UNIT TWO

medication administration

5/3/2019 Asiya.H 1
Learning objectives
At the end of this lesson learners will be able to:

1. Define the key terms and abbreviations frequently used in

medication administration.
2. Discuss the clinician’s responsibilities in preparation and
administration of medications.
3. Describe factors that can affect a drug’s action.
4. Differentiate b/n allergic reaction, side effects, toxic effect, and
idiosyncratic reaction to medications.
5. Calculate appropriate dosage of medications
5/3/2019 Asiya.H 2
General concepts of pharmacology

• Pharmacology: - is the study of the effects of drugs on

living organisms

• The terms drug and medication are often used

interchangeably by HCWs and lay persons.

• Drug: - is any substance that alters physiologic function,

with the potential affecting health.

• Medication: - a drug administered for its therapeutic

function
5/3/2019 Asiya.H 3
PHARMACOKINETICS
• For a drug to achieve a therapeutic effect, it must proceed
from the point of entry into the body to the tissue with
which it will react.
• Pharmacokinetics refers to the study of the absorption,
distribution, metabolism, and excretion of drugs.
• So drug actions are depend on four properties: absorption,
distribution, metabolism & excretion

5/3/2019 Asiya.H 4
Absorption
• It is the degree and rate of absorption/passage of a drug
from the site of administration into bloodstream.
• It depend on several factors:
 The drug’s physicochemical effects
 Its dosage form
 Its route of administration
 Its interactions with other substances in GI

5/3/2019 Asiya.H 5
Distribution
• It refers to the movement of drugs from the blood into
various body fluids and tissues.

5/3/2019 Asiya.H 6
Metabolism/ biotransformation
• After the medication is absorbed and distributed, the body eliminates the drugs.

• In metabolism, drug is activated & changed into water soluble compound that
can be excreted by body

• Liver is the primary biotransformation organ

• Determined by the presence of :

 Enzymes in the liver cells that detoxify drugs

 Diseases that affect the liver

 Blood flow to the liver

 Substances that affect liver function, and age

5/3/2019 Asiya.H 7
Excretion
• Excretion is the process in which drugs are eliminated from the
body.
• Excretion occurs primarily through hepatic biotransformation
and renal excretion.
• “Drug excretion refers to the movement of a drug or its
metabolites from the tissues back into circulation and from the
circulation into the organs of excretion”
• Factors that affect the kidneys’ ability to excrete drugs include
maturity of the kidneys, circulation,
5/3/2019 Asiya.H and disease. 8
Drug preparation/form
• Drugs are available in many forms for administration by
a specific route
• It determine the route of administration.
• Drugs prepared for administration by one route should
not be substituted by other drug forms.

5/3/2019 Asiya.H 9
Types/ forms of drugs preparations
• Pills
• Powders
• Liquids for drinking or injection
• Suppositories
• Creams
• Ointments
• And inhalants are some of them

5/3/2019 Asiya.H 10
Calculation of Flow Rate
• The flow rate is the volume of fluid to infuse over a set
period of time as prescribed by the health care
practitioner.
• The health care practitioner will identify either the
amount to infuse per hour (such as 125 ml per hour or
1000 ml over an 8-hour period).

5/3/2019 Asiya.H 11
 Calculate the hourly infusion rate as follows:

5/3/2019 Asiya.H
ADMINISTRATION OF MEDICATIONS

• Medications or drugs are given to play important role in

preventing, treating, and curing illness,

• Their administration has become one of the most

important, complex & risk-laden aspects of care.

