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Medications
 

Medications

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    Medications Medications Presentation Transcript

    • Medications(Parenteral)
      • INTRADERMAL
      • SUBCUTANEOUS
      • INTRAMUSCULAR
      • INTRAVENOUS
    • Principles related to the Administration of Medications:
      • The type of drug preparation often governs the method of administration.
      • medications are distributed in a variety of preparations and each type usually requires a specific method of administration.
      • More often preparation of a drug has only one method of administration but if the drug must be administered by some other route ,another preparation is required.
      • Drugs are adminis tered only by the route ordered by the doctor and specified on the medication label.
      • 2. The route of administration of the drug affects the optimal dosage of the drug
      • The optimal dosage of a drug administered by mouth may not be the same as the optimal dosage when the drug is administered subcutaneously
      • 3. The safe administration of medications requires knowledge of the drug and the reasons it has been prescribed.
      • Knowledge of anatomy and physiology is particularly important when medications are administered intramuscularly or subcutaneously.
    • Knowledge of the drug and its effects also helps safeguard against the administration which could harm the client. Example. A client has a slow respiration (10 breath cycle per minute) MORPHINE can be contraindicated because it can depress the respirations even more.
      • The method of administration of a drug is partially determined by the age of the patient, his orientation, his degree of consciousness and his disease.
      • It is important for the nurse to report any difficulties that are encountered when administering medication.
      • Examples : The disoriented client refuses to swallow his oral medication, nauseated client vomits his medicines after he has taken them. Unconcious client is unable to take a medication orally, a child is too young to swallow a capsule.
      • 5.The element of error is a possibility in all human activity
      • --errors in administration of medicines can be serious and because of the possibility of error is always present, special precautions are taken to avoid mistakes.
      • If the nurse is ever in doubt about her activity, she should always consult a reliable source before going ahead, most agencies have literature to which the nurse can refer , and physicians and pharmacies can be consulted.
      • If an error is made, it reported immediately to the physician or to the nurse in charge so that immediate steps can be taken to protect the client from injury.
      • 6. Each client has his own need for explanation and support with respect to the administration of the details error.
      • Medications are given to people and the nurse will find as in all her nursing care, that each individual is different.
      • Some people want to know about their medications; others prefer not to know it.
      • Example- The client upon discharge will be taking drugs at home, he needs to be instructed on the correct dosage, how and when to take the medicines .The action of the drug and indications of untoward reactions.
      • What is drug ?
      • A drug is a chemical substance used in treating ,preventing and diagnosing diseases.
      • EFFECTS OF DRUGS :
      • 1.Therapeutic Effects – are those desired results for which drug is prescribed .EX.
      • dramamine is often prescribed to prevent nausea of motion sickness. The prevention of nausea is thus the therapeutic effect of dramamine
    •  
    •  
      • 2. SIDE EFFECTS
      • are those effects other than the intended therapeutic effects for which a drug is prescribed. As stated above, Dramamine prevents nausea, but it may also cause drowsiness.
      • Some side effects should be explained to the client so that he/she will be better able to cope with them.
      • 3.SYNERGISTICS EFFECTS (Drug Interaction)
      • SYNERGISTICS EFFECTS are the results may be either harmful or beneficial.
      • As in the case of side effects, the results may be either harmful or beneficial.
      • EXAMPLE. The combination of alcohol and tranquilizers or sleeping pills is potentially lethal, as the combined effects tend to depress the respiratory systems.
      • DRUG ABUSE
      • A number of drugs on the market can cause serious and sometimes fatal poisoning, if used uncorrectly . For this reason, the federal food and drug administration has set strict controls on their use.
    • MEDICATIONS
      • INTRADERMAL – is used mainly for diagnostic purposes for testing for allergies or tuberculosis. To administer drugs intradermally, inject a small amount of serum or vaccine between the layers of the skin just below the stratum corneum. Because this route results in little systemic absorption, it produces mainly local effects.
    • Subcutaneous route
      • When using subcutaneous route you inject small amount of a drug beneath the dermis and into the subcutaneous tissues usually in the patients upper arm, thigh, or abdomen. Patients with diabetes use this technique to give themselves insulin. The drug is absorbed slowly from the cutaneous tissue, thus belonging its effects. What’s more this route requires no venipuncture and no IV access site.
