Medication Administration – Preparation Part 1.wmv

for medication administration when you come back to practice you're going to want to go into the black cabinet here in the lab pull out a scenario out of a notebook you're gonna put the notebook back after you've pulled out some labels there's also an answer key for your scenario grab all of those go ahead and get the container and it's gonna look like this that matches your patients name okay that you grabbed so Palmerton one you would grab Paul Martin ones scenario you're gonna ask one of the lab staff for needles and then we'll work with you on your scenario when you come for sign-off this is going to be in the back room we'll give you a scenario you'll pull the matching patient drawer take it to your workstation come back and get all the supplies that you need and you will draw up your medications have everything ready for us we'll come back and check it then we'll go to the bedside administer and you'll be done with your sign-off so let's go ahead and begin our practice scenario the patient on the scenario that I've been given is Kathy Donovan and I've got Kathy Donovan labels and I've got a Kathy Donovan medication bin open it up my instructor and for me that we're going to be giving the Oh 8 hundred meds and they gave me a blood sugar this morning the reading was 222 so um BM AR it says Oh 7:30 blood glucose that's B G and units here so right here I'm going to write the 222 then I'm going to come over to my sliding scale and come over and that means my patients going to get 6 units of insulin and you're going to write the 6 units right here where it says units I was also told that my patient is complaining of itching so I look on the back where they have PRN or as needed medications and I see that they have benadryl 15 milligrams I am for itching they can have it every 4 hours so I need to look over and see when my patient had it last my patient had it a little after midnight and right now it's a 800 so it's been more than four hours one thing that I want to check is my patients drug allergies I see that she's allergic to aspirin penicillin and erythromycin I need to verify that there aren't any of those listed here on her na are so I'm gonna look down and see and I do see one I see erythromycin has been ordered so I have to do three things one I have to highlight this out will give you the yellow highlighter when you come in I also need to write dc4 discontinued because if I needed to make a Xerox copy of this the highlighting doesn't always show up but the DC would I have to pull out the erythromycin so that my patient doesn't receive it by accident I'm gonna set it off to the side because I have to send that back to pharmacy and lastly I need to call the prescriber and ask them what they would like to substitute letting them know that my patients allergic to erythromycin now I'm going to go ahead and start pulling out my eight o'clock meds notice that in this time column there's also ten o'clock meds I want to be very careful not to pull those out I won't write on my ma are like a dot or a checkmark this is a medical document and I don't want to be writing all over it if I need to write notes I'll write those on a separate pad of paper the first medication that I see that I need to give is to Jackson 0.125 milligrams so let me look at my Med container here here's my digoxin it's 0.25 milligrams I noted that it's not expired that's important and I see that I have to do a drug calculation so whether you prefer ordered over have or ratio proportion whatever it is that you need to do to do your drug calculation make sure that you do I've done it and I see that I need to give a half a tablet so I'm gonna look and see whether this is scored because if it's not scored I can't split it but mine is digoxin is a high alert medication in that I can't give this to my patient unless I have checked their apical heart rate for one full minute and their heart rate must be greater than 60 for me to give this so because I need to check that and because I need to split this tablet before giving it to my patient I'm gonna put it in a separate medication cup coming down I see I have guys ID 37.5 slash five it's a combination medication that's why there's two numbers there I found my dies ID and it is 37.5 slash 25 milligrams again it's not expired potassium 60 milli equivalents I see one that's 20 milliequivalents not expired here's a second 20 milliequivalents and a third 20 milliequivalents you're checking your expiration date on every single medication you give next is lasix 20 milligrams may 6th 2005 t milligrams yep and I've got my PPD 0.1 milliliters ID intradermal I've got my PPD 0.1 milliliters the expiration is June of 2011 so it's good I see that there's nice clear fluid I've got my TV syringe it is my super keulen syringe an alcohol swab off the top of my vial even if it's a brand new vial where you pop off the top go ahead and clean it take your syringe out of the package bend this wing back so it's out of my way push the plunger up and now I'm gonna pull it back I'm gonna spin my wing because it's kind of in the way of my numbers and I'm going to put the top of the stopper right at the 0.1 milliliters I'll remove the cap and set it to the side I'm gonna need that cap again in a minute holding my vial so it doesn't move I'm gonna insert the needle inject the air into the airspace of my vial turn it over and pull back I like to pull back beyond my dose that way if I have an air bubble I can just push it right back