Nursing Process for Administering Medications

Controlled Substances These are locked up Do not leave key in the open Medications are signed out with date,

time, patient’s name and the nurse’s name when the medication is to be removed

Controlled substances are counted at the end of every shift with the oncoming nurse and the nurse leaving the facility

Assessment

Review medical history and history of what medications the patient was receiving at home

Note whether the patient was compliant with the regime

Note whether the patient was giving self own injections at home

Assessment continued Check for

allergies to medications

Check for allergies to food such as bananas or shellfish

Assessment Continued

Ask if patient has any problems swallowing pills

Assess vital signs before administering medications

Assess patient’s knowledge of meds

Ask if patient likes to take pills one at a time or several at a time

Diagnosing

Were any problems identified? Was patient knowledgeable about

meds? Does patient have any problems

swallowing? Will the patient have to give injections

to himself when he goes home? Patient is allergic to one of the

medications ordered

Diagnosing (Possible Diagnoses)

Knowledge Deficit related to not understanding purpose of prescribed medications

Potential for aspiration related to swallowing difficulties

Risk for injury related to allergy to ordered medication

Outcome Identification or Goals

Be specific Goal should be measurable Goal should be realistic

Implementation The Five Rights

Right patient Right medication Right dose Right route Right route

Safe Administration of Meds

Always check ID of patient

Ask for name & birth date

Safety Checks Three checks

Read the label for name of drug and dosage when removing medication from storage

Read the label again and compare to the MAR for correct name and dose

Read the label again when putting the medication away

Implementation Continued Never leave medications unattended Do not dump all meds into the cup for

the patient to swallow all at once Tell the patient what each pill is and

what it is for before placing in cup, use simple terms

Offer one pill at a time, if patient wants to take more than one at a time then do so after telling him what the pill is for

Implementation Continued

Be sure patient has fresh water before proceeding to administer meds

Ask patient if he can swallow pills or if he needs to have pills “floated”

If pills are to be crushed check drug book to see if it is safe to crush the pill

Implementation Continued

Offer drink of water after taking meds

Be sure patient has swallowed the pills

Do NOT mix liquid medsGive liquids in a medicine cup or a

syringe

Giving Liquid Medicationa Measure liquids at

eye level when pouring into a medicine cup

Implementation Continued Giving sublingual

or buccal medications Ensure mouth is

moist before giving

Swab mouth with moistened sponge if patient is NPO

Implementation Continued

Giving med through an enteral feeding tube If the tube has to be taken apart place

a pad under the tube to protect from drainage

Wear gloves if tube has to be taken apart

Stop the infusion

Implementation Continued

Enteral feedings continued Crush pills very fine and dissolve in

water in a medicine cup with tepid water

Have each liquid medication in a separate cup

Flush the tube with a syringe with 30 mL tepid water before administering meds

Enteral tube medication administration continued

Administer medications with the syringe

Flush with 10 mL water before giving next medication

Administer one liquid medication at a time, flushing the tube with 10 mL water in between

Enteral Medications Continued

When finished administering medications, flush with 30 mL tepid water

Resume tube feeding

Parts of a syringe & needle

Administering Parenteral Medications

Choosing the correct needle Look at the needle

wrapper for gauge and length

The larger the number, the smaller the needle

21 G or 23 G are the most common sizes for giving IM injections

Administering Parenteral Medications cont.

18 G needles are use mainly for mixing medications

The gauge means how large in diameter it is

21G needles are used for thicker medications

Parenteral Medications cont.

The wrapper of the needle will state if the needle is 5/8”, 1” or 1 ½” long

5/8” or 1” needles are used for sub-cutaneous medications

1 ½” needles are generally used for IM injections (this is necessary to get to the muscle)

Parenteral Medications Continued

Insulins are only given with an insulin syringe or other devices designed for insulin injections only

TB syringes are used for intradermal injections

Some syringes are pre-filled with a medication such as Lovenox

Insulin Pens

Obtaning Medication from Vials and Ampules

Pre-filled syringes

Vials

Ampules

Drawing up Medication

Parenteral Medications cont.

