Mindanao State University – Iligan Institute of Technology College of Nursing

Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING OTIC INSTILLATIONS

Definition: Instillation or irrigation of the external auditory canal and are generally carried out for cleaning purposes

Purposes:
1. To soften earwax so that it can be readily removed at a later time
2. To provide local therapy, to reduce inflammation and destroy infective organism in the external ear canal
3. To relieve pain

Indication: To provide ear medication. To remove foreign bodies and chemicals that may harm the ear.

Special considerations:
● INFANTS/CHILDREN:
1. Immobilize the child to prevent accidental injury due to sudden movement during the procedure.
2. In infants and children under 3 years of age, pull pinna down and back
3. For children over 3 years of age, pull pinna up and back
4. Warm drops to avoid causing pain in the tympanic membrane

Equipment needed:
● Clean gloves
● Cotton-tipped applicator
● Correct medication with a dropper
● Flexible rubber tip for the end of the dropper(optional)
● Cotton fluff
● For irrigation, add:
a. Moisture-resistant towel
b. Basin (e.g. emesis basin)
c. Irrigating solution at the appropriate temp. about 500 mL or as ordered
d. Container for the irrigating solution
e. Syringe (rubber bulb or asepto syringe)

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Mindanao State University – Iligan Institute of Technology College of Nursing
PROCEDURE RATIONALE 5 4 3 2 1
1. Check the medication card against the doctor’s order. The health care provider’s order is the most
Check the patient’s history for allergies. reliable source and only legal record of drugs that
patient is to receive. Ensures that patient
receives correct medication. Handwritten MARs
are a source of medication errors (ISMP, 2010;
Jones and Treiber, 2010).

2. Know the actions, special nursing considerations, Allows you to anticipate effects of drug and
purpose of administration, and adverse effects of the observe patient’s response.
medication.

3. Perform hand hygiene and put on PPE, if indicated. Reduces spread of microorganisms; ensures
smooth, orderly procedure.

4. Get the medication from the patient’s medication To ensure that medical errors can be avoided and will be
storage and compare the label with the drug name in given to the correct patient.
the medication card. Check expiration date.

5. Perform hand hygiene and put on PPE, if indicated. Reduces spread of microorganisms; ensures
smooth, orderly procedure

6. Approach the patient’s room and identify the patient Patient has right to be informed, and patient’s
by asking him to state his name and by checking the understanding of each medication improves
identification wristband. Explain what you are going to adherence to drug therapy.
do and reason for doing it.

7. Provide client privacy. To reduce patient’s anxiety

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Mindanao State University – Iligan Institute of Technology College of Nursing

8. Wash/sanitize hands. Put on gloves. Reduces spread of microorganisms; ensures

smooth, orderly procedure

9. Cleanse external ear (pinna &meatus of auditory

canal) of any drainage with cotton ball or washcloth To avoid cross-contamination and spread of infection
moistened with normal saline.

10. Place patient on his or her unaffected side in bed, or, Facilitates distribution of medication into ear
if ambulatory, have patient sit with head well tilted to
the side so that affected ear is uppermost.

11. Administer medication

A. OTIC DROPS

a. Draw up the amount of solution needed in the

dropper. Do not return excess solution to a
stock bottle.
b. Straighten auditory canal by pulling
cartilaginous of pinna up and back for an adult;
down and back for a child below 3 years old.
c. Hold the dropper in the ear with its tip above
the auditory canal. Do not touch the dropper to
the ear.
d. Allow drops to fall on the side of the canal.
To ensure the right amount or dosage. The excess solution
is already considered contaminated.
Straightening ear canal provides direct access to deeper ear
structures. Anatomic differences in younger children and
infants necessitate different methods of positioning canal
(Hockenberry and Wilson, 2011).
Dropping the medication directly into the ear canal may
cause discomfort to the patient.

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Mindanao State University – Iligan Institute of Technology College of Nursing

e. Release pinna after instilling drops, and have To ensure that medication is properly administered.
patient maintain the position to prevent escape
of medication.

f. Gently press on the tragus a few times. Pressure helps medication move toward tympanic
membrane
g. If ordered, loosely insert a cotton ball into the
ear canal. Prevents escape of medication when patient sits or stands.

B. EAR IRRIGATION

a. Protect the patient & bed with a waterproof

pad. Put support basin under the ear. To prevent the patient and bed from getting soiled
b. Fill bulb syringe w/ warm solution. If an
irrigating container is used, prime the tubing. Air forced into the ear is unpleasant for the client.

c. Straighten auditory canal.

To easily administer the solution
d. Direct a steady, slow stream of solution
against the roof of the auditory canal. Allow
solution to flow out unimpeded. To allow the solution to flow steadily and distribute

e. Place a cotton ball loosely in auditory meatus.

Prevents escape of solution when patient sits or stands.
f. Return after 10-15 minutes to remove the
cotton ball & assess drainage.
To assess the drainage.

12. Remove gloves. Assist the patient to a comfortable

position. To provide comfort for the patient

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Mindanao State University – Iligan Institute of Technology
13. Remove additional PPE, if used. Perform hand
hygiene.
14. Document the time and sign at the medication sheet
of the patient’s chart immediately after the medication
administration.
15. Evaluate the patient’s response to medication within
the appropriate time frame.
Learner’s Reflection: (What did you learn most of the activity? What is
its impact to you?)
Administering Non-injectable Medications
College of Nursing
Reduces spread of microorganisms.
Documentation of medications administered to the patient
will help ensure continuity of care and coordination between
healthcare professionals by giving information about the
medications that had been administered and other related
data.
To provide data on patient’s compliance to therapy.
Instructor’s Comments:
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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING NASAL MEDICATIONS

Definition: Instillation of a medical solution into the nostrils from a nasal drops/nasal spray

Purpose: To shrink swollen mucous membranes, to lessen secretions and facilitates drainage or to treat infections of nasal cavity or sinuses

Special considerations:
● INFANTS:
1. Hold the infant in the cradle position, stabilizing the head and tilting it back.
2. Give nose drops 20-30 minutes before feeding. Infants are nose breathers and nasal congestion inhibits sucking.

Equipment needed:
1. Tissues
2. Correct medication bottle with a dropper
3. Clean, disposable gloves (optional)
4. Small pillow (optional)

PROCEDURE RATIONALE 5 4 3 2 1
PREPARATION
1. Perform drug study. Find out why the drug is To avoid clinical errors and to know the purpose of the
prescribed to the patient, its drug classification, medication
mechanism of action, usual dosage range and
frequency of administration, side effects,
contraindications, drug-drug interactions, and nursing
considerations in giving the drug.

