Week 10 Original Schedule

Lesson Plan: Module 10 - Medication Administration

Purpose: Provide students with the principles of accurate medication calculation, administration, safety and legal/ethical concerns
Course Objectives: 1,2,3,4,5,6,7,8,9 Content Teaching Strategies Resources Evaluation Methods
The student will: Drug calculations Presentation ATI skill modules ATI skill completion
accurately calculate medication should all be
doses Safety, legal, ethical Discussion completed by this Skill check-off
identify and demonstrate the Rights of administration DATE!
rights of medication Physicians order Demonstration Clinical practice
administration Documentation Laboratory &
explain and identify procedures Reading/CBT Clinical practice
for controlled substances Medication administration
document properly and identify Oral
POLICY MRMC SFMC
appropriate reporting forms Enteral tubes Adverse Drug Reaction Reporting Policy PF-330 PAT-501
prepare and demonstrate accurate Topical Food Drug Interaction PF-322 PAT-515
Herbal medications DEP-PH 2.6
administration of prescribed IM Medication Administration PF-310 PAT-556
medications SQ Standard Administration Times DEP-PH 4.6
ID Approved Personnel for Med Adm PF-3324 DEP-PH-4.1
Hypoglycemia- Treatment & Protocol PF-653 PAT-179
Eye Hospital Formulary BSR - http://172.20.24.89/formulary/Policies.htm
Ear

Skills manual: Chapters 14-17

Skills 15.1-15.2; 16.1-16.7;
17.1-17.6
ATI Book: Chapters 46-48,
50-51

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 Module 10
NUR 2103
PATIENT CARE SIMULATION LABORATORY
TIME GROUP A GROUP B GROUP C
0700-0810 Injectable Medications - SQ, ID, and IM Injections - PowerPoint
Clinical Simulation Center Room 6
0810-0820 BREAK/ROTATE
0820-0930 Subcutaneous/Intradermal Practice Intramuscular Injection Practice
Mixing Insulin Vials/Ampules
0930-0935 BREAK/ROTATE
0935-1010 Intramuscular Injection Practice Subcutaneous/Intradermal Practice
Vials/Ampules Mixing Insulin

1010-1015 BREAK/ROTATE
1015-1105 Med Math PowerPoint and practice
Clinical Simulation Center Room 6

1105-1110 BREAK/ROTATE
1110-1150 (Group A) (Group B)
Administering Oral Medications, Administering Derm, Ophthalmic, Otic, Nasal, Inhaled,
Administering Medications by Enteral Tube Vaginal, and Rectal Medications
& &
Three Checks in Medication Administration The Ten Rights of Medication Administration
Pyxis Training CSC 6
CSC 6
(Group B) (Group A)
Administering Derm, Ophthalmic, Otic, Nasal, Inhaled, Administering Oral Medications,
Vaginal, and Rectal Medications Administering Medications by Enteral Tube
& &
The Ten Rights of Medication Administration Three Checks in Medication Administration
CSC 6 Pyxis Training
CSC 6
1150-1200 Recap and Documentation Review
CSC 6
**NOTE ATI SKILLS MODULES MUST BE COMPLETED PRIOR TO 0700 ON day of scheduled lab experience!

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 NOTES PAGE

Content specifically covered in Administering Oral Medications & The Ten Rights of Medication Administration:
Medication Administration window is 30 minutes before and after time on MAR otherwise med error
Always check for allergies from patient and bracelet before administering medications
Review briefly oral, buccal, sublingual, swish/spit, swish/swallow use MAR and actual medications to drive discussion
HOB up
When to hold meds nausea, vomiting, gastric suctioning
Extended Release/Enteric Coated
Fresh water at bedside
10 Rights Berman p. 412

Content specifically covered in Enteral Medication & Three Checks:

Check residual and placement
Flush with 30 mL (5mL to 10mL for kids) Gravity
Crush, slush, flush administer crushed meds first, then elixirs
Give each medication separately Berman states to flush with 30mL between meds depends on number of meds nursing judgment
3 Checks Berman p. 412 MAR review review enteric-coated/capsules/non-crushable meds

Content specifically covered in Administering Derm, Ophthalmic, Otic, Nasal, Inhaled, Vaginal, and Rectal Medications:
Use mannequins to administer/apply medications
Rotate sites; avoid areas of abrasions, irritation, cuts, burns as may absorb too much and have systemic reaction
Topical wear gloves, remove old, clean site with soap/water, apply topical
Transdermal Patches remove old patch and clean skin thoroughly; select new site and apply patch; Date/time/initial patch before placing;
document placement as well as time. Check for allergy to materials in patch
Ophthalmic lower conjunctival sac hold pressure on nasolacrimal duct for 30 seconds
Otic pull pinna upward and back (down and back for infants and children under 3)
Nasal have patient blow nose first; tip head back, not done often (quick review only); nasal spray hold head down
Inhaled
o Shake aerosol inhaler for 3-5 seconds, exhale, hold 1-2 inches from open mouth (spacer placed IN mouth), inhale when MDI depressed
for 3-5 seconds, hold breath for 10 seconds, exhale through pursed lips, rinse mouth with water and spit out
o Wait 1-2 minutes between inhalations.
o Some inhalers are not shaken, but use a medication in powder form that pt. inhales. Demo Advair used in Simulation next week
Vaginal vagina is a natural drain, have woman void prior to administration, lithotomy position, insert with index finger of gloved hand (3-4)
Rectal done with suppositories and enema rotation on earlier during Elimination Module 6 made like bullet, always lubricate

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Content specifically covered in SQ/ID station:
SQ
o Insulin review specifically mixing, Lantus (no mixing), sliding scales use MAR to review sliding scale checked by 2 nurses
o 25g and 5/8 inch (average number most common needle seen in hospital)
o Insulin syringes ONLY for Insulin and must be used for Insulin
o SQ sites abdomen, arm, thigh, back--checkerboard
o No aspiration or massaging site hold needle in place for 5 seconds after administration (nursing judgment)
o Amount - 1mL maximum
o Angle 90 degrees (Insulin syringes) can go to 45 degree for very thin
o Lovenox/Heparin in love handles
o OK sign for uncapping
o Process for drawing from vials (vial on counter/hold with non-dominant hand), air injection for multi-use (not single-use) vials
o Reading syringes (Insulin 50unit and 100 unit) safety device
o Reviewed different concentrations/vials of Heparin
o DART for administration
o Prep site with alcohol in to out circle

ID
o 15 degree angle, bevel up, bleb, leave Open To Air, hand placement and needle hold for administration (OK sign above needle/no fingers
above administration site as shown in ATI video module)
o TB syringe (1mL syringe) usually used
o Volume = 0.1mL
o Use ID arms brief practice/review

Content specifically covered in IM station:

o 21g and 1-1 inch (average number most common needle seen in hospital)
o Review of needle sizes changing needles for administration
o Amount 1mL deltoid, 2-3mL other sites
o IM site identification Deltoid, Vastus Lateralis, Ventral Gluteal only
o Angle 90 degrees
o Ampules filtered needles, no air, hold with pad/alcohol pad, pull towards self/break away from self, inverting
o Z-track - hold needle in place for 10 seconds after administration (nursing judgment)

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 **FORMAT FOR ALL SQ AND IM INJECTIONS
Non-dominant hand hold site
o Pinch for SQ
o Spread for IM
Dart in needle
Hold barrel of needle with non-dominant hand
Aspirate (IM only) Do not aspirate vaccines/immunizations
Inject with dominant hand

Notes for Recap and Documentation Review:

Discuss order of medication administration
o Nurses tend to give Insulin first
o Nurses tend to give inhalers last
Connect Care Training regarding EMR will occur in the Simulation Lab

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