KEA-MED MEDICAL COLLEGE

Department of Nursing

Medication Administration
Prepared by Hailemariam M.
2016 E.C
-Prepare for medication administration
within scope of enrolled nurse
1 ADMINISTRATION OF MEDICATION
Drug:-is the broadest term used to express a chemical substance that
has known biological effect on humans or other animals
• is any substance that alters the physiologic function of the body, with the
potential of affecting health.
 Medication or medicine:-Is a drug or any substance which may
be administered in a variety forms and by different routes for the
purpose of:-
preventing
diagnosing
treating a disease or condition
used to enhance physical or mental well
being
 The terms drug, medication, and
medicine are often used interchangeably
Con’t……..
Medication is a drug that is used for therapeutic/curative purpose.
 Medication administration means giving the medication to the

patients/clients through different route such as:-

oral,

parenteral,

topical and so on.

 Itis a basic nursing function that involves skillful technique
and consideration of the clients’ /patients safety.
Medication administration has become one of the most
important, complex, and risk-laden aspects of nursing care.
Con’t……
The nurse administering medications needs a knowledge
base about drugs:-
 Names,
 preparations,
 Classifications,
 Adverse effects and
 physiologic factors that affect drug actions
Naming of drugs (Nomenclature of drugs)
Medications or drugs can be given a variety of names:
1. Generic name: is the name assigned by the
manufacturer that first develops the drug.
-drugs are written in prescription in their generic name.
2. Trade name/Brand name : is created by the particular
manufacturer and is capitalized.
• Generic formulations are usually less expensive than
trade name products.
3. Chemical name: scientific name that describes the
constituents that make up drugs molecular structure. Also
called IUPAC name.
Con’t…..
Chemical name; name given based on the structure of the
drug.
-indicates atomic and molecular structure of a drug
- Given as a chemical formula or accompanied by a
diagram of its structure.
-often so long and complicated
e.g. Acetyl salicylic acid(C6H4OHCOOCH5)
SAFETY PRECAUTIONS WHEN ADMINISTERING MEDICATION

 Safety is one of the most important in preparing and

implementing drug administration.
o The nurse is responsible for validating, preparing, and administering
medications safely and in accordance with agency policies and
procedures.
 The nurse should observe the three checks and the ten

rights when administering medication

A. The three checks
 The label on the medication container should be

checked three times during medication preparation

SAFETY PRECAUTIONS…

1.When the nurse reaches for container or unit dose package.

( during taking from shelf or drawer)

2.Immediately before pouring or opening the medication

(before removing medication from the container) and

3.When returning the container to the drawer or shelf or prior to

giving the unit dose to the client(before putting back or discard the
container).
PRINCIPLES FOR SAFE MEDICATION ADMINISTRATION
All medications must be administered according to a Medical
orders and pharmacy/manufacturer’s instructions.
 The medication orders must be clear, legible and not open to
miss-interpretation
 If the staff member considers a medication order is unclear or

ambiguous, or is concerned that the order may be incorrect or

inappropriate for the particular medical condition, the staff
member must contact the prescriber for clarification before
administering the dose
PRINCIPLES….
 The same person should select, prepare, administer and
record the administration.
 Doses must be prepared for only one patient at a time
 Medications should be prepared for immediate
administration to a single patient and not retained for later
use
All medications must be stored in patient care areas in the
same container as received from pharmacy.
PRINCIPLES….
Medication cupboards and trolleys must not be left unattended

or should be kept locked

o Always check name, strength of the medication, expiry date on

the ampoule or bottle, If details are not legible, return to

Pharmacy.
 Infection control, hand hygiene and workplace health and

safety policies must be followed.

o Aseptic technique must be followed in preparation and

administration of medications
 10 “RIGHTS”
Ten rights ensure accuracy when administering medication.
1. Right Patient
2. Right Drug
3. Right Dosage
4. Right Route
5. Right Time
6. Right documentation
7. Right client education
8. Right to refuse
9. Right assessment
10. Right evaluation
Con’t….
1. Right client/pt: the medication is given to the client for
whom it is intended.
 medication administration record should be compared
against:-
medication orders & ID bracelet, MRN, Age, ward ,and
Bed number.
 Ask the patient to state his or her name.
 Helps to prevent serious effects of miss

administration
 This means medication is given to the intended client.
Con’t….
2.Right drug/medication: compare the medication
container label to the medication sheet before, during, and
after dispensing during preparation.
o verify medication order with medication administration
record (MAR).
o The medication given should be the medication ordered.
o Before administering check three times.
o Check the expiration date of the medication
- Know the drug’s action, dosage, side effects, and its
contraindication.
Con’t…..
3. Right dosage(Amount):the nurse ensures that the patient
is provided the right amount/dose drug.
o when medication is prepared from a dose other than
what is ordered, the chance of error increases.
o check all calculations of divided dose
 After calculating the doses the second nurse should
check.
 The nurse should know the usual dosage range of the
medication.
Con’t….
4.Right route: the prescribers order must designate a
route of administration.
 When injections are administered, the nurse must use
only preparations intended for parenteral use.
 Medications are administered by the ordered route and
the ordered route should be safe and appropriate for the client.
o Validate the route for administration on the container label and
medication sheet.
Con’t….
5.Right time: each agency has routine time schedules
for medication administrations ordered at standard
intervals.
 Give the medication at the right frequency and at time
ordered.
oCarefully validate BID, TID,QID,stat,or PRN times for drug
administration.
oNote before-meal, between-meal and after-meal
formulations.
oA medication to be given is considered ‘on time’ and
safe.
Con’t….
6.Right documentation: the drugs administered should
be recorded.
 The records in the chart includes drug name, dosage,
method of administration, exact time of administration
and signature of the nurse providing the medication
 The nurse gives the right drug for the right client with a
right dose through a right route at the right time with a
right documentation.
Con’t….
7.Right education: the patient has the right to get
information about the medication(why receiving, what to
expect, any precautions).

8.Right to refuse: adults have the right to refuse any

medication.
 Assess the reason for refusing the medication
 Provide appropriate explanation why the medication
was ordered if knowledge deficit underlies client’s
reason.
Con’t…
9.Right assessment: some medications require specific
assessment prior to administration

(e.g. pulse, blood pressure, lab results).

 Do not give medication if pulse rate <60 bpm, systolic
BP<100mmhg.

10.Right evaluation: conduct appropriate follow-

up( e.g. was the desired effect achieved or not?)
 Did the client’s experience any side effects?
Con’t…

N.B
Never administer a medication that has been
prepared by someone else.
Do not leave medication at the client’s bed side.
Documentation is a must after administration.
COMMON ABBREVIATION USED DURING
MEDICATION ADMINISTRATION

Abbreviations meanings
• Po ………………………by mouth
• ac(ante cibum)…………..before meal
• Pc(post cibum)………….after meal
• Qd ……………………….every day
• Qod ……………………...every other day
• Qid ……….........................four times a day
con’t…
• Q2h …………………………every 2 hours
• Qhr ………….................every hour
• Pm …………..................after noon
• IM………………………..Intramuscular
• SC…………………………Subcutaneous
• bid …………… ……….twice a day
• tid ………….. ………..three times a day
• hs ………………………at bed time
Con’t…
• prn ………….as needed
• OD ……………right eye
• os ...................left eye
• ou ……………both eyes
• am ………. …in the morning
• IV……………Intravenous
• ID…………….Intradermal
• KVO…………keep vein open
Con’t…
 Kg-------------kilogram

 L---------------Liter

 Mcg-----------microgram

 Mg------------milligram

 Ml-------------milliliter

 NPO-----nothing by mouth
 t or tsp----------teaspoon

 T or tsb---------tablespoon

 Tab---------------tablet
MEDICATION ORDER
A medication order is written directions provided by a
prescribing practitioner for a specific medication to
be administered to an individual.

• The physician or nurse practitioner conveys the medication plan to

others by an order called a prescription and the nurse administers the
drug to the client.
• No medication may be given to a client without a medication order.
THE COMPONENTS OF A DRUG ORDER
• Name, age, sex of the client
• Name of the medication (generic or trade name)
• Forms of the medication
• Route of administration
• Amount/dose of the medication
• Frequency of the medication
• Duration of the medication
con’t…
 The date and time the prescription was written and the name,
position and signature of the prescribing health care provider
must be included.
NB: When a component is missing from the drug order,
the drug order is incomplete and you should not
administer the medication until clarification is obtained.
TYPES OF MEDICATION ORDERS

There are several types of orders.

 1.Standing order:-is carried out as specified and indicates that a
medication is to be given for specified number of doses, until it is
canceled by another order.
E.g. ceftriaxone 1gm IV BID for 2 days.
2.PRN (as needed): the client receives medication when it is
requested/needed by the client. E.g. post operative pain medications.

3.Single order: the directive is carried out only once at a time specified.
 E.g. medications administered immediately before surgery.
o furosemide 20mg IV to be given one time at 7 am
Con’t…
4.Stat order: is a single order but one carried out at
once during emergency situation or rush.
 E.g. -Epinephrine in case of anaphylactic drug
reaction
o diazepam 10mg IV stat in seizure.
MEDICATION CHARTS
 Medication charts are legal documents and must be
completed accurately and unambiguously in order to ensure
that patients receive safe and optimal drug therapy.
A medical chart is a confidential document that contains detailed
and comprehensive information on an individual
 Medication charts should be written legibly in the
prescriber’s own handwriting and include:-
 Patient name, medical record number (MRN), ward/clinic
 If a patient ID label is used it must be affixed to every
medication chart and signed for verification by the prescriber
Con’t….
 Drug name (generic), dosage form, strength and dose required.
 Complete, clear and unambiguous directions for each item –
directions should be written in plain English (only approved
abbreviations may be used).
 Prescriber’s printed name, signature and date of order - the
prescriber’s full signature and date of order must be written for
each drug ordered
 Weight should be provided for any drug dosed by weight.
 Its purpose is to reduce the risk of prescribing, dispensing and
administration error by health professionals
Con’t….
 N.B. Each medication order must be legible,
complete and unambiguous so that the correct
patient is administered the correct drug at the
appropriate dose.

