Mathematics Review and Medication Administration Chapter 23 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Definitions  Numerator: Top number of a fraction  Denominator: Bottom number of a fraction Types of Fractions  Proper fractions: Numerator is less than the denominator  Improper fractions: Numerator is larger than the denominator  Mixed fractions: Consist of a whole number plus a fraction

Slide 3Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Changing an Improper Fraction to a Whole or Mixed Number  Divide the denominator into the numerator. Changing a Mixed Number to an Improper Fraction  Multiply the denominator into the whole number.  Add the numerator to the product; the sum is now the new number. Reducing Fractions to the Lowest Term  Find a number that will evenly divide into the numerator and the denominator.

Slide 4Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Determining Which Fraction Is Larger  If the denominators are the same, the fraction with the larger numerator is the larger fraction.  If the denominators are different, you must find a “common denominator.” Finding a common denominator means to find a number into which both denominators can be divided.  After the common denominator is found, an equivalent numerator for each fraction must be found. ( Divide the first denominator into the equivalent denominator; multiply the answer by the first numerator.)

Slide 5Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Adding Fractions That Have the Same Denominator  Add the numerators and place the sum of the numerators over the denominator. Adding Fractions That Have Different Denominators  Find common denominators for all fractions in the problem.  Find the equivalent numerators.

Slide 6Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Adding Mixed Numbers  Add the fractions of the mixed number. Then add the sum of the fractions to the whole number. Subtracting Fractions with the Same Denominator  Subtract the numerator and place it over the denominator. Subtracting Fractions with Different Denominators  Find a common denominator, and then subtract.

Slide 7Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Subtracting Mixed Numbers  When the numerator of the top fraction is smaller than that of the bottom fraction, borrow one whole number from the whole number of the mixed fraction and express it as a fraction. Multiplying Fractions  Multiply the numerators; multiply the denominators. Multiplying Fractions and Mixed Numbers  Change the mixed number to an improper fraction.  Multiply.

Slide 8Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Fractions Dividing Fractions  Write the problem down correctly; invert the second fraction.  Multiply. Dividing Fractions and Whole Numbers  Change the whole number to a fraction  Divide.

Slide 9Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Decimal Fractions The decimal fraction is a type of fraction that uses a decimal to indicate the denominator of the fraction. The placement or position of the decimal point determines whether the denominator is 10, a multiple of 10, or a division of 10.

Slide 10Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Decimal Fractions Names of Decimal Places One hundred thousandths.0001 Ten thousandths.001 Thousandths.01 Hundredths.1 Tenths 1. Unit (whole number) 10 Tens 100 Hundreds 1000 Thousands 10,000 Ten thousands 100,000 One hundred thousands

Slide 11Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Decimal Fractions Names of Decimal Places (continued)  A decimal point found left of a whole number means that the number is a fraction of a whole number.  A decimal point found after a number means that it is a whole number.  A number without a decimal point is understood to have an “invisible” decimal point behind it.

Slide 12Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Decimal Fractions Adding Decimals  Align the decimal point of each decimal fraction in a column.  Add. Subtracting Decimals  Align the decimal point of each decimal fraction in a column.  Subtract. Rounding a Number  A number found after the decimal point that is 5 or larger can increase the number before it by one whole number.

Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percents The word “percent” and its symbol, %, mean “hundredths.” A hundredth is a fraction of a whole number; therefore, a number followed by percent sign (%) is a fraction. The denominator of the fraction is understood to be 100.

Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percents Changing a Percent to a Decimal Fraction  Remove %; move the decimal point two places to the left to indicate “hundredths.” Changing a Fraction to a Percent  Change a fraction to a percent by dividing the numerator by the denominator.  Multiply the answer by 100.  Label the answer with the percent symbol, %. Multiplying by Percent  Change the percent to a decimal.  Multiply.

Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System The metric system is based on the decimal system. The decimal system uses the divisions and multiples of a unit, which is always in ratios of tens. The metric system uses the following units:  liter (L) = volume (amount) of fluids  gram (g) = weight of solids  meter (m) = measure of length

Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Smaller units of the system are designated by the following prefixes:  deci = 0.1 of the unit (liter, gram, meter); tenths  centi = 0.01 of the unit; hundredths  milli = of the unit; thousandths Larger units of the system are designated by the following prefixes:  deka = 10 times the unit (liter, gram, meter)  hecto = 100 times the unit  kilo = 1000 times the unit

Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Units of Weight  1 gram (g) = 1000 milligrams (mg)  gram (g) = 1 milligram (mg)  1 kilogram (kg) = 1000 grams (g)  kilogram (kg) = 1 gram (g) Units of Volume  1 liter (L) = 1000 milliliters (mL)  liter (L) = 1 milliliter (mL)  1 milliliter (mL) = 1 cubic centimeter (cc)

Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Approximate Equivalents of the Metric System and the Apothecary System  Volume 1 milliliter (mL)= 15 or 16 minims 4 or 5 milliliters (mL)= 1 fluid dram 30 milliliters (mL)= 1 fluid ounce 500 milliliters (mL)= 1 pint 1000 milliliters (mL)= 1 quart

Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Approximate Equivalents of the Metric System and the Apothecary System (continued)  Weight 60 milligrams (mg)= 1 grain (gr) 1000 milligrams (mg)= 15 grains 4 grams (g or gm)= 1 dram 30 grams (g)= 1 ounce 0.45 kilogram (kg)= 1 pound (lb.) 1 kilogram (kg)= 2.2 pounds (lbs.)

Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Metric Measurements of Length  The basic unit of length is the meter.  The meter is equal to inches.  meter= 1 millimeter (mm)  0.01 meter= 1 centimeter (cm)  0.1 meter= 1 decimeter (dm)  10 meters= 1 decameter (dam)  100 meters= 1 hectometer (hm)  1000 meters= 1 kilometer (km)

Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. The Metric System Metric Measurements of Length  Most frequently used equivalents 1 meter (m) = 1000 millimeters (mm) meter (m)= 1 millimeter (mm) 1 meter (m)= 100 centimeters (cm) 1 centimeter (cm)= 10 millimeters (mm) 1 millimeter (mm)= 0.1 centimeter (cm)

Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pediatric Considerations Young’s Rule  A method for the calculation of the appropriate dose of a drug for a child 2 years of age or older; applies to children up to the age of 12 Age of child _ (Age of child + 12)  Average adult dose = Child’s dose

Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pediatric Considerations Clark’s Rule  A method of calculating the approximate pediatric dosage of a drug for a child Weight of child (lbs.) 150  Average adult dose = Child’s dose

Slide 24Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pediatric Considerations Fried’s Rule  This rule is used for infants younger than 2 years of age. Age in months 150  Average adult dose = Child’s dose

Slide 25Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology This is the study of drugs and their action on the living body. Substances derived from plants and animals, from vitamins and minerals, and from synthetic sources can be used as drugs in the treatment and prevention of disease. The action of any drug on the body is a complicated process.

Slide 26Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology Pharmaceutical Phase  The making of the drug until absorption of the drug takes place in the patient’s body Pharmacokinetic Phase  The movement of the drug’s active ingredients from the body fluids into the entire system and to the site where the intended action of the drug takes place Pharmacodynamic Phase  Interaction of the drug’s active ingredient with the intended body tissues; the body’s cells respond to the action of the drug and change as the drug is metabolized

Slide 27Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology Drug Dosage  The dosage is the amount of a drug prescribed for the patient by the physician.  A dose of medicine refers to a single prescribed amount of drug given at one time.  Nurses must become familiar with therapeutic dosages of frequently used drugs to confidently administer dosages of medication to each patient.

Slide 28Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology Drug Actions and Interactions  Two general types Local: Affect only the area where the drug is placed Systemic: Affect the entire body  Drug interaction: One drug alters another drug  Potentiation: One drug increases the action or effect of another drug  Incompatibility: Drugs that do not combine chemically with other drugs  Antagonist: Drug that will block the action of another drug

Slide 29Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. An idiosyncratic response to a drug is an individual’s unique hypersensitivity to a particular drug. A reduced response to a drug is called tolerance. An adverse drug reaction is a harmful, unintended reaction to a drug administered at a normal dosage. Contraindications are conditions under which the drug should not be given. Interactions are modifications of the effect of a drug when administered with another drug. Pharmacology

Slide 30Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology Factors that may affect how patients respond to medication:  Age  Weight  Physical health  Psychological status  Environmental temperature  Gender  Amount of food in the stomach  Dosage forms

Slide 31Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Orders The nurse is ethically and legally responsible for ensuring that the patient receives the correct medication ordered by the physician. Medication orders should include the following:  Patient's name  Date and time of the order  Name of the drug  Dosage of the drug  Route of administration  Time or frequency drug is given  Signature of the physician  Any special instructions

Slide 32Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Orders Controlled Substances  Opioids, barbiturates, and other controlled drugs that have a high possibility for abuse or addiction are double-locked.  “Narcotic keys” are kept by designated nurses per shift.  Each controlled drug used is logged into the narcotic log book.  At the end of each shift, controlled drugs are carefully counted by a nurse from the outgoing shift and a nurse from the incoming shift.  Always have a witness to the “wasting” of a controlled substance.

