1. 1. Discuss the legal aspects of drugadministrationFederal drug legislation regulates the production, prescription, distribution, andadministration of drugs.Health Care Institutions implement policies to adhere to Federal and State regulation andwithin their facility.Nursing practice acts define limits on the nurse'sresponsibilities regarding medications.Legally a nurse must follow prescriber's order unless it is in error or nurse believes harm willcome to pt.Nurses are responsible for actionsquestion any order that appears unreasonable.refuse to give med until order is clarified.2. 2. Describe various routes ofmedication administrationSee the following3. oral swallowed, safest4. sublingal dissolved under tongue5. buccal medication (e.g., a tablet) is held in the mouth against the mucous of cheek6. topical topical can be dermatological, instillations, irrigations, and /or inhalations.rectalvaginaltransdermalinhalationeyeearnose7. rectal Indications for administering rectal route medication 1. Place client on side in side-lying(Sims) position or dorsal recumbent position2. Use water soluble lubricant3. remove wrapper4. wear gloves5. If a rectal suppository:-patient should bear down as you insert approximately 1.5 in. past anal sphincter into rectalcanal-patient should remain lying down for 15 min.8. vaginal Vaginal medications are available as1. Suppositories2. Foam3. Jellies4. CreamsIndications for administering vaginal medication 1. Place patient in dorsal recumbentposition2. Use water soluble lubricant3. Remove wrapper4. wear glovesFor vaginal suppositories:-instert opened suppository into applicator-insert at least 2 in. into vaginal canal- have patient remain lying down for 15 min.Medication Administration Study Guide by JacqueStudy online at quizlet.com/_1ggi339. otic Indications for administering otic route medication1. wear gloves2. position patient on side with affected ear up3. Infant: pinna down and backAdult: pinna up and back4. Remain on side for 2-3 min (notes say 5-10min). after administered5. Make sure it's room temperature (may warm on hands)place in side of canal not directly on ear drum. massage tragus of ear. May use cotton or gauzepledget.6. User sterile solutions7. Note any drainage10. dermal or transdermal clean skin.apply with gentle strokes- avoid excessive pressure.cover as indicted.rotate sites if not specific.Transdermal patch:may need time overlap.apply to area free of hair, irritation, or scratches.avoid touching medication when handling.11. transdermal: designed to be absorbed through the skin for systemic effects12. optic use standard precautions.cleanse eye inner to outer canthus.pt supine or sitting.have client look up.expose conjunctival sac.hold container 1-2 cm above eye.do not touch eye with container.never apply directly to cornea.close eye, gently blot.may hold nasolacrimal duct 30-60 sec to reduce systemic effect/ or tasterepostion as needed slowly.13. inhalation MDI- metered dose inhaler.use as instructed by care provider.shake gently.position thumb and first two fingerstilt head head back slightly.position at mouth.exhale.depress inhaler and inhale medication.follow specific instruction w/ medication.rinse mouth/brush teeth.14. nose standard precautions.have client clear nasal passages first unless ICP or surgery.may have burning/ stinging.supine position-dropshold dropper1/2 " above nares toward midline of ethmoid bone.Specific treatment areas:-posterior pharynx: head back-ethmoid/sphenoid: shoulder roll or head gently over edge of bed.-frontal/maxillary; head back and to specific side.Sprays-upright position.15. irrigations (example: bladderirrigation)surgical asepsis used in wound, bladder or other sterile body cavity.Medical asepsis used on vaginal, rectal, and gastric areas.Asepto syringes, piston syringe, and Pomeroy syringe often used.follow prescribers orders regarding type, amount, temp, and strength of solution.16. intradermal: Injection into the dermis just under the epidermis.Angle: 15 degreesExamples: for skin testing such as TB skin test or allergy testingSites for injection:1. inner forearm 3-4 finger widths below antecubital space and 1 hand widthabove wrist. 2. Upper backNeedle: 25-27 g.1/4 to 5/8 in. needleSyringe: 1 mL tuberuclin syringe with short bevelVolume: 0.01 to 0.1 mL17. Nursing considerations for giving injections BLSTR(Blaster acronym)Blood flow to site of administrationLesions at siteSkin integrity, scarringTattoosRotate Sides18. intramuscular: Involving administration of a medication into the muscle layer beneath thedermis and subcutaneous tissueInjection into a muscle.Angle: 90 degreesSites for injection:1. Deltoid2. Vastus Lateralis3. Ventroglutealrate of injection 10 sec/ per mL19. Deltoid IM injection (needle, syringe, volume)Location:three fingers below acromion process.Needle: 18-25 g, 1-1.5 in.Syringe: 1-3mL or 0.5-1.0mLVolume: 1mL or less20. Vastus lateralis (needle, syringe, volume)Location: place hand below greater trochanter.place hand above the knee.midline anterior thigh.midline of lateral side of thigh.area forms a rectangle.Needle: 18-25 g, 5/8 to 1 in.Syringe: 1-5mL Volume: Up to 3 