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Chapter 10 Preparing and Administering Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1 Learning Objectives Compare dosage forms for drugs given by the enteral route Outline procedures for giving medications enterally, parenterally, and percutaneously List processes to prevent transmission of human immunodeficiency virus (HIV) and other blood-borne pathogens Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Enteral Medications Medications given directly into the GI tract Oral; Box 10-1 Oral Medication Forms Nasogastric or PEG Rectal Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 Oral Administration Asepsis Steps to administer: Procedure 10-1 Getting ready Preparing the medication Administering the medication Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 Oral Administration (cont.) Solid form Liquids Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 5 Nasogastric Administration Appropriate patients PEG tube Medication forms: Liquids Pills: crushed, add water Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6 Procedure for Administering Nasogastric Medications Aspirate stomach contents Listen for gurgling sounds in the stomach Listen for breath sounds Put medication into the tubing Instill medications via gravity Add water to tube following medication administration Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Rectal Administration Getting ready Preparing the medication Administering the medication Concluding Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Parenteral Medications “Into the skin” Routes Reasons for parenteral administration Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9 Standard Precautions Protect health care workers Centers for Disease Control (CDC) Sharps container for disposal of needles Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 Parenteral Administration “Into the skin” Routes for administration Parenteral rationale/Advantages Disadvantages Costs Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 11 Basic Equipment Syringes: Figure 10-2 Types of syringes: Figure 10-3 Volume of medication: mL or m Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Parts of a Syringe Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 Needles Needles: gauge Hub Specialized needles Guide for needle selection: Table 10-1 Needleless system: Figure 10-6 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 Parts of the needle Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 15 Needles: Gauges Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 16 Question 1 The Z-track method is used to give medicines: 1. 2. 3. 4. Orally. That should be absorbed slowly. That are irritating or may stain the skin. Rectally. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 Question 2 ____________ are gelatin containers that hold powder or liquid medicine. 1. 2. 3. 4. Capsules Elixirs Emulsions Suspensions Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 18 Learning Objectives Outline procedures for giving medications enterally, parenterally, and percutaneously Identify anatomy landmarks used for giving parenteral medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 19 Procedure for Preparing and Administering Parenteral Medications Procedure for medication administration: Procedure 10-3 Determine site for administration Use of equipment Package Medication characteristics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20 Forms of Parenteral Medications Vials: Figure 10-7 Ampules: Figure 10-8 Mix-O-Vial: Figure 10-9 Single or Multidose vials Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 21 Vial Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 22 Ampules Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23 Forms of Parenteral Medications (cont.) Combining drugs in one syringe Mixing insulin Prefilled syringes IV solutions Secondary or “piggyback” Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24 Administering Intradermal Injections Uses Skin anatomy and needle angle: Figure 10-12 Bleb Equipment and technique Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 25 Intradermal Injections Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 26 Administering Subcutaneous Medications 2 mL into the loose connective tissue Slow onset, longer duration Placement: Figure 10-14 Sites: Figure 10-15 Technique Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27 Subcutaneous Injections Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 28 Administering Intramuscular Medications Location Absorption Equipment Sites: Box 10-3 Technique Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 29 Intramuscular Injections Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 30 Question 3 The _____ muscle is a common injection site for adults, because it is _____. 1. 2. 3. 4. deltoid; easily reached dorsogluteal; relatively free from nerves and major blood vessels vastus lateralis; less painful ventrogluteal; near the abdomen Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 31 Administering Intravenous Medications Onset and absorption Dosing and scheduling considerations Equipment Sites: Figures 10-18 (adult) and 10-19 (children) Venipuncture and intravenous infusion Procedure 10-4 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 32 Intravenous sites in adults Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 33 Intravenous sites in children Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 34 Modifications in Technique for Specific Situations Adding medication by syringe to an infusion Adding medication to a plastic bag or an IV bottle Adding medication to a volume control Adding medication by piggyback infusion Administration of medication when there is only an intermittent infusion device Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 35 Intravenous Infusion Rates Monitoring infusion rates Calculating infusion rates Infusion pumps; syringe infusion pumps Infusion controllers and volumetric pumps Implantable pumps Venous access device Common problems with intravenous infusions Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 36 Percutaneous Medications Absorption: mucous membranes or the skin Absorption and application Inhalation Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 37 Percutaneous Administration Factors affecting transdermal application Skin condition Methods of administration Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 38 Procedures for Administering Percutaneous Medications Applied to the area requiring treatment Common Forms: Box 10-4 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 39 Administering Topical Medications Clean skin before application Gloves Lotions Ointments Excess medication Dressings Patient Education – Home Care Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 40 Administering Medications to Mucous Membranes Absorption Sublingual Buccal Vaginal Ear drops: child and adult Eye Nose Respiratory Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 41
