Medication Part1


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Medication Part1

  1. 1. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 1  Tablet – small, solid dose of medication, compressed or molded; may be any color, size or shape.  Lozenge/Troche – small oval, round or oblong preparation containing a drug in a flavored or sweetened base, which dissolves in the mouth & releases the medication.  Trans-Dermal Patch – unit dose of medication NURSING SKILLS applied directly to the skin for diffusion through skin & absorption into the bloodstream. Medication Liquid Lecturer: Mark Fredderick R. Abejo R.N, M.A.N  Elixir – medication in a clear liquid containing water, alcohol, sweeteners & flavor.  Syrup – medication combined in a water & sugar solution.  Suspension – finely divided, undissolved MEDICATION particles in liquid medium that needs to be shaken before use.  Solution – a drug dissolved in another substance.FUNCTIONS OF THE NURSE Semi-Solid  Ointment – semi-solid preparation containing a Dependent – Nursing Action carried out at the drug to be applied externally. instruction or order of the Physician.  Liniment – medication mixed with alcohol, oil Independent – Nursing Action carried out within the or soap, which is rubbed on skin. legal scope of Nursing’s independent domain.  Lotion – drug particles in a solution for topical Interdependent – Nursing action performed by the use. Nurse in collaboration with other members of the  Suppository – easily melted medication Health Care Team. preparation in a firm base such as gelatin that is inserted in the body.PHARMACOLOGY  Study of actions of chemicals on Living Organisms. Drug Effects  Study of drugs & the effects to the Person. Primary (Therapeutic)IMPORTANT THINGS TO NOTE BEFORE  Intended Effect of the drug.ADMINISTERING DRUGS Therapeutic Actions of Drugs  Name of the Patient 1. Palliative : relieves the symptoms of a disease but does  Name of the Drug not affect the disease itself. Generic Name – the name assigned by the 2. Curative : treats a disease or condition. manufacturer that 1st developed the drug. 3. Supportive : sustain body function until other treatment Trade/Brand Name – selected by the drug of the body’s response can take over. company that sells the drug & is copyrighted. 4. Substitutive : replaces body fluids or substances.  Dose 5. Chemotherapeutic : destroys malignant cells.  Route (Drug Preparation) 6. Restorative : returns the body to health.  Timing & Frequency  Doctor’s Orders/Signature Secondary (Side-Effect)  Date  Not intended effect of the drug  AllergyFIVE RIGHTS  Rapidly-developing reaction.The Right Drug with  Signs & Symptoms may appear on the skin,The Right Dose through respiratory system or the GIT.The Right Route at  Anaphylactic Reaction – life-threateningThe Right Time to reaction that may result in respiratory distress,The Right Patient severe bronchospasm, tachycardia, hypotension & cardiovascular collapse. May be treated byRight Recording & Documentation epinephrine, bronchodilators & antihistamines.Right Approach  Symptoms & signs of allergy to drugs:Right Frequency FeverRight to Refuse Diarrhea – GITRight Education Urticaria – Local EffectRight Assessment Rash– Local EffectRight Evaluation Nausea – GIT Vomiting – GITThe Right Drug  Toxicity  Name  Overdose – taking in a lethal dose of medication. Generic Name  Cumulative Effect Trade Name  The body cannot metabolize one dose of the drug before another dose is administered.  Preparation  The drug is taken in more frequently than it Solid is excreted & each new dose increases the  Capsule – powder or gel form of an active drug total quantity in the body. enclosed in a gelatinous container, may also be  May cause permanent damage to the called liquigel. kidneys or liver.  Pill – Mixture of a powdered drug with a cohesive material; may be round or oval.Foundations of Nursing AbejoMedication
  2. 2. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 2  Iatrogenic Effect DRUG PREPARATIONS  The drug produces a disease condition.  Examples: Chloramphenicol, which is taken for 1. Oral (Capsule, Pills, Tablets, Extended Release, Elixir, Typhoid Fever, may cause Depression of the Bone Suspension, Syrup. ) Marrow functions, such as Anemia, 2. Topical. Drug is applied directly to the body site, usually, the Thrombocytopenia, Neutropenia, skin or mucous membranes. ( Liniment, Lotions, Ointment,  Idiosyncratic Effect Suppository, Transdermal Patch.)  It is the unexpected peculiar response to drug, 3. Injectable. Introduction of medication into the body by a either over response, under response, different syringe. ( Vials, Ampules, Pre-Filled Syringes. ) response than expected.  Unexplained response Drug Interaction DRUG CLASSIFICATIONS  Effects of one drug are modified by the prior on concurrent administration of another drug. Thereby 1. Body Systems increasing or decreasing the pharmacological effect. - Drugs that affect the bodily systems, such as the Drug Antagonism Digestive System, Cardiovascular System, etc.  