Chapter 35: Medication Administration (Part 2)

1. Chapter 35: Medication Administration (Part 2) Bonnie M. Wivell, MS, RN, CNS

2. PO – Oral SL – Sublingual Buccal Inhalation Nasal Ears, Ears Topical / Skin Application Rectal Vaginal IM - Intramuscular IV – Intravenous SC – Subcutaneous ID - Intradermal Routes Of Administration

3. Process of Administration Identify the client Inform the client Administer the drug Provide adjunctive interventions as indicated Record the drug administered Evaluate the client’s response to the drug

4. Types Oral of Medications • SOLID FORMS • Caplets • Capsules • Tablets • Scored • Gel Caps • Enteric Coated • Extended Release • LIQUID FORMS • Elixir • Extract • Acqueous Solution/ Suspension • Syrup • Tincture

5. Other Oral Forms Troche/ Lozenge Not meant to be swallowed Aerosol Topical Oral Administration Of Medication Cont’d.

6. Oral Administration Swallowed Dissolved in Liquid Crushed and put in applesauce/pudding Crushed and given via tube (pg. 718) Gastric Tube (G-tube or PEG) Enteral Feeding Tube Nasogastric Tube (NG) Always refer to drug book or check with pharmacist before crushing a medication

7. Oral Administration Cont’d. Cutting and Crushing Tablets Do not crush: Enteric Coated Capsules Beads from capsules Cut only “scored” tablets Do not swallow or chew sublingual tabs unless directed to do so

8. Buccal – between the cheek and gums Tablet Semi-Solid Paste Thick Liquid Sublingual – under the tongue Buccal and Sublingual Administration

9. Topical and Transdermal Application Types of meds given topically Anti-arthritis (Heat) Cardiac Meds (NTG Paste) Pain Med (Patch) Fentanyl (Duragesic) Other Patches Nicotine Estrogen Scopolamine What is the prescribed length of time for application?

11. Topical Application • Sprays • Oral • Topical • Nasal • Inhaled • MDI • DPI • Vaginal / Rectal • Suppositories • Creams • Ear Drops • Position ear • Eye Drops • Irrigations

14. Parenteral Administration Intramuscular Subcutaneous Intradermal Intraosseous Intravenous

15. Equipment Syringes Insulin TB Hypodermic

16. Luer Lok vs Non Luer Lok

17. Types of Insulin Pens

18. Parts of Needle

20. Sizes of Needles • Length 3/8” to 3” • Gauge 30 – 19 • 20-22G, 1-1.5” for IM • 25-30G, 3/8-1/2” for SQ

22. Filter Needle

24. Single Dose Ampule

25. Single Dose Vial

26. Multi-dose Vial

27. Insulin Preparation • Rapid, short, intermediate, and long acting • Know onset, peak and duration • ONLY regular insulin can be given IV • Sliding scale based on blood glucose • Gently roll cloudy • DO NOT SHAKE • Prepare last and administer first if mixed because regular can become “contaminated” and action can be affected • CLEAR to CLOUDY

28. Injection Angles

29. Intradermal Injection

32. Intramuscular • PAIN MEDICATION • ANTIBIOTICS • VACCINATIONS • SUPPLEMENTS • IRON • B12

33. IM Injection Sites

34. Deltoid IM Injection Site

40. 3/12/2014 NRS 105.320 W2009 40

44. Carpuject

45. Tubex

46. Where Do You Get IV and Injectable Medications? IV Solutions are standard, mixed for the patient in the pharmacy or ordered from the outside IVPB (IV Piggyback) meds are mixed in the pharmacy Pre-mixed Add-Vantage Injectable Medication Unit dose Carpuject Ampules Vials

47. NEEDLELESS SYSTEMS

48. 3ml Luer Lock Syringe + Clave Adapter

49. Where do Drugs Come From in LTC FACILITY? MEDICATIONS ARE DELIVERED FROM AN OUTSIDE PHARMACY ORDERS ARE FAXED TO PHARMACY MEDICATIONS ARE DELIVERED BY THE PHARMACY SOME STOCK DRUGS AND NARCOTICS ARE ON SITE FOR PRN USE