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Chapter 12
Administering Medication
Contents
2
Basic Knowledge about Medication
Administration
Oral Administration
3
Parenteral Administration
4
Inhalation Administration
5
Medication Anaphylaxis Test
6
Topical Administration
1
Section 1
Basic Knowledge about
Medication Administration
Contents





Drug Forms, Distribution System and
Medication Storage
Principles of Administering
Medications
Routes of Administration
Times and Time of Administration
Contributing Factors of Drug Actions
Drug Forms











Aerosol spray
Aqueous solution
Aqueous suspension
Capsule
Enteric-coated tablet
Extended/
sustained
release
Extract
Glycerite
Liniment
Lotion









Ointment
Paste
Pill
Powder/granule
Suppository
Syrup
Tablet
Tincture
Transdermal disk
patch
Troche (lozenge)
or
Four kinds




oral medications
external medications
for injection
new preparations
Distribution System



Stock Supply System
Unit-dose System
Computer-controlled Dispensing
System
Store medication

Cabinet


bright and ventilative, avoiding direct shine and keep
clean, tidy and dry.
Placement of medications



Store separately according to their different routes
(oral, injection, or topical), toxicity or untoxicity
Expensive drugs, narcotics and virulent toxicants
must be taken charge of by a special nurse who
should lock the cabinet and have the key always with
her.
On every shift

Label the container of medications
clearly





blue strip labels oral medications,
Red strip labels external medications,
and black strip labels virulent toxicants.
Label the container with name, concentration
and dose of drugs
If the labels are soiled or illegible, discontinue
using the medications


Check the medications carefully
Store the medications properly
according to their different nature.
 Medications which tend to volatilize,
deliquesce, or effloresce should be kept
in airtight bottles, e.g., ethanol, iodine,
sugar-coat tablets.

Medications that will be oxidized if
exposed to air and be denatured if
exposed to light should be kept in
airtight colored bottles. Cover the
container with shade paper box if
necessary and store it in the shady and
cool area, e.g., Vitamine C 氨茶碱 盐酸
肾上腺素

Biologic products and antibiotics that will
be destroyed and decomposed if
exposed to heat should be kept in the
dry, and shady and cool area (about
20℃) or in refrigerator (about 2～10℃)
according to their natures and
requirements of storage, e.g., an
antitoxic serum, vaccine, placental
globin, penicillin skin test solution.
Medications should be used designedly
according to valid periods in case of
invalidation, e.g., antibiotics and insulin.
 Store the inflammable and explosive
medications in airtight bottle and place
in the shady and cool area separately
and keep them away from fire and
electric appliances.

Principles of Administering
Medications




Correct Transcription and Communication of
Orders
Use the Guidelines of Three Checks and
Seven Rights to Ensure Safe Drug
Administration
Administer medication safely and accurately
Observe the client’s response to the
medication after administration
Three Checks



the check before operation
the check during operation
the check after operation
Seven Rights








the right name of the client
right bed number of the client
right name of the medication
right concentration
right dose
right route
right time.
Quality valid
Routes of Administration

Oral Routes




Parenteral Routes






Oral administration
Sublingual Administration
the intrathecal or intraspinal,
Buccal Administration
Intradermal (ID)
Subcutaneous (SQ)
Intramuscular(IM)
Intravenous( IV)
intraosseous, intrapleural,
intraarterial, intraarticular,
and intracardiac, routes
Skin and Mucous Membrane Route
Inhalation Route
Topical
administration
Skin and Mucous Membrane Route





1.Direct application of liquid or ointment (e.g., eye drops,
gargling, swabbing the throat)
2.Insertion of drug into a body cavity (e.g., placing a
suppository in rectum or vagina or inserting medicated
packing into vagina)
3.Instillation of fluid into body cavity (e.g., ear drops,
nose drops, or bladder and rectal instillation [fluid is
retained])
4.Irrigation of body cavity (e.g., flushing eye, ear, vagina,
bladder, or rectum with medicated fluid [fluid is not
retained])
5.Spraying (e.g., instillation into nose and throat)
Declining sequence of absorption

Inhalation Route＞Sublingual route＞
rectal route＞intramuscular injection＞
subcutaneous injection＞
oral administration＞skin route
Times and Time of Administration
Abbreviation
AC, ac
BID, bid
HS, hs
PC, pc
prn
qm
qd
Explanation
Ante cibum/Before meals
Twice a day
At bed time
After meals
As necessary (long term)
Every morning
Every day
Abbreviation
qod
qh
q2h
q4h
q6h
qid
SOS
St
tid
DC
Explanation
Every other day
Every 1 hour
Every 2 hour
Every 4 hour
Every 6 hour
4 times a day
As needed (only one time within
12 hours)
Immediately
3 times a day
discontinue
Contributing Factors of Drug
Actions
ADDITIVE

ANTAGONISTIC

Factors about The Drug Itself





DISPLACEMENT
INCOMPATABILITY
INTERFERENCE
Drug Dose Response
SYNERGISTIC
Drug Forms
Routes, time and interval of Administration
Drug interactions
Factors about The Body

Physiological Factors




Age and Weight
Sex
Pathological Factors
Psychological and Behavioral Factors
Section 2
Oral Administration
ORAL MEDICATIONS





