Medication Administration

0:01This is a demonstration of parental and

0:03non-parental medication administration.

0:05Now I'm going to prepare my first check.

0:08The first check is done independently by

0:10the student. First check the health care

0:13provider's orders match the MAR. Verify

0:16the patients name and allergies,

0:18medication dose, time and frequency and

0:21route. Gather appropriate medications

0:23and supplies. Check each medication

0:26individually against the MAR to include

0:28the patients name, name of med, dose,

0:32time, and frequency, and route. Checks

0:34the expiration date, and perform

0:36calculations if needed. Check pertinent

0:39labs if indicated. Review medication

0:42information needed to safely administer

0:44medications.

0:46So, my scenario is for Becky Richard.

0:49She's 46 years old. She is admitting

0:51diagnosis of rule out DBT. She um has an

0:55allergy to warin. So my shift report

0:58that I'm given is Miss Richards is a

0:5946-y old female who was admitted through

1:01the emergency room with left leg pain

1:04and a history of diabetes melodous. She

1:07had an oif of a left hip fib fracture

1:10following a motor vehicle accident. She

1:12had noticed increased pain, redness, and

1:14swelling in her left leg over the last

1:17two days. So her husband brought her to

1:18the emergency room for medical

1:20attention. She is a full code. My

1:23initial assessment is complete. Her

1:26finger stick blood sugar is currently

1:28305. Vital signs were just taken. Blood

1:31pressure 150 over 88, heart rate 96,

1:34respiratory rate 22, temperature 98.2,

1:38and SPO2 is 96% on 2 L nasal canula. The

1:43time is now 2030. Miss Parker's nurse

1:46has asked me and my instructor to

1:48prepare and give her her evening

1:50medications.

1:52I'm completing my first check. I have

1:54this for Becky Richards and I have my

1:56orders and I have my MAR and I [snorts]

1:59see that we have Leinipil ordered 10

2:01milligrams PO every evening. And I see

2:04that Leinipril 10 milligrams PO every

2:07evening and that's due at 2100. Since

2:10the time is 2030, that is when that is

2:12within the appropriate time to

2:14administer this medication. I also see

2:17an order for novalogue or insulin aspart

2:19sliding scale subcutaneous AC and HS and

2:23I see that over here on my MAR as well

2:26insulin aspart or novalog AC and HS it's

2:30due at 2100 the time is 2030 so I'm able

2:34to give that I was told that my blood

2:36sugar is 305 and according to the

2:38slotting scale 305 is five units I'm

2:42also checking that on my orders and 305

2:45also correlates to five units. I'm going

2:48to um get my medications um and go ahead

2:51and get those out so I can compare. So I

2:54have found my leinopril

2:57and I have found my insulin. So now what

3:00I'm going to do is I'm going to compare

3:02my medication across my orders and

3:05across my MAR. So this is for patient

3:08Becky Richards. She has an allergy to

3:10warin. I have Leinipril 10 milligrams PO

3:14every evening that matches Leinipril 10

3:17milligrams. It's a tablet so it's PO

3:20expiration date 9192030

3:23and I find it over here on my MAR as

3:25well. Leinipril 10 milligrams PO every

3:29evening and it's due at 2100 and again I

3:32have my Leinipril 10 milligrams. The

3:35expiration date is fine and this

3:37medication is able to be given. The

3:40patient's blood pressure is stable and

3:41normal. So I have no concerns with that.

3:44The next is my insulin. So I have no

3:46bolog or insulin aspart. Again the

3:49patient's blood sugar was 305. So I'm

3:51comparing my medication to my m and this

3:54matches. This is insulin aspart expires

3:5712 of 2030. I bring it over to my m and

4:01I hold it against that. I have insulin

4:03aspart. Insulin aspart and it's due at

4:062100. The time is now 2030. So this is

4:09able to be given and again the blood

4:12sugar was 305 which means she will get

4:15uh five units and so all of this

4:17matches. Again this is for patient Becky

4:20Richards with an allergy to warin. All

4:22of my patient numbers match 0829682968.

4:28I will also um get a medication cup

4:32ready so I have that ready for my pill.

4:36I'm also going to gather my supplies.

