Post on 04-Feb-2023
Mathematics Review and
Medication Administration
Chapter 23
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Definitions
� Numerator: Top number of a fraction
� Denominator: Bottom number of a fraction
• Types of Fractions
� Proper fractions: Numerator is less than the
denominator
� Improper fractions: Numerator is larger than the
denominator
� Mixed fractions: Consist of a whole number plus a
fraction
Slide 3Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Changing an Improper Fraction to a Whole or Mixed
Number
� Divide the denominator into the numerator.
• Changing a Mixed Number to an Improper Fraction
� Multiply the denominator into the whole number.
� Add the numerator to the product; the sum is now the
new number.
• Reducing Fractions to the Lowest Term
� Find a number that will evenly divide into the
numerator and the denominator.
Slide 4Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Determining Which Fraction Is Larger
� If the denominators are the same, the fraction with the
larger numerator is the larger fraction.
� If the denominators are different, you must find a
“common denominator.”
• Finding a common denominator means to find a
number into which both denominators can be divided.
� After the common denominator is found, an equivalent
numerator for each fraction must be found. (Divide the
first denominator into the equivalent denominator;
multiply the answer by the first numerator.)
Slide 5Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Adding Fractions That Have the Same Denominator
� Add the numerators and place the sum of the
numerators over the denominator.
• Adding Fractions That Have Different Denominators
� Find common denominators for all fractions in the
problem.
� Find the equivalent numerators.
Slide 6Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Adding Mixed Numbers
� Add the fractions of the mixed number. Then add the
sum of the fractions to the whole number.
• Subtracting Fractions with the Same Denominator
� Subtract the numerator and place it over the
denominator.
• Subtracting Fractions with Different Denominators
� Find a common denominator, and then subtract.
Slide 7Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Subtracting Mixed Numbers
� When the numerator of the top fraction is smaller than
that of the bottom fraction, borrow one whole number
from the whole number of the mixed fraction and
express it as a fraction.
• Multiplying Fractions
� Multiply the numerators; multiply the denominators.
• Multiplying Fractions and Mixed Numbers
� Change the mixed number to an improper fraction.
� Multiply.
Slide 8Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
FractionsFractions
• Dividing Fractions
� Write the problem down correctly; invert the second
fraction.
� Multiply.
• Dividing Fractions and Whole Numbers
� Change the whole number to a fraction
� Divide.
Slide 9Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• The decimal fraction is a type of fraction that uses a
decimal to indicate the denominator of the fraction.
• The placement or position of the decimal point
determines whether the denominator is 10, a
multiple of 10, or a division of 10.
Slide 10Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Names of Decimal Places
.00001 One hundred thousandths
.0001 Ten thousandths
.001 Thousandths
.01 Hundredths
.1 Tenths
1. Unit (whole number)
10 Tens
100 Hundreds
1000 Thousands
10,000 Ten thousands
100,000 One hundred thousands
Slide 11Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Names of Decimal Places (continued)
� A decimal point found left of a whole number means that the number is a fraction of a whole number.
� A decimal point found after a number means that it is a whole number.
� A number without a decimal point is understood to
have an “invisible” decimal point behind it.
Slide 12Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Adding Decimals
� Align the decimal point of each decimal fraction in a
column.
� Add.
• Subtracting Decimals
� Align the decimal point of each decimal fraction in a
column.
� Subtract.
• Rounding a Number
� A number found after the decimal point that is 5 or
larger can increase the number before it by one whole
number.
Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Multiplying Decimals
� Multiply. Decimal points in the problem do not have to
be aligned.
� The decimal place in the answer is determined by
how many numbers are found to the right of the
decimal points in the numbers multiplied.
• Dividing Decimals
� Change a decimal fraction in the divisor to a whole
number by moving the decimal point all the way to the
right.
� Move the decimal point in the dividend the same
number of places moved in the divisor.
Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Dividing Decimals (continued)
� Place the decimal point in the answer directly over the
decimal point in the dividend after moving the decimal
point in the dividend.
� If a decimal point is in the divisor, but not in the
dividend, move it the same number of places as the
divisor. Remember, there is an unexpressed decimal
point at the end of all whole numbers. Add zeros after
the decimal point in the dividend as needed.
