Unit 18
SAGUN LOHALA

Role of nurse in Medication Administration
 Learn about the diagnosis, drug, other therapies and treatment
for the patient.
 Administer medications and treatments and perform procedures
safely.
 Properly monitor, document and report responses to medication,
treatment and procedures and communicate the same to other
health care professionals clearly and accurately.

Cont’d…
 Learn about the rational for medication prior to
administration, the effect of medication, and
treatment and should administer correctly at the same
time.
 Accurately and completely report and document
administration of medication and treatment.

Cont’d…
 Clarify for accuracy, then about non-efficiency and
contraindication by consulting with the doctors and
notify the ordering doctors when the nurse makes
decision not to administer the medicine or treatment.

Cont’d…
 While doing medication, nurses should consider for:
 Follow institutional policy
 Consider client’s desire and abilities
 Foster compliance
 Correctly document all the actions related to
medication administration and medication errors

Cont’d…
 Aseptic technique should be followed while giving
injections
 Care should be taken to avoid needle-stick injuries,
which may transmit infectious diseases.

Care of medicine and medicine cupboard
 Wards should have medicine cabinet for proper care of medicines
 Cabinets should be large enough that it can accommodate all
medicines and should have separate compartment for tablets,
powders and ointments.
 Cabinets should be in separate room near to nurses’ room as far
as possible. The room should be facilitated with sink and running
water.

Cont’d…
 There should be proper lock system in the cupboards
and the key should be in easy access for doctors and
nurses
 Bottles should be arranged alphabetically.
 Poisonous medicines should be kept in separated
cupboard with separated lock and key. Senior sisters is
responsible for all those medicines

Cont’d…
 Register should be maintained to keep the account of
poisonous drugs
 Drugs with unusual colour, ordour and consistency should be
returned to pharmacy to discard.
 Oils such as Castrol oil, serum, vaccines and antibiotics such as
penicillin should be kept in fridge.

Cont’d…
 Emergency drugs should be kept separately in a tray or a box
which are portable in emergency.
 When indenting for drugs, indent only the required quantity.
 Medicine cabinet should be kept neat and clean.
 Equipment should be cleaned and replaced after use.

Cont’d…
 All inventory of drug should be maintained in each shift. On daily
basis check, verify and document the proper temperature
 Date of manufacture and expiry should be checked periodically.
 The storage should not hinder the cleaning and should have
sufficient space for movement of stocks and handling.

Cont’d…
 “Protected from light” the product is to be stored
either in a container made of material that absorbs
actinic light sufficiently to protect the contents from
change induced by such light.
 The area used for storage of IV fluids should have
adequate space and to prevent exposure to direct
sunlight.

Oxygen Inhalation
 Oxygen is a colorless, odorless
and tasteless gas that is essential
for the body to function properly
and to survive.

Oxygen Inhalation
Oxygen therapy:
 Oxygen therapy is the
administration of oxygen at a
concentration of pressure
greater than that found in the
environmental atmosphere.

Cont’d…
Purpose:
 The purpose is to increase oxygen saturation in tissues
where the saturation levels are too low due to illness
or injury.

Cont’d…
Basic Terminology:
 Hypoxia: Lack of oxygen availability
 FiO2: Fraction of O2 in inspired gas
 SpO2: Oxygen Saturation measured by pulse oxymetry
 SaO2: Arterial Oxygen Saturation

Cont’d…
Pulse oximetry:
 The most accurate non-invasive
method for detecting hypoxia. It
is used to measure the
percentage of oxygenated
hemoglobin in arterial blood.

Cont’d…
Blood gas analysis:
 It is another very accurate method for detecting hypoxia.
It is used to measure the partial pressure of oxygen
(PaO2) and carbon dioxide in blood and also blood pH
and the concentration of the main electrolytes.

Indication for oxygen therapy:
 Blue coloring of the tongue and gums (central
cyanosis).
 Documented hypoxia
 Nasal flaring
 Inability to drink or feed (when due to respiratory
distress)

Cont’d…
 Grunting with every breath and depressed mental status
(i.e. drowsy, lethargic)
 Short-term therapy (e.g. carbon monoxide poisoning) or
surgical intervention (e.g. post anesthesia recovery)
 Insufficient oxygen in atmosphere
 Congestive heart failure or impaired circulation to the
lungs

Normal Values and SpO2
 Partial pressure of arterial oxygen (PaO2)
 80 -100 mmHg - children/adults
 50 - 80 mmHg - neonates
 Partial pressure of arterial CO2 (PaCO2)
 35 - 45 mmHg children/adults
 pH = 7.35 -7.45

Cont’d…
 The normal range of oxygen saturation is 97-99%. The
main carrier for oxygen is hemoglobin. Each
hemoglobin carries 4 molecules of oxygen.

Methods of Oxygen Therapy
 Nasal prongs
 Face masks
 Venturi mask
 Reservoir mask
 High flow nasal prong therapy
 Mechanical ventilation
 Mask- BiPap or CPAP

Nasal Prongs
The prongs protrude 1 cm into
nares
Used for low
concentrations of
Oxygen 24- 44% at 1-6L/min
(4%every liter /min)

Cont’d…
A nasal cannula is a device that consists of a
plastic tube that fits behind the ears, and a set of
two prongs that are placed in the nostrils.
Nasal cannula is connected to an oxygen tank, a
portable oxygen generator or a wall connection in
the hospital

Cont’d…
Advantage
Provides 28-100% O2.
Face tents are used to provide a controlled
concentration of oxygen ad increase moisture for
patients who have facial burn or a broken nose, or
who are claustrophobic
Disadvantage
Difficult to achieve high levels of oxygenation

Face Mask (Hudson)
 Most Commonly used Mask.
 Indicated for higher concentration
than nasal prongs
 Usually applied short term
 Patient exhales through ports on sides
of mask
 It delivers 35% to 60% oxygen at 6-10
L/min.
 Flow must be at least 5 L/min

Cont’d…
Advantage
Provides 40 to 60 % O2 concentration
Used to provide moderate oxygen concentration
It’s efficiency depends on how well mask fits and
patient’s respiration demands
Readily available on most hospital units and
provides higher oxygen for patients

Cont’d…
Disadvantage
Difficult to eat with mask
Mask may be confining for some patients, who
may feel claustrophobic with the mask on

Venturi Mask
 Indicated for precise
concentration of O2
 Flow rates from 2- 14L/min
 Often used in patients who retain
CO2
 The only O2 delivery device that
delivers a specific percentage of
oxygen

Oxygen Tents
 The mask covers the
nose and does not
create a seal around
the nose

Oxygen Concentrator
 Home O2
 Converts nitrogen from air into
oxygen
 Suitable for low flow of O2 1-
4L
 Unable to be used for O2 flow
over 5L

Reservoir mask
Non‐rebreathing masks are
similar to the simple
semi‐rigid plastic masks with
the addition of a reservoir
bag, which allows the oxygen
to be delivered at
concentrations between 60%
and 90% when used at flow
rates of 10–15 L/min

High flow Nasal Cannula
 Similar to nasal cannula
 High‐flow oxygen therapy
allows the accurate delivery
of oxygen therapy of up to
100% FiO2 at a flow rate of
up to 60 L/min

Non-Invasive Ventilation
 Avoids intubation
 Flow : 20 – 40 L/min
 Fio2 : Up to 100%

A machine that generates a
controlled flow of blended air and
oxygen into a patient’s airway.
Ventilators

Article required
1. Oxygen cylinder with
regulator
2. Opening key
3. Humidifier with sterile
distilled water
4. Nasal prongs/ face mask
5. Rubber tubing
6. Lubricant lotion
7. Gauze pads/ pieces
8. Cylinder strep
9. Cotton balls
10. A bowl of water

Steps of Oxygen Therapy
 Verify the prescription for O2 administration by the doctor
 Check for patient’s identification and confirm the patient
 Explain the procedure and purpose of oxygen therapy
 Perform complete respiratory assessment for hypoxia,
monitor respiratory rate, rhythm and strength and also
assess SpO2

Cont’d…
 Perform hand hygiene
 Fill the humidifier with sterile water for injection up to
the label line.
 Join the oxygen tubing and nasal cannula/ face mask
to flow meter to source. Use extension tubing for
ambulatory clients for easy movement.

Cont’d…
 Turn the flow meter on at the prescribed flow rate. If a
patient has COPD, check doctor’s order for the
amount of required oxygen and the expected
saturation level.
 Check for bubbling in the humidifier

Safety Precautions
 Should not be given without prescription of doctor as
oxygen is a medicine
 Place the oxygen cylinder in upright position and
chain it properly or in the oxygen holder.
 Ensure adequate amount of water in humidifier, at
least one third.

Cont’d…
 Avoid changing the flow rate with the nasal prong in
patient’s nose.
 Oxygen can catch fire. So, avoid any sparks and fire
and no smoke near the oxygen cylinder.
 Oxygen delivery systems should be placed 1.5 meters
from the heat source

Cont’d…
 Secure the electric equipment at home and in hospital
as a small spark can also cause fire accidents.
 High flow oxygen therapy should be closely monitored
with formal assessments
 Fire extinguisher should be placed close to the room.

Cont’d…
 Cylinder should be checked for not to be empty as it
may cause dangerous effect as oxygen supply to the
patient.
 Assess patient for oxygen toxicity

Nebulization

Introduction
 It means administration drugs by
inhalation and directly deliver
therapeutic dose into lungs.
 It uses nebulizer which transports
medications to the lungs by means
of mist inhalation

Nebulizer
• Device used to convert liquid drugs into aerosol droplets
suitable for the patient to inhale.
• Uses oxygen, compressed air or ultrasonic power to break up
medication solution

Purpose
• To add moisture to oxygen delivery system
• To soften thick sputum and prevent mucus plugging
• To administer various drugs to the airways
• To relief respiratory insufficiency
• To relieve inflammation and allergic responses
• To relieve post-operative complications

Indication
• Bronchospasms
• Chest tightness
• Excessive and thick mucus secretions
• Respiratory congestions
• Pneumonia
• Atelectasis
• Asthma

Contraindications
In some cases, nebulization is restricted or avoided due to possible
untoward results or rather decreased effectiveness such as:
• Patients with unstable and increased blood pressure
• Individuals with cardiac irritability (may result to dysrhythmias)
• Persons with increased pulses
• Unconscious patients (inhalation may be done via mask but the
therapeutic effect may be significantly low)

Advantage of nebulization
 A convenient way of delivering high doses of inhaled
medication
 In acute severe asthma, oxygen can be used to nebulize
the drug
 It can be used by any age group

Equipment
• Medicine cardex
• Nebulizer and
• Nebulizer connecting tubes
• Compressor oxygen tank
• Mouthpiece/ face mask
• Respiratory medication to be
administered
• Normal saline solution
• Medicines prescribed by the
physician
• Kidney tray
• Sputum mug
• Cotton balls
• Clean water

Procedure
 Check for doctor’s order for the
medicine
 Prepare equipment and assemble at
bed side
 Explain the procedure and position
the patient appropriately (sitting or
semi-fowler’s)

Cont’d…
 Assess and record breath sounds, respiratory status, pulse
rate and other significant respiratory functions
 Teach patient the proper way of inhalation
 Slow inhalation through the mouth via the mouth piece
 Short pause after the inspiration
 Slow and complete exhalation
 Slow resting breaths before another deep inhalation

Cont’d…
 Place the medication in the nebulizer while adding the
amount of saline solution ordered.
 Attach the nebulizer to the compressed gas source
 Attach the connecting tubes and mouthpiece to the
nebulizer
 Turn the machine on (notice the mist produced by the
nebulizer)

Cont’d…
 Offer the nebulizer to the patient, offer assistance until he is
able to perform proper inhalation (if unable to hold the
nebulizer (pediatric/geriatric/special cases], replace the
mouthpiece with mask
 Continue until medication is consumed. It usually takes 15
minutes.
 Clean the face of the patient with clean face towel.
 Encourage patient to cough after several deep breaths.

Cont’d…
 Reassess patient status from breath sounds, respiratory
status, pulse rate and other significant respiratory
functions needed. Compare and record significant
changes and improvement. Refer if necessary

Cont’d…
 Attend to possible side effects and inhalation reactions
 Dissemble, clean and replace articles
 Wash hands
 Record and report the finding the condition of the
patient

Complication
 Palpitation
 Tremors
 Tachycardia
 Headache
 Nausea
 Bronchospasms

Nurse’s roles
1. Closely monitor all clients receiving
bronchodilators for signs of increased heart
rate, nervous agitation and restlessness
2. Patient Teaching
• proper way of doing the therapy to facilitate
effective results and prevent complications
(demonstration is very useful
• Emphasize compliance to therapy
• report untoward symptoms immediately for
apposite intervention.

Definition
⚫A Blood transfusion is the infusion of whole blood or
blood components such as plasma, RBCs, or platelets into
the venous system.

PURPOSES
To increase blood volume aftersurgery, trauma, or
hemorrhage.
To increase the numberof red blood cells in a patientwith
severe chronic anemia.
To provide platelets to patients with low platelet counts
due to treatmentwith chemotherapy.

Cont’d…
To provide clotting factors in plasma for patients with
hemophilia or disseminated intravascular coagulopathy
(DIC).
To replace plasma proteins such as albumin.
To replace fresh frozen plasma in case of DIC.

Indications
Hemorrhage
Trauma
Burns
Severanemia
Plasma proteins orclotting factordeficiency.
Leukopenia
Pathological conditionswhich result in decreased
blood cells.