Most common route
Convenient
Least expensive
Most meds available in this form
Easy to counteract overdose or toxicity
Indications

Clients who are able to swallow solid
and liquid
Contraindications







1.Clients with impaired swallowing function
2.Unconscious clients
3.clients who refuse to take medications
orally
4.clients with vomiting or/and nausea
5.clients with gastric or intestinal suction
6.clients with bowel inflammation or reduced
peristalsis
7.clients with recent GI surgery
DIFFERENT FORMS







Capsules
Tablets
Elixirs
Emulsions
Lozenges
Suspensions
Syrups
NASOGASTRIC ADMINISTRATION



For patients who cannot swallow
NG tubes
Similar to oral administration
Skills _Equipment





Medication
cards,
sheets,
or
records
Medication cart or tray
Medication cups, measuring cup, drop tube
Drinking straws
Pill-crushing or pillating device(研钵)
Kettle with warm water
Paper towels
See disk
Procedure
Medication preparation
1 ． Wash hands, wear mouth mask and assemble the
equipment
2．Follow the three checks and seven rights principle.
3．Prepare medications with appropriate method based on
different forms of medication . Fetching meds from bottles.
Fetching Method
Solid（tablet/capsule）
with spoon
Pouring liquid meds
with measuring cup
pediatric、 NG tubes or
Gastric bleeding, pillcrushing device such as a
mortar or pestle or grind pills
＜1ml，with Drop
tub
Administering medication
1 ． Wash hands. Take Medication cards, sheets, or records
Medication cart or tray to bedside.
2．Offer medications and warm water
3. Assist clients with critical illness or pediatric clients. For NG,
grind meds.
4．Teach clients the effects and cautions of meds
4．Clean the cup
See disk
Guidelines followed when
administering oral medications



1.Always administer a drug with warm boiled
water of 40~60℃ instead of with tea.
2.Medications that erode teeth such as acid
and chalybeate should be sucked with a
sucker and then rinse to protect teeth.
3.Never chew, crush or break sustained
release tablets, enteric-coated tablets and
capsules


4.Place lozenges under the tongue or
between buccal membrane and teeth
dissolved slowly rather than allow clients to
chew or swallow.
5.Generally, stomachic medications are
appropriately taken before meal, while those
irritating gastric membrane taken after meal.
Hypnotics is properly taken before sleep and
parasiticides taken in limosis or half limosis.


6.Antibiotics and sulfonamide should
be taken at certain interval to ensure
effective drug blood concentration.
7.Avoid giving fluids immediately after
a client swallows medication such as
syrup that exerts local medicating
effects on the oral mucosa


8. Allow the client to drink more water after
sulfonamide is taken to prevent the crystal
which the drug produces when excreted
through kidney with the less urine volume to
block the nephridium.
9. Observe the heart rate and rhythm closely
when cardiotonic is taken. If the heart rate is
lower than 60 times per minute or arrhythmia
occurs, discontinue to use the drug and
inform the physicist.
Section 3
Parenteral Administration
Parenteral Administration

Concept


the process that injects a certain volume of
sterile solution and/or biological products into
human body by using sterile syringe
Purpose

to prevent, diagnose and cure disease.

Characteristics




Appropriate for clients unable to take meds
orally
Rapid absorption
Difficult to Counteract Adverse Reaction
Invasive procedure, be performed using
aseptic techniques
Contents




Principles of Injections
Equipment
Draw medication
Common Injection Methods
Principles of Injections

Apply Sterile Technique Strictly
Carry out Check Principles Strictly
Perform Disinfection and Seclusion Policy
Appropriate Syringe and Needle
Appropriate Injection Site
Prepare and Administer Temporarily
Eject Air thoroughly
Note Blood Return
Insert Needle at Appropriate Angle and Depth

Give No-Pain Injection








Apply Sterile Technique Strictly



Preparation of nurses
Sterilize the local skin over injection
site as required
Maintain sterility of equipment
Carrying out Check Principles Strictly


three checks and seven rights
inspect the package of medication and
sterile equipment
Perform Disinfection and Seclusion
Policy


every client individually uses one
series of equipment
All of used equipments are disposed
according to the disinfection and
seclusion policy
Appropriate Syringe and Needle


Consider route of injection
Other factors



dosage, viscosity, irritation of medication, and the
age, height, and weight of the client, the site of
injection
check the package and the expiration date
check whether the needle is sharp, without
crooks, and is tightly connected with tip of
syringe
Appropriate Injection Site




away from nerves, bones, and blood
vessels
free of inflammation, bruises, itches,
edema, nodules and scars
change the site for each injection
When intravenously injecting, a distal
site first, proximal site later.
Prepare and Administer Temporarily


The medication solution is prepared
and dispensed when administered
To prevent from the lower effect or
contamination
Eject Air thoroughly

If not, arouse air embolism
Note Blood Return


administering by SQ(皮下)，ID, or IM,
no blood return appears
By IV or IA, blood return appears
Insert Needle at Appropriate Angle
degree and Depth




ID 5° the bevel of tip of the needle
H(SQ) 30～40°2/3 of the shaft
IM 90° 2/3 of the shaft
IV
15～30 ° 2/3 of the shaft
Give No-Pain Injection





