Lifespan Considerations, Medication Administration Routes

LIFE SPAN CONSIDERATIONS

Drug Therapy During Pregnancy

  • Teratogenic Medications: Drugs that may cause congenital abnormalities and should be avoided if possible.

  • First vs. Last Trimester:

    • First Trimester: Highest risk for teratogenic effects as organogenesis occurs.

    • Last Trimester: Increased blood flow to the fetus, which can increase drug transfer.

  • Pregnancy Safety Categories:

    • A: No risk in controlled human studies.

    • B: No risk in animal studies, but no human studies.

    • C: Risk in animal studies; weigh benefits against risks.

    • D: Evidence of risk, but may be used in life-threatening situations.

    • X: Contraindicated; risks outweigh any potential benefits.

  • Risk vs. Benefit: Always evaluate whether the benefits of the drug for the mother outweigh the potential risks to the fetus.

Pediatrics

  • Breast Milk & Medications: Some medications can pass into breast milk and affect the infant.

  • Medication Administration in Babies & Children: Oral syringes or droppers are used to accurately dose medications.

  • Physiologic Immaturity: Immature liver, kidneys, and other organs affect metabolism and excretion.

  • Calculating Dosages:

    • Doses are usually based on weight in milligrams per kilogram (mg/kg).

    • Commonly weight-based calculations are used for accuracy.

    • Neonate: Birth to 1 month.

    • Infant: 1 month to 12 months.

    • Child: 1 to 12 years.

Geriatrics

  • Pharmacokinetics Related to Aging:

    • A decline in kidney and liver function impacts drug metabolism and excretion.

  • Visual Changes & Manual Dexterity: Decreased vision and dexterity can cause medication errors.

  • Hypoalbuminemia: Lowered albumin levels lead to increased free drug concentration of protein-bound drugs.

  • Polypharmacy: Multiple medications increase risk for adverse reactions.

  • Common Medications:

    • Common prescriptions: blood pressure medications, pain relievers, anticoagulants.

    • OTC Medications: NSAIDs, antacids, laxatives.

    • Self-prescribed: Herbal supplements, vitamins.

  • Prescribing Cascade: Treating side effects of one drug with another, leading to more prescriptions.

  • Cost Considerations: Affordability can impact adherence.

  • Assessment: Obtain a complete medication history and review against Beers Criteria for potentially inappropriate medications.

PREPARING AND ADMINISTERING MEDICATIONS

Routes of Medication Administration

  • Forms of Medications:

    • Parenteral: Administered by injection (e.g., IV, IM).

    • PO (by mouth): Slowest onset.

    • Subcutaneous (Subcut): Faster than oral, slower than IM.

    • Intramuscular (IM): Faster than subcut due to vascularity.

    • Intravenous (IV): Fastest onset of action.

INTRADERMAL ROUTE (ID) - Pg. 113

  • Used For: TB tests, allergy tests.

  • Medication Preparation:

    • Wipe vial top with alcohol. Inject air equal to the dose to be withdrawn.

    • Needles & Syringes: Use a TB syringe with the bevel up at a 5-15 degree angle. Do not aspirate.

  • Sites: 3-4 finger widths below the antecubital area or 1 hand-width above the wrist.

  • Wheal (Bleb): Small, raised area (6mm) should form under the skin.

  • DO NOT rub the injection site.

SUBCUTANEOUS ROUTE (Subcut) - Pg. 114

  • Used For: Insulin, heparin.

  • Medication Preparation:

    • Clean vial top, inject air equal to medication volume.

    • A filter needle must be used to draw up medication. NEVER use filter needle to inject a patient.

    • Needles: Length 1/2" to 5/8"; gauge 25-27.

  • Insulin: Only use an insulin syringe. Always check Glucose levels before administering insulin. Verify the dose with a second nurse.

  • Sites: Rotate injection sites (abdomen, thigh, arm).

INTRAMUSCULAR (IM) ROUTE - Pg. 116

  • Used For: Vaccines, antibiotics, testosterone, and B12 shots.

  • Medication Preparation:

    • Clean vial top, inject air equal to dose.

    • Ampules: Use a filter needle to draw up but replace before injecting. Never use a filter needle on a patient. Ampules are glass, so break them away from your body.

  • Needles: Choose based on patient size; typical lengths 1-1.5 inches; gauge 20-25.

