Administration

of
Medication
Medication/Drug- a substance
administered for the diagnosis, cure,
treatment, relief or prevention of
disease.
Pharmacology- the study of the effects
of drugs on living microorganisms.
Posology- the study of dosage or amount
of drugs given in the treatment of
diseases
Pharmacy- is the art of preparing,
compounding, and dispensing drugs. The
word also refers to the place where
drugsarer prepared and dispensed.
Prescription – is the written direction for
the preparation and administration of a
drug.
Types of Drug Nomenclature
Chemical name- it describes precisely
the constituents of the drug.
•Carboxymethylsulfanyl/Propanoic
acid
Official name- the name which the drug
is listed in the official publications.
Generic name- is frequently used for the
official name.
•Carbocisteine
Trade/Brand name- the name given to a
drug by its manufacturer.
•Cisflem
Types of Drug Nomenclature
Tablet- a powdered drug compressed
into a harda small disk; some are readily
broken along a scored line; others are
enteric coated to prevent them from
dissolving in the stomach
Tincture- an alcoholic or water-and-
alcoholo slution prepared from drugs
derived from plants
Transdermal patch- a semipermeable
membrane shaped in the form of a disk
or patch that contains a drug to be
absorbed through the skin over a long
period of time
Aerosol spray or foam- a liquid, powder,
or foame dposited in a thin layer on the
skin by air pressure.
Aqueous solution- one or more drugs
dissolved in water.
Aqueous suspension- one or more drugs
finely divided in a liquid such as water.
Caplet- a solid form, shaped like a
capsule,coatedn and easily swallowed.
Capsule- a gelatinous container to hold a
drug in powder, liquid, or oil form.
Cream - a non-greasy, semisolid
preparation usedn o the skin.
Elixir- a sweetened and aromatic
solutionofl alcohol used as a vehicle for
medicinal agents.
Extract- a concentrated form of a drug
made from vegetables or animals.
Gel or jelly- a clear or translucent
semisolid thatq liuefies when applied to
the skin.
Liniment- a medication mixed with
alcohol, oil, or soapy emollient and
applied to the skin.
Lotion- a medication in a liquid
suspensionappliedo to the skin.
Lozenge (troche)- a flat, round, or
ovalpreparationh that dissolves and
releases a drug when held in the
mouth.
Ointment (salve, unction)- a semisolid FORMS:
preparation of one or more drugs used
a. Solid: tablet, capsule, pill, powder
for application to the skin and mucous
b. Liquid: syrup, suspension, emulsion,
membrane.
elixir.
• Enteric coated tablets should not be
Paste- a preparation like an ointment,
crushed before administration.
but thicker and stiff, that penetrates the
• Suspensions are never administered
skin less than ann ointment
intravenously.
Pill- one or more drugs mixed with • If the patient vomits within 20-30 mins.
acohesivea material, in oval, round, or of taking the drugs, notify the physician.
flattened shapes Do not readminister the drug without a
physicians order.
Powder- a finely ground drug or drugs;
2. Sublingual administration a drug is
some are used internally, others
placed in under the tongue, where it
externally
dissolves. In a relatively short time, the
drug is largely absorbed into the blood
Suppository- one or several drugs mixed
vessels on the underside of the tongue.
with a firm base such as gelatin and
The medication should not be
shaped for insertion into the body (e.g.,
swallowed.
the rectum); the base dissolves
Nitroglycerin is one example of a drug
gradually at body temperature, releasing
commonly given in this manner
the drug

