Routes of drug administration to patients
One of the important therapeutic measures is drug treatment. The nurse should be able to correctly prescribe the medicines needed to work in this department, store them, ensure the timely distribution of medicines to patients and know the methods of their introduction. The dispensation of medicines is made only by a nurse, patients should take medication in her presence. It is strictly forbidden to entrust this work to junior medical personnel or the patient himself.
Drugs should be prescribed daily. A nurse participating in a medical round of patients should carefully record all appointments. After a detour, the nurse writes out all the medicinal prescriptions from the case histories into a special sheet of prescriptions and prescription notebooks, which consist of two halves: one is sent to the pharmacy, the other is left in the control room.
Strong and toxic drugs are prescribed in separate notebooks, where they are noted.patient, number of medical history, date, number of ampoules;the nurse puts his signature. The whole department's recipe is sent to the senior nurse of the department, which in turn checks and relates them for verification and signature to the department head.
In large hospitals, a special transport is provided for the delivery of medications to the department.
When taking medicines from a pharmacy, a nurse checks the pharmacy inscriptions with records in prescription notebooks, checks the dosage, the appearance of the medications, after which the medications are placed in a special cabinet. Poisonous and strong drugs are removed to the safe or specially equipped refrigerator. Drugs are stored in a special room with double metal doors.
If there are any discrepancies in the dosage or defects in the manufacture of medicines, the nurse must immediately notify the head of the department and send the drug back to the pharmacy.
Drug substances come from the pharmacy in ready-to-eat form. Change the packaging, pour liquid from one bottle to another, combine powders or tablets in one package, make a solution of the powders the nurse has no right. Do not store medicines without label.
For the storage of medicines there are special cabinets that are in the position of a nurse. The cabinets must be locked and marked accordingly.
For labels of external use, yellow labels are accepted, for internal ones - white, for injected parenterally( sterile) - blue.
In the medicine cabinet are divided into groups. On each shelf there must be a corresponding inscription. Strongly smelling and flammable substances should be stored separately. Also, syringes and other materials for caring for the patient should be kept separately.
Vaccines, serums, antibiotics, water infusions and decoctions should be stored in a dedicated refrigerator at a temperature of +2 to + 4 ° C.
Shelf life of infusions of infusions of medicines: up to 5 days from the date of preparation. The shelf life of other chemotherapeutic drugs is indicated on the label and in the accompanying documentation.
Signs of unsuitable decoctions, mixtures and solutions - turbidity or discoloration. In the broths there are flakes, mold, an unpleasant smell. Powders and tablets that have changed their color or glued together are not usable. Ointments, especially with antibiotics, quickly deteriorate, change their color, exfoliate, become rancid and lose their activity.
The maximum shelf-life of sterile solutions is up to 10 days, provided that the transparency and color are preserved( for leaking and vacuum packaged products).Alcoholic and ethereal tinctures, solutions and extracts as a result of the evaporation of alcohol and ether become more concentrated with time.
For the treatment of patients, a number of toxic agents are used, the therapeutic doses of which are in most cases very small. In view of this, any overdose or intake of such medication without prescription is fraught with serious consequences.
Toxic and potent medicines are to be handled and stored separately.
In the medicine cabinet they are provided with separate lockers with lockable doors with the following designations:
A - for poisonous preparations( such as morphine, atropine, sulem, strychnine, arsenic, etc.);
B - for potent drugs( such as epinephrine, caffeine, amylinitrite, etc.).
Lists of medicines to be stored separately are attached to the inside of the door of the corresponding locker. Lockers A and B should be closed all the time, and the keys from them should be kept by the senior nurse, who once or twice a day gives the nurses a small amount of medication they need. Responsibility for storage and consumption of medicines, order at the storage sites, compliance with the rules for the issuance and prescription of medicines is borne by the head of the department.
The direct executor in the organization of storage and consumption of medicines is a senior nurse. In the places of storage and in the posts of nurses there should be tables of the highest single and daily doses of poisonous and potent medicines, as well as tables of antidotes for poisoning.
Drugs containing poisonous and narcotic drugs in offices( rooms) are subject to quantitative accounting in a special book, numbered, strung, sealed and signed by the chief doctor. In the places of storage of medicinal products, it is necessary to observe the temperature and light regimes.
The medication is dispensed by a nurse in accordance with a list of prescriptions, pasted into the medical history or located in a separate file cabinet. The appointment in the leaflet or card must be signed by the doctor with the indication of the date of appointment and the withdrawal of the medicine.
In dealing with medicines, a nurse should always be extremely attentive and cautious. Before giving the patient medication, you should carefully read the inscription on the package. The nurse distributes medicines in strict accordance with the specified time of the day( during, before or after eating, before bed, etc.).The patient should take the medicine only in the presence of a nurse. Walking patients take medicines at the nurse's table, the lying sick sister carries medicine.
Before dispensing medication, the sister thoroughly cleanses her hands, and when applying bandages, powders and other external manipulations she washes her hands after each patient. She should warn the patient that some drugs cause a change in the color of urine and feces [methylene blue, iron preparations, carboline, vicar( aura rhizome + bismuth subnitrate + buckthorn alder cake + magnesium carbonate + sodium bicarbonate), etc.].The drug can be injected into the human body through the skin, mouth or rectum in the digestive tract, into the muscle, vein, lymph, etc. The effectiveness of treatment depends largely on the route of administration of the drug. Different methods of administration have certain advantages and certain disadvantages.
External application of medicinal substances is calculated mainly on their local action. Absorption capacity of intact skin is very small, only fat soluble substances are absorbed through the discharge streams of sebaceous glands and hair follicles.
The application of medicines should always be done on clean skin with clean tools and thoroughly washed hands.
Basic methods of drug administration:
• external - through skin, mucous membranes or respiratory tract;
• Enteral( internal) - through the mouth or rectum;
• parenteral, bypassing the gastrointestinal tract.
Ointments are used mainly for skin diseases. Using a sterile spatula, spread the ointment on a sterile napkin folded in half, and apply it tightly to the affected area. The size of the napkins must match the size of the damaged area. A small layer of cotton wool is placed on top of the napkin. If you need an ointment compress, then a layer of cotton wool is put on a compress paper and pribintovyvayut.
Sometimes it is necessary to rub the ointments into the skin to suck them into deeply lying tissues. To do this, the skin area is previously washed with soap, and then, putting on the palm of the right amount of ointment, begin rubbing. Ointment is carefully rubbed on a restricted area for 30-40 minutes. Rubbing into the fibrous parts of the body is not recommended;if such a need has arisen, the hair must be shaved off. For grinding, a small amount of warm medicinal substance is poured onto the palm and rubbed on the skin until the palm is dry and the skin turns red.