Pharmacology Clear and Simple – Ch. 10 – Parenteral Medications and Administration

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Parenteral medications include:
all medications that are not injested or introduced into the gastrointestinal system
Parenteral meds: (types)
topical, ophthalmic, otic, vaginal, nasal, inhaled, and injectable (intradermal ID), subcutaneous (SC), intravenous (IV)
ID
intradermal
IM
intramuscular
SC
subcutaneous
IV
intravenous
when giving any medication, you must:
wash your hands, observe the 7 rights of medication administration (right patient, drug, dose, time, route, documentation, technique), compare order with container 3x, document the administration of the drug
topical medications are:
applied directly to the skin as a patch, ointment, cream, lotion, or gel and are absorbed transdermally (through the skin)
topical medications are sometimes used:
if patients have difficulty swallowing or cannot take oral medications because of severe nausea
some medications are applied topically to achieve a system effect by maintaining:
continuous release of therapeutic doses of the drug
transdermally
through the skin
semisolid preparations include:
creams, ointments, gels and plasters, and are applied to the surface of the skin
ointments are ___ based
petroleum based; work to keep the medication in contact with the skin
overdose
cumulative effects of medication
common ointments include
antibiotic ointments such as Bactroban ointment placed on a wound and hydrocortisone cream used for itchy skin patches
creams are medications in a ___ base
water base; absorb into skin and disappear
Kwell:
is lindane, a prescription cream used for treatment of lice and scabies
Oxy 10 Balance:
another cream, medicated, used on existing blemishes
gels are ____ ____
semisolid suspensions; particles of drugs are suspended in a thickened water base; example is MetroGel for acne
plasters are :
medicated preparations that adhere to the skin with materials such as paper, linen, moleskin, or plastic; examples include salicylic acid plaster, used for warts, and bandages that are saturated with antibiotics
plasters can be used for ____ and _____
diabetes neuropathy and arthritis; plasters must be placed on healthy, intact skin only; examples are capsaicin plaster and 5% lidocaine medicated plaster
linaments or salves and lotions are also ____ preparations
semisolid
liniments are rubbed:
onto the skin; have an ingredient, usually camphor, wintergreen, or alcohol, that irritates skin, and causes blood flow to increase to affected area and decrease pain; examples are Bengay and IcyHot
lotions are used for:
externally for skin disorders, such as itchy skin with chickenpox or poison ivy
lotions are ____ based
water
creams are ___% water and ___%oil
50% water and 50% oil
lotions are ___ on
patten on (not rubbed into skin) to allow medication to stay on target area and not absorb into skin (example is calamine lotion, apply with a cotton ball)
topical meds are also available in a ___ form
solid, such as a powder or patch
powders are often applied to skin to treat:
fungal disease or reduce moisture
Desenex:
medicine, miconazole nitrate, powder to put on toes to prevent or treat athlete’s foot
transdermal patch purpose:
holds a specific amount of medication over a specific area and delivers medication over time
patches can be used for:
nausea, pain relief, alleviate nicotine addiction, control angine, provide hormonal treatment such as birth control and hormone replacement therapy
advantages of a transdermal patch:
ease of application and removal, effectiveness over time, reliable results based on even drug distribution in the body
disadvantages of a transdermal patch:
difficultry keeping patch in place; some patients have patch fall off because of excessive dryness or oiliness
failure to wipe away leftover medication at site when changing patches:
can lead to medication overdose
NicoDerm patch:
delivers very small amounts of nicotine through skin to help curb nicotine cravings when a person is trying to quit smoking
nitroglycerin
used to treat and prevent angina; is a vasodilator that helps coronary blood vessels open up and allow more efficient blood flow to heart
angina
chest pain caused by decreased blood flow to heart
wear ____ so medication does not enter your body from patch
gloves
be sure skin area is free of:
tattoos, scarring, and redness, as these features may alter absorption of medication
in a transdermal delivery system, the medication is contained in a:
drug reservoir, which is released through a membrane when the patch is applied to the skin by an adhesive backing
a patch you may have to prepare on your own:
nitroglycerin
ophthalmic medications are placed:
directly in the eye for infections, glaucoma treatment and prevention, and to facilitate examination and treatment; can be drops or ointment
eye drops are absorbed where:
through the inner canthus of the eye
ophthalmic ointments are:
thickened drug solutions that are applied to the inside lower eyelids
ocular inserts are:
small transparent membranes that contain medication; have advantage of prolonging contact of medication with eye surface
