Professional Documents
Culture Documents
MEDICATION
ADMINISTRATION
Section 6.1 Introduction
Section 6.2 Oral medication administration
Section 6.3 Topical medication administration
Section 6.4 Parenteral medication administration
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SECTION 6.1
INTRODUCTION
KEY TERMS
adverse effect, 241
chemical name, 240
drug, 240
generic name, 240
medication, 240
medication error, 241
medication history, 246
near miss, 241
prescription, 240
side effect, 241
therapeutic effect, 241
trade name, 240
LEARNING OUTCOMES
On completion of this section you will be able to:
1.
2.
3.
4.
5.
6.
7.
LEGAL ASPECTS OF
MEDICATION ADMINISTRATION
The administration of drugs in the Australia is controlled
by law. Nurses need to (a) have a sound understanding of
the laws that govern their scope of practice in relation to
medication administration, and (b) recognise the limits of
their own knowledge and skill.
Under the law nurses are responsible for their own actions
regardless of whether there is a written medication order.
240
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UNIT 6
MEDICATION SAFETY
Medication errors are the second most common type of
incident reported in Australian hospitals with error rates of over
18% (Johnson, Tran & Young, 2011) and only 421% of people
achieving the optimum therapeutic benefit of medications
(Garfield, Barber, Walley, Willson & Eliasson, 2009). In the
Australian public health system medication adverse events cost
approximately $6 billion dollars per year and inappropriate
use of medicines $380 million (National Health and Hospitals
SECTION 6.1
INTRODUCTION
Side effect
An unintended effect of a drug that is usually predictable and may be either harmless or potentially harmful.
Adverse effect
(reaction or event)
A severe side effect that may justify a dose reduction or discontinuation of a drug. An adverse drug
effect is a response to a medication, which is harmful and unintended, and which occurs at normal doses.
Medication error
Any preventable medication event that leads to, or has the potential to lead to, harm to the person.
Near miss
A medication error that was detected and corrected before it reached the person.
Example: Amoxicillin is ordered for a person with an allergy to penicillin but identified by the nurse before
for the drug is administered.
241
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MEDICATION ORDERS
A valid medication order has seven essential parts, these include:
1.
2.
3.
4.
5.
6.
7.
PM
2400
2300
11
1100
12
1200
AM
1300
1
0100
2200
1400
10
0200
1000
2100
0900
2000
0300
0800
0400
0700
7
1900
0600
3 1500
1600
0500
5
1700
1800
242
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243
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244
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Source: Australian Commission on Safety and Quality in Health Care (2012). National Inpatient Medication Chart for Adult Patients 2012. Commonwealth of Australia. Reproduced with permission from the Australian Commission
on Safety and Quality in Health Care. Retrieved from www.safetyandquality.gov.au/wp-content/uploads/2012/02/NIMC-acute-PDF-82KB.pdf.
UNIT 6
SECTION 6.1
INTRODUCTION
Morning, mane
(at) midday
Midday
(at) night
Night, nocte
twice a day
Bd
Tds
Qid
every 4 hours
every 6 hours
every 8 hours
once a week
once a week and specify the day in full, e.g. once a week on Tuesdays
three times a week and specify the exact days in full, e.g. three times
a week on Mondays, Wednesdays and Saturdays
when required
prn
immediately
stat
before food
before food
after food
after food
with food
with food
Route of administration
epidural
epidural
inhale, inhalation
inhale, inhalation
intra-articular
intra-articular
intramuscular
IM
intrathecal
intrathecal
intranasal
intranasal
intravenous
IV
irrigation
irrigation
left
left
nebulised
NEB
naso-gastric
NG
oral
PO
PEG
per vagina
PV
per rectum
PR
PICC
right
Right
subcutaneous
Subcut
sublingual
Subling
topical
topical
International unit(s)
International unit(s)
unit(s)
unit(s)
litre(s)
milligram(s)
mg
millilitre(s)
mL
microgram(s)
microgram, microg
percentage
%
(Continued )
245
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millimole
mmol
Dose forms
capsule
cap
cream
cream
ear drops
ear drops
ear ointment
ear ointment
eye drops
eye drops
eye ointment
eye ointment
injection
inj
metered-dose inhaler
mixture
mixture
ointment
ointment, oint
pessary
pess
powder
powder
suppository
supp
tablet
tablet, tab
PCA
Source: Australian Commission on Safety and Quality in Health Care (ACSQHC) (2011a). Recommendations for Terminology, Abbreviations and Symbols
Used in the Prescribing and Administration of Medicines. Canberra: Commonwealth Department of Communications, Information Technology and the Arts.
Commonwealth of Australia. Reproduced with permission.
TYPES OF MEDICATION
PREPARATIONS AND ROUTES
OF ADMINISTRATION
Medications are available in a variety of forms and are
administered via a number of routes. See Table 63 for
examples of types of drug preparations. The route of
medication administration is documented on the prescription.
When administering a drug, the nurse should ensure that
the type of medication is appropriate for the route specified.
Examples of routes of administration include:
Topical:
Dermatologic
Ophthalmic
Otic
Nasal
Metered-dose inhalers
Vaginal
Rectal
Parenteral:
Subcutaneous (SCI)
Intramuscular (IMI)
Intravenous (IVI)
DESCRIPTION
A liquid, powder or foam deposited in a thin layer on the skin by air pressure
Aqueous solution
Aqueous suspension
Caplet
Capsule
Cream
Elixir
A sweetened and aromatic solution of alcohol used as a vehicle for medicinal agents
Extract
Gel
Liniment
A medication mixed with alcohol, oil or soapy emollient and applied to the skin
Lotion
Lozenge (troche)
A flat, round or oval preparation that dissolves and releases a drug when held in the mouth
Ointment (salve)
A semisolid preparation of one or more drugs used for application to the skin and mucous membrane
246
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UNIT 6
SECTION 6.1
INTRODUCTION
A preparation like an ointment, but thicker and stiff, that penetrates the skin less than an ointment
Pill
One or more drugs mixed with a cohesive material, in oval, round or flattened shapes
Powder
A finely ground drug or drugs; some are used internally, others externally
Suppository
One or several drugs mixed with a firm base such as gelatin and shaped for insertion into the body
(e.g. the rectum); the base dissolves gradually at body temperature, releasing the drug
Syrup
Tablet
A powdered drug compressed into a hard small disc; some are readily broken along a scored line; others are
enteric coated to prevent them from dissolving in the stomach
Tincture
Transdermal patch
A semipermeable membrane shaped in the form of a disc or patch that contains a drug to be absorbed through
the skin over a long period of time
Drug calculations
Calculating drug dosages safely and accurately is an important
nursing responsibility in medication administration. Careful and
accurate calculations are essential to the prevention of medication
errors. Sections 6.26.4 include an overview and examples of
drug calculations specific to the different routes described.
