1.
Chapter 9
Medication and fluid therapy

2.
Learning Objectives
At the end of this chapter the students will be able to
• ™
Describe various route of drug administration.
• ™
Mention the general rules & care of administering
medications.
• ™
Identify the parts and types of syringes and needles.
• ™
List the necessary equipments required for drug
administration.
• ™
Mention the five rights before drug administration.
• ™
Locate the different sites of parentral drug administration.
• ™
Demonstrate essential steps of medication administration.
• ™
List precautions for medication administration.

3.
1. Medication preparation
• Alteration in health related to acute or chronic
conditions lead clients to seek relief of their
symptoms through various treatment options.
• One modality frequently used to help alleviate
symptoms and restore health is a medication.
• Medications are substances prescribed by the
client’s health care practitioner to help in the
treatment, relief, or cure of the cause of the
client’s health alteration or in the prevention of
an alteration.

4.
• Medication management requires the
collaborative efforts of many health care
providers.
• Medications may be prescribed by a physician,
dentist, or other authorized prescriber such as
advanced practice registered nurses as
determined by individual licensing bodies.

5.
• Pharmacists are licensed to prepare and
dispense medications.
• Nurses are responsible for administering
medications.
• Dietitians are often involved in identifying
possible food and drug interactions.

6.
• Nurses play an essential role in the
administration of, education about, and
evaluation of the effectiveness of prescribed
medications.
• Nurses are responsible for educating the client
about his or her medications and its possible
side effects as well as for evaluating the
outcome of the prescribed therapy in
restoring and maintaining the client’s health.

7.
• Nurses are responsible for teaching clients
how to take their medications safely when
they are discharged.
• Nurses use special equipment such as
syringes, needles, ampules, and vials when
administering parenteral medications

8.
Syringes
• A syringe has three basic parts:
the hub, which connects with
the needle; the barrel, or
outside part, which contains
measurement calibrations; and
the plunger, which fits inside
the barrel and has a rubber tip
(see Figure).

9.
• The nurse must ensure that the hub, inside of
the barrel, and shaft and rubber plunger tip
are kept sterile.
• When handling the syringe, the nurse should
touch only the outside of the barrel and the
plunger’s handle.
• Most syringes are disposable, made of plastic,
and individually packaged for sterility.

10.
• There are several types of
• syringes, such as the
hypodermic, insulin, and
tuberculin syringes (Fig. A–C).
• When a medication is
incompatible with plastic, it
is usually prefilled in a single
dose glass syringe.
• Syringes are often
prepackaged with the
commonly used needle size
and gauge and are referred
to as disposable plastic
syringes (Figure D).

11.
Hypodermic syringe
• The hypodermic syringe comes in 2-, 2.5-, and 3-ml
sizes. The measurement calibrations (scales) are usually
printed in milliliters and minims.
• Most syringes are marked in cubic centimeters (cc),
and most drugs are ordered in milliners; these are
equivalent measurements (1 cc = 1 ml).
• The hypodermic syringe is used most often when a
medication is ordered in milliliters. When the order is
written in minims, it is safer to prepare the drug in a
tuberculin syringe

12.
Insulin syringe
• The insulin syringe is designed specially for use with
the ordered dose of insulin.
• Insulin syringes are calibrated on the U-100 (100-unit)
scale, which is based on 100 units of insulin contained
in 1 ml of solution.
• Insulin syringes come in sizes that hold 0.5 ml (50 units)
to 1.0 ml (100 units).
• Insulin syringes that hold 0.5 ml are the easiest to read
and are therefore used for low dosages.
• There are other sizes of insulin syringes that
complement the ordered dose, such as U-30 and U-50,
although these dosages are seldom prescribed.

13.
Tuberculin syringe
• The tuberculin syringe is a narrow syringe,
calibrated in tenths and hundredths of a milliter
(up to 1 ml) on one scale and in sixteenths of a
minim (up to 1 minim) on the other scale.
• Originally this syringe was designed to administer
the tuberculin drug, but it is commonly used
today to administer small or precise doses, such
as pediatric dosages.
• The tuberculin syringe should be used for doses
0.5 ml or less.

14.
Prefilled single-dose syringes
• Prefilled single-dose syringes should not be
confused with a unit dose.
• The nurse must be careful to check the
prescribed dose against that in the prefilled
syringe and discard excess medication.
• For example, if the health care practitioner
orders diazepam (Valium) 5 mg IM as a
preoperative sedative and the prefilled single-
dose contains 10 mg/2 ml, the nurse must
calculate dosage (5 mg/1 ml) and destroy 1 ml
from the syringe before administration.

15.
Needles
• Most needles are disposable, made of
stainless steel, and individually packaged for
sterility.
• Reusable needles are seldom used, except in
certain areas such as surgery and special
procedure rooms; reusable needles require
frequent inspection to ensure that the needle
is sharp, and resterilization is necessary
between uses

16.
`
• The needle has three
basic parts: the hub,
which fits onto the
syringe; the cannula, or
shaft, which is attached
to the hub; and the bevel,
which is the slanted part
at the tip of the shaft.
• Needles come in various
sizes, from 1/4 inch to 5
inches, and with gauges
that range from 28 to 14
(see Figures ).
Various Lengths and Gauges of Needles.
Gauge from left to right: 18, 20, 21, 25

17.
Ampules and Vials
• Drugs for parenteral injections are sterile
preparations.
• Drugs that deteriorate in solution are
dispensed as tablets or powders and dissolved
in a solution immediately before injection.
• Drugs that remain stable in a solution are
dispensed in ampules and vials in an aqueous
or oily solution or suspension

18.
• Ampules are glass containers
of single-dose drugs (see
Figure). The glass container
has a constriction in the stem
to facilitate opening the
• Glass, single- or multiple-dose
rubber-capped drug
containers are called vials (see
Figure).
• The vial is usually covered
with a soft metal cap that can
be easily removed.
• See Procedure 29-3 for
removing a drug from a vial
and ampule.

19.
Withdrawing Medication from a Vial
• Equipment
• Medication administration record (MAR)
• Sterile syringe and needle
• Alcohol swab
• Vial of medication

20.
Procedure
1. Wash your hands.
2. Prepare the vial.
 Open the alcohol wipe.
 New vial, remove metal cap from vial of
medicine and cleanse the rubber top of the
vial.
 Used vial, cleanse the rubber top of the vial.

21.
3. Prepare syringe.
• Choose a syringe of appropriate size to accommodate
the volume of medication to be withdrawn.
• Grasp needle and turn barrel of syringe to the right.
• Remove the needle cap and pull back on plunger to fill
syringe with an amount of air equal to amount of
solution to be withdrawn from the vial.
4. Insert the needle into the center of the upright
vial and inject air into the vial.

22.
5. Invert vial; keep the vial at eye
level and the needle’s bevel
below the fluid level, and
remove the exact amount of
medicine while touching only
the syringe barrel and plunger
tip (see Figure ).

23.
6. Expel air from the syringe while needle remains within
the inverted vial by tapping the side of the syringe with
your finger.
7. Check the amount of medicine in the syringe.
8. Turn vial upright and remove the needle.
9. Replace the needle cap. Open the sterile package of the
new needle. Remove used needle, and dispose in the
sharps container.
10. Attach the new needle to the syringe by turning the
barrel to the right.
11. Compare the medication in the syringe with the
prescribed dosage.

24.
Withdrawing Medication from an
Ampoule
Equipment
• Medical administration record (MAR)
• Ampule of prescribed medication
• Sterile syringe and needle
• Sterile gauze or alcohol swab

25.
Procedure
1. Wash your hands.
2. Hold the ampule and quickly and lightly tap the
top chamber until all fluid flows into the bottom
chamber.
3. Place a sterile gauze or alcohol wipe around the
neck of the ampule (see Figure ).

26.
4. Firmly grasp the neck of the ampule and
quickly snap the top off away from your body.
Place the ampule on a flat surface.
5. Withdraw the medication from the ampule,
maintaining sterile technique.
• Check connection of needle to syringe by
turning barrel to right while holding needle
guard.

27.
 Use a filter needle if
recommended.
 Remove needle guard, and
hold syringe in dominant
hand.
 With nondominant hand
grasp ampule and turn upside
down, or stabilize ampule on a
flat surface.
 Insert the needle into the
center of the ampule; do not
allow the needle tip or shaft to
touch the rim of the ampule.
 Keep needle tip below level of
meniscus (see Figure).

28.
• Aspirate the medication by gently pulling on the
plunger.
• If air bubbles are aspirated, remove the needle
from the ampule. Hold syringe with needle
pointing up and tap sides of the syringe.
• Draw back slightly on plunger, and gently push
the plunger upward to eject air.
• Reinsert the needle in the middle of the ampule
and continue to withdraw the medication.

29.
6. Remove excess air from the syringe and check
the dosage of medication in the syringe. Recap.
7. Discard any unused portion of the medication,
and dispose of the ampule top in a suitable
container after comparing with MAR.
8. Change needle and properly discard used needle.
Secure needle to syringe by turning the barrel to
right while holding the needle guard.
9. Wash hands.

30.
Mixing Medications from Two Vials
into One Syringe
• Compatible medications can be mixed in the
same syringe.
• If medications are going to be mixed, care
must be exercised not to contaminate one
medication with the other in their respective
vials.
• The nurse must calculate and measure
carefully to be sure the final dose is accurate.

31.
Equipment
 Medication administration record (MAR)
 Insulin vials
 Alcohol swabs
 Insulin syringe

32.
Procedure
1. Check with the client and the chart for
known allergies or medical conditions that
would contraindicate the use of the drug.
2. Gather necessary equipment.
3. Check the MAR against written health care
orders.
4. Wash your hands.

33.
5. Follow the five rights of medication
administration. Check the client’s identification
band.
FIVE RIGHTS OF DRUG ADMINISTRATION
1. Right drug
2. Right dose
3. Right client
4. Right route
5. Right time

34.
6. Remove caps from insulin vials (if not already off).
7. Slowly rotate each bottle of insulin. Never shake.
Make sure suspensions are thoroughly mixed.
(Cloudy insulin such as NPH should be completely
mixed.)
8. Clean the rubber stoppers of the vials with an
alcohol swab.

35.
9. Remove cap from the needle.
o Draw air into the syringe equal to the dose of insulin to
be given.
o Insert needle into vial of the suspension, being careful
not to touch the needle to the medication in the vial.
o Inject the air into the vial and remove the needle.
o Do not withdraw any insulin yet.
10. Fill syringe with air equal to dose of regular
insulin.
o Insert needle into bottle and inject air into vial.
o Invert bottle and pull plunger down to withdraw the
appropriate dose of insulin.

36.
11. With needle in the bottle, hold it up to the
light and look for air bubbles.
o To remove air bubbles, tap or flick the syringe
with your finger to cause air to rise.
o Push plunger to push air and some insulin
back into the vial.
o Pull back to get the appropriate dose of insulin
free of air.
o Remove the needle.

37.
12. Insert needle into the vial of longer-acting insulin;
be sure the tip of the needle is below the surface
of the fluid level.
o Invert the bottle, and slowly draw back to dose of
insulin required.
o Remove needle.
• Have another nurse check the prescribed dose.
13. Store insulin vials according to your agency policy.
14. Wash your hands.

38.
Preparing an IV Solution
• To prepare an IV solution, read the agency’s
protocol and gather the necessary equipment.
• Because IV equipment and solutions are
sterile, check the expiration date on the
package prior to usage.
• The solution can be prepared at the nurses’
work area or in the client’s room (see
Procedure below )

39.
Equipment
• IV solution (bag or bottle)
• Administration set (vented or non-vented)
• Extension set
• IV pole
• IV line filter
Procedure
1. Wash hands before preparing IV equipment.
2. Check the health care practitioner’s order for the type
and amount of solution.
3. Check integrity of the IV solution and equipment.
4. Select IV tubing in accord with agency policy.
5. Prepare IV solution label with client’s name, date, time,
additives, and your initials.

40.
Plastic Bag
6. Prepare the IV solution bag for administration
• Remove outer wrapper around IV bag of
solution.
• Inspect bag for tears or leaks by noting any
moisture on the protective covering.
• Apply gentle pressure and observe for leakage.
• Examine solution for discoloration, cloudiness, or
particulate matter by holding the bag against a
dark and light background; if there is any
evidence of contamination, do not use, and
return agency’s dispensing department.

41.
7. Hang IV bag on the IV pole.
8. Remove administration set
from the package and
close the roller clamp on
the IV tubing (see Figure).
9. Remove the protective cap
from the non-vented IV
tubing spike and maintain
the sterility of the spike.

42.
10. Grasp the port of the
IV bag with your non-
dominant hand. With
your dominant hand,
remove the plastic tab
covering the port (see
Figure ) and insert the
full length of the spike
into the bag’s port (see
Figure ).

43.
11. Squeeze and quickly release pressure on the
drip chamber of the IV tubing until the chamber
is one-third to one-half full.
12. Connect IV filter to tubing.
• Remove cap from filter.
• Fit tubing’s male adapter into filter’s female
connector, and twist to ensure tight connection.
• Hold filter so connector joint is pointed down.
• Hold tubing’s end tip higher than the tubing’s
dependent loop to displace the air.

44.
• Open roller clamp on IV
tubing to prime the
tubing and filter (see
Figure ).
• Tap the filter as the IV
solution runs through.
• Close the roller clamp on
the IV tubing

45.
13. Replace the cap on the IV tubing’s free end.
14. Tag tubing with date and time and your own
initials.
o The nurse prepares and applies a time strip to
the IV solution bag to facilitate monitoring of
the infusion rate as prescribed by the health
care practitioner (see Figure).

46.
 The IV tubing is tagged
with the date and time to
indicate when the tubing
replacement is necessary.
 IV tubing is changed
every 48 to 72 hours in
accord with the agency’s
protocol.

47.
Glass Bottle
17. Repeat steps as steps for plastic bag
18. Prepare the IV solution for administration.
• Check bottle for cracks or leaks.
• Remove metal cap, metal disk, and rubber
diaphragm from top of glass bottle, or remove
protective additive cap if pharmacy has added
medications to the IV bottle.
• Listen for the escape of air when the rubber
diaphragm is removed.

48.
19. Close the roller clamp on the IV tubing.
20. Remove the protective cap from the IV tubing
spike and maintain the sterility of the spike.
21. Place the glass bottle on a firm surface, and,
using firm downward pressure, insert the spike
through designated port on the bottle cap.
22. Invert IV bottle (if the bottle is vented, the fluid
inside the vent tube will escape), and hang the
bottle on an IV pole. Then all are as plastic bag
23. Explain to the client what you are doing before
taking the IV equipment into the client’s room.

49.
2. Medication administration
• Drugs are available in many forms for
administration by a specific route.
• The route refers to how the drug is absorbed:
Oral, buccal, sublingual, rectal
 Parenteral (hypodermic routes),
Topical, and inhalation.
• The nurse should be aware of the various drug
forms and how they are administered.
• Certain drug preparations require special
consideration regarding administration.

50.
Administering Oral, Sublingual, and
Buccal Medications
 Oral administration of drugs is the most
common route; however, there are potential
risk factors that the nurse must consider.
 Before administering oral drugs, the nurse
should assess the client’s ability to take the
medication as prescribed.
 This assessment includes the client’s gag
reflex, state of consciousness, and presence of
nausea and vomiting.

51.
• If a client has a weak gag reflex or difficulty
swallowing water, medication can be inhaled
during medication administration.
• When administering an oral drug, the nurse
prepares the medication, correctly identifies
the client, and provides some form of liquid.
• See Procedure

52.
Administering an Oral Medication
• Equipment
• Medication administration record (MAR)
Medication cup
• Medication cart or tray
• Medication properly labeled
• Glass of water or juice

53.
Procedure
1. Assess the client for potential problems (e.g.,
absence of a gag reflex).
2. Check the MAR against the health care
practitioner’s written orders.
3. Check for drug allergies.
4. Wash your hands.

54.
5. Prepare the medications for one client at a
time:
• Select the correct medication and double
check against MAR.
• Calculate the medication dose, if necessary.
Double-check calculations for accuracy.
• Avoid touching the drug while pouring in cup.

55.
• Prepare liquids by placing
the label side of the
medicine bottle against
the palm of your hand
and pouring the liquid at
eye level (see Figure).

56.
6. Check client’s armband before administering
the medications.
7. Identify the drug for the client and its
therapeutic purpose.
8. Perform any assessment required before the
administration (such as apical pulse rate
before administration of digoxin.)
9. Assist client to a sitting position.

57.
10. Offer liquids before and during ingestion;
encourage the patient to drink 5–6 oz of
water.
• If the client is unable to hold the medication
cup, assist the client by using the medication
cup to introduce the pills to the person’s
mouth one at a time.
• If a medication falls on the floor, discard the
pill and start over.

58.
11. Remain with the client until all medications
have been swallowed.
12. Wash your hands.
13. Record the administered medications on the
MAR.
14. Observe the client for side effects or adverse
reactions.

59.
Contraindications of oral medications
• When the pt is unconscious & is unable to
swallow
• When the pt is nauseating or vomiting
• When the drug is irritant to gastric mucosa
• When the pt decide to receive nothing per
oral route.
• When the drug can be inactivated by gastric
juice

60.
Sublingual and Buccal Drug
Administration
• Sublingual and buccal drugs are types of oral
medications.
• Certain drugs are given by these routes to
prevent their destruction or transformation in
the stomach or small intestines.
• The nurse should assess the integrity of the
mucous membranes by inspecting underneath
the client’s tongue and in the buccal cavity.

61.
• If the membranes are attack or painful, the
nurse should withhold the medication and
notify the health care practitioner.
• Some buccal drugs may irritate the mucosa,
requiring the nurse to use alternate sides of
the mouth to prevent irritation of the mucosa.
• Drugs given by these routes are quickly
absorbed by the mucosa’s thin epithelium and
the abundant blood supply.

62.
• Sublingual and buccal
administration of drugs
(see Figure) requires
the nurse to use
Standard Precautions
because the nurse’s
hand may come into
contact with oral
secretions.
Figure A. Sublingual Administration of a
Tablet; B. Buccal Administration of a Tablet.

63.
Procedure
Follow the five rights of safe drug
administration.
• Wash your hands and don non-sterile gloves.
• Assess the client’s knowledge of the drug and
its action.
• Explain the procedure to the client, and allow
the client time to ask questions.
• Offer the client a sip of water and explain to
the client that liquids cannot be taken until
the tablet is completely dissolved.

64.
To give a drug sublingually, ask the client to open the
mouth and lift the tongue; place the drug under the
client’s tongue.
• To give a drug sublingually, ask the client to open the
mouth and lift the tongue; place the drug under the
client’s tongue.
 Give the client the following instructions:
 Keep the medication under the tongue until it dissolves
completely to ensure absorption.
 Avoid chewing the tablet or touching the tablet with
the tongue to prevent accidental swallowing.
 Do not smoke before the drug has completely
dissolved because nicotine has a vasoconstriction
effect that slows absorption.

65.
To give a drug buccally, instruct the client to open the
mouth wide, and place the tablet between the client’s
cheek and teeth.
 Give the client the following instructions:
 Keep the medication in place until it dissolves completely to
ensure absorption.
 Do not drink liquids for an hour because some tablets take
up to an hour to dissolve.
 Do not smoke before the drug has completely dissolved
because nicotine has a vasoconstriction effect that slows
absorption.
 Remove gloves and dispose in a proper receptacle; wash
hands.
 Document the medication administration on the MAR.
When the client is receiving repeated doses of a buccal
medication, the nurse should indicate the site, such as right
buccal cavity, to prevent irritation of the same site.

66.
Administering Topical Medication
• Topical medications may be administered to
the skin, eyes, ears, nose, throat, rectum, and
vagina.
• The medication generally provides a local
effect but can also cause systemic effects.
• Drugs directly applied to the skin to produce a
local effect include lotions, pastes, ointments,
creams, powders, and aerosol sprays.

67.
• Topical drugs are usually given to provide continuous
absorption to produce different effects:
 To relieve pruritus (itching),
 To protect the skin,
 To prevent or treat an infection, to provide local
anesthesia, or to create a systemic effect.
• Topical medications are usually ordered two or three
times a day to achieve their therapeutic effect. Before
applying a topical preparation, the nurse should assess
the condition of the skin for any open lesions, rashes,
or areas of erythema and skin breakdown.

68.
Eye Medications
• Eye medications, often referred to as
ophthalmic medications, refer to drops,
ointments, and disks.
• These drugs are used for diagnostic and
therapeutic purposes—to lubricate the eye or
socket for a prosthetic eye and to prevent or
treat eye conditions such as glaucoma
(elevated pressure within the eye) and
infection.

69.
• Diagnostically, eye drops can be used to
anesthetize the eye, dilate the pupil, and stain
the cornea to identify abrasions and scars.
• The nurse should review the abbreviations
used in medication orders to ensure that the
medication is instilled in the correct eye.
Cross-contamination is a potential problem
with eye drops.

70.
The nurse should adhere to the
following safety measures to prevent
cross contamination:
• Each client should have his or her own bottle of
eye drops. Clients should never share eye
medications. Discard any solution remaining in
the dropper after instillation.
• Discard the dropper if the tip is accidentally
contaminated, as by touching the bottle or any
part of the client’s eye. The risk of transferring
infection from one eye to the other is increased if
the tip touches any part of the client’s eye.

71.
Equipment
• Medication administration record (MAR)
• Eye medication
• Tissue or cotton ball
• Nonsterile gloves

72.
Procedure
1. Check with the client and the chart for any
known allergies or medical conditions that
would contraindicate use of the drug. Check the
MAR against the written orders.
2. Gather the necessary equipment. Follow the five
rights of drug administration.
3. Take the medication to the client’s room and
place on a clean surface.
4. Explain the procedure to the client; inquire if
the client wants to instill his or her own eye
drops

73.
5. Wash hands, don nonsterile gloves. If the eye
has crust or drainage along the margins or
inner canthus, gently wash the eye. Always
wipe from inner canthus to outer.
6. Place client in a supine position with the head
slightly hyperextended.
• Instilling Eye drops
7. Remove cap from eye bottle and place
cap on its side

74.
8. Squeeze the prescribed amount of medication
into the eye dropper.Place a tissue below the
lower lid.
9. With dominant hand, hold eyedropper 1/2 to 3/4
inch above the eyeball; rest hand on client’s
forehead to stabilize. Place non-dominant hand
on cheekbone and expose lower conjunctiva sac
by pulling on cheek while applying slight pressure
to the inner canthus.

75.
10. Instruct the client to
look up, and drop
prescribed number of
drops into center of
conjunctiva sac.
 Avoid instilling
medication directly into
the cornea.
 If the client blinks and the
drops land on the outer
lid or eyelash, repeat the
procedure.

76.
11. Instruct client to gently close eyes and move
eyes.
12. Remove gloves; wash hands.
13. Record on the MAR the route, site (which
eye), and time administered.

77.
Eye Ointment
• Repeat steps as eye drop
• Lower lid:
14. With non-dominant hand, gently separate
client’s eyelids with thumb and finger, and grasp
lower lid near margin immediately below the
lashes; exert pressure downward over the bony
prominence of the cheek. Instruct the client to
look up.
15. Apply eye ointment along inside edge of the
entire lower eyelid, from inner to outer canthus

78.
• Upper lid:
16. Instruct client to look down. With non-
dominant hand, gently grasp client’s lashes near
center of upper lid with thumb and index finger,
and draw lid up and away from eyeball.
17. Squeeze ointment along upper lid starting at
inner canthus.
18. Instruct client to gently close eyes and move
eyes. Remove gloves; wash hands. Record on the
MAR the route, site (which eye), and time
administered.

79.
Ear Medications
• Solutions ordered to treat the ear are often
referred to as otic (pertaining to the ear) drops
or irrigations.
• Eardrops may be instilled to soften ear wax, to
produce anesthesia, to treat infection or
inflammation, or to facilitate removal of a
forgien body, such as an insect.

80.
• Before instilling a solution into the ear, the nurse
should inspect the ear for signs of drainage, an
indication of a perforated tympanic membrane.
Eardrops are usually contraindicated when the
tympanic membrane is perforated.
• If the tympanic membrane is damaged, all
procedures must be performed using sterile
aseptic technique; otherwise, medical asepsis is
used when instilling medications into the ear.

81.
Equipment
• Medication
• Cotton-tipped applicator
• Nonsterile gloves
• Cotton balls Tissue

82.
Procedure
1. Check with client and chart for any known
allergies.
2. Check the MAR against the health care
practitioner’s written orders.
3. Wash your hands. Calculate the dose.
4. Explain the procedure to the client.
5. Place the client in a side-lying position with the
affected ear facing up.
6. Don nonsterile gloves.

83.
7. Straighten ear canal by pulling pinna down and
back for children or upward and outward for adults
8. Instill the drops into the ear canal by holding the
dropper at least 1/2 inch above the ear canal.

84.
9. Ask the client to maintain the position for 2
to 3 minutes
10. Place a cotton ball on the outermost part of
the canal. Wash hands.
11. Document the drug, number of drops, time
administered, and the ear medicated.
 Evaluate the condition of the skin in the outer
ear between instillations

85.
Nasal Instillations
• Nasal instillations can be performed with different
preparations: drops or nebulizers (atomizer or aerosol).
Nasal drugs are administered to produce one or more
of the following effects: to shrink swollen mucous
membranes, to loosen secretions and facilitate
drainage, to treat infections of the nasal cavity or
sinuses.
• Nose drops can be instilled to remain in the nasal
passage, to reach the ethmoid and sphenoid sinuses,
or to reach the frontal or maxillary sinuses. Location is
determined by the degree of hyperextension and
position of the head during instillation

86.
Equipment
• Medication administration record (MAR)
• Non-sterile gloves
• Medication with dropper
• Tissue
• Emesis basin (optional)

87.
Procedure
1. Check with the client and chart for any known
allergies.
2. Check the MAR against health care practitioner’s
written order.
3. Wash hands. Explain the procedure to the client and
provide privacy.
4. Instruct client to blow nose unless contraindicated by
client condition (such as recent nosebleed).
5. Explain that the client may feel a burning sensation to
the mucosa or a choking sensation, or both, as the
drop trickles back into the throat.

88.
6. Place the client in a
supine position and
hyperextend the neck.
7. Position the head to
the site that facilitates
the drops’ reaching
the expected site

89.
8. Instruct the client to breathe through his or
her mouth.
9. Squeeze some medication into the dropper.
10. Insert the nasal drops about 3/8 inch into
nostril, keeping the tip of the dropper away
from the sides of the nares.

90.
11. Instill the prescribed dosage of medication and
observe the client for signs of discomfort.
12. Instruct the client to remain supine for 5
minutes.
13. Discard any unused medication remaining in the
bottle.
14. Return the client to a comfortable position and
provide the client with the emesis basin and
tissue to expectorate any medication that flows
into the or pharynx and mouth.

91.
15. Remove gloves and wash hands.
16. Record on the MAR the drug given, number
of drops instilled, and nostril medicated.
17. Observe the patient for side effects for 30
minutes after administration.

92.
Rectal Instillations
• Rectal instillations can be in the form of enemas,
suppositories, and ointments.
• Rectal ointments are used to treat local
conditions and symptoms such as pain,
inflammation, and itching caused from
hemorrhoids.
• Rectal suppositories are cone-shaped masses of
substances designed to melt at body temperature
and to produce the intended effect at a slow and
steady rate of absorption.

93.
Equipment
• Medication administration record (MAR)
• Non-sterile gloves
• Prescribed rectal suppository
• Tissue
• Water-soluble lubricant (such as K-Y jelly)
• Bedpan (optional)

94.
Procedure
1. Check with client and the chart for any known or
medical conditions that would contraindicate
use of the drug. Gather necessary equipment.
2. Check MAR against written health care
practitioner orders. Wash your hands
3. Ask client if he or she needs to void. Explain
procedure to client. Don non-sterile gloves.
4. Place the client in the Sims’, left-lateral position,
with the upper leg flexed.
5. Fold back the bed linen to expose the rectum.

95.
6. Open the package of lubricant and remove
the foil wrapper from the suppository. Read
the manufacturer’s instructions on the
wrapper for the recommended time interval
the client should retain the suppository after
insertion.
7. Apply a small amount of lubricant to the
smooth rounded end of the suppository to
reduce mucosal irritation.

96.
8. Lubricate the gloved index
finger.
9. Instruct the client to
breathe through the
mouth.
10. Insert the suppository
into the rectal canal
beyond the internal
sphincter, about 4 inches
(10 cm) for an adult and
2 inches (5 cm) for a
child.

97.
11. Avoid inserting the suppository into feces.
12. Withdraw the finger and wipe the anal area
with tissue. Instruct the client to remain in
bed for 15 minutes and to resist urge to
defecate.
13. Remove gloves, turning them inside out;
dispose of gloves; wash hands.

98.
Vaginal Instillations
• Medications inserted into the vagina are in the
form of suppositories, creams, gels, ointments,
foams, or douches.
• These medications may be used to treat
inflammation, infections, and discomfort, or as a
contraceptive measure.
• Tampon Use
• Clients should be instructed not to use tampons
after the insertion of vaginal medications because
the tampon can absorb the medication and
decrease the drug’s effect

99.
Equipment
• Medication administration record (MAR)
• Non-sterile gloves
• Prescribed vaginal suppository
• Water-soluble lubricant
• Disposable applicator
• Tissue

100.
Procedure
1. Check with the client and the chart for known
allergies or medical conditions that would
contraindicate the use of the drug. Gather necessary
equipment.
2. Check the MAR against written health care
practitioner orders. Wash your hands.
3. Follow the five rights of medication administration.
Ask the client to void.
4. Position the client in a dorsal recumbent position with
knees flexed and hips rotated laterally or in a Sims’
position if the client cannot maintain the dorsal
recumbent position.

101.
5. Don non-sterile gloves. Explain procedure to patient. If
client plans to self-administer, be very specific with
instructions.
6. Provide for privacy. Assess perineal area, inspect vaginal
orifice, note any odor or discharge from the vagina, and
inquire about any problems such as itching or discomfort.
• If secretion or discharge is present, cleanse the perineal
area with soap and water.
7. Remove suppository from the foil wrapper and, if
applicable, insert into applicator tip. Apply a small amount
of lubricant to rounded tip of suppository. If not using an
applicator, apply a small amount of lubricant to gloved
index finger.

102.
8. With nondominant hand,
spread labial folds. Insert
the suppository into the
vaginal canal at least 2
inches (5 cm) along the
posterior wall of the
vagina or as far as it will
go.
• If using an applicator,
insert as described above
and depress plunger to
release suppository

103.
9. Wipe the perineum with clean, dry tissue.
Instruct the client to remain in bed for 15
minutes.
10. Wash applicator under cool running water to
clean (warm water promotes coagulation of
protein secretions) and return to appropriate
storage in the client’s room.
11. Remove gloves, turning them inside out;
dispose of gloves in the proper container. Wash
hands.

104.
12. Record on the MAR the drug’s name dosage,
route, and date and time of administration;
document any evidence of discharge or odor
from the vagina.
13. Check with the client in 15 minutes to ensure
that the suppository did not slip out and to allow
the client to verbalize any problems or concerns.
14. Observe for effectiveness of the medication;
inspect the condition of the vaginal canal and
external genitalia between applications.

105.
Administering Nebulizer Medications
Definition:
• Nebulizer Therapy is to liquefy and remove
retained secretions from the respiratory tract.
• A nebulizer is a device that a stable aerosol of
fluid and /or drug particles.
• Most aerosol medication have bronchodilating
effects and are administered by respiratory
therapy personnel.

106.
Purpose:
1. To relieve respiratory insufficiency due to bronchospasm
2. To correct the underlying respiratory disorders
responsible for bronchospasm
3. To liquefy and remove retained thick secretion form the
lower respiratory tract
4. To reduce inflammatory and allergic responses the upper
respiratory tract
5. To correct humidify deficit resulting from inspired air by
passing the airway during the use of mechanical
ventilation in critically and post surgical patients
Equipments required
1. Dr.’s order card, client’s chart and kardex
2. Inhaler (1)
3. Tissue paper
4. Water, lip cream as required

107.
Types of nebulizer
1. Inhaler or meterd-dose nebulizer
2. Jet nebulizer
3. Ultrasonic nebulizer
 Teach the client how to use personnel device.
(Rationale: To ensure appropriate self-care after
discharge)
Avoid treatment immediately before and after
meals.(Rationale: To decrease the chance of
vomiting or appetite suppression, especially with
medication that cause the client to cough or
expectorate or those that are done in conjunction
with percussion/ bronchial drainage )

108.
Procedure
1. Perform hand hygiene
2. 2. Prepare the medication following the Five
rights of medication administration:
①Right drug
②Right dose
③Right route
④Right time
⑤Right client

109.
3. Explain to the client what you are going to do.
4. Assist the client to make comfortable position in sitting
or semi-Fowler position.
5. Shake the inhaler well immediately prior to use
6. Spray once into the air.
7. Instruction to the client:
i. Instruct the client to take a deep breath and exhale
completely through the nose
ii. The client should grip the mouthpiece with the lips,
push down on the bottle, and inhale as slowly and
deeply as possible through the mouth.

110.
iii. Instruct the client to hold
his/her breath for adult 10
seconds and then to slowly
exhale with pursed lips
iv. Repeat the above steps for
each ordered “ puffs”,
waiting 5-10 seconds or as
prescribed between puffs.
v. Instruct the client to gargle
and wipe the face if
needed.

111.
8. Replace equipments used properly and
discard dirt.
9. Perform hand hygiene.
10.Document the date, time, amount of puffs,
and response. Sign on the documentation
11. Report any findings to a senior staff.

112.
3. Parenteral
• Parenteral medications are given through a route other
than the alimentary canal; these routes are
intradermal, subcutaneous, intramuscular, or
intravenous.
• The angle of injection and the depth of penetration will
indicate the type of injection.
• Many clients have broadly classified the parenteral
route into one category: “injections” or “shots.”
• The nurse should provide the client with an
explanation of the various routes used when
administering parenteral drugs.

113.
• To prepare and administer parenteral
medications the nurse must have knowledge
of the special equipment, use manual
dexterity and sterile technique, and follow
Standard Precautions.
• An injection is an invasive procedure because
it breaks the skin barrier.
• As such, it must be performed using proper
aseptic technique to prevent risk of infection.

114.
Angle of Injection
• The angle of insertion
depends on the type of
injection.
• Figure illustrates the
angle of insertion for
each type of parenteral
injection.

115.
Intradermal Injection
• Intradermal (ID) or intracutaneous injections
are typically used to diagnose tuberculosis,
identify allergens, and administer local
anesthetics.
• The site below the epidermis is the location
for administering ID injections; drugs are
absorbed slowly from this site.

116.
• The sites commonly
used for ID injection are
the inner aspect of the
forearm (if it is not
highly pigmented or
covered with hair),
upper chest, and upper
back beneath the
scapula (Figure).
Intradermal Injection Sites: A. Inner Aspect of
the Forearm; B. Upper Chest; C. Upper Back

117.
• Only small amounts of water-soluble medication should
be used for ID injections.
• The drug’s dosage for an ID injection is usually contained
in a small quantity of solution (0.01 to 0.1 ml).
• A 1-ml tuberculin syringe with a short bevel, 25 to 27
gauge, 3/8- to 1/2-inch needle is used to provide
accurate measurement.
• If repeated doses are ordered, the site should be
rotated.
• ID injections are administered into the epidermis layer
by angling the needle 10° to 15° to the skin.

118.
Administering an Intradermal Injection
Equipment
• Medication administration record (MAR)
• Medication
• Sterile tuberculin syringe and short bevel, 25
to 27 gauge, 3/8- to 1/2-inch needle.
• Disposable gloves
• Alcohol swab and sterile 2 × 2 gauze pad

119.
Procedure
1. Check with the client and the chart for any known
allergies.
2. Wash hands.
3. Follow the five rights.
4. Prepare the medication from an ampule or vial; Take the
medication to the client’s room and place on a clean
surface.
5. Check the client’s identification armband.
6. Explain the procedure to the client.
7. Place the client in a comfortable position; provide for
privacy.

120.
8. Wash hands and don nonsterile gloves.
9. Select and clean the site.
• Assess the client’s skin for bruises, redness, or
broken tissue.
• Select an appropriate site using appropriate
anatomic landmarks.
• Cleanse the site with an alcohol wipe using a
firm circular motion; cleanse from inside to
outside; allow alcohol to dry.

121.
10. Prepare the syringe for
injection.
• Remove the needle guard.
• Express any air bubbles from
the syringe.
• Check the amount of solution
in the syringe.
11. Inject the medication.
• Hold the syringe in dominant
hand.
• With nondominant hand, grasp
the client’s dorsal forearm and
gently pull the skin taut on
ventral forearm(Figure ).

122.
• Place the needle close to the skin, bevel side up. Insert
the needle at a 10° to 15° angle until resistance is felt,
and advance the needle approximately 3 mm below
the skin surface; the needle’s tip should be visible
under the skin.
• Administer the medication slowly; observe the
development of a bleb (large flaccid vesicle that
resembles a mosquito bite). If none appears, withdraw
the needle slightly.
• Withdraw the needle.
• Pat area gently with a dry 2 × 2 sterile gauze pad.
• Do not massage the area after removing the needle.

123.
12. Discard the needle and syringe in a sharps
container.
13. Remove gloves, dispose of in appropriate
receptacle, and wash hands.
14. Observe for signs of an allergic reaction.
15. Draw a circle around the perimeter of the bleb
with a ball point pen.
16. Document medication and site of injection on
the MAR.

124.
Subcutaneous Injection
• Subcutaneous (SC or SQ) injections are commonly used in
the administration of medications such as insulin and
heparin because these drugs are absorbed slowly, to
produce a sustained effect.
• SC injections place the medication into the subcutaneous
tissue, between the dermis and the muscle.
• Clients who administer frequent subcutaneous injections
should rotate sites regularly.
• The amount of medication given varies but should not
exceed 1.0 ml; if repeated drug doses are given, rotate the
sites.
• Subcutaneous tissues are sensitive to irritating medications.
• Hard painful lumps can develop beneath the skin if the
sites are not rotated.

125.
• Common sites for SC
injections are the
abdomen, the lateral
and anterior aspects of
the upper arm or thigh,
the scapular area on the
back, and upper
ventrodorsal gluteal
areas (Figure ).

126.
• The nurse should select a sterile 0.5- to 3-ml syringe
with a 25- to 29-gauge, 3/8- to 1/2-inch needle.
• The medication is administered by angling the needle
45° or 90° to the skin.
• The client’s body weight will influence the angle used
for injection.
• As a general rule, to reach subcutaneous tissue, if you
can grasp 2 inches of tissue between two fingers, insert
the needle at a 90° angle.
• If only 1 inch of tissue can be grasped between the
fingers, use a 45° angle to administer the medication.

127.
• The length of the needle may also vary with body
weight.
• Normally for SC injections, a 25-gauge, 5/8-inch
needle is used.
• A child will require a short needle, and an obese
person may require a longer needle to ensure
placing the medication in the subcutaneous
tissue.
• The length of the needle should be approximately
half the width of the pinched skinfold.

128.
Administering a Subcutaneous Injection
Equipment
• Medication administration record (MAR)
• Medication as prescribed
• Sterile syringe and 5/8-inch needle
• Disposable gloves
• 2 alcohol swabs

129.
Procedure
1. Check with client and the chart for any known allergies.
2. Wash your hands.
3. Follow the five rights.
4. Prepare the medication from an ampule or vial. Take
medication to the client’s room and place on a clean
surface.
5. Check the client’s identification armband.
6. Explain the procedure to the client.
7. Place the client in a comfortable position; provide for
privacy.
8. Don nonsterile gloves.

