Medication Administration Nursing Responsibilities - Standard
precautions - Patient privacy - Patient preparation - Drug
preparation
Slide 3
Nursing Implications Associated with Drug Administration
Consult references/pharmacist Observe for ADRs Report drug
reactions Record observations Withhold drug if needed - notify
provider
Slide 4
Medication Orders The nurse must ensure the patient receives
the correct medication Orders should include the following: Name
Date/time Drug name Dose Route Time/frequency administration
Prescribers signature
Slide 5
Medication Orders Controlled substances - Opioids,
barbiturates, ect. double-locked - Keys with charge nurse - Log
administration of drugs - End-of-shift count - Waste controlled
substance with witness
Slide 6
Medication Orders Types of orders - Standing orders -
pre-written, no call - Verbal orders - telephone to nurse - repeat
back to provider - To be written and signed by the provider
asap
Slide 7
The Seven Rights of Medication Administration Right drug Right
dose Right patient: name and birth date Right time Right route
Right documentation Patients right to refuse
Slide 8
Medication Preparation Know the seven rights Drug reference
available Know drug action, contraindications, usual dosage, and
side effects Check label 3 times - removing drug from container or
drawer - on comparison with MAR - before giving to patient (if unit
dose) - Before returning to drawer (if multi-use container)
Slide 9
Important Considerations Enlist the patients Utilize the
pharmacists Prepare one patients medication at a time Minimize need
for calculations or compare answers with another nurses Two
licensed nurses must double check high alert drugs before
administration, i.e. insulin, heparin
Slide 10
Important Considerations Always report errors Never give an
unlabeled drug Dont confuse drug names Date and initial (multiuse
vials or containers) If you didnt prep it, dont give it
Slide 11
Important Considerations for Medication Administration 2
identifiers for safety: name and DOB If you gave it, chart it Do
not chart for someone else or have someone else chart for you Do
not transport or accept a container that is not labelled Do not put
down an unlabeled syringe
Slide 12
Important Considerations for Medication Administration Watch
the patient take it and swallow it Assess patients response If a
patient refuses a medication: do not force it, chart it If you
elect to omit a dose based on your nursing judgment, let another
nurse help make the decision. If medication is not given, document,
dose omitted because Report to the provider
Slide 13
Commonly Used Abbreviations Joint Commission on Accreditation
of Healthcare Organization (JCAHO) approved abbreviation list
institutional policy and list of used abbreviations
Slide 14
Routes of Administration Enteral - Via the GI Tract - Powders -
Pills - Tablets - Liquids or suspensions - Suppositories
Slide 15
Routes of Administration Percutaneous - Through the skin or
mucous membranes - Topical - Instillation - Inhalation
Slide 16
Routes of Administration Parenteral - Methods other than the GI
tract; needle route - Intramuscular (IM) - Subcutaneous (SC) -
Intradermal - Intravenous (IV) - Ampules - Vials
Slide 17
Enteral Administration Tablets, pills, capsules - absorbed more
slowly from GI tract into the bloodstream than via any other route
- (PO) route relatively safe - Do not crush enteric coated or
sustained release pills - Only divide scored pills - Liquid
medications: children and patients who cannot swallow pills
Slide 18
Oral Medications Unit dosage system: most common Med stays in
package until administration May place prepackaged medications in
the same cup until administered Involve the patient and include
teaching Patient refusal: return unopened medication to the drawer,
document reason, notify provider
Slide 19
Oral Medications From multi-dose containers, pour pill into the
cap, drop into a medicine cup Label cup with med name, dose Do not
touch meds with bare hands Falls on floor? Toss it. Working on med
cart? Add clean field
Slide 20
Enteral Administration of Liquid Medications PO, or via a NG,
gastrostomy, or jejunostomy tube No liquids to unconscious
patients: aspiration Some liquid medications are not to be followed
by water; some may stain the teeth Use calibrated cup or syringe
(but not IV syringe) Measure liquids at bottom of meniscus
Slide 21
Enteral Administration of Tubal Medications NG tubes: liquid
meds to unconscious patients, dysphasic patients, those too ill to
