Download Administering Medication

Medication Administration
Part II
Stephanie Stevens
MSN,RN,CNE
Routes of Administration—
Oral Route
Oral Route

Given by mouth (po) and
swallowed with liquid
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Routes of Administration—
Oral Route
Oral Route

Sublingual (SL)
 Placing the medication
under the tongue
 Should NOT be
swallowed, chewed
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Routes of Administration—
Oral Route

Buccal
 Placing solid medication against the
mucous membranes against the cheek or
under lip until dissolved
Patient Education
 Alternate cheeks with each dose to avoid
irritation
 Do not chew, swallow the medication
 No intake of liquids

Oral Medications

Aspiration
Occurs when food, fluid, or medication intended for the
GI route enters the respiratory tract.
 Always evaluate your patient’s ability to swallow
 Proper positioning will assist in preventing aspiration
 Fowler’s position or seated position
 Lateral position (when swallow, gag, and cough reflexes
are intact)


Trouble swallowing?
May need consult (Speech therapy)
 Use other routes, (IV, SC) if possible
 May administer through NG or feeding tube

Routes of Administration—
Parenteral
Injecting a medication into body tissues
Major routes include
 Subcutaneous (SQ)
 Intramuscular (IM)
 Intravenous (IV)
 Intradermal (ID)
Topical Medication Application
Skin
Protect hands by wearing gloves
Apply to clean, dry, hairless, intact skin.

Lotions, Creams, Ointments

Transdermal Medications
Topical Medication Application
Eye Instillation

Types of Ophthalmic Meds
 Eye drops
 Ointments

Problems for Older Adults
 Hand tremors
 Poor vision
 Poor grasping

Improving Compliance
 Demonstrating each step and return demonstration
Topical Medication Application
Eye Instillation

Principles of Eye Instillation
 Avoid instilling any form of eye medication directly onto
the cornea.
 Avoid touching the eyelids or other eye structures with
eye droppers or ointment tubes
 Use eye medication only for the patient’s affected eye
 NEVER allow a patient to use another patient’s eye
medication
Topical Medication Application
Nasal Instillation
 Nasal instillations come in:
Sprays
Drops
Tampons
Topical Medication Application
Ear Instillation

Internal ear structures are very sensitive to temperature
extremes

Use sterile ear drops

Do not occlude the ear with the dropper or irrigating
syringe

Straighten ear canal according to age of patient.
Topical Medication Application
Vaginal Instillation

Foams, Jellies, Creams,
Suppositories
 Administer with applicator
 Usually patients prefer to self-
administer, but if required by nurse,
use gloves.
 With any vaginal medication…
 Perineal pad may be desired
 May have a foul odor
 Allow perineal hygiene often
Topical Medication Application
Rectal Instillation



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“Bullet shaped”, thinner than vaginal suppositories
Rounded end and lubrication- prevents anal trauma
during insertion
Do not force into a mass of fecal material
Local or systemic effect
Stored in refrigerator until given
Inhaled Medications
 Respiratory tract- large surface area for
absorption
 Readily absorbed and work fast—vascularity
 Can have local or systemic effect
 Essential for patient to learn proper use of
inhaler .
Medication Administration—Parenteral


Administration of meds by injection
-Considered an invasive
procedure—use aseptic technique
-Risk of infection
-Injections requires certain skills to
ensure safe administration
-Effects of this route are rapid—
depending on the rate of
absorption.
Close observation is imperative
Medication Administration—
Parenteral
Syringes
 Syringe Parts
 Only touch the outside of the syringe
barrel and the handle of the plunger!!!
DO NOT touch the shaft of the
plunger and the needle—risk of infection.
Medication Administration—Parenteral
Types of Syringes



Standard
 Can be 3-, 5-, 0r 10-mL
 May be supplied with or without needles
 Usu. calibrated in increments of 0.2 mL
Insulin
 Calibrated in units of insulin
 Can be 0.5 – or 1 mL syringe
 Used only to administer insulin
Tuberculin
 1 mL syringes calibrated with 0.01 markings
 Used for skin testing
 May also be used for SQ, e.g. heparin
Medication Administration—
Parenteral Needles
Attached or unattached to syringes
 Has 3 parts, which fits onto the hub of the
syringe

 -Hub (fits on tip of syringe)
 -Shaft (connects to the hub)
 -Bevel (slanted tip) has narrow slit that quickly
closes after removing the needle to prevent
leakage of med.
Medication Administration—
Parenteral
Needle Length
 Vary in length—0.4 in. to 3 in.
 Length is determined by:
 Size of patient
 Weight
 Route of administration
Medication Administration—
Parenteral
Needle Gauge
Gauge – inside diameter of needle lumen
 Gauges are numbered 14 to 30.
 Needles with the smallest gauges are labeled
with the largest number.
 Selection of gauge dependent upon:

 Patient comfort
 Viscosity of fluid
 Speed of administration
Medication Administration—
Parenteral
Preparing Injections from Ampules
Contains single doses of
medication
 Use filter needle when
aspirating (drawing up)
medication into a syringe.

