Topic «Applying of basic medicines»

Application of different medicines pharmacotherapy. It studies natural matters

(herbares, minerals and others like that), and also – synthesized in chemical way.
Classification of medicines
In mechanism of therapeutic action:
Etiotropic – medicines, that directly influences on the of disease (for example,
antibiotics).
Nosotropic – medicines that influences on the certain links of pathological process
(antihypertensive medicines in patients with arterial hypertension).
Symptomatic – medicines have been prescribed with a purpose of removals of
certain symptom (medicines for pain relief in patients with arterial hypertension;
headacke often accompanied hypertensive crisis).
Substitute – medicines that supply the lack of some matter in organism (vitamins,
hormones, enzymes).
In the place of action:
Local – medicines act directly on the tissue (ointments, , powders and others like
that).
General –medicines act on the whole organism after it’s administration in blood.

Requirements for the medicines from the drug store produce the senior nurse.
Requirements are write out in 3 examples. d tablets must not be given out to patients who might
have requested a sample without prior authorization from the physician! Each time a patient receives a
small sample of a drug, this should be documented in the patient records indicating the name of the drug,
who authorized its dispensal, and that the patient was informed about the sample drug's action, side-
effects, and how to take it followed by the medical assistant's (or healthcare professional's) initials.

List A - narcotic and poison medicines.

List B - strong medicines.
These medicines are kept in the safe.
Other medicines are keep in the cabinets, marked as external use, internal use,
parenteral.
Signs in the journal should been done after each duty.
Reserve of narcotic drugs should accord to 3 days needs of the department, poisons – 5
days, strong medicine – 10 days. Temperature regimen should been observed.
Light-sensitive medicines keep in the dark safe.
Odorous substances keep separately in the tightly closed safe.
Decoctions, extracts, emulsions, antibiotics, suppositories are keep in special refrigerators
with +2 to +10 degrees.
Poisons, narcotic medicines, strong medicine are strongly taken into account in the
special book ( pages are numerated, stitched, signed by chief and certified by hospital
signet).

Parts of a Prescription
The word "prescription" stems from the Latin term praescriptus. Praescriptus is made up
of two Latin word parts, prae-, a prefix meaning before, and scribere, a word root
meaning to write. Putting it all together, prescription means "to write before," which
reflects the historical fact that a prescription traditionally had to be written before a drug
could be mixed and administered to a patient.
Many ancient prescriptions were noted for their multiple ingredients and complexity of
preparation. The importance of the prescription and the need for complete understanding
and accuracy made it imperative that a universal and standard language be used. Thus,
Latin was adopted, and its use was continued until approximately a generation ago.
Present day prescription are written in English, with doses given in the metric system, but
often you still find contracted Latin words and Roman numerals intertwined. The ancient
"Rx" and the Latin "Signatura," abbreviated as Sig., and the occasional Roman numeral
are all that remain of the ancient art of the prescription.
A prescription is a written order for compounding, dispensing, and administering drugs to
a specific client or patient and once it is signed by the physician it becomes a legal
document! Prescriptions are required for all medications that require the supervision of a
physician, that must be controlled because they are addictive and carry the potential of
being abused, and that could cause health threats from side effects if taken incorrectly,
for example heart medications (cardiac drugs), insulin, and antibiotics.

Parts of the Written Prescription

A prescription, stripped to its barest form, consists of the superscription, the inscription,
the subscription, the signa, and the name of the prescriber - written within the confines of
a form. The date and patient information is followed by the superscription, which is
followed by the inscription, then the subscription. Next follows the signatura.
1. The superscription which consists of the heading where the symbol Rx (an
abbreviation for recipe, the Latin for take thou ) is found. The RX symbol comes before
the inscription.
2. The inscription is also called the body of the prescription, and provides the names and
quantities of the chief ingredients of the prescription. Also in the inscription you find the
dose and dosage form, such as tablet, suspension, capsule, syrup.
3. The subscription, which gives specific directions for the pharmacist on how to
compound the medication. These directions to the pharmacist are usually expressed in
contracted Latin or may consist of a short sentence such as: "make a solution," "mix and
place into 10 capsules," or "dispense 10 tablets." However, that was in the old days.
Today... doctors just name the pill!
4. The signatura (also called sig, or transcription), gives instructions to the patient on
how, how much, when, and how long the drug is to be taken. These instructions are
preceded by the symbol “S” or “Sig.” from the Latin, meaning "mark."
The signatura should always be written in English; however, physicians continue to insert
Latin abbreviations, e.g. "1 cap t.i.d. pc," which the pharmacist translates into English
when s/he prints the label, such as "take one capsule three times daily after meals". Read:
Glossary of Pharmacology Terms and Symbols.
Below the Sig line is room for special instructions, such as the number of times the
prescription may be refilled, if any. You will also find the purpose of the prescription,
special instructions, warnings followed by the signature of the prescriber.

You should know and understand the following:

The date and patient information, which consists of the name of the party for whom it is
designed and the address, usually occupies the upper part of the prescription. Sometimes
age or weight is also added, though rarely.
The instruction, "take as directed" is not satisfactory and should be avoided. The
directions to the patient should include a reminder of the intended purpose of the
medication by including such phrases as "for pain," "for relief of headache," or "to relieve
itching"
And if the patient is to receive a brand name medication, rather then generic, the
physician enters NO SUBSTITUTIONS at the end of the prescription.
If there are no refills to be dispensed, it is advisable not to enter the number 0, because it
can be altered by adding numbers before the zero, thus making it a 10 to receive ten
refills (or more!). Always write out the word None, or No Refills!!!
The Drug Enforcement Administration (DEA) registration number system was
implemented as a way to successfully track controlled substances from the time they are
manufactured until the time they are dispensed to the patient.
The DEA opposes use of the DEA number for other than its intended purpose, which is
tracking controlled substances, and strongly opposes insurance company practice of
requiring that a DEA number be placed on prescriptions for non-controlled substances.
Not all medications require prescriptions. There are certain medications on the market
that can be purchased over the counter, thus their name over-the-counter drugs (OTC.)
Safety Tips
Prescription medications can be beneficial, while at the same time they may become
dangerous. If they are abused or failed to be `administered correctly the patient may
suffer a serious adverse or toxic reaction.
Consider the following:
Some patients may have difficulty seeing! Ask if their pharmacist can use a larger print
size on their prescription bottles.
While your employer, usually the doctor is responsible for prescribing the right
medication, and the pharmacist is in charge of filling the prescription, you as the medical
assistant might be responsible for administering the medications and assisting your doctor
and pharmacist in any way that you can by being able to answer questions about the
medication and also making important information about the medication available to the
patient.
Here are some tips on how you can fulfill those responsibilities:
During the initial patient intake interview ask the patient what medications he/she is
currently on. Carefully list all medications by name and the dosage instructions into the
patient's record every time the patient is seen. Write legibly and in a spot where the
doctor can refer to it easily.
Suggest that the patient carries a smaller version of her medications list in her purse or
wallet. That way, you will be able to reference it if question arise regarding current
medications.
Always ask the patient if he/she has experienced allergies to medications and also chart it
into the medical record each and every time the patient is seen. The abbreviation for no
allergies to medications generally is NKDA (no known drug allergies.) If the patient
reports allergies to medications it MUST be documented and the chart should be clearly
labeled on the outside cover. Special medication alert stickers are available!
Depending on the severity of the allergic reaction to certain medications, suggest to the
patient to wear an identification bracelet with the allergy information on it. Explain that
in an emergency situation, if he/she is unable to communicate the information on that
bracelet could save her life.
Don't forget to instruct the patient that if he/she is having any adverse or abnormal
reactions to your prescription medications to contact the nurse and physician
immediately!
Teach the patient to read prescription labels carefully and instruct them to follow any
restrictions or warnings. Make sure he/she understands which medications may affect or
impair physical or cognitive skills and instruct her to refrain from operating dangerous
machinery while on those medications. And again, make sure it is charted into the
patient's medical record!

