Medication Administration
Effective medication administration is a vital aspect of nursing practice, requiring precision, knowledge, and adaptability across various delivery methods. This section provides an in-depth overview of techniques essential for administering medications safely and efficiently, including oral administration, intestinal tube therapy, and parenteral methods like injections. You’ll learn about proper techniques for nasal instillation, eye and ear medication delivery, and the use of topical, vaginal, rectal, and inhalation therapies. Additionally, we’ll cover advanced topics such as preparing injections, mixing medications, insulin storage, and combining medications from a vial and ampoule.
By the end of this section, you should know about:
- Oral administration of medications
- Intestinal tube therapy
- Topical medications
- Nasal Instillation
- Nasal Instillation Techniques
- Eye and Ear Medication Administration
- Vaginal (cream or foam)
- Rectal Instillation (Suppository)
- Inhalation Medications
- Parenteral Medication Administration (Injections)
- Preparing the injection from the bottle
- A mixture of chemicals
- Insulin storage system
- Mixing Medications from a Vial and an Ampule
Let’s Take a closer look at them.
Oral Administration of Medications
Oral administration is the most common and preferred route of administration. Tablets and capsules are usually swallowed with 60 to 240 mL of water. Be aware that a food may interfere with certain medications and therefore should be administered on an empty stomach or with food. Nurses should also be aware of interactions between medications and nutritional or herbal supplements. The risk of aspiration is a concern, so it is important to assess the patient’s ability to swallow and position them properly. If swallowing is intact, a multidisciplinary approach should be used.
Intestinal Tube Therapy in Medication Administration
Particular care should be taken when drugs are administered via the intestinal (e.g., nasogastric or G-tube) route. Make sure medication matches tube placement (stomach vs intestine) as this affects absorption. Chemicals should be as liquid as possible and should not be mixed with water supplies. Make sure the tube is inserted and check the remaining gastric volume before giving medication to prevent complications. Always flush the pipe with water before installing the pipe opening.
Topical Medications in Medication Administration
Topical medications such as creams, ointments and bandages are used to treat local conditions. These medications can be applied to the skin, soft tissues, or intact wounds. When applying topical medications, clean gloves and methods should be used to avoid contamination, especially for open wounds. When using transdermal lotion, always remove the old lotion before applying the new lotion to avoid overdosing. Make a note of where drugs have been administered and be sure to properly dispose of pills to prevent accidental discharge.
Nasal Instillation in Medication Administration
It is administered by nasal spray, usually used to block the nose. Overuse of antiepileptic drugs, especially in children, may compromise survival or lead to adverse systemic consequences. Proper nasal donor techniques include making sure the patient is in the correct position and explaining the procedure. Always check for allergies and side effects, and be sure to administer the medication at the right time and dosage.
Instillation: The act of placing a liquid medication drop by drop, often into the eyes, ears, or other body cavities.
Nasal Instillation Techniques in Medication Administration
For the elbows, mouth and nose in Medication Administration, tilt the patient’s head back and turn the person being treated to the side. Instruct the patient to breathe through the head and through the mouth. Inject the prescribed amount of fluid into the center of the ethmoid bone and hold the droplet 1 cm above the muscle. Keep the patient seated for 5 minutes after transplantation and administer tissue to drain any fluid, being careful not to blow the nose immediately
When administering a nasal spray, ensure that the needle is applied as needed, and help keep the patient’s head slightly forward. Place the nozzle securely in the nostril and allow the patient to breathe during irrigation. Then, briefly instruct the patient to hold their breath and exhale through the mouth. Advise against blowing the nose immediately after resupply. Clean the front of the bag and perform hand hygiene after surgery.
Follow-up care includes monitoring the patient for medication efficacy, assessing medication effectiveness, and using the Teach Back method to ensure the patient understands how to administer medication effective nasal administration.
Eye and Ear Medication Administration
For eye instillation, use proper techniques to avoid touching the cornea or other eye structures with the dropper. Teach the patient not to share eye medications and ensure the medication is only for the affected eye. Intraocular medications, similar to contact lenses, are placed in the conjunctival sac, and patients must learn to handle them properly.
