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Medication Adiministration PDF
Medication Adiministration PDF
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objective: - At the end of the chapter learner will be
able to:-
1. Perform medication withdrawing from a vial and
ampoule
2. apply rights of medication administration
3. Identify necessary equipment for administering
medication via SC, ID, IM and IV.
4. administer medication and fluid with acceptable
technique
5. re-demonstrate how to administer drug via different
routes
6. Apply the necessary steps to carry out the proper
mixing of drugs
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Medication administration is a basic nursing function that
involves skillful technique and consideration of the clients’
development and safety. Nurse administering medication
is expected to have a knowledge base concerning drugs,
including: drug names, preparations, classifications,
adverse effects, mechanisms of drug actions, and
physiologic functions that affect drug action.
The nursing process can be applied to the fundamental
nursing skills of medication administration. Assessment
entails a comprehensive medication history as well as
ongoing assessment of the client’s response during and
after drug therapy.
The terms drugs and medication may be used
interchangeably, but there is slight difference b/n the two.
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Drug:-is any substance that alters the
physiologic function of the body, with
the potential of affecting health.
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Therapeutic agents are drugs or medications
that, when introduced in to living organism,
modify the physiologic functions of that
organism.
The study that deals with chemicals that affects
the body’s functioning is called pharmacology.
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Cont…
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MECHANISM OF DRUG ACTION
1. PHARMACODYNAMICS
• Drugs act at the cellular level to achieve their desired
effect.
The process by which drugs alter the cell physiology is
called pharmacodynamics.
One of the mechanisms of drug action is a drug receptor
interaction.
The drug fits the receptor sites as the key fits the lock.
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Drugs may also combine with enzymes to
achieve the expected effect, which is referred
to as drug enzyme interaction.
Some drugs act on cell membrane or alter the
cellular environment.
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Cont…
2. PHARMACOKINETICS
Pharmacokinetics is the study of the movement of
drug molecule in the body in relation to drug’s
absorption, distribution, metabolism and
excretion.
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Cont…
• Absorption:-is a process by which a drug is
transferred from its site of entry into the body
to the blood stream.
• Distribution:-after it has been absorbed into
the blood stream; the drug is distributed
throughout the body.
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Cont…
• Metabolism:-metabolism or
biotransformation is the breakdown of the
drug to an inactive form in the liver.
• Excretion:-after it is broken down into inactive
form, elimination of the drug from the body
occurs. Most drugs are excreted by the kidney.
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FACTORS AFFECTING DRUG ACTION
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Cont…
• Sex: - this is due to the difference in body fat
and fluid content between male and female
that will affect absorption and distribution of
drugs and also may be due to hormonal
fluctuation/variation.
• Weight:-wt and body surface area can affect
drug action.
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ADVERSE DRUG EFFECT
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Parts of the medication order
The medication order consists of seven parts.
These are:
• Client’s name
• Date & time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Route by which the drug is to be administered
• Frequency of administration
• Signature of a person writing the order
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Nomenclature of drugs
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• The official name:-is the name by which the
drug is identified in the official publication.
• The trade name(brand name or proprietary
name), is selected by the drug company that
sells the drug & is copyrighted. A drug can have
several trade names when produced by
different manufacturers.
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Classifications of drugs
• Drugs can be classified from d/t perspectives. For
example;
– By body system affected by the drug(drugs that affect the
respiratory system, the cardiovascular system),
– By the symptom relieved by the drug (antipain, analgesics),
– By the clinical indications for the drug (antibiotics,
antifungal …)
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Common abbreviations used in drug
administration.
Abbreviations meanings
Po ……………………..by mouth
bid ………………………twice a day
tid ………………..…….. three times a day
Qid ………………….....four times a day
ac…………………………before meal
Pc ………………………..after meal
hs ………………………at bed time
Qd …………………….every day
prn …………………….as needed
Qod ……………………every other day
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Abbreviation cont…
OS ...................left eye
OD ………….…………right eye
OU ……………both eyes
Q2h …………every 2 hours
Qhr …………...every hour
am ………. …in the morning
Pm …………...after noon
IV……………Intravenous
IM…………….Intramuscular
ID…………….Intradermal
SC…………….Subcutaneous
Stat……………once onlly
KVO…………keep vein open
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TYPES OF PREPARATION
Medications are prepared in various forms.
The most desirable form of medication for any
client is determined by the disease process
being treated, age of the person, ability of the
client to swallow etc.
Accordingly, there are –
• oral preparation
• topical preparation
• parentral preparation, etc.
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.
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– Tablets - a small disc or flat round piece of dry drug
containing one or more drugs made by compressing
a powdered form of drug(s)
– Emulsion-oil based preparation
– Enteric coated- prepared to be dissolved and
absorbed in the intestine.
– Lozenges-sweet medicinal tablet containing sugar
that dissolve in the mouth so that the medication is
applied to the mouth and throat
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Oral prep. Cont.
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.
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• Paste=thicker & stiffer than ointment
• Lotion=clear, suspension, emollient liquid
• Gel or jelly=clear, translucent form.
• Suppository=prepared to be inserted through
the rectum/ anus, & vagina
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3. Parentral preparation: - prepared to be
.
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DRUG MEASUREMENT SYSTEM
1. The metric system:-the metric system of drug
measurement system is the most widely
accepted and convenient/suitable method.
The metric system is the decimal system in which
each unit can be divided into multiples of 10.
The basic units of measurement are;
meter (linear),
liter (volume) &
gram (weight).
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Cont…
2. The apothecary system:-less convenient & precise
than the metric system and infrequently used.
In this system the basic unit of weight is the grain.
The minim, dram, ounce, pint, & quart are used for
volume.
In this system Roman numerals are used to express
numbers (grain x )and quantities less than one are
written in fraction form (grain ¼)
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Cont…
3. The household system:-used when accurate
systems of measurements are not required,
because it is the least accurate one.
Units of measurement include: drops,
teaspoon, tablespoon, teacup, cups, glasses,
etc.
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Approximate metric system equivalents
Metric Apothecary
Household
5 ml 1 fluid dram 1 teaspoonful
10 ml 2 fluid drams 1 dessert spoonful
15 ml 4 fluid drams 1 table spoonful
30 ml 1 fluid ounce 1 ounce
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Drug Dose Calculations
Several formulas may be used when calculating
drug doses.
One formula uses ratios based on the dose on
hand and the dose desired.
Dose on hand ₌ Dose desired
Quantity on hand Quantity desired
Eg. If a health care practitioner wants to
administer Amoxicillin 625 mg po TID and the
dose preparation is 250mg/5ml solution how
much volume would you administer.
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Answer:
Dose on hand= 250mg .
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Pediatric Dosages
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The approximate child dose is calculated as;
approximate child dose
= Body surface area of child × adult dose
Body surface area of adult
approximate child dose
= Body suface area of child (M²) × adult dose
1.73 m²
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Dosage cont…
Child dose =
wt of child in pound × Usual adult dose
150pound
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Intravenous medication calculation
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IV flow rates are calculated in drops/min.
To calculate IV drip rate you can use the following
formula.
Drops per min.=
amount of solution(ml) × drip rate factor gtt/ml
time in minute
1ml= 15-20 gtt/ml drop, this is the drip rate factor.
So use 15 gtt/ml for adult size cannula(green)
20 gtt/ml for pediatrics size cannula(yellow)
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Example
Q. If you want to administer 1 liter of normal saline for
an admitted adult over 8 hour, what will be the drop
per minute to administer the solution over the given
time.
Soln. Amount of solution= 1liter= 1000ml
Time given = 8 hr= 480min.
Drops per min.=
amount of solution(ml) × drip rate factor
time in minute
Drops per min.= 1000ml × 15 gtt/ml
480min
=31.25~31drop/min
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Maintaining safety when administering medication
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The three checks:-the label on the medication
container should be checked three times during
medication preparation.
• When the nurse reaches for container or unit dose
package.
• Immediately before pouring or opening the
medication and
• When replacing the container to the drawer or
shelf or prior to giving the unit dose to the client.
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The five rights of medication administration
• The five rights ensure accuracy when administering
medications. These five rights are:
– Right client/pt
– Right drug/medication
– Right dosage
– Right route
– Right time
– Right documentation
– Right client/pt education
– Right refuse
– Right assessment
– Right
• The nurse gives the right medication for a right client
in a right dosage through the right route at the right
time.
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ROUTES OF DRUG ADMINISTRATION
Pharmaceutical preparations are generally
designed for one or two specific route of
administration.
The route of administration should be indicated
when the drug is ordered.
When administering the drug, the nurse should
ensure that the pharmaceutical preparation is
appropriate for the route specified.
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Routes of Medication Administration
1. Topical
• Dermatological
• Instillations and irrigations
• Inhalation
• Ophthalmic, otic, nasal, rectal, and vaginal
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2. systemic
• Oral (PO)
– Swallowing
– Sublingual (SL)
– Buccal
– Enteral Instillation
• Suppository
• Parenteral
– Subcutaneous (SC)
– Intramuscular (IM)
– Intradermal (ID)
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–Intravenous (IV)
–Intra-arterial (IA)
–Intracardiac (IC)
–Intraosseous (IO)
–Intrathecal (intraspinal) (IT) (IS)
–Epidural (ED)
–Intra-articular
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1. Oral(po)
Drugs given orally are intended for absorption in the
stomach & small intestine.
Advantage-
• Most common & least expensive route
• Most convenient &safest route for clients
• Doesn’t break skin barrier& doesn’t cause stress.
Disadvantages
• Unpleasant taste
• GI- irritation
• May discolor or harm the teeth
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Oral cont…
Purpose
a. When local effects on GI tract are desired
b. When prolonged systemic action is desired
Contra- indications
1. For a patient with nausea & vomiting, unconscious
patients.
2. When digestive juices inactivate the effect of the
drug.
3. When there is inadequate absorption of the drug,
which leads to inaccurate determination of the
drug absorbed.
4. When the drug is irritating to the mucus membrane
of the alimentary canal.
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Sublingual and Buccal Drug Administration
• Sublingual and buccal drugs are types of oral
medications.
• Certain drugs are given by these routes to prevent
their destruction or transformation in the stomach
or small intestines.
• Drugs given by these routes are quickly absorbed by
the mucosa’s thin epithelium and the abundant
blood supply.
E.g. Nitroglycerine-a drug for treatment of angina
pectoris (severe chest pain)
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• In sublingual administration a drug is placed
under the tongue, where it dissolves.
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• Buccal means “pertaining to the cheek.”
• In buccal administration a medication is held
in the mouth against the mucous membranes
of the cheek until the drug dissolves.
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Sublingual buccal
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Enteral Instillation of Drugs
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• Position the client as appropriate; clients with
an NG tube should be placed on the right side
with the head of the bed slightly elevated for
at least 30 minutes after the instillation.
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2. Suppository
Administration of medication in to the anus
Purpose
• To produce a laxative effect. (bowel
movement),suppository is used frequently instead
of enema since it is inexpensive.
• To produce local sedative in the treatment of
hemorrhoids or rectal abscess.
• To produce general sedative effects when
medications cannot be taken by mouth
• To check rectal bleeding
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.
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• They are also used to relieve nausea and
vomiting.
• Suppositories are also used to induce
relaxation, relieve pain and local irritation,
reduce fever, and stimulate peristalsis and
defecation in clients who are constipated.
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.
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Procedure
With index finger of dominant hand, gently insert
suppository through anus, past the internal
sphincter, and place against rectal wall, 10 cm
for adults or 5 cm for children and infants.
Keep client flat on back or on side for 5 minutes.
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.
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Kinds of Suppositories Used:
1. Bisacodyl is commonly ordered for its laxative action.
It stimulates the rectum and lubricates its contents.
Normally 15 minutes is needed to produce bowel movement.
2. Glycerin or suppository for bringing about bowel movement.
If soap suppository is used cut a splinter of soap 2-6 cm.
loch and wash it in hot water to smooth the rough edges before
administration.
3. Bismuth - for checking diarrhea.
4. Opium, sodium barbital etc. for sedation
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Vaginal Instillations
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3. Parentral route:
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Medications given by parentral route usually
absorbed completely and begin acting faster
than medications given by other routes.
These medications are given through the skin;
bypassing the skin barrier & makes infection
more likely if aseptic technique is not used
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Syringes and Needles
Syringe
Hypodermic needle
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Draw up the medication.
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A) Intradermal Injection
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The ID route has the longest absorption period
(slow absorption) of all parentral routes,
for this reason, it is used for diagnostic
procedures, such as;
the tuberculin skin test, and
tests to determine sensitivity to various substances
,
because the body’s reaction to these substances is
easily visible.