2. Check the MAR (Medication Administration Record) for The health care provider’s order is the most reliable
drug name, dosage, frequency, route of administration, source and only legal record of drugs that patient is to
and expiration date, if appropriate. receive. Ensures that the patient receives correct
medication. Handwritten MARs are a source of

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Mindanao State University – Iligan Institute of Technology
3. Check each medication card against the physician’s
order according to the institution’s policy. If there are
inconsistencies, clarify them at once.
PERFORMANCE
1. Secure all the necessary equipment and obtain
appropriate medication. Prepare the medication in the
medication section, for one patient at a time.
2. Identify the client by letting the conscious client say his
full name and verify by looking at the client’s
wristband, which has his name and hospital ID number
written on it.
3. Bring the medication to the client’s bedside. Provide
privacy. Explain the procedure to the patient.
4. Perform hand washing and observe appropriate
infection control procedures. Don gloves if drainage is
present.
5. Provide the patient with paper tissues and ask the
patient to blow his or her nose.
6. Have the patient sit up with head tilted back. Or, if the
patient is lying down, tilt the head back over a pillow.
7. Draw sufficient solution into the dropper for both nares.
Administering Non-injectable Medications
College of Nursing
medication errors (ISMP, 2010; Jones and Treiber,
2010).
To ensure that medical errors can be avoided and will
be given to the correct patient.
These are the first and second checks for accuracy.
Process ensures that the right patient receives the right
medication.
Ensures the correct patient. Complies with The Joint
Commission standards and improves patient safety
(TJC, 2012). Some agencies are now using a barcode
system to help with patient identification.
Patient has the right to be informed, and the patient's
understanding of each medication improves adherence
to drug therapy.
Reduces spread of microorganisms; ensures smooth,
orderly procedure.
Ensures distribution of medication. Allows medication to
reach sinuses.
Proper positioning provides access to specific
nasal passages.
To administer the right amount/dosage
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Mindanao State University – Iligan Institute of Technology
8. Hold the tip of the dropper just above the nostril and
direct the solution laterally toward the midline of the
superior concha of the ethmoid bone as the client
breathes through the mouth. Avoid touching the
mucous membrane of the nares. Repeat for the other
nostril if indicated.
9. Have the patient remain in this position for 5 minutes.
10. Excess solutions should not be returned to a stock
bottle and dispose of all supplies appropriately. Do
handwashing.
11. Document each drug given on the medication chart.
Record the dose, time, and affix your signature.
● If a drug was refused or omitted, record this
fact on the appropriate record and document
the reason.
● Record any fluid intake if the client is on I & O
monitoring.
12. Return to the client when the drug is expected to take
effect, usually 30 minutes. Report significant deviations
from normal to the physician.
Administering Non-injectable Medications
College of Nursing
Avoids contamination of dropper. Instilling toward
ethmoid bone facilitates distribution of medication over
nasal mucosa.
Prevents premature loss of medication through
nares
To avoid contamination
Documentation of medications administered to the
patient will help ensure continuity of care and
coordination between healthcare professionals by giving
information about the medications that had been
administered and other related data.
Assessing the client’s response to the medication will
help us monitor for any unusual or adverse effects.
Doing this will help prevent any complications and
ensure patient safety. Reporting significant deviations
from the normal will allow the physician and the nurse
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Mindanao State University – Iligan Institute of Technology College of Nursing
to adjust the medications or interventions that must be
done based on the patient’s response to the medication.

Learner’s Reflection: (What did you learn most of the activity? What is Instructor’s Comments:
its impact on you?)
Through this activity I was able to learn how to properly administer nasal
medication with all the details and also I learned how to cope up with the
mistakes that I committed during my rehearsals before the actual
performance of the skill. These mistakes and practices helped me to
improve my skills and I hope that in the future I will be able to use this
skill properly.

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING MEDICATION VIA A METERED-DOSE INHALER (MDI)

Definition: A metered dose inhaler (MDI) is a handheld inhaler that uses an aerosol spray or mist to deliver a controlled dose of medication with
each compression of the canister. The medication is then absorbed rapidly through the lung tissue, resulting in local and systemic effects.

Purpose: To treat or prevent bronchospasm. To treat asthma and chronic respiratory disease.

Indication: Indicated for the treatment or prevention of bronchospasm in patients aged 4 years and older with reversible obstructive airway
disease. Drugs administered by inhalation provide control of airway hyperactivity or constriction.
Special Consideration
Teaching
• Allow for supervised practice of the procedures. Patients may have difficulty timing an inhalation with activation of the medication canister without proper instruction (Lewis et al.,
2011). 
• Teach patient to keep track of the number of inhalations in the MDI (Box 21-4). 
• Teach patients to use small, handheld peak flowmeters to monitor response to therapy when inhalers are prescribed (Barrons et al., 2011).
Pediatric 
• A spacer is of benefit to young children because they have difficulty coordinating inhaler activation and inhaling (Hockenberry and Wilson, 2011). 
• Educate child and parent about the need to use the inhaler during school hours. Help family find resources within the school or day care facility. Many school systems do not permit
self-administration of MDIs. Follow school policy regarding having the MDI available for use during school hours. A health care provider’s order may be necessary. 
Gerontologic 
• Older adults may be unable to depress medication canisters because of weakened grasp or inability to coordinate actuation of the canister with inhalation. The use of a spacer device
may be helpful. 
Home Care 
• Remind patients to carry prescribed inhalers to use as immediate treatment in case of an acute asthma attack.

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Mindanao State University – Iligan Institute of Technology College of Nursing

Equipments needed:

1. Inhaler device with medication canister (MDI or DPI) (see Fig.1, A to C)

2. Spacer device such as AeroChamber or InspirEase (optional)
3. Facial tissues (optional)
4. Stethoscope
5. Medication administration record (MAR) (electronic or printed)
6. Pulse oximeter (optional)

ACTION RATIONALE PERFORMED REMARKS

YES NO

1. Gather equipment. Check each This comparison helps to identify errors that may have
medication order against the original order occurred when orders were transcribed. The primary care
in the medical record, according to facility
provider's order is the legal record of medication orders for
policy. Clarify any inconsistencies. Check
the patient’s chart for each facility.
allergies.

2. Know the actions, special nursing This knowledge aids the nurse in evaluating the therapeutic
considerations, safe dose ranges, purpose of effect of the medication in relation to the patient’s disorder
administration, and adverse effects of the
and can
medications to be
administered. Consider the also be used to educate the patient about the medication.
appropriateness of the medication for
this patient.

3. Perform hand hygiene. This helps preventing spreading of microorganisms

4. Move the medication cart to the outside of Organization facilitates error-free administration and saves
the patient’s room or prepare for time.
administration in the medication area.

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Mindanao State University – Iligan Institute of Technology
5. Unlock the medication cart or drawer. Enter
pass code and scan employee
identification, if required.
6. Prepare medications for one patient at a
time.
7. Read the CMAR/MAR and select the proper
medication from the patient’s medication
drawer or unit stock.
8. Compare the label with the CMAR/MAR.
Check expiration dates and perform
calculations, if necessary. Scan the bar code
on the package, if required.
9. When all medications for one patient have
been prepared, recheck the label with
the MAR before taking them to the
patient.
ACTION
10. Lock the medication cart before leaving it.
11. Transport medications to the patient’s
Administering Non-injectable Medications
College of Nursing
Locking the cart or drawer safeguards each patient’s
medication supply. Hospital accrediting organizations require
medication carts to be locked when not in use. Entering pass
code and scanning ID allows only authorized users into the
system and identifies user for documentation by the
computer.
This prevents errors in medication administration.
This is the first check of the label.
This is the second check of the label. Verify calculations with
another nurse to ensure safety, if necessary.
This is a third check to ensure accuracy and to prevent
errors.
Some facilities require the third check to occur at the
bedside,
after identifying the patient and before administration.
RATIONALE PERFORMED REMARKS
YES NO
Locking the cart or drawer safeguards the patient’s
medication
supply. Hospital accrediting organizations require medication
carts to be locked when not in use.
Careful handling and close observation prevent accidental or
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Mindanao State University – Iligan Institute of Technology College of Nursing
bedside carefully, and keep the deliberate disarrangement of medications.
medications in sight at all times.

