3/2/14

Emergency tray and Trolley

List of Emergency Drugs. List of Emergency Equipment
• O2 - Tourniquet
• Morphine sulfate - O2 mask or nasal catheter
• Aramine - plaster
• Adrenalin( Epinephrin.) - Dressing scissors
• Levophed -Arm Board
• Phenergan - Small makintosh '' towel''
• Aminophylline - Tongue depressor
• Allercur         - Mouth gag
• Nor adrenaline - Air way
• Carmine (Nikethamide) - suction machine
• Lasix         - Files
• Syringes and needles - Container with alcohol
• Digoxin         - Receiver
• Na HCO3 (Sodium bicarbonate)  - Bandage
• Swabs         - Levin's tube
• Vitamin k - Ned blacks
• 0 .9% Normal Saline
• 5% D/w with complete set
• Largactil
• Diazepam
• Ergometrine
• Kcl (potassium chloride)
• 40% dextrose

Study Questions
1. Which one of the following rout of drug administration has fastest action?
a. Oral               c. Intravenous
b. Subcutaneous     d. Rectal

2. Mention two indications for oral drug administration
3. State the 5 Rs during drug administration.
4. Which one of the following site of injection most preferred for young children?
a. Vastus lateralis     c. Deltoid muscle
b. Ventrogluteal       d. Dorsogluteal

5. Explain the difference between intravenous injection and intravenous infusion.
6. List at least three immediate complications of blood transfusion.
7. Define inhalation
Read More

Two Types of Inhalation

1. Intermittent (interrupted) e.g. Nelson's inhaler.
2. Continues method e.g. steam tent.

1. Nelson's Inhaler

Equipment
• Nelson's inhaler with the mouth piece
• Cover for the inhaler (blanket or towel)
• A bowl or saucepan to carry the inhaler
• Face towel to wipe the face as patient required
• Gauze can be use around the mouthpiece to prevent burning of the lips.
• A tray. Large enough, to carry the inhaler to take it to the bedsides.
• A measuring jug with water which is 820C
• The drug ordered might be eucalyptus, tincture of benzene (about 4 cc).

Procedure
• Inhaler should be warmed and glass mouthpiece boiled
• Measure the drug as ordered. Either point in the graduate measure 90 cc of cold water and 500 cc of boiled water to bring the temperate 820c or half by half
or pour half point (300cc) of boiling water into the inhaler than 5 cc of tincture of benzene or any other drug ordered.
• Then add 300 cc water making sure that the temperature of water in the inhaler comes to 820C. This is done in order to have a good mixture of the drug. The level of the fluid should not be above the spout.
• Fix the mouthpiece firmly in the inhaler in direction opposite to the air inlet and cover the inhaler with blanket or towel
• Close windows.
• Prepare the patient usually in a sitting - up position making sure that he/she is well supported.
• Then put inhaler on a saucepan on the tray.
• Place the tray on the over- bed table or on his knees in such a way that he can bend over the inhaler easily.
• Put the spout for the escape of steam away from him.
• Cover his head with blanket.
• Tell the patient to breath in by putting his lip to the mouth piece which may be protected by a piece of gauze, and breath out by removing his lips for a moment from the mouth piece
• The treatment can take from 5-10 minutes after which the patient should be kept warm and comfortable for some time.

N.B:
1. If a Nelson's inhaler is not available a wide- mouthed jug may used. The patient should be covered up to the waist with a balance from a canopy, or the mouth of the jug may be covered with a towel to make the opening small enough for the patient to put his nose and mouth (not eyes) on it.
2. For irrational, helpless patients, stay with them throughout the procedure.
3. Report the amount and nature of any sputum or discharge.

Care of Equipment after use
• Pour out the water from the inhaler (not onto a sink)
• Wash the inhaler with hot water
• Boil the mouth piece
Read More

Oxygen tent Procedure

Purpose:
a) To keep patient in high oxygenation environment.
b) Whenever the other means are not possible.

