Unit13  Administration of Medications

Chapter 1 Basic Knowledge of Medications

一、Principles of Drug Administration

一)General Principles of Drug Administration

● Medications are prescribed only by physicians and dentists, and are to be in writing.

● Medications are given by the person who prepared them.

● Medications are not to be left at the bedside because they may not be taken correctly. 

● Narcotics and other controlled drugs are kept in locked cabinets.

二)Principles for administering medications safely

●  Check medication orders before giving drugs.  

●  Know about the drugs you are giving. Look up information on unfamiliar drugs concerning their action, dosage, and any precautions to be followed.

●  Observe the “five rights” when administering drugs.

1. Give the drug to the right patient
2.  Give the right drug.
3. Give the right dose. 
4. Give the drug at the right time;
5. Give the drug by the right method.  

   Make sure check three times:

1) before administration； 2)at the time of administration； 3) after administration.

二、Routes of Administration of Drugs

一)Oral administration 

Most commonly, drugs are administered orally.

1、Advantages: Oral administration is usually least expensive and most convenient for most patients. It is also a safe method of administwww.med126.com/kuaiji/ration in that the skin is not broken as it is for an injection.

2、 Disadvantages: may have an unpleasant taste or be difficult to swallow, irritate the gastric mucosa, be absorbed irregularly from the gastrointestinal tract, be absorbed slowly, and in some cases harm the teeth.

二)Parenteral administeration

Parenteral administration is a method of administering a drug other than through the digestive tract. Drugs are injected into body fluids or tissues through a needle.

Some of the more common routes for parenteral administration are:

● Intradermal: into the dermis (under the epidermis), including the scratch test.

● Subcutaneous (hypodermic): into the subcutaneous tissue, just below the skin

●  Intramuscular: into a muscle.

●  Intravenous: into a vein

●  Some of the less commonly used routes for parenteral administration are intracardiac (into the heart mescle), intrathecal or intraspinal (into the spinal canal), and so on.

三)Topical administration

Topical applications are those applied to a circumscribed surface area of the body. They are designed to affect only the area to which they are applied, but some systematic absorption may occur. Topical applications include:

●  Dermatologic preparations  Medications applied to the skin

●  Instillations  Medications applied into body cavities or orifices, such as the eyes, ears, nose, rectum, or vaginal.

●  Inhalations 

Chapter 2  Oral Medications

Procedure for Administering Oral Medications

 Before administering medications, it is necessary that

 1、you learn about each patient and the drug to be given from available sources.

2、 Intelligent assessment of the patient requires knowledge of the patient’s diagnosis, the plan of care, the expected actions of the drug, undesirable side effects, and signs of toxicity.

一、Assessing:

●  Clinical signs indicating a need for the medication

●  The patient’s ability to swallow the medication.

●   The patient’s ability to care herself/himself

● The patient’s knowledge knowing about the medications taken

● The patient’s willing to cooperation whit medical people.

二、Measuring medications

●  Check the medication card with either the order or with the patient's Kardex card. Make certain that the medication card, the Kardex card, and the physician's order are identical.

●  Always read the medication label three times:

1)when you take it from the shelf;

2)before you remove the medicine from the container;

3) before you put back the container. Never give a medication from an unlabeled container.

●  Be completely familiar with abbreviations and trade names, and use extreme caution with drugs which have similar names.

●  Check the medicine to make sure that it is not spoiled or outdated.

●  Measure the dose with appropriate equipment. Hold the measure at eye level when measuring liquids, with your thumbnail on the line of the desired amount. Pour liquid medicines from the unlabeled side of the bottle, to avoid soiling the label.

● Shake the required number of tablets or capsules into the container you are using. Small paper cups are usually provided. Never handle medications with your fingers.

● Assemble each medication with its card on the tray as you prepare it.

Chapter 3  Injection of Drugs

  一、Basic Knowledge of Administering Injections

一)Safety in administering injections

●  Check the “five rights” (right patient, right drug, right dose, right time, and right route) for three times.

●  Return liquid medications that are cloudy or have changed color to the pharmacy.

●  Make sure there is no incompatability among medications applied at the samewww.med126.com/zhicheng/ time.

●  Use aseptic techniques. Administering an injection is an invasive procedure. It must be performed using aseptic techniques in order to prevent infection during an injection:

a. To prevent contamination of solution, draw medication from an ampule quickly; do not allow ampule to stand open.

b. To prevent needle contamination, avoid letting needle touch contaminated

c. To prevent syringe contamination, avoid touching length of plunger or inner part of barrel; keep tip of syringe covered with cap or needle.

d. To prepare skin, wash skin soiled with dirt, drainage, or feces with soap and water and dry. Use friction and a circular motion while cleaning with an antiseptic swab; swab from center of site and move outward in a 5-cm radius.

●  Select an appropriate syringe and needle for the injection.

●  Select appropriate injection site.

●  Expel any air bubbles from the syringe before giving injection to prevent air embolism.

●  Check the appearance of blood after needles enter the site of injection.

1)For subcutaneous and intramuscular injections, if blood appears in syringe, remove needle, discard, and repeat procedure.

2)For intravenous injection, only after seeing the appearance of blood can the medication be injected into the vein.

●  Insert the needle into the appropriate depth according to different injections. See Figure 13-2.

●  Reduce the patient’s uncomfortable and painful feeling.

a. Comfort the patient through different methods, such as instruct the patient to take deep breath, distraction.

b. Assist patient to comfortable position

c. Insert the needle quickly, inject the solution slowly, and withdraw the needle quickly. Gently massage the area after the needle is withdrawn when give subcutaneous and intramuscular injections.

二)Equipment for injections

1、Syringes

2、Needles

（一)Skin Testing

  Skin testing is based on the concept that the skin will react if the person is sensitive to the antigen and not protected by antibodies that render it harmless to the body. A small amount of dilute solution of a specific antigen is introduced into or placed on the skin, and the site is then observed for signs of a reaction.

1、Functions:

1) To test the antigen.

2) To determine susceptibility to certain diseases.

2、Types of reaction

1)  Reacted positively to the test   ( +)：

(1) Local skin or mucous membrane reaction

A、 The tissue becomes flushed and puffy owing to increased capillary permeability.

B、Hives, rashes, and wheals appear and more than 1cm in radius.

C、Itching is severe. Hives can take the form of blisters, blebs, or vesicles.

D、fluid loss can diminish the blood volume to a degree that endangers life.

(2) Systemic reaction 

A、 edema;

B、swollen lymph glands;

C、inflammation of the joints;

D、malaise and fever;

E、bronchiolar constriction.

2) Reacted negatively to the test  （— )

(1)  No Hives, rashes, and wheals appear and less than 1cm in radius;

(2)   No puffy and Itching;

(3) No other uncomfortable feeling  .

3、Anaphylactic shock 

1) Causes: Anaphylactic shock, a severe allergic reaction in which there is vascular collapse and cerebral anoxia. It is a medical emergency.

2) Symptoms :

A、urticaria, bronchiolar constriction, edema, and, finally, circulatory collapse.

B、quickly to respiratory and cardiac arrest.

If a patient is unconscious, the nurse should:

●  Stop giving medication at once and make the patient in supine position.

● Give epinephrine to combat the allergic response

●  Clear the airway and maintain ventilation; give oxygen if requested by the physician.

●  Infuse DXM into vein or give diprozin 25-50mg by intravenous infusion.

●  Overcome circulatory collapse by administering I.V. solutions to expand the decreased blood volume.

●  Begin CPR if indicated.

●  Give NaHCO3 to combat the allergic response.

●  Monitor vital signs at regular intervals and keep the patient warm.