� If the dividend contains a decimal fraction and the
divisor does not, leave the divisor as it is.
Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Decimal FractionsDecimal Fractions
• Changing Fractions to Decimals
� Divide the numerator by the denominator.
• Changing a Decimal Fraction to a Common Fraction
� To change a decimal fraction to a common fraction,
give the decimal fraction a denominator according to
the position of the decimal point in the decimal
fraction.
Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PercentsPercents
• The word “percent” and its symbol, %, mean
“hundredths.”
• A hundredth is a fraction of a whole number;
therefore, a number followed by percent sign (%) is
a fraction.
• The denominator of the fraction is understood to
be 100.
Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PercentsPercents
• Changing a Percent to a Decimal Fraction
� Remove %; move the decimal point two places to the
left to indicate “hundredths.”
• Changing a Fraction to a Percent
� Change a fraction to a percent by dividing the
numerator by the denominator.
� Multiply the answer by 100.
� Label the answer with the percent symbol, %.
• Multiplying by Percent
� Change the percent to a decimal.
� Multiply.
Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
RatiosRatios
• Ratios show the relationship of one number or
quantity to another number or quantity.
• Numbers of a ratio are separated by a colon.
• A ratio is also a fraction.
• The value of a ratio is not changed if both terms are
multiplied or divided by the same number.
• When numbers are written in ratio, they must all be
expressed in the same units.
• A fraction may be written as a ratio.
Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
ProportionsProportions
• Proportion shows that the relationship between
two ratios has equal value.
• Definitions
� Means: inner terms of the proportion
� Extremes: outer terms of the proportion
• Set up the left side of the proportion as the “known”
side using information that is known or given.
Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
ProportionsProportions
• Set up the known side.
• Set up the unknown side. Use x for what you are
trying to find.
• Set up the units in the same position on each side of
the problem.
• Multiply the means.
• Multiply the extremes
• Solve for x (divide the number with the x into the
number on the opposite side of the problem).
• Label the answer with the unit of measurement that
accompanies the x in the problem.
Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
ProportionsProportions
• Review of Proportion Method
� Set up problems in the same order on both sides.
� Multiply the means; multiply the extremes.
� The number multiplied with the x is always that
number with the x to the right of it.
� Divide the number with the x into the number on the
other side of the problem.
� Label the problem by looking to see what unit of
measurement the x is with the proportion.
Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• The metric system is based on the decimal system.
• The decimal system uses the divisions and multiples
of a unit, which is always in ratios of tens.
• The metric system uses the following units:
� liter (L) = volume (amount) of fluids
� gram (g) = weight of solids
� meter (m) = measure of length
Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Smaller units of the system are designated by the
following prefixes:
� deci = 0.1 of the unit (liter, gram, meter); tenths
� centi = 0.01 of the unit; hundredths
� milli = 0.001 of the unit; thousandths
• Larger units of the system are designated by the
following prefixes:
� deka = 10 times the unit (liter, gram, meter)
� hecto = 100 times the unit
� kilo = 1000 times the unit
Slide 24Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Units of Weight
� 1 gram (g) = 1000 milligrams (mg)
� 0.001 gram (g) = 1 milligram (mg)
� 1 kilogram (kg) = 1000 grams (g)
� 0.001 kilogram (kg) = 1 gram (g)
• Units of Volume
� 1 liter (L) = 1000 milliliters (mL)
� 0.001 liter (L) = 1 milliliter (mL)
� 1 milliliter (mL) = 1 cubic centimeter (cc)
Slide 25Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Approximate Equivalents of the Metric System and
the Apothecary System
� Volume
• 1 milliliter (mL) = 15 or 16 minims
• 4 or 5 milliliters (mL) = 1 fluid dram
• 30 milliliters (mL) = 1 fluid ounce
• 500 milliliters (mL) = 1 pint
• 1000 milliliters (mL) = 1 quart
Slide 26Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Approximate Equivalents of the Metric System and
the Apothecary System (continued)
� Weight
• 60 milligrams (mg) = 1 grain (gr)
• 1000 milligrams (mg) = 15 grains
• 4 grams (g or gm) = 1 dram
• 30 grams (g) = 1 ounce
• 0.45 kilogram (kg) = 1 pound (lb.)
• 1 kilogram (kg) = 2.2 pounds (lbs.)
Slide 27Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Metric Measurements of Length
� The basic unit of length is the meter.
� The meter is equal to 39.37 inches.
� 0.001 meter = 1 millimeter (mm)
� 0.01 meter = 1 centimeter (cm)
� 0.1 meter = 1 decimeter (dm)
� 10 meters = 1 decameter (dam)
� 100 meters = 1 hectometer (hm)
� 1000 meters = 1 kilometer (km)
Slide 28Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
The Metric SystemThe Metric System
• Metric Measurements of Length
� Most frequently used equivalents
• 1 meter (m) = 1000 millimeters (mm)
• 0.001 meter (m) = 1 millimeter (mm)
• 1 meter (m) = 100 centimeters (cm)
• 1 centimeter (cm) = 10 millimeters (mm)
• 1 millimeter (mm) = 0.1 centimeter (cm)
Slide 29Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Pediatric ConsiderationsPediatric Considerations
• Young’s Rule
� A method for the calculation of the appropriate dose of
a drug for a child 2 years of age or older; applies to
children up to the age of 12
Age of child _
(Age of child + 12)× Average adult dose = Child’s dose
Slide 30Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Pediatric ConsiderationsPediatric Considerations
• Clark’s Rule
� A method of calculating the approximate pediatric
dosage of a drug for a child
Weight of child (lbs.)
150
× Average adult dose
= Child’s dose
Slide 31Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Pediatric ConsiderationsPediatric Considerations
• Fried’s Rule
� This rule is used for infants younger than 2 years of
age.
Age in months
150× Average adult dose = Child’s dose
Slide 32Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Pediatric ConsiderationsPediatric Considerations
• Estimating Body Surface Area in Children
� Body surface area is defined as the total area
exposed to the outside environment.
� Use body surface area scale to find the correct
surface area (SA).
SA (m2)
1.73 m2× Adult dose = Child’s dose
Slide 33Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PharmacologyPharmacology
• This is the study of drugs and their action on the
living body.
• Substances derived from plants and animals, from
vitamins and minerals, and from synthetic sources
can be used as drugs in the treatment and
prevention of disease.
• The action of any drug on the body is a complicated
process.
Slide 34Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PharmacologyPharmacology
• Pharmaceutical Phase
� The making of the drug until absorption of the drug
takes place in the patient’s body
• Pharmacokinetic Phase
� The movement of the drug’s active ingredients from
the body fluids into the entire system and to the site
where the intended action of the drug takes place
• Pharmacodynamic Phase
� Interaction of the drug’s active ingredient with the
intended body tissues; the body’s cells respond to the
action of the drug and change as the drug is
metabolized
Slide 35Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PharmacologyPharmacology
• Drug Dosage
� The dosage is the amount of a drug prescribed for the
patient by the physician.
� A dose of medicine refers to a single prescribed
amount of drug given at one time.
� Nurses must become familiar with therapeutic
dosages of frequently used drugs to confidently
administer dosages of medication to each patient.
Slide 36Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PharmacologyPharmacology
• Drug Actions and Interactions
� Two general types
• Local: Affect only the area where the drug is placed
• Systemic: Affect the entire body
� Drug interaction: One drug alters another drug
� Potentiation: One drug increases the action or effect
of another drug
� Incompatibility: Drugs that do not combine chemically
with other drugs
� Antagonist: Drug that will block the action of another
drug
Slide 37Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
• An idiosyncratic response to a drug is an
individual’s unique hypersensitivity to a particular
drug.
• A reduced response to a drug is called tolerance.
• An adverse drug reaction is a harmful, unintended
reaction to a drug administered at a normal dosage.
• Contraindications are conditions under which the
drug should not be given.
• Interactions are modifications of the effect of a drug
when administered with another drug.
PharmacologyPharmacology
Slide 38Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
PharmacologyPharmacology
• Factors that may affect how patients respond to
medication:
� Age
� Weight
� Physical health
� Psychological status
� Environmental temperature
� Gender
� Amount of food in the stomach
� Dosage forms
Slide 39Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication OrdersMedication Orders
• The nurse is ethically and legally responsible for ensuring that the patient receives the correct medication ordered by the physician.
