MEDICATION ADMINISTRATION

ROUTES AND COMPUTATION

PREPARED BY: RHYAN ESPERON RN LPT
Metric System
• Convert and compute metric units using simple multiplication and
division.
• Each basic unit of measurement is organized into units of 10.
Multiplying or dividing by 10 forms secondary units.
• In multiplication the decimal point moves to the right; in division the
decimal moves to the left.
• For example:
• 10mg X 10=100mg
• 10mg / 10=1mg
• The basic units of measurement in the metric system are the meter
(length), the liter (volume), and the gram (weight). For medication
calculations only use the volume and weight units.

• Gram = g or Gm
• Liter = l or L
• Milligram = mg
• Milliliter = mL
• A system of Latin prefixes designates subdivision of the basic units:
deci- (1/10 or 0.1), centi- (1/100 or 0.01), and milli- (1/1000 or 0.001).
• Greek prefixes designate multiples of the basic units: deka- (10),
hecto- (100), and kilo- (1000).
• When writing medication doses in metric units, health care providers
and nurses use fractions or multiples of a unit. Convert fractions to
decimals.
• 500mg or 0.5g
• 10ml or 0.01l
• Always place infront of decimal points 0.25g not .25 to prevent errors
Household Measurements
• Equivalents of Measurement
• Metric Apothecary Household
• 1 mL 15-16 minims* 15 drops (gtt)
• 5 mL 1 dram* 1 teaspoon (tsp)
• 15 mL 4 drams* 1 tablespoon (tbsp)
• 30 mL 1 fluid ounce 2 tablespoons (tbsp)
• 240 mL 8 fluid ounces 1 cup (c)
• 480 mL (approximately 500 mL) 1 pint (pt) 1 pint (pt)
• 960 mL (approximately 1 L) 1 quart (qt) 1 quart (qt)
• 3840 mL (approximately 4 L) 1 gallon (gal) 1 gallon (gal)
Solutions
• Nurses use solutions of various concentrations for injections,
irrigations, and infusions.
• A solution is a given mass of solid substance dissolved in a known
volume of fluid or a given volume of liquid dissolved in a known
volume of another fluid.
• 250mg/5ml Powder medicine dissolve in 10ml sterile water
Clinical Calculations
• To administer medications safely, you need to have an understanding
of basic mathematics skills to calculate medication doses, mix
solutions, and perform a variety of other activities.
Conversions Within One System.
• Converting measurements within one system is relatively easy; simply
divide or multiply in the metric system. To change milligrams to
grams, divide by 1000, moving the decimal 3 points to the left.
SAMPLE
• The doctor order 156mg of Paracetamol IV q4H, the available stock is
300mg/2ml. What is the amount to be given?

DOSAGE
------------ X QUANTITY
STOCK
156mg
---------- X 2mL
300MG
= 0.52 X 2mL
=1.04ml
A patient under your care is to receive 375mg of Amoxicillin syrup. The
available medication on hand reads 500mg/5ml, what is the amount to
be given? Show your solution.

375mg
--------- x 5ml
500mg
=0.75 x 5ml
=3.75ml
• The doctor orders 320mg/tab of aspirin to be chewed to a patient
who suffers from myocardial infarction. The available aspirin at the
pharmacy is at 80mg/tab. How many should you let the patient take?

320mg/tab
--------------
80mg/tab
=4 tabs
MEDICATION ADMINISTRATION –
ORDERS & STANDARDS
PREPARED BY: RHYAN ESPERON RN LPT
Types of Orders in Acute Care Agencies
• A medication cannot be given to a patient without a health care
provider order. The frequency and urgency of medication
administration forms the basis for medication orders. Some
conditions change the status of a patient's medication orders.

• Paracetamol 500mg 1 tab PO q4 PRN for temp >37.5C

• Paracetamol 300mg/amp IV q4 PRN for temp >38C
STANDING ORDER
• A standing order is carried out until the health care provider cancels it
by another order or a prescribed number of days elapse. Some
standing orders indicate a final date or number of treatments or
doses.

