Principles and Methods of Drug Administration

1
Principles and Methods of Drug Administration

• Chapter 2

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 ADRs
• 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
• Prescribers signature

5
Medication Orders

• Controlled substances
• - Opioids, barbiturates, ect. double-locked
• - Keys with charge 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
• Patients 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 patients medication at a time
• Minimize need for calculations or compare answers
  with another nurses
• 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
• Dont confuse drug names
• Date and initial (multiuse vials or containers)
• If you didnt prep it, dont 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 patients 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

• Review pages 48-56
• 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
• - Dont 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 needles beveled tip is
  the lumen
• - Size of the diameter of the inside of the
  needles 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)
• - Vastus lateralis muscle (thigh)
• - Rectus femoris muscle (thigh)
• - Deltoid muscle (arm)
• - Z-track method
• - Used to inject irritating meds

42
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.)
43
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.)
44
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.)
45
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.)
46
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.
47
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

48
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).
49
Parenteral Administration

• Subcutaneous injections
• - loose connective tissue between the dermis
  and the muscle layer (fatty layer)
• - absorption slower than with IM injections
• - Given at a 45-degree angle if the patient is
  thin or at a 90-degree angle if the patient has
  ample subcutaneous tissue
• - Usual needle length is ½ to 5/8 inch and 25
  gauge
• - insulin and heparin

50
Subcutaneous Injection

• Angle and needle length depend on the thickness
  of skin fold

(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
51
Parenteral Administration

• Fluid and electrolytes will be also covered again
  in systems classes
• Starting of IVs and management of tubing and
  delivery devices will be covered in skills lab

52
Parenteral Administration

• Intravenous (IV) therapy
• - fluid and electrolyte maintenance,
• restoration, replacement
• - Give meds, nutritional feedings
• - blood and blood products
• - chemotherapy to cancer patients
• - patient-controlled analgesics
• - Keep a vein open (KVO)

53
Scope of Practice

• Know LPN SOP for practice state
• OSBN LPN IV policy prohibits LPNs from
  initiating the following items
• - Antineoplastic agents
• - Blood and blood components
• - Antiarrhythmics
• - Antiseizures
• - Ambulatory infusion devices
• - Hypertensive agents

54
Parenteral Administration

• Methods of intravenous administration
• - IV push
• - Intermittent venous access device
• - Intermittent infusion (or piggyback)?
• - Continuous infusion
• - Electronic pumps and controllers
• - Patient-controlled analgesia
• - Volumetric chambers

55
Parenteral Administration

• Nursing responsibilities
• - Nurse ensures that correct fluid, amount
  started and that the fluid is regulated to infuse
  over the period ordered
• - To find the drops per minute (the drip
  rate),
• find drip factor on tubing package

56
Parenteral Administration

• Nursing Responsibilities
• - Monitor Intravenous Therapy
• - Check the infusion and the IV needle site at
  least every hour
• - Flow of fluid
• - IV site erythema, wetness, and edema
• - Phlebitis inflamed vein
• - Infiltration fluid passes into the tissues
• - Assess for chills, fever, headache, nausea,
  vomiting, anxiousness, and dyspnea

57
Parenteral Administration

• Nursing Responsibilities
• - Assess for Anaphylactic Shock
• - Respiratory distress
• - Skin reactions
• - Signs of circulatory collapse
• - GI signs and symptoms
• - Change in mental status
• - Requires immediate intervention

58
Parenteral Administration

• Nursing responsibilities
• - Record administration
• - Record information
• - Evaluate and record patients response
• - Observe for ADRs

59
Patient and Family Teaching

• must be ready to learn
• Include family as allowed by patient
• teaching enables patient to care for self
• Patient should demonstrate self-care skills
• The patient should know about their illness or
  diagnosis and treatment
• The patient should know names of all medications,
  administration schedule, common side effects,
  provider to call, where to get prescriptions

60
Promoting Cooperation with Medication regimens

• Inadequate understanding of illness or disease
• Cost of the medication
• Development of adverse effects
• Forgetfulness
• Measures to foster cooperation include
• - Education
• - Resources for drug payment
• - Memory aids

61
The Nursing Process in Pharmacology

• Assessment
• - Take med history
• - Collect physical status data
• - social networks, resources?
• Diagnosis and Planning
• - Check nursing diagnoses
• - Identify desired outcomes of nursing
  interventions
• - Know why the drug is needed, how it will be
  given, and common side effects
• Implementation
• - Prepare meds safely
• Evaluation