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2. RIGHT DOSE
The ordered dose is within the usual dosage range for the
medication.
3. RIGHT TIME
4. RIGHT ROUTE
5. RIGHT PERSON
SECOND CHECK
THIRD CHECK
SECTION 6.1
Critical Thinking Questions
1. You have been caring for the same person for six
days. They laugh when you ask their name before
administering their medication and say to you, Do you
really need to ask my name again? It hasnt changed
since the last time you asked! How will you respond?
2. Your patient is ordered ibuprofen but the only medication
in the persons drawer is labelled Nurofen. Can you
explain this discrepancy?
3. You hand the person his medications and he says to you:
The pill I usually take for my blood pressure is not white,
its blue. How would you respond?
4. The medical officer writes an order for Frusemide 400 mg
orally BD. The RN administers 10 tablets of 40 mg each.
After administering the tablets the nurse realises that the
order should have been 40 mg. The nurse is:
a. Not legally responsible for this medication error
because the doctor ordered the wrong dose.
b. Legally responsible because nurses are supposed to
have the knowledge to recognise incorrect medication
orders and the confidence to question orders that
seems unreasonable.
5. A valid medication order has seven essential parts. What
is missing from the following list?
a.
b.
c.
d.
e.
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SECTION 6.2
ORAL
MEDICATION
ADMINISTRATION
LEARNING OUTCOMES
On completion of this section you will be able to:
1.
2.
3.
4.
5.
6.
7.
KEY TERMS
buccal, 249
meniscus, 251
oral, 249
sublingual, 249
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Examples:
1. A person is prescribed atenol 75 mg orally. The
CLINICAL SCENARIO
Mr Giuseppe Esposito, 81 years, is a person on the
medical ward of Griffith Community Hospital (LevettJones & Newby, 2013). He was admitted two days
ago with gastroenteritis and dehydration. At 0800
hours Madeline (Maddie) OBrien, a nursing student,
was administering Mr Espositos oral medications
(frusemide, digoxin and enalapril). The registered
nurse (RN) supervising Maddie was interrupted by
another nurse who needed assistance with a person in
a nearby bed. The RN said to Maddie, keep going
Ill keep an eye on what you are doing from over
here.
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UNIT 6
SECTION 6.2
Note: Always check that you have used the same unit of
weights in medications calculations, for example all grams,
milligrams or micrograms.
Tablets that are scored (a line marked on the tablet)
may be broken in half or cut (see Figure 65) to obtain the
correct dosage but capsules cannot be divided. For people
who have difficulty swallowing, some medications can
be crushed to a fine powder by using a pill crusher. The
powder is then mixed with a small amount of soft food
(e.g., custard, apple sauce or honey) to improve palatability
and assist with swallowing.
4
Base of
meniscus
3
2
1
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What If
Assess: Patient allergies, ability to swallow, and drug action side effects, interactions, and adverse reactions
Determine if the above assessment data will influence administration of the medication
Organize supplies
Take the required assessment measures if not done previously (e.g., apical pulse)
252
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UNIT 6
LIFESPAN CONSIDERATIONS
Knowledge of growth and development is essential
for nurses who administer medications to infants and
children. Nurses must also know the range of safe medication
dosages for infants and children.
Infants
Oral medications can be effectively administered using
syringes, dropper, spoon or medication cups. Never mix
medications into formula or foods that are essential, since the
infant may associate the food with an unpleasant taste and
refuse that food in the future. Place a small amount of liquid
medication along the inside of the babys cheek and wait for
the infant to swallow before giving more to prevent aspiration
or spitting out. When using a spoon, retrieve and refeed
medication that is thrust outward by the infants tongue.
Children
Whenever possible, give children a choice between the
use of a spoon, dropper or syringe.
Dilute the oral medication, if indicated, with a small
amount of water. Oral medications for children are
SECTION 6.2
Older Adults
The physiological changes associated with ageing
influence medication administration and effectiveness.
Examples include altered memory, less acute vision,
decrease in renal function, less complete and slower
absorption from the gastrointestinal tract, and decreased
liver function. Many of these changes enhance the
possibility of cumulative effects and toxicity. Thus,
older people usually require smaller dosages of drugs,
especially sedatives and other central nervous system
depressants. Because older people are mature adults
capable of reasoning the nurse needs to explain the
reasons for and the effects of the persons medications.
A valid order includes the persons name; the date and time the order was written;
the generic name of the drug to be administered; the dosage of the drug; frequency
and time of administration; route of administration; and signature of the person
who wrote the order. Some medications, for example narcotics and antibiotics,
also require a finish date. The drug order should be legible and correctly spelt.
Note: Nurse initiated drugs and some over-the-counter drugs do not necessarily
require a drug order.
When administering medications nurses must be familiar with the usual dosage,
indications, contraindications, potential side effects, interactions, and adverse
effects of ordered medications.
Nurses are legally responsible for their practice. Orders that are not valid, drugs
that are contraindicated, a dose that is too high, previously unreported allergies,
and other concerns should reported in order to prevent potential adverse effects.
Use full name and designation. This is a professional expectation and helps to
promote a therapeutic relationship.
253
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Use only medications that have clear, legible labels. Notify the RN or pharmacist
if a discrepancy is identified.
Students must ensure that their calculations are checked by their supervising RN.
Prevent errors by confirming right drug, right dose, right time, right route and
right person.
Confirm the persons identification by asking them to state their name and date
of birth and checking they are consistent with the persons chart. Confirm that the
medical record number on the medication chart accords with the ID band.
In residential aged care settings photos are often used to confirm a residents ID
rather than ID bands.
SECOND CHECK!
Look at the medication label and compare with the
medication chart.
THIRD CHECK!
Recheck the five rights of drug administration.
Help the person into comfortable position to swallow the medication and give
them sufficient water or to swallow the medication. If the person is unable to hold
the pill cup, use the pill cup to introduce the medication into the persons mouth,
giving one tablet or capsule at a time.
Observe the person taking the medication do not leave on a bedside locker.
Most health care facilities and universities require RNs to countersign any
medication administered by students.
254
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SECTION 6.3
TOPICAL
MEDICATION
ADMINISTRATION
LEARNING OUTCOMES
On completion of this section you will be able to:
1.
2.
3.
4.
5.
6.
