Medication Administration

Sunday, 3 October 2021 11:40 PM

I. 10 Rights of Drug Administration

 Right Patient: Ask the name of the client and his ID band before administering. Even if you know
that patient's name, you still need to ask just to verify.
 Right Medication: Check and verify if it's the right name and form. Beware of look -alike and
sound-alike medication names.
 Right Dosage: Check the medication sheet and the doctor's order before medicating. Be aware of
the difference of an adult and a pediatric dose
 Right Route: Check order if it's through oral. IV, SQ or etc.
 Right Time: Check order for when it would be given when was the last time it was given.
 Right Documentation
 Right Client Education
 Right Refuse
 Right Assessment
 Right Evaluation

II. Medication Administration

A. Nursing Responsibilities
1. Administer only what you prepare
2. Be familiar with medication: general purpose, side effects, average dose, safety precautions
3. Document medications
4. Evaluate: client's condition, medication compatibility
5. Aseptic technique
6. No medications stored at bedside
7. Review medication administration if client is to do by himself

B. Forms
1. Solutions
 Spirits
 Syrups
 Elixir
 Suspension
 Emulsion
 Lotion
2. Inhalation
 MDI
 Powder
 Nebulizer
3. Solids
 Capsule: pills and tablets
 Suppository
 Ointment
 Powders
4. Transdermal

C. Methods
1. Topical
 Rectal
 Sublingual
 Nasal
 Eyes
 Ears
 On skin
2. Orals
 Follow directions
 Ability to swallow
3. Intravenous
 Into blood, large volume: irritating
4. Parenteral
 Subcutaneous: small amounts, non-irritating volume
 Intramuscular: into muscles, Z-track: prevent leaking and staining of subcutaneous tissue

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 Intramuscular: into muscles, Z-track: prevent leaking and staining of subcutaneous tissue
 Intradermal: just below skin, Purpose: TB testing, Locals, Allergy testing

III. Drug Administration Routes for Nurses

Route Examples Advantages Disadvantages
Enteral Oral, convenient, cheap, good sometimes inefficient, first-pass
Sublingual, absorption effect, irritates gastric mucosa,
Buccal, Rectal slow effect, unpleasant taste,
can't use if unconscious
Parenteral Intradermal, rapid, can be used for must maintain asepsis, painful,
Subcutaneous, unconscious, avoid gastric expensive, possible injury to
Intramuscular, irritation nerve
Intravenous,
Intraperitoneal,
Intrathecal,
Intra-articular,
Intra-arterial,
Intra-medullary
Topical Skin, Eye or high local concentration slow onset, local reactions, limited
Ear, Nose and without systemic effect to few drugs, systemic effect
Lungs when tissue destruction
Inhalation Through nose rapid onset, large surface most addictive, hard to regulate
or mouth area for absorption dosage

IV. Administration of Drugs

1. Medication Ordering: validate doctor's order
2. Medication Transcription
3. Medication Administration
4. Documentation
5. Unused Medication
6. Medication Safety

V. Components of a Drug Order

1. Patient name
2. Allergies
3. Date and Time order is written

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 3. Date and Time order is written
4. Drug name (generic name)
5. Drug Dosage
6. Route
7. Frequency and Duration
8. Any Specific Instructions
9. Signature: nurse must sign if verbal order, MD must sign within 24 hours

VI. Student Nurse Responsibilities

 Proper Technique: see syllabus
 Research: must look up all drugs
 Prior to giving to patient
 Sources of information: drug
 Handbook, drug cards, Pharmacology book

Triple Checking
 Check label when obtaining medication from storage.
 do side-by-side comparison of the medication with the written order and the medication sheet.
 Recheck one last time after preparation with a witness, just before administration.

