Fundamentals of Nursing, 3e

Barbara L Yoost
Lynne R Crawford

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 Chapter 35

Medication Administration

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LO 35.1 Medications and Regulations
(1 of 4)
 Drugs and medications
 Drug
• Any substance that either positively or negatively alters
physiologic function.
 Medication
• A drug specifically administered for its therapeutic effect on
physiologic function.
• Medication designations:
 Chemical name
 Official name
 Generic name
 Trade name

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LO 35.1 Medications and Regulations
(2 of 4)
 Medication standards and regulations
 Enacted to ensure uniform quality and predictable
effects
 The Pure Food and Drug Act of 1906
• United States Pharmacopeia (USP) and the National
Formulary (NF) are the only official authorities that can
establish drug standards
 U.S. Food and Drug Administration (FDA)
• Responsible for enforcing medication legislation
• Mandates that all medications undergo safety testing

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LO 35.1 Medications and Regulations
(3 of 4)
 Controlled substances
 Comprehensive Drug Abuse Prevention and Control
Act (1970)
• Established five categories of scheduled drugs
• Mandates regulations for the handling and distributing of
controlled substances
 Drug Enforcement Administration (DEA)
• Responsible for monitoring compliance

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LO 35.1 Medications and Regulations
(4 of 4)
 State and local medication regulations
 Health care facilities develop policies and procedures
• That must be in compliance with federal, state, and local
regulations
• That may be more restrictive than government controls
• The goal is to prevent adverse patient outcomes
 Nurse practice act
• Defines the functions and professional responsibilities of
nurses
• Health care facilities cannot modify or expand the nurse
practice act

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 LO 35.2 Principles of Drug Actions
(1 of 5)
 Pharmacokinetics
 Therapeutic effect
• Desired result or action of a medication
• To achieve therapeutic effect, medication must:
 Be taken into the body
 Be absorbed and distributed in cells and tissues
 Alter physiologic functioning
• Effectiveness is influenced by:
 Medication dose
 Route of administration
 Frequency of administration
 Function of metabolizing organs
 Age of patient

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 LO 35.2 Principles of Drug Actions
(2 of 5)
 Pharmacokinetics
 Absorption: passage of a drug from the administration
site into the bloodstream
 Distribution: process of delivering the medication to
tissues and organs
 Metabolism: process by which a drug is altered to a
less active form to prepare for excretion
 Excretion: process that removes the less active drug
or its metabolites

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 LO 35.2 Principles of Drug Actions
(3 of 5)
 Pharmacodynamics
 Biochemical response
• Local or systemic
• Evaluation is based on the patient's clinical condition
 Drug action factors
• Onset of action: time the body takes to respond to a drug
• Half-life: time it takes for the blood concentration of a drug to
measure one half of the original dose
• Peak plasma level: highest serum (blood) concentration
• Trough: lowest serum level

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 LO 35.2 Principles of Drug Actions
(4 of 5)
 Side effects, adverse
effects, and
interactions
 Side effects
 Adverse effects
 Toxic effects
 Allergic reactions
 Anaphylactic reaction
 Idiosyncratic reaction

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 LO 35.2 Principles of Drug Actions
(5 of 5)
 Side effects, adverse effects, and interactions
 Medication interactions
• Synergistic effect
• Antagonism
 Administering parenteral medications
• Drug incompatibility
 Precipitation
 Adverse chemical reaction
• Compatibility must be verified before mixing or administering
medications

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 LO 35.3 Nonprescription and
Prescription Medications (1 of 5)
 Nonprescription medications
 Over-the-counter (OTC) medications
• Do not require a prescription
• Regulated by the FDA
 When selecting an OTC medication, consider:
• The desired effect and potential side and adverse effects of
all ingredients
• Possible allergic reactions
• Potential interactions with other medications and herbs
• Warnings, directions, and dosage
• Safety features

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 LO 35.3 Nonprescription and
Prescription Medications (2 of 5)
 Nonprescription medications
 Vitamins
• Record vitamin use in the patient history
• Regulated by the FDA as dietary supplements
 Alternative therapies
• Herbal supplements
 Regulated by the FDA through the Dietary Supplement Health
and Education Act (DSHEA)
 Their action in the body is similar to prescription medications
 Consumers may not tell primary care providers they are using
herbal supplements

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 LO 35.3 Nonprescription and
Prescription Medications (3 of 5)
 Prescription
medications
 Medication order
components
• Patient's name
• Date and time
• Drug name
• Dosage
• Drug route
• Administration
frequency
• Signature

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 LO 35.3 Nonprescription and
Prescription Medications (4 of 5)
 Prescription
medications
 Medication
administration record
(MAR)
 Specific
documentation is
needed when a
medication is not
administered as
prescribed

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 LO 35.3 Nonprescription and
Prescription Medications (5 of 5)
 Prescription medications
 Common types of medication orders in acute care
settings
• Routine
• PRN (as needed)
• One-time or on-call
• Stat
• Now

