MEDICATIONS

FOUNDATIONS IN NURSING
Medication Administration
 A basic nursing function that involves skillful
technique and consideration of the patient’s
development and safety.

 The nurse needs a knowledge base about drugs,

including drug names, preparations,
classifications, adverse effects, and physiologic
factors that affect drug actions.
DRUG OR
MEDICATION
 Is any substance that
modifies body
functions when taken
into the body.
 A substance
administered for
diagnosis, cure,
treatment, relief, or
prevention of disease.
TYPES OF DOCTOR’S
ORDER
 1. STANDING ORDER – carried out as specified until it is
cancelled by another order.
 A specified set of standing order for all hospitalized
patient
 Physicians write a standing order and its cancellation
simultaneously
 Certain order is to be carried out for a stated number of
days or times.
 May include PRN orders
 Digoxin 0.2 mg PO q.d.
 2. p.r.n. order (“as needed”)
 The patient receives medication when it is requested or
needed
 Commonly is written for post operative pain medications
 E.g., Tylenol 650 mg q3-4h PRN for headache
 3.SINGLE ORDER – the directive is carried out
only once, at a time specified by the physician.
 E.g. Medication to be administered immediately before
surgery
 Versed 2 mg IM at 7 AM on 12/5/08
 4.
STAT ORDER
Is also a single order
But it is carried out immediately or at once
E.g., a STAT order for epinephrine or an
Antihistamine would be carried out
immediately for a patient who is experiencing
an anaphylactic drug reaction
Morphine sulfate 2 mg IV STAT
 PARTS OF THE MEDICATION ORDER

 Patient’sname
 Date and time the order is written
 Name of drug to be administered
 Dosage of the drug
 Route by which the drug is to be
administered
 Frequency of administration of the
drug
 Signature of person writing the order
 Patient’s name:
 patients full name is used
 Middle name and initial
should be included to avoid
confusion with other patients
 In some agency the patient’s
full name and identification
number and the physicians
name are imprinted on all
sheets of the patient charts
 Date and Time the order is written:

Date and time help to prevent

errors of oversight as different
nurses take charge of the unit.

The date and time are important

so that the discontinuation date
and time can be determined
accurately.
Routes for Administering
Drugs
 Oral Route
 Enteral Route
 Sublingual administration
 Buccal administration
 Parenteral Route
 Subcutaneous injection
 Intramuscular injection
 Intradermal injection
 Intravenous injection
 Topical Route
Vaginal administration
Rectal administration
Inunctions (rubbing drugs
into the skin)
Instillation
Irrigation
Skin application
THE FIVE PLUS FIVE RIGHTS
OF DRUG ADMINISTRATION
 The RIGHT Client
 The RIGHT Drug
 The RIGHT Dose
 The RIGHT Time
 The RIGHT Route
 The RIGHT Assessment
 The RIGHT Documentation
 The client’s RIGHT to Education
 The RIGHT Evaluation
 The client’s RIGHT to Refuse
PRINCIPLES IN
ADMINISTERING
MEDICATIONS
 Observe the ten rights of drug administration
 Practice Asepsis
 Nurses who administer medications are
responsible for their own action
 Be knowledgeable about the medication that
you administer
 Keep narcotics in locked place
 Use only medications that are in
clearly labeled container.
 Relabelling of drugs is the
responsibility of the pharmacist
 Return liquid that are cloudy in color
to the pharmacy
 Before administering the medication,
identify the client correctly
 Do not leave the medication at the
bed side. Stay with the client until
he/she actually takes the medication.
 The nurse who prepares the drug
administers it. Only the nurse who
prepares the drug knows what that drug
is.
 If the client vomits after taking the
medication, report this to the nurse in
charge or physician.
 Pre operative medications are usually
discontinued during the post operative
period unless ordered to be continued.
 When medication is omitted for any
reason, record the facts together with
the reason
 When medication error is made, report
it immediately to the nurse in charge or
physician.
 GUIDELINES FOR CORRECT
ADMINISTRATION OF
MEDICATIONS
 PREPARATIONS:
 Wash hand before preparing medications
 Check for drug allergies; check assessment
history and kardex
 Check medication order with health care
provider’s orders, kardex, medicine sheet and
medicine card.
 Check label on drug container three times
 Check expiration date on drug label
 Recheck drug calculation of drug
dose with another nurse
 Verify doses of drugs that are
potentially toxic with another nurse
or pharmacist
 Pour tablet or capsule into the cap of
the drug container. Open packet at
bedside after verifying client
identification
 Pour liquid at eye level. Meniscus,
the lower curve of the liquid should
be at the line of desired dose.
 Dilute drugs that irritate gastric
mucosa or give with meals.
Administration
 Administer only those drugs that you have
prepared. Do not prepare medications to be
administered by another.
 Identify the Client by ID band
 Offer ice chips to numb taste buds when giving
bad tasting drugs
 When possible, give bad tasting medications
first, followed by pleasant tasting liquids
Administration