Explain the procedure and comfort the client
Assist the client to take a comfortable
position
Divert the client’s attention
Make skin taut when inserting the needle
two quicks and one slow


quick insertion and withdrawal of needles
slow injection of medication except pediartic clients


inject less irritating medication first,
then more irritating medications in
deep muscle tissues with a sharpbeveled, long shaft needle
Follow sterile and Seclusion
techniques strictly
PARENTERAL MEDICATIONS





Intradermal
Subcutaneous
Intramuscular
Intravenous
Intraarterial
Various
sizes or
gauges
EQUIPMENT
Syringes
shaft
handle
body
plunger
barrel
tip
Needles
sheath
needle
hub
shaft
bevel
（AIDS注射器与针头不能分离）
Other Equipments


Medical tray
 Antiseptic solution
 ethanol ,iodine
 Sterile swab
 File and vial opener
 Injection card
 Kidney basin
 Sterile tweezers and vat
 Adhesive plaster 、Small pad、Tourniquet
Medication
MEDICATION FORMS


Vials
Ampules


Check medications
Prefilled tubes
扫描上图P679
Draw medication


Preparing an Injection from an Ampule
Preparing an Injection from a Vial
See disk
Preparing an Injection from a small Ampule
Preparing an Injection from a large Ampule
Preparing an Injection from a Vial
Common Injection Methods





Intradermal
Subcutaneous or Hypodermic : SQ or H
Intramuscular
Intravenous
intraarterial
Intradermal Injection(ID)

Definition


Intradermal injections involve placing drugs into the
tissue between the epidermis and dermis where
blood supply is reduced and drug absorption occurs
slowly.
Purpose



Skin test
Vaccine inoculation
A prior step to local anesthesia

Site



Skin test: The inner surface of the downside
part of forearm
vaccine inoculation : the edge below the
deltoid muscle
local anesthesia: The site for local
anesthesia
Equipment

Procedure
Equipment
site
check and explain
sterilize
draw the meds
recheck
hold bevel of needle pointing up. Spread skin taut, puncture angle(5°).
depth(bevel)
loose left hand ，Firm the hub , inject meds（0.1ml）、a small wheat
Withdraw needle ，Don’t massage the area ，recheck
Dispose of equipment （20min check result）
Cautions!





Follow the three checks and seven rights
policy and sterile technique principles
strictly
Ban sterilizing the skin with tincture of iodine
Ban embrocating time and again when
sterilizing the skin
Ban massaging the injection site after
withdrawing the needle
Don’t leave the ward until the test result is
checked
Subcutaneous or Hypodermic : SQ or H


Definition
 involve placing drugs into the loose
connective tissue under the dermis.
Purpose
 To inject medications that need to produce
effect within given time but cannot be
administered orally
 To inject vaccine
 To give local anesthesia

Site




the edge below the deltoid muscle
the lower and the upper ventral areas
the anterior and outer aspects of the thighs
the scapular areas of the upper back

Common medications


vaccines, preoperative medications, narcotics,
insulin, and heparin
＜ 2ml

Equipment and procedure
过瘦者可捏起注射部位皮肤

Procedure
equipment
sites
explain and check
sterilize
draw meds
recheck
hold （similar to ID）、spread skin taut、puncture
angle(30～40°)、depth(2/3)
loose hand, pool back to see return blood（no）、(left
hand) inject meds slowly
withdraw the needle，press，recheck
dispose the equipment
Cautions！





Follow the checks policy and sterile principle
strictly
Irritating solutions and large volumes of
drugs are inappropriately taken by SQ
Rotate injection sites frequently
Insertion angle is less than 45°
Use 1ml syringe when injecting medications
lower 1ml
Intramuscular Injections

Definition




the method to inject certain medication solutions
into muscles
faster drug absorption than subcutaneous
less danger of causing tissue damage
Purpose



Inject medications inappropriately taken by mouth
Inject medications inappropriately administered
by subcutaneous injection
Inject irritating medications
•site






Generally, the site should have well developed
muscles, being
away from large nerves, bones, and with no
blood vessels under the location, and away from
infection, necrosis, bruising, or abrasions in the
surface
Dorsogluteal muscle
Ventrogluteal muscle site
Vastus lateralis muscle site
Deltoid muscle site
1. Dorsogluteal muscle site
瘦：触诊
胖：脊柱旁开
Cross line method
8~9cm
十字法
Top of the
连线法iliac
crest
gluteal
fold
Sciatic
nerve
Upper outer quadrant
Line method
anterosuperior
iliac spine
coccyx
1. Dorsogluteal muscle site
Cross line method
Line method
2．Ventrogluteal
muscle site
（1）Triangle locating method
髂前上棘后三角区
（2）Three-fingers’ width method
髂前上棘外侧三横指处
particularly
desirable for
infants and
children lower 2
years old
the iliac
crest
the
anterosuperior
iliac spine
2．Ventrogluteal muscle site
3．Deltoid muscle site
acromion
2 to 3 finger
widths below the
acromion process
4．Vastus lateralis muscle site

on the anterior lateral aspect of the thighs


From the site 10 cm below coxa joint to Knee joint
particularly desirable for infants and children
lower 2 years old
•Position

Lying position

Lie prone


Lie on the side


with the upper leg straight and relaxed and the lower leg flexed
Lie supine or on the back



with toes pointing inward
For patients with critical illness or unable to turn over
Appropriate for Ventrogluteal muscle site
Sitting position


Common site for patients of out-hospital
Appropriate for deltoid and Dorsogluteal muscle, If for
the latter, the position should be higher

procedures
equipment
sites
explain and check
sterilize
aspirate meds
recheck
Hold as dart、tighten skin、puncture angle (90°)、
depth(2/3 of needle)
loose left hand、pool back to see return blood（no）、
(left hand) inject meds slowly
withdraw the needle，press，recheck
dispose the equipment
Cautions!



Once broken, the nurse should ask
the client keep the position, steady
the local tissue, take out the
needle by using sterile forceps or
ask a surgical doctor for help
Ban piercing all the shaft into the tissue,
avoiding the needle is broken
Rotate sites for patients with long term
injection, and select thin and long needle
Ban selecting dorsogluteal muscle site for
children lower 2 years old because they
don’t well developed
Intravenous Injections

Definition



the method to administer medications into
vein directly
the most rapid and complete absorption of
medication
cause an immediate and critical response

Purpose




To inject medication which are not suitable for
other routes ,such as irritating medications
To inject drugs or dyestuffs to diagnose diseases.
To get desired effect rapidly, especially for the
client with critical illness
To get blood sampling
•sites



peripheral superficial veins of the limbs
Scalp veins of pediatric clients
femoral vein
Dorsal
surface
of hand
Cephalic
vein
Basilic
vein
median
vein of
forearm
Inner arm
thrombophlebitis
Superf
icial
dorsal
veins
Cephalic
vein
greater
Saphena
vein
dorsal
veins
in foot
Basilic
vein
Small
Saphena
vein
Dorsal
surface
of foot
Temporal
superficial vein
frontal vein
Posterior
ear vein
occipital
vein
Scalp veins of pediatric clients
femoral vein
其定位方法：髂前上棘和耻骨结节联线中点相交处为股动脉，
股静脉在股动脉内侧0.5cm处。
•Procedures:
equipment
explain and check
aspirate meds
sites Tourniquet clench the hand sterilize
recheck
Hold syringe、tighten skin，anchor vein、puncture angle(15~30°)、
depth（blood return），Lower the needle until it is nearly parallel to
the skin ,advance needle
Two loose（Release the tourniquet and unclench the hand
),one anchor needle、 (left hand)inject meds slowly observe response
withdraw needle，press or flex elbow,recheck
dispose equipment
Vein in limbs injection
Blood in vein sampling
1.choose proper container 7.inject blood sample into
cuvette in turn：
2.check
－cultivate blood sample－
3.choose appropriate vein
sterilized blood cultivate
4.puncture
cuvette
5.pool back the plunger to
－whole blood sample－
get blood sampling
Anti agglomeration cuvette
6.two loose(Tourniquet and
－serum sample——dry
hand) one withdraw
cuvette
needle one press
8.disposal
choose appropriate vein

Ban fetching the blood sample from the
veins where intravenous transfusion or
blood transfusion is .
Volume of sample

general cultivate sample 5ml


Sub-acute infectional endocarditis 10～
15ml
Whole blood and serum: general 2ml
全血标本
抗凝试管
拔下针头，血液沿管壁缓
缓注入后，立即轻轻摇动，
使血液和抗凝剂混匀，防
止血液凝固。
血清标本
干燥试管
拔下针头，血液沿管壁缓
缓注入后避免振荡，以防
止红细胞破裂而造成溶血。
血培养标本 无菌培养瓶 先消毒瓶口，更换针头，
血液注入后轻轻摇动，再
消毒瓶塞盖好。
Scalp vein injection of pediatric
clients
Take equipment to bedside
check explain
draw medication
Assist patients to supine position with the knees flexed and abducted
Sterilize the injection site and the manipulator’s index finger
and the middle finger of non-dominant hand
0.5cm away from inner lateral femoral artery
second Check
Puncture: sterilized fingers anchor the vein at the distal and
proximal, dominant hand holds syringe (40°or 90 ° ,bevel)
（dark red blood return），Inject the medications slowly by the nondominant hand
Withdraw the needle quickly ，press to stop bleeding 3～5min
third Check
procedures of
femoral vein injection

Femoral vein:

expose the inguinal region, 0.5cm inner
lateral femoral artery
Cautions!
1．Follow the three checks and seven
rights policy and sterile technique
principles strictly
2．Clinical guidelines forIrritating
vein selection
drugs is
injected slowly
3. Control the speed of injection according
to age of client and nature of medication
4.Bis injectional method
Clinical guidelines for vein selection



Select a vein with large diameter,
straightness, good elasticity ,and away from
joint and vein valve
Avoid veins with high move, infection caused
by previous use ,such as phlebitis,
infiltration, or sclerosis
Use distal portion of vein first, then proximal
portion gradually for patients with long term
injection
Bis injectional method


