Unit 7 Administration of

medication

What is the difference between medication and

drug?

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Drug :- is any substance that alters physiologic
function, with a potential for affecting health.
Drugs can be taken for therapeutic effects,
recreations, stimulation, & other purposes.
Drugs may have abusive & compulsive nature.
They may result in withdrawal symptoms if
withheld abruptly (eg. cocain, opiates, heroines,
narcotics, and cannabis).
Medication :- is a drug administered for its
therapeutic effects.

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• Therefore all medications are drugs, but not all drugs are
medications
• Giving medication to a client is an important nursing
responsibility, especially in agencies such as hospitals and long-
term care facilities.
• To give a medication nurses need a medication order.
Medication Orders
Drug orders should include the following:
 Full name of a clients
 Generic or trade name of a drug
 The dose, route, frequency of administration,
 Signature of the prescribing physician

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Drug names
Generic name:
Name given before a drug becomes officially approved
as a medication.
Official name:
Name under which it is listed in one of the official
publications
May be the same with generic name

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Drug name...cont…
Chemical name:
Name by which a chemist knows the drug
 Is a precise description of the drug’s composition
(chemical formula)
Trade/brand name:
 Name given by the drug manufacturer
One generic drug may have several trade names based
on the number of companies marketing the drug.
Usually short and easy to remember

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 Ten “Rights” of Accurate Medication
Administration
1. Right medication (Drug)
2. Right dose
3. Right time
4. Right route
5. Right client
6. Right documentation
7. Right client education
8. Right to refuse
9. Right assessment
10. Right evaluation

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The Six Right’s of Medication Administration
1. Right patient = check the name with the order/
medication plan and while giving to the patient.
2. Right medication = Check the label three times,
3. Right route of administration = Check order with
label. Usually route indicated on container.
4. Right dose and concentration = About concentration
see instruction work in good light with good equipment
measurement
5. Right time and frequency of administration =the
drug has to be always at that time ordered.
6. Right documentation; includes time, dose, pt name….
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Types of Medication Orders
Stat order: is an order for a single dose of medication to
be given immediately.
Standing orders: are also referred to as scheduled orders
because they are administered routinely as specified
until the order is canceled by another order.
The purpose is to maintain the desired blood level of
the medication.
 BID- twice daily/ every 12 hrs
 TID- every 8 hrs
 QID- every 6 hrs
PRN orders(as needed): basis as circumstances indicate.
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 Principles of administering
medication
Perform hand hygiene
Clean and organize the work area.
Before administering and prescribed drug, you must
know the safe dose range, purpose of administration,
side effects and any special nursing considerations.
Check the pt’s chart
Check the label of the medication for the expiry date;
do not use it if expired

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Principles….
Prepare the medication using the 5 rights and 3 checks
Bring the medication to the pt’s bedside with the
medication record, at the correct time
Identify the pt by checking his identification band, if
there is no ID band, ask the pt his name. if he is unable
to identify himself, verify with a family member or with
a staff member who knows the pt.
Take the required assessment measures, such as pulse,
blood pressure etc.
Explain the purpose & action of each drug

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Principles….
Ask the pt about any known drug allergies
Administer the medication
Record the medication given on the pt’s medication
administration recorded immediately after it is given
Leave the pt in a comfortable position
Perform hand hygiene
check the amount of medication in the syringe with
the dose ordered and discard any surplus

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Principles….
Medications should not be mixed in the same syringe
unless compatibility of the medications has been
established
Do not re-cap the needle (place in kidney dish or use
the one handed method of replacing the cap)
Discard needle & syringe in puncture resistant
container – do not remove needle from the syringe
first!

