SCIENCE EDUCATION > Clinical Skills

Nursing Skills

This collection demonstrates medication preparation and administration, with videos highlighting important safety checks, considerations, dosage calculations, and common mistakes associated with improper medication administration.

  • Nursing Skills

    07:11
    Safety Checks and Five Rights of Medication Administration

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    According to the 1999 Institution of Medicine (IOM) report titled To Err is Human: Building a Safer Health System, medication errors are significant contributors to avoidable patient deaths in the hospital environment. Therefore, to maintain patient safety and to avoid medication errors, it is important that every nurse adheres to at least five "rights" of safe medication administration. These five "rights" refer to the right patient, right medication, right medication dose, right time of administration, and right route of administration. The nurse should check for these five "rights" at three different checkpoints points in the mediation administration process: 1) while comparing the Medication Administration Record (MAR) when withdrawing medications, 2) while comparing the MAR to acquired medications, and 3) while comparing the MAR to both the medication and patient identifiers at the bedside. This video will demonstrate the acquisition component of medication administration, which consists of performing the five "rights" during the first, second, and third checkpoints. Prior to acquiring medications from a medication dispensing system (MDS), the nurse must consider whether the medication is appropriate, given the patient's medical conditions, medication a

  • Nursing Skills

    10:59
    Preparing and Administering Oral Tablet and Liquid Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Oral medications are the route most preferred by patients and are one of the most commonly used routes of medication administration by providers. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract. Oral medications are available in solid forms (e.g., tablets, capsules, caplets, and enteric-coated tablets) and liquids forms (e.g., syrups, elixirs, spirits, and suspensions). Most oral medications have a slower onset of action and, in the case of liquids and swallowed oral medications, may also have a more prolonged effect. Enteric-coated tablets are covered with material that prevents dissolution and absorption until the tablet reaches the small intestine. Additional oral medication routes (not shown in this video) include sublingual administration, in which the preparation is placed under the tongue to dissolve, and buccal administration, which involves placing the medication in the cheek area between the gums and mucus membranes to dissolve. When preparing and administering oral tablets and liquid medications, the nurse must consider whether the medication is appropriate given the patient's medical conditions, medication allergies, and current clinical status and when previous doses of the medication have been administered. Pati

  • Nursing Skills

    11:44
    Preparing and Administering Topical Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Topical medications are applied directly to the body surfaces, including the skin and mucous membranes of the eyes, ears, nose, vagina, and rectum. There are many classes of topical medications, such as creams, ointments, lotions, patches, and aerosol sprays. Medications that are applied to the skin to produce slow, controlled, systemic effect are also referred to as transdermal. Transdermal absorption can be altered if lesions, burns, or breakdowns are present at the application site. Many transdermal medications are delivered via adhesive patch to achieve the slow, controlled, systemic effect. The patch should be applied to clean and hairless skin areas that do not undergo excessive movement, such as the back of the shoulder or thigh. Other topical creams or eye ointments should be applied according to the packaging and manufacturer instructions using an application device. When instilling eardrop medications, never occlude the ear canal, as this may increase pressure and rupture the ear drum. Medications that can be administered via a topical route include antibiotics, narcotics, hormones, and even chemotherapeutics. This requires adherence to the five "rights" of medication administration and three checks during the administration process to ensure the safe administration of th

  • Nursing Skills

    08:13
    Preparing and Administering Inhaled Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Inhaled medications are prescribed for conditions affecting the bronchi, which branch off of the trachea, and bronchioles, which are progressively smaller conducting airways spread throughout the lung tissue. These conditions can be classified as acute (i.e., temporary, with quick onset) or chronic (i.e., persistent and/or recurrent symptoms lasting months to years). Common acute conditions requiring inhaled medications include acute bronchitis, pneumonia, tuberculosis, pulmonary edema, and acute respiratory distress syndrome. Chronic conditions requiring inhaled medications encompass those classified as COPD (i.e., asthma, chronic bronchitis, and emphysema), as well as other chronic conditions, including cystic fibrosis, lung cancer, and pneumoconiosis. These conditions often require medications to open airways, decrease airway inflammation, and promote airflow. The delivery of medications directly into the airways allows for a faster response when compared to systemically administered medications and decreases the impact of systemic side effects. Inhaled medications come in different forms and delivery devices. Common inhaled medications include short- and long-acting bronchodilators and corticosteroids. These may be delivered using various types of inhalation delivery devices, such as metered-

  • Nursing Skills

    08:54
    Preparing and Administering Subcutaneous Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Subcutaneous medication administration is a parenteral approach to administer small amounts of medication (less than 2 mL) into the layer of tissue just below the skin. Common medications administered via the subcutaneous route include anticoagulant medications, such as heparin or enoxaparin; epinephrine administered for allergic reactions; insulin; and some immunizations. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. Subcutaneous needles have a shorter length and smaller diameter than syringes used for intramuscular injections, are typically less than 5/8th of an inch, and are 26 gauge or smaller. Medication absorption and onset is slower than for intravenous routes, with some absorption rates lasting 24 h or longer. This approach is selected for many medications that may be denatured or deactivated if given via the oral route, given the acidity of the gastrointestinal tract. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. The nurse should determine the appropriate medication dose according to the concentration provided on the container. This demonstration will present how to prepare and administer subcutaneous medications after the medica

