Vous êtes sur la page 1sur 149

ADMINISTRATION OF

MEDICATIONS
ADMINISTRATION OF MEDICATIONS

Alteration in health related to acute or


chronic conditions lead clients to seek
relief of symptoms through various
treatments options one of which is the
medication regime. Successful medical
therapy depends on the partnership of
the patient and the medical staff
(including the nurse). This increased
collaboration among health care
providers demand in-depth
ADMINISTRATION OF MEDICATIONS

Thus implementation of
prescriptions or orders of the
physician/pharmacist involves far
more than merely carrying out
tasks. As an educated,
independently licensed health
care provider, the nurse is always
responsible for any care given
(including administration of
drugs) whether prescribed by the
physician or planned by the
ADMINISTRATION OF MEDICATIONS
The nurses’ first responsibility is to understand the
ordered therapy, its goal for the patient and how it is
to be carried out. If a physician orders a medication
and it is observed that the written dosage is ten
times the usual dosage for that medication, instead of
giving the medication because “the doctor ordered
it”, call the doctor and discuss the order. More so
since the patient’s state is not static, understand his
condition in relation to the medication. If an oral
medication is prescribed for a vomiting patient, an
understanding nurse should inform the physician for
change instead of just giving the drug just because
“the doctor wrote it”.
ADMINISTRATION OF MEDICATIONS
What is a drug? Drug is any substance
other than food which when administered
alters the physiological process of the
biological being. It is a chemical substance
intended for use in the diagnosis,
treatment, cure, mitigation or prevention of
a disease. Drug is a general term used for
both legal and illegal substances (either
than food) which alters physiological
processes. Medication or medicine is more
appropriate for drugs used for therapeutic
purposes.
ADMINISTRATION OF MEDICATIONS
Uses of Drugs
Prevention- used as prophylaxis to
prevent diseases e.g. vaccines;
fluoride-prevents tooth decay.
Diagnosis- establishing the patient’s
disease or problem e.g. radio contrast
dye; tuberculosis (Mantoux) testing.
Suppression- suppresses the signs
and symptoms and prevents the
disease process from progressing e.g.
anticancer, antiviral drugs.
ADMINISTRATION OF MEDICATIONS

Treatment- alleviate the


symptoms for patients with
chronic disease e.g. Anti-
asthmatic drugs.
Cure- complete eradication of
diseases e.g. anti-biotics, anti-
helmintics.
Enhancement aspects of
health- achieve the best state of
health e.g. vitamins, minerals
ADMINISTRATION OF MEDICATIONS
Legal Aspects of Medication
Preparation, dispensing and administration of
medications are all covered by laws in every
country.

The DDA - Dangerous Drug Act. It is an act


that governs the procurement and use of some
drugs especially the narcotics e.g. morphine,
pethedine, cocaine etc. These drugs are
prescription only drugs hence cannot be
bought or administered without prescription.
Dangerous drugs are always kept under lock
and key in the Dangerous Drug Cupboard
under the care of trusted senior nurses.
ADMINISTRATION OF MEDICATIONS

Section - 34 - Dangerous Drugs


Record.
(1) A person who supplies Class A or
B, drugs shall keep on the premises
from which he supplies these drugs a
book of the prescription to be known
as the `Dangerous Drugs Record'.

(2) Before any person supplies Class A


drugs he shall record in the Dangerous
Drugs Record the following-
ADMINISTRATION OF MEDICATIONS

(b)the name, and address, signature or


thumbprint of the person to whom it is supplied;

(c) the signature of the person who supplies the


drug; and

(d) the date of supply.

(3) Where a drug is supplied under a prescription


which is retained by the supplier of the drug and
an entry is made in the Dangerous Drug Record
book enabling the prescription to be referred to, no
entry need be made in the Dangerous Drug Record
or any particulars specified in the prescription.
ADMINISTRATION OF MEDICATIONS

The procurement, supply, administration


and wastage (accidental during
preparation of administration) are always
under strict observation through
recording in the appropriate books and
usually shift to shift handing over
especially in the wards. The student
should be alert to institutional policies
guiding the supply and administration of
Dangerous Drugs in the various hospitals
where he/she may find him/herself.
ADMINISTRATION OF MEDICATIONS

Itis worth knowing that nurses are


responsible for their own actions
regardless of the presence of a
written order. If a nurse gives an
overdose of a drug because it is written
by a doctor, the error is accounted to
the nurse and not the doctor. The
nurse should bear in mind that ALL
substances are poisons: there is none
that is not a poison. The right dose
differentiates a poison from a remedy.
Drug Nomenclature

One drug can have as much as


4 different names as follows:

Chemical Name - any typical


organic name; this precisely
describes the constituents of the
drug
E.g. N-(4-
hydroxyphenyl)acetamide for
paracetamol
Drug Nomenclature