• It needs a knowledge about drugs (names, preparations,

type, side effect and physiologic factors that affect drug
actions)
5/3/2019 Asiya.H 13
Types of medication orders
• There are four common medication orders
1. Stat order:- medication given single dose immediately and once
• Stat drugs are often prescribed in emergency situations to modify a serious
physiological response
• EX:- Epinephrine (adrenaline) would be carried out immediately
for a client experiencing anaphylactic drug reaction (shock).
2. Single order or one-time order is for medication to be given once
at a specified time Ex- ceftrazone 100 mg 3hrs before surgery.
3. Standing order:- this order may or may not have termination date
may be specified number of days.
• Ex:- Amoxicillin 500 mg TID for 7 day
4. P.R.N order (when ever necessary )
• This permits the clinician to give a medication when his/her
judgment requires.
• Ex:- paracetamol 500 mg po PRN.
5/3/2019 Asiya.H 14
5/3/2019 Asiya.H 15
Components of a drug order
• Name, age, sex of the client

• Name of the medication(generic /trade name)

• Forms of the medication

• Route of administration

• Amount/dose of the medication

• Frequency of the medication

• Duration of the medication

• Date and time of prescription was written

• 5/3/2019
And signature of prescriber Asiya.H 16
Maintaining safety when administering medications
• When you administer drugs, you must follow
certain safety procedures or rules, which are also
known as ‘the five rights’.
• Right medication
• Right dose/amount
• Right route/ method
• Right time
• Right client:
• Never administer a medication that has been
prepared by someone else.
• Do not leave medication at client’s bed side under
the assumption that it will
5/3/2019 Asiya.H
be taken 17
5/3/2019 Asiya.H 18
ROUTES OF DRUG ADMINISTRATION
Definition:
 A route of administration is the path by which a drug, fluid, or other
substance is brought into contact with the body.

Classiffication/include:

 Oral

 Paranteral

 Topical

 Rectal

 Vaginal

5/3/2019
In halation Asiya.H 19
 Routes of administration

5/3/2019 Asiya.H 20
Oral Route

• Most drugs are administered by the oral route because it is the safest,

most convenient, and least expensive method.

• By swallowing.

- It is intended for systemic effects resulting from drug absorption through

the various epithelia and mucosa of the gastrointestinal tract.

• When small amounts of drugs are required, the buccal (cheek) or

sublingual route is used.

• Drugs administered through these routes act quickly because of the oral

mucosa’s thin epithelium and large vascular system, which allows the

drug to quickly be absorbed by theAsiya.H

5/3/2019 blood. 21
Advantages:
Convenient - portable, no pain, easy to take.
Cheap - no need to sterilize
Variety - tablets, capsules, suspensions, mixtures

Disadvantage
1. Sometimes inefficient - low solubility drugs may suffer poor
availability
2. Not suitable for unconscious patient
3. May cause irritation to gastric mucosa, nausea and
4. Effect too slow for emergencies.
5/3/2019 Asiya.H 22
Type of oral medications
• Lozenges (troches) – sweet medicinal tablet containing sugar that
dissolve in the mouth
• Tablets – a small disc or flat round pieces of dry drug containing one
or more drugs made by compressing a powdered form of drugs
• Capsules – small hollow digestible case usually made of gelatin, filled
with a drug to be swallowed by the patients
• Syrups – sugar containing medicine dissolved in water
• Tinctures – medicinal substance dissolved in water
• Suspensions – liquid medication with un dissolved solid particles in
it
• Pills – a small ball of variable size, shape and color sometimes coated
with sugar that contains one or more medicinal substances in solid
form taken in mouth.
• Gargle – mildly antiseptic solution used to clean the mouth or throat
• Powder – a medicinal preparation consisting of a mixture of two or
5/3/2019 Asiya.H 23
more drugs in the form of fine particles
Buccal/Sublingual route
• Some drugs are taken as smaller tablets which are held in the
mouth under the tongue (sublingual tablet).
Advantages
 Avoid hepatic first pass - The liver is by-passed thus there is
no loss of drug by first pass effect for buccal administration.
 Bioavailability is higher.
 Rapid absorption - Because of the good blood supply to the
area, absorption is usually quite rapid.
 Drug stability - pH in mouth relatively neutral ( stomach -
acidic). Thus a drug may be more stable.
Disadvantages
 Holding the dose in the mouth is inconvenient.
 Small doses only can be accommodated easily.

5/3/2019 Asiya.H 24
Parantral Route

• Intradermal

• Subcutaneous

• Intramuscular

• Intravenous

Other parenteral routes include:

• Intrathecal or intraspinal-into the spinal canal

• Intrapleural

• Intraperitoneal-injection into the peritoneum

• Intra-arterial, into an artery;

• Intracardiac, into the heart muscle;

• Intraosseous, into the bone;

5/3/2019 Asiya.H 25
• Intra-articular, into a joint
Administering intradermal injections
• Is an injection given into the outer layer of the skin
(corneum) placed just below the epidermis
Purpose
1. For diagnostic
- TB screening (Mantoux test)
- Allergic tests
2. Therapeutic
- Local anesthesia
- Vaccination
• After administration of medication check for the immediate
reactions of the skin
– 10-15 minutes for TAT
– 20-30 minutes for penicillin
–5/3/2019
72 hrs (48 to 72 hrs) for TB
Asiya.H 26
 ID medi..

5/3/2019 Asiya.H 27
Administering subcutaneous Injections
• Is depositing medication in to the loose connective tissue
underlying the dermis.
• SQ tissue is not richly supplied with blood vessels.
• Drugs commonly given in SQ includes- insulin, heparin, and
allergic medications.
Purpose
 To obtain quicker absorption than oral
 When it is impossible to give medications in other

Injection Sites:
A. Abdomen;
B. Lateral and Anterior Aspects of Upper Arm and Thigh;
C. Scapular Area on Back;
D.5/3/2019
D. Upper Ventrodorsal Gluteal Area. Asiya.H 28
Administering Intramuscular (IM) medications
• IM injection: - is an introduction of a drug into a
body’s system via the muscles.
Purpose:
- To obtain quicker action
- To avoid irritation
- It is more vascular so large volume of drug (up to
5ml) can be injected into develop muscles of adults
• Older infants and children under 2 years should no
receive more than 1 ml of medication

5/3/2019 Asiya.H 29
Intramuscular site selection
• When selecting an IM site, determines if the area is
free of infection, necrosis, bruising & abrasions
• And select safe site away from blood vessels, large
nerves/sciatic and bones
Unless it result in [common complication]:
 Abscesses
 Necrosis
 Skin slough
 Nerve injuries
 Persistent pain
5/3/2019 Asiya.H 30
These common sites include:
• Ventrogluteal site:
 Involves gluteus medium & minimums muscles in hip area
 Recommended for age over seven months.
 Provides the greatest thickness of gluteus muscle,
doesn’t have nerves & blood vessels penetrating it.
 It is also clean and away from bone
Land marks:-
A. Greater trochanter (over which the palm is placed)
B. Anterior superior iliac spine/to w/h index finger points

5/3/2019 Asiya.H 31
5/3/2019 Asiya.H 32
33
 Dorsogluteal site
 Common site for administering IM injections
 Because of potential accidental injury to sciatic
nerve, presence of major blood vessels & bone near
the site; This site should not be preferred/used.
 Studies confirmed that the exact location of the
sciatic nerve varies from one person to another.

 If a needle hits the sciatic nerve, the client may

experience permanent paralysis of the involved leg

5/3/2019 Asiya.H 34
Dorsogluteal muscle

35
 Vastus lateralis site (Anterior lateral thigh)
• Recommended if ventrogluteal site can’t be used
• Preferred site for infants under 7 months of age
• The thigh is divided into three horizontally and vertically.
• The injections are given in the outer middle third.

5/3/2019 Asiya.H 36
5/3/2019 Asiya.H 37
thigh showing the recommended (vastus lateralis) injection site

5/3/2019 Asiya.H 38
5/3/2019 Asiya.H 39
 Deltoid Muscle site
• Located in the lateral aspect of the upper arm.
• It isn’t often used because it is not well developed
in many adults & isn’t capable of absorbing large
amounts (0.5ml-1ml) and used only for adults.
• Damage to the radial nerve and artery is a risk.
Land marks:
• Lower edge of the acromion process
• A triangle is formed at the midpoint in line with the
axilla on the lateral aspect of the upper arm.
• Hepatitis B-virus vaccine should be given only in
the deltoid muscle in adults
5/3/2019 Asiya.H 40
5/3/2019 Asiya.H 41
Intravascular (IV, IA):

 Placing a drug directly into blood stream

 May be -Intravenous (into a vein)
-Advantages
 Precise, accurate and immediate onset of action, 100%
bioavailability.
 When the given drug is irritating to the body tissue if given
through other routes.
 When quick action is desired.
 When it is particularly desirable to eliminate the variability
of absorption.
5/3/2019 Asiya.H 42
Disadvantages
 Risk of embolism
 High concentrations rapidly leading to S/E
 The most dangerous route

5/3/2019 Asiya.H 43
Sites for IV injections
• Dorsal venous network
• Dorsal metacarpal veins
• Cephalic vein
• Radial vein
• Ulnal vein
• Basalic vein
• Median cubital vein
• Greater saphenous vein

5/3/2019 Asiya.H 44
5/3/2019 Asiya.H 45
5/3/2019 Asiya.H 46
vein cut down
Defn:- Dissection of a vein for inserting IV cannula
Purpose
• when vein puncture is difficult /collapsed or inaccessible
• when prolonged, continuous infusion is needed
• when rapid infusion is important

5/3/2019 Asiya.H 47
 IV Complication Assessment Intervention

Infiltration of  Infusion slows/stop  D/C IV & restart

IV solution  No back flow of blood at alternative
 IV site edematous, Painful site.
 Cold/red blanched  Cold compress
 Elevate limb.
Phlebitis  Redness,  Replace IV
/Inflammation of  pain, edema,  Do not massage
vein  heat at site and along vein, the site of
inflammation
Infection  Redness,  Replace IV .

 pain, edema ,  Cold compresses.

 Elevate the limb.
 heat at site and fever.
 Observe signs of
5/3/2019 Asiya.H sepsis 48
Air embolism  Drop in B/P.  Immediately
 Cyanosis. turn person on
 Tachycardia. left side with
 Increases venous pressure head down
 Unconsciousness  Administer O2
 check V/S
 Inform
Hypersensitivity Fever, redness, itching  D/C & inform

reaction  coughing,  Epinephrine.

 Corticosteroid
irritability, dyspnea , cyanosis
 Oxygen/
possible of convulsions,
artificial resp.
unconsciousness, death

5/3/2019 Asiya.H 49
Circulatory  Cyanosis, dyspnea,  check infusion rate
over load  cough, diaphoresis and amount given
frothy or pinkish sputum,  sodium restriction
 ascites, rapid weight gain, and diuretics
pitting edema.
Hypoglycemia Fatigue,  Check sugar level
blurred vision,
diaphoresis irritability,  Check infusion
weakness against order.

Hyperglycemia Fruity breath,  Check sugar level

 polyuria  Check infusion
against order.

5/3/2019 Asiya.H 50
Summary of IM,SQ,IV and ID Injections

5/3/2019 Asiya.H 51
Topical Route
• Topical applications are those applied to:

• A circumscribed surface area of the body

• Or immediately beneath, the point of application

 Routes for topical applications include:

 Dermatologic-applied to the skin
 Transdermal patches
• An adhesive disk secures drug ointment to skin for 24 hours to 7 days.
(E. g nitroglycerin(anti-anginal)

 Instillations & irrigations- applied into body cavities/ orifices such as:
 Urinary bladder, Eyes, ears, nose, rectum and vagina