Equipment
1. Transparent oxygen tent and its apparatus fitted with oxygen
2. Ice if the apparatus is with out refrigerator device.
3. Hanger for the tent
4. Room thermometer if needed
5. No smoking sign for the unit

Procedure
1. Remove all electrical appliances from the room as this may produce sparks.
2. Post sign of no smoking on many places in the unit
3. Prepare and check if the applicator is working properly.
4. Bring the oxygen unit to the bedside and fix the tent on the hanger.
5. Close all appliances of the tent: place ice if the apparatus is without refrigeration device.
6. Tuck the side of the hold of tent under the mattress as far as they will go.
7. Fill the tent with 12-15 liters of oxygen 40-60% concentration for the first half hour.
8. After the first half hour regulate the flow of oxygen to 6-10 liters or as ordered by the doctor until the treatment is completed.
9. Check temperature indicator frequently and adjust to 180C- 220C.
10. Record state of patient and time started and the flow of the oxygen.
Read More

Giving oxygen by nasal catheter.

There are different kinds of catheters
a) A fine catheter
b) A spectacle frame, which carries two, places of rubber tubing and is worn by the pt.
c) Two soft rubber catheters connected by y- shaped connection to the tube on O2 apparatus.

Equipment
- Oxygen cylinder with regulating valve and pressure tubing
- Wolf’s bottle
- Glass connection
- Fine catheters, lubricant, plaster
- Safety pin
- Tray containing a galipot of saline or water. Receiver for soiled applicators.

Procedure
1. Procedure is the same as giving oxygen by mask: (Procedure 1-4)
2. Connect the fine catheter with the pressure tubing. Turn on the fine adjustment to the required rate of flow the maximum liter flow being 6-7 litter /minute.
3. Catheter is lubricated preferably with water and passed backward into pharynx till the tip of the catheter is opposite the uvula. The catheter can also be inserted by measuring the distance from the patient's nose to his ear lobe. It is then taped in place. Never force catheter against an obstruction.

Note:
Oxygen catheter are removed every 8 hrs. and a clean catheter is inserted into the other nostril. Patient's receiving oxygen by catheter requires special mouth and nose care since the catheter tends to irritate the mucous membrane. Oxygen dries and irritates mucous membrane, therefore, should be passed through water (Humidified) before it is administered by catheter. The advantage of administration of oxygen by catheter is the freedom of movement that it gives to patients receiving oxygen. By this method patient can obtain about 50% concentration of oxygen.
Read More

Inhalation Procedure

Definition: Inhalation is the act of drawing in of gas vapor or steam into the lungs for therapeutic purposes it could be in dry, moist or vapour form.

i. Oxygen Administration:

Purpose
To provide and maintain a normal supply of o2 for blood, and tissues. o2 may be administered in three ways.
1. By mask
2. Nasal Catheter
3. Tent.

1. Giving O2 by mask
There are many kinds of masks used for O2 administration the common ones are:
1. The venture mask
2. The B.L.B. masks (Boothby. Lovelace & Bulbulain)

The venture mask gives a controlled amount of O2 i.e. it is not high to cause respiratory depression & it is sufficient to relieve anoxia. It gives 24-35% of O2

The B.L.B mask provides an oxygen concentration of 90% with the flow meter set at 7 liters/minute. This kind of mask allows the patient to eat, drink and to expectorate. If the patient cannot breath through his nose, the B.L.B mask should not be used.

Equipment
- A cylinder of O2 with a reducing value and pressure tubing to be connected with the O2 cylinder.
- Mask
- Safety pin to secure the tubing to the bed linen
- Tissue paper to clean the nostrils with. If the patient is unconscious, a tray containing a galipot of saline or water, wooden applicator and receiver for soiled applicator is necessary in order to clean the nostrils

Procedure
1. The adjustment is turned on before bringing the cylinder to the bedside.
2. Explain treatment to pt.
3. Bring equipment to the bedside
4. Ask him to clean his nostril to avoid obstruction (if well enough)
5. Connect the mask to tubing and open the fine adjustment to the required rate of flow. Then apply the mask to the patient's face making sure that it rests comfortably on the pt's face. See that the tubing is secured to the bed linen by means of safety pin. Stay with the patient till he is reassured if it is his first time to be on oxygen therapy.
Read More

Administering Ear Medications

Purpose:
To relieve pain
To treat infection
To better visualize during examination

