Chapter 12

Administering Medication

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Contents

Basic Knowledge about Medication Administration

1

Oral Administration 2

Parenteral Administration 3

Inhalation Administration 4

Medication Anaphylaxis Test 5

Topical Administration 6

Section 1

Basic Knowledge about Medication Administration

Contents

Drug Forms, Distribution System and Medication Storage

Principles of Administering Medications

Routes of Administration Times and Time of Administration Contributing Factors of Drug Actions

Drug Forms

Aerosol spray  Aqueous solution   Aqueous suspension  Capsule   Enteric-coated tablet   Extended/ sustained

release Extract   Glycerite  Liniment  Lotion

Ointment  Paste Pill Powder/granule Suppository  Syrup  Tablet  Tincture Transdermal disk or

patch Troche (lozenge)

Four kinds

oral medications external medications for injection new preparations

Distribution System

Stock Supply System Unit-dose System Computer-controlled Dispensing

System

Store medication

Cabinet bright and ventilative, avoiding direct shine and keep

clean, tidy and dry. Placement of medications

Store separately according to their different routes (oral, injection, or topical), toxicity or untoxicity

Expensive drugs, narcotics and virulent toxicants must be taken charge of by a special nurse who should lock the cabinet and have the key always with her.

On every shift

Label the container of medications clearly blue strip labels oral medications, Red strip labels external medications, and black strip labels virulent toxicants. Label the container with name, concentration

and dose of drugs If the labels are soiled or illegible, discontinue

using the medications

Check the medications carefully Store the medications properly

according to their different nature. Medications which tend to volatilize,

deliquesce, or effloresce should be kept in airtight bottles, e.g., ethanol, iodine, sugar-coat tablets.

Medications that will be oxidized if exposed to air and be denatured if exposed to light should be kept in airtight colored bottles. Cover the container with shade paper box if necessary and store it in the shady and cool area, e.g., Vitamine C 氨茶碱 盐酸肾上腺素

Biologic products and antibiotics that will be destroyed and decomposed if exposed to heat should be kept in the dry, and shady and cool area (about 20 ) or in refrigerator (about 2℃ ～10 ) according to their natures and ℃requirements of storage, e.g., an antitoxic serum, vaccine, placental globin, penicillin skin test solution.

Medications should be used designedly according to valid periods in case of invalidation, e.g., antibiotics and insulin.

Store the inflammable and explosive medications in airtight bottle and place in the shady and cool area separately and keep them away from fire and electric appliances.

Principles of Administering Medications

Correct Transcription and Communication of Orders

Use the Guidelines of Three Checks and Seven Rights to Ensure Safe Drug Administration

Administer medication safely and accurately Observe the client’s response to the

medication after administration

Three Checks

the check before operation the check during operation the check after operation

Seven Rights

the right name of the client right bed number of the client right name of the medication right concentration right dose right route right time. Quality valid

Routes of Administration Oral Routes

Oral administration Sublingual Administration Buccal Administration

Parenteral Routes Intradermal (ID) Subcutaneous (SQ) Intramuscular(IM) Intravenous( IV)

Skin and Mucous Membrane Route Inhalation Route

Topical administration

the intrathecal or intraspinal, intraosseous, intrapleural, intraarterial,

intraarticular, and

intracardiac, routes

Skin and Mucous Membrane Route

1.Direct application of liquid or ointment (e.g., eye drops, gargling, swabbing the throat)

2.Insertion of drug into a body cavity (e.g., placing a suppository in rectum or vagina or inserting medicated packing into vagina)

3.Instillation of fluid into body cavity (e.g., ear drops, nose drops, or bladder and rectal instillation [fluid is retained])

4.Irrigation of body cavity (e.g., flushing eye, ear, vagina, bladder, or rectum with medicated fluid [fluid is not retained])

5.Spraying (e.g., instillation into nose and throat)

Declining sequence of absorption

Inhalation Route ＞ Sublingual route ＞rectal route ＞ intramuscular injection＞ subcutaneous injection ＞

oral administration ＞ skin route

Times and Time of Administration

Abbreviation Explanation

AC, ac

BID, bid

HS, hs

PC, pc

prn

qm

qd

Ante cibum/Before meals

Twice a day

At bed time

After meals

As necessary (long term)

Every morning

Every day

Abbreviation Explanation

qodqhq2hq4hq6hqidSOS SttidDC

Every other day Every 1 hourEvery 2 hourEvery 4 hourEvery 6 hour4 times a day As needed (only one time within 12 hours)Immediately 3 times a day discontinue

Contributing Factors of Drug Actions

Factors about The Drug Itself Drug Dose Response Drug Forms Routes, time and interval of Administration Drug interactions

Factors about The Body Physiological Factors

Age and Weight Sex

Pathological Factors Psychological and Behavioral Factors

ADDITIVEANTAGONISTICDISPLACEMENTINCOMPATABILITYINTERFERENCESYNERGISTIC

Section 2

Oral Administration

ORAL MEDICATIONS

Most common route Convenient Least expensive Most meds available in this form Easy to counteract overdose or toxicity

