Medication and fluid therapy for Nurse.pptx

fundamental

1. ARSI UNIVERSITY NURSING DEPARTMENT FOUNDATION OF NURSING I By: Mohammed A (B.Sc. N, MSc N.)

2. Objective At the end of this chapter you will be able to;- Define Medication and fluid therapy Prepare Medication Withdrawing Medication from a Vial Withdrawing Medication from an Ampoule Mixing Medications from Two Vials into One Syringe Preparing an IV Solution 9/3/2024 By Mohammed A 2

3. Cont.…objective Medication calculation Administering Oral, Sublingual, and Buccal Medications Administering Eye and Ear Medications Administering Skin/Topical Medications Administering Nasal Medications Administering Rectal Medications Administering Vaginal Medications 9/3/2024 By Mohammed A 3

4. Medication and fluid therapy A medication is a substance administered for the diagnosis , treatment or relief of a symptom or for prevention of disease. Pharmacology is the study of the effect of drugs on living organisms. The written direction for the preparation and administration of a drug is called a prescription . 9/3/2024 By Mohammed A 4

5. CHANNELS OF DRUG ADMINI S T R A T I ON ENTE R AL P ARENTERAL TOPICAL 9/3/2024 By Mohammed A 5

6. Purpose of medication D r u g s can b e adminis t e r ed f or th e se purposes: Diagnostic purpose : to identify a n y disease. E.g. penicillin prior to administer. Prophylaxis : to prevent the occ u r r ence of disease e.g. heparin to prevent thrombosis, antibiotics to prevent infection. Therapeutic purpose : to cure the disease. 9/3/2024 By Mohammed A 6

7. Uses of Drugs Prevention - used as prophylaxis to prevent diseases e.g. vaccines; fluoride-prevents tooth decay. Diagnosis - establishing the patient’s disease or problem e.g. radio contrast dye; tuberculosis (Mantoux) testing. Suppression - suppresses the signs and symptoms and prevents the disease process from progressing e.g. anticancer, antiviral drugs. 9/3/2024 By Mohammed A 7

8. Cont.… T r eatmen t;- a l l e via t e t h e s y m p t o m s f or patient s wit h c h r onic disease .g. Anti-asthmatic drugs. Cure - complete eradication of diseases e.g. anti-biotics, anti- helmintics . Enhancement aspects of health - achieve the best state of health e.g. vitamins, minerals 9/3/2024 By Mohammed A 8

9. Storage of Medications Medications are dispensed by the pharmacy to nursing units. Once delivered, proper storage becomes the responsibility of the nurse. All medications must be stored in a cool dry place (usually in cabinets, medicine carts or fridges) 9/3/2024 By Mohammed A 9

10. Principles of medication administration Principles include 3 checks and 10 Rights: 3 checks are Check when obtaining the container of medicine. Check when removing the medicine from the container. Check when replacing the container. 9/3/2024 By Mohammed A 10

11. Rights of Medication Administration To prevent errors, these guidelines are - the rights- are used in drug administration. 1. Right Patient : This can be done by asking the client to mention his/her full name . check other identification also to confirm. 9/3/2024 By Mohammed A 11

12. 2. Right Medication: Right Medication : before administering any medicine, compare name on medication chart/medication order with that on the medication at least 3 times-checking medication label when removing it from storage unit, compare medication label with that on treatment chart and medication label and name on treatment chart with patient’s name tag . 9/3/2024 By Mohammed A 12

13. 3. Right Time Right Time : drug timing is very especially with some drugs like antibiotics, antimalaria drugs etc. to achieve cure and prevents resistance. Some drugs must be given on empty stomach. 9/3/2024 By Mohammed A 13

14. 4. Right Dose Careful and correct calculation is important to prevent over or under dosage of the medication. 9/3/2024 By Mohammed A 14

15. 5. Right Route An acceptable medication order must specify the route of medication. If this is unclear, the prescriber should be contacted to clarify or specify it. The nurse should never decide on a route without consulting the prescriber. 9/3/2024 By Mohammed A 15

16. 6. Right to information on drug/client education The patient has the right to know the drug he/she is taking, desired and adverse effects and all there is to know about the medication. 9/3/2024 By Mohammed A 16

17. 7. Right to Refuse Medication The patient has the right to refuse any medication. However, the nurse is obliged to explain to patients why the drug is prescribed and the consequences refusing medication . 9/3/2024 By Mohammed A 17

18. 8. Right Assessment Some medications require specific assessment before their administration e.g. checking of vital signs . Before a medication like Digoxin is administered the pulse must be checked. Some medication orders may contain specific assessments to be done prior to medication . 9/3/2024 By Mohammed A 18

19. 9. Right Documentation Documentation should b e done after medication administered and not before. 9/3/2024 By Mohammed A 19

20. 10. Right Evaluation Conduct assessment to ascertain drug action, both desired an side effect . 9/3/2024 By Mohammed A 20

21. Medication order The drug order, written by the physician, should has 7 essential parts for administration of drugs safely. Patients full name. Date and time. Drug name. Dosage. Route of administration. Time and frequency of administration. Signature of physician. 9/3/2024 By Mohammed A 21