Contraindications
Decreased cardiac output
Active infection
Fluid overload
Renal failure

Rate of infusion for components of blood
PRODUCTS INFUSION RATES
Whole blood and red blood cells 1 unit over 2-3 hours
Platelets 30- 60 minutes
Fresh frozen plasma 200ml/hourorslowly
Cryoprecipitate 1-2 ml/min

⚫ Whole blood and Packed Red blood cells:-
⚫ For acute blood loss with hypovolemia
⚫ Exchange transfusion
⚫Platelets:-
⚫ Thrombocytopenia
⚫ Untreated DIC
⚫ Thrombotic Thrombocytopenic
purpura

⚫Fresh frozen plasma:-
⚫Coagulation
disoreder
⚫Cryoprecipitate:-
⚫Haemophilia
⚫Coagulation
disorder

Preparation of Equipemnts
⚫ A Clean tray containing,
 A blood request form, blood group and cross match report
 Blood product in the containerfor transfusion along with the compatibility
forms and blood details.
 Blood administration setwith filter
 Disposablegloves
 Normal salineor heparin flush to flush in caseof block in the line.
 IV cannula
 Adhesive tape to secureIV line
 Kidney basin
 Iv pole
 A sterile traycontaining emergencymedications

NURSING PROCEDURE
Verify the physicians order forthe transfusion.
 Explain the procedure to the patient.
Ensure that theconsent formsaresigned.
 Informabout the side effects (dyspneoa, chills, headache, chest
pain, itching) to the patient and ask him/her to report to the
nurse.
Obtain baselinevital signs.
 Obtain the blood product from the blood bank and ensurethat
it is initiated within 30 minutes.
 Verifyand record the blood productand identify the patient
with anothernurse.
 Patient name, blood group, and Rh type
 Cross – matchcompatibility

Donor blood groupand Rh type
Unit and hospital number
Expiration date and timeon blood bag
Type of blood product compared with physicians or
qualified practitioners order
Presenceof clots in blood
Instruct the patient toempty the bladder.
Monitorvital signs.
Wash hands and puton gloves.
Open blood administration kit/set and move roller
clamps toa closed position and administer prescribed
medicines.

for single- tubing set:
Spike blood unit.
Squeeze drip chamberand allow the filter to fill with
blood.
Open roller clampsand allow tubing to fill with blood
to the hub.
Prime another IV tubing with normal saline and
piggyback it to the blood administration setwith a
needleand secure all connectionswith tape.
For dubble-tubbing set:
Spike the second into the normal saline bag or bottle.
Squeeze thedrip chamberand allow the filterto fill
with normal saline.

Attach tubing tovenous catheterusing sterile
precautions and open lowerclamp.
Infuse the blood ata rate of 2-5 ml/min according to
the physicians order.
Remain with the patient for the first 15-30 minutes,
monitoring vital sighs every 5 minutes for 15 minutes,
theevery 15 minutes for 1 hour, and then hourly until 1
hourafter the infusion iscompleted.
After the blood has been infused, allow the tubing to
clearwith normal saline.
Appropriately dispose off bag, tubing and gloves.
Wash hands.
Document the procedure.

RECORDING AND REPORTING
⚫Record thedate and timeof blood transfusion.
⚫Mention the details of the transfusion including type
of blood, blood group, bag number, starting time,
ending time, flow rate, and any adverse reactions
during the transfusions.
⚫Record thevital signs before, during and after the
transfusion.

NURSES RESPONSIBILITES
A. Observe for signs of transfusion reaction.
B. Observe the patientand laboratoryvalues to
determine response to transfusion.
C. Monitor IV siteand statusof infusion each time
when vital signsare taken.

COMPLICATIONS
COMPLICATIONS SIGNS AND
SYMPTOMS
NURSES
MANAGEMENT
1. Allergicreactions Rashes, flushing, hives,
pruritis, laryngealedema,
and dyspnea
• Stop the infusion
immediately.
2.Nonhemolytic febrile
reaction
Sudden chills, fever ,
flushing, headacheand
anxiety
• Keepvein open with the
normal saline
3. Septic reaction Rapid onset of chills,
vomiting, hypotension,
and fever
• Notify the physicians
immediately
4. Circulatoryoverload Cough, dyspnea,
distended neck veins,
cracklesand elevated
blood pressure
• Administer
antihistamine
parenterallyas needed
and as perorder.
5. Hemolytic reaction Low back pain,
tachypnea, hypotension

SAMPLE DOCUMENTATION
⚫11.03.2021 , 10.00 am
⚫Explained the procedure to the patient. Ensured that
the consent form was signed. Instructed the patient to
empty the bladder. Checked for bag number, grouping
and cross-matching.
⚫After premedication, whole blood (as prescribed)
B+ve, bag no.****was transfused to Mr. X at ……am.
Vitals were monitored frequently and the patientwas
observed for transfusion reactions. The transfusion
ended at ….pm. Patient felt comfortable.