NURSING PROCESS IN ADMINISTERING MEDICATIONS

I. ASSESSMENT
The first step in the nursing process; it is the systematic, organized collection of data about
the patient. Two key areas that need to be assessed are the patient’s history (past and
present illness) and his physical status

A. PAST HISTORY

• Chronic conditions • Financial support

• Drug use • Pattern of health care

• Allergies • Level of understanding of disease and

therapy
• Level of education
• Previous medical record
• Social support

B. PHYSICAL ASSESSMENT

• Weight • Vital signs

• Age • Sensory and cognitive barriers

II. NURSING DIAGNOSIS

Shows actual or potential alterations in patient’s function based on the assessment of the
clinical situation

Common Nursing Diagnoses r/t Drug Therapy:

• Ineffective health maintenance

• Risk for injury

• Noncompliance

• Knowledge deficit

• Ineffective management of therapeutic regimen

III. PLANNING
Includes goal setting, setting priorities and determining nursing interventions

For medications, planning includes activities as discussing the client’s medication needs

Nurses also formulate instructional objectives and design client education programs to assist
individuals in the self-administration of drugs
 In planning, focus on:

• Why the drug is needed

• How the drug is administered

• Common indications of adverse effects

• Best schedule to administer the drug

• Drug Interactions

IV. IMPLEMENTATION
Includes the nursing actions necessary to accomplish the established goals. Client education
and teaching is our primary responsibility

For drug therapy, implementation includes all aspects of medication administration (working
with the doctor, giving drugs as prescribed, preparing drugs, calculating dosages, using
appropriate admin techniques, staying alert for errors, documenting the drugs given)

3 types of interventions frequently involved in drug therapy:

– Drug administration

– Provision of comfort measures

– Patient/family education

Proper Drug Administration Guidelines

• Administer medications as prescribed

• Never give a drug poured or prepared by somebody else

• Never allow the med cart or tray out of your sight once you have prepared a dose

• Never leave a drug at a patient’s bedside; rather watch the patient swallow the drug

• Never return unwrapped or prepared drugs to the stock supply

• Keep the medication cart locked at all times

• Follow standard precautions as appropriate

• Consider legal aspects associated with drug therapy

• Consider ethical principles when dealing with medication errors, meds during pregnancy,
and investigational protocols

• Medication errors can easily be caused by similar sounding names, unclear orders, wrong
route of administration, and miscalculation of dosages; take care to avoid these errors
 Comfort Measures

• Placebo effect

• Manage anticipated adverse

• Lifestyle adjustment

Patient and Family Education

• Name, dose and action of the drug

• Timing of administration

• Special storage and preparation instruction

• Specific OTC drugs or alternative therapies to avoid

• Special comfort and safety measures

• Specific points about drug toxicity

• Specific warning about drug discontinuation

Additional teaching tips:

• Provide written instructions

• Use colorful graphs and charts

• Encourage client and family to ask questions

Nursing implications

• Ensure cleanliness of your hands, work area, and supplies

• Ensure availability of supplies

• Ensure adequate lighting

• Decrease environmental distractions

V. EVALUATION
• Comparing the patient’s therapeutic goals with his actual response to drug therapy
• in this phase, the nurse must be able to answer the following questions:
– What therapeutic effects should the drug produce?
– What adverse reactions is the drug known to cause?
– By what mechanism of action does the drug work?
– What should the patient know about the drug
– Which therapeutic effects has the drug produced for the patient? If none, or if the
effects have been insufficient, which issues may be involved?

12 “RIGHTS” OF DRUG ADMINISTRATION

1. RIGHT CLIENT 8. RIGHT OF THE CLIENT TO REFUSE
2. RIGHT DRUG 9. RIGHT OF THE CLIENT TO KNOW THE
3. RIGHT DOSE REASON FOR THE DRUG
4. RIGHT ROUTE 10.RIGHT EVALUATION
5. RIGHT TIME 11.RIGHT DOCUMENTATION
6. RIGHT ASSESSMENT 12.RIGHT DRUG PREPARATION
7. RIGHT MOTIVATION/ APPROACH

RIGHT CLIENT

• Check ID bracelet

• Have client state his or her name

• Address the person by name before giving the drug

• Always double check orders that the client questions

RIGHT DRUG

• Means that the right client receives the drug that was prescribed

• For hospitalized clients, the drug orders are written on the “doctor’s order sheet” and
signed by the duly authorized person

• A telephone order (TO) for medications must be cosigned by the physician within 24 hours

• Check the drug label 3 times before administering the medication

COMPONENTS OF DRUG ORDERS:

