PHOTOGUIDE TO DRUG ADMINISTRATION

Transcription

1 PHOTOGUIDE TO DRUG ADMINISTRATION SPRINGHOUSE CORPORATION Sprinqhouse. Pennsylvania

2 Contents MEDICATION OVERVIEW Reviewing Fundamentals GASTROINTESTINAL ROUTE Oral Administration Tube Administration Contributors and consultants xi Acknowledgments xii Foreword xiii Taking necessary precautions 1 The seven "rights" of drug administration 1 The nursing process and drug therapy 2 Rules of safe drug administration 3 How drugs work 3 How patient factors influence drug action 4 Universal precautions 5 Documenting medications correctly 6 Documenting oral orders 6 Safeguarding against errors 6 Questioning drug orders 6 Age-related changes or drug reactions? 7 Refusing to administer a drug 7 Preparing an incident report 7 Sample medication Kardex 8 What to do if a patient refuses medication 10 Incident report 11 How oral medication is absorbed 12 Learning about tablets and capsules 12 Ensuring absorption 12 How oral medication is absorbed in the GI tract 13 How to give tablets and capsules 13 How to measure liquid medication in a disposable cup 14 Administering oral drugs 14 How to give medication to an infant 13 Nursing considerations: Oral administration 15 Giving medication to special patients 16 Reviewing liquid oral medications 17 How to insert an NG tube 19 Equipment tor NG tube insertion 19 Comparing gastric tubes 21 How to give medication through an NG tube 22 How to remove an NG tube 23 How to give medication through a gastrostomy tube 23 How to irrigate a nonpatent gastrostomy tube 24 Nursing considerations: Gastrostomy tubes 25 How to change a gastrostomy dressing 23 Teaching gastrostomy care 26 How to reinsert a gastrostomy tube with an indwelling catheter 26 The button device: An alternative to the gastrostomy tube 26

3 How to use a gastrostomy button for enteral feeding 27 How to use the gastrostomy button to give medication 27 Nursing considerations: Gastrostomy button 28 Rectal Administration DERMATOMUCOSAL ROUTE Topical Administration Mucous Membrane Administration OPHTHALMIC, OTIC, NASAL, AND LARYNGEAL ROUTES Ophthalmic Administration Otic Administration Nasal Administration Laryngeal Administration Using the rectal route for systemic effects 29 How to apply rectal ointments 29 How to insert a suppository 29 Guide to rectal medications 30 How to administer a nonretention enema 31 Nursing considerations: Suppositories 31 How to administer a prepackaged enema 31 Preparing to give a medicated retention enema 32 How to administer a retention enema 32 Guide to enemas 33 Nursing considerations: Enemas 34 Nursing considerations: Special patients 35 How to apply nitroglycerin ointment 36 How to apply a transdermal disk 36 Guide to topical dosage forms 37 Applying medication to the skin 38 Selecting the right dressing 39 How to give medication by the sublingual or buccal routes 40 How to administer a translingual spray 40 How to administer vaginal medication 41 Bladder irrigation 41 How to administer continuous bladder irrigation 42 Nursing considerations: Bladder irrigation 42 How to give a sitz bath 43 How to instill eye drops 44 How to insert and remove an eye medication disk 44 How to enhance ocular drug absorption 45 How to instill eye ointment 45 Morgan Therapeutic Lens: Treatment guidelines 46 How to use the Morgan Therapeutic Lens 46 How to apply an eye patch 47 How to irrigate the ear 48 How to administer ear drops 48 How to give nose drops to an adult 49 Positioning the patient to treat the sinuses 50 How to give nose drops to an infant 50 How to use an atomizer 51 How to use a nasal aerosol device (Turbinaire) 52 How to spray the mouth or throat 53 How to administer a mouthwash or gargle 53 Administering lozenges 53

4 RESPIRATORY ROUTE Endotracheal Administration INJECTION TECHNIQUES Parenteral Injection Equipment Intradermal Administration Subcutaneous Administration Intramuscular Administration INFUSION TECHNIQUES Intravenous Administration Intermittent positive pressure breathing therapy 54 Preparing a patient for IPPB therapy 54 Nursing considerations: IPPB therapy 54 Portabirdll 54 Endotracheal tube administration 55 How to give drugs through an endotracheal tube 55 Endotracheal medication device 56 How to use a metered-dose inhaler 56 Drugs delivered by MDI 56 How to use an InspirEase extender 57 Breathancer extender 57 How to use a turbo-inhaler 58 Guide to syringes 60 Safety adaptation: Needle shield 60 Selecting needles 61 Safety adaptation: I.V. access system 62 How to prepare medication for injection 62 Preparing for injection 63 Learning about intradermal administration 63 Intradermal injection sites 63 How to inject medication intradermally 64 How to read a diagnostic skin test 65 Learning about subcutaneous administration 66 Subcutaneous administration sites 66 How to inject medication subcutaneously 67 How to mix insulins in one syringe using multidose vials 68 Dial-a-Dose system 68 Guidelines for insulin administration 69 Guidelines for heparin administration 69 Intramuscular injection sites 70 Intramuscular injections: Pros and cons 71 How to inject medication intramuscularly 72 Nursing considerations: I.M. injections 72 How to give intramuscular injections to infants and toddlers Maximum intramuscular solution volumes for children 74 How to use the Z-track method 74 Reducing the pain of intramuscular injections 75 When to give medications intravenously 76 I.V. administration methods: How they differ 76 Comparing peripheral venipuncture sites 77 Choosing the venipuncture site 78 How to spike and prime I.V. solutions 79 Guide to needle and catheter gauges 80 How to prime a filter 81 Guidelines for using in-line I.V. filters 82 How to add and prime a filter 82