A nurse cannot administer the drug and a

pharmacist cannot dispense a drug to a patient
unless all details are correct and complete.
Basic principle of nurse on drugs administration:
•1-The nurse must know the drug's prescribed dose, method of
administration, actions, expected therapeutic effect, possible interactions
with other drugs, and adverse effects.
•2- The nurse must know the institution's administration procedures for
the client's welfare and the nurse's legal protection.
•3- The nurse must Review physician's order for completeness the
client's name, date of the order, name of the drug, dose, rout, time of
administration, and the physician's signature.
Con’t….
•4- The nurse discusses the medication and its actions with the client;

recheck the medication order if the client disagrees with the dose or the
physician's order.
•5- The nurse must check the physician's order against the client's
medication administration record for accuracy.
•6- The nurse gives the patient right to know about the medication he is
receiving and the right to refuse it.
Medication Error
•A medication error is any preventable event that may cause or lead to
inappropriate medication use or patient harm.
•Such events may be related to professional practice, health care
products, procedures, and systems, including prescribing; order
communication; product labeling, packaging, and compounding;
dispensing; distribution; administration; education; monitoring and use.
TYPES OF MEDICATION ERRORS:

Order Error – Types of ordering errors include: inappropriate

medication selected, inappropriate dose, illegible order, duplicate order,
order not dated/timed, wrong patient/chart selected, contraindications,
verbal order misunderstood, verbal order not written in the chart, wrong
frequency, route, therapy duration, abbreviations.
Con’t…
Transcription error –Transcription involves both the orders that are
manually transcribed onto:-
•manual record (e.g., medication administration record (MAR)) and
electronically transcribed into
•computer systems (eMAR).
Types of transcription errors include: wrong medication, time, dose,
frequency, duration, rate patient/chart, verbal order misunderstanding,
verbal orders not entered into SCM system,
Con’t…..
•Preparation/Dispensing Error – Types of preparation and dispensing
errors include: Inaccurate labeling, wrong quantity, medication, dose,
diluent, formulation, expired medication, error, and delay in medication
delivery.
•Administration Error – Types of administration errors include:
•Wrong patient, dose, time, medication, route, rate, omission,
extravasation (may be an ADR) and unauthorized dose given.
Con’t….
•Contributing Factors – Types of contributing factors include:
fatigue, calculation error, knowledge deficit, performance deficit,
workload, computer software issue, computer downtime, hybrid system
(manual/computer processes), lack of communication between
practitioners, missing critical info, MAR reconciliation process, order
entry into pharmacy systems, accessed via override, charting related
error, medication reconciliation at transitions.
Medication errors is a serious problem:
• 8th leading cause of death in the US
• 7,000 deaths annually
• 44% of errors occur during administration of medication
Preventing of medication error
Avoid medication error by following things:
 By respecting ten right of patient.
 Before giving the medication check its validity.
 By checking its amount by using calculation formula and etc
An overview of Employee and Nurses
Professional Code of Conduct and Ethic
Nurses have four fundamental responsibilities:
to promote wellness,
to prevent illness,
to restore health and
to facilitate coping.

The need for nursing is universal and inherent in it is respect for human rights,
including cultural rights, the right to life and choice, to dignity and to be treated with
respect.
Con’t….
•Nursing care is respectful of and unrestricted by considerations of age,
color, creed, culture, disability or illness, gender, sexual orientation,
nationality, politics, race or social status.
•Nurses render health services to the individual, the family and the
community and co-ordinate their services with those of related groups.
•The people under every nurse’s care must be able to trust the nurse
with their health and wellbeing and to justify that trust.
Con’t….
nurses must be :-

Patient care: Patients have the right to fair and equal access to care from
all staff, according to their needs.

All employees should care for all patients equally and without prejudice to
age, gender, and economic, social, political, ethnicity, religious or other
status and irrespective of personal circumstances.

They should demonstrate a personal and professional commitment to

equality and diversity in caring for patients.
Con’t….
•Confidentiality: All patients have the right to expect that any
information they disclose in the course if their care is confidential
between themselves and their treatment team.
•Hospitals should ensure that there is a written hospital information
management policy which sets out how the hospital ensures that
information held by the hospital on patients, their families and staff is
handled confidentially.
Top 10 Qualities of a Professional Nurse are as follows

a) Communication skills: A wonderful nurse has excellent

communication skills that include speaking and listening. They are
able to follow directions without problem and can easily
communicate with patients and families to understand their needs and
explain treatments.
b) Emotional stability: A superb nurse is very stable emotionally.
Nursing is a stressful job and nurses may encounter many traumatic
situations including suffering, and death. A superb nurse is one who is
able to work without allowing the stress to cause great personal harm.
Con’t….
C) Empathy: The best nurses have empathy for the pain and
suffering of patients. They are able to feel compassion and
provide comfort.
D) Flexibility: A great nurse is flexible with regards to
working hours and responsibilities.
Nurses are often required to work long periods of overtime,
late or overnight shifts, and weekends.
Con’t….
e)Good attention to detail: a nurse understands that every step in the
nursing field is one that can have far reaching consequences. A great
nurse pays excellent attention to detail and is careful not to skip steps or
make errors.
f)Interpersonal skills: An outstanding(betam tiru) nurse has excellent
interpersonal skills and works well in a variety of clinical settings and
situations. They work well with other nurses, doctors, and other
members of the multi-disciplinary team. They also have to deal with
patients’ and their relatives.
Con’t…
g)Physical endurance: A distinguished(znegna) nurse has strong
physical endurance and is able to tolerate standing for long periods of
time, lifting heavy objects including patients, subject to Health & Safety
and Manual Handling policies, on a daily basis and often working
double shifts.

g)Problem solving skills: An excellent nurse can think

quickly and address problems as or before they arise.
Con’t…
h)Quick response: An impressive(yemidenek) nurse can
respond quickly to emergencies and other situations that arise.
Quite often, healthcare work is simply the response to sudden
incidences, and nurses must always be prepared.
i)Respect: Exemplary nurses respect people and rules. They
are mindful of confidentiality requirements and different
cultures and traditions. And they respect the wishes of the
patient.
Drug dosage calculation
Several formulas can be used to calculate drug
dosages.
One formula uses ratios:
Dose on hand (DOH) = dose desired (DD)
Quantity on hand(QOH) X (quantity desired)(QD)

The dosage must be in the same unit of measurement.

Example: if amoxicillin 625mg is ordered for a patient
& it is supplied in a liquid preparation containing
250mg in 5ml, how much would the nurse administer?
Con’t…
 Dose ordered: the amount of medication prescribed.
 Dose on hand: weight or volume of medication available in
unit supplied by pharmacy.
 The amount on hand: basic unit or quantity of medication
that contains the dose on hand.
 For solid medication the amount on hand may be one
capsule, the amount of liquid on hand may be milliter or
depending on the container.
 The amount to administer: actual amount of medication
the nurse will administer
 It is always expressed in the same unit as the amount on hand
Con’t….
250mg = 625mg
5ml X
250mgX=5m x 625mg

X= 5ml x 625mg
250mg

X= 12.5ml
So the nurse administers 12.5ml of the medication.
Con’t…
 In calculating drug dosage use this simple formula:
X= D ÷ H x Q , where X= Unknown quantity of Drug
D = Desired Dose
Q = Quantity of Solution
H = Strength on Hand
Con’t…
E.g. Physician orders 500 mg of ibuprofen (desired Dose) for
a patient and you have 250 mg (Quantity on Hand) tablets
(Quantity of solution) on hand.
Solution: D ÷ H x Q = X 500mg ÷ 250 mg x 1 tablet = 2
Injectable powder forms parenteral
• E.g. The physician orders Procaine penicillin fortified (ppf) 800,000IU; IM; bid; for 7
days. How many vials will u need?
• Soln :- PPF is 4MIU and it is reconstituted to 10ml
Dose = 800,000 x 2 x 7 = 11,200,000 IU
1 vial = 4000,000 IU
X = 11,200,000 IU
X = 2.8 vial which is 3vial needed
• E.g. order 80 mg/2ml Gentamycine injection b.i.d for 7 days. If you have 1ml of
40mg/ml ampoule, how many ampoule, do you give? Ans 28ampoules (1 amp=1ml)
Calculating paediatric doses

• There are several methods for calculating pediatric

medication dosage based on various combinations of age,
height, weight, body surface area and adult dose.

• Children are more sensitive than adults to medications

because of their weight, height, physical condition,
immature systems, and metabolism.
Con’t…
• neonate (newborn), from birth to 1 month;
• infant, 1 month to 1 year;
• early childhood, 1 year through 5 years;
• late childhood, 6 years through 12 years; and
• adolescence, 13 years through 17 years of age.
• A neonate is considered premature if born at less than 37 weeks’ gestation.
• The child who weighs more than 50 kg may receive adult dosages.

Age is considered the least reliable.