In ear instillation, ensure drops are at room temperature to avoid dizziness. Follow the correct procedure for administering ear drops, which includes positioning the patient and straightening the ear canal. After administering the drops, have the patient remain in position for 2-3 minutes and apply gentle pressure to the tragus to ensure the medication reaches the inner ear.
Vaginal Medications
Vaginal medications, available as suppositories, creams, or foams, are administered with a gloved hand or an applicator. Teach patients about proper self-administration, ensure privacy, and follow aseptic techniques. Vaginal suppositories should be inserted into the posterior vaginal wall, and the patient should be instructed on positioning and potential sensations to expect.
Vaginal Penetration in Medication Administration
Begin vaginal penetration by preparing all necessary equipment, including appropriate medication, topical pads, and gloves. Review medication orders thoroughly and use them properly throughout the procedure. Once prepared, bend the patient’s knees and place them in a comfortable reclining position, exposing the vagina. This makes it easily accessible and available to the user.
Fill the container according to the package instructions. Using the non-dominant hand, gently pull the labial folds to open the vagina. Use your dominant hand to insert the vaginal needle approximately 5 to 7.5 cm (2 to 3 inches). Then, gently press the plunger to release the needle. Ensure the medication is evenly distributed within the woman’s vagina.
After dispensing, remove the applicator and place it on a clean surface such as a paper towel. Wipe excess cream or foam from the labia or vaginal opening to keep clean. It is important for the patient to remain in bed for at least 10 minutes after administration to ensure complete absorption and prevent drug leakage.
Once the process is complete, thoroughly remove all items, remove gloves and clean with hands. Dispensing documentation in the Medication Administration Record (MAR). If the patient self-administers vaginal injections, use the Teach Back technique so that they understand how to properly use the injections and what side effects they can have. Additionally, if the patient is instructed to use the insert at home, make sure they understand how to clean it and store it for future use.
Rectal Instillation (Suppository) in Medication Administration
Rectal injections are often used for local or systemic effects, such as promoting urination or preventing seizures. The process begins with a review of the patient’s medical history and contraindications for gout or vertebral fissures. It is important to verify medication orders and confirm the patient’s understanding of the procedure if self-administered.
After making the necessary preparations, assist the patient in the Sims position, exposing only the spine for the operation. Use gloves, and if necessary, lubricate the rings and index fingers of the dominant hand with a water-soluble lubricant. Slowly insert the end of the needle into the rectum, past the intestinal mucosa, usually about 10 cm (4 inches) in adults or 5 cm (2 inches) in children.
After inserting the suppository, apply gentle pressure to the anus and make sure it stays in place, then remove the gloves and clean the area with a tissue Carefully remove used items and gloves, then perform hand hygiene. Tell the patient to lie down for at least 5 minutes to prevent removal of the suppository. Document the dosage in the MAR, and observe the patient for side effects such as flushing or decreased symptoms as they relate to the expected action of the drug
Instruct the patient on the correct self-administration technique, and use Teach Back to confirm that they understand the purpose of the medication, potential side effects, and how to properly administer it at home.
Inhalation Medications
Inhalers are designed to deliver drugs into the lungs, where they are easily absorbed by the lungs and capillaries. There are various types of inhalers, such as pressurized metered-dose inhalers (pMDIs), breath-operated inhalers (BAIs), and dry powder inhalers (DPIs), each with unique features that help deliver drugs for pMDIs stop drug use propellant and require patient breathing and ventilator operation simultaneously. BAIs, on the other hand, release the drug when the patient inhales, eliminating the need for hand-inhalation synchronization.
DPIs contain a drug in the form of a dry powder that is inhaled directly into the lungs, without the need to synchronize inhalation and activation. These inhalers are especially useful for children and elderly patients with declining dexterity. It is important to assess the patient’s ability to use the inhaler properly because improper technique can lead to ineffective treatment.
