Nursing Skills
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Transcript of Nursing Skills
Purpose Diagnosis Cure Treatment of symptoms Relief of symptoms Prevention of disease
Generic name – given before a drug becomes official
Official name – name under which it is listed in one of the official publications
Chemical name – name by which a chemist knows it; name describes the constituents of the drug precisely
Trademark or brand name – name given by the drug manufacturer
Absorption - way medication enters the blood stream
Distribution – transportation of a drug from its site of absorption to its site of action
Metabolism – liver break down to less active form; drug is converted to a less active form
Excretion – elimination from body
Therapeutic Effect or desired effect• The reason the drug is prescribed
Side Effect or secondary effect – unintended; usually predictable may be harmless or potentially harmful
Adverse Effect – side effects that are not tolerated
Idiosyncratic – unexpected & individual
Patient name Time/Date order written Name of medication Dosage of medication Frequency of dose Route Signature
Stat – immediately• Demerol 50mg IV now
Single order/one time only – given once at a specific time• Demerol 50mg IV at 0800
Standing – carried out indefinitely • Demerol 50mg IV q8h• Demerol 50mg IV q8h x 4days
PRN – as needed order • Demerol 50mg IV q4h prn
ac – before meals bid – twice a day h – hour hs – at bedtime pc – after meals q – every qid – four times a
day tid – three times
a day
IM intramuscular
IV intravenous sq subcutaneous q2h every 2
hours NPO nothing by
mouth OD right eye OS left eye OU both eyes
“U” – (unit) – Mistaken for zero: write out unit
“IU” – International Unit – Mistaken for “IV”
“Q.D” “QD” “q.d.” “qd” – Daily “Q.O.D.” “QOD” “q.o.d.” “qod” – every
other day Relating to ears – AU, AS, AD D/C – discharge or discontinue Qhs – at bedtime, hours of sleep Ss – sliding scale vs one half
Trailing zero – X.0mg – write X mg Lack of leading zero - .X mg write
0.X mg Decimal points are missed “cc” – use “ml” or “milliliters” Abbreviations for drugs due to
similar abbreviations for multiple drugs
The use of “/” write per
Right patient Right medication Right dose Right route Right time Right documentation
Clarify any inappropriate/unclear orders
Follow patient rights
Do not administer medication from an unlabeled container
Do not prepare medications and not give them
Do not leave medications at the bedside – exceptions, nitro tabs, inhalers
Verify for accuracy – insulin and anticoagulants
Do not administer medication prepared by another nurse
Check or scan patient wrist band with MAR before administration
If patient questions medication – verify order
Identify the patient – watch for similar names
Inform the patient – explain purpose of medications, potential side effects
Administer the medication – Use appropriate interventions Document medication Evaluate patient response
Decreased vision/manual dexterity Decreased renal function Slower absorption in GI tract Decreased liver function Increased proportion of fat to lean
body mass Increases the chances of
cumulative effects and toxicity
Oral Sublingual Buccal Parenteral
•Subcutaneous•Intramuscular•Intradermal•Intravenous
Topical•Transdermal•Inhalation•Ophthalmic•Otic•Nasal
Rectal Vaginal
Most common route Assess patient’s ability to swallow Tablets or capsules – do not crush
enteric coated, cut only scored tablets
Liquid medications – pour medications away from the label
Sublingual/Buccal – directly enters bloodstream, bypass liver
Assess patency of NG tube, Dob-Hoff tubes are not used for medication administration.
