1. Administering Medications
Chapter 44
Administering Medications
All medications must be administered correctly.
Define systemic and parenteral.
Never prepare medications that you will not administer nor give medications you have not prepared.
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2. Forms of Oral (Enteral) Medication
Solid
Tablet
Capsule
Liquid
Syrup
Suspension
Elixir
What is another name for oral route?
Define sublingual and buccal.
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3. Advantages of Oral Medication Administration
Safe
Can be retrieved easily if necessary
Requires no special equipment
Medicine cup
Easily taken by patient
Most medications easy to swallow
What are some of the disadvantages of the oral route?
A medicine cup may be necessary to administer an oral medication.
If the patient does not have a gag reflex do not give by the oral route.
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4. Procedure: Administering Oral Medications
Demonstrate Procedure 44-1.
Have the students practice Procedure 44-1.
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5. The Medicine Cup Define meniscus.
A medicine cup can be used for solids as well as for liquids.
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6. “Seven Rights” Right drug Right dose Right patient Right route
Right time
Right technique
Right documentation
Review the “Seven Rights” of medication administration.
Why should a medical assistant follow the “seven rights” of drug administration?
What are some of the problems that can occur if the “seven rights” are not followed?
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7. Special Considerations
Difficulty in swallowing pills
Crush pills
Place in applesauce or pudding
Enteric-coated pills cannot be crushed
Eliminates the desired effect of the coating
Scored pills can be cut; unscored pills cannot
Drug absorption time
Altered by food, physical activity, and emotions
If crushed medications are placed in applesauce or pudding make certain the patient eat all of the food.
What does a scored tablet mean?
Why should you not cut a tablet in half if it is not scored?
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8. The “Crusher” Review the types of pill crushers available. 8
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9. Check Medication Three Times
Once when removing from the shelf
A second time before pouring
A third time when returning it to the shelf
Why should the medical assistant check the medication three times?
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10. Forms of Topical Medications
Creams
Applied following direction of the hair growth
Lotions
Ointments
Remove oil-based preparations before next application
Transdermal patches
Used for continuous, systemic effects
To what layer of the skin is a topical medication applied?
Can topical medications be applied to the mucous membranes?
Drug action occurs within 1 hour of application.
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11. Procedure: Applying a Transdermal Patch
Sanitize hands
Check medication and expiration date
Explain procedure to patient
Apply patch to clean, dry, hair-free area
Use gloves
Provide written care instructions to patient
Document appropriately
Demonstrate Procedure 44-2.
Have the students practice Procedure 44-2.
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12. Applying a Transdermal Patch
The patch will not adhere to the skin properly if the area is covered with hair, lotions, or oils.
Why is it important to rotate the sites at each application?
Why is it important for the medical assistant to be wearing gloves during the procedure?
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13. Types of Vaginal Medications
Creams
Used as contraceptives, treatment for infections
Foams
Suppositories
Melt at body temperature
Define suppository.
What position will the patient need to be in when a vaginal medication is being administered?
Explain the proper way to administer vaginal medications.
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14. Rectal Administration of Medication
Used for nausea and vomiting
Prevents further upsetting GI tract
Route used for systemic or local effects
Antipyretic
Analgesic
Antiemetic
Laxative
Define antipyretic, analgesic, antiemetic, and laxative.
Explain the proper way to administer rectal medications.
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15. Types of Inhalation Medication
Gases, powders, and aerosols
Nebulizers
Provide a mist of medication
Compressor forces air into medication compartment
Metered-dose inhaler (MDI)
Used for self-administration of medication
Inhaler depresses just as patient breathes
Doses are ordered in “puffs”
How are inhaled medications absorbed through the bloodstream?
This route requires that specific instructions be provided to the patient.
Can a patient use a nebulizer and an MDI at their home?
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16. The Nebulizer A nebulizer provides a mist of medication.
Demonstrate the proper way to use a nebulizer.
Have the students practice using the nebulizer.
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17. Metered-Dose Inhaler XVII. Metered-Dose Inhaler
Please insert Figure 40-5 here.
Notes:
A. Hand-held device that dispenses medications into the airway and lungs
B. Spacer (added attachment can be used to assist the patient to coordinate breathing & dispensing)
1. Elderly may have problems using MDI because it requires
strength and coordination
C. Inhaler depresses just as patient breathes
D. First puff opens the airway and reduces inflammation
E. Second puff given 1 minute later, enters deeper into the airway
1. Each dose is held for 10 seconds, & patient is instructed to
An MDI is a hand-held device that dispenses medications into the airway and lungs.