mL21. Ventrogluteal ( (needle, syringe, volume)Location: right palm on right grater trochanter.middle finger on illiac crest.open fingersbetween pointer and middle finger.Needle: 18-25 g, 1-1.5 in.Syringe: 1-5 mLVolume: Up to 3 mL22. When is vastus lateralis typically used instead ofdeltoid for an IM injection?For children who are 1 year and younger because deltoid muscle not asdeveloped.23. intravenous: Involving administration of fluid or medication within a vein24. parenteral: Medications given by injection or infusion25. subcutaneous: Injection into the subcutaneous tissues just below the dermis.Angle: 45-90 degreesExamples: insulin and heparinSites for injection:1. abodmen just blow costal margin to iliac crest (best for heparin)2. interior aspects of thighNeedle: 25-27 g.3/8 - 5/8 in. Syringe: 1 to 3 mLVolume: No more than 1 mL26. Injection site for insulin or heparin 1. abodmen just blow costal margin to iliac crest (best for heparin)2. interior aspects of thigh3. Always verify orders on MAR, check allergies, and have another nurse check dose27. insulin always double check with another nurse.always use insulin syringe (units).inject slowly, then wait 5 sec, then withdraw.know client's blood sugar.when mixing medications draw up clear before cloudy.never given IM. SubQ or IV (reg insulin)28. Injection site for LMWH Heparin Right or left side of abdomen, 2 in. away from umbilicus is recommended.29. A nurse is administering asubcutaneous injection to a client.What is the common maximumvolume of a subcutaneousinjection?The volume of a subcutaneous injection is usually up to 1 mL30. A nurse is administering aintramuscular injection to a client.What is the common maximumvolume of a intramuscularinjection?An intramuscular injection is the administration of up to 3 mL of medication into one muscle ormuscle group.31. A nurse is administering aIntradermal injection to a client.What is the common maximumvolume of a Intradermal injection?Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01to 0.05 mL.32. A nurse needs to administer anintradermal injection to a client.Which of the following is the mostcommon site for administering anintradermal injection?The most common site for an intradermal injection is the inner aspect of the forearm. Intradermalinjections are commonly used for diagnostic purposes. Examples include tuberculin tests andallergy testing. Small volumes, usually 0.01 to 0.05 mL, are injected because of the small tissuespace. Other areas that may be used are the back and upper chest, not the stomach.33. The nurse is preparing toadminister a medication via anasogastric tube. What guideline isappropriate for the nurse to followwhen administering a drug via thisroute?Guidelines to consider when administering a drug via nasogastric tube include positioning theclient with the head of the bed elevated, administering the medication at room temperature for theclient's comfort, flushing the tube with water between each drug administered, and avoiding theuse of suction for 20 to 30 minutes after the drug is administered.34. A nurse is performing a sensitivitytest on a patient. What would be thebest type of injection to use for thisprocedure?Intradermal injections are administered into the dermis, just below the epidermis. Theintradermal route has the longest absorption time of all parenteral routes. For this reason,intradermal injections are used for sensitivity tests, such as tuberculin and allergy tests, and localanesthesia. The advantage of the intradermal route for these tests is that the body's reaction tosubstances is easily visible, and degrees of reaction are discernible by comparative study.35. What medications would mostlikely be administered via atransdermal patch?Hormonal medicationsTransdermal patches are commonly used to deliver hormones, narcotic analgesics, cardiacmedications, and nicotine.36. A client is ordered to receive an intramuscularinjection of medication. When preparing toadminister the injection, the nurse selects theventrogluteal site based on which reason?The area is free of major blood vessels and fat.The ventrogluteal site forintramuscular injection is free of major blood vessels and fat. It is consideredthe safest and least painful site. The dorsogluteal site is near the sciatic nerve and involves a high possibility ofinjecting into subcutaneous fat. The deltoid region for an intramuscularinjection has little overlying subcutaneous fat and lies close to the radial nerve.37. A nurse is explaining to a client the correct methodof using a metered-dose inhaler when self-administering a prescribed dose of medication.Which of the following is a feature of a metered-dose inhaler?It is a canister that contains pressurized medication.A meter-dose inhaler has a canister that contains medication under pressure. Itis much more commonly used than the turbo-inhaler, which is a propeller-driven device that spins and suspends a finely powdered medication. A turbo-inhaler, not a meter-dose inhaler, has propellers that get activated duringinhalation.38. A nurse has administered an intramuscularinjection. What will the nurse do with the syringeand needle?Do