Nursing Skills


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  • Nurse role – instruct clients to use inhalers correctly. Refer to Teaching on page 850
  • Advantages: avoids irritation of the upper GI tract in clients who encounter this problem It is advantageous when the medication has an objectionalbe taste or odor The drug is released at a slow but steady rate
  • Mixing meds: two vials same as insulin; one vial & one ampule – 1 st prepare & withdraw from vial because ampules do not require the addition of air prior to withdrawal of the drug Reconstitution – antibiotics Mixing Meds – Demerol & phenergan
  • Provides the greatest thickness of gluteal muscle Is sealed off by bone Contains consistently less fat than the buttock area, thus eliminating the need to determine the depth of subcutaneous fat. Side-lying position helps locate the ventrogluteal site more easily The right hand is used for the left hip, & the left hand for the right hip
  • Nursing Skills

    1. 2. <ul><li>Purpose </li></ul><ul><li>Diagnosis </li></ul><ul><li>Cure </li></ul><ul><li>Treatment of symptoms </li></ul><ul><li>Relief of symptoms </li></ul><ul><li>Prevention of disease </li></ul>
    2. 3. <ul><li>Generic name – given before a drug becomes official </li></ul><ul><li>Official name – name under which it is listed in one of the official publications </li></ul><ul><li>Chemical name – name by which a chemist knows it; name describes the constituents of the drug precisely </li></ul><ul><li>Trademark or brand name – name given by the drug manufacturer </li></ul>
    3. 4. <ul><li>Absorption - way medication enters the blood stream </li></ul><ul><li>Distribution – transportation of a drug from its site of absorption to its site of action </li></ul><ul><li>Metabolism – liver break down to less active form; drug is converted to a less active form </li></ul><ul><li>Excretion – elimination from body </li></ul>
    4. 5. <ul><li>Therapeutic Effect or desired effect </li></ul><ul><ul><li>The reason the drug is prescribed </li></ul></ul><ul><li>Side Effect or secondary effect – unintended; usually predictable may be harmless or potentially harmful </li></ul><ul><li>Adverse Effect – side effects that are not tolerated </li></ul><ul><li>Idiosyncratic – unexpected & individual </li></ul>
    5. 6. <ul><li>Patient name </li></ul><ul><li>Time/Date order written </li></ul><ul><li>Name of medication </li></ul><ul><li>Dosage of medication </li></ul><ul><li>Frequency of dose </li></ul><ul><li>Route </li></ul><ul><li>Signature </li></ul>
    6. 7. <ul><li>Stat – immediately </li></ul><ul><ul><li>Demerol 50mg IV now </li></ul></ul><ul><li>Single order/one time only – given once at a specific time </li></ul><ul><ul><li>Demerol 50mg IV at 0800 </li></ul></ul><ul><li>Standing – carried out indefinitely </li></ul><ul><ul><li>Demerol 50mg IV q8h </li></ul></ul><ul><ul><li>Demerol 50mg IV q8h x 4days </li></ul></ul><ul><li>PRN – as needed order </li></ul><ul><ul><li>Demerol 50mg IV q4h prn </li></ul></ul>
    7. 8. <ul><li>ac – before meals </li></ul><ul><li>bid – twice a day </li></ul><ul><li>h – hour </li></ul><ul><li>hs – at bedtime </li></ul><ul><li>pc – after meals </li></ul><ul><li>q – every </li></ul><ul><li>qid – four times a day </li></ul><ul><li>tid – three times a day </li></ul><ul><li>IM intramuscular </li></ul><ul><li>IV intravenous </li></ul><ul><li>sq subcutaneous </li></ul><ul><li>q2h every 2 hours </li></ul><ul><li>NPO nothing by mouth </li></ul><ul><li>OD right eye </li></ul><ul><li>OS left eye </li></ul><ul><li>OU both eyes </li></ul>
    8. 9. <ul><li>“ U” – (unit) – Mistaken for zero: write out unit </li></ul><ul><li>“ IU” – International Unit – Mistaken for “IV” </li></ul><ul><li>“ Q.D” “QD” “q.d.” “qd” – Daily </li></ul><ul><li>“ Q.O.D.” “QOD” “q.o.d.” “qod” – every other day </li></ul><ul><li>Relating to ears – AU, AS, AD </li></ul><ul><li>D/C – discharge or discontinue </li></ul><ul><li>Qhs – at bedtime, hours of sleep </li></ul><ul><li>Ss – sliding scale vs one half </li></ul>
    9. 10. <ul><li>Trailing zero – X.0mg – write X mg </li></ul><ul><li>Lack of leading zero - .X mg write 0.X mg </li></ul><ul><li>Decimal points are missed </li></ul><ul><li>“ cc” – use “ml” or “milliliters” </li></ul><ul><li>Abbreviations for drugs due to similar abbreviations for multiple drugs </li></ul><ul><li>The use of “/” write per </li></ul>
    10. 11. <ul><li>Right patient </li></ul><ul><li>Right medication </li></ul><ul><li>Right dose </li></ul><ul><li>Right route </li></ul><ul><li>Right time </li></ul><ul><li>Right documentation </li></ul>