Body weight is most common and reliable method used.
Con’t….
• Young’s rule: - Age (yr.) x Adult dose = Dose for child
Age (yr.) + 12
useful for children of age < 12 years and > 1year

• Fried’s rule :- Age (in months) x Adult dose = Dose for infant
for infants 150
useful for children of age < 2 years

• Clark’s rule: - Weight (in lb) x Adult dose = Dose for child
150(average weight of adult in lb)
= Weight (kg) x adult dose
70
useful for children of age > 12 years
Excersice
1. The usual adult dose of Diphenhydramine is 50mg. What would be
the save dose for a child weighing 27 lb?
2. The average adult dose of meperidine is 75 mg. what dose would be
appropriate for a 10 month old infant?
3. An over-the-counter cough remedy contains 120 mg of
dextromethorphan in a 60-mL bottle of product. The label states
the dose as 1.5 teaspoonfuls for a child 6 years of age. How many
milligrams of dextromethorphan are contained in the child’s dose?
Medication calculations
•Dosage By Weight
Weight in Kg * Dosage Per Kg= Y (Required Dosage)
•Example: A doctor orders 200 mg of pcm to be taken by a 15.4 lb
infant every 8 hours.
•The medication label shows that 75-150 mg/kg per day is the
appropriate dosage range. Is this doctor's order within the desired range?

•Convert 15.4 lb to kg.

 lb → kg ( ÷ by 2.2 )
• 15.4 lb ÷ 2.2 = 7 kg
Con’t..
7kg*75mg/kg=525mg(minimum Desired dosage)
7 kg * 150 mg/kg= 1,050 mg (Maximum Desired dosage) 24 hours in
one day and the medication is ordered every 8 hours.
 24 hrs / 8 hrs = 3 times per day doctor ordered medication
 200 * 3 = 600 mg ordered per day
600 mg is within the desired range of 525-1,050 mg
Con’t..
•Example: Solumedrol 1.5 mg/kg is ordered for a child
weighing 74.8 lb. Solumedrol is available as 125 mg /
2mL. How many mL must the nurse administer?
Weight in Kg * Dosage Per Kg = Y (Required Dosage)
Convert 74.8 lb to kg.
lb. → kg ( ÷ by 2.2 )
•74.8 lb ÷ 2.2 = 34 kg
34 kg * 1.5 mg/kg=51mg
 51 mg is ordered and the medication is available as 125 mg / 2 mL.
Con’t…
•Example 2 300mg aminophylline injection is prescribed. 250mg in
10ml ampoules are available. The volume of injection required is:
300mg x 10ml = 12ml
250mg
ROUTES OF DRUG ADMINISTRATION
 Pharmaceutical preparation are generally designed for
one or two specific route of administration.
 The route of administration should be indicated when
the drug is ordered
 When administering the drug, the nurse should ensure
that the Pharmaceutical preparation is appropriate for
the route specified.
Con’t….
• There are different routes of administration.
• The route chosen depends on the properties and desired
effects of the medication, as well as the physical& mental
conditions of the client.
Con’t….
1. Oral route
2. Parenteral route: medications given by injections or infusion
Intradermal: injections given in to the dermis of the skin. Eg. BCG vaccine
Subcutaneous: injections given in to subcutaneous tissue (Non-irritant
drugs). Eg. Insulin injection,measle vaccine
Intramuscular: soluble substances, mild irritants, suspensions and colloids
can be given in this route.
Eg. analgesics like diclofenac
Intravenous : drug given directly in to the vein
- can be given as a bolus e.g. furosemide, morphine, dopamine or as a
continuous infusion e.g. fluids during shock or dehydration
Con’t….
Intrathecal : injected into subarachnoid space of spinal care e.g. spinal anesthetics
Interaperitonial: injections given into the abdominal cavity. e.g. infant saline,
glucose
Intra-articular: injection given directly into a joint. e.g. hydro cortisone.
3.Topical: medications placed on the skin surface or in body cavities
e.g. lotion, dusting powder, ointment, etc.
4. Rectal: medications given into the rectum e.g. bisacodyl suppository, sodium
barbital etc.
5. Vaginal:- medications given into the vagina e.g. prostaglandin vaginal
suppository
6. Inhalation-medication, usually in form of gas vapor or steam is administered in to
the respiratory tract. eg. Salbutamol puff
ADMINISTERING ORAL MEDICATION
Definition
 Oralmedication administration is the process by
which drugs are delivered by mouth through the
alimentary tract.
 Is
an administration of medication through the mouth
and ensuring that patient swallows the medicine
TYPES OF ORAL MEDICATIONS

1.Lozenges (troches) - sweet medicinal tablet

containing sugar that dissolves in the mouth so that the
medication is applied to the mouth and throat.
2.Tablets - a small disc or flat round piece of dry drug
containing one or more drugs made by compressing a
powdered form of drug(s).
3.Capsules - small hollow digestible case usually made
of gelatin, filled with a drug to be swallowed by the
patient.
4.Syrups - sugar containing medicine dissolved in water.
5.Tinctures - medicinal substances dissolved in water.
Con…
6.Suspensions - liquid medication with undissolved
solid particles in it.
7. Pills - a small ball of variable size, shape and color
sometimes coated with sugar that contains one or more
medicinal substances in solid form taken in mouth.
8. Gargle - mildly antiseptic solution used to clean the
mouth or throat.
9. Powder - a medicinal preparation consisting of a
mixture of two or more drugs in the form of fine particles.
Con;t….
ORAL MEDICATION…
Purpose
 Drugs are taken by this route because of convenience,
absorption of the drug, ease of use, and cost
containment. It is, therefore, the most common method
used.
 To improve systemic and local effects
 When local effects on GI tract are desired
 When prolonged systemic action is desired
Con’t….
Advantage
 Most common & least expensive route

 Most convenient &safest route for clients

 Doesn’t break skin barrier &doesn't cause stress

Disadvantage
 Unpleasant taste

 GI irritation

 May discolor or harm the teeth

 Inappropriate for those clients who can’t swallow

ORAL MEDICATION……..

Contraindication
•Vomiting.

•Patient with gastric or intestinal suction.

•Patient who are unable to swallow.

•Unconscious pts.
 NPO / people who advised not to take any thing by
mouth/
Con;t…..
Precautions
 Other routes are used when a person cannot take anything by
mouth, or the drug is poorly absorbed by the gastrointestinal
tract.
 The nurse should check whether the patient has any known

allergies.
Not to crush tablets or open capsules intended to be swallowed

whole.
What foods to take (and not to take) with the medication.

What behaviors to avoid while taking the medication.

Con’t…
Complications (side effects)
 The drug may interact with other drugs the patient is

taking and alter the desired effect.

 The patient may refuse the drug.

 There may be difficulty in swallowing.

 The drug may irritate the gastrointestinal tract.

 The drug may pass quickly through the body, and the

benefits of the drug may be lost.

Administration by sublingual and buccal routes
Sublingual- drugs/tablet is placed under the tongue and allowed to
dissolve.
 This area is reach in superficial blood vessels that allows the drug to
be absorbed relatively rapidly into bloodstream for quick systemic
effect.
- Clients should not swallow sublingual tablets
- When a medication in a capsule is ordered to be given sublingually,
the fluid must be aspirated from the capsule and placed under the
tongue.
- E.g. nitroglycerin for chest pain and morphine sulphate for
breakthrough back pain.
Con;t…
Buccal administration:
 It involves placing the medications under the lip or in the side of
the mouth.
 buccal medication should not be chewed, swallowed, or placed
under the tongue.
 Buccal medication includes sustained-release nitroglycerin,
opiates, antiemetics,and sedatives.
Both sublingual and buccal routes of administration permit very
rapid absorption of medication and avoid first pass metabolism
that cause rapid inactivation of many drugs.
PARENTRAL DRUG ADMINISTRATION
Is any medication administration that involves injecting
a drug directly into:
Vein (intravenous) IV

Muscle (intramuscular) IM

Into subcutaneous tissue / SC

Into the dermis (intradermal) /ID

 The body absorbs injected medication much more

quickly than oral medications.

 Parenteral medications are given to the patients/clients

with needle and syringe

SYRINGES AND NEEDLES
• Syringe: are available in various size ranging from 0.5
to 100ml in capacity
• It has three parts
1. Plunger-inserted into the barrel
2. Barrel-marked with calibrated measurement scale
3. Tips-the area attached to the needle
Con’t…
Needle
 Made by stainless steel and come in various size.
 The needle gauge (G) and length are both important when

choosing the correct type for injection.

 Gauge(G) -inner diameter or bore of needle stated using

number, the large number ,the smaller bore ,

 25 –G needle has small opening would be used for subcutaneous

and intradermal injection.

 23-G needle has large bore used for intramuscular injection

 More viscous liquid 18-G very large bore for IV

 Length –from 3/8 inches up to 2 inches .

 Subcutaneous injection needle is short in length (3/8 inches), IM

injection needle is longer and has large bores needle.

Con’t..
 Needle has three parts
 hub or hilt -attached to the tip of syringe
 Shaft-elongated portion of needle
 Bevel-area of hole
 Syringes and needles are packed in sterile plastic

wrapper, be careful to maintain their sterility and check

expiration date.
DRUGS
 Drugs for parenteral injections are sterile preparations.
 Drugs that deteriorate in solution are dispensed as

tablets or powders and dissolved in a solution

immediately before injection.
 Drugs that remain stable in a solution are dispensed in

ampules and vials.

Ampules
 Are glass containers of single-dose drugs

 The glass container has a constriction in the stem to

facilitate opening the ampule.

 Con’t

Vials
 Glass,single- or multiple-dose rubber-capped drug
containers are called vials.
 The vial is usually covered with a soft metal cap that

can be easily removed.

WITHDRAWING MEDICATION FROM AN
AMPULE
 Wash your hands.