5 Performing Venipuncture Infusing I.V. Solution I.V. Drug Administration Central Venous Infusion How to dilate a vein 83 Locating hard-to-find veins 84 How to prepare the venipuncture site 84 How to use a steel winged needle 85 Stabilizing a vein for venipuncture 86 How to check needle placement and flow rate 86 How to insert an over-the-needle catheter 87 How to use a PROTECTIV catheter 88 How to secure the venipuncture device 88 Inside-the-needle catheter 89 How to tape venipuncture devices 89 How to apply a transparent semipermeable dressing 90 Protecting a scalp vein site 91 How to apply splints and restraints 91 How to make a mummy restraint 92 Documenting venipuncture 93 Treating extravasation 93 How to discontinue an I.V. 93 How to calculate the flow rate 94 Managing I.V. flow rate 94 Correcting obvious flow rate problems 95 Flow regulators 95 Understanding volume-control sets and filters 95 How to use a volume-control set with a membrane filter 96 Comparing I.V. administration sets 97 Avoiding common I.V. problems 98 Pediatric I.V. therapy 99 How to replace I.V. equipment 99 How to administer intermittent I.V. therapy using a heparin lock 101 Guidelines for heparinization of intermittent infusion devices 102 Flushing heparin locks 102 Heparin practice survey 102 How to use a T-connector 103 How to mix secondary I.V. infusions 103 Hanging additive sets 104 Additive sets: Indications and contraindications 104 Additive sets: Alternative equipment 105 Caring for a patient with an additive set 105 How to use a partial-fill piggyback set 105 Using a needle lock device for secondary lines 106 CRIS: Another way to deliver secondary I.V. drugs 107 How to use a CRIS adapter 108 How to cope with drug incompatibilities 109 Risks of peripheral I.V. therapy 110 Selecting a central venous infusion device 115 Forms of central venous catheters 115 Central venous infusion: Pros and cons 115 Central venous infusion sites 116

6 Preparing the patient for insertion of a central venous catheter 117 Comparing central venous infusion devices 118 How to assist with central line insertion 122 Central venous line complications 124 Teaching Valsalva's maneuver 127 How to change a central venous line dressing 127 How to change central venous line tubing 128 How to remove a central line 128 How to remove a catheter tip for culture 129 Learning about the peripherally inserted central catheter 130 Types of PICC lines 130 PICC lines: Advantages and disadvantages 130 How to insert a PICC line 131 Measuring the peripheral catheter 131 The Landmark midline venous access device 132 Complications of PICC line insertion 133 Special Infusion Techniques Special Infusion Equipment Intraosseous infusion 134 Epidural analgesia 135 Comparing epidural analgesics 135 Setup for epidural analgesia 136 Managing adverse epidural drug reactions 136 Assisting with insertion of an epidural catheter 137 What is a blood patch? 137 Nursing care plans for the patient with an epidural catheter 138 Discontinuing epidural analgesic therapy 139 Documentation 139 The Ommaya reservoir: Intraventricular access to CSF 139 Complications of epidural infusion 140 Preparing to access the Ommaya reservoir 141 Intraperitoneal therapy 141 Intraperitoneal access devices 142 Pumps and controllers: Electronic infusion devices 143 What's the difference between a controller and a pump? 143 Electronic infusion device features 143 Understanding I.V. resistance 144 Learning about the Flo-Gard 6300 pump 144 How to set up the Flo-Gard 6300 pump 145 How to program the Flo-Gard primary line 146 Learning about the LifeCare 5000 cassette drug delivery system 147 How to set up the Plum primary line 147 Patient-controlled analgesia pumps 149 Learning about the Infusaid implantable pump 150 Infusaid implantable pump 150 How to refill an Infusaid pump 150 Nursing considerations: Infusaid pump 151 How to give a bolus dose through an Infusaid sideport 152 Learning about subcutaneous access devices 153 Implantation of the subcutaneous port 153 Peripheral placement of a subcutaneous port 153

7 Nursing considerations: Subcutaneous port access 154 How to access the subcutaneous port 154 Troubleshooting problems with a subcutaneous access device 155 Insulin infusion pumps 156 Understanding MiniMed buttons 156 How to calculate insulin pump dosage 156 Documentation 157 Classifying glucose-intolerance disorders 157 Continuous subcutaneous infusions for pain control 158 The Kangaroo feeding pump 158 Parenteral Nutrition Blood Transfusions APPENDICES When to administer parenteral nutrition 159 Understanding common additives 159 Basic formulas for total parenteral nutrition 159 Assembling parenteral nutrition equipment 160 Learning about 3-in-l total parenteral nutrition solutions 160 Nursing considerations: TPN 160 Dealing with complications of TPN 161 Administering I.V. fat emulsions 162 Nursing considerations: I.V. fat emulsions 162 Learning about blood transfusions 163 Guidelines for transfusing blood components 163 Guide to blood products 164 How to use a Y set for blood administration 168 Guide to requesting and identifying blood products 169 How to use a leukocyte-removal filter 169 How to use a built-in blood pump 170 How to use a slip-on blood pump 171 Troubleshooting transfusion problems 172 Learning about blood and fluid warmers 172 Documenting blood transfusion 173 How to use a Data Chem Flo-tem lie blood or fluid warmer 173 Autotransfusion: A growing role in surgical care 173 Transfusion risks: Immediate reactions 174 How to use the Pleur-evac ATS 175 Transfusion risks: Transmittable diseases 176 A: Abbreviations commonly used in drug administration 179 B: Converting units of measure 180 C: Calculating dosages 181 D: Estimating body-surface area in children 184 E: Estimating body-surface area in adults 185 F: I.V. drug compatibility 186 G: Calculating I.V. infusion rates 188 Selected References 191 Index 192