Medication Admnistration

8/19/2019 Medication Admnistration

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MEDICATION ADMNISTRATION

DRUG - Natural or synthetic substance (when taken in to living body) afects

its unctioning or structure and is used in the diagnosis, itigation, treatent

or !revention o a disease or relieve discoort"

#$R%& $# %'D*+$N

Drugs are available in various ors such as tablets, ca!sules and

su!!ositories"

" &$D #$R%

• a!let - sha!ed like a ca!sule and coated or ease o swallowing"

• a!sule . edication in !owder, li/uid or oil or and encased

by a gelatin shell"

• 'nteric coated tablet . tablet or oral use coated with aterials

that do not dissolve in stoach" oating dissolves in intestine,

where edication is absorbed"

• 0ills . tablets containing one or ore drugs sha!ed in to

globules, ovoid or oblong"

• +ablet . !owdered dosage ro co!ressed in to hard disks"

• +roche (o1enge) . 2at, round dosage ro containing drug,

2avoring, sugar and ucilage, dissolves in outh to release

drug"

• &u!!ository . solid dosage or i3ed with gelatin and sha!ed in

the or o !ellet or insertion in to body cavity" (Rectu or

vagina), elts when it reaches body te!erature, releasing

drugs or absor!tion"4" 5UD #$R%

• n6ections . or %78

• Dro!s . or eye, ear, nose

• 'li3ir . clear 2uid containing water and 7 alcohol, usually has

sweetener added or ease o swallowing"

• &yru!s . edication dissolved in a concentrated sugar solution,

ay contain 2avoring to ake the drug ore !alatable"

• &us!ension . 9nely divided drug !articles dis!ersed in a li/uid

ediu, when sus!ension is let standing, !articles settle to the

botto o the container"• otion . drug in li/uid sus!ension a!!lied e3ternally to !rotect

skin"

• +incture- alcohol or water drug solution"

• 'ulsions . i3ture o two iiscible li/uids uniorly

dis!ersed in the or o very sall globules throughout each

other":" &'% &$D #$R%


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• $intent . '3ternally a!!lied !re!aration usually containing one

or ore drugs"

• 0aste . sei solid !re!aration, thicker and stifer than ointent,

absorbed through skin ore slowly than ointent"

• rea . a non greasy solid !re!aration used on the skin"

ABBREVIATIONS

a"c" .beore ood7 eals !"c . ater ood7 eals

b"d" . twice a day

t"i"d" . t"d"s" three ties a day

h"s" . at bed tie

h"n" . tonight

o"n" . each night

o"d" . each day

o"" . each orning

c"" . toorrow orning7 coing orning

!"r"n" . when needed s"o"s . i necessary in eergency

stat . at once

ist . i3ture

!ulv . !owder

/"i"d . our ties a day

/ . every

5;< . every ; hours

5=


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'li3 . eli3ir

MEASURING UNITS

" Gra . g4" urie . ci:" Deciliter . dl>" nternational unit . iU

?" @ilogra . kg;" iter . A" %icro curie . ui=" %icrogra . ugB" %icro liter . uC" %icroole . uol" %icron . u4" %illi curie -


4/34

ORAL MEDICATION

INTRODUCTION- +he route !rescribed or adinistering a edication

de!ends on edications !ro!erties and desired efect and on the client

!hysical and ental condition" +he oral route is easiest and the ost

coonly used" %edications are given by outh and swallowed with the

2uid" $ral edications have a slower onset o action and a ore !rolonged

efect than !arental edication" lients generally !reer oral route"

DEFINITION- adinistration o edicine through outh or !ro!hylactic and

thera!eutic efects"

PURPOSES- 1. +o !roote health . Drugs are given to the client to increase

their resistance to diseases and to eet the de9ciencies"

'"g" iron su!!leentation, vitains etc"

4" +o !revent illness"

:" +o hel! in diagnosis" '"g" bariu used in E ray"

>" +o alleviate illnessF certain drugs or sy!toatic !ain relie" '"g"

analgesics

?" +hera!eutic !ur!ose" '"g" antibiotic or inection"

CONTRAINDICATIONS

#or unconscious !atients"

#or uncoo!erative !atient"

*ter oral and gastric surgery"

• $ral cancer"

• eore diagnostic tests and o!erations"

GENERAL INSTRUCCTIONS


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1. eore adinistration (during !re!aration o drug) dentiy the !atient by checking the edication card"

heck the !hysicians order '#$R' 0R'0*RNG +


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Record the efect observed . the local or systeatic efect, its

side efect or to3icity, any co!lication"

0R'0*R*+$N $# +7C->

NUR&NG $RD'R

• &tea inhalationF

• ntake out!ut chartF

• hange o dressing every dayF

• hange o !osition every hourlyF

• Urine testing or sugerF


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D'+

• Diabetic dietF

• ow sodiu dietF

• Noral dietF

PROCEDURE

PROCEDURE

S.NO.