Safety Alerts!
Use Caution with Pain Relievers
(NAPS) -- Pain relievers, when used correctly, are safe and effective. Millions of people
use these medicines everyday. Not using them according to the label directions can have
serious consequences.
Over-the-counter (OTC) medicines list all their active ingredients on the package.
For prescription drugs, the leaflet that comes with your prescription lists the active
ingredients contained in the medicine. Many OTC medicines sold for different uses have
the same active ingredient. Also, active ingredients in OTC medicines can be ingredients
in prescription medicines. For example, a cold-and-cough remedy may have the same
active ingredient as a headache remedy or a prescription pain reliever.

There are basically two types of OTC pain relievers. Some contain acetaminophen and
others contain non-steroidal anti-inflammatory drugs (NSAIDs). These medicines are
used to relieve the minor aches and pains associated with:
headaches
colds
flu
arthritis
toothaches
menstrual cramps
These medicines are also used to treat migraine headaches, and to reduce fever.
Acetaminophen is a very common pain reliever and fever reducer. Taking too much of
this active ingredient can lead to liver damage. The risk for liver damage may be
increased if you drink three or more alcoholic drinks while using acetaminophen-
containing medicines.
NSAIDs are common pain relievers and fever reducers. Examples of OTC NSAIDs are
aspirin, ibuprofen, naproxen sodium, and ketoprofen. There are some factors that can
increase your risk for stomach bleeding:
if you are over 60
taking prescription blood thinners
have previous stomach ulcers
other bleeding problems
NSAIDs can also cause reversible damage to the kidneys. The risk of kidney damage
may increase in:
people who are over 60
people who have high blood pressure, heart disease or pre-existing kidney disease
people who are taking a diuretic

Medication Errors in The Elderly

Number of Medication Errors
The rate of medication errors in the elderly is higher than in any other age group. More
than one third of the medication errors that occur involve patients 65 years and older.
There is no single cause for the problem--and no single solution either--it is therefore
very important that every healthcare provider, doctor, pharmacist, nurse, and medical
assistant realizes the importance of medication error detection, reporting, evaluation, and
prevention, and makes preventing errors their own personal goal!
Consider the following:
Older people tend to have more long-term illnesses than younger people, such as arthritis,
diabetes, high blood pressure, and heart disease. It is common that they take
combinations of different medications for many ailments.
Misuse of Medications and Risks
When prescribed and taken appropriately, drugs have many benefits: They treat diseases
and infections, help manage symptoms of chronic conditions, and can contribute to an
improved quality of life. But medicines can also cause problems.
High blood pressure, for example, is often treated with several different drugs. Many
older people have multiple cardiovascular risk factors--high blood pressure, diabetes,
abnormal cholesterol--and will often need multiple drugs to treat them. Unless supervised
by a doctor, however, taking a mixture of drugs can be dangerous. For example, a person
who takes a blood-thinning medication should not take it with aspirin, which will thin the
blood even more. And antacids can interfere with absorption of certain drugs for
Parkinson's disease, high blood pressure, and heart disease. Before prescribing any new
drug to an older patient, a doctor should be aware of all the other drugs the patient may
be taking.
Another example are heparin and warfarin. These are medications whose use or misuse
carry ignificant potential for injury.
Subtherapeutic levels can lead to thromboembolic complications in patients with atrial
fibrillation or deep venous thrombosis, while supratherapeutic levels can lead to bleeding
complications.
These medications are commonly involved in adverse drug events for a variety of
reasons, including the complexity of dosing and monitoring, patient compliance,
numerous drug interactions, and dietary interactions that can affect drug levels. Strategies
to improve both the dosing and monitoring of these high-risk drugs have potential to
reduce the associated risks of bleeding or thromboembolic events.

Factors Affecting Medication Response

Age
Weight
Gender
Ethnic background
Physical health
Psychological status
Environmental temperature
Amount of food in stomach
Dosage form

Rules of distribution of medicine

Use the rule of 5 R!
The “Five Cs/Rs”:
• Correct/Right Patient/Child
• Correct/Right Medicine
• Correct/Right Dose
• Correct/Right Time
• Correct/Right Route
Check exp. date, name, dosage, doctors prescription, evaluate its looks, give to the
patient, mark in the list of prescriptions, put the signature.
Per os medicine should been taken under the nurse supervision.
Applying of narcotic medicine only in doctor presence, history case marks, list of
prescriptions, journal of narcotic medicine account.
"Before food" - 15-30 min. "After food" - 15-30 min. On an empty stomach (vermicide,
purgative) in the morning. Somnolent – 30 min before sleep.
Nurse should told about side effects.
Tablets that don’t have divide line cant been divided.
Not possible:
Keep medicine with disinfectant solutions.
Distribute medicine without prescription, make changes, put pills into the boxes
preliminary, change or put away from drug store package.

The administration of a medicine is a common but important clinical procedure. It is the

manner in which a medicine is administered that will determine to some extent whether
or not the patient gains any clinical benefit, and whether they suffer any adverse effect
from their medicines. For example, intravenous furosemide administered too quickly can
cause deafness; oral penicillin given with food will not be well absorbed; over-
application of topical steroids will cause thinning of the skin and may lead to systemic
side-effects.

Two main factors determine whether or not a drug will reach its intended site of
action in the body:
The bioavailability of the drug;
How the drug is given (route of administration).
Bioavailability
Bioavailability is the proportion of an administered drug that reaches the systemic
circulation and is therefore available for distribution to the intended site of action.
Drugs that are given by direct injection are said to have 100% bioavailability. Some
drugs that are particularly well absorbed by the gastrointestinal mucosa may have
bioavailability comparable to that of an dose – for example the antibiotic ciprofloxacin.
Most drugs do not have this availability by the oral route so the dose given orally is
usually higher than that given parenterally. For example, the beta-blocker propranolol
when given orally is administered in doses of 40mg and above. The equivalent dose is
1mg.The route of administration and its formulation (tablet, capsule, liquid) can clearly
influence the bioavailability of a drug.