eat Use liquid form or crush tablets and open capsules if allowed
give separately in warm water Not all tablets are safe to use when
crushed and not all capsules are safe to use when opened
Slide 22
Enteral Administration of Suppositories Rectum or vagina
Dissolves at body temperature and absorbed directly into the
bloodstream infants, patients intolerant of oral preparations, N/V
Store in cool place
Slide 23
Administration of Vaginal Medications Usually for yeast
infections Some products are used to induce labor Use gloves
Provide privacy
Slide 24
Percutaneous Administration skin /mucous membranes Mostly local
action; some act systemically topical applications (ointments,
creams, powders, lotions, and transdermal patches), instillations,
and inhalations Absorption is rapid, short duration
Percutaneous Administration Transdermal Patches
Adhesive-backed, medicated patches -sustained, continuous release
of medication over hours/days Eye drops and Eye Ointments - Dont
touch the dropper or the tube to the eye (p 70 Fig 2-18) Eardrops -
Otic solutions must be at room temperature when applied - Use only
droppers supplied with medications for administration
Slide 27
Percutaneous Administration Nose drops - individual use only
Nasal sprays - absorbed quickly; less medication used, wasted
Inhalations - mucous membranes ofrespiratory tract - relatively
limited effect or a systemic effect - used by respiratory therapy
and anesthesiologists
Slide 28
Percutaneous Administration Sublingual medications - under the
tongue, rapidly absorbed - tablet or a liquid squeezed from capsule
- Do not give water after as water reduces absorption - tablet
should dissolve (no swallowing) Buccal medications - between the
gum and the cheek, preferably above the molar - Follow same
administration guidelines as SL
Slide 29
Parenteral Administration Intramuscular (IM) Subcutaneous
Intradermal Intravenous (IV) Rationale for using these methods
include: - Absorption rate - No oral route - Emergencies - Drug is
destroyed in the GI tract
Slide 30
Parenteral Administration Equipment - Syringes - barrel,
plunger, and tip - calibrated in milliliters, minims, insulin or
heparin units - Types - Tuberculin syringe (for allergy
testing/treatments, TB testing and small quantities) - Insulin
syringe - One and three milliliter syringes - Safety-Lok
syringes
Slide 31
Parts of a Syringe. (From Elkin, M.K., Perry, A.G., Potter,
P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.].
St. Louis: Mosby.)
Slide 32
Tuberculin Syringe Calibration (From Clayton, B.D., Stock, Y.N.
[2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis:
Mosby.)
Slide 33
Calibration of U100 Insulin Syringe (From Clayton, B.D., Stock,
Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis:
Mosby.)
Slide 34
Reading the Calibrations of a 3-mL Syringe
Slide 35
Safety-Glide Syringe
Slide 36
Parenteral Administration Equipment - Needles - Parts are the
hub, shaft, and beveled tip - Opening at the needles beveled tip is
the lumen - Size of the diameter of the inside of the needles shaft
determines the gauge of the needle; the smaller the gauge, the
larger the diameter - Needle gauge selection is based on the
viscosity of the medication
Slide 37
Parts of a Needle (From Clayton, B.D., Stock, Y.N. [2004].
Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)
Slide 38
Parenteral Administration Equipment - Needle length - Selected
based on the depth of the tissue into which the medication is to be
injected - Intradermal: 3/8 to 5/8 inch - Subcutaneous: to 5/8 inch
- Intramuscular: 1 to 1 inch - Intravenous needles - Butterfly
(scalp needle) - Over the needle catheter
Slide 39
Needle Length and Gauge (From Clayton, B.D., Stock, Y.N.
[2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis:
Mosby.)
Slide 40
Parenteral Administration Equipment - needleless devices -
sheath or guard - IV caths: blunt-edged cannulas, valves, or needle
guards - IV tubing: recessed and shielded needle connectors to
reduce needle sticks
Locating IM Injection for Ventrogluteal Site (C, from Elkin,
M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and
clinical skills. [3 rd ed.]. St. Louis: Mosby.)
Slide 43
Giving IM Injection in Vastus Lateralis Site on an Adult (C,
from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing
interventions and clinical skills. [3 rd ed.]. St. Louis:
Mosby.)
Slide 44
Rectus Femoris Muscle A. Child/Infant B. Adult (From Clayton,
B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th
ed.]. St. Louis: Mosby.)
