Chapter 10 Administration Procedures

1. Chapter 10 Administration Procedures

2. Three Checks and Six Rights Three Checks When Preparing Medications Read the label: 1. Check the drug label with the medication administration record (MAR) when removing the container or unit-dose package. 2. Check the drug label again immediately before pouring or opening the medication, or preparing the unit-dose. 3. Check the drug label once more when replacing the container and/or before giving the unit-dose to the patient/client.

3. Three Checks and Six Rights Six Rights Before Administering Medications 1. Right medication 2. Right patient/client 3. Right dosage 4. Right route 5. Right time 6. Right documentation

4. Medication Orders • **A correct medication order or prescription bears the patient/client’s name, room number, date, name of drug (generic or trade), dose of the drug, route of administration, and times to administer the drug • It ends with the signature of the physician or healthcare provider ordering the drug • *If a client refuses it, write the reason and the time you notified the MD

5. Types of Orders 1. Standing order with termination. Example: Keflex (cephalexin) 500 mg PO every 6 hours × 7 days 2. Standing order without termination. Example: digoxin (Lanoxin) 0.5 mg PO every day 3. A prn order. Example: morphine 2 to 4 mg IV q 4 h prn pain 4. Single-dose order. Example: atropine 0.3 mg subcutaneous 7:30 a.m. on call to OR 5. Stat order. Example: morphine sulfate 4 mg IV stat 6. Protocols. Example: for K <3.5, K 20 mEq PO q 4 hour × 2 days

6. General Safeguards in Administering Medications • Oral medications • Handwashing • Wear gloves with possible exposure to blood or body secretions. • Injections • Handwashing and gloves • DO NOT recap needles.

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

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

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

10. Mobile Cart System • Place the patient/client’s drawer on the top of the cart. Read each medication order, and choose the unit-dose from the drawer and compare the label with the order. • After comparing the order with the unit measure, compute the dose. Check the drug label, then open or prepare the unit-dose, or pour the amount of a liquid medication. • Label the unit-dose, read the order again, and verify the dose. After preparing all of the patient/client’s medications, read the name on the medicine sheet, check the patient/client’s identification band, and administer the drugs.

11. Oral Medications • Check expiration dates. • *Check for allergies. • *Check with the physician if certain drugs are administered when the patient/client is NPO (nothing by mouth). • *administer irritating meds with meals • Do not touch stock medications with hands. • Do not break tablets that are not scored. • Do not crush enteric-coated tablets.

12. 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.

13. Parenteral Route • Adult maximum one site • 3 mL • 2 mL deltoid • Angle of insertion • Intramuscular (IM): 90-degree angle • Subcutaneous: 45-degree angle; use a 90-degree angle if the subcutaneous layer of fat is thick and the needle is short

14. 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

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

16. Mixing meds • *technique

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

18. Administering Injections • General principles • Subcutaneous heparin • Subcutaneous insulin • Z-track technique for IM injections • *if blood enters syringe, withdraw needle and discard, prepare another injection! • *Ztrack-Change needle,Add 0.2 ml of air,Inject at 90 degree angle, After give injection-wait 10 seconds IV-sites*

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

20. *Nasogastric Route • Head of bed 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.

21. Medication Administration Techniques • Nose drops • Rectal suppository • Respiratory inhaler • *wait 1 minute, shake inhaler, and puff • Skin applications • Nitroglycerin ointment • *select nonhairy site, don’t rub, recheck BP in 30 min • Transdermal disks, patches, and pads • Sublingual tablets

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

23. Neonatal and Pediatric Considerations • *Offer a popsicle to numb the taste buds. • Mix with a teaspoon of puréed fruit, ice cream, or syrup. • Pinch the nostril closed and drink medication through a straw. • Distract the child with conversation or a toy. • Use a decorative adhesive bandage to cover the injection site.

24. Geriatric Considerations • Offer a popsicle to numb the taste buds. • Mix with a teaspoon of puréed fruit, ice cream, or syrup. • Injections • Predetermine the injection site. • Insert the needle quickly. • Inject the medication slowly.