In this case drugs applied directlyAsiya.H

 5/3/2019 to mucous membranes 52
Applying Topical Medications

Purpose
 To have local effect
 To produce systemic effect
 If the skin is thin and has prolonged contact
• If drug concentration is high
• Gastrointestinal (G1) disturbance
• Reduce the risk of serious side effects

Drugs
• Ointments- provide prolonged contact of a medication with the skin
and soften the skin
• Powders used to promote drying & prevent friction skin
• 5/3/2019 Asiya.H
Creams and oils lubricate and soften the skin 53
Administering Ophthalmic Medications:
 It is application of a medications to the eye

Purpose
 To treat local eye infections
 To dilate pupil for diagnostic purpose
 To aid in controlling intraocular pressure

5/3/2019 Asiya.H 54
Drugs: -
To administer an eye medication, gently press the lower lid down and
have the client look upward while instilling into the lower conjuntival sac

Eye drops/ Ointments - instilled in lower conjuctival sac

5/3/2019 Asiya.H 55
Eye irrigation:-
Purpose:
-To remove secretions/foreign bodies
-To cleanse /soothe the eye
-To remove chemicals that may burn the eye
• Large amount tape water should be used to remove
chemicals like acids.
• Irrigation should continue for at least 15 mint
5/3/2019 Asiya.H 56
Administering Ear medications:
 Instillation of a drug into the auditory canal

Purpose: - For local effects

- To soften the wax
- To relieve pain
- To destroy organisms /insects
• Prepare client for instillation by positioning on side, with the ear
treated to the upper most
• Warm medication bottle in your hand to body To.
• Cold medication can cause nausea or vertigo

5/3/2019 Asiya.H 57
• Infant draw earlobe gently down & backward

• Adult: lift auricle upward and backward.

• Instill medication drops, holding dropper slightly above ear.

• Instruct client to remain on side for 5 to 10 min following

instillation.
Ear Irrigations: -
• Is flushing of external auditory canal

Purpose: - To cleanse (using normal saline)

5/3/2019
- To apply heat Asiya.H 58
Nasal Instillations:
• Administration of drugs into the nose

Purpose: - To treat sinus infections

- To treat nasal congestions

5/3/2019 Asiya.H 59
Rectal instillations:
• Administering drugs rectally
Adivantage:
- For local effect on GI mucosa (promoting defection)
- For systemic effects (provide analgesia, relieve nausea)
- By-pass liver - Some of the veins draining the rectum lead directly to
the general circulation, thus by-passing the liver. Reduced first-pass
effect
- Unable to take drugs orally(unconscious, children)
Disadvantage
- Erratic absorption - Absorption is often incomplete
- Not well accepted

5/3/2019 Asiya.H 60
Vaginal Applications:
• Applying medications intravaginally

Purpose:
- To treat and prevent local infections
- To remove offensive/irritating discharge
- To reduce inflammation
Vaginal medications are available in
• Foam
• Jelly/cream
5/3/2019 Asiya.H 61
Inhalants
• It is the act of drawing of gas vapor or stem into the
lungs for therapeutic purposes
• It could be in dry moist or vapor form
• The inhalants are delivered into the alveoli of the lungs,
which promote fast absorption
• Disadvantage
 Most addictive route of administration because it hits
the brain so quickly
 Difficulties in regulating exact amount of dose

5/3/2019 Asiya.H 62
5/3/2019 Asiya.H 63
BLOOD-TRANSFUSION

5/3/2019 Asiya.H 64
• Unlike many other body systems, the hematologic system truly
encompasses the entire human body

• Blood is a specialized organ that differs from other organs in its

existences in a fluid state
• The volume of blood in humans is approximately 7 to10% of the
normal body weight

• Blood is composed of plasma & various types of cells

 Plasma
 It is the fluid portion w/c consists about 55%
• It contains various proteins, such as:
• Albumin, globulin, fibrinogen,
• Factors necessary for clotting
• Electrolytes, waste products, and nutrients
5/3/2019 Asiya.H 65
 Cellular part