22. Types of Medication Orders Four types of medication orders are commonly used: Stat order : A stat order indicates that the medication is to be given immediately and only once. e.g: morphine sulfate 10 milligrams IV stat. Single order: The single order or one-time order indicates that the medication is to be given once at a specified time. e.g: Seconal 100 milligrams at bedtime. 9/3/2024 By Mohammed A 22

23. Standing order: Standing order is written in advance carried out under specific circumstances. (e.g: Amoxicillin 500mg po TID) PRN order: A PRN order or as-needed order, permits the nurse to give a medication when the client requires it. (e.g., Paracetamol 1gm po prn) 9/3/2024 By Mohammed A 23

24. Common abbreviations used in medication orders Abbreviation Meaning B.I.D. two times a day T.I.D. three times a day Q.I.D. four times a day cap capsule h.s. at bedtime ID intradermal IM intramuscular IV intravenous PO by mouth PRN as needed 9/3/2024 By Mohammed A 24

25. Cont.… Abbreviation Meaning SC subcutaneous Stat immediately supp suppository susp suspension tab tablet hrly hourly od every day a.c. before meals 9/3/2024 By Mohammed A 25

26. Drug forms Medications a r e available in variety of form. The form of th e med i cation determines its route 9/3/2024 By Mohammed A 26

27. Drug forms can be of three types ; Solid eg: tablet, capsule Liquid eg: syrup, eye drops Semi solid eg: ointment, lotion 9/3/2024 By Mohammed A 27

28. Tablet : It is the powdered medication crushed into hard disk or cylinder. Capsule : Medication covered in gelatin shell. Gel or jelly : A clear or translucent semisolid that liquefies when applied to the skin . 9/3/2024 By Mohammed A 28

29. Lozenge : A flat, round, or oval preparation that dissolves and releases a drug when held in the mouth. Lotion: Drug particles in a solution for topical use. Ointment : Semisolid preparation containing a drug to be applied externally. 9/3/2024 By Mohammed A 29

30. Powder: Single or mixture of finely ground drugs . Solution: A drug dissolved in another substance. Suspension: Finely divided, undissolved particles in a liquid medium; should be shaken before use. 9/3/2024 By Mohammed A 30

31. Syrup: Medication combined in a water and sugar solution. Suppository: An easily melted medication preparation in a firm base such as gelatin that is inserted into the body (rectum, vagina, urethra) 9/3/2024 By Mohammed A 31

32. Transdermal patch : Unit dose of medication applied directly to skin for diffusion through skin and absorption into the bloodstream. 9/3/2024 By Mohammed A 32

33. Route of administration Different route of drug administration are; Oral Parenteral Topical Inhalation 9/3/2024 By Mohammed A 33

34. Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous , intraperitoneal , intraosseous , subcutaneous and oral routes . 9/3/2024 By Mohammed A 34

35. FLUID THERAPY Oral route is always preferred over IV route. Can be life-saving in certain conditions. Loss of body water, whether acute or chronic, can cause a range of problems from mild headache to convulsions, coma, and in some cases, death. Though fluid therapy can be a lifesaver, it's never always safe, and can be very harmful. 9/3/2024 By Mohammed A 35

36. 36 FOR PROPER FLUID THERAPY, IT IS NECESSARY TO KNOW Etiology of fluid deficit and type of electrolyte imbalance present Associated illness ( i.e. DM, HTN, IHD, RHD, renal or hepatic disorders, etc.) Clinical status ( Hydration, vital data, urine output, etc.) 9/3/2024 By Mohammed A

37. BASIC PRINCIPLE OF IV FLUID THERAPY ADVANTAGE- Accurate, controlled & predictable way of administration Immediate response Prompt correction of serious fluid and electrolyte disorder 9/3/2024 By Mohammed A 37

38. BASIC PRINCIPLE OF IV FLUID THERAPY INDICATIONS Conditions when oral intake is not possible Severe vomiting & diarrhea Moderate to severe dehydration & shock Severe hypoglycemia Vehicles for several medications Total parenteral nutrition Treatment of critical problems 9/3/2024 By Mohammed A 38

39. BASIC PRINCIPLE OF IV FLUID THERAPY Disadvantage- More expensive Needs strict sterility Possible only in hospitalized patient under skilled supervision Improper selection of type of fluid can lead to serious problems 9/3/2024 By Mohammed A 39

40. Cont.… Improper volume & rate of infusion of fluid can be life threatening Improper technique of administration can lead to complications 9/3/2024 By Mohammed A 40

41. BASIC PRINCIPLE OF IV FLUID THERAPY Contraindications Should be avoided, if patient is able to take oral fluid Preferable to avoid IV fluid in patient with congestive heart failure or volume overload 9/3/2024 By Mohammed A 41

42. Complications Local: hematoma, infiltration, a nd infusion phlebitis Systemic: circulation overload, air embolism, septicemia Other: fluid contamination, fungus in IV fluids, mixing of incompatible drugs, improper technique of infusion, IV set or IV catheter related problems 9/3/2024 By Mohammed A 42

43. Complications to observe for during IV therapy: Infiltration escape of fluid into subcutaneous tissue due to dislodgement of the needle causing swelling and pain. Gross infiltration may result in nerve compression injury which can result in permanent loss of function of extremity or in case of irritating medications (vesicant), significant tissue loss, permanent disfigurement or loss of function may result. When there is infiltration, the site should be changed. 9/3/2024 By Mohammed A 43

44. Phlebitis is the inflammation of the vein. This may result from mechanical trauma due to the insertion too big a needle (for small vein) or leaving a device in place for a long time. Chemical trauma result s from irritation from solutions or infusing too rapidly. This manifests as pain or burning sensation along the vein. On observation, there may be redness, increased temperature over the course of the vein. 9/3/2024 By Mohammed A 44

45. Circulatory Overload ; the intravascular fluid compartment contains more fluid than normal. This occurs when infusion is too rapid or excess volume is infused. This manifests as dyspnoea , cough , frothy sputum and gurgling sounds on aspiration. Embolism ; obstruction of the blood vessels by travelling air emboli or clot of the blood. It is fatal. 9/3/2024 By Mohammed A 45

46. Duties of the Nurse during IV Therapy Explain the need for the IV therapy, what to expect, duration of the therapy, activities permitted during the procedure and observations to be made. Help patient to maintain activities of daily living; bathing and grooming, feeding etc. 9/3/2024 By Mohammed A 46

47. Cont.… Observation should be made on the flow rate, patency of the tubing, infusion site, level of fluid in the infusion bag/bottle, patient’s comfort and reaction to therapy. Change dressing on the IV line as may be necessary. 9/3/2024 By Mohammed A 47

48. Withdrawing Medication from a Vial Equipment Medication administration record (MAR) Sterile syringe and needle Alcohol swab Vial of medication 9/3/2024 By Mohammed A 48

49. A m p u le s . V i a ls . Ampules and Vials 9/3/2024 By Mohammed A 49

50. Procedure Wash your hands. Prepare the vial. Open the alcohol wipe. New vial, remove metal cap from vial of medicine and cleanse the rubber top of the vial. Used vial, cleanse the rubber top of the vial. 9/3/2024 By Mohammed A 50

51. Cont.… 3. Prepare syringe. • Choose a syringe of appropriate size to accommodate the volume of medication to be withdrawn. • Grasp needle and turn barrel of syringe to the right. • Remove the needle cap and pull back on plunger to fill syringe with an amount of air equal to amount of solution to be withdrawn from the vial. 4. Insert the needle into the center of the upright vial and inject air into the vial. 9/3/2024 By Mohammed A 51

52. Cont.… 5 . remove the exact amount of medicine while touching only the syringe barrel and plunger tip (see Figure ). 9/3/2024 By Mohammed A 52

53. Cont.… 6. Expel air from the syringe while needle remains within the inverted vial by tapping the side of the syringe with your finger. 7. Check the amount of medicine in the syringe. 8. Turn vial upright and remove the needle. 9. Replace the needle cap. Open the sterile package of the new needle. Remove used needle, and dispose in the sharps container. 10. Attach the new needle to the syringe by turning the barrel to the right. 11. Compare the medication in the syringe with the prescribed dosage. 9/3/2024 By Mohammed A 53

54. Confirm the vial label. 9/3/2024 By Mohammed A 54

55. Prepare the syringe . 9/3/2024 By Mohammed A 55

56. Cleanse the vial’s rubber top. 9/3/2024 By Mohammed A 56

57. Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial. 9/3/2024 By Mohammed A 57

58. Withdraw the appropriate volume of medication. 9/3/2024 By Mohammed A 58

59. Withdrawing Medication from an Ampoule Equipment Medical administration record (MAR) Ampule of prescribed medication Sterile syringe and needle Sterile gauze or alcohol swab 9/3/2024 By Mohammed A 59

60. Procedure Wash your hands. Hold the ampule and quickly and lightly tap the top chamber until all fluid flows into the bottom chamber. Place a sterile gauze or alcohol wipe around the neck of the ampule. 9/3/2024 By Mohammed A 60

61. Cont.… 4 . Firmly grasp the neck of the ampule and quickly snap the top off away from your body. Place the ampule on a flat surface. 5. Withdraw the medication from the ampule, maintaining sterile technique. Check connection of needle to syringe by turning barrel to right while holding needle guard. 9/3/2024 By Mohammed A 61

62. Cont.… Remove needle guard, and hold syringe in dominant hand. With non dominant hand grasp ampule and turn upside down. Insert the needle into the center of the ampule; do not allow the needle tip or shaft to touch the rim of the ampule. 9/3/2024 By Mohammed A 62

63. Cont.… Aspirate the medication by gently pulling on the plunger. If air bubbles are aspirated, remove the needle from the ampule. Hold syringe with needle pointing up and tap sides of the syringe. Draw back slightly on plunger, and gently push the plunger upward to eject air. Reinsert the needle into the ampule and continue to withdraw the medication. 9/3/2024 By Mohammed A 63

64. Cont.… 6. Remove excess air from the syringe and check the dosage of medication in the syringe. Recap. 7. Discard any unused portion of the medication, and dispose of the ampule top in a suitable container after comparing with MAR. 8. Change needle and properly discard used needle. Secure needle to syringe by turning the barrel to right while holding the needle guard. 9. Wash hands. 9/3/2024 By Mohammed A 64

