WEEK7- Drug administration

Question 1

what are the 6d’s of drug administration

Answer 1

drug - the name of drug, allergies
dose - check dose (grams, milligrams, micrograms) and quality/volume
date- check expiry date
duration(timing)- how often can the drug be given, patient’s history of drugs, w the time now
distance(route)- how should drug be taken, are you competent of the route
documentation- document drug,dose,date time and route

Question 2

what are the routes of admin that a first year can conduct

Answer 2

inhaled, oral, nebulised, sublingual (tongue) buccal (check) rectal, intranasal, intramuscular and subcutaneous

Question 3

which drugs are parental and which drugs are non-parental

Answer 3

non parenteral:
inhaled
oral
nebulised
sublingual
buccal
rectal
intra nasal

parenteral:
subcutaneous
intraosseous
intravenous

Question 4

how do you conduct nebuliser

Answer 4

1. add medication to chamber of nebuliser
2. attach chamber to the oxygen mask
   connect the mask using some tubing to 6-8 litres of oxygen. fine mist should be generated
3. place mask over face
4. get patient to breath in slowly and deeply over 3-5 seconds

Question 5

how do you conduct intranasal

Answer 5

1. draw up liquid drug from container.
2. check 6d’s and that equipment is intact
3. attach drawing up needle to a syringe- 4. use ampoule breaker to open drug.
4. draw up drug, insert syringe to exposed liquid and pull back on plunger of the syringe.
   REMEMBER: extra 0.1ml of liquid should be drawn up to allow dead space in device
5. remove any air in syringe
6. place blunt needle in sharps bin immediately
7. attach to atomiser device to the syringe
8. hold head back and insert tip of device into one nostril. Aim device up and out towards ear
9. briskly press plunger to administer half syringe of medication
10. swap to other nostril and deliver other half of medication

Question 6

what is the recommended needle depth for IM

Answer 6

5/8 inches to 1.5 inches.
depends on adipose (fat) tissue on the arm
most adults over 60kg will need a 1inch needle

Question 7

what are the 2 most common places to conduct IM

Answer 7

deltoid muscle
anterolateral thigh

Question 8

how to conduct IM

Answer 8

1. draw up drug from ampoule
2. check 6d’s and ensure drugs are intact
3. attach blunt (drawing up) needle to a syringe- used to filter any glass which may have entered liquid
4. use ampoule breaker to open drug
5. draw up drug, insert blunt needle/syringe into exposed liquid and pull back on the plunger of the syringe.
6. remove any air in syringe
7. place blunt needle in the sharps bin immediately.
8. select current site, prepare skin with alcohol wipe
9. select appropriately sized intramuscular needle and attach to the syringe.
10. verbalise you have removed cap from needle
11. pull skin and subcutaneous tissue downwards and sideways with one hand
12. insert the needle at 90 degrees angle into the skin until muscle is reached
13. draw back the plunger on the syringe. if no blood is seen then no vein has been entered
14. push drug in
15. wait 10 seconds then remove needle
16. push against an object to engage the safety cap on the needle and put in sharps bin

Question 9

how do you conduct subcutaneous

Answer 9

1. use same technique to draw up the medication using blunt needle
2. smaller depth syringe (3/8 to 5/8 of an inch)
3. check needle is correct size by pinching tissue with thumb and finger. needle should be half of the depth of the fold
4. select correct site, wipe skin with alcohol wipe with a circular motion
5. verbalise that cap is removed from needle
6. pinch skin together using index finger and thumb
7. inject needle between 45-to-90-degree angle then remove needle and release skin

Question 10

what considerations must be conducted before administering drugs

Answer 10

presentation
indications
actions
contraindications
cautions
side effects
dose and admin

Question 11

indications and contraindications of aspirin

Answer 11

given to query MI or ischemia
or suspected TIA (when symptoms fully resolved, isn’t being conveyed to hospital, referred into a local TIA pathway

known allergies/ sensitivity to drug
children under 16
active gastrointestinal bleeding
haemophilia or other known clotting disorders
severe hepatic failures with jaundice

Question 12

what’s the route of admin for aspirin

Answer 12

oral- to be chewed

Question 13

indications and contraindications of gtn

Answer 13

cardiac chest pain due to angina/ myocardial infarction
when the systolic blood pressure is more than 90mmHg
breathlessness due to pulmonary oedema in acute heart failure when systolic blood is greater than 110mmHg
patient with cocaine toxicity with chest pain

hypotension
head trauma
hypovolemia
cerebral haemorrhage
unconscious patient
know severe aortic. mitral stenosis
if Viagra has been taken in past 24 hours

Question 14

whats the route of admin for gtn

Answer 14

sublingual (under the tongue)

Question 15

indications and contraindications of adrenaline

Answer 15

anaphylaxis
life threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy

no indications

1:1000

Question 16

whats the route of admin for adrenaline

Answer 16

intramuscular (IM)

Question 17

indications and contraindications of chlorpenamine

Answer 17

allergic reactions falling short of anaphylaxis but causing the patient distress
alleviating distressing cutaneous symptoms in anaphylaxis only after emergency treatment with adrenaline and patient is stable

known hypersensitivity
treatment with MAOI’s- old style of anti-depressants

Question 18

whats the route of admin for chlorpenamine

Answer 18

intramuscular (IM) or oral

Question 19

indications and contraindications for hydrocortisone

Answer 19

severe/life threatening asthma
acute exacerbation of COPD
adrenal crisis- long term steroid therapy.
patients who have established adrenal crisis/ patients with suspected adrenal insuffiency on long term steroid therapy that have become unwell
pregnant woman with Addisons disease who are in labour

known allergies

Question 20

whats the route of admin for hydrocortisone

Answer 20

intramuscular

Question 21

indications and contraindications of ipratropium bromide

Answer 21

acute, severe or life-threatening asthma
asthma unreasonable to salbutamol
exacerbation of COPD unresponsive to salbutamol
expiratory wheezing

none in emergency situation

Question 22

route of admin for ipratropium bromide

Answer 22

nebuliser

Question 23

indications and contraindications of naloxone

Answer 23

reversal of acute opioid or opiate toxicity for respiratory arrest/respiratory depression
unconsciousness associated with respiratory depression of unknown cause where opioid overdose is a possibility
cardiac arrest where opioid toxicity is the likely cause
patients exposed to high patency anaesthesia if consciousness is impaired

neonates born to opioid addicted mothers

Question 24

route admin for naloxone

Answer 24

intramuscular or intranasal

Question 25

indications and contraindications of oxygen

Answer 25

critical illness required high levels of supplemental oxygen serious illness requiring moderate levels of supplemental oxygen if hypoxaemic explosive environments

Question 26

route of admin for oxygen

Answer 26

inhaled

Question 27

when administering oxygen when do you reduce it

Answer 27

administer oxygen dose until vital signs are normall then reduce oxygen dose to aim for target saturations

Question 28

what is Fi02

Answer 28

the fraction of inspired oxygen. this is an estimation of the oxygen content a person inhales and is thus involved in gas exchange at the alveolar level

Question 29

what are the different types of oxygen masks

Answer 29

simple mask (hudsons mask, flow 6- 10LPM, Fi02 35/50%) face tent (flow 10-15LPM, Fi02 30/40%) venturi mask (flow 2-15 LPM, Fi02 24/60%) partial rebreather (flow 10-15LPM, Fi02 60/80% non-rebreather (flow 10-15LPM, Fi02 80+)

Question 30

when would u put 15 litres of oxygen on straight away

Answer 30

cardiac arrest/resuscitation (15 litres until vital signs are normal- through bag valve mask) carbon monoxide poisoning (maximum dose ONLY don't reduce 02 at all- through high concentration 02 mask) Major trauma, anaphylaxis, decompression illness, major pulmonary haemorrhage, sepsis, shocking, drowsiness (15 litres per minute- high concentration mask) active convulsion, hyperthermia (15 litres until reliable SP02 reading- high concentration 02 mask)

Question 31

when would you put moderate oxygen on straight away

Answer 31

acute hypoxemia with SP02 reading below 85% (10-15 LPM- bag valve mask) deterioration of lung fibrosis or acute asthma with SPO2 between 85-83 (2-6 LPM- high concentration 02 mask) acute heart failure, pneumonia, lung cancer, pulmonary embolism, postoperative breathlessness, severe anaemia, sickle cell crisis (5-10 LPM high concentration 02 mask)

Question 32

when to give low dose of oxygen straight away

Answer 32

copd, exacerbation of cystic fibrosis, chronic neuromuscular disorder, morbid obesity, chest wall disorders (4LPM- 28% venturi mask) if oxygen saturation remains below 88% increase dose and change mask (5-10LPM- simple face mask REMEMBER: critical illness and COPD- if copd develops a critical illness/injury then target saturations of 94-98% should be aimed. Unless this causes decreased conscious level. decrease oxygen and aim for 88-92%

Question 33

indications and contraindications of glucagon

Answer 33

hypoglycaemia clinically suspected hypoglycaemia or an unconscious patient where hypoglycaemia is considered a likely cause (below 4.0 millimoles per litre) should be administered when oral glucose administration isn't possible/ is ineffective and then iv administration of glucose isn't possible pheochromocytoma- type of neuroendocrine tumour that grown in adrenal gland dont inject iv

Question 34

route of admin for glucagon

Answer 34

intramuscular

Question 35

glucose (40% oral gel) indications and contraindications

Answer 35

known or suspected hypoglycaemia in a conscious patient where there's no risk of choking or aspiration none

Question 36

route of admin for glucose

Answer 36

buccal

Question 37

indications and contraindications of paracetamol

Answer 37

relief of mild to moderate pain or high temperature with discomfort (not just high temp) known allergy don't give if further paracetamol containing products have been taken in last 4 hours (6 hours in patients with renal impairment) or if the maximum cumulative daily dose has already been given

Question 38

route of admin for paracetamol

Answer 38

oral-swallowed

Question 39

aindications and contraindications of nitrous oxide

Answer 39

moderate to severe pain labour pains severe head injury with reduced LOC chest injury and clinically suspected pneumothorax abdominal pain where intestinal obstruction is suspected violently disturbed psychiatric patients if patient has had an intraocular injection of gas within the last 8 weeks decompression sickness, consider anyone that has been diving in last 24 hours

Question 40

route of admin for nitrous oxide

Answer 40

inhaled

Question 41

drugs that i can't physically administer but need to know

Answer 41

clopidogrel:- given as oral- swallowed. used for the treatment of an ST-elevation Myocardial infarction (STEMI) dexamethasone:- given as oral solution- tablet. used for the treatment of moderate to severe croup diazepam:- given rectally. used for the treatment of prolonged convulsions or symptomatic cocaine toxicity midazolam:- given buccal. used for the treatment of prolonged convulsions benzylpenicillin:- given as IM. used for suspected meningococcal disease in patients with a non-blanching rash or signs and symptoms ondansetron;- given as IM, used for treating nausea and vomiting morphine sulphate:- given as IM injection/orally. used for the treatment of severe pain management, pain associated with MI or ed of life are