  • Nursing Skills

    12:41
    Preparing and Administering Intramuscular Injections

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Intramuscular (IM) injections deposit medications deep into the muscle tissue. Since muscle fibers are well perfused, this route of administration provides quick uptake of the medication and allows for the administration of relatively large volumes. Skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue, which allows for the less painful administration of irritating drugs (e.g., chlorpromazine, an anti-psychotic). IM injections are recommended for patients unable to take oral medications and for uncooperative patients. Some examples of medications that are commonly delivered by IM injections include antibiotics, hormones, and vaccinations. As in any other route of administration, the nurse must consider if the medication is appropriate, given the patient's medical conditions, allergies, and current clinical status. In addition, specifically for IM injections, it is important to assess the patient's muscle mass to determine the appropriate needle size. Also, if the patient has already received this injection, it is necessary to verify the injection site that was previously used and to ensure that the previous dose did not result in any adverse reactions. The sites that are most commonly utilized for IM injections include the deltoid muscle of the shoulder; the vas

  • Nursing Skills

    13:05
    Preparing and Administering Enteric Tube Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    An enteric tube is a tube that is inserted and passed into the stomach or intestines. Enteric tubes serve multiple purposes, including stomach decompression (through the removal of air, gastric contents, and secretions), enteric feeding, and/or the administration of medications or oral contrast. Enteric tubes are indicated for patients with impaired swallowing and for patients with neurological or other conditions associated with an increased risk of aspiration, or when the patient is unable to maintain adequate oral intake of fluid or calories. There are multiple types of enteric tubes, with their generic names assigned according to the insertion site and the gastrointestinal termination point. For instance, one of the common tube types is the nasogastric tube, which is inserted through a nostril and passed along the upper gastrointestinal tract into the stomach. When administering medications through an enteric tube, it is important to ensure that the tube terminates in the intended gastrointestinal location. When enteric tubes are initially placed, the position of the tube is verified by X-ray. However, due to gastric peristalsis, enteric tubes may migrate out of their intended termination location. Thus, it is important to confirm the appropriate tube location before administering the medicat

  • Nursing Skills

    11:38
    Peripheral Intravenous Catheter Insertion

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    The purpose of peripheral intravenous catheter (PIV) insertion is to infuse medications, perform intravenous (IV) fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique.

    Common IV venipuncture sites are the arms and hands in adults and the feet in children. According to the Intravenous Nurses Society (INS), the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs. This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension set. Although a PIV securement device is used here to stabilize the IV catheter, according to INS recommendations, some facilities may n

  • Nursing Skills

    07:07
    Assessing and Flushing a Peripheral Intravenous Line

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    After peripheral intravenous (IV) access is initiated, it is important to assess and maintain the IV catheter according to institutional policies and nursing standards of practice. The regular assessment of the insertion site and the surrounding areas for signs of complications is necessary to prevent IV catheter complications, including infiltration, phlebitis, infection, extravasation, or catheter dislodgement. Routine IV maintenance is equally important to preserve line patency and to reduce the risk of occlusion, thrombosis, and thrombophlebitis. According to the CDC, peripheral IV catheters (PIV) may be kept in place for as long as 96 h, with proper care and maintenance. In addition, according to the Infusion Nurses Society (INS), a pediatric patient IV catheter may be kept in place until the IV line is no longer patent or it demonstrates complications. Routine rotation every 96 h is not indicated in the pediatric population due to increased anxiety caused by needle sticks. This video demonstrates the assessment and maintenance of peripheral IV lines, including general considerations before initiating the procedure, assessing the injection site for associated complications, and maintaining catheter patency by flushing it with the normal saline solution.

  • Nursing Skills

    07:58
    Initiating Maintenance IV Fluids

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Hospitalized patients frequently require the administration of intravenous (IV) fluids to maintain their fluid and electrolyte balance. Certain medical conditions that preclude oral fluid intake may necessitate IV fluid administration, with or without electrolytes, to prevent hypovolemia, dehydration, and electrolyte imbalances. Pre-surgical and pre-procedure patients who require anesthesia are often required to be NPO (i.e., nil per os; Latin for "nothing by mouth") to prevent aspiration and to maintain hydration during the procedure. Post-surgical and post-procedure patients may also require IV fluid administration to increase intravascular volume following surgical blood loss. IV fluids can be delivered by different types of administrations sets: gravity flow infusion devices, which rely on gravitation force to push the fluid to the patient's bloodstream, or infusion pumps, which use a pump mechanism that generates positive pressure. While administering maintenance IV fluids using an infusion pump is the most common approach, facility policy; availability of infusion pump equipment; and other limitations, such as a power outage, may necessitate the use of IV gravity tubing. This video describes the approach to initiate maintenance IV fluids using gravity tubing, as well as how to calcula