Demonstrate Procedure 44-3.
Have the students practice Procedure 44-3.
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18. Inhaler with a Spacer What is a spacer? Why is a spacer used? 18
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19. Parenteral Medication Administration
Administered into the body by injection
Types of equipment needed depends on:
Viscosity of the medication
Patient’s body size
Amount of medication
Route and site of injection
Common types of parenteral administration
IM, SubQ, ID
Define aqueous solution.
What do the abbreviations IM, SubQ, and ID mean?
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20. Parenteral Administration
Advantages
Allows quick drug action
Bypasses the GI tract, increasing the rate of absorption
Disadvantage
When adverse reactions occur, patient is put at immediate risk
Why would a medication need to bypass the GI tract?
Why must you check a patient’s allergies before giving a parenteral medication?
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21. Equipment for Parenteral Administration
Vials
Ampules
Prefilled cartridge units
Syringes
Needles
Show the students an example of each type of equipment.
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22. Parenteral Administration Equipment
Quiz the students about each type of equipment.
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23. Vials Single or multiple dose
Medication dissolved in an aqueous solution or suspended in a sterile oil base
Mix content by gently rolling between palms
Check expiration date
Can consist of a powder, needing to be reconstituted
Can a multidose vials ve used for more than one patient?
Define reconsitute.
Demonstrate Procedure 44-4.
Have the students practice Procedure 40-4.
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24. Mixing Medication in a Vial
Why should the vial never be shaken to mix the contents?
What should the medical assistant do if the medication in the vial appears cloudy or has particles in it?
Demonstrate the proper way to mix medication in a vial.
Demonstrate Procedure 44-5.
Have the students practice Procedure 44-5.
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25. Ampules One-dose containers
Narrow, scored, thin neck allows easy opening
Tap the stem to remove any medication
Clean neck with an alcohol pad
Withdraw medication with filter straw or needle
Replace needle before giving injection
Never inject air into ampule
Medication won’t spill even if ampule inverted
Why is it important to get all the medication out of the end of the ampule?
Why does the medical assistant clean the neck of the ampule with an alcohol pad?
What can happen if air is injected into the ampule?
Demonstrate the proper way to open an ampule.
Demonstrate Procedure 44-6.
Have the students practice Procedure 44-6.
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26. Prefilled Cartridge Unit
Single dose of medication for injection
Unneeded portion of medication discarded
If medication is a narcotic, discarding must be witnessed and documented
Cartridges require special holder with plunger
Cartridges disposable but holders are reused
Demonstrate the technique for loading the TUBEX and or another type of injector system.
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27. Prefilled Cartridge Can the injector system be reused?
How is the injector system cleaned?
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28. Syringes Calibrated tube Plunger pulls or pushes medication in or out
Available in various sizes
3-mL size most commonly used
Calibrated in tenths of a milliliter, or minims
Disposable syringes prevent cross-contamination
Only outside of barrel and flared end of the plunger may be touched
A syringe is a hollow tube made of glass or plastic with a tip that attaches to a needle.
Show the students various sizes of syringes.
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29. Parts of a Syringe Review the parts of the syringe.
What parts of the syringe can be touched without contaminating it?
If the syringe gets contaminated it must be discarded.
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30. Types of Syringes Review the types of syringes.
Quiz the students and have them identify the types of syringes.
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31. Parts of a Needle Hub Shaft Point Gauge
Part of the needle that fits into a syringe
Shaft
Determines the needle’s length
Point
Slanted or beveled tip
Gauge
Number identifying the size of the lumen
Review the parts of the needle.
Define bevel and lumen.
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32. Types of Needles XXXII. Types Of Needles
Please insert figure 40-16A here.
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33. Needle Bevels What is the purpose of the beveled point?
Show the students examples of each type of beveled point.
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34. Common Needle Length and Sizes
Why are there different needle lengths and gauge sizes?
What is the shortest and longest needle length?
What is the thinnest and thickest needle gauge size?
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35. Procedure: Reconstituting Powdered Drugs
Points to remember:
Check expiration date
Read and follow manufacturer’s instructions
Remove hard metal cap from bottle
Cleanse rubber stopper with alcohol pad
Define reconstituted.
Review the “seven rights” of medication administration.
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36. Procedure: Reconstituting Powdered Drugs (cont.)
Insert needle into vial with diluent and withdraw needed amount
Inject fluid into vial with the powdered drug
Mix vial by gently rolling between palms
Label and date reconstituted drug vial
Demonstrate Procedure 44-4.