up pull back and sometimes if an air bubble continues to stick if you pull back very quickly it'll make it jump up off the stopper push it back up to my 0.1 moly ders turn the whole thing over as one unit and then remove the needle now I need to passively recap my needle make sure that you're noting that this is the top and this is the part where you can put the needle in now I'm not going to be holding on to the cap while I go to put the point of the needle in so as soon as I get the point in I can grab the slides and secure it snugly I don't want to push it on top because the needle might come through the top and stab me we got a patient label and I'm going to write on this patient label the drug the dose and the route PPD the dose is 0.1 milliliters and the route is ID for intradermal peel that off and I'm gonna put it down here on the syringe where there is no liquid because I need to be able to see when I'm injecting my liquid if I had a full syringe of liquid I could put my sticker up on the cap the next thing that I need to draw up is my novalog insulin they're getting that subcutaneously again their blood sugar was 222 they're gonna get six units of novalog novalog insulin i see that it's not expired I also see another date and that date tells me the date that this bottle was opened once a bottle of insulin is open it's only good for anywhere between 28 to 30 days no your agency's policy for how long it's good before it has to be thrown away if you were to find a bottle of insulin that's opened with no date that it was opened you need to discard that because you don't know how long it's been open and bacteria may have built up at in the vial they off the top of the vial and I'm going to open up my insulin syringe it's going to say insulin and it will say insulin over here on the back now that I've got this out I want to show you something these two syringes are exactly the same size aren't they this is one milliliter so it's marked in tenths of milliliters this is an insulin syringe and while it holds the same amount of fluid is this it's marked in units so insulin syringes can only be used for insulin pull back my six units of air remove my cap holding my vial I'll insert the needle inject the air into the airspace turn the whole thing over as one unit draw back and because with insulin you're often giving just a small amount it's best if you pull back more than you need and then push up to the number that you need that way you're sure that you've gotten all the air bubbles out ten nine eight seven six I'm at six units I need to have another nurse come and verify with me that this is novalog insulin that I do have six units and then that's what my patient is supposed to receive can you verify my insulin please yes I see novalog I see six units in here here's my patients blood sugar it's 222 he does get six units according to the sliding scale that is correct 222 six units and I do see six units of Novolog insulin in your syringe good could you initial with me please okay thank you welcome and she has signed at the bottom as well I'm gonna turn the whole thing over as one unit holding the vial take out my needle get the needle point once it's in I can grab the sides and cap it so the drug here is Novolog the dose is six units and the route is sq4 sub-q again I'm not gonna cover my liquid my patient was complaining of itching I know she can have the benadryl I get the benadryl I see that it's not expired and I also have to look because I have to do a drug calculation there's fifty milligrams per milliliter so my drug calculation is going to be 50 over 50 times one and that's one milliliter I'll clean off the top a three milliliter syringe that's what I have on hand and I'm careful there's no tip on the end of this it must stay sterile so I'm careful not to set that down or touch it I've got my needle for drawing my medication up and I'm going to open it and keep the package on it because I need to keep the end of this sterile I don't want to take it out and set it down I'll just connect the two now I'm gonna draw back one milliliter of air I'll remove the cap holding the vial I'll inject the air into the airspace turn the whole thing over now this bottle is fairly empty so notice when I pull back I'm just getting air so what I need to do is just pull the needle out a little bit and then draw back again I'm gonna go a little bit past what I need if I have an air bubble I can just push it right up and pull back again or I can pull back quickly and that air bubble disappears I take it to the one turn the whole thing over take it out once the point is in I can grab the sides and push it on it Benadryl 50 milligrams am not covering the medication put that on my syringe this is an IM injection and there's medication on this needle that's highly irritating to the subcutaneous and intra dermal layers so I need to change that needle for my IM injection open up my needle again keeping it the package not setting it down remove this one keeping the end of my syringe sterile connect the two and now I have a fresh needle for this medication to be administered my old meal must go in a sharps container now I'm ready to go to the bedside the things that I need to take with me are my na are my medications some alcohol preps I have three injections so maybe I can grab four or five in case I drop one a glass of water because I'm giving by mouth medications and I have my stethoscope in the room gloves are also in the room

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