TOPIC

Administering patient’s
medication, fluids and
electrolytes
Contents to be covered
Administer medication
• Principles of drug administrations
• Identify routes of drug administration
• Calculate drug dosage
• Administering oral medication
• Preparing medications from Ampoules and vials
• Administering subcutaneous injection
• Administering intramuscular injection
• Administering IV medication.
• Administering vaginal irrigations and instillation.
• Administering ophthalmic medication.
• Administering inhalation medication
Administer fluids and electrolytes
• Body fluids and electrolytes
• Setting up an intravenous infusion
• Measuring fluid intake and output
• Initiating, maintaining and terminating blood
transfusion

Facilitators:
1. Cecilia Mushi-0755207188
2. Carolyn Lissu-0787581930
 Drugs and
Drug Administrations

By,
Carolyn Lissu
May 2024
Introduction to Pharmacology
Objectives
By the end of this session, students are expected
to be able to:
• Define basic terminologies used in drug
administration
• Explain different forms of drug preparations
• Explain different sources of drugs
• List names of available drugs
• Describe drug bioavailability
• List principles of drug administration
• Describe the nurses role in drug
administration
• Describe the routes of drug administration
• List the factors to consider in drug
administration
 Basic Terminologies Used
Pharmacology
Definition of Terms
Pharmacology: Is the study of drugs and its
interaction in the living cell, it include its origin,
chemical structure, preparations, administration,
action, metabolism and excretion

Pharmacokinetics: Is the study of drug movement,

it includes the way the body handle the drugs
from administration to elimination
Pharmacodynamic: Is the study of mechanism,
action of drugs and other by biochemical and
physiological effects

Therapeutic: Is the science and arts of dealing

and treating the disease in light of
pharmacological action

Side effects: These are effects of drugs rather

than intended ones
Hypersensitivity: Is the drug reaction of an
individual which have met the drug before (as
an antigen) he formed antibodies against the
dugs (antigen) by the time he meet the dugs
again there is an antigen/antibodies reaction.

Tolerance: This is decreased responses to drugs

even in increasing dosage.
Habituation: Is a desire of continue to take a
drug in increasing dose, there is psychological
and physical dependence with no withdraw
symptoms if the drugs are stopped

Drug: Is any substance used for diagnosis,

cure, relief treatment or prevention of disease
inhuman and animal
Minimum dose: Is the smallest dose giving
effects

Maximum dose: is the highest dose which can

be used without causing side effects

Therapeutic dose: Is the dose between

maximum and minimum dose
Different Forms of Drug Preparations

Forms of Drugs Preparations

Solid forms/tablets
o These are dry – compressed powder which can
be on test with small doses.
o Some are coated and some are not coated
example
• Buccal tablets – like panadol, aspirin, septrine
• Enteric coated tablets – start to dissolve while in
the stomach
• Lozenges – kept in the moth until it dissolves,
they usually contain water sugary and mucilage
• Capsule – powder which is coated in special
easily digested covers.
• Pills – a solid spherical body containing medical
agent in a base
• Suppositories – conical shaped bodies, made of
gelatin or cacao butter containing drug for
introduction into the rectum
• Pessaries – similar to suppository but larger for
introduction into the vagina
Semi- solid forms
o Liniment – used for external application only

o Ointments – it is a greasy form/base which

containing petroleum jelly

o Creams – the same as above

Liquid forms
o Emulsions – a suspension of two invisible
liquid for example oil and water
o Mixture – a liquid preparation consist of more
than one drugs dissolved in water or other
fluids
o Syrup – a concentrated solution of sugar and
water
Gases

o They are taken through inhalations, they most

of the time act on the respiratory mucosa.

o Example oxygen
 Different Sources of Dugs
Plants sources
o All parts of plants are used as drugs example steam,
wood , roots, grasses
o Example of plant sources drug are quinine , opium
digital
Animal sources
o The drug are derived from animal bodies fluids glands
etc
o Example insulin, epinephrine
o Animal and plants are also known as organic sources
Mineral salts
o These are derived from mineral
o Example iron sulphate, folic acids, slow K