Lacrisert
hydroxypropylcellulose, insert used to treat chronic dry eye
inserts are placed
between the eye and lower conjunctiva and release medications over a period of time
when placing medications in a patient’s eye,
wear gloves and be careful not to touch dropper to eye itself to avoid spread of infection or contamination
have patient look ____ as you drop in the exact number of drops ordered
upward
put eye drops in before ______
ointment
nasolacrimal duct
runs from inside corrner of eye to the nose; have patient close eyes after insertion of eyedrops
otic medications are for the:
ear
otic medications are placed directly into the:
ear canal, to treat infections of both inner and outer ear
cerumen
ear wax
ear drops and eye drops should be at ___ temperature
room
pinna
outer ear
for ear drops in adults,
pull pinna up and back
for ear drops in children,
pull pinna down and back, straighten ear canal for best absorption
vaginal medications are usually used for ___ effect
local
vaginal medications are available in:
foams, gels, jellies, lotions
foams deliver meds via:
aerosolized foam
VCF
vaginal contraceptive foam
gels and jellies are solid particles of meds in:
viscous (thick)suspensions
metronidazole vaginal jel used to treat:
bacterial infections of the vagina
antigungal creams often used to treat:
yeast infections
IUD
intrauterine device, a contraceptive device implanted into uterus by advanced practioner; some are coated with and release the hormone progesterone
nasal medications are used to treat conditions:
seasonal allergies, asthma, congestion due to colds, and other sinus conditions
nasal medications form of:
spray, inhaler, instillation
nasal sprays are:
fine droplets inhaled from droppers or small spray bottles
before having patient use nasal drop,
have patient blow the nose before giving nasal drops to clear the mucosa for maximum absorption
have patient tilt head:
backward for nasal drops
make sure nasal dropper:
is clear and rinsed off
squueze nostril to prevent:
medicine from leaking
spray inhaler is used:
mist is sprayed into nose via a pump, bottle is not rinsed, only one per patient
CPAP
continuous positive airway pressure machine
admin meds through inhalation into respiratory system through:
cannulas, maks, and CPAPs, inhalers and nebulizers
in asthma, lungs are:
inflammed
MDIs
metered dose inhalers, used to ensure that as patient inhales, meds enter lungs; rapid method of adminstration, ideal for delivering certain kinds of drugs that break up congestion in the lungs
Mucomyst:
acetylcysteine, medicine, like albuterol, that dilates the airways to assist a patient in breathing
MDI’s are used through a ___ device
handheld, drugs are easily inhaled and begin working almost immediately at site of distress
spacer used in a MDI:
allow patient some control over when med is inhaled, its an extension tunnel that attaches to an inhaler and allows med to be held and admin when patient can inhale; useful for children and adults who are cognitively impaired or disabled
nebulizer
sometimes powders or drugs in solutions are added to special equipment called a nebulizer; this introduces the med by using compressed air or oxygen to aerosolize or suspend medication into small particles in a fine mist for inhalation into lungs through face mask or mouth piece
asthmatic patients use a nebulizer for:
ease their breathing, med opens and relaxes passages to the lungs
cystic fibrosis patients use nebulizer for:
delivering med to break up abnormally thich secretions in thei lungs and allow them to be exhaled
CPAP machine function:
forces room air or oxygen into the lungs even when patients forget to breathe
CPAP machine helps patients with:
sleep apnea, in which patient stops breathing for short periods of time in their sleep
oxygen given to patient in CPAP through:
nasal cannula or mask, order written as L/minute
nasal cannula disadvantage:
only lower concentrations of oxygen can be delivered
nasal mask advantage:
higher concentrations of oxygen can be delivered, but not as comfortable, some patients think they’re being suffocated
patients should add _____ to special chambers in CPAP machine to humidify the air
distilled water; chemicals are not added to the machine this way
injectable medications are available from manufacturer in ___ or ___ form
liquid or powder
powders must be mixed with ___ ____
sterile water or bacteriostatic sodium chloride solution
injectable meds are admin’d via:
needle and syringe and drawn up from ampules or vials
4 different routes of admin with injectible meds:
1. intradermal
2. intramuscular
3. subcutaneous
4. intravenous
ID method
intradermal, just below the epidermis, into the dermis itself (2nd layer)
ID injections used for:
TB testing and allergy testing
usual sites for ID injections:
inner aspect of forearm and upper back
in ID injection, hold the skin ___ and insert needle at ___ degrees
taut, 10-15 degrees, just under the epidermis
A ___needle is used for ID injection
short, small-gauge (diameter) needle
if injection is correct on an ID, a ___ forms
wheal
do or do not aspirate for blood in ID injection?
