•

WEEK 13: ENTERAL NUTRITION

•
• Assess patient for food allergies or
TOTAL ENTERAL NUTRITION (TEN)
intolerances
• Alternative feeding methods that ensures • Perform physical assessment of abdomen
adequate nutrition that includes enteral PLANNING
(through the gastro-intestinal system)
• For clients who can not digest foods of the • Gather the equipment and bring them to
upper GI tract is impaired and the the bedside
transport of food to the small intestines are • Explain the procedure to patient
interrupted • Provide patient privacy
• Perform hand hygiene and apply clean
ENTERAL ACCESS DEVICES gloves
1. Nasogastric or nasointestinal or IMPLEMENTATION
nasoenteric tubes
▪ Larger than 12 F (French unit) • Place the patient in High Fowler’s position
placed into stomach or elevate head of bed preferably 45
▪ Larger lumens allow delivery of degrees for some patients
liquids to the stomach or removal • Prepare the tube
of gastric contents a. Small bore tube – ensure stylet or
▪ Softer, more flexible and less guidewire in secured in a position
irritating small bore feeding tubes b. Large bore tube – place in a basin
2. Gastrostomy tube to become more pliable and
3. Jejunostomy tube flexible
• Determine how far to insert the tube
INSERTION OF NASOGASTRIC TUBE a. Tip of client’s nose → Tip of Earlobe
→ Tip of the Xiphoid
Purpose: • Lubricate the tip of the tube well with
✓ To administer tube feedings and water soluble lubricant
medications to client unable to eat by • Insert the tube with its natural curve
mouth or swallow a sufficient diet without downward, into the selected nostrils
aspirating foods or fluids into the lungs • Ask the client to hyperextend the neck
✓ To establish a means for suctioning and gently advance the tube towards the
stomach contents to prevent gastric nasopharynx
distention, nausea, and vomiting • Direct the tube along the floor of the
✓ To remove stomach contents for nostrils and toward the midline
laboratory analysis • Slight pressure and a twisting tube motion
✓ To lavage the stomach in case of are sometimes required to pass the tube
poisoning or overdose of medications into the nasopharynx
• If the tube meets resistance, withdraw it.
ASSESSMENT: Relubricate it and insert in the other nostrils
• Once the tube reaches the oropharynx,
• Check for history of surgery or deviated
the client will feel the tube in the throat
septum. Assess the patency of nares
and may gag. Ask the client to tilt the
• Determine presence of gag reflex
head forward
• Assess mental status or ability to
• If the client gags, stop passing the tube
participate in the procedure
momentarily
• Verify doctor’s order for formula, rate,
• In the coperation with the client, pass the
route and frequency
tube 5-10cm with each swallow until the
• Identify the patient using 2 identifiers
indicated length is inserted

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 flush tube with air (negative
• Ascertain correct placement of the tube
pressure). Put down slowly to
(Chech pH level 1-5)
aspirate total amount of gastric
contents and measure
EVALUATION b. If 100ml or more than the last
feeding is withdrawn, refer to
• Assess the client’s tolerance of the NGT agency policy before proceeding
• Check if it’s in the correct placement c. Re-instill the gastric contents into
• Educate the client’s understanding about the stomach
the restrictions, color and amount of d. Auscultate for gurgling sounds
gastric contents can be found in the NGT • Initiate feeding

Syringe for Intermittent Feeding

FEEDING THROUGH NASOGASTRIC TUBE
a. Pinch proximal end of feeding
ASSESSMENT tube
• Verify Doctor’s order formula, rate, route b. Remove plunger from syringe and
and frequency attach tip of syringe to end of
• Identify patient using 2 identifiers tube
• Assess patient for food allergies or c. Fill syringe with measured amount
intolerances of formula. Release tube, elevate
• Perform physical assessment of abdomen syringe to no more than 45cm (18
inches) above insertion site, and
PLANNING
allow it to empty gradually by
• Gather the equipment and bring them to
gravity
the bedside
• Prepare feeding container and formula • Flush with 30 ml water every 4 hours before
a. Check expiration date of formula and after an intermittent feeding
and integrity of container
AFTER CARE AND EVALUATION
b. Have tube feeding at room
temperature Aftercare:
c. Shake formula well
• Explain the procedure to patient 1. Keep patient in Fowler’s position for 30
• Provide patient privacy mins
• Perform hand hygiene and apply clean 2. Secure tubing to patient’s gown
gloves 3. Wash equipment used and store in the
designated area
IMPLEMENTATION
• Place the patient in High Fowler’s position Evaluation
or elevate the head of bed preferably 45
• Perform a follow-up examination of the
degrees for some patients
following:
• Verify tube placement
✓ Tolerance of feeding
a. In nasogastric tube, attach syringe
✓ Bowel sounds
and aspirate 1ml of gastric
✓ Regurgitation and feelings of
contents. Observe appearance of
fullness after feedings
the aspirated gastric contents and
note pH level if available Documentation
b. Check for gastric residual volume
(GRV) • Record amount and type of feeding
• Before each feeding for bolus and instilled, patient’s response to tube
intermittent feedings in non-critically ill feeding, tube patency, condition of nares
patients: and any side effects
a. Connect asepto syringe to the end • Document the patient’s learning towards
of feeding tube. Remove bulb and NGT feeding

