MEDICATION ADMINISTRATION

Foundation of Nursing II (FON II)

Nur2202

By:
Zainab Rabiu Abubakar
RN,BNSc,MSc

Department of Nursing Science

Learning Objectives
• At the end of this lecture, the students will be able to:
• Define Medication Administration.
• Describe Various Routes of Medication Administration.
• Discuss the Ten (10) Rights to Ensure Proper Medication
Administration.
• Understand the Drugs Dosage Calculations.
• Describe the Important Points Before Medication
Administration.
 Introduction
• Administration of medication is a basic nursing function that
involves knowledge and skill. The safe and accurate
administration of medication is the most important
responsibility of a nurse.Improper administration can cause
harmful effects. The words medication and drug are generally
used interchangeably, but not all drugs have a medical use.
Only those that have a medical use are classified as
medicines.
 Definition
• A medication is a substance administered for the diagnosis,
cure, treatment, or relief of a symptom or for prevention of
disease.

• A drug is a substance that alters physiologic function, with the

potential of affecting health.

• Medication administration is the process by which the

dosage form is administered into the body for treatment of
various diseases and disorders.
 Drug action
• This refers to the drugs ability to combine with a drug cellular receptor. Thus a drug
depending on the type of cellular receptor can have different actions e.g. local action,
systemic or both.

• Some terms used for drug action include:

 Onset- i.e. the time it takes the body to respond after medication

 Half-life -i.e. the time it takes the body to eliminate half the blood concentration level of
the original drug dose

 Duration- i.e. the time a drug remains in the system in a therapeutic concentration

 Peak plasma level- i.e. time it takes a drug to reach the highest blood concentration

 Trough -i.e. the lowest concentration of drug in the blood immediately before the next
dose is administered.
 Drug action Cont…
• Drug allergy- is an immunologic reaction to a drug.
• Drug tolerance- response to a drug and who requires
increases in the dosage to maintain a given therapeutic effect.
• Toxic effect- when the body cannot metabolize a drug thus
making the drug to accumulate in the blood.
• Idiosyncratic reaction- highly unpredictable response
resulting in overresponse, under response or atypical
response.
 Medication Abbreviations
Abbreviation Meaning
a.c. Before meals
p.c. After meals/After eating
i.c. Between meals
o.d Ones daily/everyday
b.i.d/bd Twice daily
t.i.d/t.d.s Three times daily
Mins Minutes
Hrly/h,hr Hourly/hour
ID Intradermal
SC/SQ Subcutaneous
IM Intramuscular
IV Intravenous
Nocte At night
PO Per oral/ by mouth
Stat/STAT Immediately /at once
Sup Suppositories
Susp Suspension
Cap Capsule
Tab Tablet
 Medication Abbreviations Cont…
Abbreviation Meaning

q.i.d/q.d.s Four times daily

q4h Every four hours

q6h Every six hours

q12h Every twelve hours

Inj injection

inf infusion

gtt drops

c. with
garg gargle

IU International unit

alt alternate

D5W 5% dextrose

D10W 10% dextrose

RS Ringers Lactate solution

NS Normal Saline

MgSO4 Magnesium sulfate

 Types of Drug Preparation
Medications are often available in a variety of forms. The form
of medication determines its route of administration.
• Aerosol • Lozenge (troche)
• Aqueous • Ointment (salve, unction)
• Aqueous suspension
• Paste
• Caplet
• Pill
• Capsule
•
• Powder
Cream
• Elixir • Suppository
• Extract • Syrup
• Gel or jelly • Tablet
• Liniment • Tincture
• Lotion • Transdermal patch
Types of Drug Preparation
 Why Medication Errors ???
Medication errors can occur at all stages of the medication
administration process.

Causes of such errors include:

• Ignorance of appropriate dosage schedules
• carelessness in calculating the dose
• poor writing in prescription
• failure to administer the correct drug.

Failing to apply the drug administration rights

 To Avoid Further Errors

• Adhere to the Rights

• Check the order to be sure that the information is correct ,
note the allergies
• Always double check medication calculation before
administration .
• Documentation.
 Check Three (3) Times for Safe Medication Administration
FIRST CHECK
• Read the Medication Administration Record (MAR) /Drug chart and remove the
medications 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
 Ten (10) Rights of Medication Administration

• 1. Right patient
• 2. Right drug
• 3. Right dose
• 4. Right route
• 5. Right time/Frequency
• 6. Right patient education
• 7. Right documentation
• 8. Right to refuse
• 9. Right assessment
• 10. Right evaluation
 Types of Medication Order
• 1. STAT order indicates that the medication is to be given
immediately and only once e.g inj.Lasix 40mg IV stat.