 Hold the ampule and quickly

and lightly tap the top
chamber until all fluid flows
into the bottom chamber.
 Place a sterile gauze or alcohol

wipe around the neck of the

ampule.
 Firmly grasp the neck of the

ampule and quickly snap the

top off away from your body.
 Remove needle guard, and

hold syringe in dominant hand.

Con’t….
 With non dominant hand grasp ampule and turn upside
down, or stabilize ampule on a flat surface.
 Insert the needle into the center of the ampule; do not

allow the needle tip or shaft to touch the rim of the

ampule.
 Remove excess air from the syringe and check the

dosage of medication in the syringe before injection.

WITHDRAWING MEDICATION FROM A VIAL
 Wash your hands.
 Prepare the vial.

 Open the alcohol wipe.

 New vial, remove metal cap from vial of medicine and cleanse
the rubber top of the vial. Used vial, cleanse the rubber top of
the vial.
 Prepare syringe.
 Choose a syringe of appropriate size to accommodate the volume of medication to
be withdrawn.
 Insert the needle into the center of the upright vial and inject air
into the vial.
 Invert vial; keep the vial at eye level

 Remove the exact amount of medicine

Con’t….
 Change the needle on the syringe after withdrawing a
drug from a vial.
Mixing of medications from two vials in to one syringe
 When considering mixing two medications in one syringe, you
must ensure that the two drugs are compatible.
 Be aware of drug incompatibilities when preparing medications
in one syringe.
 Certain medications, such as diazepam (Valium), are
incompatible with other drugs in the same syringe ,other drugs
have limited compatibility and should be administered within 15
minutes of preparation.
Con’t….
 Incompatible drugs may become cloudy or form a precipitate in the
syringe. Such medications are discarded and prepared again in
separate syringes.
 Mixing more than two drugs in one syringe is not recommended. If it
must be done, contact the pharmacist to determine the compatibility
of the drugs, as well as the compatibility of their pH values and the
preservatives that may be present in each drug.
 A drug-compatibility table should be available to nurses who are
preparing medications.
2.3.ADMINISTERING INTRADERMAL
MEDICATION
 It is an injection given into the dermal layer of the skin
Purpose
o For diagnostic purpose
- Test for TB infection ( mantoux test)
o Allergic reaction test

o For Immunization drug administration

 Intradermal injection may also be given for therapeutic

purpose
 The intradermal route has the longest absorption time of all
parenteral routes.
SITE OF INJECTION
 The inner aspects of fore arm
 Lateral aspects of upper arm
 Anterior chest and beneath scapula area of back
DESCRIPTION
With the intradermal injection, a small thin needle of 25 or
27 gauges and 3/8 to 3/4 inch (1-2 cm) is inserted into
the skin parallel with the forearm, with the bevel facing
upward.
 These injections are normally given in the inner palm-
side surface of the forearm.
 Administrationangle: 10-15°( the needle should be
inserted 10-15° to the skin for Intradermal Injection
Con’t….
 Slowly inject medication until wheal forms on skin
Con’t…
 Round/elongated skin elevation formed by intradermal injection
 Don’t massage the site
 The dosage given is usually very small (0.01-0.1 ml).
PRECAUTIONS
Used only with small amounts of solution because it is
painful procedure
 Do not massage after injection
 Do not inject after allergic reaction
 Do not aspirate or check because there is no blood
vessels in that area
 The nurse should ensure that the needle is inserted
into the epidermis, not subcutaneously, as absorption
would be reduced.
 Because this method of injection is often used in
allergy testing.
Summery…….
• Purpose: -
1. For diagnostic
• TB screening (Mantoux test)
• Allergic tests
 Skin testing requires the identification of changes in color and
tissue integrity.
2.Therapeutic
• Local anesthesia
• Vaccination
Summury…..
 Sites:
• The inner surface of the forearm: typically used site to assess immune
or sensitivity response
• The dorsal aspect of the upper arm
• Upper chest
• upper back, under the scapula.
• After administration of medication check for the immediate reactions
of the skin
– 10-15 minutes for TAT(tetanus Antitoxoid)
– 20-30 minutes for penicillin
– 72 hours (48 to 72 hrs) for tuberculosis test (9 mm and more - +ve for TB)
Administering subcutaneous injection
• Is depositing/adminstering medication in to the loose connective
tissue/adipose tissue underlying the dermis.
• This tissue has few blood vessels, so drugs administered here have a
slow, sustained rate of absorption into the capillaries.
• Care must be taken to ensure depositing the medication into the
intended tissue layer/subcutaneous tissue and not the underlying
muscle.
• Usually, no more than 1 mL of solution is given subcutaneously.
Giving larger amounts adds to the patient’s discomfort and may
predispose to poor absorption.
• Subcutaneous injections are administered at a 45- to 90-degree angle.
Con’t……
• Aspiration, or pulling back on the plunger to check that a blood vessel
has been entered, is not necessary and has not proved to be a reliable
indicator of needle placement.
• Aspiration is definitely contraindicated with administration of heparin
because this action can result in hematoma formation.
• Drugs commonly given SQ includes- insulin, heparin, and allergic
medications.
Purposes
• To obtain quicker absorption than oral & dermal route.
• When it is impossible to give medications in other routes.
• To have a slow, sustained rate of absorption.
Sites
• Outer aspect of the upper arms
• The abdomen (costal margin- iliac crest), avoid the area 1
and half inches around the umbilicus
• Anterior aspect of the thighs
• The upper ventral or dorsal gluteal areas
• Scapular areas of the upper back.
Absorption rates are different for different sites. Injections in
the abdomen are absorbed most rapidly, > arms, > thighs,
and > upper ventral gluteal areas.
NOTE:
 Injection sites should be free of infection, skin lesions, scars,
boney prominence and large underlying nerves.
 Choose the angle of needle insertion and needle length based on
the amount of subcutaneous tissue present.
 SQ tissue is sensitive to irritating solutions and large volumes of
medications.
 Do not aspirate insulin following injection or massage after
withdrawing needle because massaging hastens drug absorption.
Con’t…..
Administering an intramuscular injection
 is an introduction of a drug in solution form into a body’s
system via the muscles.
 Inject the medication into the denser part of the muscle
fascia below the subcutaneous tissues.
 Offersa faster rate of absorption than the subcutaneous route, and
muscle tissue can often hold a larger volume of fluid without
discomfort.
 Needle length should be based on the site for injection and the
patient’s age.
 Patients who are obese may require a longer needle, and emaciated
patients may require a shorter needle.
Purposes
 To obtain quicker action than SC and intradermal routes.
 To avoid irritation if given through other routes.
 To have prolonged effect of the administered medication.
 As an alternative if other routes are contraindicated .
Sites of IM injections
 An important point in the administration of IM injections is
the selection of a safe site away from large nerves, bones
and blood vessels.
 Identifying important anatomic landmarks and site
boundaries is important to identify complications (abscesses,
necrosis and skin slough, nerve injuries, lingering pain)
 When selecting an IM site, the nurse determines if the area is
free of infection, necrosis, bruising, abrasions, periostitis
(inflammation of the membrane covering a bone).
PRECAUTIONS
It should not be used in cases where muscle size and
condition is not adequate to support sufficient uptake of
the drug.
 It should be avoided if other routes of administration,
especially oral, can be used to provide a comparable
level of absorption and effect in any given individual's
situation and condition.
 It should not be given at a site where there is any rash
and tissue damage
 Selection of site should be away from nerves, blood
vessels and bones
SITE OF IM INJECTION
Ventrogluteal Muscle (gluteus medius): -Hip area
  Vastus Laterals Muscle (Thigh)

  Rectus femoris (anterior thigh)

  Deltoid Muscle (Upper arm muscle):

  Dorsogluteal Muscle Buttocks

Con’t….
1.Ventrogluteal site: - involves the gluteus mediums and gluteus
minimums muscles in the hip area.
 This site provides the greatest thickness of gluteal muscle, doesn’t
have nerves and blood vessels penetrating it.
 It is also clean and away from bone
 This site is recommended for adults and children over 7 months old.
Land marks:-
 Greater trochanter (over which the nurse’s palm is placed)
 Anterior superior iliac spine (to which the nurse’s index finger
directly points)
. Vastus lateralis site (Anterior lateral thigh)
• It is thick and well developed muscle and is not located near
major nerves and blood vessels.
• Recommended frequently for injection of medications if
ventrogluteal site can’t be used
• Preferred site for infants under 7 months of age. But has small
nerve endings resulting in discomfort after injection. The muscle
also doesn’t cover a joint.
• The thigh is divided into thirds horizontally and vertically. The
injections are given in the outer middle third.
• This space provides a large number of injection sites.
RECTUS FEMORIS
Used for infants and toddlers
 Lies medially to vastus lateralis.
 Identify injection site in the same manner as vastus
lateralis.
 use this when other site of IM injection are unavailable
 Disadvantage of this site is that are sciatic nerves and
numerous blood vessels run very close to it.
3.Deltoid Muscle site
• Located in the lateral aspect of the upper arm.
• It isn’t often used because it is not well developed in many adults and
isn’t capable of absorbing large amounts of solution.
• Damage to the radial nerve and artery is a risk.
• Used only for small volume of medication (0.5ml-1ml) and used for
adults but sometimes for toddlers and children.
Land marks: Lower edge of the acromion process
 A triangle is formed at the midpoint in line with the axilla on the lateral aspect
of the upper arm.
Hepatitis B-virus vaccine should be given only in the deltoid muscle in adults.
The deltoid site is located by drawing an imaginary line 2.5-5 cm
below the lower edge of the acromion process of the scapula.
Con’t….
 Childrenyounger than 18 months have poorly
developed deltoid muscles and should not receive
injections into this site.
. Dorsogluteal site

• Has been a common site for administering IM injections.

• the potential for accidental injury to the sciatic nerve and the presence of
major blood vessels and bone masses near the site. This site should not be
used.
• Studies have demonstrated that the exact location of the sciatic nerve varies
from one person to another. If a needle hits the sciatic nerve, the client may
experience permanent paralysis of the involved leg.
• Frequently, injections intended for muscle deposition are given into fat due to
insufficient needle length. This is particularly true for injections given for
women.
• IM injections should be administered into a relaxed muscle.
COMPLICATIONS
shock
 Pain with injection
 Damage to SC or IM tissues
- abscess
- SC tissue discoloration
- Hematomas, induration
 Nerve injury- temporary or permanent paralysis
 Bone injury (pain or bone damage)
 Infection of muscle or bone.
CONTRAINDICATION
Abnormal muscle tissue
 tissue underneath burns
 Scars
 Inflamed area
 Infection
Z-TRACK (ZIGZAG) INJECTION
Any IM injection may be given using Z-track
technique.
Z-track is the safest& most comfortable
technique for giving any IM injections.
Z-track prevents seepage of medication into the
needle track& reduces the pain& discomfort.
Con’t…
The skin is pulled 2.5-3.5cm laterally down&
held in this position with non-dominant hand
until the medication is injected.
After medication is injected massage of the site
is not recommended b/se it may cause irritation
by forcing medication to leak back into the
needle track.
INTRAMUSCULAR SITE SELECTION
Age of Patient Recommended Site
• Infants -- Vastus lateralis
• Toddlers and children -- Vastus lateralis or deltoid
• Adults -- Ventrogluteal or deltoid
 infants and young children - Vastus lateralis
 older children and adults - Deltoid
 Hepatitis B/Rabies - Deltoid
 Medications that are known to be irritating, viscous, or oily
solutions - Ventrogluteal
PATIENT POSITIONING
Injection Site -- Patient Position
• Deltoid -- Patient may sit or stand. A child may be held in an
adult’s lap.
• Ventrogluteal --Patient may stand, sit, lie laterally, and lay
supine.
• Vastus lateralis -- Patient may sit or lay supine. Infants and
young children may lay supine or be held in an adult’s lap.
ADMINISTERING INTRAVENOUS MEDICATION
 An introduction of a drug in solution form into vein.
 It is fastest way of administering a drugs.

Purpose
• when the immediate effect is desired (quickest).
•When the given drug is irritating to the body tissue if given
through other routes.
•It would be the route chosen in an emergency situation
• when immediate absorption is required.
• Can be life-saving in certain conditions.
• To introduce medication through the vein, particularly antibiotics.
Con’t….
N.B
IV- route is the most dangerous route of administration of
medication. Once the drug is placed directly into blood
stream, it can’t be recalled, nor can its action be slowed.
Disadvantage:
-the drugs prepared for IV administration is expensive
- Limited to highly soluble medications.
-drug distribution is inhibited by poor circulation.
Ways of IV medication administration
There are several ways to administer medication intravenously.
A. Intravenous bolus or push – this technique is used to
administer medication that can be given with in 1 minute
for rapid therapeutic action.
- Medication may be given in to a continuously infusing IV set
or in to a caped IV port.
- Avoid using the term “IV push” or “IV boules” for drugs that
require administration longer than 1 minute. Use terms like
“IV over 2 min.” or IV over 5 min.”
Con’t….
Con’t….
B.By adding the drug into IV infusion solution
C. Intermittent intravenous infusion – used to administer medications that
need to be infused for intermediate length of time, usually 20-60 min.
- Such medication are supplied either in bags that contain 50 to 250 ml of
IV fluid or in 20-60 ml syringes to be used with an infusion pump.
D. Continuous infusions - used to infuse medications that must be given
continuously to achieve the desired effect and medications that are toxic if
given over short period.
- Such medications are supplied in IV bags containing 250 to 1000 ml of
IV fluid.
Con’t….
Advantages
 Large volume can be given

 Getting rapid effect

 The route is used to administer fluid/nutrition if the patient

can not feed by mouth

Disadvantages
 The drug prepared for IV administration is expansive
 Limited to highly soluble medication

 Drug distribution is inhibited by poor circulation.

Precaution
Administer the medication slowly.
 Use aseptic technique through out the procedure.
 The client is assessed closely during the
administration, and the medication is discontinued
immediately if an untoward(yemayigeba) reaction occurs.
Sites for IV injection
 Dorsal venous network
 Dorsal metacarpal veins
 Cephalic vein
 Radial vein
 Ulnal vein
 Basalic vein
 Median cubital vein
 Greater saphenous vein
For newborns and infant use sites in the hand,scalp, forearm, and
in the foot
NOTE:
• Parenteral equipment is most frequently associated with
transmission of blood borne pathogens. Protected needle
systems should be used to protect against infection.
• Strict aseptic technique should be observed throughout the
procedure.
•Make yourself as well as the patient comfortable before giving I.V.
injection.
ADMINISTERING INTRAVENOUS INFUSION (THERAPY)
it is an introduction of a large amount of fluid (solution)
into the blood stream through a vein.
Purpose: -
1. To maintain fluid and electrolyte balance and restore acid-
base balance, in case of shock, haemorrhage and other
metabolic disorders. Ex. glucose, saline, blood, plasma &
large quantities of serum etc.
2. To introduce medication through the vein, particularly
antibiotics.
Intravenous Fluid Therapy
Can You Imagine life without water?
 Of course not, because water is essential to sustain life. Likewise,
(same) body fluids are vital to maintain normal body functioning.
 Total body fluid (TBW), accounts for approximately 60% of total
body weight (this can be 70% or higher in a newborn down to 50–
55% in a mature woman).
 Most fluids about 40% of body wt in the intracellular compartment.
• In a healthy individual, fluid intake and fluid losses are about equal.
 Total Body Fluid can be divided into Intracellular and Extracellular.
Con’t…
Extracellular fluids which consists:-
1. intravascular fluids in the blood vessels
2. interstitial fluids b/n the blood vessels and cell
3. trans cellular fluids cerebrospinal, pleural; synovial fluids
The amount of osmotic pressure depends on the ratio b/n the
concentration of ions in the infused solution and the concentration of
ions in the cell fluids.
Water moves from an area of low ion concentration (a hypotonic
solution)to an area of higher ion concentration(a hypertonic solution)
Types of Fluid
The fluids used in clinical practice are usefully classified into colloids,
crystalloids and blood products
1.Colloid
 Solutions that contain large molecules that don't pass the cell membranes.
2.Crystalloid
Solutions that contain small molecules that flow easily across the cell membranes,
allowing for transfer from the bloodstream into the cells and body tissues.
This will increase fluid volume in both the interstitial and intravascular spaces
(Extracellular)
It is subdivided into:
* Isotonic
* Hypotonic
* Hypertonic
Types of IV solutions
Isotonic Fluids (same/ equal ,tonic concentration of a
soluition.
 Isotonic solution- solutions that contain the same concentration of
solute to the solution to which they are added.
 The cell has the same concentration on the inside and outside. The cell
loves to be isotonic state and when something happens to make it
unequal(hypo or hyper)
When to consider a solution isotonic?
 When the concentration of the particles (solutes) is similar to that of
plasma, So it doesn't move into cells and remains within the
extracellular compartment thus increasing intravascular volume.
 Con’t…
A. Isotonic solutions; used to infused to replace
fluid losses ,usually extra cellular losses and to
expand the intravascular volume
Most doesn’t provide energy
1. 5%dextrose in water (DSW): shouldn’t be used
in excess b/se doesn’t contain any electrolyte
particularly sodium, hyponatremia encephalopathy
can be developing rapidly& causes death unless
promptly recognized and treated.
Con’t…
• D5W provides free water that pass through membrane pores to
both intracellular and extracellular spaces. Its smaller size allows
the molecules to pass more freely between compartments, thus
expanding both compartments simultaneously
• It provides 170 calories per liter, but it doesn't replace
electrolytes.
• The supplied calories doesn't provide enough nutrition for
prolonged use.
Take Care
D5W is not good for patients with renal failure or cardiac
problems since it could cause fluid overload.
- patients at risk for intracranial pressure should not receive D5W
since it could increase cerebral edema
- D5W shouldn't be used in isolation to treat fluid volume deficit
because it dilutes plasma electrolyte concentrations
- Not used for resuscitation, because the solution won't remain in
the intravascular space.
2. 0.9% NaCl (normal saline): it provides only Na+
and Cl-.
 It's called "normal saline solution" because the percentage of
sodium chloride in the solution is similar to the concentration of
sodium and chloride in the intravascular space.
• May be used to expand temporarily the extra cellular

compartment if circulatory insufficient is the

problem.
When to be given?
1- to treat low extracellular fluid, as in fluid volume deficit from
- Hemorrhage - Severe vomiting or diarrhea - Heavy drainage from
GI suction, fistulas, or wounds
2- Shock
3- Mild hyponatremia
4- Metabolic acidosis (such as diabetic ketoacidosis)
5- It’s the fluid of choice for resuscitation efforts.
TAKE CARE:
Because 0.9% sodium chloride replaces extracellular fluid, it
should be used cautiously in certain patients (those with
cardiac or renal disease) for fear of fluid volume overload.
Con’t…
3. Lactated ringer’s solution:
contains multiple electrolytes in about the
same concentrations as found in plasma
except Mg+& PO4-.
o is the most physiologically adaptable fluid because its electrolyte
content is most closely related to the composition of the body's
blood serum and plasma.
o Another choice for first-line fluid resuscitation for certain
patients.
When to be used?
 To replace GI tract fluid losses ( Diarrhea or
vomiting )
 Fistula drainage
 Fluid losses due to burns and trauma
 Patients experiencing acute blood loss or
hypovolemia
Notice. Both 0.9% sodium chloride and LR may be used in
many clinical situations, but patients requiring electrolyte
replacement (such as surgical or burn patients) will benefit
more from an infusion of LR.
B- HYPOTONIC FLUIDS(under beneath)
• The cell has a low amount of solute extracellularly and
it wants to shift inside the cell to get everything.(cause
cell swelling or burst,lysis.
• Compared with intracellular fluid (as well as compared
with isotonic solutions), hypotonic solutions have a
lower concentration of solutes (electrolytes).
• Hypotonic crystalloid solutions lowers the serum
osmolality(the concentration of an osmotic solution) within
the vascular space, causing fluid to shift from the
intravascular space to both the intracellular and
interstitial spaces.
Con’t…
A hypotonic solution is in which the concentration of solute is greater
inside the cell than out side of it.

