Book

Question 1

Routes of medication administration

Answer 1

Oral (GI)
Parenteral (intradermal, intravenous, intramuscular, subcutaneous)
Skin (topical)

Question 2

Barrier and absorption pattern of oral route

Answer 2

Meds must be able to pass the epithelial layers of GI
Absorption varies greatly due to: stability and solubility of meds (forms of meds: enteric-coated pills and liquids form can resist stomach and absorption occurs in the intestines, GI pH level & emptying time, presence of food in the stomach & intestines, concurrent meds)

Question 3

Barrier and absorption pattern of subcutaneous and intramuscular route

Answer 3

No significant barrier bc of large space between cells of capillary wall
Absorption rate depends on the solubility of meds (fast =10-30 mins, slow), blood perfusion at the injection site (high blood perfusion= rapid absorption, low blood perfusion= slow absorption)
Enteral or oral route (bc parental route injected to the circulatory system) < Subcutaneous absorption rate < intramuscular (bc there are more blood vessels in muscles than fat just under the epidermis layer)

Question 4

Barrier and absorption pattern of intravenous route

Answer 4

No barrier
Absorption pattern can be immediate (directly into blood) or complete (reaches blood in its entirety)

Question 5

Factors influence distribution of meds

Answer 5

Circulation: those have poor circulation that can inhibit blood flow/perfusion = delay medication distribution due to peripheral vascular/cardiac disease
Permeability of cell membrane: For example, meds in GI need to pass through the epithelial layers of GI. Meds that have lipid solubility or have transport system can pass through BBB and placenta
Plasma protein binding: med can binding/compete for protein binding sites, usually with albumin. Medications can also compete with the sites, resulting in toxicity.

Question 6

Medication prescription include

Answer 6

Client’s full name, date & time of prescription, name of medications (generic or brand), strength and dosage of medication, medication usage, route of medication, time and frequency of administration, (optional: quantity to dispense and number of refills), signature of prescribing provider.
Ex: Sam Smith, 2/6/24, 1200, Tylenol 500 mg PO daily PRN for pain, etc

Question 7

Safe administration or medications

Answer 7

Review client’s MAR, compare medications with MAR, use 2 identifiers before administration, question dosage if they are seem large or small, contact provider if prescription is illegible, incomplete or not understood, don’t document before administration

Question 8

Metabolism

Answer 8

Changing meds structure, mostly liver: group of liver enzymes known as cytochrome P450 (nutrition can affect by allowing or inhibit P450 enzymes to function normally), or some kidney and section of small intestines.
Metabolism may transform a specific medication to another form, resulting in a more active or potent form; for example, codeine is transformed to morphine, resulting in increased pain relief. Prodrugs are inactive chemicals that are activated through metabolism to exert their therapeutic effects. Oral medications pass from the small intestine to the hepatic circulation via the mesenteric and portal veins flowing into the liver, before reaching the systemic circulation. The first-pass effect can result in a lower concentration (bioavailability) of the medication reaching the systemic circulation, if a majority of the medication has already been metabolized into an inactive form before it enters the bloodstream.

Question 9

Drug-food interaction

Answer 9

Drug–food interactions can also impact rate of absorption (delay or enhance). For instance, iron preparations are better absorbed when given with orange juice or foods containing vitamin C, whereas iron is poorly absorbed when given with dairy products or antacids containing magnesium. Medications taken with food or high-fat meals will have a much slower rate of intestinal absorption. Drug–food interactions can also affect metabolism and excretion, potentially leading to medication toxicity. The nurse should instruct the client when medications should be taken with or without food and with any other restrictions. If medications are ordered or recommended to be taken on an empty stomach the nurse should administer that medication at least 1 hour before or 2 hours after a meal.

Question 10

Medication reconciliation process

Answer 10

• Document an accurate and comprehensive list (name, dose, route, frequency, and purpose) of home medications upon admission.
• Compare the list of home medications to newly prescribed medications during the current hospitalization and reconcile any discrepancies.
• Update the medication list and repeat the comparison and reconciliation process at any transition of care during the client’s hospitalization, as well as at discharge.
• Communicate the reconciled medication list to the next care provider.
• Educate the client and caregivers upon discharge and provide the client with written information about their medication.

Question 11

Oral route disadvantages and advantages

Answer 11

Advantage: Safer, Less costly, Convenient (variety of forms), Painless, Client can self-administer
Disadvantage: Slow onset of action, Subject to first-pass effect, May have an unpleasant taste, Not appropriate for unconscious clients, Not appropriate for clients with excessive vomiting and/or diarrhea
Site: By mouth/swallow

Question 12

Rectal route advantages and disadvantages

Answer 12

Advantages: Can be administered to children, unconscious clients, or clients who are unable to swallow, Increased concentration is achieved quickly
Disadvantages: Not liked by clients, Absorption varies, Rectal mucosa can become irritated or swollen
Site: Anus

Question 13

Intravenous route disadvantages and advantages

Answer 13

Advantages: Rapid onset, Can be used with clients who are unconscious, noncompliant, or unable to tolerate oral medications
Disadvantages: Sterilization and aseptic technique are essential, High cost, Invasive technique is required, Can injure nerves, tissues, or vessels
Site: Into the vein