Synthetic sources
o These are drugs synthesized in pharmaceuticals
laboratories, they are artificial made, this is the
most important group of modern therapeutic
agents
o Example magnesium sulphate, hydrogen
peroxide, aluminum hydroxide
 Names of Available Drugs
Eponymous name
o Drug are named after their founders or
discovery person
Chemical names/generic names
o These are full names given to a drug according
to its chemical structure
o Many of them are long and not widely used eg
acety salylic acid (ASA)
Approved names
o These are the names given by general medical
board council and the one recommended for
use in prescription
o They are used in official publications eg in
Tanzania national guideline recommend ALU
for Artemether lumefantrine
Trade names
o These are commercial names given by the
company which manufactured the drugs
(pharmaceutical industries) eg panadol,
fansidar, metakelfin , sheladol
 Drug Bioavailability
Drug Bioavailability
o Is the proportional of the administered drug
which reaches the circulation, and thus
produce the entire expected therapeutic
effect

o Intravenous administration has bioavailability

of 100%
 Factors Influence Bioavailability of
Oral Administer Drugs
Absorption
o Most of the drugs are absorbed in the GIT, by the
process of diffusion to the blood stream, few drugs
are absorption by active transport process
o The rate of absorption depends on physical
properties of the drugs which include how is it will
pass the wall of the gut
o Absorption also depends on presence or absence of
food in the stomach or interaction with other drugs
First pass effects
o Most drugs after absorption are carried by
portal circulation to the liver, some may be
metabolized and hence only proportional of
absorbed drug reaches the circulation and
therefore there bioavailability is reduced

o Drug like lignocain shows a very larger first

pass and thus they are not administered by
ingestion method
Hepatic first pass elimination
o Drugs absorbed from the GIT are transported by
portal circulation to the liver
o As a result the drug may be taken up by the liver
cells and metabolized
o Metabolites has no therapeutic effects to most
drugs but some the metabolites is the one with
therapeutic effect
o The concentration of a drug in the blood stream is
a good index of whether the correct dose is being
given to produce a satisfactory therapeutic effects
 Factors that Influence Drug Blood
Concentration
• Dose- the higher the dose the higher
concentration
• Route of administration -I/V has rapid raises in
blood concentration
• The distribution of the drug which enter the
tissue has low blood concentration
• The rate of elimination - the faster the body
breaks down or excrete the drug the more
rapid the blood level falls
 Principles of Drug Administration

The principles of drug administration includes

the “Five Rights” of Drug Administration
o Traditional Rights
 Right client
 Right drug
 Right dose
 Right time
 Right route
O Additional Rights

 Right assessment
 Right documentation
 Client’s right to education
 Right evaluation
 Client’s right to refuse
 Additional of ‘R’ Prescriber &Administrator
Right Client

Nurse must do:

o Verify client
o Check ID bracelet & room number
o Have client state his/her name
o Distinguish between two clients with same last
names
Right Drug

Medication order may be prescribed by:

o Physician
o Dentist
o Advanced Practice Registered Nurse (APRN)
Components of a Drug Order (Prescription)

• Date & time the order is written

• Drug name (generic preferred)
• Drug dosage
• Frequency and duration of administration
• Any special instructions for withholding or
adjusting dosage
• Physician or other health care provider’s
signature or name
• Signature of licensed practitioner
Nurse must:
o Check medication order is complete & legible
o know general purpose or action, dosage &
route of drug
o Compare drug card with drug label three times
• At time of contact with drug bottle/ container
• Before pouring drug
• After pouring drug
Right Dose
Nurse must:
o Calculate and check drug dose accurately
o Check PDR, drug package insert or drug
handbook for recommended range of specific
drugs
o Check heparin, insulin and IV digitalis doses
with another nurse
Right Time
Nurse must do:
o Administer drugs at specified times
o Administer drugs that are affected by foods, before
meals
o Administer drugs that can irritate stomach, with
food.
o Drug administration may be adjusted to fit schedule
of client’s lifestyle, activities and diagnostic
procedures.
o Check expiration date
o Antibiotics should be administered at even intervals
Right Route
Nurse must do:
o Assess ability to swallow before giving oral meds
o Do not crush or mix meds in other substances
before consultation with physician or pharmacist
o Use aseptic technique when administering drugs
o Administer drug at appropriate sites
o Stay with client until oral drugs have been
swallowed
Right Assessment