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 REMOVAL OF NASOGASTRIC TUBE Evaluation

1. Inspect nares and oropharynx for irritation

1. Verify health care provider’s order for
2. Ask if the patient is comfortable
removal
3. Observe patient for difficulty breathing,
2. Gather equipment, explain procedure to
coughing or gagging
patient
3. Perform hand hygiene, apply gloves
4. Position patient in high fowler’s if possible
5. Place towel on patient’s chest
6. Disconnect tube from administration set
7. Remove tape partially
8. Coil end of tubing until the nose
9. Instruct patient to take deep breath and
hold it. Pull tube out smoothly. Dispose
tube properly by wrapping the coiled
tubing with gloves
10. Offer tissue to patient to blow nose. Clean
the client’s nares and provide oral care
11. Perform hand hygiene

WEEK 14: CATHETERIZATION

be added for patients with leg worn bags

URINARY CATHETER (tandem system)
• Specially designed tube into the bladder
to drain urine ✓ Urine meter bags should be changed inline
• A passage tube or a tube-like material with manufactures recommendations (usually
into a body channel or cavity weekly) using Antiseptic Non-Touch
• Introduction of catheter via the urethra Technique
into the urinary bladder
Catheterization Indications

Catheter considerations 1. For Diagnostic Purposes:

➢ Monitoring of urine output
❖ Catheters particularly the indwelling type ➢ Imaging purposes (Ultrasound of
are one of the main source of infection in Kidney, Ureters, Bladders)
the hospital setting 2. Therapeutic Indications (For clients with:)
❖ Catheterization of the client affects the ➢ Acute urinary retention
patient’s body image, mobility, pain and ➢ Chronic urinary retention (Hematuria)
discomfort ➢ Initiation of continuous bladder
❖ Catheterization is carried out using a irrigation
aseptic non-touch technique (ANTT) ➢ Intermittent decompression of bladder
❖ Catheterization can be through urethral or ➢ Prolonged immobilization
suprapubic ➢ Urinary Tract Infection
Managing a urinary catheter 3. Surgical Indication
➢ Prostate surgery
✓ Catheter and drainage bag should be ➢ Bladder surgery
adequate fixed to prevent trauma ➢ Urology surgery and & gynaecology
✓ Drainage system must be closed to surgery
prevent infection ➢ Removal of kidney stone
✓ Disposable overnight drainage bag should ➢ Long surgical procedure
➢ Hip fracture and lumbar spine fracture

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 TYPES OF URINARY CATHETER PROCEDURE FOR CATHETERIZATION
1. Indwelling catheter / Foley Catheter
➢ Stays in place for days or weeks PREPARATION:
➢ Attached to a drainage bag or
1. Perform hand hygiene
directly to the toilet
2. Check room for additional precautions
➢ Must be initiated, replaced and
3. Introduce yourself to the patient
removed by a healthcare
4. Confirm patient ID using two identifiers
professional
5. Explain the process to patient: Offering of
Examples:
analgesics, bathroom room, etc.
o Rubber or coude catheter
6. Listen and attend to patient cues
o Plastic (PVC)
7. Ensure patient’s privacy and dignity
o Silicone
8. Assess ABC’s, suction, oxygen and safety
o Polyurethane
9. Apply principles of asepsis and safety
o Latex – Foley’s
10. Check vital signs
11. Complete necessary focused assessment

ASSESSMENT:

