BY C.

L 2022

BY:
Chala .L (BSc. N) ,2022

email:
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 BY C.L 2022

Outline
🞭 Terms and Definitions

🞭 Source and Naming of Drugs

🞭 Introduction to drug administration

🞭 Syringes and Needles

🞭 Drug Dosing

🞭 Medication Preparation

🞭 Routes of Administration

🞭 IV therapy 2
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Objectives
At the end of this chapter every students will be able to:

🞭 Define the key terms and abbreviations frequently used in

medication administration.

🞭 Discuss principles of safe medication administration including the

five rights of medication administration.

🞭 Correctly calculate appropriate dosage for medications

as prescribed.

🞭 Correctly demonstrate procedures for the different methods of

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Terms and Definitions

🞭 Pharmacology: is the study of the effects of drugs on

living organisms.
🞭 Drugs: are chemicals that alter functions of living organism.
🞭 Medication: is substance other than food used
🞥 to prevent disease,
🞥 to aid in diagnosis and treatment and
🞥 to restore or maintain functions in the body tissues.
🞭 Therapeutic agents: are drugs or medications that, when
introduced in to living organism, modify the physiologic
functions of that organism.
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Terms and definitions Cont’d...

🞭 Pharmacotherapeutics:
🞥 It deals with the proper selection and use of drugs
for the prevention and treatment of disease.

🞭 Pharmacodynamics:
🞥 The study of the biological and therapeutic effects of
drugs (i.e, “what the drug does to the body”).

🞭 Pharmacokinetics:
🞥 ADME of drugs (“i.e what the body does to the drug”).
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Terms and definitions Cont’d...

1. Absorption:
 It is passage of a drug from the site of administration
into the blood stream.
 Drugs are absorbed (Route of Absorption) by the mms, GIT,
respiratory tract, and skin.
 Responses to drugs vary, depending on the speed
with which the drug is absorbed into the blood or
tissues.
2.Distribution: the way in which a drug is transported from
the site of introduction to the site of action.
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Terms and definitions Cont’d...

3.Metabolism/ Biotransformation:
 Aggregate of all chemical reactions of drug in every cell.

 The process by which the body brings about changes in

drug molecule.

 Drug is converted by enzymes into a less active and

harmless agent that can be easily excreted.

 Most of this conversion occurs in the liver.

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Terms and definitions Cont’d...

4.Excretion:
 Elimination of drugs from the body.

 Excretion takes place when the drug is changed in to an

inactive form and excreted from the body.

 Important route of excretion;

 Kidneys (most important route of excretion),

 Lungs (which exhale gaseous drugs),

 Feces, saliva, tears, and mother’s milk.

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Terms and definitions Cont’d...

🞭 Drug Interactions
🞥 The combined effect of two or more drugs acting
simultaneously.

🞥 Each drug may have either a positive or negative effect on

the working of the others, i.e. they may be
 antagonistic- lessening the effectiveness of another drug
 synergistic- enhancing or improving the effectiveness
of another drug
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Terms and definitions Cont’d...

🞭 Side-effect:
🞥 A known effect, other than that primarily intended, relating to
the pharmacological properties of a medication.
 e.g. opiate analgesia often causes nausea

🞭 Adverse Reactions:
🞥 Unwanted and/or unintended effects arising from a
justified action where the correct process was followed for
the context in which the event occurred.
 e.g. unexpected allergic reaction in a patient taking a medication for
the first time 10
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Terms and definitions Cont’d...

🞭 Error:
🞥 Failure to carry out a planned action as intended
or
🞥 Application of an incorrect plan
🞥 A medication error may result in …
 an adverse event if a patient is harmed
 a near miss if a patient is nearly harmed or
 neither harm nor potential for harm
🞥 Medication errors are preventable
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Terms and definitions Cont’d...

🞭 Adverse event:
🞤 an incident that results in harm to a patient.
🞤 An adverse drug event:
 may be preventable (usually the result of an error) or
 not preventable (usually the result of an ADR or side-effect)

🞭 Anaphylaxis:
🞤 It is a life-threatening immediate reaction.
🞤 There is respiratory distress, sudden severe
bronchospasm, and cardiovascular collapse.
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Terms and definitions Cont’d...

Factors Affecting Drug Metabolism

🞭 Personal attributes, such as body weight, age, and sex.

🞭 Physiologic factors, such as state of health or disease

processes, acid-base and fluid and electrolyte balance; and
circulatory capability.

🞭 Genetic and immunologic factors play a role in drug

metabolism, as do psychologic, emotional and environmental
influences.
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Terms and definitions Cont’d...

Categories/ Classifications of Drugs

Drugs can be classified from different perspectives.
e.g. drugs may be classified by -
(a) body systems
i.e. drugs affecting the respiratory system
drugs affecting the cardiovascular system
OR
(b) the symptom relieved by the drug, or the clinical
indication for the drug i.e. analgesic, antibiotic
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Source and Naming of Drugs

Source of Drugs

🞭 Natural sources- from which drugs are obtained from:

a. Minerals: Liquid paraffin, magnesium sulfate, magnesium

trisilicate, etc.

b. Animals: Insulin, thyroid extract, heparin and antitoxin sera, etc.

c. Plants: Morphine, digoxin, atropine, castor oil, etc.

d. Microorganisms: Penicillin, streptomycin and many

other antibiotics.
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Sources & Naming of Drugs Cont’d...

🞭 Synthetic source:

a. Synthetic drugs are made in a laboratory from

chemical substances.

b. Majority of drugs currently used in therapeutics

are from synthetic source.

e.g. Aspirin, paracetamol, zidovudine, sulphonamides, etc.

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Sources & Naming of Drugs Cont’d...

Naming of Drugs
a.Chemical/ Scientific name:
 a very precise description of the drug’s chemical composition
(chemical formula).
 identifying the drug’s atomic and molecular structure.
 this name is of significance to the pharmacist.

e.g. Chemical name= Paraacetaaminofin

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Sources & Naming of Drugs Cont’d...

b.Generic name:
 the name assigned by the manufacturer who first develops
the drug (to which the drug belongs).

 It is shorter and simple.

e.g. Generic name= Paracetamol

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Sources & Naming of Drugs Cont’d...

c. Trade/ Brand name:

 is assigned/ selected by drug company market the drug and

 is copyrighted

 therefore, one generic drug may have several trade

names based on the number of companies marketing the
drug.

e.g. Brand name= Panadol, Acetaminophen,Tylenol

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Sources & Naming of Drugs Cont’d...

e.g. 2 Chemical name= Acetylsalicylic acid

Generic name = Aspirin

Trade/ Brand names = Aspro, Disprin

e.g. 3 Chemical name= Trimethoprim and Sulphamethoxazole

Generic name = Cotrimoxazole

Trade/ Brand names = Bactrim

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Drug Administration
🞭 To obtain a systemic effect, a drug must administer

to be absorbed and transported to the cells that

respond to them.

🞭 How a drug is administered depends on:

 the chemical nature of the drug,

 the quantity of the drug,

 the desired speed of effect, and

 the overall condition of the client 21

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Drug Adm. Cont’d...

🞭 Information on drug labels:

🞥 Name of medication

🞥 Total dose

🞥 Concentration

🞥 Route of administration

🞥 Expiration date

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Drug Adm. Cont’d...

🞭 Parts of medication order (Prescription):

 Date and time of the order is written
 Client’s Identification: - Full Name,Age, Sex
 Name of the drug to be administered (ex:Ampicillin)
 Dosage of the drug (5oomg)
 Route: by which the drug is to be administered (P.O,
IM, ID, IV, etc.)
 Frequency of administration (ex: QID, etc.)
 Signature of a person writing the order
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Drug Adm. Cont’d...

Injection Practice
🞭 Safe Injection practice: is one that
🞥 is given using appropriate equipment,
🞥 does not harm the receipt, does not expose the provider to
any avoidable risk and does not result in any waste that is
dangerous to the community.

🞭 Unsafe injection practice: is one that could harm the

recipient, and/ or the provider and/ or may result in waste
that is dangerous to the community. 24
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Drug Adm. Cont’d...

🞭 Needle-stick injury: Puncture of the skin caused by an

injection needle.

🞭 Sharps injury: An injury caused by puncture of the skin by

a sharp object/ instrument including an injection needle.

🞭 Safety (sharps) box: A puncture/liquid-proof container

designed to hold used sharps safely during collection,

disposal and destruction.

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Safe injections Cont’d...

Best Practices in injection safety

1.Elimination of unnecessary Injection
 Magnitude of Unsafe Injection: 70% of these injections
are unnecessary: oral medications could have been
prescribed

 Many injectable medications have an oral equivalent that is

equally strong and effective and much safer.

 Therefore unnecessary injections should be reduced through

 Promoting Rational Prescribing

 Educating the patients
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Best Practices in injection safety Cont’d...

2. Administer Injections safely

 Safety is one of the most important in preparing and
implementing drug administration.

 When you administer drugs, you must follow certain

safety rules, which are also known as” “the five Rights”.

 These rules should be carried out each time while you

give a drug to a client. Now a day There are also
other Rights In addition to 5 RIGHTS.

 Make sure you are doing the ‘right’ things. 27

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safety rules Cont’d...