• Ceftriaxone 750mg IV q8
• Erceflora 1 respule PO BID
• Azithromyzin 500mg 1 tab PO OD for 5 days
• PRN (as needed) when a patient requires.
NALBUPINE 10mg IV q8 PRN for SEVERE PAIN

• SINGLE DOSE ORDER medication to be given once at a specified

time.
A patient is for CT SCAN the doctor order to administer IV CONTRAST
single dose only.

• STAT DOSE medication is to be given immediately and only once.

Hydrocortisone 250mg IV NOW and Diphenhydramine 25mg IV now
PRESCRIPTION
• Pharmacist’s Role –
• pharmacist prepares and distributes prescribed medications.
• Pharmacists work with nurses, physicians, and other health care
providers to evaluate the effectiveness of patients' medications.

• Distribution Systems
• Systems for storing and distributing medications vary.

• Automated Medication Dispensing Systems

• Nurse's Role
• Medication Errors
• Prevent Medication Errors
• Prepare medications for only one patient at a time.
• Follow the six rights of medication administration.
• Be sure to read labels at least 3 times
• Use at least two patient identifiers and review the patient's allergies
whenever administering a medication.
• Do not allow any other activity to interrupt administration of
medication to a patient
• Double-check all calculations
• Do not interpret illegible handwriting; clarify with health care
provider.
• Question unusually large or small doses.
• Document all medications as soon as they are given.
• Evaluate the context or situation in which a medication error
occurred.
• Attend in-service programs that focus on the medications commonly
administered.
• Ensure that you are well rested when caring for patients.
• Involve and educate patients when administering medications.
• Follow established agency policies and procedures
• Components of Medication Orders
• A medication order needs to have all of the following parts:
• Patient's full name:
• Date and time that the order is written:
• Medication name:
• Dosage:
• Route of administration:
• Time and frequency of administration:
• Signature of health care provider:
SIX RIGHTS IN GIVING MEDICATION
1. The right medication
2. The right dose
3. The right patient
4. The right route
5. The right time
6. The right documentation
Maintaining Patients' Rights
• To be informed of the name, purpose, action, and potential undesired
effects of a medication
• To refuse a medication regardless of the consequences
•To have qualified nurses or physicians assess a medication history, including
allergies and use of herbals
•To be properly advised of the experimental nature of medication therapy
and give written consent for its use
•To receive labeled medications safely without discomfort in accordance with
the six rights of medication administration
•To receive appropriate supportive therapy in relation to medication therapy
•To not receive unnecessary medications
•To be informed if medications are a part of a research study
MEDICATION ADMINISTRATION – ORAL
PREPARED BY: RHYAN ESPERON RN LPT
Oral Administration
• easiest and most desirable route for administering medications is by
mouth.
• Patients usually are able to self-administer oral medications.
• Food sometimes affects their absorption so give them on an empty
stomach if absorption is decreased. Likewise give medications with
meals if absorption is enhanced by food
• tablets and capsules
• important precaution is to protect patients from aspiration.
• Proper positioning is essential
• Protecting a Patient from Aspiration
• Know signs of dysphagia
• Assess patient's ability to swallow
• Stop if patient begins to cough.
• Prepare oral medications in the form that is easiest to swallow.
• If a patient has unilateral weakness, place the medication in the
stronger side of the mouth.
• Administer pills one at a time
• Thicken regular liquids or offer fruit nectars if the patient cannot
tolerate thin liquids.
• Some medications can be crushed and mixed with pureed foods if
necessary.
• Avoid straws because they decrease the control the patient has over
volume intake, which increases the risk of aspiration.
• Have the patient hold and drink from a cup if possible.
• Time medications to coincide with mealtimes or when the patient is
well rested and awake if possible.
• Administer medications using another route if risk of aspiration is
severe.
• For powdered medications: Mix with liquids at bedside and give to
patient to drink.
• For crushed medications mixed in food: Give each medication
separately in teaspoon of food. Ensures that patient swallows all of
medicine.
• For lozenges: Caution patient against chewing or swallowing lozenges.
• For effervescent medication: Add tablet or powder to glass of liquid.
Give immediately after dissolving.
• For buccal medications: Have patient place medication in mouth
against mucous membranes of cheek until it dissolves. Avoid
administering liquids until buccal medication has dissolved.
• For sublingual medications: Have patient place medication under
tongue and allow it to dissolve completely. Caution patient against
swallowing tablet
MEDICATION ADMINISTRATION –
TOPICAL AND INHALATIONS
PREPARED BY: RHYAN ESPERON RN LPT
Skin Applications
• Medications such as lotions, pastes, and ointments.
• Create systemic and local effects,
• Apply these medications with gloves and applicators.
• Use sterile technique if a patient has an open wound. Skin
encrustation and dead tissues harbor microorganisms and block
contact of medications with the tissues to be treated.
• Before applying medications, clean the skin thoroughly by washing
the area gently with soap and water.
• When applying ointments or pastes, spread the medication evenly
over the involved surface and cover the area well without applying an
overly thick layer.
• Health care providers sometimes order a gauze dressing to be applied
over the medication to prevent soiling clothes and wiping away the
medication
Nasal Instillation
• Patients with nasal sinus alterations
sometimes receive medications by spray,
drops, or tampons.
• Decongestant spray or drops, used to
relieve symptoms of sinus congestion and
colds.
• Caution patients to avoid abuse of
medications because overuse leads to a
rebound effect in which the nasal
congestion worsens. When excess
decongestant solution is swallowed, serious
systemic effects also develop, especially in
children.
Eye Instillation
• eyedrops and ointments such as artificial tears and vasoconstrictors
• older adults, receive prescribed ophthalmic medications for eye
conditions such as glaucoma or after cataract extraction.
• Follow these principles when administering eye medications:
• Avoid instilling any form of eye medications directly onto the cornea.
The cornea of the eye has many pain fibers and thus is very sensitive to
anything applied to it.
• Avoid touching the eyelids or other eye structures with eyedroppers or
ointment tubes. The risk of transmitting infection from one eye to the
other is high.
• Use eye medication only for the patient's affected eye.
• Never allow a patient to use another patient's eye medications.
Intraocular Administration