Generic Name - is given by the


manufacturer who first develops
the drug; it is given before the
drug becomes official. It is the
name by which the drug will be
known throughout the world no
matter how many companies
manufacture it. This name is
usually agreed upon by the WHO.
Often the generic name is
derived from the chemical name.
Drug Nomenclature

Official Name – this is the name


by which a drug is listed in official
publications such as USP (United
States Pharmacopoeia), BP
(British Pharmacopoeia), BPC
(British Pharmacopoeia Codex),
and NF (National Formulary). The
above mentioned documents are
sources of drug information.
Drug Nomenclature

Trade/Proprietary/Brand Name - is
the name given to drug by the
manufacturing company and so the
company is the legal owner of that
name. So, a single generic name can be
sold under ten different trade names.
Because of this trade names should not
be used in writing prescriptions as it can
e misleading (Kinaquine is from
Kinapharma Company, and Efpac from
the Effah Pharmacy and by other names
from other Companies).
Classification of
Medication
Medications may be classified according to:
The body system that the medicine is
targeted to interacts wit; e.g.
cardiovascular medications, nervous
system medication etc.
Therapeutic usages of the medicine; e.g.
antihypertensives ,neuroleptics,
The diseases the medicine is used for; e.
g. anticancer drugs, antimalaria drugs
antihelminthics etc.
Classification of
Medication
The action of the medication can
also be used to classify the it;
e.g. beta-adrenergic blocking
agents
The overall effect of the
medication on the body can also
be a criteria for its classification;
e.g. sedatives, antianxiety drugs
etc.
Forms of Drugs
Solids
Capsule- powder, liquid or oil form
of medication enclosed in a
gelatine shell.
Tablet-a powdered form of
medication compressed into a hard
small disk or cylinder. May be a
variety of colours or sizes. Enteric
coated tablets are covered with a
substance that is insoluble in
gastric acids, thus reducing the
Tablets Capsule
Forms of Drugs
Lozenge-flat round preparation
containing drug in a flavoured or
sweetened base that dissolves in
the mouth to release the
medication; it is also called troche.

Suppository-one or more drugs


mixed into a firm base, such a
gelatin, designed for insertion into
a body cavity. The preparation
Forms of Drugs
 Pill-a mixture of powdered drug
with cohesive material in a round,
oval, or oblong shape.

Powder-a drug ground into fine


particles from a solid for
inhalation or application to the
skin.
Forms of Drugs
Semi-solids
Ointment-semisolid preparation of
one or more drugs applied to the skin
Liniment-medication mixed with
alcohol, oil or soapy emollient, which
is applied to the skin.
Paste-semisolid preparation, thicker
and stiffer than ointment; absorbed
more slowly than ointment that
penetrates through the skin.
Forms of Drugs
Cream-a non-greasy semi-solid
preparation used on the skin

Gel or Jelly- a clear translucent


semi-solid that liquefies when
applied to the skin
Forms of Drugs
Elixir-medication is a clear liquid containing
alcohol, water, sweeteners, and flavouring.
Designed for oral use.
Lotion-drug in liquid suspension designed
for topical use.
Solution-a drug dissolved in another liquid
substance; may be used orally, parenterally,
or externally
Suspension-fine drug particles dispersed in
a liquid medium. Must be shaken before use
Syrup-medication dissolved in a
concentrated sugar solution to mask
unpleasant taste
Forms of Drugs
Tincture-an alcohol or water and
alcohol solution prepared from
drugs derived from plants
Forms of Drugs
These form/preparations of drugs
are packaged as ampoules, vials,
blister packs, sachets etc.
Aam


ampoules
Blister
Vials Packs
Storage of Medications
Medications are dispensed by the
pharmacy to nursing units. Once
delivered, proper storage becomes
the responsibility of the nurse. All
medications must be stored in a
cool dry place (usually in cabinets,
medicine carts or fridges)
All medications must be stored in a cool dry place
(usually in cabinets, medicine carts or fridges)
Storage of Medications
Inless advanced countries, 3
cupboards are usually used for
drug storage.

Cupboard I-used for drugs for


external use only; e.g. calamine
lotion, detol, methylated spirit etc.
These drugs are contained in
distinctive bottles, usually ridged
with deep colours (dark green,
blue, brown) with red label marked
Storage of Medications
Cupboard II-contains drugs for
internal use only e.g. tablets,
suspension, mixtures etc. All
drugs must be labelled.
Cupboard III-contains the
dangerous drug; drugs of
addiction. E.g. Morphine,
pethedine etc.
All drugs should be kept away from
direct sunlight and at a
Storage of Medications
Another cupboard called the
Emergency Cupboard may be
stationed at or near the nurses bay
for easy access. This cupboard
contains drugs for emergency
situations e.g. aminophylline (for
asthma), hydralazine (for severe
hypertension), oxytocin (for
maternal bleeding), intravenous
infusions (for rehydration) etc.
Storage of Medications
In advanced hospitals, use is made of
computer controlled dispensing units
for a more secure storage of
medications. This is made possible
through soft wares on computers
which has patient’s particulars and
medication orders. With a password,
the nurse selects the medication
needed; the drawer with the
medication opens and the drug is
delivered.
Storage of Medications
Some medications such as
insulin, vaccines and ATS (anti-
tetanol serum) must be stored in
medication refrigerators to
preserve their potency.
ROUTES OF DRUG
ADMINISTRATION
The route of drug administration
is the path by which a drug is
brought into contact with the
body.
Drugs are introduced into the
body by several routes; it is
paramount for the nurse to
ensure that the pharmaceutical
preparation is appropriate for the
route specified
1. Enteral– administering
medication through the gastro-
intestinal route; e.g.
 Oral
 Sub-lingual
 Rectal
2. Parenteral Route
Intravenous

