Chapter 12 Administering Medication



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Evaluation

1. Whether the nurse has followed the principle of the three checks and seven rights and the principle of sterilization. Observe whether there is bleeding, seepage, or discomfort of the injection site, and access the mobility of limbs.

2.The client’s systemic reactions to the medications

3. The client’s knowledge and skills about medication and methods of administration

Skill 12-7 Arterial Injection and Blood Sampling

Purposes

1. To get arterial blood sample

2. To prepare for some special test, for example, cerebral angiography

3. To give some medications for treatment

4. To make arterial blood transfusion

Equipment




● Medical tray

● Antiseptic solution

● Medication

● Medication card

●Sterile swab

●Sterile gauze

●Adhesive plaster

●Medical tissue

●Sterile glove (if necessary)

● Sterile tweezers and vat



a syringe based on the volume of medication, 6- to 9-gauge needle

●File and vial opener

●Container for blood specimens

●Sterile cork

●Tourniquet

●Alcohol lighter (if necessary)

●Small pad

●Sandbag


● Contamination container

●Gloves


●Sterile dressing (if necessary)

Procedures and Key Points




Steps

Rationale and Key Points




1. Wash hands and wear mask, check and prepare the medication according to the physician’s order

2. Take the equipment to the bedside of the client. Identify the client. Explain the procedure to the client

3. Provide privacy

4. Have the client assume a position appropriate for the site selected

(1) For carotid artery, the client lies on back, and turn head to the opposite side of injection slightly

(2) For radial artery, the client lies on back, and stretch and relax the arm with the inner side upward

(3) For femoral artery, the client lies on back, flex and abduct the knees, expose the inguinal region

5. Sterilize the injection site. The area sterilized should be at least 5cm in diameter with the injection site as its center. Allow it to dry

6. Applying disposable gloves or sterilize the manipulator’s index finger and the middle finger of non-dominant hand

7. Inject medication or collect blood sample

(1) Check again

(2) Palpate the pump of artery and place the most clear pump site between two fingers

(3) Hold the syringe by dominant hand and insert the needle into artery at the most clear pump site in a 90-degree angle or 40-degree angle

(4) If there are bright red blood aspirated into the barrel, it indicates the needle is inserted into the artery


(5) Steady the syringe by the dominant hand. Inject the medications or collect blood sample by the non-dominant hand



Follow sterile principles strictly

To ensure correct medication administration


To encourage cooperation and reduces anxiety

The appropriate positions make it easy to access to the artery

Follow sterile principles to prevent infection

The diameter of cleaning area should be larger than 5cm

Pump of vessel indicates that the palpated vessel is artery

The nurse should pay attention to the depth and the angle of insertion when inserting into the artery to avoid transfixing the artery and bleeding. Once bleeding, withdraw the needle immediately and press the site with sterile gauze to stop bleeding.

If the color is dull red, it indicates that the needle is inserted into the vein. Once bleeding, withdraw the needle immediately and press the site with sterile gauze until bleeding stops. Change the equipment and injection site, restart the insertion process

Steadying the syringe is to prevent from damaging the artery.

Before collecting blood sample, the nurse should aspirate 0.5ml of heparin (1:500), and spread it evenly on the inside wall of barrel, then eject residual solution, to prevent blood agglutination

The volume of blood specimen for ABGs is 0.5 to 1ml









Steps

Rationale and Key Points




(6) Withdraw the needle quickly while applying sterile swab or gauze gently over the site to press 5 to 10 minutes to stop bleeding. If necessary, use sandbag to press the site of injection

8.Check again

9.If blood sample is used for Arterial Blood Gases (ABGs), as soon as the needle is withdrawn, it should insert into a sterile cork immediately. Roll the syringe in palms.
10. Once bleeding has stopped, apply a sterile adhesive dressing

11. Help the client have a comfortable position. Dispose of equipment. Wash hands or remove gloves. Record the relevant information. Send blood sample to laboratory as soon as possible



To prevent bleeding
Inserting the needle into sterile cork is to isolate the blood from the air to prevent the mistake of test result

Rolling the syringe makes the blood confuse with the antiagglutinin completely

Don’t shake the syringe

To prevent infection

Instruct the client not to massage the injection site or move the limb immediately


Evaluation

1. Whether the nurse has followed the principle of check and sterilization. Observe whether there is bleeding, infiltration, or discomfort of the injection site, and access the mobility of limbs.