Hypertonic solution is where the concentration of solutes is greater

outside the cell than inside it.
Hypotonic solutions
1. 0.33% NaCl (1/3-strength saline):
provides Na+ and Cl- & free water.
2. 0.45% NaCl (1/2-strength saline):
provides Na+, Cl-& free water used to
treat hypernatremia.
HYPERTONIC SOLUTIONS(excessive
• What is hypertonic solutions?
• The cell has an excessive amount of solute
extracellularly and osmosis is causing water to rush out
of the cell intracellular to the extracellular area which
will cause the to shirink.
• Solution that have a higher tonicity or solute
concentration. Hypertonic fluids have an osmolarity of
375 mOsm/L or higher
• The osmotic pressure gradient draws water out of the
intracellular space, increasing extracellular fluid
volume, so they are used as volume expanders.
Con’t…..
Hypertonic solutions;
1. 5% dextrose in 0.45% NaCl: a common hypertonic
solution used to treat hypovolumia& used to maintain
fluid intake.
2. 10% dextrose in water (D10W): supplies 340cal/L.
Used for peripheral nutrition (PPN).
3. 5% dextrose in 0.9% NaCl: replaces nutrients&
electrolytes. Can temporarily be used to treat
hypovolemia if plasma expander is not available.
How to know that the patient has
Hypovolemic Shock?
The patient has the following sings and symptoms:
1- Anxiety or agitation 2- Cool, Pale skin
3- Confusion 4- Decreased or no urine output
5- Rapid breathing 6- Disturbed consciousness
7- Low blood pressure 8- Low body temperature
9- Rapid pulse, often weak and
Intravenous medication flow rate calculation

To infuse a medication for a set time, the

nurse needs to calculate the appropriate
rate of flow for the medication.
IV flow rates are calculated in drops/min.
 Con’t….
To calculate IV drip rate, the nurse can use the following formula.
ml of solution X drop/min (drip rate factor) = drops/min
Hours to administer 60(min/hr)
1ml= 15-20drop, this is the drip rate factor.
For example, if you are ordered to administer 1L of solution over 8hours:
 Drop rate = 1000ml x 15-20drops/ml
8hrs 60(min/hr)
= 1000ml x 20drops/min
8hr 60 (min/hr)
= 41.67drops/min.
Therefore, you have to allow the fluid to flow at a rate of 42drops/min.
Complications Associated With
Intravenous Infusion
1. Infiltration(mesreg) – the escape of fluid into the SQ
tissue.
• S/Sx- Swelling, Pallor, Coldness or pain around the
site, decreased flow rate.

• Nursing responsibility: Discontinue the infusion if S/Sx

occurs.
Con’t…
2. Phlebitis- inflammation of vein due to mechanical,
chemical trauma.
• S/Sx- local acute tenderness, redness, warmth& slight
edema of the vein above the insertion site.
• Nursing responsibility: Discontinue the infusion
immediately.
: apply warm, moist compress

: avoid further use of vein

Con’t…
3. Thrombus- a blood clot.
• S/Sx-IV fluid flow may cease if clot obstructs needle.
• Others similar to Phlebitis

• Nursing responsibility: don’t rub/massages the affected

area
• Others the same as phlebitis.
Con’t…
4. Sepsis – the invasion of blood stream by MOs.
• S/Sx- red& tender at insertion site, fever, malaise&
other v/s changes.
• Nursing responsibility: -report immediately & treat with
appropriate antibiotics.
Con’t…
5. Air embolus- air in the circulatory system.
• S/Sx- respiratory distress, increased heart ,
cyanosis, change in level of consciousness&
decreased in BP.
Con’t…
6. Fluid over load- the condition caused when too large
volume of fluid infuses into circulatory system.
• S/Sx-engorged neck veins, increased BP, dyspnea

• Nursing responsibility: - slow the rate of infusion

-Monitor V/s
- Give diuretics.
2.6.SUBLINGUAL MEDICATION
ADMINISTRATION
 Isa medication that is placed under the tongue and allowed
to dissolve completely.( eg. Nifidipine , Nitroglycerin).
Purpose
•To provide local effects
•To prolong systemic action
•To prevent a disease
•To give palliative treatment
•To give symptomatic treatment
Con’t..
Contraindication
•Patients with nausea and vomiting
•Patients with oral surgery
•Unconscious patient
DESCRIPTION
To administer sublingual tablets, the nurse should have
the patient open his or her mouth and raise the tongue.
 The tablet should be placed under the tongue.
 Administration of buccal tablets is similar to that of
sublingual tablets.
 First, the patient should open his or her mouth.
 The tablet should be placed between the gum and the
wall of the cheek
2.7.TOPICAL ADMINISTRATION
 Definition: - is application of a drug directly to the body
sites (skin or mucus membrane).
Purpose
 To have direct (local) action on a particular site

 To produce systemic effect

TYPES OF TOPICAL MEDICATIONS
 Cream- non greasy/oily, semi solute preparation
 Ointment- semi solute than cream, for external use on skin,

conjunctiva, etc.
 Lotion- clear, suspension, emollient liquid and protect and
soothe the skin
 Gel or jelly- clear, shining form.
 The advantages of topical medications includes they have no
Gastrointestinal disturbance and reduce the risk of serious side
effects
ADMINISTERING OPHTHALMIC MEDICATIONS
 Application of a drug to the eye
Purpose
- To treat local eye infections
- To dilate pupil for diagnostic purpose /examining
- To aid in controlling intraocular pressure for patients with
glaucoma
Con’t….
Drugs: -
1.Eye drops:-
 installation of eye drop is performed for their local effects such as pupil
dilation or constriction when examining the eye or for treating infection
like trachoma. instilled in the lower conjunctival sac.
 The type and amount of solution depends on the purpose of installation.
2.Ointments: -
 usually used for local infection /irritation instilled in the lower conjunctival

sac.
 After application the eye should be closed and the client is instructed to

move the eyeball to spread the ointment client.

 Avoid touching the eyelids, lashes, or eyeball with either hand or tip of the
applicator.
 Avoid dropping a solution on to the cornea directly because it cause
discomfort.
Eye irrigation
Purpose:
• To remove secretions/foreign bodies
• To cleanse /soothe the eye
• To remove chemicals that may burn the eye
 When irrigating one eye, care should be taken so that the
overflowing irrigation fluid does not contaminate the other eye.
 Large amount tape water should be used to remove chemicals
like acids.
 The irrigation should continue for at least 15 minutes.
Con’t…
• Hold irrigation syringe about 2.5 cm (1 inch) from eye and
direct flow of solution from inner to outer canthus along
conjunctival sac.
Administering Ear medications
 Drugs in the solution form are placed in the auditory
canal for their local effect and is called instillation of a
drug into the auditory canal.
Purpose:
- For local effects
- To soften the wax
- To relieve pain
- To destroy organisms /insects lodged in the ear canal
Con’t
Drugs: Ear drops.
 Prepare client for instillation of ear medication by
positioning on side, with ear to be treated upper most,
as follows.
1. Warm medication bottle in your hand to body
temperature. Fill medication dropper with prescribed
amount of medication. Rational: instillation of cold
medication can cause nausea or vertigo.
2. Infant: draw earlobe gently downward and backward.
Rational: this separates drum membrane from floor of
cartilaginous canal.
Con’t
3.Adult: lift auricle upward and backward. Rational: this
position straightens the ear canal.

4. Instill medication drops, holding dropper slightly above

ear. Rational: This position protect dropper from
contamination.

5. Instruct client to remain on side for 5 to 10 min

following instillation. Rational: prevents medication
from escaping and facilitates distribution.
Con’t…
Ear Irrigations: - is flushing of external auditory canal
Purpose:
- To cleanse (using normal saline)
- To apply heat
Con’t
Con’t
• Pulling the pinna down and back for an infant or a child
younger than 3 years.
Nasal Instillations:
 administration of drugs into the nose.
 Medication that have a systemic effect such as

vasopressin may also be prepared as nasal installation

 Medication that are instilled by drops may also be

applied to the nasal mucus membrane by using a spray.

