Mam Parocha

ORAL MEDICATIONS -ADVANTAGES • • •

The method of administration is non-invasive and least likely to harm the patient simply through process of adminsitration -- always a good thing. Meds adminstered PO reach the desired plasma concentration more slowly, and cannot be adminsitered to unconscious, incoherent or vomitiing patients. Cost Ease of administration

-DISADVANTAGES 1. Variations in absorption 2. Irritation of gastric lining 3. First pass through effect 4. Destruction of drug by digestive enzymes 5. Aspiration 6. Discoloration of tooth enamel Definition Oral medication administration is the process by which drugs are delivered by mouth through the alimentary tract. Purpose Drugs are taken by this route because of convenience, absorption of the drug, ease of use, and cost containment. It is, therefore, the most common method used. Precautions Other routes are used when a person cannot take anything by mouth, or the drug is poorly absorbed by the gastrointestinal tract. The nurse should check whether the patient has any known allergies. It is useful to remember the following checks when administering any medication: the right patient, the right medicine, the right route, the right dose, the right site, and the right time.

Description Oral drugs are can be prescribed to be taken at different intervals, either before or after food. They can be in either liquid or solid form. Questions about the frequency with which drugs should be taken should be addressed to the primary health care provider. Preparation Wash the hands. The patient's order sheet should be checked to ensure that the dose has not already been given. Once that is confirmed, the correct drug and dose should be selected. The appropriate number of pills should be shaken onto the lid of their container and dropped into a small measuring cup to hand to the patient. This should be done immediately prior to giving the drug and not done in advance. If the medication is liquid, the bottle should be shaken, the cap removed, and the bottle held at eye level with the label turned upwards, to prevent staining. The correct dose should be poured into a measuring cup.

The patient should be informed that his or her doctor has prescribed some medicine for him or her. The nurse should check the drug and dose against the patient's prescription chart again, then confirm the patient's name on his or her wristband. The drug can then be handed to the patient, who should also be offered a drink of water to aid in swallowing pills. Liquid medicines containing iron should be taken through a straw to minimize staining of the teeth. After ensuring that the drug has been taken, the nurse should record the time and the dose that has been given. Aftercare The nurse should monitor the patient's reaction and provide reassurance, if required. Complications Possible complications include: • • • • •

The drug may interact with other drugs the patient is taking and alter the desired effect. The patient may refuse the drug. There may be difficulty in swallowing. The drug may irritate the gastrointestinal tract. The drug may pass quickly through the body, and the benefits of the drug may be lost.

INTRAVENOUS ADMINISTRATION Definition Intravenous (IV) medication administration refers to the process of giving medication directly into a patient's vein. Methods of administering IV medication may include giving the medication by rapid injection (push) into the vein using a syringe, giving the medication intermittently over a specific amount of time using an IV secondary line, or giving the medication continuously mixed in the main IV solution. IV medications are most often given through a peripheral line or saline IV lock, but may also be administered direct IV, through an implanted vascular access port or through a central line. Purpose The primary purpose of giving IV medications is to initiate a rapid systemic response to medication. It is one of the fastest ways to deliver medication. The drug is immediately available to the body. It is easier to control the actual amount of drug delivered to the body by using the IV method and it is also easier to maintain drug levels in the blood for therapeutic response. The IV route for medication administration may be used if the medication to be delivered would be destroyed by digestive enzymes, is poorly absorbed by the tissue, or is painful or irritating when given by intra-muscular (IM) or subcutaneous (SQ) injection. Precautions Proper IV administration should follow the five "rights" of medication administration to avoid medication errors: be sure it is the right patient, the right drug, the right dose, the right time, and the right route before giving any medication. The IV line must be intact before any IV medication can be administered. Some IV medications can cause severe tissue damage if injected into the tissue through an infiltrated IV site.

Some IV push medications must be diluted before injection. The health care professional must check the directions for giving the specific drug IV before performing the injection. Administration guidelines for giving IV medications must be followed to avoid serious complications from the drug injection. Most medical settings have an approved IV drug list and instructions for injecting each drug IV. Other resources include the PDR guide, drug administration handbooks, or printed inserts from the pharmaceutical company. The drug delivery rate is an important factor when administering IV medication. Some IV drugs are meant to be delivered rapidly over several minutes to obtain therapeutic effect. Other drugs are most effective when delivered slowly and intermittently throughout the day. Each drug delivery rate is unique. Administration guidelines for giving IV medications must be followed to achieve the therapeutic effect desired. IV drugs may not be compatible with certain IV fluids or other drugs. Drug incompatibility is a true risk to the patient because it can cause crystallization of the medication that may at the least clog the IV line or at the worst have an embolus effect on the patient. The health care professional must check compatibility warnings that are included in IV drug administration guidelines. The line must be flushed with saline before and after giving medications IV to avoid contact of incompatible solutions or medications. The effects of medication appear rapidly after an IV injection. The health care professional must know the indications, actions, and adverse effects of the medication that is to be delivered and must observe the patient closely for adverse medication reactions or allergic reactions and be prepared to respond with supportive therapy or drug reversing agents. Description IV push medication techniques deliver a bolus (a dose of medication injected all at once intravenously) of medication directly into a vein or access port to produce an immediate peak drug level in the patient's bloodstream. Large quantities of fluid IV push can cause severe complications; follow the recommendations of the drug administration guidelines. To deliver an IV bolus medication, draw the appropriate amount of medication that has been prepared, diluted, and/or reconstituted according to IV drug administration guidelines into a syringe. A bolus injection is most often given through a peripheral IV line, a saline lock, directly into a vein, or through a vascular access port. When giving an IV bolus medication through a peripheral line with compatible fluid, the health care professional must shut off the IV line using the control clamp. The Y-port closest to the insertion site is cleaned with an alcohol or povidone-iodine pad to prevent bacterial contamination. The health care professional must then connect the medication needle or needleless system connector to the port. The medication is injected over the period of time ordered, after which the syringe is disconnected and removed. The IV line is reopened using the control clamp and the IV flow is reset to the appropriate setting. If the peripheral line fluid is not compatible with the IV bolus medication, two syringes with 3cc of normal saline are prepared before giving the medication. The line is flushed before and after the IV medication administration with the prepared saline syringes. The Y-port is quite vulnerable to contamination when switching syringes. After the IV line is flushed the second time, the line can be reopened and the IV flow rate reset to the appropriate setting.

RISK FACTORS •

INFECTION-Any break in the skin carries a risk of infection

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PHLEBITIS-is irritation of a vein that is not caused by infection, but from the mere presence of a foreign body (the IV catheter) or the fluids or medication being given. Symptoms are warmth, swelling, pain, and redness around the vein. The IV device must be removed and if necessary re-inserted into another extremity.

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INFILTRATION-Infiltration occurs when an IV fluid accidentally enters the surrounding tissue rather than the vein. It is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is usually not painful.

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FLUID OVERLOAD-This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema.

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EMBOLISM-A blood clot or other solid mass, as well as an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism

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ELCTROLYTE IMBALANCE-Administering a too-dilute or too-concentrated solution can disrupt the patient's balance of sodium, potassium, magnesium, and other electrolytes. Hospital patients usually receive blood tests to monitor these levels. EXTRAVASATION- is the accidental administration of IV infused medicinal drugs into the surrounding tissue which are caustic to these tissues, either by leakage (e.g. because of brittle veins in very elderly patients), or directly (e.g. because the needle has punctured the vein and the infusion goes directly into the arm tissue). This occurs more frequently with chemotherapeutic agents.

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