“Z” track is recommended for all IM injections, see pp. 800 & 840 for technique

IM injections should be given at a 72o –

90o angle* Swab area with alcohol• Inject the medication slowly• Have a Band-aid handy if needed

Administer IM

Parenteral Medications cont,

See pp 798 - 799 for IM injection sites

NOTE: Wear gloves when giving IM injections

Always document site on the MAR when documenting med administration

Sites for Intramuscular Injections

Deltoid

Ventrogulteal

Vastus Lateralis

Dorsogluteal

Parenteral Medications cont.

Sub-cutaneous medications Give no more than 1 mL sub-

cutaneously Use a 5/8” or 1” needle length Swab with alcoholPinch an inch for thin patients, inject

the needle then release the pinch before injecting the medication

Angles for Needle Insertion

Sub-cutaneousl Injections cont.

Insert needle at a 45o angle

Aspiration for blood is not necessary

Inject the medication slowly

See pp 795 – 797 for sites and technique

Carpujets

Administering Insulins

Use only insulin syringes Insulin is measured in units not mg Insulin syringes are marked in

units Check the labels of the bottles of

insulin with the MAR to be sure you have right insulin

Mixing Insulins

Draw up air in the syringe for the total # of units you need to give

Obtain the bottle marked NPH (long-acting) wipe top with alcohol

Inject air with the # of units NPH insulin that is supposed to be given

Mixing Insulins cont. Next wipe the top of the bottle of

Regular insulin (short-acting) Inject air into the bottle of how many

units of regular R insulin you are supposed to give

Pick up the bottle of NPH insulin and turn upside down insert the needle and withdraw the # of units NPH you are supposed to give

Mixed insulin Turn upside down the bottle of

regular R insulin Insert needle and withdraw the #

of units or regular insulin you are supposed to give

Example: Give 3 units NPH and 10 units regular insulin. The # of units in your syringe should total 13 units

Administering Insulins The area of choice to give sub-

cutaneous insulin is in the abdomen The medication has a more consistent

rate of absorption if injected into the abdomen

If the patient insists on having the injection elsewhere, comply

See appropriate sites for insulin injections p. 795

Mixing Insulins

Intradermal Injections

These may come pre-filled in a syringe or use a TB syringe which is 1 mL & has a 5/8” needle

Usually underside of the forearm is used for the site

Cleanse the site with alcohol & allow to dry

Intradermal Injections cont.

Spread the skin taut

Insert the needle at a 10 – 15 o

angle and slowly inject the solution

Withdraw the needle

Do NOT rub!

Intradermal Injections cont.

Document the site, date, time and your name

NOTE: These are done to assess for allergic reactions which includes the Mantoux test for TB

The site should be assessed 48-72 hours later for signs of inflammation

NOTE: Nurse have to be certified by the American Lung Association with the Basic TB Test Class to perform and analyze these tests

Safety

NOTE: All needles and syringes are to be placed into a Sharp Safe immediately after use

Needles are not to be recapped after use

Administering Intravenous Medications

IV bolus or “push” Must be given by a registered nurse Must be given slowly, check drug

book for length of time for infusion Can be injected into tubing presently

being used for IV fluids or injected into an IV site which needs to be flushed with N/S before and after administering the medication

Administering Intravenous Medications

Intermittent or “Piggy back” IV meds

These are attached to the presently infusing IV tubing

Check drug book for the rate the medication is to infuse

Be sure the medication is compatible with the solution in the tubing before hanging

Adminstering Intravenous Medications cont.

Pumps are used for all IV medications Mini-infusion pumps can be used for

patients not receiving IV fluids IV line must be flushed with N/S first Central lines must be flushed with Heparin

as well as N/S at intervalsEach type of central line has its own guidelines as to amount of solution and type to flush the lines

Central lines are cared for only by RN’s

Topical Medications Ointments

Use a cotton swab, tongue blade or gloved finger to apply

Document site applied

Topical Medications cont. Powders: Used for drying, usually

in folds Transdermal patches

Remove old patch Do not get medication on your fingers Dispose patch into Sharp Safe Wipe off any remaining medication

from site

Topical Medications cont.