The main and side effects of the medicines are distinguish.

The main action of medicines, when it the purpose of prescribing, and side effects,
when preparation negatively influences on the organism and appear as:
a) intolerance of medicines (so-called idiosyncrasy) with allergic reactions, apeaaring
of some pathology (for example, candidosis at the using of antibiotics);
b) tolerance (habituation of medicines that are taken for a long time, for example,
after prolonged treating with nitroglycerine efficiency considerably falls and the grater
dose of this medicine is needed to attain medical effect. It es also purgative and soporific.
The therapeutic action of any medicinal matter appears only at introduction of its
certain amount. Taking into account there are such doses:
 Therapeutic dose: (average therapeutic) is the ordinary dose of medicinal preparation,
that vary upon the age, sex of patient, physiology state of organism, presence of other
diseases. Thus single and daily doses are distinguished. the usual dose or average dose it is the
amount needed to produce the desired therapeutic effect
 Dosage range: A term that applies to the range between the minimum amount of drug and the
maximum amount of drug required to produce the desired effect.
 Minimum dose: The least amount of drug required to produce a therapeutic effect.
 Maximum dose: The largest amount of drug that can be given without reaching the toxic effect.
 Toxic dose:The least amount of drug that will produce symptoms of poisoning.causes
poisoning of organism;
 Minimum lethal dose: The least amount of drug that can produce death.
 mortal dose c death of patient.
In case of prescribing of few medicines the potentiation (strengthening of action) of
medicinal preparations can appear; incompatibility of medicinal preparations: chemical
(simultaneous setting of preparations that have acid and alkaline reactions),
pharmacological (opposite influence on the same organ or their functions have been
taken at ones).

Drug calculations
Dose calculation is usually based on either body surface area (mg/m²) or body weight
(mg/kg) of the patient. Body weight is used more frequently for ease of calculations.
The calculation of body surface area (BSA) used to require both weight and height.
 To calculate drug doses, use the following formula:
Dose required/ Present Standard Quantity of Drug X Present Quantity of Liquid in which
Standard Quantity of Drug is Dissolved
In other words:
What you want/What you have X What it is in (dilution)
For example: a patient (child) is prescribed 90mg of Paracetamol and the medication
supplied is 120mg of Paracetamol in 5mls:
90 / 120 X 5 = 3.75mls
Medication errors arising from poor mathematical skills of nurses are an ongoing
problem
To enhance safety:
Take time working out calculations
Recheck answers
Do not be rushed by colleagues/patients/parents/ carers
Answers that look wrong probably are wrong and an initial mental estimate of the dose
may be useful.

Remember: 1 cc is the exact same amount as 1 ml!

Do YOU know the answers to the following?

1 gram = ______ milligrams (mg)

0.001 gram = _____ milligrams (mg)
1 kilogram = _____ grams (g)
0.001 kilogram (kg) = _____ gram (g)
1 liter (L) = _____ milliliters (ml) 0.001 liter (L) = _____ milliliters (ml)
1 milliliter (ml) = _____ cubic centimeter (cc)
1ml = ____ minims
4-5 ml = _____ dram
30 ml = _____ ounce
500 ml = _____ pint
1000 ml = _____ L = _____ quart
60 mg = _____ grain
1 kg = _____ pounds

Forms of medicines
Routes of administration
There are various routes of administration available, each of which has associated
advantages and disadvantages. All the routes of drug administration need to be
understood in terms of their implications for the effectiveness of the drug therapy and the
patient’s experience of drug treatment.
Routes of administration
External, and internal (enteral, parenteral).
External: via skin, mucous, respiratory tructus.
Skin: emulsions, ligaments, decoctions, powders, mixes.
Mucous: drops, ligaments.
Nose: powders, drops, ligaments, solutions, fallow.
Ears: drops used with medicine dropper, oil solutions should been warm.
Intravaginal: drags, tampons, powders, solutions for the syringing.

Topical administration
The topical application of medicines has obvious advantages in the management of
localised disease. The drug can be made available almost directly at the intended site of
action, and because the systemic circulation is not reached in great concentration, the risk
of systemic side-effects is reduced. For example:
The use of eye drops containing beta blockers in the treatment of glaucoma;
The application of topical steroids in the management of dermatitis;
The use of inhaled bronchodilators in the treatment of asthma;
The insertion of pessaries containing clotrimazole in the treatment of vaginal candidiasis.
Topical administration has also become a popular way of introducing drugs into the
systemic circulation through the skin. The development of transdermal patches that
contain drugs began with the introduction of a hyoscine-based product for the treatment
of nausea in the early 1980s.
The market for such products has since grown to include a wide range of disease
management areas including the prophylaxis of angina (glyceryl trinitrate), the treatment
of chronic pain (fentanyl) and hormone replacement (oestrogens). While the use of
transdermal drug administration is not without its problems - for example, some
preparations can cause local skin reactions - many patients find it a welcome alternative
to taking tablets.

Internal
Enteral: sublingual, per os, per rectum.
Powders, tablets, dragee, drops, mixtures, pills.
Current system shortcomings are:
1. long absorbtion in the intestine.
2. negative action of gastric, intestine juices, bile on the medicine.
3. not complete absorption of the medicine into the blood, hard to establish dosage.
Sublingual method is good – medicine is absorb and don’t ruined. Pass in the blood aside
liver and digestive tractus. Quick acting medicine – pills, tablets, solutions. (validol,
nitroglycerine).
Per rectum – resorbtive action on the organism and localized.

Oral administration
This is the most frequently used route of drug administration and is the most convenient
and economic. Solid dose forms such as tablets and capsules have a high degree of drug
stability and provide accurate dosage. Medications administered orally pass down the
digestive tract for absorption usually from the small intestine to the liver via the portal
vein. Once the medicine has been metabolised by enzymes in the liver, it enters the
circulation for systemic effect. It is important to understand the pharmacology of the
indiviual medication.
The oral route is nevertheless problematic because of the unpredictable nature of gastro-
intestinal drug absorption. For example the presence of food in the gastrointestinal tract
may alter the gut pH, gastric motility and emptying time, as well as the rate and extent of
drug absorption.
The extent to which patients can tolerate solid dose forms also varies, particularly in very
young and older patients. In such cases the use of liquids or soluble formulations may be
helpful. Many drugs, however, are not stable in solution for liquid formulation and in
such cases careful consideration should be given to the option of switching to alternative
drug treatment.
Difficulties frequently arise with patients who are prescribed modified-release
preparations as these must not be crushed or broken at the point of administration.
Modified-release formulations can delay, prolong or target drug delivery. The aim is to
maintain plasma drug concentrations for extended periods above the minimum effective
concentration.
For patients, their main advantage is that doses usually only need to be taken once or
twice daily. Damage to the release controlling mechanism, for example by chewing or
crushing, can result in the full dose of drug being released at once rather than over a
number of hours. This may then be absorbed leading to toxicity or may not be absorbed
at all leading to sub optimal treatment.
Nurses should seek advice from a pharmacist or the prescribing doctor if they are
uncertain about a formulation of solid dose forms and whether or not they are suitable for
crushing.