1. Need for catheterization and the type

ordered
2. Need to peritoneal care prior to
catheterization
3. Urinary meatus and ask for any history of
urinary difficulty
2. External Catheters
4. Client’s ability to assist in procedure
➢ Only used for male patients
5. Allergy to povidone iodine
➢ Used for urinary incontinence
6. Indications of distress or embarrassment
➢ Can be easily administered by
patients or caregivers STEPS:
Example:
o Condom catheter 1. Verify physician order for catheter insertion.
Assess for bladder fullness and pain.
3. Short-Term (Intermittent) Catheters Rationale: Palpation of a full bladder will cause an
➢ Often designed for one-time use and urge to void and or plain
discarded after use
➢ Used multiple times a day 2. Position patient prone to semi-upright with
➢ Healthcare professional gives knees raised; apply gloves, and inspect
instructions for the patient or perineal region for erythema, drainage, and
caregiver to carryout catheterization odor. Also assess perineal anatomy.
Examples:
Rationale: Assessment of perineal area allows for
o Robinson catheter
determination of perineal conditions and position
o Infant feeding tubes (For pediatric
of anatomical landmarks to assist with insertion
clients)
3. Gather supplies:
DRAINAGE BAGS
✓ Sterile gloves
❖ Selected depending on the reasons for
✓ Catheterization kit
catheter and patient choice
✓ Cleaning solution
✓ Lubricant (if not in the kit)
✓ Prefilled syringe for balloon inflation as per
catheter size
✓ Urinary bag

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ✓ Foley catheter
11.
A. For female patients:
4. Check for size and type of catheter and
▪ Help the client to dorsal recumbent
use smallest size of catheter possible
position (supine with knees flexed).
Rationale: Large catheter size increases the Ask patient to relax thighs to
risk of urethral trauma externally rotate hip joints
▪ Alternate female position: position
5. Place waterproof pad under the patient
side-lying (sims’) position with
Rationale: Prevents soiling of bed linens upper leg flexed at knee and hip.
Ensure that rectal area is covered
6. Positioning of patient depends on gender with drape to reduce risk for
contamination. Support patient
Female patient: On back with knees flexed
with pillows if necessary to maintain
and thighs relaxed so that hips rotate to
position
expose perineal area.
▪ Pick up fenestrated sterile drape.
Allow drape to unfold without
Alternatively, if patient cannot abduct leg at
touching unsterile surfaces. Allow
the hip, patient can be side-lying with upper
top edge of drape to form over
leg flexed at knee and hip, supported by
both hands. Drape over perineum,
pillows
exposing labia.
Male Patient: Supine with legs extended and ▪ In women, placing a blanket
slightly apart diamond fashion over patient, with
one corner at patient’s neck, side
Rationale: Patient should be comfortable, with corners over each arm and side
perineum or penis exposed, for ease and and last corner over perineum
safety in completing procedure
Rationale: Provide good visualization of
7. Place a blanket or sheet to cover patient structures of perineum and decreases risk
and expose only required anatomical for fecal contamination
areas
B. Male Patient
Rationale: Protects patient dignity ▪ Position supine with legs extended
8. Apply clean gloves and wash perineal and thighs slightly abducted
area with warm water and soap or ▪ Drape patient: Cover upper part of
perineal cleanser according to agency body with small sheet or blanket. Cover
policy lower extremities with sheet or blanket,
exposing only genitalia.
Rationale: Cleaning removes any secretions,
urine, and feces and reduces risk of infection Rationale: Comfortable position for patient
that aids in visualization of penis
9. Ensure adequate lighting
12. Perform hand hygiene. Wear gloves
Rationale: Helps with accuracy and speed of 13. Open catheterization kit (some products
catheter insertion have a double wrapping requiring removal
of outer wrapper or plastic covering; others
10. If using indwelling catheter and closed
require peeling back a paper top)
drainage system, attach urinary bag to the
▪ Place opened kit on clean bedside
bed and ensure that the clamp is closed
table or between the client’s legs if
Rationale: Urinary bag should be closed to possible
prevent urine drainage leaving bag ▪ Patient’s catheter size and its
positioning will dictate exact
placement

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
Rationale: Provides easy access to supplies during 17.
catheter insertion A. Female patient – Cleanse urethral
meatus
14. Open inner sterile wrap covering box using
a. Gently separate labia with fingers
sterile technique
of nondominant hand (now
Rationale: Inner sterile wrap serves as sterile field. contaminated) to fully expose
Straight catheterization trays do not routinely urinary meatus.
come with double wrapping Rationale: Optimal visualization of
urethral meatus is possible. Closure of
A. Straight intermittent catheterization – all labia during cleansing means that area
needed supplies are in sterile tray. Tray is now contaminated and requires
that contains supplies can be used for cleaning procedure to be repeated
urine collection
B. Indwelling catheterization open system – b. Maintain position of nondominant
open separate package containing hand throughout remainder of
drainage bag, check to make sure that procedure
clamp on drainage port is closed, and
place drainage bag and tubing easily Rationale: Closed drainage bag
accessible. Open outer package of sterile systems have catheter pre-attached to
catheter, maintaining sterility of inner drainage tubing and bag
wrapper
c. Use forceps to hold one cotton ball
Rationale: Open drainage bag system or hold one swab stick at a time.
requires separate sterile packaging for sterile Clean labia and urinary meatus
catheter, drainage bag and tubing and from clitoris towards anus. Use new
insertion kit cotton ball or swab for each area
you cleanse. Cleanse by wiping far
C. Indwelling catheterization closed system – labial fold, near labial fold, directly
all supplies are in sterile tray. Once sterile over center of urethral meatus
gloves are put on, check to make sure
clamp on drainage bag is closed

