University of Tabuk Faculty of Applied Medical Sciences

University of Tabuk Faculty of Applied Medical Sciences Department of Nursing Advanced Fundamentals of Nursing 1 st Year Bridging, Academic Year (AY) 1435— 1436 H Mylin G. Abalus, MSN Lecturer

Classroom Rules 1. All students must arrive in the classroom before the scheduled lecture. 2. Students should wear the prescribed dress and lab coat in class. 3. All students are encouraged to come prepared for class. Participation is necessary. 4. All mobile device should be turned off or put into silent mode. DEPARTMENT OF NURSING Curriculum & Course Development Committee 2

Policies 1. Sick leave reports or any certification for absence should be given within three days. No special return demo or quiz or exam will be given if absence/s is/are not excused. Department of Nursing 3

Grading System Assessment method Weight Midterm Exam 20% (5% Written exam +15% return demo) Final Exam 40% (10% Written exam + 15% return demo) Quizzes, Requirements (assignment) Weekly return demo Total DEPARTMENT OF NURSING Curriculum & Course Development Committee 15% 25% 100 4

Course Objectives 1. Describe the purposes of the different basic nursing skills. 2. Explain the principles and rationale of the steps of the basic nursing skills. 3. Demonstrate strict adherence to aseptic technique principles and universal precaution. 4. Analyze the importance of doing appropriate nursing responsibilities such as assessment, evaluation, and proper documentation when performing basic nursing skills. DEPARTMENT OF NURSING Curriculum & Course Development Committee 5

Course Objectives 5. Demonstrate therapeutic communication skills when performing basic nursing care. 6. Perform a systematic approach when performing basic nursing skills. 7. Safely administer medications. 8. Demonstrate good documentation skills. Department of Nursing 6

Text Book • Kozier, et. al. , Kozier's Fundamentals of Nursing: Concepts, Process, and Practice, 10 th ed. New Jersey: Pearson Education, Inc. Department of Nursing 7

Medication Administration This chapter will help you develop the skills needed to safely administer medications. Department of Nursing

Topic Outline 1. Terminologies, routes of medication administration 2. 10 rights of medication administration 3. 3 checks for safe medication administration 4. Steps to follow in medication administration regardless of route. 5. Steps in administering oral medications 6. Nursing considerations when administering oral medications DEPARTMENT OF NURSING Curriculum & Course Development Committee 9

Learning Objectives At the end of lecture-demonstration, you will be able to: Enumerate the different routes of medication administration Discuss the advantages and disadvantages of each route Perform steps to follow for all medications, regardless of type or route Administer oral medications

Routes of Administration Ø Oral (by mouth ) Ø Sublingual (under the tongue ) Ø Buccal ( between gums and cheeks ) Ø Topical (applied to the skin) Ø Inhalation ( aerosol sprays ) Ø Instillation ( nose, eyes, ears ) Ø Suppository ( rectal, vaginal ) Ø Parenteral routes ( intradermal, subcutaneous, intramuscular, and intravenous )

ORAL MEDICATION - has systemic effects or local effects on GIT or both -Most common, least expensive, most convenient, safe method Forms: - capsule, time-release pill, sprinkle, enteric coated, liquid suspension, syrups, elixir

ORAL MEDICATION DISADVANTAGES: 1 - Unpleasant test 2 -Irritation of gastric mucosa 3 -Irregular absorption from GIT 4 - Slow absorption and more prolonged effect 5 -Harm to patient’s teeth in some cases 6 -Less potent

ORAL MEDICATION CONTRAINDICATIONS: • Patient with vomiting episodes • Gastric or intestinal suction • Unconscious and unable to swallow

SUBLINGUAL MEDICATIONS placed under the tongue; good in emergencies; absorbed directly into the blood BUCCAL placed between the cheeks and gums NOTE : Instruct the patient not to swallow these medications, but instead to hold them in place until they are dissolved completely.

Pulmonary (into lungs) Medications ADVANTAGES �Absorbed quickly �Local and systemic effect �Good in emergencies DISADVANTAGES �Can increase HR and cause tremors �Can cause hyperactivity and restlessness �Can have an unpleasant taste and can irritate the mouth �MDI- difficult to administer correct dose

Ear Medication Administration OTIC MEDICATIONS: Instillation: a clean procedure except if tympanic membrane is not intact , in this case sterile technique is used PURPOSE: To soften wax To relieve pain To treat infection or inflammation

Ear Medication Administration • ADVANTAGES: – Local effect • DISADVANTAGES: – Dose is measured in number of drops – Use care to slowly squeeze the bottle to administer accurately – Person must remain with treated ear up for 35 minutes

