee 45-60 degree angle.
Z-track method is recommended for use in most IM injections now. How would the nurse perform this intramuscular medication administration?
- For irritating medications, seal deep in muscle layer to prevent leakage into the subcutaneous layer, change needle, hold skin to the side, leave needle in place for 10 seconds, withdraw needle and really skin at the same time, may apply gentle pressure
What is the preferred IM site for adults? Newborns? Toddlers?
- Adults and Toddlers -ventrogluteal
- Newborns and babies who are not walking independently- vastus lateralis
What are special considerations regarding equipment when giving an IM medication?
- Syringe size should approximate volume of medication administered
- Use tuberculin syringe for amounts <0.5 mL
- Use filter needle to draw up meds from a glass vial or ampule; change needle before administering tp prevent tissue irritation from glass fragments or medication left on needle.
What are special considerations regarding technique when administering an IM medication?
- Wash hands, wear gloves
- ID pt
- Explain procedure to pt allow time to cooperate
- Show empathy for pt and family
- Position pt
- Follow rights of med admin
- Inspct skin before inection
- Inject med slowly to minimize tissue damage
- Stabilize skin during needle removal
- Do not administer in inflamed sites, or those with edema, lesions (mole scars)
- Rotate sites; document site
- Observe for drug effectiveness or reactions; report reactions immediately
- Can use product like EMLA or lidocaine to reduce pain
What developmental needs should the nurse consider when giving medications to children?
Infants have stranger anxiety, 3-6 year olds view hospitalization, illness, or injury as punishment, 3-6 year old have fear of mutilation.
How can the nurse apply the nursing process to medication administration?
- -assess that the medication ordered is the correct medication.
- -Assess the patient's ability to self-administer medications
- -Determine whether a patient should receive a medication at a given time
- -Administer medications correctly, and closely monitor their effects.
- -Educate Patient and family about proper medication administration and monitoring.
- - Do not delegate any part of the medication administration process to nursing assistive personnel
- -Apply the nursing process to medication administration.
- -practice the 6 rights