• Medication orders should include the following:
� Patient's name
� Date and time of the order
� Name of the drug
� Dosage of the drug
� Route of administration
� Time or frequency drug is given
� Signature of the physician
� Any special instructions
Slide 40Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication OrdersMedication Orders
• Controlled Substances
� Opioids, barbiturates, and other controlled drugs that have a high possibility for abuse or addiction are double-locked.
� “Narcotic keys” are kept by designated nurses per shift.
� Each controlled drug used is logged into the narcotic log book.
� At the end of each shift, controlled drugs are carefully counted by a nurse from the outgoing shift and a nurse from the incoming shift.
� Always have a witness to the “wasting” of a controlled substance.
Slide 41Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication OrdersMedication Orders
• Types of Orders
� Standing orders
• Already written by a physician for all patients on a
particular unit or area
• Carried out without having to call the physician
� Verbal orders
• May be given in the presence of an LPN/LVN or an RN
directly or over the telephone
• Should be written on the chart and signed by the
physician as soon as possible
Slide 42Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication AdministrationMedication Administration
• Six Rights
� Right medication
� Right dose
� Right time
� Right route
� Right patient
� Right documentation
Slide 43Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication OrdersMedication Orders
• Important Considerations of Medication
Administration
� If you did not pour it, do not give it.
� If you gave it, chart it.
� Do not chart for someone else or have someone else
chart for you.
� Do not transport or accept a container that is not
labeled.
� Do not put down an unlabeled syringe.
� If given a verbal order, repeat it to the physician.
� If you make an error, report it immediately.
Slide 44Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Medication OrdersMedication Orders
• Important Considerations of Medication
Administration (continued)
� Never leave a medication with a patient or family
member. Watch the patient take it and swallow it.
� Always return to assess the patient’s response.
� Chart as soon as possible after giving medication.
� If a patient refuses medication, do not force it; chart
“Refused medication because of. . . .”
� If you elect to omit a dose based on your nursing
judgment, let another nurse help make the decision. If
medication is not given, document “Dose omitted
because. . . .” Report to the physician.
Slide 45Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Routes of AdministrationRoutes of Administration
• Enteral
� Via the GI tract
• Powders
• Pills
• Tablets
• Liquids or suspensions
• Suppositories
Slide 46Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Routes of AdministrationRoutes of Administration
• Percutaneous
� Through the skin or mucous membranes
• Topical
• Instillation
• Inhalation
Slide 47Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Routes of AdministrationRoutes of Administration
• Parenteral
� Methods other than the GI tract; needle route
• Ampules
• Vials
• Intramuscular
• Subcutaneous
• Intradermal
• Intravenous
Slide 48Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Enteral AdministrationEnteral Administration
• Preparation of Tablets, Pills, and Capsules
� These preparations enter the GI tract and are
absorbed more slowly into the blood stream than via
any other route.
� The slow absorption rate makes the PO (by mouth)
route relatively safe.
� Some PO medications are irritating to the patient’s GI
tract, and larger tablets may be difficult for some
patients to swallow.
Slide 49Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Skill 23-1: Step 5Skill 23-1: Step 5
Administering tablets, pills, and capsules.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Slide 50Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Enteral AdministrationEnteral Administration
• Preparation of Liquid Medications
� Liquid medications are often given to children; to
patients who cannot swallow tablets, pills, or
capsules; and to geriatric patients.
� Medications may be given PO or via a nasogastric,
gastrostomy, or jejunostomy tube.
� Liquids must not be given to unconscious patients
because of the possibility of aspirating.
� Some liquid medications are not to be followed by
water, and some may stain the teeth.
Slide 51Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Skill 23-2: Step 13Skill 23-2: Step 13
Administering liquid medications.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Slide 52Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Enteral AdministrationEnteral Administration
• Tubal Medications
� Nasogastric (NG) tubes are used to administer liquid
medications to unconscious patients, dysphagic
patients, and those who are too ill to eat.
� Many medications come in liquid form; if they do not,
solid tablets may be pulverized in a mortar and pestle,
and capsules can be opened.
� Not all tablets are safe to use when crushed, and not
all capsules are safe to use when opened.
