chapter 10 administration procedures

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Chapter 10 Administration Procedures

Chapter 10 Administration Procedures


Three Checks and Six Rights Three Checks and Six Rights

Three Checks When Preparing Medications

Read the label:

1. Check the drug label with the medication administration record (MAR) when removing the container or unit-dose package.

2. Check the drug label again immediately before pouring or opening the medication, or preparing the unit-dose.

3. Check the drug label once more when replacing the container and/or before giving the unit-dose to the patient/client.


Three Checks and Six RightsThree Checks and Six Rights

Six Rights Before Administering Medications

1. Right medication

2. Right patient/client

3. Right dosage

4. Right route

5. Right time

6. Right documentation


Medication OrdersMedication Orders

• **A correct medication order or prescription bears the patient/client’s name, room number, date, name of drug (generic or trade), dose of the drug, route of administration, and times to administer the drug

• It ends with the signature of the physician or healthcare provider ordering the drug

• *If a client refuses it, write the reason and the time you notified the MD


Types of OrdersTypes of Orders

1. Standing order with termination. Example: Keflex (cephalexin) 500 mg PO every 6 hours × 7 days

2. Standing order without termination. Example: digoxin (Lanoxin) 0.5 mg PO every day

3. A prn order. Example: morphine 2 to 4 mg IV q 4 h prn pain

4. Single-dose order. Example: atropine 0.3 mg subcutaneous 7:30 a.m. on call to OR

5. Stat order. Example: morphine sulfate 4 mg IV stat

6. Protocols. Example: for K <3.5, K 20 mEq PO q 4 hour × 2 days


General Safeguards in Administering MedicationsGeneral Safeguards in Administering Medications• Oral medications

– Handwashing

– Wear gloves with possible exposure to blood or body secretions.

• Injections

– Handwashing and gloves

– DO NOT recap needles.


General Safeguards in Administering Medications (cont.)General Safeguards in Administering Medications (cont.)

• Handwashing and gloves

– Heparin locks, IV catheters, IV needles

– Secondary administration sets or IV piggyback (IVPB) sets

– Application of medication to mucous membranes

– Skin applications


MasksMasks

• Strict or respiratory isolation procedures

• Splash directly into face, eyes, or mucous membranes

• Aerosolization of fluids


NeedlesNeedles

• Discard in appropriately labeled, puncture-proof containers.

• DO NOT break, bend, or recap needles after use.


Mobile Cart SystemMobile Cart System

• Place the patient/client’s drawer on the top of the cart. Read each medication order, and choose the unit-dose from the drawer and compare the label with the order.

• After comparing the order with the unit measure, compute the dose. Check the drug label, then open or prepare the unit-dose, or pour the amount of a liquid medication.

• Label the unit-dose, read the order again, and verify the dose. After preparing all of the patient/client’s medications, read the name on the medicine sheet, check the patient/client’s identification band, and administer the drugs.


Oral MedicationsOral Medications

• Check expiration dates.

• *Check for allergies.

• *Check with the physician if certain drugs are administered when the patient/client is NPO (nothing by mouth).

• *administer irritating meds with meals

• Do not touch stock medications with hands.

• Do not break tablets that are not scored.

• Do not crush enteric-coated tablets.


Liquid MedicationsLiquid Medications

• Shake liquid medications thoroughly before pouring.

• Pour liquids at eye level.

• Wipe the lip of the bottle with a paper towel before recapping.

• Disguise liquids if distasteful or irritating.

– Juice

– Straw

• Don’t dilute liquid cough medicines.


Parenteral RouteParenteral Route

• Adult maximum one site

– 3 mL

– 2 mL deltoid

• Angle of insertion

– Intramuscular (IM): 90-degree angle

– Subcutaneous: 45-degree angle; use a 90-degree angle if the subcutaneous layer of fat is thick and the needle is short


Needles for InjectionNeedles for Injection

• Subcutaneous: 25, 26, 28 gauge

• IM children and emaciated patients: 25, 26, 28 gauge

• Intradermal: 26 gauge or other fine needle

• IM injections: 22 and 23 gauge

• IV therapy: 20 and 21 gauge

• Blood transfusion: 16 and 18 gauge


Preparing the DosePreparing the Dose

• Vials

• Ampules

• Unit-dose cartridge and holder

• Unit-dose prefilled syringes


Mixing medsMixing meds

• *technique


IM Injection SitesIM Injection Sites

• Adult

– *Dorsogluteal

– Ventrogluteal

– Vastus lateralis

– Deltoid

• Children

– *Vastus lateralis

• Dorsogluteal over 5 years of age


Administering InjectionsAdministering Injections

• General principles

• Subcutaneous heparin

• Subcutaneous insulin

• Z-track technique for IM injections

– *if blood enters syringe, withdraw needle and discard, prepare another injection!

– *Ztrack-Change needle,Add 0.2 ml of air,Inject at 90 degree angle, After give injection-wait 10 seconds

IV-sites*


Medication Administration TechniquesMedication Administration Techniques

• Skin and mucous membranes

• Ear drops

– Adult: Pinna up and back

– *Child: Pinna down and back

– Rest on the unaffected side for 10 to 15 minutes

• Eye drops or ointment

– *Drops: lower conjunctival sac

– *Ointment: spread inner to outer canthus of eye


*Nasogastric Route*Nasogastric Route

• Head of bed elevated 30 degrees

• Check placement

– 15 mL of air

– Aspirate stomach contents.

– Check acidity of stomach contents.

• Flush at least 30 mL of warm water to ensure patency.



• Nose drops

• Rectal suppository

• Respiratory inhaler

– *wait 1 minute, shake inhaler, and puff

• Skin applications

• Nitroglycerin ointment

– *select nonhairy site, don’t rub, recheck BP in 30 min

• Transdermal disks, patches, and pads

• Sublingual tablets



• Vaginal suppository or tablet

• Vaginal cream


Neonatal and Pediatric ConsiderationsNeonatal and Pediatric Considerations

• *Offer a popsicle to numb the taste buds.

• Mix with a teaspoon of puréed fruit, ice cream, or syrup.

• Pinch the nostril closed and drink medication through a straw.

• Distract the child with conversation or a toy.

• Use a decorative adhesive bandage to cover the injection site.


Geriatric ConsiderationsGeriatric Considerations

• Offer a popsicle to numb the taste buds.

• Mix with a teaspoon of puréed fruit, ice cream, or syrup.

• Injections

– Predetermine the injection site.

– Insert the needle quickly.

– Inject the medication slowly.

chapter 10 administration procedures

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