    • Tissue issues:
      • There are no disadvantages to the S.C. ROUTE
      • S.C injection may damage skin tissue
      • The S.C. route cant be used when the patient has occlusive vascular disease and poor perfusion because decreases peripheral circulation
      • The S. C. Route cant be used when the patients skin or underlying tissues is grossly adipose, edematous, burned, hardened, swollen at the common injection sites, damaged by previous injections or diseased.
    • INTRAMUSCULAR
      • The I.M. ROUTE allows drugs directly into various groups at varying tissue depths. You’ll use this route to give aqueous suspensions and solutions in oil that aren’t available in oral form. The effect of a drug administered by the I.M. route is relatively rapid and aqueous I.M medications can be given to adults in doses of up to 5 ml in some sites.
    • Intramuscular MISCUES
      • Despite the advantages there are many disadvantages to the I.M. Route
      • A drug delivered I.M may precipitate in the muscle thereby reducing absorption.
      • The drug may not absorb properly if the patient is hypotensive or has poor blood supply to the muscle.
      • Improper technique can cause accidental injection of the drug into the patient’s bloodstream, possibly causing an overdose or adverse reaction.
    • Intravenous route
      • The I.V. Route allows injection of substances directly into the bloodstream through a vein. Appropriate substances includes drugs, fluids,
      • diagnostic contrast agents, and blood or blood products.
      • Administration can range from a single dose to an ongoing infusion delivered with great precision.
    • .
      • Responsibilities of the Nurse:
      • 1.Proper Administration: Seek information from physician who orders a drug with which she is not familiar.
      • 2.Safety - side effects, toxic reactions or allergies include nausea or vomiting, diarrhea, skin rash or itching, asthma, swelling ,jaundice, sore throat, muscular rigidity, drowsiness or irrational behavior, changes in pulse, respiration or blood pressure and hematuria
      • Be responsible for observing and reporting to the physician any suspicious consequences.`
      • Toxic symptoms can also result from cummulation of the drug over a long period.
      • A client who is sensitive to a particular drug will often develop an allergic reaction he may go into anaphylactic shock.
      • Sometimes a client will develop tolerance or resistance to a drug, requiring increasing doses to produce the same initial effects. tolerance may lead to addiction. sometimes develops dependence on the drug. if it is taken away from him he will suffer such withdrawal symptoms as nausea, vomiting, abdominal cramps and pain in the arms or legs.
    • 3. EFFECTIVENESS
      • The nurse evaluates drug effectiveness by collecting data. (direct questioning of the client as well as knowledge of the client and the particular drug) METHODS?
      • In order, to promote the effectiveness of the drug she might have the client change his position in bed to relieve pressure and lessen edema and look for ways to divert the clients attention and help him relax.
    • 4. LEGAL ASPECTS
      • A nurse is legally responsible for her own actions. It is enough for her simply to obey orders unquestioningly.
      • If the physician’s order for medication is unclear or seems strange, question him about it.
      • The use of correct dosage and the proper method of administration are also her responsibility
      • The use of correct dosage and the proper method of administration are also her responsibility.
      • Responsible for observation of the effects of medication on the client.
      • Often, a physician will delegate the nurse as his agent to dispense drugs. The American nurses association has pointed out that nurse has no right to perform this function unless state law allows it.
      • To protect herself, the nurse should have the physician sign all verbal orders before carrying them out.
      • 5. ORDERING AND RECORDING MEDICATIONS:
      • Medications are given upon the order of the physicians. Generally, this is a written order that is dated and signed by the physician, although some health agencies permits physician to telephone orders to nursing staff.
      • In such cases, the physician are usually require to countersign their orders within a definite number of hours.
      • In an emergency situation medications are given on a verbal order that is later written and countersigned as needed. Generally speaking, written orders are considered to be the safest practice.
    • TWO TYPES OF WRITTEN ORDERS:
      • 1. Self- terminating – a stat order is self-terminating order, that is to be carried out only once and immediately.
      • Ex: Demerol 10 mg I.M. stat
      • 2. Standing Order – are carried out indefinitely
      • Ex: Vitamin C 500 mg O.D.
    • 6. Observing and Reporting:
      • Immediately after medication has been administered. It is recorded on the client’s chart. The recording includes the following:
      • Date
      • Time
      • Name of medicine
      • Route of administration
      • Nurse signature
    • PREPARATIONS OF MEDICATIONS
      • It is the responsibility of the physician to order all medications in writing. This order may be contained in the client’s chart or some other form designed for the purpose.
