Chapter 13 Administration Procedures

1. Chapter 13 Administration Procedures

2. General Safeguards in Administering Medications • Oral medications: • Hand washing • Wear gloves when possible exposure to blood or body secretions • Injections • Hand washing and gloves • DO NOT recap needles

3. General Safeguards in Administering Medications (cont.) • Hand washing and gloves • Heparin locks, IV catheters, IV needles • Secondary administration sets or IVPB sets • Application of medication to mucous membranes • Skin applications

4. Masks • Strict or respiratory isolation procedures • Splash directly into face, eyes, or mucous membranes • Aerosolization of fluids

5. Needles • Discard in appropriately labeled, puncture-proof containers • DO NOT break, bend, or recap needles after use

6. Mobile Cart System • Place the patient’s drawer on the top of cart. Read each medication order and choose unit dose from the drawer and compare the label with the order. • After comparing the order with the unit measure, compute the dose. Then open or prepare the unit dose and pour the amount. • Label the unit dose, read the order again, and verify the dose. After preparing all the patient’s medications, read the name on the medicine sheet, check the patient’s ID band, and administer the drugs.

7. Oral Medications • Check expiration dates • Check for allergies • Check with MD if certain drugs are administered when patient is NPO • Do not touch stock medications with hands • Do not break tablets that are not scored • Do not crush enteric-coated tablets

8. Question Which medication can be broken in half or opened when a patient has difficulty swallowing the oral medications? A. Time-released capsule B. Enteric-coated tablet C. Film-coated tablet D. Scored tablet

9. Answer D. Scored tablet • A scored tablet can be broken in half. Don’t crush enteric-coated or film-coated tablets, and don’t open capsules. Doing so would compromise the medication in a time-released capsule.

10. Liquid Medications • Shake liquid medications thoroughly before pouring • Pour liquids at eye level • Wipe the lip of the bottle with a paper towel before recapping • Disguise liquids if distasteful or irritating • Juice • Straw • Don’t dilute liquid cough medicines

11. Parenteral Route • Adult maximum one site • 3 mL • 2 mL deltoid • Angle of insertion • IM 90 degree • SC 45 degree and 90 degree subcutaneous fat and needle short

12. Needles for Injection • Subcutaneous: 25, 26, 28 gauge • IM children and emaciated patients: 25, 26, 28 gauge • Intradermal: 26 gauge or other fine needle • IM injections: 22 and 23 gauge • IV therapy: 20 and 21 gauge • Blood transfusion: 16 and 18 gauge

13. Preparing the Dose • Vials • Ampules • Unit dose cartridge and holder • Unit dose prefilled syringes

14. IM Injection Sites • Adult • Dorsogluteal • Ventrogluteal • Vastus lateralis • Deltoid • Children • Vastus lateralis • Dorsogluteal over 5 years of age

15. Question Is the following statement true or false? • The preferred site for a toddler who has been walking for two months is the dorsogluteal site.

16. Answer False • The preferred site for infants is the vastus lateralis. After the child has been walking for more than a year, you can use the dorsogluteal site; however, that site is not recommended for children younger than 5 years.

17. Administering Injections • General principles • Subcutaneous heparin • Subcutaneous insulin • Z track technique for intramuscular injections

18. Medication Administration Techniques • Skin and mucous membrane • Ear drops • Adult: Pinna up and back • Child: Pinna down and back • Rest on unaffected side for 10 to 15 minutes • Eye drops or ointment • Drops: lower conjunctival sac • Ointment: spread inner to outer cantus of eye

19. Nasogastric Route • HOB elevated 30 degrees • Check placement • 15 mL of air • Aspirate stomach contents • Check acidity of stomach contents • Flush at least 30 mL of warm water to ensure patency

20. Medication Administration Techniques • Nose drops • Rectal suppository • Respiratory inhaler • Skin applications • Nitroglycerin ointment • Transdermal disks, patches, and pads • Sublingual tablets

21. Question A patient is experiencing chest pain and takes a nitroglycerin sublingual tablet. What is the maximum number of tablets the patient can take before calling the physician? A. One B. Two C. Three D. Four

22. Answer C. Three • The most common sublingual medication is nitroglycerin, which is prescribed to alleviate symptoms of angina pectoris. If a patient does not feel relief within 5 minutes, the patient can administer a second and then a third tablet at 5-minute intervals. If the pain continues after 15 minutes, the physician must be notified.

23. Medication Administration Techniques • Vaginal suppository or tablet • Vaginal cream

24. Neonatal and Pediatric Considerations • Offer popsicle to numb taste buds • Mix with pureed fruit, ice cream syrup • Pinch nostril close and drink medication through a straw • Distract child with conversation or toy • Use decorative adhesive bandage to cover injection site

25. Geriatric Considerations • Offer popsicle to numb taste buds • Mix with pureed fruit, ice cream syrup • Injections • Predetermine injection site • Insert the needle quickly • Inject the medication slowly