12. Ensure that the patient receives the Check agency policy, which may allow for administration
medications at the correct time. within a period of 30 minutes before or 30 minutes after
designated time.

13. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent the spread of
indicated. microorganisms.
PPE is required based on transmission precautions.

14. Identify the patient. Usually, the patient Identifying the patient ensures the right patient receives the
should be identified using two methods. medications and helps prevent errors.
Compare information with the CMAR/MAR.

15. Check the name and identification This is the most reliable method. Replace the identification
number on the patient’s identification band if it is missing or inaccurate in any way.
band.

16. Ask the patient to state his or her name This requires a response from the patient, but illness and
and birth date, based on facility policy. strange surroundings often cause patients to be confused.

17. If the patient cannot identify him- or This is another way to double-check identity. Do not use the
herself, verify the patient’s identification name on the door or over the bed, because these signs may
with a staff member who knows the be inaccurate.
patient for the second source.

18. Complete necessary assessments before Assessment is a prerequisite to administration of

administering medications. Check the medications.
patient’s allergy bracelet or ask the Explanation relieves anxiety and facilitates cooperation.
patient about allergies. Explain what you
are going to do and the reason to the

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Mindanao State University – Iligan Institute of Technology College of Nursing
patient.

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Mindanao State University – Iligan Institute of Technology
ACTION
19. Remove the mouthpiece cover from the
MDI and the spacer. Attach the MDI to
the spacer. (See accompanying Skill
Variation for using an MDI without a
spacer.)
20. Shake the inhaler and spacer well.
21. Have patient place the spacer’s
mouthpiece into mouth, grasping securely
with teeth and lips. Have patient breathe
normally through the spacer.
22. Patient should depress the canister,
releasing one puff into the spacer, then
inhale slowly and deeply through the
mouth.
23. Instruct patient to hold his or her breath
for 5 to 10 seconds, or as long as
possible, and then to exhale slowly
through pursed lips.
24. Wait 1 to 5 minutes, as prescribed, before
administering the next puff.
Administering Non-injectable Medications
College of Nursing
RATIONALE PERFORMED REMARKS
YES NO
The use of a spacer is preferred because it traps the
medication and aids in delivery of the correct dose.
The medication and propellant may separate when the
canister is not in use. Shaking well ensures that the patient
is receiving the correct dosage of medication.
Medication should not leak out around the mouthpiece.
The spacer will hold the medication in suspension for a short
period so that the patient can receive more of the prescribed
medication than if it had been projected into the air.
Breathing slowly and deeply distributes the medication deep
into the airways.
This allows better distribution and longer absorption time for
the medication.
This ensures that both puffs are absorbed as much as
possible.
Bronchodilation after the first puff allows for deeper
penetration by subsequent puffs.
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Mindanao State University – Iligan Institute of Technology
25. After the prescribed amount of puffs has
been administered, have patient remove the
MDI from the spacer and replace the caps on
both.
26. Have the patient gargle and rinse with
tap water after using an MDI, as necessary.
Clean the MDI according to the
manufacturer’s directions.
27. Remove gloves and additional PPE,
if used. Perform hand hygiene.
28. Document the administration of the
medication immediately after
administration. See Documentation section
below.
29. Evaluate the patient’s response to
medication within appropriate time
frame. Reassess lung
sounds, oxygenation saturation if
ordered, and respirations.
Administering Non-injectable Medications
College of Nursing
By replacing the cap, the patient is preventing any dust or
dirt
from entering and being propelled into the bronchioles with
later doses.
Rinsing removes medication residue from the mouth. Rinsing
is necessary when using inhaled steroids because oral fungal
infections can occur. The buildup of medication in the device
can attract bacteria and affect how the medication is
delivered.
Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand
hygiene prevents
the spread of microorganisms.
Timely documentation helps to ensure patient safety.
The patient needs to be evaluated for therapeutic and
adverse
effects from the medication. Lung sounds and oxygenation
saturation may improve after MDI use. Respirations may
decrease after MDI use.
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Mindanao State University – Iligan Institute of Technology College of Nursing
Learner’s Reflection: (What did you learn most of the activity? Instructor’s Comments:
What is its impact to you?)

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING MEDICATION VIA A SMALL-VOLUME NEBULIZER

Definition: Nebulization is a process by which medications are added to inspired air and converted into a mist that is then inhaled by
the patient into their respiratory system
Purpose: Nebulizer treatments are able to prevent respiratory problems from developing initially or getting worse. They are also effective at
treating acute breathing emergencies.  Steroids work to reduce inflammation and mucus production within the lungs, which can impede the
flow of oxygen.
Indications: Indicated for use in the routine management of chronic bronchospasm unresponsive to conventional therapy, and in the treatment
of acute/severe asthma. 
Teaching
• Allow for supervised practice of the procedures. Patients may have difficulty timing an inhalation with activation of the medication canister without proper instruction (Lewis et al.,
2011). 
• Teach patient to keep track of the number of inhalations in the MDI (Box 21-4). 
• Teach patients to use small, handheld peak flowmeters to monitor response to therapy when inhalers are prescribed (Barrons et al., 2011).
Pediatric 
• A spacer is of benefit to young children because they have difficulty coordinating inhaler activation and inhaling (Hockenberry and Wilson, 2011). 
• Educate child and parent about the need to use the inhaler during school hours. Help family find resources within the school or day care facility. Many school systems do not permit
self-administration of MDIs. Follow school policy regarding having the MDI available for use during school hours. A health care provider’s order may be necessary. 
Gerontologic 
• Older adults may be unable to depress medication canisters because of weakened grasp or inability to coordinate actuation of the canister with inhalation. The use of a spacer device
may be helpful. 
Home Care 
• Remind patients to carry prescribed inhalers to use as immediate treatment in case of an acute asthma attack.

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Mindanao State University – Iligan Institute of Technology College of Nursing
Equipments needed:

1. Medication ordered and diluent (if needed)

2. Medicine dropper or syringe
3. Nebulizer bottle and tubing assembly
4. Small-volume nebulizer machine (often called handheld nebulizer or simply nebulizer)
5. Pulse oximeter and peak flow device
6. Stethoscope
7. Medication administration record (MAR) (electronic or printed)

ACTION RATIONALE PERFORMED REMARKS

YES NO

1. Gather equipment. Check each medication
order against the original order in the
medical record, according to facility policy.
Clarify any inconsistencies. Check the
patient’s chart for allergies.
This comparison helps to identify errors that may have
occurred when orders were transcribed. The primary care
provider's order is the legal record of medication orders for
each facility.