65. Hold the ampule upright and tap its top to dislodge any trapped solution. 9/3/2024 By Mohammed A 65

66. Place gauze around the thin neck… 9/3/2024 By Mohammed A 66

67. …and snap it off with your thumb. 9/3/2024 By Mohammed A 67

68. Draw up the medication. 9/3/2024 By Mohammed A 68

69. Mixing Medications from Two Vials into One Syringe Some medications need to be mixed from two vials or from a v i a l a n d a n a m p u l e M i x i n g c o m p a t i b l e m e d i c a t i o n s a vo i d s t h e n e e d t o g i v e a p a t i e n t m or e t h a n on e i n j e c t i o n Consult a compatibility chart or a pharmacist for compatible medications. 9/3/2024 By Mohammed A 69

70. Cont.… If medications are going to be mixed, care must be exercised not to contaminate one medication with the other in their respective vials. The nurse must calculate and measure carefully to be sure the final dose is accurate. 9/3/2024 By Mohammed A 70

71. Equipment Medication administration record (MAR) Insulin vials Alcohol swabs Insulin syringe 9/3/2024 By Mohammed A 71

72. Procedure Check with the client and the chart for known allergies or medical conditions that would contraindicate the use of the drug. Gather necessary equipment. Check the MAR against written health care orders. Wash your hands. 5. Follow the 10 rights of medication administration. Check the client’s identification band. 9/3/2024 By Mohammed A 72

73. Cont.… 6. Remove caps from insulin vials (if not already off). 7. Slowly rotate each bottle of insulin. Never shake. Make sure suspensions are thoroughly mixed. (Cloudy insulin such as NPH should be completely mixed.) 8. Clean the rubber stoppers of the vials with an alcohol swab . 9/3/2024 By Mohammed A 73

74. Cont.… 9. Remove cap from the needle. Draw air into the syringe equal to the dose of insulin to be given. Insert needle into vial of the suspension, being careful not to touch the needle to the medication in the vial. Inject the air into the vial and remove the needle. Do not withdraw any insulin yet. 10. Fill syringe with air equal to dose of regular insulin. Insert needle into bottle and inject air into vial. Invert bottle and pull plunger down to withdraw the appropriate dose of insulin. 9/3/2024 By Mohammed A 74

75. Cont.… 11. With needle in the bottle, hold it up to the light and look for air bubbles. To remove air bubbles, tap or flick the syringe with your finger to cause air to rise. Push plunger to push air and some insulin back into the vial. Pull back to get the appropriate dose of insulin free of air. Remove the needle. 9/3/2024 By Mohammed A 75

76. Cont.… 12. Insert needle into the vial of longer-acting insulin; be sure the tip of the needle is below the surface of the fluid level. Invert the bottle, and slowly draw back to dose of insulin required. Remove needle. • Have another nurse check the prescribed dose. 13. Store insulin vials according to your agency policy. 14. Wash your hands. 9/3/2024 By Mohammed A 76

77. Preparing an IV Solution To prepare an IV solution, read the agency’s protocol and gather the necessary equipment. Because IV equipment and solutions are sterile, check the expiration date on the package prior to usage. The solution can be prepared at the nurses’ work area or in the client’s room. 9/3/2024 By Mohammed A 77

78. Equipment IV solution (bag or bottle) Administration set (vented or non-vented) Extension set IV pole IV line filter 9/3/2024 By Mohammed A 78

79. Procedure Wash hands before preparing IV equipment. Check the health care practitioner’s order for the type and amount of solution. Check integrity of the IV solution and equipment. Select IV tubing in accord with agency policy. Prepare IV solution label with client’s name, date, time, additives, and your initials. 9/3/2024 By Mohammed A 79

80. cont.… 6 . Prepare the IV solution bag for administration Remove outer wrapper around IV bag of solution. Inspect bag for tears or leaks by noting any moisture on the protective covering. Apply gentle pressure and observe for leakage. Examine solution for discoloration, cloudiness, or particulate matter by holding the bag against a dark and light background; if there is any evidence of contamination, do not use, and return agency’s dispensing department. 9/3/2024 By Mohammed A 80

81. Cont.… 7. Hang IV bag on the IV pole. 8. Remove administration set from the package and close the roller clamp on the IV tubing 9. Remove the protective cap from the non-vented IV tubing spike and maintain the sterility of the spike. 9/3/2024 By Mohammed A 81

82. Cont.… 10. Grasp the port of the IV bag with your non-dominant hand. With your dominant hand, remove the plastic tab covering the port (see Figure ) and insert the full length of the spike into the bag’s port . 9/3/2024 By Mohammed A 82

83. Cont.… 11. Squeeze and quickly release pressure on the drip chamber of the IV tubing until the chamber is one-third to one-half full. 12. Connect IV filter to tubing. • Remove cap from filter. • Fit tubing’s male adapter into filter’s female connector, and twist to ensure tight connection. • Hold filter so connector joint is pointed down. • Hold tubing’s end tip higher than the tubing’s dependent loop to displace the air. 9/3/2024 By Mohammed A 83

84. Cont.… • Open roller clamp on IV tubing to prime the tubing and filter. • Tap the filter as the IV solution runs through. • Close the roller clamp on the IV tubing 9/3/2024 By Mohammed A 84

85. Cont.…. 13. Replace the cap on the IV tubing’s free end. 14. Tag tubing with date and time and your own initials. The nurse prepares and applies a time strip to the IV solution bag to facilitate monitoring of the infusion rate as prescribed by the health care practitioner. 9/3/2024 By Mohammed A 85

86. Cont.… The IV tubing is tagged with the date and time to indicate when the tubing replacement is necessary. IV tubing is changed every 48 to 72 hours in accord with the agency’s protocol. 9/3/2024 By Mohammed A 86

87. Cont.… 17. Repeat steps as steps for plastic bag 18. Prepare the IV solution for administration. • Check bottle for cracks or leaks. • Remove metal cap, metal disk, and rubber diaphragm from top of glass bottle, or remove protective additive cap if pharmacy has added medications to the IV bottle. Listen for the escape of air when the rubber diaphragm is removed. 9/3/2024 By Mohammed A 87

88. Cont.… 19. Close the roller clamp on the IV tubing. 20. Remove the protective cap from the IV tubing spike and maintain the sterility of the spike. 21. Place the glass bottle on a firm surface, and, using firm downward pressure, insert the spike through designated port on the bottle cap. 22. Invert IV bottle (if the bottle is vented, the fluid inside the vent tube will escape), and hang the bottle on an IV pole. Then all are as plastic bag 23. Explain to the client what you are doing before taking the IV equipment into the client’s room. 9/3/2024 By Mohammed A 88

89. Medication calculation Methods used to calculate medication doses include The ratio and proportion method The formula method Dimensional analysis 9/3/2024 By Mohammed A 89

90. Calculating Tablet Dosages In calculating tablet dosages, the following formula is useful Number of tablets = 𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒 𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ Example:- Orders 1,500 mg of calcium carbonate for the patient. The drug is available in 250 mg tablets. How many tablets should be given to the patient? 250 𝑚𝑔 Number of tablets = 1500 𝑚𝑔 = 6 tablets 9/3/2024 By Mohammed A 90

91. Calculating Mixtures and Soluti ons The f ollow i n g f o r mul a is use f u l in calc u lati n g mixtures and solutions: 𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ Amount of solution to be given = 𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒 x Stock volume The orders 375 mg of cefuroxime for the patient. The drug is available in 750 mg vial. You plan to dilute it in 10 mL of sterile water. How much should you give to your patient? 375 𝑚𝑔 750 𝑚𝑔 x 10 ml Amount of solution to be given = • = 0.5 mg x 10 ml = 5 ml 9/3/2024 By Mohammed A 91

92. Calculate IV Rate – mL per hour and minute T ime (Hour or Minute) Start venoclysis with D5 0.9 NaCl 1 L to be infused for 16 hours. How many mL of the IV fluid should you infuse per hour? 1 L ÷ 16 hours = mL per hour [ 1 L x 1,000] = 62.5 mL per hour 16 hours It is easy to calculate the running rate of IV fluids in terms of mL per hour or mL per minute: ML per hour or minute = Total IV Volume 9/3/2024 By Mohammed A 92

93. Calculate IV Rate – drops per minute C a lcu l a t i ng f o r d r ops pe r min u t e i s simple wi t h t h e following formula: Time (Minute) – Drops Per Minute = Total IV Volume x Drop Factor Example The physician orders to start venoclysis with D5 0.3 NaCl 1 L solution. The IV fluid will be infused for 14 hours and the drop factor of the macrodrip used is 20. It should be regulated to how many drops per minute? – Drops Per Minute = [1 L x 1,000] x 20 [ 14 hours x 60] [1,000 mL ÷ 840 minutes] x 20 = drops per minute 1.19 x 20 = 23 to 24 drops per minute 9/3/2024 By Mohammed A 93

94. Calculate IV Rate – Remaining Time of Infusion Example A patient has 350 mL of Plain 0.9 NaCl solution as IV infusion regulated at 20 drops per minute. Drop factor 10 was used for the patient’s macrodrip set. Considering the IV fluid level of the patient, for how many minutes will it run? Calculating for the remaining time of infusion for a certain IV fluid is possible with the following formula: Drops per minute Minutes Remaining = Volume remaining (in ml) x Drop Factor 20 Drops per minute Minutes Remaining = 350 mL x 10 = 175 minutes or 3 hours 9/3/2024 By Mohammed A 94

95. Oral Medication administration Oral administration is process by which drugs are delivered by mouth through alimentary tract. They can be either liquid or solid form. 9/3/2024 By Mohammed A 95

96. Cont.… Oral medication can be by ing e sti o n , su b lingu a l administration (place the pill or direct spray between the underside of the tongue and the floor of the oral cavity)or buccal (place the medication between the patient’s cheek and gum). 9/3/2024 By Mohammed A 96

97. EN T ERAL O RAL REC T AL BUCCAL SUBLIN G UAL 9/3/2024 By Mohammed A 97

98. ORAL RO U TE Oral refers to two methods of administration: applying topically to the mouth swallowing for absorption along the gastrointestinal (GI) tract into systemic circulation po (from the Latin per os ) is the abbreviation used to indicate oral route of medication administration 9/3/2024 By Mohammed A 98

99. Advantages of oral route Most commonly used method Safe, convenient and painless procedure. Economical as sterilization of drug products is not essential Easy to administer the dosage. No need of any assistant or special technique. Self-medication is possible. Drug withdrawal is easily possible in case of overdose Useful in children as well as adult patients. Prolong duration of action. 9/3/2024 By Mohammed A 99

100. Disadvantages of oral route Onset of action is slower (30-90 min) Polar drugs can't be given as they are not absorbed Inactivation by digestive juices (penicillin-G, insulin, oxytocin). Acid sensitive drugs (penicillin-G). Presence of food in stomach first pass metabolism (for example- morphine, isoprenaline). 9/3/2024 By Mohammed A 100

101. Bad taste and unpleasant smell and irritant drugs Unconscious and uncooperative patients. During emesis and diarrhea. Antibiotics like tetracycline cause brown color staining on teeth as well as nails in infants. 9/3/2024 By Mohammed A 101

102. Oral Dosage Forms Common dose forms for oral administration 🞑 tablets 🞑 capsules 🞑 liquids 🞑 solutions 🞑 suspensions 🞑 syrups 🞑 elixirs 9/3/2024 By Mohammed A 102

103. SUBLINGUAL ROUTE Sublingual administration is where the dosage form is placed under the tongue 🞑 rapidly absorbed by sublingual mucosa 9/3/2024 By Mohammed A 103

104. SUBLINGUAL ROUTE ADVANTAGES Economical Quick termination Firs t - p a s s a v o ided Drug absorption is quick DISADVANTAGES Unpalatable & bitter drugs Irritation of oral mucosa Large quantities not given Few drugs are absorbed 12 9/3/2024 By Mohammed A 104

105. BUCCAL ROUTE Buccal administration is where the dosage form is placed between gums and inner lining of the cheek (buccal pouch) 🞑 absorbed by buccal mucosa 9/3/2024 By Mohammed A 105

106. BUCCAL ROUTE ADVANTAGES Avoid first pass effect Rapid absorption Drug stability DISADVANTAGES Inconvenience – advantages lost if swallowed Small dose limit 9/3/2024 By Mohammed A 106

107. ♣ The nurse should check wether the pt has any known allergy ♣ Check the rights ♣ ♣ Do not handle tab,cap,mix,syr unnecessarily to avoid contamination. ♣ ♣ Shake bottle well b4 taking syr a nd mix ♣ ♣ Do not adm water after giving cough syr Precaution 9/3/2024 By Mohammed A 107

108. Vomiting Reduced gi motility(after GAM bowel inflammation) resection of portion GIT Inability to swallow Pts with gastric suction/aspiration Prior to certain test/surgery Unconscious/ confused pts Poor gag reflex Contra indication 9/3/2024 By Mohammed A 108

109. Equipment's Medication card Medication tray Small plastic cups/ paper cups/ ounce glass Glass of water Caliberated disposable cups/ ounce glass Mortar& pestle Scissor Kidney tray Paper towel/ tissue paper Teaspoon Dropper Cup with sterile water for drinking 9/3/2024 By Mohammed A 109

110. Procedure Explain procedure Assist pt in sitting position if possible Lateral position can be given unless contraindicated Spread the towel under chin across chest Wash hands Take medicine card verify physician order Take appropriate medicine from shelf compare with chart and read the entire label including exp date Calculate dose & double check 9/3/2024 By Mohammed A 110

111. Cont …. PREPARATION: For tablets & cap pour required nu mber into bottle cap 1 st and then into medicine cup. Take required number. Do not touch use gloved hand . If there is need to broken to adm half dose. Assess clients condition, if not able to swallow, ask physician to dissolve in liquid. To crush the medication use mortar and pestle. 9/3/2024 By Mohammed A 111

112. Cont.… PREPARE LIQUIDS Remove bottle cap from container and place cap upside down Pour liquids from opposite side of label hold measuring cup at eye level and place thumb nail at correct measurement and scale shuold be even with fluid level. If there is excessive medicine, discard in sink. Wipe the mouth of bottle& close it. Check exp date Replace medicine to the shelf and read label again. 9/3/2024 By Mohammed A 112

113. Co n t., Administering medication Identify right pt(comparing name and medicine card, calling pt name,asking pt to repeat his name) Explain purpose of each drug and its action Offer some water or juice to the patient thus prevent sticking of medication 9/3/2024 By Mohammed A 113

114. Sublingual administration Pt should be placed in supine position The pt places medication under the tongue for atleast 10 minutes. Avoid opening mouth, eating, drinking, chewing during this time Shift the tab to a different position under the tongue if necessary Wait several minutes after dis solving the sublingual medication before drinking or rinsing the mouth. 9/3/2024 By Mohammed A 114

115. Buccal administration The tablet should be placed b/w gum and the walls of cheek. With the mouth closed, the tablet should be held in this position for 5 – 10 minutes or until it has dissolved Do not adm fluids until medication dissolves. Powdered medicines are mixed at bed side Stay with pt until swallow and check the mouth for ensuring swallowing. Wipe mouth and remove towel 9/3/2024 By Mohammed A 115

116. Co n t., Return with in 30 minutes to evaluate response Replace the articles Wash dry and replace Wash hands Recording and reporting 9/3/2024 By Mohammed A 116

117. Topical Medication Topical medications are applied directly to the body surfaces, including the skin and mucous membranes of the Eyes Ears Nose Vagina Rectum. 9/3/2024 By Mohammed A 117