2. The client’s systemic reactions to the medications

3. The client’s knowledge and skills about medication and methods of administration

Skill 12-8 Administering Vaginal Instillations

Purposes


1. To treat or prevent vaginal infection

2. To reduce vaginal inflammation

3. To relieve vaginal inflammation

Indications

1. Clients with vaginal infection

2. Clients with vaginal discomfort, for example, itch or pain

E
Vaginal medication

Applicators

Disposable gloves

Tissue

Paper tower

Perineal pad

Screen

Lubricants

Bedpan

● MAR or computer
quipment

Procedures and Key Points



Steps

Rationale and Key Points

1. Follow check principles
2. Wash hands

3. Identify the client; ask the client to state her name

4. Assess the client’s ability to use applicator or suppository and to insert the medication by himself

5. Explain techniques to the client, especially for the client who wants to self-administer medication

6. Arrange supplies for convenient use

7. Draw room curtain or close door

8. Ask the client to void

9. Help client to take a back-lying position with the knees flexed and the hips rotated laterally

10.Spread a medical cloth under the buttock of the client

11. Drape the client appropriately so that only the perineal area is exposed

12.Apply disposable gloves
13. Be sure vaginal orifice is well illuminated by room light or gooseneck lamp

14. Provide perineal care


15. Administer medication

Insert suppository

(1) Check again

(2) Remove suppository from foil wrapper and lubricate the rounded end of the suppository



To ensure safe and correct administration of medication

To reduce transfer of microorganisms

To ensure that the correct client receives medication

To indicate the level of assistance needed from nurse


To promote understanding

To ensure smooth procedure

To provide privacy

If the bladder is empty, the client will have less discomfort during the treatment, and the possibility of injuring the vaginal lining is decreased

To provide easy access to and good exposure of vaginal canal. Also allow suppository to dissolve without escaping through orifice

Provide warmth for the client

To minimize embarrassment
To prevent transmission of microorganism between nurse and client

Proper insertion requires visualization of external genitalia

To reduce the chance of transfer of microorganisms into the vagina

Lubrication reduces friction against mucosal surfaces during insertion






Steps

Rationale and Key Points

(3) Lubricate gloved index finger of dominant hand

(4) Expose the vaginal orifice by separating the labia with nondominant hand

(5) Insert the rounded end of suppository along the posterior wall of the vaginal canal about 5 to 8cm deep

(6) Withdraw the finger and wipe away the remaining lubricant from a round orifice and labia

Apply cream or foam

(1) Check the client and medication

(2) Fill cream or foam applicator following package directions

(3) With the gloved nondominant hand, gently retract labial folds

(4) Insert applicator approximately 5 to 8cm by the dominant gloved hand

(5) Slowly push the plunger to deposit medication into vagina until the applicator is empty

(6) Withdraw applicator and place on the towel. Wipe off the residual cream from labia or vaginal orifice

(7) Discard the applicator if disposable or clean it according to the manufacturer’s directions

16. Check again

17. Remove gloves by pulling them inside out and discard in appropriate receptacle. Wash hands

18.Ask client to remain on back for at least 10 minutes

19. Offer perineal pad to the client when she resumes ambulation


20. Assess the client’s response, conditions of vagina secretion and vulva

●To avoid inserting suppository into urethra

●Proper placement ensures equal distribution of medication along the wall of vaginal cavity

●To maintain comfort

●To expose vaginal orifice

●To allow even distribution of medication along vaginal walls

●Residual cream on applicator may contain microorganisms

●To reduce transmission of microorganism

●It helps medication to be distributed and absorbed

●To prevent vaginal discharge from spreading to clothing and ensure client comfort

●To evaluate medication effects


Evaluation

1. Relief of complaints

2. Amount, character, and odor of discharge

3. Appearance of vaginal orifice to compare to baseline data

4. Adverse reactions or side effects of medication

Skill 12-9 Administering Rectal Suppository

Purpose

1. To use for local actions, for example, to soften feces and alleviate constipation



2. To exert systemic effect, for example, to reduce fever or to relieve nausea and vomiting

Indications

1. Clients with constipation

2. Clients with infection in rectum

3. Clients with recent rectal surgery

Equipment


●Rectal suppository

●Lubricants

●Disposable gloves

●Medical cloth

●Screen


●MAR or computer printout

Procedures and Key Points




Steps

Rationale and Key Points

1.Follow three checks and seven rights principles

2.Wash hands, wear mouth mask, and assemble equipment

3.Take the equipment to the bedside of the client

4.Identify the client


5.Explain procedure to the client

6.Close room curtain or door, and provide screen if necessary

7.Apply disposable gloves

8.Assist the client to a side-lying position with Knees flexed. Keep client draped with only anal area exposed

9.Spread a medial cloth under the buttock of the client

10.Examine the condition of anus externally and palpate rectal walls as needed. If gloves become soiled, dispose of them by turning inside out and placing in proper receptacle

11.Apply another pair of disposable gloves

12.Remove suppository from its wrapper and lubricate its rounded end. Lubricate index finger of dominant hand with a water-soluble lubricant

13.Ask the client to take slow deep breaths through mouth and relax anal sphincter

14.Retract buttocks with nondominant hand, insert suppository gently through anus, past internal sphincter and against rectal wall, 10cm in adults, 5cm in children and infants. Gentle pressure may be needed to apply to hold buttocks together momentarily

15.Withdraw finger and wipe anal area with tissue

16.Disacard gloves by turning them inside out, and dispose of them in appropriate receptacle

