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Lesson 26
Administering Medications
99
Nursing
Professional
10/08/2012

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Term
Routes of administration:
Definition
oral, parental, topical, inhalation,intraocular,
Term
Oral routes
Definition
sublingual and buccal
Term
Sublingual –
Definition
rapid action – good vascular supply. Give nothing to drink until drug is dissolved. Place under tongue, do not swallow. Give this drug last.
Term
Buccal –
Definition
place against mucous membranes of cheek – don’t chew or swallow until dissolved. To be given last.
Term
Parenteral routes
Definition
ID, SubQ, IM, IV
Term
Intradermal (ID) –
Definition
into dermis below epidermis. Very potent, give in small doses (TB test)
Term
Subcutaneous (Sub-Q) –
Definition
into subcutaneous or adipose or fatty tissue. Sub-Q tissue has lesser blood supply than the body muscles – slower drug absorption (insulin, heparin)
Term
Intramuscular (IM) –
Definition
into the muscle – absorbed more quickly than Sub-Q because of the greater blood supply (rapid absorption)
Term
Intravenous (IV) –
Definition
into the vein THE MOST rapid absorption – preferred over injections
Term
MD may use…
Definition
epidural, intrathecal, intraosseous, intraperintoneal, intra-arterial, intracardiac, intraarticular
Term
Epidural –
Definition
in epidural space
Term
Intrathecal –
Definition
subarachnoid space or in ventricle of brain
Term
Intraosseous –
Definition
in bone marrow (used w/ infants and toddlers w/ poor venous access)
Term
Intraperitoneal –
Definition
in peritoneal cavity (chemo, dialysis)
Term
Intra-arterial –
Definition
given directly into arteries
Term
Intracardiac –
Definition
into the cardiac tissue
Term
Intraarticular –
Definition
directly into the joint (cortisone injection)
Term
Topical route
Definition
skin and mucous membrane, suppository, instilled fluid, irrigating
Term
Skin and mucous membrane –
Definition
applied for local effects – creams, ointments over affected areas. Also given for systemic effects – patch – wear gloves and write date/time on patch.
Term
Inserting a med into a body cavity
Definition
(placing suppository into vagina/rectum)
Term
Instilling fluid into body cavity (ear, nose drops, bladder/rectal – fluid is retained)
Definition
(ear, nose drops, bladder/rectal – fluid is retained)
Term
Irrigating body cavity
Definition
(flushing eye, ear, vagina, bladder or rectum – fluid is NOT retained)
Term
Inhalation route
Definition
local effect but have the potential for dangerous systemic side effects
Term
Intraocular route
Definition
Soft, contact-like disk w/ layers filled w/ medication is placed into the eye.
Term
The Joint Commission guidelines on adminstering meds –
Definition
only medication needed to treat the condition are ordered. Must be documented diagnosis, condition, or indication for each medication that is ordered
Term
Who can prescribe meds?
Definition
Physician, nurse practitioner, physician’s assistant
Term
Oder may be given as a:
Definition
verbal, standing or routine, single, STAT, NOW
Term
Verbal Order -
Definition
write complete order, enter it into computer, read it back & receive confirmation
Term
2 types of verbal orders
Definition
Directly talking to MD and Given by phone call
Term
How to document verbal orders
Definition
date/ time; Medication order, name of med, dose of med, route of med, time of med; type of order; Prescriber’s name – should sign w/in 24 hours; Nurse’s name/title
Term
Standing orders or Routine Medication Orders –
Definition
to be administered over certain number of days then stopped.
Term
PRN orders –
Definition
as needed, need to know WHY (prn pain/prn itching) & WHEN given – ex: Tylenol #3 1-2 tabs po q4-63 hrs prn pain
Term
Single (One-Time orders)
Definition
Ex. Initial dose, pre-operative medication
Term
STAT orders –
Definition
given immediately
Term
NOW orders –
Definition
Must be given w/in 90 minutes
Term
Distribution Systems
Definition
stock supply, unit dose, ADS
Term
Stock supply –
Definition
large quantities of numerous meds – high rate of medication error
Term
Unit Dose –
Definition
portable carts w/ drawers – designed to reduce medication errors
Term
Automated medicine Dispensing System –
Definition
delivery and control of narcotics, records the medication date, time, quantity & charges to the patient
Term
Nurses administer meds _________&_______________
Definition
correctly & monitors effects
Term
Nurses assess the client’s ability _________________
Definition
to self-administer meds
Term
Nurses assist with_____________scheduling of meds
Definition
time
Term
Nurses perform accurate assessments prior to_____________________.