Question 14

Buccal route advantages and disadvantages

Answer 14

Advantages: Rapid onset of action, Bypasses first-pass effects, Can be self-administered by the client
Disadvantages: Can cause irritation to open sores in the mouth, Exact site location can be difficult, Decrease in the effect of the medication if it is swallowed, Client may experience nausea and vomiting if the medication has an undesirable taste
Site: Between the cheek and the gum line

Question 15

Inhalation route advantages and disadvantages

Answer 15

Advantages: Rapid action, Smaller dose required, Medication dosage can be regulated
Disadvantages: Local irritation can precipitate respiratory secretions or bronchospasms
Site: Inhaled through the mouth into the lungs

Question 16

Intramuscular route advantages and disadvantages

Answer 16

Advantages: Faster absorption as compared to the oral route, Soluble and suspension substances can be administered
Disadvantages: Must be administered using aseptic technique, Painful, Can cause nerve damage
Site: Into the muscle

Question 17

Subcutaneous route disadvantages and advantages

Answer 17

Advantages: Can be self-administered by the client
Disadvantages: Maximum volume delivery is 1.5 mL, Slow absorption
Site: Beneath the skin

Question 18

Transdermal route disadvantages and advantages

Answer 18

Advantages: Effects can last for several days
Disadvantages: Medication dosing varies due to client factors
Site: Applied to the skin

Question 19

EFT

Answer 19

Enteral feeding tube: can be surgically inserted through the abdominal wall, into stomach or into the jejunum. Others enteral feeding tube is through the nose such as nasogastric tube into the stomach or nasoduodenal into duodenum.

Question 20

Transdermal administration

Answer 20

Transdermal applications allow for the medication to be absorbed slowly, providing prolonged medication release lasting for several days. Transdermal patches are generally applied to the upper torso, chest, upper arms, or back, or behind the ears. The medication released by these patches is absorbed through the skin for systemic distribution for a prescribed amount of time. Examples of types of medication delivered via transdermal patches include opioids, antidepressants, contraceptives, nicotine, and antinausea medications.

Question 21

Ophthalmic medications administration

Answer 21

are applied to the mucous membranes of the eyes or conjunctiva. Ophthalmic solutions are instilled into the lower margin of the eyelid (conjunctival sac). Eye drop medications, such as beta-blockers and alpha agonists, can also enter the bloodstream, causing systemic signs and symptoms. Punctal occlusion, also known as nasolacrimal occlusion, is a method used to prevent the medication from entering into the nasolacrimal duct and into the systemic circulation. After the nurse instills the eye drop(s) and the client closes the eye, the nurse places an index finger at the inner corner of the client’s eye, maintaining gentle pressure there for 30 to 60 seconds. Strict aseptic technique must be maintained when administering any medication to the eyes to avoid contamination or infection. Do not instill medication directly on the cornea, as this can cause the client pain, irritate the cornea, and increase the medication’s systemic effects.

Question 22

Otic medications administration

Answer 22

are used for the treatment of local infections and inflammation; they are instilled into the outer ear. When administering otic medications, assure that the medication is at room temperature. Never administer cold solutions into the ear canal, as this may cause the client to become dizzy and cause pain. Prior to instilling the eardrops, pull the pinna up and back gently, which helps to straighten the ear canal and facilitates the movement of the medication through the ear canal. Position the client in a side-lying recumbent position with the affected ear facing up, to prevent the medication from exiting the ear canal.

Question 23

Nasal medications administration

Answer 23

are drops or sprays instilled within the nostrils, then absorbed through the mucous membranes and into the bloodstream. Medications that can be administered via the nasal route include nicotine (smoking cessation), calcitonin (osteoporosis), sumatriptan (migraines), and corticosteroids (allergies). For these nasal medications to be absorbed, the nostrils must be clean of mucus. Decongestant nasal sprays can be purchased as OTC medications for the treatment for congestion. If the nasal decongestant is used too frequently or for too long, the client can experience rebound congestion. As the client increases the use of the nasal spray, the blood vessels in the nose narrow, causing the inside of the nose to shrink. Once the effects of the nasal spray wear off, the nasal tissue swells. Permanent swelling of the tissue can develop with continued use of the nasal spray.

Question 24

Rectal route administration

Answer 24

Medications given by the rectal route are supplied in the form of suppositories, although creams and ointments may also be prescribed. Rectal medications can be used for clients who have trouble swallowing, an obstructed bowel, or decreased movement in the intestinal tract, or clients who are unconscious. The medication is absorbed through the lining of the rectal vault. The rectum should be empty of stool before administering the medication, as this increases the medication’s effectiveness. Discuss with the client the need to refrain from passing stool for a minimum of 20 minutes once the suppository has been given to provide enough time for the medication to enter the systemic circulation and have an effect. Suppositories should not be administered to clients who have had recent rectal surgery, who have rectal bleeding, or who are at risk for bleeding (low platelet count)

Question 25

Inhaled medications

Answer 25

take the form of very small droplets that, upon inspiration, pass through the trachea into the lungs. The smaller the droplets, the deeper they will travel into the lungs, which increases the amount of the medication absorbed. Inhaled medications, also known as aerosols, are used to treat respiratory conditions such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, and infectious pulmonary disease. The most common methods of aerosol delivery are metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers. These devices expel a preset dose of medication each time they are activated. To effectively use an MDI or DPI, the client must be taught to coordinate inspirations with activation of device and to take a slow deep breath in to achieve distribution of the medication into the lungs and not to the back of their mouth, which may happen if the client inhales too quickly. For clients who are unable to coordinate this activity due to physical, cognitive, or developmental concerns, a spacer should be used to improve medication delivery. A spacer provides a chamber that holds the medication and attaches externally to the inhaler.

