Nursing implications for different med routes

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Nursing implications for different med routes
2011-02-13 03:35:22
Nursing implications different med routes

Nursing implications for different med routes
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  1. Oral/Enteral
    • Contradictions for oral med administration include: vomitting, absence of gag reflex, difficulty swallowing and decreased level of conciousness
    • Sit upright in fowlers or semi-fowlers
    • administer irritating meds w/ small amount of food
    • Don’t mix lg amounts of food or beverage in case pt. can’t finish it
    • avoid administration w/ contradicted foods/drinks (grapefruit)
    • administer 1 hour before meals, 2 hours after meals
    • time-release capsules must be swallowed whole
    • use liquid form to facilitate swallowing when possible
  2. Sublingual/buccal
    • instruct client to keep in place untill med is absorbed
    • clients should not eat or drink while the tab is in place
  3. Liquids, suspensions, elixirs
    • Follow directions for dilution and shaking
    • meniscus is at the level of the desired dose
  4. Transdermal
    • Apply patches as provided to ensure proper dosing
    • wash skin with soap and water, dry thourghly before applying
    • Place the patch on a hairless area of the skin and rotate sites to prevent skin irritation
  5. Topical
    • Apply with a glove, tongue blade, or cotton-tipped applicator
    • Never apply w/ bare hand
  6. Instillations: eyes
    • use surgical aseptic technique when instilling meds
    • Sit upright or lie supine w/ head tilted slightly and looking at ceiling
    • Rest dominant hand on the client’s forehead, hold dropper above the conjunctival sac approx. 1-2 cm, drop th emed into the center of sac and have the client close eye gently
    • apply gentle pressure w/ the finger and a clean tissue on the nasolacrimal duct for 30-60 sec to prevent systemic absorption of the med
  7. Instillations: ears
    • aseptic technique
    • sit upright or maintain a side-lying position
    • straighten the ear canal by pullng auricle upward and outward for adults and down and back for kids. hold the dropper 1 cm above the ear canal, instill, then gently apply pressure w/ finger to tragus
  8. Instillations nose
    • aseptic technique
    • supine w/ head positioned to allow meds to enter the appropriate passage
    • use the dominant hand to instill drops
    • instruct the client to breathe through the mouth, stay in supine position, and avoid blwoing his/her nose for 5 mins after insertion
  9. Inhilation with MDI
    • remove the cap from the inhaler
    • shake the inhaler 5-6 times
    • hold the inhaler w/ the mouthpiece at the bottom
    • Hold the inhaler approx 2 to 4 cm away from the mouth
    • Take a deep breath and then exhale
    • slow deep breath that should last 3-5 secs to facilitate delivery to the air passages
    • Hold breath for 10 secs to allow med to deposit in airway
    • Take inhaler out and exhale through pursed lips
    • Spacer may be used to increase the amount of the med in the oropharynx.
  10. Inhilation with DPI
    • avoid shaking the device
    • exhale completely
    • place between the lips and take a deep breath through mouth
    • hold breath 5-10 secs
    • slowly exhale through pursed lips
    • resume normal breathing
  11. Nasogastric/gastronomy tubes
    • check for proper tube placement
    • use a syringe and allow med to flow in by gravity
    • to prebent clogging flush the tubing before and after each med w/ 5-30 ml of warm water. when administration is complete, flush w/ 30-60 ml of warm water
  12. Vaginal suppositories
    • - wear gloves
    • - Remove the foil wrapper and lubricate the suppository if necessary
    • - Position client supine w/ knees bent, feet flat on the bed and close to hips (modified lithotomy position)
    • - inserted w/ applicator
    • - remain in the position for a prescribed amount of time
  13. Rectal suppositories
    • - Position the client in left lateral position Insert just beyond the internal sphincter
    • - Instruct the client to retain the med 20-30 mins for stimulation of defecation and 60 min for systemic absorption.
  14. Parenteral
    Vastus lateralis site is usually the recommended site for infants and children <2 years

    After age 2, ventral gluteal site. Both of these sites can accommodate fluid up to 2ml. The deltoid site ahs a smaller muscle mass and only can accommodate up to 1 ml.

    Use a tuberculin syringe for solution vol. <0.5 ml

    rotate injection sites and doc. each site used

    do not injuect sites that are edematous, inflamed or have moles, birthmarks or scars

    If med is give IV, immediatly monitor the client for theraputic and side/adverse effects

    discard all sharps in designated containers.
  15. ID
    • - usually used for tuberculin testing or check med sensitivities
    • - may be used for some cancer immunotherapy
    • - use small amounts of solution (0.01-0.1 ml) . mid-forearm. 10 to 15 degree angle
  16. subcutaneous
    • - Appropriate for small doses of nonirritating, water soluble meds (insulin and heparin)
    • - pinch skin and inject at 45 to 90 degree angle
    • - sites are selected for adqueate fat pad (abdomen, upper hips, lateral upper arms, thighs)
  17. Intramuscular
    • - Appropriate for irritating meds
    • - most common sites include ventrogluteal, dorsogluteal, deltoid, vastus lateralis (kids)
    • - 90 degree angle
    • - 1-3 mL, if more is needed use 2 needles and 2 seperate injection sites
  18. IV
    • appropriate for administration meds, fluid and blood
    • immediately monitor for adverse effects