Medication Administration SUBLINGUAL AND BUCCAL ROUTE

- The process by which a medicine is Advantages

administered to the patient therapeutically.
- Same as oral, plus:
Medications or medicines - Drug can be administered for local effect
- More potent than oral route because drug
- Are chemicals that are used for diagnosis, directly enters the blood and bypasses the liver
treatment and prevention of disease/s
- All medicines are drugs but not all drugs are Disadvantages
medicines
- If swallowed, drug may be inactivated by
ROUTES OF ADMINISTRATION gastric juice
- Drug must remain under the tongue until
- For small therapeutic molecules, various routes dissolved and absorbed
for drug administration are parenteral - May cause stinging or irritation of the mucous
(intravenous, intramuscular, and membranes
subcutaneous), oral, nasal, ocular, - Drug is rapidly absorbed into the bloodstream
transmucosal (buccal, vaginal, and rectal), and
transdermal. Drug preparation for Oral, Sublingual and Buccal
route
ORAL
Solid
Advantages:
- Tablet (sustained-release, entric coated,
- Most convenient effervescent)
- Usually least expensive - Capsule
- Safe, does not break skin barrier - Caplet
- Administration usually does not cause stress - Pill
- Some new oral medications are designed to - Lozenge
rapidly dissolve in the tongue allowing for - Powder
faster absorption and action
Liquid
Disadvantages:
- Aqueous solution (lipid medicine)
- Drug may have an unpleasant taste or odor - Aqueous suspension (liquid medicine with
- Inappropriate when GI tract has reduced granules)
motility - Syrup
- Inappropriate if client cannot swallow or - Elixir
unconscious - Extract
- Cannot be used before certain diagnostic tests - Tincture
or surgical procedures
- Drug may discolour teeth, harm tooth enamel
- Drug may irritate gastric mucosa
- Drug can be aspirated by seriously ill clients
Use in oral medications - Liniment
- Ointment
- Oral syringe - Gel/Jelly
- Medicine cup
- Dropper TRANSEDERMAL ROUTE
- Pill cutter
Advantages
- Pill crusher
- Mortar and pestle - Prolonged systemic effect
- Few side effects
TOPICAL ROUTE
- Avoid GI absorption problems
Topical applications are those applied to a - Onset of drug action faster than oral
circumscribed surface area of the body. They affect
only the area they are applied. Topical applications Disadvantages
include the following: - Rate of delivery may be variable
1. Dermatologic preperations - Verify that the previous patch has been
removed and disposed of appropriately to
a. Applied to the skin
2. Instillations and irrigations avoid overdose
- Medication leaves an oily or pasty substance on
a. Applied into body cavities or
orifices, such as the urinary bladder, skin sometimes soiling clothes.
eyes, ears, nose, rectum, or vagina MUCUOS MEMBRANE ROUTE
3. Inhalations
a. Administered into the respiratory Includes: Intranasal, Otic, Opthalmic, Intraocular,
tract by nebulizer or positive Vaginal, and Rectal routes
pressure breathing apparatus. Air,
Advantages:
oxygen, and vapour are generally
used to carry the drug into the - Therapeutic effects provided by local
lungs application to involved sites
- Aqueous solution readily absorbed and capable
Advantages
of systemic effects
- Few side effects - Potential route of administration when oral
- Painless routes is contraindicated

Disadvantages Disadvantages

- Drug can enter the body through abrasions and - Mucous membranes are highly sensitive to
cause systemic effects some medication concentration
- Leaves residue on the skin that may soil clothes - Patients with ruptured eardrum cannot receive
ear irrigations
Drug preparation for topical route:

- Cream
- Lotion
Drug preparation for Transdermal and Mucous MEDICATION ORDER
membrane route:
- A written direction provided by a prescribing
- Aqueous solution practitioner for a specific medication to be
- Aqueous spray or foam administered to an individual.
- Cream
Should contain:
- Gel/jelly
- Ointment - Full name of the client
- Lotion - Date and time the order is written
- Suppositories - Name of the drug to be administered
- Vaginal tablets - Dosage of the drug
Given Via: - Frequency of administration
- Signature of the person writing the order
- Inhalation
o for aqueous sprat intranasal (can be Types of medication order
oral*) 1. Standing/Routine order
- Instillation a. May or may not have a termination
o Dropping medicine into the mucous date. A standing order may be
membrane carried out indefinitely until an
- Irrigation order is written to cancel it, or it
o Flushing mucous membranes with large may be carried out for a specified
amounts of medicine number of days.
- Insertion 2. As needed order (PRN order)
o Inserting medicines into vagina or a. Permits the nurse to give a
rectum medication when, in the nurse’s
judgement the client requires it.
UNDERSTANDING MEDICATION ORDER
The nurse must use good
judgement about when the
medication is needed and when it

can be safely administered

 b. Often ordered with the term PRN or
a condition (“for”)
3. Single dose order 5. Now Order
Tranexamic acid 500mg/ ampule
a. Medication to be given once at a
specified time or situation 2ampules IVTT Now
4. Stat order MEDICATION TICKET
a. Indicates that the medication is to
be given immediately and only
once
5. Now order
a. Used when a patient needed a
medication quickly but not right
away as in a stat order
b. The nurse has a maximum of 90
minutes to complete a Now order
given once at one time