1.Right drug:
🞭 Compare drug card, client’s medication sheet (medication
record) three times, with label on drug container.
🞭 The three checks:
a. When you reach for drug container or package.
b. Immediately before pouring or opening the medication.
c. When you replacing (returning) the drug container to the
drawer or shelf.
🞭 Know the action and side effects of the drug.
🞭 Check the expiry date of the drug.
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safety rules Cont’d...

Practical
session 2mins
🞭 When the medication is received, you must read
the
and compare it to the and copy the
information to the client's .
A. label, MAR, prescription or order
B. label, prescription or order, MAR
C. prescription or order, MAR, label
D. date, prescription or order, MAR
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safety rules Cont’d...

2.Right patient:
🞭 Check the pt’s ID: - Name, Age, Bed number & Ward number.
🞭 (What is the name on the prescription (client’s MAR)?
3.Right dose:
🞭 Read the container label & calculate the dose.
🞭 Check dosage against patient’s age, weight and the
pharmacokinetics of the drug.
4.Right time:
🞭 Check the specific dose interval & give the medication at the
prescribed time. 30
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safety rules Cont’d...

5.Right route

🞭 Individual drugs are designed to be administered by specific

route- be sure to check drug labels for appropriate route
of administration.

 make sure the physician’s order is clear.

 only give the medications by the route designated.

 know the abbreviations for the different routes.

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safety rules Cont’d...

🞭 Common abbreviations used in drug admn.

Ab/n Meaning Ab/n Meaning

O/ P.O oral/ per oral OS left eye

BID twice a day OU both eye
TID three times a day AM in the morning
DC Discontinue PM after noon
Ac before meal MANE morning
Pc after meal MIDI midday
hs at bed time NOCTE night
OD right eye TOP topical/ skin
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safety rules Cont’d...

Common abbreviations ….
Ab/n Meaning Ab/n Meaning
PRN when required/ when SC/ SQ Subcutaneous
necessary ID Intradermal
Stat Immediately IV Intravenous
QD every day IVT Intravenous therapy
QOD every other day BUC inside cheek
Q2h every 2 hour S/L Sublingual (under the
tongue)
Qhr every hour
QID four times a day PR per rectum
IM Intramuscular VAG Vaginal
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safety rules Cont’d...

Right documentation

🞭 Record all information concerning the

patient and medication including:
🞤 Indication for drug administration
🞤 Dosage and route delivered
🞤 Patient response to the medication
 Both positive and negative

‘’The nurse gives the right medication for a right client in a

right dosage through the right route at the right time.’’
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Drug Adm. Cont’d...

Guidelines for Safe Administration of Medications

🞥 Never administer medications that are prepared by
another nurse.

 You are responsible for a medication error if you

administer a medication that was inaccurately
prepared by another nurse.

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Guidelines for Safe Adm. Cont’d...

🞥 Nurses should listen carefully to the client who

questions the addition or deletion of a medication.

 Most clients are aware of their prescribed

medications. If a client questions the drug or dose
you are preparing to administer, recheck the order.

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Guidelines for Safe Adm. Cont’d...

🞥 If a medication is withheld, indicate the exact reason

why in the client’s record.
 Legally you are accountable for giving ordered
medications to the client; however, circumstances may
prevent you from giving a medication as ordered.

🞥 Initial the MAR only for those medications you

actually have administered.
 This practice ensures accurate charting by clearly
indicating which actions you have performed. 37
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Guidelines for Safe Adm. Cont’d...

🞥 Do not leave medications at the client’s bedside for

any reason.

 The client may forget to take the medication,

medications can accumulate, and the client could take
two or more of the same medication, causing an
overdose, or

 another client who is confused could take the

medicine.
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Guidelines for Safe Adm. Cont’d...

🞥 Advise clients not to take medications belonging to

others and not to offer their medications to
others.

 Medications are ordered for each client on the basis

of the history, physical examination, and effectiveness
of the medication.
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Syringes and Needles

About Syringes:
 Syringes are
 made of plastic or glass,
 packaged either separately or together with needles
of appropriate sizes, and
 designed for one-time use.
 After use, syringes must be discarded in
special puncture-resistant containers (Safety
Boxes).
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Syringes and Needles

Components of Syringe

A syringe has three basic parts:

 Barrel/ outside part, which
Syringe
contains measurement
calibrations
 Plunger, which fits inside the
barrel & has a rubber tip
 Hub / Tip/ Needle Adapter,
which connects with the
needle 41
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Syringes & Needles Cont’d...

Tip
 Tip is the end of the syringe that holds the needle.
 The needle
 slips onto the tip (Non Leur-Lok) or
 can be twisted and locked in place (Leur-Lok).

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Syringes & Needles Cont’d...

About Needles:
 Needles are made of stainless steel
 Needles have plastic caps that should remain on while not
in use (that keeps them from being contaminated).
 Injection needles are
differentiated based on their:
 length of the needle (range
from 0.25 to 2 inches),
 diameter of the needle (range
from 28 to 14 gauges). 44
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Syringe & Needle Cont’d...

Components of Needle: It has 3 basic parts

 Needle Hub/ Hilt: fits onto/ attaches to the syringe;
 Cannula/ Shaft: the long part of the needle that is
embedded in/ attached to the hub; and
 Bevel: the slanted part at the tip of the shaft

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Parts of a 10 mL Leur-Lock Hypodermic Needle
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Syringe & Needle Cont’d...

Types of Syringes
 There are many different types of syringes used in the
medical field.

 They come in various sizes and have different uses, but

generally there are four common types of syringe.
A. Tuberculin Syringes
B. Glass Syringes
C. Insulin Syringes
D. Hypodermic Syringes 46
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Types of Syringes Cont’d...

Size of Hypodermic syringe

 Hypodermic syringes are calibrated (marked) in

• cubic centimeters (cc),
• milliliters (mL), or
• units.

 Practitioners often refer to syringes by the volume of

CCs (mLs) they contain.
• For example, a 3cc syringe.
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Types of Syringes Cont’d...

 Size of Hypodermic syringe

 The smaller capacity syringes (1, 2, 3 and 5 mL) are

 used most often for SC or IM injections of medication.

 The larger sizes (6, 10, and 12 mL) are commonly used to

 draw blood or

 prepare medications for IV administration.

 Syringes 20 mL and larger are

 used to inject large volumes of sterile solutions.

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Types of Syringes Cont’d...

Figure: A sample of commonly used hypodermic syringes

(35 cc, 12 cc, 5 cc, 3 mL, and 1 mL). 49
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Types of Syringes Cont’d...

Each line on the barrel represents 0.2 mL, and the

longer lines represent 1 mL.

Figure : 5 cc syringe.
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Types of Syringes Cont’d...

 There are 10 spaces between the largest markings.

 This indicates that the syringe is measured in tenths of

a milliliter. So, each of the lines is 0.1 mL.

 The longer lines indicate half and full milliliter measures.

Figure: 3 mL syringe. 51
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Types of Syringes Cont’d...

Each line on the barrel represents 0.01 mL, and the longer lines
represent 0.1 mL.
Example: How much liquid is in the 1mL syringe in Figure?
• The top ring of the plunger is at the second line after 0.5mL.
• Therefore, the amount in the syringe is 0.52 mL.

Figure: A partially filled 1 mL tuberculin

syringe.
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Drug Dosing
Dose Definitions

 The dose of a drug:

🞥 is the quantitative amount administered or taken by a
patient for the intended medicinal effect.

🞥 may be expressed as:

• a single dose, the amount taken at one time;

• a daily dose, the amount taken within a day;
• a total dose, the amount taken during the time-course
of therapy. 53
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Dose Definitions Cont’d...

 A daily dose;
🞥 may be subdivided and taken in divided doses,

🞥 two or more times per day depending on the

characteristics of the drug and the illness.

 The schedule of dosing is referred to as the dosage

regimen. e.g., QID (four times per day) for 10 days

 Drug doses vary greatly b/n drug substances; some drugs

have small doses, other drugs have relatively large doses.
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Dose Definitions Cont’d...

 The dose of a drug for a particular patient may be

determined in part on the basis of;

🞥 the patient‘s age, weight, body surface area, general

physical health, liver & kidney function, and

🞥 the severity of the illness being treated.

 The usual adult dose of a drug is the amount that ordinarily

produces the medicinal effect intended in adults.

 The usual pediatric dose is similarly defined for the infant-

or child-patient.
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Drug dosing Cont’d...

Dose Measurement
 In the institutional setting;
🞥 doses are measured & administered by
professional & paraprofessional
personnel.

🞥 a variety of measuring devices:

 calibrated cups for oral liquids

 syringes and IV sets for

parenteral medication.
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Dose Measurement Cont’d...

 In the home setting, liquid dosage is usually measured in

🞥 "household" terms, most commonly by the

teaspoonful & tablespoonful.

🞥 an oral dispenser (calibrated dropper) finds use in

administering calibrated quantities of liquid medication
to children.

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Dose Measurement Cont’d...

The Drop as a Unit of Measure

 The drop (abbreviated gtt):

🞥 is used as a measure for small volumes of liquid

medications.

🞥 does not represent a definite quantity, because drops

of different liquids vary greatly.

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Dose Measurement Cont’d...