  • Nursing Skills

    12:12
    Preparing and Administering IV Push Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Intravenous (IV) push is the rapid administration of a small volume of medication into a patient's vein via a previously inserted IV catheter. Preparations for IV push administration are commonly provided in vials or ampules for withdrawal into a syringe. This method is used when a rapid response to a medication is required, or when the medication cannot be administered via the oral route. For instance, medications commonly administered via IV push are the ones used to treat moderate or severe pain. Before administrating IV push, it is important to confirm the correct placement of the IV catheter, because the push medication can cause irritation and damage to the lining of the blood vessel and to surrounding tissues. Since IV push medications act quickly, the patients need to be closely monitored after the drug has been administered, and any error can be especially dangerous. It is imperative that the nurse adheres to the five "rights" and three checks of safe medication administration and is knowledgeable about the medication purpose and adverse effects. The nurse should determine the appropriate medication dose, based upon the medication concentration in the container. If the patient receives other IV medications, the nurse needs to ensure the compatibility of the IV push medication with othe

  • Nursing Skills

    08:40
    Preparing and Administering Intermittent Intravenous Medications with an Infusion Pump

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Primary intermittent intravenous (IV) infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered with another IV fluid, usually maintenance fluids. Intermittent infusions are delivered over a specific amount of time, which is dictated by the type of medication, such as IV antibiotics. High-volume IV medications, anywhere from 50- to 500-mL infusions, are typically delivered using an infusion pump as either primary or secondary infusions. Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping to prevent nurse medication errors. Careful review of the medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders must be assessed prior to delivering an IV medication. This review will determine if primary or secondary delivery is appropriate based on the risk for patient harm, such as for concentrated electrolyte preparations like potassium. Certain medical conditions that preclude oral fluid intake, specific medication preparations, or situations that require an increase in the blood concentration of the medication that is faster than possible through the GI tract may require IV

  • Nursing Skills

    09:29
    Preparing and Administering Secondary Intermittent Intravenous Medications

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Secondary intravenous (IV) infusions are a way to administer smaller volume-controlled amounts of IV solution (25-250 mL). Secondary IV infusions are delivered over longer periods of time than IV push medications, which reduces the risks associated with rapid infusions, such as phlebitis and infiltration. In addition, some antibiotic medications are only stable for a limited time in solution. The secondary IV medication tubing is connected to the primary macrobore (large internal diameter) IV tubing and is therefore "secondary" to the primary infusion. The secondary solution bag is typically hung higher than the primary infusion bag and is subsequently "piggybacked" on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution. As a result, the primary infusion is temporarily paused until the secondary infusion volume has been delivered. This approach ensures that the medication is completely infused due to an immediate return of maintenance IV infusion in the IV line. The secondary IV infusion can be safely delivered when the patient's fluid volume status permits temporarily pausing the delivery of maintenance fluid and in hypervolemia patients. This video demonstrates the administration of secondary intermittent IV infusion

  • Nursing Skills

    07:21
    Discontinuing Intravenous Fluids and a Peripheral Intravenous Line

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Intravenous (IV) fluid administration and peripheral IV catheters (PIVs) may be discontinued for a number of reasons. The most common reason for discontinuing IV fluids is that the patient has returned to normal body fluid volume (euvolemia) and is able to maintain adequate oral fluid intake or is being discharged from the hospital. In addition, the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) recommends replacing PIVs every 72-96 h in adults to prevent the risk of infection or phlebitis. If the PIV becomes dislodged or if the insertion site demonstrates the signs and symptoms of infection, infiltration, extravasation, or phlebitis, the PIV should be discontinued and replaced. For pediatric patients, the Infusion Nurses Society recommends replacing the PIV only when the IV infusion site is no longer patent or when it demonstrates the signs and symptoms of complications. This video describes the approach to discontinue IV fluid administration and PIVs.

  • Nursing Skills

    11:55
    Central Venous Access Device Dressing Change

    Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

    Central venous access devices (CVAD), commonly known as central lines or central catheters, are large-bore intravenous (IV) catheters that are introduced into the central circulation. Typically, CVADs terminate in the superior vena cava, just outside of the right atrium of the heart, but they may also terminate in any one of the great veins (i.e., aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or common femoral vein). Patients may need a CVAD for any number of reasons. CVADs allow for the rapid infusion of fluids to treat significant hypovolemia or shock. They are also beneficial when administering vasoactive medications, highly concentrated medications, total parenteral nutrition (TPN), or chemotherapy, because the increased blood volume in these areas allows for the hemodilution of these potentially caustic or reactive agents. Patients who must receive multiple non-compatible IV medications, those that require long-term IV medications, or those with limited vascular access may also require the placement of a CVAD. These devices may be tunneled (i.e., inserted into a vein at one location and tunneled under the skin to emerge through the skin at another site) or non-tunneled (i.e., inserted through the skin and directly into a vein). Examples of CVADs include multi-lum

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