 Assist the client to an appropriate

position, depending on the route of
administration.
 Stay with the client until the
medications are taken
 Administer no more than 2.5 to 3 ml of
solution IM at one site.
 Infants receive no more than 1 ml of
solution IM at one site
 Never recap needles
Administration
 When administering drugs to a group of clients, give drug last
to clients who need extra assistance.
 Discard needles and syringes in appropriate container.
 Discard unused solution from ampules
 Appropriately store (some require refrigeration) unused stable
solutions from open vials
 Write date and time open and your initials on the label
 Keep narcotics on a double locked drawer or closet.
Administration

 Keys to the narcotics drawer must be kept by the nurse and

not stored in a drawer or closet.
 Keep narcotic in a safe place, out of reach of children and
others in the home.
 Avoid contamination of one’s own skin or inhalation to
minimize chances of allergy or sensitivity development.
RECORDING
 Report drug error immediately to client’s health
care provider. Complete an incident report.
 Charting: Record drug given, dose, time, route
and your initials.
 Record drug promptly after given, especially
STAT doses
Administration

 Report effectiveness and results of

medication administered.
 Report to health care provider and
record drugs that were refused with
reason for refusal.
 Record amount of fluid taken with
medications on input and output chart
BEHAVIORS TO AVOID DURING
MEDICATION ADMINISTRATION

 Do not be distracted when preparing medications

 Do not give drugs poured by others
 Do not pour drugs from containers with label that are
difficult to read or whose label are partially removed
or have fallen out.
 Do not transfer drugs from one container to another
 Do not pour drugs into the hand
BEHAVIORS TO AVOID DURING
MEDICATION ADMINISTRATION
 Do not give drugs for which the expiration date has passed
 Do not guess about drugs and drug doses. Ask when in
doubt.
 Do not use drugs that have sediment, are discolored and are
cloudy.
 Do not leave medications by the bedside or with visitors
 Do not leave prepared medications out of sight
BEHAVIORS TO AVOID DURING
MEDICATION ADMINISTRATION
 Do not give drugs if the client says he or she has allergies
to the drug or drug group.
 Do not call the client’s name as a sole means of
identification
 Do not give drug if the client states the drug is different
from the drug he or she has been receiving. Check the
order.
 Do not recap needles
 Do not mix with large amount of foods or beverage or
foods that are contraindicated.
FORMS AND ROUTES FOR
DRUGS ADMINISTRATION
1. ORAL ROUTE

Advantages:
 Most convenient
 Usually less expensive
 Safe does not break skin barrier
Oral Form
 Disadvantages:

 Inappropriate for client with nausea and vomiting

 Drug may have unpleasant taste and odor
 Inappropriate if client cannot swallow (Dysphagia)
 Drug may discolor the teeth
 Drug may irritate gastric mucosa
 Drug may be aspirated by seriously ill patient
 There are a variety of forms and routes for the
administration of medications: (tablets, capsule, liquids,
suspensions, elixers)
Drug forms for oral administration:
 A. Solid – tablet, capsule, pill, powder
 Tablets and Capsule:
 Oral medications are not given to clients who are
vomiting, lack a gag reflex, or who are comatose.
 Do not mix with a large amount of food or beverage or with
contraindicated food
 Do not mix with infant formula
 Enteric coated and timed-released capsules must be
swallowed whole to be effective.
 Administer irritating drugs with food to decrease GI
discomfort
 Administer drugs on an empty stomach if food interferes
with medication absorption
 Drugs given sublingually (placed under tongue) or buccally
(place between cheek and gums) remain in place until fully
absorbed. (no food or fluids should be taken while the
medication is in place)
 B. LIQUIDS – syrup, suspension, emulsion, elixir, milk, or
other alkaline substances
 Read the label to determine whether dilution or shaking is
required.
 The meniscus is at the line of desired dose
 Many liquids require refrigeration once reconstituted

