Term
| 6 Rights of Medication Administration |
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Definition
1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Frequency
6. Right Documentation |
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1. Drs orders to MAR (Chart check)
2. MAR to Meds (When pulling out of Pyxis)
3. Pt to MAR, MAR to Meds at pt’s bedside. (Scan pt, check meds to computer before giving at bedside) |
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Term
| Injections - unless administering immediately, label! |
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Definition
Wipe top of vials with alcohol. Use filter needle to get meds from ampule.
When reconstituting powdered medication, rotate vial between palms to mix after injecting diluent.
When drawing up cloudy insulin, turn vial top-to-bottom 8-10 times instead. Rolling the vial fails to bring insulin into suspension and shaking destroys the potency. |
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| 23-25 gauge, 5/8-1 inch needle, up to 1 mL |
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| 18-23 gauge, 1-1 ½ inch needle, up to 5 mL |
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| 18-23 gauge, 1-1 ½ inch needle, up to 5 mL |
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| Subcutaneous Injections size |
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Definition
| .5-3 mL syringe with 25-29 gauge, 3/8-5/8 inch needle. |
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| Subcutaneous Injections sites |
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Definition
Fatty tissue of abdomen
Lateral and posterior aspects of upper arm or thigh
Scapular area of back
Upper ventrodorsal gluteal areas |
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o 1 mL tuberculin syringe with short bevel. 25-27 gauge, 3/8-1/2 inch needle.
o Sites:
Inner aspect of forearm or scapular area of back
Upper chest
Medial thigh
o Amount injected = 0.01-0.1 mL |
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Term
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Definition
• Placement check - Aspirate gastric contents small syringe to check color and pH (color should be golden yellow to brownish green, pH of 5 or less).
• Stop any continuous tube feeding for 15 minutes and flush tube with 15 mLs sterile water. Mix each med in 30 mLs of water – do not mix medications together. After giving each med, flush with 15 mLs water.
• Document which nare tube is in and number on tube (placement), connected to suction, clamped, or TF.
• If TF, must aspirate residual prior to giving meds; document amount/color.
If connected to suction, wait 15-30 minutes before reconnecting after giving medication. |
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• Prepare medication to correct dilution. Check for compatibility with infusing solution. Determine injection time for specific medication.
• Prep injection port closest to client with alcohol. Flush line prior to administration only if incompatible with med. Insert syringe into line port and then pinch tubing, instill med as directed, and remove needle. Flush afterwards with 5-10 mL NS to remove all medication from IV tubing. Use same time rate as medication administration. Unclamp. |
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| • Prepare medication. Prep injection port with alcohol swab. Flush saline locked IV with NS, first aspirating for blood return. Insert medication syringe into port and inject medication into vein, timing administration rate according to drug manufacturer’s instruction. Flush with second saline syringe to clear line and maintain patency of lock. Admin time should be the same as the medication to prevent a bolus of medication. |
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| Adding Meds to IV Solution |
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Definition
| • Check to ensure prescribed drug is compatible with IV solution. Draw up medication into syringe. Have another RN witness what meds you add to the bag before injecting. Wipe injection port on IV bag with alcohol. Inject medication into bag. Mix by gently agitating bag to mix thoroughly. Affix medication label to IV bag. |
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| • Ensure medication compatibility with primary infusing solution. Spike bag and prime tubing. Cleanse connection site with alcohol and then connect secondary tubing to primary at pump. Program secondary settings into infusion device. Open clamp on secondary bag. |
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Term
| Blood Administration (3 things) |
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Definition
• Check physician’s order for number and type of transfusion units. Confirm that client has signed consent for transfusion. Check that type and crossmatch have been completed and that blood is ready in blood bank. Determine patency of IV and correct catheter gauge. Begin infusion of NS with appropriate blood tubing. Obtain pretransfusion vital signs. Obtain blood bag. Validate information on blood bag with another nurse.
• Close all clamps on the Y-set tubing. Spike bag of normal saline with one arm and open clamps on both arms of the Y-tubing to flush. Close clamp on free arm and open clamp below tubing filter to prime main tubing. Close all clamps after priming. Gently agitate blood unite bag, pull back tabs on blood unit bag, and expose port. Spike blood bag port with free arm of Y-tubing, then hang unit. Prep client’s injection port with alcohol swab. Connect blood tubing and open clamp to blood bag. Start blood infusion, administering slowly at 5 mL/min for first 15 min, then increase rate.
Take and record client’s vital signs 5 min after, 15 min, and then q30min until transfusion is complete. Observe client for adverse signs. Once transfusion is complete, flush line with normal saline. Take another set of vitals after finishing the transfusion.