Ophthalmic Medications Administration • Soothe irritated tissue, dilate or constrict the pupil, treat eye diseases • You must be certain you are medicating the “right” eye • When verifying the medication order, identify whether the medication is to be given in the right eye (OD), left eye (OS), or both eyes (OU)

Ophthalmic Medications Administration • ADVANTAGES: – Produces local effect • DISADVANTAGES – Cooperation of the person is often hard to get – Some meds may burn

Nasal Medication Administration • PURPOSES: – To treat allergies – To treat sinus infections – To treat nasal congestion

Nasal Medication Administration ADVANTAGES: �Acts in minutes �Local effect �Quick relief of symptoms DISADVANTAGES: �Prolonged use may cause rebound congestion �Can lead to chronic swelling of nasal passages �Difficult to obtain pt’s cooperation

Topical (to skin) Medications - to decrease pruritus, to lubricate or soften the skin, to cause local vasoconstriction or vasodilation, to treat or prevent infection FORMS: Ø OINTMENTS – semisolid preparation of a medication in a base Ø LOTIONS – suspension or emulsion of a medication in a water or oil base Ø LINIMENTS Ø CREAMS- semi-solid emulsion in water or oil base Ø POWDERS – fine particles

Topical Medications Acts within minutes for local effect; one hour for systemic effect ADVANTAGES: �Usually easy to apply �Produces local effect but can be absorbed systematically over time DISADVANTAGES: �Accurate dose can not be specified �May be toxic if swallowed �Powder particles may be inhaled

Transdermal (through skin) Acts over a period of time hours to days ADVANTAGES: �Systemic effect �Specific dose contained on patch DISADVANTAGES: �Not effective in an emergency �May irritate the skin �Absorption of dose may be affected by skin condition and circulation

RECTAL/VAGINAL MEDICATIONS ADVANTAGES: �Can be used to administer medication if person is unconscious or vomiting DISADVANTAGES: �Difficult to administer �Embarrassing �Patient must be able to retain �Can not be used if person has lower GI disease �Can be messy

PARENTERAL MEDICATIONS • - It is the administration of medication rather than through alimentary or respiratory tract; that is by needle. • ROUTES: v. Subcutaneous- into a subcutaneous tissue, just below the skin v. Intramuscular – into a muscle v. Intradermal – under the epidermis v. Intravenous – into a vein

10 GOLDEN RULES FOR ADMINSTERING DRUGS SAFELY 1. RIGHT CLIENT – medication is given to the right client 2. RIGHT DRUG –medication given was the medication ordered. The components of the drug order are: vdate and time the order was written vdrug name or generic name vdrug dose vroute of administration vfrequency and duration of administration

3. RIGHT DOSE – is the dose prescribed for a particular patient 4. RIGHT TIME – time at which the prescribed medication should be administered 5. RIGHT ROUTE – necessary for adequate or appropriate absorption

6. RIGHT DOCUMENTATION – requires that the nurse immediately record the appropriate information about the drug administered. This includes the name of the drug, dose, route, time and date and the nurses signature 7. RIGHT ASSESSMENT – requires that appropriate data are collected prior to administration of the drug. 8. RIGHT TO EDUCATION – requires that the client receive accurate and thorough information about the medication and how it relates to his or her particular situation.

9. RIGHT EVALUATION – requires that the effectiveness of the medication be determined by the client’s response to the medication. 10. RIGHT TO REFUSE THE MEDICATION – clients can refuse to take a medication

MEDICATION ADMINISTRATION RECORD (MAR) Card - the oldest type of record used for medication administration - contains the patients name, room number, medication, dosage and route Computer Generated MAR (CMAR)

Inpatient Medication Administration Record (IMR)

THREE CHECKS: 1. At the time of contact with the drug bottle or container. 2. Before pouring the drug. 3. After pouring the drug and before returning to the packaged label.

STEPS TO FOLLOW FOR ALL MEDICATIONS, REGARDLESS OF TYPE OR ROUTE • 1. Checks medication order on MAR against physician’s order (patient name, identification number, medication, dose, route, time, and allergies).

• 2. Follows agency policies for medication administration, including the time frame for medication administration. Most agencies allow medications to be given 30 minutes before or 30 minutes after the time indicated in the MAR.

• 3. Knows drug information, including drug action, purpose, recommended dosage, time of onset and peak action, common side effects, contraindications, drug interactions, and nursing implications.

• 4. Determines if medication dosage is appropriate for patient’s age and weight.

• 5. Identifies any special considerations for medication preparation and administration, such as can the medication be crushed or a capsule opened, or should medication be administered with food or on an empty stomach.