KEY TERMS
aerosolisation, 266
atomisation, 266
dermatologic
preparations, 256
metered-dose inhaler
(MDI), 266
nebulisers, 266
ophthalmic, 259
otic, 261
suppositories, 255
transdermal patch, 256
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DERMATOLOGIC MEDICATIONS
Dermatologic preparations may be applied to the skin for
a variety of reasons, for example to:
Transdermal Medications
A particular type of dermatologic medication delivery
system is the transdermal patch. This system administers
sustained-action medications (e.g., pain relievers,
nitroglycerin, oestrogen and nicotine) via multilayered
CLINICAL ALERT
The nurse should wear gloves when applying a
transdermal patch to avoid getting any of the
medication on his or her skin, which can result in the
nurse receiving the effect of the medication.
256
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UNIT 6
SECTION 6.3
Review the medication chart and ensure that there is a valid order for
the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
257
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Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route and right person.
Confirm the persons identification by asking them to state their name
and date of birth and checking they are consistent with the persons
chart. Confirm that the medical record number on the medication
chart accords with the ID band.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Apply the medication and dressing as ordered.
Place a small amount of cream or ointment on the gloved hand,
and spread it evenly on the skin.
or
Apply sterile gloves if indicated (i.e., nonintact skin). Pour some
lotion on the gauze, and pat the skin area with it.
Apply a sterile dressing if necessary.
or
Apply a prepackaged transdermal patch.
Write the date and time on the label before application.
or
Squeeze out transdermal ointment onto premeasured medication
administration paper.
Place the applicator paper with ointment side down onto the skin.
Lightly spread the ointment.
Tape the paper applicator into place.
Knowing the date and time ensures safety and communication when
there are multiple caregivers. Writing on the patch could puncture it.
258
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UNIT 6
SECTION 6.3
OPHTHALMIC MEDICATIONS
Ophthalmic medications may be administered by
slowly pouring or dropping liquids or ointments
onto the surface of the eye. Eye drops are packaged in
Review the medication chart and ensure that there is a valid order for
the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
259
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Use only medications that have clear, legible labels. Notify the RN
or pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Confirm which eye is to be treated.
Clean the eyelid and the eyelashes using sterile cotton balls moistened
with sterile irrigating solution or sterile normal saline.
Wipe from the inner canthus to the outer canthus.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Apply the medication as ordered.
Draw the correct number of drops into the shaft of the dropper if a
dropper is used.
Instruct the person to look up to the ceiling.
Give the person a dry sterile absorbent sponge.
Expose the lower conjunctival sac by placing the thumb or fingers
of your nondominant hand on the persons cheekbone just below
the eye and gently drawing down the skin on the cheek. If the
tissues are oedematous, handle the tissues carefully to avoid
damaging them.
Holding the medication in the dominant hand, place the hand on the
patients forehead to stabilise the hand.
The person is less likely to blink if looking up. While the person
looks up, the cornea is partially protected by the upper eyelid.
A sponge is needed to press on the nasolacrimal duct after a
liquid instillation to prevent systemic absorption or to wipe excess
ointment from the eyelashes after an ointment is instilled.
Placing the fingers on the cheekbone minimises the possibility of
touching the cornea, avoids putting any pressure on the eyeball
and prevents the person from blinking or squinting.
The person is less likely to blink if a side approach is used. When
instilled into the conjunctival sac, drops will not harm the cornea as
they might if dropped directly on it. The dropper must not touch
the sac or the cornea.
260
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UNIT 6
SECTION 6.3
For liquid medications, press firmly or have the person press firmly on
the nasolacrimal duct for at least 30 seconds.
OTIC MEDICATIONS
Instillations into the external auditory canal are referred to
as otic instillations.
LIFESPAN CONSIDERATIONS
The position of the external auditory canal varies
with age. In the adult, the external auditory canal is
an S-shaped structure about 2.5 cm long. In the child under
3 years of age, it is directed upward. For this reason, to
administer otic medications to infants and young children
gently pull the pinna down and back. For a child older
than 3 years of age, pull the pinna upward and backward.
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Review the medication chart and ensure that there is a valid order
for the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
Nurses are legally responsible for their practice. Orders that are not
valid, drugs that are contraindicated, a dose that is too high, previously
unreported allergies, and other concerns should reported in order to
prevent potential adverse effects.
Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route, right person and right ear. Confirm the persons identification
by asking them to state their name and date of birth and checking
they are consistent with the persons chart. Confirm that the medical
record number on the medication chart accords with the ID band.
Clean the pinna of the ear and the meatus of the ear canal with
cotton-tipped applicators and cotton balls moistened with sterile
normal saline. Ensure that the applicator does not go into the
ear canal.
262
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UNIT 6
SECTION 6.3
Normal
position
Pressing on the tragus assists the flow of medication into the ear canal.
This prevents the drops from escaping and allows the medication to
reach all sides of the canal cavity.
The cotton helps retain the medication when the person is up.
If pressed tightly into the canal, the cotton would interfere with the
action of the drug and the outward movement of normal secretions.
263
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NASAL MEDICATIONS
Nasal instillations (nose drops and sprays) are instilled
for their astringent effect (to shrink swollen mucous
membranes), to loosen secretions and facilitate drainage,
or to treat infections of the nasal cavity or sinuses. Nasal
decongestants are the most common nasal instillations.
Review the medication chart and ensure that there is a valid order
for the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
Nurses are legally responsible for their practice. Orders that are not
valid, drugs that are contraindicated, a dose that is too high, previously
unreported allergies, and other concerns should reported in order to
prevent potential adverse effects.
Nasopharynx
Ethmoid
sinuses
Sphenoid
sinus
264
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UNIT 6
SECTION 6.3
Maxillary
sinuses
Frontal
sinuses
Position of the head to instil drops into the maxillary and frontal
sinuses.
Repeat hand hygiene.
Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route, and right person. Confirm the persons identification by asking
them to state their name and date of birth and checking they are
consistent with the persons chart. Confirm that the medical record
number on the medication chart accords with the ID band.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Administer the as ordered.
Draw up the required amount of solution into the dropper.
If the solution is directed towards the base of the nasal cavity, it will run
down the eustachian tube.
265
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Touching the mucous membrane with the dropper could damage the
membrane and cause the person to sneeze.
The person remains in the same position to help the solution come in
contact with all of the nasal surface or flow into the desired area.
This is an infection control precaution.
INHALED MEDICATIONS
Nebulisers deliver most medications administered through
the inhaled route. A nebuliser is used to deliver a fine spray
(fog or mist) of medication or moisture to a person.