      • The order should specify the following:
      • Name of drug
      • Dosage
      • How often it is to be administered
      • Method of administration to be used
      • Physician must sign the order
      • If the physician uses an abbreviation that is unclear or unfamiliar, it is the responsibility of the nurse to clarify what is meant. She should not proceed to give the medication if there are any questions concerning its administration.
    • Computation of dosage
      • Two System are used to indicate the dosage of drug:
      • 1. apothecary – uses the grain as its standard of measurement.
      • 2. Metric – uses the gram as its standard of measurement
    • FORMULA
      • D/H X Q = the amount to be given
      • D= desired amount
      • Q =diluent (Amount of dilution)
      • H – stock dosage on hand
      • Example: Give Ampicillin 250mg Q 6 H
      • STOCK IS 5OO mg/vial
      • How many cc will you give?
    • SOLUTION
      • 250 mg/ 500 mg x 2 cc = 1 cc is the amount to be given
    • PROCEDURES FOR PREPARING DRUGS:
      • The label on the bottle must be checked carefully against the medication card
      • This should be done three times:
      • 1. When taking the medicine from the self
      • 2. When preparing the medication
      • 3. When returning the bottle to the self
      • A medication should not be dispensed from a bottle with an eligible label.
    • ORAL MEDICATION
      • The following are some points to remember in administering medications by mouth in either liquid or tablet form:
      • 1. Medications cards should be compared with the kardex and the client chart to make sure that the medication has not been discontinued or changed.
      • 2. The nurse should wash her hands before preparing the medications
      • 3. Medications should be prepared individually. Each bottle should be replaced on the self before the next medication is prepared.
      • 4. If a client is receiving more than one medication, each drug should be prepared separately( more than one type of tablet or liquid should not be placed in the same container) Each medication should have separate medicine card.
      • 5.Pills or Capsules should be shaken out directly into their individual containers. They should not be touched by the nurse’s hand.
      • 6. Liquids should be poured at the eye label to ensure accurate measurement of the dosage. The top of the bottle should be wiped with a clean tissue before the cap is replaced. Liquids that have discolored or developed a strange odor should not be used.
      • 7. The medicine card should be kept with the medication at all times.
      • oral medications are absorbed chiefly in the small intestine, although they can also be absorbed in the mouth and the stomach.
      • Medications administered sublingually are absorbed through the capillaries under the tonque.
      • Drugs in liquid form, either upon administration or upon dissolution within the stomach are absorbed through the gastric mucosa.
      • Oral medications should be taken with water. In case of solid forms, the amount of water should be sufficient to make swallowing easy and to dissolve the medication.
      • In addition to being swallowed, oral medications may be held in the mouth until dissolve
      • Sublinqual administration – involves holding the medication under the tonque until it dissolves ex. Isordil 5 mg.
      • Buccal Administration – involves holding the medication between the cheek and teeth.
      • Other means of giving oral medications such as tablet and capsule:
      • Through NGT involves the giving of a pulverized tablet via the nasogastric tube.
    • ADVANTAGES OF GIVING ORAL MEDICINES:
      • Convenience
      • Economy
      • Safety
    • Disadvantages of giving oral medicines
      • Taste
      • Gastric Irritation
      • Effect Upon Teeth
    • PARENTERAL ADMINISTRATION:
      • The parenteral administration, the medication does not pass through the clients alimentary canal.
      • The parenteral route means a route of drug administration other than oral or through the gastrointestinal tract.
      • The techniques for administering injections, preparation and administration of injections follow the principles of asepsis and infection control.
    • Parenteral Administration Equipment :
      • The major equipment used to administer parenteral drugs consists of a syringe and a needle. Numerous types of syringes and needles are available.
      • Such parenteral can be given:
      • Intradermally
      • Subcutaneously (SQ)
      • Intramuscular (IM)
      • Intravenously (IV)
    • Needles
      • Needles are supplied in various lengths and gauges. The shaft ( Length of the needle) Depends on the depth to which the medication will be instilled.
      • Needle legnth vary from approximately 0.5 to 2.5 inches. The tip of the shaft is beveled or slanted, to pierce the skin more easily.
    •  
      • Filter needles that provide a barrier for glass particles are available when withdrawing medication from a glass ampule.
      • The needle gauge (Diameter) Refers to its width. For most injections, 18 to 27 gauge needles are used the smaller the number the larger the diameter
      • For example an 18 gauge is wider than a 27 gauge needle. A wider diameter provides a larger lumen, or opening, through which drugs are administered into the tissue.
    • Several Factors considered when selecting a syringe and needle.
      • Type of medication
      • Depth of tissue
      • Volume of prescribed drug
      • Viscosity of drug
      • Injections are given with sterile syringes of various types and sizes. A needle with a larger lumen is used for thicker solution while a longer one is needed for intramuscular injections. An Intradermal injection is administered with a needle with a very small lumen.
      • Different clients also need different types of needles, an obese person may require a longer needle for an intramuscular injection, a small child, a shorter one.
    • Withdrawal of Medication From a Vial:
      • STEPS:
      • 1. The rubber stopper of the vial should be cleaned with an antiseptic solution(70% Alcohol)
      • 2. Holding the empty syringe upright, the nurse withdraws the plunger until it teaches the mark indicating the dose she is going to use.
      • 3. The needle is then inserted downward through the rubber stopper into the vial.
      • 4. With the syringe still in the downward position, she pushes the plunger, forcing air into the vial.
      • 5. The vial and syringe are now inverted and the plunger withdrawn until the desired dose enters the syringe.
      • 6. The needle should be covered with a sterile wrapper while the syringe is being carried to the patient
    • Withdrawal of Medication from an Ampule:
      • 1. Wipe the outside with a sterile solution
      • 2. The top of the ampule should be tapped to make sure that all of the solutions drains into the container.
      • 3. The ampule should be opened along the break line, if one is provided. If there is no line, the nurse should create one by scoring the constriction in the top of the ampule,it is good practice to protect the hands with sponges or pledgets before breaking the ampule.
      • 4. If the needle is long enough, the nurse withdraws the required dosage with syringe in the downward position( Do not introduce air into the syringe when withdrawing medication from an ampule) IF using short needle, the syringe and ampule should be tilted.
      • 5. the needle should be covered with sterile wrapper, together with the medication card. cotton balls with alcohol, while being carried to the client.
      • Systemic Effect – refers to the actions of the drug upon the entire body.
      • Local Effect – the effect upon one specific area, such as that of an ointment upon particular area of the skin.
      • One of the most important points to remember in the administration of any medication is that client must be positively identified.
      • This may be done by asking him his name and checking the identification bracelet.
      • It should not be automatically assumed that the client in the bed is necessarily the one who is supposed to be there.
    • SUBCUTANEOUS
      • ADVANTAGE:
      • Complete absorption,
      • providing the clients circulation is good.
      • Not affected by gastric disturbances.
      • Administration is not dependent upon the consciousness or rationality of the client
    • disadvantage
      • Introducing a needle through skin, the body’s barriers against infection which is broken
    • ADMINISTRATION
      • The site is selected and cleansed with an antiseptic solution. The antiseptic is allowed to dry on the skin surface prior to insertion of the needle to prevent local irritation at the site selection.
      • The angle of insertion depends on the size of the needle used. It is recommended that the injection should be given deeply into the subcutaneous tissue.
      • If an ½ inch needle is used it is inserted at a 90 degree angle that is perpendicular to the skin surface injections with 5/8 inch needle are inserted at a 45 degree angle
      • SUPPLIES:
      • Hypodermic syringe -2cc syringe is commonly used
      • Needle –gauge 24,25 or 26 ( G 24 preferred for an adult)
      • Medicines
      • Cotton balls with alcohol
    • INTRAMUSCULAR
      • Advantage:
      • Absorption through the muscle is faster than through subcutaneous tissue because of the vascularity of the muscle area.
      • Disadvantage:
      • The danger of damaging nerves and blood vessels is greater.
    • SITE OF INJECTION:
      • Depends on:
      • Size of the patient
      • Amount of the muscle tissue available for injection
      • Proximity of nerves and blood vessels
      • Condition of the skin around the area,free from soreness
      • Nature of drug to be administered
      • Site should be anatomically safe
    • AREAS:
      • BUTTOCKS:
      • DORSOGLUTEAL site uses the gluteus maximus muscle. The site may be located by dividing the buttock into quadrants.The crest of the ilium and the inferior gluteal fold act as landmarks for describing the buttock
    • Ventrogluteal site
      • Thigh
      • Arm
    • Intradermal injection
      • An intradermal is the injection of a small amount of fluid into the dermal layer of the skin
      • It is frequently done as diagnostic measure, as tuberculin testing and allergy testing
      • The area of the body most commonly used are the medial aspect of the forearm and subscapular region at the back.