DO NOT
wheal
slight elevation of skin
do or do not massage site in ID injection
DO NOT
if medication leaks or wheal doesn’t form in ID injection:
you must do it again
IM injections:
allow medications to be absorbed quickly into bloodstream because of plentiful blood supply to muscles
Rocephin
antibiotic used for strep throat, injection
IMs are used for:
vaccinations and pain meds
onset of drug action in IM:
10-15 minutes
IM injections inserted at ___ angle
90 degree angle into a muscle
if IM is not done correctly, this damage can occur:
damage to major blood vessels, bones and nerves, and muscles at injection site
sites for IM injections depend on:
viscosity of liquid, size and development of muscle, and patient’s preference
do not inject into:
scar or tattoo, as tissues underneath may not have good blood supply
4 possible injection sites for IM:
1. deltoid
2. dorsogluteal
3. ventrogluteal
4. vastus lateralis
deltoid IM site:
upper arm, triangular muscle, 1 mL is max amount of fluid to inject, and needle length is 1 inch or less
dorsogluteal IM site:
in buttocks, more than 1 mL, safe for patients >2years; danger of hitting sciatic nerve; safest area is upper outer quadrant
ventrogluteal IM site:
used when patient can’t stand, and lies on side; not as commonly used; patients > 2 years
vastus lateralis IM site:
thigh muscle, large muscle on thigh side; for al age groups, choice in infants and small children
Z-track method
used when med is irritating to skin or may cause skin discoloration
Imferon:
med that needs to use Z-track method or else patient will have permanent discoloration of skin at site
subcutaneous injection:
if med needs to be absorbed more slowly; placed med into fat under skin
insulin & heparin are injected:
in SC layer or fatty layer
SC injections are put:
fleshy part of upper arm, the abdomen, and thigh
SC injection is at ___ angle
45 degree
IV route:
injects med right into a vein
most rapid method for admin med into bloodstream:
through an IV
IV advangates:
rapid absorption, quick relief of symptoms, fastest in an emergency
IV fluids and meds are:
admin directly to vein to treat illness, prevent illness, as part of a diagnostic procedure, or provide nutrition and hydration
disadvantages of IV therapy:
meds may be incompatible, risk of complications, like infiltrations, embolus, and infection; costs more; clots can form in IV catheter or port, making it useless
TPN
total parenteral nutrition
3 main types of fluids/solutions in an IV:
1. Dextrose
2. Saline
3. Lactated Ringer’s
Dextrose solution:
sugar and water solution.