Equipment
- Disposable tissues
- Medication
- Cotton ball
- Gloves

Procedure/Steps
1. Check the medication order against the original physician’s order.
2. Wash hands carefully.
3. Prepare the medication following the “five rights.”
4. Proceed to the client’s bed side and identify the client.
5. Put on gloves
6. Ask the client to lie on the side of unaffected ear.
7. Remove excess drainage with a dry wipe.
8. Expose the external ear canal by properly adjusting the client’s ear lobe. For adults, pull the lobe up, back, and outward. For children, pull the lobe down and back.
9. (a) Hold the dropper or the tip of the squeeze bottle above the opening of the external auditory canal. Allow the prescribed number of drops to fall on the side of the canal.
(b) Do not touch any part of the ear with the dropper or squeeze bottle during administration.
10. Instruct the client to remain the side-lying position for 5-10 minutes with the affect ear upward.
11. If the procedure is ordered for both ears, allow 5-10 minutes between instillation. Report the above steps for the other ear.
12. Dispose of gloves and wash hands.
13. Document the procedure.
Read More

Administering Ophthalmic Medications

Purposes:
• Instillation
- To provide an eye medication the client requires

• Irrigation
- To clear the eye of noxious or other foreign material or excessive secretion in the preparation for surgery

1. Review prescriber’s medication order.
2. Assess condition of client’s external eye structures.
3. Determine whether client has any known allergies to eye medications. Ask if client is allergic to latex.
4. Determine whether client has any symptoms of visual alterations.
5. Assess client’s level of consciousness and ability to follow directions.
6. Assess client’s knowledge regarding drug therapy and desire to self-administer medication.
7. Assess client’s ability to manipulate and hold eye dropper.
8. Explain procedure to client.
9. Wash hands.
10. Arrange supplies at client’s bedside.
11. Apply clean gloves.
12. Ask client to lie supine or to sit back in chair with head slightly hyperextended.
13. Wash away any crusts or drainage along client’s eyelid margins or inner canthus. Soak any crusts that are dried and difficult to remove by applying a damp washcloth or cotton ball over eye for a few minutes.
14. Hold cotton ball or clean tissue in nondominant hand on client’s cheekbone just below lower eyelid.
15. With tissue or cotton ball resting below lower lid, gently press downward with thumb or fore-finger against bony orbit.
16. Ask client to look at ceiling.
17. Instill eye drops while explaining steps to client:
A. With dominant had resting on client’s forehead, hold filled medication eye dropper or ophthalmic solution approximately 1 to 2 cm above conjunctival sac.
B. Drop prescribed number of medication drops into conjunctival sac.
C. If client blinks or closes eye or if drops land on out lid margins, repeat procedure.
D. For drugs that cause systemic effects, with a clean tissue apply gentle pressure with your finger and clean tissue on the client’s nasolacrimal duct for 30 to 60 seconds.
E. After instilling drops, ask client to close eye gently.
18. Instill eye ointment:

A. Ask client to look at ceiling.
B. Holding ointment applicator above lower lid margin, apply thin stream of ointment evenly along inner edge of lower eyelid on conjunc-tiva from inner canthus to outer canthus.
C. Have client close eye and rub lid gently in circular motion with cotton ball, if rubbing is not contraindicated.

19. Intraocular disk procedures:
A. Application:
(1) Wash hands.
(2) Put on gloves.
(3) Open package containing disk. Gently press fingertip against disk so it adheres to finger. Position convex side of disk on fingertip.
(4) With other hand, gently pull client’s lower eyelid away from the eye. Ask client to look up.
(5) Place disk in the conjunctival sac so that it floats on the sclera between the iris and lower eyelid.
(6) Pull client’s lower eyelid out and over disk.

B. Removal:
(1) Wash hands.
(2) Put on gloves.
(3) Explain procedure to client.
(4) Gently pull on client’s lower eyelid to expose disk.
(5) Using forefinger and thumb of opposite hand, pinch disk and lift it out of client’s eye.

