Medication Administration Flashcards
1
Q
What are severe allergic reactions?
A
Anaphylactic reaction
2
Q
What is an unpredictable patient response to a medication?
A
Idiosyncratic reaction
3
Q
What is a predictable but unwanted/unavoidable reaction to medications?
A
Side effects
4
Q
What occurs when the combined effect is greater than the effect of taking a substance alone?
A
Synergistic effect
5
Q
What are severe, unintended, unwanted drug reactions?
A
Adverse effect
6
Q
What is the desired result/action of a medication?
A
Therapeutic effect
7
Q
What are unpredictable immune responses to medications?
A
Allergic reaction
8
Q
What occurs when the drug action is modified by food, herb, or another medication?
A
Medication interaction
9
Q
What is the result of medication overdose or drug buildup in the blood due to impaired metabolism or excretion?
A
Toxic effects
10
Q
What happens when the drug effect is decreased by taking the drug with another substance?
A
Antagonism
11
Q
What is a chemical, generic, or trade (brand) name of a drug?
A
acetylsalicylic acid = chemical name
Prozac = trade/brand name (starts with upper case letter)
acetaminophen = generic name (starts with a lowercase letter)
12
Q
What are the most effective ways to check patient identity before administering medications?
A
At least 2 identifiers are needed:
1. Check medical record on the ID band
2. Compare an ID photo with the patient
3. Check the patient’s date of birth
4. Use barcode system to scan patient wristband
13
Q
What should be considered when administering medication to a woman who is pregnant?
A
Extreme care administering medication during pregnancy, especially 1st trimester, due to risk of harming the fetus.
14
Q
What should be considered when administering medication to an infant/baby?
A
Infants need smaller doses based on weight because of their body size and immature organs.
15
Q
How to administer medication to an infant/baby and younger children?
A
Use a calibrated dropper and place the medication to the side between the gum and cheek to prevent aspiration.
16
Q
What should be considered when administering medication to an older adult?
A
Increased fat deposits, decreased gastric mobility, decreased renal and liver function, and changes in the blood drain barrier can lead to increased side effects of medications.
17
Q
What is important to know when administering medications to older adults?
A
- Need extra time to understand treatment and swallow
- Crushed or liquid meds are easier to swallow
- Decreased hepatic/liver and renal/kidney functions may affect the dose needed since meds metabolize at a slower pace (smaller dose might be needed)
- Medication adverse effects might increase
- Teach on how to take medication at home. Focus on drug name and purpose instead of medication color since color/shape changes with the manufacturer.
- Loss of dexterity, ability to open pill bottles, visual impairment, and decreased cognitive function can affect safety.
18
Q
Which organ is affected by the metabolism of drugs?
A
Liver
19
Q
Which organ is affected by the excretion of drugs?
A
Kidneys
20
Q
If a medication with an onset of action of 30 mins was given at 8 am, when should the nurse return to evaluate the patient response?
A
8.30 am
21
Q
If the peak plasma level of a drug is reached in 8 hours, at what time will the medication given at 10 am have its greatest effect?
A
Peak will be at 6 pm
22
Q
What should the nurse do to promote patient safety when a patient is given a new antibiotic?
A
- Check for known allergies
- Wait in the clinical for 20 to 30 mins to observe for any reaction
23
Q
What are examples of synergistic drugs?
A
- Alcohol taken with a narcotic (morphine) since both depress the central nervous system
- Diuretic taken with a vasodilator since increase urine output
24
Q
What are examples of antagonist drugs?
A
- Stimulant such as cocaine taken with a depressant
- Grapefruit juice taken with statins
25
What is missing in the medication order: Digoxin 0.125 mg PO
The frequency (how often) is missing
26
What is missing in the medication order: Lasix 40 mg daily
The route is missing
27
What is missing in the medication order: Prilosec PO tid with meals
The dosage is missing
28
When is specific documentation required on the computerized or paper MAR (medication admission record) for medication administration?
If a patient refuses medication or the medication is held.
29
What medication route is under the tongue?
Sublingual
30
What medication is given sublingual?
Nitroglycerin
31
What medications cannot be crushed to be given through an enteric/intestinal tube?
Enteric-coated
time-release (CR, ER or XR)
sublingual
buccal medications
Any with a special coating
32
What can nurses delegate to UAPs regarding the patient's medications?
Observe vital signs
Pt complaints or discomforts
Report medication found in the room
Issues with IV access site
Low volume in IV bag
IV pump alarms
33
What types of medication can be administered via the topical route?
Cream or Gel
Patches
Ear drops
34
What types of medication can be administered via the parenteral route?
IM or IV meds
35
What supplies should be used to administer an intramuscular (IM) injection to an average size adult?
3 mL syringe
1.5-inch needle
36
What supplies should be used to administer a subcutaneous injection to an average-sized adult?
1 mL syringe (3mL can also be used)
5/8 inch needle
37
What assessment should be done before administering an antihypertensive drug?
Vitals - Blood pressure
Lightheadedness and dizziness
38
What assessment should be done before administering a bronchodilator drug?
Vitals - Respiratory status
Auscultation of lung sounds
39
What assessment should be done before administering a narcotic analgesic drug?
Vitals - Respiratory status
Level of consciousness
Comfort level
40
What assessment should be done before administering an anticoagulant drug?
Lab results of coagulant studies
Observe for bruises or bleeding
41
What assessment should be done before administering an antipyretic drug?
Vitals - Temperature
Cooler skin temperature
42
What are ways to reduce medication errors?
1. Read orders carefully
2. Knowledge about medication (dose/side effects)
3. Recognize prescription errors
4. Follow the 6 rights
5. Perform triple checks before administration
6. Use bar code readers
7. Have no interruption zone for preparing medications
8. Communicate with colleagues for questions or concerns
9. Create a culture of safety
43
Which abbreviations and dose designations are appropriate to use?
PO
prn
mL
bid
44
Which abbreviations and dose designations should not be used?
OD
5.0 mg (no trailing zero after whole #)
45
What is the correct angle of insertion for the types of injection?
1. 90 degree = IM or subcutaneous injections
2. 45 degree = subcutaneous injections
3. 5 to 15 degree = intradermal injection
46
What are the 6 rights of medication administration?
Drug
Dose
Time
Route
Patient
Documentation
47
When to complete 3 checks of the medications to be given?
1. Verify the medication matches the MAR, calculate the dose, and check the medication's expiration date.
2. Prepare the medication and check the label again with the MAR
3. Recheck the medication label before returning it to the storage or before opening the package at the bedside.
48
What questions should patients be asked about their medication history?
1. Do you have any food or drug allergies?
2. What prescribed medication are you taking?
3. Which over the counter medication or herb do you take ona. regular basis?
4. What is your alcohol and caffeine intake?
5. Have you stopped taking any medication recently?
49
What is a nursing diagnosis for a patient newly diagnosed heart condition with many medications?
Lack of knowledge associated with new diagnosis and prescriptions.
50
What is a goal/outcome for a patient newly diagnosed heart condition with many medications?
1. Patient will verbalize information about prescribed medications before discharge.
2. Patient will identify medication schedule implemented by next appointment.
51
What are special considerations when administering medication to children?
1. Liquids are preferred for children under the age of 5
2. Use a calibrated dropper for infants or young children. Drop medication between gum and cheek to prevent aspiration
3. Uncoated tablets or soft capsules can be crushed and served with food. Do not use formula or favorite food since the child might associate medicine with these food items and refuse them in the future
4. Give a choice when possible to either take with water or juice
5. Warn child if medication tastes bad to increase future trust
6. Priase child after medication is swallowed
52
When is oral medication administration contraindicated?
If patient:
1. not able to swallow
2. has a decreased level of consciousness
3. has no gag reflex
4. has nausea and vomiting
5. has NPO order
6. has procedure or treatment in the mouth or throat
53
Which type of oral medications should be given last?
1. sublingual
2. buccal
3. swish and swallow liquids
4. cough medicine
54
What are the appropriate techniques for administering medication via the nasogastric (NG) tube?
1. Check placement of the tube before giving the medication
2. Have patient sit upright for the medication administration
3. Keep patient head elevated after the administration for at least 30 minutes
55
What does the abbreviation pc mean?
after meals
56
What does the abbreviation bid mean?
twice a day
57
What does the abbreviation prn mean?
as needed
58
What does the abbreviation IV mean?
intravenous
59
What does the abbreviation qid mean?
four times a day
60
What are the correct techniques for applying a transdermal patch?
