Administering Medications

This is Unit Sixteen of Medical Assistant Prep. Unit Six covered the checks and the arithmetic of a medication. This unit covers giving one: the routes, oral and inhaled and eye medications, and injections, wherever the state, the practice and your training allow you to give them. Carry one idea through this lecture. The order names the route, the route decides the technique, and the checks before an injection and the watching after it are part of the procedure, not extras. A constructed injection at the end shows every step done right. By the end you will be able to give oral, inhaled and eye medications. To prepare an injection from a vial or ampule. To choose the angle and site for each injection type. And to carry an injection from order to record.

Five entries on routes and non-injected medications: oral, crushing, inhalers and spacers, and eye drops.

Named by the order.

MAS 376 Routes of Medication

The route is how a medication enters the body, and the order names it. Routes include oral, by mouth; inhaled; into the eye or ear; topical, on the skin; and parenteral, meaning by injection. The route is one of the five rights. Never change it, even for a patient who asks.

Alert and able to swallow.

MAS 377 Giving Oral Medications

Oral medications are swallowed, so the patient must be alert and able to swallow safely. Help the patient sit upright, give the medication with fluid as directed, and stay until it has been swallowed. If a patient has trouble swallowing, stop and tell the provider rather than changing the medication's form yourself.

Coated and long-acting forms.

MAS 378 Some Tablets Must Never Be Crushed

Some tablets and capsules must never be crushed or opened. Enteric-coated tablets and sustained-release or long-acting forms lose their intended action when crushed; check a drug reference or ask the pharmacist before crushing anything. Crushing a long-acting tablet can release the whole amount at once.

With a spacer.

MAS 379 Inhalers and Spacers

A metered-dose inhaler works best with a spacer, which helps the medication reach the lungs instead of the mouth. The patient shakes the inhaler, attaches the spacer, breathes out, inhales the puff through the spacer, and holds their breath for a few seconds. Reinforce the steps the provider has taught; do not invent new instructions.

The lower pocket.

MAS 380 Eye Drops and Eye Ointment

Eye drops and ointment are placed in the lower conjunctival sac, the pocket formed by gently pulling down the lower lid. Ointment is applied in a thin line moving from the inner corner of the eye outward. Do not let the dropper tip touch the eye or lashes; a touched tip is contaminated.

Four entries on preparation: syringes and needles, drawing from a vial or ampule, and keeping the needle sterile.

Chosen by order and patient.

MAS 381 Syringes and Needles

Injections use a syringe and a needle, and the needle is described by its gauge and its length. The right needle depends on the type of injection, the site, and the patient's size and age; the provider's order and the practice's procedure guide the choice. Read the syringe's markings carefully, because syringes are scaled differently.

Air in, medication out.

MAS 382 Drawing Medication From a Vial

Medication is drawn from a vial through its rubber stopper. Pull air into the syringe equal to the amount you will remove, insert the needle through the stopper, push the air in, then invert the vial and draw the medication. Verify the rights at least three times before the medication reaches the patient, including a label check against the order.

Filter needle, then change.

MAS 383 Drawing From an Ampule

An ampule is a small sealed glass container with a scored neck that is snapped open. Medication is drawn from an ampule with a blunt filter needle, which keeps out any glass particles; then the needle is changed before injecting. Ampule medication is used at once, and any leftover is discarded properly.

New for every patient.

MAS 384 Keeping the Needle Sterile

The needle and the inside of the syringe must stay sterile. Keep the needle from touching any unsterile surface, use a new sterile syringe and needle for every patient, and use single-dose vials whenever possible. Discard anything whose sterility is in question, even if it means starting the preparation again.

Nine entries on technique: the dart grip, three injection types and their angles, sites, aspiration and the Z-track method.

Quick and smooth.

MAS 385 Hold Like a Dart, Insert Quickly

Hold the syringe like a dart and insert the needle quickly at the angle the injection type calls for. A quick, smooth insertion is more comfortable for the patient, and the dart grip prevents pressing the plunger by accident. Withdraw the needle at the same angle it went in.

Skin, fat, muscle.

MAS 386 Three Injection Types and Their Angles

Three injection types are named for the tissue they reach, each with its own angle. Intradermal goes into the dermis at a shallow five to fifteen degrees, bevel up. Subcutaneous goes into the fat beneath the skin at forty-five or ninety degrees: ninety for normal-sized or larger patients, forty-five for thin patients with little fat at the site. Intramuscular goes into muscle at ninety degrees. The wrong angle puts medication into the wrong tissue, where it may not work as intended. The order gives the route and the route decides the angle, so confirm the route before choosing angle and needle.

A small bleb.

MAS 387 Intradermal Injections

An intradermal injection places a small amount of medication directly under the skin's surface. With the bevel up, insert the needle at five to fifteen degrees, advance only enough to cover the bevel, and inject; a small raised bubble, called a bleb, shows correct placement. Do not massage or cover the site afterward.

Into fat.

MAS 388 Subcutaneous Injections

Subcutaneous injections go into the fat layer under the skin; insulin and heparin are common examples. Pinch the skin, insert quickly at forty-five or ninety degrees depending on the patient's fat at the site, and inject. With heparin or an insulin pen, keep the skin pinched during the injection and release it immediately before withdrawing.

Regions and spacing.

MAS 389 Subcutaneous Sites and Rotation

Subcutaneous injection sites are rotated to protect the tissue. For insulin, choose one body region and rotate within it; the abdomen absorbs fastest, followed by the arms, thighs and buttocks. Heparin is given in the abdomen, at least two inches from the navel. Rotate heparin sites to avoid bruising in one spot.

By age and order.

MAS 390 Intramuscular Sites

Three muscles are commonly used for intramuscular injections: the ventrogluteal, the vastus lateralis and the deltoid. The ventrogluteal site is recommended for adults; the vastus lateralis in the thigh is preferred for infants, because it is their most developed muscle; the deltoid is recommended for adult vaccines. Choose the site by age and order, never by convenience.

Below the acromion.

MAS 391 Finding the Deltoid Site

The deltoid injection site is in the middle of the deltoid muscle in the upper arm. Find the bony point at the top of the shoulder, the acromion process; the site lies about one to two inches below it, in the center of the muscle. Expose the whole upper arm, so you can see the landmarks rather than guess through a sleeve.

Only when indicated.

MAS 392 Aspiration Only When Indicated

Pulling back on the plunger to check for blood, called aspiration, is done only when the practice's policy and the manufacturer indicate it. If aspiration is indicated, pull back gently and watch for blood in the syringe before injecting. Follow the practice's current procedure; do not add or skip aspiration by habit.

Sealing the path.

MAS 393 The Z-Track Method

The Z-track method, supported by evidence for intramuscular injections, keeps medication from leaking back into the tissue under the skin. Pull the skin down or to one side about an inch before inserting the needle; releasing it afterward leaves a zigzag path that seals the medication in the muscle. Use it when the order or the practice's procedure calls for it.

Four entries close the unit: insulin as high-alert, sharps after injection, the full sequence, and a constructed vaccine injection.

Insulin syringes only.

MAS 394 Insulin Is a High-Alert Medication

Insulin is a high-alert medication, meaning an error can cause serious harm. Use only insulin syringes, which are marked in units, read the markings carefully, and have the amount double-checked where the practice requires it. Never use any other kind of syringe for insulin, and never guess at a marking you cannot read.

Activate, then container.

MAS 395 Safety Devices and Sharps After Injection

After an injection, activate the needle's safety device and place the syringe straight into the sharps container. Needleless systems and engineered safety devices are used whenever possible to prevent needlesticks. Do not recap; if recapping is ever unavoidable, use only a one-handed method, never two hands.

Order to record.

MAS 396 An Injection From Start to Finish

Every injection follows one sequence. Confirm the order, and that the task is within your scope and policy. Check the rights, identify the patient with two identifiers, and ask about allergies. Prepare the medication, checking label against order. Clean your hands, glove, and select and expose the site. Clean the site, insert at the correct angle and inject. Withdraw, activate the safety device and place the syringe in the sharps container. Watch for any reaction, and document drug, route, site, time and your name. Watching afterward is part of the injection, because reactions such as anaphylaxis can begin within minutes.

A vaccine, given and watched.

MAS 397 One Injection, Done Right

A constructed case pays off the opening idea. The provider orders an intramuscular vaccine for an adult, and the assistant confirms it is within her role. She checks order, route and patient, confirms his name and date of birth, and asks about allergies and past vaccine reactions. She checks the label against the order when she picks up the vial and again as she prepares it. With his whole upper arm bare, she finds the acromion and the deltoid's center about two inches below. Gloved, she cleans the site, inserts like a dart at ninety degrees, injects, withdraws at the same angle, activates the safety device and drops the syringe in the container. She checks the label once more, documents, and has him wait the required period. The wait and prompt recording catch a reaction and prevent a double dose.

Look at what you can now do. You can give oral, inhaled and eye medications by the ordered route, and check before crushing any tablet. You can prepare an injection from a vial or ampule, keeping the needle and syringe sterile. You can match intradermal, subcutaneous and intramuscular injections to their angles and sites, and apply aspiration or the Z-track method only as indicated. And you can handle insulin and sharps safely and carry an injection through to watching and recording. Unit Seventeen turns to respiratory care and specimen collection.