Basic Vital Signs

8/9/2019 Basic Vital Signs

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What is Oralmedication? route of administration where a

substance is taken through the mouth.

Many medications are taken orallybecause they are intended to have asystemic eect, reaching dierent partsof the body via the bloodstream


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How to give Oral Medicine?Wash hands

Prepare the medication in the medication room.

Take medication tray/cart to clients room! check room and bed

number against medication record. #heck clients identi$cation band and ask client to state name.

Rationale% To make sure that you have correct client and toprevent medication error

Place client in sitting /semi sitting position.

Rationale% To prevent regurgitation and aspiration.

&'plain what type of medication you are giving and its purpose.(etermine if bedside assessment is indicated before

administering medication.)e.g. vital signs* and assess client

Rationale% To determine if the medication can be given ornot to patient depending on her current health status.


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+and medication cup to client if assessment $ndings donot contraindicate administration

er glass of water or other li-uid.

Make sure client swallows the medication.

(iscard used medicine cup.

(ocument in the medication record including assessment

$ndings, if it is indicated. Rationale% To make sure that the rights ofmedication administration have been followed.

ssess client for therapeutic drug action and possible sideeects.

0eport to physician if any adverse reaction noticed anddocument in the clients $le

Rationale:1mmediate referral to doctor will promptly treatpatients adverse reaction from medication thus prevent

further complications.


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What is SublingualMedication?

2ublingual medications are orallydisintegrating or dissolving medications

that are administered by being placedunder the tongue. These medicationsare transferred to the bloodstream fromthe mucous membranes in the mouth

after dissolving.


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How to administerSublingual medications?

Administer medication in a seated and upright position 3 Theperson taking the medication should be situated in an upright sittingposition before administering sublingual medication. (o not allow the

individual to lie down or try to administer the medication when theperson is unconscious. This could lead to accidental aspiration of themedication.

Do not eat or drink when administering medication 3 0inseyour mouth out with water. 1t4s important not to eat or drink whensublingual medication is administered because this increases the riskof the medication being swallowed, which will make it less eective.

ease smoking shortl! be"ore administration 3 (o not smokefor at least an hour before you take sublingual medication. #igarettesmoke constricts the blood vessels and mucous membranes in themouth, which will reduce the absorption level of the sublingualmedication.

#ake sublingual medication a"ter other oral medications 3#omplete administration of any other oral medications beforeadministering sublingual medications. This will allow you to

administer the dose of sublingual medication without the risk ofswallowing the dose.


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$osition the tablet properl! 3 0aise the tongue, then place thesublingual medication under it. The area under the tongue where the

medication is placed does not matter as long as the tablet iscompletely under the tongue to dissolve.

Hold in place and tilt head "orward to avoid swallowingmedication 3 +old the sublingual medication under the tongue for atleast 56 minutes. void opening the mouth, eating, talking, moving orstanding during this time to ensure that the tablet doesn4t move and

has time to dissolve completely and be absorbed.Move the tablet onl! i" needed 3 2ome sublingual medications like

nitroglycerin can cause a warm or tingling sensation in the mouthwhen they dissolve. 2hift the tablet to a dierent position under thetongue if necessary to avoid discomfort, but be sure the tablet stayscompletely under the tongue and is allowed to dissolve completely.

Wait to rinse 3 Wait several minutes after dissolving the sublingualmedication before drinking or rinsing the mouth. This will ensure thatthe medication has dissolved completely and has had a chance toabsorb into the mucous membranes.


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What is anintramuscular

in%ection?

An intramuscular

&'M( in%ection is ashot o" medicinegiven into amuscle) ertain

medicines need tobe given into themuscle "or them towork correctl!)


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Where can ' give anintramuscular in%ection?


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Deltoid Muscle &*pper arm muscle(:

#ompletely e'pose the upper arm. 7ou will givethe in8ection in the center of an upside downtriangle. 9eel for the bone that goes across the topof the upper arm. This bone is called the acromionprocess. The bottom of it will form the base of the

triangle. The point of the triangle is directly belowthe middle of the base at about the level of thearmpit. The correct area to give an in8ection is inthe center of the triangle, 5 to : inches below the

acromion process.This site should not be used ifthe person is very thin or the muscle is very small.