EXAMPLES ACUTE CARE GUIDELINES FOR TIMELY

1. Standing/Routine Order ADMINISTRATIO OF SCHEDULED MEDICATIONS
a. Paracetamol 500mg/tab 1tab PO q4
RTC (round the clock)
b. KCl drip of PNSS 1L + 40 Meqs KCl to
run for 8 hours x 3 cycles
c. Furosemide 40mg IVTT q8 with BP
precautions
2. As needed/ PRN Order
a. Clonidine 75mcg/tab 1tab SL q6 for
BP>150/90 mmHg
b. Metoclopramide 10mg IVTT q8 PRN DOSAGE CALCULATIONS
for vomiting Math calculations done for preparing appropriate
3. Single dose order doses of medicines, taking into account conversions
a. Ranitidine 50g/ampule 1 ampule of WEIGHTS AND MEASURES . Mistakes are one
IVTT 1 hour prior to surgery of the common sources of MEDICATION ERRORS
b. Diphenhydramine HCl
50mg/capsule 1 capsule 30 min 1. Be familiar with systems of measurement
prior to blood transfusion 2. Check the available dose and the desired
4. Stat order dose
a. Tranexamic acid 500mg/ ampule 3. Check if there is a need for conversion
2ampules IVTT STAT a. Always round off the the nearest
tenths for decimal.
EXAMPLES OF DOSAGE CALCULATION - The small drawer is labelled with
the name of the client currently in
- Paracetamol 250mg/5ml ¾ tsp PO q4 for fever that room and holds the client’s
o Available: Paracetamol 250mg/5mL medication for the shift or 24 hours.
o Conversion: 2. Automation of Medication Administration
o 1 tsp = 5ml - Client records are all in the
o ¾ tsp = 3.75mL computer
o 3.8mL - No longer requires the use of
- MFA 500mg/capsule PO QID medicine tickets
o Available MFA 250mg - Uses Automated Dispensing System
 MFA 250mg x 2 = MFA 500g (ADS) wherein Medication
 2 capsules Administration Record of the
- Amoxicillin 100mg PO TID patient is encoded. The system uses
o Available Amoxicillin 250mg/5mL scanner.
o Answer: 2mL
- One liter PNSS to infuse ocer 24 hours using a SOME PRACTICE GUIDELINES:
microdrip - Nurses who administer medications are
o Calculate the flow rate responsible of their own actions
o 1000mL x 60gtts/mL÷1440 min - Be knowledgeable about the medications you
o 41.66 or 42 gtts/min administer.
- Use only medications that are in a clearly
10 RIGHTS OF PATIENTS IN MEDICATION
labeled container. Always check for expiration
1. Right Patient date
2. Right Medication - Do not use liquid medications that are cloudy
3. Right Dose or any drug that have color changes
4. Right Time - Calculate drug doses accurately
5. Right Route - Administer only medications personally
6. Right assessment prepared.
7. Right Documentation - Before administering a medication, always
8. Right to Education identify the client correctly.
9. Right Evaluation - Before administering a medication, always
10. Right to Refuse identify the client correctly.
- Do not leave medications at the bedside
MEDICATION DISPENSING SYSTEMS - Review agency protocol on administration of
narcotics.
1. Medication cart
o In preparing medications, separate
- The medication cart is on wheels,
narcotics from other drugs to
allowing the nurse to move the cart
remind you necessary assessment
to outside the client’s room.
must be done prior to
- The cart contains all numbered
administration
drawers that correlate to the room
numbers on the nursing unit.
- Break only scored tablets if necessary to GENERAL PROCESS OF ADMINISTERING DRUGS
obtain the correct dosage.
- Check if agency requires the pharmacy to split 1. Identify the client
a. Use at least two methods of
the medication or if nurses can do it
o If nurses are allowed, use a cutting identifying the client
2. Inform/Educate the client of the medication
or splitting device to cut the
to be administered.
medication
3. Administer the drug appropriately
- If the client has difficulty swallowing, check if
a. Check the drug thrice
the medication can be crushed, then crush
b. Follow manufacturer’s direction
accordingly.
and agency protocol of drug
- Check agency policy
administration
CHECKING OF MEDICATION 4. Provide adjunctive interventions as
indicated
Check three times for safe medication 5. Record the drug administered
administration 6.
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 of 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., bottle

or unused unit-dose medications) against the
MAR before returning to the storage place OR
before giving the medication to the client.