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• Sites commonly used are inner surfaces of
forearm, the dorsal aspect of upper arm, & the
.
upper back.
• The needle is inserted at 15⁰ angle to the skin
for intradermal injection.
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Equipments-
• Tray
• file
• Receiver
• A vial or ampoule of sterile medication
• Vial of diluents (when necessary)
• Alcohol swab
• Dry sterile gauze
• Marking pen
• Sterile syringe and needle (1 cc syringe with short
bevel, 25 to 27 gauge needle)
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Procedure-
• Refer the chart, be sure that you have the right
patient
• Explain in the procedure to the patient
• Remove the vial cap (using file)
• Clean the rubber top of the vial with alcohol
swab
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• Tighten needle with syringe remove needle
guard
• Pull back on plunger to fill syringe with an
amount of air equal to amount of solution to
be with drawn.
• Insert needle into up-right vial.
• Inject air into bevel
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procedure. Cont..
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procedure. Cont..
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• Insert the needle at a 10° to 15° angle until
resistance is felt, and advance the needle
approximately 3 mm below the skin surface;
• The needle’s tip should be visible under the
skin.
• Inject medication slowly and with draw the
needle
• Wipe the injection site gently with sterile
gauze, do not massage the area.
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procedure. Cont..
• Check for the immediate reaction of the skin
(10-15 minutes later for tetanus, 20-30
minutes later for penicillin).
• Chart the date and time of administration of
the drug
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Intradermal Injections
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B) Subcutaneous (SC) or hypodermic
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Site of Injection
• Outer part of the upper arm
• The abdomen below the costal margin to the
iliac crest.
• The anterior aspect of the thigh
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SC cont..
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• For sc injection a 25 gauge needle is used, a
3/8 inch needle is inserted at 90 degree angle
for adult; and a 1/2 inch needle is inserted at
45 degree angle for a child.
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SC cont…
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This route is used to administer;
insulin,
heparin,
adrenalin (0.5ml) and
certain immunizations (measles vaccine).
Ordinarily no more than 1ml of solution is given
subcutaneously.
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Equipment -.
• Wash hands
• Fit part of the syringe together firmly without
touching the tip of the syringe.
• Never touch the needle also.
• If medication is in ampoule, disinfect the neck
of the ampoule and the file with the cotton
ball.
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• Fill ampoule at the base of neck and
snap/break top off, holding the cotton ball
over neck to protect fingers.
• Carefully insert the needle into the ampoule,
being careful that it doesn't touch the glass,
draw up dosage ordered.
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procedure. Cont..
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• Clean the site (usually it is in upper arms,
thighs or abdomen)
• Grasp the area between your thumb &
forefinger to tense it.
• Insert the needle elevate about 45 - 60 angle.
• Pierce the skin quickly & advance the needle
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procedure. Cont..
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Ventrogluteal (Gluteus medius)
The primary site for administering an IM injection in
clients over 7 months old is the ventrogluteal
(VG) site.
The gluteus medius is a well-developed muscle,
free of major nerves and large blood vessels.
Place palm of left hand on right greater trochanter
so that index finger points toward anterosuperior
iliac spine;
spread first and middle fingers to form a V; injection
site is the middle of the V.
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.
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Dorsogluteal
Is one of the earliest site of IM injection site at
the dorsal site of the gluteus.
These sites should be avoided in infants and
children. There is a risk of striking the sciatic
nerve.
Place hand on iliac crest and locate the
posterosuperior iliac spine.
Draw an imaginary line between the trochanter
and the iliac spine; the injection site is the
outer quadrant.
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Vastus lateralis:
• Identify greater trochanter; place hand at
lateral femoral condyle; injection site is middle
third of anterior lateral aspect.
• Is most of the time used for infants
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Deltoid
Locate the lateral side of the humerus from two
to three finger widths below the acromion
process in adults or one finger width below the
acromion process in children.
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Equipment:
• Disposable syringe and needle
• Cotton balls soaked in alcohol(swab)
• Small tray
• Medication
• Ampoule of sterile (if drug is to be dissolved)
• Fill
• Receiver.
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Procedure-
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• After inserting the needle into the buttocks,
pull back on plunger (three times) before
injecting solution, to see that the needle has
not hit a blood vessel.
• If any blood return withdraw and inject in a
different site.
• After injecting the solution, withdraw needle
quickly; and massage the area gently.
• This aids in the absorption of the medication.
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Z-Track Injection
place the client in the prone position then pull
the skin to one side, insert the needle at a 90°
angle and administer the medication.
waits 10 seconds and withdraws the needle at
the same angle of insertion; the site should
not be massaged because massaging could
cause tissue irritation.
The former method increases the risk of leakage
into the needle track and the subcutaneous
tissue.
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.
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Note:
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Complication
• Fibrosis
• Nerve damage (paralysis)
• Abscess
• Tissue necrosis
• Muscle contraction
• Gangrene
• Pain
• Necrosis and skin slough
• Periostitis (infection of the membrane
covering the bone).
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D) Intravenous (IV)
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Purpose
• When the given drug is irritating to the body
tissue if given through other routes.
• When quick action is desired.
• When it is particularly desirable to eliminate
the variability of absorption.
• When blood drawing is needed
(exsanguinations)
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IV cont…
Advantage-
• large volume can be given
• getting rapid effect.
• The route is used to administer fluid/nutrition if
the pt can’t feed by mouth.
Disadvantage
• The drugs prepared for IV administration is
expensive
• Limited to highly soluble medications.
• Drug distribution is inhibited by poor circulation.
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Equipment-
• Tray
• Medication
• Sterile needle and syringe
• Tourniquet
• Antiseptic swabs
• Receiver
• Treatment chart.
• Towel and rubber sheet
• Glove
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Procedure:-
• Prepare the try and the medication
• Explain the procedure to the patient
• Position the patient properly
• Expose the arm and apply the tourniquet
• Ask patient to open and close his fist
• Palpate the vein and clean with antiseptic
swab the site of the injection (which is mainly
the midcubital vein of the arm)
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• Hold the needle at about 25 - 300 angle in line
with the vein and puncture a bit below the
point where the needle will pierce the vein.
• Draw back to check whether you are in the
vein or not (blood return should be seen if you
are in the vein
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Procedure. Cont..
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• As the needle is removed apply pressure over
the site with swab and the forearm is flexed so
as to collapse the vein and prevent bleeding.
• Watch the patient for minutes before leaving
him
• Chart the medication given, the amount, time
& the reaction of the patient.
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Complication
• Infiltration (swelling and discomfort at the IV
site)
• Phlebitis (inflammationof a vein).
• Air embolism(introduction of air in to the
circulation)
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Intravenous injection (therapy)
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• Site of injection: - Usually one of the large
superficial veins in front of the upper arm is
used or vein on the inner aspect of the ankle.
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Equipment:-
• Sterile solution (I.V. fluid) with infusion set.
• Bandage and scissors
• Rubber and towel
• Receiver
• Tourniquet
• I.V. stand
• Antiseptic cotton swabs
• Padded arm board
• Adhesive tape
• Medication chart
Preparation of the patient: - since an infusion therapy
takes several hours to complete, the patient should first
be made comfortable/informed.
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Procedure:-
• Prepare the necessary equipment and take to the
patient's bedside.
• Cut adhesive strips about 8 cm. in length and
attach on outside of infusion set or on the stand.
• Explain the procedure to the patient.
• Open the infusion set and connect it with the bag.
Run the fluid through the tube and needle to
remove the air.
• Fix screw (clamp) on the tubing to control the flow
of the fluid.
• Invert the bottle and hang on the stand.
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Procedure. Cont..
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N.B.
• Infusion bottle (bag) should be labelled with
the date, time infusion is started, drops per
minute and any added medication.
• Inspect the drip frequently and watch for any
signs of a reaction. Stop the drip if reaction
occurs.
• Inspect the site of injection to see that the
drip is not leaking.
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Reconstituting medications
Medications are reconstituted by adding the
proper diluents (sterile water for injection &
0.9% sodium chloride solution) to a powdered
medication.
Vials of powdered medication can be packaged
along with vials of the proper type and volume
of diluents.
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E) Topical administration
when a drug is applied directly to the body sites,
it is called topical application.
• Topical applications are usually intended for
direct (local) action on a particular site,
although some systemic effects may also occur.
• The action depends on the type of tissue & the
nature of the agent.
• A topical medication is applied locally to the
skin or to mucus membrane in areas such as
the eye, internal ear canal, vagina and rectum.
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Skin application
The process of applying medication to the skin is
called inunctions.
The followings are topical preparations applied to
the skin:
• Powders:-are used to promote drying of the skin
and prevent friction on the skin.
• Ointments:-provide prolonged contact of
medication on skin and soften the skin.
• Creams& oils:-lubricate and soften the skin &
prevent drying of the skin.
• Lotions:-protect & soothe the skin.
• Aerosol spray
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Ophthalmic drops/ointments
Eye drops:-instillation of eye drops is performed
for their local effects; such as pupil dilation or
constriction when examining the eye or for
treating infections like trachoma.
• The type & amount of solution depends on
the purpose of instillation.
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• Ointments:-used to treat local infections &
irritation of the eye.
• After application the eye should be closed and
the client is instructed to move the eye ball to
spread the ointment.
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Eye Drop Administration
Use a medication dropper to place the dosage on
the conjunctival sac.
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Ear instillation
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Nasal instillation
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Nasal Medication Administration
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BLOOD TRANSFUSION
A blood transfusion is the infusion of whole
blood or a blood component such as blood
plasma, RBCs, or platelets into the venous
circulation.
Whole blood is infrequently used because the
various components can be easily separated
and used for replacement therapy.
The person receiving the blood is called
recipient and that give the blood is called
donor.
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FFP blood
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Blood typing and cross matching
• Before blood can be given to a person, it must
be determined that the blood of the donor and
that of the recipient are compatible.
• If incompatible clumping and hemolysis of the
recipient’s blood cells results and death can
occur.
• The laboratory examination to determine a
person’s blood type is called typing.
• The process of determining compatibility is
called cross-matching.
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Blood types
• The four main blood groups in the ABO system
of blood typing are: A, B, AB, and O.
• Blood type is an inherited trait and it is
determined by the type of antigen and
antibody present in the blood.
• Antigen is a substance that causes the
formation of antibody.
• Antibody is a protein substance that develops
in response to the presence of antigen in the
body.
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Blood types cont…
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• Those who have ‘O’ blood group have no
antigen and have both ‘A’ and ‘B’ antibodies
(agglutinins)
• So people who have ‘O’ blood group are called
universal donors and those who have ‘AB’
blood group are called universal recipient.
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Rh-factors
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• It is important that an Rh-negative person
receives blood from another Rh-negative
person.
• If Rh-positive blood is injected into the Rh-
negative person, the recipient develops anti-
Rh agglutinins which cause reaction and
hemolysis.
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• Rh is of special importance during pregnancy
because Rh incompatibility b/n mother and
infant/fetus blood is often the problem when
the infant has hemolytic disease.
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Selection of blood donors
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Note
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• Blood exposed to unacceptable temperature
for unknown period should be discarded.
• Do not warm the blood before using it as it
raises the temperature of the blood and
encourage the growth of the bacteria.
• Blood should not stay out side refrigerator
more than 4 hours.
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TRANSFUSION REACTIONS
Be familiar with the most usual symptoms of blood
reactions which are:-
Immediate Reaction:
a) Headache d) Backache
b) Chills e) Pyrexia
c) Rash of the skin (urticaria )
Late Reaction
a) Dyspnea d) Renal shut down in
b) Heamaturia severe cases
c) Chest pain e) Rigor (rigidity)
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Nursing Interventions in Transfusion Reaction
• Definition
– Immunologically mediated reaction to antigen causing
systemic symptoms
• Potentially life threatening
• Frequent Antigens
– Antibiotics
– Latex
– Anaesthetic agents
– Colloid fluids
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• Diagnosis
– Collapse
– Difficulty breathing
– Wheeze
– Angio--oedema
Angio
– Urticaria
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Management Anaphylaxis
• Prevention
– Avoid unnecessary drugs particularly iv
– Take drug history
• Adequate staff training and facilities
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Immediate Management 1
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Immediate Management 2
• Basic life support
– Check airway, breathing, circulation
– Oxygen
• Give adrenaline (0.5-
(0.5-1mg im
im))
• Elevate legs
• (Give intravenous fluids)
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Subsequent Management
• Antihistamines
– Chlorpheniramine iv
• Steroids
– Hydrocortisone iv
• Intensive care unit
• Immunological Testing
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Thank you!
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