118. Cont.… Topical medications differ from many other type of drugs because mishandling them can lead to certain complications in a patient or administrator of the drug. Many topical medications are epicutaneous. meaning that they are applied directly to the skin. 9/3/2024 By Mohammed A 118

119. Purpose The purpose of using topical medicine is to deliver medication directly onto areas of the skin that are Irritated, Inflamed, Itching, or Infected. 9/3/2024 By Mohammed A 119

120. Cont.… Topical medicines are often applied directly onto a rash or irritated area on the skin for rapid relief of symptoms. 9/3/2024 By Mohammed A 120

121. Cont.… There are many classes of topical medications, such as creams, ointments lotions patches aerosol sprays. 9/3/2024 By Mohammed A 121

122. Cont.… the administration of the topical medications requires wearing gloves to protect the healthcare provider from accidental exposure and absorption of the medication. Topical medications should never be applied with the bare hands . 9/3/2024 By Mohammed A 122

123. Administering Eye and Ear Medications Definition: Medications are instilled in mucous membranes of eye for various therapeutic effects. Purpose: To treat infection. To relieve inflammation. To treat eye disorders such as glaucoma. To diagnose such as foreign bodies and corneal abrasions. 9/3/2024 By Mohammed A 123

124. Eye Instillation Administration of medicine drop by drop into eyes. Articles T r a y B o w l Cotton swabs Dropper Gloves Medicine Kidney tray 9/3/2024 By Mohammed A 124

125. Perform hand washing. Position the patient. Ask patient to lie supine or sit back in chair with head slightly hyperextended. Wipe the eyes with cotton balls from inner canthus to outer canthus. Take the medicine. Expose the lower conjunctival sac by placing the thumb or fingers of nondominant hand on the client’s cheekbone just below the eye and gently drawing down the skin on the cheek. 9/3/2024 By Mohammed A 125

126. 6 . Administer the medication drops into conjunctival sac. 7. After instilling drops, ask patient to close eye gently. 8. Replace the articles and document the procedure. 9/3/2024 By Mohammed A 126

127. Ear Instillation Administration of medicine drop by drop into ear. Articles Tray Dropper Gloves Medicine 9/3/2024 By Mohammed A 127

128. Perform hand washing. Place p a t i e n t insid e - l yi n g position. Straighten ear canal by pulling auricle down and back (children younger than 3 years) or upward and outward (children 4 years of age and older and adults). Instill prescribed drops holding dropper 1 cm above ear canal Ask patient to remain in side-lying position 2 to 3 minutes. Replace the articles and document the procedure. 9/3/2024 By Mohammed A 128

129. Nasal Instillation Administration of medicine drop by drop into nose. Articles Tray Dropper Gloves Medicine 9/3/2024 By Mohammed A 129

130. Perform hand washing. Instruct the patient to clear or blow nose gently. Position the patient. Supine position with head backward. Take the medicine in dropper. Administer the nasal drops. Have patient remain in supine position 5 minutes. Replace the articles and document the procedure. 9/3/2024 By Mohammed A 130

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132. INHALATION ROUTE Inhalation is a means of administration of medications through the respiratory system in the form of a gas, vapor, etc. In this way drugs can pass directly to the lungs. major types: vaporization, gas inhalation, and nebulization. Vaporization is the process by which a drug is changed from a liquid or solid to a gas or vapor by the use of heat (such as in steam inhalation). Equipment used for inhalation route include ventilator,inhaler,nebulizer, inhalation pump, metered dose container and oral pump. 9/3/2024 By Mohammed A 132

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134. Volatile liquids and gases are given by inhalation, e.g. general anesthetics. In addition, drugs can be administered as solid particles, i.e. solutions of drugs can be atomized and the fine droplets are inhaled as aerosol, e.g. salbutamol. These inhaled drugs and vapors may act on the pulmonary epithelium and mucous membranes of the respiratory tract and are also absorbed through these membranes. For example : general anesthetics, aerosol of salbutamol and ipratropium bromide 9/3/2024 By Mohammed A 134

135. Ventilator 9/3/2024 By Mohammed A 135

136. Advantages of inhalation route certain critical emergency cases like bronchial asthma, hypoxia, apnea, angina pectoris, trauma, surgery and general anesthesia Hepatic first pass metabolism is avoided Rapid onset of action takes place (1-3 min) This route has minimum side effects Almost instantaneous absorption of the drug is achieved because of the large surface area of the lungs. 9/3/2024 By Mohammed A 136

137. Special equipments are required Irritation of the respiratory tract may take place Cooperation of the patient is required Irritant gases may enhance pulmonary secretions—should be avoided. This is an important route of entry of certain drugs of abuse. 9/3/2024 By Mohammed A 137

138. Skin Applications Skin applicants are applied using gloves. Before applying medications, clean the skin thoroughly. When applying skin applicants, spread the medication evenly over the involved surface and cover the area well. Topical skin or dermatologic preparations include ointments, pastes, creams, lotions, powders, sprays, and patches. 9/3/2024 By Mohammed A 138

