NURS 257

GENERAL HEALTH ASSESSMENT

SKILLS AND FIRST AID I

ABENA KYEREW ABEBRESE

MEDICATIONS
 Objectives
By the end of the lesson students will be able to:
1. Identify certain terms used in medication
administration
2. Identify the effects of drugs
3. Describe various routes of medication
administration

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 Definition of terms
• Medication – a substance administered for
the diagnosis, treatment, relief of symptom or
for prevention of disease.

• Drug – any chemical substance that affects the

physical and mental state of a person.

• Prescription – a written direction for the

preparation and administration of a drug.
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 Definition cont’d
• Drug toxicity- poisonous effect of a drug on
the body

• Drug allergy- immunologic reaction to a drug

• Drug tolerance occurs when the body

becomes so accustomed to a specific drug
that larger doses are needed to produce the
desired therapeutic effect.
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 Names of a drug
A drug can have several names which include;
• The generic name -is the name assigned by
the U.S. Adopted Names Council to the
manufacturer who first develops the drug.

• Proprietary / trade/ brand name – the name

assigned by pharmaceutical companies that
market the drug.

• The chemical name is a precise description of

the drug’s composition (chemical formula).
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 Effects of drugs
• Therapeutic /desired effect- primary effect
intended for giving the drug

• Side-effect: a known effect, other than that

primarily intended, relating to the
pharmacological properties of a medication

• Adverse effects: unexpected harm arising

from a justified action and may call for
discontinuation of the drug e.g. an
unexpected allergic reaction
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 Sources of drugs
1. Plants – roots, leaves, seeds, bark e.g.
atropine, morphine, digoxin and some
antibiotics
2. Animals -e.g. hormonal preparations such as
insulin, heparin, adrenalin

3. Mineral(soil) eg sodium bicarbonate, ferrous

sulphate, potassium chloride, MgSO₄,
calcium gluconate
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 Sources of drugs

4. Synthetic origin- manufactured in the lab eg.

Tranquilizers ,anticoagulants, antihistamins,
anti-anxiety, some antibiotics etc

5. Microbiological origin- eg. Vaccines,

antibiotics

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 INJECTIONS
i. Parenteral
• Parenteral refers to introduction of a
medication by any route other than the oral-
gastrointestinal route by injecting medication
into body tissue with a needle
The four routes commonly used to administer
parenteral medications are as follows:
1. Intradermal (ID) is an injection into the
dermis.
2. Subcutaneous (SC)is an injection into the fatty
tissue.

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 INJECTIONS cont’d
i. Parenteral
3. Intramuscular (IM) is an injection into the
muscle.
4. Intravenous (IV) is an injection into a vein.
Other less commonly used parenteral routes
include:
5. Intrathecal or intraspinal – into the spinal
canal
6. Intracardiac – directly into the heart muscles
or ventricles
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 INJECTIONS cont’d
• Intrapleural- into the pleural space
• Intra-arterial- into the artery
• Intra-articular- into the joint
• Epidural – into the epidural space

NB; Sterile technique is always used for any

medication injection.
• The main advantage is the fast absorption

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 INJECTIONS cont’d
ii. Topical
• The drug is applied to a circumscribed surface
area of the body.
• They affect only the area to which they are
applied
Examples include; dermatological
preparations(inunction), instillations and
irrigations, inhalations and implantations

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 Process of administering medication
1. Identify the client
2. Inform the client
3. Prepare the patient
4. Administer the drug
5. Record the drug administered
6. Evaluate the clients response to the drug

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 Syringe
• Syringes and needles are used to administer
drugs parenterally from vials and ampoules.

A syringe has three basic parts:

1. The tip, which connects with the needle
2. Barrel, which contains measurement
calibrations
3. The plunger, which fits inside the barrel and
has a rubber tip
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 Syringe Parts syri

Plunger

Barrel

tip

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 Needles
• Needles are disposable, made of stainless
steel, and individually packaged for sterility.
• They are disposable and for single use.
Reusable needles are seldom used
Parts of a needle
1. Hub- fits onto the syringe
2. Cannula or shaft- is attached to the hub
3. Bevel- the slanted part at the tip of the shaft
4. Safety cap covers the shaft
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Needles

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 Ampoules and Vials
• Drugs for parenteral injections are sterile
preparations.
• Drugs that deteriorate in solution are
dispensed as tablets or powders and dissolved
in a solution immediately before injection.
• Drugs that remain stable in a solution are
dispensed in ampoules and vials in an
aqueous or oily solution or suspension.

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 Ampoules
• Ampoules are glass containers of single-dose
drugs
• The glass container has a constriction in the
stem to facilitate opening the ampoule.
• Ampoules vary in size from 1-10ml or more
and may be pre scored for easy opening
• Open ampoules with an ampoule opener or
dry sterile gauze

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 Ampoules cont’d
• The drug is aspirated with a filter needle
• The nurse should change the needle on the
syringe after withdrawing drug from an
ampoule to prevent irritation of
subcutaneous tissue.