Dextrose 2.5% in water
D2.5W
Dextrose 5% in water
D5W
Dextrose 10% inw ater
D10W
dextrose can also come in:
combos of 20-70%, but these are for patients with extremely low blood glucose levels, like diabetic patients, infants, severly malnourished patients, and only given under very controlled circumstances
Saline solution:
saline or sodium chloride (salt) solution may be prescribed; sodium is a vital electrolyte for body, helps cells function normally along with other electrlytes such as potassium and magnesium
Saline formulas:
usual is 9% NaCl, called NSS
1/2 NSS (0.45% NaCl)
NSS can be added to dextrose solutions:
D5NS or D10/0.45 NaCl
Lactated Ringer’s solution:
created by Sidney Ringer, English physiologist, mixed dextrose, potassium chloride, sodium, & calcium to make a healthful mixture for patients
also has Ringer’s lactate (RL) and dextrose 5% in lactated Ringer’s (D5LR)
crystalloids
simple solutions (IVs) used to increase fluid volume when a patient is dehydrated or in shock from bleeding. Kept in dark cabinet because the can deteriorate if exposed to light for long periods of time
drug infusion by IV has 3 routes:
1. infusion
2. piggyback line
3. IV push
infusion is:
slow IV administration of a large volume of fluid
can contain additives such as meds, electrolytes, or minerals; usually 250-1000 mL bag or bottle
hangs on a pole higher than heart
IV fluid flows to patient via ___ or ____
gravity or infusion pump
PCA
patient-controlled analgesia pumps
PCAs allow:
patients to push a button and receive meds, usually pain meds, like morphine or Demerol
dialysis
IV treatment solution option for patients who have kidney problems
piggyback solution used when:
patient needs meds/electrolytes several times/day over short period of time
piggyback solution conists of:
separate IV bag and tubing connected to primary IV tubing
piggyback may contain:
for example, antibiotic or potassium or vitamins that is given every 4 hours in 100 mL of fluid
IV push:
quick delivery of a small amount of med in a syringe; can’t be used for drugs that irritate vein, for drugs that can be fatal if given too quickly, or for a large amount of meds
TPN is given:
when patient’s digestive system needs a complete rest; aka hyperalimentation; is a nutritional solution infused (flowed) directly into veins to give patient complete nutrition; placed directly into a large vein
TPN provides patient with:
a well-rounded supply of fluids and electrolytes, calories from fats, proteins, and vitamins
TPN fluids require
use of special long-term catheters placed by a doctor, usually in the subclavian bein; end of catheter lies in superior vena cava
peripheral lines:
IV lines placed in veins in arms, hands or feet or scalp of small child
central lines:
IV lines inserted in large veins such as subclavian vein or internal jugular vein
central lines are used:
give additives that irritate small veins, such as total parenteral nutrition
PICC
peripherally inserted central catheter lines
PICC lines are:
similar to central lines in that they terminate in large vein close to the heart, but they are inserted from peripheral site such as lower arm
lipids or fats may be added to:
IV solutions
commercial lipid solutions contain:
soybean oil or safflower oil, which is added to water, glycerin, and egg yolks
blood and blood products can be admin’d through :
an IV line
whole blood provides:
complete correction of blood loss; restores not only fluid volume but also components cuch as platelets and WBCs that were depleted
one unit of blood is___ mL
500
patients with hemophilia require only:
clotting factors and platelets, not whole blood
before blood or blood product can be given, the :
patient’s blood type must be checked against what is to be admin’d
“type and cross”
process checking patient’s blood type against what is to be admin’d
transfusion reaction:
serious negative response to admin of blood or blood products
transfucion reaction signs/symptoms:
rapid change in vital signs, dyspnea, restlessness, fever, chills, blood in urine, pain in chest, back or flank
hematuria
blood in the urine
to discontinue a blood transfusion:
clamp line infusing blood and open line infusing NSS that is hung like a Y with the blood
ampule
small glass container holds one dose of a med in solution for injections
ampule is broken by:
placing gauze around neck of container, to protect hand and keep glass from falling into med
draw solution from ampule into a:
syringe with a filtered needle and then change to a different needle to inject solution into patient; this reduces chance broken glass will enter patient
