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MEDICATION ADMINISTRATION
OBJECTIVES... <ul><li>DESCRIBE “8 RIGHTS” OF ADMINISTRATION </li></ul><ul><li>LIST SAFETY GUIDELINES </li></ul><ul><li>DES...
TYPES OF MEDICATION ORDERS <ul><li>STANDING – routine orders for certain procedures with no unusual complications </li></u...
COMPONENTS OF A DRUG ORDER <ul><li>PATIENT NAME (A) </li></ul><ul><li>ALLERGIES  (B) </li></ul><ul><li>DATE & TIME ORDER I...
 
DELIVERY SYSTEMS <ul><li>UNIT DOSE </li></ul><ul><li>COMPUTERIZED MEDICATION SYSTEMS </li></ul>
 
Unit dose system
8  RIGHTS <ul><li>RIGHT CLIENT  </li></ul><ul><li>RIGHT DOSE  </li></ul><ul><li>RIGHT DRUG  </li></ul><ul><li>RIGHT TIME <...
REALLY…THERE ARE 3 MORE! <ul><li>RIGHT TO KNOW – must explain each drug to patient </li></ul><ul><li>RIGHT  DOCUMENTATION ...
BEHAVIORS TO AVOID DURING MEDICATION ADMINISTRATION <ul><li>DO NOT BE DISTRACTED </li></ul><ul><li>DO NOT GIVE OR HOLD MED...
YOUR RESPONSIBILITIES AS A STUDENT NURSE <ul><li>PROPER TECHNIQUE – SEE SYLLABUS  </li></ul><ul><li>RESEARCH – MUST LOOK U...
ROUTES <ul><li>ORAL OR PO </li></ul><ul><li>DO NOT GIVE TO PATIENTS WHO: </li></ul><ul><li>ARE VOMITING </li></ul><ul><li>...
LIQUIDS <ul><li>MENISCUS  IS THE LINE OF THE DESIRED DOSE </li></ul>
TRANSDERMAL PATCHES <ul><li>PROVIDE   CONSISTENT BLOOD LEVELS </li></ul><ul><li>DO NOT CAUSE GI IRRITATION </li></ul><ul><...
TOPICALS <ul><li>CAN APPLY TO SKIN WITH GLOVE, TONGUE BLADE OR COTTON TIP APPLICATOR </li></ul><ul><li>BE CAREFUL NOT TO C...
INSTILLATIONS <ul><li>EYE DROPS </li></ul><ul><li>EYE OINTMENT </li></ul><ul><li>EAR DROPS </li></ul><ul><li>NOSE DROPS / ...
 
pull outer ear to straighten ear canal:
Eye Drops or Ointments <ul><li>wear gloves </li></ul><ul><li>steady hand holding applicator by resting heel of hand on pat...
 
 
Inhaler without Inhaler with spacer: spacer:
SUPPOSITORIES (RECTAL OR VAGINAL) <ul><li>remove foil </li></ul><ul><li>apply lubricant </li></ul><ul><li>insert with glov...
PARENTERAL ( OUTSIDE THE GI TRACT)
 
 
 
<ul><li>INSULIN SYRINGES CAN ONLY BE USED TO ADMINSTER INSULIN </li></ul><ul><li>INSULIN CAN ONLY BE ADMINISTERED IN AN IN...
 
NEEDLE SIZES <ul><li>THE LARGER THE GAUGE NUMBER, THE SMALLER THE DIAMETER OF THE LUMEN </li></ul><ul><li>THE SMALLER THE ...
 
MEDICATION VIAL <ul><li>A SMALL GLASS/ PLASTIC CONTAINER WITH A SELF SEALING RUBBER TOP </li></ul>
<ul><li>SELECT APPROPRIATE SYRINGE SIZE & ATTACH NEEDLE </li></ul><ul><li>CLEAN TOP OF VIAL </li></ul><ul><li>LEAVE VIAL U...
AMPULES <ul><li>A GLASS CONTAINER WITH A TAPERED NECK FOR SNAPPING OPEN AND USING ONLY ONCE </li></ul>A FILTER NEEDLE MUST...
<ul><li>SELECT APPROPRIATE SYRINGE & ATTACH FILTER NEEDLE </li></ul><ul><li>TAP STEM OF AMPULE  </li></ul><ul><li>WRAP ALC...
IMPORTANT <ul><li>NEVER, EVER  RECAP A USED NEEDLE !!!! </li></ul><ul><li>SCOOP   CAP BACK ON STERILE NEEDLES ONLY </li></ul>
ANGLES FOR INJECTION
INTRADERMAL SITES <ul><li>USUALLY CHOSEN SO THAT LOCAL REACTION CAN BE OBSERVED… </li></ul><ul><ul><li>LIGHTLY PIGMENTED <...
INTRADERMAL TECHNIQUE <ul><li>26 TO 27 GAUGE NEEDLE </li></ul><ul><li>SYRINGE: 1 ML (CALIBRATED IN 0.01 ML INCREMENTS) </l...
<ul><li>BEVEL UP </li></ul><ul><li>CLEANSE IN CIRCULAR MOTION </li></ul><ul><li>SKIN TAUT </li></ul><ul><li>10 TO 15 DEGRE...
 
 
SUBCUTANEOUS ROUTE <ul><li>SYSTEMIC EFFECT </li></ul><ul><li>SMALLER DOSES </li></ul><ul><li>SITES: ABDOMEN, UPPER HIPS, U...
 
TO ASPIRATE OR NOT ? ! ? ! <ul><li>ASPIRATION IS DRAWING PLUNGER OF SYRINGE “BACK” BY SUCTION  </li></ul><ul><li>(OBSERVIN...
SQ injections <ul><li>Choose appropriate site; equipment – angle = 45 degrees </li></ul><ul><li>Draw medication from vial ...
INTRAMUSCULAR INJECTIONS <ul><li>NO MORE THAN  2.7 ml IN SINGLE INJECTION SITE (ADULT WITH WELL DEVELOPED MUSCLES) </li></...
DELTOID MUSCLE – ONLY FOR ADULTS, USUALLY LIMITED TO 1ml
VASTUS LATERALIS SITE <ul><li>THICK MUSCLE </li></ul><ul><li>NO LARGE VESSELS NEAR </li></ul><ul><li>DOES NOT COVER A JOIN...
LANDMARKS FOR VASTUS LATERALIS SITE
VENTROGLUTEAL SITE <ul><li>RECOMMENDED FOR BOTH ADULTS & CHILDREN OVER 7 MONTHS </li></ul><ul><li>NO LARGE VESSELS OR NERV...
VENTROGLUTEAL SITE
DORSOGLUTEAL SITE <ul><li>COMMON SITE </li></ul><ul><li>SCIATIC NERVE & MAJOR BLOOD VESSELS LIE BELOW LANDMARKS </li></ul>...
DORSOGLUTEAL SITE
IM injections <ul><li>Choose appropriate site; equipment – angle = 90 degrees </li></ul><ul><li>Draw medication from vial ...
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Medadm

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Transcript of "Medadm"

