1 / 63

Principles and Methods of Drug Administration

Principles and Methods of Drug Administration. Medication Administration. Nursing Responsibilities - Standard precautions - Patient privacy - Patient preparation - Drug preparation. Nursing Implications Associated with Drug Administration. Consult references/pharmacist

jamese
Télécharger la présentation

Principles and Methods of Drug Administration

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Principles and Methods of Drug Administration

  2. Medication Administration • Nursing Responsibilities - Standard precautions - Patient privacy - Patient preparation - Drug preparation

  3. Nursing Implications Associated with Drug Administration • Consult references/pharmacist • Observe for ADR’s • Report drug reactions • Record observations • Withhold drug if needed - notify provider

  4. Medication Orders • The nurse must ensure the patient receives the correct medication • Orders should include the following: • Name Date/time Drug name Dose Route Time/frequency administration Prescriber’s signature

  5. Medication Orders • Controlled substances - Opioids, barbiturates, etc. double-locked - Keys with nurse - Log administration of drugs - End-of-shift count - Waste controlled substance with witness

  6. Medication Orders • Types of orders - Standing orders - pre-written, no call - Verbal orders - telephone to nurse - repeat back to provider - To be written and signed by the provider asap

  7. The Seven Rights of Medication Administration • Right drug • Right dose • Right patient: name and birth date • Right time • Right route • Right documentation • Patient’s right to refuse

  8. Medication Preparation • Know the seven rights • Drug reference available • Know drug action, contraindications, usual dosage, and side effects • Check label 3 times - removing drug from container or drawer - on comparison with MAR - before giving to patient (if unit dose) - Before returning to drawer (if multi-use container)

  9. Important Considerations • Enlist the patients • Utilize the pharmacists • Prepare one patient’s medication at a time • Minimize need for calculations or compare answers with another nurse’s • Two licensed nurses must double check high alert drugs before administration, i.e. insulin, heparin

  10. Important Considerations • Always report errors • Never give an unlabeled drug • Don’t confuse drug names • Date and initial (multiuse vials or containers) • If you didn’t prep it, don’t give it

  11. Important Considerations for Medication Administration • 2 identifiers for safety: name and DOB • If you gave it, chart it • Do not chart for someone else or have someone else chart for you • Do not transport or accept a container that is not labelled • Do not put down an unlabeled syringe

  12. Important Considerations for Medication Administration • Watch the patient take it and swallow it • Assess patient’s response • If a patient refuses a medication: • do not force it, chart it • If you elect to omit a dose based on your nursing judgment, let another nurse help make the decision. If medication is not given, document, “dose omitted because…” Report to the provider

  13. Commonly Used Abbreviations • Joint Commission on Accreditation of Healthcare Organization (JCAHO) approved abbreviation list • institutional policy and list of used abbreviations

  14. Routes of Administration • Enteral - Via the GI Tract - Powders - Pills - Tablets - Liquids or suspensions - Suppositories

  15. Routes of Administration • Percutaneous - Through the skin or mucous membranes - Topical - Instillation - Inhalation

  16. Routes of Administration • Parenteral - Methods other than the GI tract; needle route - Intramuscular (IM)‏ - Subcutaneous (SC)‏ - Intradermal - Intravenous (IV)‏ - Ampules - Vials

  17. Enteral Administration • Tablets, pills, capsules - absorbed more slowly from GI tract into the bloodstream than via any other route - (PO) route relatively safe - Do not crush enteric coated or sustained release pills - Only divide scored pills - Liquid medications: children and patients who cannot swallow pills

  18. Oral Medications • Unit dosage system: most common • Med stays in package until administration • May place prepackaged medications in the same cup until administered • Involve the patient and include teaching • Patient refusal: return unopened medication to the drawer, document reason, notify provider

  19. Oral Medications • From multi-dose containers, pour pill into the cap, drop into a medicine cup • Label cup with med name, dose • Do not touch meds with bare hands • Falls on floor? Toss it. Working on med cart? Add clean field

  20. Enteral Administration of Liquid Medications • PO, or via a NG, gastrostomy, or jejunostomy tube • No liquids to unconscious patients: aspiration • Some liquid medications are not to be followed by water; some may stain the teeth • Use calibrated cup or syringe (but not IV syringe) • Measure liquids at bottom of meniscus

  21. Enteral Administration of Tubal Medications • NG tubes: liquid meds to unconscious patients, dysphasic patients, those too ill to eat • Use liquid form or crush tablets and open capsules if allowed – give separately in warm water • Not all tablets are safe to use when crushed and not all capsules are safe to use when opened