Syrup- an aqueous solution of sugar

often used to
disguise unpleasant-tasting drugs

Routes of Drug Administration

1. Oral administration is the most
common, least expensive, and most
convenient route for most clients.
In oral administration, the drug is
swallowed. Because the skin is not
broken as it is for an injection, oral
administration is also a safe method.
• The major disadvantages can include an
unpleasant taste of the drugs, irritation
of the gastric mucosa, irregular
absorption from the GI tract, slow
absorption, and, in some cases, harm to
the client’s teeth.
• For example, the liquid preparation of
ferrous sulfater(iron) can stain the teeth.
3. Buccal means “pertaining to the
cheek.”In buccal administration, a
medication (e.g., at ablet) is held in the
mouth against the mucous membranes
of the cheek until the drug dissolves. The
drug may act locally on themucous
membranes of the mouth or
systemically when it is swallowed in the
saliva
4. Rectal - can be used when drug has
objectionable taste or odor
• Drug released at slow, steady rate
• Provides a local therapeutic effect
5. Transdermal - prolonged systemic
effect
• Few side effects
• Avoids GI absorption problems
• Onset of drug action faster than oral
6. Topical applications are those applied
toa circumscribed surface area of the
body.They affect only the area to which
they are applied.
Topical applications include the
following:
• Dermatologic preparations - applied to
the skin
• Instillations and irrigations- applied
into body cavities or orifices, such as the
urinary bladder, eyes, ears, nose, rectum,
or vagina
•Inhalations - administered into the
respiratory tract by a nebulizer or
positive pressure breathing apparatus.
Air, oxygen, nand vapor are generally
used to carry the drug into the lungs
7. Parenteral administration of
medications -are absorbed more quickly
than oral medications and are
irretrievable once injected. It is an
administration of
medications by a needle and a syringe.
a. Intradermal (ID) - under the epidermis
(into the dermis).
b. Subcutaneous (SC) - in the
subcutaneous tissue (also called
hypodermic)
c. Intramuscular (IM) - into the muscle.
d. Intravenous (IV) - into a vein.
Medication Orders
A physician usually determines the
client's medication needs and orders
medicationst, although in some settings
nursepractitioners and physician
assistants now order some drugs.
Types of Medication Orders
1. Stat order indicates that the
medication is to be given immediately
and only once (e.g., morphine sulfate 10
milligrams IV stat)
2. Single order or one-time order is for
medication to be given once at a
specified time (e.g., Seconal
100 milligrams at bedtime before
surgery)
3. Standing order may or may not have a
termination date. A standing order may
be carried out indefinitely (e.g., multiple
vitamins daily) until an order is written to
cancel it, or it may be carried out for a
specified number of days (e.g., KCl twice
daily × 2 days). In some agencies,
standing orders are automatically
cancelled after a specified number of
days and must be reordered.
4. PRN order, or as-needed order,
permits the nurse to give a medication
when, in the nurse's judgment, the client
requires it (e.g., Amphojel
15 mL prn). The nurse must use good
judgment about when the medication
isneeded and when it can be safely
administered.
Essential Parts of a Medication
Order
1. Client’s full name - the first and last
names and middle initials or names,
should always be used to
avoid confusion between two clients
who have the
same last name.
2. Day, month, and the year the order
was
written. Some agencies also require that
the time of day be written.
3. Name of the drug to be administered
must be clearly written. In some settings
only generic names are permitted;
however, trade names are widely used
in hospitals and health agencies.
4. Dosage of the drug includes the
amount. In many instances the strength.
Ex: Tetracycline 250mg Potassium
chloride 10% (strength) 5 mL (amount)
5. Times or frequency of administration
Ex: QID (four times a day)
Three times a day with meals (TID)
6. Route of administration of the drug.
This part of the order, like other parts,
isfrequently abbreviated
7. Signature of the ordering primary care
provider or nurse makes the drug order a
legal request. An unsigned order has no
validity, and the ordering physician or
nurse practitioner needs to be notified if
the order is unsigned.
Parts of a Prescription
Descriptive information about the client:
name,a ddress, and sometimes age
• Date on which the prescription was
written
• The Rx symbol, meaning “take thou”
• Medication name, dosage, and strength
• Route of administration
• Dispensing instructions for the
pharmacist,for example, “Dispense 30
capsules”
• Directions for administration to be
given to the client, Ex: “take on an empty
stomach”
• Prescriber’s signature
Systems of Measurement
1. Metric System - is logically organized
into units of 10; it is a decimal system.
Basic units can be multiplied or divided
by 10 to form secondary units.
Multiples are calculated by moving the
decimal point o the right, and division is
accomplished bymoving the decimal
point to the left.
The basic units of measurement are the
meter, the liter, and the gram.
Only the measurements of volume (the
liter) and of weight (the gram) are used in
medication administration.
2. Apothecaries’ System
The apothecaries’ system is older than
the metric system. Many now consider
the apothecaries’ system out of date and
have replaced it with the metric system.
The basic unit of weight in the
apothecaries’ system is
the grain (gr), and the basic unit of
volume is the minim. The word minim
means the least.”
In ascending order, the other units
of weight are the scruple, the dram, the
ounce, and the pound. Quantities in the
apothecaries' system are often
expressed by lowercase Roman
numerals, particularly when the unit of
measure is abbreviated. Unlike
othermeasurement systems, the Roman
numeral follows rather than
precedes the unit of measure. Ex: two
grains are written as gr ii. Quantities less
than 1 are expressed as a fraction, for
example, gr 1/6.
3. Household System
Household measures may be used when
more ccurate systems of measure are
not required.
• Included in household measures are
drops, teaspoons, tablespoons, cups,and
glasses.
• Although pints and quarts are often
found in the home, they are defined as
apothecaries’ measures
Converting Weights within the
Metric System
Metric system is based on units of
10.Only three metric units of weight are
used for drug dosages, the gram (g),
milligram (mg),and microgram (mcg):
1,000 mg or 1,000,000 mcg
equals 1 gram (g). Equivalents are
computed by dividing or multiplying.
Ex: To change milligrams to grams,
dividest he number of milligrams by
1,000 or move the decimal point three
places to the left.
Ex: 500 mg = ? Answer = 0.5 g Approximate Weight Equivalents:
Approximate Volume Equivalents:
It is important to put a 0 in front of the
MetricMetric,
and Apothecaries’ Systems
Apothecaries’, and
decimal point; otherwise, the reader may
miss the decimal point and administer a Household System
wrong dose
of medication.
Conversely, to convert grams to Apothecarie
Metric Househol d
milligrams, multiply the number of grams s'
by 1,000, or move the decimal point
three places to the right.
0.006 g = ? Answer = 6 mg
15 minims
1mL 15 drops gtt
(min/m)
Approximate Weight Equivalents:
Metric and Apothecaries’ Systems

