Administer drugs appropriately

Administer drugs appropriately

GENERAL RULES OF DRUG ADMINISTRATION

  1. Read the instructions carefully and incase of any doubt ask the Doctor or ward in charge
  2. Never give a drug from a container or a bottle which is not clearly labeled.
  3. Check the label against the instructions 3 times .The 1 st time before having the container, 2 nd
    time before the drug is drawn, 3rd time before the drug is administered to the patient.
  4. Give the drug following 10Rs i.e -right patient, right time, right dose, right route, right
    drug/medication, right formulation, right disposal, right storage, right equipment and right
    site.
  5. Once a drug is drawn from its container it shouldn’t be returned.
  6. Always identify the drug by reading its label on the container not by its color, smell, shape and
    size.
  7. Do not transfer drugs to another container when the old label is still on.
  8. Ask for clarification if any order regarding the dose is not readable.
  9. Watch all patients for drug reaction especially parental drugs.
  10. Watch all patients for drug reaction especially parental drugs.
  11. If any drug changes its color, it should not be administered.
  12. Liquid preparations should always be shaken before drawing from the bottles.
  13. Never use a drug which has been left in un labeled container.
  14. Always measure the dose of the drug in good light.
  15. Observe strictly the time of administration of medication.

ROUTES OF DRUG ADMINISTRATION

SYSTEMIC ROUTE

ENTERAL ROUTE
  • Oral
  • Sublingual
  • Rectal
PARENTERAL ROUTE
  • Inhalation
  • Transdermal
  • Injections

Injections, which include 

  • Intravenous
  • Intramuscular
  • Subcutaneous
  • Intra-arterial
  • Intra-articular
  • Intrathecal
  • Intradermal

 

LOCAL ROUTE

  • Skin topical
  • Intranasal
  • Ocular drops
  • Mucosal-throat, vaginal, ear,…

 Refer to Pharmacology for details about other  routes of administration that havent been explained here.

 

INHALATION

Inhalation is the breathing of air vapour or volatile medicine into the lungs.

Types

  • Moist/steam inhalation
  • Dry inhalation
MOIST/STEAM

It is used in case of inflammation of air passages and the nasal sinuses. 

       NEBULISER
Vapor is inhaled like in asthma.
Indications
-Respiratory diseases eg asthma, pneumonia
-Airway obstruction
-Nasal congestion
-Nasal bleeding
-Chest injuries and -Cardiac failure

DRY INHALATION (Oxygen administration)

It is given when the respiratory tract is diminished as in chest injuries, cardiac failure and
pneumonia.

REQUIREMENTS FOR OXYGEN ADMNISTRATION

Clean tray
-Rubber tubing
-BLB oxygen mask
-Flowmeter
-Nasal catheter
-Galipot with gauze pads
-Humidifier with distilled water

Bedside
-Oxygen source
-Screen

PROCEDURE

  1. Follow the general rules of drug administration.
  2. Determine the need of oxygen therapy in patients and check physicians order for rate, device used,
    concentration to reduce the risk of errors in administration.
  3. Position the patient in sitting up position to promote comfort.
  4. For nasal cannula, connect nasal cannula to oxygen, set up with humidification, check if oxygen
    is flowing to prongs.
  5. Place prongs in the patients nostrils two inches,place tubing over and behind each ear with
    adjuster comfortably under the chin or place tubing around the patients head with the adjuster
    at the back or base of the head and place gauze pads at the ear beneath the tubing as necessary
    to reduce irritation and pressure.
  6. Encourage the patient to breath through the nose, with the mouth closed to provide optimal
    delivery of oxygen the patient.                                                                                         
  7. For BLB mask use or attach face mask to oxygen source, start the flow of oxygen at a specified
    rate, for a mask with a reservoir, a low oxygen to fill the bag, before proceeding to the next step
    to promote oxygen supply.
  8. Position the face mask over the patients mouth adjust the elastic strap around patients head,
    adjust the flow rate.
  9. Apply the pad behind the ear as well as scalp elastic band passes to prevent irritation.
  10. Re-assess patients respiratory status ,including respiratory rate ,effort and lung sound .To
    check effectiveness of oxygen therapy.
  11. Document relevant information in patients chart.

ADMINISTRATION OF MEDICINE THROUGH INTRAVENOUS INFUSION

THE REQUIREMENTS
A TROLLERY [STRILE PROCEDURE]
TOP SHELF
Bowl containing 2 sterile towels
Galipot of swabs
Galipot of antiseptic solution
1 dissecting forceps
Sterile receiver
Sterile dressing

BOTTTOM SHELF
1 bottle of antiseptic solution
Giving set
Padded splint
Sterile gloves
Cheatle forceps in a jar
Strapping
Tourniquet or sphygmomanometer
Draw mackintosh and dressing towel
A drum of sterile swabs

Bottle holder
Receivers
Cannula in appropriate size, 2ml syringe and needle

AT THE BED SIDE
Drip stand on which to hang the bottle
Extra pillow covered with a mackintosh
Screen hand washing equipment
Sharps safety box

THE PROCEDURE

  1. Refer to general and injection medication rules .
  2. Prepare the injection trolley and take to the patients bed side 
  3. Put on gloves to prevent cross infection.
  4. Place a small pillow and protective sheet under the patient`s arm, to avoid soiling of linen.
  5. Prepare the medication to be administered , fix it on the intravenous line , fill the fluid chamber to half way ,expel the air and fix it on a drip
  6. Expose the patient`s fore arm depending on the site
  7. Request the patient to close and open his or her fist for a minute
  8. Select a vein, apply a tourniquet around the patient’s upper arm, to dilate the vein.
  9. Request the patient to close and open his or her fist for a minute
  10. Clean the area with antiseptic from center outward In circular motions covering several centimeters and permit solution to dry on the skin.
  11. Pull the skin taut bellow the entry site using the non-dominant hand, To stabilize the vein and make skin
    taut for needle entry.
  12. Hold cannula needle at 20 to 30 degree angle with sharp beveled end up insert it in the skin and into the vein, to reduce the degree of counter puncture.
  13. Once blood is seen in cannula remove tourniquet then the trocher slowly while adjusting the cannula inside the vein, to avoid puncturing the vein with the trocher.
  14. Apply pressure to the vein immediately above the end of cannula, To prevent blood flow.
  15. Attach medication line to the cannula and regulate the rate of flow using the clip, To give right amount of medicine at
    the right time
  16. Clean up any blood and secure the cannula with plaster, To ensure the cannula is held securely in place.
  17. Record the date and time of starting the infusion.
  18. Leave the patient comfortable
    and clear away.

  19. Wash hands and document the procedure.

SOME OF THE RECOMMENDED VEINS FOR INTRAVENOUS INFUSION


BACK OF THE HAND
Dorsal metacarpal veins

Dorsal metacarpal veins
Dorsal metacarpal veins

 

 

 

FORE ARM
Basilica vein
Cephalic vein

Basilica vein and Cephalic
Basilica vein and Cephalic

INNER ASPECT OF THE ELBOW

[ANTE CUBITAL FOSSA]

Medial basilic vein
Median cephalic vein

LOWER EXTRIMITY
Femoral and saphenous vein in the thigh
Dorsal venous plexus, medial and lateral marginal veins in the foot

Femoral and saphenous vein in the thigh
Femoral and saphenous vein in the thigh

SCALP VEINS
These may be useful in infants and elderly

scalp veins
scalp veins

THE COMPLICATIONS OF INTRAVENEOUS INJECTIONS

  • Necrosis occurs if the medicine goes into the surrounding tissues.
  • Damage to the arteries if the medicine is injected accidentally into the arteries.
  • If medicine is administered rapidly without following doctor`s instructions un
    desired effects may occur.
  • Thrombophlebitis.
  • Circulatory overload.
  • Embolism.
  • Shock.

FORMULAR FOR CALCULATING THE DROP RATE
Number of mls drops per min
Ordered × drop factor = drops to infuse per minute
Number of hours 60 minutes

EXAMPLE
The doctor has prescribed 1000 mls of 5% dextrose infusion to run in 10 hours’ time.

  • How many drops per minute will you regulate if infusion set has a drop factor of 20?
    1000×20 = 33.3 drops per minute
    10 x 60

FACTORS THAT MAY AFFECT THE FLOW RATE

  • Height of the infusion bottle: raising the infusion bottle higher will increase the
    rate of flow and lowering it will decrease the rate.
  • Patency of infusion set and needle: a blood clot in the needle may stop the
    infusion, the may result when there is a delay in changing the emptied infusion
    bottle.
  • Kinking of the tubing or faulty position of the needle e.g. when the needle is
    against or away from the vein wall.
  • A tight splint on or above the infusion needle will restrict the flow rate.
  • A blocked air or vent will cause the infusion to stop from running.

CARE OF THE PATIENT WHILE ON INTRAVENOUS INFUSION

  • Keep an accurate record, including the time of starting the infusion, type of the
    fluid and the amount and the prescribed rate of flow.
  • Assess the patient at frequent intervals for signs of abnormal reaction such as
    pain, sweating, restlessness or change of colour.
  • Inspect the site at regular intervals for signs of infiltration.
  • Take and record the patient`s condition.
  • If the infusion is running for some days, cleanse the area around the injection site
    with sterile gauze daily.

BLOOD TRANSFUSION

Blood transfusion refers to the intravenous replacement of lost or destroyed blood with compatible human blood.

TYPES OF BLOOD PRODUCTS
WHOLE BLOOD:
  • It is indicated to patients experiencing acute massive loss of blood or hypovolemic
    shock.
    It restores volume and raises hemoglobin count and therefore oxygen capacity.
PACKED RED BLOOD CELLS
  • Red blood cells are separated from a unit of whole blood.
    80% of plasma is removed leaving packed red blood cells which may be transfused to a
    patient to increase the number of red blood cells without overloading the circulatory
    system with fluids.
    Certain types of anaemia such as a plastic anaemia may be treated by this blood
    product.
PLATELET CONCENTRATION
  • Platelets may be administer to aid haemostasis in patients suffering from
    thrombocytopenia.
    Platelets in initiating clotting process and other clotting factors such as prothrombin,
    fibrinogen and thromboplastin.
PLASMA
  • Plasma is used to expand blood volume in cases of shock, burns, hemorrhage and while
    waiting for blood to cross matched.
INDICATIONS OF BLOOD TRANSFUSION
  • In cases of severe anaemia due to pregnancy, sickle cell disease, complicated
    malaria
  • Preoperatively in case of reduced blood volume level
  • Severe burns
  • Post operatively i.e. after major surgeries e.g. laparotomy, open reduction of internal fractures, total abdominal hysterectomy
  • Trauma following RTA [road traffic accidents]
  • When the patient lacks certain substances such as plasma or clotting factor
  • When a patient has a certain type of anaemia which cannot be treated by other measures.

THE REQUIEREMENTS
NOTE: as for intravenous infusion with addition of the following:

A TROLLEY [STERILE PROCEDURE]
TOP SHELF
-Blood giving set with a filter
-Large needle or cannula
BOTTOM SHELF
-Unit of blood
-Normal saline
-Observation chart, fluid balance chart
-Patient`s chart with details of transfusion
-Medicines as prescribed

THE PROCEDURE
NOTE: the technique of blood transfusion is similar to blood transfusion
On completion of the transfusion the empty bottle for 24 hours incase it’s needed for
testing in case of reaction.

Record the following on the patient`s chart:
-Number of the blood bottle.
-Amount of blood transfused.
-Names of nurses or doctor who checked the blood and set up the transfusion .

Urinary out put.
Administer normal saline before and after blood transfusion.

THE COMPLICATIONS OF BLOOD TRANSFUSION

The following are some of the adverse reactions which may occur during blood
transfusion;

ALLERGIC REACTIONS
  • Some patients may be hypersensitive to some substances contained in blood which he/she is receiving

Signs and symptoms

  • Itching, flushing, urticarial, signs of respiratory distress and anaphylactic shock

The management

  • Stop the transfusion immediately
  • Urgently inform doctor
  • Give anti histamine if prescribed
FEBRILE REACTION

While the transfusion is in progress, the patient may develop fever accompanied by
chills and headache. If this happens:

  • Stop the transfusion at once and notify the doctor
  • Treat the patient symptomatically such as giving him or her an extra blanket or giving the prescribed antipyretics
  • Re assure the patient
INCOMPATIBILITY REACTION