20. If excess medication is on eyelid, gently wipe eyelid from inner to outer canthus.
21. If client had an eye patch, apply clean patch by placing it over affected eye so entire eye is covered. Tape securely without applying pressure to eye.
22. Remove gloves.
23. Dispose of soiled supplies in proper receptacle.
24. Wash hands.
25. Note client’s response to instillation. Ask if any discomfort was felt.
26. Observe client’s response to medication by assessing visual changes and noting any side effects.
27. Ask client to discuss drug’s purpose, action, side effect, and technique of administration.
28. Have client demonstrate self-administration of next dose.
29. Record drug administration and appearance of client’s eye.
30. Record and report and undesirable side effects.
Read More

Administering Vaginal Medications

Purpose
• To treat or prevent infection
• To remove an offensive or irritating discharge
• To reduce inflammation
• To relieve vaginal discomfort

Equipment
• Prescribed vaginal suppository
• Client’s applicator (should be kept in client’s room)
• Clean gloves

1. Check medication order.
2. Wash hands.
3. Prepare equipment and supplies.
4. Identify client.
5. Inspect client’s external genitalia and vaginal canal.
6. Assess client’s ability to manipulate applicator and position herself.
7. Explain procedure to client.
8. Arrange supplies at client’s bedside.
9. Provide privacy.
10. Assist client to dorsal recumbent position.
11. Keep client’s abdomen and lower extremities draped.
12. Apply disposable gloves.
13. Provide adequate lighting.
14. Insert suppository:
A. Take suppository from wrapper and lubricate smooth or rounded end.
B. Lubricate gloved finger of dominant hand. Offer client perineal pad.

15. Apply cream or foam:
A. Fill applicator as directed.
B. Retract client’s labial folds with nondomi-nant gloved hand.
C. With dominant gloved hand, insert applicator 5 to 7.5 cm; push plunger.
D. Withdraw applicator and place it on paper towel. Wipe away lubricant from client’s ori-fice and labia.
E. Wash applicator and store for future use.

16. Remove and discard gloves.
17. Wash hands.
18. Instruct client to remain flat on her back for at least 10 minutes.
20. Inspect condition of client’s vaginal canal and external genitalia between applications.

21. Record medication administration.
C. Retract client’s labial folds with nondomi-nant gloved hand. D. Insert rounded end of suppository 7.5 to 10 cm along posterior wall of vaginal canal.
E. Withdraw finger and wipe away lubricant from client’s orifice and labia.
Read More

Vein Cut Down Procedure

Definition - Dissection of a vein for inserting I.V cannula or needle.

Purpose
• When vein puncture is difficult
• When pro longed, continuos infusion is needed
• When rapid infusion is important and emergency situation combine these indications.

Equipment
Sterile
• Dressing forceps (1)
• Cotton balls in a gallpot
• Solution for cleansing
• Gloves
• Hole sheet (Fenestrated towel)
• Syringe and needle
• Scalpel (surgical knife)
• Mosquito forceps (3)
• Aneurysm needle (1)
• Silk
• Intravenous cannula or vein flow (2)
• Small, straight scissors (1)
• Small, curved scissors (1)
• Needle holder (1)
• Round needle (1)
• Cutting needle (2)
• Tissue forceps (1)
• Gauze (slit at one end)
• Probe
• Fine dissecting forceps (1)
• Local anesthesia

Clean
• Receiver of dirty swab
• Stand light, if available
• Adhesive tape (plaster)
• Dressing scissors

Procedure
• Bring equipment to the bedside of the patient
• Explain procedure to the patient
• Shave the area, if needed
• Position the patient properly
• The nurse will then open the set and pour the cleaning lotion in to the galipot for the doctor
• The doctor then scrub his hands, put on gloves, clean and drape the area, he will insert the I.V
• The channel is securely tied with silk and skin is closed
• The nurse dresses the site and secure it with adhesive plaster
• Remove all equipment, wash and send for sterilization
Read More

Nursing Interventions in Transfusion Reaction

Reactions following blood transfusion may occur for various reasons. Patient must be informed that the supply of blood is not completely risk-free but that it has been tested carefully. Nursing management is directed toward preventing complications and promptly initiating measures to control any complications that occur. The following steps are taken so that a diagnosis may be made regarding the type and severity of the reaction:

♦ The transfusion set is disconnected, but the intravenous line is kept patent with a normal saline solution (0.9%) in case intravenous medication should be needed rapidly.

♦ The blood container and tubing are saved, not discarded. They are sent to blood bank for repeat typing and culture. The identifying tags and numbers are verified.

♦ The symptoms are treated as prescribed and vital signs are monitored.

♦ The patient blood is drawn from plasma hemoglobin, culture, and retyping.

♦ A urine sample is collected as soon as possible and sent to laboratory for a hemoglobin determination. Subsequent voiding of urine should be observed.

