Medication Administration

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 Medication: Concepts
1. Medications are available in a variety of
forms.
2. The form of the medication determines
its route of administration.
3. The composition of a medication
enhances it absorption and metabolism.
4. Many medications come in several
forms so be certain to use the proper
form.

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 Medication: Forms

Caplet – Shaped like a capsule and coated for

easier swallowing

Capsule – powder, liquid or oil in gelatin shell

Tablet – compressed powder

Enteric coated – dissolves in small intestine

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 Medication: Forms

Time release – granules with different coatings, or

some tablets that dissolve slowly

Lozenge – dissolves in mouth

Elixir – mixed with water or alcohol and a sweetener

Syrup – Medication dissolved

in a sugar solution

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 Medication: Forms

Suspension – drug particles in a liquid medium; when

left alone will settle in the bottom

Solution – Sterile preparation that contains water and

one or more dissolved compounds (IM, SQ,
or IV)

Lotion – liquid suspension for skin

Ointment – semisolid (salve another name)

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 Medication: Forms

Paste – semisolid, but thicker than ointment – slower

absorption

Transdermal disk or patch – semi-permeable membrane

disk or patch with drug applied to skin

Suppository – solid drug mixed with gelatin inserted into

body cavity to melt (rectum or vagina)
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 Medication: Pharmacokinetics

• Route: how enter the body

• Absorption: from site into blood
• Distribution: from blood into cells, tissues, or organs
• Action: how a medication acts
• Metabolism: changed to prepare for excretion
• Excretion: how they exit the body

This knowledge is used when selecting timing, route,

risks, and evaluating the response

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 Medication: Actions

Therapeutic Effect: expected Side effect:

or predicted physiological response that a predictable and often unavoidable
medication causes secondary effects produced at a usual
therapeutic dose

Adverse effect: unintended, Toxic effect: develop after

undesirable, and often unpredictable prolonged intake of a medication or
severe responses to medication when a medication accumulates in the
blood because of impaired metabolism
or excretion

Idiosyncratic reaction: Allergic reaction:

Unpredictable. A patient overreacts or Unpredictable. Repeated
underreacts to a medication or has a administration the patient develops an
reaction different from normal allergic response to it, its chemical
preservatives, or a metabolite
 Medication: Dose Responses

Serum half-life: Onset:

Time for serum medication Time it takes after a medication is
concentration to be halved administered for it to produce a
response

Peak: Trough:
Time at which a medication Minimum blood serum
reaches its highest effective concentration before next
concentration scheduled dose
Duration: Plateau:
Time during which the medication is Blood serum concentration is
present in concentration great enough reached and maintained
to produce a response
Medication: Dose Responses
 Medication: Interactions
Occur when one medication modifies the action
of another
A synergistic effect occurs when the combined
effect of two medications is greater than the effect
of the medications given separately

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 Medication: Routes
Oral Parenteral
Sublingual, buccal ID, Sub-Q, IM, IV

Epidural, Intrathecal (brain), Topical (ex. Nitro,

Intraosseous (bone), fentanyl)
Intraperitoneal (abdomen-
ex.chemo), Intrapleural (ex.
Chemo), Intraarterial (ex. Clot
dissolve)

Inhalation Intraocular
 Medication: Factors Influencing Routes
•Oral: convenience vs. tolerance, easy to give, often
produces local or systemic effects
•Injections: infection risk, needle, bleeding, rapid
absorption
•Skin/topical: painless, caution w/abrasions, provides
local effects
•Transdermal: prolonged systemic effects
•Mucous membranes: sensitive, less pleasant,
•Inhalation: provides rapid effect for local
respiratory effect, potential serious side effects

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 Oral Route

Easiest and most desirable

route
Food may decrease
therapeutic effect.
Assess patient’s ability to
swallow

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 Oral Route
Sublingual: under Buccal: inside mouth,
tongue cheek area

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Medication: Nasogastric tube

•Liquid form
•Dissolve in 15-30 ml.
warm water (avoid enteric
coated or time release)
•Flush tube with 15-30 ml
of water between
medications
•Flush afterwards with 30-
60ml
•If to suction, clamp 30 min

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 Nasal Instillation

• May self-administer
• Check nares for irritation
• Nasal packing for bleeding and certain surgeries may be used-
applied by provider

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 Topical Medications

Eye instillation
– Avoid the cornea.
– Avoid the eyelids with
droppers or tubes to
decrease the risk of
infection.
– Use only on the
affected eye. • Elderly may have difficulty with drops
• Risk of transmitting infection from one
– Never allow a patient to eye to the other, do not touch any
use another patient’s part of the eye with eye applicator
eye medication. • Apply ointment along lower eyelid,
drops into conjunctival sac

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 Topical Medications

Ear instillation
– Structures are very
sensitive to temperature.
– Use sterile solutions.
– Drainage may indicate
eardrum rupture.
– Never occlude the ear
canal.
– Do not force medication
into an occluded ear
canal.

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 Topical Medications
Skin
– Use gloves and applicators.
– Use sterile technique if the patient has an open wound.
– Clean skin first—remove tissue and crusting.
– Apply ointments and pastes evenly.
– Follow directions for each type of medication.

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 Topical Medications
– Transdermal patches:
• Remove old patch before applying new.
• Document the location of the new patch.
• Ask about patches during the medication
history.
• Apply a label to the patch if it is difficult to see.
• Document removal of the patch as well.

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 Topical Medications: Vaginal
Instillation
• Vaginal: use gloves, privacy, patient may choose
to self-administer, may need pad to collect any
drainage

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 Topical Medications: Rectal Instillation

• Rectal: gloves, may need lubricant, rounded end

to ease administration, place past the internal
anal sphincter to prevent expelling, do not force

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 Administering via Inhalation

Aerosol spray, mist, or powder via handheld inhalers; used

for respiratory “rescue” and “maintenance”
– Pressurized metered-dose inhalers (pMDIs)
• Need sufficient hand strength for use
– Breath-actuated metered-dose inhalers (BAIs)
• Release depends on strength of patient’s breath.
– Dry powder inhalers (DPIs)
• Activated by patient’s breath
Produce local effects such as bronchodilation
Some medications create serious systemic side effects.

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 Administering via Inhalation
Inhalers: spacer used when pt. unable to do correctly

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 Administering Injections

Each injection route differs based on the types of

tissues the medication enters.
Before injecting, know:
– The volume of medication to administer
– The characteristics and viscosity of the medication
– The location of anatomical structures underlying the
injection site
If a nurse does not administer injections correctly,
negative patient outcomes may result.

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 Minimizing Patient Discomfort

Use a sharp-beveled needle in the smallest suitable length

and gauge.
Select the proper injection site, using anatomical landmarks.
Apply a vapocoolant spray or topical anesthetic to the
injection site before giving the medication, when possible.
Divert the patient’s attention from the injection through
conversation using open-ended questioning.
Insert the needle quickly and smoothly to minimize tissue
pulling.
Hold the syringe steady while the needle remains in tissues.
Inject the medication slowly and steadily.

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 Injections: Intramuscular

Faster absorption than subcutaneous route

Many risks, so verify the injection is justified
Needles
– Very obese: 3 inches; use different route
– Thin: ½ to 1 inch
Amounts:
– Adults: 2 to 5 mL can be absorbed
– Children, older adults, thin patients: up to 2 mL
– Small children and older infants: up to 1 mL
– Smaller infants: up to 0.5 mL

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 Injections: Intramuscular (cont’d)

Assess the muscle before giving the injection.

Properly identify the site by palpating bony
landmarks.
Be aware of potential complications with each site.
The site needs to be free of tenderness.
Aspirate to ensure not in a blood vessel.
Minimize discomfort.
Insertion angle is 90 degrees.

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 Landmarks: Ventrogluteal IM

Three Landmarks: Greater Trocanter, Anterior iliac spine, iliac crest

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Ventrogluteal IM Injection

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Vastus Lateralis Site for IM Injection

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Deltoid Site for IM Injection

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 Z-Track Method in IM Injections

Decreases skin irritation & Seals the medicine in

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 Medication Administration
Injections: Subcutaneous
Medication is placed in loose connective
tissue under the dermis.
Absorption is slower than with IM injections.
Administering low-molecular-weight heparin
requires special considerations.
A patient’s body weight indicates the depth
of the subcutaneous layer.
Choose the needle length and angle of
insertion based on the patient’s weight and
estimated amount of subcutaneous tissue.

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Subcutaneous Injections

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Comparison of Angles of Insertion for
Injections

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 Injections: Intradermal

Used for skin testing (TB, allergies)

Slow absorption from dermis
Skin testing requires the nurse to be able to clearly see the
injection site for changes.
Use a tuberculin or small hypodermic syringe for skin testing.
Angle of insertion is 5 to 15 degrees with bevel up.
A small bleb will form as you inject; if it does not form, it is
likely the medication is in subcutaneous tissue, and the results
will be invalid.

