Chapter 35: Medication Administration (Part 2) Bonnie M. Wivell, MS, RN, CNS

Routes Of Administration PO – Oral SL – Sublingual Buccal Inhalation Nasal Ears, Ears Topical / Skin Application Rectal Vaginal IM - Intramuscular IV – Intravenous SC – Subcutaneous ID - Intradermal

Process of Administration Identify the client Inform the client Administer the drug Provide adjunctive interventions as indicated Record the drug administered Evaluate the client’s response to the drug

Types Oral of Medications SOLID FORMS –Caplets –Capsules –Tablets Scored –Gel Caps –Enteric Coated –Extended Release LIQUID FORMS –Elixir –Extract –Acqueous Solution/ Suspension –Syrup –Tincture

Oral Administration Of Medication Cont’d. Other Oral Forms –Troche/ Lozenge Not meant to be swallowed –Aerosol Topical

Oral Administration Swallowed Dissolved in Liquid Crushed and put in applesauce/pudding Crushed and given via tube (pg. 718) –Gastric Tube (G-tube or PEG) –Enteral Feeding Tube –Nasogastric Tube (NG) Always refer to drug book or check with pharmacist before crushing a medication

Oral Administration Cont’d. Cutting and Crushing Tablets Do not crush: Enteric Coated Capsules Beads from capsules –Cut only “scored” tablets Do not swallow or chew sublingual tabs unless directed to do so

Buccal and Sublingual Administration Buccal – between the cheek and gums –Tablet –Semi-Solid –Paste –Thick Liquid Sublingual – under the tongue

Topical and Transdermal Application Types of meds given topically –Anti-arthritis (Heat) –Cardiac Meds (NTG Paste) –Pain Med (Patch) Fentanyl (Duragesic) –Other Patches Nicotine Estrogen Scopolamine What is the prescribed length of time for application?

Topical Application Sprays –Oral –Topical –Nasal –Inhaled MDI DPI Vaginal / Rectal –Suppositories –Creams Ear Drops –Position ear Eye Drops Irrigations

Parenteral Administration Intramuscular Subcutaneous Intradermal Intraosseous Intravenous

Equipment Syringes –Insulin –TB –Hypodermic

Luer Lok vs Non Luer Lok

Types of Insulin Pens

Parts of Needle

Sizes of Needles Length 3/8” to 3” Gauge 30 – G, 1-1.5” for IM 25-30G, 3/8-1/2” for SQ

Filter Needle

Single Dose Ampule

Single Dose Vial

Multi-dose Vial

Insulin Preparation Rapid, short, intermediate, and long acting Know onset, peak and duration ONLY regular insulin can be given IV Sliding scale based on blood glucose Gently roll cloudy DO NOT SHAKE Prepare last and administer first if mixed because regular can become “contaminated” and action can be affected CLEAR to CLOUDY

Injection Angles

Intradermal Injection

Intramuscular PAIN MEDICATION ANTIBIOTICS VACCINATIONS SUPPLEMENTS –IRON –B12

IM Injection Sites

Deltoid IM Injection Site

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Carpuject

Tubex

Where Do You Get IV and Injectable Medications? IV Solutions are standard, mixed for the patient in the pharmacy or ordered from the outside –IVPB (IV Piggyback) meds are mixed in the pharmacy –Pre-mixed –Add-Vantage Injectable Medication –Unit dose Carpuject Ampules Vials

NEEDLELESS SYSTEMS

3ml Luer Lock Syringe + Clave Adapter

Where do Drugs Come From in LTC FACILITY? MEDICATIONS ARE DELIVERED FROM AN OUTSIDE PHARMACY –ORDERS ARE FAXED TO PHARMACY –MEDICATIONS ARE DELIVERED BY THE PHARMACY SOME STOCK DRUGS AND NARCOTICS ARE ON SITE FOR PRN USE

Medication Safety “SIX” (OR SEVEN) RIGHTS RIGHT MEDICATION RIGHT DOSE RIGHT PATIENT RIGHT TIME RIGHT ROUTE RIGHT DOCUMENTATION THE RIGHT OF THE PATIENT TO REFUSE

The RIGHT Medication As the physician prescribed? Trade name or generic? Does the drug match the MAR? (medication administration record) Is the drug appropriate for the patient? Does it make sense??

The RIGHT Dose DOES THE DOSE OF MEDICATION IN YOUR HAND AGREE THE DOSE ON THE MAR? ARE THE MG, MCG, ML THE SAME? IS THIS THE TIME TO DO MATH OR GO ON A BREAK!?

The RIGHT Patient –HAVE YOU CHECKED USING TWO PATIENT IDENTIFIERS? –PATIENT STATES…VERIFIES BD –PATIENT ARMBAND –COMPARE PT. ID NUMBER TO MAR –WHAT IF THERE IS NO ARM BAND?

The RIGHT Time AM or PM Q4 Tid Bid Qid qd

The RIGHT Route PO IV SC (SQ) TRANSDERMAL RECTAL IM DOES IT MAKE SENSE??

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Patient Controlled Anelgesia

PCA PUMP

MOD – Medication on Demand The Radio Frequency Identification (RFID) based wrist band, the first of its kind to be implemented successfully, assist nurses by automating the process of administering patient medication.