Indications

Clients who are able to swallow solid and liquid

Contraindications

1.Clients with impaired swallowing function 2.Unconscious clients 3.clients who refuse to take medications

orally 4.clients with vomiting or/and nausea 5.clients with gastric or intestinal suction 6.clients with bowel inflammation or reduced

peristalsis 7.clients with recent GI surgery

DIFFERENT FORMS

Capsules Tablets Elixirs Emulsions Lozenges Suspensions Syrups

NASOGASTRIC ADMINISTRATION

For patients who cannot swallow NG tubes Similar to oral administration

Skills _Equipment

Medication cards, sheets, or records Medication cart or tray

Medication cups, measuring cup, drop tube Drinking straws

Pill-crushing or pillating device( 研钵 ) Kettle with warm water Paper towels See disk

Medication preparation

1 ． Wash hands, wear mouth mask and assemble the

equipment

2 ． Follow the three checks and seven rights principle.

3 ． Prepare medications with appropriate method based on

different forms of medication . Fetching meds from

bottles.

Procedure

Fetching Method

Solid （ tablet/capsule ） with spoon

pediatric 、 NG tubes or Gastric bleeding, pill-crushing device such as a mortar or pestle or grind pills

Pouring liquid meds with measuring cup

＜ 1ml ， with Drop tub

Administering medication

1 ． Wash hands. Take Medication cards, sheets, or records

Medication cart or tray to bedside.

2 ． Offer medications and warm water

3. Assist clients with critical illness or pediatric clients. For NG,

grind meds.

4 ． Teach clients the effects and cautions of meds

4 ． Clean the cup

See disk

Guidelines followed when administering oral medications

1.Always administer a drug with warm boiled water of 40~60℃ instead of with tea.

2.Medications that erode teeth such as acid and chalybeate should be sucked with a sucker and then rinse to protect teeth.

3.Never chew, crush or break sustained release tablets, enteric-coated tablets and capsules

4.Place lozenges under the tongue or between buccal membrane and teeth dissolved slowly rather than allow clients to chew or swallow.

5.Generally, stomachic medications are appropriately taken before meal, while those irritating gastric membrane taken after meal. Hypnotics is properly taken before sleep and parasiticides taken in limosis or half limosis.

6.Antibiotics and sulfonamide should be taken at certain interval to ensure effective drug blood concentration.

7.Avoid giving fluids immediately after a client swallows medication such as syrup that exerts local medicating effects on the oral mucosa

8. Allow the client to drink more water after sulfonamide is taken to prevent the crystal which the drug produces when excreted through kidney with the less urine volume to block the nephridium.

9. Observe the heart rate and rhythm closely when cardiotonic is taken. If the heart rate is lower than 60 times per minute or arrhythmia occurs, discontinue to use the drug and inform the physicist.

Section 3

Parenteral Administration

Parenteral Administration

Concept the process that injects a certain volume of

sterile solution and/or biological products into human body by using sterile syringe

Purpose to prevent, diagnose and cure disease.

Characteristics Appropriate for clients unable to take meds

orally Rapid absorption Difficult to Counteract Adverse Reaction Invasive procedure, be performed using

aseptic techniques

Contents

Principles of Injections Equipment Draw medication Common Injection Methods

Principles of Injections

Apply Sterile Technique Strictly Carry out Check Principles Strictly Perform Disinfection and Seclusion Policy Appropriate Syringe and Needle Appropriate Injection Site Prepare and Administer Temporarily Eject Air thoroughly Note Blood Return Insert Needle at Appropriate Angle and Depth Give No-Pain Injection

Apply Sterile Technique Strictly

Preparation of nurses Sterilize the local skin over injection

site as required Maintain sterility of equipment

Carrying out Check Principles Strictly

three checks and seven rights inspect the package of medication and

sterile equipment

Perform Disinfection and Seclusion Policy

every client individually uses one series of equipment

All of used equipments are disposed according to the disinfection and seclusion policy

Appropriate Syringe and Needle

Consider route of injection Other factors

dosage, viscosity, irritation of medication, and the age, height, and weight of the client, the site of injection

check the package and the expiration date check whether the needle is sharp, without

crooks, and is tightly connected with tip of syringe

Appropriate Injection Site

away from nerves, bones, and blood vessels

free of inflammation, bruises, itches, edema, nodules and scars

change the site for each injection When intravenously injecting, a distal

site first, proximal site later.

Prepare and Administer Temporarily

The medication solution is prepared and dispensed when administered

To prevent from the lower effect or contamination

Eject Air thoroughly

If not, arouse air embolism

Note Blood Return

administering by SQ( 皮下 ) ， ID, or IM, no blood return appears

By IV or IA, blood return appears

Insert Needle at Appropriate Angle degree and Depth

ID 5° the bevel of tip of the needle

H(SQ) 30 ～ 40°2/3 of the shaft IM 90° 2/3 of the shaft IV

15 ～ 30 ° 2/3 of the shaft

Give No-Pain Injection

Explain the procedure and comfort the client Assist the client to take a comfortable

position Divert the client’s attention Make skin taut when inserting the needle two quicks and one slow

quick insertion and withdrawal of needles slow injection of medication except pediartic clients

inject less irritating medication first, then more irritating medications in deep muscle tissues with a sharp-beveled, long shaft needle