4-5mL 1 fluid dram 1 teaspoon

Metric Apothecaries

1mg 1/60 grain 1

4 fluid
15 mL tablespoon
drams
(tbsp)

60mg 1 grain

1 fluid
30mL same
ounce
1g 15 grains

4g 1 dram 500mL 1 pint (pt) same

30g 1 ounce

1000mL 1 quart (qt) same

500g 1.1 pound (lb)

4000mL 1 gallon (gal) same

1000g (1kg) 2.2 pound (lb)
 H : V :: D : x
Methods of Calculating
Dosages Once the equation is set up, multiply the
extremes and the means. Then solve for
BASIC FORMULA x.
The basic formula for calculating drug
dosages is commonly used and easy to Example:
remember: Order: Keflex 750 mg
On hand: Keflex 250 mg capsules

D = desired dose (i.e., dose ordered by

primary care provider)
H = dose on hand (i.e., dose on label of
bottle, vial, ampule)
V = vehicle (i.e., form in which the drug Example:
comes, such as tablet or liquid).
Order: Aspirin gr 10
On hand: Aspirin 325 mg tablets
Example:

1.8= 2 tablets
Example:
Order: Phenobarbital gr ii
On hand: Phenobarbital 30 mg tablets FRACTIONAL EQUATION
METHOD
The fractional equation method is similar
to ratio and proportion, except it is
written as a fraction:

RATIO AND PROPORTION METHOD

The ratio and proportion method is The formula consists of cross multiplying
considered the oldest method used for and solving for x:
calculating dosage problems. The
equation is set up with the known
quantities on the left side (i.e., H and
V). The right side of the equation
consists of the desired dose (i.e., D) and
the unknown mount to administer (i.e.,
x).