1. Write initials, date, and time on patches before applied
2. Remove patch if the patient requires CPR defibrillation
3. Clean the skin site where the patch will be placed
4. Change the location of the new patch
5. Do not place patch over bony areas
6. Do not massage the patch
61
What is the correct technique for administering ear drops in an adult patient?
1. Use ear drop that is room temperature
2. The pinna should be pulled up and back for an adult
62
What should the patient do first before administering nasal medications?
1. Blow your nose before taking meds
2. Tilt the head back or lay in supine position (flat on back)
3. Breath through the mouth
63
For patients taking steroids via an inhaler, what should be done after administration?
Rinse the mouth or get oral care
64
What position is ideal for vaginal suppository insertion?
Dorsal recumbent or modified left lateral recumbent if needed.
65
What position is ideal for rectal suppository insertion?
modified left lateral recumbent (left side with upper knee flexed)
66
What type of asepsis is used for administering parenteral (injection or IV infusion) medications?
Sterile technique
67
What is the correct technique for covering a needle for transport?
1. Use a one-handed technique to slide the needle into the cap using a scoop motion.
2. Hold the syringe vertically and snap the cap on by holding the sides of the cap.
68
What safety techniques are used when preparing an injection from an ampule?
1. Use a 2X2 gauze to cover the neck of the ampule to protect hand while snapping off the glass top
2. Use a filtered need to draw up the medication and then switch the needle for injection.
69
Two medications are to be given, one from an ampule and one from a vial. What is the correct order for putting both medications into the same syringe?
1. Attach a filter needle to the syringe
2. Draw an amount of air into the syringe equal to the vial's dose
3. Insert the needle into the vial and instill air into the space above the medication
4. Draw the medication from the vial
5. Draw up the amount of medication ordered from the ampule
70
What are the sites for subcutaneous injections?
(Fatty areas such as upper arm, abdomen, upper thighs
71
When is a subcutaneous injection route used?
Insulin administration, heparin (blood thinners)
72
When is an intradermal injection route used?
Local anesthetics, allergy skin testing, TB/tuberculosis testing
73
Where can an intradermal injection be given?
inner/anterior forearm, upper arm, scapula/shoulder area
74
Should you aspirate before giving an IM injection in the muscle?
Aspiration is not required for injections into deltoid, vastus lateralis, or ventrogluteal sites.
Yes, aspirate for the dorsogluteal site.
75
What is the maximum amount of medication that should be given for a subcutaneous injection?
less than 1 mL
76
What is the maximum amount of medication that should be given for a deltoid injection?
1 mL or less
77
How is a Z-track injection given?
1. Use non-dominant hand to pull skin tight below or side of injection site
2. Insert needle quickly at 90 degree
3. administer med slowly over 10 secs
4. Hold the needle in place 10 secs after administration
5. Apply gentle pressure with gauze when done. Do not massage the site.
78
Can EpiPen injections be done through the patient's clothes?
Yes
79
What are special considerations for administering IV medications?
1. Check for allergies
2. Check medication/IV solution compatibility
3. Dilutent
4. Rate of administration
5. IV access site - check for infiltration or phlebitis
6. Sterile technique always
80
How can nurses help older patients who take several medications at home and forget if they take them?
1. Set up pill organizer with labels
2. Automated reminders
3. Calendars or journals for reminder
4. Linking medications schedule with breakfast, lunch, bedtime
81
How can you evaluate the effectiveness of insulin?
Check blood glucose
82
If a patient is nauseous and vomiting, what is the best route to administer an antiemetic medication to help with symptoms?
Parenteral via IV or
Topical via rectal suppository
***No PO meds***
83
Barcode scanning is used to verify what?
To verify patient identification and medication
84
What instructions are important for buccal (between gums and cheeks) and sublingual (under tongue) medications?
Do not swallow these meds.
Allow them to dissolve to take effect quickly.
Do not administer with food or liquids.
85
What is the correct order for administering a metered dose inhaler (MDI) medication?
1. Shake the MDI
2. Take deep breath and blow out
3. Place mouthpiece in mouth
4. Inhale slowly and push canister
5. *Inhale for 3 to 5 seconds and hold breath 5 to 10 seconds
6. Remove inhaler and exhale through pursed lips
86
How are medications that are reconstituted in vials mixed?