Definition
med admin (checks VS, K+, blood glucose…)
Term
Nurses provide____________&_________ education
Definition
Pt and family
Term
Nurses use the nursing process to integrate medication therapy into ____________.
Definition
Pt care
Term
DON’T LET PEOPLE INTERRUPT YOU IN THE PROCESS OF
Definition
ADMINISTERING MEDICATIONS!
Term
The 6 RIGHTS medication administration
Definition
rt med, rt dose, rt patient, rt route, rt time, rt documentation
Term
1. Right Medication – check 3 times
Definition
Before removing med from drawer; As med is removed from container; Before closing the drawer
Term
2. Right Dose – perform calculations check 3 times
Definition
Measure meds accurately; Score/crush tabs if needed
Term
3. Right Patient –
Definition
ask Pt to state name and DOB (tell them it’s routine to ensure safety/ check allergies)
Term
4. Right Route – Prepare med appropriately – check 3 times
Definition
Injection – using sterile technique; Oral med – using aseptic technique
Term
5. Right Time –
Definition
can they have it yet? Have they had it? Count time frames
Term
NEVER leave med____________or _______________
Definition
in room or unattended,
Term
document on COW
Definition
document med on MAR after it has been given – document on COW prior to giving med as a safety check – always complete the sending process using the COW prior to medication administration
Term
watch patient __________
Definition
take med – may need to check some pt’s mouth.
Term
ask patients if there are any ____________________
Definition
other substances, supplements, OTC products they are taking
Term
Set priorities – give___________ 1st
Definition
Pain meds
Term
document med on MAR
Definition
after it has been given
Term
HIGH ALERT MEDICATIONS: must do checks!!!!!
Definition
PINCH+
Term
·         P
Definition
potassium & pediatric doses
Term
·         I
Definition
Insulin
Term
·         N
Definition
Narcotic Infusions (PCA)
Term
·         C
Definition
Chemotherapeutic Drugs
Term
·         H
Definition
heparin/fractionated heparin/other anticoagulants
Term
·         +
Definition
Sedatives
Term
Prior to Giving Med thru NG tube:
Definition
check pH, assess gastric residual in stomach
Term
W/ NG tube give meds
Definition
one at a time and dilute w/ 10ml of water
Term
W/ NG tube
Definition
Always flush w/ 15 – 30 mL warm water b/w each med
Term
after giving ALL meds w/ NG tube
Definition
flush tube once more with 30 – 60 mL warm water
Term
W/ NG tube elevate patient’s head for _________
Definition
45 min after meds given
Term
For tablets:
Definition
need to know onset
Term
For sublingual administered meds:
Definition
have pt place med under tongue and allow it to dissolve completely – do not swallow tab
Term
For Buccal meds:
Definition
have pt place med in mouth against cheek until dissolves – avoid liquids until dissolved- behind last molars
Term
For powdered meds:
Definition
mix w/ liquids at bedside and give to pt to drink
Term
Give effervescent powders and tabs
Definition
immediately after dissolving
Term
For highly acidic meds (aspirin), offer client
Definition
nonfat snack (crackers) if not contraindicated by client’s condition.
Term
Administer Nasal Drops:
Definition
assist pt to supine position and position head properly-Support pt’s head w/ non-dominant hand; Instruct pt to breathe through mouth; Hold dropper 1 cm above nares and instill prescribed number of drops toward midline of ethmoid bone; Have pt remain in supine position 5 minutes; Offer facial tissue to blot runny nose, nut caution pt against blowing nose for several min
Term
For access to posterior pharynx
Definition
tilt pt’s head backward
Term
For access to ethmoid/sphenoid sinus
Definition
tilt head back over edge of bed or place small pillow under pt’s shoulder and tilt head back
Term
For access to frontal/maxillary sinus;
Definition
tilt head back over edge of bed w/ head turned toward sided to be treated
Term
Administer ear drops:
Definition
Place client in side-lying position with ear to be treated facing up; Straighten ear canal by: adult – pull up and back/ baby – pull ear down & back; Instill prescribed drops holding dropper 1 cm above ear canal; Ask client to remain in side-lying position 2 – 3 min. apply gentle massage or pressure to tragus of ear w/ finger unless contraindicated due to pain.; If cotton ball is needed, place cotton ball into outermost part of canal. Do not press cotton deep into canal. Remove cotton 15 min later.