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+astus ,ateralis Muscle high(:;ook at yourthigh and divide it into < e-ual parts. The middlethird is where the in8ection will go. The thigh is agood place to give yourself an in8ection because itis easy to see. 1t is also a good spot for children

younger than < years old.


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+entrogluteal Muscle &Hip(:+ave the persongetting the in8ection lie on his or her side. To$nd the correct location, place the heel of yourhand on the upper, outer part of the thigh where

it meets the buttocks. Point your thumb at thegroin and your $ngers toward the person4s head.9orm a = with your $ngers by separating your$rst $nger from the other < $ngers. 7ou will feelthe edge of a bone along the tips of your little

and ring $ngers. The place to give the in8ectionis in the middle of the =. The hip is a good placefor an in8ection for adults and children olderthan months.


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Dorsogluteal Muscle &buttocks(:&'pose one

side of the buttocks. With an alcohol wipe draw aline from the top of the crack between the buttocksto the side of the body. 9ind the middle of that lineand go up < inches. 9rom that point, draw another

line down and across the $rst line, ending abouthalfway down the buttock. 7ou should have drawn across. 1n the upper outer s-uare you will feel acurved bone. The in8ection will go in the upperouter s-uare below the curved bone. (o not use

this site for infants or children younger than < yearsold. Their muscles are not developed enough.


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Dorsogluteal in%ectionsite


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What items do ' need togive an in%ection?

One alcohol wipe

One sterile - . - gau/e pad or otton 0alls

A new needle and s!ringe that are the

correct si/e

Disposable gloves


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How do ' give an

intramuscular in%ection?Wash !our hands with soap and dry them

completely. Put on gloves.

Open the alcohol wipe:Wipe the area where

you plan to give the in8ection. ;et the area dry. (onot touch this area until you give the in8ection.

$repare the needle:+old the syringe with yourwriting hand and pull the cover o with your

other hand. Place the syringe between yourthumb and $rst $nger. ;et the barrel of thesyringe rest on your second $nger.


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Hold the skin around where !ou will givethe in%ection:With your free hand, gentlypress on and pull the skin so that it is slightlytight.

'nsert the needle into the muscle:+old thesyringe barrel tightly and use your wrist toin8ect the needle through the skin and into themuscle at a >6 degree angle.


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heck the needle:;et go of the skin with your other hand. +oldthe syringe so it stays pointed straight in. Pull back on the

plunger a little to make sure you did not hit a blood vessel. 1fblood comes back, remove the needle immediately. (o not in8ectthe medicine. (ispose of both the syringe and the medicine. ?etmore medicine in a new syringe. When you give the secondin8ection, give it on the other side.

'n%ect the medicine:Push down on the plunger to in8ect themedicine. (o not force the medicine by pushing hard. 2omemedicines hurt. 7ou can in8ect the medicine slowly to reduce thepain.

Remove the needle:nce the medicine is in8ected, remove theneedle at the same angle as it went in. Place gau@e over the areawhere you gave the in8ection.


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What is a subcutaneousin%ection?

subcutaneous in8ection is a shot giveninto the fat layer between the skin and

muscle. 2ubcutaneous in8ections areused to give small amounts and certainkinds of medicine.


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ommonl! used s!ringes

on administeringsubcutaneous in%ection

'nsulin s!ringe:This holds a ma'imum of 5 m;of medicine. The syringe has markings from 56 to

566. The marking at 566 is the same as 5 m;.The marking at A6 is the same as B m;.

#uberculin s!ringe:This syringe holds up to 5

m; of medicine. 1t has a needle that is slightlylonger than an insulin syringe. The syringe ismarked every 6.5 m;.


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'nsulin s!ringe

#uberculin s!ringe


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Where can ' give a subcutaneous

in%ection?Abdomen:Cncover your abdomen. 7ou may give an in8ection within the following

area% below the waist to 8ust above the hip bone and from the side to about :inches from the belly button. void the belly button.