• Around 45% of the blood’s volume

• Has three types of cell:

• Red blood cells (erythrocytes)

• White blood cells (leukocytes)
• Platelets(thrombocytes)

5/3/2019 Asiya.H 66
White Blood Cells
• There are six types of white blood cells
• Neutrophils • Eosinophils
• Basophils • Monocytes
• Lymphocytes • Plasma cells

• The polymorphonuclear cells, neutrophils, eosinophils, and

basophils have granular appearance, hence the name
granulocytes
• The granulocytes and monocytes are responsible for
phagocytosis(cells engulf and dispose of foreign bodies)
• The lymphocytes and plasma cells function mainly as the
body’s immune system
5/3/2019 Asiya.H 67
Type/group and Cross match
• Blood type and cross match is a lab test that identifies the
client’s blood type and determines the compatibility of
blood b/n donor & recipient

• There are four basic blood types: A, B, AB, and O that are
determined by the presence or absence of A or B antigens
• Antigens are substances, usually proteins, that cause the
formation antibodies

• Antibodies are immunoglobulin produced by the body in

response to MO. or other antigenic sub.
5/3/2019 Asiya.H 68
• Type A and type B antigens are agglutinogens,
substances that cause agglutination

• Agglutinins are specific kinds of antibodies

whose interaction with antigens is manifested as
agglutination (clumping of RBCs)

5/3/2019 Asiya.H 69
• Blood types are also classified as either positive or
negative based on presence/absence of the Rh factor

• Rh factor refers to antigen found on the RBC

• Rh positive means the antigen is present

• Rh negative means the antigen is absent

• When factoring the four basic blood types with either Rh

positive or Rh negative factor there are eight possible
combinations

5/3/2019 Asiya.H 70
BASIC BLOOD TYPES

• A positive • A negative
• B positive • B negative
• AB positive • AB negative
• O positive • O negative

5/3/2019 Asiya.H 71
• Cross match determines the compatibility of the donor’s
blood with that of the recipient

• In the laboratory, a sample of the recipient’s blood is mixed

with that of possible donor.

• If the blood sample is compatible, the mixed sample does

not agglutinate

• For example, blood type A negative means that the

person’s blood contains A antigen but does not contain
anti-Rh agglutinins

5/3/2019 Asiya.H 72
Administrating blood transfusion

• Defn:- is the infusion of whole blood or blood

component such as:
• Plasma
• Packed red blood cells or
• Platelets from the healthy person to recipient‘s

5/3/2019 Asiya.H 73
• Blood transfusion can be
1) whole blood or
2) One of the components of blood

Precaution of blood transfusion

• Before initiating the transfusion check the blood group
of the doner with the recipant’s

• All doner’s blood should be checked weather free from

infection/hepatitis “B”, syphilis & HIV

5/3/2019 Asiya.H 74
Reaction Signs and symptoms Management/activities

Allergic reaction -Hives, itching  Stop transfusion

anaphylaxis immediately
 Notify
 Administer
antihistamine
parentrally

Febrile reaction  fever and chills  Stop transfusion immediately

(fever) develops  headache  Treat the symptoms
during infusion  malaise
Hemolytic  immediate onset  Stop transfusion immediately
transfusion  facial flushing  Obtain blood samples
reaction  fever ,chills  Obtain first voided urine
(incompatibility of  headache  Treat shock if present
blood product)  low back pain
 shock
5/3/2019 Asiya.H 75
Circulatory over load  dyspnea  Slow or stop
(too much blood )  dry cough  Monitor
 pulmonary vital signs
edema  Notify

Bacterial reaction  fever  Stop

(present of bacteria)  dry, flushed infusion
skin  Monitor
 abdominal vital signs
pain  Notify
 Administer
antibiotic
stat

5/3/2019 Asiya.H 76
• Questions ??

5/3/2019 Asiya.H 77