STEPS RATIONAL

1

2

3

4

5

6

7

89

Iash hands with soa! and water"

Read the !hysicians !rescri!tion

and enter it in the edicine card"

%ake sure that all the edicines

are entered correctly" +ake out the edicine ro the

shel ater reading the edicine

card"heck the edicine table thrice,

check the e3!iry date o the

edicine" +ake out the edicine as ollows

• +ake out tablets or ca!sule

ro the bottle in to the lid

o the container 9rst"

• Do not touch with hands"

• 0our syru!s ro the side o

the bottle away ro thelabel" Do not !our an e3cess

aount"

Ii!e the outh o the bottle with

a clean duster and close it tightly"

0lace the card with edicine on

the tray"

Reduce transer o icroorganiss ro

hands to edication"#or giving a correct dose to the !atient at

the right tie, or convenient

adinistration by staf and students" +o check the !ossibility o !ouring a wrong

edicine"

+o ensure the right and valid edicine"

+o get the re/uired nuber o tablets or

ca!sules" it coes e3tra, it ay be

!oured back in the bottle container" +o

!revent containation !ouring ro the

side o the bottle !revents s!oiling o the

label"

Ii!ing kee!s the bottle clean it avoids

containation o drugs"

+o !revent istakes in giving drugs"

+o !revent error which ay occur"


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10

11

12

13

+ake the tray to the bed side"dentiy the !atient"

• y calling out his nae"

• *sk the !atient to re!eat his

nae"

• 8eriy identi9cation with the

nurse

Record and edication card"

Give !ro!er !osition"

*dinister the edicine"

&tay with the !atient until he has

swallowed the edicine"

0rovide water or drinking ater

the edicine is adinistered"

#or easy adinistration and absor!tion"

&taying with the !atient will ensure that he

has taken the edicine"


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CONCLUSION- the oral edication gives sae, efective, and econoical

route or adinistering edications" t !rovides sustained drug action with

inial discoort" *dinistering edication by oral route re/uires !roble

solving and knowledge a!!lication uni/ue to !roessional nursing"

SUBLINGUAL MEDICATION

INTRODUCTION- &ublingual edications are orally disintegrating or

dissolving edications that are adinistered by being !laced under the

tongue" +hese edications are transerred to the bloodstrea ro the

ucous ebranes in the outh ater dissolving, allowing or /uick

absor!tion that avoids the loss o !otency which ay coe with 9rst-!ass

etabolis in the stoach and liver" Doctors ay recoend sublingual

edications to treat certain conditions, or i a !atient has trouble swallowing

or digesting edication"

DEFINITION- &ublingual and buccal edication adinistration is a way o

giving soeone edicine orally (by outh)" &ublingual adinistration is

when edication is !laced under the tongue to be absorbed by the body" +he

word KsublingualL eans Kunder the tongue"L

PURPOSES- there is a need or the edication to be absorbed ra!idly"

STEPS OF PROCEDURE

S.

NO

.

STEPS RATIONAL

1

2

3

4

5

6

Iash hands"

0re!are edication, adhering to> rights o drug adinistration"

dentiy client by reading

identi9cation bracelet and

addressing client by nae"

'3!lain !rocedure and !ur!ose

o drug"

8eriy allergies listed on

edication record or card"

Reduces risk or inection"

Decreases chance o drug errors"

on9rs identity o client"

Decreases an3iety, !rootes

coo!eration"

Decrease nurses e3!osure to


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7

8

9

10

Done gloves"

0lace tablet-

• Under tongue or

sublingual edication"

• etween check and gu

on either side o outh or

buccal adinistration

(avoid broken or irritated

area)"

Note . i clients ucous

ebranes are dry, ofer a si!

o water beore giving

edication"

nstruct client not to swallow

drug but to let drug dissolve"

Discard gloves and wash hands"Docuent adinistration on

edication record"

clients body secretions"

Reduces additional irritation"

#acilitates absor!tion by !ro!er

route"

Reduces transer o icroorganiss"

&erves as legal record o edication

adinistration and !reventsaccidental re edication"

I*RNNG&- do not atte!t to take any edication sublingually that was not!rescribed as such"

&oe edications re/uire digestive actin to absorb and ay be efective oreven harul i taken sublingually"

D$U%'N+*+$N- +he ollowing should be noted on the clients chart"

" Nae, aount and route o drug given"4" 0ur!ose o adinistration i drug is given on a when needed (!"r"n)

basis":" *ssessent data relevant to !ur!ose o edication">" 'fects o edication on client"?" +eaching o inoration about drug used or about sel adinistration o

edication"


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ADMINISTRATION OF PARENTERAL MEDICINE

INTRODUCTION- adinistration o !arenteral edicine is an invasive

!rocedure and it ust be !erored under a strict ase!tic techni/ue"

0arenteral edicine can be adinistered in the body by the subcutaneous,

intra uscular, intra deral and intravenous route" 'ach ty!e o in6ection

re/uires certain skill so that the edicine reaches its !ro!er location" +he

efect o !arenteral edicine adinistered ay develo! ra!idly de!ending

on the rate o drug absor!tion"

DEFINITION- 0arenteral adinistration involves giving drug by a route

throgh in6ection into the body tissue"

PURPOSE- to get a ra!id and systeic efect o drug"

+o obtain a3iu efect o the drug even when the !atient is

unconscious, unable to swallow due to neurological or surgical

ilteration afecting the throat and outh or when the !atient isuncoo!erative"

&oe edicines that can not be adinistered orally due to !oor

absor!tion in G tract" Ihen the drug is to3ic and irritating to the gastrointestinal ucosa"

+o obtain a local efect at the site o the in6ection eg" ocal anesthesia,

diagnostic tests (tuberculin test), sensitivity test, local thera!eutic

efect" +o restore blood volue by re!lacing the 2uid eg" n shock"


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TPES OF IN"ECTION

N+R*-D'R%*- when edicines are introduced in to the deris"


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!lunger

&yringes are available in various si1es ,4,?,C,4C, and ?Cl"

syringes ay be o two aterials-

• G*&& &JR'NG'&

*dvantages- the arkings are accurate and thereore e3act /uantity can be

drawn"

- +he 2uid level can be clearly seen as the glass is

trans!arent"- +hey can be easily sterili1ed by boiling and reused"- Glass syringes are resistance to !unctures"

Disadvantages- glass syringes can break"- +hey carry a greater risk o air ebolis because they are

rigid"

-they are ore e3!ensive" Glass syringes are no ore !reered because the

risk o s!reading dangerous disease like *D& when not !ro!erly sterili1ed"

• 0*&+ &JRNG'&


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*dvantages- 0lastic syringe do not break easily"

- ecause they are colla!sible, they allow !ro!er e!tyingo the syringe, hence less risk o air ebolis"

- +hey are chea!er"- +hey are dis!osable"

Disadvantages- !lastic syringes are not very accurate in

scale"- +hey can not be easily sterili1ed"- +hey can not be reused"

• &0'* &JRNG'&- nsulin syringe has arking in units>C in l (red) or =C in

l (green) are suitable or adinistration o insulin"- +uberculin syringe is a syringe o l ca!acity withC"C l

arkings" t is useul or adinistration o very sall

volue"- &terile dis!osable syringes are ade o !lastic and are

!acked with a needle to be 93ed at the tie o use"

*dvantages- need no sterili1ation"

- n6ections are less !ainul as needle is shar!"- onvenient to use"

Disadvantage- works outcostlier as they are not reusable

4" N((*+()- needles coe !acked in individual sheets to allow

2e3ibility in choosing the right needle" %ost o the needles are ade

o stainless steel and are o diferent si1es, which is rust !roo" +he

ti! which is at the end o the shat is beveled" +he bevelling ay be

short, very short or regular" Needle is available in diferent gauge

thickness and length" +he gauge nubers are ro : (thickest) to

4A (9nest)" De!ending on the route o adinistration, si1e o the


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!atient and the thickness o the solutions to be in6ected, the needle

is selected"

:" +he needle has three !arts-- " riteria or selection o syringe and needles

• +he route !rescribed

• 8iscosity o edicine

• *ount o edicine to be adinistered

• ody si1e and aount o saety tissue"

SITES FOR GIVING IN"ECTIONS" N+R*%U&U*R NM'+$N

*"Deltoid uscle

" 8entro gluteal uscle

" Dorso glutealD" 8astus lateralis


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4" &UU+*N'$U& NM'+$N- the best si1e or giving a subcutaneous

in6ection includes vascular areas around the outer as!ect o the

u!!er ar, the abdoen ro below the costal argin o iliac crest

and the anterior as!ect o the thigh" +hese areas are easily

accessible" $uter sites include the sca!ular areas o the u!!er back and u!!er

ventral or dorsal gluteal areas"No in6ection sites should be used or ore than ;-A weeks"

:" N+R*D'R%* NM'+$N- intra deral in6ections are given ostly

or skin testing (tuberculin test and allergic test)" +he edicines are

in6ected in to the deris where blood su!!ly is reduced and drugabsor!tion occurs slowly" +he inner orear and u!!er back are the

ideal locations"

GENERAL INSTRUCTIONS TO BE ,EPT IN MIND

n6ection should be given ater doctors !rescri!tion"

&trict ase!tic techni/ue to be ollowed in the sterili1ation o e/ui!ent,

in the !re!aration o edication, in the adinistration o in6ection"

&yringes and needles used or in6ections should be ke!t se!arately

ro those which are used or other !ur!oses"

&yringes should be airtight"

* needle should be shar! and !atent"

hange the needle ater withdrawing the edicine ro the rubber

sto!!er container, beore giving in6ection to the !atient"

$bserve C rights o adinistration o edicines"

Never use a drug whose e3!iry date is over"

*lways ake the !atient rela3ed and give hi a coortable !osition

while giving in6ections"


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*lways give a test dose beore adinistration o all ty!es o seru,

and certain antibiotics such as !enicillin etc" to rule out an allergic

reaction"

Never in6ect any air while giving in6ection"

&elect the a!!ro!riate site"