#high:Cncover the entire leg. 9ind the area halfway between the knee and hip

and slightly to the side. ?ently grasp the area to make sure you can pinch 5 to :inches of skin.

,ower back:Cncover the back from the waist to the top of the buttocks. 1maginea line that runs across the back 8ust above the crack between the buttocks. nin8ection may be given below the waist and above this line. ?ive the in8ectionhalfway between the spine and the side.

*pper Arm:Cncover the arm to the shoulder. +ave the person getting thein8ection stand with his hand on his hip. 2tand ne't to and a little behind theperson. 9ind the area halfway between the elbow and shoulder. ?ently grasp theskin at the back of the arm between your thumb and $rst : $ngers. 7ou should beable to grasp 5 to : inches of skin.


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Subcutaneous in%ection sites


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What items do ' need togive an in%ection?

One alcohol wipe

One sterile - . - gau/e pad or otton 0alls

A new needle and s!ringe that are thecorrect si/e

Disposable gloves


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How do ' give asubcutaneous in%ection?

2ubcutaneous in8ections can be given straight in at a >6 degree angle orat a DA degree angle. ?ive the in8ection at a >6 degree angle if you cangrasp : inches of skin between your thumb and $rst $nger. 1f you cangrasp only 5 inch of skin, give the in8ection at a DA degree angle.

Open the alcohol wipe:Wipe the area where you plan to give thein8ection. ;et the area dry. (o not touch this area until you give thein8ection.

$repare the needle:+old the syringe with your writing hand and pullthe cover o with your other hand. Place the syringe between your thumband $rst $nger. ;et the barrel of the syringe rest on your second $nger.


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1rasp the skin:With your other hand, grasp the skin.

'nsert the needle into the skin:+old the syringebarrel tightly and use your wrist to in8ect the needle

into the skin. nce the needle is all the way in, pushthe plunger down to in8ect the medicine.

$ull out the needle:0emove the needle at the same

angle you put it in. ?ently wipe the area with thegau@e pad.


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What is 'ntradermal in%ection?

n intradermal in8ection is the in8ection of asmall amount of Euid into the dermal layer ofthe skin. 1t is fre-uently done as a diagnostic

measure, such as for tuberculin testing)screening test for tuberculosis referred to asa tine test* and allergy testing )placing verysmall amounts of the suspected antigen orallergen in a solution under the skin*. The

intradermal in8ection is made in skin areas ofthe body that are soft and yielding.


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S!ringe used in administering'ntradermal in%ection

ften the tuberculin syringe is the onlysyringe with $ne enough calibrations to

measure the minute dose that is used. gauge :F needle, which is one3fourth toone3half inch in length, is usually selected.

The Euid is in a small welt or GwhealG )asmall swelling of the skin due to the

medication placed under the skin* 8ustunder the surface of the skin and betweenits layers.


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How do ' give 'ntradermalin%ection?

2elect area on inner aspect of forearm that is not heavilypigmented or covered with hair. Cpper chest or upper backbeneath the scapulae also are sites for intradermal

in8ections.

#leanse the area with an alcohol swab by wiping with a $rmcircular motion and moving outward from the in8ection site.llow skin to dry. 1f skin is oily, clean area with pledgetmoistened with acetone.

Place needle almost Eat against patients skin, bevel sideup. 1nsert needle into skin so that point of needle can beseen through skin.


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2lowly in8ect agent while watching for a small

wheal or blister to appear. 1f none appears,withdraw needle slightly.

Withdraw needle -uickly at the same angle it was

inserted.

bserve the area foe sign of reaction at orderedintervals, usually at :D3 to :3 periods. 1nform the

patient of this inspection


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What is 'ntravenousadministration?

n intravenous administration is one of the mostcommon, important tools in modern medicine.1=s allow doctors/nurses to administer Euids,blood products, and medications directly into apatient4s bloodstream via a small tube.

This allows rapid absorption and precise controlover the dosage of the substance administered,which is vital for a variety of medical procedures,including giving Euids to treat dehydration, givingblood to a patient losing it rapidly, or issuingantibiotic treatments.


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Where are the commonvenipuncture site?