Have the students practice Procedure 44-4.
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37. Procedure: Withdrawing Medication from a Vial
Points to remember:
Check expiration date; check drug three times
Cleanse rubber stopper with alcohol
Inject air equal to amount of drug to be withdrawn from vial
Withdraw needed amount of medication
Remove any bubbles
Cover needle one-handed by “scoop” method
Review the “seven rights” of medication administration.
Demonstrate Procedure Procedure 44-5.
Have the students practice Procedure 44-5.
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38. “Scoop” Method Explain the “scoop” method.
When should the scoop method be used?
Have the students practice performing the “scoop” method.
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39. Procedure: Withdrawing Medication from an Ampule
Points to remember:
Check medication and expiration date
Clean neck of ampule with alcohol pad
Tap down any drug in neck of ampule to the bottom portion of the ampule
Snap the neck off the ampule
Using a syringe with a filter straw needle, withdraw the needed amount of medication
Discard the used ampule
Why does the medical assistant clean the neck of the ampule with an alcohol pad?
Demonstrate Procedure 44-6.
Have the students practice Procedure 44-6.
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40. Needle Stick Prevention
Focus on the task at hand
Do not recap needles
Use “scoop” method to recap needle only in an emergency
Properly use safety syringes and needles
Always dispose of needles and syringes as one unit in a puncture-resistant container
Show the students an example of a puncture-resistant container.
What should a medical assistant do if he or she is stuck with a clean or dirty needle?
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41. Injection Sites Review the various injection sites.
Why is it important to know the amount of medication that can be administered at each site?
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42. Intradermal (ID) Injection
Placed into the dermis with bevel up
Wheal appears when drug injected
Commonly used for allergy and TB skin testing
Small amount of medication administered
Absorption rate slow, drug reaction localized
Review the layers of the skin.
Why should the bevel be up?
Why does a wheal appear after administering the medication?
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43. Intradermal (ID) Injection (cont.)
Sites used
Forearm, upper chest, hairless area of back
Tuberculin syringe and ⅜- to ½-inch, 26- to 27-gauge needle used; given at 10- to 15-degree angle
Show the students each ID injection site on a mannequin.
Why are ID injections given at a 10- to 15-degree angle?
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44. The ID Injection Review the layers of the skin.
What is another name used for wheal?
An ID injection injects deposits of medication under which layer of the skin?
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45. Sites Used for ID Injections
Never touch a site after cleaning it.
Show the students each ID injection site on a mannequin.
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46. Procedure: Administering an ID Injection
Points to remember:
Area selected should not be scarred or inflamed
Area should be fairly free of hair
Cleanse injection site outward in a circular motion
Let air-dry because site wet with alcohol may cause stinging and interfere with test results
Stretching the patient’s skin taut will permit easier insertion of the needle.
Should the medical assistant aspirate the injection site?
What should the medical assistant do if he or she does not create a wheal?
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47. Procedure: Administering an ID Injection (cont.)
Pull skin taut with thumb of hand not holding syringe
Insert needle at a 10- to 15-degree angle until bevel barely penetrates skin; release skin
Do not aspirate; inject liquid, observing for wheal
Demonstrate Procedure 44-7.
Have the students practice Procedure 44-7.
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48. Tuberculin Testing Mantoux test Postive results If positive results:
Mycobacterium tuberculosis
Most sensitive test
Postive results
Induration of 10 mm or greater appearing within 48 to 72 hours
If positive results:
Need chest x-ray and sputum analysis
Should health care workers have a Mantoux test every year?
What does it mean when a patient has a positive results?
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49. ID Testing Results Review each ID testing result. 49
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50. Induration Numerical Scale
Define induration.
Demonstrate how to measure the diameter of the induration.
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51. Charting Demonstrate how to properly document an ID injection.
Demonstrate how to properly document a Mantoux test and results.
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52. Subcutaneous (SubQ) Injections
Placed into fatty layer beneath dermis
Used for small amounts of nonirritating medication (less than 2 mL)
Absorption rate is slow
Blood supply in SubQ tissue is minimal
Review the layers of the skin.
What medications are given SubQ?
What other abbreviations are used to indicate subcutaneous?
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53. Subcutaneous (SubQ) Injections (cont.)
Sites used
Upper outer area of arm, thigh, and abdomen
Rotate sites to minimize tissue damage
Needles used: ⅝ inch, 25 to 28 gauge, in 3 mL syringe, given at 45-degree angle
Aspirate before injecting drug
Show the students examples of syringes and needles used to give a SubQ injection.