Example:
Order: Lanoxin 0.25 mg
On hand: Lanoxin 0.125 mg
tablets
Example:
Order: Atropine gr 1/100
On hand: Atropine 0.4 mg/mL
Ten “Rights” of Medication
Administration
RIGHT MEDICATION
• The medication given was the medication
ordered.
• Read the label on the medication
a. When it is taken from the medication cart
b. Before withdrawing the medication
c. After withdrawing the medication.
• Note expiration date
• Know indication and nursing
considerations
RIGHT DOSE
• The dose ordered is appropriate for the
client.
• Give special attention if the calculation
indicates multiple pills/tablets or a large
quantity of a liquid medication. This can be
an indication that the math
calculation may be incorrect.
• Double-check calculations that appear
questionable.
• Know the usual dosage range of the
medication.
• Question a dose outside of the usual
dosage range
RIGHT TIME
• Give the medication at the right frequency
and at the time ordered according to
agency policy.
• Medications should be given within the
agency guidelines.
• Medication given 30 minutes before or 30
minutes after time ordered is acceptable.
Know the last time of administration for any
PRN drug
• Refer to policy and procedure manual.
**Standard administration times are set by
each facility.
Ex: OD TID BID QID q4
RIGHT ROUTE
• Give the medication by the ordered route.
• Make certain that the route is safe and
appropriate for the client
• If a change in route is needed, request new
order from physician.
• Ex: Tylenol 650mg suppository cannot be
changed to PO route without a new order.
RIGHT PATIENT/CLIENT
• Medication is given to the intended client.
• Check the client’s identification band with
each administration of a medication.
• Identify the patient by asking patient to
state name
• Know the agency’s name alert procedure
when clients with the same or similar last
names are on the nursing unit
RIGHT CLIENT EDUCATION
• Explain information about the
medication to the client (e.g.,why receiving,
what to expect, any precautions)
RIGHT DOCUMENTATION
• Document medication administration after
giving itn not before.
• If time of administration differs from
prescribed time,note the time on the MAR
and explain the reason and
follow-through activities (e.g., pharmacy
states medication will be available in 2
hours) in nursing notes.
• If a medication is not given, follow the
agency’s
policy for documenting the reason why.
RIGHT TO REFUSE
• Adult clients have the right to refuse any
medication.
• The nurse’s role is to ensure that the client
is fully informed of the potential
consequences of refusal and to
communicate the client’s refusal to the
health care provider.
RIGHT ASSESSMENT
• Some medications require specific
assessments prior to administration
(e.g.,apical pulse, blood pressure, lab
results).
• Medication orders may include specific
parameters for administration (e.g., do not
give if pulse less than 60 or systolic blood
pressures less than 100).
RIGHT EVALUATION
• Conduct appropriate follow-up (e.g., was
the desired effect achieved or not?)
• Did the client experience any side effects
or adverse reactions?)
Guidelines in Administering
Medications
• Nurses who administer medications are
responsible for their own actions. Question
any order that is illegible or that you
consider incorrect. Call the person who
prescribed the medication for clarification.
• Be knowledgeable about the medications
you administer. You need to know why the
client is receiving the medication. Look up
the necessary information if you are not
familiar with the medication.
• Keep narcotics and barbiturates in locked
place
• Use only medications that are in a clearly
labeled container.
• Do not use liquid medications that are
cloudy or have changed color.
• Calculate drug doses accurately. If you are
uncertain, ask another nurse to double-
check your calculations.
• Administer only medications personally
prepared.
Before administering a medication, identify
the client correctly using the appropriate
means of identification, such as checking
the identification bracelet.
• Do not leave medications at the bedside,
with certain exceptions (e.g., nitroglycerin,
cough syrup). Check agency policy.
• If a client vomits after taking an oral
medication, report this to the nurse in
charge, or the primary care provider, or
both
•Take special precautions when
administering certain medications; for
example, have another nurse check the
dosages of anticoagulants, insulin, and
certain IV preparations.
• Most hospital policies require new orders
from the primary care provider for a client’s
postsurgery care.
• When a medication is omitted for any
reason, record the fact together with the
reason.
• When a medication error is made, report
it immediately to the nurse in charge, the
primary care provider, or both.
• Always check a medication’s expiration
date.
Check Three Times for Safe
Medication Administration
FIRST CHECK
• Read the MAR and remove the
medication(s) from the client’s drawer.
Verify that the client's name and room
number match the MAR.
• Compare the label of the medication
against the MAR.
• If the dosage does not match the MAR,
determine if you need to do a math
calculation.
• Check the expiration date of the
medication
SECOND CHECK
While preparing the medication (e.g.,