    • Supplies needed:
      • Tuberculin syringe or 1 cc syringe
      • 26 gauge needle
      • Medicine to be used
      • Cotton balls with alcohol
      • Ball pen
    • PROCEDURE
      • The needle is inserted at a 15 degree angle with the bevel up and the fluid is injected produce a small bleb under the skin.
    • TEN RIGHTS IN GIVING MEDICATIONS:
      • 1.right patient
      • 2.right drug
      • 3.right route
      • 4.right time/frequency
      • 5.right dosage/dose
      • 6.right preparation
      • 7.right action
      • 8.right order
      • 9.right approach
      • 10.right documentation
    • PARTS OF THE SYRINGE
      • PLUNGER
      • BARREL
      • TIP
    • PARTS OF THE NEEDLE
      • NEEDLE
      • HUB
      • CANNULA
      • BEVEL
    • Administering Intradermal Injection
      • Assessment:
      • Check the medical orders. Collaborates nursing activities with medical treatment.
      • Compare the medication administration on record (MAR) with the medical record.Ensures accuracy.
      • Read and compare the label on the drug with the MAR at least three times.(PREVENTS ERRORS)
      • Check for any documented allergies to food or drugs. (Ensures safety.)
      • Determine how much the client understands about the purpose and technique for administering the injection. Provides an opportunity for health teaching.
    • PLANNING:
      • Prepare to administer the injection according to the schedule prescribed. Complies with medical orders.
      • Obtain clean gloves, tuberculin syringe, appropriate needle, and alcohol swabs. ( Facilitates drug preparation and administration.
      • Prepare the syringe with the medication. Fills the syringe with the appropriate volume.
    • IMPLEMENTATION:
      • Wash your hands or perform an alcohol-based handrub. don gloves. (Reduces the transmission of microorganism)
      • Read the name of the clients identification band.( Prevent errors)
      • Pull the privacy curtain.( Demonstrates respect for the clients dignity)
      • Select an area on the inner aspect of the forearm. approximately a hand’s breadth above the client’s wrist.( provides a convenient and easy location for accessing intradermal tissue)
      • Cleanse the area with an alcohol swab using a circular motion. Outward from the site where the needle will pierce the skin. (Removes microorganisms following principles of asepsis)
      • Allow the skin to dry. ( reduces tissue irritation)
      • Hold the client’s arm and stretch the skin taut. Helps to control placement of the needle.
      • Hold the syringe almost parallel to the skin at a 10’ to 15’ angle with the bevel pointing upward. Then insert the needle about 1/8 inch. (Facilitates delivering the drug between the layers of the skin and advances the needle to the desired depth.
      • Push the plunger of the syringe and watch for a small wheal (ELEVATED CIRCLE) to appear. Verifies correct injection of the drug.
      • Withdraw the needle at the same angle at which it was inserted. (Minimizes trauma and discomfort.)
      • Do not massage the area after removing the needle.(Prevents interfering with the test results)
      • Deposit the uncapped needle and syringe in a puncture-resistant container. Prevents injury
      • Remove gloves and perform hand hygiene.
      • ( Reduces the risk for transmission of microorganism.)
      • Observe the client’s condition for at least the first 30 minutes after performing an allergy test. Ensures that emergency treatment can be quickly administered.
      • Observe the area for signs of a local reaction at a standard intervals such as 24 and 48 hours after the injection site.( Determine the extent to which the client responds to the injected substance.
    • EVALUATION
      • Injection is administered
      • Client remains free of any untoward effects.
    • DOCUMENT
      • The Date, Time, Drug, Route, and specific site
      • Client response
      • ADMINISTERING SUBCUTANEOUS INJECTION
      • Assessment:
      • Check the medical orders. Collaborates nursing activities with medical treatment.
      • Compare the medication administration on record (MAR) with the medical record. Ensures accuracy.
      • Read and compare the label on the drug with the MAR at least three times. (PREVENTS ERRORS)
      • Determine where the last injection was given to ensure site rotation. Prevents tissue injury.
      • Check for any documented allergies to food or drugs. (Ensures safety.)