Roll the vial in your hands (do not shake because it will cause air bubbles)
87
What assessment finding will make you want to administer an injection at a different site?
If the site has a mole, rash, scar, or skin breakdown.
88
Where are the Deltoid and Vastus lateralis muscles for administering IM injections?
Deltoid - point of injection is midline below the middle or index finger in line with the axilla.
Vastus lateralis - point of injection is in the center third of the lateral thigh.
89
What are the correct steps for a direct IV push through a saline lock (intermittent access port)?
1. Prepare medication in the syringe
2. Clean injection port of saline lock with alcohol wipe
3. Flush the IV with saline
4. Inject the medication
5. Flush the IV with saline
90
What is the correct technique for using an insulin pen?
Prime the pen with 2 units before use
91
What medication order needs to be administered immediately?
Any order that reads "stat"
92
What are some correct actions for administering medications?
1. Give meds within 30 mins of scheduled time
2. Apply topical meds with gloves
3. Alternate sides of the cheeks with buccal meds
4. Document on the MAR if patient refuse meds or you hold meds
93
Which vitamin can cause adverse effects such as nausea, vomiting, and blurred vision?
Vitamin A
94
Which herbal drug promotes physical stamina and mental concentration?
ginseng
95
Which herbal drug helps with anxiety sleeping but can interact with antidepressants?
St. John's wort
96
What form does a medication with an enclosed cylindrical gelatin coating come in?
Capsule
97
What is the effect experienced when a patient taking morphine experiences respiratory depression and decreased urine output?
Toxic effect
98
What is the correct way to administer a medication via the buccal route?
Place medication inside the cheek
99
How do you determine if a patient requires a spacer for the inhaler?
The ability of the patient to control the rate of the inhalation
100
What is the appropriate site to administer an IM injection to an infant?
vastus lateralis
101
Why is an iron IM injection administered via the Z-track method?
to prevent the drug from irritating sensitive tissue and staining
102
Where should eyedrops be administered?
lower conjunctival sac
103
How should patients be positioned after administration of eardrops to the left ear?
right lateral
104
What do you do if you notice that the medication dose ordered is more than the usual therapeutic dose?
Call the prescriber to clarify the order
105
What medication is given via the intradermal route?
test for allergy sensitivity
106
How do you locate the ventrogluteal injection site?
greater trochanter, anterior iliac spine, and iliac crest
107
What is the preferred site to administer heparin injection?
Abdomen since heparin is administered as a subcutaneous injection
108
What is a priority before administering an IV bolus medication?
Confirm placement and patency of the IV line
109
What is a priority to prevent aspiration when administering oral medication?
Check for gag reflex
110
When can you cut a pill?
If the pill is scored with a line in the middle, cut it in half using a pill cutter.
111
How do you discard a controlled substance as waste?
A witness is required to verify the medication was not used. It is documented in the controlled substance inventory.
112
What do you do if an enteric-coated pill is ordered, but the patient wants the medication crushed?
You cannot crush enteric-coated pills. Call the pharmacy to see if another form, such as liquid, is available, and then call the provider for an updated order.
113
What is the correct way to administer a sublingual tablet?
Under the tongue
114
What actions should the nurse take for patients taking herbal medications?
1. It is important to include the herbal medications that the patient reports using in the medication history because there is a possibility of interactions between herbals and prescribed medications.
2. The primary care provider should always be informed about the herbs being used by the patient.
3. It is essential for the nurse to identify potential adverse effects of the herbal medications to prevent harmful drug interactions.
***Nurses cannot recommend a company for the patient to purchase herbal preparations and cannot allow patients to self-administer the herbs while in the hospital without a specific physician's order.
115
The nurse is caring for a patient who is unable to hold a cup or spoon. How should the nurse administer oral medications to the patient?
Use a small paper cup to place the pills into the patient’s mouth.
**Using a cup rather than the nurse touching the pills maintains medical asepsis. Crushing the pills with food is appropriate for a patient with dysphagia, not for a person who is unable to hold objects. Liquid medications may be used for some swallowing difficulties or to replace very large pills. It is not safe to leave medications on a table, because they can be contaminated, lost among other items, dissolve in spilled liquids, or be missed.
116
What action should the nurse take first when preparing to administer medications to a patient?