Follow sterile and Seclusion techniques strictly

PARENTERAL MEDICATIONS

Intradermal Subcutaneous Intramuscular Intravenous Intraarterial

（ AIDS 注射器与针头不能分离）

EQUIPMENTSyringes

Needles

plunger barrel tiphandle

shaft body

bevelshafthub

Various sizes or gauges

sheath

needle

Other Equipments

Medical tray Antiseptic solution

ethanol ,iodine Sterile swab File and vial opener Injection card Kidney basin Sterile tweezers and vat Adhesive plaster 、 Small pad 、 Tourniquet

Medication

MEDICATION FORMS

Vials Ampules

Check medications Prefilled tubes

扫描上图 P679

Draw medication

Preparing an Injection from an Ampule Preparing an Injection from a Vial

See disk

Preparing an Injection from a small Ampule

Preparing an Injection from a large Ampule

Preparing an Injection from a Vial

Common Injection Methods

Intradermal Subcutaneous or Hypodermic : SQ or H Intramuscular Intravenous intraarterial

Intradermal Injection(ID)

Definition Intradermal injections involve placing drugs into the

tissue between the epidermis and dermis where blood supply is reduced and drug absorption occurs slowly.

Purpose Skin test Vaccine inoculation A prior step to local anesthesia

Site Skin test: The inner surface of the downside

part of forearm vaccine inoculation : the edge below the

deltoid muscle local anesthesia: The site for local

anesthesia

Equipment

Procedure Equipment check and explain draw the meds

site sterilize recheck

hold bevel of needle pointing up. Spread skin taut, puncture angle(5°). depth(bevel)

loose left hand ， Firm the hub , inject meds （ 0.1ml ）、 a small wheat

Withdraw needle ， Don’t massage the area ， recheck

Dispose of equipment （ 20min check result ）

Cautions!

Follow the three checks and seven rights policy and sterile technique principles strictly

Ban sterilizing the skin with tincture of iodine Ban embrocating time and again when

sterilizing the skin Ban massaging the injection site after

withdrawing the needle Don’t leave the ward until the test result is

checked

Subcutaneous or Hypodermic : SQ or H

Definition involve placing drugs into the loose

connective tissue under the dermis. Purpose

To inject medications that need to produce effect within given time but cannot be administered orally

To inject vaccine To give local anesthesia

Site the edge below the deltoid muscle the lower and the upper ventral areas the anterior and outer aspects of the thighs the scapular areas of the upper back

Common medications vaccines, preoperative medications,

narcotics, insulin, and heparin ＜ 2ml

Equipment and procedure

Procedure equipment explain and check draw meds

sites sterilize recheck

hold （ similar to ID ）、 spread skin taut 、 puncture angle(30 ～ 40°) 、 depth(2/3)

loose hand, pool back to see return blood （ no ）、(left hand) inject meds slowly

withdraw the needle ， press ， recheck

dispose the equipment

过瘦者可捏起注射部位皮肤

Cautions ！

Follow the checks policy and sterile principle strictly

Irritating solutions and large volumes of drugs are inappropriately taken by SQ

Rotate injection sites frequently Insertion angle is less than 45° Use 1ml syringe when injecting medications

lower 1ml

Intramuscular Injections

Definition the method to inject certain medication solutions

into muscles faster drug absorption than subcutaneous less danger of causing tissue damage

Purpose Inject medications inappropriately taken by mouth Inject medications inappropriately administered

by subcutaneous injection Inject irritating medications

•site

Generally, the site should have well developed muscles, being

away from large nerves, bones, and with no blood vessels under the location, and away from infection, necrosis, bruising, or abrasions in the surface

Dorsogluteal muscle Ventrogluteal muscle site Vastus lateralis muscle site Deltoid muscle site

1. Dorsogluteal muscle site

十字法连线法

Cross line method Line method

瘦：触诊胖：脊柱旁开 8~9cm

anterosuperior iliac spine

coccyx

Top of the iliac crest

gluteal fold

Upper outer quadrant

Sciatic nerve

Cross line method

1. Dorsogluteal muscle site

Line method

2 ． Ventrogluteal muscle site （（ 11 ）） Triangle locating methodTriangle locating method 髂前上棘后三角区髂前上棘后三角区 （ 2 ） Three-fingers’ width method髂前上棘外侧三横指处

the iliac crest

the anterosuperior iliac spine particularly

desirable for

infants and

children lower 2

years old

2 ． Ventrogluteal muscle site

3 ． Deltoid muscle site

2 to 3 finger widths below the acromion process

acromion

on the anterior lateral aspect of the thighs

From the site 10 cm below coxa joint to Knee joint

particularly desirable for infants and children

lower 2 years old

4 ． Vastus lateralis muscle site

•Position Lying position

Lie prone with toes pointing inward

Lie on the side with the upper leg straight and relaxed and the lower leg flexed

Lie supine or on the back For patients with critical illness or unable to turn over Appropriate for Ventrogluteal muscle site

Sitting position Common site for patients of out-hospital Appropriate for deltoid and Dorsogluteal muscle, If for the

latter, the position should be higher

proceduresequipment explain and check aspirate meds

sites sterilize recheck

Hold as dart 、 tighten skin 、 puncture angle (90°) 、 depth(2/3 of needle)

loose left hand 、 pool back to see return blood （ no ）、 (left hand) inject meds slowly

withdraw the needle ， press ， recheck

dispose the equipment

Cautions!