• Get baseline data before drug administration

Right Documentation
Immediately record appropriate information
o Name, dose, route, time and date, nurse’s initial
or signature
• Client’s response:
o Narcotics
o Analgesics
o Antiemetic
o Sedatives
o Unexpected reactions to medications.
• Use correct abbreviations and symbols.
Right to Education
• Client teaching:

o therapeutic purpose
o side-effects
o diet restrictions or requirements
o skill of administration
o laboratory monitoring

• Principle of Informed Consent

Right Evaluation
Client’s response to medications
o Effectiveness
o Extent of side-effects or any adverse reactions.
Right to Refuse
Nurse must:
o Determine when possible reason for refusal.
o Facilitate patient compliance.
o Explain risk for refusing medications and
reinforce the reason for medication.
o Refusal should be documented immediately.
o Head nurse or health care provider should be
informed when omission pose threat to
patient.
 Role of a Nurse in Drug
Administration
Nurses Role in Drug Administration
• To ensure safe and reliable administration and
to monitor side effects.
• To help patients understand the purpose of
their treatment and promote compliance with
taking medication.
• To ensure that they have the knowledge to
ensure the correct administration of drugs, this
includes pharmacology, anatomy, physiology
and legal issues.
• To take a reliable drug history from the patient
and if necessary, from relative or friends which
include previous exposure to drugs, drugs
being taken at the time and, in particular any
adverse effects resulting from their use.
Routes of Drug Administration
• The choice of which route of drug administration to
be used depends on two factors which are:
o Depending of the drug: The existing preparations
o Depend on the state of the patient: Emergency or
the impossibility of intake to some routes
• A route of drug administration is the path by which a
drug or other substance is brought into contact with
the body.
• Drugs are introduced into the body by several
routes.
• When administering a drug, the nurse should
ensure that the pharmaceutical preparation is
appropriate for the route specified
• There are four major routes of drugs
administration which are commonly used
which are:
o Enteral route
o Parental route
o Topical route
o Inhalation route
Enteral Route
• Oral route: The mouth is commonly used
route for administering drugs.
Advantage of oral route administration
• Most convenient
• Usually least expensive- cheaper to
manufacture
• Safe, does not break skin barrier
• Administration usually does not cause stress
• The gastrointestinal tract provides a huge
surface area for absorption.
• The drug can be taken home and does not
need the attendance of a career.
• Portable.
• No pain, easy to take.
• Cheep, no need to sterilize (but must be
hygienic of course.)
Disadvantage of oral route administration
• Absorption can be variable and depends on the
chemical nature of the drug, e.g. its ionization,
solubility and stability
• Absorption can also depend on the stomach
contents. For example the absorption of
tetracycline antibiotics is inhibited in the
presence of milk.
• Drugs may affect gastric emptying and this may
affect absorption.
• Inappropriate for patient with nausea and
vomiting
• Drug may have unpleasant taste and odor
• Inappropriate when gastrointestinal tract has
reduced motility
• Inappropriate if patient cannot swallow or is
unconscious (limited uses)
• Drug may discolor teeth, harm teeth enamel.
Example hydrochloric acid.
• Drug may irritate gastric mucosa
• Some of the drug may be partially absorbed or
destroyed by the gastric juices example insulin
Sublingual route
o The medication is placed under the tongue, and allowed
to dissolve slowly.
o Because of the reach blood supply in in this region it
results into rapid onset of the action.
o The patient is instructed not to move the drug with the
tongue nor to eat or drink anything until the
medication has completely dissolved
Advantage of sublingual route administration
• Same as oral route plus
• Drug can be administered for the local effects
• More potent than oral because the drug directly enter
the circulation and bypasses the liver
Disadvantage of sublingual route
administration