Some oral drugs can have a local effect e.g. oral antacids reduce the stomach acidity.
The oral route is the most common route of administration. This is for several reasons:
• It is associated with less pain and anxiety than other routes such as intramuscular
injections
• It is often cheaper than other preparations such as intravenous
• Less equipment is required and the procedure is often less time-consuming and
more convenient.
CONTRAINDICATIONS:
• Unconscious state
• Absent gag reflex
• Inability to swallow
• Vomiting
CAUTIONS :
• Digestive tract trauma/illness
• Post gastro-intestinal surgery
• Nil-by-mouth
• Nausea
• Diarrhoea

Sublingual
The sublingual mucosa offers a rich supply of blood vessels through which drugs can be
absorbed. This is not a common route of administration but it offers rapid absorption into
the systemic circulation. The most common example of sublingual administration is
glyceryl trinitrate in the treatment of acute angina.
The pharmaceutical industry has formulated and marketed ‘wafer’-based versions of
tablets that dissolve rapidly under the tongue. These are aimed at particular markets
where taking tablets may be problematic, such as the treatment of migraine (rizatriptan)
where symptoms of nausea may deter patients from taking oral treatments. The
formulation is also used to treat conditions where compliance with prescribed drug
regimens may be problematic, for example, olanzapine used to treat schizophrenia can be
administered by the sublingual route.
Rectal administration
The rectal route has considerable disadvantages in terms of patient acceptability and
unpredictable drug absorption but it does offer a number of benefits. It offers a valuable
means of localised drug delivery into the large bowel, for example the use of rectal
steroids in the form of enemas or suppositories in the treatment of inflammatory bowel
disease. Antiemetics can be administered rectally for nausea and vomiting and
paracetamol can be give to treat patients with a pyrexia who are unable to swallow.
Administration of drugs via enteral feeding tubes
Drugs should only be administered via fine-bore enteral feeding tubes as a last resort and
other routes of administration should be considered first. Most drugs are not licensed for
administration via enteral feeding tubes.
Interaction can occur between drugs and the enteral feed. Clinically significant
interactions include, phenytoin, digoxin, ciprofloxacin and rifampicin. A pharmacist
should therefore be involved in any decision to administer drugs via this route.

Parenteral administration: aside of digestive tract.

Parenteral drug administration can be taken literally to mean any non-oral means of drug
administration, but it is generally interpreted as relating to injection directly into the
body, by-passing the skin and mucous membranes. The common routes of parenteral
administration are intradermal, hypodermic, intravenous, intraarterial, into abdomen,
pleural cavity, heart, intraspinal, into the bone marrow, morbid place.
Advantages of parenteral administration:
Drugs that are poorly absorbed, inactive or ineffective if given orally can be given by this
route, unaltered form pass into the blood
The intravenous route provides immediate onset of action
The intramuscular and subcutaneous routes can be used to achieve slow or delayed onset
of action
Patient compliance problems are largely avoided .
Disadvantages of parenteral administration:
Requires trained staff to administer
Can be costly
Can be painful
Difficulties or impossible applying in case of bleeding, skin eraption.
Aseptic technique is required. Before using syringes nurse should wash carefully hands
under running water, wipe hands by individual towel, put gloves. Sterile material take
only by the sterile tweezers.
May require supporting equipment for example, programmable infusion devices
NB: The correct administration of parenteral doses requires the use of appropriate
injection technique. If performed incorrectly, for example using the wrong sized needle it
can cause damage to nerves, muscle and vasculature and may adversely affect drug
absorption.
Intramuscular and subcutaneous injection:
In general the injection of drugs into the muscle or the adipose tissue beneath the skin
allows a deposit or ‘depot’ of drug to become established that will be released gradually
into the systemic circulation over a period of time. By altering the formulation of the
drug, the period over which it is released can be influenced. For example, the formulation
of antipsychotic agents such as flupentixol in oil allows them to be administered once a
month or every three months.
Complications: infiltration, abscess, necrosis, phlegmon, allergy reactions due to the
aseptic breaks. Such as: not sterile syringes, not complete nurse hand processing, not
correct infusion, not complete allergy anamnesis.
If aseptic rules was broken inflammatory infiltration appears. Pain in the place of
injection, reddening, local high temperature. About complications doctor should know.
Warm compress should apply on this place.
If first aid was not provide – abscess could appear. High temperature, constant acute pain,
expressed reddening, fluctuation. Call surgeon!

Prophylaxis of infiltrates and abscesses:

1. Manipulation sister should work in special dressing, observe rules of aseptic and
antiseptic during injections.
2. Observe technique of injections. Medical needle 8sm, thin, according to
subcutaneous fat.
3. Only sterile syringes.
4. Palpate tissues before injection. In case of deep consolidation don’t make injection.
5. Preparing oil solution injection should check that syringe needle is not in the
vessel.
6. Don’t inject cold solutions. Oil sol. Warm – 37-38 C.
7. After injection recommend warm for better absorption.
8. Hypertonic solutions (analgin, magnesium) dilute by Novocain or physiologic sol.
For quickly absorption.

Intravenous injection
In many respects the administration of medicines via the IV route is an admission that the
use of other routes will not allow for an intended therapeutic outcome or goal of the
treatment to be met. Not only is the route inconvenient for the patient and practitioner,
but it carries the greatest risk of any route of drug administration. By administering
directly into the systemic circulation either by direct injection or infusion, the drug is
instantaneously distributed to its sites of action.
Such administration is frequently complex and confusing. It may require dose
calculations, dilutions, information to be gathered on administration rates and
compatibilities with other solutions, and the use of programmable infusion devices.
Moreover the preparation of medicines requires the use of an aseptic technique, often in a
ward environment that is unsuited for such work. It is imperative that to minimise the risk
of errors occurring in the administration of medicines that practitioners can demonstrate
their competence to practice safely in this area, and have access to appropriate sources of
expert information and advice.
Considerations when preparing an intravenous injection or infusion
Is the drug suitable for preparation at ward level or should it be prepared in pharmacy?
Does the drug require initial dilution?
If so what diluent is required and in what volume?
Does the drug require further dilution?
If so to what volume and with what diluent?
Is the drug suitable for direct injection or must it be infused over time?
What length of time can it be administered over?
Is an infusion device required?
Is the drug compatible with other drugs or fluids to be administered at the same time?
Does the drug cause any local reaction when given?
Is any monitoring required during or after administration?