Ban piercing all the shaft into the tissue, avoiding the needle is broken

Rotate sites for patients with long term injection, and select thin and long needle

Ban selecting dorsogluteal muscle site for children lower 2 years old because they don’t well developed

Once broken, the nurse should ask the client keep the position, steady the local tissue, take out the needle by using sterile forceps or ask a surgical doctor for help

Intravenous Injections

Definition the method to administer medications into

vein directly the most rapid and complete absorption of

medication cause an immediate and critical response

Purpose To inject medication which are not suitable for

other routes ,such as irritating medications To inject drugs or dyestuffs to diagnose diseases. To get desired effect rapidly, especially for the

client with critical illness To get blood sampling

•sites

peripheral superficial veins of the limbs Scalp veins of pediatric clients femoral vein

Inner armInner arm

Cephalic vein Basilic

vein

median vein of forearm

Cephalic vein

Basilic vein

Superficial dorsal veins

dorsal veins in foot

SmallSaphenavein

Dorsal Dorsal surface surface of footof foot

greaterSaphenavein

Dorsal Dorsal surfacesurfaceof handof hand

thrombophlebitis

Scalp veins of pediatric clients

Temporal superficial vein frontal vein

Posterior ear vein

occipital vein

femoral vein其定位方法：其定位方法：髂前上棘和耻骨结节联线中点相交处为股动脉，髂前上棘和耻骨结节联线中点相交处为股动脉，股静脉在股动脉内侧股静脉在股动脉内侧 0.5cm0.5cm 处。处。

•Procedures:equipment explain and check aspirate meds

sites Tourniquet clench the hand sterilize recheck

Hold syringe 、 tighten skin ， anchor vein 、 puncture angle(15~30°) 、

depth （ blood return ）， Lower the needle until it is nearly parallel to the skin ,advance needle

Two loose （ Release the tourniquet and unclench the hand

),one anchor needle 、 (left hand)inject meds slowly observe response

withdraw needle ， press or flex elbow,recheck

dispose equipment Vein in limbs injection

Blood in vein sampling

1.choose proper container

2.check

3.choose appropriate vein

4.puncture

5.pool back the plunger to get blood sampling

6.two loose(Tourniquet and hand) one withdraw needle one press

7.inject blood sample into cuvette in turn ： － cultivate blood sample

－ sterilized blood cultivate cuvette

－ whole blood sample－Anti agglomeration cuvette－ serum sample——dry

cuvette 8.disposal

choose appropriate vein

Ban fetching the blood sample from the veins where intravenous transfusion or blood transfusion is .

Volume of sample

general cultivate sample 5ml Sub-acute infectional endocarditis 10 ～

15ml Whole blood and serum: general 2ml

全血标本 抗凝试管 拔下针头，血液沿管壁缓缓注入后，立即轻轻摇动，使血液和抗凝剂混匀，防止血液凝固。

血清标本 干燥试管 拔下针头，血液沿管壁缓缓注入后避免振荡，以防止红细胞破裂而造成溶血。

血培养标本 无菌培养瓶 先消毒瓶口，更换针头，血液注入后轻轻摇动，再消毒瓶塞盖好。

Scalp vein injection of pediatric clients

Take equipment to bedside check explain draw medication

Assist patients to supine position with the knees flexed and abducted

Sterilize the injection site and the manipulator’s index finger and the middle finger of non-dominant hand

0.5cm away from inner lateral femoral artery second Check

Puncture: sterilized fingers anchor the vein at the distal and proximal, dominant hand holds syringe (40°or 90 ° ,bevel)

（ dark red blood return ）， Inject the medications slowly by the non-dominant

hand

Withdraw the needle quickly ， press to stop bleeding 3 ～ 5min

third Check

procedures of femoral vein injection

Femoral vein: expose the inguinal region, 0.5cm inner

lateral femoral artery

Cautions!Cautions!

1 ．． Follow the three checks and seven rights policy and sterile technique principles strictly

2 ． Clinical guidelines for vein selection

3. Control the speed of injection according to age of client and nature of medication

4.Bis injectional method

Irritating drugs is injected slowly

Clinical guidelines for vein selection

Select a vein with large diameter, straightness, good elasticity ,and away from joint and vein valve

Avoid veins with high move, infection caused by previous use ,such as phlebitis, infiltration, or sclerosis

Use distal portion of vein first, then proximal portion gradually for patients with long term injection

Bis injectional method

When injecting irritating medication, normal saline should be used to inject at first to test the needle is in the vein.