Slide 53Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Skill 23-3: Step 13aSkill 23-3: Step 13a
Administering tubal medications.
Slide 54Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Skill 23-3: Step 16Skill 23-3: Step 16
Administering tubal medications.
Slide 55Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Enteral AdministrationEnteral Administration
• Suppositories
� Cone-shaped, egg-shaped, or spindle-shaped
medication made for insertion into the rectum or
vagina
� Dissolves at body temperature and absorbed directly
into the bloodstream
� Useful for infants, patients who cannot take oral
preparations, and patients with nausea and vomiting
� Stored in cool place so they do not melt
Slide 56Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• With these routes, medications are absorbed
through the skin or the mucous membranes.
• Most produce a local action, but some produce a
systemic action.
• Drugs include topical applications, instillations, and
inhalations and ointments, creams, powders, lotions,
and transdermal patches.
• Absorption is rapid but of short duration.
Slide 57Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Ointments
� An oil-based semisolid medication; may be applied to
the skin or a mucous membrane
• Creams
� Semisolid, nongreasy emulsions that contain
medication for external application
• Lotions
� Aqueous preparations that are used as soothing
agents that relieve pruritus, protect the skin, cleanse
the skin, or act as astringents
Slide 58Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Transdermal Patches (Topical Disk)
� Adhesive-backed medicated patches applied to the
skin provide sustained, continuous release of
medication over several hours or days.
• Eyedrops and Eye Ointments
� Care should be taken to keep all ophthalmic
preparations sterile by not touching the dropper or the
tube to the eye.
• Eardrops
� Containers of solutions to be used as eardrops will be
labeled “otic.” They must be at room temperature
when applied.
Slide 59Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-4Figure 23-4
A variety of medications are available as transdermal patches.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 60Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Nosedrops
� Nosedrops are for individual use only.
• Nasal Sprays
� Sprays absorbed quickly; less medication is used and
wasted when administered in this manner.
• Inhalation
� Drugs may be absorbed through the mucous
membranes of the respiratory tract.
� Inhalation produces a relatively limited effect or a
systemic effect.
� This method is actively used by respiratory therapy
and anesthesiologists.
Slide 61Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Sublingual Administration
� Drug is administered by placing it beneath the tongue
until it dissolves.
� Drug may be a tablet or liquid squeezed out of a
capsule.
� It is rapidly absorbed into the bloodstream.
• Buccal Administration
� A tablet is placed between the cheek and teeth, or
between the cheek and the gums.
� Absorption into the capillaries of the mucous
membranes of the cheek gives rapid onset of the
drug’s active ingredient.
Slide 62Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Parenteral AdministrationParenteral Administration
• Equipment
� Syringes
• Syringe consists of a barrel, a plunger, and a tip.
• Outside of the barrel is calibrated in milliliters, minims,
insulin units, and heparin units.
• Types
� Tuberculin syringe
� Insulin syringe
� Three-milliliter syringe
� Safety-Lok syringes
� Disposable injection units
Slide 63Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-5Figure 23-5
Parts of a syringe.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 64Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-6Figure 23-6
Tuberculin syringe calibration.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Slide 65Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-7Figure 23-7
Calibration of U100 insulin syringe.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Slide 66Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-8Figure 23-8
Reading the calibrations of a 3-mL syringe.
Slide 67Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-10Figure 23-10
Safety-Glide syringe.
Slide 68Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-12Figure 23-12
Parts of a needle.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Slide 69Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Equipment (continued)
� Needles
• Parts are the hub, shaft, and beveled tip.
• Opening at the needle’s beveled tip is the lumen.
• Size of the diameter of the inside of the needle’s shaft
determines the gauge of the needle; the smaller the
gauge, the larger the diameter.
• Needle gauge selection is based on the viscosity of the
medication.
Slide 70Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Equipment (continued)
� Needle length
• Selected based on the depth of the tissue into which the
medication is to be injected
• Intradermal: 3/8 to 5/8 inch
• Subcutaneous: 5/8 to 1/2 inch
• Intramuscular: 1 to 1 1/2 inch
� Intravenous needles
• Butterfly (scalp needle)
• Over-the-needle catheter (Angiocath, Jelco)
Slide 71Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-13Figure 23-13
Needle length and gauge.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Slide 72Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Equipment
� Needleless devices
• Devices are designed with a sheath or guard that
covers the needle after it is withdrawn from the skin.