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 Vials
• A vial is a small glass bottle with a sealed
rubber cap
• The vial is usually covered with a soft metal
cap that must be removed to access the
medication
• The vial is cleaned and pierced with a needle
• Equivalent amount of air must be injected into
a vial before drawing the medication

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 Vials cont’d
• Vials could be for single dose or multi dose
• Powdered drugs are reconstituted before
administration

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 Medication administration
Intramuscular injection
• In IM injection the drug is injected into the
muscle at 90 degrees
• IM injections promote rapid drug absorption
and provides an alternate route when the
drug is irritating to subcutaneous tissue.
• The IM route enhances the absorption rate
because there are more blood vessels in the
muscles than in subcutaneous tissue but
depends on circulatory status of patient.
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 IM injection
• Common sites used for IM injections include
ventrogluteal, deltoid, vastus lateralis,
dorsogluteal.
• Care must be taken to prevent injury to sciatic
nerve and the superior gluteal artery

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 Site for IM injections
• Ventrogluteal Muscle: This muscle is located in
the hip. Assist patient lie lateral or prone. Place
hand on side and spread the pointer finger and
middle finger into a “V” and give the injection
between those fingers.

• Deltoid Muscle: The deltoid muscle is located in

the upper arm, just below the shoulder. To mark
this site, place the palm of your hand on the
shoulder and spread your thumb from the other
4 fingers in an upside down “V” shape. Make sure
that the middle of the arm is centered in your
“V”. Give the injection into the middle of the “V”.
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 Site for IM injections
• Vastus Lateralis Muscle: This muscle is located
in the thigh. To properly mark this muscle,
divide the front of the thigh into thirds from
the top to the bottom of the thigh. The needle
should go into the middle third.
• Dorsogluteal Muscle: This is the large muscle
in the backside. Divide one buttock into
quadrants, halfway down the middle and
halfway across. Give the injection in the
outer, upper quadrant, almost toward the hip.
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 Procedure for administering
intramuscular injection
1. Check the label on the medication against
the chart 3x
2. Prepare a tray with the necessary
requirement
3. Wash and dry hands and provide privacy
4. Explain drug and procedure to patient and
help into required position
5. Prepare the medication and expel air
6. Select and clean the site using circular motion
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 Procedure for administering
intramuscular injection
7.Use the ulna side of non dominant hand to
pull the skin approximately 2.5cm to the side
8. Hold the syringe between the thumb and fore
finger and insert needle at 90° into the muscle
9. Aspirate by pulling back on plunger, if blood
appears withdraw the needle, discard and
prepare new injection

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 Procedure for administering
intramuscular injection
10. If blood does not appear, inject medication
steadily and slowly
11. Withdraw the needle at 90° and apply gentle
pressure to the site with dry cotton
12.Discard the needle into the safety box
13. Discard other items ,wash and dry hands
14. Document relevant information
15. Assess the effectiveness of the medication
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 Intravenous medication
• A needle is inserted directly into a vein and
medication enters directly into the
bloodstream
• A solution containing the drug may be given in
a single dose or by continuous infusion
• IV route is the best way to deliver a precise
dose quickly and in a well-controlled manner
throughout the body
• It is also used for irritating solutions, which
would cause pain and damage tissues

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 Methods of administering IV
medication
• Large volume infusion- drug is added to N/S
or Ringers solution e.g potassium, vitamins
• Intermittent IV infusion- the medication is
mixed in small amount of IV solution(50-
100ml) and administered at regular intervals.
• Volume controlled infusion (children)-a small
fluid container is attached to an infuser to
deliver precise regular doses of medication

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 Methods of administering IV
medication
• Intravenous push (bolus)- undiluted
medication is pushed directly into systemic
circulation
• Intermittent injection ports- devices are
attached to an IV catheter for medication to
be administered without continous IV infusion

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 Procedure for administration of IV
medication (bolus) with indwelling line

1. Assess the patient’ IV insertion site for

infection, swelling, leakage, patency of IV line
2. Check vital signs as a baseline data
3. Prepare a tray with the following: MAR, drug,
sterile syringe and needle, gloves, gallipot
with swab , antiseptic solution, second hand
watch
4. Check the medication against the MAR,

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 Procedure for administration of IV
medication
5. Prepare the correct dosage and check with
MAR
6. Perform hand hygiene, explain procedure and
provide privacy
7. Compare label with MAR
8. Wear gloves ,open clean the injection port
and flush line with sterile normal saline(1ml)
9. Insert the syringe containing the medication
into the port and push the medication slowly

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 Procedure for administration of IV
medication
10. Observe the patient closely for adverse
reactions
11. Remove the syringe when all medication is
administered
12. Inject 1ml normal saline into the line to flush
the line and close the port
13. Dispose equipment appropriately
14.Perform hand hygiene and observe patient
closely for adverse reaction
15. Document all relevant information
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Administration of Topical Medication
• Topical medications may be administered to
the skin, eyes, ears, nose, throat, rectum, and
vagina.
• The medication generally provides a local
effect but can also cause systemic effects.
• Topical drugs are usually given to provide
continuous absorption
• They produce different effects: to relieve
pruritus, protect the skin, prevent or treat an
infection, provide local anesthesia, or create a
systemic effect.
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 Ophthalmic instillations
Eye medications include drops, ointments and
gel.
Eye drops/ocular lubricants, are used to keep
eyes moist and provide temporary relief from
discomfort.
The drops interact with the tears in your eyes
from the moment you drop them in your eyes.
Closing your eyelids spreads the drops. When
drops spread they moisten and lubricate the
surface.
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 Types of eye drops

• Dilating drops during eye exams.

• Redness-relieving drops.
• Lubricating drops for dry eye.
• Itch-relieving (anti-allergy) drops.
• Numbing drops before surgery.
• Antibiotic drops for some infections.
• Pressure-lowering drops for long-term
treatment of glaucoma

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 Procedure for applying eye drops
A. Preparing the Drops
1. Always wash your hands before handling
your eye drops or touching your eyes.
2. If you’re wearing contact lenses, take them
out — unless your ophthalmologist has told
you to leave them in.
3. Shake the drops vigorously before using
them.
4. Remove the cap of the eye drop medication.
5. Do not touch the dropper tip.
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 Procedure continued
B. Putting in Eye Drops
6. Tilt your head back slightly and look up.
Some people find it helpful to focus on a specific
point on the ceiling
7. Use one hand to pull your lower eyelid down,
away from the eye. This forms a pocket to catch
the drop.
8. Hold the dropper tip directly over the eyelid
pocket.

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 Procedure continued
B. Putting in Eye Drops
9. Squeeze the bottle gently and let the eye
drop fall into the pocket.

10. Don’t touch the bottle to your eye or eyelid.

This can give bacteria or other contaminants a
chance to grow in your eye drops.

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 Procedure continued
C. After You’ve Put in Eye Drops:
11. Close your eyes and do not blink.
12. Apply gentle pressure to your tear ducts,
where the eyelid meets the nose.
13. Hold the tear ducts closed for a minute or
two—or as long as your ophthalmologist
recommends—before opening your eyes. This
gives the drop time to be absorbed by the eye,
instead of draining into your nose.

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 Procedure continued
C. After You’ve Put in Eye Drops:
14. Wipe any unabsorbed drops from your
closed lids with a tissue.
15. Repeat the same procedure with the other
eye, if necessary.
16. Wash your hands after handling medication
and touching your face.

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 Eye ointments and gels
• Eye ointments are an alternative to eye drops.
These are remedies whose preparation is
based on creams and which are suitable for
localized use on the eye.
• Gels and ointments tend to stay in the eyes
longer, so they're recommended for overnight
use.
• Using a mirror or having someone else give
you the eyedrops/ointment may make the
procedure easier.
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 Procedure for applying eye
ointment/gel
A. Preparing the Drops
1. Always wash your hands before handling
your eye ointment or touching your eyes.
2. If you’re wearing contact lenses, take them
out — unless your ophthalmologist has told
you to leave them in.
3. Remove the cap of the medication.
4. Avoid touching the tip of the tube against
your eye or anything else - the medication
and its container must be kept clean.
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 Procedure continued
B. Putting in the ointment
5. Holding the tube between your thumb and
forefinger, place it as near to your eyelid as
possible without touching it.

6. Brace the remaining fingers of that hand

against your face.

7. Tilt your head forward slightly

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 Procedure continued
B. Putting in the ointment
8. While tilting your head back, pull down the
lower lid of your eye with your index finger to
form a pocket.

9. Squeeze ribbon of ointment or gel into the

pocket made by the lower eyelid. Remove your
index finger from the lower eyelid

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 Procedure continued
C. After putting applying the ointment
10. Blink your eye gently; then close your eye
for 1 to 2 minutes.

11. With a tissue, wipe any excess ointment or

gel from the eyelids and lashes. With another
clean tissue, wipe the tip of the tube clean.

12. Replace and tighten the cap right away.

13. Wash your hands to remove any medication.
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 More Tips for Using Eye
Drops/ointments
• If you need to take more than one type of eye
drop at the same time, wait three to five
minutes between the different kinds of
medication.
• Use your drops exactly when and how your
doctor tells you to.

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 More Tips for Using Eye
Drops/ointments
• Ask your ophthalmologist or pharmacist if it’s
OK to keep the drops in the refrigerator. When
the drops are cold it might be easier to feel
the drop when it hits the eye, so you can tell
where it has landed.
• If you have a lot of trouble putting in your eye
drops, ask a caregiver or family member to
help.

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END OF PRESENTATION
THANK YOU.

ANY
QUESTIONS?

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