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Pharmacology Unit 2 • Need to Know • Chapter 10 Interpreting Physicians Orders –Calculations text. –Memorize abbreviations • Need to know • Chapter 11 Reading Med Labels –Calculations book –be able to identify • Trade Name, Generic Name • Manufacturer • Dosage Strength • Form • Amount 2/05 JP Page 1 of 23 Medication Storage • Med. Room • Med cart - keep locked • Med refrigerator • Controlled Substance storage Medication Records •MAR –Medication Administration Record • Check Allergies Unit Dose System • Each dose of medication is packaged separately • Marked with generic and/or brand name • Marked with dose • Remember –DO Administration of Medications primary obligation as a nurse: NO HARM !!! • Need knowledge in Pharmacology Code of Ethics • Maintain individual competence in admin. of medications • recognize/accept responsibility for actions and judgement 2/05 JP Page 2 of 23 Errors in Med Administration • Report it immediately –Charge nurse, instructor • ALL errors need reporting –complete variance • If many, re-education Medication Errors • Reporting STAT may save pt. life and expense. • Cover-up or neglect to report is as criminally liable the error How to avoid making med. errors: • Know state nurse practice act • Know facility policy and procedures • Follow the 6 “rights” The 6 Rights of Medication Administration • Right Patient • Right Med. • Right Dose • Right Time • Right Route • Right Document. 2/05 JP Page 3 of 23 as making Right Patient • Proper ID of pt (use 2 identifiers) - compare MAR with wrist band –then ask name • Don’t call by name first • Never leave med. at bedside • Stay with pt until taken • Never give unless absolutely certain you are giving to right pt Right Medication • Rule of three - look at med 3 times before administering Check 3 Times • When removing med. from drawer • When placing in med. cup / syringe • When opening packages at bedside with MAR Right Medication • Make sure label legible • CONCENTRATE!!! • Know what med is, it’s intended effect and potential SE • NEVER administer a medication that someone else has prepared (unless it is still in it’s original container) 2/05 JP Page 4 of 23 Right Dose • The correct amount • Always listen to the client • Know what usual dose should be - if unusual, don’t hesitate to question the order • Medicine cup How to measure the Right Dose - use meniscus at eye level - if pour excess, discard extra amount • Look carefully at syringe markings • Insulin doses and syringes are different - U-100 mostly Unused Medication • All prepared unused med should be discarded and NOT returned to original container • Administer at time ordered • Know abbreviations • Know set intervals • Know when not to give • STAT - immediately 2/05 JP Right Time Page 5 of 23 • PRN - as needed or on request. –First assess symptoms • HS - Hour of Sleep Right Route • Know what usual route is • If not ordered, assumption is PO • Check reference!! Right Documentation • Put on right pt’s chart, on right MAR • Military time • Nurse who gives it, charts it • If STAT or PRN med: –document time on MAR –document time, focus, data, action and response in nurses notes • When client refuses: Documentation –You are obligated to explain the med. and it’s importance –If still refuses, circle the med. time and write “refused” and your initials –Explain in nurses notes 2/05 JP Page 6 of 23 Giving meds as Student Practical Nurse • Give under instructor supervision - NO ONE ELSE until comps!! • May not start IV’s or give IV meds As students, you may: • Observe IV sites • Inc or Dec drip rates • Hang new bags of plain • DC IV’s • Add meds to IV bags IV’s if supervised Students may not: Questionable meds • If you find a syringe - discard it • If you find meds at bedside with no order - discard it • What the drug is • MD • Patient condition • Local Routes of Administration Determined by: Type of Desired effect • Systemic 2/05 JP Page 7 of 23 Enteral Routes • Meds. Administered by way of digestive tract • Oral, gastric tube, rectal • Simple • Convenient • Safe • Economical Oral or PO Advantages Disadvantages • Unpleasant taste, odor • Some harmful to teeth, mucous membranes • Cannot use with N & V • Cautious with difficulty swallowing • Peristaltic rate What can influence PO absorption? • Full stomach • Dilution • Food and drug may be incompatible 2/05 JP Page 8 of 23 Methods of giving oral drugs • Swallow via mouth –Pill, tablet, caplet, capsule, liquid • Med syringe • NG-tube, Peg tube Rectal Rectal administration •Local effects •Systemic effects 3 different types: •Suppository •Ointment •Liquid Inserting suppository • Explain procedure • Sims position – preferably left Sims • Use gloves!!!!!!! • Remove from wrapper • Lubricate 2/05 JP Page 9 of 23 • Insert blunt side first • Push toward umbilicus, past internal sphincter • Press buttocks together Rectal Ointments • Same as suppositories but applicator is attached to tube • inserted into anus Percutaneous Routes • Through the skin and mucous membranes • Includes: –Topical, Sublingual, Buccal, Eye, Ear, Nose, Vagina, Inhalation Topical Meds •Include: –Ointments –Creams –Lotions –Transdermal Transdermal Meds. • Absorbed through skin • Patches / ointments • Examples ??? 