Medication Administration

Medication Routes

1. Oral
● convenient, cost-effective, and most commonly used medication administration
route
2. Sublingual/Buccal
● form of the enteral route of medication administration that offers the benefit of
bypassing the first-pass effect
● Sublingual - under the tongue
● Buccal - on the cheek
● Sublingual tissue has highly permeable mucosa with rapid access to the
underlying capillaries while buccal tissue is less permeable and has slower drug
absorption
3. Rectal
● allows for rapid and effective absorption of medications via the highly
vascularized rectal mucosa
● Only about half of the drug absorbed in the rectum directly goes to the liver
4. Intravenous
● Most common parenteral route of medication administration and can bypass the
liver's first-pass metabolism
● Peripheral veins are often utilized in the parenteral administration of medications
● Upper extremity is usually the preferred site for intravenous medication as it has a
lower incidence of thrombophlebitis and thrombosis than the lower limbs
● The median basilic or cephalic veins of the arm or the metacarpal veins on the
hand's dorsum are commonly used. In the lower extremity, the dorsal venous
plexus of the foot can be used.
5. Intramuscular
● Can be administered in different body muscles
○ Deltoid
○ Dorsogluteal
○ Ventrogluteal
○ Rectus femoris
○ Vastus lateralis muscles
● The dorsogluteal site, or the buttock's upper outer quadrant, is a common site
chosen traditionally for intramuscular injections by healthcare professionals, it
poses a potential risk of injury to the superior gluteal artery and sciatic nerve.
● Insert needle at 90 degrees angle the right deltoid.
6. Subcutaneous
 ● Medications are administered to the layer of skin referred to as cutis, just below
the dermis and epidermis layers.
● Subcutaneous tissue has few blood vessels; therefore, the medications injected
undergo absorption at a slow, sustained rate.
● Subcutaneous medication can be administered to various sites, including the
upper arm's outer area and abdomen, avoiding a 2-inch circle around the navel,
the front of the thigh, the upper back, or the upper buttock area behind the hip
bone.
● Insert needle at 45 degrees angle at the lateral aspect of the upper left arm
7. Intradermal
● Are injections administered into the dermis, just below the epidermis.
● The ID injection route has the longest absorption time of all parenteral routes.
● These types of injections are used for sensitivity tests, such as TB allergy, and
local anesthesia tests
● 10-15 Degrees angle with the bevel facing up, administer medication until
wheal/bleb is formed.

10 Rights of Medication Administration.

1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time
6. Right of the Patient to Refuse
7. Right Patient Education
8. Right Assessment
9. Right Evaluation
10. Right Documentation
IV Therapy

IV Therapy
● IV fluid infusions are prescribed by health care providers to restore or maintain hydration
and electrolyte status within the body.
● It is used to deliver medication, vitamins, blood, or other fluids to those who need them

Types Of Intravenous Fluid Concentrations

● Isotonic
○ Typically administered for fluid and electrolyte replacement.
○ Isotonic fluids have a similar concentration to the solutes contained in blood, so
they do not cause the osmotic movement of fluid into or out of the patient’s
individual cells.
○ An example of isotonic fluid is 0.9% normal saline.
● Hypertonic
○ Have a higher concentration of solutes than blood
○ They are typically used in critical care situations to treat hyponatremia and avoid
pulmonary edema by relying on osmosis to help remove excess fluid.
○ An example of a hypertonic fluid is dextrose 5% in 0.9% normal saline (D5NS).
● Hypotonic
○ Have a lower concentration of solutes than blood.
○ The goal of hypotonic fluid administration is to move fluids into a patient’s cells
due to osmosis.
○ Hypotonic solutions are commonly used when a patient has severe intracellular
dehydration such as during diabetic ketoacidosis.
○ An example of hypotonic fluid is 0.45% normal saline (1/2NS)

II. Parts of IV Set

Sterile spike
● This part of the tubing must be kept sterile as you
spike the IV fluid bag.
Drip chamber
● The drip chamber allows air to rise out from a fluid
so that it is not passed onto the patient. It is also used to
calculate the rate at which fluid is administered by gravity
(drops per minute). It should be kept ¼ to ½ full of solution.
Back Check valve
● A backcheck valve prevents fluid or medication
from traveling up into the primary IV bag.
Access ports
● Access ports are used to infuse secondary medications
and to administer IV push medications. These may also be referred to as
 “Y ports.”
Roller clamp
● A roller clamp is used to regulate the speed, or stop, an infusion by gravity.