♦ The blood bank is notified that a suspected transfusion reaction has occurred.

♦ The reaction is documented according to the institution’s policy.
Read More

Blood Transfusion Procedure

Definition: It is the giving of blood to a patient through a vein

Purpose
• To counteract severe hemorrhage and replace the blood loss.
• To prevent circulatory failure in operation where blood loss is considerable, such as in rectal resection hysterectomy and arterial surgery.
• In severe burns to make up for blood lost by burning but only after plasma and electrolytes have been replaced.
• For treatment of severe anemia due to cancer, marrow aplasia and similar conditions.
• To provide clotting factors normally present in blood, which may be absent as a result of disease.

Equipment
• Bottle containing blood, with the patient name, blood group and Rh. Factor and expiry date.
• Blood giving set
• Sterile syringes and needle
• Alcohol swabs
• Sterile gauze
• Rubber sheet and towel
• Tourniquet
• Arm splint
• Bandages and scissors
• Adhesive tape
• Receiver for dirty swabs
• I.V pole (stand)
• Patient's chart.

Procedure
• Explain procedure to patient
• Before blood transfusion is administered, the nurse has to check the blood group & RH- factor if cross match of the donor's & the recipient’s blood is done and is compatible. And also check for HIV other blood born pathoges.
• Prepare the tray with necessary items
• Before taking it to the patient's room, check the patient's name, hospital number, bed number, blood group, Rh. Factor and the expiry date with a 2nd nurse or a doctor.
• Blood should be used within 21 days of its withdrawal date, if sodium citrate is used it can be used until 36 days.
• Take it to the pt's room
• Hang the bottle & remove the air from the tubing
• Put pt. in a comfortable position.
• Place rubber & towel under the arm
• Check the vital signs before administering
• Choose the vein
• Apply tourniquet
• Clean the skin & feel for a distended vein & clean again.
• Puncture the vein with the needle (the needle here should be short and wide so that it does not cause occlusion easily)
• After you make sure that you are in the vein release tourniquet & open the clamp.
• The drop/minute at the beginning should be very slow
• Watch patient closely for any reaction
• If there is no reaction from the patient regulate the rate of flow according to the patient's conditions & the order.
• Splint the arm & position it comfortably.
• Remove the equipment you have used, wash and return to its proper place.
• Record the time you started the blood & any other pertinent information.
• Check pt. frequently.

Note:
1. Always member to have anti- histamine injection ready in case a patient has reaction from the blood.
2. Be familiar with the most usual symptoms of blood reactions which are:

Immediate Reaction:
a) Headache
b) Backache
c) Chills
d) Pyrexia
e) Rash of the skin (urticaria )

Late Reaction
a) Dyspnea
b) Renal shut down in severe cases
c) Heamaturia
d) Chest pain
e) Rigor (rigidity)
Read More

Intravenous Therapy procedure

Definition: It is the administration of a large amount of fluid into the system through a vein.

Purpose
• To maintain fluid & electrolyte balance
• To introduce medication particularly antibiotics.

Equipment
• IV fluid as ordered
• Sterile syringe & needle
• Rubber & towel
• Receiver
• Alcohol swabs
• Arm board
• Bandage & scissors
• Tourniquet
• I.V pole
• Adhesive tape
• Medication chart

Preparation of the Patient
Since an infusion therapy takes several hours to complete, the patient should first be made comfortable.

Procedure
• Take equipment to the patient's bedside
• Explain the procedure to the patient. Be sure you have rightpatient.
• Remove air form the tubing
• Place rubber & towel under the arm
• Apply tourniquet about 3 c.m. above the intended site of entry.
• Observe & palpate for suitable vein
• Cleanse the skin with alcohol swabs thoroughly & place the swab used thumb the retract down the vein & soft tissue 4 c.m. below the intended site of injection.
• Hold needle at 450 angle line with the vein
• Pierce the skin and puncture the vein
• Check if you are in the vein by drawing back with the syringes. (blood returns if you are in the vein)
• Release the tourniquet gently
• Start the flow of solution by opening the clamp.
• Support needle with sterile gauze or sterile cotton balls If necessary to keep it in proper position in the vein
• Anchor the I.V. tubing with the adhesive tape to prevent pull on the needle.
• Place arm board or splint under the arm and bandage around.
• Adjust the rate of flow
• Rate of flow is regulated by the following formula.

