Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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small, solid dose of medication, Tablet – small, compressed or molded; may be any color, size or shape. small oval, round or oblong Lozenge/Troche – small preparation containing a drug in a flavored or sweetened base, which dissolves in the mouth & releases the medication. unit dose of medication Trans-Dermal Trans-Dermal Patch – unit applied directly to the skin for diffusion through skin & absorption into the bloodstream.
NURSING SKILLS M edication
Liquid Elixir – medication medication in a clear liquid containing water, alcohol, sweeteners & flavor. Syrup – medication medication combined in a water & sugar solution. Suspension – finely finely divided, undissolved particles in liquid liquid medium that needs needs to be shaken before use. a drug dissolved in another substance. Solution – a
Lecturer: Mark Lecturer: Mark Fredderick R. Abejo R.N, M.A.N M.A.N
MEDICATION
FUNCTIONS OF THE NURSE
Semi-Solid Ointment – semi-solid semi-solid preparation containing a drug to be applied externally. Liniment – medication medication mixed with alcohol, o il or soap, which is rubbed on skin. Lotion – drug drug particles in a solution for topical use. Suppository – easily easily melted medication preparation in a firm base such as gelatin gelatin that is inserted in the body.
Nursing Action carried out at the Dependent – Nursing instruction or order of the Ph ysician. Nursing Action carried out within the Independent – Nursing legal scope of Nursing’s of Nursing’s independent domain. domain. – Nursing Nursing action performed by the Interdependent Nurse in collaboration with with other members members of the Health Care Team. PHARMACOLOGY Study of actions of chemicals on Living Organisms. Study of drugs & the effects to the Person.
Drug Effects Primary (Therapeutic) Intended Effect of the drug.
IMPORTANT THINGS TO NOTE B EFORE ADMINISTERING DRUGS
Name of the Patient Patient Name of the Drug Generic Name – Name – the the name assigned by the manufacturer that 1 st developed the drug. Trade/Brand Name – Name – selected selected by the drug company that sells the drug & is copyrighted. Dose Route (Drug Preparation) Timing & Frequency Doctor’s Orders/Signature Date
FIVE RIGHTS The Right Drug with The Right Dose through The Right Route at The Right Time to The Right Patient
Right Recording & Documentation Documentation Right Approach Right Frequency Right to Refuse Right Education Right Assessment Right Evaluation The Right Drug Name Generic Name Trade Name
Preparation Solid powder or gel form of an active drug Capsule – powder enclosed in a gelatinous container, may also be called liquigel. Pill – Mixture Mixture of a powdered drug with a cohesive material; may be round or oval.
Foundations of Nursing Medication
Therapeutic Actions of Drugs Palliative : relieves the symptoms of a disease but does not affect the disease itself. 2. Curative : treats a disease or condition. 3. Supportive : sustain body function until other treatment of the body’s response can take over. 4. Substitutive : replaces body fluids or substances. 5. Chemotherapeutic : destroys malignant cells. 6. Restorative : returns the body to health.
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Secondary (Side-Effect) Not intended effect effect of the drug Allergy Rapidly-developing reaction. Signs & Symptoms may appear on the skin, respiratory system or the GIT. Anaphylactic life-threatening Anaphylactic Reaction – life-threatening reaction that may result in respiratory distress, severe bronchospasm, tachycardia, hypotension & cardiovascular collapse. May be treated by epinephrine, bronchodilators & antihistamines. antihistamines. Symptoms & signs of allergy to dru gs: Fever Diarrhea – Diarrhea – GIT GIT Urticaria – Urticaria – Local Local Effect Rash – Local Local Effect Nausea – Nausea – GIT GIT Vomiting – Vomiting – GIT GIT Toxicity Overdose – Overdose – taking taking in a lethal dose of medication. Cumulative Effect The body cannot metabolize one dose of the drug before another dose is ad ministered. The drug is taken in more frequently than it is excreted & each new dose increases the total quantity in the body. May cause permanent damage to the kidneys or liver.
Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Iatrogenic Effect The drug produces a disease condition. Examples: Chloramphenicol, which is taken for Typhoid Fever, may cause Depression of the Bon e Marrow functions, such as Anemia, Thrombocytopenia, Neutropenia, Idiosyncratic Effect It is the unexpected peculiar response to drug, either over response, under response, different response than expected. Unexplained response Drug Interaction Effects of one drug are modified by the prior on concurrent administration of another drug. Thereby increasing or decreasing the pharmacological effect. Drug Antagonism Conjoint effect of two drug is less than the effect of drug acting separately Drug Summation The combined effect of two drugs produ ces a result equals the sum of the individual effects of each agent. Drug Synergism The combined effects of drugs is greater than the sum of each individual agent acting independently Drug Potentiation The concurrent administration of two drugs in which one drug increases the effect of the other dru g.
Dr ug Tolerance
A decreased physiologic response to the repeated administration of a drug or chemically related substance. Excessive increase in the dosage is required in order to maintain the desired therapeutic effect.
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DRUG PREPARATIONS
1. Oral (Capsule, Pills, Tablets, Extended Release, Elixir, Suspension, Syrup. ) 2. Topical . Drug is applied directly to the bod y site, usually, the skin or mucous membranes. ( Liniment, Lotions, Ointment, Suppository, Transdermal Patch.) 3. Injectable. Introduction of medication into the body b y a syringe. ( Vials, Ampules, Pre-Filled Syringes. )
DRUG CLASSIFICATIONS
1. Body Systems - Drugs that affect the bodily systems, such as the Digestive System, Cardiovascular System, etc. 2. Symptoms Relieved - Ex: Fever, Colds, Cough, etc. 3. Clinical Indication of the Drug - Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive.
PHARMACOKINETICS - Study of the movement of drug molecules in the body.
Absorption.
The process by which a drug is transferred from its site of entry into the body to the bloodstream. Factors That Affect Drug Absorption
Route of Administration. Injected medications are usually absorbed more rapidly than oral medications
Dr ug Abu se
Inappropriate intake of a substance, either continually or periodically.
Drug Solubility. Liquid medications are absorbed more rapidly than solid preparations, as liquid medications do not have to be dissolved by the gastric juices.
Dr ug D ependence
It is person’s reliance or a need to take a drug or substance. Intense physical or emotional disturbance is produced if drug is withdrawn.
Dru g Addiction
It is due to biochemical changes in the body tissues, especially the nervous system. These tissues come to require the substance from normal functioning.
Local Conditions at the Site of Administration. The more extensive the absorbin g surface, the greater the absorption of the drug, thus, a more rapid effect will occur. Food in the stomach can delay the absorption of some medications or enhance the rate of absorption of other drugs.
Drug Dosage. A higher dose than the no rmal is usually given when a patient is in acute distress and the maximum therapeutic effect is desired as quickly as possible. A maintenance dose is a lower dosage that becomes the usual or daily dosage
Serum Drug Levels. After a drug has been absorbed, its serum level can be monitored by drawing blood and measuring the drug’s peak & trough levels.
Blood Flow. Rich blood supply enhances absorption.
Pain Stress
Dru g Habituation
It is the emotional reliance on a drug to maintain a sense of well being, accompanied by feelings of need or cravings for drug.
DRUG NOMENCLATURE
Chemical Name : Precise description of the drug’s chemical composition. Generic Name : The name assigned by the manufacturer that first develops the drug. Often derived from the Chemical Name. Official Name : The name by which the drug is identified in the official publication. Trade Name : Also referred to as the Brand Name or Proprietary Name. Selected by the drug company that sells the drug & is copyrighted. A drug can have several Trade Names but the same Generic Name.
Foundations of Nursing Medication
pH. Acidic drugs are well absorbed in the stomach. Basic drugs remain ionized or insoluble in an acid environment. They can only be dissolved in the Small Intestines.
Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
3 Antagonist, drug will attempt to attach but because
attachment is uneven, there is no drug response.
Metabolism Also called Biotransformation. The breakdown of the drug to an inactive form. The liver is the primary site for drug metabolism. Physiologic changes or presence of a Liver disease may complicate the process. Factors That Affect Drug Metabolism
Age Nutrition Liver enzymes involved in metabolism rely on adequate amount of amino acids, lipids, vitamins and carbohydrates. Insufficient amount of major body hormones
Distribution After a drug has been absorbed into the bloodstream, it is distributed throughout the body. Drug accumulates in specific tissues for its action to take place. Distribution depends on the rate of perfusion and capillary permeability to the drug. Excretion
After the drug is broken down to an inactive form, excretion of the drug from the body occurs. The Kidneys excrete most of the drugs. ( most important route of excretion ) The Lungs excrete gaseous substances such as inhaled anesthesia. Many drugs are also excreted through the intestines.
