Ch. 46 and 47 Administering Medication

Right patient

Identify the patient by full name or by date of birth.

Right drug

A basic understanding of the information located on a drug label is essential. Check the drug label three times for confirmation of the right drug.

Right dose

Determine the accurate dose when there is a mismatch with the ordered dose.

Right route

Clarify the route of administration by checking the prescription order.

Right time

Clarify the time of medication administration by checking the prescription order.

Right technique

Understand the appropriate techniques of all routes of drug administration.

Right documentation

• Document the date and time of administration

• Document the lot number and manufacturer of vaccines.

• Inspect the site of injection for parenteral medications before administration.

• Document the exact site of administration for parenteral medications.

• Document all pertinent information if the patient calls in for a refill of the prescription

Medicine for children

• Document current weight since this is used for drug dosing.

• Gain cooperation by getting down on the child’s level and use a soft, firm voice.

• Offer choices of care by asking, for example, which leg the child would prefer for receiving an injection.

• Divert the child’s attention to relieve stress.

• Encourage parent participation.

Medicine for older adults

• Educate the patient and the patient’s family about the medication

• Request that the patient bring a list of all medications for every visit, including over-the-counter (OTC) medications, so as to maintain a current medication record.

• Advise patients to use daily or weekly medication dispensers if they are on multiple medications.

Tablets

Solid compressed oral dosage forms that break apart in the stomach or in the mouth if not quickly swallowed

Lozenges

Solid oral medication in flattened disk form that dissolves in the mouth to coat the throat

Syrups

Solutions of sugar and water, usually containing flavoring and medicinal substances

Suspensions

Insoluble drug substances contained in a liquid

Emulsions

Mixture of oil and water that can improve the taste of otherwise distasteful products such as cod liver oil

Gels and magmas

Dosage forms that consist of minerals suspended in water

Fluid extracts

Combinations of alcohol and vegetable products, which are more potent than tinctures

Tinctures

Alcoholic preparations of a chemical substance or soluble drug from plant sources

Extracts

Very concentrated combinations of vegetable products and alcohol or ether

Elixirs

Aromatic, alcoholic, and sweetened preparation

Rectal administration

The suppository is inserted with the pointed end first approximately 2 inches above the rectal sphincter muscles in adults, and 1/2 to 1 inch in children.

V*aginal administration

• After administration, the patient should lie down to avoid leakage.

• The patient should wear a pad to absorb drainage.

Oral administration

• The oral medication should be taken with enough water.

• The patient should have an intact swallowing reflex.

Nasal administration

• Teach the patient not to exceed the amount or frequency ordered by the provider.

• Excess amount can dry the mucosa and make congestion worse.

Topical administration

• Apply lotions by dabbing with a soft cloth, a cotton ball, or a tongue blade.

• A tongue blade is used to remove ointment from a jar or tube.

• Rotate sites to prevent skin irritation.

Needles

Needles are classified based on gauge and length. Gauge is the diameter, or lumen size, of a needle. The size of needle gauges ranges from 14 (the largest) to 31 (the smallest, used for insulin administration).

Syringes

Syringes consist of a barrel, a calibrated scale (or scales), the flange, the plunger, and the tip. The typical syringe holds up to 3 mL and has a milliliter (cubic centimeter) scale

Intradermal injections

• These are useful for allergy testing and tuberculin screening.

• The angle of insertion of the injection is 15 degrees, almost parallel to the skin surface.

• The center of the anterior forearm is the best site for injection.

Subcutaneous injections

• These involve administering medication between the epidermis and the muscle into the adipose tissue.

• The angle of insertion is typically 45 degrees, but the needle length determines the angle of administration.

Sites for intramuscular injection

• deltoid

• vastus lateralis (upper lateral quadrant of thigh for infants and children)

• dorsogluteal (deep IM injections)

• ventrogluteal