Examples of the calibrated droppers used in the administration

of pediatrics medications 59
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Dose Measurement Cont’d...

Dropper Calibration

 1mL of water = 1gram (1000mg)

 1 drop of water=45-55mg
 Thus, 1ml = 20 drops (assuming 50mg/drop)

 BUT WAIT!!

 Few liquids have the same surface & flow characteristics

as water, therefore the size of drop varies depending on
liquid
 Must calibrate dropper for each specific liquid
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Dose Measurement Cont’d...

 A dropper may be calibrated by counting the drops of a

liquid as they fall into a graduate cylinder until a measurable
volume is obtained.

 The number of drops per unit volume is then

established (e.g., 20 drops/mL).

Dropper Calibration- Example:

 If a nurse counted 40 drops of a medication infilling a

graduate cylinder to the 2.5 mL mark, how many
drops per milliliter did the dropper deliver? 61
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Dose Measurement Cont’d...

 First, identify known and unknown variables

– Known: 40 drops = 2.5ml
– Unknown: # drops = 1ml
 Next, set up a ratio equation and solve for

 = 16 drops 62
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Dose Calculations
General Dose
Calculations
 As a health care provider often needs to calculate:
🞥 The size of a dose

🞥 The number of doses

🞥 The total quantity of medication to dispense

Calculations of the Number of Doses
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General dose Calcul. Cont’d...

Calculations of the Total quantity of medication

Total amount = number of doses X size of dose

 Examples: How many milliliters of a liquid medicine would

provide a patient with 2 tablespoonfuls BID for 8 days?
Number of doses = 2 X 8 =16
Size of dose = 2 tablespoonfuls or 30 mL
Total amount = 16 X 30 mL = 480 mL

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General Dose Calcul. Cont’d...

Calculations of the Size of a Dose

 Examples: How many teaspoonfuls would be prescribed

in each dose of an elixir if 180 mL contained 18 doses?

65
 Dose Calcul. Cont’d...

Calculation of the Dose based on Potency

 The potency of some drugs is express in terms of units

 Amt of drug equivalent to dose in units

Example: How many mLs of U-100 insulin should be

used to obtain 40 units of insulin if U100 insulin
contains 100 units/ml
 Dose Calcul. Cont’d...

• Known
o Insulin = 100 units/ml
o Dose = 40 units
• Set up equation to solve for dose in ml

X= 0.4ml
 Dose Calcul. Cont’d...

Practical session 2

5mins

The physician prescribes a bolus of furosemide

(Lasix) 100 mg IV push to be given STAT. The
available vials are labeled “Furosemide 40 mg/2
mL.”

How many mLs of Lasix will you give?

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Dose Calcul. Cont’d...

Quiz 2:
1. The physician prescribed 25 mg of Librium, IM. Add 2 mL of
diluent to yield 100 mg/2mL. How many Ml will you give?
2. Order: Streptomycin 600 mg IM daily. Calculate the dosage.

69
Pediatric Dosing Considerations
 Age, Weight, and Health status
 Remember a number of biological functions vary
depending on stage of development

Dosing Based on Age

 Neonate or newborn = birth to 1 month
 Infant = 1month to 1 year
 Early childhood = 1 year through 5 years
 Late childhood = 6 years through 12 years
 Adolescence = 13 years through 17 years
 Pediatric Dose Cont’d...

General guidelines
 Doses usually based on subgroups
• <2 years consult your physician
• 2 to 6 years
• 6 to 12 years
• Over 12 years
 Pediatric Dose Cont’d...

Dosing Based on Weight

 Usual adult dose is generally suitable for an “average”
person (i.e., 70 kg or 154 lb adult)
 Dosing: mg/kg or mg/lb
 Calculating a dose for a child based on weight and the
adult dose

Dose = Weight (kg) X Adult Dose

70
 Pediatric Dose Calcul. Cont’d...

 Multiple rules are often used to determine dosing in

pediatrics
 Pediatric Dose Calcul. Cont’d...

Dosing Based on Body Surface Area (BSA)

 Often used for cancer chemotherapy, pediatrics

 Estimating BSA based on Weight and Height
• Find height and weight of patient on appropriate
chart or Nomogram (adult or pediatric)
• On nomogram draw line connecting height and weight
• Read point of intersection on BSA line = this is
the patient’s approximate BSA for their given height
and weight
 Pediatric Dose Calcul. Cont’d...

 Approximating a dose for a child based on BSA and

the adult dose

 Example: If the adult dose of a drug was 75 mg, what

would be the dose for a child weighing 40 lbs and
measuring 32 inches using the BSA method?
 Pediatric Dose Calcul. Cont’d...

 Known
– Adult dose 75mg

– BSA from chart= 0.6 m2

– Average adult BSA = 1.73 m2

 Solve for dose using equation

 Pediatric Dose Calcul. Cont’d...

 Example 2: If the usual adult dose ephedrine sulfate is

25 mg/m2, what would be the dose for a child
weighing 18 kg and measuring 82 cm in height?

Dose = BSA of child (in m2) * Dose per m2

– From nomogram BSA = 0.6 m2

– Dose = 25 mg/m2 x 0.6 m2 = 15 mg
Reconstitution of Dry Drug Powder
Reconstitution of PO Dry Powders

 Calculations of the Final Volume of

reconstituted solution & Total Drug Content
 Final Volume of reconstituted solution = Powder
Volume + Solvent Volume
 Total drug amount = Final concentration * Final
Volume
 Reconst. of dry powder Cont’d...

E.g. The instructions indicate that ampicillin should be

reconstituted by the addition of 78 ml of water to
make 100 ml of suspension such that each dose is
125 mg/5ml.

🞥 What is the volume of powder in the vial?

🞥 What is the total drug amount present?

 Reconst. of dry powder Cont’d...

 What is the volume of powder in the vial?

🞥 Total vol = 100ml;
🞥 Vol of water added = 78ml;
🞥 Vol of powder= 100 ml – 78 ml = 22 ml

 What it the total drug amount present?

🞥 Final concentration = 125mg/ml;
🞥 Final vol = 100 ml/bottle
🞥 Total drug amount =125mg/5 ml * 100 ml/bottle =
2500 mg/bottle
 BY C.L 2022

Reconst. of dry powder Cont’d...

 Modifying Instructions for Desired Concentration

 If a physician writes a Rx for Ampicillin 100mg/5
ml, but it is only available as a 100 ml bottle of
125mg/5ml, how many ml of water should be added
to the dry powder?
🞥 Assume the dry powder would normally be
reconstituted with 78 ml to provide 100 ml of a
125mg/5ml suspension as in the previous
question
81
 Reconst. of dry powder Cont’d...

 Step 1: Calculate powder volume

• 100 ml –78 ml = 22 ml of powder
 Step 2: Calculate total amount of drug in bottle
• 125 mg/5 ml * 100 ml = 2500mg of powder in bottle
 Step 3: Calculate total volume amount needed to get
appropriate strength (100mg/5 ml)
• 2500mg/X ml = 100mg/5 ml X =125 ml
 Step 4: Adjust for volume of dry powder
• 125 ml – 22 ml = 103 ml of water needed
 Reconst. of dry powder Cont’d...

Reconstitution of IV Dry Drug Powder

 Powder Volume + Solvent Volume = Final Volume of
reconstituted solution
 Often powder volume is small and does not significantly
contribute to final volume of reconstituted solution,
thus the volume of solvent used will approximate the final
volume of reconstituted solution.
 Solvent Volume = Final Volume of reconstituted solution
 Reconst. of dry powder Cont’d...

Example 1: If a vial of penicillin G contains 200,000 units, how

many ml of solution should be added to the vial of dry powder
to prepare a solution having a concentration of 25,000
units/ml.
🞥 Known
 Vial = 200,000units;
 Final concentration = 25,000units/ml
🞥 Set up an equation to solve for ml to add
 Reconst. of dry powder Cont’d...

Example 2: If package states to dissolve 5,000,000

units of dry powder in 23 ml for reconstitution which
will yield a concentration of 200,000/ml...

🞥 What is the powder volume?

 The powder volume is significant in this case:

 Thus
🞤 5,000,000 unit/Xml =200,000units/ml X =25.
🞤 Ifyou had to add 23 ml to the vial for reconstitution
per directions- the powder volume is 2ml
 Reconst. of dry powder Cont’d...

🞥 Example 3: How many ml of sterile water should be

used to prepare the following
– Potassium G 5,000,000 units
– Powder volume (2ml)
– Sterile water for injection (? ml)
– Make solution containing 500,000 units/ml

 Step 1: calculate final volume of solution

 Step 2: adjust for powder volume:
10 ml – 2 ml = 8ml of sterile water are needed
 BY C.L 2022

Medication Preparation

Obtaining Medication From a Glass Ampule

🞭 Definition:
 Ampule is made of clear
glass with a constricted neck
that must be snapped off to
allow access to the
medication.
 It contain volumes from 1ml
to 10 ml or more.
Purpose:
To make drugs available for injection
To avoid medication errors 87
 BY C.L 2022

Medication from ampule Cont’d...

Equipment:
🞭 Medical administration
record (MAR)
🞭 Ampule of prescribed
medication
🞭 Sterile syringe and needle
🞭 Filter needle
🞭 Sterile gauze
88
 BY C.L 2022

Medication from ampule Cont’d...

