Medication Administration: Oral, Rectal, Topical

Report
Medication Administration
Automated
Medication
Administration
Equipment
 Pyxis
 SureMed
 MedServe
Essential Components of a
Medication Order
 Client’s Name
 Medical Record Number,
Room/Bed #
 Date & time of order
 Name of Medication
 Dosage of Medication
 Route
 Frequency of
administration
 MD’s signature
Six “Rights” of Medication
Administration
 Right Patient (check name band,
ask client their name)
 Right Medication
 Right Dose
 Right Route
 Right Time (frequency)
 Right Documentation
* Client’s also have the right to
refuse (say no) to medication
The Nurse’s Responsibility for
Medication Administration
 Assess whether the client
can tolerate the meds
 Administer meds
accurately & timely
 Monitor for side-effects
 Know contraindications
 Client teaching
 Practice the “Six
Rights”(stressed in clinical)
 Evaluation (effectiveness &
client response)
Types of Oral Medications
 Tablets
 Capsules
 Sublingual
 Buccal
 Elixirs
 Enteric Coated
Precise & Safe
Medication
Administration
Rectal Medications
 Provide for privacy
 Explain procedure to client
 Place client in Sim’s position
 Apply clean gloves
 Lubricate tip, round end inserted first
 Encourage client to relax , deep breathe
 Insert past sphincter, towards umbilicus
 Have client remain on side at least five mins. (hold
buttocks together etc.)
Rectal
Medication
Administration
Ophthalmic Medications
 Place HOB down or low
Fowler’s
 Provide Kleenex for client
 Have client look towards ceiling
 Instill meds in conjunctiva (if
gtts)
 If ointment, apply ribbon from
inner to outer canthus
 Know od, os, ou routes
Topical & Inhalation Medications
 Ointments (absorbed via mucous membranes, skin)
 Inserted (vaginal)
 Instilled (ear/nose gtts)
 Lotions
 Sprays (nasal)
 Pastes (absorbed through skin)
 Inhalation (nebulized treatments, MDI)
Topical Ointments
Otic
Medications
MDI
Medications
Medications via NGT/EFT
 Determine whether med comes in elixir form
 Crush all except for EC meds and mix with water or
other liquid medications
 Stop feedings, clamp tube, apply syringe, unclamp tube,
flush tube with approx. 30cc water
 Clamp tube, remove syringe, pull plunger from barrel,
reattach barrel, pour meds through barrel
 Add water as necessary to keep things flowing smoothly
 After all meds have been given, flush with 30cc water,
clamp tube, remove syringe, start feedings
Documentation
Always record:
 Date, time & your initials or signature, title (R.
Otten, SN,CSUF )
 Medication, route (site) and actual time given
 Reason why med was omitted (ie. refused)
 Client’s response to the medication
Medication
Administration
Records (MARs)
Nursing Considerations for Injection
Sites
Assess for adequate tissue & muscle
availability/client body wt.
 Assess where previous injections
have been administered
 Assess client restrictions
 Assess for quantity & quality of
medication to be administered

Parts of a Needle & Syringe
Syringe:






Barrel
Plunger
Tip
Needle:
Bevel
Shaft
Hub
Types of Syringes
Tips of Syringes
Luer-Lok
Non Luer-Lok
Pre-Filled Systems
Assembling the Device
Scoop Method
Safety Devices
Needless Systems
Three Types of Injections

Intradermal
- Injected into dermal skin layers
(Allergy tests, PPDs, etc.)

Subcutaneous
- Injected into subcutaneous
tissues (Heparin, Insulin)

Intramuscular
- Injected into deep muscles
(narcotic analgesics, iron)
Intradermal Injections

Given in small doses (i.e.. 0.1cc)
 Common sites include: RFA, LFA
 Use 1cc syringe with 26-27 gauge
needle, 1/4 - 5/8 inch long
 Administer with needle at 5-15 degree
angle with bevel of needle up
 Check for “bleb” or “wheal”
 Document site in medication
book/nurses’ notes
Intradermal Injections
Subcutaneous Injections
Given in doses of 0.5cc - 1.5 cc
 Common sites include: deltoid, abdomen
 Deltoid landmarks: Find Acromium Process and go 4 to 6
finger-lengths below
 Rotate sites to minimize tissue damage
 Use Insulin/TB syringe for these meds
 For other SQ meds use 1-3 cc syringe,
25-27 gauge needle, 3/8-5/8 inch length
 Insert needle 45-90 degrees

Deltoid Injections
Vastus Lateralis Injections
 Site
well-developed in both adults &
children, lacks major blood vessels/nerves
 Landmark: Find Greater Trochanter &
Knee, divide thigh up into three equal
quadrants with hand, middle 1/3 is the
site for injection (lateral aspect).
 Good for clients with position restrictions
Intramuscular Injections
Vastus Lateralis
Dorsogluteal Injections
 Rarely used due to Sciatic nerve risk
 Less accessible than other sites (i.e.
requires side-lying or turned further)
 Landmark: Find Greater Trochanter &
Iliac Crest, draw quadrants and
administer in upper two quadrants
Dorsogluteal Injections
What other site is used for IMs?
Ventrogluteal
 Good for deep injections
 Away from blood vessels and nerves
 Z-track
 Thick, viscous meds
 Antibiotics
 Large volume
 Irritating
What if……
when giving an IM injection, the
aspirate comes back with blood.
 What is the correct procedure
and why?
Preparing NPH & Regular Insulin
 Swab tops of both vials
 Inject desired units of air into NPH vial,
remove needle and then inject desired
units of air into Regular vial
 Invert Regular vial and withdraw
desired units of insulin (no bubbles)
 Insert needle into NPH vial, invert and
withdraw desired units of insulin
Regular & NPH
Insulins
Mixing Insulins
NPH
Insulin
Regular
Insulin
Remember !!!
If an IM injection requires the
administration of > 3cc of
medication, divide the medication
up into two equal doses and
administer in different sites.
Remember !!!
Always double-check Insulin
& Heparin amounts/doses
with another licensed person
(RN/LVN/INSTRUCTOR)

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