Conjoint effect of two drug is less than the effect of 2. Symptoms Relieved drug acting separately - Ex: Fever, Colds, Cough, etc. Drug Summation 3. Clinical Indication of the Drug  The combined effect of two drugs produces a result - Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive. equals the sum of the individual effects of each agent. Drug Synergism  The combined effects of drugs is greater than the sum of each individual agent acting independently Drug Potentiation PHARMACOKINETICS  The concurrent administration of two drugs in which one drug increases the effect of the other drug. - Study of the movement of drug molecules in the body.Drug Tolerance Absorption.  A decreased physiologic response to the repeated  The process by which a drug is transferred from its administration of a drug or chemically related site of entry into the body to the bloodstream. substance. Factors That Affect Drug Absorption  Excessive increase in the dosage is required in order to maintain the desired therapeutic effect.  Route of Administration.  Injected medications are usually absorbed moreDrug Abuse rapidly than oral medications  Inappropriate intake of a substance, either continually or periodically.  Drug Solubility.  Liquid medications are absorbed more rapidly thanDrug Dependence solid preparations, as liquid medications do not have  It is person’s reliance or a need to take a drug or to be dissolved by the gastric juices. substance.  Intense physical or emotional disturbance is produced  pH. if drug is withdrawn.  Acidic drugs are well absorbed in the stomach.  Basic drugs remain ionized or insoluble in an acidDrug Addiction environment.  It is due to biochemical changes in the body tissues,  They can only be dissolved in the Small Intestines. especially the nervous system. These tissues come to require the substance from normal functioning.  Local Conditions at the Site of Administration.  The more extensive the absorbing surface, the greaterDrug Habituation the absorption of the drug, thus, a more rapid effect  It is the emotional reliance on a drug to maintain a will occur. sense of well being, accompanied by feelings of need  Food in the stomach can delay the absorption of some or cravings for drug. medications or enhance the rate of absorption of other drugs.  Drug Dosage.  A higher dose than the normal is usually given when aDRUG NOMENCLATURE patient is in acute distress and the maximum therapeutic effect is desired as quickly as possible.  Chemical Name : Precise description of the drug’s  A maintenance dose is a lower dosage that becomes chemical composition. the usual or daily dosage  Generic Name : The name assigned by the manufacturer that first develops the drug. Often  Serum Drug Levels. derived from the Chemical Name.  After a drug has been absorbed, its serum level can be  Official Name : The name by which the drug is monitored by drawing blood and measuring the identified in the official publication. drug’s peak & trough levels.  Trade Name :Also referred to as the Brand Name or Proprietary Name. Selected by the drug company that  Blood Flow. sells the drug & is copyrighted. A drug can have  Rich blood supply enhances absorption. several Trade Names but the same Generic Name.  Pain  StressFoundations of Nursing AbejoMedication
  3. 3. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 3  Antagonist, drug will attempt to attach but because attachment is uneven, there is no drug response. Metabolism  Also called Biotransformation.  The breakdown of the drug to an inactive form.  The liver is the primary site for drug metabolism.  Physiologic changes or presence of a Liver disease may complicate the process. Factors That Affect Drug Metabolism  Age  Nutrition  Liver enzymes involved in metabolism rely on adequate amount of amino acids, lipids, vitamins and carbohydrates.  Insufficient amount of major body hormonesDistribution  After a drug has been absorbed into the bloodstream, it is distributed throughout the body.  Drug accumulates in specific tissues for its action to take place.  Distribution depends on the rate of perfusion and capillary permeability to the drug. Excretion  After the drug is broken down to an inactive form, excretion of the drug from the body occurs.  The Kidneys excrete most of the drugs. ( most important route of excretion )  The Lungs excrete gaseous substances such as inhaled anesthesia.  Many drugs are also excreted through the intestines. Factors That Affect Drug Excretion  Renal Excretion  Carried out by glomerular filtration and tubular secretion, which increases quantity of drug excreted.  Drugs Factors That Affect Drug Distribution  Probenecid, prevent the excretion of penicillin.  Antacid, prevent elimination of ASA  Plasma-Protein Binding  Blood Concentration Level  Medications connect with plasma protein in the  Half-Life vascular system.  Clients with reduced plasma protein such as kidney or liver disease could receive a heightened drug effect.  