Medication Administration and Diagnostic Tests Notes

Medication Administration

One-Time Dose

• A one-time dose is not an emergency.

STAT Dose

• A STAT dose is needed immediately.

Renewal

• Renewal requires doctor's approval for more medication.

Protocols

• Protocols are order sets, like for chest pain, including what to do and which meds to pull.

Unit Dose System

• Prepackaged, pre-labeled, and preshipped from pharmacy (often to long-term care).
• Hospitals typically use Pyxis or Omnicell systems.
• Access requires login, password, and often fingerprint.

Controlled Substances

• Require two-nurse check.
• Must be locked up.

Oral Medications (Liquid)

• Measure at eye level using the meniscus.

Eye Drops

• Do not touch the eye with the dropper.
• Place drops in the corner of the eye (pull down).

Eye Ointment

• Apply under the eye.

Ear Drops

• Adults: Pull ear up and back.
• Children: Pull ear down and back.

Inhalers

• Use a spacer for better medication delivery.

Rectal Suppositories

• Lubricate the suppository and index finger.
• Insert with the pointed end first.
• Insert along the side of the rectum, avoiding stool.

Feeding Tube Medication Administration

• Administer one medication at a time.
• Flush with 30 mL of water between medications.
• Flush again after all medications are given.
• If patient is on continuous suction: Turn off/clamp suction before administering meds to prevent removal via suction. Then turn it back on.
• Elevate head of bed to 30 degrees or higher for 30-60 minutes to prevent aspiration.

Medication Errors

• Report immediately.
• If witnessing a med error, report it.

Injections

• After drawing up medication, wavel syringe.
• Label syringe with medication name, dose, and patient name.
• Avoid hairy or inflamed areas, as well as blood vessels or previous injection sites; rotate sites.

Intradermal Injections

• Use a 1 mL syringe.
• Use a 25-29 gauge needle.
• Insert at a 5-15 degree angle.

Subcutaneous Injections

• Maximum of 1 mL.
• Use a 25-27 gauge needle (per textbook).
• Insert at a 45-90 degree angle.

Intramuscular Injections

• 1-3 mL can be administered.
• Deltoid: Maximum 1 mL.
• Legs and hips: Up to 3 mL.
• Insert at a 90-degree angle.
• Muscles:
  • Rectus femoris
  • Vastus lateralis
  • Ventrogluteal

Preventing Needle Sticks

• Do not recap needles.
• Drop needle into sharps container.

Ampules

• Use a filter needle to draw medication out after breaking the top with a special tool or casing.

Mixing Drugs

• Only mix compatible drugs.

Z-Track Injection

• Move the skin/muscle to the side, inject, and release.

Diagnostic Tests

General Information

• Know the purpose of the test.
• Understand patient instructions (eating, drinking, prep).

Complete Blood Count (CBC)

• Includes all parts of the blood.
• Leukopenia: Sharp fall in leukocytes (low white blood cells).

Comprehensive Metabolic Panel (CMP)

• Includes electrolytes.

Blood Glucose

• Poke finger, wipe away first drop, then squeeze out more for the test.

Coagulation Tests

• Heparin: PTT
• Warfarin: PT/INR

Ova and Parasites Test

• Stool sample test.

Occult Blood Test

• Tests for blood in the stool: smear stool on paper, add developer.

CT Scans

• Involve radiation.
• Patient must lay still for up to 45 minutes.

MRI

• No metal.
• Patient must lay still for up to 45 minutes.

Contrast Allergy

• Shellfish allergy is related to iodine in contrast.
• There's iodine in shellfish.

Cardiac Catheterization

• Looking for blockages; can place stents.
• Post-procedure care: Watch for bleeding, keep patient still with pressure on site (femoral or radial artery), and check distal pulses.

Culture Specimen Collection

• Only touch the area being cultured (e.g., back of throat or wound).

Patient Admission

Initial Actions

• Start planning for discharge.
• Assess patient.
• Prepare the room.
• Orient patient to the space.

Types of Admissions

• Emergency and routine.

LPN Role During Admission

• Assist the RN with various tasks.