2/05 JP for systemic effects Page 10 of 23 Transdermal Meds. • Chose clean, dry, hairless site • Rotate sites • Remove old patch or ointment Eye Medication (Opthalmic) • Liquid drops • Ointments • Have look up and focus on specific object Eye Drops • Wash hands • Apply gloves • Retract lower conjunctival sac • Place drop in center of everted lower lid • Place gentle pressure on inner canthus • Instruct pt. to close eyes • Wipe off excess • Wash hands 2/05 JP Page 11 of 23 Eye Ointments • Squeeze thin ribbon along lower lid • Start at inner canthus • Wipe away excess • Never touch applicator to eye Ear Medications (Otic) • Adult = pull pinna up and back • Child = down and back • Do not touch ear with dropper • Instill prescribed drops • Direct against side of canal • Remain on side for ~10 min to keep med in ear Nasal / Respiratory Medications • Have rapid absorption • Inhalants –Usually administered by hand held devices –MDI - metered dose inhalant •Aerosol –Based on use of compressed air or oxygen forcing mist through tubing to mouthpiece 2/05 JP Page 12 of 23 •Nasal sprays or drops –High Fowlers –Head tilted back –Tip of bottle just inside nares –Squeeze as pt. inhales Sublingual • Placed under the tongue • Dissolve and are absorbed in mucous membranes • Between cheek and gum • Leave there until absorbed Buccal •How is a zydis administered? Zydis Vaginal Administration • Douche • Vag supp, creams, gels • Use applicator • Pt should lie down for 30 min after insertion 2/05 JP Page 13 of 23 Parenteral Routes • Medication administered outside the digestive tract • Medications administered by injections (needle) Injection Routes •Intradermal •Subcutaneous •Intramuscular •Intravenous • Syringes Injection Equipment – various sizes • Needles – various • Barrel –marked • Plunger gauges and lengths Parts of syringe with calibrations –fits inside barrel –rubber flange measures dose • Tip 2/05 JP Page 14 of 23 Parts of Needle •Hub •Shaft •Bevel Sterile Parts?? • Ideas ??? Needles • Various sizes • Gauge and length vary with method of administration – need to know differences! Gauge • Needles inner diameter • Larger number = smaller diameter • 29-G to 14-G • 3/8 inch to 2 inch • SubQ - uses shorter needle • IM - uses longer needle 2/05 JP Length Page 15 of 23 Medications for injection • Liquid • Reconstituted powder • May come in: - Ampules - Vials Cautions • Injections are most hazardous method • May damage nerves, tissue, blood vessels • May lead to infections Avoiding Complications • Select site carefully • Maintain sterility • Choose proper needle • Think: aspirate? • Establish site rotation When do we not aspirate? • Intradermals • SubQ heparin, Lovenox, or insulin 2/05 JP Page 16 of 23 Intradermal Meds • Just beneath epidermis • TB skin test / Allergy testing • Dose very small - usually 0.1 ml Intradermal Equipment • TB syringe (1 ml.) with fine gauge, short needle • 3/8 - 5/8 inch length • 25 - 27 G Intradermal needle angle • Almost flat against skin • Bevel up • Inserted ~ 1/8 inch • Do not aspirate (10-15º angle) Skin prep • Let alcohol dry before • Do not massage after • No bandaid/covering • Almost always given in inner aspect of lower arm Documentation • Must include site, time • Read in 24, 48, 72 hrs • Can draw circle around site if no site map 2/05 JP Page 17 of 23 Subcutaneous (SubQ) Injections • Hypodermic • Under all layers of skin • Given for slower systemic absorption • Isotonic, watery, nonirritating Used When: • Med more effective in this route • Pt can’t/won’t swallow • Med. destroyed in GI tract or irritating Not used when: • Pt in shock • Bad vascular system • Gross adipose, edema, burns at usual sites • Skin is diseased Not used when: • Skin tissue damaged by previous injection • Drug not recommended for SubQ route SubQ sites • Most common: Arms abdomen, thighs • Less common: Scapula • Need fat fold of 1 inch 2/05 JP Page 18 of 23 SubQ equipment • TB (1 ml) or 3 ml syringe • Short, fine gauge • 1/2 - 5/8 inch • 25 - 27 G • Most common is insulin • Also see anticoags • Dose usually < or = 1 ml • Max. of 2 ml • Needle angle 45º - 90º SubQ meds SubQ Do’s and Don’ts • Do skin prep • Do aspirate… UNLESS? • Inject slowly • Do massage…UNLESS? • Document Insulin • Gently shake Intermediate or Long Acting •NR = RN • Air into N, air into R • Draw up R, draw up N 2/05 JP Page 19 of 23 • Given when: Intramuscular injections - med not in oral form - large dose - Pt condition requires - rapid effect desired Risks of IM’s • May damage blood vessels, nerves, bone • Esp. dorsogluteal, sciatic nerve, large bl vessels • Ventrogluteal 5 Basic sites: • Deltoid • Dorsogluteal • Vastus lateralis • Rectus femoris 2/05 JP Page 20 of 23 • 1 - 3 ml syringe • 21 - 23 G • 1 - 1.5 inch needle • Need to get to muscle IM equipment IM med • Many different meds • Dose = 3 ml. max (deltoid – 2 ml max) • Angle of needle 90 degrees • Choose site carefully • Spread tissue before • Always aspirate • Withdraw quickly • Massage after IM Specifics Z-track method • Used for irritating drug • Seals off needle tract • Use 1.5 - 2 inch needle • Discard needle used to draw up med 2/05 JP Page 21 of 23 Z-track • Gluteal site only • Pull skin laterally • Insert needle, aspirate and inject • Wait 10 sec, withdraw, allow skin to return Z-track •DO NOT MASSAGE!! Intravenous Injections • Advantages: - delivers rapidly - predictable effect • Can irritate vein • Inc risk of complication • Expensive • Inc risk of contaminate • Constant monitoring Disadvantages Phlebitis • Inflammation of vein • Warmth, erythema 2/05 JP Page 22 of 23 IV infiltrate • IV med / fluid passes out of vein into tissue • cool, hard, tender, edema • Microdrip = 60 • Macro = 10, 15 or 20 Review IV Formula • What is the formula? 2/05 JP Page 23 of 23