    11. 12. <ul><li>Clarify any inappropriate/unclear orders </li></ul><ul><li>Follow patient rights </li></ul><ul><li>Do not administer medication from an unlabeled container </li></ul><ul><li>Do not prepare medications and not give them </li></ul><ul><li>Do not leave medications at the bedside – exceptions, nitro tabs, inhalers </li></ul>
    12. 13. <ul><li>Verify for accuracy – insulin and anticoagulants </li></ul><ul><li>Do not administer medication prepared by another nurse </li></ul><ul><li>Check or scan patient wrist band with MAR before administration </li></ul><ul><li>If patient questions medication – verify order </li></ul>
    13. 14. <ul><li>Identify the patient – watch for similar names </li></ul><ul><li>Inform the patient – explain purpose of medications, potential side effects </li></ul><ul><li>Administer the medication – </li></ul><ul><li>Use appropriate interventions </li></ul><ul><li>Document medication </li></ul><ul><li>Evaluate patient response </li></ul>
    14. 15. <ul><li>Decreased vision/manual dexterity </li></ul><ul><li>Decreased renal function </li></ul><ul><li>Slower absorption in GI tract </li></ul><ul><li>Decreased liver function </li></ul><ul><li>Increased proportion of fat to lean body mass </li></ul><ul><li>Increases the chances of cumulative effects and toxicity </li></ul>
    15. 16. <ul><li>Oral </li></ul><ul><li>Sublingual </li></ul><ul><li>Buccal </li></ul><ul><li>Parenteral </li></ul><ul><ul><li>Subcutaneous </li></ul></ul><ul><ul><li>Intramuscular </li></ul></ul><ul><ul><li>Intradermal </li></ul></ul><ul><ul><li>Intravenous </li></ul></ul><ul><li>Topical </li></ul><ul><ul><li>Transdermal </li></ul></ul><ul><ul><li>Inhalation </li></ul></ul><ul><ul><li>Ophthalmic </li></ul></ul><ul><ul><li>Otic </li></ul></ul><ul><ul><li>Nasal </li></ul></ul><ul><li>Rectal </li></ul><ul><li>Vaginal </li></ul>
    16. 17. <ul><li>Most common route </li></ul><ul><li>Assess patient’s ability to swallow </li></ul><ul><li>Tablets or capsules – do not crush enteric coated, cut only scored tablets </li></ul><ul><li>Liquid medications – pour medications away from the label </li></ul><ul><li>Sublingual/Buccal – directly enters bloodstream, bypass liver </li></ul>
    17. 18. <ul><li>Assess patency of NG tube, Dob-Hoff tubes are not used for medication administration. </li></ul><ul><li>If to suction, turn suction off </li></ul><ul><li>Verify tube placement, aspiration or auscultation </li></ul><ul><li>Flush tube with 15-30 ml of water </li></ul><ul><li>Dissolve medications in warm water </li></ul><ul><li>Slowly administer medications through tube </li></ul><ul><li>Flush tube –assuring administration </li></ul><ul><li>Leave suction off for 30 minutes </li></ul><ul><li>Record water used for flush/administration on Intake report </li></ul>
    18. 19. <ul><li>Tube placed through abdominal wall </li></ul><ul><li>If to feeding, place on hold </li></ul><ul><li>Check residual by aspiration. </li></ul><ul><li>Flush tube with 15-30 ml of water </li></ul><ul><li>Dissolve medications in warm water </li></ul><ul><li>Slowly administer medications through tube </li></ul><ul><li>Flush tube –assuring administration </li></ul><ul><li>Resume feedings </li></ul><ul><li>Record water used for flush/administration on Intake report </li></ul>
    19. 20. <ul><li>Provides local effect </li></ul><ul><li>Dermatological- applied to skin </li></ul><ul><li>Installations/Irrigations – urinary bladder, ears, eyes, nose, rectum, vagina </li></ul><ul><li>Inhalations – into the respiratory system </li></ul>
    20. 21. <ul><li>Prolonged systemic affect </li></ul><ul><li>Patches- nitroglycerine, estrogen, nicotine </li></ul><ul><li>Apply to clean area of skin </li></ul><ul><li>Each application to a different site </li></ul><ul><li>May cause localized, redness, itching </li></ul><ul><li>Wear gloves when applying to avoid receiving the medication </li></ul>
    21. 22. <ul><li>Administered by irrigation or installation </li></ul><ul><li>Drops or ointment </li></ul><ul><li>Clean eye from inner canthus to outer </li></ul><ul><li>Medication is placed in the lower conjuctival sac </li></ul>
    22. 23. <ul><li>Installation or irrigation </li></ul><ul><li>Softening of wax to ease with removal </li></ul><ul><li>Reduce inflammation/infection </li></ul><ul><li>Aseptic technique </li></ul><ul><li>Sterile technique if eardrum is perforated </li></ul>
    23. 24. <ul><li>Drops or spray </li></ul><ul><li>Shrink swollen membranes </li></ul><ul><li>Loosen secretions to facilitate drainage </li></ul><ul><li>Treat infections </li></ul><ul><li>Chronic use of decongestants- rebound effect </li></ul>
