What are the Rights of med admin (patient’s and nurse’s RIGHTS)?
Nurses’ Rights:
1. Complete & Clearly written order
2. Correct medication & dose dispensed!
3. Accurate information on medications
4. Relevant policy to guide practice
Patients’ Rights:
1. To be EDUCATED on medications
2. To REFUSE
3. To have QUALIFIED HCP access meds Hx
4. To be properly advised on medications
5. To receive meds SAFELY
6. To NOT receive unnecessary meds
7. To be informed if meds are part of RESEARCH STUDY
8. To receive appropriate, supportive THERAPY
What are the 5 Patients’ Rights? (5+5)
- Right patient
- Right medications
- Right dose
- Right site
- Right time
- Right assessment
- Right documentation
- Right to refuse
- Right education
- Right evaluation
What are the Enteral (Oral) route?
Enteral (Oral/PO) – Enter the Digestive Tract
1. Liquid vs solid
2. DON’T CRUSH Extended release, Controlled release, and Enteric-coated!!!
3. Less costly
4. More convenient
5. Safer
6. Typically takes longer to start working
7. When to AVOID:
1. Experiencing nausea or vomiting
2. Have decreased GI Motility
3. Can’t swallow
What are the Nasogastric & Gastronomy tubes route?
- Check placement. HOW?
- X-RAY!!!
- Aspirate/pull back and see if you see stomach-looking contents or if it has an acidic pH
- Push air bolus and listen over the stomach to see if you hear griggle! - Put patient’s HOB on SEMI-FOLWER’s position or 30 degrees!!!!!!
- Prevent clogging by:
- Crushing pills or give liquid
- Flush before & after with 20-45 mL of WATER!!
- IF CLOGGED, reinsert or use ENZYMES!!
What are the TOPICAL route? What should you do when administering topical medications?
TOPICAL (Applied to SKIN or Mucus membrane)
1. Transdermal – patches
2. Ophthalmic – eyes
3. Otic – ears
4. Nasal – nose
5. Intravaginal – vagina
6. Rectal – rectum
- Remove old patch before putting new on
- WEAR GLOVESSS!! Avoid Contact with the meds bc the effect could effect you too!
What are the Parenteral route?
Parenteral – Bypass the Digestive Tract!!
- Works instantly
- Intradermal – under the skin (like TB test)
- Intramuscular
- SubQ
- Intravenous
What are the 2 oral absorption route?
Oral Absorption– ABSORBS DIRRECTLY into the mucous membrane SO DON’T CHEW/crush them; just let them dissolve!!!
- Sublingual –> under the tongue!!!!
- Buccal –> btwn. gums and cheeks!!
(Bypass the first pass effect of the liver duhhh)
What do you need to know about Ophthalmic Administration???????
- Don’t let the tip touch the eyes or skin
- Open the lower eyelid, drop it to the sac, and press on the tear duct with a tissue
- WAIT 3-5 MINUTES BETWEEN EACH DROP!!!!!!
What do you need to know about Otic (ear drops) Administration???????
- AdUlt & Children over age of 3: pull UP & back
- ChilDren under 3: pull Down & back
What do you need to know about rectal med Administration???????
- Don’t overhandle them because IT CAN DISENTIGRATE
- Wear GLOVES!
- Use lubricant to pass thru the INTERNAL SPHINCTER!!!!
- DON’T ALLOW TO SOFTEN!!!!!!!!!
Heparin is given by what?? (remember, think of the med classification of anticoagulants)
NOT by PO, BUT by SubQ and IV!!!!
What are the important things to Know about SUBCUTANEOUS SITES???????!!!
- Decreased absorption due to decreased blood supply there
- ROTATE SITES for FREQUENT INJECTION!!!!
- 45 to 90 DEGREE ANGLE!!!!!!
- NO Need to ASPIRATE!
Sites include:
Back arm, back, stomach (in the umbilical region), and thighs!!!!
What are things to know about INTRAMUSCULAR site of injection??? What are the 3 sties??
HOW DO YOU FIND THE LANDMARKS FOR VENTROGLUTEAL INJECTIONS??!!
Sites:
1. Deltoid
2. Vastus lateralis (thigh)
3. Ventrogluteal (hip)
Deep into body of a muscle
1. Absorption 10-20 mins
2. Safety: max of 30 mL in LARGE muscle, feel for landmarks to find site, AND ASPIRATE to assure not in a vessel UNLESS DELTOID SITE!!!
3. Sites: away from nerves, bones, large vessels, scars or bruises
4. If blood in syringe, discard, obtain new syringe
TO FIND THE LANDMARK FOR VENTROGLUTEAL:
- You put a “V” with your point finger and your middle finger!!
What are important things to know for deltoid injections?
- Not always developed in many adults
- Potential for injury to nerves
- ONLT 1 ML and less!!!!
- DO NOT ASPIRATE DELTOID!!!!!!!
What is the Z-TRACK method for injection
Where you pull back the skin as you inject
What are important things to know for intradermal injections?
- Typically used for skin testing (TB)
- slow absorption
- Insert bevel up- small bleb should appear
- Common sites: the chest, back of the chest, and antecubital
What are the delegation considerations regarding med admin?
- Nurses MUST administer the meds
- UAPs can watch for potential side effects and report their occurrence to the nurse
- UAPs can notify the nurse if the condition worsens
- UAPs can provide perineal care after med admin!!!!!!
- UAPs let the nurse know if patient complains of discomfort or pain at IV site
For controlled substances, what are the nursing responsibilities???
- Shift counts ( 2 RNs)
- Counts when removing meds ( 1 RNs)
- Disreptencies (2 RNs)
- Witnessing partial dose wastes of controlled substances (2 RNs)
What are the angle of needles for different injections?
- Intradermal injections – 10 to 15 degree angle
- Subcutaneous injections – 45 to 90 degree angle
- Intramuscular injections – 90 degree angle
What are the needle size (gauge) and needle length (inches) for different injections??
Do you aspirate Subcutaneous??
NO
Do you aspirate Intramuscular?? Deltoid? Vastus lateralis? Ventro-gluteal
Deltoid - NOOOO!! NEVER!!
Vastus lateralis and Ventrogluteal – YES!!
