Medication Administration

Medication Administration

Core nursing function

• involves skillful technique

• consideration of safety principles

  • consider the patient’s developmental state, individual characteristics, and health status

Nurse ____ needs to have knowledge of drugs

• drug names, preparations, classifications, adverse health effects, and physiologic factors affect drug action

Nurses must have sufficient knowlege about drugs being administered to safely care for their patients

• Joint commission made several recommendations regarding safe practices when administering

Assessment, Diagnoses, Patient-centered outcomes

Nursing process on med administration

_____

• comprehensive med history

• awareness of patient’s allergies

  • vitamins and herbals matter too

• patient ____

• ongoing ___of the patients’s response during and after med administration

  • what does the med do

____

• are developed and problem identification stems from the assessment data

____

• are evaluated after implementation of the plan of care

• are tailored to patient’s needs

Drug Nomenclature

Generic name (acteamiophin) vs Trade name (tylenol)

the systematic naming system used to identify pharmaceutical drugs

Drug Preparations

Enteral (oral)

• entering mouth

• capsule, pill, tablet, extended release, elixir, suspension, syrup

Topical (suppository, drops)

• entering skin, blood, eyes, ears

• Liniment, lotion, ointment, transdermal patch

• suppository

  • solid or semi-solid medication dosage form designed to be inserted into a body orifice (rectum and vagina)

Parenteral (injection, infusion, implantation) administration

• Need a needle (don’t play with needles, ask parental units)

• delivery of medications or fluids directly into the body through injections or infusions, completely bypassing the gastrointestinal (GI) tract and liver first-pass metabolism

• Injectable, infusion, implantation

Drug Classification

Classified by effect on body system, chemical composition, clinical indication or therapeutic action

Pharmaceutical

• what is it doing in your body

• Describes how the drug works at a molecular or cellular level, including its mechanism of action

• Refers to the mech of action MOA, physiologic effect PE, and chemical structure CS of the drug

Therapeutic

• Describes what the drug does clinically or the condition it treats

• Refers to the clinical indication for the drug or therapeutic action (eg. analgesic, antibiotic, or antihypertensive)

Drug indications

Pharmacotherapeutics

• why the pt is taking, what is the med doing, effect on the body

• study and clinical use of medications to prevent, diagnose, and treat diseases, as well as to alter normal bodily functions.

• combines pharmacology with patient-specific medical knowledge to optimize drug therapy

Pharmacokinetics

• what the body does to a drug

• takes drug to where it needs to go,

• Absorption

• Distribution- relies on bloodstream and proteins

• Metabolism- how it gets filtered and broken down (biotransformation = how much of the drug is available for you), OLDER people have slower metabolism (lower med doses)

• Excretion

Pharmacodynamics

• What a drug does to the body, including receptor interactions, agonists, antagonists, potency, and efficacy

Drug action

Factors affecting ___

• developmental concerns

• body weight

• biological sex

• cultural and genetic factors

• psychological factors

• pathology

• environment

• timing

Drug blood level monitoring

• therapeutic range

  • want to find the happy medium

• half life

Cpertinent US drug legislation

Chemical name

Identifies drug’s atomic and molecular structure

generic name

assigned by the manufacturer that first develops the drug; derived from the chemical name

Official name (monograph)

name by which the drug is identified in official publications (typically generic name)

Trade name

brand name copyrighted by the company that sells the drug

absorption

factors affecting ___ of meds

• route of administration

• lipid solubility

• pH

• blood flow

• Local conditions at site of administration

• Drug dosage

Distribution

Occurs after a drug has been injected or absorbed into bloodstream, the drug molecules are transported throughout the body to where they take action Metabolism and excretion occur after ____

Depends on

• adequacy of blood circulation

• protein binding, which affects the drug’s ability to leave the blood stream or storage areas (such muscle, fat, or other tissues) and enter the cells

• selectively permeable BBB that protects the CNS with its capillary wall but can also limit the passage of drugs intended to act on CNS

