MEDICATION

Prepared by:
JENIFER F. TUGAS RN, MAN

Learning Objectives:
On completion of the discussion, students will be able to describe:
• selected terms related to the administration of medications.
• actions of drugs in the body.
• factors affecting medication action.
• types of medication orders.
• converting units of weight and measure.
• calculating dosages.
• administering medication through various routes.
• know the 14 rights of medication administration.
• verbalize steps used in administering medications safely.
• recognize when it is appropriate to delegate medication administration
 Pharmacokinetic Factors in Drug Therapy
1. Absorption is the process by which a drug passes from its site of
administration into the bloodstream.

Factors That Affect Drug Absorptions:

• Blood flow- rich blood supply enhances absorption. IM injection
promotes faster absorption than SC injection.
• Pain- slows gastric emptying rate, so the drug taken orally will be
absorbed slowly.
• Stress- causes vasoconstriction, so the drug taken orally will be absorbed
slowly.
• Foods- interferes with drug absorption.
• Exercise- can decrease blood circulation to the GI tract by causing more
blood flow to the muscles. Oral drugs will be absorbed more slowly.

Absorption…
• Nature of the absorbing surface- Transport of drug molecules is faster
through a single layer of cells. Drugs applied to the mucous membrane will
be absorbed faster than those applied on the skin.
• Solubility of the drug- The drug must be in solution. Liquid drugs are
absorbed faster than solid drugs.
• pH- Acidic drugs are best absorbed in the acidic environment. Alkaline
drugs are best absorbed in alkaline environment.
• Drug concentration- Drugs administered in high concentration tend to be
more rapidly absorbed than the drugs administered in low concentrations.
Bolus dose is given to obtain rapid effect of a drug.
• Dosage form- An active drug may be combined with another substance
from which it is slowly released, or may be prepared in vehicle that offers
relative resistance to the digestive action of the stomach contents
e.g. enteric coated drugs like erythromycin
2. Distribution. Is the transport of a drug from its site of
absorption to its site of action
Factors That Affect Drug Distribution:
A. Plasma- Protein Binding
• Medications connect with plasma proteins (albumin) in vascular
system.
• Strong attachments have a longer period of drug action.
• Clients with reduced plasma proteins could receive a heightened drug
effect
e.g. clients with kidney or liver disease

Distribution..
B. Volume distribution
• Client with edema has enlarged area in which a drug can be
distributed, and may need an increased dose.
• Smaller dose may be needed for client with dehydration.

C. Barriers to Drug Distribution

• Prevent some medication from entering certain body organs.
1. Blood Brain Barrier. To pass through this barrier, drug must be lipid
soluble and loosely attached to plasma proteins.
2. Placental Barrier. Shields from the possibility of adverse drug
effects. Many substances, like drugs, nicotine and alcohol do not cross
the placental barrier.
Distribution..
D. Obesity
• Body weight plays a role in drug distribution because blood flows
through fat slowly, thus increasing time before drug is released.

E. Receptor Combination
• A receptor is an area on a cell where drug attaches and response takes
place.
• A receptor is usually protein or nucleic acid. Other receptors are
enzymes, lipids, and carbohydrate residues.
• Drugs can have agonist or antagonist effect.
• Agonist will connect itself to the receptor site and cause
pharmacological response.
• Antagonist will attempt to attach but because attachment is uneven,

3. Metabolism or Biotransmission
• A sequence of chemical events that change a drug to a less active form
after it enters the body. Also called detoxification.
• The liver is the principal site of drug metabolism.
• Oral medications: Go directly to the liver via the portal circulation
before entering the systemic circulation.
• Many medications become entirely inactivated by the liver the first
time they go through it.
 Metabolism…
• Factors That Affect Drug Metabolism:
1. Age. Infant and elderly have reduced ability to metabolize some
drugs.
2. Nutrition. Liver enzymes involved in metabolism rely on adequate
amounts of amino acids, lipids, vitamins and carbohydrates.
3. Insufficient amounts of major body hormones. Insulin/ adrenal
corticosteroids can reduce metabolism of drugs in the liver.

4. Excretion
• Is the process by which drugs are eliminated from the body
• Most important route of excretion for most drugs is kidneys.
Factors That Affect Drug Excretion:
1. Renal excretion. Carried out by glomerular filtration and tubular
secretion, which increase quantity of drug excreted.

2. Drugs can affect elimination of other drugs. Examples:

• Probenecid prevents excretion of penicillin
• Antacid increases elimination of ASA

3. Blood concentration levels. When peak level of the drug is reached,

excretion levels become greater than absorption and blood levels of
drugs begin to drop.
 Physiologic Changes Associated with Aging that
Influence Medication Administration and Effectiveness
1. Altered memory. Increase risk of error in taking medications
2. Less acute vision
3. Decrease in renal function resulting in slower elimination of drugs.
4. Less complete and slower absorption from gastrointestinal tract.
5. Increased proportion of fat to lean body mass which facilitates retention
of fat soluble drugs and increases potential for toxicity.
6. Decreased liver function, which hinders biotransformation of drug.
7. Decreased organ sensitivity. These may lead to under response to drugs.
8. Altered quality of organ responsiveness, resulting in adverse effects
becoming pronounced before therapeutic effects are achieved.

Quick Quiz
You are caring for a patient who has diabetes complicated by kidney
disease. You need to make a detailed assessment when administering
medications because this patient may experience problems with:
a. Absorption
b. Metabolism/Biotransformation
c. Distribution
d. Excretion
 Principles in Administering Medications
1. Observe the 14 Rights of drug administration.
2. Practice asepsis. Wash hands before and after preparing medications.
3. Nurses who administer medications are responsible for their own actions.
Question any order that you consider incorrect (maybe unclear or inappropriate).
4. Be knowledgeable about the medications that you administer.
• A fundamental rule of safe drug administration is: “Never administer an
unfamiliar medication.”
5. Keep narcotics in locked place.
6. Use only medications that are in clearly labeled containers. Re-labelling of
drugs is the responsibility of the pharmacist.
7. Return liquid that are cloudy in color to the pharmacy.

Principles…
8. Before administering the medication, identify the client correctly.
9. Do not leave the medication at the bedside. Stay with the client until he
actually takes the medications.
10. The nurse who prepares the drug administers it. Only the nurse who prepared
the drug knows what that drug is. Do not accept endorsement of medications.
11. If the client vomits after taking the medication, report this to the nurse in-
charge or physician.
12. Preoperative medications are usually discontinued during the postoperative
period unless ordered to be continued.
13. When a medication is omitted for any reason, record the fact together with
the reason.
14. When a medication error is made, report immediately to the nurse in- charge
or physician. To implement necessary measures immediately. This may prevent
any adverse effects of the drug.
 Quick Quiz
If a nurse experiences a problem reading a physician’s medication order,
the most appropriate action will be to:

a. Call the physician to verify order.

b. Call the pharmacist to verify order.
c. Consult with other nursing staff to verify.
d. Withhold the medication until physician makes rounds.
 STANDARD TIMINGS OF MEDICATION
ADMINISTRATION
Frequency Time
• Once a day 06:00am or 08:00am
• Two times a day or every 12 hours 08:00am and 06:00pm
• Three times a day or every 8 hours 08:00am, 01:00pm, 06:00pm
• Four times a day or every 6 hours 08:00am, 2:00pm,08:00pm,2am

The Abbreviations Frequency

• Ac before meal • OD Once a day or daily
• PC after meal • BD or BID Twice or Two times
• PO per oral a day
• NPO nil per oral/ nothing per • TID or TDS Three times a day
oral • HS at bed time
• D/C discontinue • QID Four times a day
• Ad Lib as desired • Q1H Every 1 hour
• Gtts drops • Q2H Every 2 hours
•U Unit • Q3H Every 3 hours
• Pre. Op before operation • Q6H Every 6 hours
• Post. Op after operation • Q8H Every 8 hours
• Tab. Tablet • Q12H Every 12 hours
Route
• ID Intra dermal IVPB Intravenous
piggyback
• IM Intramuscular GT Gastrostomy tube
• SC Subcutaneous NG Nasogastric tube
• IV Intravenous OD Right eye
• PO Per oral or by mouth OS Left eye
• PV Per vagina OU Both eyes
• PR Per rectum AD Right ear
• SL Sublingual or under the tongue AU Both ears
Medication Administration
Pharmacist role
- prepares and distributes medication

Nurse’s Role:
• To determine medications ordered are correct
• Assess patient’s ability to self- administer
• Determines medication timing
• Administers medications correctly
• Closely monitors effects
• Provides patient teaching
• Does not delegate medication administration to AP
 Health Care Provider’s Role
Prescribers
-Physicians, nurse practitioners, physician’s assistance
• Orders
-Written (hand or electronic)
-Verbal
-Telephone
• Abbreviations
-Can cause errors; use precaution
-Know prohibited and error- prone abbreviations

Medication Error
• Any preventable event that may cause inappropriate medication use or
jeopardize patient safety

• When an error occurs:

➢ First assess the patient’s condition, then notify the health care provider
➢ When patient is stable, report the incident
➢ Prepare and file an occurrence or incidence report
➢ Report near misses and incidents that cause harm

• During transitions in care, reconcile medications

Evidence- Based Practice
In recent study nurses identified factors contributing to medication
errors (Kim et al., 2011):
• Being unfamiliar with the drug;
• The need for advanced drug preparation
• Failure to recheck a medication before administration;
• Workload;
• Miscommunication around verbal orders;
• Clinician miscommunication;
• And not being alert while checking medications;
• As a result of failure of nurses to follow policy.

•Nurses need to make clinical judgements when

administering medications and not simply give
drugs automatically.
•This includes thorough patient assessment and an
understanding of pharmacokinetics, growth and
development, nutrition, and mathematics
Nursing Process: Assessment
• Through the patient’s eyes
- Consider patient’s preferences and values
- Assess patient experiences
• History
- Allergies
- Medications
- Diet history
- Patient’s perceptual or coordination problems
• Patient’s current condition
• Patient’s attitude about medication use

Nursing Diagnosis
• Nursing diagnoses that may apply during medication administration
- Impaired Health Maintenance
- Lack of knowledge (Medication)
- Nonadherence (Medication Regimen)
- Adverse Medication Interaction
- Complex Medication Regimen (Polypharmacy)
Planning
• Organize care activities to ensure the safe administration of
medications
• Goals and outcomes
- Setting goals and related outcomes contributes to patient safety and
allows for effective use of time during medication administration.
• Setting priorities
- Provide the most important information about the medications first.
• Teamwork and collaboration

Implementation
• Health promotion
- Patient and family caregiver teaching
• Acute care
- Receiving, transcribing, and communicating medication orders.
- Accurate dose calculation and measurement
• Avoidance of distractions
- Correct administration
- Recording medication administration
• Special considerations
- Infants
- Older adults
Evaluation
• Through the patient’s eyes
- Partner with your patients.
- Ensure patients understand and safely administer their medications.
• Patient outcomes
- Use knowledge of the desired effect and common side effects of each
medication to compare expected outcomes with actual findings

14 Rights of Drug Administration

• Right Drug • Right Assessment
• Right Patient • Right Documentation
• Right Time/ Frequency • Right Evaluation
• Right Dose • Right Principle of Care
• Right Route • Right Approach
• Right Education and Information • Right Prescription
• Right to Refuse Medication • Right Nurse Clinician
Right Principle of Care
• Observe the proper standards of
preparing medications and
observing the right of the
patients.
• As a nurse, we need to treat our
patient with dignity & respect.
Encourage patient in decision-
making and communicate about
their clinical condition and
treatment options.
Right Prescription
• It is the responsibility of the
nurse to confirm right order of
the physician with the right
patient, right medication, with
the right dose and route, the
correct frequency of the
medication and the signature of
the ordering physician.
Right Approach
• The nurse’s manner should be
appropriate for the patient’s age
to whom the drug is being
administered, especially when
the patient is a child. However,
the nurse should also be patient
with older patients.
Right Nurse Clinician
• Only the licensed registered
nurse has the right to prepare and
administer the medication to the
right patient and must be
responsible and accountable on
her own actions.
 Quick Quiz
• Nurses are legally required to document medications that are
administered to patients.
• The nurse is mandated to document which of the following?
a. Medication before administering it.
b. Medication after administering it.
c. Rationale for administering it.
d. Prescriber rationale for prescribing it.
Medication Ticket

Practice Drug Calculation

 Storage
• Cupboard offorMedications
I-used drugs for external use only; e.g. calamine lotion, detol,
methylated spirit etc.
• These drugs are contained in distinctive bottles, usually ridged with deep colors
• (dark green, blue, brown) with red label marked POISON and FOR
EXTERNAL USE ONLY
• Cupboard Il-contains drugs for internal use only e.g. tablets, suspension,
mixtures etc. All drugs must be labelled.
• Cupboard Ill-contains the dangerous drug; drugs of addiction. E.g. Morphine,
Pethedine etc.
• Cupboard IV - called the Emergency Cupboard may be stationed at or near
the nurses bay for easy access. This cupboard contains drugs for emergency
situations e.g. aminophylline (for asthma), hydralazine (for severe
hypertension), oxytocin (for maternal bleeding), intravenous infusions (for
rehydration) etc.
 Basic principle of nurse on drugs
administration
1. The nurse must know the drug's prescribed dose, method of administration,
actions, expected therapeutic effect, possible interactions with other drugs, and
adverse effects.
2. The nurse must know the institution's administration procedures for the client’s
welfare and the nurse's legal protection.
3. The nurse must Review physician's order for completeness the client’s name,
date of the order, name of the drug, dose, rout, time of administration, and the
physician's signature.
4. The nurse discusses the medication and its actions with the client; recheck the
medication order if the client disagrees with the dose or the physician’s order.
5. The nurse must check the physician's order against the client's medication
administration record for accuracy.
6. The nurse gives the patient the right to know about the medication he is
receiving and the right to refuse it.

Let’s review… MEDICATION ORDER

• A medication order - is written directions provided by a prescribing practitioner
for a specific medication to be administered to an individual

1. PRN medications - are given on an "as needed" basis for specific signs &
symptoms. Signs or symptoms of illness or discomfort can include:
• Tiredness • Increased anxiety or agitation • Headache • Earache • Redness in a cut
or a scrape • Coughing • Sneezing • Fever • Itching • Cramping

2. STAT ORDER - Indicates the medication to be given immediately and only

once. Ex Morphine 10 milligrams IV stat

3. SINGLE ORDER - One time order indicates that the medication is to be given
 Routes of Administration
A: Enteral Tract Routes
• The common enteral routes of administration used in general medical practice are
as follows:
1. Oral: The best, and most convenient, way of administering drugs is by mouth.
The effects of oral administration are often not seen until 30 to 45 minutes after
administration.
2. Orogastric/nasogastric tube (OG/NG): This route is generally used for oral
medications when the patient already has the tube in place for other reasons.
3. Sublingual (SL): Some drugs can be administered sublingually, the drug is
placed under the tongue, where it quickly dissolves. The drug is then absorbed into
the vast capillary network present in the mucous membranes.
4. Buccal: Absorption through this route between the cheek and gum is similar to
sublingual absorption.
5. Rectal : Rectal administration may have both local and systemic effects. It may

B: Parenteral Routes
• Any method of administration that does not involve passage through the digestive
tract is termed parenteral. Parenteral routes include the following:
1. Topical: Certain drugs can be placed on the skin, where they are slowly
absorbed into the capillary network underneath the skin.
2. Intradermal: Drugs can be injected into the dermal layer of the skin.
3. Intranasal: The drug is aerosolized and instilled in the nose, whereby
the drug is rapidly absorbed through the massive vascular network in the
nasal tissues.
4. Subcutaneous: With subcutaneous administration, medications are injected into
fatty, subcutaneous tissue under the skin and overlying the muscle.
5. Intramuscular: The most commonly used route of parenteral medication
administration is the intramuscular route.
 B: Parenteral Routes…..
6. Intravenous. Most medications used in emergency medicine are designed to be
administered intravenously.
7. Endotracheal: Sometimes it is possible to administer emergency medications
down an endotracheal tube, which permits absorption into the capillaries of the
lungs.
8. Sublingual injection: Certain drugs can be injected into the vast capillary
network immediately under the tongue. Lidocaine is the agent most frequently
given by this route.
9. Intracardiac: Injection of a medication directly into the ventricle of the heart is
referred to as intracardiac administration.
10. Intraosseous: When an IV line cannot be started in children under 6 years of
age, many emergency medications can be administered intraosseously. A needle
can be placed in the anterior aspect of the proximal tibia, through which

Non-parenteral Route Medication

Administration
• Oral medication administration
Definition: is the most common and convenient type for most clients by
which the drug is swallowed to the stomach, or administrated under the
tongue for slow action.
Purpose
1. To provide safe, effective drug therapy with minimal complications and
discomfort.
2. To provide a convenient route for drug therapy.
Advantages
1. It's the easiest, least expensive, safe, and most desirable type of drug
to administration.
2. Has the slowest onset of action because it is absorbed through the
gastric mucosa into the bloodstream for a systemic effect.
3. Can have a local effect (for example, anti-acids)
4. Is supplied in the form of tablets, capsules, enteric-coated tablets,
liquids, syrups, and suspensions.

Disadvantage
1. Unpleasant taste of the drugs.
2. Irritation of the gastric mucosa.
3. Irregular absorption from the gastrointestinal tract.
4. Slow absorption.
5. Harm to the client's teeth.
6. Is contraindicated in a client who is vomiting or cannot swallow food
or fluids, who is having gastric suctioning, or who lacks mental
awareness.
• Never crush enteric- coated or sustained- release tablets.
• Crushing enteric- coated tablets allows the irritating medication to
come in contact with the oral or gastric mucosa, resulting in mucositis
or gastric irritation.
• Crushing sustained- released medication allows all the medication to
be absorbed at the same time, resulting in a higher than expected
• Topical. Application of medications to a circumscribed area of the
body
A. Dermatologic. Includes lotions, liniments and ointments.
• Wash and pat dry area well before application to facilitate absorption.
• Use surgical asepsis when open wound is present.
• Remove previous application before the next application.
• Apply only thin layer of medication to prevent system absorption.
• Use glove when applying the medication over a large surface
e.g. Large area of burns

B. Opthalmic. Include instillations and irrigations.

1. Instillations. To provide an eye medication that the client requires.
2. Irrigation. To clear the eye of noxious or other foreign material.
• Position client either sitting or lying.
• Use sterile technique.
• Clean the eyelid and eyelashes with sterile cotton balls moistened with
sterile normal saline from the inner to outer canthus.
• Instill eye drops into lower conjunctival sac.
• Instill a maximum of two drops at a time. Wait for 5 minutes if additional
drops need to be administered. This is for proper absorption of the
medication.
• Avoid dropping a solution onto the cornea directly, because it causes
discomfort.
 Topical..
• Instruct the pt. to close the eyes gently. Shutting the eyes tightly causes
spillage of the medication..
• For liquid eye medications, press firmly on the nasolacrimal duct
(inner canthus) for atleast 30 seconds to prevent systemic absorption
of the medication.

C. Otic. Includes instillations and irrigations.

Instillations
1. To soften earwax.
2. To reduce inflammation and treat infection.
3. To relieve pain

Otic…
• Warm solution at room or body temperature . Using hot or cold solution into
the ear can cause nausea, vertigo, and pain.
• Side lying position with the ear being treated uppermost.
• Clean the pinna and the meatus of the ear canal with cotton- tipped applicator.
• Straighten the ear canal.
• 0-3 years old: pull the pinna downward and backward.
• Older than 3 years old: pull the pinna upward and backward.
• Instill eardrops on the side of the auditory canal to allow the drops to flow in
and to continue to adjust to body temperature.
• Press gently but firmly a few times on the tragus of the ear to assist the flow of
medication into the ear canal.
• Ask the client to remain in side lying position for about 5 minutes.
• Insert small piece of cotton fluff loosely at the meatus of the auditory canal for
D. Nasal. Nasal instillations usually are instilled for their astringent effect
(to shrink swollen mucous membrane), to loosen secretions and facilitate
drainage or treat infections of the nasal cavity or sinuses.
E.g. decongestants, steroids, calcitonin.
• Have the client blow the nose prior to nasal instillation.
• Assume back lying position, or sit up and lean head back.
• Elevate the nares slightly by pressing the thumb against the patient’s tip of
the nose. While the client inhales, squeeze the bottle.
• Keep head tilted backward for 5min after instillation of drops.
• When the medication is used on a daily basis, alternate nares to prevent
irritation.
For sinus instillation:
• Parkinson’s position for frontal and maxillary sinuses.
• Proetz position for ethmoid and sphenoid sinuses.

E. Inhalation. Use of nebulizers, metered- dose inhalers (MDI).

• Semi or high fowler’s position. To enhance full chest expansion allowing
deeper inhalation of the medication.
• Shake the canister several times. To mix the medication and ensure uniform
dosage delivery.
• Position the mouthpiece 1 to 2 inches from the client’s open mouth. As the
client starts inhaling, press the canister down to release one dose of the
medication. This allows delivery of medication more accurately into the
bronchial tree rather than being trapped in the oropharynx then swallowed.
• Instruct client to hold breath for 10 seconds. To enhance complete
absorption of the medication.
• If bronchodilator, administer a maximum of 2puffs, for at least 30sec
interval. Administer bronchodilator before other inhaler medications. This
opens airway and promotes greater absorption of the medication.
• Wait at least 1min before administration of the 2nd dose inhalation of a
different medication by MDI.
F. Vaginal
Advantage: Provides local therapeutic effect.

Disadvantages: Has limited use.

• Drug forms: Tablet, liquid (douches), cream, jelly, foam and suppository
• Use applicator or sterile gloves for vaginal administration of medication.
• Vaginal Irrigation. Is the washing of the vagina by a liquid at low pressure.
It is also called douche.
• Empty the bladder before the procedure.
• Position and drape the client.
1. Instillation: back- lying position with knees flexed and hips rotated
laterally.
2. Irrigation: back- lying position with the hips higher than the shoulders
G. Rectal.
Advantage: Can be used when drug has objectionable taste or odor.
Disadvantage:
1.Dose absorbed is unpredictable.
● Need to be refrigerated so as not to soften.
● Have client lie on left side and breathe through the mouth to relax the
anal sphincter.
● Insert suppository until a sensation of “as if something has grabbed it
away,” occurs. This indicates that the suppository has been inserted
past the internal anal sphincter.
● Ensure that the suppository comes in contact with the rectal wall. This
ensures accurate absorption of the medication.
● Client must remain on side for 20min after insertion. To promote
adequate absorption of the medication.
Parenteral Route Medication
•Administration:
Is the route by which injections are used to instill medications into
body tissues. Injected drugs act more quickly than oral medications
because they reach the bloodstream either directly or by rapid
absorption through the tissues, thus the client's condition can change
rapidly.
• Parenteral drugs can be administered through four different
routes:
1. Intradermal (ID) is an injection into the dermis.
2. Subcutaneous (SC) is an injection into the subcutaneous tissue.
3. Intramuscular (IM) is an injection into the muscle.
4. Intravenous (IV) is an injection into a vein.
Equipment of Parenteral drugs
administration
• A: Syringe
A syringe consists of a cylindrical barrel, a tip designed to fit the hub of
a hypodermic needle, and a close-fitting plunger.
Characteristics of syringe:
1. Syringes are single -use and disposable or descried.
2. Syringe are used to administration of medication, or liquid food by
Nasogastric tube or used for diagnostic measures such as pull-up sample
of blood or abscess.
 Parts of the Syringe

B: Needles:
A needle has 3 parts: the hub, the shift, and the bevel.
Characteristics of needles:
1. Size of needles varies in length from ¼ inch to 3 inches. (1inch to 1½
inches for IM injection, ⅜ to ⅝ inches for SC or ID injection.
2. As the needles gauge gets smaller the needle diameter becomes larger.
3. Selection of needles gauge depends on the viscosity of fluid.
4. Chooses of needles length according to the client's size and weight and
type of tissue into which the drugs is to be injected.
 Needle Gauges and Color Code

Only five intramuscular injection sites that allow for

administration with lowest risk of damage to adjacent
nerves
injection sitesand blood vessels:
Location
Deltoid m. Locate on upper arm, lateral aspect
Ventrogluteal m. located on the side of the hip over gluteus
muscle between anterior and superior
spines of the iliac crest.
Dorsogluteal m. Located over gluteus minimum and edge
of gluteus maximum muscles in upper
outer quadrant.
Vastuslateralis m. located on mid-thigh, lateral aspect
Rectus femoral m. located on mid-thigh, anterior aspect.
 I:injection
• It is an Intramuscular Injection(
of medications into the muscle. IM)
• Needle length is 1”, 1 ½”, 2”. To reach the muscle layer.
• Use needle gauge 20, 21, 22, 23 depending on the viscosity of
medication.
• Clean the injection site with alcoholized cotton ball. To reduced
microorganisms in the area.
• Inject the medication slowly to allow tissues to accommodate
volume.

Sites selected for Intramuscular injection:

1. Ventrogluteal muscle (von Hochsteter’s site)
• It lies over the gluteus minimums. Involves the gluteus Medias
and minimums it is situated deep and away from major nerves
 • 2.Dorsogluteal muscle
• It is composed of the thick gluteal muscle of the buttocks. The muscle
is in the posterior superior iliac spine, the injection site is then lateral
and superior site by positioning the patient on prone position or side –
lying position. The Dorsogluteal site can be used for adult and
children with well develop gluteal muscle which develop by walking.
• The site should not be used for infants under 3 years, because the
gluteal muscles are not well- developed yet.
• To locate the site, the nurse draws an imaginary line from the greater
trochanter to the posterior iliac spine. The injection site is lateral and
superior to this line.
• Another method of locating this site is to imaginary divide the buttock
into four quadrants. The upper outer quadrant is the site of injection.
Palpate the crest of the ilium to ensure that the site is high enough.
● Avoid hitting the sciatic nerve, major blood vessel or bone by locating
the site properly

3. Deltoid muscle
• The deltoid muscle is in the edge of the acromion process, which forms the
base of a triangle in line with the midpoint of the lateral aspect of the
upper arm.
• To locate the site, palpate the lower edge of the acromion process and the
midpoint on the lateral aspect of the arm that is in line with axilla. This is
approximately 5cm. (2in or 2 to 3 fingerbreadths below the acromion
process.
• Should be use this site only for small medication volumes (0.5 to 1.0 ml)
and when other sites are inaccessible because of dressings or casts.
• Not used often for IM injection because it is relatively small muscle and it
is very close to the radial nerve and radial artery.

• Variation of the IM injection: Z- tract technique

4. Vast us lateral's muscle
• It is located on the anterior lateral aspect of the thigh; in an adult it extends
from a Handbreadth above the knee to a handbreadth below the greater
trochanter of the femur. The middle third of the muscle, anterior lateral aspect
of the thigh is the suggested site for injection.
• This injection site used in the adult client and is the preferred site for infants
under 7 months; the muscle is thick and well developed.
• Assume back- lying or sitting position.
5. Rectus femur's muscle.
• The muscle belong to
quadriceps muscle group it is
used only occasionally for (IM)
injection.
• It is situated on the middle
third, anterior aspect of the
thigh.
• Its advantage the patient can
reach this site easily.
Disadvantage is considerable
discomfort for some people.
 Advantage of Intramuscular Injection (IM)
1. The muscle is less sensitive to irritating and viscous drugs.
2. Adult client can safely tolerate as much as 4 ml of medication in larger
muscles such as the gluteus medius without discomfort than subcutaneous
tissue.
3. Safe method than other parenteral administration rout.
4. Slow action of medication can be achieved by this rout of administration.
5. Some medication need to absorbed slowly and harm if given intravenous
such as oily hormone, long acting penicillin.

Disadvantage of Intramuscular Injection

(IM)
1. Tissue injury (burn, wound)
2. Presence of nodules
3. Lumps
4. Abscesses
5. Tenderness
6. Other pathology such as (viral hepatitis B), (cross infection)
7. Sciatic nerve injury (nerve damage)
8. Sterile abscess
9. Gangrene
General Principles in Parenteral Administration of Medications
1. Check the doctor’s order.
2. Identify the client properly. This ensures that the medication administered
to the right client.
3. Practice ASEPSIS. To prevent infection.
4. Use appropriate needle size. To minimize tissue injury.
5. Plot the site of injection properly. To prevent hitting nerves, blood vessels,
bones.
6. Use separate needles for aspiration and injection of medication. To
prevent irritation of tissues.
7. Introduce air into the vial before aspiration. To create positive pressure
within the vial and to allow easy withdrawal of medication.

Principles…
8. Allow a small air bubble (0.2ml) in the syringe to push the medication
that may remain in the hub and lumen of the needle.
9. Introduce the needle in a quick thrust. To lessen discomfort.
10. Either spread or pinch muscle when introducing the medication.
Depending on the size of the client.
11. Minimize discomfort by applying cold compress over injection site
before introduction of medication to numb nerve endings; apply warm
compress to improve circulation in the area.
12. Aspirate before introduction of medication. To check if blood vessel had
been hit.
13. Support the tissues with cotton swabs before withdrawal needle. To
prevent discomfort of pulling tissues as needle withdrawn.
14. Apply pressure at the site for few minutes. To prevent bleeding.
15. Evaluate effectiveness of the procedure and make relevant
documentation.
II. Subcutaneous Injection (SC)

Sites selected for SC injection.

1. Outer aspect of the upper arms.
2. Outer aspects of the abdomen
below the costal margin to the iliac
crests.
3. The anterior aspects of the thigh.
4. The scapular areas of the upper
back
5. Upper ventrogluteal and
dorsogluteal areas.
 Advantage of SC injection
1. Drug given subcutaneously are isotonic, nonirritating, no viscous, and
water soluble, example of medication given SC (epinephrine, heparin,
insulin, tetanus toxoid, allergy medications, vaccine, narcotics and heparin).
2. Small doses of medication (0.5 – 1 ml) should be given SC.
3. Area of injection can easily accessible.
4. Patient can do self – administration SC injection (Insulin).
5. Multiple areas of injections may be rotated to avoid drug administration
complication.
6. Needle 25 gauge ⅝ inches with medium bevel inserted at 45° degree angle
for thin patients; 90 ° angle to obese patients.

Disadvantage of Subcutaneous Injection (SC) administration:

1. Tissue is sensitive to irritating solution and large volume of
medication.
2. Medication collecting within the tissues can cause sterile abscesses
which appear as hardened, painful lump.
Special consideration on SC Injection:
• For heparin injection: Do not aspirate. Do not massage injection site to
prevent hematoma formation.
• For Insulin injection: Do not massage to prevent rapid absorption
which may result to hypoglycemic reaction. Always inject insulin at
90 ° angle to administer the medication in the pack between the SC
and muscle layer. Adjust the length of the needle, depending on the
size of the client.
• For other medications, aspirate before injection of medication to check
III: Intradermal Injection (ID)
 • It is the administration of a drug into the dermal layer of the skin just
beneath the epidermis.
Sites selected for Intradermal injection
1. Inner aspect of lower arm.
2. Upper site of chest.
3. Back site of chest beneath the scapulae.
4. Commonly the left arm is used for tuberculin test and the right arm is
used for all other test.

Characteristics of Intradermal Injection (ID) administration

• (Advantage)
1. Used for skin test (tuberculin test); use left arm and right arm for all
other tests.
2. Drug absorption occurs slowly.
3. Commonly used to antibiotic screening test (allergy test).
4. Tuberculin syringe 1 ml and with needle (¼ - ½ inches) 25,26 or 27 gauge
is used; needle length 3/8”, 5/8”, or ½”
5. The needle inserted at 10- 15 ° degree angle of injection ; bevel up
6. Small amount of medication (0.01 – 0.1ml) are injected intradermally and
slowly over 3 to 5sec to form a wheal or bleb.
7. Bleb should be appearing after needle withdrawal.
8. Do not massage the site of injection. To prevent irritation of the site, and to
prevent absorption of the drug into the SC.
• Disadvantage of Intradermal Injection (ID) administration
1. Negative result if bleb does not appear or if the site bleeds after
injection.
2. Irritation of skin due to large amount of drug administration.
 IV: Intravenous Injection ( IV)
• It is the administration of medication to the client's bloodstream directly by the
vein.
• Direct IV, IV push, IV infusion
Characteristics Intravenous of Injection (IV) administration
(Advantage).
1. When rapid effect is required.
2. Route is appropriate when medications are too irritating to the tissue when
given by other routes.
3. When there are contraindications to give medication by other route such as
abscesses on gluteal muscles occur, compromised GI function or peripheral
circulation.
4. When large volume infusion or medication are indicated.
5. When there are multi dose of drug administration for long period.

Disadvantage of Intravenous Injection (IV)

administration
1. Rapid severe reactions to the medication (anaphylactic
shock).
2. Infection transmission.
3. Fluid volume overload.
4. Transmission of infection by contaminated syringe such
as (HIV, viral hepatitis B).
5. Thrombophlebitis repeated injection on the same vein.
Preparing an AMPULE

IV Bolus Drug Administration

• Heparin Lock Drug Administration

• · Mini– Infusion Pump

— The mini– infusion
pump is battery operated
and delivers medication
in very small amounts of
fluid (5 to 60 mL) within
controlled infusion times
using standard syringes.
• Piggyback– a piggyback is a small (25 to
250mL) IV bag or bottle connected to a short
tubing line that connects to the upper Y– port of
a primary infusion line or to an intermittent
venous access such as a saline lock.

• The piggyback tubing is a microdrip or macrodrip

system. The set is called a piggyback because the
small bag or bottle is set higher than the primary
infusion bag or bottle. In the piggyback setup the
main line does not infuse when a compatible
piggybacked medication is infusing. The port of the
primary IV line contains a back– check valve that
automatically stops the flows. After the piggyback
solution infuses and the solution within the tubing
falls below the level of the primary infusion drip
chamber, the back– check valve opens, and the
primary infusion starts to flow again.
•

Volume- control Administration (Solu- set)

• Volume—control administration sets (e.g., Volutrol, Buretrol, Pediatrol) are small (50 to 150 mL) containers
that attach just below the primary infusion bag or bottle. The set is attached and filled in a manner similar to
that used with a regular IV infusion. However, the priming filling of the set is different, depending on the type
of filter (floating valve or membrane) within the set. Follow package directions for priming sets.
 Types of IV Fluids
1. Isotonic solution. Has the same concentration as the body fluids.
• E.g. D5W, NaCl 0.9%, Plain Ringer’s lactate, plain Normosol M
2. Hypotonic. Has lower concentration than the body fluids
• E.g. NaCl 0.3%
3. Hypertonic solution. Has higher concentration than the body fluids
• E.g. D10W, D50W, D5LR, D5NM
1.Verify the doctor’s order.
Nursing Interventions in IV Infusion
2.Know the type, amount, and indication of IV therapy.
3. Practice strict asepsis.
4. Inform client and explain purpose of IV therapy.
5. PRIME IV tubing to expel air. This will prevent air embolism.
6. Clean the insertion site of IV needle from center to the periphery with
alcoholized cotton swab.
7. Shave area of needle insertion if hairy.
8. Change IV tubing every 72 hours. To prevent contamination.
9. Change/ alter IV needle insertion site every 72 hours. To prevent
thrombophlebitis.
10. Regulate IV every 15- 20min. To ensure administration of proper volume of
IV fluid as ordered.

Complications
• 1. Infiltration. ofoutIV
The needle is Infusion
of vein, and fluids accumulate in the
subcutaneous tissues.
Assessment
● Pain
● Swelling
● Skin is cold at needle site
● Pallor of the site
● Flow of IV rate decreases or stops.
● Absence of backflow of blood into the tubing as the fluid is put down, or the IV
tubing is kinked.
Nursing Interventions
● Change the site of needle.
● Apply warm compress. This will reabsorb edema fluid and reduce swelling.
2. Circulatory Overload. Results from administration of excessive
volume of IV fluids.
Assessment
● Headache
● Flushed skin
● Rapid pulse
● Increased BP
● Weight gain
● Syncope or faintness
● Pulmonary edema
● Increased venous pressure
● Coughing
● SOB (shortness of breath)
● Tachypnea
3. Drug Overload. The patient receives an excessive amount of fluids
containing drugs.
Assessment
● Dizziness
● Shock
● Fainting
Nursing Intervention
● Slow infusion to KVO. Notify physician
4.Superficial Thrombophlebitis. It is due to overuse of a vein, irritating solutions
or drugs, clot formation, large bore catheters.
Assessment
● Pain along the course of vein
● Vein may feel hard and cordlike
● Edema and redness at needle insertion site
● Arm feels warmer than the other arm
Nursing Interventions
● Change IV site every 72 hours.
● Use large veins for irritating fluids.
● Stabilize venipuncture at area of flexion.
● Stabilize venipuncture at area of flexion.
● Apply cold compress immediately to relieve pain and inflammation; later follow
with warm compress to stimulate circulation and promote absorption.

5. Embolism. Air manages to get into the circulatory system; 5ml of air or
more causes air embolism.
Assessment
● Chest, shoulder, or backpain
● Hypotension
● Dyspnea
● Cyanosis
● Tachycardia
● Increased venous pressure
● Loss of consciousness
Nursing Interventions
● Do not allow IV bottle to “run dry”
● “Prime” IV tubing before starting infusion.
● Turn patient to left side in the Trendelenburg position. To allow air to rise
6. Nerve Damage. May result from tying the arm too tightly to the splint.
Assessment
● Numbness of fingers and hands
Nursing Interventions
● Massage area and move shoulder through its ROM.
● Instruct the pt to open and close hand several times each hour.
● Physical therapy may be rquired.
Note: apply splint with fingers free to move.

7. Speed Shock. May result from administration of IV push medications rapidly.

• To avoid speed shock, and possible cardiac arrest, give most IV push
medication over 3 to 5 minutes
 Drugs orders
All orders should be written clearly and legibly, and the drug order should
contain seven parts:
1. The name of the client.
2. The date and time when the order is written.
3. The name of the drug to be administered.
4. The dosage.
5. The route by which it is to be administered and special directives about
its administration.
6. The time of administration and frequency.
7. The signature of the prescribing practitioner writing the order (e.g., the
prescribing practitioner or advanced practice registered nurse).

Medication Administration and

Documentation
•Record all information concerning the patient and
medication including:
a. Indication for drug administration.
b. Dosage and route delivered.
c. Patient response to the medication, Both positive and
negative.
 Always remember:TYPES OF
1. Therapeutic Effect - expected or predicted physiological response that a
MEDICATION
medication cause. ACTION
2. Side Effect - predictable and unavoidable secondary effects produced at a usual
therapeutic dose.
Ex: nausea, loss of appetite, stomach pain
3. Adverse effect - undesirable and unpredictable severe response to medication
4. Toxic Effect - developed after a prolonged intake of a medication accumulates
in the blood because of impaired metabolism and excretion
Ex: liver and kidney damage
5. Allergic Reactions - unpredictable immunologic response to medication
Ex: paracetamol produces rash or swelling as allergic reaction
6. Idiosyncratic Reaction - overreacts or underreacts to medication or has a
reaction different to normal.

RESPONSIBILITY OF NURSE
REGARDING MEDICATION
ADMINISTRATION
• Follow institutional policy
• Consider client’s desire and abilities
• Foster compliance
• Correctly document all actions related to medication
administration and medication errors
 CHARTING MEDICATION
After the administration of the drugs to our client, make sure that
we have to document all the necessary information with the date,
time and your initials on the chart of the client and with the
following:
•Progress note
•Administration
•Special problems encountered:
• New symptoms
• Patient’s statement
• Patient tolerance

Principle of Prevention Needles – stick

injury.
1. Use strict aseptic technique during all steps of preparation and
administration.
2. Avoid touching the tip of the needle, the inside of the barrel,
the shaft of the plunger, or the needle with an unsterile object.
3. Protect the nurse's fingers and face from being cut by glass of
ampoule through place a piece of sterile gauze between thumb
and the ampule neck or around the ampule neck.
4. Perform hand hygiene to reduce transmission of
microorganisms.
 Principles of Prevention Needles- stick
Injury
5. Cleans site of injection with antiseptic swab from center and rotate
outward in circular direction to prevent insertion of microorganism
inside human body.
6. Discard equipment in appropriate area (punctured- proof
container).
7. Careful insert the needle into the upright vial through the center of
the rubber cap.
8. Never bend or break needles before disposal.
9. Recap used needles under specified circumstance by inserting the
needle into cap using one hand.

•Thank you for Listening.

•Caritas Christi Urget Nos