  1. 1. MEDICATION ADMINISTRATION
  2. 2. OBJECTIVES... <ul><li>DESCRIBE “8 RIGHTS” OF ADMINISTRATION </li></ul><ul><li>LIST SAFETY GUIDELINES </li></ul><ul><li>DESCRIBE ROUTES OF ADMINISTRATION </li></ul><ul><li>EXPLAIN EQUIPMENT & TECHNIQUE </li></ul><ul><li>DISCUSS CHARTING METHODS </li></ul><ul><li>DISCUSS ASSOCIATED NURSING INTERVENTIONS </li></ul>
  3. 3. TYPES OF MEDICATION ORDERS <ul><li>STANDING – routine orders for certain procedures with no unusual complications </li></ul><ul><li>PRN – orders to be carried out as needed </li></ul><ul><li>SINGLE (ONE-TIME ONLY) – only 1 dose </li></ul><ul><li>STAT – give immediately </li></ul>
  4. 4. COMPONENTS OF A DRUG ORDER <ul><li>PATIENT NAME (A) </li></ul><ul><li>ALLERGIES (B) </li></ul><ul><li>DATE & TIME ORDER IS WRITTEN (C) </li></ul><ul><li>DRUG NAME ( USUALLY GENERIC) (D) </li></ul><ul><li>DRUG DOSAGE (E) </li></ul><ul><li>ROUTE (F) </li></ul><ul><li>FREQUENCY & DURATION (G) </li></ul><ul><li>ANY SPECIFIC INSTRUCTIONS (G) </li></ul><ul><li>SIGNATURE – nurse must sign if verbal order; MD must sign within 24 hours (H) </li></ul>
  5. 6. DELIVERY SYSTEMS <ul><li>UNIT DOSE </li></ul><ul><li>COMPUTERIZED MEDICATION SYSTEMS </li></ul>
  6. 8. Unit dose system
  7. 9. 8 RIGHTS <ul><li>RIGHT CLIENT </li></ul><ul><li>RIGHT DOSE </li></ul><ul><li>RIGHT DRUG </li></ul><ul><li>RIGHT TIME </li></ul><ul><li>RIGHT ROUTE </li></ul>
  8. 10. REALLY…THERE ARE 3 MORE! <ul><li>RIGHT TO KNOW – must explain each drug to patient </li></ul><ul><li>RIGHT DOCUMENTATION – Document after administration </li></ul><ul><li>RIGHT TO REFUSE – cannot make patient take meds </li></ul>
  9. 11. BEHAVIORS TO AVOID DURING MEDICATION ADMINISTRATION <ul><li>DO NOT BE DISTRACTED </li></ul><ul><li>DO NOT GIVE OR HOLD MEDS DISPENSED BY OTHERS </li></ul><ul><li>DO NOT POUR FROM CONTAINERS WITHOUT LABELS OR DIFFICULT TO READ LABELS </li></ul><ul><li>DO NOT GIVE EXPIRED DRUGS </li></ul><ul><li>DO NOT GUESS ABOUT DOSAGES OR DRUGS </li></ul><ul><li>DO NOT LEAVE BY THE BEDSIDE, OR UNATTENDED ANYWHERE </li></ul><ul><li>DO NOT GIVE IF THE CLIENT STATES ALLERGIES OR HAS CONCERNS ABOUT THE DRUG </li></ul><ul><li>DO NOT MIX WITH FOOD OR LIQUIDS IF CONTRAINDICATED </li></ul>
  10. 12. YOUR RESPONSIBILITIES AS A STUDENT NURSE <ul><li>PROPER TECHNIQUE – SEE SYLLABUS </li></ul><ul><li>RESEARCH – MUST LOOK UP ALL DRUGS PRIOR TO GIVING TO PATIENT </li></ul><ul><li>SOURCES OF INFORMATION: DRUG HANDBOOK, DRUG CARDS, PHARM BOOK ) </li></ul>
  11. 13. ROUTES <ul><li>ORAL OR PO </li></ul><ul><li>DO NOT GIVE TO PATIENTS WHO: </li></ul><ul><li>ARE VOMITING </li></ul><ul><li>ARE COMATOSE </li></ul><ul><li>LACK A GAG REFLEX </li></ul><ul><li>ARE NPO </li></ul><ul><li>HAVE FEEDING TUBES </li></ul><ul><li>HAVE NG TUBES (UNLESS NG TUBE CAN BE CLAMPED ) </li></ul>
  12. 14. LIQUIDS <ul><li>MENISCUS IS THE LINE OF THE DESIRED DOSE </li></ul>
  13. 15. TRANSDERMAL PATCHES <ul><li>PROVIDE CONSISTENT BLOOD LEVELS </li></ul><ul><li>DO NOT CAUSE GI IRRITATION </li></ul><ul><li>PUT DATE, TIME & INITIALS ON PATCH </li></ul><ul><li>REMOVE OLD PATCH & CLEAN SKIN </li></ul><ul><li>WEAR GOVES!!!! </li></ul>