This is a serious reaction. It occurs when the donor`s blood is not compatible with that of a recipient
The signs and symptoms

  • Shivering
  • Chills
  • Headache
  • Lower back pain
  • Nausea and sometimes vomiting
  • Patient may have haemoglobinuria
  • Acute renal failure

The management

  • Stop the transfusion immediately and notify doctor
  • Keep the vein open with normal saline
  • If the patient is shocked treat for shock
  • Keep blood for rechecking at the blood bank
  • Take the blood samples from the site
  • Collect a urinary specimen to determine haemoglobinuria
  • Give a diuretic as prescribed by the doctor
CIRCURATORY OVERLOAD

NOTE: if the volume of blood administered is greater than what the circulatory system
can conveniently accommodate, the patient will have;

  • Distended neck veins
  • Dyspnea
  • Dry cough and pulmonary oedema

The management
-Stop the transfusion and notify the doctor who may order to stop completely or
to give at slower rate.
-Administer prescribed medicines.
-Check and record vital signs at different intervals.

PYOGENIC REACTION

The blood or equipment for giving the blood may be contaminated with bacteria. Patient
will manifest with the following signs and symptoms

  • High fever
  • Chills
  • Nausea
  • Vomiting

The management
-Stop the transfusion immediately
-Tepid sponge the patient
-Inform the doctor and the blood bank
-Monitor the vital signs
-Give antibiotics and antipyretics as prescribed by the doctor

DISEASES THAT CAN BE TRANSMITTED THROUGH BLOOD TRANSFUSSION
  • Malaria
  • Syphilis
  • Viral hepatitis
  • HIV/AIDS
  • Sickle cell disease
THE ROLES OF A NURSE BEFORE, DURING AND AFTER BLOOD TRANSFUSION
BEFORE BLOOD TRANSFUSION [NURSE`S INTERVENTIONS]
  • Ensure that blood transfusion has been prescribed for the patient by the doctor as indicated in the patient`s file 
  • Properly identify the patient to be transfused
  • Explain the procedure to the patient to the patient to allay anxiety
  • Counsel, reassure and health educate the patient and relatives about the benefit of blood transfusion to the patient
  • To establish an iv line by insertion of a cannula into the identified vein , maintain it in situ and to obtain a blood sample and take it to the laboratory for grouping and cross match in order to obtain the compatible donor
  • To collect the compatible blood pack from the laboratory for the patient to be transfused
  • While at the laboratory to collect the compatible blood pack for the patient, observe the blood pack for the following;

-The blood group
-Blood name
-Expiry date
-Rhesus factor
-The reference number

  • Check the blood pack for leakages and incase of any, its changed with a new one
  • Check for the color of blood, clots and in case of any clots , its changed with a new one
  • Check the infusion set in order to confirm that its intact
  • To take vital observations i.e. BP TPR and maintain a temperature chart
  • To position the patient`s arm in a comfortable position
  • To warm the blood at room temperature to prevent chills
  • To connect the blood pack together with the infusion system on the drip stand firmly
  • To fill the air chamber with a little blood followed by expelling air from the infusion set by running blood through it
  • To administer any prescribed treatment
DURING TRANSFUSION
  • Note the time the transfusion has started
  • Observe the rate of blood flow so as to ensure that it’s in normal rate
  • Observe the patient for any reactions and in case they occur stop the transfusion immediately
  • Take the vital observations again to ensurethat the patient is still stable
  • Observe the site of infusion line for swelling, leakages, pain and infusion system for blood clotting
  • To disconnect the transfusion system from the infusion line after successful transfusion
  • To record the time the transfusion has ended
  • To thank the patient for the cooperation.
AFTER TRANSFUSION
  • After transfusion continuously monitor the patient for post transfusion reactions
  • Continuously monitor the vital observations and maintain a temperature chart
  • To maintain the empty blood pack at the bed side for 8- 12 hours

NOTE; administer normal saline before and after blood transfusion
Administer blood for 4 hours [whole blood and packed red blood cells]
Administer blood for 20 minutes [plasma platelets and cryoprecipitate

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5 thoughts on “Administer drugs appropriately”

  1. Thanks for the good info. But of late they recommend that the blood is administered at its temperature from the fridge not warming it. Thanks

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