Intramuscular

Intrathecal

Intradermal

Subcutaneous etc.
Routes Of Drug
Administration
3. Topical Route (usually for local effect)
On the skin
Nasally

On the cornea


In the ear etc.
4. Inhalation
[Pls Read and make notes on 3 and 4
above]
Enteral Route
Drug is administered through the gastro-
intestinal route
1. Oral route – it is the most commonly
used route for most drugs because it is
 Safe
 Convenient
 Least expensive
Routes Of Drug
Administration
The medicine is swallowed with
fluid or is given through a tube.
This route is contra-indicated in
patient on nil per os, or patients
with operations of the GIT.

2. Sub-lingual; the drug is placed


under the tongue to dissolve
slowly and be absorbed.
Routes Of Drug
Administration
 drugs can also be administered
into the buccal cavity (into the
superior posterior aspect of the
cheek next to the molars. Drugs
administered through these
routes act quickly due to the thin
and large vascularisation which
permits quick absorption into the
blood stream
Routes Of Drug
Administration
3. Drugs can also be administered
into the rectum. The suppository
gradually dissolves at body
temperature and releases the
drug which is then absorbed
through the mucous . Rectal
administration of drug is
contraindicated in diarrhoea,
rectal prolapse or rectal
surgeries.
Routes Of Drug
Administration
Parenteral Route – this means
introduction of medicines by
injection into body tissues or blood
vessels. Because this is an invasive
procedure, sterile technique must
always be applied.
It has the following advantages:
Rapid and predictable absorption
By pass GIT enzymes and gastric
acid hence used for drugs that can
be destroyed by gastric acid and
Routes Of Drug
Administration
Can be used for unconscious and
uncooperative patients.
However, it
Needs strict asepsis
Pain is associated with the injection
More expensive
Self administration is difficult because it
is difficult/needs skilled person
Difficulty in correcting overdose errors
Risk of infection or local irritation
Routes Of Drug
Administration
1.Intramuscular injection- the drug is
administered into the muscle and it
passes through capillary walls to
enter the blood stream.
Advantages
 More rapid absorption than
subcutaneous injection; onset of
action is about 10 -15 minutes
 Absorption can be hastened by drug
preparation (aqueous is faster than
oil)
Routes Of Drug
Administration
More painful than SQ.
Vasoconstriction cannot be used to
slow down preparation
Subcutaneous Route-drug is injected
beneath the skin to permeate
capillary wall and enter the blood
stream
Advantages
Slow absorption rate (onset of
action about 20minutes)
Routes Of Drug
Administration
Rate of absorption can be altered
by preparation of drug (oil
preparations are slow to be
absorbed, local vasoconstriction.

Disadvantages
Only smaller volumes can be
administered compared to IM
injections
Irritating drugs may produce
Routes Of Drug
Administration
Intravenous Route- drug is administered
directly into the blood stream.

Advantages
Rapid onset of action within 1-2 minutes
Most irritating substances may be given
Very large volumes of drug may be
given
Preferred route of medication in
emergencies
100% bioavailability of drug.
Routes Of Drug
Administration
Dangerous complications e.g.
embolism and immediate toxic
effects
Very technical; getting the vein
regulating the right dose per
minute
Requires greater care.
Routes Of Drug
Administration
Topical Applications-medications are
applied to the skin or mucous membrane
for local effect or for absorption into the
blood stream. Although a large number
of topical drugs are applied to the skin,
other topical drugs include the eye,
nose, ear, rectal and vaginal preparation.

Creams, lotions, ointments etc. are usually


for local effects, however, small amounts
are absorbed into the system resulting in
systemic effects
Routes Of Drug
Administration
Inhalations-gaseous and volatile
substances such as anaesthetic
agents, oxygen are administered
by inhalation using nebulizers
positive pressure apparatus.

