ADMINISTERING ORAL MEDICATIONS |
|
口服给药 |
Assessment |
|
评估 |
1. Identify the drug(s) ordered: action, purpose, normal dosage and route, common side effects, time of onset and peak action, and nursing implications. |
1、确认药物:作用、目的、正常剂量及给药途径、常见副作用、起效和药峰时间、和护理含意。 | |
2. Assess for any contraindications to oral medication. |
2、评估是否有口服禁忌。 | |
3. Check allergies and replace any missing or faded identification bracelets. |
3、检查过敏资料,补充遗失或替换退色的识别腕带。 | |
4. Assess client's knowledge regarding medications. |
4、评估病人的药物知识。 | |
5. Assess client's preferences for fluids. Maintain fluid restrictions as prescribed. |
5、评估病人液体喜好。按处方维持液体限制。 | |
Implementation |
实施 | |
1. Use Standard Protocol. |
1、按标准程序开始操作。 | |
Preparing medications |
|
准备药物 |
2. Compare medication administration record with scheduled medication list. If discrepancies exist, check against original physician orders. |
2、对照用药记录与药物单。如有异议,应核对原始医嘱。 | |
Nurse alert: Review five rights. |
|
注意:药物“五对”。 |
3. Arrange cups in medication preparation area or move medication cart to position outside client's room. |
3、在药物准备区备好杯子,或将药车推到病房外。 | |
4. Unlock medicine drawer or cart. |
4、打开药柜或药车。 | |
5. Prepare medications for one client at a time. |
5、准备药物,一次准备一个病人。 | |
6. Select correct drug from stock supply or unit dose drawer. Compare label of medication with MAR or computer printout. |
6、从备用药或单位剂量抽屉中选择所需药物。 | |
7. Check drug dose. If label dose differs from ordered dose, calculate correct amount to give. |
7、核对药物剂量。如标签剂量不同于医嘱剂量,应算出正确剂量。 | |
8. To prepare unit dose tablets or capsules, place packaged tablet or capsule directly into medicine cup without removing wrapper. |
8、准备单位剂量药片或胶囊时,直接将包装好的药片或胶囊放入药杯,无需除去包衣。 | |
9. To prepare tablets or capsules from a floor stock bottle, pour required number into bottle cap and transfer medication to medication cup. Do not touch medication with fingers; return extra tablets or capsules to bottle. |
9、从原料瓶准备药片或胶囊时,将所需药物倒入瓶盖,再转到药杯,勿使手指触碰药品。将剩余药片或胶囊倒回药瓶。 | |
10. Check the expiration date of each drug. Return all outdated drugs to pharmacy. |
10、核对每种药物的有效期。将过期药品退还药房。 | |
11. Place all tablets or capsules requiring preadministration assessments (e.g., pulse rate, blood pressure) in a separate cup. |
|
11、单独放置需要进行药前评估的药品(如脉率、血压)。 |
12. Medications that need to be broken in order to administer half the dose can be broken using a gloved hand or cut with a cutting device. |
12、需切半服用的药物可带手套用手掰开或用刀具切开。 | |
13. When preparing liquids, thoroughly mix before administering. Check and discard medications that are cloudy or have changed color: |
13、药液:用前需摇匀。检查并弃用混浊或变色药品。 | |
|
| |
14. If giving less than 5 ml of liquids, prepare medication in a sterile syringe without a needle. |
14、如所给药液少于5毫升,备药时可使用无针头注射器。 | |
Nurse Alert: EC or SR tablets may be available in liquid or suppository form. Crushing alters absorption rate. |
|
注意:肠衣片或缓释制剂有液剂和栓剂两种,研碎后可改变吸收率。 |
15. Narcotic preparation. Check narcotic record for previous drug count and compare with supply available. |
15、麻醉药品。核对用药记录,检查以前 用药数量及可用药品。 | |
16. Sign out narcotics according to agency policy. |
16、根据医院规定登记麻醉药品使用情况。 | |
Administering medications |
|
发药 |
17. Take medications to client within 30 minutes before or after scheduled time. 医学 全在.线提供www.lindalemus.com |
17、在预定给药时间30min内携药品至病人床前。 | |
18. Identify client. |
18、确认病人。 | |
19. Perform necessary preadministration assessment for specific medications. |
19、实施特定药品的用前评估。 | |
20. Discuss the purpose of each medication and its action with client. Allow client to ask any questions about drugs. |
20、与病人讨论每种药品的用药目的及其作用。允许病人询问药品相关问题。 | |
21. Assist client to sitting or side-lying position. |
21、协助病人取坐位或侧卧位。 | |
Nurse Alert: Check ability to swallow if appropriate. |
|
注意:检查吞药能力。 |
22. Administer drugs properly: |
22、正确给药: | |
Nurse Alert: Decide on sequence of administration.
|
注意:确定给药顺序。
| |
23. Stay until client has completely swallowed each medication. If concerned about ability or willingness to swallow, ask client to open mouth and inspect for presence of medication. |
23、确认病人服下全部药物后方可离开。如担心病人吞咽能力或不愿意吞咽药物,应要求病人张嘴检查口腔内是否存有药物。 | |
24. For certain medications that should not be given on an empty stomach, offer client nonfat snack. |
24、有些药物不能空腹服用,服用时应向病人提供非脂肪食物。 | |
25. Replenish stock such as cups and straws, return cart to medicine room, and clean work area. |
25、补充备用品,如药杯和吸管。推车返回药房,清洁工作区。 | |
26. Use Completion Protocol. |
26、按标准程序完成操作。 | |
Evaluation |
评价 | |
1. Return within appropriate time to determine client's response to medications. |
1、及时返回病房确定病人对药物的反应。 | |
2. Evaluate client's learning needs. |
2、评价病人学习需要。 | |
3. Identify Unexpected Outcomes and Nursing Interventions |
3、确认意外结果和护理措施。 | |
Record and Report |
记录和报告 | |
1. Actual time given and signature according to agency policy. |
1、按医院规定登记实际给药时间及签名。 | |
2. Drugs withheld and reason. |
2、停用药物及理由。 | |
3. Adverse effects/client response. |
3、不利效应及病人反应。 |