FORMS OF LIQUID PREPARATIONS

 Syrup – sugar – based liquid medication
 Suspension – water-based liquid medication shake the
bottle before use of medication to properly mix it.
 Emulsion – oil-based liquid medication
 Elixir – alcohol-based liquid medication
SUBLINGUAL ROUTE
 A drug that is placed under the tongue, where it dissolves
 When the medication is in capsule and ordered sublingually,
the fluid must be aspirated from the capsule and placed
under the tongue.
 Advantages:
 Same with oral
 Drug can be administer for local effect
 Drug is rapidly absorbed in the bloodstream
SUBLINGUAL ROUTE
Disadvantages:

 A. if swallowed, drug may be inactivated by gastric juices

 B. drug must remain under the tongue until dissolved and

absorbed
BUCCAL
 A medication is held in the
mouth against the mucous
membranes of the cheek until
the drug dissolves
 The medication should not be
chewed, swallowed, or place
under the tongue
 The nurse may offer the patient
a drink of water or oral care.
This ensures that the tablet will
dissolve appropriately.
Midazolam is used for:
 Emergency treatment of
seizures
 Sedation during medical
procedures.
BUCCAL
Advantages:
 Same with oral
 Drug can be administered for local effect
 Ensures greater potency because drug directly enters the
blood and by pass the liver.

Disadvantages:
 If swallowed, drug may be inactivated by gastric juice.
 TOPICAL
 Application of medication to a
circumscribed area of the body.
 Intended for direct action at a particular
site.
 If the site of application is readily
accessible, such as the skin, an agent can
be easily place on it
 If it is a cavity, such as the nose, a
mechanical applicator is needed.
Types of Topical application

1. Dermatologic – includes lotion, liniments and ointments

2. Opthalmic – includes instillations and irrigations
1. Instillations – to provide an eye medication that the
client require
2. Irrigation – to clear the eye of noxious or other foreign
material
3. Otic – includes instillation and irrigations
 INSTILLATION
 To soften earwax
 To reduce inflammation and treat
infection
 To relieve pain

 IRRIGATION
 To remove cerumen or pus
 To apply heat
 To remove foreign body
 D. NASAL
 To loosen secretions and
facilitate drainage or treat
infection of the nasal cavity or
sinuses

 E. INHALATION
 Use of nebulizer, (MDI)
Metered dose inhalers

 F. VAGINAL
 Drug Form: tablet, liquid,
cream, jelly, foam and
suppository
Vaginal
 Creams, foams, and tablets
can be applied intravaginally
using a narrow, tubular
applicator with an attached
plunger.
 Suppositories is
administered by vaginal
insertion. Should be
refrigerated for storage.
 Ask patient to void before
inserting the medication.
RECTAL INSTILLATIONS
 Can be used when the drug
has objectionable taste or
odor
 Use primarily for their local
actions such as laxative and
fecal softeners.
 After the drug is inserted, the
patient should remain in that
position for 5 minutes.
 If laxatives, it must remain in
position for 35 to 45 minutes.
Glycerin suppositories Acetaminophen/paracetamol
suppositories

Eucalyptol suppository for tx of

some upper respiratory ailments
PARENTERAL
 Safety is always a special concern with
parenteral medication.
 There are multiple types of parenteral route:
 INTRADERMAL
 SUBCUTANEOUS
 INTRAMUSCULAR
 Z-TRACT TECHNIQUE
 INTRAVENOUS
jhdsakd
Parts of a Needle