Volume Distribution VARIABLES INFLUENCING THE EFFECT OF A  Client with edema has an enlarged area in which a MEDICATION drug can be distributed and may need an increased dose. 1. Developmental Considerations  Barriers to Drug Distribution  During pregnancy, most medications are  Blood Brain Barrier contraindicated due to its possible adverse effects on  Placental Barrier the fetus.  Obesity  Certain drugs have a Teratogenic Effect, which are  Receptor Combination known to have a potential to cause developmental  A receptor is an area on the cell wall ( protein or defects in the embryo or fetus. nucleic acid ) where drug attaches and response takes  Breastfed infants are also at a risk for adverse effects place. from the drugs in the mother’s body.  Agonist, drug will connect itself to the receptor site and cause pharmacological response.Foundations of Nursing AbejoMedication
  4. 4. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 4  Children are given smaller doses of medication  In certain circumstances (emergencies), a verbal order from because the immaturity of their organs are responsive physician may be given to RN or pharmacist to the medication.  Unless specific orders to the contrary are written, all drugs  Older Adults are also responsive to medication that may have been ordered while at home are discontinued because their bodies have experienced physiologic  Explain to patient and family how the patient’s drug plan is changes associated with the aging process. to be implemented  Small body size, reduced weight & reduced body  In some inpatient facilities, patients keep medications at water also alter distribution. bedside and learn or continue to administer as they would  Drugs are excreted more slowly from the body as a at home result of changes in kidney functions of Older people.  Promotes patient’s independence  Nurse should be aware when patients are allowed to do this2. Weight  Notation should be made on patient’s care plan  Expected responses to drugs are based largely on those  When patient has had surgery or is transferred to another reactions that occur when the drugs are given thealthy clinical service or another health agency, it is general adults (18-65 years old, 150 lb.) practice that all orders related to drugs are discontinued and  Drug doses for children are calculated by weight or new ones written Body Surface Area.  Check that all medications are appropriately reordered3. Sex  The difference in the distribution of body fat & fluids TYPES OF MEDICATION ORDERS in men & women is a minor factor affecting the action of some drugs. 1. Standard Order  Carried out until cancelled by another order.4. Genetic & Cultural Factors  The Physician specifies that a certain order is to be  Asian patients may require smaller doses of a drug carried out for a stated number of days or times. Once because they metabolize it at a slower rate. the stated period has passed, the order is cancelled  African Americans appear to require larger doses of automatically. some medications that are used to lower blood pressure. 2. PRN Order  Herbal treatments that are popular in some cultures  As needed, or only when necessary. may interfere with or counteract the action of  Commonly written for post-operative pain medication. prescribed medication. 3. Stat Order5. Psychological Factors  Carried out immediately and for one time only.  The patient’s expectations of the medication affects the response to the medication. 4. Single Order  Placebo is a pharmacologically inactive substance.  The medication is only ordered once, at a time  Some patients appear to have the same response with specified by the Physician. the placebo as with an active drug. 5. Self-Terminating6. Pathology  The presence of a disease may affect the drug action. PARTS OF A MEDICATION ORDER  Pathologic conditions that involve the Liver may slow themetabolism & alter the dosage of the drug needed 1. Patient’s Name to reach a therapeutic level. 2. Date & Time when the Order was written. 3. Name of the Drug to be administered.7. Environment 4. Dosage of the Drug  Sensory deprivation and overload may affect drug 5. Route by which the Drug is to be administered. responses. 6. Frequency of administration of the Drug.  Nutritional state may also affect the body’s reaction to 7. Signature of the Person/Physician writing the Order. certain drugs. TRANSCRIPTION OF MEDICATION ORDERS8. Timing of Administration  Kardex  The presence of food in the stomach delays the  Medication Sheet or Medication Administration absorption of orally administered medications. Record  Medication CardMEDICATION ORDERS Questioning Medication Order  Any drug order suspected to be in error should be No medication may be given to a patient without a questioned medication order from a physician or, in some states, a  Suspected error should be noted and reported nurse practitioner  On occasion, nurse may not think there is an error but may Orders are written on a form designed specifically for a not understand why medication has been prescribed physician’s order, which becomes a permanent part of the  Ask how order relates to patient’s care plan patient’s record  May prevent medication error if wrong med has been Many facilities use a computer-generated pharmacy order ordered system and can receive a medication order by fax from the  Confusion over placement of decimal point can be physician prevented by always having a zero precede the decimal for Physician enters drug order into computer, computer sends clarity (no need for zero after decimal – can cause order directly to pharmacy and enters order into patient’s confusion if decimal is unclear or missed completely) permanent record  Drug to which patient is allergic may inadvertently be Prevent any guessing when handwriting is illegible or drug prescribed names are similar  Notation should be made in patient’s record of past adverse Provides physicians with recommended doses of reactions medication, indicates laboratory tests that monitor action of  Do not administer and question when, in nurse’s judgment, drug, and lists potential interactions that may occur. patient is allergic  Patient may wear wristband indicating specific allergiesFoundations of Nursing AbejoMedication
  5. 5. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 5 Drug may be ordered that would potentially interact with another med patient is taking All unfamiliar meds should be verified before administering Guessing is a gross carelessness action – checking with person that wrote the order is the only safe procedure Nurses have the right to refuse to administer any medication that, based on their knowledge and experience, may be harmful to patient Must notify physician of refusalCaring for Controlled Substances Safely  Controlled substances are kept in a locked drawer or container as a safety measure  Narcotics or controlled substances may be ordered only by physician (sometimes, nurse practitioners registered with Dept. of Justice)  Record must be kept for each narcotic administered  Forms are kept with narcotics  Information required:  receiving patient’s name  hour narcotic was given  name of physician prescribing narcotic  name of nurse administering narcotic  Narcotics are checked daily  Amount on hand is counted and each dose used must be accounted for on the narcotic record  Nurse has a secure i.d. code that provides access into the system, Identifies patient by name or i.d. number, and verifies count for each drug as it is removed  Count that does not check properly must be reported immediately  If for any reason a narcotic prepared for administration has to be discarded, a 2nd nurse should act as witness, and that person should also sign the narcotic sheet  also document with a witness any time a full dosage is not given and some of the narcotic needs to be disposed ofPREPARATION AND ADMINISTRATIONOF DRUGSDefinition : GENERAL INSTRUCTIONS:Drug or medicine is a chemical agent which acts to maintain,improve and restore physiologic processes of the body.  Be sure doctors order is complete & well understood before carrying it out.Purposes in general:  Know the client’s condition & all other factors related to the proper use of the drug. - To maintain and promote health  Be alert for signs of allergy & idiosyncrasy manifested by the - To restore physiologic processes client. - To aid in diagnosis  Know the purpose & therapeutic effect of each drug ordered. - To provide palliative effect  Be familiar with standard abbreviations & symbols - To supply substances which is deficient. (Ex. Insulin) commonly used. - To help prevent disease  Verbal orders are accepted in extreme emergencies.  Observe the ―RIGHTS‖ in giving medications.Assessment for all medications administration:  Always clarify doubtful /unclear order before executing it  Verify if drug is to be delayed or omitted for specific period - Client’s diagnosis of time - Client’s medication  Do not leave medicine with the client to take by himself - Client’s allergies to medication  Do not give drug that shows physical changes or - Specific drug action deterioration - S/S of side effects or adverse reaction  Report an error in medication immediately to the nurse in - Client’s age & developmental stage charge. - Problems in self-administering a medication (e.g. poor  The nurse who prepares the medication must be responsible eyesight, unsteady hands) for administering and recording it. Never endorse it to another nurse. - Client’s ability to cooperate during administration  Always observe asepsis in preparing and administering - Client’s knowledge of & learning needs about medication drugs.  Always use the corresponding medication card for each drug prepared and administered.Foundations of Nursing AbejoMedication
  6. 6. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 6ROUTES FOR ADMINISTERING DRUGS serious clients are scheduled medications. last)A. ORAL ROUTE – having the Patient Swallow the 3. Wash your hands Handwashingmedication removes microorganisms that Advantages Disadvantages can cause infection. Most convenient  Inappropriate for client 4. Gather necessary equipment. Make Usually less expensive with N & V sure medicine glasses are clean and Safe, does not break skin  Drugs may have dry. barrier unpleasant taste and odor 5. Check medication 3 times before Administration usually  Inappropriate when GIT taking to the client: does not cause stress has reduced motility. o When taking the medication  Inappropriate if client from the storage area Rechecking can lead cannot swallow. o Before placing medication to accuracy in  Cannot used before into the medicine rack/glass medication certain diagnostic test or o Before placing medicine to the surgical procedure storage area  May discolor teeth, harm 6. Place medication in each separate Mixing liquid tooth enamel. container with the corresponding medicine can reduce  May irritate gastric card behind each medicine glass. concentration and mucosa. strength of the drug.  Can possible aspirated. 7. Observe the 5 Rights in administering medications:Drug Forms for Oral Administration: o Right client o Right drug Solid: tablet, capsule, caplet, lozenges, pill, powder o Right dose Liquid : syrup, suspension, emulsion, elixir, milk or o Right time other alkaline substances. o Right route 8. Correctly calculate dose if Enteric coated tablets should not be crush before necessary administration. 9. Set the medicine glass at eye level Other forms of oral medication that should not be chewed when pouring or crushed: 10. Ascertain client’s identity before SR – Sustained Release administering medications. Check XL – Extended Release room or bed or card, call out CR/CRT – Controlled Release client’s name, check I.D., wrist SA – Sustained Action band o LA – Long Acting 11. Give medications one at time. Give Liquid and cough Do not administer enteric – coated with antacids, milk or liquid medications and cough syrup syrup does not need another alkaline substance last water follow up Suspension are never administered through IV If patient vomits within 20 – 30 minutes of taking the drug, 12. Elevate client’s head to prevent The client might notify the physician. Do not re-administer the drug aspiration. forget or might without doctor’s orders. ignore taking the medicinesAdministration of Oral Medication 13. Remain with the client until all The client might medications have been swallowed. forget or mightDefinition: Never leave any medications at ignore taking the Oral Medication is the administration of drugs by client’s side, for client to take as he medicinesmouth for systemic effect. It may be in the form of pills, tablets, pleasescapsules and liquid. 14. File medicine card on the card rack. 15. Wash hands Prevents spread ofObjectives infection  To prepare & administer the most common, least 16. Record all medications given right expensive route of administering medication safely after administration.  To provide a sustained drug action and increased 17. Check client 30 min to 1 hour later absorption without feelings of nausea and vomiting. for effects of medication.Equipments:  Medication tray with medication B. SUBLINGUAL ROUTE – drugs that is placed under the  Medicine card tongue, where it dissolves.  Mortar and pestle for crushing pill  Water, juice or milk (if not contraindicated by drug C. BUCCAL ROUTE – a medication is held in the mouth absorption) against the mucous membranes of the cheek until the drugs dissolves PROCEDURE RATIONALE1. Check medicine cards with Advantages Disadvantages physician’s order sheet or client’s Counter checking Sublingual / Buccal Sublingual / Buccal chart for written orders or any prevents error in  Most convenient  Inappropriate for client changes in the order. medication  Usually less expensive with N & V2. Arrange the medicine cards in the  Safe, does not break skin  Drugs may have medication tray according to the barrier unpleasant taste and odor following: Systemic way will  Administration usually  If swallowed, drug may o Location of the client facilitate lesser error does not cause stress be inactivated by gastric o Time of administration and minimize time  Can be administered for juice. o Condition of client (more involved in local effect  Drug must remain underFoundations of Nursing AbejoMedication
  7. 7. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 7 Drugs is rapidly absorbed the tongue until dissolved taking to the client: into the bloodstream. and absorbed. o When taking the medication Ensures greater potency from the storage area Rechecking can lead because drug directly o Before placing medication to accuracy in enters the blood and into the medicine rack/glass medication bypass the liver o Before placing medicine to the storage area 6. Place medication in each separate container with the corresponding card behind each medicine glass. 