Patient self-administration
For many years the standard method of medicines administration in the healthcare
settings such as hospitals and nursing homes has been based on nurses interpreting a
prescription and giving the relevant medicine in the required dose via the required route.
The patient’s role in the process has been passive.
Self-administration as an alternative means of administering medicines is based on the
patient being encouraged to play a central and active part in their drug treatment, just as
they would be expected to do if at home.
The safety and success of a self-administration scheme is based on an ongoing nursing
assessment that measures individual patients’ ability to interpret and participate in their
prescribed treatment regimen.
This assessment must initially evaluate whether or not patients administer any prescribed
treatment at home, whether or not they are able to read medicine labels, can understand
dose instructions and open medicine containers or packaging (Box 1). The assessment
must also reflect events that take place during the hospital stay.
For example a patient judged to be capable of self-administration before surgery is
unlikely to be able to do so in the immediate postoperative period. Such changes in
patient capability must be reflected in the patient’s care plan, and any indications that the
ability to self-administer is compromised should trigger a return to nurse-administered
treatment.
The system requires that safe and secure arrangements are in place for patients’
medicines and that local policies and procedures are in place to guide practice (NMC,
2006).
A number of factors have stimulated hospital practitioners to look at the benefits of self-
administration for patients and carers. There is now widespread acknowledgement that
traditional methods of medicines administration in hospitals do little to encourage patient
compliance and often leave patients being discharged with a bewildering bag of
medicines that they may never have seen before and may not be sure how to take.
Encouraging those patients who are able to administer their own medicines, as they
would do at home, raises the possibility of identifying their education needs and
improving concordance. For those assessed as unable to self-administer, consideration
needs to be given prior to discharge to the problems this may present.
Criteria for patient assessment for self-administration:
Is the patient receiving medicines and willing to participate?
Does the patient appear confused or forgetful?
Does the patient have a history of drug / alcohol abuse / self harm?
Does the patient self-administer at home?
Can the patient read medicines labels?
Can the patient open medicines containers?
Can the patient open his or her medicines locker?
Do the patient know what his or her medicines are for (and dosage, instructions, side-
effects)?
The successful operation of an extensive self-administration scheme throughout an acute
hospital offers insights into the complexities and contradictions of modern medicines
management which may have been hidden by the drug trolley approach.
It requires an acknowledgement that the traditional manner of working does not meet the
needs of most patients, and for ward-based practitioners to be committed to adopting this
approach in their practice. It also requires a truly integrated multi-professional approach
that focuses on ensuring patients gain the maximum benefit from their medicines.

Allergy reactions:
Nettle-rash, acute catarrh, conjunctivitis, Kvinke oedema, anaphylaxis shock.
Call doctor!

First aid in anaphylaxis shock:

- stop injection;
- nip tourniquet higher the injection place;
- horizontal position. Fixed toungue;
- prick around injection place with 0,5 ml 0,1% adrenaline solution (diluted in
isotonic solution of NaCl 1:10);
- call ambulance;
- control arterial pressure and pulse;
- if its not enough – 60-90 mg prednisolone intravenous or intramuscular;
- symptom therapy;
- in case of shock on penicillin – 1 000 000 ED pennicillinaze in the 2 ml of isotonic
solution;
- if not help – 2,5% pipolfen solution 2-4 ml or 2% solution of suprastine 2-4 ml
intramuscular, in case of systolic arterial oressure is nit less that 100 mm.mercury;
- if its needed provide cardiopulmonary reanimation;

The Most Common Types of Drugs Currently Available:

Analgesics: Drugs that relieve pain. There are two main types: non-narcotic analgesics for mild pain,
and narcotic analgesics for severe pain.
Analgesics generally recommended are: Tylenol, Tylenol with codeine, Vicodin, Darvon and Ultram.
These medications, except Tylenol are prescribed for pain at the physician's discretion and are generally
prescribed for those requiring a greater analgesic effect than acetaminophen alone can deliver, and/or
those who are allergic to, or cannot take aspirin.

Antacids: Drugs that relieve indigestion and heartburn by neutralizing stomach acid.

Antianxiety Drugs: Drugs that suppress anxiety and relax muscles (sometimes called axiolytics,
sedatives, or minor tranquilizers).

Antiarrhythmics: Drugs used to control irregularities of heartbeat.

Antibacterials: Drugs used to treat infections.

Antibiotics: Drugs made from naturally occurring and synthetic substances that combat bacterial
infection. Some antibiotics are effective only against limited types of bacteria. Others, known as broad
spectrum antibiotics, are effective against a wide range of bacteria.

Anticoagulants and Thrombolytics: Anticoagulants prevent blood from clotting. Thrombolytics help
dissolve and disperse blood clots and may be prescribed for patients with recent arterial or venous
thrombosis.

Anticonvulsants: Drugs that prevent epileptic seizures.

Antidepressants: There are three main groups of mood-lifting antidepressants: those belonging to the
tricyclics, SSRI (selective serotonin reuptake inhibitors) class, and monoamine oxidase inhibitors.
Tricyclic Antidepressants
Elavil (Amitriptyline) dose is typically 2.5 to 50 mg per night. Elavil is known forpain relieving effects and ability to
help sleep. This medication should be takenearly in the evening, or half-dose in the evening and the other half at bedtime to
avoid morning hangover.
Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic drug similar to Elavil with
muscle relaxant qualities. May be taken along with Elavil to provide muscle relaxant relief. This
medication usually reaches its maximum effect after one to two weeks of continuous use.
Sinequan (Doxepin) a typical dose is 2.5 to 75 mg. Also a tricyclic that functionsin the body as an
antihistamine. Available in tablet form as well as liquid.
Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar effects as Elavil but may be less
sedating.
Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as effective as the other anti-
depressants, however, is chemically different and may be less likely to cause side effects. Desyrel is a
mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at
night. It has also been reported to cause nightmares.
Many of the tricyclic antidepressants have side effects that may be intolerable for some people. These
include constipation, drowsiness, dry mouth and eyes, headache, heart rate abnormalities, increased
sensitivity to sunlight, morning "hangover," and weight gain. These side effects may improve after
patients have been using the medication for a few weeks. If not the doctor should be consulted regarding
another medication.