• 2. SINGLE order or one-time order is for medication to be

given once at a specified time e.g preoperative medications -
Seconal 100 milligrams at bedtime before surgery)
 Types of Medication Order Cont…
• 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).

• 4. PRN order/as-needed order permits the nurse to give a

medication when the patient requires it. It is based on patient
symptoms, such as pain, nausea, or itching. (e.g
Acetaminophen 500 mg PO every 4-6 hours as needed for
pain).
Essential Part of Medication Order
• Full name of the client
• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of administration
• Route of administration
• Signature of the person writing the order
 Routes of Administration
• Oral route
• Parenteral route
• Topical route
• Inhalation
Administration of Oral Medication
 Oral Administration
• Oral administration-medication is defined as the administration of
medication by mouth.

• Sublingual administration –a medication is placed under the tongue to

dissolve.

• Buccal administration- buccal means “pertaining to the cheek.” In buccal

administration, a medication (e.g a tablet) is held in the mouth against the
mucous membranes of the cheek until the drug dissolves.
 Oral Administration

Oral route is the most convenient, safest, painless and least expensive, and it
is the one most common used. The drug is swallowed by mouth, but
contraindicated for patient adversely affected with a swallowing disorder
or a decreased level of consciousness.

Oral preparations forms may be :

 solid (tablets , capsules & powders ) .
 liquid ( suspensions ,elixirs, syrups, mixtures).
Parenteral Administration
 Parenteral Administration
The Parenteral route is when a drug is injected or infused into the body
and shows effects more quickly compare to other route of
administration.
Parenteral route includes;
• Intradermal ID (hypodermic)—under the epidermis (into the dermis)
• Subcutaneous SC — into the subcutaneous tissue, just below the skin
• Intramuscular IM—into a muscle
• Intravenous IV—into a vein
• Intrathecal ---- (into the spinal canal) is most commonly used for
spinal anesthesia.
Angle of Injections
 Intravenous Fluids
• Intravenous fluids (IV Fluids) also known as intravenous solutions, are
supplemental fluids used in intravenous therapy to restore or maintain
normal fluid volume and electrolyte balance when the oral route is not
possible.
 Types of IV Fluids
There are two types of fluids that are used for intravenous
drips; crystalloids and colloids.
 Crystalloid Solutions
• These are the most common types of IV fluid. They contain
small dissolved molecules that pass easily from the
bloodstream into tissues and cells. There are three subgroups
of IV fluids in the crystalloid category:
• Hypotonic
• Hypertonic
• Isotonic
 Hypotonic Solution
• These intravenous solutions increase fluid levels within cells.
This is particularly helpful for conditions such as diabetes,
which may reduce levels of cellular fluid. E.g,
• 0.45% NaCl
• 0.225% NaCl
• 2.5% dextrose in water
 Hypertonic Solution
• A hypertonic solution has a higher concentration of solute
than another solution. E.g,
• 3% NaCl
• 5% NaCl
• 5% dextrose in 0.45% NaCl
• 5% dextrose in 0.9% NaCl
• 5% dextrose in Lactated Ringer’s
• 10% dextrose in water
• 20% dextrose in water
• 50% dextrose in water.
 Isotonic Solution
• Lactated Ringer’s
• Lactated Ringer’s helps people with extensive burns, severe injuries or major loss
of blood. A variation of this isotonic fluid is called Ringer’s Solution, and it is free of
lactate. Often find in emergency rooms, ambulances and other places dealing with
critical health issues.

• 0.9% NaCl
• Normally available as 0.9 normal saline solution.This is salt solution that is used in
clinical practice.
• Its function can range from rehydration, wound cleaning, catheter irrigation, dilute
other medication, etc.

• Two other isotonic solutions are used in more specific circumstances:

• 5% dextrose in water
• This fluid supports hospitalized patients who can’t eat normal food by supplying
them with calories.
• PlasmaLyte
• It shares almost identical electrolyte levels with blood plasma in the body.
 Colloid Solutions

