Lab midterm

10 rights of medication administration

1. Right patient

2. Right medication

3. Right dose

4. Right route

5. Right time 

6. Right education

7. Right assessment

8. Right evaluation

9. Right documentation 

10. Right to refuse

3 checks of medication administration

Checking that it’s the right med, right concentration, right dose, not expired

1.  When you take it out of the cupboard

2. Before you draw it up

3. Before giving to the patient

Supplies for oral route administration

medication, oral syringe, glass of water/juice and straw, paper towels, medication cup

Supplies for topical administration

warm water basin, wash cloth, towel, soap, clean/sterile gloves, medication, pen

Supplies for estrogen patch/nitroglycerin ointment

pen, transparent dressing or tape

Supplies for eye medication

cotton ball or tissue, water basin with warm water and wash cloth

Supplies for ear medications

 medication bottle with dropper, cotton-tipped applicator, cotton balls

Supplies for rectal suppository

MAR, rectal suppository, water-soluble jelly lube, clean gloves, tissue, drape

Supplies for nebulizer

medication, medicine dropper, nebulizer bottle and tubing, nebulizer machine, pulse oximeter, stethoscope

How to position patient for medication administration for various routes

Oral: sitting or fowlers. Stay there for 30 minutes after administering

Topical: so skin is exposed

Estrogen patch/nitroglycerin ointment: so skin is exposed

Eye medications: lie supine or sit back in a chair with head hyperextended, looking up

Ear medications: on side with ear to be treated facing up

Inhaler: stand/sit up

Rectal suppository: Left side-lying Sim’s position with upper leg flexed upward

Nasal spray: upright position with head slightly titled forward

Materials and equipment for injections

Syringe, small gauze pad, alcohol swab, vial or ampule of medication, clean gloves, sharps container

Technique for recapping needle

One hand behind back to avoid needle stick injuries

Needle for intradermal (ID.) injections

25- or 27- gauge needle, ⅛ inch to ⅝ inch

Identify and assess the sites for administering intradermal injections.

Note lesions or discolorations of skin. Select a site three to four finger widths below antecubital space and one hand above the wrist. Upper back can also be used. 

Procedure for administering intradermal injections

Clean site 2 inches in circular direction of site

Hold gauze between 3-4th fingers of non-dominant hand

Hold needle bevel up

Stretch skin with nondominant forefinger or thumb

Advance needle slowly at a 5-15 degree angle through the epidermis, about ⅛ inch below the surface

Inject slowly, there should be resistance 

Materials and equipment for subcutaneous injection

25- gauge, ⅛ to ⅝ inch needle

Small gauze pad 

Alcohol swab

Medication

Clean gloves

sharps

Needle size for subcutaneous injection

25- gauge, ⅛ to ⅝ inch needle

Identify and assess the sites for administering subcutaneous injections.

Backs of arms, back, glutes, abdomen, thighs, free of skin lesions, bony prominences, or large underlying muscles/ nerves. Palpate sites, avoid masses or tenderness.

Procedure for administering subcutaneous injections

Clean in a two inch circle

Hold like a dart

45-90 degree angle, 

pinch the skin with non-dominant hand

Insert quickly and firmly. Continue to pinch while injecting

 Heparin: inject over 30 seconds.

Remove quickly, apply gentle pressure but do not massage

Needle size for an intramuscular injection

20- to 23- gauge, 1 to 1.5 inch

Rule of thumb: 22- gauge, 1 inch

Sites for intramuscular injection

Ventrogluteal, vastus laterals, and deltoid

Ventrogluteal is the recommend site.

procedure for administrating intramuscular injections

• Clean site with antiseptic swab. Apply swab at centre of site and rotate outward in circular direction for about 5 cm (2 inches).

• Hold swab or gauze between third and fourth fingers of nondominant hand.

• Position ulnar side of nondominant hand just below site and pull skin laterally approximately 2.5 to 3.5 cm (1 to  inches). Hold position until medication is injected. With dominant hand inject needle quickly at 90-degree angle into muscle

• After needle pierces skin, still pulling on skin with nondominant hand, grasp lower end of syringe barrel with fingers of nondominant hand to stabilize it. Move dominant hand to end of plunger. Avoid moving syringe.

• Aspirate by pull back on plunger 5 to 10 seconds. If no blood appears, inject medication slowly at rate of 10 sec/mL 

• Apply gentle pressure to site. Do not massage site. Apply bandage if needed.