      • Determine how much the client understands about the purpose and technique for administering the injection. Provides an opportunity for health teaching.
      • Inspect the potential injection site for signs of bruising, swelling, redness, warmth or tenderness ( Indicates injured tissue areas to avoid)
      • PLANNING
      • Prepare to administer the injection according to the schedule prescribed. Complies with medical orders.
      • Obtain clean gloves, tuberculin syringe, appropriate needle, and alcohol swabs. ( Facilitates drug preparation and administration
      • Prepare the syringe with medication. (Fills the syringe appropriate volume)
      • Add 0.1 to 0.2 ml of air to the syringe.( Flushes all the medication from the syringe at the time of the injection.
      • IMPLEMENTATION
      • Wash your hands or perform an alcohol-based handrub. don gloves. (Reduces the transmission of microorganism)
      • Read the name of the clients identification band.( Prevent errors)
      • Pull the privacy curtain.( Demonstrates respect for the clients dignity)
      • Allow the skin to dry. (Reduces tissue irritation)
      • Bunch the skin at the site or spread it taut. Facilitates placement in the subcutaneous level of tissue according to the clients body composition and adipose tissue.
      • Pierce the skin at a 45’ or 90’ angle of entry. ( Facilitates placement in the subcutaneous level of tissue according to the length of the needle used.)
      • Release the tissue once the needle is inserted, use the hand to support the syringe at its hub. (Steadies the syringe).
      • Pull back gently on the plunger with a free hand and observe for blood in the barrel( Determines if the needle lies in a blood vessel).
      • Inject the medication by pushing on the plunger if there is no blood after aspiration. (Ensure subcutaneous administration)
      • Withdraw the needle quickly while applying pressure against the medication site. (Controls Bleeding.)
      • Massage the site unless contraindicated. (Promotes absorption and relieves discomfort)
      • Deposit the uncapped needle and syringe in a puncture-resistant container (Prevents injury)
      • Removes gloves, performed hand hygiene. Reduces the transmission of microorganisms.
      • Assess the client’s condition at least 30 minutes after giving the injection.( aids in evaluating the drug’s effectiveness.
      • EVALUATION
      • Injection is administered
      • Client experiences no untoward effects
      • DOCUMENT:
      • The date, time, dose, route, and specific area
      • Site assessment data
      • Client’s response
      • EVALUATION
      • Injection is administered
      • Client experiences no untoward effects
      • DOCUMENT:
      • The date, time, dose, route, and specific area
      • Site assessment data
      • Client’s response
    • SAMPLE DOCUMENTATION:
      • 25 U regular insulin administered in l.upper arm. Site appears free of redness ,swelling, warmth, tenderness and bruishing. Alert and oriented 30 minutes after injection.
    • INTRAMUSCULAR INJECTION
      • Assessment:
      • Check the medical orders. Collaborates nursing activities with medical treatment.
      • Compare the medication administration on record (MAR) with the medical record.Ensures accuracy.
      • Read and compare the label on the drug with the MAR at least three times.(PREVENTS ERRORS)
      • Check for any documented allergies to food or drugs. (Ensures safety.)
      • Determine where the last injection was given. (Prevents tissue injury)
      • Determine how much the client understands about the purpose and technique for administering the injection. Provides an opportunity for health teaching.
      • Inspect the potential injection site for signs of bruishing, swelling, redness, warmth, tenderness or irritation ( Indicates tissue injury)
    • PLANNING:
      • Prepare to administer the injection according to the schedule prescribed. Complies with medical orders.
      • Obtain clean gloves, tuberculin syringe, appropriate needle, and alcohol swabs. ( Facilitates drug preparation and administration
      • Prepare the syringe with medication. (Fills the syringe appropriate volume)
      • Add 0.1 to 0.2 ml of air to the syringe.( Flushes all the medication from the syringe at the time of the injection.
      • IMPLEMENTATION
      • Wash your hands or perform an alcohol-based handrub. don gloves. (Reduces the transmission of microorganism)
      • Read the name of the clients identification band.( Prevent errors)
      • Pull the privacy curtain.( Demonstrates respect for the clients dignity
      • Select and prepare an appropriate site by cleansing it with an alcohol swab. (Removes colonizing microorganisms)
      • Allow the skin to dry. Reduces tissue irritation.
      • Spread the tissue taut. Facilitates placement in the muscle.