Benzodiazepines (antidepressant and anti-anxiety properties)

Xanax (Alprazolam) a typical dose is 0.25 to 1.5 mg at night. Xanax has been found to be more effective
if taken with 2400 mg (per day) of ibuprofen. However, Xanax may cause depression in some people,
and has been known to be addictive. Xanax may be effective for some fibromyalgia patients if taken in
low does.
Klonopin (Clonazepam) 0.5 to 1 mg at night is helpful in sleep myoclonus (arm and/or leg spasms).
Klonopin may help patients who grind their teeth. It stays active in the body longer, and has the same
possibility of being addictive as Xanax, and may cause depression in some people.
The antidepressant and anti-anxiety properties of these medications can cause the following effects:
Depression, drowsiness, impaired coordination, impaired memory, muscular weakness and/or
concentration problems, and they are known to be addictive.

Serotoning Boosting Medications

Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical dose is 1 to 20 mg in the
morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating
tricyclics such as Elavil or Sinequan.
Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning. This medication is the
most potent of this type. A sedating medication may be needed at night in conjunction with Paxil. It can
cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report
having fewer side effects with Paxil as compared to Prozac.
Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven helpful for some patients.
Sedating medication may also be needed to combat insomnia.
Serzone (Nefazodone) is the newest of these agents. As well as increasing serotonin, it also increases
norespinephrine. Serzone's efficacy and side effects are similar to Effexor.
Effexor (venlafaxine hydrochloride) the usual dose is 27.5 mg two times per day. This dosage can be
adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac-like drugs,
however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness,
anxiety, insomnia and increased blood pressure.
The following are some of the side effects of serotonin boosting medications: anxiety/nervousness,
headache, insomnia, mood swings, sexual difficulties, nausea and stomach distress.

Antidiarrheals: Drugs used for the relief of diarrhea. Two main types of antidiarrheal preparations are
simple adsorbent substances and drugs that slow down the contractions of the bowel muscles so that the
contents are propelled more slowly.

Antiemetics: Drugs used to treat nausea and vomiting.

Antifungals: Drugs used to treat fungal infections, the most common of which affect the hair, skin, nails,
or mucous membranes.

Antihistamines: Drugs used primarily to counteract the effects of histamine, one of the chemicals
involved in allergic reactions.

Antihypertensives: Drugs that lower blood pressure. The types of antihypertensives currently marketed
include diuretics, beta-blockers, calcium channel blocker, ACE (angiotensin- converting enzyme)
inhibitors, centrally acting antihypertensives and sympatholytics.

Anti-Inflammatories: Drugs used to reduce inflammation - the redness, heat, swelling, and increased
blood flow found in infections and in many chronic noninfective diseases such as rheumatoid arthritis
and gout.

Antineoplastics: Drugs used to treat cancer.

Antipsychotics: Drugs used to treat symptoms of severe psychiatric disorders. These drugs are
sometimes called major tranquilizers.
Antipyretics: Drugs that reduce fever.

Antivirals: Drugs used to treat viral infections or to provide temporary protection against infections such
as influenza.

Barbiturates: Als called sleeping drugs.

Beta-Blockers: Beta-adrenergic blocking agents, or beta-blockers for short, reduce the oxygen needs of
the heart by reducing heartbeat rate.

Bronchodilators: Drugs that open up the bronchial tubes within the lungs when the tubes have become
narrowed by muscle spasm. Bronchodilators ease breathing in diseases such as asthma.

Cold Remedies: Although there is no drug that can cure a cold, the aches, pains, and fever that
accompany it can be relieved by aspirin or acetaminophen often accompanied by a decongestant,
antihistamine, and sometimes caffeine.

Corticosteroids: These hormonal preparations are used primarily as anti-inflammatories in arthritis or

asthma or as immunosuppressives, but they are also useful for treating some malignancies or
compensating for a deficiency of natural hormones in disorders such as Addison's disease.

Cough Suppressants: Simple cough medicines, which contain substances such as honey, glycerine, or
menthol, soothe throat irritation but do not actually suppress coughing. They are most soothing when
taken as lozenges and dissolved in the mouth.
As liquids, they are probably swallowed too quickly to be effective. A few drugs are actually cough
suppressants. There are two groups of cough suppressants: those that alter the consistency or production
of phlegm such as mucolytics and expectorants; and those that suppress the coughing reflex such as
codeine (narcotic cough suppressants), antihistamines, dextromethorphan and isoproterenol (non-
narcotic cough suppressants).

Cytotoxics: Drugs that kill or damage cells. Cytotoxics are used as antineoplastics (drugs used to treat
cancer) and as immunosuppressives.

Decongestants: Drugs that reduce swelling of the mucous membranes that line the nose by constricting
blood vessels, thus relieving nasal stuffiness.

Diuretics: Drugs that increase the quantity of urine produced by the kidneys and passed out of the body,
thus ridding the body of excess fluid. Diuretics reduce water logging of the tissues caused by fluid
retention in disorders of the heart, kidneys, and liver. They are useful in treating mild cases of high
blood pressure.

Expectorants: Drugs that stimulate the flow of saliva and promotes coughing to eliminate phlegm from
the respiratory tract.

Hormones: Chemicals produced naturally by the endocrine glands (thyroid, adrenal, ovary, testis,
pancreas, and parathyroid). In some disorders, for example, diabetes mellitus, in which too little of a
particular hormone is produced, synthetic equivalents or natural hormone extracts are prescribed to
restore the deficiency. Such treatment is known as hormone replacement therapy.
Hypoglycemics (Oral): Drugs that lower the level of glucose in the blood. Oral hypoglycemic drugs are
used in diabetes mellitus if it cannot be controlled by diet alone, but does require treatment with
injections of insulin.

Immunosuppressives: Drugs that prevent or reduce the body's normal reaction to invasion by disease or
by foreign tissues. Immunosuppressives are used to treat autoimmune diseases (in which the body's
defenses work abnormally and attack its own tissues) and to help prevent rejection of organ transplants.

Laxatives: Drugs that increase the frequency and ease of bowel movements, either by stimulating the
bowel wall (stimulant laxative), by increasing the bulk of bowel contents (bulk laxative), or by
lubricating them (stool-softeners, or bowel movement-softeners). Laxatives may be taken by mouth or
directly into the lower bowel as suppositories or enemas. If laxatives are taken regularly, the bowels
may ultimately become unable to work properly without them.

Muscle Relaxants: Drugs that relieve muscle spasm in disorders such as backache. Antianxiety drugs
(minor tranquilizers) that also have a muscle-relaxant action are used most commonly.
Tricyclic Antidepressants
Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of
FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.
Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or
Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic
muscle relaxant that has been found to decrease pain in some FMS patients.
Patients should be cautioned that muscle relaxants can cause drowsiness and they should not operate a
motor vehicle when taking this type of medication. There are other muscle relaxants to try if these do
not work.
Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of
FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.
Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or
Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic
muscle relaxant that has been found to decrease pain in some FMS patients.

Sedatives: Same as antianxiety drugs.