• be careful with pregnancy

Metabolism

Biotransformation is the change of an active drug from its OG form to an inactivated or new form

The liver is the primary site for drug ____. Various processes and enzymes are involved ____. Most drugs are inactivated by the liver and transformed to inactive substances for excretion

• physiologic changes associated with aging, the presence of liver disease, or other factors that impair functioning of liver decrease its ability to metabolize drugs

• GI tract, lungs, kidneys also have role in drug metabolism

Drugs given orally move from the intestinal lumen to liver by way of portal vein

some drugs are extensively metabolized in the liver and do NOT make it to systemic circulation. This reduction in bioavability is referred to as the first pass effect or pre systemic metabolism

• such as nitroglycerin are not given orally b/c most of the durg would be detroyed by the liver with little or no drug left to work in body. It is only given via sublingual, transdermal, or IV routes

• some drugs are metabolized by liver to inactive form, reducing amount of active drug left in body

• other drugs may be metabolized to active drug metabolite (another form) and may be more active than the OG drug

Excretion

Process of removing a drug, or its metabolites (products of metabolism) from the body

• kidneys excrete most drugs through urine

• Lungs are the primary route for excretion of gaseous substances such as inhalation anesthetics

• Bile- either directly through feces or returned to liver and then eventually excreted by kidney

• skin has minimal excretory function

Some meds may be contraindicated or dosages may need to be adjusted

• if renal ___ is impaired, Changes associated with aging, disease or presence of other factos that impair the functioning of the kidney can decrease their ability to excrete drugs

• Manufactures are required by law to include specific info regarding implications for specific populations, including geriatric or prego patients, on the package inserts of prescription drugs and bio products

• Of particular concern are details concerning the ___ of these drugs in older adults whose renal function has declined

Pharmacodynamics

Process by which drugs alter cell physiology and affect the body

Drugs turn on, turn off, promote, or block responses that are part of the body’s processes

Drug receptor interaction occurs when the drug interacts with 1 or more cellular structures to alter cell function

Drugs may also combine with other molecules in the body to achieve their effect

other drugs act on cell membrane or alter cellular environment to achieve their effect

Adverse Drug Reactions ADRs

Side effects: ADRs

• allergic effects: anaphylactic reaction

• drug tolerance

• toxic effect

• idiosyncratic effect

  • rare, unpredictable, and severe adverse reaction that occurs in only a small percentage of people taking a medication or treatment

• Drug interactions: antagonistic and synergistic effects

Adverse Druge Events ADEs

• According to FDA criteria, serious ADE is defined as an action that is life threatening, requires intervention to prevent death or permanent impairment and/or leads to death, hospitalization, disability, or congenital anomaly

  • must be documented

  • report to a national database like MedWatch

Allergic Effect

Immune system response that occurs when the body interprets the administered drug as a foreign substance and forms antibodies against the drug

• drug allergy manifests differently depending on the drug, allergy, and patient

• Clinical manifestations of allergic reactions range from mild to severe

• the rxn can occur immediately after the patient receives the med or be delayed for hrs to days

• Symptoms may become more severe each time the drug is introduced into the body

IV

Med that does NOT go through liver, is 100% all drug

Allergic Reaction

Signs and symptoms of a drug allergy

• rash, urticaria (raised, red, or skin-colored welts (wheals) that are typically very itch), fever, diarrhea, nausea, vomiting

Anaphylactic rxn (anaphylaxis)- most serious allergic effect

• Anaphylaxis is life threatening and results in resp distress, sudden severe bronchospasm, and cardiovascular collapse

• This rxn is treated with vasopressors, bronchodilators, corticosteroids, oxygen therapy, IV fluids, and antihistamines

Drug tolerance

Occurs when the body becomes accustomed to the effects of a particular drug over a period of time

Larger doses of the drug must be taken to produce the desired effect

• For ex: patients using morphine for extended period of time become tolerant to drug’s therapeutic effects and eventually need higher and higher doses to control their pain

Toxic Effect

Toxicities are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death

• nephrotoxicity or damage to the kidney

Toxicities can occur from a cumulative effect, A mismatch between absorption and excretion means that each new dose increased the total quantity in the body

Older adults are especially at risk for experiencing cumulative effect

• this is related to altered drug metabolism and elimination due to impaired hepatic metabolism and renal clearance related to normal changes in these systems associated with aging

Idiosyncratic Effect

Paradoxical effect is any unusual or peculiar response to a drug that may manifest itself by overresponse, under response, or even the opposite of the expected response

Related to a patient’s unique response to a drug and are though to be the result of genetic enzyme deficiencies that lead to an abnormal mech of drug breakdown

Term may become obsolete as ADR reporting continues and specific mechs of ADRs are discovered

Older adults often have unpredictable or erratic responses to meds

Drug Interactions

Occur when 1 drug is affected in some way by another drug, food, or another substance that is taken at same time

Meds are given together when their actions are synergistic or when one drug potentiates (increases) the therapeutic effects of another drug. Or decreases the therapeutic effect and/or increases the adverse effects

Additive effect - drugs with similar pharmacologic actions, results in an increase in the overall effect

• Synergistic effect= drugs with different sites or MOA; results in greater effects when taken together (one drug potentiates the other)

• Antagonistic effect = combined drugs alter the overall sum effect or negate each other

  • results in an effect less than that of each drug alone, interference = one drug interferes with the metabolism of another

  • Leads to the buildup of a med (that cannot be metabolized) and can result in toxicity or an ADR displacement = one drug binds to protein binding sites and forces another drug to be displaced

  • Results in the released drug becoming pharmacologically active and can lead to an increase in effect of the unbound drug

Dietary supplements, herbs, and other natural remedies are another potential problem area for drug interactions

• when asking pt. if they are taking any meds, ask if they are taking any herbal or natural supplements

• health care providers need to identify viable resources and be aware of the intended benefits, possible adverse effects, potential drug interactions, and perioperative implications related to these types of supplements

enteric coated, extended

Can NOT crush ___ meds or ____ release meds

Therapeutic Range

Concentration of drug in the blood serum that produces the desired effect without causing toxicity

Provides the desired medical benefit without causing severe toxicity or side effects

Peak level

Highest plasma concentration of a drug

measured after a dose is administered

Trough level

point when the drug is at lowest concentration, indicating the rate of elimination

• Typically drawn 30 min before the next dose is scheduled to be administers

Half-life

amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

• When a drug is given at consistent dose, it takes 4 or 5 half lives to achieve a steady concentration and develop balance between tissue and serum concentrations. This is when max therapeutic effects occur

Calculations

Dimensional anlysis

Standing Order

Routine order

Carried out until cancelled by another order

PRN

___ order: as needed

Single or one-time order

prescription instruction to administer or dispense a drug just once at a specific time

Stat

___ order: carried out immediately

emergency,

laxatives/diretics often used for severe edema

Parts of med order

• Patient’s name

• Date and time order is written

• Name of drug to be administered

• Dosage of drug

• Route by which drug is to be administered

• Frequency of administration of drug

• Signature of person writing the order

Always do read back when taking verbal orders

Medication Supply Systems

Stock supply

Individual unit dose supply

med cart

computerized automated dispensing system

Bar code- enabled med cart BCMA

NEED TO SCAN, errors happen if not and you can get in trouble with Pharm

3 checks of med administration

Read the label

• when the nurse reaches for the container or unit dose package

• After retrieval from the drawer and compared with the eMAR/MAR or compared with the eMAR/MAR immediately before pouring from a multi dose container

• Before giving the unit dose med to the patient or when replacing the multi-dose container in drawer or shelf

_____

1. First Check

• When it happens: As you take the medication out of the storage drawer, automated dispensing cabinet, or supply bin.