Behaviors to avoid during medication administration

 Do not be distracted
 Do not give or hold meds dispensed by others
 Do not pour from containers without labels or difficult to read labels
 Do not give expired drugs
 Do not guess about dosages or drugs
 Do not leave by the bedside, or unattended anywhere
 Do not give if the client states allergies or has concerns about the drug
 Do not mix with food or liquids if contraindicated

Medication Functions of the Nurse

1. Dependent — Nursing Action carried out at the instruction or order of the Physician
2. Independent — Nursing Action carried out within the legal scope of Nursing's independent
domain.
3. Interdependent — Nursing action performed by the Nurse in collaboration with other members of
the Health care team

Variables influencing the effect of a medication

1. Developmental Considerations
 During pregnancy, most medications are contraindicated due to its possible adverse effects of
the fetus.
 Certain drugs have a Teratogenic Effect, which are known to have a potential to cause
developmental defects in the embryo or fetus.
 Breastfed infants are also at a risk for adverse effects on the drugs in the mother's body.
2. Weight
 Expected responses to drugs are based largely on those reactions that occur when the drugs a
given healthy adults (18-65 years old, 150 lb.)
 Drug doses for children are calculated by weight or Body Surface Area.
3. Sex
 The difference in the distribution of body fat & fluids in men & women is a minor factor affecting
the action of some drugs.
4. Genetic & Cultural Factors
 Asian patients may require smaller doses of a drug because they metabolize it at a slower rate.
 African Americans appear to require larger doses of some medications that are used to lower
blood pressure.
 Herbal treatments that are popular in some cultures may interfere with or counteract the action of
prescribed medication.
5. Psychological Factors
 The patient's expectations of the medication affects the response to the medication.
 Placebo is a pharmacologically inactive substance.
 Some patients appear to have the same response with the placebo as with an active drug
medications.
6. Pathology
 The presence of a disease may affect the drug action.
 Pathologic conditions that involve the Liver may slow the metabolism & alter the dosage of the

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  Pathologic conditions that involve the Liver may slow the metabolism & alter the dosage of the
drug needed to reach a therapeutic level.
7. Environment
 Sensory deprivation and overload may affect drug responses.
 Nutritional state may also affect the body's reaction to certain drugs.
8. Timing of Administration
 The presence of food in the stomach delays the absorption of orally administered medications.

Drug Standards
 Developed to ensure uniform quality of drugs
 R.A 6125: Dangerous Drug Act
 The Dangerous Drug Act of 1972

MIMS
 A book containing list of products used in medicine; the description of the product; chemical test
for determining identity, purity, and formulas; and prescriptions.

Routes
 Oral or PO (per os; by mouth)
 Do not give to patients who:
 Vomiting
 Comatose
 Lack gag reflex
 NPO
 Feeding Tubes
 NG tubes (unless tube is clamped)

Routes of Administration
1. Oral
2. Sublingual
3. Parenteral route
a. Intravenous
b. Intramuscular
c. Intradermal
d. Subcutaneous
4. Topical: medication applied to skin and mucous membranes generally have local effects
a. Applied to skin
b. Rectal
c. Otic
d. Optic
e. Nasal

Forms of Medication Preparation

A. Oral
1. Tablet — compressed or molded substance
2. Capsules — substances encased in either hard or a soft soluble container or gelatin shell that
dissolves in stomach
3. Powder and granules — finely ground substance, usually mixed with water or juice
4. Troches, lozenges and pastilles — designated to be dissolved in the mouth
5. Enteric coated — coated tablets that dissolves in the intestines rather than the stomach, to
decrease gastric irritability, NEVER CRUSHED.
6. Time release capsules — encased substance that are further enclosed in smaller casings that
deliver a drug dose over an extended period of time.
7. Sustained release — compounded substance designed to release a drug slowly to maintain a
steady blood medical level.