Purpose:
- To treat sinus infections
- To treat nasal congestions
 Nose isn’t a sterile cavity, but because of its connection

with the sinuses, medical asepsis should be maintained

when instilling nasal medications.
Rectal instillations
Administering drugs rectally
Purpose:
- For local effect on GI mucosa (promoting defection) as
a laxative & fecal softener.
- For systemic effects (provide analgesia, relieve nausea)
using antipyretic and antiemetic drugs.
 Proper placement is important for suppositories to

promote retention of the medication until it dissolves

and is absorbed.
Con’t….
Note
 use disposable glove to insert vaginal and rectal
medication to prevent contamination.
 once the suppository is inserted the client should
remain in that position for 5 min,unless the suppository
is for laxative purpose in which case it must remain in
place for 35-45min or until the client feel urge to
defecate
Vaginal Applications
Applying medications intravaginally

Purpose:

- To treat and prevent local infections

- To remove an offensive or irritating discharge

- To reduce inflammation

- To relive vaginal discomfort

 Vaginal medications are available in foam, jelly, cream.
Medicated irrigations or douches can also be given
Con’t
 Creams can be applied intravaginally using a
narrow ,tubular applicator. Suppositories that melt when
exposed to body temperature are also prepared for
vaginal insertion.
 The client should be asked to void before inserting the
medication &privacy should be maintained with
draping.
Con;t
• Creams can be applied intravaginally using a narrow,
tubular applicator.
• The client should be asked to void before inserting the
medication & privacy should be maintained with
draping.
KINDS OF SUPPOSITORY
1. Bisacodyl (Dulcolax) is commonly ordered for its
laxative action.
 It stimulates the rectum and lubricates its contents.
 Normally 15 minutes is needed to produce bowel
movement.
2. Glycerine or suppository for bringing about bowel
movement.
 If soap suppository is used cut a splinter of soap 2-6
cm. loch and wash it in hot water to smooth the rough
edges before administration.
3. Opium, sodium barbital etc. for sedation
Minimize potential risk to the safe administration of
medication
 Client medication chart in relation to timing and route of medication
to be administered and checked
 Issues were raised related to drug and poison administration with
appropriate personnel.
 Common contraindications and adverse reactions of prescribed
medications are checked for and identified and referred to authorized
health personnel.
Con;t
 Client identity for any known allergies is confirmed. and checked
 Ensure infection prevention and control methods are applied
correctly.
 Pharmacology and substance incompatibilities are identified in
relation to specific situations involving medication administration.
 Expiry dates of medication prior to administration are checked.
Prepare for medication administration within the scope of
enrolled nurse
 The process of medication administration to the p’t is explained
&ensured their readiness.
 The client positioned appropriately prior to administration of medication.

 Administration route for each medication to be administered is correctly

identified using appropriate terminology.
 The effects of commonly used medications on the body are considered
prior to medication for administration of drugs.
ADMINISTRATION OF BLOOD TRANSFUSION
• A blood transfusion is the infusion of whole blood or
a blood component such as blood plasma, RBCs, or
platelets into the venous circulation.
• The person receiving the blood is called recipient and
that give the blood is called donor.
Purpose of blood transfusion
• To counteract sever hemorrhage& replace blood loss
• To prevent circulatory failure
• In severe burns (plasma& electrolyte replacement)
• To treat severe anemia (from cancer, hematologic
disorder)
• To provide the clotting factor e.g. hemophilia
• HIV/AIDS to replace loss of immunoglobulin /ARV
BLOOD TYPING AND CROSS MATCHING
 Before a blood can be given for the person it must be
determined that the blood of the donor and that of the
recipient are compatible.
 If incompatible clumping and hemolysis of the

recipient’s blood cells result and death can occur.

 The laboratory examination to determine a persons

blood type is called typing. The process of determining

compatibility is called cross-matching.
Con;t
• Typing: is the laboratory examination to determine a
person’s blood type.
• Cross-matching: is the process of determining
compatibility between blood specimens of the donor
and recipient.
• Before blood can be given to a person, it must be
determined that the blood of the donor and that of
the recipient are compatible
Con’t
• If incompatible clumping and hemolysis of the
recipient’s blood cells results and death can occur.
Blood types
• The four main blood groups in the ABO system of blood
typing are: A, B, AB, and O.
• Blood type is an inherited trait and it is determined by
the type of antigen and antibody present in the blood.
Con’t
• Antigen: is a substance that causes the formation of
antibody.
• Antibody: is a protein substance that develops in
response to the presence of antigen in the body.
• Agglutinins: is antibody that causes a clumping of
specific antigen.
Con;t
• People who have ‘A’ blood group have ‘A' antigen and ‘B’
antibody (agglutinins) on their RBCs
• people who have ‘B’ blood group have ‘B’ antigen and ‘A'
antibody.
• Those who have ‘AB’ blood group have both ‘A’ and ‘B’
antigen and no antibody on their RBCs.
• And those who have ‘O’ blood group have no antigen and
have both ‘A’ and ‘B’ antibodies (agglutinins)
Con;t
So people who have ‘O’ blood group are called universal
donors and those who have ‘AB’ blood group are called
universal recipient.
Selection of blood donors
• Donor’s blood must be typed
• Determine whether the donor is free from diseases like
HIV, HBV, etc
• Blood donated from people who have allergies or those
with history of chronic diseases such as TB, cancer and
hemophilia, is usually not used.
• Individuals may give blood only if blood count,
temperature, pulse, respiration, and blood pressure are
within normal range.
Con;t
Autologous transfusion: patients who will need blood can
give their own blood.
• this eliminates the risk of cross infection donor to receipt
and decrease the risk for complication from mismatched
blood.
• The blood should be given 5weeks before surgery.
• The patient’s own blood can be salvaged during surgery or
collected from tubes& drains to allow for autologous
transfusion.
Con;t
Initiating the transfusion
• The procedure for starting a blood transfusion is basically
the same as for an IV-solution.
• If possible large veins should be selected because no
smaller needle or catheter than no 19 gauge should be
used.
• This size is necessary because of the viscosity(zlglgnet of
the blood.
Con;t
• Vital signs should be taken and recorded just before
starting the transfusion.
• If the patient’s body temperature is 100 degree
Fahrenheit (37.8 degree centigrade) or higher, the
physician should be notified.
• Blood that has not been used within 30min after
arrival from blood bank should be returned.
Blood products
Whole blood; is frequently used because the various
components can be easily separated and used for
replacement therapy unless blood loss has been massive.
• A single unit of whole blood or blood component should
be infused with in a 4 hours period.
• Patients receive only the blood they need.
-E.g. Excessive bleeding/blood loss secondary to injury or
trauma, delivery, APH, etc
Con’t
Packed RBCs: may be used in the following situations.
• Patients with anemia(suffering with a low RBC count)
• Patients with cardiovascular collapse
• Patients with GI bleeding
• Safe storage of blood is limited to 35 days (before
RBCs begin to deteriorating)
Con’t
Platelet: Platelet infusion is indicated for the
treatment or prevention of bleeding associated with
deficiencies in the number or function of patient’s
platelets.
 TRANSFUSION REACTIONS
• When preparing and administering a transfusion,
nurses should use every precaution to prevent the
occurrence of transfusion reaction.
• A nurse should stay with the client for the first 15min.
and check vital signs at least every 15min.for the first
half hour, and then every half hour or every hour,
until the transfusion is completed.
Con;t
• The followings are some of the transfusion reactions
which may potentially occur.
1. Allergic reaction: allergy to transfused blood
• S/Sx- hives(is an out break of swollen, pale red bumps or
plaques on the skin that appears suddenly.)
- itching, anaphylaxis
• N/R- stop transfusion immediately KVO with normal
saline. Administer antihistamine parentally b/se it cause
vasodilation.
Con;t
2. Febrile reaction: fever developed during infusion
• S/Sx-Fever, chills, headache& malasia
• N/R- stop transfusion immediately KVO with normal
saline.
-Administer antihistamine parentally b/se it cause
vasodilation.
-Treat symptoms.
Con’t
3. Hemolytic transfusion reaction :due to
incompatibility of blood products
• S/Sx- immediate onset, facial flushing, fever, chills,
headache, low back pain& shock
• N/R- stop transfusion immediately KVO
-treat shock if present
-obtain blood sample from site
-send unit, tubing & filter to lab.
Con’t
4. Circulatory overload: if too much blood is infused.
• S/Sx-dyspnea, dry cough, pulmonary edema
• N/R- stop or slow infusion
-Monitor V/s
-Place upright with feet dependant
5. Bacterial reaction: if bacteria present in the transfused blood.
• S/Sx- the same as AFI
-Treat with antibiotics.
GENERAL INSTRUCTIONS
– Blood should be fresh
– Correct blood must be given to correct patient.
– Blood must be stored at 4 degree C to 6 degree C.
in the refrigerator, should not be below 4 degree C.
or heated.
– Avoid shaking the container, if needed blood can be
mixed gently, if cells have settled at the bottom
LO3: ADMINISTER MEDICATIONS WITHIN LEGAL
PARAMETERS(MEWESEN)
 1- law related to medication administration
 Nurses might encounter(agatemew) criminal law if they have been involved in
the theft of medicines or have acted with gross negligence which, in extremis
might lead to a charge of manslaugh(nefse matfat)
 This Regulation is issued by the Council of Minister pursuant to Article 5 and
34 of the Definition of Powers and Duties of the Executive Organs of the
Federal Democratic Republic of Ethiopia Proclamation No. 471/2005 (as
amended by Proclamation No. 603/2008) and Article 2(43) and 55(1) of the
Food, Medicine and Health Care Administration and Control Proclamation No.
661/2009.
RESPONSIBILITY AND ACCOUNTABILITY OF
NURSES TO ADMINISTER MEDICATION
 the Code(denb) of Professional Conduct emphasizes that the nurse is
accountable for his or her actions as well as decisions.
 The code of conduct leaves the nurse in no doubt about his or her
personal and professional account-ability.
 It states that each nurse should ‘act at all times’ in the best interests
of the patient, and sets out principles for practice which
embrace(yaze) all aspects of care settings.
 The primacy of patients’ and clients’ interests is explicit(glts)
throughout the code(denb)
Con’t
Professional practice license given to any health
professionals shall be renewed every five years upon
ethical and competence evaluation.
A health professional whose license has been suspended

or revoked shall be prohibited to practice his profession.