pouring, drawing up, or placing unopened
package in a medication cup), look at the
medication label and check against the
MAR.
THIRD CHECK
Recheck the label on the container (e.g.,
vial, bottle, or unused unit-dose
medications) against the MAR before
returning to its storage place or before
giving the medication to the client
PARENTERAL MEDICATIONS
Parenteral administration of medications -
are absorbed more quickly than oral
medications and are irretrievable once
injected. It is an administration of
medications by a needle and a syringe.
a. Intradermal (ID) - under the epidermis
(into the dermis).
b. Subccutaneous (SC) - in the
subcutaneous tissue (also called
hypodermic)
c. Intramuscular (IM) - into the muscle.
d. Intravenous (IV) - into a vein.
Angles of Insertion for Parenteral Injections
Three Parts of Syringes
• Tip - which connects with the needle
• Barrel - or outside part, on which the
scales are printed
• Plunger - which fits inside the barrel
• The choice of syringe depends on
many factors,such as medication,
location of injection, and type of tissue.
• Syringes ranging from 1 to 3 mL may
have two scales marked on them: the
minim and the milliliter.
• The milliliter scale is the one normally
used; the minim scale is used for very
small dosages.
• The larger sized syringes (e.g., 10, 20,
and 50 mL)are not used to administer
drugs directly but can be useful for
adding medications to IV solutions or
for irrigating wounds.
3-mL syringe marked in tenths (0.1) of mL
and in minims
insulin syringe marked in 100 units
insulin syringe marked in 100 units
Different insulin syringes based on the
amount of insulin required. Note the
difference in the number of units of insulin
per line.
Tuberculin syringe was originally designed to
administer tuberculin solution. It is a narrow
syringe, calibrated in tenths and hundredths of
a milliliter (up to 1 mL) on one scale and in
sixteenths of a minim (up to 1 minim) on the
ther scale. This type of syringe can also be
useful in administering other drugs, particularly
when small or precise measurement is
indicated.
The tip of a syringe varies and is classified
as either a LuerLok or non-Luer-Lok
• A Luer-Lok syringe has a tip that requires
the needle to be twisted onto it to
avoidaccidental removal of the needle.
• The Non–Luer-Lok syringe has a smooth
graduated tip, and needles are slipped onto
it.
Needles are made of stainless steel, and
most are disposable.
Parts of Needles
* Hub - which fits onto the syringe
* Shaft or Cannula - which is attached to the
hub
* Bevel - which is the slanted part at the tip
of the needle
Needles Used for Injections have
Three Variable Characteristics
1. Slant or length of the bevel. The
bevel of the needle may be short or
long. Longer bevels provide the
sharpest needles and cause less
discomfort. They are commonly used
for SC and IM injections. Short bevels
are used for ID and IV injections
because a long bevel can become
occluded if it rests against
the side of a blood vessel.
2. Length of the shaft. The shaft length
of commonly used needles varies from
1/2 to 2 inches. The appropriate needle
length is chosen according to the
client’s muscle development,
the client’s weight, and the type of
injection.
3. Gauge (or diameter) of the shaft. The
gauge varies from #18 to #30. The
larger the gauge number, the smaller
the diameter of the shaft
PREVENTING NEEDLESTICK
INJURIES
Ampules & Vials
Ampule is a glass container usually
designed to hold a single dose of a
drug. It is madeof clear glass and has a
distinctive shape with a constricted
neck. Ampules vary in size from 1 to 10
mL or more.
Most ampule necks have colored
marks around them,indicating where
they are pre-scored for easy opening.
Vial is a small glass bottle with a sealed
rubber cap. Vials come in different
sizes,froms single-use vials to multiple-
dose vials.They usually have a metal or
plastic cap that protects the rubber
seal and must be removed to
access the medication.
 Sites for Intradermal Injections
Examples of vial preparation of a. Inner lower arm
powdered drugs b. Upper chest
c. Back beneath the scapulae
• The left arm is commonly used for TB
1. Single-dose vial
screening and the right arm is used for
Instructions for preparing a single-dose
all other tests.
vial state that 1.5 mL of sterile water is
to be added to the sterile dry powder,
thus providing a single dose of
2 mL. The volume of the drug powder
was 0.5mL. Therefore, the 1.5 mL of
water plus the 0.5mL of powder results
in 2 mL of solution. In other instances,
the addition of a solution does not
increase the volume. Therefore, it is
important to follow the manufacturer’s
directions.
Intramuscular Injection
2. Multidose vial
A dose of 750 mg of a certain drug is
orderedfor a client. On hand is a 10-g Injections into muscle tissue or
multidose vial. Intramuscular Injections (IM) are
The directions for preparation read: absorbed more quickly than
“Add 8.5mL of sterile water, and each subcutaneous injections because of the
milliliter will contain 1.0 g or 1,000 mg.” greater blood supply to the body
To determine the amount to inject, muscles.
the nurse does these calculations:
Factors to consider in selecting the size
and length of the needle
• Muscle
• Type of solution
• Amount of adipose tissue covering the
muscle
• Age of the client