Rationale: Closed drainage bag systems

have catheter pre-attached to drainage
tubing and bag

15. Apply sterile gloves. Drape perineum,

B. MALE PATIENT – cleanse the penis
keeping gloves and working surface of
a. With nondominant hand (now
drape sterile
contaminated) retract foreskin (if
16. Arrange supplies on sterile field,
uncircumcised) and gently grasp penis
maintaining sterility of the gloves. Place
at shaft just below glans. Hold shaft of
sterile tray with cleaning medium (pre-
penis at right angle to body. This hand
moistened swab sticks or cotton balls,
remains in this position for remainder of
forceps and solution), lubricant, catheter,
procedure
and prefilled balloon inflation syringe
(indwelling catheterization only) on sterile Rationale: When grasping shaft of penis, avoid
drape pressure on dorsal surface to prevent compression
of urethra. Positioning penis at this 90-degree
Rationale: Provides easy access to supplies
angle to patient straightens out curvature of male
during catheter insertion and helps to
urethra and eases insertion
maintain aseptic technique. Appropriate
placement is determined by size of patient b. With uncontaminated dominant hand
and position during catheterization cleanse meatus with cotton balls/swab

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 sticks, using circular strokes, beginning
19. Allow bladder to empty full unless
at meatus and working outward in spiral
institution policy restricts maximum volume
motion. Repeat 3 times using clean
of urine drained
cotton ball/stick each time

20. Collect urine specimen as needed by

Rationale: Circular cleansing pattern
holding end of catheter over cup. Fill to
follows principles of medical asepsis
desired level. Label and bag specimen
according to agency. Send specimen to
18. Insert catheter
laboratory as soon as possible.
A. FOR FEMALE PATIENT:
Rationale: Sterile specimen for culture
a. Ask patient to bear down gently
analysis can be obtained. Fresh urine
and slowly insert catheter through
specimen ensures more accurate findings
urethral meatus

Rationale: Bearing down For straight or intermittent catheterization:

may help visualize urinary When urine flow stops, withdraw catheter
meatus and promotes slowly and smoothly until removed.
relaxation of external Rationale: Relaxation of external sphincter
urinary sphincter, aiding in aids in insertion of catheter
catheter insertion
For indwelling catheterization: Inflate
b. Advance catheter total of 5 to 7.5 cm (2-
catheter balloon
3 inches) in an adult or until urine flows
out end of catheter. Release labia but
21. For female patients:
maintain secure hold on catheter
a. As soon urine appears, advance
catheter another 2.5cm-5cm (1-2
Rationale: Urine flow indicates that
inches). Do not force catheter if
catheter tip is in bladder. It also prevents
resistance is met.
accidental dislodgement of catheter
Rationale: Ensures the catheter tip
is completely inside bladder.
B. FOR MALE PATIENTS
b. Release labia but maintain secure
a. Gently apply upward traction to penis
hold of catheter with nondominant
as it is held in 90-degree angle from
hand. Secure catheter tubing to
body. Position the penis perpendicular
inner thigh
to body for patent catheter insertion
Rationale: Ensures the catheter tip
Rationale: Straightens urethra to ease
is completely inside bladder.
catheter insertion
For male patients:
b. Ask patient to bear down as if to void
and slowly insert catheter through a. After catheter is inserted through
urethral meatus meatus and urine appears,
advance catheter to birfurcation of
Rationale: Relaxation of external sphincter
drainage and balloon inflation port.
aids in insertion of catheter
Lower penis and hold catheter
1. Advance catheter 17 to 22.5 cm (7-9 securely in non-dominant hand
inches) or until urine flows out end of
Rationale: There is natural resistance as
catheter
the catheter passes through the U-
Rationale: Length of male urethra varies. shaped bulbar urethra. Further
Flow of urine indicates that tip of catheter advancement of catheter to
is in bladder but not necessarily the bifurcation of drainage and balloon
balloon part of an indwelling catheter inflation port ensures that balloon part

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 of catheter is not still in prostatic Rationale: Drainage bags that are below level of
urethra bladder ensure free flow of urine, thus decreasing
risk for CAUTI
b. With free dominant hand, connect
prefilled syringe in injection port at 23. Check to make sure that there is no
end of catheter. Slowly inject amount obstruction to urine flow. Coil excess tubing
of solution required to fill balloon as on bed and fasten to bottom sheet with clip
designated by manufacturer or another securement device
Rationale: Indwelling catheter
Rationale: Obstruction prevents free flow of urine
balloons should not be overinflated or
and increases risk for CAUTI
underinflated to prevent occlusion of
catheter drainage holes, balloon 24. Provide hygiene as needed. Help patient to
distortion, and bladder irritation comfortable position.

c. After inflating catheter balloon, 25. Dispose of used equipment in appropriate

release catheter from nondominant receptacles
hand. Gently withdraw catheter until
resistance is felt. Then advance 26. Label specimen container correctly for
catheter slightly. Male patient: If
culture with patient present, place in
retracted, replace foreskin over glans
biohazard container, and send to
penis
Rationale: Withdrawing catheter
laboratory with completed requisition.
places catheter balloon at base of Rationale: Ensures prompt diagnostic
bladder; slight advancement reduces
analysis.
risk of excessive pressure
REMOVAL OF FOLEY CATHETER
d. Connect drainage tubing to catheter
if it is not already preconnected.
Rationale: Ensures proper drainage by 1. Review medical order for removal of
gravity. Placement on side rails catheter. In cases of genitourinary
increases risk for tension applied to surgery, it is especially important to
catheter, and bag can be raised obtain an order.
above level of bladder 2. Perform hand hygiene, put on clean
gloves, and provide privacy.
e. Secure catheter with catheter
3. Provide an explanation of procedure.
securement device at catheter
4. Position patient with waterproof pad
bifurcation (see manufacturer
directions). Allow enough slack to
under buttocks and cover with bath
allow leg movement and Securing blanket, exposing only genital area
indwelling avoid any traction on and catheter. Position females in
catheter. dorsal recumbent position and male
Rationale Securing indwelling patients in supine position
catheters reduces risk of urethral Rationale: Premature removal of catheter
trauma, urethral erosion, Catheter inpatients who have undergone GU
Associated UTI, or accidental removal surgery could injure patient.
5. Remove catheter securement device
22. Clip drainage tubing to edge of and free drainage tubing
mattress. Position drainage bag 6. Move syringe plunger up and down to
lower than bladder by attaching to
loosen and then withdraw plunger to
bedframe. Do not attach to side
0.5 mL. Insert hub of syringe into
rails of bed.

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 inflation valve (balloon port). Allow 12. Initiate voiding record or bladder
balloon fluid to drain into syringe by diary. Instruct patient to report when
gravity. Make sure that entire amount urge to void occurs and that all urine
of fluid is removed by comparing needs to be measured. Make sure that
removed amount to volume needed patient understands how to use
for inflation collection container.
Rationale: Partially inflated balloon can 13. Ensure easy access to toilet,
traumatize urethral wall during commode, bedpan, or urinal. Place
removal. Passive drainage of catheter urine “hat” on toilet seat if patient is
balloon will prevent formation of ridges using toilet. Place call bell within easy
in balloon. These ridges can cause reach
discomfort or trauma during removal.
CONCERNS TO LOOK AFTER FOLEY
CATHETERIZATION
7. Pull catheter out smoothly and slowly.
Examine it to ensure that it is whole.
Catheter should slide out easily. Do not 1. Check the catheter position to confirm it is
use force. If you note any resistance, in the right position
2. Ensure the catheter is connected to the
notify health care provider if balloon
urine bag
does not deflate completely
3. Close the cap of the urine bag, if the urine
Rationale: Promotes patient comfort bag is open assess if they’re any risks of
and safety. nosocomial infection that may occur
inside the patient’s room
8. Wrap contaminated catheter in 4. Catheter and the drainage bag should be
waterproof pad. Unhook collection adequately fixed to prevent trauma
bag and drainage tubing from bed. (Complications occur if the catheter is not
Rationale: Prevents transmission of secured and placed properly)
microorganisms 5. Catheter tubing must not be kinked or
pass under the client’s pressure areas

9. Reposition patient as necessary.

Provide hygiene as needed. Lower
level of bed and position side rails
accordingly

10. Empty, measure, and record urine

present in drainage bag. Discard in
appropriate receptacle. Remove and
discard gloves. Perform hand hygiene.
Rationale: Records urinary output.
Reduces transmission of
microorganisms.