Rotate the site o in6ection to !revent tissue 9brosis"

Use the correct techni/ue or giving in6ection"

*ter in6ecting always with draw the needle to ake sure that it is not

in a blood vessel in case intra uscular and subcutaneous in6ections"

there is the !resence o blood in the syringe withdraw the needle and

select another site or the in6ection"

%assage the area at the site o in6ection e3!ect in case o intra deral

in6ection"

n6ection should be charted and signed iediately ater it is

adinistered by the nurse"

$bserve or any reaction o drugs ater adinistration"

INTRAMUSCULAR IN"ECTION


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DEFINITION- it is the adinistration o in6ection in to the dee! uscle

tissue" Ihen irritating !re!arations are given intra uscularly, the track

ethod o in6ection is used to inii1e tissue irritation by sealing the drug

within uscle tissue"

PURPOSES- 1. +o adinister edication dee!ly in to uscle tissue, without

in6ury to the !atient"

4" to adinister a edication with absor!tion and onset o action /uicker

than the oral route and that ay be irritating to the subcutaneous tissues"

:" to obtain a local efect at the site o in6ection as local anesthetics"

ASSESSMENT OF T!E PATIENT- review !hysicians edication order"

• @now inoration regarding e3!ected action o the drug"

• onsider actors that contraindicate intra uscular in6ection"

• *ssess indications or intra uscular in6ection"

• *ssess clients edical history, history o allergies and edicationhistory"

• onsider clients age"

• *ssess clients knowledge regarding edication and dosage schedule"

• $bserve clients verbal and non verbal res!onse towards receiving

in6ection"

NURSING OB"ECTIVE-1. Develo! individuali1ed goals or the client

based on nursing diagnosis"

2. %inii1e the discoort o the !atient"

:" %inii1e the clients an3iety"

0*+'N+ 0R'0*R*+$N- " '3!lain the !rocedure to the !atient"

4" 0rovide !rivacy, i needed"

:" Restrain the site o in6ection in case o children"

>" *s or as !ossible avoid eal tie"

?" Divert the attention o the !atient away ro the in6ection by riendlyconversation"

;" $fer bad !an i client has to reain in bed or a considerable tie

beore, during and ater the !rocedure"

A" 0lace !atient in coortable and rela3ed !osition"

EUIPMENTS- * tray containing


19/34

• Dis!osable syringes and needles o various si1e according to the

need in a covered tray"

• +ranser orce!s in a 6ar containing antise!tic solution"

• &terile cotton swab and gau1e !ieces in sterile container"

• %ethylated s!irit in a container

• owl with water (as !er hos!ital !olicy)

• @idney tray with !a!er bag

• Drug ordered

• Iater or in6ection

• #ile to cut a!oule

• &all covered sterile tray

PROCEDURE

S.N

O.

STEPS RATIONAL

4

:

>

?

;

A

=

Iash hands"

lose roo curtain or door"

@ee! linen or gown dra!ed over

body !arts not re/uiring e3!osure"&elect a!!ro!riate in6ection site by

assessing si1e and integrity o

uscle" 0al!ate or areas o

tenderness or hardness" Note

!resence o bruising or area o

inection"

*ssist client to coortable !osition

de!ending u!on the site chosen"

• 8astus laterals- client lies 2at,

su!ine with knees 2e3ed"

• 8entro gluteal- client lies side

or back, 2e3es knee and hi!

on side to be in6ected"

• Dorso gluteal- client lies

!rone with eet turned inward

or lies on side with u!!er

knee and hi! 2e3ed and

!laced in ront o lower leg"

• Deltoid region- client ay sit

or lie 2at with lower ar

2e3ed but rela3ed across

abdoen or la!"

Relocate site using anatoical land

Reduces transer o icroorganiss"

+o !rovide !rivacy"

+o visuali1e the in6ection site"

%uscle should be sot when rela3ed and

9r when tensed indicates healthy

tissue"

0osition that reduces strain on uscle

inii1es discoort o in6ection"

n6ection in to correct anatoic site

!revents in6ury to nerves, bones and

blood vessels"hildren oten 6erk or !ull away

une3!ectedly causing in6ury to

theselves"


20/34

B

C

4

:

>

?

;

A=

arks"

Restrain child

leanse site with an antise!tic

swab" *!!ly swab at centre o the

site and rotate, outward in a

circular direction or about ? c"? degree angle"

0ointed towards the knees"• client uscle ass is very

sall, gras! body o uscle

between thub and 9nger"

• irritating !re!arations are to

be given use track

techni/ue"

*ter needle enters site, gras!

between lower ends o syringe

barrel with non doinant hand to

end o !lunger" *void oving

syringe. using track ethod hold skin

tightly with non doinant hand"

Use doinant hand to ove

careully towards end o !lunger"

&lowly !ull back on !lunger to

%echanical action o swab reoves

secretions containing icroorganiss"

&wab reains readily accessible or

when needle is withdrawn"0revents needle ro touching sides o

ca! thus !revents containation" 5uick, sooth in6ection re/uires !ro!er

ani!ulation o syringe" Needle ust be

in6ected at BC degree angle to enter

uscle and so air lock rises to to! o

edication towards !lunger"