Then change the syringe with medication for injection to prevent medication irritating tissue once the insertion fails

Factors contributing to failing to inject

shallow ： if inject medication turgidity and pain No blood return Blood return continue inserting the needledeep ： if inject medication

no turgidity but pain No blood return Blood return withdraw the needle, repeat the procedure

good

Bevel sticks to the vessel wall

The key to venipuncture for special clients

1 ． Obese patients Vein is deep but stable palate the vein clearly, sterilize the index finger of

nondominant hand, increase angle degree of venipuncture( 30°~ 40°) ， insert the needle from the site above the vein

2 ． Aged patients vein is superficial and fragile but unstable(easily moved) so it is essential to anchor the vein from the distal and

proximal portions before venipuncture

3.Severely dehydrated patients Vein may collapse Applying warm compresses and light tapping

and massage over the vein may foster venous dilation well

4.Patients with edema Vein may be seen unclearly Massage skin above tended vein may expose

the vein

Arterial Injection and blood sampling

Definition the nursing skill to inject medications into artery

and collect arterial blood as specimen. Common sites common carotid artery: illness in head and face humerus artery （ 肱 动 脉 ） and subclavian artery : illness in

superior limb and chest femoral artery: illness in inferior limb and abdomen Radial artery( 桡动脉 )

•Purposes

1. To get arterial blood sample, Arterial Blood Gases (ABGs)

2. To prepare for some special test, for example, cerebral angiography

3. To give some medications for local chemotherapy

4. To make arterial blood transfusion with high tension ， in order to rescue patients with shock

•Equipment

•Medical tray•Antiseptic solution•Medication•Medication card•Sterile swab•Sterile gauze•Adhesive plaster•Medical tissue•Sterile glove (if necessary)•Sterile tweezers and vat

• a syringe based on the volume of medication, 6- to 9-gauge needle•File and vial opener•Container for blood specimens•Sterile cork •Tourniquet •Alcohol lighter (if necessary)•Small pad•Sandbag• Contamination container•Gloves•Sterile dressing (if necessary)

Take equipment to bedside check explain draw medication

Assist patients to proper position:

Sterilize the injection site and the manipulator’s index finger and the middle finger of non-dominant hand

second Check

Puncture: sterilized fingers anchor the artery at the distal and proximal, dominant hand holds syringe (40°or 90 ° ,bevel)

（ bright red blood return ）， Inject the medications or collect blood sample by the non-dominant hand

Withdraw the needle quickly ， press to stop bleeding 5 ～ 10min

third Check,assist client,equipment

procedures

position

For carotid artery, lies on back, and turn head to the opposite side

of injection slightly For radial artery

lies on back, and stretch and relax the arm with the inner side upward

For femoral artery the client lies on back, flex and abduct the knees,

expose the inguinal region

sites

femoral artery the inguinal region, femoral artery

Radial artery(桡动脉) 2cm upward the wrist joint of inner or palm surface of

forearm

carotid artery

Check_equipment

Before collecting blood sample, the nurse should aspirate 0.5ml of heparin (1:500), and spread it evenly on the inside wall of barrel, then eject residual solution, to prevent blood agglutination

collect blood sample

Blood volume: 0.1~1ml If blood sample is used for Arterial Blood

Gases (ABGs), as soon as the needle is withdrawn, it should be inserted into a cork immediately. Roll the syringe in palms.

Radial artery injection(桡动脉)

静脉注射泵 (intravenous injection pump)

图片 CAI 课件

Section 4

Inhalation Administration

Inhalation Administration

Concept the process that medications administered with

inhalers are dispersed into an aerosol spray or mist that penetrates lung airways by nose or mouth

Characteristics Local and systemic effects Rapid absorption, small dose, light adverse effects

Common medications

bronchodilators （支气管扩张剂） Eliminate bronchospasm ：氨茶碱，沙丁胺醇

expectorants （祛痰剂）： α－糜蛋白酶 decongestants （解除充血剂）： Dex Antibiotics ：庆大霉素、卡那霉素

Purpose

To moisturize the airway To prevent and treat infection of

respiratory system bronchitis ( 支气管炎 ) ， Bronchiectasis( 支

气管扩张 ) ， pneumonia, pulmonary empyema( 肺脓肿 ), pulmonary tuberculosis

To relieve airway obstruction bronchial asthma ( 哮喘 ) ， or bronchitis ( 支

气管炎 )

Common types

ultrasonic nebulization oxygen nebulization handheld nebulization, Compressed nebulization

ultrasonic nebulization

Ultrasonic nebulization creates aerosol spray or mist of medication through high frequency vibration of ultrasonic production film （超声发生器薄膜，透生膜） .

This equipment also can regulate the amount of spray and warm the medication solution.

Equipment

Ultrasonic nebulizersmedications

Atomization tank,entrant sound membrane

Screwed pipe and mouthpiece

Indicator light

Power and volume switch

timer

An ultrasonic nebulizer

Water flume,crystal transducer

Ultrasonic generator

procedures

Pour cooldistilled water into water flume, 250ml or immerse entrant sound membrane

add medication diluted with sterile normal saline 30~50ml into atomization tank

Connect each part of the nebulizer and tubing

Turn on the power switch.