      • Hold the syringe like a dart and pierce the skin at a 90’ angle. (Reduces discomfort)
      • Steady the syringe and aspirate to observe for blood. Determines if the needle is in a blood vessel.
      • Instill the drug if no blood is apparent. Deposit the drug into the muscle.
      • Withdraw the needle quickly while applying pressure against the medication site. (Controls Bleeding.)
      • Massage the site unless contraindicated. (Promotes absorption and relieves discomfort)
      • Deposit the uncapped needle and syringe in a puncture-resistant container (Prevents injury)
      • Removes gloves, performed hand hygiene. Reduces the transmission of microorganisms.
      • Assess the client’s condition at least 30 minutes after giving the injection.( aids in evaluating the drug’s effectiveness.
    • SAMPLE DOCUMENTATION
      • DATE AND TIME
      • Demerol 50 mg given IM into R. Dorsogluteal site for pain rated as #8 on a scale of 0-10. No signs of irritation at the site .Rates pain at # 5 3o minutes after injection.
      • Stat order – it is a type pf order to be carried out immediately.
      • Speed Shock – A complication of administration of drug that results from rapid IV of medication.
      • Intravenous – it is the route of drug administration that promotes the most rapid absorption
      • Sublingual – it is the method of drug administration that involves placing the medication under the tonque.
      • Elixir – it is an alcohol-based liquid medication.
      • Habituation – it is the psychological reliance on a drug to maintain a sense of well being.
      • Anaphylaxis = a severe allergic reaction following administration of drug.
      • PRN Order – the type of physician’s order that is carried out upon judgement of the nurse as required by the patient.
      • High concentration of drugs promote rapid effect in the absorption of medication.
      • The Pharmacist is responsible to relabel the drug if the drug erase or contaminated.
      • The nurse who prepares the medication
      • administers it during medication administration
      • Never leaves the medication at the bedside
      • the nurse questions unclear physicians’s order
      • The nurse should keep the narcotics in locked cabinets.
      • The nurse repeats dose of oral medications if the client vomits immediately after the administration of the medication
      • During application of dermatologic medications the nurse includes the following nursing action
      • Clean the area of application before the next dose of the drug
      • Remove previous application before the next dose of the drug.
      • During application of medication into the ear the appropriate nursing action is to instill the medication directly into the tympanic membrane.
      • During administrations of edication into the dorsogluteal site, the nursing action will minimize the discomfort from the injection site would be instruct the client to curl his toes inward while in prone positions.
      • 5 ML air can cause air embolism in a client receiving intravenous injection.
      • During the blood transfusion the nurse should check cross-matching and blood-typing before blood transfusion, two nurse should check the label of the blood transfusions and administered blood transfusion for 4 hours.
      • The client receiving blood transfusions experiences rashes, pruritus and dypnea. The best nursing action is to stop the blood transfusions.
      • A nurse who is assisting in the care of a client with cancer should ensure adequate and pain control by start with low medications doses and gradually increase to a dose that relieves pain without exceeding the maximal daily dosage.
      • A nurse who begins to administer medications to a client via nasogastric feeding tube suspects that the tube has become clogged the nurse should aspirate the tube first.
      • A nurse is planning to give subcutaneous injection of insulin. The nurse plans to do which of the following after giving injection is place the needle and syringe in a labeled, rigid plastic container.
      • After giving IM medications the nurse should massage the injection site with alcohol to relieve pain.
      • Negligence is the failure to meet established standards of care.
    • Compute for the following problems
      • 1.administered ampicillin oral suspension 50mg.p.o q6 for 7 days.
      • A. how many l/dose in 30 ml will you administered?
      • B. how many bottles of the medication will you request?
      • A) D/S X DILUTION –QUANTITY OF DRUG
      • 50MG X 5ML
      • -=125MG
      • B)2 ml/dose x 4 doses (Q6)/day =8 mls/day
      • 8mls/dayx7 days =56 mls
      • 56mls/30mls/bottle= 2 bottles
    • Administered atrophine sulfate 0.3mg IM on call to OR
      • STOCK:500 mcq/1ml ampule
      • How many ml will you inject?
      • CONVERT 0.3mg-mcq
      • (1 mg =1,000 mcq)
      • 0.3MG X1,000 mcq/mq=300mcq
      • D/S X Dilution =quqntity of drug
      • 300 mcq x 1 ml = 0.6ml