• Remember that blood cannot be returned to the blood bank after it has been checked out for 20 minutes. Blood transfusion must be complete in less than 4 hours. |
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| Transdermal Medications (Patches) |
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Definition
• Obtain transdermal patch or premeasured paper that accompanies medication tube. Don gloves. Alternate areas with each dose of medication to prevent skin irritation. Remove previous medicated patch, fold in half, and discard in biohazard box.
• Cleanse site before applying dose. Place prescribed medication directly on paper (usually ½-1 in strip.) Apply to clean, dry, hairless, intact skin. Use paper to spread medication paste over a 2 inch area. Secure with tape.
• NEVER cut a transdermal patch as it will release the entire dose to the client at once, which could lead to overdose. |
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Definition
| • Position pt on side, with ear to be treated in uppermost position. In children, draw pinna gently downward and backward. In adults, lift pinna upward and backward. Instill medication drops, holding dropper slightly above ear. Instruct client to remain on side for 5-10 minutes after instillation. |
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| Tilt head up, ask pt to look up. Pull down lower lid and drop prescribed drops into center of conjunctival trough. Ask client to close eyelids and moves eyes gently. Remove excess medication with tissue. |
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| Expose conjuctival trough by pulling lower lid down on cheek. Instruct pt to look upwards. Keep tube ½ inch from eye. Squeeze ribbon of ointment along middle 1/3 of trough. Ask client to close eyelids and moves eyes gently. Remove excess medication from client’s eye area with tissue. Caution pt that vision may be temporarily blurred. |
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| • Explain that the pt must not swallow drug or eat, smoke, or drink until medication is fully absorbed. Ask pt to place tablet under tongue. |
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| • Place pt in sitting position with head tilted back or in supine position with head tilted back over pillow. Fill dropper with prescribed amount of medication. Place dropper just insde the naris and instill correct dosage. Repeat in other naris. Wipe away any excess with tissue. Instruct pt not to sneeze or blow nose and to keep head tilted back for 5 minutes to prevent medication loss. |
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| MDI (Metered-Dose Inhaler) |
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Definition
• Assist pt to sitting position. Insert canister into dispenser. (For new canister, test spray MDI into air one or two times.) Shake MDI with canister to mix medication and propellant before EACH puff. Instruct pt to remove mouthpiece and hold inhaler 2 in from mouth. Mist is to be inhaled into airways. Instruct pt to exhale through pursed lips, depress inhaler to release a puff of medication, and inhale slowly and deeply for 3-5 seconds. Tell pt to hold breath for 10 seconds, and then slowly exhale through pursed lips. Insure pt waits 1-2 min between inhalations. Have client rinse mouth after using MDI and teach to remove canister and clean mouthpiece daily with soap and water.
• When using spacer, do the same but first insert the MDI mouthpiece into spacer. |
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| Dry Powder Inhaled Medication |
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Definition
| o Remove capsule from package, peeling back foil cover to expose only one capsule. Open the outer cap of inhaler device and open the mouthpiece. Insert capsule into center of chamber of the inhalation device. Hold the device upright and close mouthpiece until a click is heard. Press the side mounted piercing buttin in completely, then release. Have the pt breathe out completely and then breathe slowly and deeply with sufficient energy to hear the medication capsule vibrate. Have the client hold the deep breath as long as comfortable ,then return to normal breathing. Open mouthpiece and discard remaining capsule. Close mouthpiece and outer cap and store at bedside. Clean unit only as necessary, using warm water and allowing device to air dry thoroughly before next use. |
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• Place pt in side-lying position. Squeeze dollop of lubricant onto paper towel. Remove foil wrapper from the suppository. Moisten suppository tip with warm water or lubricant to facilitate insertion. Don clean gloves and inspect anal area for hemorrhoids. Instruct client to bear down and insert the suppository about 1 ½ in into the rectal canal beyond the anal sphincter.
• Instruct client to lie for 15 minutes while medicine is absorbed and that suppository may take up to an hour to be effective. Return after 15 minutes to ensure pt is comfortable. Chart medications and results obtained. |
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| • Don gloves. Place client in side-lying position. Remove foil wrapper from suppository. Insert into applicator. Don clean gloves. Insert applicator with suppository into the vaginal canal at least 2 inches. Instruct client to lie for 15 minutes to allow the suppository to absorb. Wash applicator and return to appropriate place in client’s room. Chart medication and assessment findings. |
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| Administering SubQ Heparin |
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Definition
| • Double check heparin calculated dose with another nurse. Check client’s record for site of previous injection; rotate to new site for this injection. Select site on client’s lower abd (at least 2 finger breadths from umbilicus) or select area of fatty tissue above iliac crest. Cleanse site with alcohol. Gently pinch subq tissue and inject medication slowly without aspirating first. Wait 10 seconds before withdrawing needle. Press and hold gauze over site. |
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