There are two kinds of nebulisation: atomisation and
aerosolisation. In atomisation, a device called an atomizer
produces droplets for inhalation. In aerosolisation,
the droplets are suspended in a gas, such as oxygen. The
smaller the droplets, the further they can be inhaled into the
respiratory tract. When a medication is intended for the nasal
mucosa, it is inhaled through the nose; when it is intended
for the trachea, bronchi and/or lungs, it is inhaled through
the mouth. A large-volume nebuliser can provide a heated or cool
mist and is generally used for long-term therapy such as that
following a tracheostomy.
A metered-dose inhaler (MDI) (Figure 610) is a
pressurised container of medication that can be used by
a person to release medication through a mouthpiece. The
force with which the air moves through the nebuliser causes
the large particles of medicated solution to break up into
finer particles, forming a mist or fine spray. MDIs can deliver
accurate doses, provide for target action at the needed sites,
and sustain fewer systemic effects than medication delivered
by other routes.
To ensure correct delivery of the prescribed medication
by MDIs, nurses need to instruct the person t how to
use the inhaler correctly. The person needs to compress
266
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UNIT 6
SECTION 6.3
CLINICAL ALERT
LIFESPAN CONSIDERATIONS
CLINICAL SCENARIO
Trent Fulton, 35 years, is being discharged from hospital
today following a two week admission for pneumonia
and acute exacerbation of asthma. The RN caring for
Children
Spacers are recommended for children (as well as
adults) as they hold a medication in suspension and
allow the child to take several deep breaths in order to
inhale all the medication.
Learning how to use a spacer can be a frightening
experience for a young child. Use a doll or stuffed animal
to demonstrate its use, and allow the child to play with
the equipment before putting it in place. Having the
child sit in a parents lap during the procedure can help
the child relax and be more cooperative.
ADMINISTERING METERED-DOSE
INHALER MEDICATIONS
Review the medication chart and ensure that there is a valid order
for the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
Nurses are legally responsible for their practice. Orders that are not
valid, drugs that are contraindicated, a dose that is too high, previously
unreported allergies, and other concerns should reported in order to
prevent potential adverse effects.
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Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route, and right person. Confirm the persons identification by asking
them to state their name and date of birth and checking they are
consistent with the persons chart. Confirm that the medical record
number on the medication chart accords with the ID band.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Educate the person about the purpose of the medication and how
the inhaler is to be used (as follows):
Ensure that the canister is rmly and fully inserted into the inhaler.
Remove the cap, holding inhaler upright, shake vigorously for 3
to 5 seconds.
Exhale comfortably (as in a normal full breath) away from the
inhaler.
Hold the inhaler with the canister on top and the mouthpiece at
the bottom.
Slightly tilt chin to ensure open airway.
Place the MDI inhaler mouthpiece in the mouth between the
teeth and close lips to create a seal.
If using a spacer with the metered-dose inhaler:
Shake the MDI for 3 to 5 seconds and insert the mouthpiece into
the spacer.
Place the spacer in the mouth between the teeth and close lips
to create a seal.
Administering the medication
Instruct person to:
Whilst breathing in press down once on the MDI canister and
inhale slowly and deeply.
Remove the inhaler from mouth, close mouth and hold your
breath for a few seconds or as long as possible.
Exhale slowly away from the mouth piece.
Replace cap.
Repeat the inhalation if ordered. Wait 1 to 2 minutes between
inhalations of bronchodilator medications.
If two inhalers are to be used, the bronchodilator medication (which
opens the airways) should be given prior to other medications.
Following use of the inhaler, rinse the mouth with water and spit
it out.
Clean the MDI mouthpiece and spacer if appropriate as indicated
using mild soap and water. Then let it air-dry before reusing.
Store the canister at room temperature.
Repeat hand hygiene.
Unless the persons mouth is closed around the MDI the prescribed
dosage may not be inhaled and the person may not receive the
required therapeutic dose.
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UNIT 6
SECTION 6.3
VAGINAL MEDICATIONS
Vaginal medications are inserted as creams, foams or
suppositories to treat infection or to relieve vaginal discomfort
(e.g., itching or pain). Creams and foams are applied by using
Nurses are legally responsible for their practice. Orders that are not valid,
drugs that are contraindicated, a dose that is too high, previously unreported
allergies, and other concerns should reported in order to prevent potential
adverse effects.
Use full name and designation. This is a professional expectation and helps
to promote a therapeutic relationship.
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Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right route,
and right person. Confirm the patients identification by asking them to
state their name and date of birth and checking they are consistent with the
persons chart. Confirm that the medical record number on the medication
chart accords with the ID band.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Prepare medication
Unwrap the suppository, and put it on the opened wrapper.
or
Fill the applicator with the prescribed cream, or foam
according to the manufacturers instructions.
Ask the woman to pass urine.
If the bladder is empty, the person will have less discomfort during the
treatment, and the possibility of injuring the vaginal lining is decreased.
Clean the perineal area if the woman has not recently showered.
The posterior wall of the vagina is about 2.5 cm longer than the anterior
wall because the cervix protrudes into the uppermost portion of the anterior
wall.
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UNIT 6
SECTION 6.3
This position allows the medication to flow into the posterior fornix after it
has melted.
Most health care facilities and universities require RNs to countersign any
medication administered by students.
RECTAL MEDICATIONS
Review the medication chart and ensure that there is a valid order
for the drug/s to be administered.
Report and clarify any omissions, inconsistencies, inaccuracies or
incomplete prescription orders to the supervising RN or MO.
Nurses are legally responsible for their practice. Orders that are not
valid, drugs that are contraindicated, a dose that is too high, previously
unreported allergies, and other concerns should reported in order to
prevent potential adverse effects.
271
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Assist the person into the left lateral or left Sims position.
Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Check the five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route, and right person. Confirm the persons identification by asking
them to state their name and date of birth and checking they are
consistent with the persons chart. Confirm that the medical record
number on the medication chart accords with the ID band.
THIRD CHECK!
Recheck the label on the container against the medication chart.
Unwrap the suppository.
Repeat hand hygiene and don a glove on the hand used to insert
the suppository.
Administer the as ordered.
Lubricate the smooth, rounded end of the suppository according
to the manufacturers instructions.
Lubricate the gloved index nger.
Ask the person to breathe through the mouth.
Insert the suppository gently into the anus, rounded end rst
according to the manufacturers instructions and along the wall
of the rectum with the gloved index finger. For an adult, insert
the suppository 10 cm after passing the sphincter.
272
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UNIT 6
SECTION 6.3
Anal sphincter
LIFESPAN CONSIDERATIONS
Administering rectal medications to
infants and children
Obtain assistance to gently hold an infant or young
child to prevent accidental injury due to sudden
movement during the procedure.