Transdermal patches continued Write the date and time on the patch

to be applied Apply the patch on a different site Do not get medication on your fingers Document site where patch was

placed

Administering Eye Medications

Eye ointment Cleanse hands and apply gloves Ask patient to look at the ceiling Pull down the lower lid exposing

the conjunctiva Inject the ointment from inner

canthus to outer canthus

Eye Instillation

Eye Medications Continued

Eye drops Cleanse hands, apply gloves Get tissue for patient to hold Have patient look at the ceiling Pull down the lower lid exposing

the conjunctiva

Eye drops Continued Inject the ordered number of drops

into the “pocket” of exposed conjunctiva

Apply pressure at the inner canthus to prevent systemic absorption of the medication

Ask the patient to wipe away any excess with the tissue

Teach patient not to rub eye afterwards

Eye Drops Continued If more than one

eye drop is prescribed ensure that the correct sequence is used

Allow a few minutes in between different drops

Administering Ear Drops

Turn the patient so the affected ear is facing the ceiling

Be sure ear medication is not cold, can warm the medication in warm tap water prior to administering the drops

Pull the pinna up and back

Ear Drops Continued Drop the medication on the side of the

canal Press gently on the tragus a few times

to propel the medication deeper into the canal

Gently insert a cotton ball loosely into the ear

Teach the patient to maintain position for 5 minutes

Ear Instillation

Vaginal Suppositories or Foam Have patient void before

administering medication Place patient into the lithotomy

position Drape patient With gloved hands spread labia,

cleanse area with warm washcloth Use the applicator with the

medication following directions on the package

Vaginal Suppositories or Foam Continued

Teach patient to remain in supine position for 5 – minutes

Patient may need perineal pad afterwards to prevent soiling undergarments

Document medication on the MAR

Rectal Medications

Cleanse hands, apply gloves Turn patient on his side Apply lubricant to the suppository

& insert into the anus Teach patient not to bear down

Rectal Medications

Rectal Foam The medication will come with a

device for instilling the medication Read the directions and with gloved

hands instill the medication as directed

Medications by Inhalation Have patient take a deep breath to

open airways and exhale deeply If using a spacer insert the mouthpiece

into the mouth after the patient has exhaled and squeeze the container as the patient takes a deep breath

Teach patient to hold breath for 5 – 10 seconds allowing the medication to disperse throughout the lungs

Inhalers Continued Teach patient to hold breath for 5 –

10 seconds Have patient rinse mouth after any

inhaled medications If using more than one inhaled

medication at one time, give bronchodilator first, steroids are given last and mouth has to be rinsed after

Nebulizers

Nebulizers are used with oxygen or compressed air to give a mist

Be sure mask is clean Mix ordered medication in the

nebulizer Insert the nebulizer into the tubing Turn on the oxygen or air

compressor

Nebulizers continued The patient places the mouthpiece into

his mouth and keeps it there until all the medication is used (usually 10 minutes) Some nebulizers use a mask instead of a mouthpiece

Have the patient rinse mouth after the treatment

Cleanse nebulizer and allow to air dry then place into a bag to keep it clean

Medications by Inhalation cont.

For inhalers, check order for how many “puffs”

Be sure there is medication in the inhaler, see p. 810 for method

Have the patient take a deep breath and exhale

Hold the inhaler 1” – 2” away from the nose and mouth as inhaler is pushed and the patient takes a deep breath

Other Situations

Omitted Drugs*If a scheduled drug was not given on time this fact must be documented with the reason

Situations Continued

Refused Drugs Ensure the patient understands the

consequences of not taking the medication

Document the incident with what the patient said

Inform the charge nurse of the situation

Medication Errors If a mediction error occurs the incident

has to be reported to the charge nurse and the physician

Assess the patient for any adverse reactions

Complete a Variance Form or Incident Report

NOTE: Analyzing Variance forms helps the institution discover problems in the process of med administration and can avoid future errors

Evaluation of Goals

Was goal met? Example the Nursing Diagnosis for Knowledge Deficit

Was the patient able to verbalize knowledge about the drug (s)?

If goal was not reached can you think of any changes in interventions you could make to achieve the goal?