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 LO 35.4 Forms of Medication and
Routes of Administration (1 of 5)
 Forms of medication
 Routes of medication
administration
 Oral administration
• Swallowed
• Sublingual
• Buccal
• Nasogastric, gastric,
intestinal, and jejunal
tubes

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 LO 35.4 Forms of Medication and
Routes of Administration (2 of 5)
 Topical medications
 Applied to the skin or
mucous membranes
 Inhaled medications
 Administered through
the respiratory tract

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 LO 35.4 Forms of Medication and
Routes of Administration (3 of 5)
 Parenteral medications
 The four major sites of injection are
• Intradermal (ID): Shallow injection into the dermal layer just
under the epidermis
• Subcutaneous (subcut; subcutaneously): Injection into the
subcutaneous tissue just below the skin
• Intramuscular (IM): Injection into a muscle of adequate size
to accommodate the amount and type of medication
• Intravenous (IV): Injection or infusion directly into the
bloodstream through a vein

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 LO 35.4 Forms of Medication and
Routes of Administration (4 of 5)
 Parenteral medication preparation
 Supplies
• Syringes
 Sizes: 0.5 to 60 mL or larger
 Types: standard, tuberculin, and insulin
 Common gauges: 18 to 30
 Needle length: ¼ to 3 inches

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 LO 35.4 Forms of Medication and
Routes of Administration (5 of 5)
 Parenteral medication preparation
 Filter needles or straws
• Used when medications are being withdrawn from a glass
ampule.
 Needleless delivery systems
• Significantly decrease needlestick injuries and exposure to
bloodborne pathogens.
• Needleless devices are disposed of in the same manner as
are regular needles.

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LO 35.5 Safe Medication Administration
(1 of 3)
 Interpreting the order
 Use clinical judgment
 Clarify unclear medication orders
 Medication errors
 Be aware of common causes of medication errors
 Abbreviations
 Use approved abbreviations
• Consult The Joint Commission's Do Not Use list
 Measurement systems
 Metric, apothecary, and household

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LO 35.5 Safe Medication Administration
(2 of 3)
 Calculation methods
 Dimensional analysis method
• Identify the units of measure.
• Start the equation with the dose to be given, then the
concentration or supply available.
• Include any conversions needed.
• Cross off units that appear in both the numerator and
denominator.
• Numbers on the top of the equation are multiplied, and the
numbers on the bottom are multiplied.
• The final step is to divide the numerator by the denominator
and add the correct units to the numeric answer.

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LO 35.5 Safe Medication Administration
(3 of 3)
 Administering medications by using the six rights
 Verify right drug, right dose, right time, right route,
right patient, and right documentation
 Perform three medication safety checks
 High-risk situations for medication administration
 Follow safeguards for preventing medication errors
 Patient rights
 American Hospital Association’s Patient Care
Partnership program

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 LO 35.6 Assessment

 Initial assessment
 Produces baseline data
 Ongoing assessment
 Evaluates medication effectiveness
 Enables early identification of adverse effects
 Important data to be collected
 Patient's medical history; allergy information;
medication history, physical examination results, and
relevant laboratory results

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 LO 35.7 Nursing Diagnosis

 Examples
 Lack of Knowledge
• Supporting Data: Lack of exposure to information, patient
took a double dose of furosemide, patient unaware of
possible side effects
 Constipation
• Supporting Data: Opioid pain medication use, reported hard
stools, painful defecation
 Impaired Health Maintenance
• Supporting Data: Verbalized misunderstanding of therapeutic
regimen, refusal to continue prescribed medications

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 LO 35.8 Planning

 The following are patient goals according to the

nursing diagnoses:
 The patient will verbalize side effects of medications
before discharge.
 During outpatient visit, the patient will verbalize
understanding of the need for adequate fluid and fiber
intake to prevent constipation.
 The patient will take medications daily until the next
appointment.

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LO 35.9 Implementation and Evaluation
(1 of 16)
 Medication administration
 Each medication that a nurse administers must be
prescribed by a health care provider and be
appropriate for the patient.
 Use the Medication Administration Record when
preparing and administering all medications.
 Follow established protocols for administering
medications safely by each route.
 Use special techniques for children and elderly
individuals.