• What to do: Compare the label of the medication directly against the MAR or physician's order to verify the right patient, drug name, dose, route, and expiration date.

2. Second Check

• When it happens: While preparing, pouring, drawing up, or opening the medication (outside the room or at the prep station).

• What to do: Recheck the medication label against the MAR to ensure the dosage, calculation, and form are exact.

3. Third Check

• When it happens: At the patient’s bedside just before administering the medication (or when returning the stock/unused container).

• What to do: Verify the patient's identity using at least two unique identifiers (such as name and date of birth) against the MAR and allergy band, and perform a final comparison of the medication label against the MAR

Rights of med administration

1. Right med

2. Right patient

3. Right dosage

4. Right route

5. Right time

6. Right reason

7. Right assessment data

   1. Go back after 60 min and reassess pain

8. Right documentation

9. Right response

10. Right to education

11. Right to refuse

Required info

___ for controlled substances

• Name of patient receiving controlled substance

• Amount of substance used

• Hour controlled substance was given

• Name of prescribing provider

• Name of nurse administering substance

Identifying

____ the patient

• checking the ID bracelet

• Validating patient’s name (first identifier)

• Validating patient’s ID number, med record number, and/or birth date (2nd identfier)

• Comparing with the EMAR or MAR

• Asking patient to state his or her name if able

Documentation

Med record ___

• name and dose of med

• route and time of administration

• name of person administering med

• site used for injection

• location of topical or transdermal application

• Naris, eye, or ear used for those administrations

• Intentional or inadvertently omitted drugs

  • document reason it was not given

• Refused drugs

  • document the refusal

• med errors

  • sometimes they happen, not going through career w/o med error

  • CHECK PATIENT 1st! then notify dr.

med errors

Types of ____

• Inappropriate prescribing of the drug

  • Drs prescribe, you unsure what it is and give too high a dose

  • NOT SURE = Look it up

• Extra, omitted or wrong doses

• administration of drug to wrong patient

• administration of drug by wrong route or rate

• Failure to give med within prescribed time

• incorrect preparation of drug

• improper technique when administering drug

• Giving drug that has deteriorated

If ___ occurs

• Check patient’s condition immediately, observe for adverse effects

  • tell the pt. what is happening

• Notify nurse manager and primary care provider

• Complete form used for reporting errors, as dictated by facility policy

  • special event, event, unusal occurrence report

Ways to prevent ___

• Med reconciliation

• Read labels at least 3X and compare to MAR

• Prepare meds for 1 patient at a time

• use at least 2 patient identifiers

• Follow your rights of administration

• Review and verify allergies

• Reporting

• Educate and involve patient when administering meds

• Errors occur when nurses “work around” tech (overrides or BPA)

• Double check calculations of high alert meds and verify with another RN: insulin, heparin, infusion

• Question unusually small or large doses

  • probably wrong

Patient Teachings

Review techniques of med administration

Remind patient to take med as prescribed for as long as prescribed

Instruct patient NOT to alter dosages without consulting physician

Caution patient NOT to share meds

WARRIORS card; always educate

teach about med when you give it

• address key info, what is it? why prescribed? how long will they have to take it? when?

• provide easy to read education sheets

• provide schedule (pill box)

• provide care giver with same info

• allow time for questions

Oral

Routes of administration:_____

• solid form: tablets, capsules, pills

• Liquid form: elixirs, spirits, suspensions, syrups

• Oral route: having patient swallow drug

• Enteral route: administering drug through enteral tube

• Sublingual administration: placing drug under tongue

• Buccal administration: placing drug between tongue and cheek

PO

Oral abbreviation: most common, slower onset

• given with fluid or food

• Absorbed in GI tract

• need to assess ability to swallow, do they have gag reflex, persistant N/V?, LOC?

• NPO?

• Check med was really swallowed

  • some “pocket it” in cheeks

  • Difficulty swallowing alternatives?