Factors That Affect Drug Excretion
Factors That Affect Drug Distribution
Plasma-Protein Binding Medications connect with plasma protein in the vascular system. Clients with reduced plasma protein such as kidney or liver disease could receive a heightened dru g effect. Volume Distribution Client with edema has an enlarged area in which a drug can be distributed and may need an increased dose. Barriers to Drug Distribution Blood Brain Barrier Placental Barrier Obesity Receptor Combination A receptor is an area on the cell wall ( pro tein or nucleic acid ) where drug attaches and response takes place. Agonist, drug will connect itself to the receptor site and cause pharmacological response.
Foundations of Nursing Medication
Renal Excretion Carried out by glomerular filtration and tubular secretion, which increases quantity of drug excreted. Drugs Probenecid, prevent the excretion of penicillin. Antacid, prevent elimination of ASA Blood Concentration Level Half-Life
VARIABLES INFLUENCING THE EFFECT OF A MEDICATION
1. Developmental Considerations During pregnancy, most medications are contraindicated due to its possible adverse effects on the fetus. Certain drugs have a Teratogenic Effect, which are known to have a po tential to cause developmental defects in the embryo or fetus. Breastfed infants are also at a risk for adverse effects from the drugs in the mother’s body.
Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Children are given smaller doses o f medication because the immaturity of their organs are responsive to the medication. Older Adults are also responsive to medication because their bodies have experienced physiologic changes associated with the aging pro cess. Small body size, reduced weight & reduced body water also alter distribution. Drugs are excreted more slowly from the body as a result of changes in kidney functions of Older people. 2. Weight Expected responses to drugs are based largely on tho se reactions that occur when the drugs are given th ealthy adults (18-65 years old, 150 lb.) Drug doses for children are calculated by weight or Body Surface Area.
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In certain circumstances (emergencies), a verbal order from physician may be given to RN or pharmacist Unless specific orders to the contrary are written, all drugs that may have been ordered while at home are d iscontinued Explain to patient and family how the patient’s drug plan is to be implemented In some inpatient facilities, patients keep medications at bedside and learn or continue to administer as they would at home Promotes patient’s independence Nurse should be aware when patients are allowed to do this Notation should be made on patient’s care plan When patient has had surgery or is transferred to another clinical service or another health agency, it is general practice that all orders related to drugs are discontinued and new ones written Check that all medications are appropriately reordered
3. Sex
The difference in the distribution of body fat & fluids in men & women is a minor factor affecting the action of some drugs.
4. Genetic & Cultural Factors Asian patients may require smaller doses of a drug because they metabolize it at a slower rate. African Americans appear to require larger doses of some medications that are used to lower blood pressure. Herbal treatments that are popular in some cultures may interfere with or counteract the action of prescribed medication. 5. Psychological Factors The patient’s expectations of the medication affects the response to the medication. Placebo is a pharmacologically inactive substance. Some patients appear to have the same response with the placebo as with an active drug.
TYPES OF MEDICATION ORDERS
1. Standard Order Carried out until cancelled by another order. The Physician specifies that a certain order is to be carried out for a stated number of days or times. Once the stated period has passed, the order is cancelled automatically. 2. PRN Order As needed, or only when n ecessary. Commonly written for post-operative pain medication. 3. Stat Order Carried out immediately and for one time only. 4. Single Order The medication is only ordered once, at a time specified by the Ph ysician. 5. Self-Terminating
6. Pathology The presence of a disease may affect the drug action. Pathologic conditions that involve the Liver may slow themetabolism & alter the dosage of the drug needed to reach a therapeutic level. 7. Environment Sensory deprivation and overload may affect drug responses. Nutritional state may also affect the body’s reaction to certain drugs.
PARTS OF A MEDICATION ORDER
1. Patient’s Name 2. Date & Time when the Order was written. 3. Name of the Drug to be administered. 4. Dosage of the Drug 5. Route by which the Drug is to be administered. 6. Frequency of administration of the Drug. 7. Signature of the Person/Physician writing the Order.
8. Timing of Administration The presence of food in the stomach delays the absorption of orally administered medications.