Procedure:
1.Wash your hands.

2.Confirm the ampule label.

3.Hold the ampule upright

and lightly tap the
top chamber until all
fluid flows into the
bottom chamber.
89
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Medication from ampule Cont’d...

4.Place sterile gauze 5.Snap the top off the

around the thin neck of ampule and place it on
ampule. a flat surface.

90
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Medication from ampule Cont’d...

6. Withdraw the medication, maintaining sterile technique.

🞭 Check connection of needle to syringe by turning barrel to right
while holding needle guard. (Use a filter needle if recommended.)
🞭 Remove needle guard, and hold syringe in dominant hand.
🞭 With non-dominant hand grasp ampule to stabilize on a 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.
🞭 Keep needle tip below level of meniscus.
🞭 Aspirate the medication by gently pulling on the plunger.

91
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Medication from ampule Cont’d...

Draw up the medication.

92
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Medication from ampule Cont’d...

…withdraw the medication

🞭 If air bubbles are aspirated:
 Remove the needle from the ampule.
 Hold syringe with needle pointing up and tap sides of the
syringe.
 Draw back slightly on plunger and gently push the
plunger upward to eject air.
 Reinsert the needle in the middle of the ampule and
continue to withdraw the medication.
93
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Medication from ampule Cont’d...

7.Remove excess air from the syringe and check the dosage
of medication in the syringe.

8.Recap (replace needle cap), remove used needle by

turning the barrel to the left, & dispose in sharps container.

9.Secure new needle to syringe by turning the barrel to right

while holding the needle guard.

10.Discard any unused portion of medication and ampule top

in a suitable container after comparing with MAR.

11.Wash hands. 94
 BY C.L 2022

Medication Preparation Cont’d...

Obtaining Medication From a Vial

Definition:
🞭 Vial is a small glass bottle with
 a rubber seal
 a protective plastic/ metal cap
that prevents the rubber from
being punctured prior to use at
the top.
Purpose:
 To prepare needed amount of medication
 To package multi or single-dose parenteral
medication. 95
 BY C.L 2022

Medication from vial Cont’d...

Equipment:
🞭 Medication administration
record (MAR)
🞭 Vial of prescribed
medication
🞭 Sterile syringe and needle
🞭 Filter needle
🞭 Alcohol swab
96
 BY C.L 2022

Medication from vial Cont’d...

Procedure:
1. Wash your hands. 2. Confirm the vial label

97
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Medication from vial Cont’d...

3.Prepare the vial.

 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.

98
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Medication from vial Cont’d...

4.Prepare syringe.
 Choose a syringe of appropriate size.
 Grasp needle cap and turn barrel of syringe to the
right. and remove the needle cap.

99
 BY C.L 2022

Medication from vial Cont’d...

5.If the vial is new

• Fill syringe with an amount of
air equal to amount of
solution to be withdrawn from
the vial.
• Insert the needle into the
rubber top and inject air into
the vial. (Creates positive
pressure inside vial to allow
accurate withdrawal of medicine)
100
 BY C.L 2022

Medication from vial Cont’d...

6.Invert vial; keep the vial at

eye level and the needle’s
bevel below the fluid level,
and remove the exact
amount of medicine while
touching only the syringe
barrel and plunger tip.

101
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Medication from vial Cont’d...

7. Expel air from the syringe while needle remains

within the inverted vial by tapping the side of the
syringe with your finger.

8.Check the amount of medicine in the syringe.

9.Turn vial upright and remove the needle. (Prevents the
leakage of solution from the vial)

102
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Medication from vial Cont’d...

10.Recap and remove used needle by turning the barrel

to the left, and dispose in the sharps container.

11.Secure needle to syringe by turning the barrel to

right while holding the needle guard.

12.Compare the medication in the syringe with the

prescribed dosage on MAR.

13.Wash hands.

103
 BY C.L 2022

Medication from vial Cont’d...

Non-constituted Drugs
1.Compare the labels.
 Non-constituted
Drugs come in
separate vials
(consists of two
vials):
 one containing a
powdered medication
 other containing a liquid
mixing solution. 104
 BY C.L 2022

Medication from vial Cont’d...

2.Remove all solution

from the vial
containing the
mixing solution.

105
 BY C.L 2022

Medication from vial Cont’d...

3.Cleanse the top of 4. Agitate or shake

the vial containing the the vial to ensure
powdered drug and inject complete mixture.
the solution.

106
 BY C.L 2022

Medication from vial Cont’d...

5.Prepare a new syringe 6. Withdraw the

& needle. appropriate volume of
medication.
107
 BY C.L 2022

Standards for Administering Injections

🞥 Prepare a well-laid up tray.

🞥 Wash hands with soap and water.

🞥 Drip dry.You can use small paper towels/ single use

towels.

🞥 Check for the integrity of the vial/ ampoule for the

following expiry date, breach, leaks, particles or any
contamination.

108
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Standards Cont’d...

🞥 Make sure that the right dose, formulation and route

are used for the right patient or client

🞥 For medications that need to be reconstituted (power

forms) it should be done according to the
manufacturer’s instruction, using the correct diluents.

🞥 Draw the right dose as prescribed using right injection

equipments

109
 BY C.L 2022

Standards Cont’d...

🞥 Ensure aseptic technique while giving the injection

🞥 Administer the drug at the correct site

🞥 Do not recap, bend or break needles prior disposable,

single use needles and syringes after giving injections.

🞥 However, if there is a need to recap a needle due to

various reasons, needles must be recapped using
the “one-handed” recap method.

110
 BY C.L 2022

Standards Cont’d...

The “one-handed” recap method:

🞥 First, place the needle cap on a firm, flat surface.

🞥 Next, with one hand holding the syringe, use the needle to
“scoop” up the cap.

111
 BY C.L 2022

Standards Cont’d...

🞥 With the cap now covering the needle tip, turn the
syringe upright so the needle and syringe are pointing toward
the ceiling.

🞥 Finally, using the forefinger and thumb of your other hand,

grasp the cap just above its open end and push the cap firmly
down onto the hub.
112
 BY C.L 2022

Standards Cont’d...

🞥 Dispose the used syringes & needles immediately into the

sharp’s container.

 Never give used syringes & needles to pts to carry home

even if they came with the equipment

🞥 A patient should be kept for at least 5 minutes after the

injection has been given and be observed for any
possible adverse effect or events.

🞥 Thank the patient or the client

🞥 Record the date and time of injection administered. 113

 BY C.L 2022

Preparation and Route

 Drugs are available in many forms for administration by
a specific route.

 The nurse should be aware of

 the various drug forms and
 how they are administered.

114
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Preparation and Route Cont’d...

Drug preparations (Forms)

Oral Solids
 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).
 compressed or molded substances, to be
swallowed whole, chewed before swallowing, or placed
in the buccal
pocket or under the tongue (sublingual) 115
 BY C.L 2022

Preparation and Route Cont’d...

 Caplets: gelatin-coated tablets that dissolve in the

stomach
 Capsules - substances encased in either a hard or a soft
soluble container or gelatine shell that dissolves in the
stomach.
 Pills: a small ball of variable size, shape & color sometimes
coated with sugar that contains one or more medicinal
substances in solid form taken in mouth.

116
 BY C.L 2022

Preparation and Route Cont’d...

 Powder and granules: finely ground substances

 a medicinal preparation consisting of a mixture of two or
more drugs in the form of fine particles.
 Troches, lozenges, and pastilles: similar preparations of
drugs designed to dissolve in the mouth
 sweet medicinal tablet containing sugar that dissolves in
the mouth so that the medication is applied to the mouth
and throat. (medicated sweet)
e.g. throat pastille (a sweet for people with a cough or a sore
throat)
117
 BY C.L 2022

Oral adm. Cont’d...

118
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Preparation and Route Cont’d...

 Enteric-coated: coated tablets that dissolve in the

intestines
 Time-release (Extended-release) capsules: encased
substances that are further enclosed in smaller casings that
deliver a drug dose over an extended period of time
 Sustained-release: compounded substances designed to
release a drug slowly to maintain a steady blood medication
level

119
 BY C.L 2022

Preparation and Route Cont’d...

Topical
 Liniments: substances mixed with an alcohol, oil, or soapy
emollient that is applied to the skin
 an oily liquid, usually containing alcohol, that is rubbed into the
skin to reduce pain or stiffness in a joint (= place where two
bones are connected)
 Ointments: semisolid substances for topical use
 a thick oily substance, usually containing medicine, which is put
on the skin where it is sore or where there is an injury, in
order to cure it. E.g. eye ointment 120
 BY C.L 2022

Preparation and Route Cont’d...

Topical…
 Pastes: semisolid substances, thicker than an ointment,
absorbed slowly through the skin
 thick soft sticky substance made by mixing a liquid with a
powder, especially to make a type of glue
 Transdermal patches: contain medication that is aborbed
through the skin over an extended period of time
 Suppositories: gelatine substances designed to dissolve
when inserted in the rectum, urethra, or vagina
121
 BY C.L 2022

Preparation and Route Cont’d...

Inhalants
 Inhalations: drugs or dilution of drugs administered by the
nasal or oral respiratory route for a local or systemic effect
 Effervescence: drugs given of small bubbles of gas.

122
 BY C.L 2022

Preparation and Route Cont’d...

Solutions
 Solutions: contain one or more soluble chemical substances
dissolved in water
 Enemas: aqueous solutions for rectal instillation
 Douches: aqueous solutions that function as a cleansing or
antiseptic agent that may be dispensed in the form of a
powder with directions for dissolving in a specific quantity
of warm water

123
 BY C.L 2022

Preparation and Route Cont’d...

Solutions…
 Suspensions: particle or powder substances that must be
dissolved in a liquid (shaken vigorously) before admin.
 Emulsion: a two-phase system in which one liquid is
dispersed (isolated) in the form of small droplets
throughout another liquid
 a mixture that results when one liquid is added to another and
is mixed with it but does not dissolve into it

124
 BY C.L 2022

Preparation and Route Cont’d...

Solutions…
 Syrups: substances dissolved in a sugar liquid
 a very sweet, thick, light-coloured liquid made by dissolving
sugar in water (a type of sweet liquid medicine)
 Gargles: aqueous solutions
 mildly antiseptic solution used to clean the mouth or throat
 Mouthwashes: aqueous solutions that may contain alcohol,
glycerin, and synthetic sweeteners and surface-active
flavoring and coloring agents
125
 BY C.L 2022

Preparation and Route Cont’d...

Solutions…
 Nasal solutions: aqueous solutions in the form of drops or
sprays
 Optic (eye) and otic (ear) solutions: aqueous solutions
that are instilled as drops
 Elixirs: nonaqueous solutions that contain water varying
alcohol content, and glycerin or other sweeteners
 a substance, usually a liquid, with a magical power to cure,
improve or preserve
126
 BY C.L 2022

Preparation and Route Cont’d...

 Certain drug preparations require special consideration

regarding administration.
 For example:
 Chewable tablets are designed to be chewed before
swallowing because chewing enhances gastric
absorption.
 Buccal and sublingual medications must be allowed to
dissolve completely before the client can drink or eat.
 Suspensions and emulsions should be administered
immediately after shaking and pouring from the bottle.
127
 BY C.L 2022

Preparation and Route Cont’d...

 Drugs prepared for administration by one route should not

be substituted by other drug forms.

 For example, when a client has difficulty swallowing a

large tablet or capsule, the nurse should not administer
an oral solution or elixir of the same drug without first
consulting the physician because a liquid may be more
easily and completely absorbed, producing a higher
blood level than a tablet.

128
 BY C.L 2022

Preparation and Route Cont’d...

Drug routes
 The route refers to how the drug is absorbed:
 Oral, Buccal, Sublingual, Rectal,
 Parenteral (Hypodermic routes),
 Topical, and
 Inhalation.

 Be sure to check drug labels for the appropriate route

of administration.
129
 BY C.L 2022

Preparation and Route Cont’d...

Common routes:
1. Enteral: The delivery of any medication that is
absorbed through the GI tract
2. Parenteral: By definition, parenteral means introduction of a
medication by any route other than the oral-gastrointestinal
route.
 However, medical usage of this term refers to
injecting medication into body tissue.
 Sterile technique is always used for any medication injection.
130
 BY C.L 2022

Preparation and Route Cont’d...

Common routes…

1.Enteral 2.Parenteral
 Oral  Intradermal  Topical
 Sublingual  Subcutaneous • Skin (Transdermal)
 Buccal  Intramuscularly • Ear

 Intravenous • Eye

 Inhalation • Nose
• Rectal
 Intraosseous
infusion • Vaginal
131
 BY C.L 2022

Preparation and Route Cont’d...

132
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Preparation and Route Cont’d...

Oral Route
 Most drugs are administered by the oral route

 Purpose:
 When local effects on GI tract are desired
 When prolonged systemic action is desired (It is slower
acting than other routes, such as injectables)
 It is the safest, most convenient, & least expensive method.

133
 BY C.L 2022

Preparation and Route Cont’d...

 Contra- indications:
 For a patient with nausea and vomiting.
 For unconscious patients.
(Be sure the patient has an adequate level of consciousness
to prevent aspiration)
 When digestive juices inactivate the effect of the drug.
 When there is inadequate absorption of the drug.
 When the drug is irritating to the mm of the alimentary
canal.
134
 BY C.L 2022

Preparation and Route Cont’d...

 When small amounts of drugs are required, the buccal

(cheek) or sublingual route is used.
 Drugs administered through these routes act quickly
because of the oral mucosa’s thin epithelium and
large vascular system, which allows the drug to
quickly be absorbed by the blood.
 Certain oral drugs are prepared for sublingual or buccal
administration to prevent their destruction or
transformation in the stomach or small intestines.
135
 BY C.L 2022

Preparation and Route Cont’d...

 Buccal drugs are designed to be

placed in the buccal pocket
(superiorposterior aspect of the
internal cheek next to the molars)
for absorption by the mucous
membrane of the mouth.
 Sublingual medications are
designed to dissolve quickly when
placed under the tongue.
136
 BY C.L 2022

Preparation and Route Cont’d...

 For example
 Erythrityl tetranitrate (an anti-anginal) can be given either
sublingually or buccally as prescribed,
 whereas Isoproterenol hydrochloride (a bronchodilator)
& nitroglycerin (an anti-anginal) are given sublingually,
and
 Methyltesterone (an androgen) is given only buccally.

137
 BY C.L 2022

Preparation and Route Cont’d...

Parentral Route
 The four routes that nurses commonly use to administer
parenteral medications are:
A. Intradermal (ID)
B. Subcutaneous (SC)
C. Intramuscular (IM)
D. Intravenous (IV)

138
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Preparation and Route Cont’d...

Parenteral Routes…

 Other parenteral routes, such as intrathecal or

intraspinal, intracardiac, intrapleural, intra-arterial, and
intra-articular, are used by physicians and in some
cases by advanced practice registered nurses for
medication administration.

139
 BY C.L 2022

1. Administering Oral Drugs

 Oral administration of drugs is the most common route;

however, there are potential risk factors that the nurse
must consider.
 Before administering oral drugs, the nurse should assess
the client’s ability to take the medication as prescribed.
 This assessment includes the client’s
 gag reflex,
 state of consciousness, and
 presence of nausea and vomiting.
140
 BY C.L 2022

Oral adm. Cont’d...

Equipment:

🞭 Medical administration record (MAR)

🞭 On a medication tray:
 Medicine as ordered
 Medicine glass (cup)
 Standard-size teaspoon or medicine dropper
 Glass of fresh water with straw
 Paper tissue or napkin
 Something to take away the taste, if desired and allowed, such
as a piece of ice, a cracker, or a slice of orange
141
 BY C.L 2022

Oral adm. Cont’d...

Procedure:
1.Perform hand hygiene.
2. Assemble all
equipments.
3. Verify the medication order using the client’s kardex.
Check any inconsistencies with Dr. before administration. (To
not miss any medication orders)
4.Proceed from top to bottom of the kardex when preparing
medications. (To reduce the chance of medication errors)
5.Select the correct medication from the shelf or drawer and
compare the label to the medication order on the kardex 142
 BY C.L 2022

6.Prepare the medications for one client at a time:

From the multi-dose bottle:
 Pour a pill from the multi-dose bottle into the container lid
and transfer the correct amount to a medicine cup. (Pouring
medication into the lid eliminates handling it.)
Liquid medications:
 Pour the liquid medications into medicine cup, by holding the
bottle with the label toward the palm of your hand &
measure the liquid at eye level. (gives the most accurate
measurement.)
 Wipe the neck if necessary. (helps keep the label readable) 143
 BY C.L 2022

Oral adm. Cont’d...

In the case of unit packing:

 Leave unit dose medication in wrappers and place them
in a medication cup. (keep medications clean and safe.)
If the client is unable to swallow pills:
 Place the pill in a pill crusher and crush the pill until it is in
powder form. (Crushed medications are often easier to swallow
BUT Do not crush time-release capsules or enteric-coated tablets. )
 Dissolve substance in water or juice, or mix with applesauce to
mask the taste.
 If no need to crush, cut tablets at score mark only. 144
 BY C.L 2022

Oral adm. Cont’d...

7.Recheck each medication with the Kardex. (To

ensure preparation of the correct dose)

8.When you have prepared all medications on a tray,

compare each one again to the medication order. (To
check all medications many times to prevent errors.)

9.Bring medication to the client you have prepared.

Rationale: Hospital/ Agency policy considers 30 minutes
before or after the ordered time as an acceptable variation
145
 BY C.L 2022

Oral adm. Cont’d...

10. Identify the client before giving the medication: (to

prevent medication errors)
 Ask the client his/her name,
 Ask a staff member to identify the client, or
 Check the name on the identification bracelet if available
11. Perform necessary assessments before giving
medications (Additional checking includes taking VSs and allergies
to medications, depending on the medication’s action)
12. Assist client to a comfortable position to take medications
(Sitting as upright as possible makes swallowing medication easier and
less
likely to cause aspiration) 146
 BY C.L 2022

Oral adm. Cont’d...