Medication Administration—
Parenteral
Preparing Injections from a Vial






Vials –single or multi-dose container that has a
rubber seal at the top
Air needs to be injected because it is a closed
system .
Can be liquid or powder
Medications that are unstable in solution are
packaged dry.
The vial label specifies the solvent or diluent
needed to prepare or reconstitute a desired
medication concentration
Common diluents-normal saline, sterile distilled
water
Medication Administration—
Parenteral
Mixing Medications

Medications can be mixed—if they are
compatible

Most nursing units have charts that list meds
that are compatible

May need to consult a pharmacist
Medication Administration—Parenteral
Mixing Medications

What if…
Mixing one med from vial and other from ampule?
Mixing meds from two vials?
Medication Administration—
Parenteral
Preparing Insulin Therapy
When preparing U-100 insulin, use a U100-unit-scaled syringe.
 Always have a second nurse double-check
insulin for right drug, dose, etc.
 Gently roll (not shake) all cloudy insulin for
resuspension of insulin.

Medication Administration—
Parenteral
Preparing Insulin Therapy

Mixing two types of insulin in a syringe

Prepare the short-acting insulin first, then the
intermediate acting
Other principles to consider when mixing insulins

Do not mix insulin with other medications or diluents
unless approved by prescriber
Administering Injections—
Ways to Minimize Discomfort
 Change needle after drawing up
medication
 Position the patient so that muscle
tension is decreased.
 Use Z-track method when administering
irritating meds
Administering Injections—
Ways to Minimize Discomfort
 Divert patient’s attention—talk to
the patient
 Insert the needle QUICKLY and
SMOOTHLY to minimize tissue
pulling
 Hold the syringe barrel steady
while the needle remains in tissues
 Inject the medication SLOWLY
and STEADY.
Administering Medication—
Subcutaneous Injections
Subcutaneous or SC/SQ
 Injection of medication into the
loose connective tissue under the
dermis
 Has slower absorption rate than
IM
Administering Medication—
Subcutaneous Injections

Subcutaneous Sites (preferred or best sites)
 Outer posterior aspect of the upper arms
 Abdomen below the costal margins to the iliac
crest and 2” in. away from the umbilicus
 Anterior aspects of the thighs
 -Recommended site for heparin injections is the
abdomen.
 Low molecular weight heparin - right or left side
of the abdomen. Give 2” from the umbilicus
Administering Medication—
Subcutaneous Injections



Other SC sites for other medications
 Scapular areas of the upper back
 Upper buttocks
Using the right equipment
 U-100 insulin syringe for insulin
 Tuberculin syringe for heparin
Injection sites
 Rotating injections within the same body part for a
sequence provides more consistency in the absorption of
insulin.
 Fastest to slowest absorption sites= abdomen→ arms→
thighs→buttocks
Administering Medication—
Subcutaneous Injections
Give only small doses
-Amount of dose 0.5-1.0ml
Patient’s body weight indicates the depth of the SC layer
-Amount of SQ tissue determines angle of administration
Administering Medication—
Intramuscular Injections

Provides faster absorption than SC

Uses a longer and larger gauge needle than
SC

Administer IM injections so that the needle
is perpendicular to the patient’s body—as
close as 90 degree angle as possible
Administering Medication—
Intramuscular Injections

Sites
 Consider the following
 Area free from infection or necrosis?
 Any localized bruising or abrasions?
 Location of the underlying nerves, bones, major blood
vessels?
 Volume to be administered?

Each site has certain advantages and
disadvantages
Administering Medication—
Intramuscular Injections
 Ventrogluteal
 -Bony Landmarks
Greater trochanter
Anterior superior iliac spine
Iliac crest
Administering Medication—
Intramuscular Injections
 Vastus lateralis
 Bony Landmarks
Greater trochanter
Patella of knee
Administering MedicationsIntramuscular Injections

Rectus femoris
 Bony Landmarks
Anterior superior iliac spine
Patella of knee
Administering Medication—
Intramuscular Injections

Dorsogluteal
 Bony Landmarks
 Greater trochanter
 Posterior superior iliac spine
 Iliac crest
Administering Medication—
Intramuscular Injections

Deltoid
 Bony Landmark
Acromium process
Administering Medication—
Intramuscular Injections
Z-Track Method

Recommended to use when giving IM medications that
are irritating
 Select site. Pull the overlying skin and SC tissue at
least 1inch laterally to the side with the non-dominant
hand.
 Hold the skin in this position until you administer the
injection.
 After preparing the site with alcohol pad, inject the
needle deep into the muscle and slowly inject the
medication if no blood return on aspiration
 Hold 10 seconds, then withdraw the needle and
release the skin
Administering Medication—
Intradermal Injections
Usually used for skin testing (diagnostic )
 Medication is usually potent—inject into the dermis,
where there is reduced blood supply
 Assess:


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Site for changes in color and tissue integrity.
Best to choose a site lightly pigmented, free of lesions
and relatively hair free
Best sites - upper back , upper arms, and inner
forearms
Administering Medication—
Safety Devices
 Most frequent route of exposure to blood-
borne diseases is from needle-stick injuries
 However, over 80% are preventable with
implementing safe needle devices
 Syringes
 Special design—has sheath or guard that immediately
covers the needle after it is withdrawn from the skin,
reducing the risk of injury
 Disposal of both in a receptacle—red sharps
container; DO NOT RECAP!
 Use these whenever possible to reduce injury