TRANSCRIPTION OF MEDICATION ORDERS Kardex Medication Sheet or Medication Administration Record Medication Card
MEDICATION ORDERS
Questioning Medication Order
No medication may be given to a patient without a medication order from a physician or, in some states, a nurse practitioner Orders are written on a form d esigned specifically for a physician’s order, which becomes a permanent part of the patient’s record Many facilities use a computer-generated pharmacy order system and can receive a medication order by fax fro m the physician Physician enters drug order into computer, computer sends order directly to pharmacy and enters order into patient’s permanent record Prevent any guessing when handwriting is illegible or drug names are similar Provides physicians with recommended doses of medication, indicates laboratory tests that monitor action of drug, and lists potential interactions that may occur.
Foundations of Nursing Medication
Any drug order suspected to be in error should be questioned Suspected error should be noted and reported On occasion, nurse may not think there is an error but may not understand why medication has been prescribed Ask how order relates to patient’s care plan May prevent medication error if wrong med has been ordered Confusion over placement of decimal point can be prevented by always having a zero precede the decimal for clarity (no need for zero after decimal – can cause confusion if decimal is unclear or missed completely) Drug to which patient is allergic may inadvertently be prescribed Notation should be made in patient’s record of p ast adverse reactions Do not administer and question when, in n urse’s judgment, patient is allergic Patient may wear wristband indicating specific allergies Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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Drug may be ordered that would potentially interact with another med patient is taking All unfamiliar meds should be verified before administering Guessing is a gross carelessness action – checking with person that wrote the order is the only safe procedure Nurses have the right to refuse to administer any medication that, based on their knowledge and experience, may be harmful to patient Must notify physician of refusal
Cari ng for Contr oll ed Substances Safely
Controlled substances are kept in a locked drawer or container as a safety measure Narcotics or controlled substances may be ordered only by physician (sometimes, nurse p ractitioners registered with Dept. of Justice) Record must be kept for each narcotic administered Forms are kept with narcotics Information required: receiving patient’s name hour narcotic was given name of physician prescribing narcotic name of nurse administering narcotic Narcotics are checked daily Amount on hand is counted and each dose used must be accounted for on the narcotic record Nurse has a secure i.d. code that provides access into the system, Identifies patient by name or i.d. number, and verifies count for each drug as it is removed Count that does not check properly must be reported immediately If for any reason a narcotic prepared for administration has to be discarded, a 2 nd nurse should act as witness, and that person should also sign the narcotic sheet also document with a witness any time a full dosage is not given and some of the narcotic needs to be disposed of
PREPARATION AND ADMINISTRATION OF DRUGS Definition : GENERAL INSTRUCTIONS:
Drug or medicine is a chemical agent which acts to maintain, improve and restore physiologic processes of the body. Purposes in general: To maintain and promote health To restore physiologic processes To aid in diagnosis To provide palliative effect To supply substances which is deficient. (Ex. Insulin) To help prevent disease Assessment for all medications administration: Client’s diagnosis Client’s medication Client’s allergies to medication Specific drug action S/S of side effects or adverse reaction Client’s age & developmental stage Problems in self-administering a medication (e.g. poor eyesight, unsteady hands) Client’s ability to cooperate during administration Client’s knowledge of & learning needs about medication
Foundations of Nursing Medication
Be sure doctors order is complete & well understood before carrying it out. Know the client’s condition & all other factors related to the proper use of the drug. Be alert for signs of allergy & idiosyncrasy manifested by the client. Know the purpose & therapeutic effect of each drug ordered. Be familiar with standard abbreviations & symbols commonly used. Verbal orders are accepted in extreme emergencies. Observe the ―RIGHTS‖ in giving medications. Always clarify doubtful /unclear order before executing i t Verify if drug is to be delayed or omitted for specific period of time Do not leave medicine with the client to take by himself Do not give drug that shows physical c hanges or deterioration Report an error in medication immediately to the nurse in charge. The nurse who prepares the medication must be responsible for administering and recording it. Never endorse it to another nurse. Always observe asepsis in preparing and administering drugs. Always use the corresponding medication card for ea ch drug prepared and administered.
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Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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ROUTES FOR ADMINISTERING DRUGS A. ORAL ROUTE – having the Patient Swallow the medication
Advantages Most convenient Usually less expensive Safe, does not break skin barrier Administration usually does not cause stress
Disadvantages Inappropriate for client with N & V Drugs may have unpleasant taste and odor Inappropriate when GIT has reduced motility. Inappropriate if client cannot swallow. Cannot used before certain diagnostic test or surgical procedure May discolor teeth, harm tooth enamel. May irritate gastric mucosa. Can possible aspirated.
Dru g Forms for Oral Administration:
Solid: tablet, capsule, caplet, lozenges, pill, powder Liquid : syrup, suspension, emulsion, elixir, milk or other alkaline substances. Enteric coated tablets should not be crush before administration. Other forms of oral medication that should not be chewed or crushed: SR – Sustained Release XL – Extended Release CR/CRT – Controlled Release SA – Sustained Action o LA – Long Acting Do not administer enteric – coated with antacids, milk or another alkaline substance Suspension are never administered through IV If patient vomits within 20 – 30 minutes of taking the drug, notify the physician. Do not re-administer the drug without doctor’s orders.
Administration of Oral Medication Definition: Oral Medication is the administration of drugs by mouth for systemic effect. It may be in the form of pills, tablets, capsules and liquid. Objectives To prepare & administer the most common, least expensive route of administering medication safely To provide a sustained drug action and in creased absorption without feelings of nausea and vomiting. Equipments: Medication tray with medication Medicine card Mortar and pestle for crushing pill Water, juice or milk (if not contraindicated by drug absorption)
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PROCEDURE Check medicine cards with physician’s order sheet or client’s chart for written orders or any changes in the order. Arrange the medicine cards in the medication tray according to the following: Location of the client o Time of administration o Condition of client (more o
Foundations of Nursing Medication
RATIONALE
Counter checking prevents error in medication
Systemic way will facilitate lesser error and minimize time involved in
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serious clients are scheduled last) Wash your hands
Gather necessary equipment. Make sure medicine glasses are clean and dry. Check medication 3 times before taking to the client: When taking the medication o from the storage area Before placing medication o into the medicine rack/glass Before placing medicine to the o storage area Place medication in each separate container with the corresponding card behind each medicine glass.
Observe the 5 Rights in administering medications: Right client o Right drug o Right dose o Right time o Right route o 8. Correctly calculate dose if necessary 9. Set the medicine glass at eye level when pouring 10. Ascertain client’s identity before administering medications. Check room or bed or card, call out client’s name, check I.D., wrist band 11. Give medications one at time. Give liquid medications and cough syrup last
medications. Handwashing removes microorganisms that can cause infection.
Rechecking can lead to accuracy in medication
Mixing liquid medicine can reduce concentration and strength of the drug.
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Liquid and cough syrup does not need water follow up
12. Elevate client’s head to prevent aspiration.
The client might forget or might ignore taking the medicines
13. Remain with the client until all medications have been swallowed. Never leave any medications at client’s side, for client to take as he pleases 14. File medicine card on the card rack. 15. Wash hands
The client might forget or might ignore taking the medicines
Prevents spread of infection
16. Record all medications given right after administration. 17. Check client 30 min to 1 hou r later for effects of medication.
B. SUBLINGUAL ROUTE – drugs that is placed under the tongue, where it dissolves. C. BUCCAL ROUTE – a medication is held in the mouth against the mucous membranes of the cheek until the drugs dissolves
Advantages Sublingual / Buccal Most convenient Usually less expensive Safe, does not break skin barrier Administration usually does not cause stress Can be administered for local effect
Disadvantages Sublingual / Buccal Inappropriate for client with N & V Drugs may have unpleasant taste and odor If swallowed, drug may be inactivated by gastric juice. Drug must remain under Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Drugs is rapidly absorbed into the bloodstream. Ensures greater potency because drug directly enters the blood and bypass the liver
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the tongue until dissolved and absorbed.
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D. TOPICAL ROUTE – Inserting or rubbing drug onto the Skin or Mucous Membrane. a) Dermatologic ( includes lotions, liniments,
ointments, pastes and powders ) Wash and pat dry area well before application to facilitate absorption of drugs. Use surgical asepsis when open wound is p resent. If the skin has lesions, wear gloves or use tongue depressor to apply medications. Apply only a thin layer of medication
b) Ophthalmi c / Eye M edication
Objectives To provide an eye medication the client requires to treat an infection or other reason. Considerations The eye is the most sensitive organ to which the nu rse applies medications. Care must be taken to prevent instilling medication directly into cornea. Instilling wrong concentration may cause local irritation of the eyes as well as systemic effects Equipment Medication bottle with eye dropper or ointment tube Cotton ball or tissue Eye patch or tape (optional)
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PROCEDURE Check medicine cards with physician’s order sheet or client’s chart for written orders or any changes in the order. Arrange the medicine cards in the medication tray according to the following: a. Location of the client b. Time of administration c. Condition of client (more serious clients are scheduled last) Wash your hands
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Gather necessary equipment. Check medication 3 times before
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Foundations of Nursing Medication
RATIONALE
Counter checking prevents error in medication
Rechecking can lead to accuracy in medication
Provide easy access to eye and minimizes drainage of medication through the tear duct.
10. Clean the eyelid /lashes if necessary using a cotton soak in sterile saline. Wiping from inner to outer canthus, one cotton for each eyes.
Eye Drops 11. Squeeze prescribed dose in the eyedropper 12. Place a tissue below the lower lid
13. Hold eyedropper one-half to threefourth inch above eyeball with dominant hand
Administration of Eye M edication
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taking to the client: When taking the medication o from the storage area Before placing medication o into the medicine rack/glass Before placing medicine to the o storage area Place medication in each separate container with the corresponding card behind each medicine glass. Observe the 5 Rights in administering medications: Right client o Right drug o Right dose o Right time o Right route o Correctly calculate dose if necessary Place client in supine position or sit back in chair with head slightly hyperextended
14. Gently press downward with thumb or forefinger against bony orbit. Exposes lower conjunctival sac by pulling down on cheek.
15. While client looks up, drop prescribed dose into center of the conjunctival sac.
16. While client closes and move eyes, place finger on either side of the nasolacrimal duct for 1 minute.
Ensure correct dosage Cotton or tissue absorbs medication that escapes eye Helps prevent accidental contact of dropper with eye, thus reducing risk of injury and transfer of infection. Prevents pressure and trauma to eyeball and prevents fingers from touching eye. Prevent damage directly to the cornea. Reduces stimulation of blink reflex Prevents overflow of medication into nasal passage and possible systemic effect.
Systemic way will facilitate lesser error and minimize time involved in medications. Handwashing removes microorganisms that can cause infection.
Abejo
Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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Eye Ointment 17. Separate client’s eyelids and grasp lower lid, exert downward pressure over the cheek. 18. Instruct patient to look up 19. Apply ointment along insidebedge of the lower eyelid from inner to outer canthus. 20. Wipe excess medication
2. Distributes medication without traumatizing eye Promtes comfort and facilitate cleanliness 3.
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Place client in comfortable position Wash hands Assess for possible drug reaction Documentation
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Eye Irrigation
Have patient sit or lie with head tilted toward side of affected eye Clean from inner toward outer canthus to prevent debris entering lacrimal ducts Expose lower conjunctival sac, hold irrigator about 2.5 cm (1‖) from eye, direct flow from inner to outer canthus Irrigate until solution is clear or all of the solution has been used Use only enough force to remove secretions gently Avoid touching any part of eye Dry area with cotton balls or gauze sponge Chart irrigation, appearance of eye, d rainage, and patient’s response
c) Otic ( Ear ) M edication
Includes instillations and irrigations Instillations: To soften earwax To reduce inflammation To treat infection To relive pain Irrigations: To remove cerumen or pus To apply heat To remove a foreign body or object
Administration of Ear M edication Objectives To soften earwax so that it can be readily removed at a later time To provide local therapy to reduce inflammation, destroy infective organism. To relieve pain
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PROCEDURE Check medicine cards with physician’s order sheet or client’s chart for written orders or any changes in the order. Arrange the medicine cards in the medication tray according to the following: a. Location of the client b. Time of administration c. Condition of client (more serious clients are scheduled last) Wash your hands
Gather necessary equipment. Check medication 3 times before taking to the client: When taking the medication o from the storage area Before placing medication o into the medicine rack/glass Before placing medicine to the o storage area Observe the 5 Rights in administering medications: Right client o Right drug o Right dose o Right time o Right route o Warm medication by running warm water over the bottle.
Correctly calculate dose if necessary 9. Place the client in side- lying position with the affected ear facing up. The nurse should stabilize the client’s head with his or her hand. 10. Fill medication dropper with prescribed amount of medication. 11. Prepare client for instillation as follows: Infants: draw the auricle gently downward and backward. Adults / Children : lift pinna upward and backward 12. Instill the medicine into the ear canal holding the dropper 1 cm above ear canal
RATIONALE
Counter checking prevents error in medication
Systemic way will facilitate lesser error and minimize time involved in medications. Handwashing removes microorganisms that can cause infection.
Rechecking can lead to accuracy in medication
Prevents nausea and vertigo that may occur if the medication is too cold
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13. Ask the client to maintain the position for 2-5 minutes. Apply gentle massage or pressure to tragus of ear with finger. 14. 15. 16. 17.
Provide easy access to ear for instillation of medicine. Stabilizing the head promotes safety.
Straightening of ear canal provides direct access to deeper external ear structures. Forceful instillation of medicine into occluded canal can cause injury to eardrum. Allows complete distribution of medication. Pressure and massage moves medication inward.
Place client in comfortable position Wash hands Assess for possible drug reaction Documentation
Equipment
Medication bottle with dropper Cotton tipped applicator Cotton ball
Foundations of Nursing Medication
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Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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A.
Nasal Sprays
Gently insert the bottle tip into one nostril as shown in drawing A. Keep head upright. Sniff deeply while squeezing the bottle. Repeat with other nostril. Tilt your head (or have the patient tilt his or her head) to the side as shown in drawing A. Or lie down with the affected ear up as shown in drawing B. Guidelines for Removing Excessive/ Impacted Cerumen
Place 5 to 10 drops of the cerumen-softening solution into the ear canal, and allow it to remain for at least 15 minutes. Prepare a warm (not hot) solution of plain water or other solution as directed by your doctor. Eight o unces of solution should be sufficient to clean out the ear canal. To catch the returning solution, hold a container under the ear being cleaned. An emesis basin is ideal because it fits the contour of the neck. Tilt the head down slightly on the side where the ear is being cleaned. Gently pull the earlobe down and back to expose the ear canal as shown in drawing A. Place the open end of the syringe into the ear canal with the tip pointed slightly upward toward the side of the ear canal, as shown in the drawing. Do not aim the syringe into the back of the ear canal. Make sure the syringe does not obstruct the outflow of solution. Squeeze the bulb gently — not forcefully — to introduce the solution into the ear canal and to avoid rup turing the eardrum. (Note: Only health professionals trained in aural hygiene should use forced water sprays [e.g., Water Pik] to remove cerumen.) Do not let the returning solution come into contact with the eyes. If pain or dizziness occurs, remove the syringe and d o not resume irrigation until a doctor is consulted. Make sure all water is drained from the ear to avoid predisposing to infection from water-clogged ears. Rinse the syringe thoroughly before and after each use, and let it dry. Store the syringe in a cool, dry p lace (preferably, in its original container) away from hot surfaces and sharp instruments. Do this procedure twice daily for no longer than 4 consecutive days.
B.
Pump Nasal Sprays
Prime the pump before using the first time. Hold the bottle with the nozzle between the first two fingers and thumb on the bottom of the bo ttle. Tilt the head forward. Gently insert the nozzle tip into one nostril as shown in drawing B. Sniff deeply while depressing the pump once. Repeat with other nostril. C.
Nasal Inhalers
Warm the inhaler in hand just before use. Gently insert the inhaler tip into one nostril as shown in drawing C. Sniff deeply while inhaling. Repeat with other nostril. Wipe the inhaler after each use. Make sure the cap is tightly in place between uses. Discard after 2-3 months even if the inhaler still smells medicinal.
If broncholilator, administer a max. of 2 puffs for at least 30 second interval. D.
Nasal Drops
Squeeze the bulb to withdraw medication from the bottle. Lie on bed with head tilted back over the side of the bed as shown in drawing D. Place the recommended number of drops into one no stril. Gently tilt head from side to side. Repeat with other nostril. Lie on bed for a couple o f minutes after placing drops in the nose.
d) Nasal M edication
Nasal instillation ( nose drops ) usually are instilled for their astringent effect .
Administration of Nasal Medication Objectives To shrink swollen mucous membrane To loosen secretions and facilitate drainage. To treat infections of the nasal cavity or sinuses.
e) Vaginal Medication
Drug Forms: tablet, cream , jelly, foam, suppository Vaginal Irrigation ( Douche ) : is the washing of vagina by a liquid.
Equipment
Do not rinse the dropper.
Medication bottle with dropper or spray container Facial tissue
Foundations of Nursing Medication
Empty the bladder before the procedure Position and drape the client. Instillation : back lying position with knees flexed and hips rotated laterally. Irrigation : back lying position with the hips higher than the shoulder ( use bedpan )
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Nursing Skills Medication Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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Guidelines for Applying Vaginal Antifungal Products
Administration of Rectal Suppository
Start treatment at night before going to bed. Lying down will reduce leakage of the product from the vagina. Wash the entire vaginal area with mild soap and water, and dry completely before applying the product. Vaginal cream: (If prefilled applicators are being used, skip to step 4.) Unscrew the cap; place the cap upside do wn on the end of the tube. Push down firmly until the seal is broken. Attach the applicator to the tube by turning the applicator clockwise. Squeeze the tube from the bottom to force the cream into the applicator. Squeeze until the inside piece of the applicator is pushed out as far as possible and the applicator is completely filled with cream. Remove the applicator from the tube. Vaginal tablets/suppositories: Remove the wrapper and place the product into the end of the applicator barrel. While standing with your feet slightly apart and your knees bent, as shown in drawing A, or while lying on your back with your knees bent, as shown in drawing B, gently insertthe applicator into the vagina as far as it will go comfortably.
Gently squeeze the suppository to determine if it is firm enough to insert. Chill a soft suppository by p lacing it in the refrigerator for a few minutes or by running it under cool running water. Remove the suppository from its wrapping. Dip the suppository for a few secon ds in lukewarm water to soften the exterior. Lie on your left side with knees bent or in the knee-to-chest position (see drawings A and B). Position A is best for selfadministration of a suppository. Small children can be held in a crawling position.
Push the inside piece of the applicator in and p lace the cream as far back in the vagina as po ssible. To deposit vaginal tablets/suppositories, insert the applicator into the vagina and press the plunger until it stops. Remove the applicator from the vagina. After use, recap the tube (if using cream). Then clean the applicator by pulling the two pieces apart and washing them with soap and warm water. If desired, wear a sanitary pad to absorb leakage of the vaginal antifungal. Do not use a tampon to absorb leakage. Continue using the product for the length of time specified in the product instructions. Use the product every day without skipping any days, even during menstrual flow.
f)
Rectal M edication
Drugs administered rectally exert either a local or systemic effect on the gastrointestinal mucosa.
Considerations Rectal medication is a convenient and safe method of giving certain medications but not as reliable as oral or parenteral routes in terms of drug absorption and distribution. Improper placement can result in expulsion of the suppository before medication dissolves and is absorbed into the mucosa. Never force a suppository into a mass of fecal material. It may be necessary to administer a small cleansing enema before a suppository can be inserted. Do not cut the suppository into sections to divide the dosage, the active drug may not be distribute evenly within the suppository.
Foundations of Nursing Medication
Relax the buttock just before inserting the suppository to ease insertion. Gently insert the tapered end of the suppository high into the rectum. If the suppo sitory slips out, it was not inserted past the anal sphincter (the muscle that keeps the rectum closed). 4‖ – adults, 2‖ – children and infants) Continue to lie down for a few minutes and hold the buttocks together to allow the suppository to dissolve in the rectum. The parent/caregiver may have to gently hold a child’s buttocks closed. Remember that the medication is most effective when the bowel is empty. Try to avoid a bowel movement after insertion of the suppository for 30 minutes up to 1 hour so that the intended action can occur.
E.
ENTERAL TUBE ROUTE – administration of medicine via nasogastric tube.
ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING TUBE
Use liquid meds or meds that can be crushed and combined with liquid Bring liquid med to room temp Remove clamp from tube, checking for tube placement before administering drug Flush tube with 15 – 30 mL water (5 – 10 mL for children) before giving meds and immediately after Give meds separately and flush with water between each drug Disconnected from suction and clamped 20 – 30 minutes after administration Disconnect continuous tube feeding, leaving tube clamped for short period of time Document water intake and liquid med on I & O chart
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