The appropriate organ shall notify to the public the list of

health professionals whose licenses have been suspended

and revoked.
Con….
 Any health professional shall practice his profession in accordance with
the standards of health care and scope of professional practice set by
the executive organ.
 Any health professional shall perform his professional duties in
accordance with the relevant code of ethics.
 The code of conduct for health professionals shall be determined by
regulations to be issued pursuant to this Proclamation.
 Any health professional or other person who is aware of the existence
of professional mal-practice shall report the same to the appropriate
regulatory organ.
Prescribing and Dispensing of Medicines

 Medicine shall only be prescribed by a medical

practitioner who is licensed by the appropriate organ.
 Any medical practitioner shall prescribe medicine
following prescription procedures and on a standard
prescription paper.
 Medicines shall be dispensed by medical professional .
Con…
 Penalty

 1/ Unless a higher penalty is provided under the Criminal Code:

 a) Any licensed person who:
 (1) impedes(agede) the work of inspector assigned pursuant to
sub-article
 (2) (a) of Article 5 of this Proclamation shall be punishable with
imprisonment for not less than one year and not exceeding five
years or with a fine(genzeb mekecho) not less than Birr 10,000 and
not exceeding Birr 50,000 or with both;
Con’t…
 Transfers the certificate of competence or license issued
to him to any person by way of any means without the
permission of the executive organ shall be punishable
with imprisonment of not less than two years and not
exceeding five years and a fine of not less than Birr
50,000 and not exceeding Birr 100,000;
Con’t..
 Any licensed medicine manufacturer, importer, exporter
or wholesaler who sales medicine to a person without a
certificate of competence or license shall be punishable
with imprisonment of not less than five years and not
exceeding seven years and with a fine of not less than
Birr 50,000 and not exceeding Birr 100,000;
Con’t…
 Any person who advertises by way of any means to
encourage the abuse of narcotic drugs or psychotropic
substances or causes or allows such advertising or causes the
illegal production of narcotic drugs or psychotropic
substances through the inappropriate use of precursor
chemicals shall be punishable with imprisonment of not less
than seven years and not exceeding fifteen years and with a
fine of not less than Birr 30,000 and not exceeding Birr,
50,000;
THE ROLE OF THE NURSE IN THE
ADMINISTRATION OF MEDICATIONS
 Registered nurses often work in hospitals or outpatient facilities, where they
provide hands-on care to patients by administering medications, managing
intravenous lines, observing and monitoring patients' conditions, maintaining
records and communicating with doctors.
 Nurses perform a critical role in preventing medication errors
 Assess that the medication ordered is the correct medication.
-Assess the patient's ability to self-administer medications
-Determine whether a patient should receive a medication at a given time
Con’t..
 Administer medications correctly, and closely monitor their effects.
-Educate Patient and family about proper medication administration
and monitoring.
- Do not delegate any part of the medication administration process
to nursing assistive personnel
-Apply the nursing process to medication administration.
-practice the ten common rights
 NB-the nurse gives a right drug with right dose for the right
patient via the right root at the right time
LO4-MONITOR AND EVALUATE CLIENT’S
RESPONSE TO ADMINISTER MEDICATION
 Administration of medications is recorded in accordance
with relevant policy and procedures.
 Contribute to information provided to clients and
caretakers on medication administration (including
possible side effects) in consultation/collaboration with
the health care team.
 Client understanding of information provided is
evaluated
 Con’t…
 Emergency actions to address acute and delayed adverse
reactions are implemented within role responsibility.
 Response to emergency strategies is recorded and reported,
where appropriate.
 Client experiencing pain is assessed and managed using
appropriate medication and non medication therapies.
 Effectiveness of pain relieving medication is recorded and
reported
 DEVELOP STRATEGIES FOR PAIN
LO5.
MANAGEMENT
 Pain is an uncomfortable feeling that tells you something may be wrong.
 It can be steady, throbbing, stabbing, aching, pinching, or described in
many other ways.
 Pain can bring about other physical symptoms, like nausea, dizziness,
weakness or drowsiness.
 It can cause emotional effects like anger, depression, mood swings or
irritability.
 Perhaps(perhaps) most significantly, it can change your lifestyle and
impact your job, relationships and independence.
CLASSIFICATIONS OF PAIN
 nociceptive pain-caused by tissue damage
 neuropathic pain-caused by nerve damage
 psychogenic pain, which is pain that is affected by psychological
factors.
con…t
 Other classifications
 Pain on injury(including surgery)
 Pain from disease(acute)
 Pain from disease (chronic)
 Unusual pain situations
 Bruising, sprains, broken bones, surgical pain
 MI, cholecy stitis, toothache, migraine (headache), appendicitis
 Cancer pain; low back pain; arthritis
Con…t
 Pain management nurses are care for patients who are
suffering from both acute and chronic pain.
 Nurses can help patients more accurately report their pain by using
these very specific PQRST assessment questions:
 P = Provocation/Palliation
 What were you doing when the pain started?
 What caused it?
 What makes it better or worse?
 What seems to trigger it? Stress? Position? Certain activities?
Con..t
 What relieves it? Medications, massage, heat/cold, changing
position, being active, resting?
 What aggravates it? Movement, bending, lying down, walking,
standing?
 Q = Quality/Quantity

 What does it feel like? Use words to describe the pain such as sharp, dull,
stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or
stretching.
Con’t…
 R = Region/Radiation
 Where is the pain located? Does the pain radiate? Where? Does it feel
like it travels/moves around? Did it start elsewhere and is now localized
to one spot?
 S = Severity Scale
 How severe is the pain on a scale of 0 to 10, with zero being no pain
and 10 being the worst pain ever? Does it interfere with activities? How
bad is it at its worst? Does it force you to sit down, lie down, slow down?
How long does an episode last?
Con’t..
 T = Timing
 When/at what time did the pain start? How long did it last? How
often does it occur: hourly? daily? weekly? monthly? Is it sudden
or gradual? What were you doing when you first experienced it?
When do you usually experience it: daytime? night? early
morning? Are you ever awakened by it? Does it lead to anything
else? Is it accompanied by other signs and symptoms? Does it
ever occur before, during or after meals? Does it occur
seasonally?
Con’t..
 Documentation
 In addition to facilitating accurate pain assessment, careful and
complete documentation demonstrates that you are taking all
the proper steps to ensure that your patients receive the highest
quality pain management. It is important to document the
following:
Con’t
 Ask the patient what his or her pain level was prior to taking pain
medication and after taking pain medication.
 Timely re-assessment following any intervention and response to
treatment. Quote the patient’s response.
 Communication with physician. Always report any change in condition.
 Patient education provided and patient’s response to learning. Don’t
write “patient understands” without a supportive evaluation such as
patient can verbalize, demonstrate, describe, etc.
NURSING MANAGEMENT OF PAIN

1. Pharmacological

2. Non pharmacological pain mgt

 Non pharmacological interventions to alleviate pain rely on the
inhibition of pain signaling.
 Non pharmacological analgesia therefore involves the inhibition
of nociceptive input by activating separate antinociceptive
outputs
Con’t
 Non pharmacological approaches to the relief of pain are more
commonly associated with non acute settings and may be classified
as follows:
 (i)psychological interventions (including distraction, stress
management, hypnosis, and other cognitive-behavioral
interventions),
 (ii)acupuncture and acupressure,
 (iii)transcutaneous electrical nerve stimulation,(iv)physical therapies
(including massage, heat/cold, physiotherapy, osteopathy, and
chiropractic).
Pharmacological pain mgt
 Administering Pharmacological Measures for Pain
Management. ... Opioids are narcotics; they are used for
moderate to severe pain; non-opioids are non-narcotic
analgesics that are used to treat mild pain and they also to
serve as adjuvant medication for the relief of pain.
WHO Analgesic Ladder Step 1-3
 The 3 step WHO analgesic ladder is also used for providing
stepwise pain relief for pain due to other causes.
 1- Non-opioid medications: (step 1 WHO Analgesic ladder
– mild to moderate pain
 Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin,
ibuprofen, naproxen, diclofenac weaken and reduce the levels of
chemical mediators (prostaglandins) produced during
inflammation, relieving symptoms of pain, swelling and redness.
COMPOUND ANALGESICS: (STEP 2 ON THE WHO
ANALGESIC LADDER – MILD TO MODERATE PAIN
 Compound analgesics are a combination of drugs in a single
tablet usually including codeine (a weak opiate) and aspirin or
paracetamol.
 Compound analgesics may be used on their own or in
combination with NSAIDs (such as ibuprofen). NSAIDs,
paracetamol and opioids decrease pain via different mechanisms
so used together can improve pain relief.
Some low dose compound analgesics may be purchased over-
the-counter (OTC) but most require a prescription.
OPIOID MEDICATIONS (STEP 3 ON THE WHO
ANALGESIC LADDER – SEVERE PAIN
 Medications derived from morphine (or synthetic analogs) mimic the
body’s own analgesic system and are strongest and most effective
painkillers currently available.
 They work in the central nervous system by binding to Opioid receptors
in the pre- and post-synaptic membrane stopping the passage of
neurotransmitters across the nerve synapse which blocks or attenuates
the experience of pain.
 Opioid medications include morphine, oxycodone, codeine, tramadol,
buprenorphine, fentanyl and diamorphine (heroin
Last Slide
It’s Over