Check the medication administration record (MAR).
117
The nurse is developing a plan of care for a patient. What is the most appropriate goal for a patient related to medications?
The patient will administer all medications correctly by discharge.
118
*Medication Administration Practice Guidelines
1. Nurses who administer medications are responsible for their own actions.
2. Always look up medication you are unfamiliar with. You need to know why you are giving the medication, as well as possible s/e to look for.
3. Narcotics and barbiturates are supposed to be in locked places
4. Use only medications in clearly labeled containers
5. Do not use liquid medications that are cloudy or have changed color
6. Calculate drug and when in doubt have another nurse double check you
7. Administer medications only that you have personally prepared. Never administer medications that you did not prepare.***
8. Identify the client correctly using the appropriate means of identification such as ID bracelet
9. Do not leave meds at the bedside
10. If the client vomits after a PO med, report to PCP
11. Take special precautions when administering certain
medications (counts, double check, etc.)
12. Most facilities require new orders after surgery
13. When a medication is omitted for any reason, record the facts
14. When a medication error is made, report it immediately to
the charge nurse and PCP.
15. Always check the medication expiration date
16. If there is any question regarding the medication order, either by the nurse or the patient, do not administer the medication. Call the provider for clarification.
119
*Medication reconciliation
Medication reconciliation is reviewing the patient's home medications and compare to current ones and should occur upon admission*, transfer*, and discharge*.
120
*Medication should be checked 3 times
1. Upon removing from dispensing system
2. While preparing
3. Before returning to the storage place or before giving to the client
121
*Side Effects
Predictable but unwanted. Sometimes unavoidable reactions to medications.
122
*Adverse effect
Severe, unintended, unwanted, and and often unpredictable drug reactions.
123
*Toxic effect
Result from a medication overdose or the buildup of medication in the blood due to impaired metabolism and excretion.
124
*Allergic effect
Unpredictable immune responses to medications
125
*Anaphylaxis
Severe allergic reaction usually occurring immediately after drug is administered. Can be fatal if treatment is not obtained promptly.
126
*Idiosyncratic Reaction
Unpredictable patient response to medication. Can be over-response, under-response, or abnormal reaction to the medication.
127
*Age Related Changes & Medication
1. Altered Memory
2. Decreased Visual Acuity
3. Decrease in renal function resulting slower elimination and high concentrations in the bloodstream
4. Less complete and slower absorption from GI tract
5. Increased proportion of fat to lean body mass which increases risk of fat-soluble drugs toxicity
6. Decreased liver function, which hinders biotransformation of drugs
7. Decreased organ sensitivity
8. Altered quality of organ responsiveness, resulting in adverse effects becoming pronounced
before therapeutic effects are achieved.
9. Decreased manual dexterity
128
*Pharmacodynamics
mechanism of drug action and the relationships between concentration and responses in the body.
129
*Pharmacokinetics
The study of absorption, distribution,
biotransformation, and excretion of drugs.
1. Absorption: process by which a drug passes into the bloodstream. Route of
administration matters.
2. Distribution: transportation of drug from site of absorption to site of action
3. Biotransformation (Metabolism): process by which a drug is converted to a less active form (Liver)
4. Excretion: process by which metabolites and drugs are eliminated from the
body (Kidneys)
130
*Routes of Administration and time until effect
Oral (30 to 90 mins)
Sublingual (3 to 5 mins)
Buccal
Rectal
Vaginal
Topical
Transdermal (variable)
Inhalation (2 to 3 mins)
Subcutaneous (15 to 30 mins)
Intramuscular (10 to 20 mins)
Intradermal
Intravenous (30 to 60 seconds)
131
*Types of Medication Orders
Stat Order: give medication immediately
Single Order: one time order
Standing order: may or may not have a termination date
PRN order: as needed
132
*Essential Parts of a Drug Order
1. Full name of the client
2. Date and time the order is written
3. Name of the drug to be
administered
4. Dosage of the drug
5. Frequency of administration
6. Route of administration
7. Signature of the person writing the
order
133
*6 Rights of Medication Administration
Patient rights related to medication administration include the following:
Right Drug
Right Dose
Right Time
Right Route
Right Patient
Right Documentation
134
*Oral medication routes
Swallowed
Sublingual
Buccal
Nasogastric, gastric, intestinal, and jejunal tubes
135
*Oral Medication Principles
1. Always check with pharmacy before crushing tablets.
2. Confirm the client’s ability to take the medication orally
3. Keep meds that require specific
measurements (BP, Pulse, etc.) aside
from the other medications.