2. Know the actions, special nursing This knowledge aids the nurse in evaluating the therapeutic
considerations, safe dose ranges, purpose effect of the medication in relation to the patient’s disorder
of administration, and adverse effects of
and can
the medications to be administered.
Consider the appropriateness of the also be used to educate the patient about the medication.
medication for this patient.

3. Perform hand hygiene. This helps preventing spreading of microorganisms

4. Move the medication cart to the outside of Organization facilitates error-free administration and saves
the patient’s room or prepare for time.
administration in the medication area.

5. Unlock the medication cart or drawer. Enter Locking the cart or drawer safeguards each patient’s
pass code and scan employee medication supply. Hospital accrediting organizations require
identification, if required.
medication carts to be locked when not in use. Entering pass

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Mindanao State University – Iligan Institute of Technology
6. Prepare medications for one patient at a
time.
7. Read the CMAR/MAR and select the proper
medication from the patient’s medication
drawer or unit stock.
8. Compare the label with the CMAR/MAR.
Check expiration dates and perform
calculations, if necessary. Scan the bar
code on the package, if required.
ACTION
9. When all medications for one patient have
been prepared, recheck the label with
the CMAR/MAR before taking them to the
patient.
10. Lock the medication cart before leaving it.
Administering Non-injectable Medications
College of Nursing
code and scanning ID allows only authorized users into the
system and identifies user for documentation by the
computer.
This prevents errors in medication administration.
This is the first check of the label.
This is the second check of the label. Verify calculations with
another nurse to ensure safety, if necessary.
RATIONALE PERFORMED REMARKS
YES NO
This is a third check to ensure accuracy and to prevent
errors.
Some facilities require the third check to occur at the
bedside,
after identifying the patient and before administration.
Locking the cart or drawer safeguards the patient’s
medication
supply. Hospital accrediting organizations require medication
carts to be locked when not in use.
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Mindanao State University – Iligan Institute of Technology
11. Transport medications to the patient’s
bedside carefully, and keep the
medications in sight at all times.
12. Ensure that the patient receives the
medications at the correct time.
13. Perform hand hygiene and put on PPE, if
indicated.
14. Identify the patient. Usually, the patient
should be identified using two methods.
Compare
information with the MAR/CMAR.
15. Check the name and identification
number on the patient’s identification
band.
16. Ask the patient to state his or her name
and birth date, based on facility policy.
17. If the patient cannot identify him- or
herself, verify the patient’s identification with
a staff member who knows the patient for
the second source.
Administering Non-injectable Medications
College of Nursing
Careful handling and close observation prevent accidental or
deliberate disarrangement of medications.
Check agency policy, which may allow for administration
within a period of 30 minutes before or 30 minutes after
designated time.
Hand hygiene and PPE prevent the spread of
microorganisms.
PPE is required based on transmission precautions.
Identifying the patient ensures the right patient receives the
medications and helps prevent errors.
This is the most reliable method. Replace the identification
band if it is missing or inaccurate in any way.
This requires a response from the patient, but illness and
strange surroundings often cause patients to be confused.
This is another way to double-check identity. Do not use the
name on the door or over the bed, because these signs may
be inaccurate.
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Mindanao State University – Iligan Institute of Technology College of Nursing
18. Complete necessary assessments before Assessment is a prerequisite to administration of
administering medications. Check the medications.
patient’s allergy bracelet or ask the Explanation relieves anxiety and facilitates cooperation.
patient about allergies. Explain what
you are going to do, and the reason for
doing it, to the patient.
OOK
ACTION RATIONALE PERFORMED REMARKS

YES NO

19. Scan the patient’s bar code on the Scanning provides an additional check to ensure that the
identification band, if required. medication
is given to the right patient.

20. Remove the nebulizer cup from the device To get enough volume to make a fine mist, normal saline
and open it. Place premeasured unit-dose may need to be added to the concentrated medication.
medication in the bottom section of the cup
or use a dropper to place a concentrated
dose of medication in cup (Figure 1) and add
prescribed diluent, if required.

21. Screw the top portion of the nebulizer Air or oxygen must be forced through the nebulizer to form a
cup back in place and attach the cup to the fine mist.
nebulizer. Attach one end of tubing to the
stem on the bottom of the nebulizer cuff and
the other end to the air
compressor or oxygen source.

22. Turn on the air compressor or oxygen
(Figure 2). Check that a fine medication
mist is produced by opening the valve. Have
patient place mouthpiece into mouth and
grasp securely with teeth and lips.
If there is no fine mist, make sure that medication has been
added
to the cup and that the tubing is connected to the air
compressor or oxygen outlet. Adjust flow meter if necessary.

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Mindanao State University – Iligan Institute of Technology
23. Instruct patient to inhale slowly and
deeply through the mouth. A nose clip may
be necessary if the patient is also breathing
through the nose. Hold each breath for a
slight pause, before exhaling.
24. Continue this inhalation technique
until all medication in the nebulizer
cup has been
aerosolized (usually about 15 minutes).
Once the fine mist decreases in amount,
gently flick the
sides of the nebulizer cup.
25. Have the patient gargle and rinse with
tap water after using the nebulizer, as
necessary. Clean the nebulizer according to
the manufacturer’s
directions.
26. Remove gloves and additional PPE,
if used. Perform hand hygiene.
ACTION
27. Document the administration of the
medication immediately after
administration. See
Documentation section below.
Administering Non-injectable Medications
College of Nursing
While the patient inhales and holds the breath, the
medication
comes in contact with the respiratory tissue and is absorbed.
The longer the breath is held, the more medication can be
absorbed.
Once the fine mist stops, the medication is no longer being
aerosolized. By gently flicking the cup sides, any medication
that is stuck to the sides is knocked into the bottom of the
cup,
where it can become aerosolized.
Rinsing is necessary when using inhaled steroids, because
oral
fungal infections can occur. Rinsing removes medication
residue from the mouth. The buildup of medication in the
device can affect how the medication is delivered, as well as
attract bacteria
Removing PPE properly reduces the risk for infection
transmission
and contamination of other items. Hand hygiene prevents
the spread of microorganisms.
RATIONALE PERFORMED REMARKS
YES NO
Timely documentation helps to ensure patient safety.
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Mindanao State University – Iligan Institute of Technology
28. Evaluate patient’s response to medication
within appropriate time frame. Reassess lung
sounds, oxygenation saturation if ordered,
and respirations.
College of Nursing
The patient needs to be evaluated for therapeutic and
adverse
effects from the medication. Lung sounds and oxygenation
saturation
may improve after nebulizer use. Respirations may
decrease after nebulizer use.

Learner’s Reflection: (What did you learn most of the activity? Instructor’s Comments:
What is its impact to you?)

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING VAGINAL MEDICATIONS

Definition: It is an instillation of vaginal creams, foams, and tablets applied intravaginally using a narrow, tubular applicator with an attached
plunger. Suppositories that melt when exposed to body heat are also administered by vaginal insertion. Vaginal irrigation is the process of intravaginal
cleansing with a liquid solution. 

Purpose: A vaginal suppository provides targeted relief from conditions affecting the vagina. Vaginal irrigation is used to prevent or treat infection.

