Medications can be administered in many ways. The parenteral route allows medications to be injected into the patient using a syringe. There are four types of parenteral routes that are commonly used. These routes are intradermal, subcutaneous, intramuscular, and intravenous.
A medical prescriber will choose a specific parenteral route based on several factors, such as the type of medication, how quickly the therapeutic effect is desired, and the patient’s needs. Medications that are injected intravenously can have a faster therapeutic effect than the other parenteral routes. A pharmacologist will take this into consideration when planning medications.
Intradermal injections are administered in hairless areas of the body. Most often these injections are given on lightly pigmented and thinly keratinized areas of the skin such as the upper chest, medial thigh sites, and inner aspect of the forearm or scapular area of the back. Using these injection sites allows the nurse to observe any reaction to the injected medication.
Intradermal injections do not enter the bloodstream. These types of injections are meant to provide a localized effect on a specific area and often cause a blister to appear at the injection site. The test for TB is an example of an intradermal injection.
Subcutaneous injections are best suited for administering medications that need to be slowly absorbed into the body to produce a sustained effect. The types of medications that are administered subcutaneously are absorbed through the capillaries. This route is much slower compared to intramuscular and intravenous routes. Insulin and heparin are two medications that are administered via subcutaneous injections.
Intramuscular injections provide rapid absorption in to the body. The rate of absorption depends on a patient’s circulatory state. Most intramuscular injections are administered on the hip, buttocks, upper arm or front of the thigh.
Instillation medications are liquids that are administered to the eyes and ears. These types of medications can be drops, ointment, or sprays. Special care needs to be made with using instillation medications because of they are used improperly they can spread disease.
To administer installation medications in the eye for a patient, the following steps should be takes:
-Review over the prescription instructions
-Always wash your hands and apply clean gloves. Sterile gloves can be used but are not necessary.
-The patient should be positioned so that the patient is looking up toward the ceiling. This can be accomplished in lying down or sitting down if the patient tilts his head back.
-Pull down gently on the skin below the eye that is infected. You want to expose the conjuctival sac.
-If you are administering eye drops, only administer the prescribed number of drops into the center of the conjuctival sac. Avoid touching the eyelids or lashes with the medicine dropper because doing so can spread the disease to the medicine dropper. After the drops are administered, release the skin and with a sterile cotton ball and gently press the inner corner of the eye for 1-2 minutes. Pressing on the inner corner of the eye with a cotton ball or tissue can help to prevent the absorption of the medication through the lacrimal canal.
-If you are administering eye ointment, only half the amount of ointment should be used on the conjuctival sac. It is very possible that the patient’s vision will become blurred temporarily.
-Whether using eye drops or ointment, after the medication is administered the patient should be instructed to keep his or her eyes closed for 1-2 minutes.
-No medication should be placed on the cornea because it can cause severe pain or damage.
There are many different types of medications and many different types of routes that can be used to administer medication. The oral route is the most commonly thought of route. Oral medications can be in tablet, capsule, and liquid form. Most oral medications are absorbed in the small intestine. Depending on the form, the dose of oral medications can be easily divided. Tablets can be cut into half or quarters to reduce the dosage. Liquid medications can be reduced easily. Only capsules dosages are not as easily reduced. Capsules must be taken who because they are enteric-coated. This special coating prevents the medication from being released too early. There are special precautions that should be taken when oral medications are used. A person, who is vomiting, has a weak or no gag reflex or is a nonresponsive state should not be given oral medications. Oral medications should not be taken with large amounts of food or liquids. This is because the food or liquids can reduce the effectiveness of the medication. Food and liquid can also interfere with the absorption of medication. Oral medications are recommended to be taken on an empty stomach unless otherwise directed. There are three forms of liquid medications- elixirs, emulsions, and suspensions. An elixir is a solution of alcohol and water that is often sweet smelling. The alcohol and water are used to carry the medicine into the body. An emulsion is a suspension of a liquid within a second liquid. The first liquid can not mix with the second liquid. A suspension consists of finely divided, undissolved particles that are dispersed in a liquid.
A nurse is an important member of a healthcare team. The nurse is often the first healthcare provider to assess a patient. A nurse’s assessment can provide valuable information for the healthcare team, especially the physician.
A nursing diagnosis is basically a statement that describes the patient’s response to a health problem that the nurse is licensed and competent to treat. A guide was developed to outline the types of diagnosis a nurse is able to make. This guide was created by the Nursing Diagnosis Association (NANDA).