most injectable solutions are supplied in ____ instead of ampules
vials
vials are:
glass or plastic containers sealed on top with rubber stoppers; this makes inside of container sterile
viales are either ____ or ____
multiple-dose or unit-dose
when an injection is given, ____ are used to puncture skin
needles, to deliver meds to desired location
when an IV infusion is started,
a needle is used to puncture the skin and place a plastic catheter
needles are based on:
length and circumference
a shorter needs is used for:
ID injections
a longer needs is used for:
IM injections
a ____ needle is used in children or adults with ___ muscles
small, small
a ____ needle is used in adults with large muscles
longer
needle’s gauge:
determined by width or circumference of the lumen
lumen
inside of the needle
gauges vary from ____ to ____
14 (largest) to 27 (smallest)
viscosity of fluid given determines the:
gauge
20 gauge needle may be needed for ____ fluid
thick
thin fluid can pass through a ____ gauge needle
27 gauge needle
OSHA
Occupational Safety & Health Administraition, run under the Department of Labor
OSHA requires that employers:
protect employees from accidental needle sticks
needle protectors
safety devices that OSHA requires, protecting employees from blood-borne pathogens; either retract needle before it’s pulled out of patient or cover needle after use
scoop method:
lay the cap on a flat surface and scoop it into the needle
various needle lengths:
3/8″ 1/2″ 1″ 1 1/2″
syringe:
holds the fluid to be admin’d
syringe has 3 parts:
1. barrel
2. tip
3. plunger
barrel is the:
hollow part of the syringe that holds liquid medication and through which the plunger passes
needle is:
attached to tip of syringe
plunger is part:
that pushes med through barrel and needle to deliver med to intended site
3 basic syringe types:
1. tuberculin TB
2. insulin
3. standard
tuberculin syringe:
for TB testing or other ID injections, little fluid is injected, and therefore a narrow, finely calibrated syringe is used; calibrated to 1/100 of a mL (0.01 mL); used frequently for newborns and children because doses of meds are small
insulin syringe is:
calibrated in units instead of mL; holds <1mL
standard U-100 syringe
has 100 units calibrated on barrel, and each line usually equals 2 units; each mark = 1 unit, not 2
all insulin syringes are used solely for :
insulin because an error in measurement can be fatal; no other syringe should be used for insulin; usually have orange in coloring to ID them as insulin syringes
hypodermic syringe:
standard syringe, available in sizes from 3-60mL
syringes are available w/o needles to deliver meds into the:
mouth
in emergency situations, some drugs are available in:
a prefilled cartridge
IM (Deltoid) injections go:
into arm muscles, volume 0.5-1 mL, 23-25 gauge, 5/8 inch, and 90 degrees
IM (ventrogluteal) injections go:
into muscles, 1-2mL, 18-23 gauge, 1 1/4 – 3 inches, 90 degrees
IM (Vastus lateralis) in adults injections go:
thigh muscle, 1-2mL, 20-23 gauge, 1 1/4 – 1 1/2 inch, 90 degrees
IM (vastus lateralis in child) injections go:
thigh muscle, 0.5-1mL (infants) <2 mL children, 23-25 gauge, 5/8 inch – 1 inch, 90 degree
IM (dorsogluteal) injections go:
muscle, 1-2 mL, 18-23 gauge, 1 1/4 – 3 inch, 90 degree
SC injections go:
subcutaneous tissue, <1mL, 25-29 gauge, 5/8 inch, 45 degree angle
ID injections go:
under epidermis, 0.1-0.2 mL, 25-27 gauge, 5/8 inch, 10 to 15 degrees
“spikes” the bag
inserting the end of the tubing into the outlet port of the bag or bottle; cap on spike section of IV tubing is removedjust before it’s inserted into IV container
drip chamber:
below the spike, allows flow of fluid from bag after it’s been primed (emptied of air) by squeezing it
length of IV tubing varies from ____ to ____ inches
6 to 120 inches, depending on need
rigid parts of IV set are made from
plastic or polymerized chloride
most common needle sizes for IV infusions are:
14 (largest) to 24 (smallest) gauges
needle can be two types:
1. winged “butterfly” type
2. straight needle within a catheter, called Angiocath
tourniquet should never be placed on patient for more than:
2 minutes
after inserting IV line, document:
1. size & device type
2.date & time inserted
3. site location
4. solution type
5. name of person who inserted IV catheter or hung IV bag
6. any additives added to IV solution
7. flow rate
8. number of attempts at insertion (successful & unsuccessful)
9. complications, if any