Indications: To prevent or treat vaginal infection. To treat vaginal inflammation. To treat dryness of vaginal mucosa.

Equipment needed:
● Drape
● Correct vaginal suppository or cream
● Applicator for vaginal cream
● Clean gloves
● Lubricant for a suppository
● Disposable towel
● Clean perineal pad
● IV pole
● Irrigating solution
● For an irrigation, add:
a. Moisture-proof pad
b. Vaginal irrigation set (these are often disposable) containing a nozzle, tubing and a clamp, and a container for the solution

PROCEDURES RATIONALE 5 4 3 2 1
PREPARATION
1. Perform drug study. Find out why the drug is prescribed To avoid clinical errors and to know the purpose of the
to the patient, its drug classification, mechanism of medication
action, usual dosage range and frequency of

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Mindanao State University – Iligan Institute of Technology College of Nursing
administration, side effects, contraindications, drug-
drug interactions, and nursing considerations in giving
the drug.
2. Check the MAR (Medication Administration Record) for To ensure right medication, right dosage, right time and
drug name, dosage, frequency, route of administration, frequency, and right route of administration is provided
and expiration date, if appropriate. to the right patient.
3. Check each medication card against the physician’s The health care provider’s order is the most reliable
order according to the institution’s policy. If there are source and only legal record of drugs that patient is to
inconsistencies, clarify them at once. receive. Ensures that patient receives correct medication.
PERFORMANCE
1. Secure all the necessary equipment and obtain These are the first and second checks for accuracy.
appropriate medication. Prepare the medication in the Process ensures that the right patient receives the right
medication section, for one patient at a time. medication.
2. Identify the client by letting the conscious client say his Ensures correct patient.
full name and verify by looking at the client’s wristband,
which has his name and hospital ID number written on
it.
3. Bring the medication to the client’s bedside. Provide For easier access to medication. Patient has right to be
privacy. Explain the procedure to the patient. informed, and patient’s understanding of each
medication improves adherence to drug therapy.
4. Perform hand washing and observe appropriate infection Reduces transfer of microorganisms
control procedures.
5. Ask the client to void. Voiding prevents passing of urine during insertion of
suppository.
6. Place the client in a back-lying position with the knees Position provides easy access to and good exposure of
flexed and the hips rotated laterally. Drape the client vaginal canal. Dependent position also allows suppository
appropriately so that only the perineal area is exposed. to completely dissolve in vagina. Minimizes patient’s
embarrassment by limiting exposure.
7. Prepare the equipment.
● Unwrap the suppository, and place it on the opened Organization saves time and lessen chances of error
wrapper or
● Fill the applicator with the prescribed cream, jelly, or
This ensures correct dosage of medication is
foam. Directions are provided with the

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Mindanao State University – Iligan Institute of Technology College of Nursing
manufacturer’s applicator. administered
8. Assess and clean the perineal area:
● Don gloves. To prevent spread of microorganisms.

● Provide perineal care to remove microorganisms. Exposes the vaginal orifice. Wiping from front and back
Spread the labia with the fingers and clean the decreases the risk of urinary tract infections. This
area at the vaginal orifice with a washcloth and technique prevents contamination of vaginal orifice with
warm water, using a different corner of the debris surrounding the anus.
washcloth with each stroke. Wipe from front to
back.
9. Administer the vaginal suppository, cream, foam, jelly
or irrigation.

SUPPOSITORY:
● Spread the labia with your nondominant hand to Lubrication reduces friction against mucosal surfaces
expose the vaginal orifice. Lubricate the tip of the during insertion.
suppository which is inserted first. Insert
suppository well into the vagina.
● Insert the suppository about 8 cm to 10 cm along Proper placement of suppository ensures equal
the posterior wall of the vagina, or as far as it
distribution of medication along walls of vaginal cavity.
will go.

● Ask the client to remain lying in the supine This gives the medication time to be absorbed in the
position for 5 to 10 minutes following insertion. vaginal cavity.
The hips may also be elevated on a pillow.

VAGINAL CREAM, JELLY, OR FOAM

● Gently insert the applicator about 2 inches,
Pushing the plunger will deploy the cream into the
slowly pushing the plunger until the applicator is
empty. Remove the applicator and place it on the vaginal orifice
towel. Discard the applicator if it is disposable or
clean it according to the manufacturer’s
directions.

IRRIGATION: Allows hips to be higher than shoulders and solution to

● Place the client on a bedpan. Clamp the tubing.
reach posterior wall of vagina. Bedpan collects solution.
Hang the irrigating container on the IV pole so

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Mindanao State University – Iligan Institute of Technology College of Nursing
that the base is about 12 inches above the
vagina.
Priming tubing removes air and moistens nozzle tip.
● Run fluid through the tubing and nozzle into the
bedpan.

● Insert the nozzle about 7 to 10 cm carefully into Correct angle allows nozzle access into vagina.
the vagina, directing the nozzle toward the Rotating nozzle allows irrigation of all areas in vagina.
sacrum, following the vaginal canal’s direction. Remaining solution drains by gravity.
Start the flow, rotating the nozzle several times.
Use all the irrigating solution, permitting it to
flow out freely into the bedpan. Remove the
nozzle from the vagina then assist the client to a
sitting position on the bedpan.
10. Dry the perineum with tissue paper and apply a clean Provides comfort.
perineal pad.
11. Dispose all supplies appropriately. Remove the glove by Reduces spread of microorganisms.
turning it inside out. Do handwashing.

12. Document the irrigating solution or the drug given on
medication chart. Record the dose, time, patient’s
response and affix your signature.
● If drug was refused or omitted, record this fact
on the appropriate record and document the
reason.
Documentation of medications administered to the
patient will help ensure continuity of care and
coordination between healthcare professionals by giving
information about the medications that had been
administered and other related data.

13. Return to the client when the drug is expected to take
effect, usually 30 minutes. Report significant deviations
from normal to the physician.
Assessing the client’s response to the medication will
help us monitor for any unusual or adverse effects.
Doing this will help prevent any complications and
ensure patient safety. Reporting significant deviations
from the normal will allow the physician and the nurse
to adjust the medications or interventions that must be
done based on the patient’s response to the medication.

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Mindanao State University – Iligan Institute of Technology College of Nursing

Learner’s Reflection: (What did you learn most of the activity? What is Instructor’s Comments:
its impact to you?)

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING RECTAL MEDICATIONS

Definition: Insertion of medications into the rectum in the form of suppositories. It is a convenient and safe method of giving certain medications.

Purpose: Administered for a localized effect in the gastrointestinal system or for a systemic effect when oral route is contraindicated.

Indication: This is indicated for patients who has constipation, hemorrhoids, fever, nausea, or pain.

Contraindication: Rectal medications are contraindicated after rectal or bowel surgery, with rectal bleeding or prolapse, and with low platelet counts.  

Special considerations:
● Infants/children:
1. Obtain assistance to immobilize an infant or young child. This prevents accidental injury due to sudden movement during the procedure.
2. For a child or infant, insert a suppository 5 cm (2 in.) or less.