Median ubital +ein

The most commonly used site for a venipuncture is atthe bend of the elbow, also called the antecubitalfossa. 2everal veins in the antecubital fossa providee'cellent access. The median cubital vein, asuper$cial vein that forms a connection point betweenthe cephalic and basilic veins of the arm is large, andtherefore easier to see and feel. 0isks associated with

using this vein include penetration of the bicepstendon and the brachial artery. These tissues lie 8ustbelow the median cubital vein so care must be takennot to puncture too deeply.


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ephalic +ein

The cephalic vein runs super$cially under the skinalong the outer side of the upper and lower arm,eventually dipping under the shoulder to 8oin thea'illary vein in the armpit. This is anotheracceptable venipuncture site if scarring is present

in the antecubital space from previousvenipunctures or if the antecubital veins are notpalpable. The cephalic vein is more commonlyaccessed on the forearm rather than the upper

arm. 7ou can also access the cephalic sign in theinside of the wrist as it runs down to the thumb.


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0asilic +ein

The basilic vein, another main super$cial vein ofthe arm, runs along the inner side of the upperarm and forearm. The basilic vein is alsocommonly used for a venipuncture in the forearmrather than the upper arm. This is becausehalfway up the upper arm, the vein turns inwardsto become a deep vein. (eep veins run alongarteries and present a risk for puncture to theartery.


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Dorsal Metacarpal +eins

The veins that run down the middle of the hand,called dorsal metacarpal veins, can also be usedfor intravenous infusions as well as for drawingblood if the antecubital vein isn4t accessible.

+and veins aren4t as large as the veins in theforearm and antecubital fossa. 1n some hospitals,it4s policy to start with the veins on the hand as a$rst choice for an intravenous line and work yourway up if you can4t access a lower vein.


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What items do ' need toadminister '+?

2terile disposable gloves

ppropriate si@e Gover3the3needleG 1=

catheter )typically 5D 3 :A gauge* Hag of 1= Euid

Ion3late' tourni-uet

2terile bandage or dressing ?au@e

lcohol wipesMedical tape

2harps container


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How do ' prepare andadminister '+?

$repare the '+ tubing 2 prepare the 1= tubing by suspendingthe 1= bag from an elevated stand, $lling the tubing with salinesolution, and checking for any bubbles. 1f necessary, clamp the

tubing so that it doesn4t drip onto the Eoor. He sure to removeany bubbles from the tubing by gently tapping, s-uee@ing, orEushing them out of the line.

1n8ecting air bubbles into a patient4s bloodstream can cause aserious condition called an embolism. ne easy techni-ue forremoving bubbles from the 1= tubing is to uncoil the tubing toits full length and run the roller valve all the way up to the drip

chamber. Ie't, puncture the 1= bag with the tubing spike andpinch the drip chamber. pen the roller valve and release theline J Euid should Eow down the length of the tubing withoutproducing any bubbles.


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hoose a suitable gauge catheter "or the situation2 Typically, 1= catheters are mounted over the needleused to puncture the vein. fter the vein is accessed, thecatheter is left in place for easy access to the vein.#atheters come in dierent si@es called gauges. Thesmaller the gauge number, the thicker the catheter andthe more rapidly medicine can be administered andblood can be drawn. +owever, thick catheters are alsocause more painful insertion, so it3s important not touse a catheter that3s bigger than !ou need. 1ngeneral, for 1=s, you4ll need a catheter that4s about 5D3:Agauge. Tend towards higher3gauge )thinner* catheters forchildren and the elderly, but tend towards lower3gauge)thicker* catheters when rapid transfusion is needed.


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$ut on sterile gloves 2 put on sterile glovesbefore you handle your e-uipment and touch the

patient. 1f at any point your gloves4 sterilitybecomes compromised, take them o and put on anew pair. 1t4s better to be safe than sorry. Heloware situations where most medical standards

re-uire changing gloves% Hefore touching the patient

Hefore clean/aseptic procedures )likeadministering 1= medications*

fter procedures with a risk of body Euid e'posure fter touching the patient

fter touching the patient4s surroundings

Hefore moving to a dierent patient.