Intradermal Injection

Intradermal (ID) injection is the

administrationof a drug into the dermal
layer of the skin justbeneath the Lateral view of the right buttock
epidermis. This method of showing the three gluteal muscles used
administration is frequently used for for intramuscular injections
allergy testing and tuberculosis
(TB) screening
VENTROGLUTEAL SITE
DORSOGLUTEAL SITE
is in the gluteus medius muscle,which
• Historically, the dorsogluteal site was
lies over the gluteus minimus. The
primarily used for intramuscular
ventrogluteal site is the preferred site
injections. However, this site
for intramuscular injections because
is close to the sciatic nerve and the
the
superior gluteal nerve and artery. As a
area:
result, complications (e.g.,numbness,
• Contains no large nerves or blood
pain, paralysis) occurred if the nurse
vessels.
injected a medication near or into the
• Provides the greatest thickness of
sciatic nerve.
gluteal muscle consisting of both the
• In addition, there tends to be more
gluteus medius and gluteusminimus.
subcutaneous tissue at the
• Is sealed off by bone.
dorsogluteal site. As a result, the
• Contains consistently less fat than the
medication may be injected into the
buttock area, thus
subcutaneous tissue instead of the
eliminating the need to determine the
muscle, which can then affect
depth of subcutaneous fat.
the intended therapeutic effect.

RECTUS FEMORIS SITE

Landmarks for the ventrogluteal site for
an intramuscular injection
• The rectus femoris muscle, which
belongs to the quadriceps muscle
group,is used only occasionally for
intramuscular injections.
• It is situated on the anterior aspect of
the thigh. Its chief advantage is that the
clients who administer their own
injections can reach the site easily.

VASTUS LATERALIS SITE

• The vastus lateralis muscle is usually
thick and well developed in both adults
and children.
• It is recommended as the site of
choice for intramuscular injections for
infants and young children because it is
the largest muscle mass

Landmarks for the rectus femoris

muscle of the upper right thigh,
used forintramuscular injections.
Landmarks for the vastus lateralis site
of an adult’s right thigh, used for IM
injection.
DELTOID SITE
• The deltoid muscle is found on the
lateral aspect of the upper arm. It is not
used often for intramuscular
injections because it is a relatively
small muscle and is very close to the
radial nerve and radial artery.
• It is sometimes considered for use in
adults because of rapid absorption
from the deltoid area, but no more
than 1 mL of solution can be
administered. This site is recommended
for the administration of hepatitis B
vaccine in adults.

The nurse locates the upper landmark

for the deltoid site by placing four
fingers across the deltoid muscle with
the first finger on the acromion
process. The top of the axilla is the
line that marks the lower border
landmark. A triangle within these
boundaries indicates the deltoid
muscle about 5 cm (2 in.) below the
acromion process.

Landmarks for the deltoid muscle of

the upper arm, used for IM injections.

A method of establishing the deltoid

muscle site for an IM injection.