Medication Administration

1. Medication Administration

2. Automated Medication Administration Equipment • Pyxis • SureMed • MedServe

3. Essential Components of a Medication Order • Client’s Name • Medical Record Number, Room/Bed # • Date & time of order • Name of Medication • Dosage of Medication • Route • Frequency of administration • MD’s signature

4. Six “Rights” of Medication Administration • Right Patient (check name band, ask client their name) • Right Medication • Right Dose • Right Route • Right Time (frequency) • Right Documentation * Client’s also have the right to refuse (say no) to medication

5. The Nurse’s Responsibility for Medication Administration • Assess whether the client can tolerate the meds • Administer meds accurately & timely • Monitor for side-effects • Know contraindications • Client teaching • Practice the “Six Rights”(stressed in clinical) • Evaluation (effectiveness & client response)

6. Types of Oral Medications • Tablets • Capsules • Sublingual • Buccal • Elixirs • Enteric Coated

7. Precise & Safe Medication Administration

8. Rectal Medications • Provide for privacy • Explain procedure to client • Place client in Sim’s position • Apply clean gloves • Lubricate tip, round end inserted first • Encourage client to relax , deep breathe • Insert past sphincter, towards umbilicus • Have client remain on side at least five mins. (hold buttocks together etc.)

9. Rectal Medication Administration

10. Ophthalmic Medications • Place HOB down or low Fowler’s • Provide Kleenex for client • Have client look towards ceiling • Instill meds in conjunctiva (if gtts) • If ointment, apply ribbon from inner to outer canthus • Know od, os, ou routes

11. Topical & Inhalation Medications • Ointments (absorbed via mucous membranes, skin) • Inserted (vaginal) • Instilled (ear/nose gtts) • Lotions • Sprays (nasal) • Pastes (absorbed through skin) • Inhalation (nebulized treatments, MDI)

12. Topical Ointments

13. Otic Medications

14. MDI Medications

15. Medications via NGT/EFT • Determine whether med comes in elixir form • Crush all except for EC meds and mix with water or other liquid medications • Stop feedings, clamp tube, apply syringe, unclamp tube, flush tube with approx. 30cc water • Clamp tube, remove syringe, pull plunger from barrel, reattach barrel, pour meds through barrel • Add water as necessary to keep things flowing smoothly • After all meds have been given, flush with 30cc water, clamp tube, remove syringe, start feedings

17. Documentation Always record: • Date, time & your initials or signature, title (R. Otten, SN,CSUF ) • Medication, route (site) and actual time given • Reason why med was omitted (ie. refused) • Client’s response to the medication

18. Medication Administration Records (MARs)

19. Nursing Considerations for Injection Sites • Assess for adequate tissue & muscle availability/client body wt. • Assess where previous injections have been administered • Assess client restrictions • Assess for quantity & quality of medication to be administered

20. Parts of a Needle & Syringe Syringe: • Barrel • Plunger • Tip Needle: • Bevel • Shaft • Hub

21. Types of Syringes

22. Tips of Syringes Luer-Lok Non Luer-Lok

23. Pre-Filled Systems

24. Assembling the Device

25. Scoop Method

26. Safety Devices

27. Needless Systems

28. Three Types of Injections • Intradermal - Injected into dermal skin layers (Allergy tests, PPDs, etc.) • Subcutaneous - Injected into subcutaneous tissues (Heparin, Insulin) • Intramuscular - Injected into deep muscles (narcotic analgesics, iron)

29. Intradermal Injections • Given in small doses (i.e.. 0.1cc) • Common sites include: RFA, LFA • Use 1cc syringe with 26-27 gauge needle, 1/4 - 5/8 inch long • Administer with needle at 5-15 degree angle with bevel of needle up • Check for “bleb” or “wheal” • Document site in medication book/nurses’ notes

30. Intradermal Injections

31. Subcutaneous Injections • Given in doses of 0.5cc - 1.5 cc • Common sites include: deltoid, abdomen • Deltoid landmarks: Find Acromium Process and go 4 to 6 finger-lengths below • Rotate sites to minimize tissue damage • Use Insulin/TB syringe for these meds • For other SQ meds use 1-3 cc syringe, 25-27 gauge needle, 3/8-5/8 inch length • Insert needle 45-90 degrees

32. Deltoid Injections

33. Vastus Lateralis Injections • Site well-developed in both adults & children, lacks major blood vessels/nerves • Landmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect). • Good for clients with position restrictions

34. Intramuscular Injections

35. Vastus Lateralis

36. Dorsogluteal Injections • Rarely used due to Sciatic nerve risk • Less accessible than other sites (i.e. requires side-lying or turned further) • Landmark: Find Greater Trochanter & Iliac Crest, draw quadrants and administer in upper two quadrants

37. Dorsogluteal Injections

38. What other site is used for IMs?

39. Ventrogluteal • Good for deep injections • Away from blood vessels and nerves • Z-track • Thick, viscous meds • Antibiotics • Large volume • Irritating

40. What if…… when giving an IM injection, the aspirate comes back with blood. • What is the correct procedure and why?

41. Preparing NPH & Regular Insulin • Swab tops of both vials • Inject desired units of air into NPH vial, remove needle and then inject desired units of air into Regular vial • Invert Regular vial and withdraw desired units of insulin (no bubbles) • Insert needle into NPH vial, invert and withdraw desired units of insulin

42. Regular & NPH Insulins

43. Mixing Insulins NPH Insulin Regular Insulin

44. Remember !!! If an IM injection requires the administration of > 3cc of medication, divide the medication up into two equal doses and administer in different sites.

45. Remember !!! Always double-check Insulin & Heparin amounts/doses with another licensed person (RN/LVN/INSTRUCTOR)