  • Don’t just leave med at bedside, watch them take it

• Make sure patient is sitting up to prevent choking

• Some patients like to hand them one pill at time or put i their mouth.

• Tell them what pills you are giving them and what it’s for, open in front of them

Sublingual

Placed under the tongue

• Nitroglycerin, some ped meds

Buccal

in between back teeth and cheek— very vascular

• some opioids/seizure meds

• Rapid absorption into blood stream by avoiding GI tract

• Do NOT give any liquid

Liquid

___ meds: available in syringe, multi-dose vial with dropper, single dose

Should be shaken before pouring dose (if applicable)

• remove cap and place facing up

• cover label to avoid destruction in case of spill

• place med cup at eye level before pouring

• If you go over the intended dose, correct it. do NOT pour it back into the bottle-discard it

• make sure bottle is clean before recapping

Enteral

Gastric tube or naso-gastric tube (GT or NGT) meds should say GT

Med administration through an artifical tube (NG tube, gastrostomy tube, etc)

EnFit connectors

Topical

Application to skin has slow absorption b/c of physical makeup of skin

Meds placed on the mucous membranes and resp airways are absorbed quickly b/c these tissues contain many blood vessels

Inhalation

Metered Dose Inhaler MDI

Rapid absorption and relief for breathing difficulties and anesthesia

Given during inhalation. Spacer may be used for patients that have difficulty

If multiple inhalers: give bronchoDILATOR first. want to give corticosteroids last and rinse out mouth after. This will prevent fungal infection

Nebulizers: liwuid med placed in dispenser and inhaled through mask

Nasal

___ drops

• gloves

• tilt head back flat or supine

• stay for 1-2 mins

• not sterile but maintain asepsis

• clean tip off after use

___ sprays

• sitting up or with head tilted

• spray during inhalation

Otic

Ear drops

• treats ear infections or softens wax

• Drops should be room temp

• Side-lying, ear up, drops alongside canal

• gently massage the tragus to move med if needed

• stay on side about 5-10min

Transdermal

skin

• absorbed through skin

• Rotate sites- include date, time and initials on patch

• Do NOT place on abrasions unless ordered that way

Ophthalmic

Eye drops

• gloves

• tilt head back

• wipe eyes if secretions

• apply drops to conjunctival sac

• Apply pressure to naso-lacrimal duct

If ointment: apply from inner canthus to outer canthus

Apply pressure (or have patient) to inner canthus for a minute to stop it from going into tear duct

Wipe away any excess on the outside of eye

Do NOT touch the tip of applicator/dropper to eye

Multiple meds: wait 5 mins in between

Rectal

____ meds (PR): suppositories-antipyretic (fever), laxative or stool softener

• given b/c relief is needed quickly. Vascular area

Postion patient on Left side with upper leg flexed (gravity helps here towards the colon)

You WILL wear gloves and unwrap the suppository

Add lubricant to rounded end of suppository

Patient can take a deep breath and exhale 1st

Proceed to insert into the rectum at least 1 in past the anal sphincter

Vaginal

Foams, creams, liquids, gels, suppositories used for infection or contraception

Gloves! May have to perform peri-care 1st. Position in lithotomy position on pad in case of secretions

Best to do at bedtime to allow med to remain in place

do NOT use tampons

Enteral Tubes

Name these

NG

____ tube

Levin tube

Flexible rubber or plastic single lumen

You can add connector for feeding and med administration

These tubes are INflexible and cause patient discomfort

Salem Sump Tube

Flexible double-lumen tube

Allows for air to escape and suction to occur

You can add connector for feeding and med administration

These are NOT for long term use

Single

Nasogastric (____ lumen) Sobhoff

Verify correct placement prior to use

• nose to ear then ear to xiphoid process

Med administration

enteral feedings

Has a single, narrow internal channel.