The drugs are almost immediately


absorbed into systemic
circulation due to larger surface
area, high vascularization and
Routes Of Drug
Administration
Advantages
Drug is delivered close to the
target tissue if local action is
desired
There is rapid absorption if
systemic effect is desired.
Abbreviations used in drug
administration
◦ a.c before meals
◦ aq water
◦ bd or bid twice a day
◦ g gram
◦ im intramuscular
◦ iv intravenous
◦ p.c after meals
◦ tid three times a day
◦ qid four times a day
MEDICAL ORDERS

A prescription is a written instruction


from a licensed prescriber concerning
the form and dosage of a drug to be
issued to a patient. It is a medication
order. However, in certain situations, a
verbal order may be given directly or
through the telephone.
Medication orders may be written on
the client’s medical records sheets
(folder) or on a legal prescription pads
Medical Orders

Types of Medication Orders


Generally, there are 2 types of
orders:
Standing orders
Self-terminating orders
Medical Orders

Standing orders are carried out


until it is cancelled by another
order; that is until the prescriber
discontinues or modifies the dosage
or frequency with another order or
until a prescribed number of days
has elapsed as determined by the
agency policy.
E.g. Insuline 10U SC qd at 1800
(6pm). This order has no limit and
must be continued until it (order) is
Medical Orders

A prn order, like IM Morphine 15mg q4h


prn, is a standing order; there is no
direction as to when it should be stopped.
The order does not specify the number of
days or number of dosages of the drug to
be received.

Self-terminatingOrder: this order


specifies the number of days or the
number of dosages of the drug the client
is to receive.
Medical Orders

E.g. Caps Tetracycline 250mg PO q6h x 5


days. This implies that on the 5 th day,
when patient receives the 20th dosage,
the order ends; the day (time) of the first
dose marks day 1.

A stat order is an order for a single dose


of a medication but it must be given
immediately; as soon as possible. This
‘once and immediately’ order is usually
given in emergency or serious situations.
Medical Orders

A medication order must have the


following:

1.The full name of the patient:


writing the full name of the patient
prevents a state of confusion when
two patients bear the same first or
last name. Also, the patient’s
number (In-patient or out-patient)
may be added and also the ward if
Medical Orders

2. Date and Time the order is written:


this is important to establish when an
order is given and when it was carried
out. It also helps to determine when an
order automatically terminates.
3. The Form and Name of the drug:
the name and form of the drug to be
administered should be written using
preferably the generic name. In cases
where trade names are used which
nurse is not familiar with, clarification
should be sought from the prescriber or
the pharmacopoeia.
Medical Orders

4. Dosage of the drug: dosage of the


drug includes the amount, frequency or
time(s) of administration and the
strength. E.g.

 Caps Tetracycline 500mg tid x 5 days;


500mg (amount), tid (frequency).

 IVF 50% (strength) Dextrose 5ml


(amount)
nocte (time) x 2 days (duration).
Medical Orders

5. Route of Administration and


special directives about its
administration. Since it is possible
for one drug to have several
possible routes of administration, it
is important that the route
preferred by the prescriber is
stated in the order. If for any
reason a prescribed route is
contraindicated in the patient, the
nurse should notify the prescriber
Medical Orders

Special directives may include ‘ give


slowly over 20, 30, 40 etc. minutes;
take before, after or with meals; etc.

6. Signature of the Prescriber: the


signature makes the medical order a
legal request. Without it, the order is
invalid.
NB: for medical orders taken verbally,
the nurse signs it, to be co-signed by
the prescriber later.
Dose Calculation and Conversions
When prescriptions are issued for
medication orders to be carried out,
it becomes necessary at times to
calculate doses to be given
especially when the drugs are
dispensed in lager doses or
strengths; or the units are different.
Dose Calculation and
Conversions
Measurements (units) can be in the
1. Metric system e.g. gram (g),
meter (m) etc.

2. Apothecary System e.g. grain (gr),


minim (m), pint (pt).

3. Household System e.g. drop (gtt),


teaspoon (tsp) or tablespoon (tsp)
Metric
1ml
15ml
30ml
500ml
1000ml
4000ml

Apothecary
15 minims
4 fluid drams
1fluid ounce
1pint
1 quart
1gallon

Household
15 drops (gtt)
1tablespoon
1fluid ounce
1pint
1 quart
1gallon
Dose Calculation and
Conversions
Metric
1mg
60mg
1g
4g
30g
500g
1000g (1kg)
Dose Calculation and Conversions
Trial Question 1
If a prescription given orders Inj.
Cephalexin 500mg IV qid x 2 days but
the pharmacy dispenses 2g in 10ml,
the dose to be administered is …………

Trial Question 2
If Inj. Heparin 10000 units SC is ordered
but 40,000 units per ml vial is supplied
from the pharmacy, how many
millilitres should be administered?
Dose Calculation and
Conversions
The paediatric dose of any
medication is usually smaller than
the adult dose. Several rules have
been devised to calculate the
infants’ and children’s dosages
such as Young’s Rule, Clark’s Rule
and Fried’s Rule. These rule give
approximate dosages.

