Pharmacology Unit 4 Med Administration
Suppositories
What medication should be kept in a refrigerator?
Medications containing alcohol because the alcohol with evaporate off
What medications should be kept with the lid tight and why?
pills coated to slow the release of the drug (enteric-coated tablets) and timed-release capsules should not be crushed.
What pills cannot be crushed?
Medication Labeling
(A)name, address, and telephone number of the pharmacy (B)date when the prescription was filled (C)Rx (prescription) number (D)name and address of the patient (E)directions to the patient (Latin abbreviations translated into English for the patient), and name and quantity of medication (F)the manufacturer (G)number of refills and expiration date (H)name of the prescriber
prescription
(A)name, address, telephone number, and Drug Enforcement Administration (DEA) number of the prescriber (B)patient's name, address, and date of birth (C)date (D)Rx (abbreviation for prescription or treatment) (E)inscription (name of drug, dosage, and quantity to be dispensed) (F)signature (directions to the patient) NOTICE THEY ARE NOT REFERRING TO SOMEONE SIGNING SOMETHING (G)number of refills (H)whether a generic drug can be used (I)prescriber's signature.
bubble packs
•1 month supply of med •Long term care
transdermal or topical, nasal, inhaled, ophthalmic, otic, and vaginal
What does the book list as parenteral routes of medication administration?
a device that forces room air or oxygen into the lungs, even when the patient forgets to breathe. it is ideal for patients with sleep apnea, in which the patient stops breathing for short periods of time while asleep.
What is a CPAP and who needs it?
tablets that have added antacids to prevent stomach irritation.
What is a buffered tablet?
MDIs are used to deliver specific doses of medication through a hand-held inhalation device.
What is a meter dosed inhaler and how is it used?
Explain that timed-released capsules cannot be opened or crushed because doing so releases the drug all at once, causing an overdose
How will you educate a parent regarding extended release medication?
Narcotics
•Check count correct before administration •Check for evidence of tampering
Oral Liquid Medications
Easier to swallow than solid and absorbed quicker
It will have ER, XR, or XL following the name
How can you tell if a medication is extended release
To decrease discomfort, ear medications should be at room temperature before they are given. To decrease discomfort, ear medications should be at room temperature before they are given. the patient must keep the affected ear upright for a few minutes to allow maximum absorption of the medication. Adults should pull the pinna up and back; the outer ear should be pulled down and back in children, to straighten the ear canal for best absorption.
How do you administer ear drops to both young and old?
Wear gloves and be careful not to touch the dropper to the eye or eyelid itself. Have the patient look upward as you drop in the exact number of drops ordered. After the drops are instilled, have the patient close his or her eyes. Applying light pressure with a finger on the inner part of the closed eyelid after administration of the medication also helps to keep the drug from leaking into the nasolacrimal duct.
How do you administer eye drops?
Apply to the inside of the bottom eyelid or conjunctival sac. Pull down on the lower eyelid and apply the ointment stream from the inner (nasal) to outer aspect. You may need to use a twisting motion to break the ointment stream. Be sure not to touch the tip of the tube to the eye or eyelid.
How do you apply ointment to eyes?
1. Follow all steps from Procedure Box 10-9 up until actually inserting the needle. 2. Before inserting the needle, pull the skin laterally 1 inch away from the injection site (see Fig. 10-15). 3. Insert the needle at 90°, as for all IM injections. 4. Aspirate for blood return (accidental placement in a blood vessel) by pulling backward on the plunger if agency policy requires. 5. If no blood is noted, gently and slowly inject all medication. (If blood is noted, withdraw the needle, discard the syringe and needle, and start the procedure over with a clean needle and syringe.) 6. Wait 10 seconds before removing the needle, to allow medication to be absorbed deeply. 7. Remove the needle and syringe quickly at the same angle of insertion engaging the needle's safety device and place a cotton ball at the insertion site. 8. Quickly release traction on the Z-track position (see Fig. 10-15). This prevents medication from leaking back into more superficial tissues. 9. Dispose of the needle and syringe immediately in a sharps container. Do not recap. 10. Assess the patient and the injection site. 11. Cover the wound with an adhesive bandage. 12. Remove gloves and wash hands. 13. Docu
How is the Ztrack method done?
select the proper needle length and gauge and adjust the angle of injection to reach the appropriate tissue level. The usual sites for ID injections are the inner aspect of the forearm and the upper back. After preparing the site with an alcohol swab, hold the skin taut and insert the needle just under the epidermis at a 10° to 15° angle. Typically, a short, small-gauge (diameter) needle is used. If the injection is administered properly, a wheal will form
How to administer intradermal injections. Which sites are used?
eye drops first because because ointment forms a barrier that will not allow drops to penetrate.
If you have orders to apply both eye drops and ointment, which do you apply first and why?
1. Observe the seven "rights" of medication administration. 2. Read the order, and compare it with the label on the medication container. Check the expiration date. 3. Wash hands. 4. Compare the medication order with the container a second time. 5. Identify the patient, and explain what you will be doing. 6. Compare the order and the container a third time. 7. Put on gloves. 8. Inspect the application site, and make sure that it is clean, dry, and free of lesions. 9. Carefully remove the adhesive backing from the patch. 10. Place the patch on the selected site, and make sure that all edges of the adhesive adhere securely to skin. 11. Remove gloves and wash hands. 12. Document medication dosage, location, and the patient's response.
Medication Process for both applying a patch and removal and disposal of a medication patch in a home setting
Warning labels
The pharmacist places them on the prescription container to make sure the patients understand the best way to take the medication and become aware of possible situations to avoid. the are usually a bright color to make sure they are not overlooked; examples include: Shake well; Keep refrigerated; For the ear; Take medication on an empty stomach; Do not drink alcoholic beverages when taking this medication; Do not crush; May cause drowsiness or dizziness
1. Observe the seven "rights" of medication administration. 2. Read the medication order, and compare it with the medication container. Check the expiration date. 3. Wash hands. 4. Compare the medication order with the container a second time. 5. Assess the patency of the nose dropper. 6. Identify the patient, and explain what you will be doing. 7. Compare the order with the container a third time. 8. Put on gloves. 9. Ask the patient to tilt his or her head backward. 10. Draw up medication into the dropper, as ordered. 11. Insert the dropper with medication into the nostril, as ordered. 12. Squeeze the dropper. 13. Ask the patient to maintain head tilt while you squeeze the nostril for a few moments, to prevent medication from leaking. 14. Assess the patient. 15. Remove gloves and wash hands. 16. Document dosage, site of placement, and the patient's response.
What are the steps for administering a nasal spray?
This equipment introduces the medication by using compressed air or oxygen to aerosolize or suspend medication into small particles in a fine mist for inhalation into the lungs through a face mask or mouthpiece. Commonly used by asthmatic patients and patients with cystic fibrosis
What is a nebulizer? What different types of patients need this?
an extension tunnel that attaches to an inhaler and allows the medication to be held and administered whenever the patient can inhale, rather than escaping into the air if the patient exhales instead of inhaling. especially useful for children and for adults who are cognitively impaired or disabled.
What is a spacer (also called an AeroChamber)
a drug that improves heart function. it is placed sublingually for immediate relief of chest pain or during a heart attack
What is nitroglycerin? What route is it administered?
ear drops (otic drops)
What medication should be kept at room temperature?
liquid medications in a suspension must be shaken
When to shake a medication
It is used to administer medications that are caustic or will stain the skin.
Why is the Ztrack technique used?
mesalamine
a gastrointestinal anti-inflammatory medication. (for active ulcerative colitis)
Air emboli
can occur if air enters the vein
Thrombus or phlebitis
can result from extremes in solution pH, needle or catheter trauma, particulate material, irritating drugs, or selection of a vein too small for the volume of solution infused
emulsions
drug preparations that contain oils and fats in water, magmas, liquid and fine particles in water (Milk of Magnesia)
powders
finely ground forms of an active drug, sometimes given for pain relief (Goody's powder) placed on the tongue and absorbed through the blood stream for pain relief
Elixer
named because it contains alcohol (etoh) •Dimatapp elixir used for cold symptoms •Must be Tightly capped to prevent evaporation and change the concentration •Should not be given to children or anyone suffering from diabetes or alcoholism
Infiltration
occurs when the IV catheter becomes displaced and allows IV fluids and medications to leak into the tissue surrounding the vein
Effervescent salts
produce carbonation when mixed with water •Examples: alka-seltzer •Advantage is the medicine is already dissolved before entering patient and stomach does not have to do the work
Infant Developmental adaptations
•Double check calculations •Dose usually based on weight •Do not mix with formula or food •Most available in liquid form - If not, verify that med can be crushed •Hold infant to avoid aspiration •If im injection- use appropriate injection sites
medication carts
•Drawer for po meds (tablets, capsules) •Drawer for alternate routes (eye/ear gtts, patches) •Drawer for liquid meds •Narcotics drawer (double lock) •Drawer for supplies (straws, spoons, tissues, BP cuff) •Drawer for parenteral supplies (syringes, needles, alcohol swabs, band aids, etc.
Ventrogluteal
• used when the patient cannot stand and, instead, lies on his or her side •Not commonly used, but considered safe for anyone older than 2 •To locate this site, place the heel of the hand over the greater trochanter of the patient's hip with your thumb pointing toward the patient's umbilicus. • Your index finger should be on the patient's anterior iliac spine. Spread your middle finger back as far as possible. •The injection is then given in the center of the triangle formed by your index and middle fingers
intramuscular injection needles
•"shots" - antibiotics, vitamins, pain meds, vaccinations, etc. •3 ml syringe (appropriate to hold the needed volume of medication) •18g - 23g needle •1 - ½ inch long •Maximum volume •Deltoid 1 ml but still use the syringe that holds 3ml •Lower extremities 3 ml •Dorsogluteal 5 ml •Ventrogluteal 5 ml
Medication label
•1 Strength of drug dispensed •2 The dosage form •3 Amount of drug dispensed •4 Warning labels (see p.79 Fast tip 5.1) •5 The manufacturer •6 Refill information •7 The prescriber name •8 Expiration date
Inhaled Medications
•Administered into the respiratory system •Quick and effective way to access blood vessels •Techniques used are cannulas, masks and continuous positive airway pressure (CPAP) machine, inhalers ad nebulizers •Patients with asthma benefit from the use of inhalers, due to inflammation of their lungs •Special devices such as metered-dose inhalers (MDI) •Are used to ensure that as the patient inhales, the medicine enters the lungs •Powders are more easily inhaled if sterile water or NACL is added to be aerosolized with medication
expiration of medication orders
•Any time patient is moved to a different unit in acute care •Any time patient undergoes surgery •Upon discharge or transfer to another facility-including long-term care •Any change in any part of any order creates a NEW order, cannot just change part of existing order on MAR
young and middle aged adults developmental adaptations
•Ask if any particular assistance needed •Use the opportunity for review or teaching of medication information •Allow time for questions
solution
•Can be seen through (thinner LIQUID) •Medication evenly distributed throughout the liquid and will not separate •No need to shake before administering
tablets
•Check integrity of tablet/capsule •Check integrity of packaging •Some must be kept in original container
Planning medication administration
•Check mar against original md order •May be a task assigned to a certain shift or personnel, if any question check yourself! •Note if patient is npo or scheduled for any testing that may alter medication schedule •Check time limits for prn medications •??any questions - hold medication until order is clarified
Verbal/telephone orders
•Check with supervisors, to see if you are allowed to take a verbal order from the physician •May be given during an emergency, most often times will be given as a stat order (medication to be given immediately) •Identify yourself, and the patient, explain the problem, and restate the order for clarification
Pyxis/Omnicell/Emar
•Computer controlled •Unit dose •Immediate documentation
Parts of a prescription
•Date •Physician's name, contact information and Dea number •Patient's name, address, and date of birth •Inscription (name of drug, dosage, and quantity to be dispensed) •Signature (directions for taking the drug) •Subscription (refill) •Physician's signature
Multidose vials
•Date when opened •If no date, do not use •Store as directed
geriatrics adults developmental
•Do not assume patient is feeble, many elderly take meds independently and are very knowledgeable about side effects, use, etc. •If necessary, crush pills and mix with applesauce or other. •Check that no enteric coated or slow release meds are crushed •Check food/medication interactions •If patient is unable to follow instructions, give most important medications first and return with other meds, later if possible •Changing administration times can be helpful •Patient may be more alert later in the day
metered-dose inhaler (MDI)
•Easily inhaled and begin working immediately at the site of distress •Albuterol dilates the airways to assist a patient in breathing •Spacers allow the patient some control over when the medication is inhaled •An extension tunnel that attaches to an inhaler and allows the medication to be held and administered whenever the patient can inhale, rather than escaping in to the air if patient exhales •Especially useful with children and adults who are cognitively impaired •Patients should have their own inhalers, they are not to be shared •Prescription dosages may vary, even though it is the same medication
Preschooler developmental adaptation
•Explain that medicine in necessary •If IM injection, explain that the shot will hurt like a bug bite •Do not lie •May be able to take a chewable form or may be able to swallow tablet
toddler developmental adaptions
•Explain what you are doing •Demonstrate on the toy, if possible •If im injection, have assistance with holding the child to avoid injury •Praise cooperative behavior
dorsogluteal injection
•Find greater trochanter and posterior superior iliac spine •Draw an imaginary line between the two •Injection site is above and this line •Do not use in children under age 3 •Do not use on Anyone who has never walked
automatic stop orders
•Given for a limited time only •Schedule II and III drugs after injury or surgical procedure •Antibiotics (if they are ordered to be taken for 10 days and then stopped, it is not to be refilled unless prescriber renews it) •d/c means to discontinue an order •Prescriptions must be clear •It is our job as nurses to be a safety check before the prescription is sent to the pharmacist, making sure all information is accurate and legible
assessment
•Imperative that you know what condition medications are being given for •Follow specific orders for particular medications •Generally assess system medication is intended to affect: •Blood pressure medication - check BP before administering drug •Insulin - check blood sugar before giving dose
Nebulizers
•Introduces medications by using compressed air or oxygen to aerosolize or suspend medication into small particles in a fine mist for inhalation into the lungs through a face mask or mouthpiece •Common with asthmatic patients and cystic fibrosis to break up thick mucus •Place the liquid medication in the chamber attached to the nebulizer tubing and pump. Once the pump is turned on, the mist will start to form, and the patient can begin to inhale the aerosol, as prescribed, through a special mouthpiece or mask
enteral medications
•Involve the GI tract •Most common route is oral administration - least invasive and well tolerated •Absorption is slower compared to parenteral route •Disadvantages of oral administration •Choking •Possible aspiration into the lungs, resulting in infection or possible death •Some medicine is important to take on an empty stomach to insure rapid action •While others patient's are advised to take with a glass of milk or food, due to being irritating to the gastric mucosa and leads to nausea and vomiting •Some may need to be taken with a full glass of water, due to risk of dehydration and stomach irritation
Z-track method
•Many medications can be very irritating to the skin or may cause skin discoloration •now the recommendation for all adult IM injections •If a health-care professional does not use the Z-track method with a medication such as Imferon, the patient may have permanent discoloration of the skin at the site
Suspension
•Medication is dispersed in the liquid, but not evenly and may separate •must be shaken before administering •Pepto-Bismol and amoxicillin
Parenteral Medications
•Medication is not ingested or introduced into the gastrointestinal system •Includes topical, ophthalmic, otic, vaginal, nasal, inhaled, and injectables •Intradermal (ID), Intramuscular (IM), subcutaneous (SC), and Intravenous (IV)
stock
•Medications kept on floor •Poured as needed
CPAP machine
•Not as portable as an mdi or nebulizer •Ideal for patients with sleep apnea •Stop breathing for short periods of time while asleep •Oxygen is considered a medication and needs an order by a doctor, most often prescribed as l/minute •Long use of cpap and nasal cannula requires moisture to avoid drying out the skin and mucosa. •Distilled water needs to added to the special water of a cpap machine •Distilled water is better than tap water, because of the chemicals in tap water
Administration of medication into nasogastric and gastric tubes
•Only liquids or tablets that have been crushed and mixed with water can be delivered through the tube •With ng and gastric tubes placement must be checked before administering anything through tube. •Initially needs to be checked by xray, then after that can be checked by injected a air bubble into the tube and listening with your stethoscope around the stomach •Be sure to flush the tubes with nSS (Normal Saline Solution) before and after medications are administered to keep tube patent •If giving multiple meds through a tube, they all have to be given individually
Oral Solid Medications and Administration
•POUR OUT OF THE BULK BOTTLE INTO THE CAP FIRST THEN POURED INTO THE MEDICINE CUP •PILLS INDIVIDUALLY PACKAGED ARE REFERRED TO AS UNIT-DOSE •GROUP OF INDIVIDUAL DOSES MAY COME PREPACKAGED AND ARE CALLED A BLISTER PACK •GENTLY PRESS ON THE TABLET SO ONLY THAT PILL FALLS INTO THE MEDICINE CUP •ALWAYS wash hands before administering medications and avoid touching the pill to prevent any transfer of microbes •tablets come in a variety of sizes, colors, and shapes •Oblong tablets are known as caplets
Buccal route
•Pouch or cheek applying to mouth or throat to relieve inflammation •Lozenges •Important to tell patient not the bite or swallow med, decreasing the effects •Swish and swallow medications (nystatin) used to prevent fungal infections •Lidocaine solution used with patients receiving chemotherapy and have mouth sores •May need to refrain from drinking for 15 to 20 minutes after taking, to maximize effects and prevent being washed away
solids (powder or patch)
•Powders are used often applied to the skin to treat fungal disease or reduce moisture •Transdermal patches hold a specific amount of medication over a specific area and deliver the medication over a certain period of time •Often used to treat nausea, pain, nicotine addiction, angina, and hormonal treatments •Advantages •Ease of application and removal, effectiveness over time, and reliable results •Disadvantages •Difficulty keeping patch in place •Make sure to wipe away any residue before applying a new patch •Wear gloves when administering, remove the sticky back, and apply them to an appropriate location on the body
7 rights of drug administration
•Right patient. Know the patient to whom you are administering the medication. •Right drug. Know the correct medication to be administered. •Right dose. Know the correct dose to give the patient. •Right time. Know the correct time the medication should be given, and inform the patient. •Right route. Know the correct route of administration by which the drug should be given. •Right technique. Know the correct method for administering the medication. •Right documentation. Know how to complete a patient's chart accurately, with all pertinent information
Oral Solid Medications
•Some tablets may need to be crushed and mixed with food or liquid to make swallowing easier •Using a silent knight or mortar and pestle •Gelatin-coated capsules - can be easily pulled apart and mixed with food (SAFETY ALERT) FIND OUT IF THIS IS A MEDICATION THAT CAN BE OPENED) •Approve by pharmacy and should only be mixed with small amounts of soft, thick food like ice cream, applesauce or pudding •Enteric Coated - improve swallowing or prevent release in the stomach, not released in the stomach, but in the intestines •Useful for patients with stomach ulcers and sensitivity
Unit dose
•Standard doses in individual package or syringe or vial •Acute care/ltc •Sent from Pharmacy
syringes
•Standard, or hypodermic, are available in sizes ranging from 3 to 60 mL. Even if the needle is attached or packaged together, a different gauge or length needle may be necessary, especially if the patient is small or is a child •are available without needles to deliver medication into the mouth
Liquid meds
•Store as directed •Check expiration date
Vaccines
•Store in refrigerator •Check expiration dates and lot #
Rectal medication administration
•Suppositories, enemas, suspensions or ointments •Necessary with severe nausea and vomiting or not alert enough to swallow •Some medications do not have parenteral form which is why it could not be administered iv or no iv access in patient •Suppositories must be refrigerated, due to release of medication when warm •Administer immediately after being opened to prevent melting •Enemas are liquids administered through rectum to soften stool, cleanse bowels or deliver medication •Most often times not seen in an ambulatory setting, but sometimes have to be administered by patients at home for bowel preparation for procedure or surgery •Rectal suspensions and ointments are usually administered through and applicator tip placed into the rectum
Deltoid
•The __________ is a triangular muscle in the upper arm that is usually well-developed and easily accessible •Because the _________ tends to be small, the general rule of thumb is that 1 mL is the maximum amount of fluid to inject, and the length of the needle should not exceed 1 inch
Manufacturer information
•Trade name: always capitalized, the name given to the drug by the manufacturer •Generic name: always lowercase (unless at beginning of a sentence), Official name by US pharmacopeia •Drug strength and form: the amount of active drug (mg, mcg, g) and form or unit of measure (tablets, capsules, teaspoons &, etc.) •Route of administration: explains how to take medication •Total quantity: the total amount of med in the container in tablets, capsules, or milliliters •If the powder's total weight in the package and total concentration and mLs, if the substance has been reconstituted •NDC number and lot number: assigned to each medication, product, and size of the container, NDC followed by 10 numbers
Nasal Route Medications
•Treat conditions such as seasonal allergies, asthma, congestion due to colds, and other sinus conditions •Available in a spray, inhaler or instillation •Instruct patient to blow nose before giving nasal drops or sprays because it clears the mucosa for maximum absorption •Instruct patient to tilt head backward to maximize absorption •Make sure dropper is patent and rinsed out after administration •Never use nasal sprays for more than one patient
written orders
•Try to obtain whenever possible. •As a health-care professional, you help ensure the patient's safety by proofreading a prescription before the patient takes it to the pharmacy •If a prescriber has poor handwriting, offer to write or type the prescription, and then have the prescriber read and sign it (YOU CANNOT DO THIS WITH SCHEDULED DRUGS!)
Subcutaneous injection Needles
•Tuberculin or insulin syringe •23G - 29 G needle •3/8 - 5/8 inches long •Maximum volume 2ml, but 1ml is safest practice •Angle of insertion 45 degrees or 90 degrees (self-administered)
Intradermal Injection Needles
•Tuberculin syringe •25g - 28g needle •3/8 inch long •Maximum volume 0.3 ml •Angle of insertion 15 degrees
sublingual route (SL)
•Under the tongue - rich blood supply which equals a rapid absorption •Nitroglycerin - for immediate relief of chest pain or during a heart attack •Slower than iv, but does not have to pass completely though digestive system
Oral liquid administration
•Use a calibrated medicine cup •Important to place on flat surface and pour liquid into the cup at eye level •Patient may need water after swallowing a thick liquid •Do not offer water if the medication was given to coat the throat •May be drawn up into a syringe without a needle and administered into the buccal pouch (cheek) •THIS HELPS PREVENT aspiration, Do not injected directly to the back of the throat •A lot of times used with children or people who have trouble swallowing •If given to infants have in a semi reclined position, not flat on back or supine •Measure liquid from the bottom of the meniscus
Vaginal Medications
•Used for local effect •Available in foams, gels, jellies and lotions •Foams deliver medication via aerosolized foam •Gels and jellies are solid particles of medication in a viscous suspension •Creams, jellies and gels are all products that can release hormones for contraceptive purposes •Antifungal creams are used to treat yeast infections •Intrauterine device (IUD) contraceptive device implanted into the uterus by an advanced practitioner •Some devices are coated with and release the hormone progesterone
School aged/adolescent developmental adaptation
•Usually able to take medications similar to adult •Provide privacy with injections •Use deltoid for im injections if possible. If not, allow patient to choose injection site if not contraindicated
Standing Orders
•Vary by facility •Used for specific routine circumstances •Need to be reviewed and updated regularly •Are not exempt from a timely signature and must be signed by the prescriber asap •Written orders for PRN patient needs •Pain MEDICINE, laxatives, cough meds, & etc. •Can be used with administering medications that are frequently adjusted •Continuous IV Medications Emergent situation medication
buffered tablets
•added antacids to prevent stomach irritation •May be scored (grooved in halves) make it easier to cut pill in half
intramuscular (IM) injection
•allow medications to be absorbed quickly into the bloodstream because of the plentiful blood supply to muscles •Preferred for vaccinations and pain medications •Onset usually happens within 10 to 15 minutes •Inserted at a 90-degree angle •Usually not a lot of pain if the time is taken to pick the correct site and inject slowly •Damage to major blood vessels, bones, and nerves can occur if an inappropriate site or improper technique is used •Site depends on the viscosity of the liquid, the size and development of the muscle, and, to a certain extent, the patient's preference
semisolids
•creams, ointments, gels and plasters that are applied to the surface of the skin •Ointments are petroleum based (be careful if patient is on oxygen) •Should be wiped away before additional doses are administered, prevent overdose •Creams are water based that absorb into skin and disappear •Gels are semisolid suspensions, particles of drug are suspended in a thickened water base •Plasters adhere to skin with material such as paper, linen, moleskin or plastic •Liniments are rubbed on the skin •Have ingredients that irritate the skin causing blood flow to increase to the affected area and decrease pain •Lotions are used for external skin disorders (itchy skin or poison ivy) •Similar to creams and are water based but lotions contain more oil than water •Patted on, not rubbed in the skin
Vials
•glass or plastic containers sealed on top with rubber stoppers •This makes the inside of the container sterile because it does not have to be opened or broken •either multiple-dose or unit-dose
ampule
•is a small glass container that holds only one dose of a medication in solution for injections •is broken by placing gauze around the neck of the container, to protect the hand and to keep glass from falling into the medicine
Subcutaneous (SubQ) Injections
•may be prescribed if the medication must be absorbed more slowly than it does with an IM injection •Injected into the fat under the skin •Insulin is one example of a medication that is administered by the SC route •Patients rarely complain of pain and the site does not usually bleed a lot •Most commonly given is heparin and insulin
Timed-release or delayed action
•prevents from being broken down in the acidic environment of the stomach •Breaks down in the alkalotic area of the small intestine •Cannot be opened or crushed because doing so releases the drug all at once, causing overdose
Intradermal (ID) injection
•site is just below the epidermis, in the dermis itself •Often used for tb tests and allergy testing •Usual sites are inner aspect of the forearm and the upper back •After preparing the site with an alcohol swab, the health-care professional holds the skin taut and inserts the needle just under the epidermis at a 10° to 15° angle •If medication is administered effectively, a wheal will form •Gently remove the needle, and do not massage the site. •If some of the medication leaks or a wheal does not form, you will have to repeat the procedure.
Needles
•used to puncture the skin and underlying layers, to deliver medication to the desired location •removed after catheter is inserted when iv is started •shorter is used for ID injections, and a longer one is used for IM injections •small is used in children or in adults with small muscles. Longer are used in large adults or in patients with large muscles •gauge is determined by the width or circumference of the lumen
vastus lateralis
•used when the deltoid is not well developed in infants and small children •This site can be used in all age groups and is the site of choice in infants and small children •To locate this site properly, place one hand on the patient's upper thigh (just below the greater trochanter) and the other hand on the patient's lower thigh (just above the knee)