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Routes of medication administration
Routes of drug administration determines:
= Onset
= Duration
= Intensity and degree of localization
Absorption of a drug depends on the selection of the
appropriate routes of administration,
The selection depends on:
 Drug factors /physical and chemical property/
 Patient factor /desired site and speed of response

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Routes of Medication Administration
Enteral
Oral (PO)
Sublingual (SL)
Bucal
Parenteral
Subcutaneous (SC)
Intramuscular (IM)
Intradermal (ID)
Intravenous (IV)
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1. ENTERAL ADMINISTRATIONS
A. Oral route / drug swallowed/
 Medication that are given by mouth.
B. Sublingual
• Drug place under the tongue, where it dissolves.
• The drug is largely absorbed in to the blood vessels on the
underside of the tongue in a relatively short time.
• The medication should not be swallowed, e.g. Nitroglycerine
 Advantage - produces rapid action
- No first pass effect
C. Buccal –is held in the mouth against the mucus
membrane of the cheeck until the drugs dissolved.
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Drugs that are given in buccal or sublingual
route have rapid absorption & higher
concentration of a drug in blood than that of
drugs taken per OS to be ingested.
This is because;
There is no first pass metabolism
There is no drug food complex
There is no drug destruction by digestive
enzymes

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Advantage = less expensive
= safe method
= most convenient
=When local effects are desired.
=prolonged systemic action is desired.
Disadvantages
 drugs may have unpleasant taste
 drugs may irritate the gastric mucosa
 drugs may absorbed irregularly from GIT
 drugs may absorb slowly
 In some cases drugs harm the patient teeth
 Emesis of drugs
 May be destructed by digestive enzymes stomach content
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Contraindications
For patient with nausea and vomiting
For unconscious patients
When the patient is unable to swallowing.
When the drug is irritating to mucus membrane &
alimentary canal
When the effect of the drugs is inactivated by the
digestive juice
 NPO patient

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 Procedure
Prepare your tray and take it to
Equipment the patient's room
Begin by checking the order
Tray Place solution and tablets in a
Towel separate container.
Measuring spoon If suspension, shake the bottle
Water well before pouring
Identify the pt. and remain with
Chart and medication the pt. until each medicine is
card swallowed
Ordered medication Offer additional fluid as necessary
Straw if necessary unless contra-indicated
Record the medication given
Take care of the equipment
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 2. parenteral medication
Definition:- Medication that are given by injection or
infusion.
Advantage:-
 absorbed completely and begin acting faster than
medications given by other routes.
 The method of choice in emergences, the answer is rapid,
predictable absorption
 Most efficient method of drug administration
 Fairly quick absorption
 When drug would be altered by the digestive juices
(insulin)
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Disadvantage:-
× May cause damage if administered incorrectly
× Injection abscess can occur
× Accidental penetration of blood vessels may cause
hematoma or necrosis of vessel depends on the
medicine.
× Medication intended for certain injection route is used
for the wrong route may cause tissue damage
× Allergic reaction occurs fast e.g. : anaphylactic shock

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Syringe and Needle
Syringe can be made of glass, metal or plastic
 Syringes are also made in other size level 5, 10, 20 and
50 ml
 Needle – is made of stainless steel
Parts of needle:
Hub:- which fit in to the syringe
Canulla:- hollow tube connected with the hub
Bevel:- the slanted part of the tip of the need

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Parts of syringe
Plunger
Barrel
Hash marks
Use most appropriate
sized syringe for
higher
accuracy TB Syringe

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Fig. 2 Syringes / from top to bottom, 10 ml, 3 ml,
tuberclin, insulin and low dose insulin /

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 Preparing The Syringe
Pull medication into the syringe
Tap the side of the barrel to displace air bubbles
to the distal tip
Express out the excess air bubbles
Confirm accuracy of medication dosage
Rubber edge of the plunger lines up with
the dosage marking on the barrel

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Preparing the Site
Wipe the intended site with alcohol
Start wiping from the center moving outward
Let the site air dry
Introducing alcohol into the site causes irritation
Do not blow on the site to hasten drying – causes
contamination

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I. INTRADERMAL INJECTION
 Definition- It is injection given in to the outer layer of the skin,
in to the epidermis
 The amount to be injected ranges from 0.01-0.1cc. It has slow
rate of absorption.
 Purpose:
 For diagnostic purpose as = Allergic reaction test
 For therapeutic purpose = BCG
 Site of injection
 Inner part of forearm mid way between the wrist and
elbow(frequently used)
 Upper back; across scapula
 Upper chest
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ID injection sites