Fried’s Rule consider children under


one year and so considers the
Dose Calculation and
Conversions
Fried’s Rule for children under 1year
Infant dose = age of child in months x Adult
Dose
150 months

Young’s Rule assumes a person under 12½


years is a child; for children over 1year.

Child’s Dose= Age of child in years x Adult


Dose
Age of child in years +12
Dose Calculation and
Conversions
Clark’s Rule calculates the dose of a
child base on his/her weight and have
an advantage over the other rules in
that it can be used for children of all
ages. An average adult weight of 150
pounds is (approx. 68kg). Can be used
for children of all ages.

Child’s Dose = weight of child (in pounds) x


Adult dose
150
Dose Calculation and
Conversions
Clarks Rule calculates the dose of
a child based on his or her weight
and it have an advantage over the
other rules n that it can be use for
children of all ages. An average
adult weight of 150pounds
[approx.65kg] is used

Childs Dose = Weight of child in pounds ×


Adult Dose
150months
Dose Calculation and
Conversions
The Body Surface Area (BSA)
method of calculating drug doses
is widely used for two types of
patients:
Cancer patients
Paediatric patients.

The BSA calculations are done in


two ways:
1. Using the standard chart which
Dose Calculation and Conversions

2. Calculation using the formula

Patient’s dose = Patient’s BSA (m²) X Drug Dose (mg)


1.73 m²

The average adult is considered to have a BSA


of 1.73m².The BSA of an individual is
determined by drawing a straight line
connecting the person’s height and weight.
The point at which the line intersects the
centre column indicates the person’s BSA in
square meters.
Dose Calculation and
Conversions
E.g. If the adult dose of a drug is
100mg, calculate the
approximate dose for a child with
a BSA of 0.83m², using the
equation above.
Ans 48mg.
Nomograph to Determine
BSA
Rights of Medication
Administration

Medication errors can be detrimental to


patients. To prevent these errors, these
guidelines are -the rights- are used in drug
administration.
1. Right Patient: correct identification of
the client cannot be over emphasized. This
can be done by asking the client to
mention his/her full name which should be
compared with that on the identification
bracelet or the patient’s folder and
medication/treatment chart for
confirmation.
Rights of Medication
Administration
Beware of same and similar first and
surnames to prevent the error of
administering one person’s medication to
another and vice versa.
2. Right Medication: before administering
any medicine, compare name on medication
chart/medication order with that on the
medication at least 3 times-checking
medication label when removing it from
storage unit, compare medication label with
that on treatment chart and medication
label and name on treatment chart with
patient’s name tag.
Rights of Medication Administration

3. Right Time: drug timing is very


especially with some drugs like
antibiotics, antimalaria drugs etc.
to achieve cure and prevents
resistance. Some drugs must be
given on empty stomach e.g.
antituberculosis drugs; and some
after meals e.g. NSAIDS-these
must be noted and adhered to.
Rights of Medication
Administration

The interval of administration of


drugs should also be adhered to
because it is important for many
drugs that the blood
concentration is not allowed to
fall below a given level and for
others two successive doses
closer than prescribed might
increase blood concentration to a
dangerous level that can harm
the patient..
Rights of Medication
Administration

4. Right Dose: this becomes very


important when medications at
hand are in a larger volume or
strength than the prescribed
order given or when the unit of
measurement in the order is
different from that supplied from
the pharmacy. Careful and correct
calculation is important to
prevent over or under dosage of
the medication.
Rights of Medication
Administration

5. Right Route: an acceptable


medication order must specify
the route of medication. If this is
unclear, the prescriber should be
contacted to clarify or specify it.
The nurse should never decide on
a route without consulting the
prescriber.
Rights of Medication
Administration
6. Right to information on drug/client
education; the patient has the right to
know the drug he/she is taking, desired
and adverse effects and all there is to
know about the medication. The charter
on patient’s right made this clear.
7. Right to Refuse Medication: the
patient has the right to refuse any
medication. However, the nurse is
obliged to explain to patients why the
drug is prescribed and the
consequences refusing medication.
Rights of Medication
Administration

8. Right Assessment: some


medications require specific assessment
before their administration e.g. checking
of vital signs. Before a medication like
Digoxin is administered the pulse must
be checked. Some medication orders
may contain specific assessments to be
done prior to medication
9. Right Documentation:
documentation should be done after
medication and not before.
Rights of Medication
Administration

10. Right Evaluation; conduct


assessment to ascertain drug
action, both desired an side
effect.
Rights of Medication
Administration

Drug Administration
For convenience, especially when
many patients are to receive
medication at a given time. The
patient should be known and
folders arranged in the order in
which the medications would be
dispensed.
Rights of Medication
Administration

Administration of drug entails five


interrelated steps:
Identification of the patient
Administration of the drug
Adjunctive nursing interventions
Recording
Evaluation of effectiveness of the
drug
Enteral Drug Administration

