PHARMACOLOGICAL PERSPECTIVES  IN NURSE’S CONTEXTUALITIES
FIVE RIGHTS IN DRUG                 ADMINISTRATION RIGHT DOSE    The nurse       Minimizes any forms of errors       C...
FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT CLIENT   The nurse      Identifies the patient correctly RIGHT ROUTE   Oral ...
FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT TIME   The nurse must know why a medicine is ordered    for certain times of th...
FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT ASSESSMENT RIGHT APPROACH RIGHT DOCUMENTATION RIGHT EVALUATION RIGHT TO CONS...
ORAL MEDICATION• Assessment – client’s knowledge, diet status, oral  cavity, ability to swallow• Enteric coated not be cru...
ORAL MEDICATION• LIQUID MEDICATION  – Shake liquid medication    if necessary  – Pour away from liquid    bottle  – Do not...
ORAL MEDICATIONS
ORAL MEDICATIONS• Absorption is reduced by the presence of  food• Dilute or dissolve irritating drugs to reduce  gastric i...
ORAL MEDICATIONS• INFANTS  – Use calibrated dropper, nipple or syringe  – Keep infant 45 degrees  – Not to use medicine as...
VAGINAL INSTILLATIONSAvailable as suppo, enema, foam,jellies, creamsIndividually packaged in foil wrappersFoam, jellies, c...
RECTAL MEDICATION Differ in shape from V, thinner,  bullet shaped, roundedSPECIAL ASSESSMENT Bowel function, ability to ...
OTIC INSTILLATIONS         Internal ear structuresHigh sensitivity with extreme temperatures    Causes vertigo (severe diz...
OTIC MEDICATIONSPECIAL ASSESSMENT Warm meds in hands Don gloves Turn to unaffected side Clean outer ear Straighten ea...
OPTHALMIC APPLICATIONEye drops, ointment, OTC artificial tears, vasoconstrictors                           PRINCIPLESCorne...
OPTHALMIC MEDICATION Check solution & warm in hands Lie on back or sit with head turned  to affected side Cleanse eyeli...
NASAL INSTILLATION             Altered nasal sinuses             Spray, drops, tampons             (Decongestant spray)   ...
NOSE DROP MEDICATION Have patient blow nose Position patient – head is tilted  back or specific position to  expose sinu...
INHALANTS          Deeper passages of respiratory tract          Vascular alveolar – capillary network                 EAS...
METERD DOSE NEBULIZER
ORAL INHALERMETERED DOSE INHALER
IRRIGATION• Medications may be used to irrigate or wash  out body cavity & delivered thru a stream of  solution (sterile w...
PARENTERAL DRUG ADMINISTRATIONADVANTAGES                   DISADVANTAGES• More rapid absorption      • Penetrates the firs...
PARENTERAL DR ADMINISTRATION                       UG              SPECIAL CONSIDERATIONThe size and type are determined b...
VIAL – single or multiple dose glass container with a rubber seal at the top         NSS or sterile water used as diluents...
PARTS OF SYRINGE
3 cc SYRINGE                 STANDARD U 100 INSULIN1 ml Tuberculin with Leur Lock
25 gauge 1 inch needle   With safety cap21 gauge 1 inch needle   With safety cap 18 gauge 1 inch needle
INTRADERMAL INJECTION                                     Upper chest                        Upper back     Inner aspect o...
SUBCUTANEOUS INJECTION Free of infection,skin lesions, scars,bony prominences                                   SCAPULARIS...
SITES FOR INTRAMUSCULAR INJECTION                                                   DORSOGLUTEAL   Place hand on iliac cre...
INCLUDES GLUTEUS MUSCLE & MINIMUSVENTROGLUTEAL SITE                                                  A deep site          ...
VASTUS LATERALIS
DELTOID MUSCLE  Easy accessible   Use for small drug        Not for infants                     Potential injury or damage...
Z TRACK METHODGrasp and pull the muscle before injecting the drug             Leaves a zigzag path        Prevents spillag...