13.Administer the medication:

 Offer water or fluids with the medication (You should be
aware of any fluid restrictions that exist)
 Open unit dose medication package and give the
medication to the medicine cup
 Review the medication’s name and purpose
 Discard any medication that falls on the floor
 Mix powder medications with fluids at the bedside if needed
Rationale: Powdered forms of drugs may thicken when mixed
with fluid.You should give them immediately 147
 BY C.L 2022

Oral adm. Cont’d...

14.Remain with the client until he/she has taken

all medication. Confirm the client’s mouth if
needed. Rationale:
 Be sure that the client takes the medication.
 Leaving medication at the bedside is unsafe.

15.Perform hand hygiene.

148
 BY C.L 2022

Oral adm. Cont’d...

16.Record medication administration on the appropriate

form and Sign after you have given the medication (Documentation
provides coordination of care and giving signature maintains
professional
accountability)
 If a client refused the medication, record the reason according
to your hospital/agency policy on the record. Rationale:To
verifies the reason medications were omitted as well as the
specific nursing assessments needed to safely administer
medication
 Document VSs or particular assessments according to your
hospital’s form. (To confirm medication’s action) 149
 BY C.L 2022

Oral adm. Cont’d...

Record & sign medication admin...

 Sign in the narcotic record for controlled substances when
you remove them from the locked area (e.g, drawer or shelf).
(Federal law regulates special documentation for controlled
narcotic substances)
17.Check the client within 30mins after giving medication.
Rationale:
 To verify the client’s response to the medication
 Particularly, you should check the response after administered
pain killer whether if the medication relieves pain or not. 150
 BY C.L 2022

Oral adm. Cont’d...

Essential Points To Remember

 Remember the 5  Always keep the bottle f

R's o
tightly closed. m
 Right patient
 Clean and keep the l
 Right medication g
 Right route label of the bottle h
 Right dose clear. .
 Right time  Cheek their expiration
 Keep the rim of date.
the bottle clean.  Keep medication away
151
 BY C.L 2022

Oral adm. Cont’d...

 Give your undivided attention to your work while

preparing and giving medications.
 Make sure that a graduate clinician checks some potent
drugs.
 Avoid touching the drug while pouring in cup.
(If unit-dose is available, leave drug in the wrapper until at the
bedside.)
 Never give medications from unlabeled container.
 Never return a dose once poured from the bottle.
 Never give medicine that someone poured or drawn. 152
 BY C.L 2022

Oral adm. Cont’d...

 Never leave medicine:

 at bed side of a patient and
 within reach of the children
 Check your patient's vital sign may be necessary before
and after administrating some drugs
e.g. digitals, ergometrine
 When the medicine is no longer needed, empty the
bottle into the toilet.
153
 BY C.L 2022

2. Administering Parenteral Drugs

 Parentral routes refers to injecting medication into body
tissue.
 Angle of Injection depends on the type of injection.

154
 BY C.L 2022

A. Intradermal Injection

 Definition: It is an injection given into the dermal layer

of the skin.

 Purpose:
🞥 For diagnostic purpose like;
 Fine test (Mantoux test)
 Allergic reaction
🞥 For prevention purpose like;
 Vaccination 155
 BY C.L 2022

ID injection Cont’d...

 Amount of medication (drug’s dosage):

• a small quantity of solution (0.01 to 0.1 ml).
• If repeated doses are ordered, the site should be rotated.
 Syringe: a 1ml tuberculin syringe.
 Needle:
• Length: 3/8 to 1/2 inch.
• Size : 26 to 28 gauges
 Angle of injection: 10° to 15°
156
 BY C.L 2022

ID injection Cont’d...

 Sites of Injection:
A. Inner aspect of
the forearm
B. Upper chest
C. Upper back beneath
the scapula
D. Upper arm at the
deltoid muscle
157
 BY C.L 2022

ID injection Cont’d...

Equipment:
🞭 Medical administration record
(MAR)
🞭 Medication
🞭 Sterile tuberculin syringe
🞭 Disposable gloves
🞭 Alcohol swab
🞭 Sterile 2×2 gauze pad (Adhesive
Bandage)
🞭 Safety box
158
 BY C.L 2022

ID injection Cont’d...

Procedure:
1.Check with the client & MAR for any known allergies.
2.Prepare medication:
• Check the medication. • Draw the medication.

159
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ID injection Cont’d...

3.Explain the procedure to the ct & provide for privacy.

4.Place the client in a comfortable position.
5. Don non-sterile gloves.
6.Prepare the administration site (Select and clean).
 Assess the client’s skin for redness or broken tissue.
 Select the site using the anatomic landmarks.
 Cleanse the site with an alcohol wipe using a firm
circular motion; from inside to outside;
 Wait 30 seconds to allow drying. 160
 BY C.L 2022

ID injection Cont’d...

Prepare the administration site 161

 BY C.L 2022

ID injection Cont’d...

7.Prepare the syringe.

 Remove the needle
guard.
 Express any air
bubbles from the
syringe.
 Check the amount of
solution in the syringe.
162
 BY C.L 2022

ID injection Cont’d...

8.Inject the medication.

 With dominant hand:
hold the syringe.
 With non-dominant hand:
– grasp the client’s dorsal
forearm and
– gently pull the skin taut
on ventral forearm.
163
 BY C.L 2022

ID injection Cont’d...
8. Inject the medication…

 Insert the needle bevel side up at a 10° to 15° angle

until resistance is felt (advance the needle ≈3mm
below the skin surface)
NB: the needle’s tip should be visible under the skin.

164
 BY C.L 2022

ID injection Cont’d...

8. Inject the medication…

 Administer the medication slowly.
 Observe the development of a bleb (large flaccid vesicle
that resembles a mosquito bite).
9. Withdraw the needle.
10. Pat area gently with a dry 2 × 2 sterile
gauze pad (Cover the puncture site with adhesive
bandage).
 Do not massage the area after removing the needle.
11. Discard the needle and syringe in a sharps
container.
165
 BY C.L 2022

ID injection Cont’d...

12.Remove gloves and dispose them in appropriate

receptacle.
13.Draw a circle around the perimeter of the bleb with a
ball point pen. (Allows for easy recognition and
observation of the injection site)
14.Wash hands.
15. Observe for signs of an allergic reaction.
16. Document.
166
 BY C.L 2022

B. Subcutaneous Injection

 Definition: It is
– injecting of drug under the skin in the
subcutaneous tissue (under the dermis) or
– placing the medication between the dermis and
the muscle.

 Purpose:
 To obtain quicker absorption than oral administration
 When it is impossible to give medication orally 167
 BY C.L 2022

SC injection Cont’d...

 Amount of medication (drug’s dosage):

• given varies but should not exceed 1.0 ml;
• If repeated injections are given, you should rotate the
site of injection so that each succeeding injection is
about 5 cm away from the previous one.
 Syringe: a sterile 1 to 3 ml syringe.
 Needle:
• Length: 5/8 to 1/2 inch.
• Size : 24 to 26 gauges. 168
 BY C.L 2022

SC injection Cont’d...

 Angle of injection:
As a general rule, to reach subcutaneous tissue
 If you can grasp
• 2 inches of tissue between two fingers, insert
the needle at a 90° angle.
• only 1 inch of tissue between the fingers, use a 45°
angle to administer the medication.
 If the client has substantial SC tissue, spread the
169

tissue taut and insert the needle at a 90° angle.

 BY C.L 2022

SC injection Cont’d...

45º

Subcutaneous Injection
170
 BY C.L 2022

SC injection Cont’d...

 Sites of Injection gluteal areas

A.Abdomen
B.Lateral and anterior
aspects of the
upper arm and
thigh
C.Scapular area on
back
D.Upper ventrodorsal
171
 BY C.L 2022

SC injection Cont’d...

Equipment:
🞭 Medical administration record
(MAR)
🞭 Alcohol swab
🞭 Sterile 2 × 2 gauze pad
🞭 Sterile syringe and needle
🞭 Medication as prescribed
🞭 Disposable gloves
🞭 Safety box
172
 BY C.L 2022

SC injection Cont’d...

Procedure:
1.Check with the client & chart for any known allergies.
2.Prepare medication.
• Check the medication. • Draw the medication.

173
 BY C.L 2022

SC injection Cont’d...

3.Explain the procedure to the ct & provide for privacy.

4.Place the client in a comfortable position.
5. Don non-sterile gloves.
6.Prepare the administration site (Select and clean).
 Assess the client’s skin for redness or broken tissue.
 Select the site using the anatomic landmarks.
 Cleanse the site with an alcohol wipe using a firm
circular motion; from inside to outside;
 Wait 30 seconds to allow drying. 174
 BY C.L 2022

SC injection Cont’d...

7.Prepare the syringe.

 Remove the needle
guard.
 Express any air bubbles
from the syringe.
 Check the amount of
solution in the syringe.

175
 BY C.L 2022

SC injection Cont’d...

8.Inject the medication.

 With dominant hand: hold
the syringe b/n your thumb
and forefingers.
 With non-dominant hand:
– Pinch the SC tissue.
– If the client has
substantial SC
spread the tissue taut.
tissue, 176
 BY C.L 2022

SC injection Cont’d...

8. Inject the medication…

 Insert the needle quickly at a 45° or 90° angle.