Why is it important for a medical assistant to aspirate before injecting the medication?
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54. Injection Angles Review the various injection angles.
Why must the medical assistant understand which angle to use for an injection?
Why are SubQ injections given at a 45-degree angle?
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55. Sites Used for SubQ Injections
Never touch a site after cleaning it.
Show the students each SubQ site.
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56. Procedure: Administering a SubQ Injection
Points to remember:
Cleanse the injection site outward in a circular motion with an alcohol pad
Grasp generous portion of skin at the injection site
Insert needle at 45-degree angle
Aspirate; inject medication
Massage with clean cotton ball, gently but firmly
Document appropriately
Demonstrate Procedure 44-8.
Have the students practice Procedure 44-8.
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57. Intramuscular (IM) Injections
Injected into large muscles
Used when rapid absorption is needed
Sites used
Deltoid, vastus lateralis, ventrogluteal, dorsogluteal
Needles used
1 to 1½ inches, 20 to 21 gauge, given at a 90-degree angle in a 3-mL syringe
Show the students examples of syringes and needles used to give an IM injection.
Why is it important to aspirate before injecting the medication?
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58. Muscles Used for IM Injections
Deltoid: for both adults and older children
Vastus lateralis: preferred site for infants and young children
Ventrogluteal (gluteus medius and gluteus minimus): used from infancy to adulthood
Dorsogluteal: traditional site for IM injections
Close to sciatic nerve
Show the students IM injection sites.
What could happen if the sciatic nerve is hit during an IM injection?
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59. Muscles for IM Injections
Locate the vastus lateralis.
This site provides rapid drug absorption.
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60. Muscles for IM Injections (cont.)
Locate the dorsogluteal injection site.
Demonstrate how to locate the correct dorsogluteal injection site.
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61. Muscles for IM Injections (cont.)
Locate the ventrogluteal site.
All forms of injectable medication can be given at this site.
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62. Procedure: Administering an IM Injection to a Child
Points to remember:
Vastus lateralis is the site of choice for children up to the age of 12 months
Use deltoid once child is walking
Parent, guardian, or another health care professional should restrain the child
Use only as last resort
Gain child’s cooperation if possible
Why should the vastus lateralis site be used?
What should the medical assistant do if blood is drawn into the syring during aspiration?
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63. Procedure: Administering an IM Injection to a Child (cont.)
Needle should not be allowed to move during aspiration
Clean cotton ball or gauze is used to massage the injection site
Chart appropriately
Demonstrate Procedure 44-9.
Have the students practice Procedure 44-9.
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64. Pediatric Injection
Why is this site used on a patient who is not walking yet?
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65. The Deltoid Muscle
No more than 2 mL for adults and 1 mL for children should be injected into this site.
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66. Procedure: Administering an IM Injection to an Adult
Points to remember:
Explain the procedure to the patient
Deltoid used for smaller amounts of medication
Always wear gloves when giving injections
Aspirate before injecting medication
Withdraw needle at same angle it was inserted
Demonstrate Procedure 44-10
Have the students practice Procedure
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67. Z-Track IM Injection Special technique used when drug could cause:
Skin discoloration
Irritation to subcutaneous tissue
Stops medication from leaking back into subcutaneous tissue
Preferred sites
Vastus lateralis
Ventrogluteal
Demonstrate Procedure 40-11
Have the students practice Procedure
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68. Procedure: Administering Medication Using Z-Track
Points to remember:
Frequently used sites include:
Pull skin laterally from injection site, approximately 1 to 1½ inches
Administer the medication while holding the skin away from the injection site
After the injection, remove the needle and release the skin, sealing off track
Demonstrate Procedure
Have the students practice Procedure
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69. Functions of IV Fluids Maintain blood volume Regulate body temperature
Transport nutrients to and from cells for cell metabolism
Aid in digestion
What is the goal of IV fluid administration?
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70. Categories of IV Solutions
Show the student example of the basic supplies and equipment needed to administer IV fluids.
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71. Therapeutic Uses of IV Solutions
Explain how an IV line is started.
Explain drip rate.
Explain how to discontinue an IV line.
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72. Conclusion Medication can be administered in many ways
Medical assistants need to understand purpose and use of each method in order to administer medications:
Accurately
Efficiently
Safely
Review the forms of medications.
Review the routes of medication.
Review the injection sites for medication administration.
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