4:39So, I need an insulin syringe. This is a

4:4229 gauge half mill. Um, it's the orange

4:46cap. So, this is my insulin syringe. I'm

4:48going to have that ready. I am filling

4:51out my label, so I have that ready to go

4:54as well. I'm going to get um some

4:58alcohol swabs to have.

5:03All right. And I have my drug cards

5:04ready. So, I have checked everything. I

5:06have completed my first check. And now

5:08I'm ready to do my second check with my

5:10instructor.

5:25So, we are pretending that this is

5:27outside of the patient's room. And this

5:30is my second check.

5:32For the second check, this is done with

5:34the instructor.

5:36Check the medication lab with the MAR as

5:39each drug is prepared.

5:41Verbalize the patient name, name of

5:44medication, dose, time, and frequency,

5:46and route.

5:48State safe dose dose ranges. Indicate

5:51reason for administration,

5:53classification, mechanism of action,

5:55adverse

5:57side effects, and nursing

5:58considerations. For injections,

6:01vigorously clean rubber stopper of vial

6:04with alcohol swab. Withdraw medication

6:07from vial using blunt tip needle. Then

6:09scoop cap to cover needle. Replace blunt

6:12tip needle with appropriate needle for

6:13injection. Not done with insulin

6:16syringe. Label syringe if used with name

6:19of drug, dose, and the initials.

6:22Identify landmarks, needle gauge, and

6:24size for injections. Use your table

6:27below.

6:28All right. So, I have my instructor

6:30right here with me and so she is going

6:32to do my second check. So, this is

6:35medications to Mar. So, the first one

6:38that I have is my Novalog insulin. Um,

6:42so I see that on here for PE patient

6:45Becky Richards um 082968 patient number

6:49and allergy to Warren. Um, her blood

6:52sugar was 305, meaning that she will get

6:54five units. So that matches with my

6:57medication and again it's due at 2100.

7:00The time is 2030. So it's appropriate to

7:03give. Um I have my uh expiration date is

7:07within date. I have my um insulin

7:11syringe here. So I'm going to go ahead

7:14and open that up.

7:19I'm going to clean vigorously for 10 to

7:2215 seconds.

7:27I'm going to take the lid off. Lay that

7:30down.

7:31I can move the little white safety out

7:34of the way so I can see. I'm going to

7:37draw up five units of air.

7:43And I'm going to inject

7:45into my insulin.

7:50Going to draw back five units. And I'm

7:53going to ask my instructor to verify

7:55this with me that it is five units. And

7:57another RN since it's insulin will also

8:00verify that this is correct.

8:03Utilizing the scoop method, I will

8:05safely recap my needle.

8:09And

8:13I have a label that's ready for this.

8:15That way it is ready to go. I'm going to

8:18put this to the side.

8:21My next one is my leinipril. So I'm

8:24bringing that directly over to my MAR

8:26leinipril 10 milligrams PO every evening

8:29for patient Becky Richards. Again,

8:31allergy to warin patient numbers match.

8:34And I see that this is due at 2100. The

8:37time is 2030. So I'm able to give this

8:40and again this all matches. Leinipril 10

8:43milligrams PO it's a pill. Um an

8:46expiration date 9192030.

8:49So this is able to be given. So I'm

8:51putting this here. So now I'm going to

8:52tell my instructor about the medications

8:55that I'm going to be giving. The first

8:57one is insulin aspart or novalog. It is

8:59a antid-diabetic and it's rapid acting.

9:02I know that this lowers blood glucose by

9:04increasing peripheral glucose uptake in

9:06the cells by stopping the liver from

9:08changing glycogen to glucose. My patient

9:12is taking this for type 2 diabetes.

9:14Things that I need to know specifically

9:16is the onset peak and duration. Onset of

9:1910 to 20 minutes, peak of 1 to three

9:21hours, duration 3 to 5 hours. Side

9:24effects that I need to be aware of is

9:26that this can cause hypoglycemia which

9:28could present as the patient being cold,

9:30clammy, sweating, or even shakiness.

9:34Nursing considerations is I need to have

9:36a food tray ready in the room since this

9:38is a rapid acting insulin and I should

9:41rotate injection sites.

