PHARM: Day 1 Part 4

Overview of Medication Administration Techniques

• Discussion of less commonly used medication routes

• Focus on rectal diazepam and transdermal nitroglycerin

Rectal Diazepam for Seizure Management

• Purpose: Used as a backup for treating seizures.

• Administration Technique:

  • Use a mannequin for demonstration.

  • Step 1: Remove the cap from the syringe.

  • Step 2: Lubricate the tip of the syringe.

  • Step 3: Position the patient on their side, with the upper leg forward to expose the rectum.

  • Step 4: Use your non-dominant hand to separate the buttocks.

  • Step 5: Insert the syringe gently until snug at the rectal opening.

  • Step 6: Push the plunger slowly, counting to three.

  • Step 7: Hold the syringe in place and count to three before removing it.

  • Step 8: Hold the buttocks together for another three seconds to prevent leakage.

  • Importance of positioning: Patient should remain on their side for optimal medication absorption, especially following a seizure episode.

Transdermal Nitroglycerin Application

• Application Skills for Transdermal Medications:

  • Administering patches and pastes properly.

  • Step 1: Remove the old patch or ointment.

  • Step 2: Cleanse the area gently; rotate sites to avoid irritation.

  • Step 3: Date, time, and initial the new patch or application paper.

  • Dosage Measurement:

    • Use a scale to measure dosage accurately, ensuring units correspond correctly.

  • Considerations:

    • Adjust application based on patient condition and medication absorption issues.

    • Awareness of possible inconsistencies in drug absorption.

  • Key guidelines:

    • Assess for skin permeability issues like sweating (diaphoresis) that can affect adhesion and absorption.

Intranasal Administration Fundamentals

• Ideal Technique:

  • Administering medication intranasally, aimed toward the tips of the ears to enhance absorption.

  • Use for various conditions, including pain management (e.g., fentanyl for pediatric patients).

  • Understanding dosage calculations based on body weight for drugs like intranasal fentanyl.

IO (Intraosseous) Access Techniques

• Indications and Considerations:

  • Method for rapid medication and fluid delivery, especially during emergencies.

  • Use specific sites for insertion such as the proximal tibia or distal femur based on patient age and condition.

  • Administration Steps:

    • Prepare the area, aiming for a 90-degree angle of insertion relative to the skin.

    • Drill into the bone carefully, stopping upon meeting resistance to avoid over-penetrating.

    • Connect IV lines properly post insertion for administering fluids and medications effectively.

• Anesthesia Recommendations: Administering lidocaine pre-insertion for pain management.

Lidocaine as a Supplemental Medication

• Applicability with IO access for patient comfort.

• Administration protocol: 'two of two for two' strategy allows for effective numbing prior to insertion.

• Importance of monitoring patient response to lidocaine and adjusting dosages as necessary.

Vital Documentation Practices

• Importance of Clear Documentation:

  • Recording pre-administration practices, dosages, times of administration, and patient reactions.

  • Document consent and refusal of medication to ensure legal and procedural compliance.

  • Awareness of protocol requirements concerning medication wastage and its proper documentation.

Classroom Guidance and Interactive Discussions

• Engaging students in learning through practical demonstrations while addressing frequent misconceptions.

• Highlighting safety precautions in medication administration to prevent errors.