The delivery of any medication



that is absorbed through the
Oral Medication
Oral medication can be by ingestion,
sublingual administration (place the
pill or direct spray between the
underside of the tongue and the
floor of the oral cavity)or buccal
(place the medication between the
patient’s cheek and gum).
p
Oral Medication

A tray or trolley should be set with:


Drug to be administered
Water in a jug
Glass on a saucer all in the tray
Spoons
Mortar and pestle (when necessary)
Towel
Straw
Spatula
Patient’s folder/treatment chart and pen
Gastric Tube
Administration
Gastric tubes provide access
directly to the GI system.
Rectal Administration
The rectum’s extreme vascularity
promotes rapid drug absorption.
Medications do not travel through
the liver, and are not subject to
hepatic alteration.
Parenteral Medication
Drug administration outside of the
gastrointestinal tract. Parenteral
medication is an invasive
procedure and so must be carried
out observing the standard
infection prevention measures
sterile techniques.

Equipment
The Syringe is one of the
equipment for administration of
Parenteral Medication
All syringes have
A tip which connects with the
needle
A barrel which has the calibration
The plunger which fits inside the
barrel.
Syringes come in different shapes,
sizes and colours. They may be
made of glass or rubber or metal.
Syringes and Needles
Parenteral Medication
Parenteral Medication

The standard syringes come in


2, 3, 5 and 10cc sizes. There are
the 50, 60 and 100cc syringes
which are not for injection but for
adding large amounts of sterile
solutions to infusions or irrigating
wounds.
The Insulin Syringes are
designed specially for use with the
ordered dose of insuline. An insuline
may come in concentrations of
Parenteral Medication
The insuline syringe should always
match the concentration of the
insuline. The syringes usually have
a permanently attached needles
that are thin (26-30)and short (¼").
Parenteral Medication
Tuberculine Syringe, caliberated in
tenths and hundredths of a cubic
.
centimeter on one side and in sixteeths
of a minim on the other side, is a narrow
syringe. This syringe originally designed
for tuberculin injections can also be used
for small and precise doses especially in
children. It is used for doses of 0.5ml or
less.
Parenteral Medication

Prefilled single dose syringes are


already filled with a drug. If the
dose ordered is lesser, the excess
is expelled before administration.
Parenteral Medication
The Needles are usually made of
stainless steel and are usually
disposable. They may be packaged with
the syringe or separately. However,
some special needles for surgery or
special procedures may be reused and
hence are sterilizes after each use.
Parenteral Medication

A needle has 3 parts:


The hub; the larges part which
fits onto the syringe
The cannular/shaft/stem; the
long part which connects to the
hub
The bevel is the slanted part at
the end of the shaft. The bevel
may be short or long. The longer
the bevel, the sharper the
Parenteral Medication

The length of the bevel selected is based on


the type of injection to be given. The long
bevels are sharp and produce less pain when
injected into subscutaneous and muscle
tissues. Short bevel needles are used for
intradermal and intravenous injection to
pervent occlusion of the bevel with tissue.
A filter needle has a filter inside the needle to
prevent drawing up particles of glass or
rubber in ampoules or vials.
Before injection, the filter needle should be
changed with one without it.
Parenteral Medication

Needles for injection has 3


variables:
The slant of the bevel,
The length of the cannular
The gauge/diameter of the
cannular.
The larger the gauge number,
the smaller the diameter of the
shaft. The shaft varies from 3/8 to
5 inches while gauge varies from
Parenteral Medication

Thick and oily preparations need


larger needle hose than aqueous
one and thicker muscles need
longer needle shaft. The choice
of needle, thus, depends on
muscle mass, type of injection
the type of parenteral route for
the injection
Parenteral Medication
Ampoules and Vials
Because parenteral drug administration is
an invasive procedure, parenteral injections
(preparations) are sterile. Drugs that
deteriorate in solution are dispensed in
tablets
or powders and dissolved in solution
immediately before injection.
Parenteral Medication
So left over from such preparation
should not be used especially if they are
discoloured after some hours. Ampoules
and vials are frequently used to package
parenteral medication
An ampoule is a glass container usually
designed to hold single dose of a drug. It
is made of clear glass in a particular
shape with a constriction at the neck
(may be coloured) for easy opening.
Parenteral Medication