• Intravenous catheters have been designed with
blunt-edged cannulas, valves, or needle guards to
minimize injuries.
• IV tubing with recessed and shielded needle connectors
has been designed, further reducing needlesticks.
Slide 73Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Intramuscular Injections
� Involves inserting a needle into the muscle tissue to
administer medication
� Site selection
• Gluteal sites
• Vastus lateralis muscle
• Rectus femoris muscle
• Deltoid muscle
� Z-track method
• Used to inject medications that are irritating to the
tissues
Slide 74Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-15, CFigure 23-15, C
Locating IM injection for ventrogluteal site.
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 75Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-16, CFigure 23-16, C
Giving IM injection in vastus lateralis site on adult.
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 76Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-17Figure 23-17
Rectus femoris muscle. A, Child/infant. B, Adult.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Slide 77Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-18, CFigure 23-18, C
Giving IM injection in deltoid site.
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 78Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-19Figure 23-19
A, Z-track method. B, Using an air lock. C, Administering IM injection
by airlock technique.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Slide 79Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Intradermal Injections
� Introduction of a hypodermic needle into the dermis
for the purpose of instilling a substance such as a
serum, vaccine, or skin test agent
� Not aspirated
� Small volumes (0.1 mL) injected to form a small
bubblelike wheal just under the skin
� Used for allergy sensitivity tests, TB screening, and
local anesthetics
� A tuberculin syringe used with a 25-gauge, 3/8- to
5/8-inch needle
Slide 80Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-20Figure 23-20
Angles of insertion for intramuscular (90°), subcutaneous (45°), and
intradermal (15°).
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Slide 81Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Subcutaneous Injections
� Injections made into the loose connective tissue
between the dermis and the muscle layer
� Drug absorption slower than with IM injections
� Given at a 45-degree angle if the patient is thin or at a
90-degree angle if the patient has ample
subcutaneous tissue
� Usual needle length is 1/2 to 5/8 inch and 25 gauge
� Used to administer insulin and heparin
Slide 82Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-21Figure 23-21
Subcutaneous injection. Angle and needle length depend on the
thickness of skinfold.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Slide 83Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Intravenous Therapy
� Provide fluid and electrolyte maintenance, restoration,
and replacement
� Administer medication and nutritional feedings
� Administer blood and blood products
� Administer chemotherapy to cancer patients
� Administer patient-controlled analgesics
� Keep a vein open for quick access
Slide 84Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Methods of Intravenous Administration
� IV push
� Intermittent venous access device
� Intermittent infusion (or piggyback)
� Continuous infusion
� Electronic pumps and controllers
� Patient-controlled analgesia
� Volumetric chambers
Slide 85Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-23Figure 23-23
PCA infusion pump.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Slide 86Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 23-24Figure 23-24
Volumetric chamber.
Slide 87Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Nursing Responsibility
� The nurse must ensure that fluid of the ordered type
and amount is started and that the fluid is regulated to
infuse over the period ordered.
� To find the drops per minute (the drip rate), you must
know which type of IV tubing will be used with the
infusion and obtain the drip factor for the tubing to be
used.
Slide 88Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Nursing Responsibility (continued)
� Monitor intravenous therapy
• Check the infusion and the IV needle site at least every
hour.
� Flow of fluid
� IV site: erythema, wetness, and edema
� Phlebitis: inflamed vein
� Infiltration: fluid passes into the tissues
• Assess for chills, fever, headache, nausea, vomiting,
anxiousness, and dyspnea.
Slide 89Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Percutaneous AdministrationPercutaneous Administration
• Nursing Responsibility (continued)
� Assess for anaphylactic shock
• Respiratory distress
• Skin reactions
• Signs of circulatory collapse
• GI signs and symptoms
• Change in mental status
� Requires immediate intervention.
Slide 90Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing ProcessNursing Process
• Nursing Diagnoses
� Anxiety
� Health-seeking behaviors
� Injury, risk for
� Knowledge deficient
� Mobility, impaired
� Noncompliance: drug regimen
� Sensory/perception, disturbed