“The larger the gauge the smaller the diameter of the shaft”
SYRINGES
 Tip
 Barrel
 Plunger
RECOMMENDED NEEDLE
SIZES
INTRADERMAL injection
 The administration of drug into the dermal layer
of the skin beneath the epidermis.
 Action:
 Local effect
A small amount is injected so that volume
does not interfere with wheal formation or
cause a systemic reaction
 Used for observation of an inflammatory
reaction to foreign proteins. (tuberulin testing)
SITES:
 Locations are chosen so that an inflammatory
reaction can be observed.
 Preferred areas are lightly pigmented, thinly
keratinized, and hairless, such as the ventral
midforearm, clavicular area of the chest and scapular
area of the back.
EQUIPMENT
 Needle: 26 – 27 gauge
 Syringe: 1ml calibrated in 0.01 ml increments
(usually 0.01-0.1ml injected)
Techniques for ID
 Cleanse the area using a circular motion;
observe sterile technique
 Hold the skin taut
 Insert the needle, bevel up, at a 10-15 degree
angle; the outline of the needle under the skin
should be visible
 Inject medication slowly to form a wheal (blister
or bleb)
 Remove the needle slowly; do not recap
 Do not massage the area; also instruct the client no to do so
 Mark the area with a pen, and ask the client no to wash it off
until read by a health care provider.
 Assess for allergic reaction in 24 to 72 hours; measure the
diameter of local reaction. (indurated area are assessed, do
not include redness)
SUBCUTANEOUS injection
 Into the subcutaneous tissue,
lies between the epidermis
and the muscle
 SITE: outer aspects of the
upper arm, abdomen, anterior
aspect of the thigh, upper
back, upper ventral or dorso
gluteal area.
 Used to administer insulin,
heparin, and certain
immunizations
 Action:
 Systemic effect
 Sustained effect; absorbed mainly through the capillaries
 Usually slower in onset than with the IM route
 Used for small doses of nonirritating water soluble drugs.

 Equipment:
 Needle: 25 – 27 gauge, ½ - 5/8 inches in length
 Syringes: 1 to 3 ml (usually .5 to 1.5 ml injected
 Insulin syringes measured in units for use with insulin only
Technique:

 Cleanse the area with a circular motion using

sterile technique
 Pinch the skin
 Insert the needle at an angle appropriate to body
size: 45 to 90 degrees
 Release the skin
 Aspirate except with heparin
 Inject the medication slowly
 Remove the needle quickly; do not recap
 Gently massage the area, unless contraindicated
as with heparin
 Apply gentle pressure to the injection site if the
client is on anticoagulant therapy to prevent
bleeding or oozing into the tissue and
subsequent bruising and tissue damage.
 Apply bandage if needed.
INTRAMUSCULAR (IM)

 Into the muscle

 The selection of a safe site away from large
nerves, bones and blood vessels.
 Often used to administer drugs that are
irritating, because of few nerve endings.
 It is best to palpate a muscle before injecting
 Action:
 Systemic effect
 Usually more rapid effect of drug than with SC route
 Used for irritating drugs, aqueous suspensions, and
solutions in oil.
 Sites:
 Adequate muscle size and minimal major nerves and
blood vessels in the area.
 Ventrogluteal, dorsogluteal, deltoid, vastus lateralis
 Equipment:
 Needle 20 to 23 gauge; 18 gauge for blood products; 1 – 1.5
inches in length.
 Technique:
 Same as for SC injections, with two exceptions: flatten
the skin area using the thumb and index finger and
injects between them; insert the needle at a 90 degree
angle into the muscle.
 Syringe: 1 to 3 ml (usually .5 to 1.5 ml injected)
Preferred IM injection site:
 VENTROGLUTEAL: volume of drug
administered is 1 – 3ml, with a 20 to 23
gauge, 1.25 – 2.5 inch needle.
 Slightly angle the needle with iliac crest.

 DORSOGLUTEAL: volume of drug

administered is 1 -3 ml, 18 – 23 gauge, 1.25 –
3 inch needle
 Place the needle at a 90 degree angle to the skin
with the client prone.
 DELTOID: volume of drug administered is 0.5 to 1
ml, with a 23 to 25 gauge, 5/8 to 1.5 inch needle
 Placethe needle at a 90 degree angle to the skin or slightly
toward acromion.
 VASTUS LATERALIS: volume of drug
administered is <0.5 ml in infants (max=1ml); 1.0 ml
pediatrics, 1 -1.5 ml for adults (max=2ml)
 Direct the needle at the knee at a 45 to 60 degree
angle to the frontal, sagittal, and horizontal plane of
the thigh.
Z-TRACK TECHNIQUE
 Any IM injection may be given using the Z-
track technique
 Prevents seepage of the medication into the
needle track and reduces pain and discomfort
 Also suggested for elderly client, with
decrease muscle mass
 A clean needle is attached to the syringe after
the syringe is filled with medications; this
prevent the injection of any residual
medication into the tissue.
 Needlesshould be at least 1.5 inches long.
 SITE: ventrogluteal, vastus lateralis, or dorso gluteal
site
 Technique:
 Skin is pulled down or to one side about 1” and held in this
position
 The needle is inserted and nurse aspirate carefully to detect
the presence of blood.
 Medication is injected slowly
 Needle is steadily withdrawn
 Displaced tissue is released and allowed to return to its
normal position.
 Massage of the site is not recommended it may cause
irritation.
Medications via
Intravenous Solution
 Have an immediate effect
 The most dangerous route of administration
because the drug is placed directly into the
blood stream, it cannot be recalled or slowed.
 Used in most emergency situations when
immediate absorption is required
 Action:
 Systemic effect
 More rapid than IM or SQ

 Sites:
 Accessible peripheral veins (cephalic or cubital veins of
the arm; dorsal vein of hand)
 In newborns, the vein of the feet, lower legs and head
may also be used.
TECHNIQUE
 Apply a tourniquet
 Cleanse the area using aseptic technique
 Insert butterfly or a catheter, and feed up into a
vein until blood returns. Remove tourniquet.
 Stabilize the needle and dress site
 Monitor the flow rate, distal pulses, skin color
and temperature, and insertion site.
Reducing discomfort in
SQ and IM Administration
 Select a needle of the smallest gauge that is
appropriate for the site and solution to be injected,
and select the correct needle length
 Be sure the needle is free of medication that may
irritate superficial tissues as the needle is inserted.
 Use the Z-track technique for IM injections
 Inject the medication into a relax muscle
 Do not inject on area that may feel hard on
palpation or tender to patients
 Insert the needle with a dart like motion without hesitation
and remove it quickly at the same angle at which it was
inserted.
 Inject the solution slowly so that it may be dispersed more
easily into the surrounding tissues.
 Apply gentle pressure after injections.
 Rotate site when the patient is to receive repeated injections
COMMON TYPES OF
MEDICATION ERRORS
 Inappropriate prescribing of the drug
 Extra, omitted or wrong doses
 Administration of a medication to a patient
that was not ordered for him or her
 Incorrect route or incorrect rate
 Failure to give medication at prescribed time
and interval
 Incorrect preparation of a drug before
administration
 Giving expired or drug that has deteriorated
AMPULE = is a glass container usually designed to
hold a single dose of a drug
VIAL = is a small glass water with a sealed rubber
cap. Usually with metal or plastic cap that protect the
rubber seal.
Common abbreviations used in
Medication Order
 ac = before meals ID = intradermal
 ad lib = freely as desired IM = Intramuscular
 aq = water IV = Intravenous
 bid = twice a day OD = right eye
 Ĉ = with OS = left eye
 cap = capsule OU = both eyes
 dil = dissolve, dilute pc = after meals
 elix = elixir po = per orem/ by mouth
 Gm, gm, or g = gram prn = as needed
 gtt = drop q = every
 hs = at bed time qAM = every morning
 qh = every hour ŝ = without
 q2h = every 2 hours ss = one-half
 q3h = every 3 hours stat = at once
 qid = four times a day tab = tablet
 OD = once a day tid = three times
 qod = every other day a day
 qs = sufficient quantity tinct = tincture
 Rx = take
 sc/Sc/sq = subcutaneous
GOOD DAY EVERYONE!!!