177
 BY C.L 2022

SC injection Cont’d...
8.Inject the medication…
 Release the SC tissue and
grasp;
 the barrel of syringe with non-dominant hand, and
 the plunger with dominant hand.

 By pulling back on the plunger aspirate, & observe for

blood.
 If blood appears, remove the needle and discard.
 If blood does not appear, inject the medication slowly.
178
 BY C.L 2022

SC injection Cont’d...

9.Remove the needle quickly.

10.Apply gentle pressure at the site with dry sterile 2 ×
2 gauze; do not massage the injection site.
11.Do not recap the needle; discard the needle in a
sharps container.
12.Remove gloves & dispose of in appropriate receptacle.
13. Wash hands.
14. Observe for signs of an allergic reaction.
15. Document. 179
 BY C.L 2022

C. Intramuscular Injection

 Definition: It is an introduction of a drug into a body's

system via the muscles.
 Purpose:
 To obtain quick action next to the IV route
 To avoid an irritation from the drug if given
through other route.
 Disadvantage
 Painful
 Local tissue damage 180
 BY C.L 2022

IM injection Cont’d...

 Amount of medication (drug’s dosage): You should

determine the maximum volume to inject based on the site
and the client’s muscle development:
• 4 ml for a large muscle (gluteus medius) in a well
developed adult
• 1 to 2 ml for less developed muscles in children, elderly,
and thin clients
• 0.5 to 1.0 ml for the deltoid muscle
NB: When more than 4 ml is ordered, the medication can
be divided into two different sites. 181
 BY C.L 2022

IM injection Cont’d...

 Syringe: select a sterile 1ml to 5ml syringe.

 Needle:
• Length: 1 to 2 inch.
• Size : 20 to 22 gauges.
 Angle of injection: insert the needle at a 90° angle.

182
 BY C.L 2022

IM injection Cont’d...

90º

Intramuscular Injection
183
 BY C.L 2022

IM injection Cont’d...

 Sites of Injection
A.Dorsogluteal site
 Place hand on iliac crest and locate
the posterosuperior iliac spine.
 Draw an imaginary line between
• the greater trochanter and
• the posterosuperior iliac spine.
 The injection site is the outer quadrant.
184
 BY C.L 2022

IM injection Cont’d...

Dorsogluteal Site185
 BY C.L 2022

IM injection Cont’d...

Site of Injection…
B.Ventrogluteal site
 Place palm of left hand on right
greater trochanter so that index
finger points toward
anterosuperior iliac spine.
 Spread first and middle fingers to
form a V.
 Injection site is the middle of V.
186
 BY C.L 2022

IM injection Cont’d...

Ventrogluteal Site187
 BY C.L 2022

IM injection Cont’d...

Site of Injection…

C.Vastuslateralis site
 Identify greater
trochanter
 Place hand at lateral
femoral condyle;
 Injection site is
middle third of
anterior lateral aspect. 188
 BY C.L 2022

IM injection Cont’d...

Site of Injection…
D. Deltoid site
 Three finger widths
below the acromion
process in adults
or
 One finger width
below the acromion
process in children.
189
 BY C.L 2022

IM injection Cont’d...

Equipment:
🞭 Medical administration record
(MAR)
🞭 Medication as prescribed
🞭 Sterile and needle
🞭 Alcohol swab
🞭 Non-sterile gloves
🞭 Sterile 2 × 2 gauze pad
🞭 Safety box
190
 BY C.L 2022

IM injection Cont’d...

Procedure:
1.Check with the client & chart for any known allergies.
2.Prepare medication.
• Check the medication. • Draw the medication.

• Add 0.1 to 0.2 ml of air to the syringe. (Ensures that all the
medication is expelled from the needle’s sha
ft) 191
 BY C.L 2022

IM injection Cont’d...

3.Explain the procedure to the ct & provide for privacy.

4.Place the client in a comfortable position.
🞭 Deltoid: sitting position

🞭 Ventrogluteal:

• Side-lying: flex the knee on the injection side,

• Supine: flex the knee on the injection side, or

• Prone: point toes inward toward each other to

internally rotate the femur.
192
 BY C.L 2022

IM injection Cont’d...

5.Don non-sterile gloves.

6.Prepare the administration site (Select and clean).
 Assess the client’s skin for redness, scarring, breaks in
the skin, and palpate for lumps or nodules.
 Select the site using the anatomic landmarks.
 Cleanse the site with an alcohol wipe using a firm
circular motion; from inside to outside;
 Wait 30 seconds to allow drying.
193
 BY C.L 2022

IM injection Cont’d...

7.Prepare the syringe.

 Remove the needle
guard.
 Express any extra air
bubbles from the
syringe.
 Check the amount of
solution in the syringe.
194
 BY C.L 2022

IM injection Cont’d...

8.Inject the medication.

 With dominant hand: hold
the syringe b/n your
thumb and forefingers.
 With non-dominant hand:
Pull the skin up or to one
side (Z-track technique)

195
 BY C.L 2022

IM injection Cont’d...

Inject the medication…

 Insert the needle
 Deltoid: quickly
insert the
needle with a
dart like
motion at a
90° angle.

196
 BY C.L 2022

IM injection Cont’d...

 Aspirate by pulling back on the plunger, and observe for

blood.
 If blood appears, remove the needle and discard.
 If blood does not appear, inject the medication
slowly, about 10 sec/ml.
9.Wait 10 seconds after the medication has been
injected, then smoothly withdraw the needle at the
same angle of insertion.
197
 BY C.L 2022

IM injection Cont’d...

10. Apply gentle pressure at the site with dry sterile 2

× 2 gauze; do not massage the injection site.
11.Do not recap the needle; discard the needle in a
sharps container.
12.Remove gloves & Wash hands.
13. Observe for signs of an allergic reaction.
14. Document.
15. Inspect the injection site within 2 to 4 hours and
evaluate the client’s response to the medication. 198
BY C.L 2022

199
 BY C.L 2022

D. Intravenous Injection

 Definition: It is the introduction of a drug in solution

form into a vein.
 Purpose:
 When the given drug is irritating to the body tissue if
given through other routes.
 When quick action is desired.
 When it is particularly desirable to eliminate
the variability of absorption.
200
 BY C.L 2022

IV injection Cont’d...

 Amount of medication (drug’s dosage): often the

amount is not more than 10 ml at a time.
 Administration methods: IV medications are
administered by one of the following methods:
• IV push or IV bolus • IV fluid container

201
 BY C.L 2022

IV injection Cont’d...

 IV push medications can also be given:

 directly into the vessel by vein puncture or
 into a central line
 When giving an IV push medication into a continuous
infusion line, you must
 stop the fluids in the primary line; or
 pinch the IV tubing closed to inject the drug.
This technique is safe and prevents you from having to
recalculate the drop rate of the primary infusion line.
202
 BY C.L 2022

IV injection Cont’d...

Pinch or closed the IV tubing of an infusion line to

administer an IV push medication.
203
 BY C.L 2022

IV injection Cont’d...

Equipment:
🞭 Medical administration 🞭 Tourniquet
record (MAR) 🞭 Receiver
🞭 Medication Tray 🞭 Disposable gloves
🞭 Towel and rubber sheet 🞭 Sterile needle and
🞭 Alcohol swabs syringes
🞭 Medication
204
 BY C.L 2022

IV injection Cont’d...

Procedure:
1.Check with the client & chart for any known allergies.
2.Prepare medication.
• Check the medication. • Draw the medication.

205
 BY C.L 2022

IV injection Cont’d...

3.Explain the procedure to the ct & provide for privacy.

4.Place the client in a comfortable position.
5. Don non-sterile gloves.
6.Prepare the administration site (Select and clean).
 Assess the client’s skin for redness or broken tissue.
 Place rubber sheet and towel under his arm (to
protect the bed linen).
 Expose the arm.
206
 BY C.L 2022

IV injection Cont’d...

6.Prepare the administration site…

 Select the site of the injection (Which is mainly the

midcubital vein of the arm).
 Apply tourniquet about 15 cm above the intended site
of entry.
 Ask patient to open and close his fist.
 Palpate the vein & clean with alcohol swab with a
circular motion; proceed from center of the site outward.
 Wait 30 seconds to allow drying.
207
 BY C.L 2022

IV injection Cont’d...

7.Prepare the syringe.

 Remove the needle guard.
 Express any air bubbles
from the syringe.
 Check the amount of
solution in the syringe.

208
 BY C.L 2022

IV injection Cont’d...

8.Inject the medication.

 With dominant hand:
– hold the needle at about 45°
angle in line with the veins.

 With non-dominant hand:

– grasp the client’s dorsal forearm &
– retract down the vein & soft
tissue 4 cm below the intended
site of injection using thumb.
209
 BY C.L 2022

IV injection Cont’d...