Question 26

Insulin vs TB skin test syringe

Answer 26

• Insulin is administered using an insulin syringe, which consists of an attached needle, barrel, and plunger. Sizes of insulin syringes range from 0.25 mL to 1.0 mL. The larger the insulin syringe, the more insulin it can hold. For example, a 0.50-mL syringe can hold 50 units of insulin. When selecting the syringe size to use when drawing up insulin, the nurse should consider the amount (number of units prescribed) of insulin being drawn up.
• Tuberculin (TB) syringes are specifically made for administration of medication under the skin and to complete a tuberculosis test, also known as a purified protein derivative (PPD) test. The needle on the syringe is a fine needle, usually 26 to 27 gauge (G). Some TB syringes come with the needle permanently attached, while others come with the needle detached, requiring the nurse to place the needle on the syringe. This type of syringe holds a maximum amount of 1 mL and is able to measure amounts to the hundredths (0.01 mL).

It is vital to recognize the difference between insulin and TB syringes, because an insulin syringe is inappropriate as a substitution for a TB syringe. The units of measurement are different on the syringes. and the length of the needle is shorter on the TB syringe. The TB syringe needle is shorter because it is used to administer medications intradermally (between the layers of the skin), whereas the insulin needle is slightly longer to administer the insulin subcutaneously (below the skin). Thus, it is crucial that the nurse uses the appropriate needle for the prescribed medication.

Question 27

Injection info

Answer 27

Intradermal injection (5-15 angle): needle length (5/8-1/4), gauge size (25-27). Intradermal medications are often used for diagnostic purposes, such as testing for allergies or tuberculosis. The dermis layer of the skin does not have a rich blood supply, so medication injected there is absorbed slowly. The maximum amount of medication that should be injected into the dermis should be 0.1 mL.
When selecting a site for injection, it is important to avoid areas of the skin that are inflamed, have scars or lesion, or are covered by hair. Typically, the ventral aspect of the client’s forearm is the site used. Never rub the site of injection afterward, as doing so might result in a false-positive response. It is also important to circle the area where the injection occurred to permit accurate reading of the results. If the purpose of the intradermal injection is for diagnosing allergies, the client will need to be closely monitored for a designated period of time for an allergic reaction.

Intramuscular injection (90 angle): needle length (1 1/2-5/8), gauge size (18-25). intramuscular (IM) route permits medication to be delivered into a large skeletal muscle, where a faster rate of absorption can be achieved and a larger volume of medication can be administered compared to a subcutaneous or intradermal injection. In addition, the large muscles have fewer pain receptors and, therefore, are better sites for administering viscous or irritating medications. Three muscles are commonly used for IM injections: vastus lateral, ventrogluteal, and deltoid.
The nurse should select the site, the syringe size, and needle size for IM injection based on the following factors.
1. The age and size of the client: Certain muscles should not be used in certain age groups. For example, the deltoid muscle should not be used in infants because this muscle is not large enough to assure safe delivery of an injection. Refrain from using muscles that are thin or wasted, as medication is absorbed poorly from these sites.
2. The amount of medication to be given: Only certain amounts of medication can be delivered to each of the three muscles commonly used for IM injections. Older adults may only tolerate a maximum of 1 mL in a single IM injection.
3. The condition of the anticipated site: Pain, mobility impairment, edema, inflamed or bruised areas, abrasions, or rashes of an anticipated site should be avoided.

Subcutaneous injection (45-90 angle): needle length (5/8-3/8), gauge size (25-27). Medications given by the subcutaneous route are delivered into the adipose tissue. Although the adipose tissue has a generous supply of capillaries, it lacks larger blood vessels. In consequence, absorption from this tissue will be slower and more controlled than when a medication is administered via the intramuscular or intravenous route. Common medications administered subcutaneously include insulin and low-molecular-weight heparins.
Multiple sites can be used for subcutaneous injections. However, when selecting a site, the nurse should keep the following considerations in mind.
1. Condition of the skin: Moles, abrasions, bruises, scars, and inflammation.
2. Presence of lipohypertrophy: The formation of small lumps beneath the skin due to irritated fatty tissue. 3. This occurs in clients who are receiving long-term subcutaneous injections and is very common in clients who inject insulin. To reduce the development of lipohypertrophy, subcutaneous sites should be rotated.
The amount of adipose tissue: This will determine the angle and length of needle used for the injection.