If to suction, turn suction off Verify tube placement, aspiration or
auscultation Flush tube with 15-30 ml of water Dissolve medications in warm water Slowly administer medications through
tube Flush tube –assuring administration Leave suction off for 30 minutes Record water used for flush/administration
on Intake report
Tube placed through abdominal wall If to feeding, place on hold Check residual by aspiration. Flush tube with 15-30 ml of water Dissolve medications in warm water Slowly administer medications
through tube Flush tube –assuring administration Resume feedings Record water used for
flush/administration on Intake report
Provides local effect Dermatological- applied to skin Installations/Irrigations – urinary
bladder, ears, eyes, nose, rectum, vagina
Inhalations – into the respiratory system
Prolonged systemic affect Patches- nitroglycerine, estrogen,
nicotine Apply to clean area of skin Each application to a different site May cause localized, redness, itching Wear gloves when applying to avoid
receiving the medication
Administered by irrigation or installation
Drops or ointment Clean eye from inner canthus
to outer Medication is placed in the
lower conjuctival sac
Installation or irrigation Softening of wax to ease with
removal Reduce inflammation/infection Aseptic technique Sterile technique if eardrum is
perforated
Drops or spray Shrink swollen membranes Loosen secretions to facilitate
drainage Treat infections Chronic use of decongestants-
rebound effect
Inhalation Nebulizers- delivered by a
fine spray MDI- metered dose inhaler Rapid localized relief
Provides local therapeutic effect Treat infections & vaginal discomfort Foams, creams, suppositories Medical aseptic technique is used Application:
• Tubular applicator with a plunger (2in)• Suppositories inserted with the index finger
of a gloved hand (3-4in) Patient to remain supine for approx
5-10minutes
Suppositories Insert approx 4 inches Left lateral/supine for 5-10
minutes Retain for 30-40minutes Medication released at a
slow steady rate
Intramuscular (IM)• Ventrogluteal, vastus lateralis,
dorsogluteal, deltoid • Gauge and needle size depend on
amount of solution, muscle to be used, condition of patient
Ampule – Glass, unit dose, draw up using filter needle then change to injection needle, do not inject air into ampule
Vial – Rubber seal, unit or multiple dose, clean top prior to withdrawing medication, inject air into vial equal to the amount to be withdrawn
Reconstitution – adding of sterile water or sterile normal saline
Mixing Medications – if compatible
Use if volume is 0.5 - 1 cc, but not more than 1 ml. Use a 23 -25 gauge, 1 inch needle.
Client may be positioned sitting, standing, supine, or prone.
Locate site by measuring 2–3 fingerbreadths below the acromion process on the lateral midline of the arm.
Use if volume is 1 - 3 cc, but less than 4 cc. Use a 20 - 23 gauge, 1-1/2 inch needle.
Position client in side-lying or supine position, with knee flexed on injection side,
Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter. Administer medication above imaginary line at midpoint.
Use if volume is 1 - 3 cc. Use a 20 - 23 gauge, 1-1/2 inch needle
This is the preferred site for adults
Position client in supine, prone, lateral position.
Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger (forming a "V"). Injection of medication is given within the "V" area.
Use 22–25 gauge, 5/8–1 inch needle.
Position client in supine or sitting position.
Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the middle third and anterior lateral aspect of the thigh.
Subcutaneous(SQ) – Ex. Insulin• #25 gauge, 3/8 or 5/8-inch needle, 2ml syring,
inserted at either a 45 degree or 90 degree angle.• Site: Abdomen, upper arm, thigh• Sites rotated to avoid tissue damage, aid
absorption Intradermal (ID) – Ex. TB
• #25-#27guage needle, ¼ to 5/8 inch needle; insert at a 5 to 15 degree angle, bevel up
• Medication forms a bleb under the epidermis (small wheal on the skin)
• Site: inner lower arm, the upper chest, & the back beneath the scapulae
Figure 33-35
Mixing two types of insulin
Enter directly into blood stream –rapid effect
Large Volume – 500-1,000 ml Intermittent – piggy back IV push (IVP) – verify rate of
infusion Assess IV site, redness, swelling, s/s
infection, Verify IV patency prior to
administering IV medications All IV fluids must be labeled
Infection – (catheter related) – sepsis Air embolism – introduction of air
during administration•S/S respiratory distress, chest pain, hypotension, weak rapid pulse
Infiltration – seepage of fluid into surrounding tissue•S/S swelling coolness, discomfort