Take 3~5 min for warm-up,adjust amount of spray

Turn on the timer switch:15~20min

Explain,positionPlace the mouthpiece into the client’s mouth.instruct to take deep breath

oxygen nebulization

Oxygen nebulization is accomplished by using the force of an oxygen stream or compressed air passed through the fluid in a nebulizer or an atomizer ( 喷雾器 ).

oxygen nebulization

Or a jet-aerosol nebulizer

T connector

Mouth piece

Cap of meds cup

The highest level of liquid

meds cup

To oxygen source

A jet-aerosol nebulizer

oxygen nebulization: procedure

No water in Humidifying bottle,Oxygen flow rate 6~8L/min

handheld nebulization

Concept A handheld nebulizer (HHN) is a metered–

dose inhalers (MDIs) that can be used by clients to self-administer measured doses of an aerosol( 气雾 ) medication

Purpose To eliminate bronchospasm

Dex, bronchodilators such as 氨茶碱，舒喘灵

handheld nebulization _With Areochamber

Metered-Dose Inhalers

Inspire spray

Hold breath 10s

expire

1 ～ 2spray/次

See disk

Section 6

Topical Administration

Contents

Nasal Instillations Eye Instillations Ear Instillations Vaginal Instillations Rectal Instillations Skin Application

Vaginal Instillations

applicator Supine position 15min

Rectal Instillations

6~7cm,lie on the side 15min

Skin Application

Ointment or cream

tincture powder

Sublingual

Section 5

Medication anaphylaxis test

过敏反应（ anaphylactic reaction/anaphylaxis ）

过敏性休克 (allergic/anaphylactic shock)

medication history allergic history

family allergic history （用药史、过敏史、家族史）

过敏试验 (allergic/anaphylactic test)

skin test ( 皮试 )

intradermal test （皮内注射试验）

What is anaphylactic reaction

to medication?

What is anaphylactic test of

medication?

Characteristics of Anaphylactic Reaction to Medication

An pathological immune reaction

Anaphylaxis does not usually happen to patients who take the medication for the first time ， but not absolutely.

sensitized coursenon typical exposure 、 cross reaction( 隐性致敏、交叉反应 )

allergy

Anaphylaxis only happens to a few persons with allergic habitus, with no relation to dosage.

The different medications with similar chemical structure may lead to

full or part cross reactions.

Characteristics

过敏反应的特点

是一种病理性的免疫应答。 通常不发生在首次用药，必须有致敏过程；但不

是绝对的，隐性致敏或交叉反应。 只发生在少数人 , 是对某些药物“质”的过敏 , 而

不是“量”的中毒。 具有相同化学结构的药物之间会发生完全或部分

交叉反应

Medications prone to provoke anaphylaxis:

Antibiotics : penicillin streptomycin cephalothin

Biological products : TAT Narcotics: procaine Contrast medium: Iodide

Safely and correctly administering meds

• Inquire • medication history

• Allergic history

• Family allergic history

（用药史、过敏史、家族史）

• Anaphylactic test

before administering meds

•It is a clinical method to monitor whether the patients get immediate or delayed anaphylaxis after the small dosage medication came into the body through some approaches .

Anaphylactic test?

•skin test: intradermal injection

scratch test( 划痕试验 )•conjunctiva method （眼结膜试验法）•intravenous injection

Skin test can detect the anaphylaxis,but sometimes the result is false negative.Why:

insufficient dosage

Have taken anti-allergic medication before the test.

（皮试。假阴性：计量小或服用抗过敏药）

1.How to dispense the allergic reagent of penicillin and other common medications

2.To learn test method and determination of the test result

3.How to treat the anaphylactic reaction, especially allergic shock

contents

Part 1 Penicillin Anaphylactic Test

Mechanism of penicillin anaphylaxis The clinical manifestations of penicillin

anaphylaxis The treatment of penicillin allergic

shock The method of penicillin anaphylactic

test

Mechanism of penicillin anaphylaxis

6— 氨基青霉烷酸 青霉烯酸 青霉噻唑酸 某些霉菌 ( 青霉菌 )

半抗原

蛋白质或多肽分子 全抗原

使 T 淋巴细胞致敏 B 淋巴细胞

浆母细胞和浆细胞产生抗体IgEIgG IgM

释放血管活性物质

hapten

肥大细胞嗜碱性粒细胞

再次接触该抗原

组胺、白三烯、 5 － HT

皮肤、呼吸道、循环、消化道、休克血管扩张、通透性增加、平滑肌收缩、腺体分泌增多

antigen

The clinical manifestations of penicillin anaphylaxis

Anaphylactic shock Respiratory failure symptoms Cardiovascular failure symptoms Central nervous system symptoms Cutaneous allergic symptoms

Serum sickness reaction Anaphylaxis of organ and tissue

Cutaneous anaphylaxis Respiratory anaphylaxis digestive system anaphylaxis

The treatment of penicillin allergic shock

•Emergency treatment on site•Stop medication immediately•Lie on the back,keep warm

