Medication Administration Automated Medication Administration Equipment Pyxis Sure

Medication Administration

Automated Medication Administration Equipment Pyxis Sure. Med. Serve

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

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

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

Types of Oral Medications Tablets Capsules Sublingual Buccal Elixirs Enteric Coated

Precise & Safe Medication Administration

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. )

Rectal Medication Administration

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

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)

Topical Ointments

Otic Medications

MDI Medications

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. 30 cc 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 30 cc water, clamp tube, remove syringe, start feedings

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

Medication Administration Records (MARs)

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

Parts of a Needle & Syringe: Barrel Plunger Tip Needle: Bevel Shaft Hub

Types of Syringes

Tips of Syringes Luer-Lok Non Luer-Lok

Pre-Filled Systems

Assembling the Device

Scoop Method

Safety Devices

Needless Systems

Three Types of Injections q Intradermal - Injected into dermal skin layers (Allergy tests, PPDs, etc. ) q Subcutaneous - Injected into subcutaneous tissues (Heparin, Insulin) q Intramuscular - Injected into deep muscles (narcotic analgesics, iron)

Intradermal Injections Given in small doses (i. e. . 0. 1 cc) q Common sites include: RFA, LFA q Use 1 cc syringe with 26 -27 gauge needle, 1/4 - 5/8 inch long q Administer with needle at 5 -15 degree angle with bevel of needle up q Check for “bleb” or “wheal” q Document site in medication book/nurses’ notes q

Intradermal Injections

Subcutaneous Injections Given in doses of 0. 5 cc - 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

Deltoid Injections

Vastus Lateralis Injections q Site well-developed in both adults & children, lacks major blood vessels/nerves q Landmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect). q Good for clients with position restrictions

Intramuscular Injections

Vastus Lateralis

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

Dorsogluteal Injections

What other site is used for IMs?

Ventrogluteal Good for deep injections Away from blood vessels and nerves Z-track Thick, viscous meds Antibiotics Large volume Irritating

What if…… when giving an IM injection, the aspirate comes back with blood. What is the correct procedure and why?

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

Regular & NPH Insulins

Mixing Insulins NPH Insulin Regular Insulin

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

Remember !!! Always double-check Insulin & Heparin amounts/doses with another licensed person (RN/LVN/INSTRUCTOR)