4. Use straws for liquid meds that can cause teeth discoloration
5. Always label oral meds when drawing into a syringe or medicine cup
136
*Oral medication administration
1. Easiest and most convenient route of administration
2. Assess patient's ability to swallow
Use a different route for NPO patients
3. After administration, verify medication was swallowed
4. Use special techniques for patients swallowing large tablets
5. Use a calibrated syringe or medication cup to administer liquid medications that are not premeasured
6. Do not use medications in containers with missing or hard-to-read labels; do not return medication to a multidose container
7. Medication may be administered by the enteral route
137
*Oral Medication Administration: Infants
1. Never mix meds into foods that are essential b/c the infant may associate the food with the unpleasant taste and refuse it. Never mix meds with formula.
2. Place small amount along inside of cheek and wait for infant to swallow before giving more
138
*Oral Medication Administration: Children
1. Whenever possible, give the child choices
2. Dilute in small amount of water
3. If not already, mix with small amount of sweetened substance (honey, jam, etc.)
4. Never mix with necessary food (milk, juice, etc.)
5. Present honestly, not as a food or treat
6. If using sweetened substance, use impeccable oral hygiene
139
*Oral Medication Administration: Older Adults
1. Usually require smaller dosages
2. Still need to explain reasons for and effects of meds
3. Be sure to get info on vitamins, herbs and supplements
4. Look into socioeconomic factors
140
*Nasogastric or Gastrostomy Medication
1. Try to get med in liquid form because this is far less likely to clog the tube as a crushed pill could.
2. If liquid form is viscous, further dilute it with sterile water
3. Cold can cause discomfort, so be sure to warm all solutions to at least
room temperature before administering
4. Assess tube placement prior to initiating feeds
5. Aspirate stomach contents before administering feed. Call PCP if
content is greater than 100ml.
6. Flush with 15-30ml between all medications and once finished
141
*Injection Medication Administration
Principles
1. Always inject with the bevel up on the needle
2. When deciding appropriate size, you have to look at gauge and length of the needle
3. Gauge sizes are #18-#30. The larger the number, the smaller the needle
4. The deeper you are going, the longer needle you will need (ex: need
longer needles for IM then SubQ injections
5. Clean with alcohol and scrub in circular motion from inside to outside
142
*Ampule
1. Nurse has to use gauze to break the neck of the ampule (glass)
2. Requires the use of a filter needle to filter out microscopic glass
particles
3. Try to draw from the center of the ampule, avoid touching the
sides
143
*Vial
1. Mix the solution by rotating between your palms, never shake it
2. Alcohol swab the top before inserting your needle
3. Draw up and insert the amount of air according to how much
medicine you intend to pull up
144
*Mixing Meds in One Syringe
1. You will see this with Insulin only specifically regular (R) and intermediate (NPH)
2. Regular insulin=clear
3. Intermediate insulin=cloudy
Example: Order is for 10 units of R insulin & 30 units of NPH
Principle: clear before cloudy!
1. Inject 30ml of air into the NPH vial
2. Inject 10 units of air into the R vial and immediately withdraw 10units of insulin
3. Reinsert the needle into the NPH vial and withdraw 30 units of insulin
145
*Intradermal Injections
We are injecting the drug just beneath the epidermis.
Usually only inserting small amount of medication (0.1mL)
Common Uses: allergy testing and TB
screenings
Common Sites: lower arm, upper chest, and back beneath the scapulae
Administration:
***#25-#27-gauge needle that is 1/4-5/8 in long
Pull the skin taught with your non-dominant hand
(helps with discomfort and makes for easy entry)
***With the bevel up, slide under the skin at a 15-degree angle
Should visibly see a small bubble of fluid underneath the skin
Never massage or put pressure on the site
146
*Subcutaneous Injections
***Common uses: vaccines, insulin, heparin. Volume of fluid: 0.5-1 mL
Common sites: outer aspect of upper arm, anterior aspect of thigh, abdomen
Syringe size: Insulin syringe (1-2 mL)
Needle size: #25 gauge; #30 gauge for insulin
***Needle length:
Adult of normal weight: 5/8” needle inserted at 45-
degree angle OR 3/8” needle inserted at 90 degree angle
***Insulin needle: 4-6 mm in length
***Do not aspirate
147
*Subcutaneous Injections best practice
1. 5/8” needle inserted at 45-degree angle with skin pinched, if client is lean and lacks adipose tissue
2. 3/8” needle inserted at 90-degree angle with skin spread, if client has more than ½” of adipose tissue