7. Observe the 5 Rights in administering medications: o Right client o Right drug o Right dose o Right time o Right route 8. Correctly calculate dose if necessary 9. Place client in supine position or sit Provide easy access back in chair with head slightly to eye and hyperextended minimizes drainage of medication through the tear duct. 10. Clean the eyelid /lashes ifD. TOPICAL ROUTE – Inserting or rubbing drug onto the necessary using a cotton soak inSkin or Mucous Membrane. sterile saline. Wiping from inner to outer canthus, one cotton for each a) Dermatologic ( includes lotions, liniments, eyes. ointments, pastes and powders )  Wash and pat dry area well before application to Eye Drops facilitate absorption of drugs.  Use surgical asepsis when open wound is present. 11. Squeeze prescribed dose in the Ensure correct  If the skin has lesions, wear gloves or use tongue eyedropper dosage depressor to apply medications. 12. Place a tissue below the lower lid Cotton or tissue  Apply only a thin layer of medication absorbs medication that escapes eye b) Ophthalmic / Eye Medication 13. Hold eyedropper one-half to three- Helps prevent fourth inch above eyeball with accidental contact ofAdministration of Eye Medication dominant hand dropper with eye, thus reducing risk ofObjectives injury and transfer  To provide an eye medication the client requires to of infection. treat an infection or other reason. 14. Gently press downward with thumb Prevents pressure or forefinger against bony orbit. and trauma toConsiderations Exposes lower conjunctival sac by eyeball and prevents  The eye is the most sensitive organ to which the nurse pulling down on cheek. fingers from applies medications. Care must be taken to prevent touching eye. instilling medication directly into cornea.  Instilling wrong concentration may cause local 15. While client looks up, drop Prevent damage irritation of the eyes as well as systemic effects prescribed dose into center of the directly to the conjunctival sac. cornea. ReducesEquipment stimulation of blink  Medication bottle with eye dropper or ointment tube reflex  Cotton ball or tissue  Eye patch or tape (optional) 16. While client closes and move eyes, Prevents overflow of place finger on either side of the medication into nasolacrimal duct for 1 minute. nasal passage and PROCEDURE RATIONALE possible systemic1. Check medicine cards with effect. physician’s order sheet or client’s Counter checking chart for written orders or any prevents error in changes in the order. medication2. Arrange the medicine cards in the medication tray according to the following: Systemic way will a. Location of the client facilitate lesser error b. Time of administration and minimize time c. Condition of client (more involved in serious clients are scheduled medications. last)3. Wash your hands Handwashing removes microorganisms that can cause infection.4. Gather necessary equipment.5. Check medication 3 times beforeFoundations of Nursing AbejoMedication
  8. 8. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 8 PROCEDURE RATIONALEEye Ointment 1. Check medicine cards with physician’s order sheet or client’s Counter checking17. Separate client’s eyelids and grasp chart for written orders or any prevents error in lower lid, exert downward pressure changes in the order. medication over the cheek. 2. Arrange the medicine cards in the18. Instruct patient to look up medication tray according to the19. Apply ointment along insidebedge Distributes following: Systemic way will of the lower eyelid from inner to medication without a. Location of the client facilitate lesser error outer canthus. traumatizing eye b. Time of administration and minimize time20. Wipe excess medication Promtes comfort and c. Condition of client (more involved in facilitate cleanliness serious clients are scheduled medications. last) 3. Wash your hands Handwashing removes microorganisms that can cause infection. 4. Gather necessary equipment. 5. Check medication 3 times before taking to the client: o When taking the medication from the storage area Rechecking can lead o Before placing medication to accuracy in into the medicine rack/glass medication o Before placing medicine to the21. Place client in comfortable position storage area22. Wash hands 6. Observe the 5 Rights in23. Assess for possible drug reaction administering medications:24. Documentation o Right client o Right drug o Right doseEye Irrigation o Right time o Right route Have patient sit or lie with head tilted toward side of 7. Warm medication by running warm Prevents nausea and affected eye water over the bottle. vertigo that may Clean from inner toward outer canthus to prevent debris occur if the entering lacrimal ducts medication is too Expose lower conjunctival sac, hold irrigator about 2.5 cm cold (1‖) from eye, direct flow from inner to outer canthus 8. Correctly calculate dose if Irrigate until solution is clear or all of the solution has been necessary used 9. Place the client in side- lying Provide easy access Use only enough force to remove secretions gently position with the affected ear to ear for instillation Avoid touching any part of eye facing up. The nurse should of medicine. Dry area with cotton balls or gauze sponge stabilize the client’s head with his Stabilizing the head Chart irrigation, appearance of eye, drainage, and patient’s or her hand. promotes safety. response 10. Fill medication dropper with prescribed amount of medication. 