 Puncture the vein at a 25° 8.Inject the medication…

angle
 Drawback the plunger to check whether you are in the
vein or not. (Blood return should be seen if you are in the vein)
 Once you know that you are in the vein,
• release the tourniquet,
• gently lower the angle of the needle (when it is
nearly paralleled to the vein), and
• instills the medication. Give very slowly unless there is
an order to give it fast (Normally 40-60 drops is given in
210
1 min).
 BY C.L 2022

IV injection Cont’d...
9. Remove the needle quickly.
10.Apply pressure over the site after removing the
needle to prevent bleeding.Tell patient to flex his
elbow.
11.Discard the needle in a sharps container.
12.Remove gloves & dispose of in appropriate receptacle.
13. Wash hands.
14. Check the pt's pulse in between. Any complaint
from the patient should not be ignored.
15.Watch the patient for few minutes before leaving him. 211
 BY C.L 2022

Summary of Parenteral Drug Administration

Equipment:

🞭 Medical administration 🞭 Disposable gloves

record (MAR)
🞭 Alcohol swab
🞭 Medication
🞭 Sterile 2×2 gauze pad
🞭 Medication Tray (Adhesive Bandage)
🞭 Sterile syringe and 🞭 Safety Box
Needle
🞭 Receiver

212
 BY C.L 2022123

Summary of Parenteral Drug Administration

Procedure:
1.Check with the client & MAR for any known allergies.
2.Prepare medication
3.Explain the procedure to the ct & provide for privacy.
4.Place the client in a comfortable position.
5.Don non-sterile gloves.
6.Prepare the administration site (Select and Clean).
7.Prepare the syringe.
8.Inject the medication.
 BY C.L 2022124

Summary of Parenteral Drug Administration

9.Remove the needle quickly.

10. Apply gentle pressure at (or pat; ID) the site with
dry sterile 2 × 2 gauze (do not massage injection
site).
11.Discard the needle in a sharps container (Do not
recap the needle).
12.Remove gloves & dispose of in appropriate receptacle.
13. Wash hands.
14. Observe for signs of an allergic reaction.
15. Document.
 BY C.L 2022

Sublingual Medication Administration

Place the pill or direct spray between the underside of the
tongue and the floor of the oral cavity.

215
 BY C.L 2022

Buccal Medication Administration

Place the medication between the patient’s cheek and

gum.

216
 BY C.L 2022

Transdermal Medication Administration

🞭 Absorbed through the skin at a slow, steady rate

🞭 Method:

🞤 Clean administration site

🞤 Apply medication

🞤 Leave medication in place for required time.

🞤 Monitor the patient for desirable or adverse effects.

217
 BY C.L 2022

Pulmonary Medication Administration

🞭 Medications are administered into the pulmonary

system via inhalation or injection.

218
 BY C.L 2022

Metered Dose Inhaler

219
BY C.L 2022

Eye Drop Administration

Use a medication dropper to place the prescribed dosage

on the conjunctival sac.

220
 BY C.L 2022

Nasal Medication Administration

221
BY C.L 2022

Aural Medication Administration

Manually open the ear canal & administer the appropriate

dose.

222
BY C.L 2022

Intravenous Therapy
 Definition: It is the administration of a large amount of

fluid (50-500 even more), electrolytes, nutrients,

or medications into the system through a vein.
 Purpose:
 To maintain fluid & electrolyte balance
 To introduce medication particularly antibiotics.

223
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

 IV therapy requires
A.Parenteral fluids (solutions) and

B. Special equipment:

 Administration set, and

 IV pole,

C. IV Devices OR an established venous route.

224
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

A. Types of parenteral fluids

🞭 There are three types of parenteral fluids that are classified in

accord with the tonicity of the fluid relative to normal
blood plasma.

🞭 The normal osmolarity of blood is b/n 280 & 295 mOsm/L, so

the desired effect of the tonicity of the fluid is determined as

 Hypotonic fluid,

 Isotonic fluid, or

 Hypertonic fluid. 225

 BY C.L 2022

IV (Infusion) Therapy Cont’d...

1.Hypotonic fluid (hypo-osmolar, less than 290 mOsm/L)

🞭 lowers the osmotic pressure and causes fluid to move into

the cells;

🞭 if fluid is infused beyond the client’s tolerance, water

intoxication may result.

🞭 Eg. Sodium chloride 0.45%

226
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

2.Isotonic fluid (iso-osmolar, 290 mOsm/L)

🞭 increases extracellular fluid volume;

🞭 if fluid is infused beyond the client’s tolerance, cardiac

overload may result.

🞭 Eg.

Dextrose 2.5% in 0.45% saline;

Ringer’s lactate;

Normal saline (NS), 0.9%;

227
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

3.Hypertonic fluid (hyperosmolar, greater than 290 mOsm/L)

🞭 increases the osmotic pressure of the blood plasma, drawing
fluid from the cells;

🞭 if fluid is infused beyond the client’s tolerance, cellular

dehydration may result

🞭 Eg.

Dextrose 5% in saline 0.9%;

Dextrose 5% in lactated Ringer’s

228
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

B. Administration Set
1.Hollow spike (Piercing pin) with a protective cap:
 It is inserted into the administration port of the IV bag.
 It is important that remains sterile when inserted.

2. Drip chamber:
 This is where the solution flows prior to its entry into the
tubing;
 It acts as a pressurizing chamber for non-vented bags.
229
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

3.IV Tubing with

 a roller clamp (used to regulate the flow of
fluids through the IV tubing),
 a rubber injection port, and
 a protective cap over the needle adapter.

230
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

C. IV Devices: .

🞭 Intracath is a term used to refer to a plastic tube inserted

into a vein

 Angiocatheter is a type of intracath with a metal stylet

to pierce the skin and vein, after which the plastic
catheter is threaded into the vein and the metal stylet
is removed, leaving only the plastic catheter in the
vein.
E.g. IV cannula or catheter: A flexible tube that is used
to insert medication within body cavity or blood vessel. 231
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

🞭 Selecting the gauge of the needle or catheter:

 Infants and small children, 24 gauge

 Preschool through preteen, 24 or 22 gauge

 Teenagers and adults, 22 or 20 gauge

 Geriatric, 22 or 24 gauge

232
BY C.L 2022

233
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

Figure; Peripheral IV Devices: A. Butterfly; B. Angiocatheter

234
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

Peripheral Veins used in IV Therapy

Figure A. Arm and Forearm; B. Dorsum of the Hand; C. Dorsal

Plexus of the Foot 235
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

Monitor IV Therapy

236
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

Equipment:
🞭 Rubber & towel sheet
🞭 IV fluid as ordered

🞭 IV pole 🞭 Receiver

🞭 IV cannula or catheter (Vigo) 🞭 Alcohol swabs

🞭 Adhesive tape & scissors 🞭 Tourniquet

🞭 Sterile gloves 🞭 Medication chart

237
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

Procedure:
1. Take equipment to the patient's bedside.
2. Explain the procedure to the patient.
3. Place the pt in a comfortable position.
 Extend the arm in the most comfortable position.
4. Set IV bag and tube (Remove air from the tubing)
 Prepare the IV solution bag for administration
 Prepare the IV tubing (administration set)
238
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

🞭 Prepare the IV solution bag for administration

 Remove outer wrapper around IV bag of solution.

 Inspect bag for tears or leaks by noting any moisture on the

protective covering.

 Apply gentle pressure and observe for leakage.

 Examine solution for discoloration, cloudiness, or particulate

matter by holding the bag against a dark and light background; if
there is any evidence of contamination, and do not use.

 Hang IV bag on the IV pole.

239
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

🞭 Prepare the IV tubing (administration set)

 Remove administration set from the package.

 Close the roller clamp on the IV tubing.

 Remove the protective cap from the non-vented IV

tubing spike.

 With your non-dominant hand grasp the port of the

IV bag and insert the full length of the spike into the
bag’s port with your dominant hand.
240
 BY C.L 2022

 Squeeze and quickly

release pressure on the
drip chamber of the IV
tubing until the chamber
is 1/3 to 1/2 full.

 Open the roller clamp

on the tubing to allow the
fluid to enter the tube and
expel
the air.
241
 BY C.L 2022

IV (Infusion) Therapy Cont’d...

5.Place rubber sheet & towel under the patient arm.

6.Select the vein and apply tourniquet about 15 cm above
the intended site of entry.
7.Observe & palpate for suitable vein.
8. Apply sterile gloves & cleanse the skin with alcohol swabs.
9.Use thumb to retract down the vein & soft tissue 4 cm
below the intended site of injection.
10. Hold IV device (Vigo) at 45° - 25° angle line with the vein.
11. Pierce the skin and puncture the vein.
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12. Check if you are in the vein by drawing back with the
metal stylet. (blood returns if you are in the vein)
13. Release the tourniquet immediately & apply pressure
over the end of cannula.
14. Attach IV tube with Vigo & start flow of solution
by opening the clamp.
15. Support needle (Vigo) with adhesive tape to keep it
in proper position in the vein.
16. Anchor the IV tubing with the adhesive tape to prevent pull
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17. Adjust the rate of flow by the following formula.

ml of solution X drop/min (drop rate factor)= drops per min
Hours to administer X 60 (min/hr)
1ml= 15-20 drop, this is the drop 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 42 drops/min.

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Note:
 Infusion bottle or IV bag should be labeled with:
• date and time of infusion started
• drop per minute
• added medications

 If more than one bottle as used in 24 hrs, it should be labeled as

bag 1, 2, 3, and so on.
 Usual areas used for intravenous infusion are:
a)The median basilic vein on the inner surface of the arm.
b) A vein on top of the foot
c) In an infant the jugular vein and the scalp vein

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