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 II. Subcutaneous injection /sc/.
 Definition: - Injection of drug under the skin, in the subcutaneous
tissue
 Has usually slowed, sustained and complete absorption.
 Small amounts (0.5- 1m1) of medication using, small gauge needle.
 Purpose
 To obtain quick absorption than oral administration
 To administer medication that are inactivated by GIT enzymes ( E.g.
Insulin, heparin)
 Site of injection
 Outer upper arm
 The abdomen
 The upper buttocks
 Anterior aspect of the thigh
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Sc procedures
Prepare the syringe and needle
Identify the site
Cleanse the site
Pinch a fold of skin up
Quickly dart the needle into the fold at a 450 angle
 900 angle is an alternative especially with ½” needle
Release the fold
Aspirate checking for blood return
Inject steadily
Quickly withdraw the needle and discard
Massage the site to enhance absorption
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NB.
If repeated injections are given the nurse should
rotate the site of injection so the succeeding
injection is about 5 cm away from the previous
one.
Teach diabetic patients to inject them selves their
insulin
Avoid damaged skin, delicate skin hematoma,
oedema

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 III. intramuscular injection /im/
 Definition:- It is administration of medication in to the muscle using
a 3-5ml syringe
 Indication:-
 = For medication that irritate subcutaneous tissue and unsafe to give
Intravenously eg. B. Penicillin
 = When fast absorption is required.
 = When there is a need to administer large dose.
 Sites Selection of the site is
 Dorsogluteal Buttock
 Ventrogluteal
based on
 Thigh(Vastus lateralis & Muscle size
 Rectus femoris) Health status of the pt
 Deltoid Adequacy of blood supply
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Sites of IM
Deltoid

Buttock
Dorsal gluteal
Ventrogluteal

Thigh
Vastus lateralis
Rectus femoris

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 1. VENTROGLUTEAL MUSCLE
It is gluteus medius lies over gluteus minimus
no large blood vessels and nerves
To establish the exact sites:
 Place the palm of the hand on greater trochanter with the
fingers toward the patient head.
 Then place the index finger on the anterior superior iliac
spine and extend the middle finger dorsally
 Palpate the crest of the ileum and press below it.
 The injection site is in the centre of the triangle formed i.e
the index finger, 3rd finger and crest of the ileum.
 Volume 1 – 3 ml
 Good site for children <7months
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Ventrogluteal injection

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2. DORSOGLUTEA SITE

 It is thick muscle of the buttocks.

 The injection site must be chosen carefully to avoid strike of :
- Sciatic nerve
- Large blood vessels & bone
Two methods:

 * First method – divide the buttock by two imaginary lines into 4

quadrant
 draw a vertical line from crest of ileum to gluteal fold
 move a horizontal line from medial fold
to the lateral aspect of the buttock
 choose the upper outer aspect of the
upper outer quadrant
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Second method
palpate the posterior iliac spine then draw an
imaginary line to the greater trochanter of the
femur.
This line is parallel to the sciatic nerve.
the injection site is lateral and
superior of this line.

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Indication:
= used in adult and older children with well developed
muscle.
Contraindication:
=infant under 3 years.
Position when administering drug:
= prone position
= side lying position with the upper leg flexed at the
thigh and knee and placed in front of the lower leg.

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3. VASTUS LATERALIS SITE
It is well developed and thick muscle in both
children and adults.
It is a muscle on side of the thigh
It is strongly recommended site since there is no
nerve and blood vessels near by the muscle.

4. RECTUS FEMORIS
– muscle over the front of the thigh
Can inject up to 5 ml volume
Practice often is to divide larger
volumes into 2 injections of smaller volume
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Thigh Injection Site
To find the site
Place one hand at the top of the
thigh at the groin
Place one hand on the distal (lower) thigh above
the knee
The area between the 2 hands can be used
Anterior surface of the thigh at the
midline is the rectus femoris
Lateral to the midline is the
vastus lateralis

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5. DELTOID
Easily reached
Smaller sized muscle limits volume used =2 ml
maximum
Site is 2 - 3 finger below the acromial process (AC) and
above the armpit crease
Area often identified as a triangle