not recap the needle; place it in a puncture-resistant container.39. A nurse is using an 18-gauge needle to administer amedication to a client. The nurse knows that whencompared to a 27-gauge needle, an 18-gauge needlehas which of the following features?Larger diameterFor most injections, 18- to 27-gauge needles are used; the smaller the number,the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. The needle gauge or the diameter refers to its width40. A nurse needs to administer an intradermaltuberculin skin test injection to a client. Which ofthe following is the most suitable angle whenadministering an intradermal injection?10-degree angle. When administering an intradermal injection, the nurse should hold the syringealmost parallel to the skin at a 10-degree angle with the bevel pointing upward.This facilitates delivering the medication between the layers of the skin andadvances the needle to the desired depth.41. What is the most suitable angle when administeringan subcutaneous injection?A nurse administers a subcutaneous injection at a 45-degree angle or a 90-degree angle to reach the subcutaneous level of tissue, depending on the length ofthe needle.42. 3. Identify essential parts of a medication order Full name of the client Date and time the order is written Name of the drug to be administered Dosage of the drug Frequency of administration Route of administration Signature of the person writing the order43. 4. List and define the various types of medicationordersStanding or routine order Given until order is changed or patient is discharged.PRN order medication to be given when patient requires it (as needed) often seenwith pain medsSingle (one-time) order medication to be given only once at a specified time.Common for pre-op. or before diagnostic examsSTAT order signal dose of medication to be given immediately and only once.Often for emergencies when a patient's condition changes suddenlyNow order used when a patient needs a medication quickly but not right waylike a STAT order. When receiving a now order, the nurse has up to 90 min. toadminister. (administer it as soon as you get it. )Scheduled order To be given at a specified time or frequency -ex: AC, PC,"nightly" or "at bedtime"44. 5. List 6 essential steps to follow when whenadministering medication1.Identify client2.Inform client3.Administer the drug4. Provide adjunctive interventions as indicated5.Record the drug administered6.Evaluate the client's response to the drug45. 6. Describe physiologic changes inolder adults that alter medicationadministration and effectiveness Altered memory Decreased visual acuity Decrease in renal function Less complete and slower absorption from the gastrointestinal tract Increased proportion of fat to lean body mass Decreased liver function Decreased organ sensitivity Altered quality of organ responsiveness Decrease in manual dexterity46. 8. Patients' Rights 1. RIGHT MEDICATION:READ LABEL 3 TIMESCompare to MarWatch for look alike/sound alikeKeep doses packaged until administrationMulti-dose2. RIGHT DOSE:Give appropriate doseDouble check calculationsKnow usual dosage rangeQuestions doses outside usual ranges,3 systems: Metric, Apothecary, Household3. RIGHT TIME:Exact timeAgency timeUsually 1 hour before or after a meal or after scheduled time4. RIGHT ROUTE: Correct routeAppropriate for clientClient able to take complete doseSpecial medsOthersLiquidsSublingualParenteral5. RIGHT CLIENT:Always identify, 2 identifiers(unique, may not use rm#), Patient identifiersAlways recheckAllergies6. RIGHT CLIENT EDUCATION: Right to know name and information about medicationThe education to take safely, and make informed decisions7. RIGHT DOCUMENTATION: ImmediateMarChartAnecdotal8. RIGHT TO REFUSE:Inform client prior to administration about medication9. RIGHT ASSESSMENT: Some medications require specific assessments prior to administration(e.g., apical pulse, blood pressure, lab results). Medication orders may include specific parametersfor administration (e.g., do not give if pulse less than 60 or systolic blood pressure less than 100).10. RIGHT EVALUATION: Conduct appropriate follow-up (e.g., was the desired effect achieved ornot? Did the client experience any side effects or adverse reactions?).47. Physical Assessment beforemedication administrationABILITY TO SWALLOWGASTROINTESTINAL MOTILITYADEQUATE MUSCLE MASSADEQUATE VENOUS ACCESSBODY SYSTEM ASSESSMENT48. Information Collected DuringInitial Assessment pertaining tomedicationDuring the initial assessment, it is important to perform a medication history, assess for a historyof any allergies and medication intolerances, evaluate the patient's medical history, and determinethe patient's pregnancy and lactation status.49. 