Internal
Enteral: sublingual, per os, per rectum.
Powders, tablets, dragee, drops, mixtures, pills.
Current system shortcomings are:
long absorbtion in the intestine.
negative action of gastric, intestine juices, bile on the medicine.
not complete absorption of the medicine into the blood, hard to establish dosage.
Sublingual method is good – medicine is absorb and don’t ruined. Pass in the blood aside liver and digestive tractus. Quick acting medicine – pills, tablets, solutions. (validol, nitroglycerine).
Per rectum – resorbtive action on the organism and localized.
Oral administration
This is the most frequently used route of drug administration and is the most convenient and economic. Solid dose forms such as tablets and capsules have a high degree of drug stability and provide accurate dosage. Medications administered orally pass down the digestive tract for absorption usually from the small intestine to the liver via the portal vein. Once the medicine has been metabolised by enzymes in the liver, it enters the circulation for systemic effect. It is important to understand the pharmacology of the indiviual medication.
The oral route is nevertheless problematic because of the unpredictable nature of gastro-intestinal drug absorption. For example the presence of food in the gastrointestinal tract may alter the gut pH, gastric motility and emptying time, as well as the rate and extent of drug absorption.
The extent to which patients can tolerate solid dose forms also varies, particularly in very young and older patients. In such cases the use of liquids or soluble formulations may be helpful. Many drugs, however, are not stable in solution for liquid formulation and in such cases careful consideration should be given to the option of switching to alternative drug treatment.
Difficulties frequently arise with patients who are prescribed modified-release preparations as these must not be crushed or broken at the point of administration. Modified-release formulations can delay, prolong or target drug delivery. The aim is to maintain plasma drug concentrations for extended periods above the minimum effective concentration.
For patients, their main advantage is that doses usually only need to be taken once or twice daily. Damage to the release controlling mechanism, for example by chewing or crushing, can result in the full dose of drug being released at once rather than over a number of hours. This may then be absorbed leading to toxicity or may not be absorbed at all leading to sub optimal treatment.
Nurses should seek advice from a pharmacist or the prescribing doctor if they are uncertain about a formulation of solid dose forms and whether or not they are suitable for crushing.
Some oral drugs can have a local effect e.g. oral antacids reduce the stomach acidity.
The oral route is the most common route of administration. This is for several reasons:
It is associated with less pain and anxiety than other routes such as intramuscular injections
It is often cheaper than other preparations such as intravenous
Less equipment is required and the procedure is often less time-consuming and more convenient.
CONTRAINDICATIONS:
Unconscious state
Absent gag reflex
Inability to swallow
Vomiting
CAUTIONS :
Digestive tract trauma/illness
Post gastro-intestinal surgery
Nil-by-mouth
Nausea
Diarrhoea
Sublingual
The sublingual mucosa offers a rich supply of blood vessels through which drugs can be absorbed. This is not a common route of administration but it offers rapid absorption into the systemic circulation. The most common example of sublingual administration is glyceryl trinitrate in the treatment of acute angina.
The pharmaceutical industry has formulated and marketed ‘wafer’-based versions of tablets that dissolve rapidly under the tongue. These are aimed at particular markets where taking tablets may be problematic, such as the treatment of migraine (rizatriptan) where symptoms of nausea may deter patients from taking oral treatments. The formulation is also used to treat conditions where compliance with prescribed drug regimens may be problematic, for example, olanzapine used to treat schizophrenia can be administered by the sublingual route.
Rectal administration
The rectal route has considerable disadvantages in terms of patient acceptability and unpredictable drug absorption but it does offer a number of benefits. It offers a valuable means of localised drug delivery into the large bowel, for example the use of rectal steroids in the form of enemas or suppositories in the treatment of inflammatory bowel disease. Antiemetics can be administered rectally for nausea and vomiting and paracetamol can be give to treat patients with a pyrexia who are unable to swallow.
Administration of drugs via enteral feeding tubes
Drugs should only be administered via fine-bore enteral feeding tubes as a last resort and other routes of administration should be considered first. Most drugs are not licensed for administration via enteral feeding tubes.
Interaction can occur between drugs and the enteral feed. Clinically significant interactions include, phenytoin, digoxin, ciprofloxacin and rifampicin. A pharmacist should therefore be involved in any decision to administer drugs via this route.
Parenteral administration: aside of digestive tract.
Parenteral drug administration can be taken literally to mean any non-oral means of drug administration, but it is generally interpreted as relating to injection directly into the body, by-passing the skin and mucous membranes. The common routes of parenteral administration are intradermal, hypodermic, intravenous, intraarterial, into abdomen, pleural cavity, heart, intraspinal, into the bone marrow, morbid place.
Advantages of parenteral administration:
Drugs that are poorly absorbed, inactive or ineffective if given orally can be given by this route, unaltered form pass into the blood
The intravenous route provides immediate onset of action
The intramuscular and subcutaneous routes can be used to achieve slow or delayed onset of action
Patient compliance problems are largely avoided .
Disadvantages of parenteral administration:
Requires trained staff to administer
Can be costly
Can be painful
Difficulties or impossible applying in case of bleeding, skin eraption.
Aseptic technique is required. Before using syringes nurse should wash carefully hands under running water, wipe hands by individual towel, put gloves. Sterile material take only by the sterile tweezers.
May require supporting equipment for example, programmable infusion devices
NB: The correct administration of parenteral doses requires the use of appropriate injection technique. If performed incorrectly, for example using the wrong sized needle it can cause damage to nerves, muscle and vasculature and may adversely affect drug absorption.
Intramuscular and subcutaneous injection:
In general the injection of drugs into the muscle or the adipose tissue beneath the skin allows a deposit or ‘depot’ of drug to become established that will be released gradually into the systemic circulation over a period of time. By altering the formulation of the drug, the period over which it is released can be influenced. For example, the formulation of antipsychotic agents such as flupentixol in oil allows them to be administered once a month or every three months.
Complications: infiltration, abscess, necrosis, phlegmon, allergy reactions due to the aseptic breaks. Such as: not sterile syringes, not complete nurse hand processing, not correct infusion, not complete allergy anamnesis.
If aseptic rules was broken inflammatory infiltration appears. Pain in the place of injection, reddening, local high temperature. About complications doctor should know.
Warm compress should apply on this place.
If first aid was not provide – abscess could appear. High temperature, constant acute pain, expressed reddening, fluctuation. Call surgeon!
Prophylaxis of infiltrates and abscesses:
Manipulation sister should work in special dressing, observe rules of aseptic and antiseptic during injections.
Observe technique of injections. Medical needle 8sm, thin, according to subcutaneous fat.
Only sterile syringes.
Palpate tissues before injection. In case of deep consolidation don’t make injection.
Preparing oil solution injection should check that syringe needle is not in the vessel.
Don’t inject cold solutions. Oil sol. Warm – 37-38 C.
After injection recommend warm for better absorption.
Hypertonic solutions (analgin, magnesium) dilute by Novocain or physiologic sol. For quickly absorption.
Intravenous injection
In many respects the administration of medicines via the IV route is an admission that the use of other routes will not allow for an intended therapeutic outcome or goal of the treatment to be met. Not only is the route inconvenient for the patient and practitioner, but it carries the greatest risk of any route of drug administration. By administering directly into the systemic circulation either by direct injection or infusion, the drug is instantaneously distributed to its sites of action.
Such administration is frequently complex and confusing. It may require dose calculations, dilutions, information to be gathered on administration rates and compatibilities with other solutions, and the use of programmable infusion devices.
Moreover the preparation of medicines requires the use of an aseptic technique, often in a ward environment that is unsuited for such work. It is imperative that to minimise the risk of errors occurring in the administration of medicines that practitioners can demonstrate their competence to practice safely in this area, and have access to appropriate sources of expert information and advice.
Considerations when preparing an intravenous injection or infusion
Is the drug suitable for preparation at ward level or should it be prepared in pharmacy?
Does the drug require initial dilution?
If so what diluent is required and in what volume?
Does the drug require further dilution?
If so to what volume and with what diluent?
Is the drug suitable for direct injection or must it be infused over time?
What length of time can it be administered over?
Is an infusion device required?
Is the drug compatible with other drugs or fluids to be administered at the same time?
Does the drug cause any local reaction when given?
Is any monitoring required during or after administration?
Patient self-administration
For many years the standard method of medicines administration in the healthcare settings such as hospitals and nursing homes has been based on nurses interpreting a prescription and giving the relevant medicine in the required dose via the required route. The patient’s role in the process has been passive.