MAJOR LONG EXAMINATION      APRIL 14, 2008        MONDAY
Medications
Medications
Medications
Medications
Medications
Medications
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Medications

  1. 1. PHARMACOLOGICAL PERSPECTIVES IN NURSE’S CONTEXTUALITIES
  2. 2. FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT DOSE  The nurse  Minimizes any forms of errors  Checks the supply – UNIT DOSE or STOCK SUPPLY  Requires two nurses to verify the medicine being administered RIGHT DRUG  The nurse  Compares the medicine card or unit dose recording form with the physician’s order  Compares the label three times  Administers one has prepared
  3. 3. FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT CLIENT  The nurse  Identifies the patient correctly RIGHT ROUTE  Oral (Buccal or Sublingual)  Parenteral
  4. 4. FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT TIME  The nurse must know why a medicine is ordered for certain times of the day & whether the time can be altered  EXAMPLE: q8h and TID  The q8h (every 8 hour) is intended for around the clock  TID (three times a day) is given during waking hours (8 – 1 – 6)  QID (8 – 12 – 4 – 6)  Physician orders (stat, prn, single dose, standing)
  5. 5. FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT ASSESSMENT RIGHT APPROACH RIGHT DOCUMENTATION RIGHT EVALUATION RIGHT TO CONSIDER THE CLIENT’S REFUSAL TO TREATMENT OR MEDICATION
  6. 6. ORAL MEDICATION• Assessment – client’s knowledge, diet status, oral cavity, ability to swallow• Enteric coated not be crushed only the scored tablet• Time release capsule contents may be mixed with food• SOLID MEDICATIONS – All solid medications can be placed in one container unless if one needs further assessment before administering – Unit dose in original individual package – Reduce chance of contamination – medicines into cap of container, top side down, transfer to medicine cap and replace lid and container
  7. 7. ORAL MEDICATION• LIQUID MEDICATION – Shake liquid medication if necessary – Pour away from liquid bottle – Do not administer alcohol based products to alcohol dependents – Iron preparation with straw
  8. 8. ORAL MEDICATIONS
  9. 9. ORAL MEDICATIONS• Absorption is reduced by the presence of food• Dilute or dissolve irritating drugs to reduce gastric irritation
  10. 10. ORAL MEDICATIONS• INFANTS – Use calibrated dropper, nipple or syringe – Keep infant 45 degrees – Not to use medicine as child’s favorite food or punishment – If using NGT, check for patency
  11. 11. VAGINAL INSTILLATIONSAvailable as suppo, enema, foam,jellies, creamsIndividually packaged in foil wrappersFoam, jellies, creams with inserter orapplicator; suppo with a gloved handPatient prefers to insert their own,privacy needed SIMS POSITIONPerineal pads providedAseptic technique & perineal hygiene RETRACT LABIA WITH NON DOMINANT HAND INSERT 2 – 3INCHES
  12. 12. RECTAL MEDICATION Differ in shape from V, thinner, bullet shaped, roundedSPECIAL ASSESSMENT Bowel function, ability to retain supp or enem Supp from refrigerator Provide privacy Left lateral position Gloves or finger cot Lubricant Insert approx 2 inches, retain 10 – 20 minutes If enem retain 20 – 30 min
  13. 13. OTIC INSTILLATIONS Internal ear structuresHigh sensitivity with extreme temperatures Causes vertigo (severe dizziness)
  14. 14. OTIC MEDICATIONSPECIAL ASSESSMENT Warm meds in hands Don gloves Turn to unaffected side Clean outer ear Straighten ear canal by pulling pinna UP & BACK (ADULTS), DOWN & BACK (CHILDREN > 3) Instill gtts along side w/o touching ear Remain on side 5 – 10 min
  15. 15. OPTHALMIC APPLICATIONEye drops, ointment, OTC artificial tears, vasoconstrictors PRINCIPLESCornea is supplied with pain fibersRisk of transmitting infectionUsed only for affected eyeNever allows a person to use another’s eye medication
  16. 16. OPTHALMIC MEDICATION Check solution & warm in hands Lie on back or sit with head turned to affected side Cleanse eyelid & eyelashes Have patient look up Assist patient in keeping eye open by pulling down on cheekbone with thumb or forefinger Lower conjunctiva near outer canthus OINTMENT – Squeeze into lower conjunctiva moving from inner to outer canthus, do not touch eye with applicator, have client blink 2-3 times Wipe any excess from inner to outer canthus
  17. 17. NASAL INSTILLATION Altered nasal sinuses Spray, drops, tampons (Decongestant spray) Overuse SwallowedREBOUND EFFECT SYSTEMIC EFFECTS
  18. 18. NOSE DROP MEDICATION Have patient blow nose Position patient – head is tilted back or specific position to expose sinuses Push up on tip of nostril Place dropper slightly upward just inside the nostril not touching nose with applicator Head tilted 5 minutes Instruct not to blow, drops may produced unpleasant tasteSPECIAL CONCERNS (+) if patient begins to aspirates & coughs? (+) if patient is infant?
  19. 19. INHALANTS Deeper passages of respiratory tract Vascular alveolar – capillary network EASY ABSORPTIONDesigned to produce LOCAL EFFECTS but have dangerous SYSTEMIC EFFECTS (Oxygen and general anesthetics)
  20. 20. METERD DOSE NEBULIZER
  21. 21. ORAL INHALERMETERED DOSE INHALER
  22. 22. IRRIGATION• Medications may be used to irrigate or wash out body cavity & delivered thru a stream of solution (sterile water, NSS, antiseptic)• Eye, ear, throat, vagina & urinary tract• Avoid further injury to the tissue• Prevent transmission of infection• Maintain patient’s comfort
  23. 23. PARENTERAL DRUG ADMINISTRATIONADVANTAGES DISADVANTAGES• More rapid absorption • Penetrates the first line of and effect defense, the skin• Effects are more • Danger of damaging predictable nerves and blood vessels• Desirable for patients • Pain might be present who are irrational, • Possibility of abscess unconscious on having GI formation disturbances
  24. 24. PARENTERAL DR ADMINISTRATION UG SPECIAL CONSIDERATIONThe size and type are determined by Know the volume of the drugthe type of medication and amountto be injected CharacteristicsThe size of the needle is determined Viscosityby the route of administration, size, Anatomical structures orage landmarksSurgical asepsis Position of comfortNo way of protecting unusedmedication Ice application priorRotate sites Divert client attentionDo not mixedAssess if you need assistance –restraining or turningCountercheck
  25. 25. VIAL – single or multiple dose glass container with a rubber seal at the top NSS or sterile water used as diluentsAMPULES – contain single doses of meds in a liquid form from 1 – 10 ml ormore, made of glass with a constricted neck, colored ring around the neck
  26. 26. PARTS OF SYRINGE
  27. 27. 3 cc SYRINGE STANDARD U 100 INSULIN1 ml Tuberculin with Leur Lock
  28. 28. 25 gauge 1 inch needle With safety cap21 gauge 1 inch needle With safety cap 18 gauge 1 inch needle
  29. 29. INTRADERMAL INJECTION Upper chest Upper back Inner aspect of the forearm Sample: Tuberculin testing and allergy tests DRUGS ARE POTENT DERMIS Reduced blood supply and absorption slowed
  30. 30. SUBCUTANEOUS INJECTION Free of infection,skin lesions, scars,bony prominences SCAPULARIS AREA ON BACK & largeunderlying muscle or blood vessels ABDOMENLATERAL & ANTERIOR ASPECTS UPPER VENTRODORSAL OF UPPER ARM & THIGH GLUTEAL AREA Insulin self administration Loose connective tissues under dermis Heparin injection Slowed absorption Pain receptors ROTATE SITES
  31. 31. SITES FOR INTRAMUSCULAR INJECTION DORSOGLUTEAL Place hand on iliac crest and locate the posterosuperior iliac spine. Draw an imaginary line between the trochanter and the iliac spine. Risk of striking sciatic nerve & greater trochanter or major blood vessels Not used with infants or children under 3 y/o Avoid contamination
  32. 32. INCLUDES GLUTEUS MUSCLE & MINIMUSVENTROGLUTEAL SITE A deep site Situated away from major nerves & blood vessels Less chance of contamination Place of left hand on right greater Easily identified by atrochanter – index finger is pointing prominent bony landmark at the anterosuperior iliac spine. Spread first and middle finger to form V
  33. 33. VASTUS LATERALIS
  34. 34. DELTOID MUSCLE Easy accessible Use for small drug Not for infants Potential injury or damage to ulnar radial or brachial artery
  35. 35. Z TRACK METHODGrasp and pull the muscle before injecting the drug Leaves a zigzag path Prevents spillage of the medicine Minimizes tissue irritation
  36. 36. MAJOR LONG EXAMINATION APRIL 14, 2008 MONDAY

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