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LO 35.9 Implementation and Evaluation
(2 of 16)
 Medication administration
 Oral medications
• Easiest and most convenient route of administration
• Assess patient's ability to swallow
• Use a different route for NPO patients
• After administration, verify medication was swallowed
• Use special techniques for patients swallowing large tablets
• Use a calibrated syringe or medication cup to administer
liquid medications that are not premeasured
• Do not use medications in containers with missing or hard-to-
read labels; do not return medication to a multidose
container
• Medication may be administered by the enteral route
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LO 35.9 Implementation and Evaluation
(3 of 16)
 Medication administration
 Sublingual and buccal medications
• Allow rapid absorption of medications
• Sublingual medication: place under the tongue
• Buccal medication: Place against the inner cheek
• Use standard precautions
 Topical medications
• Place on skin surface, on mucous membranes, or in body
cavities
• Cleanse the skin before applying topical medications
• Use gloves and applicators to avoid absorption on your skin

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LO 35.9 Implementation and Evaluation
(4 of 16)
 Medication administration
 Transdermal medications
• Designed to be absorbed through skin for systemic effect
• Remove current patch and clean skin before application
• Rotate patch placement sites
• Document patch removal and placement in MAR
 Ophthalmic instillation
• Ophthalmic medications are used to treat eye irritation,
infections, or disorders such as glaucoma
• Eyedrops can be used for diagnostic procedures or to
anesthetize the eye for procedures
• Avoid cross-contamination

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LO 35.9 Implementation and Evaluation
(5 of 16)
 Medication administration
 Otic instillation
• Used to treat ear infections and associated pain, soften
earwax to ease removal, apply a local anesthetic, and
remove foreign particles trapped in the ear canal
• Use eardrops at room temperature
• If the tympanic membrane has been damaged, all
procedures are performed with sterile technique

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LO 35.9 Implementation and Evaluation
(6 of 16)
 Medication administration
 Nasal medications
• Administer by drop or nebulizer formulations into the nose
• Use medical asepsis
• Decongestant sprays or drops
 Most common medications administered through nasal
instillation
 May have systemic effects

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LO 35.9 Implementation and Evaluation
(7 of 16)
 Medication administration
 Inhaled medications
• Devices include MDIs, DPIs, and nebulizers.
• Assess patients before and after administering inhaled
medications.
• Provide education on calculating remaining inhaler doses.
 Vaginal medications
• Creams, foams, tablets, liquids, suppositories, and gels
• Refrigerate vaginal suppositories.
• Offer patients absorbent pads and comfortable
undergarments for drainage.
• Do not use tampons after vaginal medication administration.

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LO 35.9 Implementation and Evaluation
(8 of 16)
 Medication administration
 Rectal medications
• Medication effects can be local or systemic.
• Rectal suppositories are often stored in the refrigerator.
• Wear clean, disposable gloves when administering rectal
suppositories.
• Place an unwrapped suppository above the internal anal
sphincter and against the mucous membrane.
• Instill liquid medications in the rectum using an enema
solution.

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LO 35.9 Implementation and Evaluation
(9 of 16)
 Medication administration
 Parenteral medications
• Administered by injection into tissue, muscle, or a vein
• Follow standard precautions and sterile technique.
• Observe the patient closely for medication responses.
• Equipment: syringes, needles, or another injection
mechanism and the vial or ampule from the pharmacy that
contains the medication
 Preparing parenteral medications
• May be premixed and packaged as a unit dose or may have
to be prepared by the nurse

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LO 35.9 Implementation and Evaluation
(10 of 16)
 Medication
administration
 Preparing parenteral
medications
• Ampules and vials
• Reconstituting
powdered medications
• Prefilled cartridge or
syringe
• Mixing medications in
one syringe

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LO 35.9 Implementation and Evaluation
(11 of 16)
 Medication
administration
 Intradermal
administration
• Given into the dermis
• Used for local
anesthetics, allergy
testing, and
tuberculosis testing
• Common sites: inner
forearm, the upper arm,
and the scapular area

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LO 35.9 Implementation and Evaluation
(12 of 16)
 Medication
administration
 Subcutaneous
administration
• Administered into layer
of fat below dermis
• Common sites:
abdomen, lateral upper
arm and thigh, scapular
area of the back, and
upper ventrodorsal
gluteal area

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LO 35.9 Implementation and Evaluation
(13 of 16)
 Medication
administration
 Intramuscular
administration
• Common sites:
ventrogluteal, vastus
lateralis, deltoid
• Z-track method
• Epinephrine auto-
injectors

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LO 35.9 Implementation and Evaluation
(14 of 16)
 Medication administration
 Intravenous administration
• Administered through a catheter inserted into a vein
• IV medications are delivered by
 IV push (IVP) or bolus
 Intermittent small-volume administration or IV piggyback (IVPB)
 Volume control administration set (IV pump or controller)
• Before administering assess
 Patient allergies
 Medication or IV solution incompatibilities
 Amount and type of diluent needed for the medication
 Rate of medication administration
 IV access site

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 LO 35.9 Implementation and
Evaluation (15 of 16)

 Medications and home care

 Educate patients and
caregivers about medications
 Types of medications
administered in the home:
oral, transdermal, peritoneal
dialysis, and IV treatments
with infusion pumps

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LO 35.9 Implementation and Evaluation
(16 of 16)
 Evaluation
 Clinical observation is an important way to evaluate
the effectiveness of medications.
 Subjective and objective data show evaluation of
medication responses.
 Assess for adverse effects of medications.
 Laboratory tests indicate the patient response to
some medications.
 Significant patient deviations from normal response
must be reported to the primary care provider.

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