&!eeds insertion and discoort

'nsures that edications reach uscle

ass

'nsures that edication reaches uscle

ass"

reates 1ig1ag !ath through tissues thatseals needle track to avoid tracking o

edication"

&ooth ani!ulation o syringe !arts

reduces discoort ro needle

oveent"

&kin ust reain !ulled until ater drug

is in6ected"

*s!irate o blood in to syringe indicates

intra venous !laceent o needle" ntra

uscular in6ections should be given slow

to reduce !ain and tissue traua"


21/34

Bas!irate edication" blood

a!!ears in syringe, reove needle

and dis!ose of edication and

syringe !ro!erly" Re!eat

!re!aration !rocedure" no blood

in6ect edication slowly"Iithdraw needle /uickly while

!lacing antise!tic swab gently

above or over in6ection site"Ihen using track ethod, kee!

needle inserted or C seconds ater

in6ecting edication" +hen release

clients skin ater withdrawing

needle"%assage skin lightly" n children,

!lace sall band aid over !uncture

site"*ssist client to coortable

!osition"Discard unwra!!ed needle or

needle enclosed in saety shield

and attached syringe in to

a!!ro!riate labeled rece!tacles"Reove gloves and wash hands"

&u!!ort o tissue around in6ection site

inii1es discoort during needle

withdrawal"

*llows edication to dis!ense evenly"

+issue !lanes slides across one another

to create 1ig1ag !ath that seals

edication in to uscle tissue"

%assage can stiulate circulation and

i!rove drug distribution" and aid

!revent bleeding"Gives client sense o well being"0revents in6ury to client and health

!ersonal" Needles should not be

reca!!ed beore dis!osal"

'duces transission o icroorganiss"

OBSERVATION- Return to roo and ask i client eels any acute !ain,

burning, nubness or tingling at in6ection site"

• Return to evaluate clients res!onse o edication in C-:C inutes"

• *sk client to e3!lain !ur!ose and efects o edication"

RECORDING- iediately ater edication chart the ty!e, dose, route, date

and tie o edication adinistered in edication record.

• Re!ort any undesirable efect ro edication to nurse in charge or

!hysician"

Record clients res!onse to edication.

PATIENT AND FAMIL TEAC!ING- 1. lient re/uiring, regular in6ections

should learn i!ortance o rotating sites" +each aily ebers the

techni/ue o adinistering drug"

4" nstruct the to aintain sterile techni/ue"

:" nstruct the to observe or edication side efect"

>" *llow or several return deonstrations"


22/34

?" +each !ro!er ethod o dis!osal o needles and e/ui!ent"

INTRAVENOUS IN"ECTION

INTRODUCTION- in6ections are !arenteral thera!y" t eans giving o

thera!eutic agents including ood outside the alientary tract is orcing o a

2uid in to a cavity, a blood vessel or body tissue through a hollow tube or

needle" 'ach in6ection route is uni/ue in regard to the ty!e o tissue in to

which the edication is in6ected" +he characteristic o tissue in2uence rate o

edication" +he nurse should know the volue o the edication to

adinister, the edication characteristics, viscosity and the location o

anatoical structures underlying in6ection sites"

DEFINITION- intravenous in6ection eans the introduction o a concentrated

dose o edication directly in to the systeic circulation in sall aount" t

is in6ection o a bolusor a sall volue o edication through an e3i3ting 8

inusion line or he!arin lock"

PURPOSES- the ain !ur!ose to adinister edicine"

n eergencies a ast acting drug ust be delivered /uickly through 8

route" +he adinistration o 8 route cause less discoort"

+o !revent and treat shock and colla!se"

+o eet !atients basic re/uirents or calories, water ,inerals and

vitains" +o su!!ly the body ade/uate aount o 2uid when !atient is not able

to take by outh" +hrough 8 route thera!eutic blood levels can be established"

ASSESSMENT OF PATIENT- review clients edical record or !hysicians

order stating ty!e and aount o 8 2uid"


23/34

$btain inoration ro drug reerence book or !haracist concerning the

co!osition, !ur!ose or adinistration and side efect to e3!ect" Deterine the client understanding o reason or 8 2uid"

Deterine the !resence o any actor that increases the clients risk or

develo!ent o co!lication i"e" very young,very old client, !resence o heart

ailure or renal ailure"

NURSING OB"ECTVES- 0rovide !rivacy to the client"

• 'nsure client !osition is not contraindicated by edical condition"

• Nurse take s!ecial care to avoid errors in dosage calculation and

!re!aration"

• Nurse should check vital signs beore and ater inusion"

• Do not use an area, which shws signs o inection"

• n6ections should be ree o abnoralities that ay interere with

edical absor!tion"

• Do not use the sae site re!eatedly because site becoes hardend"

PATIENT PREPARATION- e3!lain the !rocedure to the !atient to win his

con9dence"

+acully send the visitors out o !atients roo"

the general condition allows ask the !atient to wash hands with soa!