When injecting irritating medication,
normal saline should be used to inject
at first to test the needle is in the vein.
Then change the syringe with
medication for injection to prevent
medication irritating tissue once the
insertion fails
Factors contributing to failing to inject
shallow：if inject medication
turgidity and pain
No blood return
Blood return
continue
inserting the needle
Bevel sticks to the vessel wall
deep：if inject medication
no turgidity but pain
No blood return
Blood return
withdraw the needle, repeat the
procedure
good
The key to venipuncture for special
clients


1．Obese patients

Vein is deep but stable

palate the vein clearly, sterilize the index finger of
nondominant hand, increase angle degree of
venipuncture( 30°~ 40°)，insert the needle from the site
above the vein
2．Aged patients

vein is superficial and fragile but unstable(easily moved)

so it is essential to anchor the vein from the distal and
proximal portions before venipuncture

3.Severely dehydrated patients



Vein may collapse
Applying warm compresses and light tapping
and massage over the vein may foster
venous dilation well
4.Patients with edema


Vein may be seen unclearly
Massage skin above tended vein may expose
the vein
Arterial Injection and blood sampling







Definition
the nursing skill to inject medications into artery
and collect arterial blood as specimen.
Common sites
common carotid artery: illness in head and face
humerus artery（ 肱 动 脉 ） and subclavian artery : illness in
superior limb and chest
femoral artery: illness in inferior limb and abdomen
Radial artery(桡动脉)
•Purposes




1. To get arterial blood sample, Arterial Blood
Gases (ABGs)
2. To prepare for some special test, for example,
cerebral angiography
3. To give some medications for local
chemotherapy
4. To make arterial blood transfusion with high
tension，in order to rescue patients with shock
•Equipment
•Medical tray
•Antiseptic solution
•Medication
•Medication card
•Sterile swab
•Sterile gauze
•Adhesive plaster
•Medical tissue
•Sterile
glove
(if
necessary)
•Sterile tweezers and vat
• a syringe based on the
volume of medication, 6- to 9gauge needle
•File and vial opener
•Container
for
blood
specimens
•Sterile cork
•Tourniquet
•Alcohol lighter (if necessary)
•Small pad
•Sandbag
• Contamination container
•Gloves
•Sterile dressing (if necessary)
Take equipment to bedside
check explain
draw medication
Assist patients to proper position:
Sterilize the injection site and the manipulator’s index finger
and the middle finger of non-dominant hand
second Check
Puncture: sterilized fingers anchor the artery at the distal and
proximal, dominant hand holds syringe (40°or 90 ° ,bevel)
（bright red blood return），Inject the medications or collect blood
sample by the non-dominant hand
Withdraw the needle quickly ，press to stop bleeding 5～10min
third Check,assist client,equipment
procedures
position

For carotid artery,


For radial artery


lies on back, and turn head to the opposite side
of injection slightly
lies on back, and stretch and relax the arm with
the inner side upward
For femoral artery

the client lies on back, flex and abduct the knees,
expose the inguinal region
sites

femoral artery
 the inguinal region, femoral artery

Radial artery(桡动脉)


2cm upward the wrist joint of inner or palm surface of
forearm
carotid artery
Check_equipment

Before collecting blood sample, the
nurse should aspirate 0.5ml of heparin
(1:500), and spread it evenly on the
inside wall of barrel, then eject residual
solution, to prevent blood agglutination
collect blood sample


Blood volume: 0.1~1ml
If blood sample is used for Arterial Blood
Gases (ABGs), as soon as the needle is
withdrawn, it should be inserted into a cork
immediately. Roll the syringe in palms.
Radial
artery
injection(桡动脉)
静脉注射泵(intravenous injection
pump)

图片CAI课件
Section 4
Inhalation Administration
Inhalation Administration

Concept


the process that medications administered with
inhalers are dispersed into an aerosol spray or mist
that penetrates lung airways by nose or mouth
Characteristics


Local and systemic effects
Rapid absorption, small dose, light adverse effects
Common medications

bronchodilators（支气管扩张剂）




Eliminate bronchospasm：氨茶碱，沙丁胺醇
expectorants（祛痰剂）： α－糜蛋白酶
decongestants （解除充血剂）：Dex
Antibiotics ：庆大霉素、卡那霉素
Purpose


To moisturize the airway
To prevent and treat infection of
respiratory system



bronchitis (支气管炎)， Bronchiectasis(支气管
扩张)，pneumonia, pulmonary empyema(肺
脓肿), pulmonary tuberculosis
To relieve airway obstruction
bronchial asthma (哮喘)， or bronchitis (支气
管炎)
Common types




ultrasonic nebulization
oxygen nebulization
handheld nebulization,
Compressed nebulization
ultrasonic nebulization


Ultrasonic nebulization creates aerosol
spray or mist of medication through
high frequency vibration of ultrasonic
production film（超声发生器薄膜，透生
膜）.
This equipment also can regulate the
amount of spray and warm the
medication solution.
Equipment
Ultrasonic nebulizers
medications
Atomization
tank,entrant
sound
membrane
Screwed
pipe and
mouthpiece
Indicator
light
Power and
volume
switch
timer
Ultrasonic
generator
Water
flume,crystal
transducer
An ultrasonic
nebulizer
procedures
Pour cooldistilled
water into water flume,
250ml or immerse
entrant sound
membrane
add medication
diluted with sterile
normal saline
30~50ml into
atomization tank
Turn on the
power switch.
Take 3~5 min
for warmup,adjust
amount of
spray
Connect each
part of the
nebulizer and
tubing
Turn on the
timer
switch:15~
20min
Explain,position
Place the mouthpiece into
the client’s mouth.instruct
to take deep breath
oxygen nebulization