Sex Hormones (Female): There are two groups of these hormones (estrogens and progesterone), which
are responsible for development of female secondary sexual characteristics. Small quantities are also
produced in males. As drugs, female sex hormones are used to treat menstrual and menopausal disorders
and are used as oral contraceptives. Estrogens may be used to treat cancer of the breast or prostate,
progestins (synthetic progesterone to treat endometriosis).

Sex Hormones (Male): Androgenic hormones, of which the most powerful is testosterone, are
responsible for development of male secondary sexual characteristics. Small quantities are also
produced in females. As drugs, male sex hormones are given to compensate for hormonal deficiency in
hypopituitarism or disorders of the testes. They may be used to treat breast cancer in women, but
synthetic derivatives called anabolic steroids, which have less marked side- effects, or specific anti-
estrogens are often preferred. Anabolic steroids also have a "body building" effect that has led to their
(usually nonsanctioned) use in competitive sports, for both men and women.

Sleeping Drugs: The two main groups of drugs that are used to induce sleep in patients with insomnia
are benzodiazepines and barbiturates. All such drugs have a sedative effect in low doses and are
effective sleeping medications in higher doses. Benzodiazepines drugs are used more widely than
barbiturates because they are safer, the side-effects are less marked, and there is less risk of eventual
physical dependence.
 Sleep Medications may be used occasionally during flares or when the patient is having severe sleeping
problems. They can be habit forming, however, Ambien is thought to be less habit forming, is well
tolerated, with few side effects, and there are no known drug interactions. This sleep medication should
not be used more than two or three times a week.

Tranquilizers: This is a term commonly used to describe any drug that has a calming or sedative effect.
However, the drugs that are sometimes called minor tranquilizers should be called antianxiety drugs,
and the drugs that are sometimes called major tranquilizers should be called antipsychotics.

Vitamins: Chemicals essential in small quantities for good health. Some vitamins are not manufactured
by the body, but adequate quantities are present in a normal diet. People whose diets are inadequate or
who have digestive tract or liver disorders may need to take supplementary vitamins.

NSAIDS (anti-inflammatories) Advil, Clinoril, Motrin, Naproxen, Relafen and Voltaren. Used alone,
these anti-inflammatories have not proven effective in reducing FMS pain. However, Elavil and Xanax's
effectiveness is increased when used in combination with ibuprofen (2400 mg per day). If the patient has
arthritis, osteoarthritis or tendinitis these medications would be helpful in alleviating the pain.
Advil, Motrin, Naproxen, Relafen, etc., are non-steroidal anti-inflammatories. These medications can
cause stomach upset and some patients have developed bleeding ulcers.

Medication Administration Step-by-Step

Administering Eye Drops

Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (drops)
Nonsterile gloves
Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from
the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented
Remove cap from eye bottle and place cap on its side
Squeeze the amount of medication as prescribed into the eyedropper
Put a tissue below the lower lid
With dominant hand, hold eyedropper ½ to ¾ inch above the eyeball, the rest hand is on patient forehead
to stabilize
Place nondominant hand on cheekbone and expose lower conjunctival sac by pulling on cheek while
applying slight pressure to the inner chantus
Instruct the patient to look up and drop the drops into center of conjunctival sac
Do not instill medication drops directly into the cornea
If the patient blinks and the drops land on the outer lid or eyelash, repeat the procedure
Instruct patient to close and move eyes gently
Remove gloves and wash hands
Record the route, site, and time administered on the MAR

Administering Eye Medication Disk

Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (medication disk)
Nonsterile gloves
Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from
the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented

To Insert Medication Disk:

Open sterile package and pres dominant, gloved finger against the oval disk so it lies lengthwise across
fingertip
Instruct patient to look up
With non-dominant hand, gently pull the lower eyelid down and place the disk horizontally in the
conjunctival sac. The disk should float on the sclera between the iris and the lower eyelid
Pull the lower eyelid out, up and over the disk
Instruct patient to blink several times
If disk is still visible, repeat the steps
When the disk is in place, instruct patient to press his fingers against his closed lid but do not rub eyes or
move the disk across the cornea
If the disk falls out, rinse it under cool water and reinsert it

To Remove Medication Disk:

With non-dominant hand, invert the lower eyelid and identify the disk
If the disk is located in the upper eye, instruct patient to close the eye and place your finger on closed
eyelid. Apply gentle, long, circular strokes and instruct patient to open the eye. Disk then should be
located in the corner of eye. With your fingertip, slide the disk to the lower lid, then proceed
With dominant hand, use the forefinger to slide the disk onto the lid and out the patient’s eye
Remove gloves and wash hands
Record it on the MAR

Administering Eye Ointment

Medical Equipments:
Medication Administration Record (MAR)
Tissue or cotton ball
Eye Medication (ointment)
Nonsterile gloves

Nursing Procedures:
Assess the patient and the cart for any allergies
Check the written orders on MAR
Obtains the necessary equipments
Follow the five rights of drug administration
Determine the identification armband
Explain the procedure to the patient and ask if he or she wants to instill his or her own eye drops
Wash hand and don non-sterile gloves
Gently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from
the innter canthus to the outer and use warm soaks to soften material if necessary)
Position patient in a supine position with the head slightly hyperextented
For Lower Lid:
With non-dominant hand, separate eyelids with thumb and finger, and grasp lower lid near margin
immediately below the lashes, exert pressure downward over the bony prominence of the cheek
Instruct the patient to look up
Apply eye ointment along inside edge of the entire lower eyelid, from inner to outer canthus
For Upper Lid:
Instruct patient to look down
With non-dominant hand, gently grasp patient’s lashes near center of upper lid with thum and index
finger, and draw lid up and away from eyeball
Apply ointment along upper lid starting at inner chantus

Administering Ear Medication

Medical Equipments:
Medication Administration Record (MAR)
Cotton-tipped Applicator
Cotton Balls
Medications
Non-sterile gloves
Tissue

Nursing Procedures:
Determine the allergies for any medication
Check the written order on MAR
Wash hand
Calculate the dose
Identify patient’s armband
Explain the procedure to the patient
Place patient in a side lying position with the affected ear facing up
Don non-sterile gloves
Straighten the ear canal by pulling the pinna down and back for children or upward and outward for
adults (Pull ear up and back for adults, down and back for children)
The drops are instilled into the ear canal by holding the dropper at least ½ inch above the ear canal
Instruct patient to maintain the position for 2-3 minutes
Place a cotton ball n the outermost part of the canal
Apply to other ear 5 min. later
Wash hand
Record the drug, number of drops, time administered, and medication on MAR