Slide 45
Giving IM Injection in Deltoid Site (C, from Elkin, M.K.,
Perry, A.G., Potter, P.A. [2004]. Nursing interventions and
clinical skills. [3 rd ed.]. St. Louis: Mosby.)
Slide 46
Figure 23-20 A, Z-track method. B, Using an air lock. C,
Administering IM injection by airlock technique. (From Potter,
P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St.
Louis: Mosby.)
Slide 47
Parenteral Administration Intradermal injections - serum,
vaccine, or skin test agent - Not aspirated - Small volumes (0.1mL)
injected to form a small wheal just under the skin - Used for
allergy sensitivity tests, TB screening, local anesthetics -
tuberculin syringe with 25-gauge, 3/8 to 5/8 inch needle
Slide 48
Figure 23-21 Angles of insertion for intramuscular (90),
subcutaneous (45), and intradermal (15). (From Potter, P.A., Perry,
A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis:
Mosby.)
Slide 49
Parenteral Administration Subcutaneous injections - loose
connective tissue between the dermis and the muscle layer (fatty
layer) - absorption slower than with IM injections - Given at a
45-degree angle if the patient is thin or at a 90-degree angle if
the patient has ample subcutaneous tissue - Usual needle length is
to 5/8 inch and 25 gauge - insulin and heparin
Slide 50
Subcutaneous Injection Angle and needle length depend on the
thickness of skin fold (From Elkin, M.K., Perry, A.G., Potter, P.A.
[2004]. Nursing interventions and clinical skills. [3 rd ed.]. St.
Louis: Mosby.)
Slide 51
Parenteral Administration Fluid and electrolytes will be also
covered again in systems classes Starting of IVs and management of
tubing and delivery devices will be covered in skills lab
Slide 52
Parenteral Administration Intravenous (IV) therapy - fluid and
electrolyte maintenance, restoration, replacement - Give meds,
nutritional feedings - blood and blood products - chemotherapy to
cancer patients - patient-controlled analgesics - Keep a vein open
(KVO)
Slide 53
Scope of Practice Know LPN SOP for practice state OSBN LPN IV
policy prohibits LPNs from initiating the following items: -
Antineoplastic agents - Blood and blood components -
Antiarrhythmics - Antiseizures - Ambulatory infusion devices -
Hypertensive agents
Parenteral Administration Nursing responsibilities - Nurse
ensures that correct fluid, amount started and that the fluid is
regulated to infuse over the period ordered - To find the drops per
minute (the drip rate), find drip factor on tubing package
Slide 56
Parenteral Administration Nursing Responsibilities - Monitor
Intravenous Therapy - Check the infusion and the IV needle site at
least every hour - Flow of fluid - IV site: erythema, wetness, and
edema - Phlebitis: inflamed vein - Infiltration: fluid passes into
the tissues - Assess for chills, fever, headache, nausea, vomiting,
anxiousness, and dyspnea
Slide 57
Parenteral Administration Nursing Responsibilities - Assess for
Anaphylactic Shock - Respiratory distress - Skin reactions - Signs
of circulatory collapse - GI signs and symptoms - Change in mental
status - Requires immediate intervention
Slide 58
Parenteral Administration Nursing responsibilities - Record
administration - Record information - Evaluate and record patients
response - Observe for ADRs
Slide 59
Patient and Family Teaching must be ready to learn Include
family as allowed by patient teaching enables patient to care for
self Patient should demonstrate self-care skills The patient should
know about their illness or diagnosis and treatment The patient
should know names of all medications, administration schedule,
common side effects, provider to call, where to get
prescriptions
Slide 60
Promoting Cooperation with Medication regimens Inadequate
understanding of illness or disease Cost of the medication
Development of adverse effects Forgetfulness Measures to foster
cooperation include: - Education - Resources for drug payment -
Memory aids
Slide 61
The Nursing Process in Pharmacology Assessment - Take med
history - Collect physical status data - social networks,
resources? Diagnosis and Planning - Check nursing diagnoses -
Identify desired outcomes of nursing interventions - Know why the
drug is needed, how it will be given, and common side effects
Implementation - Prepare meds safely Evaluation