For a child under 3 years, the nurse should use the
gloved fifth finger for insertion. After this age, the
index finger can usually be used.
For a child or infant, insert a suppository 5 cm or less.
273
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SECTION 6.4
PARENTERAL
MEDICATION
ADMINISTRATION
KEY TERMS
ampoule, 277
bevel, 276
burette (piggyback)
infusion, 290
deltoid site, 284
diluent, 277
drawing up needle, 278
gauge, 276
hub, 276
intramuscular (IM)
injections, 282
intravenous push
(bolus), 290
parenteral, 274
piggyback, 290
reconstitution, 277
rectus femoris site, 284
shaft, 276
subcutaneous injection, 278
avastus lateralis site, 283
ventrogluteal site, 282
vial, 277
Z-track technique, 285
LEARNING OUTCOMES
On completion of this section you will be able to:
1.
2.
3.
4.
5.
6.
274
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UNIT 6
SECTION 6.4
EQUIPMENT
To administer parenteral medications, nurses use syringes and
needles to withdraw medication from ampoules and vials.
Syringes
Syringes have three parts: the tip, which connects with
the needle; the barrel, or outside part, on which the scales
are printed; and the plunger, which fits inside the barrel
(Figure 612). When handling a syringe, the nurse may
touch the outside of the barrel and the handle of the
plunger; however, the nurse must avoid letting any unsterile
object contact the tip or inside of the barrel, the shaft of
the plunger, or the shaft or tip of the syringe.
Tip
Barrel
Plunger
2
30
m
A
10 20 30 40 50 60 70 80 90 100 units
15 25 35 45 55 65 75 85 95
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Bevel
Gauge number
Needles
Needles are made of stainless steel and are disposable.
A needle has three discernible parts: the hub, which
fits onto the syringe; the shaft, which is attached to the
hub; and the bevel, which is the slanted part at the tip of
the needle (Figure 616). Needles used for injections have
three variable characteristics:
1. Slant or length of the bevel: The bevel of the needle
25
Shaft
Hub
Use appropriate puncture-proof disposal containers to dispose of uncapped needles and sharps (see Figure 617). Never throw sharps in
wastebaskets.
Never recap used needles (i.e., ones that have been inserted into people) except under specified circumstances (e.g., when transporting
a syringe to the laboratory for an arterial blood gas or blood culture).
When recapping an unused needle (i.e., one used for drawing up a medication into a syringe prior to administration) use a one-handed
scoop method. This is performed by (a) placing the needle cap and syringe with needle horizontally on a flat surface, (b) inserting the
needle into the cap, using one hand (see Figure 618), and then (c) using your other hand to pick up the cap and tighten it to the needle hub.
276
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UNIT 6
SECTION 6.4
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Administration of subcutaneous
medications
Among the many kinds of drugs administered subcutaneously
are vaccines, insulin, and heparin. Common sites for
subcutaneous injections are the outer aspect of the upper arms,
the anterior aspect of the thighs and the abdomen. These areas
are convenient and normally have good blood circulation. Only
small doses (0.5to 1 mL) of medication are usually injected via
the subcutaneous route.
The type of syringe used for subcutaneous injections
depends on the medication to be given. Generally a 1- or 2-mL
syringe is used for most subcutaneous injections. However, if
insulin is being administered, an insulin syringe is used; and if
heparin is being administered, a prefilled cartridge may be used.
Needle sizes and lengths are selected based on the persons
body mass, the intended angle of insertion, and the planned site.
Generally a #2526 gauge, 16 mm needle is used for adults of
normal weight, and the needle is inserted at a 45-degree angle;
a 9 mm needle is used at a 90-degree angle. A child may need a
12 mm needle inserted at a 45-degree angle.
One method nurses use to determine length of needle is
to pinch the tissue at the site and select a needle length that
is half the width of the skinfold. To determine the angle of
insertion, a general rule to follow relates to the amount of
tissue that can be pinched or grasped at the site. A 45-degree
angle is used when 2.5 cm of tissue can be grasped at the site;
a 90-degree angle is used when 5 cm of tissue can be grasped.
Subcutaneous injection sites need to be rotated in an orderly
fashion to minimise tissue damage, aid absorption and avoid
discomfort. This is especially important for people who must
receive repeated injections, such as people with type 1 diabetes.
Nurses have traditionally been taught to aspirate by pulling
back on the plunger after inserting the needle and before
CLINICAL SCENARIO
Mr Arthur Barrett, 74 years, was diagnosed with cancer
of the colon and scheduled for a bowel resection
(Levett-Jones, Hoffman, Dempsey & Sinclair, 2013).
As this is major abdominal surgery Mr Barrett was
prescribed enoxaparin sodium (Clexane).
278
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UNIT 6
SECTION 6.4
Review the medication chart and ensure that there is a valid order
for the drug/s to be administered.
A valid order includes the persons name; the date and time the order
was written; the generic name of the drug to be administered; the
dosage of the drug; frequency and time of administration; route of
administration; and signature of the person who wrote the order. Some
medications also require a finish date. The drug order should be legible
and correctly spelt.
Ensure the SC route is most appropriate for the person and for the
type of medication prescribed.
Nurses are legally responsible for their practice. Orders that are not
valid, drugs that are contraindicated, a dose that is too high, previously
unreported allergies, and other concerns should reported in order to
prevent potential adverse effects.
FIRST CHECK!
Compare the label on the medication container and packaging
against the order on the medication chart to ensure that the right
medication is given.
Use only medications that have clear, legible labels. Notify the RN or
pharmacist if a discrepancy is identified.
SECOND CHECK!
Look at the medication label and compare with the medication
chart Check the first five rights of medication administration.
Prevent errors by confirming right drug, right dose, right time, right
route and right person.
279
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Select a site that has not been used frequently and one that is free of
tenderness, hardness, swelling, scarring, itching, burning or localised
inflammation. These conditions could hinder the absorption of the
medication and may also increase the likelihood of injury and discomfort
at the injection site.
Clean the injection site with an antiseptic swab. Start at the centre
of the site and clean in a widening circle to about 5 cm. Allow the
area to dry thoroughly.
Position the swab on the persons skin near to the intended site.
Grasp the syringe in your dominant hand by holding it between
your thumb and fingers. With palm facing to the side or upward
for a 45-degree angle of insertion, or with the palm downward for
a 90-degree angle of insertion, prepare to inject.
280
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UNIT 6
SECTION 6.4
90
45
Skin
Subcutaneous
tissue
Muscle
Do not recap the needle before disposal as this increases the risk of
needlestick injuries.