3. Make sure inject needle with bevel up
4. Insulin is absorbed fastest in the abdomen followed by the arms and the slowest in the thighs and buttocks
5. Rotate injection sites to prevent lipoatrophy and lipohypertrophy.
148
*IM Injections
Common Uses:
1. Deltoid – immunizations
2. Ventrogluteal – medication that requires large muscle for absorption and/or volume > 1 mL
Volume of Fluid:
Deltoid – 0.5 1 mL
Ventrogluteal – 3 mL max for adult with developed gluteal muscle; 1-2 mL for adults with less
developed gluteal muscle
Common Sites:
Deltoid, ventrogluteal, vastus lateralis, rectus femoris
149
*IM Syringe
Syringe size:
Deltoid – 1 mL syringe
Ventrogluteal – 3 to 5 mL syringes
Needle size:
Deltoid - #23-#25 gauge
Ventrogluteal - #21-#22 gauge
Needle length:
Deltoid – 1 inch
Ventrogluteal – 1.5 inches
150
*IM Aspiration
1. Deltoid – no aspiration
2. Ventrogluteal – no aspiration; preferred site for IM injections
3. Dorsogluteal – not used routinely for IM injections. Due to the proximity to the sciatic nerve. Slow aspiration for blood over 5-10 seconds should be performed to prevent inadvertent injection into the gluteal artery or venous circulation
151
*Injection medication principles
1. Always inject with the bevel up on the needle
2. When deciding appropriate size, you have to look at gauge and length of the needle
3. Gauge sizes are #18-#30. The larger the number, the smaller the needle
4. The deeper you are going, the longer needle you will need (ex: need longer needles for IM then SubQ injections
5. Clean with alcohol and scrub in circular motion from inside to outside
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*IV Medication
Administration Principles
1. Check for adverse reactions. IV drugs have a rapid onset.
2. Check compatibility of existing fluids prior to adding in IV medications
3. Always label IV meds and fluids with name, dose, date, time, and nurse’s initials
4. Never administer anything (fluids or meds) concurrently with blood products
5. Most systems have needless entry points
6. It's good practice to give medications to the port closest to the patient.
7. Always clean the port with alcohol before giving IV meds
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*Parenteral Needles
Filter needles:
Used when medications are being withdrawn from a glass ampule.
Needleless delivery systems:
Significantly decrease needlestick injuries and exposure to bloodborne pathogens.
Needleless devices are disposed of in the same manner as are regular needles.
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*Z-track method
Use the z-track method to prevent the medication from leaking into surrounding tissue and causing
damage. For medications that discolor tissue or are irritating to the tissue.
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*Transdermal Patch Medication
Administration
1. Apply only to clean, hairless areas of skin that are not subject to excessive movement or wrinkling
2. Never put over top bruises, cuts, burns, or any other breaks in the skin
3. Nurse should always wear gloves when placing and removing patches to avoid getting medication substance on their hands
4. New patches should be placed in a different site, and any prior residue from an old patch should be wiped
off prior to placing new one
5. Nurse must label patch with date, time, and initials
6. When removing the patch, fold it to where the medication is on the inside.
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*Ophthalmic Medication
Administration
1. Use sterile cotton ball soaked with sterile water or sterile Normal Saline
and wipe from inner canthus to outer canthus before instilling any drops or ointments.
2. Do not let anything touch the applicator.
3. Tilt the patient’s head back.Have the patient look up. Pull the patient’s lower eyelid down to form a pouch.
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*Ophthalmic Solution
1. Have client look up and draw down the skin on the cheek.
2. Come from the side instead of straight on. They are less likely to blink
3. Instill drops in outer third of the lower conjunctival sack
4. Plug the lacrimal duct with a sponge to prevent systemic absorption
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*Ophthalmic Ointment
1. Squeeze 2cm (1/2 inch) of ointment from in the lower conjunctival sac from inner canthus to outward canthus of the eye
2. Have the close their eyes to help the medication spread appropriately
3. Instruct patient to close and roll the eyes to spread the medication around – will cause temporary blurring of vision.
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* Otic Medication
Administration Principles
1. ***Pull pinna up and back for anyone over the age of 3, down and back for anyone younger
than 3yo
2. Warm solution prior to instillation
3. After instilling the correct number of drops, press firmly on the tragus for a few seconds to aid in absorption.
4. Have the client remain sideling with ear up for 5min after instillation
5. May insert cotton loosely in the meatus for 15-20min when the client wants to sit up
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*Ear (Otic) Irrigation
1. Forewarn the patient they may feel fullness, warmth, or slight discomfort when solution is instilled
2. Best if the client is sitting or lying with head tilted toward affected ear so solution can then flow rom
ear canal into a basin
3. Straighten ear canal the same way as if giving ear meds
4. Use gentle pressure when instilling so you don’t damage tympanic membrane
5. Either irrigate until solution is done or until the entire canal has been cleanses (whatever your order
is for)
6. Have client remain in side lying position on affected side to facilitate drainage of excess fluid by
gravity
7. Can place loose cotton swab in ear canal to help absorb excess drainage (do not shove far into ear,
just let it sit barely on the outside of the canal)
8. Always assess character and amount of any ear drainage returned
9. ***If the patient complains of pain or dizziness during the procedure, stop and assess the complaint.
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*Nasal Medication Administration
Principles
1. ***Blow nose first before administration
2. Tilt head back slightly or have the patient in a supine position with head tilted back.
3. Insert the end of the delivery device 1/3” into one nostril. Have the patient plug the opposite nostril.
4. For kids keep their head straight because we want to prevent
excessive systemic absorption of the medication
5. Administer the drops or spray as the patient inhales through the nose.
6. Check nasal mucosa regularly for irritation
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*Vaginal Medication Administration
Principles
1. Have the client void prior to medication administration
because it increases their comfort level
2. Provide perineal care prior to administering medication
3. Store suppositories in the refrigerator to maintain their firm
shape
4. Lubricate both the suppository and your gloved finger for comfort
5. Insert the suppository 8-10cm or 3-4 in along the posterior wall
6. Ask patient to remain side lying for 5-10min after administration
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*Rectal Medication
Administration Principle
1. Have patient lay in left lateral or left sims position with upper leg flexed
2. Lubricate the glove and your index finger
3. Encourage relaxation b/c it relaxes the external sphincter
3. Insert beyond the internal sphincter (10cm/4in)
4. Press the buttocks together for a few minutes
5. Ask the client to remain side-lying for at least 5 min to help retain the suppository
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*Inhaled Medication
Administration
Principles
1. Spacers may be used to facilitate medication absorption.
2. Shake inhaler for 3-5 seconds before use
3. Exhale comfortably
4. Press down on canister and inhale slowly and deeply
through the mouth
5. Hold breath for 10 seconds or as long as possible
6. Rinse mouth with water to remove remaining medication and reduce irritation
7. Clean mouthpiece after reach use with mild soap and
water
8. Store canister at room temperature
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*Nursing diagnoses related to medication administration
Anxiety
Ineffective Health maintenance
Readiness for enhance immunization status
Deficient knowledge (medications)
Impaired swallowing
Effective therapeutic regimen management
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*Planning related to medication administration
1. ***Always organize your care activities to ensure the safe administration of medications.
2. Setting goals and related outcomes contributes to patient safety and allows for wise use of time during medication administration.
3. ***Provide the most important information about the medications first.
4. On discharge, ensure that patients know where and how to obtain medications.
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*Intervention related to medication administration
Teach the patient and family:
1. Medication benefit
2. How to take the medication correctly
3. Symptoms of side effects
4. Safe use and storage of medications
***Help the patient and family establish a medication routine
Refer them to community resources for transportation as needed.
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*Evaluation related to medication administration
***Value patients’ participation in evaluation.
Ensure that patients understand their medication schedules and are able to safely administer their medications.
***Be alert for reactions in patients taking several medications.
Evaluate patient responses:
Physiological measures
Behavioral responses
Rating scales
Patient statements
