Lecture 12

Drug administration process

Prescriber writes the order, pharmacist fills the order, nurse administers the order

5 rights

right client, drug, dose, time, route

5 + 5 rights

Assessment, documentation, patient’s right to education, right evaluation, right to refuse

Checking label of medication with MAR3 times

When Nurse reaches for container or unit dose package, compare medication with the MAR immediately before pouring from multi dose container, before replacing in drawer or before giving medication to patient

as lib

As desired

qs

Sufficient quantity

If a drug has a long half life, it is given only____. If short half life, given_______

Once a day, Several times a day at specified intervals

For discrepancies between order and the manufacturers recommendations for timing….

Consult pharmacist or prescriber

Antibiotics should be

admin at even intervals

Enteric coated tablets

Have a coding that delays absorption until after the tablet leaves the stomach mucosa. Should not be crushed or issue since they irritate stomach mucosa, Do not crush or chew extended release

Inhalation meds

Given for local and systemic effects, nasal and oral inhalers

Intradermal injection

Injected into dermis just below epidermis

Mostly for diagnostic purposes

Tuberculin syringe

1/4-1/2 in needle

25–27 gauge

Makes a small bleb (PPD test)

5 to 15° angle into outer layers of dermis in small amt 0.01-0.1 mL

Subcutaneous injection guidelines

Avoid areas of brushing, rashes

Pink skin with non-dominant hand, admin With dominant hand

90° angle, 45° angle for thin pt/kid

2 inches away from umbilicus

do not aspirate

Do not massage

Applied gentle pressure

Subcutaneous injections

Admin with dominant hand after needles inserted then released tissue unless instructed otherwise

Insulin and heparin are usually inserted at 90° angle

Pepper and other anticoagulants, Follow manufacturers recommendation for injection sites

Do not aspirate, do not massage

Make sure insulin and syringe are both U100

Only use insulin Syringe for admin insulin

90° angle use for average size patient

45° angle for kid, or thin, Emaciated, or cachectic pt

If 2 inches use 90° angle

Just below dermis of skin

Slower absorption than IM or IV

1 mL tuberculin syringe

Needle 1/2-5/8

25-30 gage

Mixing insulins

Most insulin are produced in concentrations of 100 units/ml is calibrated to correspond with 100 unit insulin syringes. Bottles and syringes are color-coded to Avoid error. 100 units are orange

Regular (clear) insulin is always drawn up first then NPH (cloudy) insulin

Administer 2 insulins immediately after mixing

Do not administer insulin if discolored

Do not shake to mix since it separates NPH needs to be rolled

IM sites

Deltoid muscle ( <1 mm), ventrogluteal (safest IM site, preferred site for adults, < 3 mm), vastus lateralis muscle ( infants, children, < 3 mm)

Implications for IM route

Absorb faster than SQ due to greater vascularity in muscles

3mL Syringe for adults with 1-1 ½ inch length 21-23 gauge

Child/underdeveloped adult 5/8-1 inch, 23-50 gauge

Obese adult may need longer needle and 90° angle

IM Guidelines

Assess muscle size & integrity (site)

1-3 mL volume range, 1-2 mL im deltoid site

Ventrogluteral site preferred

Non dominant hand to pull skin taut

Aspirate for blood per facility policy

Admin 90° angle

Admin at rate 1mL every 10 sec

Wait 10 sec after admin then remove needle

IM ____gauge,______needle

20-25, 5/8 - 1 ½ “

SC ____gauge,______needle

25-30, ½ - 5/8 “

ID ____gauge,______needle

25-27, ¼ - ½ “

3 mL syringe

1.3 mL

1 mL tuberculin syringe

0.68 mL

0.5 insulin syringe

9 U

Stock drug method

Drugs are dispensed to all pt from same containers

Unit dose method

Drugs are individually wrapped and labeled for single doses and has eliminated many drug dosage errors

Guidelines for correct medication administration

If injection being given, never recap, when admin to group, give drugs last to client who needs extra assistance (g tube meds)