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Medication Administration. Automated Medication Administration Equipment. Pyxis SureMed MedServe. Essential Components of a Medication Order. Client’s Name Medical Record Number, Room/Bed # Date & time of order Name of Medication Dosage of Medication Route Frequency of administration

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Essential Components of a Medication Order

  • Client’s Name

  • Medical Record Number, Room/Bed #

  • Date & time of order

  • Name of Medication

  • Dosage of Medication

  • Route

  • Frequency of administration

  • MD’s signature


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Six “Rights” of Medication Administration

  • Right Patient (check name band, ask client their name)

  • Right Medication

  • Right Dose

  • Right Route

  • Right Time (frequency)

  • Right Documentation

    * Client’s also have the right to refuse (say no) to medication


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The Nurse’s Responsibility for Medication Administration

  • Assess whether the client can tolerate the meds

  • Administer meds accurately & timely

  • Monitor for side-effects

  • Know contraindications

  • Client teaching

  • Practice the “Six Rights”(stressed in clinical)

  • Evaluation (effectiveness & client response)


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Types of Oral Medications

  • Tablets

  • Capsules

  • Sublingual

  • Buccal

  • Elixirs

  • Enteric Coated



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Rectal Medications

  • Provide for privacy

  • Explain procedure to client

  • Place client in Sim’s position

  • Apply clean gloves

  • Lubricate tip, round end inserted first

  • Encourage client to relax , deep breathe

  • Insert past sphincter, towards umbilicus

  • Have client remain on side at least five mins. (hold buttocks together etc.)



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Ophthalmic Medications

  • Place HOB down or low Fowler’s

  • Provide Kleenex for client

  • Have client look towards ceiling

  • Instill meds in conjunctiva (if gtts)

  • If ointment, apply ribbon from inner to outer canthus

  • Know od, os, ou routes


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Topical & Inhalation Medications

  • Ointments (absorbed via mucous membranes, skin)

  • Inserted (vaginal)

  • Instilled (ear/nose gtts)

  • Lotions

  • Sprays (nasal)

  • Pastes (absorbed through skin)

  • Inhalation (nebulized treatments, MDI)





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Medications via NGT/EFT

  • Determine whether med comes in elixir form

  • Crush all except for EC meds and mix with water or other liquid medications

  • Stop feedings, clamp tube, apply syringe, unclamp tube, flush tube with approx. 30cc water

  • Clamp tube, remove syringe, pull plunger from barrel, reattach barrel, pour meds through barrel

  • Add water as necessary to keep things flowing smoothly

  • After all meds have been given, flush with 30cc water, clamp tube, remove syringe, start feedings


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Documentation

Always record:

  • Date, time & your initials or signature, title (R. Otten, SN,CSUF )

  • Medication, route (site) and actual time given

  • Reason why med was omitted (ie. refused)

  • Client’s response to the medication



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Nursing Considerations for Injection Sites

  • Assess for adequate tissue & muscle availability/client body wt.

  • Assess where previous injections have been administered

  • Assess client restrictions

  • Assess for quantity & quality of medication to be administered


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Parts of a Needle & Syringe

Syringe:

  • Barrel

  • Plunger

  • Tip

    Needle:

  • Bevel

  • Shaft

  • Hub



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Tips of Syringes

Luer-Lok

Non Luer-Lok







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Three Types of Injections

  • Intradermal

    - Injected into dermal skin layers (Allergy tests, PPDs, etc.)

  • Subcutaneous

    - Injected into subcutaneous tissues (Heparin, Insulin)

  • Intramuscular

    - Injected into deep muscles

    (narcotic analgesics, iron)


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Intradermal Injections

  • Given in small doses (i.e.. 0.1cc)

  • Common sites include: RFA, LFA

  • Use 1cc syringe with 26-27 gauge needle, 1/4 - 5/8 inch long

  • Administer with needle at 5-15 degree angle with bevel of needle up

  • Check for “bleb” or “wheal”

  • Document site in medication book/nurses’ notes



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Subcutaneous Injections

  • Given in doses of 0.5cc - 1.5 cc

  • Common sites include: deltoid, abdomen

  • Deltoid landmarks: Find Acromium Process and go 4 to 6 finger-lengths below

  • Rotate sites to minimize tissue damage

  • Use Insulin/TB syringe for these meds

  • For other SQ meds use 1-3 cc syringe,

    25-27 gauge needle, 3/8-5/8 inch length

  • Insert needle 45-90 degrees



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Vastus Lateralis Injections

  • Site well-developed in both adults & children, lacks major blood vessels/nerves

  • Landmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect).

  • Good for clients with position restrictions




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Dorsogluteal Injections

  • Rarely used due to Sciatic nerve risk

  • Less accessible than other sites (i.e. requires side-lying or turned further)

  • Landmark: Find Greater Trochanter & Iliac Crest, draw quadrants and administer in upper two quadrants




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Ventrogluteal

  • Good for deep injections

  • Away from blood vessels and nerves

  • Z-track

  • Thick, viscous meds

  • Antibiotics

  • Large volume

  • Irritating


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What if……

when giving an IM injection, the aspirate comes back with blood.

  • What is the correct procedure and why?


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Preparing NPH & Regular Insulin

  • Swab tops of both vials

  • Inject desired units of air into NPH vial, remove needle and then inject desired units of air into Regular vial

  • Invert Regular vial and withdraw desired units of insulin (no bubbles)

  • Insert needle into NPH vial, invert and withdraw desired units of insulin



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Mixing Insulins

NPH

Insulin

Regular Insulin


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Remember !!!

If an IM injection requires the administration of > 3cc of medication, divide the medication up into two equal doses and administer in different sites.


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Remember !!!

Always double-check Insulin & Heparin amounts/doses with another licensed person

(RN/LVN/INSTRUCTOR)