Self-administration as an alternative means of administering medicines is based on the patient being encouraged to play a central and active part in their drug treatment, just as they would be expected to do if at home.
The safety and success of a self-administration scheme is based on an ongoing nursing assessment that measures individual patients’ ability to interpret and participate in their prescribed treatment regimen.
This assessment must initially evaluate whether or not patients administer any prescribed treatment at home, whether or not they are able to read medicine labels, can understand dose instructions and open medicine containers or packaging (Box 1). The assessment must also reflect events that take place during the hospital stay.
For example a patient judged to be capable of self-administration before surgery is unlikely to be able to do so in the immediate postoperative period. Such changes in patient capability must be reflected in the patient’s care plan, and any indications that the ability to self-administer is compromised should trigger a return to nurse-administered treatment.
The system requires that safe and secure arrangements are in place for patients’ medicines and that local policies and procedures are in place to guide practice (NMC, 2006).
A number of factors have stimulated hospital practitioners to look at the benefits of self-administration for patients and carers. There is now widespread acknowledgement that traditional methods of medicines administration in hospitals do little to encourage patient compliance and often leave patients being discharged with a bewildering bag of medicines that they may never have seen before and may not be sure how to take.
Encouraging those patients who are able to administer their own medicines, as they would do at home, raises the possibility of identifying their education needs and improving concordance. For those assessed as unable to self-administer, consideration needs to be given prior to discharge to the problems this may present.
Criteria for patient assessment for self-administration:
Is the patient receiving medicines and willing to participate?
Does the patient appear confused or forgetful?
Does the patient have a history of drug / alcohol abuse / self harm?
Does the patient self-administer at home?
Can the patient read medicines labels?
Can the patient open medicines containers?
Can the patient open his or her medicines locker?
Do the patient know what his or her medicines are for (and dosage, instructions, side-effects)?
The successful operation of an extensive self-administration scheme throughout an acute hospital offers insights into the complexities and contradictions of modern medicines management which may have been hidden by the drug trolley approach.
It requires an acknowledgement that the traditional manner of working does not meet the needs of most patients, and for ward-based practitioners to be committed to adopting this approach in their practice. It also requires a truly integrated multi-professional approach that focuses on ensuring patients gain the maximum benefit from their medicines.
Allergy reactions:
Nettle-rash, acute catarrh, conjunctivitis, Kvinke oedema, anaphylaxis shock.
Call doctor!
First aid in anaphylaxis shock:
stop injection;
nip tourniquet higher the injection place;
horizontal position. Fixed toungue;
prick around injection place with 0,5 ml 0,1% adrenaline solution (diluted in isotonic solution of NaCl 1:10);
call ambulance;
control arterial pressure and pulse;
if its not enough – 60-90 mg prednisolone intravenous or intramuscular;
symptom therapy;
in case of shock on penicillin – 1 000 000 ED pennicillinaze in the 2 ml of isotonic solution;
if not help – 2,5% pipolfen solution 2-4 ml or 2% solution of suprastine 2-4 ml intramuscular, in case of systolic arterial oressure is nit less that 100 mm.mercury;
if its needed provide cardiopulmonary reanimation;
The Most Common Types of Drugs Currently Available:
Analgesics: Drugs that relieve pain. There are two main types: non-narcotic analgesics for mild pain, and narcotic analgesics for severe pain.
Analgesics generally recommended are: Tylenol, Tylenol with codeine, Vicodin, Darvon and Ultram. These medications, except Tylenol are prescribed for pain at the physician's discretion and are generally prescribed for those requiring a greater analgesic effect than acetaminophen alone can deliver, and/or those who are allergic to, or cannot take aspirin.
Antacids: Drugs that relieve indigestion and heartburn by neutralizing stomach acid.
Antianxiety Drugs: Drugs that suppress anxiety and relax muscles (sometimes called axiolytics, sedatives, or minor tranquilizers).
Antiarrhythmics: Drugs used to control irregularities of heartbeat.
Antibacterials: Drugs used to treat infections.
Antibiotics: Drugs made from naturally occurring and synthetic substances that combat bacterial infection. Some antibiotics are effective only against limited types of bacteria. Others, known as broad spectrum antibiotics, are effective against a wide range of bacteria.