Equipment needed:
1. Suppository
2. Clean glove
3. KY jelly

PROCEDURE RATIONALE 5 4 3 2 1
PREPARATION
1. Perform drug study. Find out why the drug is prescribed To anticipate patient’s response avoid clinical errors and
to the patient, its drug classification, mechanism of to know the purpose of the medication

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Mindanao State University – Iligan Institute of Technology
action, usual dosage range and frequency of
administration, side effects, contraindications, drug-
drug interactions, and nursing considerations in giving
the drug.
2. Check the MAR (Medication Administration Record) for
drug name, dosage, frequency, route of administration,
and expiration date, if appropriate.
3. Check each medication card against the physician’s
order according to the institution’s policy. If there are
inconsistencies, clarify them at once.
PERFORMANCE
1. Secure all the necessary equipment and obtain
appropriate medication. Prepare the medication in the
medication section, for one patient at a time.
2. Identify the client by letting the conscious client say his
full name and verify by looking at the client’s wristband,
which has his name and hospital ID number written on
it.
3. Bring the medication to the client’s bedside. Provide
privacy. Explain the procedure to the patient.
4. Perform hand washing and observe appropriate infection
control procedures.
5. Assist the client to a left lateral position with the upper
leg flexed. Drape the client appropriately so that only
the buttocks are exposed.
6. Prepare the equipment by unwrapping the suppository,
and leave it on the opened wrapper. Don gloves.
Administering Non-injectable Medications
College of Nursing
To ensure right medication, right dosage, right time and
frequency, and right route of administration is provided
to the right patient.
The health care provider’s order is the most reliable
source and only legal record of drugs that patient is to
receive. Ensures that patient receives correct medication.
These are the first and second checks for accuracy.
Process ensures that the right patient receives the right
medication.
Ensures correct patient.
For easier access to medication. To protect the dignity of
the patient. Patient has right to be informed, and
patient’s understanding of each medication improves
adherence to drug therapy.
Reduces transfer of microorganisms
This position exposes the anus and helps the person to
relax his external anal sphincter muscle.  Lying left
lateral is preferred because of the anatomical position of
the rectum and colon. Less likelihood of suppository
expulsion.
Maintains privacy and facilitates relaxation.
Minimizes contact with fecal material to reduce
transmission of infection.
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Mindanao State University – Iligan Institute of Technology
7. Lubricate the smooth, rounded end of the suppository.
Then lubricate the gloved index finger.
8. Ask the client to breathe through the mouth.
9. Insert the suppository gently into the anus with the
rounded end first. Push further along the wall of the
rectum with the gloved index finger. For an adult, insert
the suppository up to 4 inches. For a child or infant,
insert a suppository 5 cm (2 in.) or less.
10. Withdraw the finger then press the buttocks together for
a few seconds.
11. Dispose all supplies appropriately. Remove the glove
by turning it inside out. Do handwashing.
12. Instruct client to remain flat or in the left lateral position
for at least 5 minutes.
13. Document the drug given. Record the dose, time,
patient’s response and affix your signature.
● If drug was refused or omitted, record this fact
on the appropriate record and document the
reason.
14. Return to the client when the drug is expected to take
effect, usually 30 minutes. Report significant deviations
from normal to the physician.
Administering Non-injectable Medications
College of Nursing
Lubrication reduces friction as suppository enters rectal
canal.
To relax his anal sphincter muscle.
Forcing suppository through constricted sphincter causes
pain.
Suppository needs to be against rectal mucosa for
eventual absorption and therapeutic action.
Provides comfort. To avoid escape of medication.
Reduces transfer of microorganisms.
Prevents expulsion of suppository.
Documentation of medications administered to the
patient will help ensure continuity of care and
coordination between healthcare professionals by giving
information about the medications that had been
administered and other related data.
Assessing the client’s response to the medication will
help us monitor for any unusual or adverse effects.
Doing this will help prevent any complications and
ensure patient safety. Reporting significant deviations
from the normal will allow the physician and the nurse
to adjust the medications or interventions that must be
done based on the patient’s response to the medication.
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Mindanao State University – Iligan Institute of Technology College of Nursing
Learner’s Reflection: (What did you learn most of the activity? What is Instructor’s Comments:
its impact to you?)

Lynn, Pamela, Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 2nd edition, 2008

Patricia A. Potter and Anne Griffin Perry , Canadian Fundamentals of Nursing: 4th edition, 2009

Kozier, Erb, Berman, Snyder: Fundamentals of Canadian Nursing: 2nd Canadian Edition 2010

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING TOPICAL MEDICATIONS (DERMATOLOGIC PREPARATIONS)

Definition Topical administration of medication involves applying drugs locally to the skin, mucous membranes, or tissues. Topical drugs such as
lotions, patches, pastes, and ointments primarily produce local effects; but they can create systemic effects if absorbed through the skin.
Systemic effects are more likely to occur if the skin is thin, drug concentration is high, contact with the skin is prolonged, or the drug is
applied to skin that is not intact. To protect from accidental exposure, apply topical drugs using gloves and applicators.

Purpose Used to nourish the skin and protect it from harm. Used for local treatment. Some are meant to affect the whole body after being
absorbed through the skin.

Indication Topical treatment for dermal infections

Contraindication Hypersensitivity to the specific substance, concurrent use of curariform muscle relaxants and other relaxants and other neurotoxic
drugs. Consult the current Physicians Desk Reference (PDR) for further specifics.

Special considerations:
 If skin is inflamed, instruct patients to use only warm water rinse without soap for cleaning.
 Teach patient how to manage a transdermal patch that begins to peel off before the next dose is due. Rather than tape the patch or cover it, 17
instruct patient to remove it, clean the skin, and apply a new patch to a different area (Ball and Smith, 2008).
 Changes in the skin of an older adult patient include increased wrinkling, dryness, flaking, and increased tendency to bruise. Be aware of these
changes when applying topical medications to ensure proper application. Older skin is often more fragile and must be handled gently when
applying topical medications.
 Instruct patient to wrap applicators, used patches, and similar materials and dispose of them into cardboard or plastic disposable containers.
Careful disposal is necessary to ensure the safety of patient, other adults, pets, and children.