17.Check again

18.Ask the client to remain flat or on side for 5 minutes




●To ensure safe and correct administration of medication

●To ensure that the correct client receives medication

●To promote understanding and cooperation

●To maintain privacy and minimize embarrassment

●Provide warmth for the client

●To prevent contamination with infected fecal material

●To help the client relax external anal sphincter

●To determine presence of active rectal bleeding. Palpation determines whether the rectum is filled with feces, which may interfere with suppository placement


●Lubrication reduces friction as suppository enters rectal canal

●Forcing suppository through constricted sphincter causes pain

●Suppository must be placed against rectal mucosa for eventual absorption and therapeutic action

●To provide comfort

●Ask the client to control over the urge to defecate so as to prevent expulsion of suppository





Steps

Rationale and Key Points

19.If suppository contains laxative or fecal softener, place call light within reach

5 minutes

20.Return within 5 minutes to determine whether the suppository was expelled

21.Observe effects of the suppository 30 minutes after administration



●Call light allows client to obtain assistance to bedpan or toilet
●Reinsertion may be necessary
●Evaluate effectiveness of the medication


Evaluation

1. Conditions of bowel elimination

2.Relief of symptoms

3.Adverse reactions or side effects of medication
Skill 12-10 Using Metered-Dose Inhalers

Purposes


To decrease resistance to airflow by using bronchodilators, expectorants and decongestants

Indications

Clients with chronic respiratory disease such as chronic asthma, emphysema, or bronchitis

E
●Facial tissues (optional)

●MAR or computer printout

quipment

●MDI with medication canister

●Kidney tray


Procedures and Key Points

Steps

Rationale and Key Points

1.Follow three checks and seven rights principle

2.Wash hands. Assemble equipment

3.Take the equipment to the bedside of client. Check the client

4.Explain and demonstrate how to inhaler and give the client opportunity to manipulate inhaler. Explain what metered dose is, and warn client about overuse of inhaler, including side effects of medication

5. Medication administration


●To ensure correct medication administration

●Nurses should simplify the procedure, explain in detail, and allow the client to ask questions at any time in order to help the client know how to use







Steps

Rationale and Key Points

No Aerochamber

(1) Remove mouthpiece cover from inhaler

(2) Shake inhaler well

(3) Have the client take a deep breath and exhale

(4) Instruct the client to position the inhaler in one of the two ways: ①open lips and place inhaler in mouth with opening toward the back of throat; ②position the device 2.5 to 5 cm from the mouth

(5) Ask the client hold inhaler with thumb at the mouthpiece and the index finger and middle finger at the top, keep the inhaler in proper position

(6) Teach the client to tilt his/her head back slightly, inhale slowly and deeply through his/her mouth, and depress medication canister fully

(7) Hold breath for approximately 10 seconds after every deep breath

(8) Exhale through pursed lips

With Areochamber

(1) Remove mouthpiece cover from MDI and open mouthpiece of Aerochamber

(2) Insert MDI into the end of Aerochamber

(3) Shake inhaler well

(4)Place the mouthpiece of areochamber in mouth and close lips

(5)Breathe normally through the aerochamber’s mouthpiece

(6)Depress the medication canister, spraying one puff into areochamber


(7)Breathe in slowly and fully for 5 seconds
(8)Hold breath for 5 to 10 seconds

●To ensure fine particles are aerosolized

●Prepare the client’s airway to receive the medication

●Directing aerosol spray toward airway

●Positioning the mouthpiece 2.5 to 5cm from the mouth is considered as the best way to deliver the medication
●Medication is distributed to airways during inhalation. Inhalation through mouth draws medication more effectively into airways
●Allow tiny drops of aerosol spray to reach deeper branches of airways

●Keep small airways open during exhalation


●Aerochamber is a spacer that traps medication released from the MDI; the client then inhales the drug from the device. These devices deposit up to 80% of the medication in the lungs rather than in the oropharynx

●To ensure fine particles be aerosolized

●Teach the client not to insert beyond the raised edge of the mouthpiece. Avoid covering small exhaltiomn slots with the lips to prevent medication escapiing through mouth

●Allow client to relax before delivering medication

●Emit spray that allows finer particles to be inhaled. Large droplets are retained in areochamber

●To ensure particles of medication are distributed to deeper airways

●To ensure full medication distribution



Steps

Rationale and Key Points

6. Instruct client to wait 2 to 5 minutes between inhalations or as ordered by physician
7.After medication inhalation, remove medication canister and clean inhaler in warm water

8.Assess client’s respirations and auscultate lungs



●Medication must be inhaled sequentlyially. First inhalation opens airways and reduces inflammation. Second or third inhalation penetrates deeper airways

●Accumulation of spray around mouthpiece can interfere with proper distribution during use

●To evaluate the effects of medication

Evaluation

1. Conditions of breathing

2. Relief of symptoms

3. Adverse reactions or side effects of medication

4. Client’s knowledge about medication and skill of inhalation









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