A nursing diagnosis is different from a physician’s diagnosis in that unlike a physician, a nurse does not prescribe treatment for fighting a disease, like medication or lifestyle changes. A nurse diagnosis does develop a care plan that can help to restore the patient to a normal living situation. This includes a return to regular activities and functions.
A nursing diagnosis contains several key elements. It will first identify the potential or actual health problem that the nurse is licensed and competent enough to treat according to the NANDA. It may also include the potential cause of the problem based on obvious symptoms.
As pertaining to drug therapy, a nursing diagnosis will commonly identify and language barriers that are experienced between the healthcare provider and the patient. The diagnosis will also detail the potential risk for injury related to side effects of a drug. This is very common when analgesics are prescribed because analgesics can impair a patient’s normal daily activities such as driving a car.
Before obtaining a blood specimen from a patient, it is important to verify that the patient followed any special dietary instructions that were given by his or her physician. For example, if a patient was required to refrain from eating for a certain period of time, typically overnight or for a certain span of time, the specimen should not be collected unless these guidelines were followed. Collecting a specimen could give false results. While studying how to become a phlebotomist, this is one thing you will learn.
Once it is determined that any dietary guidelines have been followed, the phlebotomist technician should ask the patient if he or she is allergic to latex. Exposure to latex can cause serious life-threatening reactions in people who are allergic to it. If a patient is allergic to latex, use only latex free equipment and do not allow any latex items into the patient’s room.
The spread of infection can be greatly reduced simply by using proper hand sanitizing. Hands can easily be decontaminated by washing or using alcohol-based hand sanitizer’s. Hospitals and care facilities usually have these types of sanitizers available throughout and even in patient rooms. When using hand sanitizers, more is better. It is important to use a generous amount of sanitizer and to let it evaporate in order to achieve antisepsis. Hands that are visibly dirty or that are contaminated with blood or other body fluids must be washed with good old fashioned soap and water. If there is no hand-washing facility available, detergent containing wipes can be used followed by the use of an alcohol-based hand cleaner. You may even be required to wear gloves, depending on your facility protocol.
A phlebotomist is comfortable and familiar with blood collection because that is his or her job. However, it is important to remember that not everyone is comfortable around blood or needles and that not all patients have had a blood test performed. Although most patients have had a blood test done it is a good idea to always explain a little about what you are intending to do during the test. Patients who have had blood test done before may need very little explanation. Patients who have never had blood tests done may need a more detailed explanation of the process. Also keep in mind that special procedures may require additional information. You may even have to obtain specimens from patients who do not speak or understand English. If this should occur, you may have to use nonverbal means to demonstrate what is about to occur. Some patients may have many questions about the name or names of the tests to be preformed. Depending on your healthcare facility, the information you disclose could be limited. Some healthcare facilities prefer that all questions be answered by the patient’s physician. Never attempt to explain the purpose of a test to a patient because a single test can be used to determine any one of several different problems. You do not want to mislead or alarm a patient unnecessarily. You may encounter patients that object to specimen collection. This commonly occurs with inpatients that are not usually aware of all of the tests that may have to be preformed. If a patient is uncooperative, it is important to remind the patient that the doctor needs the test results to provide proper care. If the patient is adamant about refusing to let you obtain a specimen, simply write on the requisition form that the patient refused to have blood drawn and let the appropriate personnel know that a specimen was not collected because of patient refusal.
The administration of medications and fluids through intravenous routes can be very beneficial to a patient’s health. The proper assembling of intravenous equipment is an important first step in this process.
If fluid will be administered to a patient, the type of fluid that will be used must be identified, checked for expiration and discoloration. Once the fluid is checked and the fluid bag is removed from its protective covering an administration set must be attached.
An administration set consists of tubing that transports fluid to the intravenous catheter that was placed in the patient’s circulatory system. There are two common types of administration sets- microdrip and macrodrip. A microdrip administration set produces small drops of fluid (60 drops per 1 cc). This type of tubing restricts the amount of fluid that is administered. A macrodrip administration set produces large drops of fluid (10 to 15 drops per 1 cc) and allows for a fast infusion of fluid into the circulatory system.
To assemble the intravenous equipment the appropriate drip set should be set aside and tubing should be unwrapped. The regulatory clamp should be engaged around on the tubing. The plastic tubing should not be tangled during this process.
