MEDICATION
Administration
Medication Administration
A basic nursing function that involves
skillful technique and consideration of
the patient’s development and safety.
Thenurse 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
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’S NAME
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/ Medication
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.
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
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
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.
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
Report
effectiveness and results of
medication administered.
Report to health care provider and record
drugs that were refused with reason for
refusal.
Recordamount 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
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
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
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.
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
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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
Place the 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.
Needles should 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
Removing medication from an
ampule and vial
Tapping stem of ampule
Twisting motion of wrist while holding
ampule
Snapping off top of ampule (use gauze or
cotton/cloth to snap off the ampule)
Withdrawing medication with the use of
syringe from upright ampule
Withdrawing medication from inverted
ampule.
Injecting air with vial upright, the air injected is
equivalent to the amount or dose desired.
Positioning needle tip in solution
Withdrawing medication from inverted vial
Tapping to remove air bubbles.
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
GUIDE IN PREPARING Medication Card
Freq Time BMC NCH SJH
TID 8-1-6 PINK PINK PINK
BID 8-6 YELLOW YELLOW YELLOW
OD 8 WHITE WHITE WHITE
QID 8-12-4-8 BLUE BLUE BLUE
Q4 8-12-4-8-12-4 BLUE
Q8 8-4-12 PINK
Q5/Q12 6-12-6-12 ORANGE
HS 8/9PM RED RED RED
PRN WHITE WHITE WHITE
Medication Cards
Oral
BID
Parenteral
TID
Treatment
NEBULIZATION// TOPICAL
APPLICATION
GOOD DAY EVERYONE!!!
