Parenteral administration chat


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oral administration
intramuscular administration
subcutaneous administration
intradermal administration

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  • Tor’s
  • Parenteral administration chat

    1. 1. Charity F. Zambrano, R.N.
    2. 2. <ul><li>To prepare and administer medications safely, using subcutaneous, intramuscular, intradermal routes. </li></ul><ul><li>Parenteral medication – medication that are given by injections or infusion directly into the body tissues. (ID, SC, IM). </li></ul>
    3. 3. Medication - is a substance administered for the diagnosis, cure, treatment or relief of a symptom or prevention of disease. Rx Prescription -is a written direction for the preparation and administration of a drug.
    4. 4. Pharmacology is the study of the effect of drugs on living organisms. Pharmacokinetics is the study of absorption, distribution, biotransformation and excretion of drugs.
    5. 5. Pharmacokinetics <ul><li>ABSORPTION </li></ul><ul><ul><li>is the process by which a drug passes from its site of administration into the bloodstream. </li></ul></ul><ul><li>DISTRIBUTION </li></ul><ul><ul><li>is the transport of a drug from its site of absorption to its site of action. </li></ul></ul>
    6. 6. <ul><li>METABOLISM / BIOTRANSFORMATION </li></ul><ul><ul><li>a sequence of chemical events that change a drug to a less active form after it enters the body. Liver is the principal site of drug metabolism. </li></ul></ul><ul><li>EXCRETION </li></ul><ul><ul><li>is the process by which drugs are eliminated from the body. Most important route of excretion for most drugs is kidneys. </li></ul></ul>
    7. 7. A drug has different kinds of names… <ul><li>Generic name = given before a drug becomes official. </li></ul><ul><li>Chemical name = is the name by which a chemist knows it; this name describes the constituents of the drug. </li></ul><ul><li>Trademark or Brand name = given by the drug manufacturer </li></ul>BRAND NAME GENERIC NAME - MEFENAMIC ACID PONSTAN MANUFACTURER’S NAME
    8. 8. EFFECTS OF DRUGS <ul><li>Therapeutic effect </li></ul><ul><li>-is the primary effect intended, or the reason the drug is prescribed. </li></ul><ul><li>Side effect </li></ul><ul><li>-These are usually predictable and may be either harmless or harmful . </li></ul><ul><li>Adverse effect </li></ul><ul><li>-A more severe side effects are called adverse effects that may justify for the discontinuation of a drug. </li></ul>
    9. 9. <ul><li>Drug toxicity </li></ul><ul><li>- results from overdosage, ingestion of a drug intended for external use. </li></ul><ul><li>Drug allergy </li></ul><ul><ul><li>an immunologic reaction to a drug. Can occur anytime from a few minutes to 2 weeks. </li></ul></ul><ul><ul><li>Ex. Skin rashes, nausea and vomiting, pruritus, diarrhea </li></ul></ul>EFFECTS OF DRUGS
    10. 10. * Anaphylactic reaction = severe allergic reaction usually occurs immediately after the administration of the drug. This response can be fatal if the symptoms are not noticed immediately and treatment is not obtained promptly. The earliest symptoms are: shortness of breath, acute hypotension and tachycardia.
    11. 11. Types of Drug Preparation <ul><li>Caplet </li></ul><ul><li>Capsule </li></ul><ul><li>Elixir/Syrup </li></ul><ul><li>Gel/Jelly </li></ul><ul><li>Liniment </li></ul><ul><li>Lotion </li></ul><ul><li>Lozenges </li></ul><ul><li>Ointment </li></ul><ul><li>Pill </li></ul><ul><li>Suppository </li></ul><ul><li>Tablet </li></ul><ul><li>Transdermal Patch </li></ul>
    12. 12. Types of Parenteral Drug Preparation <ul><li> Ampules </li></ul><ul><ul><li>made of glass with a constricted neck, usually prescored that can be easily snapped off. </li></ul></ul><ul><ul><li>Vials </li></ul></ul><ul><ul><li>- it is a single or multidose container with a rubber seal at the top and a metal cap protector. </li></ul></ul>
    13. 13. Routes of Administration Oral sublingual buccal Rectal Vaginal Topical dermatologic preparations instillations & irrigations inhalations Parenteral intramuscular (IM) intradermal (ID) subcutaneous (SQ) intravenous (IV)
    14. 14. Medication Orders TYPES: 1. stat order 2. single order 3. standing order 4. PRN order
    15. 15. Parts of Legal Doctor’s Order <ul><li>Name of the patient </li></ul><ul><li>Date and Time the order is written </li></ul><ul><li>Name of the drug to be administered </li></ul><ul><li>Dosage of the drug </li></ul><ul><li>Route of administration </li></ul><ul><li>Time or Frequency of administration </li></ul><ul><li>Signature of the physician writing the order </li></ul>
    16. 16. Nine (9) “Rights”of Medication Administration <ul><li>Right client </li></ul><ul><li>Right medication </li></ul><ul><li>Right dose </li></ul><ul><li>Right time </li></ul><ul><li>Right route </li></ul><ul><li>Right documentation </li></ul><ul><li>Right approach </li></ul><ul><li>Right education </li></ul><ul><li>Right to refuse </li></ul>
    17. 17. Three (3) “checks” of M edication A dministration R ecord 1. Check the order of the doctor in the MAR 2. Check the drug in the MAR before preparing it. 3. Check the prepared drug in the MAR before giving it to the client.
    18. 18. M edication A dministration R ecord
    19. 19. M edication Cards
    20. 20. Parenteral Medications Intramuscular (IM) Intradermal (ID) Subcutaneous (SC / SQ) Intravenous (IV) Because these medications absorbed quickly than oral medications, the nurse must prepare them carefully and accurately. It requires the same nursing knowledge as for oral and other drug preparation; however, because injections are invasive procedure , aseptic technique must be used to minimize the risk of infection.
    21. 21. Equipments <ul><li>Syringes </li></ul><ul><li>a. hypodermic syringes </li></ul><ul><li>= 2ml, 2.5ml, 3ml, </li></ul><ul><li>5ml, 10ml </li></ul><ul><li>b. insulin syringe </li></ul><ul><li>c. tuberculin </li></ul><ul><li>syringe </li></ul>
    22. 22. <ul><li>2. Needles </li></ul><ul><li>Parts :>Bevel </li></ul><ul><li>>Shaft </li></ul><ul><li>>Gauge number </li></ul><ul><li>>Hub </li></ul><ul><li>3 variable characteristics of a needle: </li></ul><ul><li>a. slant or length of the bevel </li></ul><ul><li>=SQ and IM, has longer bevels, provide the sharpest needles and cause less discomfort. </li></ul><ul><li>=ID and IV, has short bevels </li></ul>
    23. 23. b. Length of the shaft = commonly used needles varies from ½ to 2 inches. The appropriate needle length is chosen according to the client’s muscle development, weight and the type of injection. c. Gauge (diameter) of the shaft = varies from #18 to #28. The larger the gauge number, the smaller the diameter of the shaft.
    24. 24. Parts of hypodermic needle:
    25. 25. Intradermal Injections An intradermal (ID) injection is the administration of a drug into the dermal layer of the skin just beneath the epidermis. Usually only a small amount of liquid is used, for example 0.1ml. This method of administration is frequently used for allergy testing and tuberculosis (TB) screening.
    26. 26. SITES: a. Inner lower arm b. Upper chest c. Back beneath the scapulae
    27. 27. Subcutaneous injections (just beneath the skin) Kinds of drugs commonly administered: 1. vaccines 2. preoperative medications 3. narcotics 4. insulin 5. heparin
    28. 28. SQ Common Sites : 1. outer aspect of the upper arms 2. anterior aspect of the thighs 3. abdomen 4. scapular areas of the upper back 5. upper ventrogluteal and dorsogluteal areas.
    29. 29. IM ( Intramuscular Injections) -injections into muscle tissue Absorbs more quickly than subcutaneous injections because of the greater blood supply to the body muscles. Several factors indicate the size and length of the needle to be used: 1. muscle 2. type of solution 3. amount of adipose tissue covering the muscle 4. age of the client
    30. 30. Selected body sites: <ul><li>1. Ventrogluteal site </li></ul><ul><li>Position: </li></ul><ul><li>>back </li></ul><ul><li>>prone </li></ul><ul><li>>side-lying </li></ul><ul><li>Position client on his or her side with the knee bent and raised slightly toward the chest.The trochanter will protrude, which facilitates locating the ventrogluteal site.The nurse places the heel of the hand on the client’s greater trochanter, with the fingers pointing towards the client head. </li></ul>
    31. 31. With the index finger on the client’s anterior superior iliac spine, the nurse stretches the middle finger dorsally(toward the buttocks), palpating the crest of the ilium and then pressing below it. The triangle formed by the index finger, the third finger, and the crest of the ilium is the injection site.
    32. 32. <ul><li>2. Vastus lateralis site = situated on the anterior lateral aspect </li></ul><ul><li>of the thigh. The land- </li></ul><ul><li>mark is established by </li></ul><ul><li>dividing the area bet- </li></ul><ul><li>ween the greater tro- </li></ul><ul><li>chanter of the femur & </li></ul><ul><li>the lateral femoral into </li></ul><ul><li>thirds & selecting the </li></ul><ul><li>middle third. </li></ul>
    33. 33. <ul><li>3. Dorsogluteal site = palpate the posterior superior iliac spine, then draws an imaginary line to the greater trochanter of the femur. This line is lateral to and parallel to the sciatic nerve. </li></ul>
    34. 34. 4. Deltoid Site - found on the lateral aspect of the upper arm. Place the 4 finger across the deltoid muscle with the first finger on the acromion process. The top of the axilla is the line that marks the lower border landmark. A triangle w/in these boun- daries indicates the deltoid muscle about 5cm below the acromion process. Pinch grasp technique can reduce discomfort of an IM inj.
    35. 35. <ul><li>5. Rectus Femoris = used occasionally for IM injections. Situated on the anterior aspect of the thigh. </li></ul><ul><li>The advantage of </li></ul><ul><li>this is that clients who </li></ul><ul><li>need to administer their </li></ul><ul><li>own injection can reach </li></ul><ul><li>this site easily. </li></ul><ul><li>Disadvantage is that it </li></ul><ul><li>may cause discomfort </li></ul><ul><li>for some client. </li></ul>
    36. 37. Intravenous (IV) – needle is injected into the vein. Direct IV, IV push,IV infusion. This is the most rapid route of absorption of medications.
    37. 38. Intravenous (IV) – needle is injected into the vein. Direct IV, IV push,IV infusion. This is the most rapid route of absorption of medications. Legal aspects of drug medication: <ul><li>Republic Act 9173 “The Philippine Nursing Act of 2002” </li></ul><ul><li>Section 28 Article VI: Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications… </li></ul><ul><li>- requires that the drugs be written in their Generic Names. </li></ul><ul><li>Republic Act 6675 </li></ul>
    38. 39. Abbreviation Explanation ac before meals pc after meals po or PO by mouth cap capsule dil dissolve, dilute h hour hs at bedtime/hours of sleep kg or Kg kilogram l or L liter OD right eye OS left eye OU both eyes Common Abbreviations in Drug Administration
    39. 40. Common Abbreviations in Drug Administration prn when needed q every qAM every morning q2h every two hours qod every other day stat immediately tab tablet susp suspension supp suppository CBR complete bed rest BRP bathroom privileges ad lib freely, as desired
    40. 41. od once a day bid twice a day tid three times a day qid four times a day gr grain gtt drop mcg or ug microgram cc ml *** Some abbreviations above are not anymore accepted/or discouraged internationally, due to high medication errors/confusion in medication orders. Yet, it is still used in the Philippines. INSTEAD… we are encourage to use the full word . Common Abbreviations in Drug Administration
    41. 42. Formula for computation of dosage: <ul><li>Oral medications: solids </li></ul><ul><li>Desired dose </li></ul><ul><li>= quantity of drug </li></ul><ul><li>Stock Dose </li></ul><ul><li>(D/S=Q) </li></ul><ul><li>ex: An antihypertensive agent, minoxidil(Loniten)5mg p.o is ordered. Stock is 2.5mg/tab. </li></ul><ul><li>How many tablets should be administered? </li></ul><ul><li>Answer: D= 5mg </li></ul><ul><li> = </li></ul><ul><li> S = 2.5mg/tablet </li></ul>2 tablets
    42. 43. Formula for computation of dosage: <ul><li>Oral medications: Liquid preparations </li></ul><ul><li>Desired dose </li></ul><ul><li>X Dilution = Quantity of drug </li></ul><ul><li>Stock Dose </li></ul><ul><li>ex: Paracetamol 250mg / 5 ml , give 500 mg P.O every 4 hours RTC. </li></ul><ul><li>Answer: D= 500mg </li></ul><ul><li> X 5ml </li></ul><ul><li> S = 250 mg </li></ul>= 10 ml
    43. 44. Medication Error Leads to a patient’s Death!