Term
Administer ear irrigation:
Definition
Assess the tympanic membrane or review medical record for history of eardrum perforation, which contraindicates ear irrigation; Assist client in assuming sitting or lying position with head tilted or turned toward affected ear. Place towel under client’s head & shoulder, and have client hold kidney-shaped basin under affected ear.; Fill irrigating syringe with solution (appx 50 mL); Gently grasp auricle, straighten ear canal by pulling it down and back (children) or upward and outward (children 4 - adult); Slowly instill irrigating solution by holding tip of syringe 1cm above opening of ear canal. Allow fluid to drain out during instillation. Continue until canal is cleansed or all solution is used.
Term
Administer vaginal suppository:
Definition
Remove suppository from foil wrapper and apply liberal amt of sterile water-based lubricating jelly to the rounded end. Lubricate gloved index finger of dominant hand.; With non-dominant gloved hand, expose vaginal orifice by gently retracting labial folds.; With dominant gloved hand, gently insert rounded end along posterior wall of vaginal canal entire length of finger to ensure equal distribution of medication along walls of vaginal cavity.; Withdraw finger, and wipe away remaining lube.
Term
Administer cream or foam:
Definition
Fill cream or foam applicator following directions on pkg.; With non-dominant gloved hand, expose vaginal orifice by gently retracting labial folds; With dominant gloved hand, insert applicator appx 5 – 7.5 cm (2 – 3 in) push applicator plunger to deposit med into vagina to all equal distribution of med.; Withdraw applicator and place on paper towel. Wipe off residual cream.Dispose of supplies, remove gloves, and perform hand hygiene.Instruct client to remain on back for at least 10 min to allow med to be distributed and absorbed evenly throughout vaginal cavity and not lost thru orifice. Document med administration on MAR. Offer client perineal pad when she resumes ambulation. Evaluate client’s response to med and inspect appearance of discharge of vaginal canal and condition of external genitalia between applications.
Term
Administering rectal medications
Definition
Put on clean gloves; Assist client to Sims’ position. Keep client draped with only anal area exposed. Be sure there is adequate lighting to visualize anus. Examine condition of anus externally and palpate rectal walls as needed. Dispose of gloves if soiled. Apply new pair of clean gloves. Remove suppository from wrapper and lubricate rounded end. Lubricate index finger of dominant hand. Ask client to take slow deep breaths thru mouth and relax anal sphincter. Retract buttocks with non-dominant hand, insert suppository gently thru anus, past internal sphincter and against rectal wall, 10 cm (4 in) in adults, 5 cm (2 in) in children and infants. Apply gentle pressure to hold buttocks together if needed to keep med in place. Withdraw finger, and wipe anal area with tissue. Dispose of supplies, remove gloves and perform hand hygiene. Ask client to remain flat or on side for at least 5 min to prevent expulsion of suppository.   If suppository contains laxative or fecal softener, place call light within reach. Document med administration on MAR. Observe for effects of suppository at times that correlate with the med onset, peak and duration.
Term
IM always ______ 1st?
Definition
Aspirate
Term
Sub-Q; Stay away from:
Definition
Scars and damaged adipose tiussue
Term
EYE drops go in_______
Definition
lower conjunctive gap
Term
A student nurse ___________ take a verbal order.
Definition
cannot
Term
Always check blood glucose level _______ to giving insulin
Definition
prior
Term
Medication reconciliation
Definition
verify, clarify, recocile, transmit
Term
______ do not handle med orders
Definition
AP
Term
Nursing Diagnosis related to med admin
Definition
knowledge deficit, non-compliance
Term
PINCH + drugs are high risk. Never give in ___________ IV
Definition
undiluted
Term
Topical route
Definition
wear gloves, clean skin bf and af, label patch
Term
EYE drops
Definition
wait 10-15 min bt different eye drop meds
Term
EAR drops
Definition
up for adults/ down for kids
Term
Nurse ERR article
Definition
30 bf/ af is too short. Greater risk of errors
Term
Narcotic wasting article
Definition
unwitnessed wasting is a violation of NPAs. Can be arrested by DHEC. Dispose of narcotics immediately!
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