• Best for: Long-term enteral feeding and nutrition, where gastric suction is not required

Nasto-intestinal

Duo tube

It features two separate channels inside a single nasal entry path:

• Gastric Lumen (wider bore/sump): Siphons or suctions fluid and gas from the stomach to reduce gastric pressure, prevent vomiting, and lower aspiration risk.

• Intestinal/Jejunal Lumen (narrower bore): Extends past the stomach down into the duodenum (nasoduodenal, ND) or the jejunum (nasojejunal, NJ) to deliver liquid nutrition or medications directly into the small intestine.

PEG

flexible feeding tube placed directly through your abdominal wall into your stomach to deliver nutrition, fluids, and medications

Percutaneous Endoscopic Gastrostomy

J or GJ tube

Feature	J-Tube (Jejunostomy Tube)	GJ-Tube (Gastro-Jejunostomy Tube)
Where it goes	Bypasses the stomach entirely and ends in the jejunum.	Enters the stomach and threads a thin tube further down into the jejunum.
Number of ports/lumens	Single port/route for feeding into the intestine.	Dual ports: a G-port (in the stomach) and a J-port (in the jejunum).
Stomach access	No direct access to the stomach for venting or medications.	Allows simultaneous stomach venting/drainage (G-port) and intestinal feeding (J-port).
Best used when	The patient needs direct intestinal feeding and does not require stomach access.	The patient needs jejunal feeding plus the ability to vent air/fluid or give specific meds via the stomach.

Kangaroo Pump

medical device used for enteral nutrition (tube feeding) to deliver liquid formulas, water, and flushes directly into a patient's stomach or small intestine

Tube administration

Enteral

Each med should be crushed separately and administered separately

Checking placement of NG tube

• X-ray

• marking at nose after confirmation

Checking residuals

Flush orders

Patient elevated in Semi-Fowlers or Fowlers position for at least 30 min

• suction

Patient is on fluid restriction

Make sure you document on I&O

Suggestions

___ for preparing and administering meds through enteral feeding tube

___ have been consistent for the past 10-15yrs

• Verify current feeding tube’s placement (distal location) and patency- note tubes that terminate in stomach can tolerate larger boluses than tubes in intestines

• verify dosage form, drug, formulation, and any preparation steps with the prescription/order

• Use liquid meds if they are appropriate for enteral administration

  • in liquid med not specifically formulated for enteral administration, sugars, preservatives and agents that thicken solution may cause GI disturbances and impact med absorption

  • Dilute thick suspensions as needed typically with equal parts med and water

• Certain immediate release solid dosage med can be crushed and made into slurry. grind meds to fine powder and mix with 30mL of purified water immediatly before administration through tube

• certain capsules may be opened, powder emptied into water and med administered through tube check manufacter recs and pharmocy

• attach clean oral/enteral syringe for administering flushes and meds

• flush tube with at least 15ml of water before each med and after med to maintain tube patency

• give meds seperatly and flush with water between each, may not be physcially or chemically compatible

• keep med adminstration awasy from suction and clamped for 30min after adminstartion of med to allow absorption

• check compatability of med with tube feeds, may need to discontiune feeds

• document total water and liquid med volume on intake and output record

• adjust water if intake restrictions, follw policy on enteral feeding tube med adminitster

• collaborate with other IPs

(Desired / Have) X Supply = x

What is the formula to calculate how much med to give

Syringe

Parenteral

equipment

____: single use, appropriate size

• use smallest possible

• sizes range .5ml to 60ml

• accuracy

• maintain sterility while filling

hand-operated device that holds, pushes, or draws in fluid,

Needle

Parenteral

equiptment

____: single use, appriate size

• different sizes and lengths for areas of body

3 parts

• hub

• shaft

• bevel or slanted tip

sharp, hollow metal instrument attached to it that actually pierces the skin or tissue

Routes

Parenteral ____ of administration

Intradermal

• shallow into dermal layer (just under epidermis)

Subcutaneous

• subcutaneous tissue, just below the skin

Intramuscular

• into muscle of adequate size

Vial

Preparation of med: ____

• hand hygiene

• ___ contains single or multiple doses

• Withdraw med with filter needle of blunt needle (rubber stopped dull needle)

• Remove cap (discard), scrub with alcohol wipe

• Inject air into ___ equal to amount of fluid to be withdrawn (inject air into air_

• Invert ___ and remove amount of med (keep needle in solution)

• Tap syringe to remove air

• Replace cap (scoop method) and remove filter needle and apply needle for injection. Keep needle hub and tip of syringe sterile

Ampule

Prep of med: ___

• hand hygiene (wear glove)

• USe filter needle to prepare the med and replace when adminstering (removes glass from___)

• Tap top of ___ (ensures all fluid is in the bottom)

• Wrap alcohol wipe or gauze around neck of ___ and snap neck

• Remove med (can invert to remove the med or keep flat surface)

• Tap syrine- causes bubbles to rise toward needle

• Recap (scoop method), reomve filter needle, replace with approatiate needle for injection

• Discard ___ and filter needle in sharpes

SQ (subcutanous)

Prep of med: ___

___ injections

Sites

• abdomen- 2 inc away from umbilicus, incisions, stoma, wound

• Lateral aspect of upper arms

• Thigh (hand from grown and knee)

• Scapula and upper gluteal areas (less commonly used)

Needles

• 1-3mL

• gauge 25-27, length 1/8-5/8in

• Insulin syringe for administration of insulin only

• Don gloves

• choose appropriate site for administration

• Cleanse skin with alcohol and allow to dry

• Inject, dart like action, slowly inject med

• Withdraw needle

• engage safety over need and discard in sharps

• remove gloves, hand hygiene

• injection angle 90-45

  • thin 45

  • average size or obese 90

IM (intramuscular)

Administration of a med

Sites

• Ventrogluteal

  • preferred site for adult

  • safe: away from major blood vessels, nerves

  • position on side, knees bent

  • Locate greater trochanter (head of femur) and anterior superior iliac spines

  • Place palm of hand on greater trochanter (non-dominant)

  • Index finger-anterior superior iliac spine. Thumb toward grown fingers toward head

  • Spread middle fingers along iliac crest toward buttocks. Site, center of triangle (middle and index finger)

    

• Vastus lateralis

  • Preferred site for infants, small kids and some adults

  • selecting appropriate injection site

  • one hand above knee

  • one hand below greater trochanter

  • Middle third of muscle (midline of thighs top to midline of thigh’s outer side)

• Deltoid

  • If muscle is not well developed, injury risk

  • can be used for immunizations for adults, older kids

  • small volume, .5-lml

  • selecting appropriate injection site

  • palpate lower end of acromion process. Place 3 fingers below acromion process

  • inject in center of triangle

• Z-Track

  • Used for injecting irritating substances (will dec pain, irritating, staining at injection site)

  • Technique:

    • pull skin and SC tissue laterally to side

    • inject at 90 angle

    • aspirate with 1 hand

    • Inject med, needle remains inserted for 10 sec (allows med to disperse evenly)

    • Withdraw needle, release skin

ID (intradermal)

Administration of med: ___

• shallow injection just under epidermis into dermal layer

• Use, TB, allergy testing

• Prep

  • 1 ml syringe, 25-27 gauge, 1/8-5/8 in

• Site

  • forearm

  • scapula

• Don gloves, cleanse site with alcohol, air dry

• pull skin

• inject needle at 5-15 angle, bevel up, advance needle 3mm

• Slowly inject med, see a bleb (like mosquito bite)

• withdraw needle slowly

• engage safety, place in sharps

• remove gloves, hand hygiene

Non-Adherence

Asses for ___

• too many meds

• poor patient education

• fear of addiction

• perception that meds not needed

• depression

• cognition

• functional ability

• dislike side effects

• busy lifestyle

• financial