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Medications

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  • 1. PHARMACOLOGICAL PERSPECTIVES IN NURSE’S CONTEXTUALITIES
  • 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. FIVE RIGHTS IN DRUG ADMINISTRATION RIGHT CLIENT  The nurse  Identifies the patient correctly RIGHT ROUTE  Oral (Buccal or Sublingual)  Parenteral
  • 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. 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. 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. 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. ORAL MEDICATIONS
  • 9. ORAL MEDICATIONS• Absorption is reduced by the presence of food• Dilute or dissolve irritating drugs to reduce gastric irritation
  • 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. 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. 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. OTIC INSTILLATIONS Internal ear structuresHigh sensitivity with extreme temperatures Causes vertigo (severe dizziness)
  • 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. 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. 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. NASAL INSTILLATION Altered nasal sinuses Spray, drops, tampons (Decongestant spray) Overuse SwallowedREBOUND EFFECT SYSTEMIC EFFECTS
  • 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. 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. METERD DOSE NEBULIZER
  • 21. ORAL INHALERMETERED DOSE INHALER
  • 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. 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. 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. 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. PARTS OF SYRINGE
  • 27. 3 cc SYRINGE STANDARD U 100 INSULIN1 ml Tuberculin with Leur Lock
  • 28. 25 gauge 1 inch needle With safety cap21 gauge 1 inch needle With safety cap 18 gauge 1 inch needle
  • 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. 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. 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. 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. VASTUS LATERALIS
  • 34. DELTOID MUSCLE Easy accessible Use for small drug Not for infants Potential injury or damage to ulnar radial or brachial artery
  • 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. MAJOR LONG EXAMINATION APRIL 14, 2008 MONDAY

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