• One less common way to administer eye medications is by the

intraocular route.
• These medications resemble a contact lens. You place the medication
into the conjunctival sac where it remains for up to 1 week.
• You need to teach patients how to insert and remove the disk and to
monitor for adverse medication reactions.
Ear Instillation
• Instill eardrops at room temperature
to prevent vertigo, dizziness, or
nausea.
• Although the structures of the outer
ear are not sterile, sterile solutions
are used in case the eardrum is
ruptured. The entrance of nonsterile
solutions into middle ear structures
often results in infection.
Vaginal Instillation
• Vaginal medications are available as suppositories, foam, jellies, or creams.
Solid, oval-shaped suppositories are packaged individually in foil wrappers
and are sometimes stored in the refrigerator to prevent them from melting.
• Foam, jellies, and creams are administered with an applicator inserter. Give
a suppository with a gloved hand in accordance with standard precautions.
• Patients often prefer administering their own vaginal medications and need
privacy.
• Because vaginal medications are often given to treat infection, discharge is
usually foul smelling.
• Follow aseptic technique and offer the patient frequent opportunities to
maintain perineal hygiene.
Rectal Instillation

• Rectal suppositories are thinner and more bullet shaped than vaginal
suppositories.
• The rounded end prevents anal trauma during insertion.
• Rectal suppositories contain medications that exert local effects such
as promoting defecation or systemic effects such as reducing nausea.
• They are stored in a refrigerator until administered.
• Pressurized metered-dose inhalers