Complications of IV Therapy

➔ Infiltration
● occurs when the tip of the catheter slips out of the vein.
● The catheter passes through the wall of the vein, or the blood vessel wall allows
part of the fluid to infuse into the surrounding tissue, resulting in the leakage of IV
fluids into the surrounding tissue.
● Infiltration may cause pain, swelling, and skin that is cool to the touch.
● If the infiltration is severe, you may consider the application of a compress in
addition to elevating the affected limb.
➔ Extravasation
● refers to infiltration of damaging intravenous medications, such as
chemotherapy, into the extravascular tissue around the site of infusion.
● Extravasation causes tissue injury, and depending on the medication, site, and
length of exposure, it can cause tissue death, which is also referred to as
necrosis
➔ Phlebitis
● Is the inflammation of a vein.
● Phlebitis of superficial veins can occur due to trauma to the vein during insertion
of the IV catheter. It can cause redness and tenderness along the vein and can
lead to infection if not treated appropriately.
● Treatment may include warm compresses and nonsteroidal anti-inflammatory
medications.
➔ Infection
● can occur whenever the skin barrier is broken by the insertion of an IV catheter.
● Signs of infection include redness, warmth, tenderness, and possible fever.

IV THERAPY Checklist

A.Setting up an IV

1. Verify doctor’s order. (pls. state what’s the order, basing on the situation given

2. Observe the 10 “R’s”

3. Explain the procedure to the patient

4. Do hand hygiene before and after the procedure

5. Prepare materials completely (IV solution, IV set, IV label, Antiseptic wipes/cottonballs with
alcohol and kidney basin)
6. Check the sterility and integrity of the IV solution, IV set and other devices
7. Open the seal of the IV solution aseptically; maintain port sterility at all times

8. Open administration set aseptically and close the IV clamp/ regulator

9. Spike the IVF port aseptically
10. Fill the drip chamber to atleast half full and prime tubing aseptically

11. Remove air bubbles (if any) and put back the cover to the distal end of the tubing
12. Discard all waste materials

B. Changing/ Follow up an IV

1. Verify doctor’s order. (pls. state what’s the order, basing on the situation given.
2. Observe the 10 “R’s”

3. Explain the procedure to the patient

4. Assess IV site for redness, swelling, pain etc…

5. Check the patency of the site

6. Do hand hygiene before and after the procedure

7. Prepare materials completely (IV solution, IV label, Antiseptic wipes/cottonballs with alcohol
and kidney basin)

8. Check the sterility and integrity of the IV solution

9. Open the seal of the IV solution and; maintain port sterility at all times
10. Close roller clamp
11. Spike the IVF port aseptically

C.Administering IV drugs

1. Verify the written medication card with the doctor’s order (pls. state based on what you’ve
picked)
2. Verify the skin test of drug (if necessary)
3. Observe the 10 “R’s”

4. Explain the procedure to the patient

5. Do hand hygiene before and after the procedure
6. Assess IV site for redness, swelling, pain etc
7. Check patency of the site

8. Do hand hygiene before and after the procedure

9. Prepare materials completely (right drug, correct syringe, tray and Antiseptic wipes/cotton
balls w/ alcohol)

10. Disinfect injection port of the diluent, vial and the ampule before breaking then aspirate
the right dose aseptically

11. Aspirate the right amount of diluent for the drug. (If the drug needs to be diluted)

2. Aspirate the right drug

 13. Disinfect the Y- injection port and insert the syringe

14. Kink or close the IV tubing from the bottle and push IV drug slowly and aseptically
15. Flush with 1-2 cc IVF after and regulate to desired rate
16. Document on the patient’s chart
17. Discard all waste materials properly

D. Discontinuing an IV

1. Verify doctor’s order to discontinue IV including IV medication

2. Observe the 10 “R’s”
3. Explain the procedure to the patient
4. Do hand hygiene before and after the procedure

5. Prepare materials completely (IV tray, dry and wet cottonballs, plaster, bandage scissors
and kidney basin)
6. Close the roller clamp
7. Moisten adhesive tapes around the IV site with wet cottonballs, remove plaster gently

8. Be ready with dry cottonballs. Remove IV catheter then immediately apply pressure over
the venipuncture site
9. Inspect IV catheter for completeness

1. Verify doctor’s order to discontinue IV including IV medication 2. Observe the 10 “R’s” 3.

10. Place plaster over venipuncture site
11. Discard all waste materials properly
12. Document the time of discontinuance

Infection Control

Infection control
● Refers to the policy and procedures implemented to control and minimize the
dissemination of infections in hospitals and other healthcare settings with the main
purpose of reducing infection rates
● Precaution orders have to be placed and implemented even before a confirmatory
diagnosis is reached to avoid the possible transmission of the infectious pathogen
● Hospital-acquired infections are one of the most common healthcare complications
● The most effective and least expensive way for clinicians to also apply infection control
principles is by washing hands before and after any patient interaction

Transmission-Based Precautions

Standard precautions
● Used for all patient care.
 ● It includes hand hygiene, personal protective equipment, appropriate patient placement,
clean and disinfected patient care equipment, textiles and laundry management, safe
injection practices, proper disposal of needles and other sharp objects.