139. Procedure for Applying Skin Preparations POWDER ;- Make sure the skin surface is dry. Spread apart any skinfolds, and sprinkle the powder until the area is covered with a fine thin layer of powder. Cover the site with a dressing if ordered. 9/3/2024 By Mohammed A 139

140. LOTION ;- Shake the container before use. Put a little lotion on a small gauze dressing or gauze pad, and apply the lotion to the skin by stroking it evenly in the direction of the hair growth. 9/3/2024 By Mohammed A 140

141. CREAMS, OINTMENTS, PASTES ;- Take the medicine in gloved hands. Spread it evenly over the skin using long strokes in the direction of the hair growth. Apply a sterile dressing if ordered by the physician. 9/3/2024 By Mohammed A 141

142. AEROSOL SPRAY Shake the container well to mix the contents. Hold the spray container at the recommended distance from the area (usually about 15 to 30 cm. Cover the client’s face with a towel if the upper chest or neck is to be sprayed. Spray the medication over the specified area. 9/3/2024 By Mohammed A 142

143. TRANSDERMAL PATCHES Select a clean, dry area that is free of hair. Remove the patch from its protective covering, holding it without touching the adhesive edges, and apply it by pressing firmly with the palm of the hand for about 10 seconds. Advise the client to avoid using a heating pad over the area to prevent an increase in circulation and the rate of absorption. Remove the patch at the appropriate time, folding the medicated side to the inside so it is covered. 9/3/2024 By Mohammed A 143

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145. Direct application of liquids- Gargle Gargling is the act of bubbling a liquid in mouth to reduce the sore throat. The head is tilted back, allowing a mouthful of liquid to sit in the upper throat. 9/3/2024 By Mohammed A 145

146. Insertion of drug into body cavity- suppository A suppository is a medicated solid dosage form used in the rectum, vagina and urethra. Vaginal suppositories are called pessaries. Urethra suppositories are called bougies. 9/3/2024 By Mohammed A 146

147. Rectal suppository Rectal suppository: Insertion of medications into the rectum in the form of suppositories. Procedure: Give left lateral position, with the upper leg flexed. Expose the buttocks. Wear gloves. Unwrap the suppository and lubricate the suppository. Lubricate the gloved index finger. 9/3/2024 By Mohammed A 147

148. Encourage the client to relax. Insert the suppository gently into the anal canal, rounded end first along the rectal wall using the gloved index finger. Press the client’s buttocks together for a few minutes. Ask the client to remain in the left lateral or supine position for at least 5 minutes to help retain the suppository. 9/3/2024 By Mohammed A 148

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150. Vaginal Instillations Medications inserted into the vagina are in the form of suppositories, creams, gels, ointments, foams, or douches. These medications may be used to treat inflammation, infections, and discomfort, or as a contraceptive measure. Tampon Use Clients should be instructed not to use tampons after the insertion of vaginal medications because the tampon can absorb the medication and decrease the drug’s effect 9/3/2024 By Mohammed A 150

151. Equipment Medication administration record (MAR) Non-sterile gloves Prescribed vaginal suppository Water-soluble lubricant Disposable applicator Tissue 9/3/2024 By Mohammed A 151

152. Procedure Check with the client and the chart for known allergies or medical conditions that would contraindicate the use of the drug. Gather necessary equipment. Check the MAR against written health care practitioner orders. Wash your hands. Follow the five rights of medication administration. Ask the client to void. Position the client in a dorsal recumbent position with knees flexed and hips rotated laterally or in a Sims’ position if the client cannot maintain the dorsal recumbent position. 9/3/2024 By Mohammed A 152

153. Cont.… 5. Don non-sterile gloves. Explain procedure to patient. If client plans to self-administer, be very specific with instructions. 6. Provide for privacy. Assess perineal area, inspect vaginal orifice, note any odor or discharge from the vagina, and inquire about any problems such as itching or discomfort. If secretion or discharge is present, cleanse the perineal area with soap and water. 7. Remove suppository from the foil wrapper and, if applicable, insert into applicator tip. Apply a small amount of lubricant to rounded tip of suppository. If not using an applicator, apply a small amount of lubricant to gloved index finger. 9/3/2024 By Mohammed A 153

154. Cont.… 8. With non dominant hand, spread labial folds. Insert the suppository into the vaginal canal at least 2 inches (5 cm) along the posterior wall of the vagina or as far as it will go. If using an applicator, insert as described above and depress plunger to release suppository 9/3/2024 By Mohammed A 154

155. Cont.… 9. Wipe the perineum with clean, dry tissue. Instruct the client to remain in bed for 15 minutes. 10. Wash applicator under cool running water to clean (warm water promotes coagulation of protein secretions) and return to appropriate storage in the client’s room. 11. Remove gloves, turning them inside out; dispose of gloves in the proper container. Wash hands. 9/3/2024 By Mohammed A 155

156. Cont.… 12. Record on the MAR the drug’s name dosage, route, and date and time of administration; document any evidence of discharge or odor from the vagina. 13. Check with the client in 15 minutes to ensure that the suppository did not slip out and to allow the client to verbalize any problems or concerns. 14. Observe for effectiveness of the medication; inspect the condition of the vaginal canal and external genitalia between applications. 9/3/2024 By Mohammed A 156

157. Mohammed A ( Bsc .N, MSc .N) 9/3/2024 By Mohammed A 157