Download LWW PPT Slide Template Master

Chapter 10
Administration Procedures
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Checks and Six Rights
Three Checks When Preparing Medications
Read the label:
1. Check the drug label with the medication administration record
(MAR) when removing the container or unit-dose package.
2. Check the drug label again immediately before pouring or
opening the medication, or preparing the unit-dose.
3. Check the drug label once more when replacing the container
and/or before giving the unit-dose to the patient/client.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Checks and Six Rights
Six Rights Before Administering Medications
1. Right medication
2. Right patient/client
3. Right dosage
4. Right route
5. Right time
6. Right documentation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medication Orders
• **A correct medication order or prescription bears the
patient/client’s name, room number, date, name of drug
(generic or trade), dose of the drug, route of
administration, and times to administer the drug
• It ends with the signature of the physician or healthcare
provider ordering the drug
• *If a client refuses it, write the reason and the time you
notified the MD
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Orders
1. Standing order with termination. Example: Keflex
(cephalexin) 500 mg PO every 6 hours × 7 days
2. Standing order without termination. Example: digoxin
(Lanoxin) 0.5 mg PO every day
3. A prn order. Example: morphine 2 to 4 mg IV q 4 h prn
pain
4. Single-dose order. Example: atropine 0.3 mg
subcutaneous 7:30 a.m. on call to OR
5. Stat order. Example: morphine sulfate 4 mg IV stat
6. Protocols. Example: for K <3.5, K 20 mEq PO q 4 hour
× 2 days
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Safeguards in
Administering Medications
• Oral medications
– Handwashing
– Wear gloves with possible exposure to blood or body
secretions.
• Injections
– Handwashing and gloves
– DO NOT recap needles.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Safeguards in
Administering Medications (cont.)
• Handwashing and gloves
– Heparin locks, IV catheters, IV needles
– Secondary administration sets or IV piggyback
(IVPB) sets
– Application of medication to mucous membranes
– Skin applications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Masks
• Strict or respiratory isolation procedures
• Splash directly into face, eyes, or mucous membranes
• Aerosolization of fluids
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Needles
• Discard in appropriately labeled, puncture-proof
containers.
• DO NOT break, bend, or recap needles after use.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mobile Cart System
• Place the patient/client’s drawer on the top of the cart.
Read each medication order, and choose the unit-dose
from the drawer and compare the label with the order.
• After comparing the order with the unit measure,
compute the dose. Check the drug label, then open or
prepare the unit-dose, or pour the amount of a liquid
medication.
• Label the unit-dose, read the order again, and verify the
dose. After preparing all of the patient/client’s
medications, read the name on the medicine sheet,
check the patient/client’s identification band, and
administer the drugs.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Oral Medications
• Check expiration dates.
• *Check for allergies.
• *Check with the physician if certain drugs are
administered when the patient/client is NPO (nothing by
mouth).
• *administer irritating meds with meals
• Do not touch stock medications with hands.
• Do not break tablets that are not scored.
• Do not crush enteric-coated tablets.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Liquid Medications
• Shake liquid medications thoroughly before pouring.
• Pour liquids at eye level.
• Wipe the lip of the bottle with a paper towel before
recapping.
• Disguise liquids if distasteful or irritating.
– Juice
– Straw
• Don’t dilute liquid cough medicines.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Route
• Adult maximum one site
– 3 mL
– 2 mL deltoid
• Angle of insertion
– Intramuscular (IM): 90-degree angle
– Subcutaneous: 45-degree angle; use a 90-degree
angle if the subcutaneous layer of fat is thick and the
needle is short
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Needles for Injection
• Subcutaneous: 25, 26, 28 gauge
• IM children and emaciated patients: 25, 26, 28 gauge
• Intradermal: 26 gauge or other fine needle
• IM injections: 22 and 23 gauge
• IV therapy: 20 and 21 gauge
• Blood transfusion: 16 and 18 gauge
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Preparing the Dose
• Vials
• Ampules
• Unit-dose cartridge and holder
• Unit-dose prefilled syringes
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mixing meds
• *technique
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
IM Injection Sites
• Adult
– *Dorsogluteal
– Ventrogluteal
– Vastus lateralis
– Deltoid
• Children
– *Vastus lateralis
• Dorsogluteal over 5 years of age
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Injections
• General principles
• Subcutaneous heparin
• Subcutaneous insulin
• Z-track technique for IM injections
– *if blood enters syringe, withdraw needle and
discard, prepare another injection!
– *Ztrack-Change needle,Add 0.2 ml of air,Inject at 90
degree angle, After give injection-wait 10 seconds
IV-sites*
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medication Administration Techniques
• Skin and mucous membranes
• Ear drops
– Adult: Pinna up and back
– *Child: Pinna down and back
– Rest on the unaffected side for 10 to 15 minutes
• Eye drops or ointment
– *Drops: lower conjunctival sac
– *Ointment: spread inner to outer canthus of eye
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
*Nasogastric Route
• Head of bed elevated 30 degrees
• Check placement
– 15 mL of air
– Aspirate stomach contents.
– Check acidity of stomach contents.
• Flush at least 30 mL of warm water to ensure patency.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medication Administration Techniques
• Nose drops
• Rectal suppository
• Respiratory inhaler
– *wait 1 minute, shake inhaler, and puff
• Skin applications
• Nitroglycerin ointment
– *select nonhairy site, don’t rub, recheck BP in 30 min
• Transdermal disks, patches, and pads
• Sublingual tablets
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medication Administration Techniques
• Vaginal suppository or tablet
• Vaginal cream
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Neonatal and Pediatric Considerations
• *Offer a popsicle to numb the taste buds.
• Mix with a teaspoon of puréed fruit, ice cream, or syrup.
• Pinch the nostril closed and drink medication through a
straw.
• Distract the child with conversation or a toy.
• Use a decorative adhesive bandage to cover the injection
site.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Geriatric Considerations
• Offer a popsicle to numb the taste buds.
• Mix with a teaspoon of puréed fruit, ice cream, or syrup.
• Injections
– Predetermine the injection site.
– Insert the needle quickly.
– Inject the medication slowly.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins