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Chapter 10 Preparing and Administering Medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 10 Lesson 10.1 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 2 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 3 Enteral Medications • Medications given directly into the GI tract • Oral; Box 10-1 Oral Medication Forms • Nasogastric or PEG • Rectal Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4 Oral Administration • • • • • Asepsis Steps to administer: Procedure 10-1 Getting ready Preparing the medication Administering the medication Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5 Oral Administration (cont.) • Solid form • Liquids Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6 Nasogastric Administration • Appropriate patients • PEG tube • Medication forms: – Liquids – Pills: crushed, add water Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 7 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8 Rectal Administration • Getting Ready • Preparing the medication • Administering the medication • Concluding Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 9 Parenteral Medications • “Into the skin” • Routes • Reasons for parenteral administration Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10 Standard Precautions • Protect health care workers • Centers for Disease Control (CDC) • Sharps container for disposal of needles Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 11 Parenteral Administration • “Into the skin” • Routes for administration • Parenteral rationale/Advantages • Disadvantages • Costs Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 12 Basic Equipment • Syringes: Figure 10-2 • Types of syringes: Figure 10-3 • Volume of medication: mL or m Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13 Parts of a Syringe Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 14 Needles • Needles: gauge • Hub • Specialized needles • Guide for needle selection: Table 10-1 • Needleless system: Figure 10-6 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 15 Parts of the needle Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 16 Needles: Gauges Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 17 Chapter 10 Lesson 10.2 Elsevier items and derived items © 2010, 2006, 2003, 2000 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 19 Procedure for Preparing and Administering Parenteral Medications • Procedure for medication administration: Procedure 10-3 • Determine sight for administration • Use of equipment • Package • Medication characteristics Elsevier items and derived items © 2010, 2006, 2003, 2000 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 21 Vial Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 22 Ampules Elsevier items and derived items © 2010, 2006, 2003, 2000 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” Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 24 Administering Intradermal Injections • Uses • Skin anatomy and needle angle: Figure 10-12 • Bleb • Equipment and technique Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 25 Intradermal Injections Elsevier items and derived items © 2010, 2006, 2003, 2000 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 27 Subcutaneous Injections Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 28 Administering Intramuscular Medications • Location • Absorption • Equipment • Sites: Box 10-3 • Technique Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 29 Intramuscular Injections Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 30 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 31 Intravenous sites in adults Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 32 Intravenous sites in children Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 33 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 34 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 35 Percutaneous Medications • Absorption: mucous membranes or the skin • Absorption and application • Inhalation Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 36 Percutaneous Administration • Factors affecting transdermal application • Skin Condition • Methods of Administration Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 37 Procedures for Administering Percutaneous Medications • Applied to the area requiring treatment • Common Forms: Box 10-4 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 38 Administering Topical Medications • • • • • • • Clean skin before application Gloves Lotions Ointments Excess medication Dressings Patient Education – Home Care Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 39 Administering Medications to Mucous Membranes • • • • • • • • Absorption Sublingual Buccal Vaginal Ear drops: child and adult Eye Nose Respiratory Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 40