METRIC SYSTEM: kg>g>mg>mcg NURSING PROCESS IN DRUG ADMINISTRATION

- Large to small – multiply by 1000 Assessment

- Small to large – Divide by 1000
• History
1 kg 1000 g • Diet History
• Allergies
1g 1000 mg
• Medications Perceptual Problems
1 mg 1000 mcg • Current condition
• Medications
HOUSEHOLD
• Patient’s Attitude About Medication Use
Drop (gtt) 15 gtt = 1 • Factors Affecting Adherence to Medication Therapy
ml
Teaspoon 1 tsp =5 mL Diagnosis
(tsp)
• Anxiety
Tablespoon 1 T = 3 tsp
• Ineffective Health Maintenance
(T)
Ounce (oz) 1 oz= 2T • Deficient Knowledge (Self-administration)
• Noncompliance (Medication)
Cup 1 cup= 8 oz
• Impaired Swallowing
Pint (pt) 1 pt =2 cups • Impaired Memory
Quart (qt) 1 qt
Planning
= 4cups
= pt • Goal: The patient will safely self-administer all
Gallon 1 gal = 4qt ordered medications before discharge
(gal)
• Outcomes:
LIQUID MEASURES
o The patient verbalizes understanding of desired and
1 mL 1 cc adverse effects of medications
o The patient states signs, symptoms and treatment of
1L 1000 mL hypoglycemia
o The patient is able to monitor blood glucose levels to
determine if it is safe to take medication or if an
alternation in dose is needed.
CONVERSION AMONG LIQUID MEASURES o The patient prepares a dose of ordered medication
o The patient describes a daily routine that will
1 tbsp 15 mL integrate timing of medication with daily activities.
• Setting priorities
1 tbsp ½ fl oz=4 o Pain medications
dr o Anti-hypertensive medications
500 mL 1 pt • Teamwork and Collaboration
1000 mL 1 qt (2 pt) o Family caregivers
(1L) o Community

Implementation
- To convert from Farenheit to centigrade
• Health Promotion
- C = (F-32) + 1.8
o Teach a patient and family about the benefit
of a medication and the knowledge needed
to take it correctly.
- To convert Centigrade to Farenheit o Integrate patient’s beliefs and cultural
practices into the treatment plan
- F = (C x 1.8) +32 o Help a patient and family establish a
medication routine that fits into the schedule
o Make referrals to community resources
• Patient and Family Teaching
o Include information about the purpose, action,
timing, dosage and side effects of medications
 o Have the patient explain the topic which you 5. Check expiration date in drug label, card; use drug
instructed him or her so you can confirm only if date is current.
understanding 6. Recheck drug dose calculation with another nurse
7. Verify doses of drugs that are potentially toxic with
Evaluation another nurse/pharmacist
• Evaluation is more effective when you value your 8. Pour tablet/capsule into the cap of the drug container.
patient’s participation, hence, partner with patients With unit dose, open packet at bedside after verifying
and include them in the evaluation. client identification.
9. Pour liquid at the eye level. Meniscus, the lower
GOAL EXPECTED EVALUATIVE curve of the liquid, should be at the line of the desired
OUTCOME MEASURE dose.
Patient and Patient and Written 10. Dilute drugs that irritate gastric mucosa (aspirin;
family will family describe measurement. potassium) or give with meals.
understand information about Have patient
medication medication, write out Administration:
therapy dosage, schedule, medication
purpose, and schedule for a 24- 1. Administer only those drugs that you have prepared.
adverse effects hour period. 2. Do not prepare medications to be administered by
another.
Patient and Direct 3. Identify the client by ID band, ID photo and name
family identify Observation: tag/band.
situations that Have patient 4. Offer ice chips to numb taste buds when giving bad-
require medical complete return tasting drugs.
intervention demonstration by 5. When possible, give bad-tasting medication first,
filling insulin followed by pleasant-tasting liquids.
syringe and 6. Assist the client to appropriate position, depending on
administering
the route of administration
injection
7. Provide only liquids allowed on the diet
8. Stay with the client until the medications are taken
Association of Nursing Service Administrators of the 9. Administer no more than 1.5-3mL of solution IM at 1
Philippines, inc (ANSAP) site
10. Infants receive no more than 1mL of solution IM at 1
10 Golden Rules for Administering Drugs Safely: site and no more than 1mL SQ.
1. Right drug 11. Never recap needles (universal precaution), use the
2. Right drug to the right patient “fishing method” instead
3. Right dose 12. When administering drugs to a group of clients, give
4. Right drug by the right route drug last to clients who need extra assistance
5. Right drug at the right time 13. Discard needles and syringes in appropriate
6. Document each drug you administer containers
7. Teach your patient about the drugs he is receiving 14. Drug disposal is dependent on agency policy
8. Take a complete patient drug history (risk of adverse 15. Controlled substance must be returned to the
drug reactions when a number of drugs are pharmacy. Some disposals need signature of witness.
taken/when pt is taking alcoholic drinks) 16. Discard unused solutions for ampules
9. Find out if the patient has any allergies 17. Appropriately store (some require refrigeration)
10. Be aware of potential drug-drug or drug-food unused stable solutions from open vials.
interactions 18. Write date ad time opened, and your initials on label
19. Keep narcotics in a double-lock drawer or closet
General Guidelines for Correct Administration of 20. Medication carts must be locked at all times when a
Medications nurse is not in attendance.
21. Keys to the narcotics drawer must be kept by the
Preparation: nurse and not stored in a drawer or closet
1. Wash hands before preparing medications 22. Keep narcotics in a safe place, out of reach of
2. Check for drug allergies, check the assessment hx children and others in the home
and Kardex 23. Avoid contamination of one’s own skin or inhalation
3. Check the medication order with health care to minimize chances of allergy or sensitivity
provider’s orders, Kardex, medication sheets and development.
medication card.
4. Check label on container 3x.
Recording HS Half- Mistaken as Use “half
strength bedtime strength”
1. Report drug error immediately to the client’s health or “bed
care provider and to the nurse manager. time”
2. Complete incident report hs At Mistaken as half- Use
3. Charting: record the drug given, time, route, and your bedtime, strength “bedtime”
initials hour of or half-
4. Record drugs promptly after given, especially STAT sleep strength”
doses o.d or OD Once Mistaken as Use “daily
5. Record effectiveness and results of medications daily “right eye” “
administered, esp PRN medication Per os By The “os” can be Use “PO”,
6. Report to health care provider and record drugs that mouth, mistaken as OS “by
were refused with reason for refusal orally mouth” or
orally”
7. Record amount of fluid taken with medications in
q.d or QD Every Mistaken as QID Use
input and output chart
day “daily”
8. Do not be distracted when preparing medications qhs Nightly Mistaken as qhr Use
9. Do not give drugs prepared by others and or every hour “nightly”
10. Do not pour drug from containers with labels that are bedtime
difficult to read/whose labels are partially SC, SQ, sub Subcuta Mistaken as SL, Use
removed/fallen off q neous SQ mistaken as 5 “subcutane
11. Do not transfer drugs from one container to another. every ously”
12. Do not give medications for which the expiration date TIW or tiw 3 times a Mistaken as 3 Use “3
has passed. week times a day, or times
13. Do not guess about drugs and drug doses. Ask when twice a week weekly”
in doubt. Trailing 1 mg Mistaken as 10 Do not use
14. Do not use drugs that have sediment, are discolored, zero after mg if the decimal trailing
or are cloudy (should not be) decimal point is not seen zeros for
15. Do not leave prepared medications out of sight point (e.g., doses
1.0 mg_) expressed
16. Do not give drugs if the client says he/she has
in whole
allergies to the drug or drug group
numbers
What to avoid during drug administration: “Naked” 0.5 mg Mistaken as 5 mg Use zero
decimal if rge decimal before a
1. Do not call the client’s name as the sole means of point (e.g., point is not seen decimal
identification .5 mg) point when
2. Do not give drug if the client states the drug is the dose is
different from the drug he or she has been receiving. less than a
Check the order whole unit
3. Do not recap Abbreviatio Mg/mL The period is Use mg,
ns such as unnecessary and mL etc
4. Do not mix drug with large amount of food or
mg or mL could be mistaken without
beverage or foods that are contraindicated with a as the number 1 if terminal
RECORDING DRUG ADMINISTRATION period after written poorly period
3 Dram Symbol fir dram Use metric
ABBREVI INTEN MISINTERPRE CORREC mistaken as 3 system
ATION DED TATION TION X3d For three Mistaken as 3 Use “for
MEANI days doses three days”
NG >And < Greater Mistaken as Use
ᶣg Microgr Mistaken as “mg” Use mcg than and opposite of “greater
am less than intended, than”, “less
AD, AS, AU Right Mistaken as OD, Use “right mistakenly use than”
ear, left OS, OU (right ear, left incorrect symbol
ear, each eye, left eye, each ear, each @ At Mistaken as 2 Use “at”
ear eye) ear”
OD, OS, Right Mistaken as AD, Use “right & And Mistaken as 2 Use “and”
OU eye, Left AS, AU eye, left + Plus or Mistaken as 4 Use “and”
eye, eye, or and
Each eye each eye” o Hour Mistaken as a Use “hr”,
BT Bedtime Mistaken as BID Use zero “hour”
(twice daily) “bedtime”
 ABBREVIATION MEANING

PO Per orem, orally

Inj Injection

IM Intramuscular

IV Intravenous

SC Subcutaneous

ID Intradermal

IT Intrathecal

OD (omni die) Once a day

BID (bis in die) Twice a day

TID (ter in die) Thrice a day

QID (quarter in die) Four times a day

q(quaque) Every

q4 Every four hours

Hs (hora somni) At bed time

STAT (statim) At once

ac (ante cebum) Before meals

pc (post cebum) After meals

PRN (pro re nata) When required

STANDARD TIME FOR ADMINISTRATION

Once a day OD 8am

Twice a day BID 8 am, 8pm

Three times a TID 8am, 2pm, 8pm

day
Four times a QID 8am, 12pm,
day 4pm, 8pm
Before meals AC 5:30am,
11;30am,
5:30pm
After meals PC 8am, 2pm, 8pm

Once a day, OD HS 9pm

before bedtime
 ROUTES OF DRUG ADMINISTRATION

Factors

➢ Characteristic of the drug

➢ Emergency/routine use
➢ Effect of gastric pH, digestive enzymes and first-pass
metabolism
➢ Age of patient
➢ Site of action of the drug (local or systemic)
➢ Condition of the patient (unconscious, vomiting,
diarrhea)
Oral Route

➢ Refers to two methods of administration:

- Applying topically to the mouth
- Swallowing for absorption along the gastrointestinal
(GI) tract into systemic circulation
➢ po (from Latin per os) is the abbreviation used to
indicate oral route of medication administration

Disadvantages

➢ Sometimes inefficient- only part of the drug may be

absorbed
➢ First-pass effect- drugs absorbed orally are initially
transported to the liver via the portal vein
➢ Irritation to gastric mucosa- nausea and vomiting
➢ Destruction of drugs by gastric acid and digestive
Advantages
juices
➢ Effect too slow for emergencies o Economical
➢ Unpleasant taste of some drugs o Quick termination
➢ Unable to use in unconscious patient o First-pass avoided
o Drug absorption is quick
Common dose form for oral administration
Disadvantages
➢ Solid form
o Tablets: normal or enteric coated o Unpalatable and bitter drugs
o Capsules: coated drug or liquid containing o Irritation of oral mucosa
(gelatin) o Large quantities not given
➢ Liquid form o Few drugs are absorbed
o Solutions: completely soluble either aqueous
or alcoholic
o Suspensions: small water-insoluble solid
drug particles dispersed in water
o Syrups: aqueous sugar solution
o Elixirs: alcoholic sugar solution