• If swallowed drug may be inactivated by

gastric juice
• Drug must remain under the tongue until
dissolved and absorbed
• Drug is rapidly into the blood stream
Buccal route
o The tablet or capsule is placed in the oral cavity
between the gum and the cheek.
o The client is instructed not to manipulate the
medication with the tongue; otherwise, it could get
displaced to the lingual area where it will be more
rapidly absorbed, or to the back of the throat, where
it could be swallowed.
Advantage of buccal route administration
• Same as sublingual route
Disadvantage of buccal route administration
• The same as sublingual plus
• Dose absorbed is unpredictable
Rectal Route
o This means the drugs passed through the
rectum.
o Rectal drugs are normally in suppository form,
although a few laxatives and diagnostic agent
are given via enema.
Advantage of rectal route
• Favor the drugs which has objectionable taste
or odor, or when it can be changed by
digestive enzymes.
• Drug released at slow steady rate.
• It avoids irritation of the upper GIT.
• Is reasonable convenient and safe method of
giving drugs when the oral method is unsuitable,
as when the patient is unconscious
• Venous blood from the rectum doesn’t pass to
the liver thus no first pass effects
Disadvantage of rectal route
• Absorption is slower than other routes
• It is irregularly and uncompleted absorption
• Causes irritation to the rectum
• Inconvenience to administer
Inhalation route
o Inhalation is the breathing of air vapour or volatile
drugs into the lungs.
o The gaseous drugs are inhaled and absorbed
through epithelium of the alveoli of the lungs.
o Drug administered through this route may be for
the local or systemic effects.
o Examples of the drug given by inhalation for
systemic effects are volatile anesthetics agents
such as ether, and halothane
E.g. of local inhalation is nitrate which relieve pain
due to anginal pectoris
Advantage of inhalation route
• Acts very quickly because the lungs have a
larger surface area for absorption and they are
reach supplied with blood.
• Drug act at the site of action .e.g. pulmonary
diseases.
• Introduces drug throughout respiratory tract
• Can be used to unconscious client
Disadvantage of inhalation route
• Poor regulation of dosage
• Inconvenience
• Drug intended for localized effect can have
systemic effects
• Of use only for respiratory system
Topical Route
o This means application of drug locally at an
intended site such as skin, eye, ear or nose.
o Smoothing and softening the dry and rough
areas of the skin.
o To provide antiseptic or bacterio-static effects
in order to inhibit the growth and
multiplication of micro organism
o To provide a cleansing effects for the removal
of dirty demis or infected tissue
Advantage of topical applications
• Provide a local effect
• Few side effects

Disadvantage of topical route

• Drug can enter body through abrasions and
cause systemic effects
• May soil clothes
Parenteral route
o The term parenteral “refer to method of drug
administration other than oral and topical
o It is commonly used to indicate the
administration of drugs by “Injections”
o The common types of injections includes,
intradermal, subcutaneous, intramuscular and
intravenous
o Drugs given parenterally must be sterile,
readily soluble, absorbable, and non irritating.
o Sterile aseptic technique must be used to
avoid infection.
o Accurate drug dosage, proper rate of injection
and proper site of injection are essential to
avoid harm such as tissue injuries.
o An injected drug is irretrievable, and an error
in dosage or method or site of injection is not
easy corrected.
Intradermal
o Injection is made in the upper layer of the skin
to the dermis
o The amount of drug given is small and
absorption is slow.
o Common method used for allergy testing.
o The injections are best made with a fine, short
needle (26 gauge) and a small barrel syringe
Advantage of intradermal route of
administration
• Absorption is slow (this is an advantage in
testing for allergies).

Disadvantage of intradermal route

• Amount of drug administered must be small
Subcutaneous route
o Small amount of drug in solution are given
subcutaneously (hypodermically)
o The needle is inserted through the skin with
quick movement, but the injection is made
slowly and steadily.
o The piston of the syringe should be withdrawn
slightly before injecting the drug to make sure
that a blood vessel has not been entered

o The angle of insertion should be 45 to 60

degrees and should be made on the outer
surface of the upper arm or on the anterior
surface of the thigh – there are few larger
blood vessels and sensation is less keen than
on the medial surface of the extremities
o Movement of the part after administration tends to
increase the rate of absorption.
o Injected drugs are limited (0.5 – 2ml)
o Irritating drugs can results into formation of sterile
abscesses and necrotic tissue
Advantage of subcutaneous route
• Onset of drug action is faster than oral route