Number of ml. of sol's number of drops in a ml.
Number of hrs. over which sol. is to be administered x 60 minutes

1ml = 15 drops

E.g. if 1000ml of 5% D/w is to run for 24 hrs, how many drops per minutes should it run?

1000 ml. x 15 gtt/ml. = 1000 x 15 gtt. = 10 gtt/min
     24 x 60 min.             24 x 60 min.

Note:
1. The arm board should be long enough to extend beyond the wrist and elbow joint.
2. Board should be padded
3. Infusion bottle should be labeled with the date, time infusion is started, drops per minute, and any added medications. If more than one bottle as used in 24 hrs, it should be labeled as bag 1,2,3, and so on.
4. Extend the arm in the most comfortable position.
5. Usual areas used for intravenous infusion are:

a) The median basilic vein on the inner surface of the arm.
b) A vein on top of the foot
c) In an infant the jugular vein and the scalp vein
Read More

Vein injection procedure

Definition: It is the introduction of a drug in solution form into a vein. Often the amount is not more than 10.ml. at a time.

Sites for IV injection
1. Dorsal Venous network
2. Dorsal metacarpal Veins
3. Cephalic Veins
4. Radial vein
5. Ulnar vein
6. Baslic vein
7. Median cubital vein
8. Greater saphenous vein

Purpose
• When the given drug is irritating to the body tissue if given through other routes.
• When quick action is desired.
• When it is particularly desirable to eliminate the variability of absorption.
• When blood drawing is needed (exsanguinations)

Equipment
• Tray
• Towel and rubber sheet
• Sterile needle and syringes in a sterile container
• Sterile forceps in a sterile container
• Alcohol swabs
• File
• Medication
• Tourniquet
• Receivers (2)
• Treatment Chart
• Glove

Procedure
• Prepare your tray & the medication
• Explain the procedure to the patient
• Position the patient properly
• Place rubber and towel under his arm(to protect the bed linen)
• Expose the arm and apply tourniquet
• Ask pt. To open and close his fist.
• Palpate the vein and clean with alcohol swab the site of the injection (Which is mainly the mid cubital vein of the arm)
• Clean with a circular motion; proceed from center of the site outward.
• Hold the needle at about 450 angles in line with the veins.
• Puncture the vein and draw back to check whether you are in the vein or not. (Blood return should be seen if you are in the vein)
• Once you know that you are in the vein, release the tourniquet and gently lower the angle of the needle
• When it is nearly paralleled to the vein and instills the medications. Give very slowly unless there is an order to give it fast (Normally 40-60 drops is given in 1 minute).
• Check the pt's pulse in between. Any complaint from the patient should not be ignored.
• Apply pressure over the site after removing the needle to prevent bleeding. Tell patient to flex his elbow.
• Watch the patient for few minutes before leaving him.
• Remove your equipment
• Put the pt. In a comfortable position
• Wash, sterilize and place the equipment in order.
• Chart the medication given the amount, time & the reaction of the pt.

Note:
1. Have a bowl of water to rinse the needle used immediate
2. Make yourself as well as the pt. Comfortable before giving injection.
3. It is the fastest way of drug administration
4. Never recup a used needle
Read More

Intera Muscular Injection

Definition: It is an introduction of a drug into a body's system via the muscles.

Purpose
• To obtain quick action next to the intra- venous route
• To avoid an irritation from the drug if given through other route.

Equipment
• Tray
• Ordered drug (ampoule, vial)
• Sterile syringes and needle in a container
• Alcohol swab
• Receiver
• A bowl of water for used syringes and needle
• File
• Sterile jar with sterile forceps
• Chart

Sites for I.M. Injection
• Ventrogluteal muscle
• Dorsogluteal muscle
• Deltoid muscle
• Vastus Lateralis

