Drug administration & Blood transfusion.pptx

Good notes

1. BLOOD TRANSFUSION & DRUG ADMINISTRATION Dr. JOSTINE Mutinda

2. TRANSFUSION This is intravenous administration of blood and blood components/ products Purpose- To replace lost blood and to treat factor specific deficiencies

3. Indications Massive blood loss Severe hemolysis in the newborn Severe anemia Perioperatively in major surgeries Bleeding disorders such as hemophilia

4. Pretransfusion Assessment Patient history - to determine the history of previous transfusions as well as previous reactions to transfusion. The history should include: the type of reaction, its manifestations, the interventions required, and whether any preventive interventions were used in subsequent transfusions. The number of pregnancies a woman has had (increased number can increase her risk for reaction). Other concurrent health problems, with careful attention to cardiac, pulmonary, and vascular disease.

5. Requirements Disinfected trolley with a tray containing: Sterile blood transfusion set IV solution of normal saline/ water for injection Clean gloves Unit of blood/blood product Observation chart Resuscitation tray

6. Preparation for the procedure Confirm that the transfusion has been prescribed. Check that patient’s blood has been typed and cross-matched. Verify that patient has signed a written consent form Explain the procedure to the patient (including signs of transfusion reaction). Obtain the blood from the blood bank after the IV line is started . Avail all the requirements Take vital signs, Instruct patient to empty the bladder

7. P rocedure interventions Wash hands and wear gloves Double-check the labels with another nurse to confirm: the blood/product to be transfused patient identification data the blood group and Rh type crossmatch compatibility if screening was done expiry date and presence of clots.

8. Check the blood for gas bubbles and any unusual color or cloudiness. Ensure transfusion is initiated within 30 min after removal from the blood bank refrigerator Monitor closely for 15–30 min to detect signs of reaction: The 1 st hr : Monitor every 15 mins then hourly till the end Note that administration time does not exceed 4 hr because of the increased risk for bacterial proliferation. Be alert for signs of adverse reactions.

9. Post- procedure Obtain vital signs and compare with baseline measurements. Dispose of used materials properly. Document procedure in patient’s medical record, including patient assessment findings and tolerance to procedure. Monitor patient for response to and effectiveness of the procedure.

10. Documentation Date and time of the procedure Vital signs: Before, during and after the procedure Lab findings: Full haemogram etc Any drugs given before, during and after the procedure Start and completion time of the transfusion Amount of blood administered Any transfusion reaction noted

11. Possible transfusion reactions Febrile , non-hemolytic reaction- caused by antibodies to donor WBCs. It occurs more frequently in patients who have had previous transfusions (exposure to multiple antigens from previous blood products).  Patient presents with are chills followed by fever . Acute hemolytic reaction- most dangerous, and potentially life threatening, type of transfusion reaction. Occurs when the donor blood is incompatible with that of the recipient.

12. Circulatory overload - If too much blood infuses too quickly, hypervolemia can occur . Allergic reaction- Some patients may develop urticaria (hives) or generalized itching during a transfusion (due to presence of proteins in the blood).

13. Administration of medication Medication administration: the direct application of a prescribed medication whether by injection, inhalation, ingestion, or other means to the body of the individual by an individual authorized to do so .

14. Common abbreviations used in drug administration Abbreviations: po = orally (per orum ); stat = in one dose; bd = twice daily; tds = three times daily; od = once daily. QID means 4 times daily or 6 hourly. IM = intramuscular; IV – intravenous NPO- Nil per orum (nothing by mouth) PRN is an acronym for the Latin term “pro re nata ,” which means “as needed” In situ- in place or position

15. Purpose and indications Purpose: For diagnostic purposes, to cure or treat a condition, to reduce symptoms to prevent an illness. Indications: patients on the prescribed medications clients eligible for specific routine immunizations

16. Rights of drug administration Rights of Medication Administration include: The Right Person. The Right Medication. The Right Time. The Right Dose. The Right Route . The Right Documentation. The Right to Refuse.

17. ROUTES OF DRUG ADMINISTRATION

18. Oral route Many drugs can be administered orally as liquids, capsules, tablets, or chewable tablets. Types of oral administration: Buccal - dissolved inside the cheek Sublingual administration- dissolved under the tongue They can also be swallowed with fluid or via NG tube

19. Purpose for oral route Oral- to provide a safe effective route Buccal - to prevent destruction in the stomach Sublingual- to provide a sustained medication action with minimal discomfort and prevent destruction/ biotransformation

20. Advantages- the oral route is the most convenient and usually the safest and least expensive. Disadvantages- food and other drugs in the digestive tract and the PH may affect how much of and how fast the drug is absorbed. Some orally administered drugs irritate the GIT

21. Contraindications to oral administration When a person cannot take anything by mouth When a drug must be administered rapidly or in a precise or very high dose Impaired GIT absorption

22. Procedure for oral medication 1. Wash and dry hands 2. Wheel trolley to begin at one end of the ward 3. Confirm with assistant the rights of medication administration and counter check the medication container. 4. Dispense medications on to a saucer or medicine measure appropriately 5. For liquids shake gently to mix 6. Place medicine measure on flat surface and pour liquid with label uppermost

23. 7. Measure correct dose at eye level or meniscus 8. Wipe the tip of the bottle, replace cork/cap and store in its unit after dispensing 9. For patients getting more than one medication, use a separate container for each mixture 10. Confirm patient’s identity before giving medicine 11. Give one tablet at a time, give water as appropriate and ensure patient has swallowed

24. 12. For sublingual medications, instruct patient to place the medication under the tongue and allow it to dissolve completely . 13. For buccal medications, instruct patient to place medication in the lower or upper buccal pouch against the cheek until it dissolves completely. 14. Leave patient in an appropriate position 15. Wash and dry or sanitize hands before moving to the next patient

25. 16. When all patients have been given due medication, take equipment to treatment room and store medications appropriately 17 . Process instruments/equipment and store in accordance with hospital disposal guidelines 18. Wash and dry hands 19. Record in the medication register and balance the medication books appropriately

26. Parenteral administration The term parenteral is usually used for drugs given by injection or infusion P arenteral administration involves use of the following routes: • Intrademal - into the dermis, just below the epidermis. Subcutaneous-a needle is inserted into fatty tissue just beneath the skin for drugs like insulin • Intramuscular (in a muscle)- is preferred to the subcutaneous route when larger volumes of a drug product are needed. • It is given in the upper arm, thigh, or buttock.

27. Intravenous (in a vein)- through a vein a drug is delivered immediately to the bloodstream and tends to take effect more quickly than when given by any other route Intrathecal (around the spinal cord)- a needle is inserted between two vertebrae in the lower spine and into the space around the spinal cord. It produces rapid or local effects on the brain, spinal cord Implantation- Certain drugs hormonal contraceptives may be given by inserting plastic capsules under the skin

28. Procedure for IM injection 1. Explain the procedure & Wash and dry hands 2. Assemble, arrange equipment and take to the ward / bedside/ treatment room 3. Take the treatment sheet and ampoule or vial of the prescribed medication from the tray and with the assistant check the rights of medication administration 4. Remove the metal cap from the vial using a file. 5. Use the pair of forceps to pick one cotton wool ball, place it in the galipot, gently spray little antiseptic over it to prepare a swab for disinfecting the rubber site for puncture

29. Procedure cont … 6.For ampoules, clean the septum of the vial using antiseptic solution and dry with sterile swab. Using the file, while protecting the fingers with a cotton wool swab, break the ampoule at the neck. 7. If the medication is to be diluted, reconstitute it with correct amount of sterile water for injection and mix well 8. To withdraw the medication from a vial draw up the syringe and inject amount of air equivalent to medication required. 9.To withdraw the medication from ampoule, ensure the piston is plugged in completely, lift the ampoule and withdraw the dose required carefully without contaminating the plunger/piston

30. 10. Counter check with the assistant 11. Remove used needle and discard in sharp container and replace with new needle, place the medication in the syringe in the kidney dish. 12. Check the rights again with assistant and take the kidney dish containing the medication to bed side while assistant takes care of the medication trolley 13. Explain the procedure to the patient/client a second time ,ask him/her not to move while the injection is being given and help him/her to choose the site to be injected 14. Locate the injection site and wipe with spirit swab

31. 15. Hold the skin between the fore fingers and thumb and insert the needle adt 90 degrees 16. Withdraw the piston slightly. 17. If blood is seen discard medication and equipment and prepare again. If no blood is seen, push the medication in slowly but steadily until the piston reaches the end of the barrel 18. Quickly withdraw the needle while applying firm pressure and support on the needle site. 19. Immediately discard needle and syringe into sharps container 20. Indicate time and sign on the prescription sheet. 21. Record in the medication register.

32. Safe injection sites: Middle thigh; upper lateral quadrant Divide the upper thigh into three equal parts. Locate the middle of these three sections. The injection should go into the outer top portion of this section.

33. Giving subcutaneous injection Step 1 to 12 are as for IM injection 13.Locate the injection site and wipe with the spirit swab. Hold the skin between the forefingers and thumb and insert the needle at 45 degrees into the subcutaneous tissue. 14. Withdraw the piston slightly to ensure that the point of the needle has not entered a blood vessel. If blood is seen discard medication and equipment and prepare again . 15. If no blood is seen, push the medication in slowly but steadily until the piston reaches the end of the barrel

34. 16. Quickly withdraw the needle while applying firm pressure and support on the needle site 17 . Immediately discard needle and syringe into sharps container 18. Indicate time and sign on the prescription sheet . 19. Record in the medication register.

35. Administering intradermal medication Step 1- 7 is as for administering IM injection 8. To withdraw the medication from ampoule/vial , ensure the piston is plugged in completely. Lift the ampoule/vial and withdraw the dose required and counter check with the assistant 9. Place the medication in the syringe in the kidney dish. 10. Explain the procedure to the patient/client a second time and ask him/her not to move while the injection is being given. 11. Help the patient /client to choose the site to be injected. (For BCG, the site is prescribed in the immunization policy). 12. Inspect the site for lesions, inflammation, edema, tenderness and scars from previous injections

36. Giving Intradermal injection cont.. 13. With non-dominant hand, stretch skin over site with fore finger and thumb. Insert needle gently and slowly at 5-15 degrees angle, bevel up until resistance is felt, then advance to ≤1/8 inch below the skin

37. Giving Intradermal injection cont.. 14.Observe for wheal formation 15. Withdraw the needle while applying firm pressure and support using a swab on the needle site. 16. Do not massage the site 17. Immediately discard needle and syringe into sharps container 18. Indicate time and sign on the prescription sheet . 19. Record in the medication register . 20. Appreciate client for cooperation

38. Administering IV medication Step 1- 11 is as for IM drugs 12. Swab the cannula site with cotton wool swab. Connect a syringe with sterile water for injection to intravenous port and withdraw the piston/plunger. Check for back flow of blood and air. If air is present in the syringe remove the syringe from the port and push the air out then connect the syringe again and push the water for injection. 13. Carefully and slowly over the prescribed duration, inject the medication while observing patient’s reaction

39. 14. Clear cannula by infusing 1-2mls of sterile water for injection 15 . Remove the syringe while applying pressure on the intravenous line. 16. Immediately discard needles and syringe into sharps container 17. Indicate time and append signature on the prescription sheet. 18. Record in the medication register.

40. Instillation of ear drops Otic route - Drugs used to treat ear inflammation and infection can be applied directly to the affected ears. Requirements Disposable clean gloves Medication in a dropper Cotton wool balls in a receiver Medication sheet Receiver for clinical waste

41. Procedure 1. Explain the procedure to the client/patient 2. Wash hands and assemble requirements 3. Position the patient in upright position with affected ear facing upward 4. Observe rights of medication administration . 5. Wash hands and wear clean gloves 6. Pull the pinna of the ear upward and the auditory meatus backward for adults or downwards and backwards for children

42. Instillation of ear drops cont … 7. Instill prescribed drops holding the dropper 1/2inch above the opening of the ear canal. 8. Position a piece of cotton wool ball at the opening if medication is running out 9. Ask patient to remain in same position for 2-3 minutes 10. Decontaminate equipment and discard other wastes appropriately, remove gloves and wash hands

43. Instillation of eye drops Ocular route- Drugs used to treat eye disorders are made in form of liquid/drops, gel, or ointment so that they can be applied to the eye. Ocular drugs are almost always used for their local effects. Requirements Disposable clean gloves Medication in a dropper Normal saline Cotton Wool balls in a receiver Treatment sheet Receiver for clinical waste

44. Procedure 1. Explain the procedure to the client/patient 2. Assemble requirements 3. Position the patient in supine position 4. Follow the rights of medication 5. Wash hands and wear clean gloves 6. Clean the affected eye(s) with a cotton wool swab moistened with normal saline 7. Use each cotton wool ball for only one stroke, moving from the inner to the outer canthus of the eye

45. Instillation of Eye drops cont … 8. Tilt the patient’s/client’s head back slightly if he is sitting or place the head over a pillow if he is lying down 9. Instill prescribed drops holding the dropper 1/2inch above the opening of the eye. 10. Position a piece of cotton at the opening if medication is running out 11. Ask patient to remain in same position for 2-3 minutes 12. Wipe off excess solution with gauze or cotton wool balls. 13. Decontaminate equipment and dispose other waste appropriately, remove gloves and wash hands

46. Other routes Vaginal route-Medicines primarily delivered by intravaginal administration (pessaries) include estrogens and progestogens, and antibacterials and antifungals to treat bacterial vaginosis and yeast infections respectively.

47. Nasal route- drugs e.g. corticosteroids are breathed in and absorbed through the thin mucous membrane that lines the nasal passages Nebulization requires the use of special devices do administer medication intranasally .

48. Cutaneous route - Drugs applied to the skin are usually used for their local effects and thus are most commonly used to treat superficial skin disorders. The formulation may be an ointment, cream, lotion, solution, powder, or gel . Transdermal route - Some drugs are delivered body wide through a patch on the skin. Only drugs to be given in relatively small daily doses can be given through patches e.g. nitroglycerin

49. Nebulization Definition: This is the process by which aerosolized medications are directly delivered into the air way by inhalation method . Purpose : To deliver medications directly into the mucosa of the lungs in the fastest, noninvasive manner Indications : Patients with respiratory distress symptoms requiring symptomatic relieve In conditions such as: Asthma Chronic obstructive pulmonary disease (COPD)

50. Rectal washouts/suppositories Many drugs that are administered orally can also be administered rectally as a suppository e.g. acetaminophen, diazepam, and laxatives. A suppository is prescribed for people who cannot take a drug orally Definition : This is the process of introducing fluid into the rectum or lower colon Purpose: To administer medication through the rectum To evacuate the rectum .

51. Indication(s) Pre-operatively for lower gastrointestinal tract operations Diagnostic purposes e.g. Endoscopy Specimen collection Fecal impaction. Treatment e.g. antipyretics

52. Requirements Top shelf: Gloves (disposable) Drapes Prescribed enema/medication Incontinence sheet and mackintosh Rectal tube/rectal catheter/syringe Bed pan/commode Lubricating jelly Bottom shelf: Toilet paper Air freshener Receiver for soiled linen

53. Steps 1. Screen the patient’s bed 2. Wheel the trolley to the bedside 3. Wash hands, dry and put on glove . 4. Ask the assistant to position the patient in the left lateral position with knees flexed and buttocks moved to the side of the bed 5. Drape the patient 6. Lubricate the rectal tube/catheter 7. Expel any air in the tubing then clamp

54. 8. Insert the tube, in an upward and forward motion Adults (7cm – 12cm) Child 5 – 7cm Infant 2.5 – 3.375 cm 9. Release the clip slowly to allow the prescribed solution to run in by gravity and then clip the tube 10. Ask the patient to breathe in and out as the fluid runs in to avoid pushing it out. If cramping occurs stop flow of fluid until the cramp is over

55. 11. Gently withdraw the catheter and urge the patient to retain the fluid as long as possible 12. Place the rectal tube in a receiver as you withdraw it 13. Assist the patient to a sitting position on the bedpan commode or toilet. 14. Ask the patient not to flush the toilet 15. If specimen is required use a bed pan or commode

56. Administering oral medications Procedure 1. Explain the procedure, wash and dry hands 2. Wheel trolley to begin at one end of the ward 3. Confirm with assistant the rights of medication administration and counter check the medication container. 4. Dispense medications on to a saucer or medicine measure appropriately 5. For liquids shake gently to mix

57. 6. Place medicine measure on flat surface and pour liquid with label uppermost 7. Measure correct dose at eye level or meniscus 8. Wipe the tip of the bottle, replace cork/cap and store in its unit after dispensing 9. For patients getting more than one medication, use a separate container for each mixture 10. Confirm patient’s identity before giving medicine

58. 11. Give one tablet at a time, give water as appropriate and ensure patient has swallowed 12 . For sublingual medications, instruct patient to place the medication under the tongue and allow it to dissolve completely . 13. For buccal medications, instruct patient to place medication in the lower or upper buccal pouch against the cheek until it dissolves completely. 14. Leave patient in an appropriate position

59. 15. Wash and dry or sanitize hands before moving to the next patient 16 . When all patients have been given due medication, take equipment to treatment room and store medications appropriately 17. Process instruments/equipment and store in accordance with hospital disposal guidelines 18 . Wash and dry hands 19. Record in the medication register and balance the medication books appropriately

60. ADMINISTRATION OF OXYGEN Definition: Giving of oxygen through the airway to correct hypoxia and prevent tissue damage. Purpose : To achieve and maintain arterial oxygen saturation above 95 % Indications: Airway obstruction Severe infections e.g. septicemia, lung disease Ineffective cardiac function e.g. heart failure Shock causing stagnation of blood flow Compromised respiratory system Conditions leading to hypoxia and hypoxemia. Myocardial Infarction and Cardiac arrhythmias During labor in maternal / fetal distress Others as indicated by the physician

61. Requirements Oxygen tubing Humidifier with distilled water Oxygen cylinder and key / oxygen point Oxygen stand Flow meter and gauge Oxygen mask/nasal prongs

62. Procedure 1. Perform hand hygiene 2. Explain the procedure to the patient and reassure . 3. Assemble the equipment and connect the various gadgets 4. Connect the patient to the pulse oximeter and monitor the work of breathing 5. Correctly position the oxygen delivery device and secure it in place 6. Open the cylinder, start oxygen flow and close the flow meter 7. Regulate the oxygen flow as required 8. Encourage the patient to breath normally (where possible)

63. 9 . Clear the environment after the procedure 10. Perform hand hygiene NB: Remove all articles that can cause fire from around the oxygen giving area Always have a spare cylinder ready to replace the finished one Oxygen should not be given for a long time to prevent oxygen toxicity All empty cylinders must be labelled “Empty” and arrange for refilling

64. IV Fluid therapy IV solutions contain dextrose or electrolytes mixed in various proportions with water. Pure, electrolyte-free water can never be administered IV because it rapidly enters red blood cells and causes them to rupture . Solutions are often categorized as isotonic, hypotonic, or hypertonic, according to whether their total osmolality is the same as, less than, or greater than that of blood .

65. Indications To provide water, electrolytes, and nutrients to meet daily requirements To replace water and correct electrolyte deficits due to diarrhea and vomiting, sepsis and burns To administer medications and blood products Total parenteral nutrition

66. The formula for calculating the IV flow rate (drip rate) is: Total volume (in mL) Divided by time (in min) Multiplied by the drop factor (in gtts /mL). Preparing to administer iv therapy-Before performing venipuncture, the nurse carries out hand hygiene, applies gloves, and informs the patient about the procedure. Next the nurse selects the most appropriate insertion site and type of cannula for a particular patient.

67. Factors to consider when selecting a site for venipuncture The following are factors to consider when selecting a site for venipuncture: Condition of the vein Type of fluid or medication to be infused Duration of therapy Patient’s age and size Whether the patient is right- or left-handed Patient’s medical history and current health status Skill of the person performing the venipuncture

68. Selecting venipuncture devices-Equipment used to gain access to the vasculature are mostly cannulas. Teaching the patient-Except in emergency situations, a patient should be prepared in advance for an IV infusion. The venipuncture, the expected length of infusion, and activity restrictions are explained

69. Preparing the IV site Before preparing the skin, the nurse should ask the patient if he or she is allergic to latex or iodine, products commonly used in preparing for IV therapy. Excessive hair at the selected site may be removed by clipping to increase the visibility of the veins and to facilitate insertion of the cannula and adherence of dressings to the IV insertion site. Because infection can be a major complication of IV therapy, the IV device, the fluid, the container, and the tubing must be sterile.

70. Performing venipuncture- Anchor the vein by holding the patient's arm and placing a thumb BELOW the venepuncture site or apply a tourniquet above. Ask the patient to form a fist so the veins are more prominent. Enter the vein swiftly at a 30 degree angle or less, and continue to introduce the needle along the vein at the easiest angle of entry . Secure the cannula with a strapping/dressing

71. IV access devices

72. Monitoring flow The nurse monitors IV infusions frequently to make sure that the fluid is flowing at the intended rate. The flow rate is calculated when the solution is originally started, then monitored at least hourly. Total volume (in mL) / Time (in min) x Drop factor (in gtts /mL) = IV flow rate (in gtts /min) Flushing of a vascular device is performed to ensure patency and prevent the mixing of incompatible medications or solutions.

73. Discontinuing an infusion The removal of an IV catheter is associated with two possible dangers: bleeding and catheter embolism. To prevent excessive bleeding, a dry, sterile pressure dressing should be held over the site as the catheter is removed. Firm pressure is applied until hemostasis occurs.