FUNDA LEC

Medication Administration

Key Concepts  Official Name – is the name under which a

drug is listed in one of the official
 Define the selected key terms. publications
 Describe legal aspects of administering
medications.
Purpose of Medication:
 Discuss the important concepts related to
the safe and effective administration of  Diagnostic purposes:
medication.
 Describe various routes of medication  Prophylaxis:
administration.
 List examples of various types of  Therapeutic purposes:
medication orders.
 List the common abbreviation used in Uses of Drugs
relation to administration of medication.
 Describe actions of drugs on the body.  Prevention – e.g. vaccines
 Understand the calculation of drug.  Diagnosis – TB testing
 Develop knowledge regarding medication  Suppression – e.g. anti-cancer; antiviral
assessment drugs
 Treatment – e.g. anti-asthmatic drugs
Definition  Cure – eradicate the disease e.g.
antibiotics
 A medication is a substance  Health supplement – e.g. vitamins,
administered for the diagnosis, cure, minerals
treatment, or relief of a symptom or for
prevention of disease. Legal Aspects of Medication
 A drug is any substance that alters
physiologic function, with the potential of
affecting health.  Dangerous Drug Act – 1030 and The
 Pharmacology is the study of the effect Narcotic Drugs and Psychotropic
of drugs on living organisms Substances Act -1985.
 Prescription is the written direction for  It is an act that governs the
the preparation and administration of a procurement and use of some
drug. drugs especially the narcotics e.g.
morphine, pethidine, cocaine etc.
Drug Nomenclature
Philippines (National level) Comprehensive
 Chemical Name – any typical organic Dangerous Drugs Act of 2002 (Republic Act
name; this precisely describes the No. 9165). Republic Act No. 6425, otherwise
constituents of the drug e.g. Ibuprofen known as the Dangerous Drugs Act of 1972, as
(anti-inflammatory). Amended, providing Funds therefore, and for other
 Generic Name – It is the name by which purposes.
the drug will be known throughout the
world no matter how many companies Dangerous drugs are always kept
manufacture it. It is agreed upon by the under lock and key in the
WHO. e.g. Acetaminophen, Paracetamol, Dangerous Drug Cupboard under
Mefenamic acid, Ibuprofen the care of trusted senior nurses.
 Trade Name – called the brand name, is
the name given by the drug manufacturer “Nurses are responsible for their actions”
and identifies its property of that
company. E.g. Paracetamol - Calpol,
Biogesic, Metacin
Types of Drug Preparations

Routes for Administering Drugs

 Different route: Oral, Parenteral, Topical,

Inhalation
 Oral (p.o. means Per Os)by mouth
 Tablets, capsules, lozenges, and
liquids
 Slower absorption through GI tract

 Buccal (BUCC) or Sublingual (SL)

 Buccal:
 Sublingual:
 Faster absorption; by passes GI
tract

Parenteral drug packaging

 Ampule: glass or plastic container that is

sealed and sterile
 Cartridge: small barrel prefilled with sterile
drug
 Vial: small bottle with rubber diaphragm
that can be punctured by needle
With injection part model
Other Routes for Administering Drugs Inhalation & Topical Routes

 Endotracheal tube (ETT) – breathing tube

(Lidocaine, atropine, naloxone,
epinephrine, diazepam)
 Epidural: Epidural space
 Intraosseous: Bone marrow
 Intraperitoneal: Medication administered
into peritoneal cavity
 Nasogastric tube - NGT, Intubation
 PEG tube - Percutaneous endoscopic
gastrostomy
 Intraarterial: Arteries
 Transdermal (TD)- transdermal patch like
nitrol for chest pain

Routes for Administering Drugs

 Inhalation –

 Topical-

 Urethral –

 Vaginal and rectal-

 Eye or ears, nose – cream, ointments,

drops or irrigation

Topical Route

 Transdermal patch Otic / Ophthalmic Instillation:

 Before instill ear drops, have the client lie on

his or her side.
 Straighten the ear canal to help the
medication reach the eardrum.
 For adult,
 For young child and infant,
 Eye:

 Rectal suppository

FIGURE 13-4 To administer eye ointment, squeeze ¼

inch-wide strip of ointment into the conjunctival sac.
Drawing Up Medication from an Ampule

 Wash hands and gather

equipment
 Grasp the stem with an
alcohol swab
 Snap off the ampule’s neck
away from the hands and
face.
 Uncap the needle and insert
the needle into the ampule.
Avoid touching the rim with
the needle.

Drawing Up Medication from an Ampule

 Used for allergy and tuberculin skin testing

 Site of injection is inner forearm, may use back and
upper chest.
 Volume: 0.01 – 0.05ml
 TB syringe is used gauge 25 – 27; 5/8 or ½ inch
needle.
 Administration angle: 10-15 degree angle
 Cleanse site with alcohol
 Pull skin taut, insert needle with bevel up 5-15
degree angle
 Push plunger to in still medication creating a wheal
under skin
 Withdraw needle at same angle inserted.
Administering an Intradermal Injection for Administering Subcutaneous Injection
Skin Tests

Intramuscular Administration

 Administer into a muscle

 Volume: up to 4 ml
 Equipment: 1-5 ml syringe gauge 18-23, 5/8
to 3 inch needle
 Administration angle: 90 degree
 Injection site is the center of the triangle, 3
finger widths (1-2 inches) below the acromion
process
 Vastus lateralis: Injection site is the lateral
area of the thigh. Site of choice for infants &
young children. It has largest muscle mass.
 Ventral luteal: Injection site lies within the
triangle formed by the index and middle
fingers. Contains no large nerves, used for Z-
track injection.
 Dorsal gluteal: injection site is above and
lateral to the line. Most dangerous site
because of sciatic nerve location.

Dorsogluteal site

Subcutaneous Administration
 Common subcutaneous injections: heparin,
lovenox and insulin
 Onset: within a half hour
 Volume: up to 1 ml
 Equipment TB or insulin syringe
 Administration angle: 45 or 90 degree angle
 Bunch the skin
 Hold needle like “dart”
 Pierce skin with quick motion 45-90 degree
angle
 Do Not Aspirate
 Inject medication slowly
 Quick remove needle. Do Not Recap.
Ventrogluteal site Vastus Lateralis Assessment for Reactions

 Assess patient after giving drugs that affect RR,

HR, BP, LOC, blood sugar and pain.
 These approximate time table will help guide
you in your assessment.
 Approximate Onset:
 IV –
 IM –
 SC –
 PO –

Administering an Intramuscular Injection Drug Actions on the Body

 Onset of action – the time after administration

when the body initially responds to the drug.
 Peak plasma level – the highest plasma level
achieved by a single dose when the elimination
rate of the drug equals to absorption.
 Drug half-life – the time required for the
elimination process to reduce the concentration
of the drug to one half what it was at initial
administration.
 Plateau – a maintained concentration of a drug
in the plasma during series of scheduled dose.
Z-track IM Administration
Administering an Intramuscular Injection
 Method used with irritating medications
(Vistaril, Iron) Matching Type:
 Used to “trap” medication in muscle and
prevent “tracking” of solution through _____ Absorption through GI tract
tissues. _____ Under the tongue
 Stabilize needle with thumb and _____ Small bottle with rubber diaphragm
forefinger. _____ Less irritation of tissue
 Aspirate. If no blood, then inject _____ Direct application to skin
medication slowly and steady. _____ Need to rotate sites
 Wait 10 seconds then quickly withdraw
needle and release skin. A. Topical drug
 Do Not Massage B. Oral drug
 Do Not Recap. C. Intramuscular drug
D. Intramuscular dug
When to Aspirate/Not to Aspirate IM & SC E. Sublingual drug
Injection F. Vial
 Aspiration before injection a medication
Principles of Medication Administration
will ensure that the needle is not in a
blood vessel. If blood appears in the
syringe, withdraw the needle, discard  Three (3) checks and 10 Rights:
the syringe, and prepare a new injection. 1st Check when _______________ of
medicine.
 When administering SC heparin/insulin,
Do NOT aspirate. Because of the 2nd Check while _________________.
anticoagulant properties of heparin,
aspiration could damage surrounding 3rd Check the medication
tissue and causes bleeding and bruising. _________________. Or before opening the
medication package at the bedside.
Rights of Medication Administration Directions for
administration to be
1. __________ – look the order & compare to given to the client
medication on hand, expiration date,
damaged, allergies
2. __________ - look at the order, compare Refill or special
the drugs & dose, double check with other labeling e.g. “refill × 1”
nurse
3. __________ – time/ frequency & time due
Prescriber’s signature
4. __________ – confirm if the patient can
tolerate, IV access, size of needle
5. __________ - Check the ID band & data of
patient if matches
6. ____________ - History, types of drugs &
actions, check the v/s, lab result
7. ____________ – name, frequency,
Basic Guidelines in Administering Medication
actions, dosage, side effect
____________ - document &  Assess the patient’s history for allergies to drug,
8. communicate to physician food interactions, and drug contraindications, and
9. ____________ – after administration, notify the physician if any exist.
communicate to other nurse (name,  Follow Infection Control Policy during the process of
frequency, route, site, date, time, v/s) administration,
10. ____________ – right effect to patient  Identify patient using 2 identifiers; complete name
and file number checked against ID band. Do not
identify patient using room or bed number.
Quick Question  Gather data that may influence drug administration
like vital signs, lab result, patient's behavior.
1. How do you properly identify the patient  Client has the right to refuse a medication
before administering a drug? regardless of the consequence.
 Gather data that may influence drug administration
2. Which drug route has fastest action?
like vital signs, lab result, patient's behavior.
 Administer medications you have personally
a) Subcutaneous prepared, unless the medication has been supplied
b) Intramuscular in a unit of use package.
c) Intravenous  Do not administer medications from containers that
d) Inhalation
are unmarked or illegible. Do not give medications
Essential Parts of Drug Order that have changed in color, appearance, or from
which the container is broken or crusted.
 Always check medication expiration dates.
1. Patient’s full name
 Tablets and capsules should be maintained in their
2. Date and time
wrappers and opened at the bedside immediately
3. Legible writing
prior to use.
4. Drug name
 Avoid conversation during preparation of medicine.
5. Dosage of the drug
 With each drug, inform the patient of the drugs
6. Route of administration
name, purpose, action, and potential side effects.
7. Time and frequency of administration
 The medication order shall be written in the
8. Signature of physician
physician order sheet and transcribe in the
Parts of Prescription Medication Sheet.
 Medications shall be double checked by a witness
 Client’s information: name, address, and during preparation and administration.
age  Any order that is incomplete, illegible, or of any
 Date of written order concern should be clarified prior to administration.
 The Rx symbol “take thou”  Do not leave medications unattended and
 Medication name, dosage, strength accessible to patients, family or visitors.
 Route of administration  Remain with the patient while they take medications.
 Pharmacist dispensing instruction e.g. 30  When the medication error is made, report it
capsules immediately to the nurse in-charge or physician.
 Broad Classification of Drugs