 Solid: tablet, capsule, caplet, lozenges, pill, powder

 Liquid : syrup, suspension, emulsion, elixir, milk or other alkaline substances.
 Enteric coated tablets should not be crush before administration.
 Other forms of oral medication that should not be chewed or crushed:
a. SR: Sustained Release
b. XL: Extended Release
c. R/CRT: Controlled Release
d. SA: Sustained Action
e. LA: Long Acting

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 e. LA: Long Acting

Liquid
Meniscus is the line of the desired dose
Take readings from the bottom of the meniscus

Preparation and Route

Advantage: Safest, most convenient, and least expensive
Disadvantage: slower action, unpleasant taste, and irritation of the gastric mucosa
a. Buccal (cheek)
b. Sublingual (SL)
B. Topical
Can apply to skin with glove, tongue blade or cotton tip applicator.
Be careful not to contaminate medication (no double dipping)
a. Transdermal Patches
Provide consistent blood levels
Do not cause GI irritation
Put date, time, initials on the patch. Remove old patch and clean skin then wear gloves.
1.Powder— lightly dusted on skin
2. Liniments — substance mixed with alcohol, oil, soapy emollient
3. Ointment— semi-solid substance for topic I use
4. Pastes — semi-solid substance, thicker than ointment, absorbed slowly through the skin
5. Transdermal patches — contain medication that is absorbed through the skin over an extend d
period of time.
6. Suppositories — gelatinous substances designated to be dissolve when inserted on rectum or
vagina.
C. Inhalants
1. inhalations — drugs administered by nasal or oral respiratory route for local or systemic
effect.
D. Solutions
1. Solutions — contains one or more chemical dissolved in water.
2. Emulsion — 2-phase system in which the liquid is dispensed in a form of small droplets
though out another liquid.
3. Nasal solutions — aqueous solution in the form of drops or spray
4. Douches — aqueous solution that function as cleansing or antiseptic agent that may be
dispensed in the form of a powder for dissolving warm water.
5. Optic or otic solutions — aqueous solutions that are instilled as drops.
6. Enemas — aqueous solution for rectal instillation
7. Mouthwashes — aqueous solution that may contain alcohol, glycerin, and synthetic
sweeteners and surface active flavoring and coloring agent
8. Suspensions — particle or powder substance that must be dissolved in a liquid before
administration
9. Syrups — substance dissolve in sugar
10. Elixirs — non-aqueous solution that contain water, varying alcohol content and glycerin or
sweeten

Assessment for Reactions

 Assessment needs vary and depend on route and medication.
 Always assess patient after giving drugs that affect RR, HR, BP, LOC, blood sugar and pain.
 These approximate time table will help guide you in your assessment.
Approximate Onset:

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Approximate Onset:
Intravenous 3 - 5 min
Intramuscular 3 - 20 min
Subcutaneous 3 - 20 min
Oral medication 30 - 45 min

Indications
Drugs can be administered for these purposes:
a. Diagnostic purposes. e.g. assessment of liver function or diagnosis of myasthenia gravis.
b. Prophylaxis .e.g. heparin to prevent thrombosis or antibiotics to prevent infection.
c. Therapeutic purposes. e.g. replacement of fluids or vitamins, supportive purposes (to enable
other treatments, such as anesthesia), palliation of pain and cure (as in the case of antibiotics).

Symptoms and signs of allergy to drugs

1. Fever
2. Diarrhea - GIT
3. Urticaria - Local Effect
4. Rash - Local Effect
5. Nausea - GIT
6. Vomiting - GIT

Effects of Drugs
a. Therapeutic Effect/ Desired Effect: the primary effect intended for the prescribed drug.
b. Side Effect/ Adverse Effect:
○ the secondary effect of a drug unintended
○ Usually predictable and maybe either harmless or potentially harmful

Common Mild Allergic Responses

Skin Rashes an epidermal vesicle, urticarial wheal, or macular eruption
Pruritus itching of the skin with or without rash
Angioedema edema due to increased permeability of the blood capillaries
Rhinitis excessive watery discharge from the nose
Lacrimal Tearing excessive tearing
Nausea/Vomiting
Wheezing due to accumulated fluid and swelling of the respiratory tissue
Dyspnea difficulty of breathing
Diarrhea irritation of the large mucosa of the intestine

c. Anaphylactic Reaction: A severe allergic reaction usually occurs immediately after the
administration of the drug
d. Drug Tolerance: Exists in a person who has unusually low physiologic response to a drug and
who require an increase in the dosage to maintain a given therapeutic effect.
e. Cumulative Effect: the increasing response to a repeated dose of a drug; occurs when the rate of
administration exceeds the rate of metabolism or excretion
f. Idiosyncratic Effect: Unexpected and individual response to a drug
g. Drug Interaction: Effect of one drug to another drug which are taken at the same time; May have
synergistic or inhibiting effect
h. Iatrogenic Disease: Disease caused unintentionally by medical therapy

Types of medication orders

Standing • Routine orders for certain procedures with no unusual complications
• Scheduled orders
• Is in effect until the prescriber discontinues or modifies the dosages or
frequency
• When order has specified no of days (automatic stop)
PRN • Orders to be carried out as needed
• as needed basis as circumstances indicate (frequency will be indicated)
• Nurse need to document assessment and time administration

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 • Nurse need to document assessment and time administration
Single (one-time • Only one dose
only) • One time medication or may require the administration of drops or tablet over a
short period of time
• Diagnostic or therapeutic procedures
STAT • Give immediately
• Single dose to be given immediately
• Emergency situation

Telephone/Verbal Order Guidelines

R Repeat the order to physician
E Emergency only or No opportunity
W Write the details of orders in the Physician order
R Require doctor to sign within 24 HOURS
I Identify for whom the order is made
T Two nurses verify / listen to order is safe
E Evening shift only

E. Parenteral Medication

1. Intravenous medication
 Ampules - no dilutes, indicated to be given standard dosage
 Vials

Parts of Syringe

 Never recap used needle

 Scoop cap back on sterile needles only

Angles for Injection

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 2. Intradermal Injection
Sites
 Chosen so that local reaction can be observed
○ Lightly pigmented
○ Hairless
○ Usually in forearm
○ Think TB Testing
Technique
 26 to 27 gauge needle
 Syringe: 1 mL (calibrated in 0.01 mL increments)
 Bevel up
 Cleanse in circular motion
 Skin taut
 10 to 15 degree angle
 Inject medication to form a blister or bleb
 Do not massage the area

3. Intradermal Injection
Route
 Systemic effect
 Smaller dose
Sites
 Abdomen, Upper hips, Upper back, latter upper arms and thighs

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Technique
25 to 27 gauge needle size
1/2 to 5/8 in length

To aspirate or not to aspirate?

 Aspiration is drawing plunger of syringe "back" by suction
 Observing for blood before injection
 Helps determine needle in tissue or muscle and that medication will not be injected into vessel
 Aspiration contraindicated with certain medications (heparin and insulin) consult drug handbook

4. Subcutaneous Injection
 Choose appropriate site
 45 degree angle
 Draw medication from vial or ampule
 Pinch up skin between fingers and thumb of non-dominant hand
 Insert needle
 Steady syringe - use non dominant hand to hold barrel
 Use dominant hand to push plunger
 Inject medication

Vastus Lateralis Site

 Thick muscle
 No large vessels near
 Does not cover a joint
 Desirable for infants & children (gluteal muscles not fully developed)
Landmarks for Vastus Lateralis Site

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Landmarks for Vastus Lateralis Site

Ventrogluteal site
 Recommended for both adults & children over 7 months
 No large vessels or nerves
 Accessible with client on side, back or abdomen

Dorsogluteal site
 Common site
 Sciatic nerve & major blood vessels lie below landmarks
 Don't use for children under age 3 (gluteal muscles too small)

Intramuscular Injection
 Choose appropriate site
 90 degrees angle
 Draw medication from vial or ampule
 Spread skin somewhat taut using non-dominant hand

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  Spread skin somewhat taut using non-dominant hand
 Insert needle
 Steady syringe - use non dominant hand to hold barrel
 Use dominant hand to aspirate (pull back on plunger)
 Inject medication if no blood is aspirated. If blood is aspirated, withdraw syringe and over.

Drug Computation

Medication Card

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 Intradermal Subcutaneous Intramuscular Intravenous
Action Local Effect Systemic Effect Systemic Effects Systemic
-Wheal -Sustained effect -Rapid effect that Effect
formation (absorbed through SQ - More rapid
-Used to capillaries) -Used for in 1M and SQ
observe for --slower onset than irritating,
inflammation 1M aqueous
reaction -- used for small suspensions
doses of non and solution in oil
irritating , water
soluble drugs
Sites Lightly With adequate fats • ventrogluteal Accessible
pigmented , size: • dorsogleteal peripheral
thinly • abdomen • vastus lateralis vein
keratinized and •Upper hips (infant)
hairless areas: •Upper back
.VentraI •Lateral arms
midforearm •Lateral thigh
•Clavicular area
of the chest,
•scapular area
of the back
Equipment Needle: Needle: Needle: Needle:

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Equipment Needle: Needle: Needle: Needle:
Gauge 25 to Gauge 25-27, h to Gauge 20-23,1 to Adults:
27, 3 to 12 inch 5/8 inch 1.5 Gauge 20-21 ,
inches 1-1.5 inches
Syringe: 1 ml Syringe: 1-3 ml Infants
Syringe: 1-5 ml Gauge 24, , I
inch
Children:
Gauge 22, 1
inch
Technique 1. Cleanse area using 1. Cleanse area using 1. Cleanse area 1. Apply tourniquet
circular motion circular motion using circular
2. Hold skin taut 2. Pinch the skin motion 2. Cleanse area
3. Insert needle, BEVEL 3. Insert needle at 45 to 2. Flatten skin
UP at 10-15 degree 90 degree angle area using the 3. Insert the
angle (with thumb and catheter
4. Inject medical slowly little subcutaneous index finger or
to form a wheal tissues) and inject butterfly
5. Do not massage 4. Release the skin between them into the
5. Do not aspirate 3. Insert needle at veins until
6. Inject medication 90 degree blood
slowly angle return
4. Stabilize
the needle
and dress
the site

B.1 Topical Route: Inserting or rubbing drug onto the Skin or Mucous Membrane.
A. Dermatologic ( includes lotions, liniments, ointments, pastes and powders )
 Wash and pat dry area well before application to facilitate absorption of drugs.
 Use surgical asepsis when open wound is present.
 If the skin has lesions, wear gloves or use tongue depressor to apply medications.
 Apply only a thin layer of medication

B. Opthalmic/Eye Medication
Administration of Eye Medication
Objectives
 To provide an eye medication the client requires to treat an infection or other reason.
Considerations
 The eye is the most sensitive organ to which the nurse applies medications. Care must be taken
to prevent instilling medication directly into cornea.
 Instilling wrong concentration may cause local irritation of the eyes as well as systemic effects.

C. Otic ( Ear) Medication

a. Includes instillations and irrigations
Instillations:
 To soften earwax
 To reduce inflammation
 To treat infection
 To relive pain
Irrigations:
 To remove cerumen or pus
 To apply heat
 To remove a foreign body or object
Administration of Ear Medication
Objectives
 To soften earwax so that it can be readily removed at later time
 To provide local therapy to reduce inflammation, destroy infective organism.
 To relieve pain

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D. Nasal Medication: Nasal instillation ( nose drops ) usual instilled for their astringent effect.
Administration of Nasal Medication
Objectives
 To shrink swollen mucous membrane
 To loosen secretions and facilitate drainage.
 To treat infections of the nasal cavity or sinuses.

E. Rectal Medication
 Drugs administered rectally exert either a local or systemic effect on the gastrointestinal mucosa.
Considerations
 Rectal medication is a convenient and safe method of giving certain medications but not as
reliable as oral or parenteral routes in terms of drug absorption and distribution.
 Improper placement can result in expulsion of the suppository before medication dissolves and is
absorbed into the mucosa.
 Never force a suppository into a mass of fecal material. It may be necessary to administer a small
cleansing enema before a suppository can be inserted. Do not cut the suppository into sections
to divide the dosage, the active drug may not be distribute evenly w thin the suppository.

Suppository: easily melted medication preparation in a firm base such as gelatin that is inserted
in the body.

Enteral Route: administration of medicine via nasogastric tube

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