Because frequently the drug will


be both above the constriction an
and in the main portion of the
ampoule, one should flick the
upper portion (above the
constriction) severally with the
finger nails to bring all
medication to the main portion of
the ampoule before snapping it
open after filling the neck.
Parenteral Medication
A sterile gauze placed around the
neck before breaking prevent cuts
form the glass.
A single or multiple-dose glass
bottles with a sealed rubber cap is
called a vial. They are usually
covered with a soft metal cap that
can be easily removed. The rubber
capping must be cleaned with
antiseptic(e.g. methylated spirit)
swab before a needle is inserted.
Withdrawing medication from
Ampoules
Wash and dry hands
Select appropriate ampoule
Select the appropriate needle and syringe
Take ampoule and observe for expiry
date, cloudiness (return to pharmacy if
noticed)
While holding the ampoule flick at its
neck/stem repeatedly with the fingernails
to return trapped contents to the base of
the ampoule.
File if not scored at the neck
Withdrawing medication from
Ampoules
Wrap a sterile gauze at the neck
of the ampoule and gently snap
open.
Tilt ampoule slightly to one side,
uncap needle on syringe and
insert needle below the level of
the drug
Gently pull on the plunger to
draw medicine into the syringe
Change needle used in
Withdrawing Medication from an
Vial
Wash and dry hands
Take the vial and observe for expiry date,
direction for mixing
Withdraw the appropriate diluents into a
syringe
 with a dissecting for remove metal or
rubber cap covering the rubber stopper
Clean with swap containing methylated
spirit
Introduce needle through the middle of the
rubber and release diluent into the vial.
Withdrawing Medication from
an Vial
Shake or roll between the palms till clear
solution free from lump is obtained.
Placing the syringe in the centre of the
rubber stopper, inject air into the vial.
Invert the vial and keep the needle bevel
in the solution
With syringe at eye level, ensure the
desired dose is drawn up.
Slowly and gently, withdraw needle from
the vial and re-cap on a levelled surface
Withdrawing Medication from
an Vial
Using ink, mark the current date,
time and initials on the vial
Label the syringe with drug,
dose, date and time if not to be
used immediately
Wash and dry hands.
Withdrawing Medication from
an Vial
Ifwithdrawing medication from two
vials (multiple-dose) and mix in one
syringe, draw up from the multiple
vial first then the single vial to
prevent contamination of the
multiple-dose vial.

In case of insulin, draw up the


regular insulin first before the short
acting one.
Withdrawing Medication from
an Vial
Intradermal Injection

An intradermal (intracutaneous)


injection is the administration of a
drug into the dermal layer of the
skin just beneath the epidermis.
Only small volumes of drug are
administered by this route; about
0.01-0.1ml.

Thisroute is indicated typically for


diagnosis of tuberculosis (tuberculin
Intradermal Injection

Needle gauge 25-27 with short


bevel is used; about 3/8 -1/2
inches are used with the
tuberculin syringe for accurate
measurement.

Sitesfor injection are the inner


aspect of the fore arm, upper
chest, upper back beneath the
scapular.
Intradermal Injection
Intradermal Injection
Intradermal Injection

Procedure
Wash and dry hands
Position client comfortably
Select injection site and inspect for
oedema, redness or tenderness or
sites of previous injection
With antiseptics swab, clean site
While holding swab between fingers
of non-dominant hand, pull cap off
from the needle
Intradermal Injection

With thumb and forefinger of non-


dominant hand, stretch skin over
the selected site and insert needle
at an angle of 5°-15°, bevel up to
about 1/8 inch below the skin.
Do not aspirate; push plunger
slowly to inject the drug to form a
small bleb under the skin surface.
Gently withdraw needle while
applying gentle pressure with the
Intradermal Injection

Make patient comfortable, than


him and discard equipment as
appropriate
Document.
Subcutaneous Injections
(Sc, SQ)
Subcutaneous Injections (Sc, SQ)
Itis the administration of drug into the
subcutaneous tissue; between the dermis
and the muscle. It is usually used for
insulin and anticoagulant administration.
Sites used usually are lateral and
anterior aspects of the upper arm and
thigh, upper back below the scapulae.
Drug is slowly absorbed; hence if repeated
doses are given, the sites should be
rotated to prevent hard painful lumps from
developing as a result of irritation and poor
absorption of the drug
Subcutaneous Injections
(Sc, SQ)
Procedure
Wash and dry hands
Assemble the equipment needed with
right syringe and needle.
Prepare and load drug
Position patient, clean site with antiseptic
swab
Hold swab in a non-dominant fingers, pull
cap from needle
With syringe in between thumb and
forefingers of the dominant hand
Subcutaneous Injections
(Sc, SQ)
Pinch the skin with non dominant
hand
Inject needle quickly and firmly at
an angle of 45°-90°, release skin
and grasp tip of syringe with non
dominant hand and pull back the
plunger to ascertain that needle is
not in vein (if in vein, blood will be
drawn into the syringe on pulling
back the plunger).
Subcutaneous Injections
(Sc, SQ)
Withdraw needle while applying
pressure to the site
Massage site if acceptable and
settle him comfortably
Discard equipment as
appropriate
Wash and dry hands
document
Intramuscular Injection
(IM)
It is the administration of into the
muscle tissue . The volume of
medication to be administered IM
vary, but usually, 5ml is
considered as the maximum for
large muscles e.g. gluteal
muscle.
However, babies, the elderly and
emaciated patients are unable to
tolerate this amount; 2ml is
usually the maximum for them
Intramuscular Injection
(IM)
Large healthy muscles free from abscesses,
necrotic tissue, sloughing and damaged
nerves and skin should be used.