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Reducing Discomfort Technique
 Select a needle of the smallest gauge
 Be sure the needle is free from medication
 Use the Z-track technique for intramuscular injection to prevent
leakage of medication in to the needle track, thus minimize the
client’s discomfort.
 Inject the medication in relaxed muscle.
 Insert the needle with quick motion and remove quickly with slow
angle os insertion
 Inject the solution slowly
 Hold an alcohol pad against the skin while removing the needle.
 Rotate the site when the client is to receive repeated injection.
 Do not administer more solution on one injection than is
recommended for site.
 Do not inject areas that feel hard on palpation or tender to the
client. 42
IM Technique
Prepare syringe and needle
Identify site
Prepare site – let alcohol air dry
Pull the skin taut
Dart the needle in at 900
The quicker the dart like insertion, the less painful
Slowly and steadily inject the medication
Quickly withdraw needle and properly discard
Massage site – enhances absorption

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Intravenous Administration Route
Quickest route to deliver medication directly into
the bloodstream
Fastest absorption rate
Dependent on adequate perfusion

Site of Injection
Large vein at cubital fossa/ inner aspect of elbow
Visible superficial vein at dorsum of hand/palm
Scalp veins and jugular veins in infant
Vein at inner side of ankle

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Various angles for d/t types of injection

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Procedure
Take equipment to the pt's bed side or room
Explain the procedure to the patient
Draw your medication
Expel the air from the syringe
Select and clean the site; apply tourniquet if IV
Grasp the area between your thumb & forefinger to
tense it(not for Id and IV)
Insert the needle with appropriate elevation
Pierce the skin quickly & advance the needle
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Aspirate to determine that the needle has not
entered in to a blood vessel (for Id, Sc and IM)
Inject the drug slowly.
Withdraw the needle and massage the area with
alcohol swab(Don't massage the site for Id)
Chart the amount and time of administration
immediately.
Take care of the equipment- wash, sterilize and
return to its place
Watch for undesired reaction (side effect of the
drug) etc
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Intravenous infusion
It is the administration of a large amount of fluid
into the system through a vein.
Purpose
 To maintain fluid & electrolyte balance
 To introduce medication particularly antibiotics.

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 Cont…
Equipments
IV fluid as ordered Arm board
Sterile syringe & Bandage & scissors
needle Tourniquet
Rubber & towel I.V pole
Receiver Adhesive tape
Alcohol swabs Medication chart

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Procedures
 Be sure you have right patient and explain the
procedure to the pt.
 Take equipment to the patient's bedside
 Prepare IV solution & tubing; maintaining strict
aseptic technique
 Clamp IV tubing, uncap spike on administration set &
insert into the IV bag
 Flush the tubing with IV fluid until all of the bubbles
are removed; then recap.

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Procedures
 Place rubber & towel under the arm
 Apply tourniquet about 3-8 cm above the intended site
of entry.
 Observe & palpate for suitable vein
 Cleanse the skin with alcohol swabs thoroughly
 Put on clean gloves
 Use the other hand to anchor the vein by applying
traction on the skin a few cms below the insertion site
 Position the IV cannula with the bevel-up

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Procedures….
 Pierce the skin and puncture the vein with the angle
<450
 After first flashback of blood in the chamber of the
stylet; decrease the angle of the cannula and advance
 Release the tourniquet
 Apply pressure to the vein above the cannual tip and
remove the stylet completely & attach the tubing
 Open the tubing clamp to start the flow
 Observe the site for signs of swelling or leakage

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Procedures….
Tape the cannula following hospital policy
Regulate the flow by counting the drops per minute in
the drip chamber
Remove all equipment and dispose of properly
Remove gloves and clean hands
Document procedure on the pt’s chart

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I.V. drop rate calculation
= Volume of the solution in ml X Drops per mL
time in min

Example: Dr’s order on the chart: Give 2 liters 5% DNS in 24/hrs

Answer
Step #1
1. Identify given
 2 liters x 1000 = 2000 mL
 24 hr X 60=1440 minute
 Drops per minute = 20drops/ min
2. Insert the numbers into the formula and calculate
 = 2000ml X 20drops/min = 27.7 (28 drops/min)
1440 minute
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Thank You

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 Quiz-2
1. Write advantages(two) and disadvantages(three) of
oral medication
2. Parentral medicatio is:
A. medication administered by injection
B. given for parents
C. applied on parentral route
D. Need parent control
3. Write at least two sites of IM injection
4. Degree of injection for subcutaneous route