Medication Administration

Medication Administration

• 1. Medication Administration Medication Administration
• 2. Automated Medication Administration Equipment Automated Medication Administration Equipment Pyxis SureMed MedServe
• 3. Essential Components of a Medication Order Essential Components of a Medication Order Client’s Name Medical Record Number, Room/Bed # Date & time of order Name of Medication Dosage of Medication Route Frequency of administration MD’s signature
• 4. Six “Rights” of Medication Administration Six “Rights” of Medication Administration Right Patient (check name band, ask client their name) Right Medication Right Dose Right Route Right Time (frequency) Right Documentation * Client’s also have the right to refuse (say no) to medication
• 5. The Nurse’s Responsibility for Medication Administration The Nurse’s Responsibility for Medication Administration Assess whether the client can tolerate the meds Administer meds accurately & timely Monitor for side-effects Know contraindications Client teaching Practice the “Six Rights”(stressed in clinical) Evaluation (effectiveness & client response)
• 6. Types of Oral Medications Types of Oral Medications Tablets Capsules Sublingual Buccal Elixirs Enteric Coated
• 7. Precise & Safe Medication Administration Precise & Safe Medication Administration
• 8. Rectal Medications Rectal Medications Provide for privacy Explain procedure to client Place client in Sim’s position Apply clean gloves Lubricate tip, round end inserted first Encourage client to relax , deep breathe Insert past sphincter, towards umbilicus Have client remain on side at least five mins. (hold buttocks together etc.)
• 9. Rectal Medication Administration Rectal Medication Administration
• 10. Ophthalmic Medications Ophthalmic Medications Place HOB down or low Fowler’s Provide Kleenex for client Have client look towards ceiling Instill meds in conjunctiva (if gtts) If ointment, apply ribbon from inner to outer canthus Know od, os, ou routes
• 11. Topical  & Inhalation Medications Topical & Inhalation Medications Ointments (absorbed via mucous membranes, skin) Inserted (vaginal) Instilled (ear/nose gtts) Lotions Sprays (nasal) Pastes (absorbed through skin) Inhalation (nebulized treatments, MDI)
• 12. Topical Ointments Topical Ointments
• 13. Otic Medications Otic Medications
• 14. MDI Medications MDI Medications
• 15. Medications via NGT/EFT Medications via NGT/EFT Determine whether med comes in elixir form Crush all except for EC meds and mix with water or other liquid medications Stop feedings, clamp tube, apply syringe, unclamp tube, flush tube with approx. 30cc water Clamp tube, remove syringe, pull plunger from barrel, reattach barrel, pour meds through barrel Add water as necessary to keep things flowing smoothly After all meds have been given, flush with 30cc water, clamp tube, remove syringe, start feedings
• 16. Slide24
• 17. Documentation Documentation Always record: Date, time & your initials or signature, title (R. Otten, SN,CSUF ) Medication, route (site) and actual time given Reason why med was omitted (ie. refused) Client’s response to the medication
• 18. Medication Administration Records (MARs) Medication Administration Records (MARs)
• 19. Nursing Considerations for Injection Sites Nursing Considerations for Injection Sites  Assess for adequate tissue & muscle availability/client body wt.  Assess where previous injections have been administered  Assess client restrictions  Assess for quantity & quality of medication to be administered
• 20. Parts of a Needle & Syringe Parts of a Needle & Syringe Syringe:  Barrel  Plunger  Tip Needle:  Bevel Shaft Hub
• 21. Types of Syringes Types of Syringes
• 22. Tips of Syringes Tips of Syringes Luer-Lok Non Luer-Lok
• 23. Pre-Filled Systems Pre-Filled Systems
• 24. Assembling the Device Assembling the Device
• 25. Scoop Method Scoop Method
• 26. Safety Devices Safety Devices
• 27. Needless Systems Needless Systems
• 28. Slide35 Three Types of Injections q Intradermal - Injected into dermal skin layers (Allergy tests, PPDs, etc.) q Subcutaneous - Injected into subcutaneous tissues (Heparin, Insulin) q Intramuscular - Injected into deep muscles (narcotic analgesics, iron)
• 29. Slide36 Intradermal Injections q Given in small doses (i.e.. 0.1cc) q Common sites include: RFA, LFA q Use 1cc syringe with 26-27 gauge needle, 1/4 - 5/8 inch long q Administer with needle at 5-15 degree angle with bevel of needle up q Check for “bleb” or “wheal” q Document site in medication book/nurses’ notes
• 30. Intradermal Injections Intradermal Injections
• 31. Subcutaneous Injections Subcutaneous Injections  Given in doses of 0.5cc - 1.5 cc  Common sites include: deltoid, abdomen  Deltoid landmarks: Find Acromium Process and go 4 to 6 finger-lengths below  Rotate sites to minimize tissue damage  Use Insulin/TB syringe for these meds  For other SQ meds use 1-3 cc syringe, 25-27 gauge needle, 3/8-5/8 inch length  Insert needle 45-90 degrees
• 32. Deltoid Injections Deltoid Injections
• 33. Slide42 Vastus Lateralis Injections qSite well-developed in both adults & children, lacks major blood vessels/nerves qLandmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect). qGood for clients with position restrictions
• 34. Intramuscular Injections Intramuscular Injections
• 35. Vastus Lateralis Vastus Lateralis
• 36. Dorsogluteal Injections Dorsogluteal Injections Rarely used due to Sciatic nerve risk Less accessible than other sites (i.e. requires side-lying or turned further) Landmark: Find Greater Trochanter & Iliac Crest, draw quadrants and administer in upper two quadrants
• 37. Dorsogluteal Injections Dorsogluteal Injections
• 38. What other site is used for IMs? What other site is used for IMs?
• 39. Ventrogluteal Ventrogluteal Good for deep injections Away from blood vessels and nerves Z-track Thick, viscous meds Antibiotics Large volume Irritating