Anticoagulants and Thrombolytics: Anticoagulants prevent blood from clotting. Thrombolytics help dissolve and disperse blood clots and may be prescribed for patients with recent arterial or venous thrombosis.
Anticonvulsants: Drugs that prevent epileptic seizures.
Antidepressants: There are three main groups of mood-lifting antidepressants: those belonging to the tricyclics, SSRI (selective serotonin reuptake inhibitors) class, and monoamine oxidase inhibitors.
Tricyclic Antidepressants
Elavil (Amitriptyline) dose is typically 2.5 to 50 mg per night. Elavil is known forpain relieving effects and ability to help sleep. This medication should be takenearly in the evening, or half-dose in the evening and the other half at bedtime to avoid morning hangover.
Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic drug similar to Elavil with muscle relaxant qualities. May be taken along with Elavil to provide muscle relaxant relief. This medication usually reaches its maximum effect after one to two weeks of continuous use.
Sinequan (Doxepin) a typical dose is 2.5 to 75 mg. Also a tricyclic that functionsin the body as an antihistamine. Available in tablet form as well as liquid.
Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar effects as Elavil but may be less sedating.
Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as effective as the other anti-depressants, however, is chemically different and may be less likely to cause side effects. Desyrel is a mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at night. It has also been reported to cause nightmares.
Many of the tricyclic antidepressants have side effects that may be intolerable for some people. These include constipation, drowsiness, dry mouth and eyes, headache, heart rate abnormalities, increased sensitivity to sunlight, morning "hangover," and weight gain. These side effects may improve after patients have been using the medication for a few weeks. If not the doctor should be consulted regarding another medication.
Benzodiazepines (antidepressant and anti-anxiety properties)
Xanax (Alprazolam) a typical dose is 0.25 to 1.5 mg at night. Xanax has been found to be more effective if taken with 2400 mg (per day) of ibuprofen. However, Xanax may cause depression in some people, and has been known to be addictive. Xanax may be effective for some fibromyalgia patients if taken in low does.
Klonopin (Clonazepam) 0.5 to 1 mg at night is helpful in sleep myoclonus (arm and/or leg spasms). Klonopin may help patients who grind their teeth. It stays active in the body longer, and has the same possibility of being addictive as Xanax, and may cause depression in some people.
The antidepressant and anti-anxiety properties of these medications can cause the following effects: Depression, drowsiness, impaired coordination, impaired memory, muscular weakness and/or concentration problems, and they are known to be addictive.
Serotoning Boosting Medications
Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating tricyclics such as Elavil or Sinequan.
Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning. This medication is the most potent of this type. A sedating medication may be needed at night in conjunction with Paxil. It can cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report having fewer side effects with Paxil as compared to Prozac.
Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven helpful for some patients. Sedating medication may also be needed to combat insomnia.
Serzone (Nefazodone) is the newest of these agents. As well as increasing serotonin, it also increases norespinephrine. Serzone's efficacy and side effects are similar to Effexor.
Effexor (venlafaxine hydrochloride) the usual dose is 27.5 mg two times per day. This dosage can be adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac-like drugs, however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness, anxiety, insomnia and increased blood pressure.
The following are some of the side effects of serotonin boosting medications: anxiety/nervousness, headache, insomnia, mood swings, sexual difficulties, nausea and stomach distress.
Antidiarrheals: Drugs used for the relief of diarrhea. Two main types of antidiarrheal preparations are simple adsorbent substances and drugs that slow down the contractions of the bowel muscles so that the contents are propelled more slowly.
Antiemetics: Drugs used to treat nausea and vomiting.
Antifungals: Drugs used to treat fungal infections, the most common of which affect the hair, skin, nails, or mucous membranes.
Antihistamines: Drugs used primarily to counteract the effects of histamine, one of the chemicals involved in allergic reactions.
Antihypertensives: Drugs that lower blood pressure. The types of antihypertensives currently marketed include diuretics, beta-blockers, calcium channel blocker, ACE (angiotensin- converting enzyme) inhibitors, centrally acting antihypertensives and sympatholytics.
Anti-Inflammatories: Drugs used to reduce inflammation - the redness, heat, swelling, and increased blood flow found in infections and in many chronic noninfective diseases such as rheumatoid arthritis and gout.
Antineoplastics: Drugs used to treat cancer.