  22. Enteral Administration of Suppositories • Rectum or vagina • Dissolves at body temperature and absorbed directly into the bloodstream • infants, patients intolerant of oral preparations, N/V • Store in cool place

  23. Administration of Vaginal Medications • Usually for yeast infections • Some products are used to induce labor • Use gloves • Provide privacy

  24. Percutaneous Administration • skin /mucous membranes • Mostly local action; some act systemically • topical applications (ointments, creams, powders, lotions, and transdermal patches), instillations, and inhalations • Absorption is rapid, short duration

  25. Percutaneous Administration • Ointments - oil-based; semisolid; skin or mucous membrane • Creams - Semisolid, non-greasy emulsions; external application • Lotions - Aqueous, soothing: pruritus, protectant, cleansing, astringent

  26. Percutaneous Administration • Transdermal Patches Adhesive-backed, medicated patches -sustained, continuous release of medication over hours/days • Eye drops and Eye Ointments - Don’t touch the dropper or the tube to the eye (p 70 Fig 2-18) • Eardrops - ‘Otic’ solutions must be at room temperature when applied - Use only droppers supplied with medications for administration

  27. Percutaneous Administration • Nose drops - individual use only • Nasal sprays - absorbed quickly; less medication used, wasted • Inhalations - mucous membranes ofrespiratory tract - relatively limited effect or a systemic effect - used by respiratory therapy and anesthesiologists

  28. Percutaneous Administration • Sublingual medications - under the tongue, rapidly absorbed - tablet or a liquid squeezed from capsule - Do not give water after as water reduces absorption - tablet should dissolve (no swallowing) • Buccal medications - between the gum and the cheek, preferably above the molar - Follow same administration guidelines as SL

  29. Parenteral Administration • Intramuscular (IM)‏ • Subcutaneous • Intradermal • Intravenous (IV)‏ • Rationale for using these methods include: - Absorption rate - No oral route - Emergencies - Drug is destroyed in the GI tract

  30. Parenteral Administration • Equipment - Syringes - barrel, plunger, and tip - calibrated in milliliters, minims, insulin or heparin units - Types - Tuberculin syringe (for allergy testing/treatments, TB testing and small quantities) - Insulin syringe - One and three milliliter syringes - Safety-Lok syringes

  31. Parts of a Syringe (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.) .

  32. Tuberculin Syringe Calibration (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

  33. Calibration of U100 Insulin Syringe (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

  34. Reading the Calibrations of a 3-mL Syringe

  35. Safety-Glide Syringe

  36. Parenteral Administration • Equipment - Needles - Parts are the hub, shaft, and beveled tip - Opening at the needle’s beveled tip is the lumen - Size of the diameter of the inside of the needle’s shaft determines the gauge of the needle; the smaller the gauge, the larger the diameter - Needle gauge selection is based on the viscosity of the medication

  37. Parts of a Needle (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

  38. Parenteral Administration • Equipment - Needle length - Selected based on the depth of the tissue into which the medication is to be injected - Intradermal: 3/8 to 5/8 inch - Subcutaneous: ½ to 5/8 inch - Intramuscular: 1 to 1 ½ inch - Intravenous needles - Butterfly (scalp needle)‏ - Over the needle catheter

  39. Needle Length and Gauge (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

  40. Parenteral Administration • Equipment - needleless devices - sheath or guard - IV caths: blunt-edged cannulas, valves, or needle guards - IV tubing: recessed and shielded needle connectors to reduce needle sticks

  41. Parenteral Administration • Intramuscular (IM) injections - Site selection - Gluteal sites: ventrogluteal (gluteus medius) http://www.youtube.com/watch?v=Ip2hbl_k_vc - Vastuslateralis muscle (thigh) http://www.youtube.com/watch?v=WRVCptt-wpg

  42. Rectus femoris muscle (thigh) - Deltoid muscle (arm) - Z-track method - Used to inject irritating meds

  43. Locating IM Injection for Ventrogluteal Site (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

  44. Giving IM Injection in Vastus Lateralis Site on an Adult (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

  45. Rectus Femoris Muscle A. Child/Infant B. Adult (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

  46. Giving IM Injection in Deltoid Site (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

  47. Figure 23-20 (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) A, Z-track method. B, Using an air lock. C, Administering IM injection by airlock technique.

  48. Parenteral Administration • Intradermal injections - serum, vaccine, or skin test agent - Not aspirated - Small volumes (0.1mL) injected to form a small wheal just under the skin - Used for allergy sensitivity tests, TB screening, local anesthetics - tuberculin syringe with 25-gauge, 3/8 to 5/8 inch needle

  49. Figure 23-21 (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Angles of insertion for intramuscular (90°), subcutaneous (45°), and intradermal (15°).

More Related