•Administering epinephrine immediately

•0.1% epinephrine 1ml H,every 0.5h repeatedly H or iv 0.5ml

•Correct Hypoxia and improving respiration

•Oxygen administration

• If depressed respiration: •mouth-to-mouth artificial breathing

•respiratory stimulants: nikethamide/lobeline

•If laryngeal edema:•incision of trachea or intubation of trachea

treatment

•Treating allergic shock•Dexamethasone 5~10mg

25% glucose IV or•Hydrocortisone 200~400mg

5%~10% glucose ivdrip

•Anti-histamine medications: 异丙嗪 25~5

0mg im 、苯海拉明 40mg im

treatment

•Improve cardiovascular function （ correct shock ）：

•Increase peripheral blood capacity•10%GS,balanced solution ivdrip

•dopamine or metaraminol

•Cardiac arrest•cardiac compression

•Observe the patient intensively and record information ：

•vital signs urine volume consciousness

treatment

The method of penicillin anaphylactic test

Test objects ：•First take medication ( 首次用药者 )•Stop penicillin three days ago and reuse

（停药 3天以上再用者）

•The batch of the medication is changed ( 更换批号 )

The method of penicillin anaphylactic test

•The anaphylactic test reagent and its dispensing method

•Method of anaphylactic test

•Result determination

                          

                         

                          

                         

                          

                         

The anaphylactic test reagent

Reagent ： 200 ～ 500u P/ml NS

0.1ml ID

(1)P 80,0000u+4ml isotonic saline=20,0000u/ ml

(2)dilute 0.1ml P solution+ isotonic saline to1ml =2,0000u/ ml

(3) dilute 0.1ml P solution + isotonic saline to 1ml =2000u/ ml

(4) dilute 0.25ml P solution + isotonic saline to 1ml =500u/ ml

mix completely when diluting every time （每次稀释时均需将溶液混匀。）

Dispensing method of reagent

Method of anaphylactic test

0.1ml 500u /ml ID

check the result after 20min

Result determination

Negative result:

There is no skin redness, swelling,

blush and the patient has no

uncomfortable feeling.

（阴性：皮丘无改变，周围不红肿，无红晕，病人无自觉症状。）

•The wheal becomes large.•There is skin redness and swelling. •The diameter of the wheal is more than 1cm,or there is pseudopodium.•The patient has pruritus feeling.•Dizziness,fluster,nausea may occur in severe cases,even anaphylactic shock.

（阳性：局部皮丘隆起增大，出现红晕，直径大于 1cm，或周围出现伪足、有痒感。严重时病人可出现头晕、心慌、恶心，甚至过敏性休克。）

Positive result:

Cautions of penicillin administration

Inquire the patient’s medication history,allergic history and family allergic history before test.

（皮试前应询问用药史、过敏史家族过敏史。） Normal/isotonic saline is always used as menstruum to

dissolve and dilute penicillin.

（配制试验液的溶媒多采用生理盐水 ,不用注射用水。） Menstruum, syringe and needle used in dilute penicillin is

banned to use in other medications.

（配制试验液的溶媒、注射器、针头不宜交叉使用。）

Dispense allergic test reagent when used.The dosage and concentration of reagent is accurate.

（试验液的浓度、剂量应准确，且应现用现配。） Anti － histamine medications is banned in 24h before test

in case of false negative .

（皮试前 24h 禁用抗组织胺类药物，以免影响皮试反应结果）

Be ready for aids before,and keep epinephrine on hand .

( 过敏试验前应准备好抢救物品，以备急救。 )

Keep close watch on the patient.

( 在进行皮内试验时应严密观察过敏反应，首次注射青霉素者需观察 30min后再离开。 )

If positive,penicillin should be banned,and the nurse should report to the doctor.Record penicillin positive result on the doctor’s order sheet,medical record ， injection card and bedside card,and inform the patient and his family of the result.

（阳性结果者不用青霉素，并及时告诉医生，将阳性结果标识在医嘱单、病历、注射卡、床头卡上。并告知病人及家属。）

If you doubt false positive ， control experiment is made to exclude allergy induced by disinfector.

（疑假阳性反应做对照试验，以排除消毒剂的影响）

Part II streptomycin anaphylactic test

Clinical manifestation: Twitch because of deficient

calcium （低钙抽搐） Be similar to penicillin

Treatment 10%葡萄糖酸钙、 5 ％氯化钙其他同 penicillin

The anaphylactic test reagent of streptomycin

Reagent ：

2500u /ml 0.1ml ID

(1)S 100,0000u+3.5ml isotonic saline=25’0000u/ ml

(2)dilute 0.1ml S solution+ isotonic saline to 1ml =2,5000u/ ml

(3)dilute 0.1ml S solution + isotonic saline to 1ml =2500u/ ml

mix completely when diluting every time

（每次稀释时均需将溶液混匀）

Dispensing method of reagent streptomycin

Method of anaphylactic test

0.1ml 2500u/ ml ID

check the result after 20min

Result determination

Be similar to penicillin

TAT(tetanus antitoxin) anaphylactic test

The cause of anaphylaxis The method of TAT anaphylactic

test TAT desensitized injection

The cause of anaphylaxis

The immune serum of equine( 马 ) Neutralise tetanus toxin ： prevent and cure Heterogeneous protein