Procedure
• Do the ABC of the procedure.
• Prepare tray & take it to the patien’s room
• Prepare the medication
• Draw the medicine
• Expel the air from the syringe
• Choose the site of injection (the site for intra- muscular)
• Using the iliac crest as the upper boundary divided the buttock into four. Clean the upper outer quadrant with alcohol swab:
• Stretch the skin and inject the medicine
• Draw back the piston (plunger) to check whether or not you are in the blood vessel ( if blood returns, withdraw and get a new needle & reinject in a different spot)
• Push the drug slowly into the muscle
• When completed, withdraw the needle and massage the area with swab gently to and absorption.
• Place the patient comfortably
• Take care of the equipment you have used & return to their places
• Chart the amount, time route and type of the medicine
• Check the patient's reaction

Note:
1. The needle for i.m. Injection should be long
2. Strict aseptic technique should be observed throughout the procedure.
3. Injection should not be given in areas such as inflamed, edematous, those containing moles and pus.
Read More

3/1/14

Sub Cutaneous Injection Procedure

Definition: Injecting of drug under the skin in the sub- cutaneous tissue, (under the dermis)

Purpose:
• To obtain quicker absorption than oral administration
• When it is impossible to give medication orally

Equipment
• Tray
• Sterile syringe & needle (disposable)
• Alcohol swabs
• Medication
• File
• Medication card and patient chart
• Receiver
• Water in a bowel
• Disposing box

Site of Injection
• Outer part of the upper arm
• The abdomen below the costal margin to the iliac crest.
• The anterior aspect of the thigh

Procedure
• Take equipment to the pt's bed side or room
• Explain the procedure to the patient
• Draw your medication
• Expel the air from the syringe
• Clean the site (usually it is in upper arms, thighs or abdomen)
• Grasp the area between your thumb & forefinger to tense it.
• Insert the needle elevate about 450 - 600 angle.
• Pierce the skin quickly & advance the needle
• Aspirate to determine that the needle has not entered a blood vessel
• Inject the drug slowly.
• After injecting withdraw the needle and massage the area with alcohol swab.
• Chart the amount and time of administration immediately.
• Take care of the equipment- wash, sterilize and return to its place
• Watch for undesired reaction (side effect of the drug) etc.

Note.
If repeated injections are given, the nurse should rotate the site of injection so that each succeeding injection is about 5 cm away from the previous one.
Read More

Intradermal Injection Procedure

Definition: It is an injection given into the dermal layer of the skin (corneum)

Purpose
For diagnostic purpose
a. Fine test (mantoux test)
b. Allergic reaction

For therapeutic purpose
c. Intradermal injection may also be given like in vaccination

Site of Injection
• The inner part of the forearm (midway between the wrist and elbow.
• Upper arm, at deltoid area for BCG vaccination

Equipment
• Tray
• Syringe & needle (sterile)
• Receiver
• Drug (to be injected)
• File
• Alcohol swab
• Marking pen
• Water in the bowel to rinse syringe and needle

Procedure
• Take equipment to the patient's side
• Explain procedure to patient
• Get hold of the arm & locate the site of injection.
• Clean the skin with swab and inject the drug about 0.1. 0.2 inch in to the epidermis after the bevel of the needle is no longer visible. Don't massage the site.
• Check for the immediate reaction of the skin (10-15 minutes later for tetanus, 20-30 minutes later for penicillin)
• If it is for tine test, mark the area
• Chart the data and time of the administration of the drug.
• Take care of the equipment & return to their places.
• Do not forget to do the reading after 72 hours if it is for fine test (tuberculin test)
• Document about the procedure
Read More

Kinds of Suppositories Used

1. Bisacodyl (Dulcolax) is commonly ordered for its laxative action. It stimulates the rectum and lubricates its contents. Normally 15 minutes is needed to produce bowel movement.

2. Glycerin or suppository for bringing about bowel movement. If soap suppository is used cut a splinter of soap 2-6 cm. loch and wash it in hot water to smooth the rough edges before administration.

3. Bismuth - for checking diarrhea.

4. Opium, sodium barbital etc. for sedation
Read More

How to use Suppository

Purpose
• To produce a laxative effect. (bowel movement),suppository is used frequently instead of enema since it is inexpensive.
• To produce local sedative in the treatment of hemorrhoids or rectal abscess.
• To produce general sedative effects when medications cannot be taken by mouth
• To check rectal bleeding

Equipment
• Suppository (as ordered)
• Gauze square
• Rectal glove or finger cot
• Toilet paper
• Receiver for soiled swabs
• Bedpan, if the treatment is in order to produce defection.
• Screen
• Mackintosh and towel