• Date and time the order is written

• Drug name

• Drug dosage

• Route of administration

• Frequency of administration

• Physician/ provider’s signature

Categories of Drug Orders

• Standing order- protocols derived from guidelines created by healthcare providers for
use in specific settings, for treating certain diseases or sets of symptoms

• Standard order- may be an ongoing order, may be given for a specific number of doses
or days. May include prn orders

• One time or single order- given once and usually at a specific time

• PRN orders- given at the client’s request and nurse’s judgment concerning need and
safety
• Stat orders- given once immediately

RIGHT DOSE

• Refers to the dose prescribed for a particular client

NURSING IMPLICATION:

• Be familiar with the various measurement system and the conversion from one system to
another

Measuring devices:

• Medication cups

• Dropper

• Syringe

– Tuberculin

– Insulin

– General purpose

• For use in administering .50-50ml of medication

Nursing Implication:

• Always use the appropriate measuring device and read it correctly

• Always measure the volume of a liquid medication at the lowest point of the meniscus

• Shake all suspensions and emulsions

• When measuring drops of medication with a dropper, always hold the dropper vertically
and close to the medication cup

• Do not attempt to divide unscored tablets and do not administer tablets which have been
broken unevenly along the scoring

When preparing to administer an injectable medication:

• Determine the exact volume of drug to be administered

• Select the right type and size of syringe and needle

• When removing a drug from a multiple dose vial, wipe the stopper on the vial with an
alcohol sponge

• Inject an amount of air into the vial equal to the volume of fluid to be removed and
withdraw the required amount of liquid

• If there are air bubbles in the syringe, these must be removed by holding the syringe with
the needle toward the ceiling and tapping the syringe with your finger to move the air
bubbles toward the hub. They should be expelled by gently pushing on the plunger.
• When medication is in a glass ampule, flick the top of the ampule to be sure all medication
is in the larger bottom portion. Wrap the neck of the ampule with dry gauze pad and snap
off the top

RIGHT ROUTE

• Is necessary for adequate or appropriate absorption

• Includes the correct route of administration, and administration in such a way that the
client is able to take the entire dose of the drug and receive maximal benefit from it

Nursing implications

• Be sure to know the prescribed route by which a medication is to be administered

• If no route is specified in the order, the prescribing physician should be questioned about
the intended route

• Always gain the client’s cooperation, before attempting to administer a dose of medication

• Consider the client’s developmental level during administration of medication

• Assess the client’s ability to swallow prior to administering oral medications

• Use aseptic technique when administering drugs especially parenteral ones

RIGHT TIME

• The time at which the prescribed dose should be administered

Nursing Implication

• To achieve maximum effectiveness, medications are scheduled to be administered at a

specific time

• Administer drugs that are affected by foods, such as tetracycline and penicillin before
meals

• Administer drugs such as potassium and aspirin after meals or with food

• It is the nurse’s responsibility to check whether the client is scheduled for diagnostic
purposes such as endoscopy, fasting blood sugar etc.

• Check the expiration date. Discard the medication or return to pharmacy if the date is
passed

• Antibiotics should be administered at even intervals throughout a 24-hour period to

maintain therapeutic blood level

RIGHT DOCUMENTATION

• Requires that the nurse immediately record the appropriate information about the drug
administered

• right documentation includes the drug, dosage, route, time, and the client’s response
 Nursing implication:

• Be sure to document the medication and the time it was administered

• Document site location after administering intradermal, subcutaneous, or intramuscular

injection

• Document the effectiveness of medication administered within:

– 30 minutes to 1 hour for oral meds

– 20 min for intramuscular meds

– 10-15 min for intravenous bolus meds

• Delay in charting could result in forgetting to chart the medication

• Documentation is also the primary evidence for insurance companies

• Right documentation as not only a legal requirement but also a safety responsibility of the
nurse

CLIENT’S RIGHT TO EDUCATION

• This right is a principle of informed consent which is based on the individual’s having the
knowledge to make a decision

Patient teaching topics:

• Name of medication

• Purpose of medication

• How and when to take medication

• How to monitor drug’s effectiveness

• Drugs/foods that may cause interactions

• Possible adverse effects

• Signs and symptoms to bring to the doctor’s attention

• Storing and handling

RIGHT OF THE CLIENT TO REFUSE MEDICATION

• Clients can and do refuse medications

NURSING IMPLICATIONS:

• Be sure to assess client’s reason for refusing medication

• If knowledge deficit underlies client’s reason for refusal. Provide appropriate explanation
for why medication is ordered

• Document if client refuses medication and client reason

• Secure consent and report or inform the physician