Slide 33Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Orders Types of Orders  Standing orders Already written by a physician for all patients on a particular unit or area Carried out without having to call the physician  Verbal orders May be given in the presence of an LPN/LVN or an RN directly or over the telephone Should be written on the chart and signed by the physician as soon as possible

Slide 34Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Administration Six Rights  Right medication  Right dose  Right time  Right route  Right patient  Right documentation

Slide 35Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Orders Important Considerations of Medication Administration  If you did not pour it, do not give it.  If you gave it, chart it.  Do not chart for someone else or have someone else chart for you.  Do not transport or accept a container that is not labeled.  Do not put down an unlabeled syringe.  If given a verbal order, repeat it to the physician.  If you make an error, report it immediately.

Slide 36Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Orders Important Considerations of Medication Administration (continued)  Never leave a medication with a patient or family member. Watch the patient take it and swallow it.  Always return to assess the patient’s response.  Chart as soon as possible after giving medication.  If a patient refuses medication, do not force it; chart “Refused medication because of....”  If you elect to omit a dose based on your nursing judgment, let another nurse help make the decision. If medication is not given, document “Dose omitted because....” Report to the physician.

Slide 37Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Routes of Administration Enteral  Via the GI tract Powders Pills Tablets Liquids or suspensions Suppositories

Slide 38Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Routes of Administration Percutaneous  Through the skin or mucous membranes Topical Instillation Inhalation

Slide 39Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Routes of Administration Parenteral  Methods other than the GI tract; needle route Ampules Vials Intramuscular Subcutaneous Intradermal Intravenous

Slide 40Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Enteral Administration Preparation of Tablets, Pills, and Capsules  These preparations enter the GI tract and are absorbed more slowly into the blood stream than via any other route.  The slow absorption rate makes the PO (by mouth) route relatively safe.  Some PO medications are irritating to the patient’s GI tract, and larger tablets may be difficult for some patients to swallow.

Slide 41Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Enteral Administration Preparation of Liquid Medications  Liquid medications are often given to children; to patients who cannot swallow tablets, pills, or capsules; and to geriatric patients.  Medications may be given PO or via a nasogastric, gastrostomy, or jejunostomy tube.  Liquids must not be given to unconscious patients because of the possibility of aspirating.  Some liquid medications are not to be followed by water, and some may stain the teeth.

Slide 42Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Skill 23-2: Step 13 Administering liquid medications. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Slide 43Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Enteral Administration Tubal Medications  Nasogastric (NG) tubes are used to administer liquid medications to unconscious patients, dysphagic patients, and those who are too ill to eat.  Many medications come in liquid form; if they do not, solid tablets may be pulverized in a mortar and pestle, and capsules can be opened.  Not all tablets are safe to use when crushed, and not all capsules are safe to use when opened.

Slide 44Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Skill 23-3: Step 13a Administering tubal medications.

Slide 45Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Skill 23-3: Step 16 Administering tubal medications.

Slide 46Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Enteral Administration Suppositories  Cone-shaped, egg-shaped, or spindle-shaped medication made for insertion into the rectum or vagina  Dissolves at body temperature and absorbed directly into the bloodstream  Useful for infants, patients who cannot take oral preparations, and patients with nausea and vomiting  Stored in cool place so they do not melt

Slide 47Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration With these routes, medications are absorbed through the skin or the mucous membranes. Most produce a local action, but some produce a systemic action. Drugs include topical applications, instillations, and inhalations and ointments, creams, powders, lotions, and transdermal patches. Absorption is rapid but of short duration.

Slide 48Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Ointments  An oil-based semisolid medication; may be applied to the skin or a mucous membrane Creams  Semisolid, nongreasy emulsions that contain medication for external application Lotions  Aqueous preparations that are used as soothing agents that relieve pruritus, protect the skin, cleanse the skin, or act as astringents

Slide 49Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Transdermal Patches (Topical Disk)  Adhesive-backed medicated patches applied to the skin provide sustained, continuous release of medication over several hours or days. Eyedrops and Eye Ointments  Care should be taken to keep all ophthalmic preparations sterile by not touching the dropper or the tube to the eye. Eardrops  Containers of solutions to be used as eardrops will be labeled “otic.” They must be at room temperature when applied.

Slide 50Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-4 A variety of medications are available as transdermal patches. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 51Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Nosedrops  Nosedrops are for individual use only. Nasal Sprays  Sprays absorbed quickly; less medication is used and wasted when administered in this manner. Inhalation  Drugs may be absorbed through the mucous membranes of the respiratory tract.  Inhalation produces a relatively limited effect or a systemic effect.  This method is actively used by respiratory therapy and anesthesiologists.

