Chapter 28: Administering Medications
what should be done for parenteral administration
++Check the order and label during administration -Adhere to the "seven rights" throughout procedure -Provide the maximum safety and comfort to patient; least painful when done quickly
what gauge should be used for a SQ injection?
+25 gauge needle is standard size can be less or more depending on the viscosity of the medication
how much can the deltoid muscle hold?
+Can hold only 1 to 2 mL of medication +Injection site is two fingerbreadths below acromial process
what is Z-tract IM injection
+Displaces the upper tissue laterally before the needle is inserted +Palpate site using anatomically correct markings, and localize injection site visually +Insert needle into the anatomically correct location, and slowly release medication into the deep muscular tissue
IM injections given if?
+Drug would irritate the subcutaneous tissues +More rapid absorption is desired +Large volume of medication is to be injected +++fastest absorbed
why is the vastus lateralis safest for infants?
+Fewer nerves and blood vessels to avoid One handwidth below proximal end of greater trochanter (in adults)
legal and ethical issues
+Follow the physician's orders exactly as written +If questions, ask for clarification before you proceed +Prevent errors by following safe practice procedures +Implement the "seven rights," and perform the three drug order and label checks +Know complications and side effects +Always check for allergies +Patient comes first; never risk giving incorrect medication
what size needle would be used for a child and for an obese adult patietn at the ventrogluteal region?
+For a child you will need a 1-inch needle, whereas +for an obese adult patient, you may need a 2½- to 3-inch needle to reach depth of the muscle
important things to remember
+If the vial is damaged or label is unclear, do not use it +Never give a medication you did not draw up yourself; the person who administers the medication is legally responsible for any drug errors +Make sure that controlled substances are stored AWAY from all other medications +If a multidose vial is opened, discard after 28 days of being opened +If you aspirate and see blood, do not continue +If you aren't sure, ASK!!!
how much can be administered in SQ?
+no more than 2 mL
Assessment factors
+obtain a complete and accurate history. ex Details about the patient's health history, current and past use of all medications, negative responses to medications, drug allergies.
what are some suggested questions for gathering medication information.
1. What provider-prescribed or OTC drugs are you currently taking? 2. What medications have you taken over the past 6 months to 1 year, and why? 3. Do you regularly use any alternative or herbal products? What are they? 4. Where do you store your medications at home? 5. Can you tell me why you are taking the prescribed medications?
What are the 7 rights of medication administration?
1. right patient 2. right drug 3.right dose 4.right route 5.right time 6.right technique 7. right documentation
what gauge is preferred for an IM injection?
21 gauge is preferred for thick viscosity IM injections. not thick then a 22-25 is normally fine
When must it be read? Why do we require a two-step PPD?
48-72 hours after the ID injection has been placed. + 2step Tb checks for a immune response bc sometimes with the first Tb pt has no immune response 2nd one then body has a immune response
what angle should an IM be inserted?
90 degree
transdermal pathces
Absorbed slowly through skin to create timed-release systemic effect. usually on for 7 days
tinctures
Alcoholic preparations of soluble drug or chemical substance
elixirs
Aromatic, alcoholic, sweetened preparation
What does it mean to aspirate?
Aspirating is pulling back on the plunger after the needle has be placed in the patient.
syringes
Barrel, flange, plunger, tip
fluid extraction
Combinations of alcohol and vegetable products;
ampule
Contains a single dose of medication. neck is scored. allows for the neck to be snapped
multidose vial
Contains enough medication for multiple injections. write date of open bc it is only good for 28days.
Needle gauge
Diameter or lumen of the tip of the needle
++++what should NOT be done after doing the Z-tract IM injection?
Do not massage the site afterwards. The medication is given______ because it is potentially irritating to the skin.
Liniments (emulsions):
Have higher portion of oil than lotions; volatile active ingredients may be added
suspensions
Insoluble drug substances contained in a liquid
single-dose vial
Needle put through stopper for medicine withdrawal
prefilled syringe
Packaged unit of medicine ready to administer. just attach needle it is already filled with medication
Rectal administration:
Rapid absorption into bloodstream; useful if the patient is nauseated, vomiting, or unconscious; suppository form
ointments
Semisolid medications containing bases such as petrolatum; remove from jar or tube with tongue blade to prevent contamination
syrups
Solution of sugar and water, flavoring, medicinal substances
Oral administration:
Sprays, swabs, sublingual tablets, and buccal tablets; treat for local infection or for pain relief
what are liquid oral dosage forms?
Syrups, suspensions, gels Extracts and fluid extracts
what are solid dosage forms?
Tablets, capsules, lozenges Tablets are usually coated Capsules may be timed-release
Mantoux test used to screen for?
Tb exposure +Antibodies move to site, if positive, and cause swelling and induration +Anyone with an induration of 15 mm or greater is considered positive
for multiple daily injections it is okay to rotate sites to prevent tissue damge?
True. keep rotaion record
Nasal administration:
Used for local effect, but may get into bloodstream; use with caution
Vaginal administration:
Used to treat local infections; best administered with the patient lying down
Needle length
Varies based on area of injection. into the muscle you need a longer needle. into the SQ you need a shorter
extracts
Very concentrated combinations of vegetable products or chemicals; very strong
Sharps containers (puncture proof-container)
Where needles/ are placed after contamination. generally red container. do not put cap back on used needles
right documentation
___ all information from the vile. have to know if it is a vaccine have to right the lot number and the manufacturer and location of the vaccine was given.
what must be documented to determie therapeutic doese?
age, weight, and height
wheal
aka a bubble. can be done 2 ways 1. blow to the skin 2. by injections intradermal ex by ppd, allergy injections
ID site is used for?
allergy testing or PPD (Mantoux)
what angle should the injection be administed for the SQ
angle of insertion is 45 degrees
Bevel
angle slanted tip of the needle. ___ has to be up when you give a injection
bevel
angled tip of the needle. need to be facing up when going in depends how it slices into the tissue
Right Patient
ask pt for the name or date of birth.
injections should never be given near where?
blood vessels, scar tissue, moles, warts, etc. just go an 1/4 in left right bottom
right time
certain ___ that a medication should be given ex insulin, drowsy meds
what can happend if the injection in the dorsogluteus is administered wrong?
common sciatic nerve injuris occur and thi site is discourage +Acceptable for adults with care to locate exact site
lotions
controls itching; dab with soft cloth
what should not be done after giving the PPD?
do nothing to the site after injection. do not apply pressure do not massage do not place a bandage over it. do not aspirate
right technique
does the medications have to be given intramuscularlly or subcutaneously or intradermally
where is the traditional site for deep IM injections?
dorsosluteal region
what are signs of anaphylactic shock?
edema on the site of the injection, broncoconstriction, vasodialation-blood vessels opening, diarrhea,
when should allergies be checked?
every time th pt comes in
right drug/right dose
give the righ medication, strenght of the medication (math)
subcutaneous
given between epidermis and muscle, into fatty areolar layer called adipose tissue
right route
how is the medication suppose to be given to the pt
amount
how much madication the patient will receive. quanity.
what is the preferred site for an infant to insert IM injections?
infants or children is the vastus lateralis +It is the only developed muscle in infants
what are parenteral medications?
injectable medications; ampule, single dose vial, multidose, prefilled syringe.
ID injections
is given within skin layers at a 15 degree angle with the smallest gauged needle (27-30)
when pouring make sure the palm of the hand is where?
is on the label and everything is at eye level
flange
is the part that we hold on to at the bottom with our fingers
what is the first step in drug administration?
is to check the written order
Meniscus
is what we look at when we measure medication. bottom curved seam of the liquid. comes from the greek work menisc which means crecent
scored
is when a tablet has an indentation down the center which makes it easier to break or snap in half. Meication has to be scored in order to give the patient half a tablet
what is the best sites for injections of PPD?
left forearm. upper chest, and back (usually for allergy teting)
vasovago response
light head or pass out sign that they had an injection and they are processing the info
what are topical forms?
lotions liniments (emulsions) ointments trandermal patches
chronic conditions may affect the body's ability to?
metabolize and excrete medication
if you aspirate and you see blood you must do what?
must stop and withdraw the needle.
Patients must understand the drug regimen may?
need family support, must be able to afford medication. teach them how to do them. demonstration and return demonstration
what should you never do when giving an insulin injection?
never aspirate do not massage the site
how long are we suppose to observe the pt after the drug has been administered for any reactions? the standard for new medication administered to the pt
observe for 20-30 minutes
how do you apply topical medications?
on a cotton swap or tongue depresser then to the pts.
what is the vastus lateralis part of?
quadriceps group of the thigh
ALWAYS check weight and height of what patients?
record each visit pediatric patients and dabetic for weight only
mucous membrane form include?
rectal administration vaginal administration oral administration nasal administration
edema
redness and swelling. expansion of something. can response to a responds of something
needle point
sharpened end of needle
when pouring a liquid where should you measure?
the lowest part o the meniscus
Deltoid muscle is?
the muscular cap of shoulder, located at top upper arm
plunge
the part that we pull back on for example when we aspirate
barrel
the place where the medication is going to fill up. read the lines
how many millimeters should a person with weak immune system ex HIV,kidney transplant or aids should meaure?
they look for 5mm or greater if healthy they look for 15 mm or greater sizes of induration
viscosity
thickness or thiness of the liquid
Bronchoconstriction
tightening of the bronchiis. happends because of an anyphylatic shock
why is aspiration done?
to make sure that you have not placed the needle in the vein +This makes the injection IV, not IM, SQ or ID
insulin syringes are calibrated in?
units. we use a U-100 syringe. also prefilled cartridges
what needle should be used to inject insulin?
use the smallest needle(30) gauge possible and rotate sites
what is the preferred site in an adult?
vastus lateralis, deltoid, ventrogluteal, and gluteus medius muscles +Must be careful with the gluteus medius bc of sciatic nerve damage
what is the largest mass of the gluteus medius muscle?
ventrogluteal region
what site is considered safe for both infants and adults? and why
ventrogluteus. free of major nerves and blood vessels.
asymtpmatic
without symptoms