Equipment needed:
1. Gloves (clean and sterile if required) 5. Solution to wash area, if indicated
2. 2” x 2” gauze pads for cleaning 6. Medication
3. Medication container/application tube 7. Tongue blades/cotton applicator
4. Gauze to cover area
PROCEDURES RATIONALE 5 4 3 2 1
PREPARATION
1. Perform drug study. Find out why the drug is To avoid clinical errors and to know the purpose of the

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Mindanao State University – Iligan Institute of Technology
prescribed to the patient, its drug classification,
mechanism of action, usual dosage range and
frequency of administration, side effects,
contraindications, drug-drug interactions, and nursing
considerations in giving the drug.
2. Check the MAR (Medication Administration Record) for
drug name, dosage, frequency, route of administration,
and expiration date, if appropriate.
3. Check each medication card against the physician’s
order according To the institution’s policy. If there are
inconsistencies, clarify them at once.
PERFORMANCE
1. Secure all the necessary equipment and obtain
appropriate medication. Prepare the medication in the
medication section, for one patient at a time.
2. Identify the client by letting the conscious client say his
full name and verify by looking at the client’s
wristband, which has his name and hospital ID number
written on it.
3. Bring the medication to the client’s bedside. Explain
the procedure to the patient. Assist the client to a
comfortable position, either sitting or lying down.
Provide privacy.
4. Perform hand washing and observe appropriate
infection control procedures.
5. Inspect skin or mucous membrane areas for lesions,
rashes, erythema and breakdown. Note the presence of
excessive body hair.
6. Expose the area to be treated then apply the
medication and dressing as ordered:
● Place a small amount of cream on the tongue
Administering Non-injectable Medications
College of Nursing
medication
To ensure right medication, right dosage, right time and
frequency, and right route of administration is provided
to the right patient.
The health care provider’s order is the most reliable
source and only legal record of drugs that patient is to
receive. Ensures that patient receives correct medication.
These are the first and second checks for accuracy.
Process ensures that the right patient receives the right
medication.
Ensures correct patient.
For easier access to medication. To protect the dignity of
the patient. Patient has right to be informed, and
patient’s understanding of each medication improves
adherence to drug therapy.
Reduces transfer of microorganisms
Cleaning site thoroughly promotes proper
assessment of skin surface. Assessment provides
baseline to determine change in condition of skin
after therapy. Application of certain topical
agents can lessen or aggravate these symptoms
Provides visualization for application and protects
privacy
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Mindanao State University – Iligan Institute of Technology
blade and spread it evenly on the skin.
● Apply sterile gloves if indicated. Pour some lotion
on the gauze and pat it evenly on the skin,
following the direction of hair growth.
● If a liniment is used, rub it into the skin using
long, smooth strokes. Repeat the application until
the area is covered.
● Apply a sterile dressing as necessary.
7. Provide a clean gown or pajamas after the application if
the medication will come in contact with the clothing.
8. Remove gloves and perform hand hygiene. Dispose all
supplies appropriately.
9. Assess the client’s response right after the
administration of the drug. Return to the client within
the appropriate time frame and report significant
deviations from normal to the physician.
10. Chart the medication administered.
Learner’s Reflection: (What did you learn most of the activity? What is
its impact to you?)
Administering Non-injectable Medications
College of Nursing
Retains moisture within skin layers.
Softening topical agent makes it easier to spread
on skin.
Ensures even distribution and sufficient dosage of
medication. Technique prevents irritation of hair
follicles.
To avoid contamination
To prevent patient from getting unnecessary doses of the
medication.
Keeps patient’s environment neat and reduces
spread of infection and residual medication to
others.
Assessing the client’s response to the medication will
help us monitor for any unusual or adverse effects.
Doing this will help prevent any complications and
ensure patient safety. Reporting significant deviations
from the normal will allow the physician and the nurse to
adjust the
To provide data on patient’s compliance to therapy.
Instructor’s Comments:
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Mindanao State University – Iligan Institute of Technology College of Nursing

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Mindanao State University – Iligan Institute of Technology College of Nursing
Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING ORAL MEDICATIONS

Definition:

Purpose:

Indication:

Contraindications:

Special considerations:
● INFANTS:
1. A syringe or dropper provides the best control for administering drugs.
2. Place small amounts of liquid along the side of the infant’s mouth. To prevent aspiration or spitting out, wait for the infant to swallow before
giving more.
3. Have the infant suck the medication through a nipple. However, other methods should be used for unpleasant tasting medicine so that infant
will not associate the unpleasant taste with the nipple. Medications should not be added to the infant’s formula for the same reason.
● CHILDREN:
1. Whenever possible, give child a choice between the use of a spoon, dropper or syringe.
2. Dilute the oral medication with a small amount of water, if indicated. Do not dilute in large quantities of water because the child might refuse
to drink the entire amount to be administered.
3. Crush medications that are not supplied in liquid form and mix them in honey, flavored syrup, jam, or a fruit puree.
4. Place the toddler on your lap in a sitting position.

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Mindanao State University – Iligan Institute of Technology College of Nursing
5. To prevent nausea , pour a carbonated beverage over finely crushed ice and give it before or immediately after the medication is
administered.
6. Follow medication with a drink of water, juice, a softdrink, a popsicle or a frozen juice bar. This removes any unpleasant after taste.
7. For children who take sweetened medications on a long-term basis, follow the medication administration with oral hygiene. These children are
at high risk for dental caries.

● ELDERS: usually require smaller dosages of drugs, especially sedatives and other CNS depressants.

Equipment needed:
1. Medication tray
2. Disposable medication cup: small paper or plastic cups for tablets and capsules, waxed or plastic calibrated medication cups for liquids.
3. Straws to administer drugs that may discolor the teeth
4. Drinking glass and water or juice
5. Pill crushing device (optional)
6. Medication chart/record

PROCEDURES RATIONALE 5 4 3 2 1
1. Perform drug study. Find out why the drug is prescribed
to the patient, its drug classification, mechanism of
action, usual dosage range and frequency of
administration, side effects, contraindications, drug-
drug interactions, and nursing considerations in giving
the drug.
2. Check the MAR (Medication Administration Record) for
drug name, dosage, frequency, route of administration,
and expiration date, if appropriate. Check each
medication card against the physician’s order according
to the institution's policy. If there are inconsistencies,
clarify them at once.
3. Determine whether the client doesn’t have any difficulty
in swallowing, on NPO, is nauseated or vomiting, has
decreased or absent bowel sounds or has gastric
suction.
4. Check pt’s medical history for any allergies.
PERFORMANCE
1. Perform hand washing and observe appropriate

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Mindanao State University – Iligan Institute of Technology College of Nursing
infection control procedures.
2. Secure all the necessary equipment and obtain
appropriate medication. Prepare the medication in the
medication section, for one patient at a time.
3. Get the proper medication bottle/box/packaging from
the medication drawer and compare with Kardex or
order. Make sure to check the expiration date.
4. Do drug dosage calculations.
5. TABLETS OR CAPSULES:
Use a disposable medicine cup for unit dose-packaged
medications. Open wrapper at patient’s bedside. Do not
touch tablets with your bare hands. Break only scored
tablets by using a file or cutting device.

Separate narcotics and medications that require special

nursing assessments such as BP, RR and/or HR
measurements.

If the patient has pain/difficulty swallowing the drug,

crush the tablet(s) with a pill crusher into a fine
powder. Then mix the powdered drug with a small
amount of food or water e.g. soup, custard or juice.
Check with the pharmacist or drug handbook before
crushing the drug.

LIQUID MEDICATION:
a. Countercheck label of liquid medication against
the doctor’s order/medication card.

b. Mix drug thoroughly before pouring. Discard

drug that has changed color or turned cloudy.

c. Grasp liquid medication bottle with the label

against your palm into a medicine cup/spoon.
Pour drug away from the label.

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Mindanao State University – Iligan Institute of Technology College of Nursing
d. Read the amount of medication on the bottom of
the meniscus (crescent-shaped upper surface of
a column of liquid), at eye level.

e. Use a paper towel to wipe the bottle lip before

capping the bottle.

f. When giving less than 5 mL drug, use a sterile

syringe without the needle.