• 6. Checks expiration date of medication. • 7. When preparing medication, verifies correct medication, dose, time, route, and expiration date.

• 8. Calculates dosage accurately. • 9. Locks medication cart after removing medication.

• 10. At the bedside, verifies correct patient (using two methods of identification, including armband), medication, expiration date, dose, route, time, and presence of drug allergies.

• 11. Remains with the patient until sure he has taken the medication.

• 12. Does not leave medication unattended at bedside. • 13. Reassesses for therapeutic and side effects. • 14. Teaches patient about the medication as needed.

• 15. Document the administration of medication immediately after administration. 8/6/12 1320 Percocet, 1 tablet given PO. —K. Sanders, RN • 16. Evaluate the patient’s response to medication within appropriate time frame.

ADMINISTERING ORAL MEDICATIONS A- assess appropriateness of drug to patient - review medical history, allergy assessment, lab data - assess pt’s ability to swallow - assess pt’s knowledge of the med - verify the pt’s name, dose, route, and time of administration - assess pt’s vital signs

ADMINISTERING ORAL MEDICATIONS • Nursing Diagnoses – Impaired swallowing – Deficient knowledge – Noncompliance – Risk for aspiration – Anxiety

ADMINISTERING ORAL MEDICATIONS • Goal/Expected outcome: – Patient will swallow medication – Patient will experience the desired effect from the medication – Patient will not aspirate – The patient does not experience adverse effects – Patient understands and complies with the medication regimen

ADMINISTERING ORAL MEDICATIONS • 1. Prepares and administers medications according to “Medication Guidelines: Steps to Follow for All Medications. ”

Tablets and Capsules • 2. If pouring from a multi-dose container, do not touch the medication. Pour the tablet into the cap of the bottle, then into the medication cup.

3. Pour correct number into medication cup. 4. If necessary to give less than a whole tablet, break scored tablet with hands; use a pill cutter if necessary. Does not break unscored tablet.

• 5. If drug is unit-dose, do not open package; place entire package in paper (soufflé) cup. • 6. If patient has difficulty swallowing, checks to see if the pill can be crushed. If so, mixes with soft food, such as applesauce.

• 7. Pours all medications scheduled at the same time into the same cup, except uses separate cup for any medications requiring pre-administration assessment (e. g. , digoxin).

• 8. If patient is able to hold it, places tablet or medication cup in her hand. If unable to hold it, place medication cup to her lips and tip the pill(s) into her mouth. • 9. Provide liquid to swallow the pills.

Sublingual Medications • 10. Place or have patient place the tablet under the tongue and hold there until completely dissolved.

Buccal Medications • 11. Place or have patient place the tablet between cheek and teeth and hold there until completely dissolved.

Liquids • 12. Shake the liquid, if necessary, before opening the container. • 13. Place bottle lid upside down on the counter. • 14. Hold bottle with label in palm of the hand.

• 15. Pour medication, slightly twists bottle when finished to prevent dripping. • 16. If medication drips over bottle lip when pouring, wipe with a clean tissue or paper towel—only the outside lip of the bottle.

• 17. Holds medication cup at eye level to measure dosage. • 18. Positions patient in high Fowler’s position if possible; or raises head of bed as much as allowed; or uses side-lying position.

• When giving small amounts of liquids (e. g. <5 ml), prepare the medication in a sterile syringe without the needle or in a specially designed oral syringe. Label the syringe with the name of the medication and the route (PO). Rationale: Any oral solution removed from the original container and placed into a syringe should be labeled to avoid medications being given by the wrong route (e. g. IV). This practice facilitates client safety and avoids tragic errors. Department of Nursing 60

NURSING CONSIDERATIONS ADMINISTERING ORAL MEDS INFANTS : 1. Oral medications can be effectively administered in several ways: • Use a syringe or a dropper • A medication nipple which allows the infant to suck the medication • A spoon or medication cup, for older children.

2. Never mix medications into food that are essential. Rationale: Infant may associate the food with an unpleasant taste and refuse the food in the future. Never mix medications with formula. 3. Place a small amount of liquid medication along the side of the baby’s cheek and wait for the infant to swallow before giving

more. Rationale: To prevent or spitting out. aspiration 4. When using a spoon, retrieve and refeed medication that is thrust outward by the infant’s tongue.

Thanks for listening. Any questions?

Post-lecture Evaluation What are three checks before giving medication? What are things to document after giving oral medications. DEPARTMENT OF NURSING Curriculum & Course Development Committee 65

Topic for the Next Session 1. Parenteral medication administration 2. Preparation of meds from vials and ampules DEPARTMENT OF NURSING Curriculum & Course Development Committee 66