DRUG ADMINISTRATION

Objectives : At the end of this lecture the student will able to know all the following : Definition of drug & drug administration . Policy of drug administration . Oral route & injections . Needle gauge & length . Types of injections . Intramuscular , Intradermal & subcutaneous injection

All abbreviations related to drug administration . Methods to decrease the pain during administration . General assessment . Nursing diagnosis .

Definition of drug : Is a substance used for diagnosis , treatment ,relieve or prevention of disease .

Definition: A route of administration is the path by which a drug, fluid, or other substance is brought into contact with the body.

Polices of drug administration (nurses responsibility) Check physician order . Check the timing of drug ordered by physician such as before or after food because medication action can interact with food . Check 10 rights of medication administration .

Don’t administered drug that is ordered by unofficial abbreviations . Don’t administered drug that is not labeled . Check the expire date of drug . Check drug with the physician order & medication charts . Check patient allergy . Don’t administered drug that is prepared by another person .

Patient’s Rights Because of the risks involved in drug administration patients have the right to: - be informed of the name, purpose, action & potential side effects of drugs - refuse a medication regardless of the consequences

Patient’s Rights (con’t) - receive labelled medications safely in accordance with the ten (10) rights - be adequately informed of the experimental nature of any drug and sign a written consent . - not receive unnecessary medications

The nurse is also responsible for ensuring that they have the knowledge to ensure the correct administration of drugs. This includes pharmacology, anatomy and physiology, and legal issues.

WHAT CONSTITUTES A LEGAL MEDICATION ORDER Medication Charts should be written legibly in the prescriber’s own handwriting and include: Patient’s name , medical record number (MRN), ward/clinic

Drug name (generic), dosage form, strength and dose required Complete, clear and unambiguous directions for each item . directions should be written in simple English (only approved abbreviations may be used)

Prescriber’s printed name, signature and date of order - the prescriber’s full signature and date of order must be written for EACH DRUG ordered . Accept verbal orders only in emergency to save the life of patient . Weight should be provided for any drug dosed by weight.

Each medication order must be legible, complete and unambiguous so that the correct patient is administered the correct drug at the appropriate dose. A nurse cannot administer the drug and a pharmacist cannot dispense a drug to a patient unless all details are correct and complete.

Every registered nurse is legally responsible for the correct administration of drugs. This includes the 10 “rights” of administration: Right patient Right drug Right dose Right route Right time

Right education . Right refuse . Right assessment Right evaluation Right documentation

Right Patient : check the patient name & hospital number against the chart & I.D. band. ask the patient to state his/her name, & their date of birth (D.O.B)

Right Drug : - before removing it from the trolley Check the drug three times: - before removing it from the trolley - when the drug is removed from the container - before the container is returned to storage - check the expiry date of the drug Check the drug with another register nurse .

Routes of Administration

Route for administration (Time until effect) Intravenous : 30-60 seconds Endotracheal : 2-3 minutes Inhalation : 2-3 minutes Sublingual : 3-5 minutes

Intramuscular : 10-20 minutes Subcutaneous : 15-30 minutes Rectal : 5-30 minutes Ingestion : 30-90 minutes Transdermal : (topical) variable (minutes to hours)

Oral medication Administration of medication by mouth & ensuring that patient swallow the medicine . Forms ( tables ,capsule , syrup )

Contraindications to oral administration Unconscious patient . Patient on nil / oral ( NPO ) . Gastric or intestinal suction . Patient who are unable to swallow . Continuous vomiting .

Instruction related to oral administration Never giving water after cough syrup it leaves soothing effects to prevent cough . Drug which stimulate appetite must be given before foods . Give medicine at correct time & see patient takes it .

Injections Are parenteral therapy , it means giving of therapeutic agents including food outside the alimentary tract . Injections is forcing of a fluids into cavity ,blood vessels or body tissue through a hollow tubes or needle.

Advantages Get rapid & systemic effects of drugs . To provide needed effects even the patient is unconscious . It useful for medication that can not be given orally . To restore blood volume by replacing the fluids & give nourishment to patient .

