1. Preparing and Administering Medications
Chapter 10
Preparing and Administering Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1

2. Learning Objectives
Outline procedures for giving medications parenterally and percutaneously
List processes to prevent transmission of human immunodeficiency virus (HIV) and other blood-borne pathogens
Identify anatomy landmarks used for giving parenteral medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

3. Parenteral Administration
“Into the skin”
Routes for administration
Parenteral rationale/Advantages
Disadvantages
Costs
Which route is commonly used when a patient undergoes allergy testing?
Why would the parenteral route be preferred over the oral route?
What effect occurs in the liver that causes the oral dosage to be higher than the IV dosage of the same drug?
What is the difference between aseptic and sterile technique related to drug administration?
Are pregnant healthcare workers at greater risk of exposure to blood-borne pathogens such as hepatitis B or HIV?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

4. Standard Precautions Protect health care workers
Centers for Disease Control (CDC)
Sharps container for disposal of needles
Never recap a used needle!!!!
When should the nurse use standard precautions in the clinical area?
Is it important for the nurse to recap the needle after medication administration?
What are examples of blood-borne pathogens?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

5. Basic Equipment Syringes Types of syringes: Figure 10-3
Volume of medication: mL
Which syringe would the nurse select when administering volumes less than 1 mL?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

6. Practice Each person safely remove the syringe from the paper wrapper.
Note the tip of the syringe.
Note the barrel.
Maneuver the plunger using only the end of the plunger. Never touch the part of the plunger that will go into the barrel.
Note size of syringe, measurement increments and type of tip.
Straight tip of Leur lock tip
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

7. Needles Needles: gauge Hub Specialized needles
Guide for needle selection: Table 10-1
Needleless system: Figure 10-6
Which is the larger needle, a 16-gauge or a 25-gauge?
What does the nurse consider when selecting the length of the needle?
When would a patient receive patient-controlled analgesia (PCA)?
What is the difference in route of PCA compared to PCEA?
Needleless systems have become popular as a type of delivery system because of safety issues associated with needle disposal.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

8. Memory Tool The lower the gauge, the higher (bigger) the diameter.

10. Practice The needle hub attaches to the plunger tip.
Ensure the needle is secure before you attempt to remove the needle cover.
Note the angle of the needle bevel.
Think: How should the needle enter the skin?

11. Question 1
The Z-track method is used to give medicines: Select all that apply
Orally.
Rectally.
That should be absorbed slowly.
That are irritating to the skin.
That may stain the skin.
Correct Answer: 3
Rationale: The Z-track technique of injection is used to administer IM medications that are irritating or may stain the skin.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

12. Procedure for Preparing and Administering Parenteral Medications
Procedure for medication administration: Procedure 10-3
Determine site for administration
Use of equipment
Package
Medication characteristics
When inspecting sterile packages, what are considerations to which the nurse should pay close attention?
When should the nurse return medications to the pharmacy?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

13. Forms of Parenteral Medications
Vials
Ampules
Ampulae
Can you describe the procedure the nurse should follow when inserting a needle through the rubber diaphragm of a vial?
If the vial contains a powder, the nurse adds the recommended fluid. This is referred to as reconstitution of the drug.
How does the nurse determine the type of diluent to use for drug reconstitution?
When withdrawing medication from an ampule, the nurse uses a special needle that contains a filter to prevent glass shards from being drawn up into the syringe.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

14. Mix-o-vial
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

15. Multidose vial
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

16. Forms of Parenteral Medications (cont.)
Combining drugs in one syringe
Mixing insulin
Prefilled syringes
IV solutions
Secondary or “piggyback”
Why must the nurse inject air into a vial before withdrawing the drug?
Which insulin is drawn up first when mixing Regular and NPH insulin?
When the nurse opens a multidose vial, what should be added to the label?
Can you think of an instance when a prefilled syringe would be helpful?
What amount of solution volume do secondary infusions usually contain?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

17. Administering Intradermal Injections
Uses
Skin anatomy and needle angle
Bleb
Equipment and technique
Do not massage
What instructions will the nurse provide to the patient following an intradermal injection?
What needle gauge and length is used when administering intradermal medications?
Can you think of a drug or situation when an intradermal injection may be given?
What type of symptoms will the nurse observe if the patient is allergic or reacting to the medication given intradermally?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

18. 0.01 to 0.1 mL intradermal

19. Administering Subcutaneous Medications
2 mL into the loose connective tissue
Slow onset, longer duration
Placement
Sites
Technique
Do not massage
Why do medications that are administered subcutaneously have a slow onset and long duration of drug action?
What length of needle is commonly used when administering subcutaneous medications?
Why is it important to rotate sites when administering medications subcutaneously?
To make sure the needle has not accidentally entered a vein or artery, you would typically pull back on the plunger (aspirate) and check the syringe for blood. With what medication do you NOT aspirate prior to administering?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

20. Administering Intramuscular Medications
Location
Absorption
Equipment
Sites
Technique
Do not massage
What is the maximum amount of volume that can be administered intramuscularly to infants?
How does the nurse determine the needle length for an IM injection?
How do the techniques for injection differ when you compare the IM to the Z-track technique?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

22. Practice Put on your clean gloves.
Practice darting the needle into the injection pod.
Do NOT ever let go of the syringe!
“The hand that darts doesn’t let go!” Mrs. M.
Practice placing the injection in the proper site and injecting fluid to the site.
Use a dry sterile gauze on the site with pressure after removing the needle

23. Assess the needle length and angle

24. Giving insulin Rotate the sites.
Mixing: ensure the insulins are compatible
NPH: Regular then Regular: NPH
Air in NPH (cloudy), Air in
Regular (clear), turn over bottle,
Draw up Regular (clear) then
Draw up NPH (cloudy)