Week 2- SKILLS AND KEY POINTS airway and drug

5 R’s of drug admin and 3 additional ones

• drug, dose, route , time patient

• reason, documentation, response

3 Checks when grabbing a drug from the kit and 3 point checking with partner?

• Drug

• strength

• expiry date

Liquid and Buccal Oral administration- how are you doing it?

Liquid —> purple syringe, patient sitting, observe they swallowed it

Buccal —> (<2yrs) , put req dose of gel onto gloved finger, retract infant’s cheek and massage onto mucosa, observe until all administered and absorbed

Tablets and ODT how to administer to pt?

Tablet —>pt sitting, place tablet and water in their hands instruct to swallow, make sure they swallowed safely.

ODT- same thing but place on tip of pt tongue, once dissolved, instruct to swallow as normal

How to administer Sublingual drug admin

Sitting or semi reclined, prime bottle spray, instruct pt to open mouth wide lift tongue to roof of mouth, from 3-4cm away, aim nozzle under pt tongue and depress once, wipe down bottle using alcohol swab once finished

Metered Dose inhaler (MDI) with spacer procedure

Shake and prime inhaler by pressing 2x, prep spacer by squeezing it to open, insert inhaler into spacer, pt places lips around mouthpiece, suppress 1x breathe in and out for 4-5x, repeat total of 12 x (12 x 100mcg/depress of inhaler)

What does a spacer for an MDI do?

Ensure higher concentration in lungs, reduced oral pharyngeal disposition (less in mouth)

How many times to breathe after taking a MDI puff?

4-5 breaths

Total amount given of MDI puffer?

12 (12×100microg/depress of inhaler)

What nebuliser oxygen rate for COPD?

6l/min

What nebuliser oxygen rate for asthma?

8l/min

What happens if nebuliser oxygen rate is <6 or >8?

• <6 doesn’t nebulise properly

• >8 blows off drug too quickly

Why must a pt be sitting upright for nebulsation?

If pt was slouching, lying down airway is partially compromised, so ensuring it gets through effectively.

Inhaled methoxyflurane procedure

Tilt inhaler 45 degrees and pour methoxyflurane into base, rotate twisting in hands until internal wick is soaked, start with gentle breaths then normal, close finger over the port for higher conc.

EpiPen procedure?

blue to sky, orange to thigh, can go through clothes, hold for 3 sec, then remove.

How much is EpiPen adult vs Jnr? When do you use Jnr?

• Adult is 300microg

• Jnr is 150microg and for children <6yrs

Drugs need to be drawn up from an ____ into a _____?

Drugs need to be drawn up from an ampoule into a syringe

What size syringe do IM use?

retractable needle with either 1ml or 3ml, bc we have the max 2ml in thigh and max 1ml in shoulder

What size syringe do IV use?

3ml or 10ml syringe

What size syringe does intranasal use?

luerlock 1ml syringe +MAD (mucosal atomisation device)

What are the large and small marks for 10ml syringe?

• large mark 1ml

• small mark 0.2ml

What angle is IM injected at?

90 degree angle (sideways)

What are the large and small marks for vanish point 1ml and 3ml syringe for Intramuscular injections?

1ml —> large mark 0.1ml small mark 0.01ml

3ml —> large mark 0.5ml, small mark 0.1ml

Dead space of extra medication for intranasal admin for unprimed devices?

0.1ml

At what does should you split the medication between nostrils and why?

• >0.5ml split between nostrils

• to INCREASE SURFACE AREA for absorption

At what intransal dosage should you consider alternative route?

>2ml seek another route

What size cannula used for dorsum of hand vs Antecubital Fossa?

• Dorsum of hand- 20g pink for adults

• Antecubital Fossa (larger volumes) 18g (or 16g if clinically indicated)

When priming a giving set, what do you do if air bubbles are present?

Briskly tap the air bubbles until all air expelled