Contact precaution
● Used for patients with known or suspected infections that can be transmitted through
contact.
● For those patients, standard precautions are needed, plus limit transport and movement
of patients, use disposable patient care equipment, and thorough cleaning and
disinfection strategies.
● Patients with acute infectious diarrhea such as Clostridium difficile, vesicular rash,
respiratory tract infection with a multidrug-resistant organism, abscess or draining wound
that cannot be covered need to be under contact precautions.

Droplet precautions
● Used for patients with known or suspected infections that can be transmitted by air
droplets through the mechanism of a cough, sneeze, or by talking.
● In such cases, it is vital to control the source by placing a mask on the patient, using
standard precautions plus limitations on transport and movement.
● Patients with respiratory tract infection in infants and young children, petechial or
ecchymotic rash with fever, and meningitis are placed under droplet precautions.

Airborne precautions
● Use for patients with known or suspected infections that can be transmitted by the
airborne route.
● Those patients require to be in an airborne infection isolation room with all the
previously mentioned protections.
● The most important pathogens that need airborne precautions are tuberculosis,
measles, chickenpox, and disseminated herpes zoster.
● Patients with suspected vesicular rash, cough/fever with pulmonary infiltrate,
maculopapular rash with cough/coryza/fever need to be under airborne precaution.
MIO

MIO
● Measurement of a patient’s fluid intake by mouth, feeding tubes or IV Catheters and
output from kidneys, GI tract, drainage tubes and wounds.

Intake
● Measurement of all the fluids entering the body.
● anything the client drinks, including water and beverages
● all foods that are liquid at room temperature, like ice cream, gelatin, sherbert, pudding,
custard, ice chips, and popsicles
● the fluids provided through intravenous therapy, enteral, or total parenteral nutrition
● Ice chips (melts half their volume) e.g. 8 oz of ice chips is only 4 oz intake

Assess hydration status

● Skin Turgor
Output
● Measurement of all fluid levels that leaves the clients body such as urine, perspiration,
exhalation, diarrhea, vomiting, drainage, bleeding and wounds.

Formula

Intake + Output = Total

> Intake = Gain
>Output = Loss

Conversions

1g 1mL

1 oz 30mL

1 pint 50 mL

1 quart 1000 mL

1 ttsp 5 mL
 1 tbsp 15 ml

1 cup 240 mL

ABG

Arterial Blood Gas

● Diagnostic tool to evaluate the partial pressures of gas in blood and acid-base content
● An arterial blood gas (ABG) explicitly tests blood taken from an radial artery.
● Whole blood is the required specimen for an arterial blood gas sample.
● The specimen is obtained through an arterial puncture or acquired from an indwelling
arterial catheter.
● Arterial or venous specimens must be collected anaerobically with lyophilized heparin
anticoagulant in 1- to 3-mL sterile syringes.
● Liquid heparin has atmospheric PO2 and PCO2 values that dilute the sample
● Automated blood gas analyzers are commonly used to analyze
blood gas samples, and results are obtained within 10 to 15 minutes.
Automated blood gas analyzers, directly and indirectly, measure
specific components of the arterial blood gas sample

ABG Components
● pH = measured acid-base balance of the blood
● PaO2 = measured the partial pressure of oxygen in arterial blood
● PaCO2 = measured the partial pressure of carbon dioxide in arterial blood
● HCO3 = calculated concentration of bicarbonate in arterial blood
 ● Base excess/deficit = calculated relative excess or deficit of base in arterial
blood
● SaO2 = calculated arterial oxygen saturation

Allen Test
● necessary before an ABG is drawn from either upper extremity to check for
adequate collateral flow
● The arterial site commonly used is the radial artery, which is superficial and easily
palpable over the radial styloid process.
● The next most common site is the femoral artery.
● The test is performed on the unilateral upper extremity chosen for the procedure

ABG Values
● pH (7.35-7.45)
● PaO2 (75-100 mm Hg)
● PaCO2 (35-45 mm Hg)
● HCO3 (22-26 mEq/L)
● Base excess/deficit (-4 to +2)
● SaO2 (95-100%)

ABG Interpretation
ROME = Respiratory-Opposite ; Metabolic-Equal

Acidosis Alkalosis

ph 7.35 7.45

PaCO2 45 35

HCO3 22 26

Normal pH = Fully Compensated

All Abnormal = Partially Compensated

Normal PaCO2 or HCO3 = Uncompensated