130.
9. Select and clean the site.
• Assess the client’s skin for bruises, redness, hard tissue, or
broken skin.
• Cleanse the site with an alcohol swab; cleanse from inside
outward.
10. Prepare for the injection.
• Remove the needle guard and express any air bubbles from
the syringe; check the dosage in the syringe.
• With dominant hand, hold the syringe like a dart between
your thumb and forefingers.
• Pinch the subcutaneous tissue between the thumb and
forefinger with the nondominant hand. If the client has
substantial subcutaneous tissue, spread the tissue taut.

131.
11. Administer the injection.
• Insert the needle quickly at a 45° or 90° angle.
• Release the subcutaneous tissue and grasp the barrel of the syringe
with nondominant hand.
• With dominant hand, aspirate by pulling back on the plunger gently,
except when administering an anticoagulant injection.
• If blood appears, remove needle and discard in a sharps container.
• Inject medication slowly if there is no blood present.
• Remove the needle quickly and lightly massage area with alcohol
swab; do not massage the injection site after the administration of
an anticoagulant.
• Do not recap the needle; discard the needle in a sharps container.

132.
12. Position client for comfort.
13. Remove gloves and wash hands.
14. Record on the MAR the route, site, and
time of injection.
15. Observe the client for any side or adverse
effects and assess the effectiveness of the
medication at the appropriate time.

133.
Intramuscular Injection
• Intramuscular (IM) injections are used to
promote rapid drug absorption and to provide
an alternate route when the drug is irritating
to subcutaneous tissue.
• The IM route enhances the absorption rate
because there are more blood vessels in the
muscles than in subcutaneous tissue;
however, the absorption rate may be affected
by the client’s circulatory status.

134.
• The nurse should determine the maximum volume to inject
on the basis of the site and the client’s muscle
development:
• 4 ml for a large muscle (gluteus medius) in a well
developed adult
• 1 to 2 ml for less developed muscles in children, elderly,
and thin clients
• 0.5 to 1.0 ml for the deltoid muscle
 When more than 4 ml is ordered, the medication can be
divided into two different sites.

135.
There are four common sites for administrating IM injections ;Injection sites
are identified by using appropriate anatomic landmarks (see Figure below ).

136.
• The primary site for administering an IM injection
in clients over 7 months old is the ventrogluteal
(VG) site.
• The gluteus medius is a well-developed muscle,
free of major nerves and large blood vessels.
• The nurse should avoid using the deltoid and
dorsogluteal sites in infants and children.
• There is a risk of striking the sciatic nerve when
using the dorsogluteal site.
• The deltoid muscle is not well developed in
infants and children.

137.
• The nurse will need to decide on the gauge and length
of the needle on the basis of the consistency of the
solution, the site, and how far the needle must be
injected to reach the muscle.
• A 21- to 23-gauge needle will accommodate the
consistency of most drugs and will minimize tissue
injury and subcutaneous leakage.
The needle’s length is determined by the site:
• 1 1/2-inch needle, VG site for average-sized adults
• 1-inch needle, VG site for children
• 1-inch needle, deltoid or vastus lateralis

138.
• An obese client usually requires a 2-inch needle
to ensure that the needle will reach a large
muscle such as the gluteal muscle.
• For example, for a client weighing 100 pounds,
use a needle 1 to 1 1/2 inches long; usually
• for a child use only a 1-inch needle.
• It is important to consider the size of the client
when determining the needle length; some
children are large, and some adults are small.
• The nurse should administer an IM injection at a
90° angle.

139.
Administering an Intramuscular Injection
Equipment
• Medication administration report (MAR)
• Sterile 3-ml syringe and long bevel, 20 to 22
gauge, 1- to 2-inch needle (average-sized, adult
client receiving a drug in an aqueous solution)
• Medication as prescribed
• Alcohol swab
• Nonsterile gloves
• Sterile 2 × 2 gauze pad

140.
Procedure
1. Check with client and the chart for any known
allergies.
2. Wash hands.
3. Follow the five rights.
4. Prepare the medication from an ampule or vial
• Add 0.1 to 0.2 ml of air to the syringe.
• Take medication to the client’s room and place on
a clean surface.
5. Check the client’s identification armband.
6. Explain the procedure to the client; provide for
privacy.

141.
7. Place the client in an appropriate position to
expose the site.
• Deltoid: sitting position.
• Ventrogluteal:
• Side-lying: flex the knee, pivot the leg forward
from the hip about 20° so it can rest on the bed.
• Supine: flex the knee on the injection side.
• Prone: point toes inward toward each other to
internally rotate the femur.

142.
8. Don nonsterile gloves.
9. Select and clean the site.
• Assess the client’s skin for redness, scarring, breaks in
the skin, and palpate for lumps or nodules.
• Select site using the anatomic landmarks.
• Cleanse the area with an alcohol swab, cleanse from
inside outward using friction; wait 30 seconds to allow
to dry.
10. Prepare for the injection.
• Remove the needle cap by pulling it straight off, and
expel any air bubbles from the syringe.

143.
11. Administer the injection.
• Deltoid: quickly insert the
needle with a dart like
motion at a 90° angle
(Figure1 ).
• Ventrogluteal: quickly
insert the needle
using a dart like motion and
steady pressure at a 90°
angle to the iliac crest in
the middleof the V (Figure
2).

144.
• Aspirate by pulling back on the plunger, and observe for
blood.
• If blood appears, remove the needle and discard.
• If blood does not appear, inject the medication slowly,
about 10 sec/ml.
• Wait 10 seconds after the medication has been injected,
then smoothly withdraw the needle at the same angle of
insertion.
• Apply gentle pressure at the site with a dry, sterile 2 × 2
gauze; do not massage the injection site. Swab using gentle
pressure.
• Discard the needle and syringe in a sharps container; do
not recap the needle.

145.
12. Position client for comfort; encourage client
receiving ventrogluteal injections to perform
leg exercises (flexion and extension).
13. Remove gloves, wash hands.
14. Record on the MAR the dosage, route, site,
and time.
15. Inspect the injection site within 2 to 4 hours
and evaluate the client’s response to the
medication

146.
Administering Medication via IV Injection
Intravenous Injections
• The intravenous (IV) route is used when a rapid drug
effect is desired or when the medication is irritating to
tissue.
• IV administration provides immediate release of
medication into the bloodstream; consequently, it can
be dangerous. IV medications are administered by one
of the following methods:
 Intravenous fluid container
 Volume-control administration set
 Intermittent infusion by piggyback or partial fill
 Intravenous push (IVP or bolus)

147.
Adding Medications to an IV Solution
• When administering IV medications, regardless of
the method used, the nurse should assess the
patency of the infusion system and the condition
of the injection site for signs of complications
such as infiltration (swelling and discomfort at the
IV site) and phlebitis (inflammation of a vein).
• Some IV medications or solutions with high or
low pH or high osmolarity are irritating to veins
and can cause phlebitis.

148.
• Before administering any IV medication, the
nurse should note the client’s allergies, drug
or solution incompatibilities, the amount and
type of diluents needed to mix the
medication, and the client’s general condition
to establish a baseline for administering
medication.

149.
Administering Medications via IV
Bolus or IV Push
• The method of
medication
administration by IV bolus
or IV push injection is
determined by the type of
IV system. For example,
an IV push medication
can be injected into a
saline or heparin lock (see
Figur) or into a
continuous infusion line.

150.
• When giving an IV push
medication into a
continuous infusion line,
the nurse must stop the
fluids in the primary line;
the nurse usually pinches
the IV tubing closed to
inject the drug (see Figure).
• This technique is safe and
prevents the nurse from
having to recalculate the
drip rate of the primary
infusion line.

151.
4. Fluid therapy
Setting an IV line
• It is administration of large amount of solution /
fluid in to circulatory system through vein.
• PURPOSE
• To maintain fluid electrolyte balance
• To maintain acid base balance
• To introduce medications (antibiotic, vitamin)
• To provide caloric when the pt is NPO
• To maintain an access to circulatory system when
the pt is taking intermittent medication.
151

152.
Equipment
• Iv set/ tube
• Pole
• Alcohol swab
• Solution
• Glove
• Tourniquet
• Medication chart
• Receiver
• Scissor
• Plaster
• Canula
152

153.
PROCEDURE
• Explain procedure, Wash your and , Assemble
all the necessary equipment
• Connect bag & tubing, run solution through
tubing to displace air from it, Cover it.
• Position the pt comfortably & select the vein
• Apply tourniquet 10 – 12 cm above the
selected site, Clean the site with alcohol swab
153

154.
• Hold the needle 450 with the vein & insert it
• Draw back the needle to check if you are in
the blood. Release the tourniquet
• Connect the tubing to the canula & start the
flow. Anchor the tubing with plaster
• Adjust flow rate
154

155.
• • Count the number of drops for
a 15-second interval and
multiply by 4; for example, if the
drop factor of tubing is 10
drops/ml then the drop rate
should be 21 drops/minute to
infuse 1000 ml/8 hours (Figure).
• Open the regulator clamp slowly
to increase the drip flow rate;
close the regulator clamp to
decrease the drip rate to achieve
21 drops/minute.
• Recount the drop rate after 5 and
15 minutes.

156.
Calculating & regulating flow rate
• Flow rate= Number of ml of solution x No of drops in ml
• No of hrs in which solution runs x 60minute
• E.g. A 5% DW is to be administrate run over a 12 hr time,
calculate drops per minute to finish it over given time
1000ml x 15 drops /ml = 20.83= 21 drops/min
12 x 60 min
• In IV solution may not flow at a rate it is calculated
originally so it should be monitored at least hourly.
• Replace equipments, Wash your hand. Record the
procedure
• Observe the pt and monitor the flow.
156

157.
IV fluid therapy
• IV therapy requires frequent client monitoring by
the nurse to ensure an accurate flow rate and
other critical nursing actions.
• These other actions include ensuring client
comfort and positioning; checking IV solution for
correct solution, amount, and timing; monitoring
expiration dates of the IV system (tubing,
venipuncture site, dressing) and changing as
necessary; and being aware of safety factors.

158.
• Coordinate client care with the maintenance
of IV lines.
• Clients with IV therapy usually require
assistance with hygienic measures, such as
changing a gown .
• Change IV tubing when doing site care to
decrease the number of times the access
device is manipulated, thereby decreasing the
risk for infiltration and phlebitis.

159.
• When initiating IV therapy,
the nurse should assess for
a venipuncture site. Figure
• When assessing clients for
potential sites, consider
their age, body size, clinical
status and impairments, and
the skin condition.
Peripheral Veins Used in Intravenous Therapy. A. Arm
and Forearm; B. Dorsum of the Hand; C. Dorsal Plexus of
the Foot

160.
• Lower extremity veins are used for IV therapy
only when so prescribed by the health care
practitioner; circulating blood in the lower
extremities is likely to pool and clot, which
may result in an embolism.
• Select a vein for puncture at its most distal
end to maintain the integrity of the vein,
because venous blood flows with an upward
movement toward the heart.

161.
• Once the solution is prepared for administration,
the nurse calculates the rate and explains the
procedure to the client
• There are three ways to administer solutions:
1. Initiate the infusion by performing a
venipuncture.
2. Use an existing IV system: catheter, heparin or PI
lock, central line, or implanted port.
3. Add a solution to a continuous-infusion line.

162.
Blood Transfusions
• Is the infusion of whole blood or blood component
(plasma, RBCs, platelets,) from the healthy person (Donor)
to the recipient vein.
• PURPOSE
• To replace blood losses in sever hemorrhage.
• To provide clotting factors which may be lacking due to
disease (eg.haemophelia)
• To prevent circulatory collapse in OR where blood loss is
considerable. E.g. hysterectomy.
• In case of anemia from cancer, marrow aplasia, and similar
conditions.
• In case of sever burn to replace blood losses.

163.
Equipment
• Blood unit labeled with name, blood group, Rh, expiry date.
• Blood administration set (Y-administration set tubing with
in-line filter)
• V/s equipment
• Bags of normal saline
• Adhesive tape
• Tourniquet
• Glove
• Regular administration set
• Alcohol swabs and tape
• Receiver

164.
Procedure
1. Greet and explain the procedure to the
patient.
2. Gather all the necessary equipment.
3. Check the label on the blood bag (pts name,
Rh, blood group, expiry date etc)

165.
4. Hang NS with the
administration set to
start the transfusion.
5. Position the pt
comfortably & select the
vein.
6. Place the rubber and
towel under the pts arm.
7. Take V/S to have base line
information for further
judgment.

166.
8. CHOOSE THE VEIN:- Apply tourniquet 10 – 12
cm above the selected site.
9. Clean the site with alcohol swab
10. Hold the needle 450 with the vein & insert it
11. Draw back the needle to check if you are in
the blood. Release the tourniquet
12. Connect tubing to the canula & start flow.
Anchor the tubing with plaster

167.
13. Adjust flow rate.
14. Replace equipments. Splint the site if
needed.
15. Wash your hand.
16. Record the procedure. Observe the pt and
monitor the flow.

168.
Precaution
• Blood should not be taken from a donor with :-
Hepatitis (B, C) in the last 6 month
• Blood transfusion in the last 6 month (except serum
albumin)
• Malaria, syphilis, possible exposure to HIV
• Recent immunization (may transmit live organisms e.g.
1 year for rabies, 1 month for rubella, 2 weeks for live
attenuated vaccines, Cancer
• No medication should be added to blood product. Flow
rate is 5-10 gtt /min.
• Do not heat but put on pt chest to bring its T0 to room
temperature.