Oxygen nebulization is accomplished
by using the force of an oxygen stream
or compressed air passed through the
fluid in a nebulizer or an atomizer (喷雾
器).
oxygen nebulization
Or a jet-aerosol nebulizer
Mouth piece
T connector
Cap of meds cup
The highest level
of liquid
meds cup
To oxygen source
A jet-aerosol nebulizer
oxygen nebulization: procedure
No water in
Humidifying
bottle,Oxygen
flow rate
6~8L/min
handheld nebulization

Concept


A handheld nebulizer (HHN) is a metered–
dose inhalers (MDIs) that can be used by
clients to self-administer measured doses of
an aerosol(气雾) medication
Purpose

To eliminate bronchospasm

Dex, bronchodilators such as氨茶碱，舒喘灵
handheld nebulization
_With Areochamber
Metered-Dose
Inhalers
See disk
Inspire spray
Hold breath 10s
expire
1～2spray/次
Section 6
Topical Administration
Contents






Nasal Instillations
Eye Instillations
Ear Instillations
Vaginal Instillations
Rectal Instillations
Skin Application
Vaginal Instillations
applicator
Supine position
15min
Rectal Instillations
6~7cm,lie on the
side 15min
Skin Application
Ointment or
cream
tincture
powder
Sublingual
Section 5
Medication anaphylaxis test
过敏反应（anaphylactic reaction/anaphylaxis）
过敏性休克(allergic/anaphylactic shock)
medication history allergic history
family allergic history （用药史、过敏史、家族史）
过敏试验(allergic/anaphylactic test)
skin test (皮试)
intradermal test（皮内注射试验）
What is anaphylactic reaction
to medication?
What is anaphylactic test of
medication?
Characteristics of Anaphylactic
Reaction to Medication
allergy
An pathological immune reaction
Anaphylaxis does not usually happen to
patients who take the medication for the
first time，but not absolutely.
sensitized course
non typical exposure、cross
reaction(隐性致敏、交叉反应)
Characteristics
Anaphylaxis only happens to a few
persons with allergic habitus, with no
relation to dosage.
The different medications with similar
chemical structure may lead to
full or part cross reactions.
过敏反应的特点

是一种病理性的免疫应答。

通常不发生在首次用药，必须有致敏过程；但不
是绝对的，隐性致敏或交叉反应。

只发生在少数人,是对某些药物“质”的过敏,而
不是“量”的中毒。

具有相同化学结构的药物之间会发生完全或部分
交叉反应
Medications prone to provoke
anaphylaxis:




Antibiotics : penicillin streptomycin
cephalothin
Biological products : TAT
Narcotics: procaine
Contrast medium: Iodide
Safely and correctly administering
meds
• Inquire
• medication history
• Allergic history
• Family allergic history
（用药史、过敏史、家族史）
• Anaphylactic test
before
administeri
ng meds
Anaphylactic test?
•It is a clinical method to monitor whether the
patients get immediate or delayed
anaphylaxis after the small dosage
medication came into the body through
some approaches .
•skin test: intradermal injection
scratch test(划痕试验)
•conjunctiva method（眼结膜试验法）
•intravenous injection
Skin test can detect the
anaphylaxis,but sometimes the result is
false negative.Why:
insufficient dosage
Have taken anti-allergic
medication before the test.
（皮试。假阴性：计量小或服用抗过敏药）
contents
1.How to dispense the allergic reagent of
penicillin and other common medications
2.To learn test method and determination of
the test result
3.How to treat the anaphylactic reaction,
especially allergic shock
Part 1
Penicillin Anaphylactic Test




Mechanism of penicillin anaphylaxis
The clinical manifestations of penicillin
anaphylaxis
The treatment of penicillin allergic
shock
The method of penicillin anaphylactic
test
Mechanism of penicillin
anaphylaxis
6—氨基青霉烷酸
青霉烯酸
hapten
青霉噻唑酸
某些霉菌(青霉菌)
半抗原
antigen
全抗原
使T淋巴
细胞致敏
B淋巴细胞
蛋白质或多肽分子
再次接
触该抗原
肥大细胞
嗜碱性粒细胞
释放血管
活性物质
组胺、白三
烯、5－HT
产生抗体IgE
IgG IgM
浆母细胞和浆细胞
皮肤、呼吸道、循环、
消化道、休克
血管扩张、通透性增加、平
滑肌收缩、腺体分泌增多
The clinical manifestations of
penicillin anaphylaxis

Anaphylactic shock






Respiratory failure symptoms
Cardiovascular failure symptoms
Central nervous system symptoms
Cutaneous allergic symptoms
Serum sickness reaction
Anaphylaxis of organ and tissue



Cutaneous anaphylaxis
Respiratory anaphylaxis
digestive system anaphylaxis
The treatment of penicillin
allergic shock
•Emergency treatment on site
•Stop medication immediately
•Lie on the back,keep warm
•Administering epinephrine immediately
•0.1% epinephrine 1ml H,every 0.5h repeatedly
H or iv 0.5ml
treatment
•Correct Hypoxia and improving
respiration
•Oxygen administration
• If depressed respiration:
•mouth-to-mouth artificial breathing
•respiratory stimulants: nikethamide/lobeline
•If laryngeal edema:
•incision of trachea or intubation of trachea
treatment
•Treating allergic shock
•Dexamethasone 5~10mg
25% glucose
IV or
•Hydrocortisone 200~400mg
5%~10% glucose
ivdrip
•Anti-histamine medications:异丙嗪
25~50mg im、苯海拉明40mg im
treatment
•Improve cardiovascular function
（correct shock）：
•Increase peripheral blood capacity
•10%GS,balanced solution ivdrip
•dopamine or metaraminol
•Cardiac arrest
•cardiac compression
•Observe the patient intensively
and record information：
•vital signs urine volume consciousness
The method of penicillin
anaphylactic test
Test objects：
•First take medication (首次用药者)
•Stop penicillin three days ago and reuse
（停药3天以上再用者）
•The batch of the medication is changed
(更换批号)
The method of penicillin
anaphylactic test
•The anaphylactic test reagent
and its dispensing method
•Method of anaphylactic test
•Result determination
The anaphylactic test reagent
Reagent：200～500u P/ml NS
0.1ml ID
Dispensing method of reagent
(1)P 80,0000u+4ml isotonic saline=20,0000u/ ml
(2)dilute 0.1ml P solution+ isotonic saline to1ml =2,0000u/ ml
(3) dilute 0.1ml P solution + isotonic saline to 1ml =2000u/ ml
(4) dilute 0.25ml P solution + isotonic saline to 1ml =500u/ ml
mix completely when diluting every time
（每次稀释时均需将溶液混匀。）
Method of anaphylactic test
0.1ml
500u /ml
ID
check the result after 20min
Result determination
Negative result:
There is no skin redness, swelling,
blush and the patient has no
uncomfortable feeling.
（阴性：皮丘无改变，周围不红肿，无红晕，
病人无自觉症状。）
Positive result:
•The wheal becomes large.
•There is skin redness and swelling.
•The diameter of the wheal is more than 1cm,
or there is pseudopodium.
•The patient has pruritus feeling.
•Dizziness,fluster,nausea may occur in severe
cases,even anaphylactic shock.
（阳性：局部皮丘隆起增大，出现红晕，直径大于1cm，或周
围出现伪足、有痒感。严重时病人可出现头晕、心慌、恶心，
甚至过敏性休克。）
Cautions of penicillin
administration

Inquire the patient’s medication history,allergic history and
family allergic history before test.
（皮试前应询问用药史、过敏史家族过敏史。）
Normal/isotonic saline is always used as menstruum to
dissolve and dilute penicillin.
（配制试验液的溶媒多采用生理盐水,不用注射用水。）
 Menstruum, syringe and needle used in dilute penicillin is
banned to use in other medications.
（配制试验液的溶媒、注射器、针头不宜交叉使用。）

Dispense allergic test reagent when used.The dosage and
concentration of reagent is accurate.
（试验液的浓度、剂量应准确，且应现用现配。）
 Anti－histamine medications is banned in 24h before test
in case of false negative .
（皮试前24h禁用抗组织胺类药物，以免影响皮试反应结果）
 Be ready for aids before,and keep epinephrine on hand .
(过敏试验前应准备好抢救物品，以备急救。)

Keep close watch on the patient.
(在进行皮内试验时应严密观察过敏反应，首次注射青霉素
者需观察30min后再离开。)
 If positive,penicillin should be banned,and the nurse
should report to the doctor.Record penicillin positive
result on the doctor’s order sheet,medical record，
injection card and bedside card,and inform the patient
and his family of the result.
（阳性结果者不用青霉素，并及时告诉医生，将阳性结果标
识在医嘱单、病历、注射卡、床头卡上。并告知病人及家
属。）


If you doubt false positive，control experiment is
made to exclude allergy induced by disinfector.
（疑假阳性反应做对照试验，以排除消毒剂的影响）
Part II streptomycin
anaphylactic test
 Clinical
 Twitch
manifestation:
because of deficient calcium
（低钙抽搐）
 Be
similar to penicillin
 Treatment
10%葡萄糖酸钙、5％氯化钙
 其他同 penicillin

The anaphylactic test reagent of
streptomycin
Reagent：
2500u /ml
0.1ml ID
Dispensing method of
reagent streptomycin
(1)S 100,0000u+3.5ml isotonic saline=25’0000u/ ml
(2)dilute 0.1ml S solution+ isotonic saline to 1ml =2,5000u/ ml
(3)dilute 0.1ml S solution + isotonic saline to 1ml =2500u/ ml
mix completely when diluting every time
（每次稀释时均需将溶液混匀）
Method of anaphylactic test
0.1ml 2500u/ ml ID
check the result after 20min
Result determination
Be similar to penicillin
TAT(tetanus antitoxin)
anaphylactic test



The cause of anaphylaxis
The method of TAT anaphylactic
test
TAT desensitized injection
The cause of anaphylaxis

The immune serum of equine(马)