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Types of Syringes

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Parts of a Syringe

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Parts of the Needle

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Types of Needles

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Needle With Plastic Guard

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Medication Administration
Parenteral

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 Medication Administration
Parenteral (cont’d)
If two medications are compatible, they can be mixed
in one injection if the total dose is within accepted
limits, so the patient receives only one injection at a
time.
Mixing medications
– Mixing medications from a vial and an ampule
• Prepare medication from the vial first.
• Use the same syringe and filter needle to withdraw medication
from the ampule.
– Mixing medications from two vials

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Mixing Medications from Two Vials

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 Insulin Preparation

Insulin is the hormone used to treat diabetes.

It is administered by injection because the GI tract
breaks down and destroys an oral form of insulin.
Use the correct syringe:
– 100-Unit insulin syringe or an insulin pen to prepare U-
100 insulin
Insulin is classified by rate of action:
– Rapid, short, intermediate, and long-acting
Know the onset, peak, and duration for each of your
patients’ ordered insulin doses.

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 Mixing Insulins

Patients whose blood glucose levels are well controlled on a

mixed-insulin dose need to maintain their individual routine
when preparing and administering their insulin.
Do not mix insulin with any other medications or diluents unless
approved by the prescriber.
Verify insulin doses with another nurse while preparing them if
required by agency policy.

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 Types of Orders in Acute Care Agencies
Standing or routine: prn:
Administered until the dosage is Given when the patient
changed or another medication requires it
is prescribed
Single (one-time): STAT:
Given one time only for a Given immediately in an
specific reason emergency

Now: Prescriptions:
When a medication is needed Medication to be taken
right away, but not STAT outside of the hospital
 Medication: Orders
Medication: Orders

Patients full name

Date and time order
written
Drug name
Dosage
Route
Time and frequency
Signature of provider

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 Medication Orders - What’s Wrong

Drug + Dose + Route + Time/Frequency

Tylenol 1000mg PO q4 hours prn
Demerol 50mg IM q2hours prn
Synthroid 0.05mcg 1 tablet
Aspirin 2 tabs prn
Colace 100mg PO BID

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 Medication Administration

Pharmacist’s role
– Prepares and distributes medication
Distribution systems (unit dose or automatic medication
dispensing system [AMDS])
– Area for stocking and dispensing medication
Nurse’s role
– Assess patient’s ability to self-administer, determine whether
patient should receive, administer medication correctly, and
closely monitor effects; do not delegate this task.
Medication error

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 Automated Medication Dispensing
System
Automated: control the dispensing of
medications, may be networked with
computerized medical record, may include
controlled substances

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 Medication: Administration Systems

Systems for storing and distributing medications

•Unit dose: 24 hour supply in drawer for each
patient

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 Medications: Seven Rights

Right patient: 2 identifiers (compare name/ID

with MAR)
Right drug: need order, match MAR
Right dose
Right route
Right time: institutional
Right documentation: after it is given
Right to refuse

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 Medication: Nurse Role
1. Follow 7 rights
2. Read labels 3x and compare to MAR
3. Use at least 2 patient identifiers
4. Avoid interruption
5. Double check calculations, verify with another RN, follow policy
6. Question unusual doses
7. Record after medication given
8. Report errors, near-misses
9. Participate in programs designed to reduce error
10.Patient education about medications

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 Medication Errors

Report all medication errors.

Patient safety is top priority when an error occurs.
Documentation is required.
The nurse is responsible for preparing a written
occurrence or incident report: an accurate, factual
description of what occurred and what was done.
Nurses play an essential role in medication
reconciliation.

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 Medication Errors: How does it happen?

• Inaccurate prescribing
• Giving the wrong medication
• Using the wrong route
• Giving at the wrong time
• Extra doses
• Omission of scheduled dose

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 Medication Errors: How does it happen?

• Similar drug names (25%)

• CeFAZolin vs. CefTRIAXone
• Limit verbal orders; follow all procedures
• Use only approved abbreviations, symbols
• OK to question, clarify, repeat
• Occurrence report for errors: nurse’s responsibility, MD
informed, within 24 hours, reflect, context, identify
factors
• Caution with transfers within and between facilities

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 Medication: Error Prevention
•Checking compatibility charts
•Checking kidney or liver function & allergies
•Never administer drugs prepared or documented by
others
•Never leave meds at bedside
•Open med at bedside – check medication sheet with ID
band
•Some drugs require 2 nurses to check (insulin, heparin,
hyperalimentation, etc.)
•Check expiration dates

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 Nursing Diagnoses

•Knowledge deficit regarding drug therapy related to

unfamiliarity with information resources
•Noncompliance regarding drug therapy related to
limited economic resources (or health beliefs)
•In effective management of therapeutic regimen related
to complexity of drug therapy (or knowledge deficit).
•Impaired swallowing related to neuromuscular
impairment

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