If bleeding occurs, apply pressure to the site with dry sterile gauze
until it stops.
Proper disposal protects the nurse and others from injury and
contamination.
281
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Select a site on the abdomen at least 5 cm inches away from the umbilicus and above the level of the iliac crests. Avoid injecting into
bruises, scars or areas of tenderness.
Do not aspirate when administering heparin subcutaneously as this can damage the surrounding tissue and cause bleeding and bruising.
Do not massage the site after the injection as this causes bleeding and hastens drug absorption.
Note: Enoxaparin sodium, a low molecular weight heparin, comes in prefilled syringes with a small air bubble. Do not expel the air bubble
unless the dose needs to be adjusted.
Intramuscular medication
administration
Injections into muscle tissue, or intramuscular (IM)
injections, are absorbed more quickly than subcutaneous
injections because of the greater blood supply to the body
muscles. Muscles can also take a larger volume of fluid without
discomfort than subcutaneous tissues, although the amount
varies among individuals. An adult with well-developed
muscles can usually tolerate up to 3 mL of medication in the
gluteus medius and gluteus maximus muscles (Figure 621).
A maximum volume of 1 to 2 mL is usually recommended
for adults with less developed muscles. In the deltoid muscle,
volumes of 0.5 to 1 mL are recommended.
Iliac crest
Anterior superior
iliac spine
Gluteus medius
Gluteus minimus
(underlying medius)
Ventrogluteal Site
The ventrogluteal site is in the gluteus medius muscle,
which lies over the gluteus minimus (see Figure 622). The
ventrogluteal site is the preferred site for IM injections in people
older than 7 months (Zimmerman, 2010) because the area:
Gluteus maximus
Greater trochanter
of femur
The muscle
The type of solution
282
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UNIT 6
Anterior superior
iliac spine
Injection site
SECTION 6.4
Greater trochanter
of femur
Deep
femoral
artery
Iliac crest
Sciatic
nerve
Rectus
femoris
Vastus
lateralis
Femoral
artery
and vein
Greater trochanter
of femur
formed by the index finger, the third finger, and the crest of the
ilium is the correct injection site (Figures 622 and 623).
Vastus lateralis
(middle third)
Lateral femoral
condyle
283
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Posterior
superior
iliac spine
Injection
site
Greater
trochanter
Sciatic
nerve
Deltoid Site
The deltoid muscle is found on the lateral aspect of the upper
arm. It is infrequesntly used for IM injections because it is a
relatively small muscle and is very close to the radial nerve
and radial artery. The deltoid site is sometimes considered
for use in adults because of rapid absorption from the deltoid
area, but no more than 1 mL of solution can be administered.
This site is recommended for the administration of hepatitis B
vaccine in adults.
The upper landmark for the deltoid site is located by
the nurse placing four fingers across the deltoid muscle
with the first finger on the acromion process. The top of
the axilla is the line that marks the lower border landmark
(Figure 629). A triangle within these boundaries indicates
the deltoid muscle about 5 cm below the acromion process
(Figures 630 and 631).
284
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UNIT 6
SECTION 6.4
Anterior superior
iliac spine
Clavicle
Acromion process
Deltoid muscle
Scapula
Rectus femoris
Axilla
Vastus lateralis
Humerus
Deep brachial
artery
Radial nerve
Patella
Clavicle
Acromion process
Deltoid muscle
Scapula
Axilla
Humerus
Deep brachial
artery
Radial nerve
285
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Review the medication chart and ensure that there is a valid order for
the drug/s to be administered.
A valid order includes the persons name; the date and time the
order was written; the generic name of the drug to be administered;
the dosage of the drug; frequency and time of administration;
route of administration; and signature of the person who wrote
the order. Some medications also require a finish date. The drug
order should be legible and correctly spelt.
Ensure the IM route is most appropriate for the person and for the type
of medication prescribed.
FIRST CHECK!
Compare the label on the medication container and packaging against
the order on the medication chart to ensure that the right medication
is given.
Use only medications that have clear, legible labels. Notify the RN
or pharmacist if a discrepancy is identified.
SECOND CHECK!
Look at the medication label and compare with the medication chart
Check the first five rights of medication administration.
286
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UNIT 6
SECTION 6.4
Prepare the medication from the ampoule or vial for drug withdrawal
using a non-touch technique:
Flick the upper stem of the ampoule several times with a fingernail.
Use a piece of gauze or an unopened alcohol wipe between your thumb
and break off the top by bending it towards you to ensure.
Dispose of the top of the ampoule in the sharps container.
Place the ampoule on a flat surface.
Attach the drawing up needle to the syringe.
Remove the cap from the drawing up needle, insert it into the centre of
the ampoule, and withdraw all of the drug.
Hold the ampoule slightly on its side, if necessary, to obtain all of the
medication.
Remove the drawing up needle and place it in the sharps container.
Attach the regular needle, invert the syringe upright, expel air and
discard excess medication into an acceptable receptacle, depending
on ordered amount.
This will bring all medication down to the main portion of the
ampoule.
Clean the injection site with an antiseptic swab. Start at the centre of
the site and clean in a widening circle to about 5 cm. Allow the area to
dry thoroughly.
Position the swab on the persons skin near to the intended site.
Remove and discard the needle cover. Inject the medication using a
Z-track technique:
Use the ulnar side of the nondominant hand to pull the skin
approximately 2.5 cm to the side. When the skin returns to its
normal position after the needle is withdrawn and a seal is formed over
the intramuscular site.
Skin
Subcutaneous
tissue
Muscle
Medication
A
Inserting an intramuscular needle at a 90-degree angle using the Z-track method: A, skin pulled
to the side; B, skin released.
Note: If the person is emaciated or an infant, the muscle may be pinched.
Holding the syringe between the thumb and forefinger (as if holding a
pencil), pierce the skin quickly and smoothly at a 90-degree angle
and insert the needle into the muscle.
287
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If the needle is in a small blood vessel, it takes time for the blood
to appear.
Discard the uncapped needle and attached syringe into the proper
receptacle.
Do not recap the needle before disposal as this increases the risk
of needlestick injuries.
Massaging the site may cause the leakage of medication from the
site and result in irritation.
Proper disposal protects the nurse and others from injury and
contamination.
288
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UNIT 6
What If
SECTION 6.4
Wait 10 seconds to permit the medication to disperse into the muscle tissue
289
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LIFESPAN CONSIDERATIONS
Infants and children
The vastus lateralis site is recommended as the
site of choice for IM injections for infants. There are
no major blood vessels or nerves in this area, and it is
the infants largest muscle mass. It is situated on the
anterior lateral aspect of the thigh.
