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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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.