Neutralise tetanus toxin：prevent and cure
Heterogeneous protein
The clinical manifestation of
anaphylaxis


Fever, immediate or delayed serum sickness
Allergic shock occasionally
The method of TAT
anaphylactic test
Test objects：
•First take TAT
(首次用药)
•Stop therapy with TAT more than 1
week ago
(停药1周以上)
The method of TAT
anaphylactic test
•The anaphylactic test reagent
and its dispensing method
•Method of anaphylactic test
•Result determination
The anaphylactic test reagent
TAT
Reagent：
150u TAT/ml isotonic saline
0.1ml ID
Dispensing method of reagent
TAT 1500u(original solution)
0.1ml TAT 1500u + isotonic saline to 1ml =150u/ml
Method of anaphylactic test
0.1ml 150u/ml TAT ID
check the result after 20 minute
Result determination
of TAT
Negative result:
No local skin redness and swelling. No
abnormal systemic reaction.
(阴性:局部皮丘无红肿，病人无全身异常反应)。
Determination criterion
Positive result:
•The wheal is red and swelling.
•Induration with diameter larger than 1.5cm,
•blushing with diameter larger than 4cm,
•Sometimes there is pseudopodium
•The patient has pruritus feeling.
•The systemic reaction is similar to that of penicillin and
serum sickness is the most common.
(阳性:局部皮丘红肿，硬结直径大于1.5cm，红晕范围直径
大于4cm，有时出现伪足或有痒感。全身过敏性反应表现与青
霉素过敏反应相似，以血清病型反应多见。)
TAT desensitized injection

Mechanism of desensitized injection



Object：Positive result and no substitute
Concept：Divide the dosage into several
smaller dosages and inject them separately
and continuously in a short period time
Mechanism：Neutralise and consume IgE
gradually ，up to totally.
 temporary desensitization

Desensitized injection method
Desensitized injection method
20min interval
Times
TAT(ml)
Normal Saline
Administration
Route
1
0.1ml
0.9ml
IM
2
0.2ml
0.8ml
IM
3
0.3ml
0.7ml
IM
remainder
diluted to
1ml
IM
4
If anaphylaxis occur,dose decrease
and times increase
TAT脱敏注射

适用对象：

TAT是一种特异性抗体，没有可以代替的药物，皮试
结果即使阳性，仍需考虑使用。

定义：分次小剂量注射

机理

逐渐中和IgE。直至脱敏。

暂时，会重建致敏状态：故日后如再用TAT还须重做
皮内试验。
脱敏注射步骤
次数
1
2
3
4
抗毒血清
（ml）
0.1
0.2
0.3
余量
生理盐水
（ml）
0.9
0.8
0.7
至1ml
注射法
肌内注射
肌内注射
肌内注射
肌内注射
每隔20min注射1次，每次注射后均需密切观察。
在脱敏过程中，如发现患者有全身反应，如气促、
紫绀、荨麻疹或发生过敏性休克时应立即停止注
射，并迅速对症处理。如反应轻微，待反应消退
后，酌情增加注射次数，减少每次注射量，以达
到顺利注入余量的目的。
Part 4 Procaine(novocaine)
anaphylactic test
Test method:
•First use procaine(首次用药者)
•0.25% procaine solution 0.1ml ID
•Check the result after 20min
•Result determination is similar to penicillin
Iodic Preparation AnaphylacticTest

Test objects


So if it is the first time to use them,
anaphylactic test should be done 1 or 2 days
before graphs with iodode.
Method of Anaphylactic Test



Oral Administration
Intradermal Injection
Intravenous Injection
Determination criterion

Oral Administration


If the symptoms of paralysis of mouth,
dizziness, palpitation, nausea, and vomiting,
or/and urticaria are present, the result is
positive.
Intradermal Injection
 If
local skin becomes red and swelling or
sclerosis appears, with the diameter more
than 1cm, the result is positive.

Intravenous Injection
 If
the blood pressure, pulse, respiration and
face color of the client have changed, if the
client has palpitation, mucous edema,
nausea and vomiting, uritcaria and other
discomforts, the result is positive.
Part 5 Cytochrome C
anaphylactic test
Test method:
• First use Cyt C
• Intradermal test
• Dilute Cyt C solution 0.1ml (15mg per 2ml) to 1ml,
• reagent 0.75mg/ml 0.1ml ID
• 20min, positive：local redness and swelling，with the
diameter of wheal larger than 1cm，papular appears
• scratch test
Cytochrome C
• scratch test
• Put one drip of original Cyt C solution on the
forearm
• Make two scratches 0.5cm long and little
bleeding deep with a sterile needle
• 20min, result determination is similar to ID
Part 6 Cephalosporin
anaphylactic test


Part cross-reaction between
Cephalosporin and penicillin

The mechanism is similar to penicillin

They have the sameβ-lactam structure
Test method :cephalothin(先锋霉素)

Test method :cephalothin(先锋霉素)

Reagent: 500μg/ml 0.1ml ID

Dilute method
0.5g cephalothin+2ml NS
250mg/ml
dilute 0.2ml cephalothin + NS to 1ml
50mg/ml
dilute 0.1ml cephalothin + NS to 1ml
5mg/ml
dilute 0.1ml cephalothin + NS to 1ml
500μg/ml