When a number of injections are to received,


the sites should be rotated so that muscles
are not overused or over irritated.

The length of the needle and gauge id


selected based on the volume and thickness
(viscosity) of the medication and the muscle
size.
Intramuscular Injection
(IM)
In babies and young children,
quadriceps muscles on the
anterior and lateral aspects of
the thighs are best to guard
against damaging the large
sciatic nerve at the gluteal
muscle.
Intramuscular Injection (IM)
Dorsogluteal Site utilizes the gluteus
maximus muscle for injection. The get the
injection site, the buttock is divided into four
(4) quadrants with and imaginary line. The
exact site is the upper outer aspect of the
upper outer quadrant of the buttocks.
Venterogluteal site uses the gluteus
medius and gluteus minimus for injection. It is
a very desirable site because there are
neither large nerves nor large blood vessels in
the area; and it also it has less fatty tissues.
Because it is far from the rectum, there is less
risk of contamination and abscess formation
Dorsogluteal Venterogluteal
Site site

Sites for IM injections


Intramuscular Injection (IM)
To locate the site, the nurse’s
opposite hand rests on the patient’s
opposite hip, fingers pointing
towards (patient’s) head. The index
finger is placed on the anterior
superior iliac spine, the middle
finger stretched dorsally pressing
just below the iliac crest to form a V;
a triangle is formed between the
two (index and middle) fingers and
the crest of the ilium which is the
Intramuscular Injection
(IM)
Quadriceps Site uses the rectus
femoris and vastus lateralis. The latter
is located at the anterior aspect of the
thigh. The site for site is midway
between the greater trochanter of the
femur and the knee.
Deltoid normally for smaller volumes
of drug than the other muscles
mentioned earlier. It is lateral to the
humerus; injection site about 1-2
inches below the acromium process
Quadriceps Site Deltoid Injection site
Intramuscular Injection
(IM)
Procedure
As for subcutaneous injection but
the needle is introduced deeper
into the muscle at 90° angle.
Intravenous Therapy
Intravenous therapy is the administration
of fluids, electrolytes nutrients and
medication through the intravenous route.

Objectives
To supply fluids when patients are unable
to take it liberally
To provided salts needed to maintain
electrolyte balance
To provide nutrients e.g. glucose, protein
(albumen and vitamins)
Intravenous Therapy

Administer drugs for rapid actions


or when drugs are irritating to the
tissues

Sites for intravenous therapy


The site chosen for intravenous
infusion
depends on:
Type of infusion
Duration for the infusion
Intravenous Therapy
For adults, the veins on the arm
are:
Basilic vein
Median cubital vein
Dorsal veins
Median vein
Radial vein
Cephalic vein
Intravenous Therapy
On the foot, the veins are;
Great saphenous vein
Dorsal plexus
Intravenous Therapy
Duties of the Nurse during IV Therapy
Explain the need for the IV therapy, what
to expect, duration of the therapy,
activities permitted during the procedure
and observations to be made.
Help patient to maintain activities of daily
living; bathing and grooming, feeding etc.
Observation should be made on the flow
rate, patency of the tubing, infusion site,
level of fluid in the infusion bag/bottle,
patient’s comfort and reaction to therapy.
Intravenous Therapy
Change dressing on the IV line as
may be necessary.
Intravenous Therapy
Complications to observe for during IV
therapy:
Infiltration escape of fluid into
subcutaneous tissue due to dislodgement of
the needle causing swelling and pain. Gross
infiltration may result in nerve compression
injury which can result in permanent loss of
function of extremity or in case of irritating
medications (vesicant), significant tissue
loss, permanent disfigurement or loss of
function may result. When there is
infiltration, the site should be changed.
Intravenous Therapy
Phlebitis is the inflammation of the vein.
This may result from mechanical trauma
due to the insertion too big a needle (for
small vein) or leaving a device in place for
a long time. Chemical trauma result s from
irritation from solutions or infusing too
rapidly. This manifests as pain or burning
sensation along the vein. On observation,
there may be redness, increased
temperature over the course of the vein.

Thesite should be changed and warm


compress should be applied.
Intravenous Therapy
Circulatory Overload; the
intravascular fluid compartment
contains more fluid than normal.
This occurs when infusion is too
rapid or excess volume is infused.
This manifests as dyspnoea, cough,
frothy sputum and gurgling sounds
on aspiration.

Embolism; obstruction of the blood


Intravenous Therapy
Flow rate is the volume of
intravenous fluid to be infused over
a set period of time as prescribed by
the prescriber. The flow rate should
also be observed for and bottles or
bags changed before blood is drawn
up the infusion set or air enters the
tube. Flow rate has to be calculated
as:
Total amount of fluid to be infused X drop
factor Total time in minutes
Intravenous Therapy
Factors influencing flow rate are:
Position of the extremity
Patency of the tubing and
Height of the infusion bottle/bag.