Use needles that will place medication in the main
muscle mass; infants and children usually require smaller,
shorter needles (#22 to #25 gauge, 16 to 25 mm long)
for IM injections.
The vastus lateralis is recommended as the site of
choice for toddlers and children.
For the older child and adolescent, the recommended
sites are the same as for the adult: ventrogluteal or
deltoid. Ask which arm they would like the injection in.
Older Adults
Older people may have decreased muscle mass or
muscle atrophy. A shorter needle may be needed.
Assessment of appropriate injection site is critical.
Absorption of medication may occur more quickly than
expected.
INTRAVENOUS MEDICATION
ADMINISTRATION
Because IV medications enter the persons bloodstream
directly by way of a vein, they are indicated when a rapid
effect is required. The IV route is also appropriate when
medications are too irritating to tissues to be given by other
routes. Examples of methods used to administer medications
intravenously include:
Administering intravenous
medications via IV push (bolus)
An IV push or bolus is the intravenous administration of
medication directly into the systemic circulation. It is used
when a medication cannot be diluted or in an emergency
situation. A bolus IV injection is introduced into an IV line
through an injection port close to the patient. Medications
administered in this way may be irritating to the lining
290
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UNIT 6
SECTION 6.4
Medication port
Air filter
Administration spike
Administering intravenous
medications via a burette or a
piggy-back
An intermittent infusion is a method of administering a
medication mixed in a small amount of IV solution, such
as 50 or 100 mL (Figure 633) via a burette (Figure 634)
or a piggyback (Figure 635). The drug is administered at
regular intervals, such as every 8 hours, with the drug
being infused over a short period of time such as 30 to
60 minutes.
Administering intravenous
medications via an IV infusion
M06_BERM1971_01_SE_C06.indd 291
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CLINICAL SCENARIO
Mr Arthur Barrett (Levett-Jones, Hoffman, Dempsey &
Sinclair, 2013) was prescribed four IV medications.
For each medication specify the action, the correct
type of IV injection procedure to be followed, and any
related practice points in terms of contraindications
and compatibility with IV fluids etc.
IV medications ordered:
1. Frusemide 40mg
2. Amoxicillin 500mg
Piggyback set
Primary set
Piggyback or
primary port
with backcheck
valve
Clamp
Secondary port
3. Potassium Chloride 2g
4. Gentamycin 80 mg
anti-infective agents
potassium
insulin
narcotics
sedative agents
chemotherapy drugs
Heparin (and other anticoagulants).
www.cec.health.nsw.gov.au/programs/high-riskmedicines#publications1
Review the medication chart and ensure that there is a valid order for
the drug/s to be administered.
A valid order includes the persons name; the date and time the
order was written; the generic name of the drug to be administered;
the dosage of the drug; frequency and time of administration; route
of administration; and signature of the person who wrote the order.
Some medications also require a finish date. The drug order should
be legible and correctly spelt.
Ensure the IV route is most appropriate for the person and for the type
of medication prescribed.
292
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UNIT 6
SECTION 6.4
FIRST CHECK!
NOTE: In most facilities two RNs are required to check IV medications
Compare the label on the medication container and packaging against
the order on the medication chart to ensure that the right medication
is given.
Check the compatibility of the medication(s) and IV fluid.
Use only medications that have clear, legible labels. Notify the RN
or pharmacist if a discrepancy is identified.
SECOND CHECK!
Look at the medication label and compare with the medication chart
Check the first five rights of medication administration.
293
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294
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UNIT 6
SECTION 6.4
Proper disposal protects the nurse and others from injury and
contamination.
FURTHER READING
WEBLINKS
health-professionals/cpd/activities/onlinecourses/medication-safety-training
http://learn.nps.org.au/mod/page/view.
php?id54279
page/view.php?id54278
http://www.health.gov.au/internet/main/
publishing.nsf/Content/nmp-quality.htm
295
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REFERENCES
296
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UNIT 6
SECTION 6.4
Student:
Assessor name and signature:
Comments:
NA
Date:
297
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Student:
Assessor name and signature:
Comments:
NA
Date:
298
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UNIT 6
SECTION 6.4
NA
Reviews the medication chart and ensures that there is a valid order for the drug/s to be
administered
Reports and clarifies any omissions, inconsistencies, inaccuracies or incomplete prescription
orders to the supervising RN or MO
Reviews the Australian Medicines Handbook or a similar drug resource if unfamiliar with the
medication/s ordered
Performs hand hygiene
299
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Date:
300
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UNIT 6
SECTION 6.4
NA
Reviews the medication chart and ensures that there is a valid order for the drug/s to be
administered
Reports and clarifies any omissions, inconsistencies, inaccuracies or incomplete prescription
orders to the supervising RN or MO
Reviews the Australian Medicines Handbook or a similar drug resource if unfamiliar with the
medication/s ordered
Performs hand hygiene
Gathers the correct equipment:
Clean gloves
Cotton-tipped applicator
Correct medication bottle with a dropper
Flexible rubber tip (optional) for the end of the dropper, which prevents injury from
sudden motion, for example, by a person who is disoriented
Cotton wool
Normal saline
PERFORMING THE PROCEDURE
Introduces self to the person
Closes curtain or door. Assists the person to a comfortable position, usually lying with ear to
be treated uppermost.
Demonstrates a person-centred approach to medication administration and obtains the
persons verbal consent
Repeats hand hygiene
Conducts appropriate assessments of the person:
Appearance of the pinna of the ear and meatus for signs of redness and abrasions.
Type and amount of any discharge
Unlocks the dispensing system and obtains the correct oral medication.
FIRST CHECK: Compares the label on the medication container or package against the order
on the medication chart to ensure that the right medication is given
Checks the expiry date of the medication.
SECOND CHECK: Checks the five rights of drug administration
Confirms which ear is to be treated.
Checks whether the person has any drug allergies
Repeats hand hygiene and changes gloves
Cleans the pinna of the ear and the meatus of the ear canal with cotton-tipped applicators and
cotton balls moistened with sterile normal saline. Ensures that the applicator does not go into
the ear canal.
THIRD CHECK: Rechecks the label on the container against the medication chart
301
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Date:
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UNIT 6
SECTION 6.4
Student:
Assessor name and signature:
Comments:
NA
Date:
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NA
Reviews the medication chart and ensures that there is a valid order for the drug/s to be
administered
Reports and clarifies any omissions, inconsistencies, inaccuracies or incomplete prescription
orders to the supervising RN or MO
Reviews the Australian Medicines Handbook or a similar drug resource if unfamiliar with the
medication/s ordered
Performs hand hygiene
Gathers the correct equipment:
Metered-dose nebuliser with medication canister and spacer if indicated
PERFORMING THE PROCEDURE
Introduces self to the person
Demonstrates a person-centred approach to medication administration and obtains the
persons verbal consent
Closes curtain or door. Assists the person to a sitting position
Repeats hand hygiene
Conducts appropriate assessments of the person
Unlocks the dispensing system and obtains the correct oral medication.