  14. 16. TOPICALS <ul><li>CAN APPLY TO SKIN WITH GLOVE, TONGUE BLADE OR COTTON TIP APPLICATOR </li></ul><ul><li>BE CAREFUL NOT TO CONTAMINATE MEDICATION ( NO DOUBLE DIPPING!!) </li></ul>
  15. 17. INSTILLATIONS <ul><li>EYE DROPS </li></ul><ul><li>EYE OINTMENT </li></ul><ul><li>EAR DROPS </li></ul><ul><li>NOSE DROPS / SPRAYS </li></ul>
  16. 19. pull outer ear to straighten ear canal:
  17. 20. Eye Drops or Ointments <ul><li>wear gloves </li></ul><ul><li>steady hand holding applicator by resting heel of hand on patient’s forehead </li></ul><ul><li>intill medicine inside lower lid – not directly on cornea </li></ul><ul><li>after instillation of drops – lightly press inner canthus to prevent drop from entering tear duct </li></ul>
  18. 23. Inhaler without Inhaler with spacer: spacer:
  19. 24. SUPPOSITORIES (RECTAL OR VAGINAL) <ul><li>remove foil </li></ul><ul><li>apply lubricant </li></ul><ul><li>insert with gloved finger </li></ul><ul><li>must push beyond sphincter & ridge </li></ul>
  20. 25. PARENTERAL ( OUTSIDE THE GI TRACT)
  21. 29. <ul><li>INSULIN SYRINGES CAN ONLY BE USED TO ADMINSTER INSULIN </li></ul><ul><li>INSULIN CAN ONLY BE ADMINISTERED IN AN INSULIN SYRINGE </li></ul>
  22. 31. NEEDLE SIZES <ul><li>THE LARGER THE GAUGE NUMBER, THE SMALLER THE DIAMETER OF THE LUMEN </li></ul><ul><li>THE SMALLER THE GAUGE NUMBER, THE LARGER THE DIAMETER OF THE NEEDLE </li></ul><ul><li>COMMON RANGE: 18 TO 26 </li></ul><ul><li>ALSO VARIOUS NEEDLE LENGTHS – IM injections must be given with longer needles to put medicine into the muscle </li></ul>
  23. 33. MEDICATION VIAL <ul><li>A SMALL GLASS/ PLASTIC CONTAINER WITH A SELF SEALING RUBBER TOP </li></ul>
  24. 34. <ul><li>SELECT APPROPRIATE SYRINGE SIZE & ATTACH NEEDLE </li></ul><ul><li>CLEAN TOP OF VIAL </li></ul><ul><li>LEAVE VIAL UPRIGHT </li></ul><ul><li>INJECT AIR INTO VIAL EQUAL TO AMOUNT YOU WILL GIVE CLIENT (2CC OR 2 MLS) ML = CC </li></ul><ul><li>INVERT VIAL AND REMOVE PRESCRIBED AMOUNT OF MEDICATION </li></ul>WITHDRAWING FROM VIAL
  25. 35. AMPULES <ul><li>A GLASS CONTAINER WITH A TAPERED NECK FOR SNAPPING OPEN AND USING ONLY ONCE </li></ul>A FILTER NEEDLE MUST BE USED WHEN WITHDRAWING FROM AN AMPULE. A NEW NEEDLE MUST BE ATTACHED FOR INJECTION.
  26. 36. <ul><li>SELECT APPROPRIATE SYRINGE & ATTACH FILTER NEEDLE </li></ul><ul><li>TAP STEM OF AMPULE </li></ul><ul><li>WRAP ALCOHOL PAD AROUND NECK AND SNAP AWAY FROM YOUR BODY </li></ul><ul><li>WITHDRAW MEDICATION WITHOUT TOUCHING RIM OF AMPULE ( CAN TURN UPSIDE DOWN !!!!) </li></ul><ul><li>REPLACE FILTER NEEDLE WITH ADMINISTRATION NEEDLE </li></ul>
  27. 37. IMPORTANT <ul><li>NEVER, EVER RECAP A USED NEEDLE !!!! </li></ul><ul><li>SCOOP CAP BACK ON STERILE NEEDLES ONLY </li></ul>
  28. 38. ANGLES FOR INJECTION
  29. 39. INTRADERMAL SITES <ul><li>USUALLY CHOSEN SO THAT LOCAL REACTION CAN BE OBSERVED… </li></ul><ul><ul><li>LIGHTLY PIGMENTED </li></ul></ul><ul><ul><li>HAIRLESS </li></ul></ul><ul><ul><li>USUALLY FOREARM </li></ul></ul><ul><ul><li>THINK TB TESTING </li></ul></ul>