11. Encourage patient to maintain or

increase fluid intake (unless
contraindicated).
Rationale: Maintains normal urine
output.

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 WEEK 16: MEDICATION ADMINISTRATION

DEFINITION 3. Medication Regulations and Nursing

❖ Substance used in the diagnosis, Practice (Nurse Practice Acts)
treatment, cure, relief or prevention of a. Professional Regulation
health problems Commission (PRC) – ensures that
Prevention – vaccines (E.g. Prophylaxis) the one administers the
Relief – antipyretics and analgesics medication is registered nurse
❖ To safely and accurately administer (medication administration cannot
medications, you need knowledge related be delegated or can be given to
to: other healthcare members, E.g.
✓ Legal aspects of care Nursing Aide cannot administer the
✓ Pharmacology – know different kinds medication)
of medication b. Association of Nursing Service
✓ Pharmacokinetics – functions of Administration of the Philippines
drugs (ANSAP) – surveillance of nurses
✓ Physiology with IVT certification (must be IVT
✓ Pathophysiology – alteration of body certified)
functions
✓ Human Anatomy – medication
administration routes (E.g Ocular, PHARMACOLOGICAL CONCEPTS
Intramuscular – Deltoid)
✓ Mathematics – how many tablets or MEDICATION NAMES
cc/ml the medication must be
administered A. Chemical – exact description of
medication’s composition
B. Generic – the manufacturer who first
MEDICATION LEGISLATION AND STANDARDS develops the drug assigns the name, and
then listed in the U.S Pharmacopeia
C. Trade or Brand/Proprietary name – name
1. Federal regulations
under which a manufacturer markets the
a. Pure food and Drug Act – ensures
medication (E.g. Unilab – Biogesic, Taisho –
that every medication is free from
Tempra)
impurities
b. Food and Drug Administration CLASSIFICATION
(FDA) - Philippines: Bureau of Food
and Drugs (BFAD) – all kinds of ❖ According to the medication’s
mediations must be licensed by characteristics
BFAD and undergoes vigorous ❖ Effect of medication on body system
testing before consumption ❖ Symptoms the medication relieves
c. MedWatch Program – voluntary ❖ Medication’s desired effect (E.g. Anti-
program in where medication hypertensive meds – lowers blood
errors can be reported pressure)
2. Health care institutions and medication
MEDICATION FORMS
laws
a. Republic Act 6675 (Generics Act of a. Solid – capsules, tablets, soft gels
1988) – all prescription must be b. Liquid – syrup and suspension
prescribed or identified through c. Topical – cream, jelly, ointment, serum
their generic name d. Parenteral – intravenous, intramuscular,
intradermal, subcutaneous
e. Instillation – ocular (eyes), otic (ears), open
wounds, genitls

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 iii. Too much vitamin C intake
PHARMACOKINETICS AS BASIS OF can lead to development
MEDICATION ACTIONS of kidney stones
c. Idiosyncratic reaction – overreaction
1. The study of how medications: or underreaction or different
✓ Absorption - enters the body reaction from normal
✓ Distribution - are absorbed and d. Allergic reaction – unpredictable
distributed into cells, tissues or response to a medication (E.g. skin
organs test)
i. Half-life – medication is no e. Medication interaction – when one
longer potent or effect to medication modifies the action of
the body (every another (E.g Diabetic medications to
medication has diff. half- lower the insulin level)
lives)
✓ Reach their site of action
ROUTES OF ADMINISTRATION AND
✓ Alter physiological function
INSTILLATIONS
✓ Metabolism – organ for drug
metabolism is the liver it is how
the medication Is tolerated by the 1. Oral routes – placed in the membrane of
human body the mouth, the client is instructed not to
✓ Excretion – medications are take any fluid to reach the desired effect
excreted by the kidneys of the medication
i. Nephrotoxic drugs – TB • Sublingual administration –
medications are harmful to medication is given under the
the kidney, these tongue
medications cannot be • Buccal administration – medication
given if the kidney is is given between the gums and
compromised. inner lining of the mouth cheek
(buccal pouch)

TYPES OF MEDICATION ACTION Administration:

*There are no safe drugs
➢ Easiest and most desirable route
1. Therapeutic effect – expected or ➢ Food sometimes affect absorption
predicted physiological response, kills the ➢ Aspiration precautions
desired problem or disease ➢ Enteral or small-bore feedings:
2. Adverse effect – unintended, undesirable, o Verify that the tube location is
often unpredictable compatible with med absorption
a. Side effect – predictable, o Use liquids when possible
unavoidable secondary effect (E.g o If medication is to be given on an
Nausea and vomiting) empty stomach, allow at least 30
b. Toxic effect – accumulation of mins before or after feeding
medication in the bloodstream o Risk of drug to drug interactions is
i. Morphine Sulfate Toxicity – higher in oral administration
too much morphine or
given anesthesia to the 2. Parenteral routes
client, can cause • Four major sites of injection
decreased RR and cardiac • Intradermal
arrest ▪ Used for skin testing
ii. Ferrous sulfate overdose – (TB, allergies
too much iron intake ▪ Slow absorption from
dermis