6. Place the prepared medication and medication card on

the medication tray together.
7. Countercheck the medication label on the bottle with
the medication card for the 3rd time before returning the
bottle or box to its storage place.
8. Transport medication carefully, keeping it in sight at all
times. Avoid leaving prepared medications unattended.
9. Identify the client by letting the conscious client say his
full name and verify by looking at the client’s wristband,
which has his name and hospital ID number written on
it.

10. Inform the client of the purpose of the drug and the
expected side effects using layman's terminologies.
Provide privacy.
11. Take the required assessment measures, such as HR
and RR or BP.
● Take client’s HR before administering digitalis
medications
● Take client’s BP 15 minutes before and 15
minutes after giving cardiac meds esp.
antihypertensive drugs and diuretics
● Take the RR prior to administration of narcotics.

If any of the findings are above or below the normal

range, withhold the drug and refer to the prescriber.

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Mindanao State University – Iligan Institute of Technology College of Nursing
12. Assist the client to a sitting position, or, if not possible,
to a side-lying position.
13. Administer the drug in the prescribed dosage and at the
right time.

a. Take the drug to the client within the time frame

of 30 minutes before or after the scheduled
time.

b. Offer water or other pertinent fluids with pills,

capsules, tablets, and liquid medications.

c. If client has difficulty swallowing, ask the client

to place the drug on the back of the tongue
before taking the water.

d. If the drug has an objectionable taste, offer ice

chips for client to suck beforehand or give the
drug with applesauce, juice or bread.

e. If the client says that the drug you are giving is

different from what the client has been
receiving, do not give the drug without first
checking the original order.
14. Stay with the client until all medications have been
swallowed.
15. Dispose all supplies appropriately. Replenish stocks for
next dose.
16. Document each drug given on medication chart. Record
the dose, time, and affix your signature.
● If drug was refused or omitted, record this fact
on the appropriate record and document the
reason.
● Record any fluid intake if client is on I & O
monitoring.

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Mindanao State University – Iligan Institute of Technology College of Nursing
17. Return to the client when the drug is expected to take
effect, usually 30 minutes. Report significant deviations
from normal to the physician.

Learner’s Reflection: (What did you learn most of the activity? What is Instructor’s Comments:
its impact to you?)

Name: _____________________________________________ Date: ____________________________

Evaluator: __________________________________________ Score: ___________________________

ADMINISTERING MEDICATIONS VIA GASTRIC TUBE

Definition:

Purpose:

Assessment: Research each medication to be given, especially for mode of action, side effects, nursing implications, ability to be crushed, and whether
the medication should be given with or without food. Verify patient name, dose, route, and time of administration. Also assess patient’s knowledge of
medication and the reason for its administration. Auscultate the abdomen for evidence of bowel sounds. Percuss and palpate the abdomen for
tenderness and distention. Ascertain the time of the patient’s last bowel movement and measure abdominal girth, if appropriate.

Special Considerations:
● If medications are being administered via an NG tube that is attached to suction, the tube should remain clamped, off suction, for a period of

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time after medication administration. This allows for medication absorption before returning to suction. Check facility policy and drug reference
for specific drug requirements.
● If necessary to use plunger in irrigation syringe to administer medications, instill gently and slowly. Gravity administration is considered best to
avoid excess pressure.
● Give medications separately and flush with water between each drug. Some medications may interact with each other or become less effective if
mixed with other drugs.
● If the patient is receiving tube feedings, review information about the drugs to be administered. Absorption of some drugs, such as phenytoin
(Dilantin), is affected by tube feeding formulas. Discontinue a continuous tube feeding and leave the tube clamped for the required period of time
before and after the medication has been given, according to the reference and facility protocol.
● Ongoing assessment is an important part of nursing care for both evaluation of patient response to administered medications and early detection
of adverse effects. If an adverse effect is sus- pected, withhold further medication doses and notify the patient’s primary healthcare provider.
Additional intervention is based on type of reaction and patient assessment.

Equipment:
● Irrigation set (60-mL syringe and irrigation container)
● Medications (crushed or in liquid form)
● Water (gastrostomy tubes) or sterile water or saline (nasogastric tubes), according to facility policy

PROCEDURE RATIONALE 5 4 3 2 1
1. Check the medication card against the doctor’s order.
Check the patient’s history for allergies.

2. Know the actions, special nursing considerations,

purpose of administration, and adverse effects of the
medication.

3. Perform hand hygiene and put on PPE, if indicated.

4. Prepare medications for one patient at a time.

5. Get the medication from the patient’s medication
storage and compare the label with the drug name in
the medication card. Check expiration date.

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Mindanao State University – Iligan Institute of Technology College of Nursing
6. Prepare the medication.
Pills
● Using a pill crusher, crush each pill one at a
time.
● Dissolve the powder with water or other
recommended liquid in a medication cup.
● Keep the package label with the medication cup.
Liquid
● When pouring liquid medications in a multi-dose
bottle, hold the bottle with the label against the
palm.
● Use the appropriate measuring device when
pouring liquids, and read the amount of
medication at the bottom of the meniscus at eye
level.
● Wipe the lip of the bottle with a paper towel.

7. Approach the patient’s room and keep the medications

in sight at all times.

8. Identify the patient by asking him to state his name and

by checking the identification wristband. Explain what
you are going to do and reason for doing it.

9. Assist patient to High Fowler’s position, unless

contraindicated.

10. Wash/sanitize hands. Put on gloves.

11. If patient is receiving continuous tube feedings, pause

the tube feeding pump.

12. Pour the water into the irrigation container. Fold the
gastric tube over on itself and pinch with fingers.
Alternately, open port on gastric tube delegated to
medication administration. If necessary, position
stopcock to correct direction. Disconnect tubing for

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Mindanao State University – Iligan Institute of Technology College of Nursing
feeding from gastric tube and cap.

13. Insert tip of the 60-mL syringe into tube. Aspirate

gently to check residual feeding to determine placement
of the tube.

14. Note the amount of any residual. Replace residual back

to the stomach

15. Fold the gastric tube and remove the syringe. Remove
the plunger of the syringe and reinsert the syringe in
the gastric tube. Pour 30 mL of water into the syringe.
Unclamp the tube and allow the water to enter the
stomach by gravity.

16. Administer the first dose of medication by pouring into

the syringe. Follow with a 5 to 10 mL water flush
between medication doses. Follow the last dose of
medication with 30 to 60 mL of water flush.

17. Clamp the tube, remove the syringe and replace the
feeding tubing and restart tube feeding if appropriate
for medications administered.

18. Remove gloves and additional PPE, if used. Perform

hand hygiene.
19. Assist patient to a comfortable position. If receiving a
tube feeding, the head of the bed must remain elevated
at least 30 degrees.
20. Document the time and sign at the medication sheet of
the patient’s chart immediately after the medication
administration.
21. Evaluate the patient’s response to medication within the
appropriate time frame.

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Mindanao State University – Iligan Institute of Technology College of Nursing
Learner’s Reflection: (What did you learn most of the activity? What is Instructor’s Comments:
its impact to you?)

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