NUR141#6

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Author:
lwendt
ID:
38985
Filename:
NUR141#6
Updated:
2010-10-01 16:32:46
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medication administration
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Description:
carolyn's lecture #6
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  1. Oral Medications
    • most commonly used method
    • • safest and easiest route for the patient, least expensive, absorbed in stomach and SI
    • • avoid oral medications in patients who are NPO, having difficulty swallowing, unconscious or are vomiting – check for alternate route
    • parenteral –absorbed outside in outside of GI tract
    • enteral- absorbed in
  2. Oral Medications:
    • • Tablet-compressed hard discs, scored
    • • Enteric Coated-goes thru stomach and is absorbed in SI
    • • Capsule-liquid, powder
    • • Extended release
    • o SR – sustained release
    • o XL – extended release
    • o CR – controlled release
    • o SA – sustained action
    • o LA – long acting
    • • Elixir-sweetened
    • • Emulsion-oil based, need to be shaken
    • • Lozenge
    • • Powder
    • • Solution
    • • Suspension
    • • Syrup
    • • Tincture
  3. Tablets, Capsules:
    • · place in medication cup(s). Do not touch medication with fingers. If necessary to touch –wear gloves, Fowlers position, check to make sure patient swallowed.
    • • if necessary, crush tablets before administering-may be dissolved in liquid or given with applesauce, pudding (if appropriate)
    • • if giving enteric-coated, sustained released, extended release and delayed release-do not crush or break
    • no big pills with someone with aspiration problems, watch diet limitations
  4. Liquids:
    • • Elixirs, spirits, suspensions, syrups
    • • Water-based vs Alcohol based, is patient an alcoholic
  5. Liquid-Normal Oral Route
    • • place medicine cup on level surface
    • • hold bottle with label against palm
    • • pour at eye level
    • • measure the volume at the base of the meniscus
    • • label medicine cup; may take original container to bedside
    • • use a syringe to measure amounts less than 5mls, syrinces not the same as IV syringe. Place between gum and cheek.
    • Dilute medications that stain and then give water.
    • If you overfill med cups do not put back in original container
  6. Feeding Tubes:
    • • most medications that can be administered orally can be administered via feeding tubes
    • • liquid medications are preferred, but some medications can be finely crushed and mixed with sufficient water to ensure complete passage of the drug to the stomach
  7. Examples of Feeding Tubes
    • Nasogastric Tube – NG Tube, short time (a few days)Percutaneous endoscopic gastrostomy tube – PEG Tube, put in through OR, long term feeding. Watch for peritoneal cavity displacement.
  8. Guidelines for Checking Nasogastric/Orogastric Tube Placement:
    • • x-ray done on insertion and if there is doubt e.g. measurement doesn’t add up
    • • Measurement of tube from nares (NG)/mouth (OG) to the end of the tube, document every 4-8 hours
    • • Aspirate gastric contents and observe color (green) of aspirate, return contents if not for decompression,
    • • Measure pH – normal less than 5.5, different meds can change ph
    • • Auscultatory method – not reliable
  9. Liquid-Gastrointestinal Tube Route (Nasogastric, Nasointestinal)
    • • Use only liquid medication or crushable
    • • Do not use enteric coated, sustained release, extended release or delayed release medications
    • • Administer at room temperature
    • • Elevate HOB to prevent reflux and aspiration, bed no lower than 30 degrees
    • • Check for tube placement before administering medication
    • • Flush tube with 15-30 mL of water before and immediately after giving medication(s)
    • • Give medications separately and flush with 10 mL of water between each drug
    • • If tube is connected to suction, keep it disconnected from suction and clamped for 20-30 minutes after giving medications
    • • Discontinue continuous tube feeding and leave tube clamped for required period of time before and after medication has been given, according to reference and agency protocol, does meds need to be given on empty stomach?
    • • Document water intake and liquid medication given on I & O record
  10. Additional Techniques
    • • make sure you clamp the tube between flushes and when administering medications
    • • make sure syringe is held in upright position to prevent spills
    • • equipment (syringe etc) should be new or be labeled with date that follows the policy for appropriate use
    • • use an appropriate size syringe for liquid measurements as needed
  11. Sublingual medication:
    • • sublingual-placement under the tongue allows the drug to diffuse into the capillary network and therefore, to enter the systemic circulation directly
    • • administration of an agent by this route has the advantage that the drug bypasses the intestine and liver and is not inactivated by metabolism, dissolve completely, no drink until it is dissolved
    • can give water before medication unless NPO
  12. Buccal Medication:
    • • between the upper or lower molars and cheek
    • • the patient is instructed to keep these products against the buccal surface of the mouth until they are completely dissolved usually 5-10 minutes (Taylor 791)
    • alternate sides with administration
    • • should not be swallowed/no fluids
  13. Topical Medications
    • Topical Medications - Applied to skin or mucosal membranes
    • • Eyes
    • • Ears
    • • Nose
    • • Mouth
    • • Lungs-inhalers
    • • Vagina
    • • Rectum
  14. Skin applications:
    • • Inunction-drugs incorp into some medium and then applied
    • • Powders-can be inhaled so be careful
    • • Ointments-prolonged contact
    • • Creams or Oils-lubricate and soften skin
    • • Lotions-protects and soothes, cotton ball or gauze
  15. Transdermal patches:
    • • Deliver hormones, narcotic analgesics, cardiac medications, nicotine, daily or longer intervals, constant level of drugs.
    • • Medications intended for daily use or for longer interval
    • • Maintain consistent serum drug levels
    • • Narcotic analgesic patches
    • • Clear patches-find first before applying a new one.
    • • Aluminum backing-do not defribulate
    • Be careful with high temp, can increase absorption of medication
  16. Guidelines for transdermal patches:
    • • Wear gloves to apply and remove
    • • Position patient so that surface on which the topical material is to be applied is exposed
    • • Rotate application sites/chose appropriate site - document on MAR
    • • Apply the patch at the same time of the day
    • • Write date, time, & initials on the patch (some patches stay in place for 3-7 days)
  17. Application of Transdermal Patch:
    • • remove old patch before applying new one
    • • assess for any skin irritation
    • • remove backing from new disk
    • • place adhesive side down and press firmly
    • • circle outer edges of disk with 1 or 2 fingers to ensure adequate disk contact with skin – Do not rub over medication
    • • dispose of old patches carefully
    • Remember to date and initial
  18. Eye Instillations and Irrigations:
    • • Direct application not onto sensitive cornea
    • • Application into conjunctival sac
    • • Eyedrops
    • • Ointments
    • • Eye Irrigation
    • • Eye Medication Disks
  19. Instilling Eyedrops
    • • wash hands/apply gloves
    • • with the dominant hand resting on the patient’s forehead, hold the filled medication eye dropper approximately 1-2 cm (1/2 to 3/4 in.) above the conjunctival sac
    • • drop prescribed number of drops into conjunctival sac
  20. Correct Instillation of Eye Drops:
    • Patient Blinks
    • • If the patient blinks or closes eye or if drops land on outer lid margins, repeat procedure
  21. Instilling Eyedrops
    • • after instilling drops, release lower lid and ask patient to close the eye gently
    • • apply gentle pressure to the nasolacrimal duct for 30-60 seconds – prevents medication from flowing into the tear duct and minimizes the risk of systemic effects
    • have patient not rub their eye
  22. Gentle Pressure Over Inner Canthus
  23. Patient who blinks easily:
    • • place the patient in the supine position, with the head turned to one side-45° from midline
    • • the eye to received the eye drops should be upper most-with the eye closed, drop the prescribed dose on the inner canthus
    • • have the patient turn slowly from side to midline, than toward the other side while blinking
    • • the eye drops will move via gravity and surface tension into the conjunctival sac
  24. Instillation of Eye Ointment
    • • position patient in either supine or sitting position
    • • head should be slightly tilted back
    • • remove any secretions from eye by wiping area with sterile gauze from inner to outer canthus
  25. Eye Ointment
    • • have the patient look upward and instill the medication into the conjunctival sac by exerting gentle traction to keep the conjunctival sac open
    • • gently squeeze the tube of medication along the border of the conjunctival sac starting at the inner canthus and working towards the outer canthus applying an even strip ½ inch
    • • once the medication is instilled, release the lower lid of the eye
    • • ask the patient to close the eye and move it around and/or gently rub the eyelid to assist with distributing the medication
    • • remove any excess medication with sterile gauze
  26. Caution!
    • • use only medications labeled for ophthalmic use – Abbreviations OD, OS, OU
    • • medications should be kept away from other similarly shaped containers
    • • many eye medications cause blurred vision, so warn patients not to drive or engage in other dangerous activities immediately after using eye medications
  27. Ear Instillations and Irrigations
    • • Local effect on exterior auditory canal
    • • Soften wax
    • • Relieve pain
    • • Apply local anesthesia
    • • Destroy organisms
    • • Destroy an insect lodged in canal
  28. Instilling ear drops:
    • • medication should be at body temperature
    • • note condition of external ear structures and canal
    • • have patient assume side-lying position with ear to be treated facing up. If cerumen or drainage occludes outermost portion of ear -wipe out gently - do not force wax inward to block or occlude canal
    • • straighten ear canal by pulling auricle
    • o up and back for adults
    • o straight back for school-age child
    • o down and back for children under 3 years
    • • allow drops to fall on side of canal
    • • patient remain in side-lying position 2-3 minutes.
    • • apply gentle pressure to tragus of ear
  29. Correct Instillation of Ear Drops:
    • • if using cotton ball-place a medication-soaked cotton ball plug gently and loosely into outermost part of canal to prevent oozing; a dry cotton ball will absorb the medication
    • • remove in 15 minutes
  30. Instilling nasal drops:
    • • patient in supine position
    • • posterior pharynx - tilt head backwards
    • • ethmoid or sphenoid sinus - tilt head back over edge of bed or place pillow under shoulders
    • • frontal or maxillary sinus - tilt head back over edge of bed or pillow with head turned toward side being treated
    • • support patients head with non-dominant hand
    • • instruct patient to breathe through mouth
    • • hold dropper 1 cm (1/2 in.) above nares and instill prescribed number of drops toward midline of ethmoid bone
    • • leave in supine position for 5 minutes and offer a tissue
  31. Instilling nasal spray:
    • • have patient in sitting position
    • • one nostril should be occluded- immediately after shaking bottle insert tip into open nostril
    • • repeat in opposite nostril
    • • assist to comfortable position after medication has been absorbed
    • • caution patient to use these sprays only as needed, for as short a period as possible & only as directed, rebound effect
  32. Inhalation Therapy:
    • • For best results, requires a cooperative patient who can inhale deeply and can manage the psychomotor tasks of using the equipment and preparing the medication
    • • In institutional settings, besides oxygen therapy, drugs may be administered via intermittent positive-pressure breathing (IPPB) machines, small-volume nebulizer or nebulizer
  33. Inhalation medications:
    • • Bronchodilators
    • • Nebulizers
    • • Metered dose inhaler (MDI) – used with or without spacer
    • • Dry powder inhaler (DPI) - disk
  34. Metered-Dose Inhaler (MDI):
    • • obtain MDI with medication canister
    • • remove cap, hold inhaler upright, and grasp with thumb and first two fingers
    • • shake inhaler
    • • tilt head back slightly and have patient exhale
  35. Positioning inhaler:
    • • open mouth with inhaler 1-2 inches away from mouth
    • • or place mouthpiece into mouth grasping securely with teeth and lips
    • • spacer mouthpiece is always placed in mouth
  36. Metered-dose Inhalers:
    • • Inhale slowly and deeply through mouth
    • • press down on canister to release medication (one puff) while continuing to inhale a full breath
    • o 2-3 seconds, one puff only
    • • hold breath for 5 -10 seconds or as long as possible – remove inhaler – exhale slowly
    • • if repeat puffs of the same medication are ordered, wait 1-5 minutes between puffswait 2-5 minutes between different meds
  37. Small Volume Nebulizer
    • • premeasured dose
    • • inhale slowly
    • • hold each breath 5-10 seconds or as long as possible before exhaling
    • • continue this technique until all medication in the nebulizer cup has been aerosolized approximately 15 minutes
  38. Vaginal Medications
    • • Always use gloves
    • • Via vaginal applicator or suppository insertion
    • • Have patient void
    • • Use water soluble lubricant
    • • Place in lithotomy position/elevate hips on a pillow
    • • Creams, jellies, and foam use the gloved, non-dominant hand to spread labia & expose vagina
    • • Gently insert applicator as far as possible into the vagina
  39. Vaginal suppositories:
    • • Unwrap suppository that has warmed to room temperature
    • • Insert suppository (rounded end first) as far as possible into the vagina with dominant index finger
    • • Patient remain in supine position with hips elevated for 5-10 minutes - allows for melting and spreading of medication
  40. Rectal suppositories:
    • • Position patient on the left side in a Sims position unless contraindicated
    • • Apply water soluble lubricant to gloved index finger and the rounded end of the suppository
    • • Gently insert suppository, rounded end first, along the rectal wall about 3-4 inches (1 inch past the internal sphincter) Have patient deep breathe
    • • Patient should remain lying on their left side for at least 5 minutes to allow for absorption of the medication
    • • Suppositories given for laxative purposes should remain in position for 35-45 minutes until the patient feels the urge to defecate
  41. Safe, therapeutic and effective medication administration is a major responsibility of professional nurses.

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