and water" Restrain the site in case o children"

heck the vital signs and record it in nurses record or uture

reerence" Divert the attentin o !atient away ro the inusion"

*d6ust height o bed or coortable working o nurse"

&elect the height on non doinant ar to give a3iu reedo or

the !atient" 0lace the ackintosh and towel under the area where the inusion is

started" 0rovide !rivacy i necessary"

0lace the !atient in a coortable and rela3ed !osition suitble or

inusion site"

PREPARATION OF ARTICLES

&"N$

"

*R+'& 0UR0$&'

4

:

* tray containing

&terile syringes and needles o various

si1es

&terle cotton swabs7gau1e !ieces in a

sterile container

+o deliver a certain volue o drugs

de!ending on the route o

adinistration

+o clean the site beore giving

in6ection


24/34

>

?

;

A

=

B

C

* bowl with water and an antise!tic

solution

&terile water or in6ection

Drug ordered

*!ule 9le

* kidney tray and !a!er bag

* ackintosh and towel

+ourni/uet

@nie dish (sterile sall covered tray)

*dhesive !laster and scissors

+o rinse the glass syringes, needles

and to !ut the dis!osable syringes

+o dissolve !owder or o drugs

+o adinister drug to the !atient

+o cut and o!en the a!ule and

o!en the vial

+o dis!ose o used swabs, a!ules

and vials

+o !rotect the bed

+o !re!are the vein or 8 in6ection

+o carry the !re!ared edicine to

the !atient" +o secure the needle in case o

in6ection is to be re!eated"

PROCEDURE

S.NO

.

STEPS RATIONAL

4

:

Iash hands, a!!ly gloves"

heck !hysicians order or the ty!e

o edication, dosage and route"

P$(/$/%& (*%%&( $

/+(

• +a! to! o the a!ule lightly

and /uickly with 9ngers until

2uid leaves te neck"

• 0lace a sall gauge !iece or

swab against the neck o thea!oule"

• #ile the neck o the a!ule

and sna! the neck /uickly

and 9rly away ro hands"

• nsert the syringe needle in to

the centre o the a!oule"

(do not let the needle ti! or

shat touch the ri o

Reduces transission o

icroorganiss"

'nsures sae and accurate drug

adinistration"

Dislodge the 2uid that collects above

the neck so that all edicines ove in

to the lower chaber"

0rotects the 9ngers o the nurse ro

traua"

0revents shating o glass toward the

nurse or in to the a!ule"

$utside o the ri o the a!oule is

unsterile"


25/34

>

a!oule)"

• *s!irate the edicines ro

the a!oule by !ulling back

the !iston gently"

• air bubbles are as!irated,

do not e3!el air in to the

a!oule"

• +o e3!ell thee3cess o air

bubbles, reove the needle

ro a!ule and hold it

!ointing u!ward"

• hange the needle and !lace

the syringe in the knie dish"

P$(/$/%& (*%%&( $

%/+

• Reove the etal ca!covering the vial with a 9le"

Ii!e of the surace o the

vial with a s!irit swab"

• +ake syringe and withdraw

the aount o solvent

re/uired to dissolve the

edicine (eg" %edicine is in

!owder or)

• +ake syringe with needle and

!ull back the !iston to draw

an aount air in to the

syringe e/uivalent to the

volue o edication to be

as!ired ro the vial"

• nsert the ti! o the needle

into the rubber ca! o the

vial" (a!!ly !ressure while

doing needle insertion)"

• n6ect air in to the vial"• nvert vial and withdraw the

re/uired aount o edicine

by holding the vial between

the thub and iddle 9nger

o the non doinant hand

and gras! the syringe with

the doinant hand"

• 0ush the air in to the vial"

Iithdrawal o !iston creates a negative

!ressure and hel!s in the as!iration o

edicine in to the syringe"

*ir !ressure will orce the 2uid out o

the a!oule and the edicine will be

lost"


26/34

? • 0ull back the !iston to take

out the re/uired edicine

and reove the syringe"

• hange the needle and kee!

the syringe in the knie dish"

• Re!lace the vial in a kidney

tray and the used needle in

the !uncture !roo container"

A*%&%)$/%& %&(%&

heck the edicine ordered"

• '3!lanation to the !atient

• Iash hands and wear gloves

• dentiy the client again by

asking the nae and

checking records

• &!read the ackintosh andthe towel under the site to be

!unctured or 8 in6ection"

• 0re!are the vein by a!!lying

tourni/uet above the vein and

ask the !atient to close the

9st"

• lean the site with an

antise!tic swab at the centre

o the site"

• Ihen the needle is in the

vein ask the client to rela3

the 9st and reove the

tourni/uet and !ush the

edicine slowly"

• Reove the needle and !ut

!ressure on the !uncture site

with a sterile swab"

• %ake the !atient cortable

and record the !rocedure"

+o withdraw the re/uired aount i

edicine"

+o cary the !re!ared edicine to the

!atient in a sterile container"

#or sae dis!osal o articles"

+o ensure accuracy

+o allay an3iety

+o !revent cross inection

+o ensure accuracyF double check is

necessary beore drug adinistration

+o !revent soiling o the beds"

Distended vein creates easy insertion

o needle"

leaning o skin will reduce chances o

inection"

#or easy sooth 2ow o edicine in to

the vein"

+o !revent esca!e o blood"

+o !revent error"

OBSERVATION

• observe client closely or adverse reaction as drug is adinistered and

or several inutes thereater"

• $bserve or any contraindication, i"e" swelling and discoort etc"

• Notice clients verbal and non verbal e3!ression or the inusion"


27/34

PATIENT AND FAMIL TEAC!ING

• +each caregiver to a!!ly !ressure with sterile gauge i needle alls

out"

• +each the !atient and aily about the i!ortance o intravenous

inusion"

INTRADERMAL IN"ECTION

DEFINITION- it is the adinistration o edication in to the deris, below the

e!ideris"

PURPOSES- to obtain local efect at the site o in6ection such as to test allergic

reactions o the drug"

ASSESSMENT OF T!E PATIENT

Review !hysicians edication order"

@now inoration regarding e3!ected reaction when testing skin

with s!eci9c allergen or edication"

*ssess clients knowledge o !ur!ose and reaction o skin testing"

NURSING OB"ECTIVES

Develo! individuali1ed goals or the client based on nursing diagnosis"

%inii1es the discoort o the !atient"

%inii1es the clients an3iety"

PATIENT PREPARATION

'3!lain the !rocedure to the !atient"

0rovide !rivacy i needed"

Restrain the site o in6ection in case o children"

0ossibly avoid eal ties"

@ee! the attention o the !atient away ro the in6ection by riendly

conversation"• $fer bad !an i client has to reain in bed or a considerable tie

beore, during and ater the !rocedure"

0lace !atient in coortable and rela3ed !osition"

&elect the a!!ro!riate site or in6ection"

EUIPMENT- a tray containing

• Dis!osable syringes and needles o various si1e according to the

need in a covered tray"


28/34

• +ranser orce!s in a 6ar containing antise!tic solution"

• &terile cotton swab and gau1e !ieces in sterile container"

• %ethylated s!irit in a container

• owl with water (as !er hos!ital !olicy)

• @idney tray with !a!er bag

• Drug ordered

• Iater or in6ection

• #ile to cut a!oule

• &all covered sterile tray

PROCEDURE

S.NO

.

STEPS RATIONAL

1

2

3

4

5

6

7

8

9

10

11

12

Iash hands

lose roo curtain or door"

@ee! linen or gown dra!ed overbody !arts not re/uiring e3!osure"

&elect a!!ro!riate in6ection site"

ns!ect skin surace over sites or

bruises, in2aation or edea"

Note lesions or discolorations o

orear" &elect site three or our

9nger width below antecubital

s!ace and hand width above wrist"

*ssist the client to coortable

!osition with elbow and orear

e3tended and su!!orted on 2at

surace"

*!!ly dis!osable gloves"

leance site with an antise!tic

swab" a!!ly swab at centre o the

site and rotate outward in a circulardirection or about ? c"


29/34

13

14

15

16

17

18

19

bevel o needle !ointing u!"Iith non doinant hand stretch

skin over site with ore9nger or

thub"Iith needle alost against clients

skin insert it slowly at ? to ?

degree angle untill resistance is

elt" +hen advance needle through

e!ideris to a!!ro3iately :

below skin surace" Needle ti! can

be seen through skin"n6ect edication slowly" Norally a

resistance is elt" not, needle is

too dee!" Reove and being again"

Ihile in6ecting edication notice

that sall bleb resebling

os/uito bite a!!ears on skin

surace"Iithdraw needle while a!!lying

alcohol swab gently over site during

needle withdrawal"Dont assage the site"

*ssist client to coortable

!osition"

Discard unca!!ed needle or needle

enclosed in saety sheid and

dis!ose syringe in a!!ro3iately

labeled rece!tacles"Reove gloves and wash hands"

'nsure needle ti! is in deris"

&low in6ection inii1e disconort at

site"

leb indicates edication is dee!osited

in deris"

su!!ort o tissue around in6ection site

inii1es the discoort"

%assage ay dis!ose edication intounderlying tissue layers and alter test

result"Gives client sense o well being"

0revents in6ury to client and health

!roessional" a!ing o needle is risky"

&!ecial saety shields !revents !ricks"

Reduces transission o

icroorganiss"

OBSERVATION

&tay with client and observe or any allergic reaction"

Use skin !ensil and draw circle around !erieter o in6ection site" Read

site within >= to A4 hours to in6ection"

*sk client to discuss i!lication o skin testing and signs o

hy!ersensitivity"

RECORDING

Record aount and ty!e o testing substance and date and tie on

edication record"


30/34

Record areas o in6ection and a!!earance o skin on nurses notes"

Re!ort any undesirable efects ro edication to nurse in charge

o !hysician"

PATIENT AND FAMIL TEAC!ING

Ihen client is tested in a clnic or other out !atient de!artent, have the

call or ollow u! to ckeck the skin test results"

'3!lain the client the skin reactions to observe"

SUBCUTANEOUS IN"ECTIONDEFINITION- subcutaneous eans under the skin" t is the adinistration

o edication in to the subcutaneous tissue by using a short needle to

in6ect a drug in to the tissue layer between the skin and the uscle"E'. nsulin

PURPOSES- slow absor!tion o edications"

ASSESSMENT OF T!E PATIENT

• heck !atients nae, bed no" and other identi9cation"

• heck the diagnosis and age o !atient"

• heck the !ur!ose o the in6ection"

• heck the !hysicians order or ty!e o in6ection"

• heck the consciousness o the !atient"

• heck the site o in6ection or any allergic reaction"

• heck the abilities and liitations o !atient"• heck the !atients !revious e3!erience with in6ection"

• heck articles available in !atients unit"

NURSING OB"ECTIVES

0rovide !rivacy or the client"

'nsure the clients !osition is not contraindicated by edical condition"

Nurse should take s!ecial care to avoid errors in dosage calculation

and !re!arations" Nurse should take care that the tissue around the needle stays nearly

noral in tension and a!!earance" &elect an area, which shows no signs o inection"

heck the vital signs beore and ater the in6ection"

PATIENT PREPARATION

'3!lain the !rocedure to the !atient"

0rovide !rivacy i needed"

Restrain the site o in6ection in case o children"


31/34


32/34

C

4

:

>

?

;

A

=

B

4C

Relocate site using anatoic

landarks"

leanse site with antise!tic swab"

*!!ly swab

*t centre o site and rotate outwardin circular direction ro about c"?-BC degree angle"

•#or obese client !inch skin atsite and in6rect needle below

tissue old at BC degree"

*ter needle enters site gras! lower

end o syringe board with non

doinant hand" *void oving

syringe"

&lowly !ull back on !lunger to

as!irate edication" blood

a!!ears in syringe with draw needle,

discard edication and syringe

!ro!erly and re!eat !rocedure" no

blood a!!ears in6ect edication

slowly"

Iith draw needle /uickly while

!lacing antise!tic swab gently

re/uires insertion in correct site to

avoid in6ury to underlying nerves,

bones or blood vessels"

%echanical action o swab reoves

secretion containing icroorganis"

&wab reains readily, accessible orwhen needle is with drawn"

0reventing nedle ro touching sides

o ca! !revent containation"

5uick, sooth in6ection re/uires

!ro!er ani!ulation o syringe !art"

Needle !enetrates the tight skin

easier than loose skin" 0inching skin

elevates subcutaneous tissue"5uick, 9r insertion inii1es

discoort"

$bese client have atty layer o

tissue above subcutaneous layer"

0ro!erly !erored in6ection re/uiressooth ani!ulation o syringe

!arts" %oveent o syringes ay

dis!lace needle and cause

discoort"*s!iration o blood in to syringe

indicates intravenous !laceent o

needle subcutaneous edication are

generally not or intravenous

absor!tion"

su!!orting tissue around in6ection

site inii1es discoort during

needle withdrawal"%ssage stiulates circulation and

i!roves drug distribution and

absor!tion gives client sense o well

being"


33/34

above or over site"

%assage site lightly (e3ce!t or

insulin and he!arin)"

*ssist client o coort !osition"

Discard unca!!ed needle or needle

enclosed in saety shield and

attached syringe in

a!!ro!riately labeled rece!tacle"

Reove gloves and wash hands"

0revent in6ury to client and health

care !ersonal"

Reduces transission o icro

organiss"

OBSERVATIONS- observe client closely or any adverse reaction as drug is

adinistered oe several inutes there ater"

• $bserve or any swelling or edea"

• $bserve whether the !atient had any irritation or the in6ections"

• $bserve or any unusual !ain or hardening o thet !articular !ortion"

RECORDING- record in nurses note nuber o atte!ts or inertion, si1e

o needle and when it was given"

• Record !atients verbal and non verbal res!onse to in6ection"

• Record whether there was any co!lication"

PATIENT AND FAMIL TEA!ING- teach the !atient to hold the cotton swab

or soe ore tie"

lient who re/uire daily in6ections wil need to learn techni/ues o sel

adinistration" * aily eber or a signi9cant others should also be

taught in6ection techni/ue" +each the aily about the !ur!!ose or which the in6ection was given"


34/34

BIBLIOGRAPHY

The Trained Nurses Association of India, Fundamentals of nursing A procedure of

manual (2007), New Delhi, secretar general on !ehalf of TNAI"

Temple smith #ean, #ohnsons oung $oee, %&&', Nurses guide to clinical procedures,

New or, ippincott"

*lement Nisha, 20%+, principles and practice of nursing %, nursing arts and procedures,

New Delhi, -..-// medical pu!lishers"

raash 1atan, 2007, .anipal mannual of nursing procedures, fundamentals of nursing,

angalore (India), */ pu!lishers and distri!uters"

Documents

Medication Admnistration