11. Prepare client for instillation as Straightening of ear follows: canal provides direct c) Otic ( Ear ) Medication Infants: draw the auricle gently access to deeper  Includes instillations and irrigations downward and backward. external ear  Instillations: Adults / Children : lift pinna upward structures. To soften earwax and backward To reduce inflammation 12. Instill the medicine into the ear Forceful instillation To treat infection canal holding the dropper 1 cm of medicine into To relive pain above ear canal occluded canal can  Irrigations: cause injury to To remove cerumen or pus eardrum. To apply heat 13. Ask the client to maintain the Allows complete To remove a foreign body or object position for 2-5 minutes. Apply distribution of gentle massage or pressure to medication. PressureAdministration of Ear Medication tragus of ear with finger. and massage moves medication inward.Objectives 14. Place client in comfortable position  To soften earwax so that it can be readily removed at 15. Wash hands a later time 16. Assess for possible drug reaction  To provide local therapy to reduce inflammation, 17. Documentation destroy infective organism.  To relieve painEquipment  Medication bottle with dropper  Cotton tipped applicator  Cotton ballFoundations of Nursing AbejoMedication
  9. 9. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 9 A. Nasal Sprays Gently insert the bottle tip into one nostril as shown in drawing A. Keep head upright. Sniff deeply while squeezing the bottle. Repeat with other nostril.Tilt your head (or have the patient tilt his or her head) to B. Pump Nasal Spraysthe side as shown in drawing A. Or lie down with theaffected ear up as shown in drawing B. Prime the pump before using the first time. Hold the bottle with the nozzleGuidelines for Removing Excessive/ Impacted Cerumen between the first two fingers and thumb on the bottom of the bottle. Place 5 to 10 drops of the cerumen-softening solution into the ear canal, and allow it to remain for at least 15 minutes. Tilt the head forward. Prepare a warm (not hot) solution of plain water or other solution as directed by your doctor. Eight ounces of Gently insert the nozzle tip into one solution should be sufficient to clean out the ear canal. nostril as shown in drawing B. Sniff To catch the returning solution, hold a container under the deeply while depressing the pump once. ear being cleaned. An emesis basin is ideal because it fits the contour of the neck. Repeat with other nostril. Tilt the head down slightly on the side where the ear is being cleaned. C. Nasal Inhalers Gently pull the earlobe down and back to expose the ear canal as shown in drawing A. Warm the inhaler in hand just before use. Place the open end of the syringe into the ear canal with the tip pointed slightly upward toward the side of the ear canal, Gently insert the inhaler tip into one as shown in the drawing. Do not aim the syringe into the nostril as shown in drawing C. Sniff back of the ear canal. Make sure the syringe does not deeply while inhaling. obstruct the outflow of solution. Squeeze the bulb gently—not forcefully—to introduce the Repeat with other nostril. solution into the ear canal and to avoid rupturing the eardrum. Wipe the inhaler after each use. Make (Note: Only health professionals trained in aural sure the cap is tightly in place between hygiene should use forced water sprays [e.g., Water Pik] uses. Discard after 2-3 months even if the to remove cerumen.) inhaler still smells medicinal. Do not let the returning solution come into contact with the eyes. If pain or dizziness occurs, remove the syringe and do not If broncholilator, administer a max. of 2 puffs for at least 30 resume irrigation until a doctor is consulted. second interval. Make sure all water is drained from the ear to avoid predisposing to infection from water-clogged ears. D. Nasal Drops Rinse the syringe thoroughly before and after each use, and let it dry. Squeeze the bulb to Store the syringe in a cool, dry place (preferably, in its withdraw medication original container) away from hot surfaces and sharp from the bottle. instruments. Do this procedure twice daily for no longer than 4 Lie on bed with head consecutive days. tilted back over the side of the bed as shown in drawing D. Place the recommended number of drops into one nostril. Gently tilt head from side to side. Repeat with other nostril. Lie on bed for a couple of minutes after placing drops in the nose. Do not rinse the dropper. d) Nasal Medication  Nasal instillation ( nose drops ) usually are e) Vaginal Medication instilled for their astringent effect . Drug Forms: tablet, cream , jelly, foam, suppositoryAdministration of Nasal Medication Vaginal Irrigation ( Douche ) : is the washing of vagina by aObjectives liquid.  To shrink swollen mucous membrane  To loosen secretions and facilitate drainage.  Empty the bladder before the procedure  To treat infections of the nasal cavity or sinuses.  Position and drape the client.  Instillation : back lying position with knees flexed and hips rotated laterally.  Irrigation : back lying position with the hips higherEquipment than the shoulder ( use bedpan )  Medication bottle with dropper or spray container  Facial tissueFoundations of Nursing AbejoMedication