FIRST CHECK: Compares the label on the medication container or package against the order
on the medication chart to ensure that the right medication is given
Checks the expiry date of the medication.
SECOND CHECK: Checks the five rights of drug administration
Checks whether the person has any drug allergies
Repeats hand hygiene
THIRD CHECK: Rechecks the label on the container against the medication chart
Educates the person about the purpose of the medication and instructs person about how
the inhaler is to be used:
Ensure that the canister is firmly and fully inserted into the inhaler.
Remove the cap, holding inhaler upright, shake vigorously for 3 to 5 seconds.
Exhale comfortably (as in a normal full breath) away from the inhaler.
Hold the inhaler with the canister on top and the mouthpiece at the bottom.
Slightly tilt chin to ensure open airway
Place the MDI inhaler mouthpiece in the mouth between the teeth and close lips to create
a seal
If using a spacer with the metered-dose inhaler:
Shake the MDI for 3 to 5seconds and insert the mouthpiece into the spacer.
Place the spacer in the mouth between the teeth and close lips to create a seal
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UNIT 6
SECTION 6.4
Date:
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NA
Reviews the medication chart and ensures that there is a valid order for the drug/s to be
administered
Reports and clarifies any omissions, inconsistencies, inaccuracies or incomplete prescription
orders to the supervising RN or MO
Reviews the Australian Medicines Handbook or a similar drug resource if unfamiliar with the
medication/s ordered
Performs hand hygiene
Gathers the correct equipment:
Drape
Correct vaginal suppository or cream
Applicator for vaginal cream
Clean gloves
Lubricant for a suppository
Disposable towel
Clean perineal pad
PERFORMING THE PROCEDURE
Introduces self to the person
Closes curtain or door
Demonstrates a person-centred approach to medication administration and obtains the
persons verbal consent
Unlocks the dispensing system and obtains the correct oral medication.
FIRST CHECK: Compares the label on the medication container or package against the order
on the medication chart to ensure that the right medication is given
Checks the expiry date of the medication.
SECOND CHECK: Checks the five rights of drug administration
Checks whether the person has any drug allergies
Repeats hand hygiene and dons gloves
THIRD CHECK: Rechecks the label on the container against the medication chart
Prepares medication:
Unwraps the suppository, and puts it on the opened wrapper.
or
Fills the applicator with the prescribed cream, or foam according to the manufacturers
instructions
Asks the woman to pass urine
Assists the woman to a back-lying position with the knees flexed and the hips rotated laterally
Drapes the woman appropriately so that only the perineal area is exposed
Assesses the vaginal orifice for inflammation; amount, character, and odour of vaginal discharge;
and for complaints of vaginal discomfort
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UNIT 6
SECTION 6.4
Date:
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U D
NA
Unlocks the dispensing system and obtains the correct oral medication.
FIRST CHECK: Compares the label on the medication container or package against the order on
the medication chart to ensure that the right medication is given
Checks the expiry date of the medication.
SECOND CHECK: Checks the five rights of drug administration
Checks whether the person has any drug allergies
THIRD CHECK: Rechecks the label on the container against the medication chart
Repeats hand hygiene and dons a glove on the hand used to insert the suppository
Applies the medication as ordered.
Lubricates the smooth, rounded end of the suppository according to the manufacturers instructions
Lubricates the gloved index finger.
Asks the person to breathe through the mouth
Inserts the suppository gently into the anus, rounded end first according to the
manufacturers instructions and along the wall of the rectum with the gloved index finger.
For an adult, inserts the suppository 10 cm after passing the sphincter. For an infant or child,
inserts the suppository 5 cm or less after passing the sphincter.
Withdraws the finger and gently presses the persons buttocks together for a few minutes
Ask the person to remain flat or in the left lateral position for at least 5 minutes
Removes glove by turning it inside and repeats hand hygiene
Assesses and documents the procedure includes the type of suppository given/name of the
drug, the time it was given, the amount of time it was retained if it was expelled, the results or
effects, and the response of the person
Student and supervising RN completes and signs the medication chart correctly
Concludes encounter, ensures the persons comfort and informs them of follow up. Places the
call bell within reach of the person
PRIORITIES POST PROCEDURE
Disposes of used equipment
Repeats hand hygiene
Returns to the person to monitor effectiveness of the medication administered
Student:
Assessor name and signature:
Comments:
Date:
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Student:
Assessor name and signature:
Comments:
NA
Date:
309
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Student:
Assessor name and signature:
Comments:
NA
Date:
310
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UNIT 6
SECTION 6.4
NA
Reviews the medication chart and ensures that there is a valid order for the drug to be
administered
Reviews the Australian Medicines Handbook or a similar drug resource if unfamiliar with the
medication/s ordered
Ensures the IV route (bolus, burette or infusion) is most appropriate for the person and for
the type of medication prescribed
Determines whether the medication should be given by bolus injection, burette
(or piggy-back), or via an IV infusion
Reports and clarifies any omissions, inconsistencies, inaccuracies or incomplete prescription
orders to the supervising RN or MO
Performs hand hygiene
Gathers the correct equipment:
Medication chart
Antiseptic swabs
Clean gloves
Correct medication
Dilutent (if medication is in powdered form)
Sterile syringe of appropriate size
Sterile drawing up needle if not using a needleless system
Burette or piggy-back bag (if required)
IV additive label (for burette)
Sterile normal saline if there is a need to flush the cannula before or after the IV medication
PERFORMING THE PROCEDURE
Introduces self to the person
Closes curtain or door
Demonstrates a person-centred approach to medication administration
Repeats hand hygiene
Determine and conduct appropriate assessments of the person
FIRST CHECK: Compares the label on the medication container or package against the order
on the medication chart to ensure that the right medication is given.
ENSURES TWO RNS ARE PRESENT TO CHECK THE MEDICATION
Checks the expiry date of the medication
Calculates the correct dosage of the medication
For bolus injections ensures the correct rate of injection is known
SECOND CHECK: Compares the medication label with the medication chart. Checks the first
five rights of drug administration
THIRD CHECK: Rechecks the label on the container against the medication chart and rechecks
the five rights of drug administration
Checks whether the person has any drug allergies
Repeats hand hygiene and dons gloves
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Date:
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