Essential Clinical Skills for Patient Care

Posted on May 28, 2025 in Medicine & Health

Positioning for Enteral Feeding

Patients receiving enteral feedings should be placed in a semi-Fowler’s position (head of bed at 30-45 degrees). This helps prevent aspiration and ensures proper digestion.

Forms of Medications

  • Tablets are solid forms of medication compressed into small disks.
  • Capsules contain medication in a gelatin shell.
  • Suppositories are designed for rectal or vaginal use.
  • Lozenges dissolve in the mouth.

Rectal Medication Administration

Medications given rectally bypass digestive enzymes, which helps prevent stomach irritation and allows the drug to work effectively. This route is useful when patients experience nausea or vomiting.

Lubricant for Rectal Suppositories

Only water-soluble lubricants (e.g., KY Jelly) should be used when administering rectal suppositories. Petroleum-based lubricants (e.g., Vaseline) can prevent absorption.

Medication Safety

Before administering any medication, the first step is to check the patient’s identification using two identifiers (name & DOB). This ensures medication safety and prevents errors.

Alternative Routes for Vomiting Patients

If a patient is vomiting, the rectal route is the best alternative because it avoids the stomach and ensures absorption.

Medications Not Suitable for Feeding Tubes

Enteric-coated tablets cannot be crushed or given via a GI tube because the coating protects the drug from stomach acid or prevents stomach irritation.

Positioning for Enema Administration

For an enema, patients should be positioned in the left side-lying position to allow gravity to help distribute the solution effectively.

Syringes for Insulin Administration

Insulin should be administered using a syringe calibrated in units to ensure accurate dosing.

Parts of a Syringe

The barrel is the part of the syringe with calibrations for measuring medication volume.

Needle Gauge Sizes

The lower the gauge number, the larger the needle diameter. Example: 18 gauge is larger than a 22 or 25 gauge needle.

Drawing Medication from an Ampule

A filter needle is required when withdrawing medication from an ampule to prevent glass contamination.

Advantages of Parenteral Medications

Parenteral (injection) medications have a faster onset of action than oral drugs because they bypass the digestive system.

Types of Parenteral Medication Containers

An ampule is a glass container that must be broken open before withdrawing medication.

Injection Angles

Subcutaneous injections should be given at a 45°-90° angle, depending on the amount of tissue.

Subcutaneous Injection Volume

The usual amount for subcutaneous injections is 1 mL or less to prevent tissue damage.

Allergy Testing

A patch test is used to determine allergic reactions to substances.

Ampule Safety

A filter needle or straw is required after opening an ampule to remove any glass particles.

G-Tube Feeding Guidelines

  • Verify tube placement.
  • Check for residual volume.
  • Keep the patient in an elevated position.
  • Never lay the patient flat during a feeding.

Dosage Calculation for Tablets

To find the correct number of tablets to administer: Dose ordered ÷ Dose available = Tablets needed
Example: 7.5 mg needed, available 15 mg tablets → Give 0.5 tablet

Three Main Medication Routes

  1. Enteral – By mouth (PO) or feeding tube
  2. Parenteral – Injection (IV, IM, SubQ, ID)
  3. Percutaneous – Absorbed through skin or mucous membranes

IM Injection Site for Infants

The vastus lateralis (thigh) is the preferred IM injection site for infants because it has the largest muscle mass.

IV Complications

  • Infiltration: Fluid leaks into surrounding tissue (swelling, coolness)
  • Phlebitis: Inflammation of the vein (redness, warmth)
  • Septicemia: Infection in the bloodstream (fever, chills)

Checking Medication Labels

Medication labels should be checked three times:

  1. When retrieving the medication
  2. When preparing the medication
  3. At the patient’s bedside before administration

Hypertension Risk Factors

  • Modifiable risks: Smoking, diet, obesity, high cholesterol
  • Non-modifiable risks: Family history

Hypertension Treatment

Lifestyle changes (diet, exercise, smoking cessation) are the first steps before medications.

Insulin Administration for Thin Patients

For thin patients, the best angle for subcutaneous insulin injection is 45 degrees.

Most Rapid Medication Route

IV (Intravenous) administration is the fastest route, but it has the highest risk of adverse effects.

Metabolic Syndrome

A cluster of risk factors that increase the risk of heart disease:

  • High blood pressure
  • High blood sugar
  • High triglycerides
  • Low HDL (good cholesterol)
  • Abdominal obesity

Common Medical Abbreviations

  • TID = Three times a day
  • STAT = Immediately
  • BID = Twice a day
  • NPO = Nothing by mouth
  • SUBQ = Subcutaneous injection

Cholesterol and Lipid Medications

  • Statins: Most effective for lowering LDL (bad cholesterol)
  • Bile Acid Sequestrants: Cause bloating, nausea, constipation
  • Niacin (B3): Raises HDL but causes flushing, itching
  • Omega-3 Fatty Acids: Lower triglycerides but may cause bloating, nausea

Cardiovascular Disease and Diabetes Link

  • 80% of people with diabetes die from cardiovascular disease.
  • High cholesterol and high blood pressure increase heart disease risk.

IV Drip Rate Calculations

Formula:
mL/hr = Total Volume (mL) / Time (hr)
Example: 1000 mL over 10 hours = 100 mL/hr

Military Time Conversion

  • 4:00 PM = 1600
  • 10:00 AM = 1000

Body Mass Index (BMI) Categories

  • Normal: 18.5 – 24.9
  • Overweight: 25 – 29.9
  • Obese: 30+

Needle Parts

  1. Hub – Connects to the syringe.
  2. Shaft – Long, hollow tube.
  3. Beveled Tip – Slanted tip for smooth insertion.