Chapter 7 Medication Administration

Objectives  Define all key terms.  Explain what supplies are needed for medication administration.  Select the correct needle and syringe for parenteral injections.  Describe the solutions used in IV therapy.  Describe blood products.

Objectives  Describe how to administer oral medications safely.  Discuss the methods for administering medications through nasogastric or gastric tubes.  Discuss how to inject IM, SC, and ID medications safely.  Describe how to administer ophthalmic and otic medications correctly.

Objectives  Discuss precautions for the safe administration of inhalation therapy.  Describe how to apply transdermal patches correctly.  Describe how to insert vaginal and rectal medications safely.  Discuss how to prepare the patient for IV therapy.

Nonparenteral Supplies  Bottles and unit-dose packages  Droppers  Inhalation delivery systems  Patches  Suppositories

Safety  Use correct supplies for route.  Do not touch medications with your hands.  Dispose of or cleanse droppers after use.  Humidify oxygen or room air.  Do not cut transdermal patches—apply to intact skin only.  Monitor patient after administration.

Critical Thinking  What would happen if a patient used a CPAP machine with a mask for 30 minutes without having added water to the inhaled air?

Parenteral Supplies for Injectable Medications  Ampules and vials  Needles  Syringes  Safety devices  Prefilled syringes  IV supplies  IV solutions  IV setups

Critical Thinking  Why do you think vials are used more than ampules?

Safety  Practice good hand hygiene.  Change needle after insertion into ampules or use filter.  Clean site.  Use safe needles.  Use proper sharps disposal procedure.  Monitor patient after injection.

Critical Thinking  Why is it dangerous to recap a needle? With so many safety devices available, why do you think there are still so many needle-sticks?

Blood Products  Whole blood  Packed red cells  Platelets  Polymerized hemoglobin

Critical Thinking  Why do physicians prescribe different blood products instead of just giving whole blood?

Administering Medications  Oral medications  Opthalmic administration  Other types

Oral Medications  Medications by mouth  Nasogastric and gastric tube administration

Ophthalmic Administration  Drops  Ointments

Other Administrations  Otic  Nasal  Inhalation—inhalers and nebulizers  Transdermal  Vaginal  Rectal

Injections  Intramuscular  Subcutaneous  Intradermal  IV

Intramuscular  Hormones, vaccinations, and pain medications  Needle length 1–1½ inches  Gauge 21–23  Syringe capacity to 5 cc  Enter at 90-degree angle

IM Sites  Deltoid  Dorsogluteal  Ventrogluteal  Vastus lateralis

Critical Thinking  Are the dorsogluteal and ventrogluteal the same site? When would you use each method?

Z-track Method  Same as regular IM, but displace the skin before and after needle removal  Used for fluids that stain the skin

Subcutaneous Injections  Into fat layer—less blood supply and nerve endings  Can be done by patient at home  Sites (usually abdomen, back of upper arm, and thigh)  45-degree angle  Needle length ⅜ inch to ½ inch  Gauge 25–31  Syringe capacity 1 mL

Intradermal Injections  Under epidermis  10–15 degree angle  25–31 gauge needle  Needle length ⅜ to ½ inch  Sites (usually forearm)

IV Administration  IV insertion  Flushing indwelling devices  Complications of IV therapy  Documentation

Documentation  Size and type of device  Date and time inserted  Site location  Type of solution  Name of healthcare provider inserting/hanging  Additives

Documentation Continued  Flow rate  Type of infusion pump used  Number of attempts at insertion  Patient response  Complications, if any, and your interventions  Patient teaching

Assessment Documentation  Date and time  Condition of site  Site care provided  Dressing change  Site change  Tubing and solution change  Patient teaching

Summary  What new piece of information in this chapter were you most interested to learn?  What questions do you still have about the information in this chapter?  Return to Objectives to determine extent of learning.Objectives

Credits Publisher: Margaret Biblis Acquisitions Editor: Andy McPhee Developmental Editor: Yvonne N. Gillam Production Manager: Samuel A. Rondinelli Manager, Electronic Development: Kirk Pedrick Technical Project Manager, EP: Frank Musick Design Associate, EP: Sandra Glennie The publisher is not responsible for errors or omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regards to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation.