ASSISSTING IN DRUG ADMINISTRATION

NCM 109 RLE

INFANTS AND CHILDREN
PROCESS OF ADMINISTERING MEDICATION
 Knowledge of growth and development is essential
1. Identify the client for the nurse administering medications to children
 Do not ask - “ are you juan dela cruz?”  Oral medications for children are usually prepared in
- the client may answer yes to the wrong name sweetened liquid form to make them more palatable
2. Inform the client  The parents may provide suggestions about what
3. Administer the drug method is best for their child.
4. Record the drug administered  Necessary foods such as milk or orange juice should
ENSURING SAFE MEDICATION ADMINISTRATION not be used to make the taste of medications,
because the child may develop unpleasant
A. Three checks association and may refuse that food in the future.
B. “ Rights of Drug Administration  The nurse needs to acknowledge that the child will
feel some pain; denying this fact only deepens the
THREE CHECKS child’s distrust. After the injection, the nurse or the
parent can cuddle and speak softly to the infant and
1. Before you pour, mix or draw up medication. Check its give the child a toy to dispel the child’s association of
label against the entry on the MAR be sure that he name, the nurse only with the pain.
route, dose and time match the MAR entry ELDERS
2. AFTER you prepare the medication and before  Physiologic changes associated with aging that
returning the container to the medication cart or influence medication administration and
discharging anything, check the label against the MAR effectiveness.
entry again. 1. Altered memory
3. AT THE BEDSIDE, check the medication again before 2. Less acute vision
actually administering it. 3. Decrease in renal function resulting in slower
elimination of drugs and higher drug concentration in
T WELVE RIGHTS OF DRUG ADMINISTRATION the bloodstream for longer periods.
 Right drug 4. Less complete and slower absorption from the
 Right time GIT
 Right administration 5. Increased proportion of fat to lean body mass,
 Right approach which facilitates retention of fat-soluble drugs ans
 Right technique increase potential toxicity.
 Right of the client to be informed of his medication 6. Decreased liver function, which hinders
 Right of client to refuse biotransormation of drugs.
 Right assessment 7. Decreased organ sensitivity, which means that
 Right frequency the response to same drug concentration in the
 Right Documentation vicinity of the target organ is less in older people that
 Right route in the young.
 Right patient 8. Altered quality of organ responsiveness resulting
in adverse effects becoming pronounced before
MEDICATION ADMINISTRATION ERRORS therapeutic effects are achieved
9. Decrease in manual dexterity die to arthritis and
 Can occur at all stages of administration process decrease flexibility.
 Common reason nurses do not follow five rights
 Poor pharmacologic knowledge PS: The route of administration that is chosen may have
 Miscalculations profound effect the speed and efficiency with which the
 Interruptions ( such as monitor alarms, telephones drugs acts
and inquires from family or healthcare team
members )
ORAL MEDICATION
 Increased workloads
 Fatigue ORAL ROUTE
- is the most commonly used for medications.
DEVELOPMENTAL CONSIDERATIONS  The drug is swallowed and absorbed from the
stomach or small intestines.
 It is important for the nurse to be aware of how  ADVANTAGE : convenient, less expensive
growth and development of medications for all age
and safe
groups, particularly the very young and the very old.

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 DISADAVANTAGE : unpleasant taste, irritate  TOPICAL ROUTE - drug acts locally or is absorbed
gastric mucosa, patient must be conscious. directly through skin. This includes lotions, liniments,
 Potential for aspiration ointment and transdermal patch
 May be harmful to the teeth  Lotion - emollient ( softening or soothing agent )
 Onset of action is slow  Liniment - oily liquid to rub into the skin
 Cannot be used if :  Ointment - Semi solid fatty substance for skin or
 Nausea and vomiting mucous membrane
 Decreased gastric motility  Transdermal Patch - Releases constant controlled
 Difficult of swallowing amounts of medication for systemic effect.

DRUGS FORMS SOLID

 Scored tablet - contains an indented mark to be use
for possible breakage into partial doses.
 Enteric coated tablet - contains and acid insoluble
coating that does not dissolve until the tablet reaches
the small intestine.
 Time-released tablet / capsule - designed to be
released and absorbed in stages or gradually over
time.
 Capsule - A gelatinous container that holds the liquid,
powder or oil form of the drug.
- When swallowed the gelatin container dissolves in
the gastric juices.
 Powder - Finely grouped drugs usually mixed with
liquid before ingesting
- Some are used internally or externally and some
are mixed with a diluent
DRUGS FORMS LIQUID
 Syrup - sugar-based liquid medication.
 Suspension - Water based liquid medication.
 Emulsion - oil based liquid medication
 Elixir - alcohol based liquid medication
SUBLINGUAL MEDICATION
SUBLINGUAL ROUTE - is held under the tongue and
absorbed across the sublingual mucus membrane
 ADAVANTAGE :
 Same as oral
 Used for local systemic effect
 Absorbed directly in the blood stream
 DISADVANTAGE
 If swallowed, drug may be inactivated by gastric
juices
 Must remain under the tongue until dissolved
and absorbed.
BUCCAL MEDICATION
 Should not be chewed, swallowed or placed under
the tongue
 ADVANTAGE
 Same as oral
 Drug can be administered for local effect
 Ensures greater potency because drug directly
enters the blood and bypass the liver.
TOPICAL (SKIN) MEDICATION
 Wash hand and pat dry area well before application to
facilitate absorption.
 Use SURGICAL ASEPSIS when open wound is present
 Remove previous application before next application
 Apply only thin layer of medication to prevent systemic
absorption
 Use gloves when applying the medication over large
surface.
OPHTHALMIC MEDICATION
OPTHALMIC ROUTES - includes instillation and
irrigations
 Instillation - to provide an eye medication that the
client requires.
 Irrigation - to clear the eye of noxious or other foreign
material
ADMINISTERING OPTHALMIC MEDICATIONS
 Position client either sitting or lying when applying
 Clean the eyelid and eyelashes with sterile
cotton balls moistened with sterile normal saline
from 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 drop is needed.
 Avoid dropping a solution onto the cornea directly.
 Instruct the patient to close the eyes gently
 For liquid eye medications, press firmly on the
nasolacrimal duct for at least 30 seconds.
OTIC MEDICATION
OTIC ROUTES : includes instillation and irrigations
 Intstillations
 To soften earwax
 To reduce inflammation
 To relieve pain
 Irrigation

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 To remove cerumen or pus

 To apply heat
 To remove foreign body
ADMINISTERING OTIC MEDICATIONS
 Warm solution at room or body temperature
 Side lying position with 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 that 3 years old : pull the PINNA upward
and backward NEEDLES
 Instill eardrops on the side of the auditory canal to  Disposable stainless steels sheaths that attatch to a
allows the drops to flow in and continue to adjust to syringes.
body temperature.
 Press gently but firmly a dew times on the tragus of PARTS OF THE NEEDLES
the ear to assist the flow of medications into the ear
canal
 Press gently but firmly a few times on the tragus of
the ear to assist the flow of medication in the ear
canal
 Insert a small piece of the cotton fluff loosely at the
meatus of the auditory cana for 15-20 minutes.

NASAL MEDICATION
NASAL ROUTE - includes instillation and inhalation

ADMINISTERING NASAL DROPS

 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 client’s tip of the nose. While the client inhaled squeeze  Gauge -Inside diameter of the lumen. “ The smaller
the bottle the gauge, the larger the diameter
 Keep the head tilted backward for 5 minutes after  Needle gauge 14- 30
instillation of nasal drops
 When the medication is used only on a daily basis,
alternate nares to prevent irritation

ENTERAL ( NASOGASTRIC AND GASTROSTOMY )

MEDICATION

 For patient who cannot swallow or who have feeding  Bevel - Slanted tip with a narrow slit
tubes.  Slant is designed to make an opening that will close
TYPES OF NEBULIZER quickly to prevent leakage of medicine, blood and
 Atomizers - disperse the medications in the form of serum.
large droplet
 Aerosol sprayers - suspend the droplets of  Length - The distance from the top to the hub .
medication in a gas. Commonly 3/8 to 3

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PARENTERAL MEDICATIONS
SYRINGES

 Requires sterile technique  INTRADERMAL INJECTION - SUBCUTANEOUS

 Usually made of plastic and are disposable TISSUE
 SOme have the needle attached; others do not  The administration of a drug into the dermal layer
of the skin beneath the epidermis

 Needle : Gauge 25,26,27 ( 10-15 degree angle ;

bevel up)
 Inject a small amount of drug slowly over 3-5
seconds to form a wheal or bleb
 Do not massage the site of injection.

 SUBCUTANEOUS INJECTION
 Drugs administered subcutaneously are as
follows; vaccines , preoperative medications,
narcotics, insulin, heparin

 Ampule : Thin walled disposable glass container with

narrow neck that you must snap off to access the
medications
 Vial : Single dose or multi dose plastic or glass
container with a rubber stopper that seals off
 A plastic or metal cap covers the ribber stopper
to protect it until use.

 A needleless system can extract medicine from a vial

 Only small doses medications should be injected via
this route (0.5-1mL)
 REMEMBER : for repeated injections, rotate sites to
minimize tissue damage, aid absorption and
decrease discomfort
 DO not use sites with lesions or sites over body
prominences, large underlying vessels or nerves

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 Locate the greater trochanter, anterior superior iliac

spine and iliac crest.

DORSOGLUTEAL MUSCLE SITES

 Not recommended for close proximity to sciatic nerve
and gluteal artery
 Contraindicated for infants and children
 Causes paralysis of the leg involved.

 INTRAMASCULAR INJECTION
 Absorbed faster that SC
 Can tolerate 3-4 ml injection
 Always aspirate before injecting medications
 NEEDLE = length is 1’, 1 1/2, .2
 GAUGE 20-23 depending on the viscosity of medication
 23 water bases, 20 viscous DELTOID MUSCLE SITES
 REMEMBER: clean the injection site with alcoholized  Located in the middle pf the third upper arm. Inject
cotton ball, inject the medication slowly to allow the tissue on .5 to 1 ml
to accommodate volume
 Avoid in infants, close to radial nerve and branchial
 SITE: a safe distance from nerves, large blood vessels and
bones, large enough to accommodate the volume of artery.
medication given  Locate the lower acromion process and go 2
 Ventrogluteal site fingerbreadths down. Or place fingerbreads across
 Dorsogluteal site the deltoid muscle, with top finger on the acromion
 Vastus lateralis process. The injection goes 3 fingerbreadths below
 Rectus femoris the process.
 Deltoid
 Z- track technique - seals the need track and prevent VASTUS MUSCLE SITES
medication from leaking out the muscle up through  Located in the antero -lateral thigh
the needle track and into the sc  Preferred site for infants and children
 Drug are rapidly absorbed, accommodate large
volume of medication.

VENTROGLUTEAL MUSCLE SITES

 Common site for adults and infants over 7-12moths
old
 Located on the lateral hip, involves gluteus medius
and minimus
 Safest and least painful site for IM

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 INTRAVENOUS MEDICATIONS
 To prevent complications
- use scrupulous sterile technique
- administer the medication slowly
 Be aware that in addition to the effects of the
medicine, the volume of the fluid infused has
possible consequences
 Observed the patient carefully for signs of
adverse reactions
 Have an antidote on hand if the drug has
potentially serious effects
 Assess the client before, during and after giving
the medication
 Determine that the drug is compatible with the
fluid that is infusing; consult a pharmacist If
necessary.
 Determine that the drug is compatible with the
plastic IV bag and tubing, you may occasionally
need to use a glass IV bottle and special tubing
 Observe the insertion site often; ensure that the
cannula is in the vein before administering.

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