    24. 25. <ul><li>Inhalation </li></ul><ul><li>Nebulizers- delivered by a fine spray </li></ul><ul><li>MDI- metered dose inhaler </li></ul><ul><li>Rapid localized relief </li></ul>
    25. 26. <ul><li>Provides local therapeutic effect </li></ul><ul><li>Treat infections & vaginal discomfort </li></ul><ul><li>Foams, creams, suppositories </li></ul><ul><li>Medical aseptic technique is used </li></ul><ul><li>Application: </li></ul><ul><ul><li>Tubular applicator with a plunger (2in) </li></ul></ul><ul><ul><li>Suppositories inserted with the index finger of a gloved hand (3-4in) </li></ul></ul><ul><li>Patient to remain supine for approx 5-10minutes </li></ul>
    26. 27. <ul><li>Suppositories </li></ul><ul><li>Insert approx 4 inches </li></ul><ul><li>Left lateral/supine for 5-10 minutes </li></ul><ul><li>Retain for 30-40minutes </li></ul><ul><li>Medication released at a slow steady rate </li></ul>
    27. 28. <ul><li>Intramuscular (IM) </li></ul><ul><ul><li>Ventrogluteal, vastus lateralis, dorsogluteal, deltoid </li></ul></ul><ul><ul><li>Gauge and needle size depend on amount of solution, muscle to be used, condition of patient </li></ul></ul>
    28. 29. <ul><li>Ampule – Glass, unit dose, draw up using filter needle then change to injection needle, do not inject air into ampule </li></ul><ul><li>Vial – Rubber seal, unit or multiple dose, clean top prior to withdrawing medication, inject air into vial equal to the amount to be withdrawn </li></ul><ul><li>Reconstitution – adding of sterile water or sterile normal saline </li></ul><ul><li>Mixing Medications – if compatible </li></ul>
    29. 30. <ul><li>Use if volume is 0.5 - 1 cc, but not more than 1 ml. Use a 23 -25 gauge, 1 inch needle. </li></ul><ul><li>Client may be positioned sitting, standing, supine, or prone. </li></ul><ul><li>Locate site by measuring 2–3 fingerbreadths below the acromion process on the lateral midline of the arm. </li></ul>
    30. 31. <ul><li>Use if volume is 1 - 3 cc, but less than 4 cc. Use a 20 - 23 gauge, 1-1/2 inch needle. </li></ul><ul><li>Position client in side-lying or supine position, with knee flexed on injection side, </li></ul><ul><li>Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter. Administer medication above imaginary line at midpoint. </li></ul>
    31. 32. <ul><li>Use if volume is 1 - 3 cc. Use a 20 - 23 gauge, 1-1/2 inch needle </li></ul><ul><li>This is the preferred site for adults </li></ul><ul><li>Position client in supine, prone, lateral position. </li></ul><ul><li>Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger (forming a &quot;V&quot;). Injection of medication is given within the &quot;V&quot; area. </li></ul>
    32. 33. <ul><li>Use 22–25 gauge, 5/8–1 inch needle. </li></ul><ul><li>Position client in supine or sitting position. </li></ul><ul><li>Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the middle third and anterior lateral aspect of the thigh. </li></ul>
    33. 34. <ul><li>Subcutaneous(SQ) – Ex. Insulin </li></ul><ul><ul><li>#25 gauge, 3/8 or 5/8-inch needle, 2ml syring, inserted at either a 45 degree or 90 degree angle. </li></ul></ul><ul><ul><li>Site: Abdomen, upper arm, thigh </li></ul></ul><ul><ul><li>Sites rotated to avoid tissue damage, aid absorption </li></ul></ul><ul><li>Intradermal (ID) – Ex. TB </li></ul><ul><ul><li>#25-#27guage needle, ¼ to 5/8 inch needle; insert at a 5 to 15 degree angle, bevel up </li></ul></ul><ul><ul><li>Medication forms a bleb under the epidermis (small wheal on the skin) </li></ul></ul><ul><ul><li>Site: inner lower arm, the upper chest, & the back beneath the scapulae </li></ul></ul>
    34. 35. Figure 33-35 Mixing two types of insulin
    35. 36. <ul><li>Enter directly into blood stream –rapid effect </li></ul><ul><li>Large Volume – 500-1,000 ml </li></ul><ul><li>Intermittent – piggy back </li></ul><ul><li>IV push (IVP) – verify rate of infusion </li></ul><ul><li>Assess IV site, redness, swelling, s/s infection, </li></ul><ul><li>Verify IV patency prior to administering IV medications </li></ul><ul><li>All IV fluids must be labeled </li></ul>
    36. 37. <ul><li>Infection – (catheter related) – sepsis </li></ul><ul><li>Air embolism – introduction of air during administration </li></ul><ul><ul><li>S/S respiratory distress, chest pain, hypotension, weak rapid pulse </li></ul></ul><ul><li>Infiltration – seepage of fluid into surrounding tissue </li></ul><ul><ul><li>S/S swelling coolness, discomfort </li></ul></ul>