10: patient teaching
how to stop IV therapy:
put on gloves, loosen securing tape, pull out needle/catheter, dispose of it, apply pressure to site w/gauze, assess patient, document removal & time/date
IV site could have:
redness and swelling, warmth at site, patient complains of tendernedd or pain, or site feels like a firm rope, or cannula is no longer in a vein, notify your supervisor immediately, do not remove IV line w/o permission
IV complications:
bleeding, infection, phlebitis, infiltration, catheter dislodgment, occlusion, vein irritation, severed catheter, hematoma, venous spasm, thrombosis, thrombophlebitis, circulatory overload, nerve, tendon or ligament damage, systemic infection, air embolism, allergic reaction, incompatibility of meds, irreversible med error
infiltration occurs when:
IV catheter becomes displaces and allows IV fluids and meds to leak into tissue surrounding vein
thrombus or phlebitis:
blood clot or vein inflammation: can result from extremes in solution pH, needle or catheter trauma, particulate material, irritating drugs, slection of a vein too small for volume of solution infused; check vein for inflammation sign (redness, swelling, warmth to touch) or pain
air emboli can occur:
(bubbles released into bloodstream) if air enters vein; rapidly injecting air into vein can be fatal
particulate material can cause:
(small particles)vein irritation; small pieces of glass can chip away from vial or bottle; many IVs have final filter in line
True or False: Signs and symptoms of infection are redness, heat, swelling and pain.
True
True or False: IV tubing is clamped off with a filter
False
True or False: IM injections are given at a 90 degree angle
True
True or False: An ampule is usually broken to remove the solution
True
True or False: Vials come only in single-dosage units
False
True or False: A 27 gauge needle is larger than a 20 gauge needle
False
True or False: IM injections usually use a 3/8 inch needle
False
True or False: Drug viscosity determines needle length
False
True or False: Tuberculin syringes are used to give insulin
False
True or False: An U-100 insulin syringe holds 200 mL
False
True or False: Cartridge holders are disposed of with the prefilled cartridge
False
True or False: Otic medications go in the eye
False
True or False: Always wash an ear dropper with soap and water after use
False
True or False: Place used needles in biohazard containers after use
True
True or False: Otic and ophthalmic solutions are interchangeable
False
You are monitoring a patient who is receiving a blood transfusion, and he suddenly complains of chills and begins to have trouble breathing. What do you do?
Before blood or a blood product is given, the patient’s blood type must be checked against what is to be administered, called “type and cross.” It is quite possible that the patient is having a reaction to the blood in the transfusion. Signs and symptoms of a reaction include a rapid change in vital signs, dyspnea, restlessness, fever, chills, blood in urine, and pain in chest, back or flank. You will want to stop the blood transfusion in this case. To do so, you fill first clamp the line infusing the blood and the open the line infusing NSS(Natural Saline Solution) that is hung like a Y with the blood. You should closely watch the patient’s vital signs, including pulse, temperature, RR, BP, when transfusing blood products.
By which route is insulin usually given?
Subcutaneous
At which angle is a TB Test given?
10 to 15 degrees
An IM injection in an infant should be injected into which muscle?
Vastus lateralis
What is not true about Z-track injections?
Release the skin before removing the needle
Allergy testing is done via which route?
ID
Childhood vaccinations are administered via which route?
IM
A 90 degree angle is used with which of the following injections?
IM
Minute amounts of medication such as 0.1 mL are usually administered via which rote?
ID
Which route allows medication to reach the bloodstream the fastest?
IV
Ophthalmic medications are given in the:
Eye
A suppository is a type of medication that can be given via what route?
Anal or vaginal
An IV solution can include all of the following EXCEPT:
250NS
Dialysis is a procedure involving IV fluids for a condition affecting this organ:
Kidney failure
An IV catheter should be discontinued during which circumstance?
Phlebitis, Infiltration, Signs of Infection
A “Y”-tubing setup is used to administer:
Blood and blood products

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