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Medications

Lab Skills#3

QuestionAnswer
1. Checks chart for order 2. Review policy and procedure
3. State goals a. 6 rights: patient, drug, dose, time, route, documentation b. no adverse reaction c. narcotic=pain relief, heparin=no thrombophlebitis, insulin=wnl blood sugar d. minimal discomfort from the injection Compares medical order with information transcribed to the MAR.
Reviews pertinent drug info in appropriate text. Perform hand hygiene
1. Selects appropriate size and gauge needle and syringe according to type of med, size of patient, and volume of med 2. Checks expiration date
3. Compares med label with MAR 3 times: a. when obtaining from drawer b. after preparing drug c. before returning unused med to drawer or at patient bedside. 4. Vial: cleanse rubber stopper. With needle cap in place pull back on plunger to draw air into the syringe equivalent to the amount of med to be aspirated. Injects air, needle is above the liquid. Ampule: break, x to filter needle No bubbles
5. STEPS Vial: pull plunger, get slightly more; tap syringe. Withdraws Ampule: withdraws appropriate taps syringe (Discards ampule in sharps container). 6. Caps or changes needle without contaminating and proceeds to patient’s room.
7. Provides privacy for patient 8. Performs hand hygiene
*1. Identifies patient 2 ways with MAR at bedside: a. Have pt. to state name and DOB b. wrist band & MR # *2. Check the 6 rights: patient, drug, dose, route, time, documentation *3. Checks patient allergies 4. Explains procedure to patient 5. Establishes method of comm. during the procedure 6. Allow patient verbalization (using established method of communication)
9. Raises bed to comfortable working height and raises rail up on the opposite side 10. Correctly positions patient and drapes according to procedure
11. Assess patient: a. allergies, age, body build, muscle size, where last injection was given, condition of tissue to be injected. b. if pain med, level of pain on 1-10 scale. c. if insulin, BS 11a. d. if Heparin, check last PPT and for s/s thrombophlebitis. e. if PRN med, time of last dose. f. if narcotic check vital signs
12. Selects appropriate injection site for med and palpates site for masses, edema, or tenderness. Verbalizes anatomic landmarks. 13. Cleanses site with alcohol in circular motion without retracing steps to a 2” diameter.
14. Applies non-sterile gloves 15. Procedures 1. With non-dominant hand, either spreads or pinches up skinfold.
STEPS 2. Inserts needle at appropriate angle: a. sub-q: 45° or 90° b. IM 90° 3. Releases pad of tissue and steadies the lower end of the syringe barrel with non-dominant hand (unless z-track method)
4. (IM Only) aspirates to check for blood 5. Injects med slowly and steadily then withdraws needle quickly while placing alcohol swab on skin above injection site with gloved hand.
6. Applies gentle pressure at site. Does not massage. Observes for bleeding. * 16. Clean-up & Follow-up education 1. Does not recap needle. If present, activates needle safety device before disposing syringe in sharp container.
2. Removes gloves correctly and performs hand hygiene 3.Follow-up:a. narcotics/cns depressants:safety,return 30 minutes, rescale pain. Not get out of bed. adverse reactions b.insulin: pt gets meal tray, see % eaten & sugar, Assess for s/s hypoglycemia. c.heparin: any bleeding, PT & PTT, thrombophlebitis
4. Follow-up education: a. teach purpose, effects of meds. b. cns depressants: Instruct to not get out of bed with out assistance. c. insulin: teach self administration, s/sx or hyper/hypoblycemia, site 5. Leave patient safe and comfortable a. side rails up b. bed at lowest position c. call light with reach d. reposition patient
6. Discards equipment according to policy, cleans up equipment and disposes of appropriately STEPS 7. Performs hand hygiene
17. Documents a. Date and time medication given b. Type of medication c. Amount of medication d. Location e. Route f. Identify Initials If narcotics given: sign out on narcotic sheet (if available). If wastage: fill out sheet (or electronically sign) with licensed witness, observe waste and sign wastage sheet with you. If med is a PRN order : narrative doc needed for pt complaint
If med is a PRN order : narrative documentation needed for patient complaint, assessment, and medication given. reassess in 10-30 minutes (depending on route), document pt response. Report any undesirable effects to MD and/or charge nurse and document. * DON STERILE GLOVES CORRECTLY
Created by: palmerag
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