Types Intradermal Intramuscular Intravenous . Subcutaneous . Intraspinal . Intraosseous (into peritoneal cavity) . Venesection ( open vein insert tube to administer medicine or taking out blood )

Parts of needles

Needles Parts are the hub, shaft, and beveled tip. Opening at the needle’s beveled tip is the lumen. Size of the diameter of the inside of the needle’s shaft determines the gauge of the needle; the smaller the gauge, the larger is the diameter. Needle gauge selection is based on the viscosity of the medication.

Needle Length Selected based on the depth of the tissue into which the medication is to be injected Intradermal: 3/8 to 5/8 inch Subcutaneous: 5/8 to 1/2 inch Intramuscular: 1 to 1 1/2 inch

Needle length & gauge

Insulin syringe

Intramuscular Injections Involves inserting a needle into the muscle tissue to administer medication Site Selection : Gluteal sites Vastus lateralis muscle Rectus femurs muscle Deltoid muscle Z-track Method : Used to inject medications that are irritating to the tissues

Locating IM injection for ventrogluteal site.

Dorsogluteal sites

Old Method

Current method

Giving IM injection in vastus lateralis site on adult.

Deltoid muscles

Equipment Syringe & needle Cotton swap Antiseptic solution ( spirit) Medication Medication administration cards / physician order Tray

Important point in the procedure Needle inserted at 90 angle Aspirate to check for blood Do massage after needle remove Ask patient to take rest for 15 minute Inspect the area for bleeding after removing of needle . Check for limb movement to confirm there is no nerve injury .

Intradermal Injections Gauge-25-29 Length-1/4 to ½ inch Amount- 0.1 ml Angle 10 - 15 degrees DO NOT ASPIRATE

Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agent Not aspirated Small volumes (0.1 ml) injected to form a small bubble like wheal just under the skin Used for allergy sensitivity tests, TB screening, and local anesthetics A tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle

Important point Insert needle at 10 – 15 angle . Don’t aspirate & don’t massage ( to prevent absorption into subcutaneous tissue ) . Inject medication slowly over (3 – 5) second while watching for small blister to appear . Wait for 15 – 60 minute to read the allergy test & for 48 – 72 hours to read the test of tuberculin .

Subcutaneous injections Gauge-25-29 Length-3/8, ½ and 5/8 inches Angle 45 - 90 degrees DO NOT ASPIRATE

Injections made into the loose connective tissue between the dermis and the muscle layer Drug absorption slower than with IM injections Given at a 45-degree angle if the patient is thin or at a 90-degree angle if patient fat . Usual needle length is 1/2 to 5/8 inch and 25 gauge Used to administer insulin and heparin

Common site Outer aspect of upper arm . Posterior chest wall below the scapula . Anterior abdominal wall below breast to iliac crest . Anterior & lateral aspect of the thigh .

Methods to Decrease the Pain of Injections Encourage client relaxation-position client to have muscle relaxed . Change needle after preparing medication in syringe . Avoid injecting into sensitive or hardened skin . Use needle long enough to reach muscle. “Dart” needle quickly into muscle Use smallest gauge possible .

Inject medication slowly Do not move needle once inserted . Withdraw needle quickly . Apply pressure/ice to site before injection.

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS frequency

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS Meaning Abbreviations morning MANE midday MIDI night NOCTE Twice a day BD Three times a day TDS Four times a day QID Give immediately STAT COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS Mosby items and derived items © 2005 by Mosby, Inc.

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequency ac pc q.h.or 1/24 q2h or 2/24 q4h or 4/24 before meals after meals every hour every two hours every four hours

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route BUC O/P.O S/L ID IM IMI SC inside cheek oral/per oral sublingual (under the tongue) Intradermal intramuscular intramuscular injection subcutaneous

COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route SCI IVI IVT NEB PR TOP VAG subcutaneous injection intravenous injection intravenous therapy nebuliser per rectum topical/skin vaginal

Assessment Medical history History of allergies Medication data Diet history Assess the site of injection . Perceptual or coordination problems Current condition

Nursing Diagnoses Deficient knowledge (medications) pain Disturbed sensory perception Impaired swallowing Ineffective therapeutic regimen management

Good Luck