The administration set must be connected to the fluid bag. To do this the cap protecting the drip chamber and the plastic tab protecting the fluid bag must be removed. The administration set tubing is then connected to the fluid bag. Maintaining the sterility of these connecting points is important to preventing the risk of infection to the patient.
Arterial blood is the best specimen for many analyses because it composition is fairly consistent, unlike venous blood that varies due to the metabolic needs of the body. Unfortunatley, arterial blood collection is a potentially more painful collection method to the patient compared to venipunture. Arterial blood collection is also more technically difficult for the healthcare worker to obtain. This is why arterial specimens are not routinely used for blood tests. The main reason why an arterial puncture would be considered by a phlebotomist technician is to be able to evaluate arterial blood gases (ABGs).
Arterial blood gases are primarily obtained to diagnose and manage respiratory diseases. The collection of arterial blood gases can provide information concerning a patient’s oxygenation, ventilation, and acid-base balance. This type of collection can also benefit patients with other disorders, such as diabetics, who need to manage their electrolyte and acid-base balance.
Arterial blood collection requires great care to be accurate. These types of specimens are very sensitive. Preanalytical errors, inaccurate patient assessment and improper specimen collection and handling can cause inaccurate diagnostic results. Because this type of blood specimen is so sensitive, it is only acquired when necessary.
There are several instruments that are used to process arterial blood gas specimens. Most of these instruments directly measure pH, partial pressure of carbon dioxide, and partial pressure of oxygen and calculate bicarbonate, base excesses of deficiencies, and oxygen saturation. There are also instruments that can measure the sodium, potassium, chloride, ionized calcium, glucose, and hemoglobin in the same specimen.
There are three main arterial puncture sites that are commonly used to obtain arterial access. These three sites are the radial artery, the brachial artery and the femoral artery. There are advantages and disadvantages to each artery.
The radial artery is located in the thumb side of the wrist. This artery is the most commonly used site for arterial punctures. It is usually the first choice because it is easily accessible in most patients. The biggest advantage for using the radial artery is the presence of collateral circulation. Collateral circulation is a term used to describe a site that is supplied with blood from more than one artery. This is beneficial because circulation can be maintained even if one vessel is obstructed or damaged. Another advantage of using the radial artery as an arterial puncture site is that there is less of a chance of hematoma formation. A disadvantage of using the radial artery is due to the size of this artery. The radial artery is smaller than arteries in other areas and requires great skill to puncture successfully. A patient with low cardiac output often can not use the radial artery as a puncture site because the artery may be difficult or impossible to locate.
The brachial artery is the next choice if the radial artery can not be used for arterial puncture. The brachial artery is located in the medial anterial aspect of the antecubital fossa near the insertion of the biceps muscle. This artery is larger and much easier to palpate and puncture. If large volumes of blood need to be collected, this artery is preferred over the radial artery. Although not as good as the radial artery, the brachial artery has adequate collection circulation. Compared to the radial artery, the brachial artery can be harder to palpate and the chance of hematoma formation following a procedure are greater.
The femoral artery is the largest artery used for arterial puncture. This artery is located superficially in the groin, lateral to the pubis bone. The femoral artery is usually the last arterial puncture site used generally in emergency situations by physicians and specially trained emergency room personnel. There is very poor collateral circulation with this artery and an increased risk of infection due to its location in the groin.
After speaking with so many new and recent nurse graduates lately, I have been inspired and encouraged by your strength, dedication, and intelligence. I have great faith in you all, and a renewed faith in the future of the nursing profession. Many negative stories about the nursing profession have been circulating on the new or from unhappy nurses, but I assure you that unhappy nurses make up a very small percentage of the professional field. There are many more heartwarming and wonderful stories out there about the help and support nurses get from their co-workers and superiors, the joy of helping others, and how nurses thrive and move forward in spite of the challenges. I also interviewed experienced nurses who spoke of a profession that offers them great rewards as well as endless opportunities for professional and personal growth.
Once you enter the nursing profession, you will never be the same. Your life will be forever changed. You will develop an appreciation for life and a respect for death beyond the scope of an average person. You will see the best and the worst of the human spirit, and you will become a better, more compassionate person because of this. You will walk the path of a healer and illuminate the darkness for those you help. Your life will be infused with meaning.
A great majority of my colleagues will say becoming a nurse was the best thing they ever did. It is a pleasure and a privilege to serve those people in need as an allied health professional. I personally welcome anyone who is interested in joining the beloved profession of nursing.