Disadvantage of subcutaneous route

• Involve sterile technique
• More expensive than oral
• Only small volume of drug can be administered
• Some drugs can irritate tissue and cause pain.
Intramuscular route
o Injections are made through the skin and
subcutaneous tissue into the muscular tissue.
o Muscle tissue has a rich blood supply, medication
moves quickly into blood vessels to produce more
rapid onset of action than oral
o The anatomical structure of the muscle permits
this tissue to receive a larger volume of
medication. e.g. deltoid and biceps muscle should
receive a maximum of 3ml
o Injection site must be located away from bone,
larger blood vessels, and nerves.
o The size and length of the needle are
determined by body size and muscle mass, the
type of the drug to be administered, the
amount of adipose tissue overlying the
muscle, and the age of the client.
o Muscles into which injection can usually be
made conveniently are those of the buttock,
the lateral side of the thigh, and the deltoid
region of the arm.
o The gluteal muscles are usually thick and well
suited to the injection of the larger i.m doses.
o The drugs may be in aqueous soln, aqueous
suspension, or a soln or suspension of oil.

Advantage of intramuscular injection

• Pain from irritating drug is minimized.
• Can administer larger volume than
subcutaneous
• This injection is technically easier than IV.
• The gastrointestinal tract and first pass
metabolism are avoided
Disadvantage im injections
• Break skin barrier
• Can produce anxiety
• Injections can be painful.
• Self administration is difficult.
• Rarely, abscesses can form at the site of
injection.
• The needle may puncture a small blood vessel
and cause bruising of the skin
Intravenous injections
o Medications and fluids are administered
directly into the blood stream and
immediately available for use by the body.
o The IV route is used when a very rapid onset of
action is desired.
o It requires skill and sterile asepsis, and the
drug must be highly soluble and capable of
withstanding sterillization.
o IV route is of great value in emergencies.
o The dose and amount of absorption can b
determined with accuracy.
o The injection is usually made into the median
basilic or median cephalic vein at the bend of
the elbow; however any accessible vein can be
used.
o Factors that determine the choice of a vein are
related to the thickness of the skin over the vein,
the closeness of the vein to the surface, and the
presence of firm support (bone) under the vein
o A vein that normally is distended with blood is
much easier to enter than a partially collapsed vein
Advantage of IV route
• A rapid onset of action is achieved
• The entire injected dose is almost instantly
available, since it bypasses the gastrointestinal
tract and first pass metabolism.
• A lower dose is administered than if the drug is
given orally.
• Administration is useful for drugs that are irritant
when administered intramuscularly
Disadvantage of IV routes
• Break skin barrier
• Limited to highly soluble drugs
• Drug distribution inhibited by poor circulations
• The drug has to be administered by trained
person.
• Inadvertent injection into an artery can cause
arterial spasm with resulting tissue damage.
• Accidental overdose can have serious
consequences
 Factors to Consider in Drug
Administration
• Pharmacodynamics: how the drug works in the
body.
• Interactions: possible effects of other medication or
food on the ordered medication.
• Allergies: patient history of hypersensitivity to drug
or drug class.
• Contraindications: medical conditions that preclude
the use of the ordered drug
• Side effects: potential adverse reactions to the drug.
• Toxic effects: dangerous effects that often
occur due to build up of drug in body or
impaired metabolism.
• Tolerance: certain drugs require increasing
doses over time to achieve the same effect.
• Physiological variables: sex, age, size, and
physical condition may alter how a drug is
processed in the body.
• Diet: certain foods, liquids, or nutritional
states may alter the drug's effect on the body
 Key Points

• Always remember the Five Rights” of Drug

Administration
• Nurse should follow all principles of drug
administration.
• Nurse to ensure safe and reliable
administration of drug for patient safety
 Evaluation

• What are the principles of drug administration

• List any five factors to consider during drug
administration
• What are the roles of a nurse in drug
administration
References
• Bennett, P. N. (2003). Clinical pharmacology. (9th ed.).
London: Churchill Livingstone.
• Gould, D., Greenstein. B., & Trounce, J. (2004). Trounce’s
clinical pharmacology for nurses (17th ed.). London:
Churchill Livingstone.
• Greenstein, B. (2009). Trounce’s clinical pharmacology for
nurses (18th ed.). London:Churchill Livingstone.
• Laurence, D. R., Bennett, P. N., & Brown, M. J. (1997).
Clinical pharmacology (8th ed.). Edinburgh: Livingstone
Churchill.
• Rang, H. P. (1995). Pharmacology (3rd ed.). London:
Churchill Livingstone
Thank you