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ▪ Skin testing requires o Medication cannot escape
the nurse to be able from the injection site
to clearly see the • Other routes
injection site for • Epidural (spinal cord)
changes • Intraosseous (bone)
▪ Use of tuberculin or • Intraperitoneal
small hypodermic • Intrapleural
syringe for skin testing • Intraarterial
▪ Angle of Insertion: 5- • Route usually limited to physicians
15 degrees bevel up • Intracardiac and intraarticular
▪ Small bleb will form
Equipment for Parenteral Administration:
• Subcutaneous – placed into the loose
connective tissue under dermis A. Equipment
• Intramuscular a. Syringes (Luer-lok and Non-luer
▪ Faster absorption that SQ lok)
▪ Angle of administration: 90 Parts:
degrees
▪ Body mass index and adipose
tissue influences needle size
selection
▪ Amounts: B. Needles
o Adults: 2-5ml (4-5ml if
unlikely to be absorbed
properly
o Children, geriatric
clients and thin
patients: 2 ml *Other needles have SESIP design (Syringe
o Smaller children and Engineered Sharps Injury Protection) to lessen the risk of needle
injury to nurses
older infants: up to 1 ml
o Small infants: up to 0.5 Preparing an injection from an ampule:
ml
➢ Snap off ampule neck
For IM – Ventrogluteal (Gluteus medius) ➢ Aspirate medication into syringe using filter
needle
▪ Medication must be administered deep
➢ Replace filter needle with an appropriate
and away from major nerves and blood
size needle or needless device
vessels
➢ Administer injection
▪ Preferred as the safest site for all ages
▪ Recommend for medication volumes Preparing an injection from a vial
greater than 2 ml
➢ If dry, use solvent or diluent as needed
For IM – Vastus Lateralis ➢ Inject air into vial
➢ Label multidose vials after mixing
▪ Used for adults and children
➢ Refrigerate remaining doses if needed
▪ Used middle third of muscle for
injections Minimizing patient’s discomfort
▪ Often used for infants, toddlers, and
children receiving biologicals ➢ Use a sharp-beveled needle in the smallest
suitable length and gauge; position
For IM – Deltoid patient comfortably.
➢ Select the proper injection site.
▪ Use of Z-track method
o Zigzag path seals needle

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ➢ Apply a vapocoolant spray or topical 5. Intraocular route – for eyes
anesthetic. Divert the patient’s attention
For optic instillation:
from the injection. Insert the needle quickly
and smoothly.
➢ Hold the syringe steady while the needle • Avoid the cornea
remains in tissues. • Avoid the eyelids with droppers or
➢ Inject the medication slowly and steadily. tubes to decrease the risk of
infection
3. Topical Administration – local effects that is • Used only on the affected eye
only spread in a specific area of the body,
usually administered for burn victims For intraocular instillation:
• Skin • Disk resembles a contact lens
• Mucous membranes • Educate the client on how to insert
Skin Applications: and remove the contact lens/disk
• Teach about the possible adverse
• Use gloves and applicators, clean skin first effects
• Use sterile technique if the client has an 6. Auricular route/Ear Instillation (Otic)
open wound • Instill eardrops at room
• Follow directions for each type of temperature
medication • Use sterile solutions
• For transdermal patches: (E.g. • Check for eardrum rupture if
Contraceptive patch) patient has ear drainage
o Remove old patch before applying ▪ Eardrum – clear white with
new blood streak
o Document the location of new ▪ Otitis media – yellow
patch discharge
o Ask about patches during the • Never occlude the ear canal
medication history
o Apply a label to the patch if it’s
difficult to see SYSTEMS OF MEDICATION MEASUREMENT
❖ Require the ability to compute medication
o Document also the removal of the accurately and measure the medications
pouch correctly
❖ Metric system – ml/cc, meter, liter, gram
4. Inhalation route – E.g nebulization, ❖ Most locally organized – 1mg not 1.0 mg
salbutamol nebule (decimals are not allowed in the charting)

a. Pressurized metered-dose inhalers -

need sufficient hand strength to use ❖ Household system – equivalents such as 1
b. Breath-actuated metered dose inhaler teaspoon, 1 glass, most familiar to
– releases depends on the strength of individual but inaccuracy is a
pt’s breathing disadvantage
c. Dry powder inhalers (DPIs) – activated ❖ Solution
by the patient’s breath