 Analgesics – to reduce pain

 Antipyretics – to reduce fever
 Antibiotics – to treat bacterial infection
 Anti-viral – to treat viral infection
 Antihypertensive – to treat hypertension
 Anti-diabetic – to treat diabetes
 Anthelmintic – destroy & expel worms
 Anti-coagulants – inhibit or decrease the
blood clotting process.
 Anti-inflammatory – reduces inflammation
 Anti-histamine – it prevent or relieve allergy
 Antidotes – it counteract the effect of poison
Medication Dispensing System
 Antacids – react with HCL to decreased
 Medication Cart activity of stomach secretions
 Medication Cabinet  Anti-convulsant – used to treat convulsions
 Medication Room  Antidiarrheals – used to treat diarrhea
 Antitussives – inhibit cough reflex (CNS)
 Anti-asthmatics – relief for asthma by
relaxing smooth muscles of bronchioles
 Antifungal – inhibits the growth of fungi
 Antispasmodic – relieve spasmodic pains or
muscle spasm
Standard Timing Medication Administration  Antiseptic – inhibit the growth of bacteria
 Anti-emetics – relieves nausea & vomiting
 Coagulants – helps in the coagulation of
blood
 Carminatives – cause expulsion of gas from
stomach & intestines

Types of Medication Action

 Potentiating Effect – is the effect of one or

both drug may be increase or decreased
which may be beneficial or harmful.

 Synergistic Effect – occurs when one or

two drugs increase the action of one or
another drugs resulting to a greater effect.

Types of Medication Orders Drug Misuse: OTC or prescribed drugs

 Drug abuse – is the inappropriate

1. ___________– “statim” a Latin term that indicates intake of a substance, either
that he medication is to be given immediately and continually or periodically.
only once and administered within 5 minutes or less.  Drug dependence – is a person
2. ___________– indicates that the medication is to be reliance on or need to take a drug
given once at a specified time. or substance. It is either
3. ___________– is written in advance carried out physiological or psychological.
under specific circumstances.
4. ___________– “pro re nata” a Latin term that
stands for as needed order, permits the nurse to
give a medication when the client requires it.
5. ___________– orders not written as STAT, ASAP,
NOW or PRN. This are usually carried out within 2
hours of the time the order is written by the
physician.
Types of Medication Action Pharmacokinetics

 _____________ – curative  It is defined as what body does to the drug.

 _____________ – unexpected
medical problem Four Steps:
 _____________ – triggering the  Absorption – drug passes in the blood stream
adverse effect
 Distribution – transportation of a drug
 _____________ – hypersensitivity
 Metabolism – drug converted to a less active
reactions
form
 _____________ – unpredictable or
 Excretion – drug are eliminated from the body
untoward reactions to drugs that
have no obvious relationship to Pharmacodynamics: it is defined as what a drug does
dose and causes a liver toxicity. in the body.

 Therapeutic Effects: Is the expected or Factors Affecting Medication Action

predicted physiological response that
medication causes.  Culture
 Gender
 Side Effects/ Adverse Effects: Every  Environment
medication cause some harm to patient.  Psychological
 Diet
 _____________are predictable and  Illness and disease
often unavoidable secondary  Time of administration
effects produced at a usual
therapeutic dose. Quick Quiz
 _____________are undesirable
and unpredictable severe Where does absorption of oral drug occur?
responses to medication. a) Small intestine
b) Heart
 Local or systemic Effects: when apply c) Liver
topically to the skin it is absorbed into the d) Kidney
blood stream.
 Toxic Effects: Develop after prolonged Medication Error
intake of a medication or when a
medication accumulates in the blood  Four main types:
because of impaired metabolism or 1. Prescription errors
excretion. 2. Transcription/ interpretation error
 Allergic Reactions: Unpredictable 3. Preparation errors
immunological responses to a medication. 4. Most medication errors occur during
 ________________ is a severe administration stage.
allergy to a drug that the body react Systems of Drug Measurement
immediately
 Metric system
 Idiosyncratic Reactions: A patient  Household system
overreacts or underreacts to a medication  Apothecary system
or has a reaction different from normal.  Solutions
 Metric system: units are used is milligram,
gram, milliliter, liter
 Household system: measures in drops,
teaspoons, tablespoons or cups for
measuring medications.

 Apothecary system: it is older system, weight

is measure in grain (gr), volume is the minim.
Other are in dram, ounce and pound.
 Dosage and Calculations Metric Table

1,000 micrograms (mcg) =1 1 milliliter (mL)= 1 cubic

Milligrams (mg) centimeter (cc)
1,000 grams (G) = 1 kilogram 1 teaspoon (tsp) = 5
(kg) milliliters (mL)
1,000 milligrams (mg) = 1 1,000 milliliters (mL) = 1 liter
gram (G) (L)
2.2 pounds (lbs) = 1 kilogram 3 teaspoons (tsp) = 1
(kg) tablespoon (Tbsp)
30 milliliters (mL) = 1 ounce 1 tablespoon (Tbps) = 15
(oz) milliliters (mL)
2 tablespoons (Tbps) =
1ounce (oz)

EXAMPLE:

Give Paracetamol 250mg/tab, 1 tablet every

6 hours for fever.

Desired dose: Paracetamol 250mg/tab

Stock dose: Paracetamol 500mg/tab
Dosage Calculation 250mg/tab
500mg/tab

Answer =0.5 tablet

You will give 0.5 or half tablet of Paracetamol
500mg to achieve the desired dose of 250
mg.
DRUG COMPUTATION

Basic Formula: EXAMPLE

 EXAMPLE

Basic Formula:

Drop factors for IV tubing

 macro drop
10 gtt/ml
15 gtt/ml
20 gtt/ml Example

 An IV of 2000 ml has been ordered to run

 micro drop over 16 hours. Set calibration is 10gtt/min.
60 You start the infusion at 0800.
mgtt/ml
 What is the infusion time?
16hrs

What time on the clock will the infusion

be done?
O800 t 1600 =2400 or 12midnight
Practice Z- track Method

1. Give Cefuroxime 375mg IV q 8hrs via 1.Inserting an intramuscular needle at a 90° angle
soluset to run for 30 minutes. Stock is using the Z-track method: A, skin pulled to the side;
Cefuroxime 750 mg, diluted in 10 ml sterile B, skin released. Note: When the skin returns to its
water. How many ml to be given? normal position after the needle is withdrawn, a
2. The doctor order an oral suspension. The seal is formed over the intramuscular site. This
order is to administer 50mg by mouth every prevents seepage of the medication into the
4 hours as needed for fever. You’re subcutaneous tissues and subsequent discomfort.
dispensed with a bottle that reads 25mg/2ml.
How many teaspoons will you administer per
dose?

Intravenous Administration

Vein site on the arms are:

 Basilic vein
 Median cubital
 Dorsal veins
 Radial veins
 Cephalic vein
On the foot:
 Great saphenous
vein
 Dorsal plexus

Parts of an IV infusion Set

Nursing Responsibilities in IV Therapy

 Explain to the client the need for the IV

therapy and what to expect
 Help client to maintain activates of daily living
 Observe the flow rate, patency of the tubing,
infusion site, level of fluid in the infusion
bottle.
 Change dressing on the IV line as necessary
Ventrogluteal & vastus lateralis