9:44My second drug I'm giving is Lecinril.

9:47This is an ACE inhibitor. It works by

9:50blocking the production of chemicals

9:51that cause blood vessels to narrow and

9:54the relaxation of blood vessels lowers

9:56blood pressure and reduces workload on

9:58the heart. My patient is taking this for

10:01hypertension. What I need to know before

10:03giving, I need to be sure and check the

10:05blood pressure before giving and I know

10:07the patient's blood pressure was 150

10:10over 88. So I have no concerns in giving

10:12this. Side effects are it could drop the

10:15patient's blood pressure causing

10:16dizziness particularly when changing

10:18positions. It can also cause dry cough

10:21and fatigue. Nursing considerations is I

10:25want to implement fall precautions as

10:26again this may make the patient dizzy

10:28when she stands. So, I want to ask her

10:30to call for help before she gets up out

10:32of the bed.

10:34So, I have my medications ready and

10:37labeled. I have all of my supplies that

10:39I need, and I am ready to enter into the

10:42patient's room for my third check.

10:46All right, I'm now going to be doing my

10:48third check, which will be at the

10:49bedside with my instructor.

10:53Knock knock. I'm entering the room. I'm

10:57doing my hand hygiene and I'm also

10:58pulling the curtain for privacy.

11:01Hi, Mrs. Richards. My name is Kristen

11:04and I'm an ACC nursing student. I'm here

11:06to administer your medications uh today.

11:09For your safety, if I can please check

11:11your armband and I see Becky Richards on

11:14here and that matches Becky Richards.

11:16Medical record number 082968082968.

11:22Great. Date of birth also matches 426x.

11:26Miss Richards, I see that you have an

11:28allergy to couadin or warin. Um, is

11:31there anything else that you're allergic

11:32to that I need to be aware of? No,

11:35there's not. Okay, great. Great. Um,

11:37well, I'm going to go ahead and start

11:40preparing your um, medications as I do a

11:43third check with my instructor for your

11:45safety. So, I'm going to pause for just

11:47a moment and do that. For the third

11:50check, check medication label against

11:52MAR prior to administering medication.

11:55Educate the patient by stating the name,

11:58indication, or reason and two to five

12:00most common side effects for each

12:03medication. For oral medications, you're

12:06going to raise the head of the bed to a

12:07fowler's position and assess the

12:09patient's ability to swallow.

12:13Okay. Okay. So, in my third check, uh

12:15the first one I am looking at is the

12:18Leinipril. So, I'm going to hold that

12:20here against my MAR. I have Leinipril 10

12:23milligrams. Leinipril 10 milligrams PO.

12:26It is a peel and it's due at 2100 and

12:30the time is now 2030. So, it is safe to

12:33administer this medication.

12:36The next one is my Novalog or insulin

12:39aspart and I have that here um for a 5

12:44blood sugar. The patient is going to

12:45receive five units. So, this matches. I

12:48also have my insulin syringe that I drew

12:51up with my instructor. So, insulin

12:53aspart novalog novolog 3055 units. And I

12:57do have five units in my syringe. And

13:01again, it is due at 2100. The time is

13:0420:30, so it's safe to give. And again,

13:06this is all for patient Becky Richards,

13:08allergy to warin. Um, and I have checked

13:11all of my entry measures and those all

13:13match.

13:15All right, Mrs. Richards. Um, so what I

13:18have for you today, uh, to give you is a

13:20couple of medications. The first one is,

13:23uh, your leinipril. So, while I get that

13:26ready since it is something that you

13:27need to swallow, I'm going to check your

13:29swallow reflux. So, if you'll please do

13:31that for me. Good. Okay. Any problems at

13:34all with that going down? No. Okay.

13:38And is the at a good height. It looks

13:40like you're sitting up at a at a nice

13:42high position. Good. Okay. So, this

13:46medication called Leinipril, this is for

13:48your high blood pressure. And so, our

13:50goal is to bring your blood pressure

13:52back down to a more normal level. Um, a

13:55few things I need for you to know is

13:57that this medication could cause your

14:00blood pressure to drop a little bit too

14:01much, which could cause you to become

14:03dizzy. So, if that were to occur, I want

14:05you to let me know. It can also cause a

14:08dry cough and fatigue. So, one of the

14:10things I want you to do just to keep you

14:12safe is if you'll please press your call

14:14bell before getting up out of bed. That

14:16way, a staff member can come in and

14:18assist you.