Teach patients how to properly use their inhalers, including how to recognize when they are low on medication. Teach them the difference between rescue chemicals and maintenance chemicals, and make sure they understand when and how to use each. In addition, provide guidance on the use of spacers containing pMDIs when necessary to improve drug delivery.
| Pressurized metered-dose inhalers (pMDIs): Devices used to deliver a specific amount of medication to the lungs, commonly used for asthma or other respiratory conditions. |
Parenteral Medication Administration (Injections)
Parenteral drugs inject drugs directly into the body’s tissues and require sterile formulation to prevent infection. The drug is administered via needle and syringe, which comes in a variety of sizes and types depending on the route and tissues targeted Syringes typically range from 0.5 mL to 60 mL, with a 1-3 mL syringe commonly used for subcutaneous or intramuscular (IM). injection. Larger syringes can be used for irrigation or intravenous (IV) administration.
Careful selection is needed to ensure accurate dosing and minimize side effects. Needles vary in length and measurement, with longer needles used for IM injections and shorter ones for skin incisions. The unit of measurement is based on the viscosity of the solution and is made with large viscosity gauges. Follow hygienic procedures when preparing the product, and use proper disinfection techniques to avoid contamination during application
Before administration, ensure that the injection site is clean and the patient is in normal condition. After the medication is administered, observe the patient’s immediate reaction or any side effects and record the procedure. It is important to educate patients about their medications, including possible side effects, the purpose of injection, and any methods of self-administration if appropriate.
Intravenous (IV): Medication administration directly into the vein, allowing for rapid absorption into the bloodstream.
Preparation for Injection from an Ampule
An ampoule is a sealed glass container that holds a single volume of liquid solution, typically 1 mL to 10 mL or more. The neck of the amplifier is constricted which must be trimmed to receive the solution, and a collar ring marks a pre-marked area indicating where it is easy to break in. To begin the maintenance, make sure the amplifier is clean and held directly from the body. Using a filter needle carefully draws the solution into the syringe. The filter catalog is important because it prevents small crystals from contaminating the product. Once the drug is withdrawn and before giving the injection, remove the filter needle and place the needle or a standard needleless device This step ensures that the correct needle is inserted into the injection.
Preparing the Injection from the Bottle
A vial is a container that can be single or multiple, sealed with a rubber band. This may include liquid formulations or powder formulations. Powdered formulations require dilution, which is usually reconstituted with sterile saline or distilled water. The bottle is indicated with inputs and quantities required. Unlike ampoules, vials are a closed system, which means air enters the vial before the drug is removed to avoid creating a vacuum that would make it difficult to aspirate the solution. If contamination from the rubber stopper is a problem, a filter can be used. For bulk bottles, be sure to label the bottle with the time and date the bottle was mixed with the new contents. Refrigerate the bottle after reconstitution if necessary.
A mixture of chemicals
If the drugs are compatible, they can often be mixed in the same syringe to reduce the number of drugs injected into the patient. Checking medication plans or pharmacists is important to ensure compatibility. Start by preparing the product from the mixing bottle from the bottle and amplifier. Then, use the same syringe and filter needle to remove the drug from the ampoule. This command eliminates the need to inflate the ampoule. When mixing chemicals in two bottles, follow procedures to avoid contamination, ensure accurate dosing, and maintain aseptic technique. Aerate the bottles before administration, and always verify the final dose by checking with another nurse.
Insulin storage system
Insulin is a hormone used to manage diabetes and must be given by injection because the insulin taken will break down in the digestive tract. It is usually in the U-100 dose, that is, 100 units of insulin per milliliter of product, although five times as much U-500 insulin is also used in rare cases. The dose should also be checked. Insulin can be classified into types based on its rate of action: rapid-acting, short-acting, intermediate-acting, and long-acting. Knowing the onset, peak, and duration of each is critical to successful monitoring. Insulin can be administered as a combination of various forms, such as a mixture of short-acting (regular) and intermediate-acting (NPH) insulin. Some premixed formulations are available, but it is important to follow proper procedures in mixing insulin, such as mixing rapid-acting insulin.
Mixing Medications from a Vial and an Ampule
When mixing medication from both a vial and an ampule, the vial preparation should be done first. Using the same syringe and filter needle, draw the medication from the ampule afterward. This sequence is important because air is not needed to withdraw medication from an ampule. Always ensure the order of medication preparation and mixing is followed carefully to prevent contamination and ensure the proper dose is administered.