Administering Nose Drops

Medical Equipments:
Medication Administration Record (MAR)
Medication with Dropper
Emesis Basin (optional)
Non-sterile Gloves
Tissue
Nursing Actions:
Check the allergies that patient may have
Determine the written order on MAR
Wash hands
Check patient’s identification armband
Explain the procedures to the patient and provide privacy
Ask patient to blow nose unless contraindicated
Inform the patient that he/she may feel a burning sensation to the mucosa or a choking sensation, or both,
as the drop trickles back into the throat
Place patient in a supine position and hyperextend the neck and position the head to the site that facilitates
the drop reaching the expected site
Instruct the patient to breathe through mouth
Squeeze medications into the dropper
Insert the nasal drops about 3/8 inch into nostril and keep the tip of the dropper away from the sides of the
nares.
Instill the medication as prescribed and observe for signs and discomforts
Ask the patient to maintain supine position for 5 minutes
Discard any unused medication remaining in the bottle
Position the patient to a comfortable position and proved the patient with the emesis basin and tissue to
expectorate any medication and flows in to the oropharynx and mouth
Remove gloves and wash hands
Record the medication given, doses, and time on MAR
Observe the patient for side effects for 30 minutes after administration

Nasal Sprays:
Have patient sit up
Insert tip of container into nostril
Have patient take a deep breath as you squirt
No need to tilt head back

Lung Sprays:
Have patient stand up
- this lowers the diaphragm and allows for better lung expansion
Shake the inhaler well
- shake for 15-30 sec.
Let patient place the spacer device on the inhaler
Instruct patient to breathe out to the end of a normal breath
Ask patient to tilt chin up
- do not hyper-extend!
Let patient place spacer tube in mouth
- instruct patient to seal lips around the tube
Ask patient to activate inhaler
- patient must inhale slowly and deeply over 5 seconds
- be sure patient doesn't use the nos
- patient must hold breath for 10 seconds - before exhaling
Wait for 2-5 minutes before next puff
Give water to rinse mouth after all doses are taken

Topical Meds:
Open wound - sterile technique
- Sterile cotton swabs or tongue depressor
Nitro paste:
- Use a unit dose patch
- Shiny area up, remove sealed portion
Prepare own nitro paste:
- Tear off piece of nitro paper
- Light print showing thru is the side you want up
- Start at beginning of line, squeeze slowly so med. is no bigger or smaller than top of tube
- Fold paper in half (med over all paper)
- Open and place on patient
- Tape in place-move around patient in clockwise manner
- If ordered chest only, the alternate side to side
- Look for previous patch before applying your patch
- To remove:
Wet one end of paper towel
Take off, wipe, and dry area
Watch for reactions to this medication - headache and lightheadedness

Vaginal Suppository Administration:

Equipments:
Medication Administration Record (MAR)
Prescribed vaginal suppository
Disposable applicator
Non-sterile gloves
Water soluble lubricant
Tissue

Nursing Actions:
Identify any allergies or medical condition that contraindicate the use of drug
Obtain necessary equipment
Check the written order on MAR
Wash hands
Follow the five rights of medication administration
Instruct patient to void
Place patient in a dorsal recumbent position with knees flexed and hips rotated laterally on in a Sims’
position if the patient cannot maintain the dorsal recumbent position
Insert suppository into vaginal canal
Patient remains lying for 10-15 min after insertion to ensure absorption of medication

Rectal Suppository Administration

Medical Equipments:
Medication Administration Record (MAR)
Prescribed Rectal suppository
Water Soluble Lubricant (K-Y Jelly)
Non-sterile Gloves
Tissue
Bedpan (as optional)

Nursing Procedures:
Identify any allergies that patient has
Gather necessary equipments
Determine the written order on MAR
Wash your hands
Check the patient’s identification
As patient if she or he wants to void
Explain the procedure to the patient briefly
Don non sterile gloves
Place patient in the Sim’s left lateral position with the upper leg flexed
Open the package of lubricant and remove the foil wrapper from the suppository
Apply a small amount of lubricant to the smooth rounded end of the suppository
Lubricate the gloved index finger
Ask the patient to breathe through the mouth
Insert the suppository into the rectal canal beyond the internal sphincter about 4 inches for an adult and 1
inch for a child
Avoid inserting the suppository into feces
Withdraw the finger and wipe the anal area with tissue
Ask patient to remain in bed for 15 minutes and to resist urge to defecate
Remove glove and wash hand
Record the name of the drug, dosage, route, and time of administration on MAR
Observe the effectiveness of medication

Oral Medications:
Pills
- Can be swallowed directly or sublingual (leave these under the tongue until dissolved)
- Open pack & drop into medicine cup
Granule/ Powders
- Pour into a cup up to correct dosage
Liquids
- Unit dose is a sealed container
- Water based liquid - read meniscus down
- Oil based liquid - read meniscus up

Parentral Meds:
Syringes
- Unit doses and self prepared
- The numbers represent:
1. Volume
2. Gauge of needle (diameter of inside of needle) the higher the number the smaller the needle hole
3. Length of needle
- Insulin syringes and needles
- Tuberculin syringes and needles
- The color of the packaging represents the gauge of the needle
- All needles are interchangeable except for the insulin syringe
- The tuberculin syringe is not lure-locked, needle pulls off- can measure in tenths and hundredths-
pediatrics

- 2 types of insulin syringes -

a. 100 U = 1cc - each line = 2 Units
b. 50 U - each line = 1 Unit
- Unit dose syringe comes prefilled by the company - usually use entire contents - discard what
will not be used.
- Tubex syringe - cartridge with holder - prefilled - discard into sharps container.

Administering a Metered Dose Inhaler (self administration)

Equipments:
Medication Administration Record (MAR)
Inhaler
Non-sterile Gloves
Wash basin or sink to rinse mouth
Tissue (optional)

Nursing Actions:
Check any allergies that patient has or any medical condition that is contraindicated with the use of thd
drug
Obtain all equipments
Check the written order on MAR
Wash hands
Follow the five right of medication administration
Check the patient identification
Allow the patient o hold and manipulate the canister and explain how the canister fits into the inhaler.
Have the patient demonstrate the insertion of the canister
Discuss the metered-dose concept and frequency of dose to the patient
Explain that the inhaler should be shaken before each use
Remove the mouthpiece and cap from the bottle and insert the stem into the small hole on the flattened
portion of the mouthpiece. The patient should grasp the inhaler with thumb and first two fingers
Instruct the patient to exhale, place the mouthpiece into the mouth and tighten the lips (seal) around the
mouthpieces
Ask the patient to firmly push the cylinder down against the mouthpiece only once, while slowly inhaling
until the lungs feel full
Instruct the patient to remove the mouthpiece while holding the breath for about 10 seconds then exhale
slowly through pursed lips
Repeat the doses as prescribed and waiting 1 minute between puffs
A mouthwash can be use by the patient to remove the taste of the medication
Demonstrate to the patient how to wash the mouthpiece under tepid running water to remove secretions
If two or more inhaler medication are prescribed, wait 5-10 minutes between inhalations or as specifically
ordered by physician
Record all the drug’s name, dose, date, and time for medication on MAR
Observe for effectiveness of medication and relief of the patient’s symptoms