Question

A 59-year-old man has been admitted. He has a 90-minute history of severe crushing chest pain. Received nitroglycercin  1 tablet sublingual stat, nitroglycercin patch to upper extremities every six hours, morphine sulfate 2 mg IV. Timpotic eye drops OU bid. Digoxin 0.25 mg po stat.

1. How should the nurse safely administer transdermal or topical medications?

2. List four principles for administering eye instillations.

3. Identify four sites for subcutaneous injections.

4. Identify three sites for Intramuscular injection sites.

5. Explain the purpose for receiving Morphine Sulfate IV.

Conversions:

A. gr 1/2 = ___ mg

B. 2 teaspoons = mL

C. 6 ounces____=mL

50 mL NS with antibiotic IV to infuse in 20 minutes. The drop factor is 20 gtt/mL. Flow rate: ______ gtt/min

Answer 1

Question 1

To apply a transdermal patch

-Clean the hands and wear a glove

-Decide on the location for applying the patch

-If there is a patch placed previously remove it and clean the site

-Carefully cut the packaging of the patch using a scissors.Take care not to cut the patch as this may cause sudden release of drug all at once which result in overdosage

-If there is excess hair in the site trim it using scissors

-Carefully remove the back paper of the patch

-Apply the patch on a clean ,dry , hairless skin and press on all areas of the patch firmly

Question 2

Following principles should be applied while applying eye instillations

-Always use separately labelled containers for each eye to avoid cross infection

-If both drops and ointments are prescribed to be administered at the same time, always apply drops first,then apply ointment because ointment can affect absorption of drops

-Do not direct the medication towards the cornea,as it can cause damage to cornea.Always direct the medication to the lower eyelid

-If there is eye discharge or if you want to wipe away excess medication do not use a dry cotton ball,as the fibres can harm cornea

-Always work from the medial canthus outwards to the lateral canthus while applying ointment to reduce chances of infection

-While opening a medication container label the opening date and discard after 2 weeks

-Medication container should not touch the eye

Question 3

Sites for subcutaneous injection

-Outer upper arm

-Back of upper arm

-Upper thigh

-Lower abdomen around the umbilicus

-Upper buttock

Question 4

Sites for intramuscular injection

-Deltoid

The densest part of the muscle is to be located at the midlateral aspect upper arm in line with axilla, 2.5 cm below acromion process.This prevent damage to radial nerve and brachial artery

-Dorsogluteal

Make the patient lie on his side with knees slightly flexed.An imaginary line is drawn horizontally from the cleft of buttock to the greater trochanter of femur.Another line is drawn vertically midway between the previous line.Locate upper outer quadrant. Divide this quadrant into four.Then the desired location is the upper quadrant.This will prevent injury to sciatic nerve and gluteal artery, with access to gluteus maximus

-Ventrogluteal

Make the patient lie on his left lateral position. Place your left palm on his greater trochanter.Point and reach the superior iliac crest with the index finger.Now extend the middle finger away from the index finger so that a V is formed between the index and middle finger.The desired point is the centre of V.This will give access to gluteus minimus and medius

-Thigh muscles(vastus lateralis and rectus femoris)

Question 5

Morphine is an opioid analgesic.It acts at substantial gelatinosa of dorsal horn of spinal cord and prevents release of excitatory neurotransmitter from the primary afferents carrying pain impulses.It relieves visceral poorly localised dull pain better than the sharp pain.It also causes vasodialatation and shifts blood from pulmonary to peripheral circulation. It also causes sedation.Here,it is given to relieve the pain of angina