Slide 52Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Sublingual Administration  Drug is administered by placing it beneath the tongue until it dissolves.  Drug may be a tablet or liquid squeezed out of a capsule.  It is rapidly absorbed into the bloodstream. Buccal Administration  A tablet is placed between the cheek and teeth, or between the cheek and the gums.  Absorption into the capillaries of the mucous membranes of the cheek gives rapid onset of the drug’s active ingredient.

Slide 53Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Parenteral Administration Equipment  Syringes Syringe consists of a barrel, a plunger, and a tip. Outside of the barrel is calibrated in milliliters, minims, insulin units, and heparin units. Types  Tuberculin syringe  Insulin syringe  Three-milliliter syringe  Safety-Lok syringes  Disposable injection units

Slide 54Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-5 Parts of a syringe. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 55Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-6 Tuberculin syringe calibration. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)

Slide 56Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-7 Calibration of U100 insulin syringe. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)

Slide 57Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-8 Reading the calibrations of a 3-mL syringe.

Slide 58Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Safety-Glide syringe.

Slide 59Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Parts of a needle. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)

Slide 60Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Equipment (continued)  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  Intravenous needles Butterfly (scalp needle) Over-the-needle catheter (Angiocath, Jelco)

Slide 61Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Needle length and gauge. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)

Slide 62Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Equipment  Needleless devices Devices are designed with a sheath or guard that covers the needle after it is withdrawn from the skin. Intravenous catheters have been designed with blunt-edged cannulas, valves, or needle guards to minimize injuries. IV tubing with recessed and shielded needle connectors has been designed, further reducing needlesticks.

Slide 63Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Intramuscular Injections  Involves inserting a needle into the muscle tissue to administer medication  Site selection Gluteal sites Vastus lateralis muscle Rectus femoris muscle Deltoid muscle  Z-track method Used to inject medications that are irritating to the tissues

Slide 64Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-15, C Locating IM injection for ventrogluteal site. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 65Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-16, C Giving IM injection in vastus lateralis site on adult. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 66Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Rectus femoris muscle. A, Child/infant. B, Adult. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13 th ed.]. St. Louis: Mosby.)

Slide 67Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 23-18, C Giving IM injection in deltoid site. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 68Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure A, Z-track method. B, Using an air lock. C, Administering IM injection by airlock technique. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Slide 69Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Intradermal Injections  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 bubblelike 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

Slide 70Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Angles of insertion for intramuscular (90°), subcutaneous (45°), and intradermal (15°). (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Slide 71Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Subcutaneous Injections  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 the patient has ample subcutaneous tissue  Usual needle length is 1/2 to 5/8 inch and 25 gauge  Used to administer insulin and heparin

Slide 72Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Subcutaneous injection. Angle and needle length depend on the thickness of skinfold. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

Slide 73Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Intravenous Therapy  Provide fluid and electrolyte maintenance, restoration, and replacement  Administer medication and nutritional feedings  Administer blood and blood products  Administer chemotherapy to cancer patients  Administer patient-controlled analgesics  Keep a vein open for quick access

Slide 74Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Methods of Intravenous Administration  IV push  Intermittent venous access device  Intermittent infusion (or piggyback)  Continuous infusion  Electronic pumps and controllers  Patient-controlled analgesia  Volumetric chambers

Slide 75Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure PCA infusion pump. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Slide 76Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Volumetric chamber.

Slide 77Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Nursing Responsibility  The nurse must ensure that fluid of the ordered type and amount is started and that the fluid is regulated to infuse over the period ordered.  To find the drops per minute (the drip rate), you must know which type of IV tubing will be used with the infusion and obtain the drip factor for the tubing to be used.

Slide 78Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. IV drip rate calculation 1500 ml IV Saline is ordered over 12 hours. Using a drop factor of 15 drops / ml, how many drops per minute need to be delivered? 1500 (ml) X 15 (gttss / ml) x 60 (gives us total minutes) = 31 gtts / minute

Slide 79Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Nursing Responsibility (continued)  Monitor intravenous therapy Check the infusion and the IV needle site at least every hour.  Flow of fluid  IV site: erythema, wetness, and edema  Phlebitis: inflamed vein  Infiltration: fluid passes into the tissues Assess for chills, fever, headache, nausea, vomiting, anxiousness, and dyspnea.

Slide 80Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Percutaneous Administration Nursing Responsibility (continued)  Assess for anaphylactic shock Respiratory distress Skin reactions Signs of circulatory collapse GI signs and symptoms Change in mental status  Requires immediate intervention.

Slide 81Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process Nursing Diagnoses  Anxiety  Health-seeking behaviors  Injury, risk for  Knowledge deficient  Mobility, impaired  Noncompliance: drug regimen  Sensory/perception, disturbed