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,ook "or prominent veins 3 $nd a site on the patientto administer the 1=. 9or most patients, the most

accessible veins are on the underside of the forearm,the inner GcrookG of the elbow, or the back of the hand,though any accessible vein can be used to start an 1=.

There are certain places you won'twant to insert an1=.

These include% Places where the 1= will interfere with surgery

1n the same location as another recent 1=

1n a site that shows signs of infection )redness,

swelling, irritation, etc.* 1n a limb on the same side of the body as a

mastectomy or vascular graft )this can lead tocomplications*


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Appl! a tourni4uet 2To get your chosen veins toswell up for easy insertion, apply a tourni-uet behind)in the direction of the torso* the intended 1= site. 9orinstance, if you4re going to insert the 1= into thetypical site of the underside of the forearm, you mightput the tourni-uet part of the way up the upper arm.

(on4t tie the tourni-uet too tight J this can causebruising, especially in the elderly. 1t should be tight,but not so tight that you can4t slip a $ngerunderneath.

;etting the limb hang limp towards the Eoor while a

tourni-uet is in place can help the veins become moreprominent by increasing the blood Eow to the limb.


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$alpate the vein i" necessar! 2 1f you4rehaving a hard time $nding suitable veins, it canbe helpful to palpate the patient4s skin in the areaof the 1= site. lign your $nger in the direction ofthe vein, then press down on the skin above it.

7ou should feel the vein Gpush backG. #ontinue

pressing with a bouncing motion for about :63


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Disin"ect the '+ site 2 Tear open a fresh alcohol

wipe and apply it to the skin in the area that the1= will be inserted. Wipe gently but thoroughly,ensuring an even coat of alcohol. This killsbacteria on the skin, minimi@ing the chance of

infection when the skin is punctured.


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$repare the catheter "or insertion)0emovethe catheter from its sterile packaging. HrieEy

inspect it to ensure that it is intact and working.Press down on the Eashback chamber to ensure itis tight. 2pin the catheter hub to ensure it sitsloosely on the needle. 0emove the protective cap

and inspect the needle, taking care to ensure theneedle doesn4t touch anything. 1f everything looksin order, prepare to insert the needle.

(on4t allow the catheter or needle to come intocontact with anything other than the patient4sskin in the 1= site. This can compromise theirsterility and increase the risk of infection.


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'nsert the needle 2Cse the non3dominant handto stabili@e the patient4s limb with gentle

pressure, taking care not to touch the 1= sitedirectly. Take the catheter in your dominant handand insert the needle )bevel facing up* throughthe skin. 0educe the angle of insertion as you

advance the needle into the vein J use ashallow3angled approach.

;ook for a Eashback of blood at the catheter hub.This is a sign that you4ve successfully hit the vein.nce you see the Eashback, advance the needleone more centimeter )cm* into the vein.


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Remove and discard the needle 2Maintaining pressureon the skin, pull the needle )onlythe needle J not thecatheter* about 5 cm back out of the vein. 2lowly advance

the catheter into the vein while maintaining pressure onthe vein and skin. When the catheter is seated in the vein,remove the tourni-uet and secure the catheter by placing asterile bandage or dressing over the lower half of thecatheter hub. He sure not to block the the 1= tubing

connection with your dressing. 'nsert the tubing 2+old onto the catheter hub with your

thumb and inde' $nger. Keep it securely seated in the vein.Csing your other hand, carefully pull the needle )and onlythe needle* out of the vein. (ispose of the needle in a

proper sharps container. Ie't, remove the protective coverfrom the end of the 1= tubing and carefully insert it into thecatheter hub. 2ecure it in the catheter by screwing andlocking in place.


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Secure the '+ 2 9inally, secure the 1= against thepatient4s skin. Place a piece of tape over the

catheter hub, then make a loop in the cathetertubing and tape this down with a second piece oftape over the $rst. 2ecure the other end of theloop above the site of the 1= with a third piece of

tape. Putting loops in the tubing reduces thestrain on the 1= catheter, making it morecomfortable for the patient and less likely toaccidentally be removed from the vein.

Make sure there are no kinks in the loop J thiscan interfere with the Eow of medicine into thebloodstream.


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Basic Vital Signs