The clinical manifestation of anaphylaxis Fever, immediate or delayed serum sickness Allergic shock occasionally

Test objects ：

•First take TAT ( 首次用药 )•Stop therapy with TAT more than 1 week ago ( 停药 1周以上 )

The method of TAT anaphylactic test

•The anaphylactic test reagent and its dispensing method

•Method of anaphylactic test

•Result determination

The method of TAT anaphylactic test

The anaphylactic test reagent TAT

Reagent ：150u TAT/ml isotonic saline

0.1ml ID

TAT 1500u(original solution)

0.1ml TAT 1500u + isotonic saline to 1ml =150u/ml

Dispensing method of reagent

Method of anaphylactic test

0.1ml 150u/ml TAT ID

check the result after 20 minute

Result determination of TAT

Negative result:

No local skin redness and swelling. No

abnormal systemic reaction. (阴性 : 局部皮丘无红肿，病人无全身异常反应 )。

Positive result:•The wheal is red and swelling.

•Induration with diameter larger than 1.5cm,

•blushing with diameter larger than 4cm,•Sometimes there is pseudopodium•The patient has pruritus feeling.

•The systemic reaction is similar to that of penicillin and serum sickness is the most common.

(阳性 : 局部皮丘红肿，硬结直径大于 1.5cm，红晕范围直径大于 4cm，有时出现伪足或有痒感。全身过敏性反应表现与青霉素过敏反应相似，以血清病型反应多见。 )

Determination criterion

TAT desensitized injection

Mechanism of desensitized injection Object ： Positive result and no substitute Concept ： Divide the dosage into several

smaller dosages and inject them separately and continuously in a short period time

Mechanism ： Neutralise and consume IgE gradually ， up to totally.

temporary desensitization

Desensitized injection method

Desensitized injection method

Times TAT(ml) Normal SalineAdministration Route

1

2

3

4

0.1ml

0.2ml

0.3ml

remainder

0.9ml

0.8ml

0.7mldiluted to 1ml

IM

IM

IM

IM

20min interval

If anaphylaxis occur,dose decrease and times increase

TAT 脱敏注射

适用对象： TAT 是一种特异性抗体，没有可以代替的药物，皮试

结果即使阳性，仍需考虑使用。 定义：分次小剂量注射 机理

逐渐中和 IgE 。直至脱敏。 暂时，会重建致敏状态：故日后如再用 TAT还须重做

皮内试验。

脱敏注射步骤 次数 抗毒血清

（ ml ）生理盐水（ ml ）

注射法

1

2

3

4

0.1

0.2

0.3

余量

0.9

0.8

0.7

至 1ml

肌内注射肌内注射肌内注射肌内注射

每隔 20min注射 1 次，每次注射后均需密切观察。在脱敏过程中，如发现患者有全身反应，如气促、紫绀、荨麻疹或发生过敏性休克时应立即停止注射，并迅速对症处理。如反应轻微，待反应消退后，酌情增加注射次数，减少每次注射量，以达到顺利注入余量的目的。

Part 4 Procaine(novocaine) anaphylactic test

Test method:

•First use procaine( 首次用药者 )•0.25% procaine solution 0.1ml ID

•Check the result after 20min

•Result determination is similar to penicillin

Iodic Preparation AnaphylacticTest

Test objects So if it is the first time to use them,

anaphylactic test should be done 1 or 2 days before graphs with iodode.

Method of Anaphylactic Test Oral Administration Intradermal Injection Intravenous Injection

Determination criterion

Oral Administration If the symptoms of paralysis of mouth,

dizziness, palpitation, nausea, and vomiting, or/and urticaria are present, the result is positive.

Intradermal Injection If local skin becomes red and swelling or

sclerosis appears, with the diameter more than 1cm, the result is positive.

Intravenous Injection If the blood pressure, pulse, respiration and

face color of the client have changed, if the client has palpitation, mucous edema, nausea and vomiting, uritcaria and other discomforts, the result is positive.

Part 5 Cytochrome C anaphylactic test

Test method:• First use Cyt C

• Intradermal test• Dilute Cyt C solution 0.1ml (15mg per 2ml) to 1ml,

• reagent 0.75mg/ml 0.1ml ID

• 20min, positive ： local redness and swelling ， with the diameter of wheal larger than 1cm ， papular appears

• scratch test

Cytochrome C

• scratch test• Put one drip of original Cyt C solution on the

forearm

• Make two scratches 0.5cm long and little bleeding deep with a sterile needle

• 20min, result determination is similar to ID

Part 6 Cephalosporin anaphylactic test

Part cross-reaction between Cephalosporin and penicillin The mechanism is similar to penicillin They have the sameβ-lactam structure

Test method :cephalothin(先锋霉素 )

Test method :cephalothin(先锋霉素 )

Reagent: 500μg/ml 0.1ml ID

Dilute method

0.5g cephalothin+2ml NS 250mg/ml

dilute 0.2ml cephalothin + NS to 1ml 50mg/ml

dilute 0.1ml cephalothin + NS to 1ml 5mg/ml

dilute 0.1ml cephalothin + NS to 1ml 500μg/ml

谢谢 !谢谢 !