Antipsychotics: Drugs used to treat symptoms of severe psychiatric disorders. These drugs are sometimes called major tranquilizers.
Antipyretics: Drugs that reduce fever.
Antivirals: Drugs used to treat viral infections or to provide temporary protection against infections such as influenza.
Barbiturates: Als called sleeping drugs.
Beta-Blockers: Beta-adrenergic blocking agents, or beta-blockers for short, reduce the oxygen needs of the heart by reducing heartbeat rate.
Bronchodilators: Drugs that open up the bronchial tubes within the lungs when the tubes have become narrowed by muscle spasm. Bronchodilators ease breathing in diseases such as asthma.
Cold Remedies: Although there is no drug that can cure a cold, the aches, pains, and fever that accompany it can be relieved by aspirin or acetaminophen often accompanied by a decongestant, antihistamine, and sometimes caffeine.
Corticosteroids: These hormonal preparations are used primarily as anti-inflammatories in arthritis or asthma or as immunosuppressives, but they are also useful for treating some malignancies or compensating for a deficiency of natural hormones in disorders such as Addison's disease.
Cough Suppressants: Simple cough medicines, which contain substances such as honey, glycerine, or menthol, soothe throat irritation but do not actually suppress coughing. They are most soothing when taken as lozenges and dissolved in the mouth.
As liquids, they are probably swallowed too quickly to be effective. A few drugs are actually cough suppressants. There are two groups of cough suppressants: those that alter the consistency or production of phlegm such as mucolytics and expectorants; and those that suppress the coughing reflex such as codeine (narcotic cough suppressants), antihistamines, dextromethorphan and isoproterenol (non-narcotic cough suppressants).
Cytotoxics: Drugs that kill or damage cells. Cytotoxics are used as antineoplastics (drugs used to treat cancer) and as immunosuppressives.
Decongestants: Drugs that reduce swelling of the mucous membranes that line the nose by constricting blood vessels, thus relieving nasal stuffiness.
Diuretics: Drugs that increase the quantity of urine produced by the kidneys and passed out of the body, thus ridding the body of excess fluid. Diuretics reduce water logging of the tissues caused by fluid retention in disorders of the heart, kidneys, and liver. They are useful in treating mild cases of high blood pressure.
Expectorants: Drugs that stimulate the flow of saliva and promotes coughing to eliminate phlegm from the respiratory tract.
Hormones: Chemicals produced naturally by the endocrine glands (thyroid, adrenal, ovary, testis, pancreas, and parathyroid). In some disorders, for example, diabetes mellitus, in which too little of a particular hormone is produced, synthetic equivalents or natural hormone extracts are prescribed to restore the deficiency. Such treatment is known as hormone replacement therapy.
Hypoglycemics (Oral): Drugs that lower the level of glucose in the blood. Oral hypoglycemic drugs are used in diabetes mellitus if it cannot be controlled by diet alone, but does require treatment with injections of insulin.
Immunosuppressives: Drugs that prevent or reduce the body's normal reaction to invasion by disease or by foreign tissues. Immunosuppressives are used to treat autoimmune diseases (in which the body's defenses work abnormally and attack its own tissues) and to help prevent rejection of organ transplants.
Laxatives: Drugs that increase the frequency and ease of bowel movements, either by stimulating the bowel wall (stimulant laxative), by increasing the bulk of bowel contents (bulk laxative), or by lubricating them (stool-softeners, or bowel movement-softeners). Laxatives may be taken by mouth or directly into the lower bowel as suppositories or enemas. If laxatives are taken regularly, the bowels may ultimately become unable to work properly without them.
Muscle Relaxants: Drugs that relieve muscle spasm in disorders such as backache. Antianxiety drugs (minor tranquilizers) that also have a muscle-relaxant action are used most commonly.
Tricyclic Antidepressants
Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.
Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic muscle relaxant that has been found to decrease pain in some FMS patients.
Patients should be cautioned that muscle relaxants can cause drowsiness and they should not operate a motor vehicle when taking this type of medication. There are other muscle relaxants to try if these do not work.
Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.
Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic muscle relaxant that has been found to decrease pain in some FMS patients.
Sedatives: Same as antianxiety drugs.
Sex Hormones (Female): There are two groups of these hormones (estrogens and progesterone), which are responsible for development of female secondary sexual characteristics. Small quantities are also produced in males. As drugs, female sex hormones are used to treat menstrual and menopausal disorders and are used as oral contraceptives. Estrogens may be used to treat cancer of the breast or prostate, progestins (synthetic progesterone to treat endometriosis).
Sex Hormones (Male): Androgenic hormones, of which the most powerful is testosterone, are responsible for development of male secondary sexual characteristics. Small quantities are also produced in females. As drugs, male sex hormones are given to compensate for hormonal deficiency in hypopituitarism or disorders of the testes. They may be used to treat breast cancer in women, but synthetic derivatives called anabolic steroids, which have less marked side- effects, or specific anti-estrogens are often preferred. Anabolic steroids also have a "body building" effect that has led to their (usually nonsanctioned) use in competitive sports, for both men and women.
Sleeping Drugs: The two main groups of drugs that are used to induce sleep in patients with insomnia are benzodiazepines and barbiturates. All such drugs have a sedative effect in low doses and are effective sleeping medications in higher doses. Benzodiazepines drugs are used more widely than barbiturates because they are safer, the side-effects are less marked, and there is less risk of eventual physical dependence.
Sleep Medications may be used occasionally during flares or when the patient is having severe sleeping problems. They can be habit forming, however, Ambien is thought to be less habit forming, is well tolerated, with few side effects, and there are no known drug interactions. This sleep medication should not be used more than two or three times a week.
Tranquilizers: This is a term commonly used to describe any drug that has a calming or sedative effect. However, the drugs that are sometimes called minor tranquilizers should be called antianxiety drugs, and the drugs that are sometimes called major tranquilizers should be called antipsychotics.
Vitamins: Chemicals essential in small quantities for good health. Some vitamins are not manufactured by the body, but adequate quantities are present in a normal diet. People whose diets are inadequate or who have digestive tract or liver disorders may need to take supplementary vitamins.
NSAIDS (anti-inflammatories) Advil, Clinoril, Motrin, Naproxen, Relafen and Voltaren. Used alone, these anti-inflammatories have not proven effective in reducing FMS pain. However, Elavil and Xanax's effectiveness is increased when used in combination with ibuprofen (2400 mg per day). If the patient has arthritis, osteoarthritis or tendinitis these medications would be helpful in alleviating the pain.
Advil, Motrin, Naproxen, Relafen, etc., are non-steroidal anti-inflammatories. These medications can cause stomach upset and some patients have developed bleeding ulcers.
Medication Administration Step-by-Step
Administering Eye Drops
Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (drops)
Nonsterile gloves
Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented
Remove cap from eye bottle and place cap on its side
Squeeze the amount of medication as prescribed into the eyedropper
Put a tissue below the lower lid
With dominant hand, hold eyedropper ½ to ¾ inch above the eyeball, the rest hand is on patient forehead to stabilize
Place nondominant hand on cheekbone and expose lower conjunctival sac by pulling on cheek while applying slight pressure to the inner chantus
Instruct the patient to look up and drop the drops into center of conjunctival sac
Do not instill medication drops directly into the cornea
If the patient blinks and the drops land on the outer lid or eyelash, repeat the procedure
Instruct patient to close and move eyes gently
Remove gloves and wash hands
Record the route, site, and time administered on the MAR
Administering Eye Medication Disk
Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (medication disk)
Nonsterile gloves
Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented
To Insert Medication Disk:
Open sterile package and pres dominant, gloved finger against the oval disk so it lies lengthwise across fingertip
Instruct patient to look up
With non-dominant hand, gently pull the lower eyelid down and place the disk horizontally in the conjunctival sac. The disk should float on the sclera between the iris and the lower eyelid
Pull the lower eyelid out, up and over the disk
Instruct patient to blink several times
If disk is still visible, repeat the steps
When the disk is in place, instruct patient to press his fingers against his closed lid but do not rub eyes or move the disk across the cornea
If the disk falls out, rinse it under cool water and reinsert it
To Remove Medication Disk:
With non-dominant hand, invert the lower eyelid and identify the disk
If the disk is located in the upper eye, instruct patient to close the eye and place your finger on closed eyelid. Apply gentle, long, circular strokes and instruct patient to open the eye. Disk then should be located in the corner of eye. With your fingertip, slide the disk to the lower lid, then proceed
With dominant hand, use the forefinger to slide the disk onto the lid and out the patient’s eye
Remove gloves and wash hands
Record it on the MAR
Administering Eye Ointment
Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (ointment)
Nonsterile gloves
Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented
For Lower Lid:
With non-dominant hand, separate eyelids with thumb and finger, and grasp lower lid near margin immediately below the lashes, exert pressure downward over the bony prominence of the cheek
Instruct the patient to look up
Apply eye ointment along inside edge of the entire lower eyelid, from inner to outer canthus
For Upper Lid:
Instruct patient to look down
With non-dominant hand, gently grasp patient’s lashes near center of upper lid with thum and index finger, and draw lid up and away from eyeball
Apply ointment along upper lid starting at inner chantus
Administering Ear Medication
Medical Equipments:
Medication Administration Record (MAR)
Cotton-tipped Applicator
Cotton Balls
Medications
Non-sterile gloves
Tissue
Nursing Procedures:
Determine the allergies for any medication
Check the written order on MAR
Wash hand
Calculate the dose
Identify patient’s armband
Explain the procedure to the patient
Place patient in a side lying position with the affected ear facing up
Don non-sterile gloves
Straighten the ear canal by pulling the pinna down and back for children or upward and outward for adults (Pull ear up and back for adults, down and back for children)
The drops are instilled into the ear canal by holding the dropper at least ½ inch above the ear canal
Instruct patient to maintain the position for 2-3 minutes
Place a cotton ball n the outermost part of the canal
Apply to other ear 5 min. later
Wash hand
Record the drug, number of drops, time administered, and medication on MAR
Administering Nose Drops
Medical Equipments:
Medication Administration Record (MAR)
Medication with Dropper
Emesis Basin (optional)
Non-sterile Gloves
Tissue
Nursing Actions:
Check the allergies that patient may have
Determine the written order on MAR
Wash hands
Check patient’s identification armband
Explain the procedures to the patient and provide privacy
Ask patient to blow nose unless contraindicated
Inform the patient that he/she may feel a burning sensation to the mucosa or a choking sensation, or both, as the drop trickles back into the throat
Place patient in a supine position and hyperextend the neck and position the head to the site that facilitates the drop reaching the expected site
Instruct the patient to breathe through mouth
Squeeze medications into the dropper
Insert the nasal drops about 3/8 inch into nostril and keep the tip of the dropper away from the sides of the nares.
Instill the medication as prescribed and observe for signs and discomforts
Ask the patient to maintain supine position for 5 minutes
Discard any unused medication remaining in the bottle
Position the patient to a comfortable position and proved the patient with the emesis basin and tissue to expectorate any medication and flows in to the oropharynx and mouth
Remove gloves and wash hands
Record the medication given, doses, and time on MAR
Observe the patient for side effects for 30 minutes after administration
Nasal Sprays:
Have patient sit up
Insert tip of container into nostril
Have patient take a deep breath as you squirt
No need to tilt head back
Lung Sprays:
Have patient stand up
- this lowers the diaphragm and allows for better lung expansion
Shake the inhaler well
- shake for 15-30 sec.
Let patient place the spacer device on the inhaler
Instruct patient to breathe out to the end of a normal breath
Ask patient to tilt chin up
- do not hyper-extend!
Let patient place spacer tube in mouth
- instruct patient to seal lips around the tube
Ask patient to activate inhaler
- patient must inhale slowly and deeply over 5 seconds
- be sure patient doesn't use the nos
- patient must hold breath for 10 seconds - before exhaling
Wait for 2-5 minutes before next puff
Give water to rinse mouth after all doses are taken
Topical Meds:
Open wound - sterile technique
- Sterile cotton swabs or tongue depressor
Nitro paste:
- Use a unit dose patch
- Shiny area up, remove sealed portion
Prepare own nitro paste:
- Tear off piece of nitro paper
- Light print showing thru is the side you want up
- Start at beginning of line, squeeze slowly so med. is no bigger or smaller than top of tube
- Fold paper in half (med over all paper)
- Open and place on patient
- Tape in place-move around patient in clockwise manner
- If ordered chest only, the alternate side to side
- Look for previous patch before applying your patch
- To remove:
Wet one end of paper towel
Take off, wipe, and dry area
Watch for reactions to this medication - headache and lightheadedness