  30. 40. INTRADERMAL TECHNIQUE <ul><li>26 TO 27 GAUGE NEEDLE </li></ul><ul><li>SYRINGE: 1 ML (CALIBRATED IN 0.01 ML INCREMENTS) </li></ul>
  31. 41. <ul><li>BEVEL UP </li></ul><ul><li>CLEANSE IN CIRCULAR MOTION </li></ul><ul><li>SKIN TAUT </li></ul><ul><li>10 TO 15 DEGREE ANGLE </li></ul><ul><li>INJECT MEDICATION SLOWLY TO FORM A BLISTER OR BLEB </li></ul><ul><li>DO NOT MASSAGE THE AREA </li></ul>
  32. 44. SUBCUTANEOUS ROUTE <ul><li>SYSTEMIC EFFECT </li></ul><ul><li>SMALLER DOSES </li></ul><ul><li>SITES: ABDOMEN, UPPER HIPS, UPPER BACK, LATER UPPER ARMS AND THIGHS </li></ul><ul><li>NEEDLE SIZE: 25 TO 27 GAUGE </li></ul><ul><li>USUALLY 1/2 TO 5/8 IN LENGTH </li></ul>
  33. 46. TO ASPIRATE OR NOT ? ! ? ! <ul><li>ASPIRATION IS DRAWING PLUNGER OF SYRINGE “BACK” BY SUCTION </li></ul><ul><li>(OBSERVING FOR BLOOD BEFORE INJECTION) </li></ul><ul><li>HELPS DETERMINE NEEDLE IN TISSUE OR MUSCLE AND THAT MEDICATION WILL NOT BE INJECTED INTO VESSEL </li></ul><ul><li>ASPIRATION CONTRAINDICATED WITH CERTAIN MEDICATIONS ( HEPARIN AND INSULIN) CONSULT DRUG HANDBOOK!!! </li></ul>
  34. 47. SQ injections <ul><li>Choose appropriate site; equipment – angle = 45 degrees </li></ul><ul><li>Draw medication from vial or ampule </li></ul><ul><li>Pinch up skin between fingers and thumb of non-dominant hand </li></ul><ul><li>Insert needle </li></ul><ul><li>Steady syringe – use non dominant hand to hold barrel </li></ul><ul><li>Use dominant hand to push plunger </li></ul><ul><li>Inject medication </li></ul>
  35. 48. INTRAMUSCULAR INJECTIONS <ul><li>NO MORE THAN 2.7 ml IN SINGLE INJECTION SITE (ADULT WITH WELL DEVELOPED MUSCLES) </li></ul><ul><li>CHILDREN & ELDERLY – MAY LIMIT TO 1 – 2ml </li></ul><ul><li>USUALLY 1&1/2 INCH, 21 TO 23 GAUGE NEEDLE </li></ul>
  36. 49. DELTOID MUSCLE – ONLY FOR ADULTS, USUALLY LIMITED TO 1ml
  37. 50. VASTUS LATERALIS SITE <ul><li>THICK MUSCLE </li></ul><ul><li>NO LARGE VESSELS NEAR </li></ul><ul><li>DOES NOT COVER A JOINT </li></ul><ul><li>DESIRABLE FOR INFANTS & CHILDREN (GLUTEAL MUSCLES NOT FULLY DEVELOPED) </li></ul>
  38. 51. LANDMARKS FOR VASTUS LATERALIS SITE
  39. 52. VENTROGLUTEAL SITE <ul><li>RECOMMENDED FOR BOTH ADULTS & CHILDREN OVER 7 MONTHS </li></ul><ul><li>NO LARGE VESSELS OR NERVES </li></ul><ul><li>ACCESSIBLE WITH CLIENT ON SIDE, BACK OR ABDOMEN </li></ul>
  40. 53. VENTROGLUTEAL SITE
  41. 54. DORSOGLUTEAL SITE <ul><li>COMMON SITE </li></ul><ul><li>SCIATIC NERVE & MAJOR BLOOD VESSELS LIE BELOW LANDMARKS </li></ul><ul><li>DON’T USE FOR CHILDREN UNDER AGE 3 (GLUTEAL MUSCLES TOO SMALL) </li></ul>
  42. 55. DORSOGLUTEAL SITE
  43. 56. IM injections <ul><li>Choose appropriate site; equipment – angle = 90 degrees </li></ul><ul><li>Draw medication from vial or ampule </li></ul><ul><li>Spread skin somewhat taut using non-dominant hand </li></ul><ul><li>Insert needle </li></ul><ul><li>Steady syringe – use non dominant hand to hold barrel </li></ul><ul><li>Use dominant hand to aspirate (pull back on plunger) </li></ul><ul><li>Inject medication if no blood is aspirated. If blood is aspirated, withdraw syringe and start over. </li></ul>
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