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Medication Administration
Automated Medication Administration Equipment
PyxisSureMedMedServe
Essential Components of a Medication Order
Client’s NameMedical Record
Number, Room/Bed #Date & time of orderName of MedicationDosage of MedicationRoute Frequency of
administrationMD’s signature
Six “Rights” of Medication Administration
Right Patient (check name band, ask client their name)
Right MedicationRight Dose Right RouteRight Time (frequency)Right Documentation* Client’s also have the right
to refuse (say no) to medication
The Nurse’s Responsibility for Medication Administration
Assess whether the client can tolerate the meds
Administer meds accurately & timely
Monitor for side-effectsKnow contraindicationsClient teachingPractice the “Six Rights”(stressed in clinical)
Evaluation (effectiveness & client response)
Types of Oral Medications
TabletsCapsulesSublingualBuccalElixirsEnteric Coated
Precise & Safe Medication Administration
Rectal MedicationsProvide for privacyExplain procedure to clientPlace client in Sim’s positionApply clean glovesLubricate tip, round end inserted firstEncourage client to relax , deep breatheInsert past sphincter, towards umbilicusHave client remain on side at least five
mins. (hold buttocks together etc.)
Rectal Medication Administration
Ophthalmic Medications
Place HOB down or low Fowler’s
Provide Kleenex for clientHave client look towards
ceilingInstill meds in
conjunctiva (if gtts)If ointment, apply ribbon
from inner to outer canthus
Know od, os, ou routes
Topical & Inhalation MedicationsOintments (absorbed via mucous
membranes, skin)Inserted (vaginal)Instilled (ear/nose gtts)LotionsSprays (nasal)Pastes (absorbed through skin)Inhalation (nebulized treatments, MDI)
Topical Ointments
Otic Medications
MDI Medications
Medications via NGT/EFT
Determine whether med comes in elixir formCrush all except for EC meds and mix with water
or other liquid medicationsStop feedings, clamp tube, apply syringe,
unclamp tube, flush tube with approx. 30cc waterClamp tube, remove syringe, pull plunger from
barrel, reattach barrel, pour meds through barrelAdd water as necessary to keep things flowing
smoothlyAfter all meds have been given, flush with 30cc
water, clamp tube, remove syringe, start feedings
DocumentationAlways record:
Date, time & your initials or signature, title (R. Otten, SN,CSUF )
Medication, route (site) and actual time given
Reason why med was omitted (ie. refused)
Client’s response to the medication
Medication Administration Records (MARs)
Nursing Considerations for Injection Sites Assess for adequate tissue & muscle availability/client body wt.
Assess where previous injections have been administered
Assess client restrictions Assess for quantity & quality of medication to be administered
Parts of a Needle & Syringe
Syringe: Barrel Plunger Tip
Needle: BevelShaftHub
Types of Syringes
Tips of Syringes
Luer-Lok
Non Luer-Lok
Pre-Filled Systems
Assembling the Device
Scoop Method
Safety Devices
Needless Systems
Three Types of Injections
Intradermal - Injected into dermal skin layers (Allergy tests, PPDs, etc.)
Subcutaneous - Injected into subcutaneous
tissues (Heparin, Insulin) Intramuscular - Injected into deep muscles (narcotic analgesics, iron)
Intradermal Injections
Given in small doses (i.e.. 0.1cc) Common sites include: RFA, LFA Use 1cc syringe with 26-27 gauge
needle, 1/4 - 5/8 inch long Administer with needle at 5-15 degree
angle with bevel of needle up Check for “bleb” or “wheal” Document site in medication
book/nurses’ notes
Intradermal Injections
Subcutaneous Injections Given in doses of 0.5cc - 1.5 cc Common sites include: deltoid, abdomen Deltoid landmarks: Find Acromium
Process and go 4 to 6 finger-lengths below Rotate sites to minimize tissue damage Use Insulin/TB syringe for these meds For other SQ meds use 1-3 cc syringe, 25-27 gauge needle, 3/8-5/8 inch length Insert needle 45-90 degrees
Deltoid Injections
Vastus Lateralis Injections
Site well-developed in both adults & children, lacks major blood vessels/nerves
Landmark: Find Greater Trochanter & Knee, divide thigh up into three equal quadrants with hand, middle 1/3 is the site for injection (lateral aspect).
Good for clients with position restrictions
Intramuscular Injections
Vastus Lateralis
Dorsogluteal Injections
Rarely used due to Sciatic nerve risk
Less accessible than other sites (i.e. requires side-lying or turned further)
Landmark: Find Greater Trochanter & Iliac Crest, draw quadrants and administer in upper two quadrants
Dorsogluteal Injections
What other site is used for IMs?
VentroglutealGood for deep injectionsAway from blood vessels and nervesZ-trackThick, viscous medsAntibioticsLarge volumeIrritating
What if……when giving an IM injection, the aspirate comes back with blood.
What is the correct procedure and why?
Preparing NPH & Regular Insulin
Swab tops of both vialsInject desired units of air into NPH vial, remove needle and then inject desired units of air into Regular vial
Invert Regular vial and withdraw desired units of insulin (no bubbles)
Insert needle into NPH vial, invert and withdraw desired units of insulin
Regular & NPH Insulins
Mixing Insulins
NPH
Insulin
Regular Insulin
Remember !!!
If an IM injection requires the administration of > 3cc of medication, divide the medication up into two equal doses and
administer in different sites.
Remember !!!
Always double-check Insulin & Heparin
amounts/doses with another licensed
person(RN/LVN/INSTRUCTOR)