  • Injection Sites for Adults: Deltoid, ventrogluteal, vastus lateralis.

  • Z-Track Method: Prevents irritation. Often used with iron and hydroxyzine injections.

BUCCAL & SUBLINGUAL ROUTE - Pg. 105

  • Used For: Nitroglycerin, certain pain meds. Wear gloves for this method.

  • Mechanism: Absorbed rapidly from oral mucosa & Avoids first-pass effect since absorbed directly into the bloodstream.

  • Sublingual & Swallowed = Inactivated: Do not swallow these medications as they lose effectiveness. Advise the patent to leave medication under the tongue and to no swallow.

ORAL ROUTE (PO) - Pg. 103

  • Also Called: Enteral route.

  • Types of Oral Medications: Capsules, tablets, lozenges, liquids (elixirs, syrups, suspensions).

  • Patient Positioning: Patient should be upright. Fowlers or high fowlers. 45-90 degree angle.

  • Assessment: Check patients ability to swallow. Consider any recent surgeries or conditions that may affect swallowing, and provide assistance as needed.

  • Final Check: Verify patient swallows the medication completely.

NG & G-TUBE ROUTE - Pg. 107

  • Used For: Liquids or crushed medications dissolved in liquids. Patients who can’t swallow.

  • NG Tube Placement: Verify placement as per facility policy. This is a must.

  • Patient Positioning: Keep patient positioned at 30-90 degrees for 30 minutes post-administration to prevent aspiration.

  • Medication Do’s and Don’ts:

    • Do: Give medications separately

    • Do: Dilute with 15-30 ml of warm water

    • DONT: Put crushed medication directly into tube

  • Medication Preparation:

    • Flushes: Use 10 mL of water between each medication; flush with 30 mL after the last dose.

OPHTHALMIC ROUTE - Pg. 126

  • Used For: Eye drops for glaucoma, infections.

  • Assessment: Ensure no contact lenses; clean from inner to outer canthus, and position the patient to a sitting position with head tilted back slightly.

  • Application: Eye Drops are placed in the lower conjunctival sac; ointments applied along the inner edge of the lower lid. For infants, drops are placed in the corner of the eye while closed, so that the medication will go in once the eye is opened.

  • It is important to apply pressure to the lacrimal duct for 30-60 seconds after medication has been installed.

OTIC ROUTE - Pg. 127

  • Used For: Antibiotics, Ear infections, wax softening.

  • Temperature: Warm to body temperature to avoid dizziness.

  • Pinna Position:

    • Under 3 years: Pull pinna down and back.

    • Over 3 years: Pull pinna up and back.

NASAL ROUTE - Pg. 131

  • Used For: Treat swelling of the nasal mucosa and congestion.

  • Assessment: Assess for deviated septum, or fracture.

  • Drops: Remain supine for 5 minutes.

  • Spray: occlude the nostril while administering to the to the other.

  • Preparation: Patient blows nose before administration (except in cases of nasal surgery, or high intracranial pressure).

  • Patient Positioning: Lean head forward slightly for drops, slightly back for sprays.

RESPIRATORY INHALATION ROUTE - Pg. 127

  • Used For: Asthma, COPD (bronchodilators and corticosteroids).

  • Order: Bronchodilator first if both are prescribed.

  • Inhalers: Use spacer if necessary; instruct patient to inhale deeply and hold breath for a few seconds after each dose.

VAGINAL ROUTE - Pg. 132

  • Used For: Infections, birth control, creams, foams, gels, suppositories.

  • Assessment: Ask patient to urinate first.

  • Patient Positioning: Lithotomy position, with hips elevated for 5-10 minutes after.

  • Time: Best time to administer med is night time.

RECTAL ROUTE - Pg. 108

  • Used For: Anti-nausea, pain, laxatives, hemorrhoid treatment

  • Pros/Cons: Rapid absorption; may be uncomfortable and embarrassing.

PATCHES - Transdermal Therapeutic System (TTS) - Pg. 130

  • Used For: Long-term drug release (e.g., pain or blood pressure).

  • Site: Non hairy site (dont shave area)

  • Do not cut!

  • Preparation: Remove old patches, and Rotate sites; avoid irritated skin.

EVERY TIME YOU PASS MEDS... THINK

Always ensure correct patient, medication, dose, route, time, documentation, assessment, right to refuse, evaluation, and patient education.