Nasal instillation – spray, drops, tampons

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 DOSE CALCULATION METHODS Nurse’s role:
❖ Ensures medication calculations with
another nurse to ensure accuracy ❖ Determining medications ordered
❖ Ratio and proportion method (E.g. 1:2 = are correct, assessing, pt’s ability to
4:80 self-administer, determining
❖ Formula: whether patient should receive
medications at a given time,
𝑫 (𝑫𝒆𝒔𝒊𝒓𝒆𝒅 𝒐𝒓 𝒅𝒐𝒄𝒕𝒐𝒓′ 𝒔 𝒐𝒓𝒅𝒆𝒓)
𝒙 𝑸 (𝑸𝒖𝒂𝒏𝒕𝒊𝒕𝒚) administering medications
𝑺 (𝑺𝒕𝒐𝒄𝒌 𝒐𝒓 𝒂𝒗𝒂𝒊𝒍𝒂𝒃𝒊𝒍𝒊𝒕𝒚 𝒐𝒇 𝒎𝒆𝒅𝒊𝒄𝒂𝒕𝒊𝒐𝒏 )
correctly and closely monitoring
effects
❖ Cannot be delegated
Problem 1: Cotrimoxazole 500mg 1 tab q12 ❖ Includes patient teaching
(Stock 1000 mg per tab)
Pharmacist’s role
𝟓𝟎𝟎 𝒎𝒈
𝒙 𝟏
𝟏𝟎𝟎𝟎 𝒎𝒈 ❖ Prepares and distributes
medication
𝟎. 𝟓 𝒙 𝟏
MEDICATION ERRORS
𝟏
= 𝒕𝒂𝒃𝒍𝒆𝒕 ❖ Report all medication errors.
𝟐
❖ Patient safety is top priority when an
error occurs.
❖ Documentation is required.
Problem 2: Morphine 30mg per ampule
❖ The nurse is responsible for preparing a
(Stock 10 mg per ampule)
written occurrence or incident report:
𝟑𝟎 𝒎𝒈 an accurate, factual description of
𝒙 𝟏
𝟏𝟎 𝒎𝒈 what occurred and what was done.
❖ Nurses play an essential role in
𝟑𝒙 𝟏
medication reconciliation.
𝟑 𝒂𝒎𝒑𝒖𝒍𝒆
6 RIGHTS OF MEDICATION ADMINISTRATION
✓ Right medication
Problem 3: Ampicillin 350 ml q6 ✓ Right dose
(Stock 500 ml, diluent is 2 ml) ✓ Right patient
✓ Right route
𝟑𝟓𝟎 𝒎𝒍
𝒙 𝟐 𝒎𝒍 ✓ Right time
𝟓𝟎𝟎 𝒎𝒍
✓ Right documentation
𝟎. 𝟕 𝒙 𝟐
𝟏. 𝟒 𝒎𝒍 MAINTAINING PATIENT’S RIGHTS
✓ To be informed about a medication
HEALTH CARE PROVIDER’S ROLE
✓ To refuse a medication
❖ Prescriber can be physician, nurse
✓ To have a medication history
practitioner or physician’s assistant
✓ To be properly advised about
❖ Orders can be written (hand or
experimental nature of medication
electronic) verbal, or given by the
✓ To receive labeled medications safely
telephone
✓ To receive appropriate supportive
❖ Use caution when using abbreviations,
therapy
it can cause errors

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ATC Around the clock
✓ To not receive unnecessary OD Right eye
medications OU Left eye
✓ To be informed if medications are part OS Both eyes
of a research study Rx To take
HS Hours of sleep
TYPES OF ORDERS IN ACUTE CARE AGENCIES IM Intramuscular
SL Sublingual
AD Right ear
AS Left Ear
AU Both ears

HOW TO READ A PRESCRIPTION

*Prescriber – found at the top of prescription

Pt’s
data

Rx = To serve

Inscription
(Main part)

Subscription
(Direction)

Signature

COMMON NURSING ABBREVIATION FOR

MEDICATION ADMINISTRATION
ABBREV. MEANING
BID Twice a day
QID 4 times a day
TID 3 times a day
AC Ante cibum (Before meals)
PC Post-cibum (After meals)
PRN As needed / As necessary
SC/SQ Subcutaneous
IV Intravenous
NG Nasogastric
PV Per Vagina
PR Per Rectum
ANST Anti-negative skin test

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT