MOD 4 Routes of Administration

Question 1

Controlled-release

Answer 1

Oral tablet or capsule formulations that maintain consistent serum drug levels

Question 2

Dosage Form

Answer 2

Form in which drugs are manufactured; includes elixirs, tablets, capsules, suppositories, parenteral drugs, and transdermal systems

Question 3

Enteric-coated

Answer 3

Coating of tablet or capsule that makes it insoluble in stomach acid

Question 4

Interventions

Answer 4

Planned nursing activities performed on a patient’s behalf, including assessment, promotion of adherence to drug therapy, and solving problems related to drug therapy

Question 5

Parenteral

Answer 5

Injected administration; subcutaneous, intramuscular, or intravenous route

Question 6

6 Rights ( rights of medication administration)

Answer 6

Assist to ensure accuracy in drug therapy:
Right patient
Right medication
Right dosage
Right route
Right time
Right documentation

Question 7

Topical

Answer 7

Application of drugs (e.g. solutions, ointments, creams, or suppositories) to skin or mucous membranes

Question 8

Transdermal

Answer 8

absorption of drugs (e.g. skin patches) through skin

Question 9

Enteral Route

Answer 9

Anything that goes through the intestine specifically the mouth & esophagus

Question 10

Enteral route advantages

Answer 10

easily self administered
decreased risk of systemic infection (less invasive, less risk of infection)
Less risk of toxicity: slow to peak concentration

Question 11

Enteral route disadvantages

Answer 11

First pass effect: decreased bioavailability

Slow drug action: longer for patients to see effects due to absorption

GI irritation by same drug

Question 12

Oral Meds types

Answer 12

Tablets
-regular tablets
-chewable tablets
-enteric coated
-extended release
-sublingual
-buccal

Question 13

Regular tablets proper administration

Answer 13

Take with 8 oz of water to promote dissolution and absorption and clears med from esophagus

Question 14

Chewable tablets beware of

Answer 14

Children think they are candy

Question 15

Enteric coated tablets

Answer 15

coating helps tablet not dissolve until the small intestine. This is done to avoid gastric irritation.

Educate patient to not chew or crush the med since it will then dissolve in the stomach acid not the small intestine

Question 16

Extended release tablets

Answer 16

Slower absorption; usually 12-14 hours

contains larger amount of active drug

crushing may cause adverse effects or death

Educate patient not to crush cause that would create a larger dose all at once which can lead to overdosing

Question 17

Sublingual tablets be mindful they

Answer 17

dissolve quickly

Question 18

Buccal Tablets absorbed how

Answer 18

absorbed directly into the blood stream with rapid systemic effects

Question 19

Other oral drug forms (other than tablets)

Answer 19

Capsules
Solutions
Suspension

Question 20

Capsules proper administration

Answer 20

take with 8 oz of water for dissolution and absorption

Question 21

Solution proper administration

Answer 21

use appropriate measuring devices. Accurate measurements is extremely important

Advantage: dose not have to dissolve to be absorbed

Question 22

Suspension how it works

Answer 22

Drug particles settle when standing still. If not remixed then the liquid vehicle is given without the drug

Shake well to main consistent dose

Advantage: dose not have to dissolve to be absorbed (quicker effect)

Question 23

Oral Med Administration

Answer 23

Avoid aspiration by position pt at > 30

Open unit package at patient’s bedside & place the capsule tablet in medicine cup

for liquid meds, place at eye level and pour desired amount of solution

administer meds with or without food as indicated to enhance absorption and prevent upset stomach

For infants and children administer liquid meds with syringe or dropper

Hold oral meds if the patient cannot take anything orally (NPO patients) or if they are vomiting, sedated, or unconscious

Question 24

GI Tubes advantages

Answer 24

Allow use of GI tract in patients who cannot take oral drugs

can be used over longer periods of time if necessary

may avoid or decrease injection use and need which lowers infection chances

Question 25

GI tubes disadvantages

Answer 25

First Pass Effect Slow Drug Action GI irritation by some drugs May be aspirated into lungs (tube could be misplaced and need to position at least 30 degrees) Tubes can become clogged

Question 26

GI Tubes Other considerations

Answer 26

Liquid meds are preferred over crushed tablets or emptied capsules (can clog tube) Tube should be rinsed before and after meds (with 30 ml)

Question 27

GI Tube administration

Answer 27

Liquid med when possible crush pills and dissolve in 30 ml large catheter. Tipped syringe and aspirate gastric fluid and assess ph (checks placement) Rinse the tube and instill med with gravity flow (without plunger in syringe) and rinse the tube again with 50 ml Clamp off the tube from suction or drainage for at least 30 mins

Question 28

Parental Route injection types

Answer 28

Subcutaneous intramuscular intravenous

Question 29

Subcutaneous adv

Answer 29

(needs 25-gauge, 5/8 in long, insulin uses specific needle) relatively painless very small needles can be used no first pass metabolism

Question 30

Subcutaneous disadv

Answer 30

only small amount of drug (up to 1 ml) can be given: if needing more than might have to do subq in multiple spots absorption is relatively slow few drugs can be given this route (heparin, insulin) because other drugs might cause pain, necrosis, or abscess formation Infection risk Can be irrevirsible

Question 31

Steps for administering subcutaneous

Answer 31

Use only sterile drug perparations labeled or commonly used for sub q injections Use 25 gauge needle, 5/8 inch needle Select appropriate injection site based on pt preference, drug characteristics, and visual inspection hold the syringe like a pencil, insert needle quickly at 45-90 angle, use enough force to penetrate skin and sub q tissue release skin, pull back on the syringe to see if blood appears in the syringe, if there is no blood administer medication, if there is blood remove the needle and prepare a new med NEVER aspirate when giving heparin Remove needle quickly and apply pressure for a few seconds

Question 32

Subcutaneous Injection sites

Answer 32

Abdomen lateral posterior arms scapula mid-anterior thigh

Question 33

Intramuscular injection adv

Answer 33

Can be used for several drugs absorption to rapid because muscle tissue is highly vascularized no first pass metabolism

Question 34

Intramuscular disadv

Answer 34

relatively small amount of drug can be administer (up to 3 ml) Risk of damage to blood vessels or nerves if not positioned correctly infection risk can be irrevirsible

Question 35

IM injection administration

Answer 35

use only drug preparations labled or commonly used for IM injections. Check label instruction for mixing drugs in powdered form use 1 1/2 in needle for most adults and 5/8 in to 1 1/2 in needle for children (depending on size of pt) use smallest needle that accommodates the med. A 22 gauge is satisfactory for most drugs Injection site. based on pt preference, drug characteristics, anatomy landmarks, and visual inspection. rotate sites if pt gets frequent inj. don't administer on side of mastectomy cleans area with alcohol sponge tighten skin, hold syringe like pencil, and insert the needle quickly at a 90 angle. use enough force remove quickly

Question 36

Other considerations for IM

Answer 36

Very important to find anatomical landmarks

Question 37

IM injection sites

Answer 37

ventrogluteal site Deltoid site Vastus lateralis

Question 38

Ventrogluteal site

Answer 38

Position first digit on superior iliac spine make sure correct placement of hand (thumb should be pointing toward groin) spread first two fingers and administer IM Injection in between fingers just below rim of iliac crest

Question 39

Deltoid site

Answer 39

Locate the acromion process and measure 2-3 finger widths (2.5- 5cm ) below it. Make a V with the other hand placed directly under fingers measuring from the acromion process and locate the area in the middle 3rd for injection

Question 40

Vastus Lateralis

Answer 40

middle third of thigh

Question 41

Intravenous inj adv

Answer 41

can be given to pt who cannot take meds by GI tract rapid action larger amounts of drug can be given (500 ml) Allows for slow administration when indicated no first pass metabolism

Question 42

Intravenous disadv

Answer 42

time and skill required to acquire and maintain an IV line phlebitis and thrombosis high risk of adverse effects and toxicity due to rapid action risk of infection can be irrevirsible

Question 43

Phlebitis and Thrombosis

Answer 43

result of injury to endothelial cells from: repeated punctures. IV catheter, hypertonic iv fluids, or irritating drugs

Question 44

IV push meds

Answer 44

most must be pushed slowly over 2 minutes or longer

Question 45

Intermittent infusion

Answer 45

usually prepared in pharmacy diluted in 50-100ml infused over 30-60 mins

Question 46

continuous infusion

Answer 46

diluted in larger volumes administered continuously over several hours to prevent drug accumulation and adverse effects or toxic levels

Question 47

Steps for IV administration

Answer 47

Use only meds labeled for IV use check label and make sure it is appropriate for the amount of fluid used to dissolve the drug prep should happen immediately prior to use check site for patency, signs of inflammation and phlebitis before administration administer according to requirements (rapid or slow, IV push, intermittent, continous) when more than one drug is given flush in between drugs. do not mix drugs in syringes or in iv fluids unless it is stated that drugs are compatible IV line should be flushed and capped after administration is completed (flush, administer, flush, cap)

Question 48

Topical application adv

Answer 48

when applied appropriately to intact skin it has local action with minimal systemic absorption or systemic adverse effects. Can be given topically as a patch for systemic absorption when administered to mucous membranes most drugs are well and rapidly absorbed

Question 49

Topical disadv

Answer 49

Some drugs may irritate skin causing itching, rash, or discomfort with damaged skin, systemic absorption is increased as well as systemic adverse effects specific prep must be used for topical application

Question 50

Topical administration steps

Answer 50

Use only drug prep labeled for derm use cleanse skin, remove any previously applied med, and apply the drug in a thin layer, broken skin or open lesions make sure to use sterile gloves or a tongue blade or a cotton tipped applicator

Question 51

Administration to the eye

Answer 51

use drug prep labeled for opthalmic use wash hands open eye to expose conjuctival sac drop med in conjuctibal sac w/o touching the eye with the tip provide tissue for blotting wait 1-5 mins before next drug

Question 52

Administer to the eye children

Answer 52

prepare the med place child in a head lowered position steady the hand holding the med against the childs head gently retract lower lid and drop in conjuctival site

Question 53

Nasal administration

Answer 53

have pt hold their head back and drop med in the nostrils

Question 54

Nasal administration with children

Answer 54

place pt in supine position with the head lowered, instill the med, maintain position and then place child in the prone position

Question 55

Ear administration

Answer 55

open the ear canal in adults by pulling the ear up and back open the ear canal in children by pulling ear down and back drop med on side of ear canal

Question 56

Rectum administration

Answer 56

lubricate the end of the suppository with water soluble lubricant wear a glove or finger cover insert into rectum the length of the finger place suppository next to mucosal wall if pt prefers and is able provide support for self administration

Question 57

Administer med to vagina

Answer 57

Use gloves or an applicator for insertion if applicator is used wash with soap and water after each use if pt prefers or is able provide support for self administration