Procedure
1. Check medication order.
2. Review client’s medical record for rectal surgery/ bleeding.
3. Wash hands.
4. Prepare needed equipment and supplies.
5. Apply disposable gloves.
6. Identify client.
7. Explain procedure to client.
8. Arrange supplies at client’s bedside.
9. Provide privacy.
10. Position client in Sims’ position.
11. Keep client draped, except for anal area.
12. Examine external condition of client’s anus. Palpate rectal walls.
13. Dispose of gloves, if soiled, and reapply new gloves.
14. Remove suppository from wrapper and lubricate rounded end.
15. Lubricate gloved finger of dominant hand.
16. Ask client to take slow, deep breaths through mouth and to relax anal sphincter.
17. Retract client’s buttocks with nondominant hand.
18. With index finger of dominant hand, gently insert suppository through anus, past the internal sphincter, and place against rectal wall, 10 cm for adults or 5 cm for children and infants.
19. Withdraw finger and wipe client’s anal area clean.
20. Remove and dispose of gloves.
21. Wash hands.
22. If suppository contains a laxative or fecal softener, be sure that client will receive help to reach bedpan or toilet.
23. Keep client flat on back or on side for 5 minutes.
24. Return in 5 minutes to determine if suppository has been expelled.
25. Observe client for effects of suppository 30 minutes after administration.
26. Record medication administration.
Read More

Type of Oral Medication

1. Lozenges (troches) - sweet medicinal tablet containing sugar that dissolve in the mouth so that the medication is applied to the mouth and throat

2. Tablets - a small disc or flat round piece of dry drug containing one or more drugs made by compressing a powdered form of drug(s)

3. Capsules - small hollow digestible case usually made of gelatin, filled with a drug to be swallowed by the patient.

4. Syrups - sugar containing medicine dissolved in water

5. Tinctures - medicinal substances dissolved in water

6. Suspensions - liquid medication with undissolved solid particles in it.

7. Pills and gargle - a small ball of variable size, shape and color some times coated with sugar that contains one or more medicinal substances in solid form taken in mouth.

8. Effervescence - drugs given of small bubbles of gas.

9. Gargle - mildly antiseptic solution used to clean the mouth or throat.

10. Powder - a medicinal preparation consisting of a mixture of two or more drugs in the form of fine particles.

Equipment
• Tray
• Towel
• A bowl of water for used mediation cup
• Measuring spoon
• A Jug of water (boiled water)
• Chart and medication card
• Ordered medication
• Straw if necessary

Procedure
• Prepare your tray and take it to the patient's room
• Begin by checking the order
• Read the label 3 times
• Place solution and tablets in a separate container.
• If suspension, shake the bottle well before pouring
• Take it to the pt's bedside
• Keep the medication in site at all time
• Identify the patient carefully using all identification variables. (Pt’s name, bed number…)
• Remain with the pt. until each medicine is swallowed
• Offer additional fluid as necessary unless contra-indicated
• Record the medication given, refused or omitted immediately.
• Take care of the equipment & return them to their proper places.
• Wash your hands.

Note
1. Remember the 5 R's� Right patient� Right medicatio� Right rou� Rig� Right time
2. Always keep the bottle tightly closed.
3. Clean and keep the label of the bottle clear.
4. Keep medication away from light.
5. Cheek their expiration date.
6. Keep the rim of the bottle clean.
7. Give your undivided attention to your work while preparing and giving medications.
8. Make sure that a graduate nurse checks some potent drugs.
9. Never give medications from unlabeled container
10. Never return a dose once poured from the bottle.
11. Check your patient's vital sign may be necessary before and after administrating some drugs e.g. digitals, ergometrine.
12. Never give medicine that some one poured or drawn.
13. Never leave medicine at bed side of a patient and within reach of the children
Read More

Oral Administration

Definition: Oral medication is drug administered by mouth
Purpose
a. When local effects on GI tract are desired
b. When prolonged systemic action is desired

Contra- indications
1. For a patient with nausea & vomiting, unconscious patients.
2. When digestive juices inactivate the effect of the drug.
3. When there is inadequate absorption of the drug, which leads to inaccurate determination of the drug absorbed.
4. When the drug is irritating to the mucus membrane of the alimentary canal.
Read More
Subscribe to: Posts (Atom)