• Colloid solutions stay in the bloodstream and provide

nutrients to help patients regain strength. Colloid IV fluids
include:
• 5% albumin
• 25% albumin
• Hetastarch
Topical Administration
 Topical Administration
• A topical route is a way to deliver medication that is applied
onto a particular part of the body. Drugs can be applied to the
skin or mucous membrane. There are many common forms of
topical medication such as lotions, gels, patches, and
powders, but they are mainly formulated as creams or
ointments.
• Drugs can be applied to the skin or mucous membrane such
as the eyes, ears, nose, urethra, rectum, or vagina.
 Topical Administration
Eye instillation Nasal instillation
Transdermal patch Application to skin
Inhalation
 Inhalation
• Inhalations—administered into the respiratory tract by a
nebulizer or positive pressure breathing apparatus. Air,
oxygen, and vaporization (steam heat) are generally used to
carry the drug into the lungs.
Inhalation
Nebulization
Vaporization
 Drug Dosage Calculations
• There a various formulas used for drug dosage calculations by
nurses both for adults and paediatrics. It is important to use
one method consistently to avoid confusion in calculations
and to promote client safety. When calculating drug dosages,
there are times when the nurse may need to round numbers.
• However the common one for adults are based on ratio
(desired over have method) i.e.
x quantity = amount required
 Paediatrics Dosage Calculations
• There are several rules devised to calculate the doses in
infants and children. This includes Fried’s rule, Young’s rule,
Clark’s rule, etc.
• It is important for the nurse to know that all these rules are
for an approximate dose which might need to be adjusted
based on the child’s response.
• Also, all calculations are based on proportionate adult doses.
 Paediatrics Dosage Calculations Cont…

• Children's doses may be calculated from adult doses by using

age, body-weight, or body-surface area
• Body-weight may be used to calculate doses expressed in
mg/kg.
Example 1:
• A child is ordered 90 mg of oral
paracetamol(syrup). The bottle contains 120 mg
in 5 ml. How many milliliters will you administer ?
Answer
• Prescribed dose (D) X quantity= amount required
• Dose on hand (H)
90 x5 = 3.75ml
120
Example 2:
• A 34 kg child is ordered Erythromycin(oral
suspension) 40mg/kg/day, in 4 doses per
day , how many mg/dose will you give ?
• Drug dose x body weight
• Answer divide by 4 doses
40mg x 34 kg = 1360 mg/day
1360 = 340 mg per dose
4 doses
Example 3:
• Ali is ordered 15 mg of Gentamycin IV
injection . (80mg in 2 ml) How many milliliters
will you administer ?

• Answer
15 x 2 = 0.37ml (0.4ml)
80
 How to Calculate IV Flow Rate
• it may be measured as ml/hour or liter/hour or drops/min
• The dropper of the drip set can give number of drops /ml (the
drop factor)
( check the manufactures for drop factor)
• Common drops factors are :
1. 10drops/ml = blood set
2. 15drops/ml = regular set
3. 60 drops /ml = microdropper

Note:The common constant drop factor for adults is 15 while for

children is 60.
 Metric Conversions

• 1 kilogram = 1000grams
• 1 gram = 1000 milligrams
• 1 milligram = 1000 micrograms
• 1 litre = 1000 millilitres
 Calculate IV Flow Rate (drops/min)
• The formula :

Volume (ml) x drop factor(drops/ml)

time(min)

= drops/min
Example 1:
• 1.5 liter of saline is ordered over 12hrs using
15 drops/ml (drop factor), how many
drops/min needed to be delivered ?

• Answer = 1500(ml) x 15(drops/ml)

12 x60(total min)

= 31 drops/min
Example 2:
• The Dr. ordered 500 ml of 1/5 dextrose saline
for Ali over 8 hours , how many drop/min will
you give by regular drip set ?

Answer = 500 (ml) x 15 (drops/ml)

8 x60 (total min)

15.6 = 16 drops/min
 Calculate IV Flow Rate (ml /hrs)
Formula : ( using infusion or syringe pump)
Volume (ml)
time(hrs)
= ml/hr
• E.g 1 liter to be given for 24hrs ,how many ml
to be infused /hr? = 1500 (ml)
24
= 41.6ml/hr
 Tablet Dose Calculation

Required dose
Stock dose = tablets to be given
Example:
• 1.5mg of drug is prescribed for a patient nocte. Each tablet comes in 3mg.
How many tablets do you administer?

• Answer
• Cross multiply & solve for
tablet= tabletx1.5mg
1 tab-----3mg
tablet----1.5 mg
÷3= 1.5x1 ÷ 3

𝒙=¿= (1.5mg ÷ 3mg)

0.5 tablet (half tablet)
 Documentation in Medication
Administration
• One of the most important rules in drug administration is
documentation.
• Thus in the event that the drug is not given due to client’s
refusal or absence during medication it must still be
documented.
• The nurse should document that a drug has been given after
the client has received the drug.
 Important Points to Remember in
Medication Administration
• Do not administer a medication prepared by another person
• Consider client’s concerns during medication
• If medication is not given, such action must be documented
with reasons
• Do not leave medication by the bedside of the client
unattended
• Sign all actions
References
 Kozier & Erb’s Fundamentals of Nursing,concept,process, and
practice,Tenth Edition.Audrey Berman and,Shirlee Synder 2016.
 www.nottingham.ac.uk/nmp/sonnet/rlos/placs/skin-prep/
 www.nottingham.ac.uk/nmp/sonnet/rlos/placs/injectionsites
 www.nottingham.ac.uk/nmp/sonnet/rlos/placs/subcutaneous