1. Medication Administration

2. Automated Medication Administration Equipment
Pyxis
SureMed
MedServe

3. Essential Components of a Medication Order
Client’s Name
Medical Record Number, Room/Bed #
Date & time of order
Name of Medication
Dosage of Medication
Route
Frequency of administration
MD’s signature

4. Six “Rights” of Medication Administration
Right Patient (check name band, ask client their name)
Right Medication
Right Dose
Right Route
Right Time (frequency)
Right Documentation
* Client’s also have the right to refuse (say no) to medication

5. The Nurse’s Responsibility for Medication Administration
Assess whether the client can tolerate the meds
Administer meds accurately & timely
Monitor for side-effects
Know contraindications
Client teaching
Practice the “Six Rights”(stressed in clinical)
Evaluation (effectiveness & client response)

6. Types of Oral Medications
Tablets
Capsules
Sublingual
Buccal
Elixirs
Enteric Coated

7. Precise & Safe Medication Administration

8. Rectal Medications Provide for privacy Explain procedure to client
Place client in Sim’s position
Apply clean gloves
Lubricate tip, round end inserted first
Encourage client to relax , deep breathe
Insert past sphincter, towards umbilicus
Have client remain on side at least five mins. (hold buttocks together etc.)

9. Rectal Medication Administration

10. Ophthalmic Medications
Place HOB down or low Fowler’s
Provide Kleenex for client
Have client look towards ceiling
Instill meds in conjunctiva (if gtts)
If ointment, apply ribbon from inner to outer canthus
Know od, os, ou routes

11. Topical & Inhalation Medications
Ointments (absorbed via mucous membranes, skin)
Inserted (vaginal)
Instilled (ear/nose gtts)
Lotions
Sprays (nasal)
Pastes (absorbed through skin)
Inhalation (nebulized treatments, MDI)

12. Topical Ointments

13. Otic Medications

14. MDI Medications

15. Medications via NGT/EFT
Determine whether med comes in elixir form
Crush all except for EC meds and mix with water or other liquid medications
Stop feedings, clamp tube, apply syringe, unclamp tube, flush tube with approx. 30cc water
Clamp tube, remove syringe, pull plunger from barrel, reattach barrel, pour meds through barrel
Add water as necessary to keep things flowing smoothly
After all meds have been given, flush with 30cc water, clamp tube, remove syringe, start feedings

17. Documentation Always 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

18. Medication Administration Records (MARs)

19. 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

20. Parts of a Needle & Syringe
Barrel
Plunger
Tip
Needle:
Bevel
Shaft
Hub

21. Types of Syringes

22. Tips of Syringes
Luer-Lok
Non Luer-Lok

23. Pre-Filled Systems

24. Assembling the Device

25. Scoop Method

26. Safety Devices

27. Needless Systems

28. 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)

29. Intradermal Injections
Given in small doses (i.e.. 0.1cc)
Common sites include: RFA, LFA
Use 1cc syringe with 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

30. Intradermal Injections

31. Subcutaneous Injections
Given in doses of 0.5cc 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 degrees

32. Deltoid Injections

33. 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

34. Intramuscular Injections

35. Vastus Lateralis

36. 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

37. Dorsogluteal Injections

38. What other site is used for IMs?

39. Ventrogluteal Good for deep injections
Away from blood vessels and nerves
Z-track
Thick, viscous meds
Antibiotics
Large volume
Irritating

40. What if……
when giving an IM injection, the aspirate comes back with blood.
What is the correct procedure and why?

41. Preparing NPH & Regular Insulin
Swab tops of both vials
Inject 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

42. Regular & NPH Insulins

43. Mixing Insulins
NPH
Insulin
Regular Insulin

44. 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.

45. Remember !!!
Always double-check Insulin & Heparin amounts/doses with another licensed person (RN/LVN/INSTRUCTOR)