9. Outline Steps to administermedications safely1. Use the rights2.Calculate doses carefully; double-check with a second RN3. Watch for drugs with similar names4. Watch for clients with same last names5. Clarify illegible orders6. Know and use your resources7. Keep up with changes in medication orders**You are responsible for all medications you giveAll errors should be reported: it is your responsibility! (clarify order, never assume. askanother nurse, look up medication, call pharmacy, or contact physician)50. SAFE MEDICATION ADMINISTRATION To administer medications safely, the following actions are necessary:Accurately interpret the provider's order. ( readback all verbal, telephone orders to theprovider, students do not take verbal or telephone orders)Accurately calculate the amount of drug to give for the prescribed dose. (never give amedication you have not prepared)Develop a systematic and safe procedure, using the six rights for drug administration,including accurate identification using two separate identifiers.Document medication administration according to best practice principles.Explain the purpose of the medication to the patient.Prevent medication errors.Promote standardized communication.Promote healthcare planning and home or community-based care.Evaluate the patient's response to medications.51. what should the nurse assess after amedication is given to the patient?effectiveness of the drugmonitoring for adverse drug effectsmonitoring for allergic reactionsthe patients knowledge level concerning perscribed medication52. 10. Describe how to prepare medicationsfrom ampules and vialsNever open bare handedUse sterile filter needleTap ampule to move medication from top/neck Set on flat surface or hold upside down to remove medDo not allow needle or tip or shaft to touch rimExpress air bubbles outside of ampuleNever use filter needle for injection!Remove filter needle after medication drawn upDispose of ampule in sharps container53. 11. Identify equipment required forparenteral medication. Identify parts of needle and syringeWhat parts must be kept sterile?Equipment preparation: syringe/needle (size/gauge)Medication Prep:VialsReconstituting from powderTwo medications in one syringeall internal parts must be kept sterile as well as the entire shaft of the needle.54. 12. identify sites with correct anatomical terms used for ID, subq, andIM injections:intradermal injection sites55. Intramuscular injection sites56. Subcutaneous injection sites57. IV injection sites hand and arm58. 13. Identify equipment used for intradermal, subcutaneous, andintramuscular injections. Each needs client MAR and ampule or vialmedication to be administered. clean gloves, alcohol swabs, and maybea bandaid.intradermal: tuberculin syringe or 1-mL syringecalibrated into hundredths, 1/4-5/8 inch needle 25-27gauge , 0.01-0.1ml (5-15 degree with bevel up)subcutaneous: insulin or heparin syringe or 3mL, 3/8-5/8inch needle 25-27 gauge, no more than 1.5mL (45-90degree angle depending on size of client)Intramuscular: 3-5ml syringe, 1-1.5 inch needle 18-27gauge (22-25 preferred), no more than 3mL -divide ifgreater (90 degree )59. 14. State steps to mix 2 medications in one syringe Step 1 Draw air into the syringe to equal the amount of medication to bewithdrawn from vial 1 (i.e. 1 mL)Step 2 Insert syringe into vial 1 and inject the air. Do not let the needle touchthe medication. Then, remove the the needle.Step 3 Draw air into the syringe to equal the amount of medication to bewithdrawn from vial 2 (i.e. 0.5ml).Step 4 Insert needle into vial 2 and inject the air.Step 5 Withdraw the desired amount of medication from vial 2 (i.e. 0.5 mL)Step 6 Insert NEW needle into vial 1, invert vial and withdraw desiredamount of medication. (Ex: Total volume would be 1.5 mL)60. 15. Describe 3 checks for unit dose and stock meds *Before you pour: check the medication label against the MAR*While you pour:Verify the label against the MAR* At the bedside:Check the medication again*Stock/Bulk meds Check label against the MAR before returning to storage61. 16. Describe the 2 checks for correct patientidentification. Identify what may not be used.Wrist BandPatient states namePatient states DOBMARYou cannot use the room #62. 17. Identify abbreviations that are on the do not uselistU Write "unit"IU Write "International Unit"Q.D., QD, q.d., qd Write "daily"Q.O.D., QOD, q.o.d., qod Write "every other day"Trailing zero Write 0.X mgMS Write "morphine sulfate"MSO4 and MgSO4 Write "magnesium sulfate"> Write "greater than"< Write "less than"Abbreviations for drug names ....Write drug names in fullApothecary units..........Use metric units@ Write "at"cc Write "mL" or "milliliters"g Write "mcg" or "micrograms63. 18. commonly used abbreviations: PO: per oralSL: sublingualSQ: subcutaneoussubq: subcutaneousID: intradermalIM:intramuscularinj: injectiontop: topicalgtt: dripcap: capsuletab: tabletsusp: suspensionstat: do right awayasap: as soon as possibleac: before mealspc: after mealsTO: telephone orderVO: verbal order64. abbreviations continued: ad lib: as desiredD/C: discontinuedprn: as neededh and hr: hours with line over it : withoutc with line over it: withx with line over it: exceptp with line over it: afterelix: elixirNPO: nothing per oralBID: twice dailyTID: three times a dayOS: left eyeOD: right eye or overdoseOU: both eyes65. abbreviations continued: NKA: no known allergiesNKDA: no known drug allergiesqh or QH: per hourq2h or Q2H: every two hoursq4h or Q4H: every 4 hoursATC: around the clockHS: hour of sleephs: hour of sleep66. ... ...