  10. 10. Nursing SkillsMedicationPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 10Guidelines for Applying Vaginal Antifungal Products Administration of Rectal Suppository Start treatment at night before going to bed. Lying down  Gently squeeze the suppository to determine if it is firm will reduce leakage of the product from the vagina. enough to insert. Chill a soft suppository by placing it in Wash the entire vaginal area with mild soap and water, and the refrigerator for a few minutes or by running it under dry completely before applying the product. cool running water. Vaginal cream: (If prefilled applicators are being used, skip  Remove the suppository from its wrapping. to step 4.) Unscrew the cap; place the cap upside down on  Dip the suppository for a few seconds in lukewarm water to the end of the tube. Push down firmly until the seal is soften the exterior. broken. Attach the applicator to the tube by turning the  Lie on your left side with knees bent or in the knee-to-chest applicator clockwise. Squeeze the tube from the bottom to position (see drawings A and B). Position A is best for self- force the cream into the applicator. Squeeze until the inside administration of a suppository. Small children can be held piece of the applicator is pushed out as far as possible and in a crawling position. the applicator is completely filled with cream. Remove the applicator from the tube. Vaginal tablets/suppositories: Remove the wrapper and place the product into the end of the applicator barrel. While standing with your feet slightly apart and your knees bent, as shown in drawing A, or while lying on your back with your knees bent, as shown in drawing B, gently insertthe applicator into the vagina as far as it will go comfortably.  Relax the buttock just before inserting the suppository to ease insertion. Gently insert the tapered end of the suppository high into the rectum. If the suppository slips out, it was not inserted past the anal sphincter (the muscle that keeps the rectum closed). 4‖ – adults, 2‖ – children and infants)  Continue to lie down for a few minutes and hold the buttocks together to allow the suppository to dissolve in the rectum. The parent/caregiver may have to gently hold a Push the inside piece of the applicator in and place the child’s buttocks closed. cream as far back in the vagina as possible. To deposit  Remember that the medication is most effective when the vaginal tablets/suppositories, insert the applicator into the bowel is empty. Try to avoid a bowel movement after vagina and press the plunger until it stops. insertion of the suppository for 30 minutes up to 1 hour so Remove the applicator from the vagina. that the intended action can occur. After use, recap the tube (if using cream). Then clean the applicator by pulling the two pieces apart and washing them with soap and warm water. E. ENTERAL TUBE ROUTE – administration of medicine If desired, wear a sanitary pad to absorb leakage of the via nasogastric tube. vaginal antifungal. Do not use a tampon to absorb leakage. Continue using the product for the length of time specified in the product instructions. Use the product every day ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING without skipping any days, even during menstrual flow. TUBE  Use liquid meds or meds that can be crushed and combined f) Rectal Medication with liquid  Drugs administered rectally exert either a local or  Bring liquid med to room temp systemic effect on the gastrointestinal mucosa.  Remove clamp from tube, checking for tube placement before administering drugConsiderations  Flush tube with 15 – 30 mL water (5 – 10 mL for children)  Rectal medication is a convenient and safe method of before giving meds and immediately after giving certain medications but not as reliable as oral or  Give meds separately and flush with water between each parenteral routes in terms of drug absorption and drug distribution.  Disconnected from suction and clamped 20 – 30 minutes  Improper placement can result in expulsion of the after administration suppository before medication dissolves and is  Disconnect continuous tube feeding, leaving tube clamped absorbed into the mucosa. for short period of time  Never force a suppository into a mass of fecal  Document water intake and liquid med on I & O chart material. It may be necessary to administer a small cleansing enema before a suppository can be inserted.  Do not cut the suppository into sections to divide the dosage, the active drug may not be distribute evenly within the suppository.Foundations of Nursing AbejoMedication