14:20Do you have any questions? No. Okay. So,

14:23here is that Leinipil for you.

14:27Wonderful. That went down. Okay. Good.

14:31All right. The next medication that I'm

14:33going to give you is your insulin. This

14:36is called Novalog and this is for your

14:38type 2 diabetes. Um, one of the things

14:40that's going to help you to do is to

14:42reduce your blood sugar, which is

14:43currently at 305. A couple of things I

14:46want you to watch out for is this could

14:48cause your blood sugar to drop too much.

14:51Um, and because of that, you may feel

14:53some shakiness, some clamminess, feeling

14:56cold, sweating. So, if you were to

14:58experience any of those symptoms, I want

15:00you to let me know right away. Um, it's

15:03also important that you eat very soon

15:06after taking this medication since it is

15:08a rapid acting insulin. And so I see

15:10that your food tray is coming in right

15:13now. So we'll help you get set up to eat

15:15just as soon as we finish. Next, assess

15:18the selected injection site and then

15:21apply clean gloves. Okay, we're going to

15:25be doing this here on the outer aspect

15:27of your left arm. I'm inspecting the

15:30skin. I don't see any issues. Is there

15:32any problems if I use that area of your

15:34arm? No. Okay, great. I'm going to go

15:37ahead and put my clean gloves on.

15:42Next, you will cleanse the injection

15:44site using an alcohol wipe. Use firm

15:48circular motion while moving outward

15:49from the injection site. Then allow to

15:52air dry. Okay, I'm cleaning going from

15:55inward to outward.

16:00Remove the needle cap. Pull straight

16:02off. Hold the syringe in the dominant

16:04hand between the thumb and the

16:06forefinger.

16:09For subq, grasp skin with a non-dominant

16:12hand to ensure that the medication

16:14reaches the subcutaneous tissue. Follow

16:16this rule. If you can grasp 2 in of

16:19tissue, insert the needle at a 90°

16:21angle. If you can grasp one inch of

16:24tissue, insert the needle at a 45°

16:26angle. Quickly dart the needle through

16:29the skin using the thumb and forefinger

16:31of the dominant hand. For subq, you can

16:33go at a 45 or 90 degree angle.

16:38Use thumb and forefinger of the

16:40non-dominant hand to hold the lower end

16:42of the syringe for subq. Withdraw needle

16:45at the same angle inserted.

16:48If oozing is present, apply gentle

16:50pressure using gauze, bandage, or

16:52alcohol wipe. Do not massage the

16:54injection site. Safely activate the

16:56needle protection device with one hand

16:58and dispose in the nearest sharps

17:01container.

17:09All right, Miss Richards. Um, so do you

17:12have any questions at all? We have

17:13completed your medication

17:15administration. Good. Okay, no

17:17questions. Wonderful. Um, so let's go

17:20ahead um and check on a few things and

17:23that way uh you can eat your breakfast.

17:25Um, are you currently having any pain?

17:28No. Do you need to go to the restroom?

17:31No. Okay. What about um any of your

17:33possessions? No. And your position is

17:36okay. All right. So, I've got your bed

17:38down here in the lowest position. Uh,

17:41both of the side rails are up. Here is

17:44your call bell. So, if you need anything

17:46at all, you can uh let me know and you

17:48can press that and I'll be back in about

17:51an hour to check on you. Okay. All

17:54right. I'm going to do my hand hygiene

17:57and I'm going to exit the room to do my

18:00documentation.

18:01Next, document the right patient, right

18:05medication, right dose, right time,

18:09right route, including the injection

18:11site, right indication or reason, right

18:14documentation, and the right response.

18:17Reassess following metadministration.

18:20For PO, you will reassess in 1 hour. For

18:23IM, 30 minutes. For IV, 15 minutes. And

18:28for insulin, you will assess based off

18:31of certain criteria.