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How To Administer Medication
How To Administer Medication
RIGHT PATIENT
An important step in administering medication safely is being sure the medication is
given to the right patient
Read the physicians order to make sure for whom the medication is ordered.
Check the patients identification band and ask the patient to state his or her name
RIGHT ROUTE
Read the physicians order to determine the route of administration
Dilute the drug if indicated
Know right method of giving drugs e.g. oral, parenteral
Know the abbreviations used to designate the route of administration e.g. IV, IM, PO
Review the available forms of drug to make sure the drug can be given according to
the order
Make sure the patient is able to take the drug by the route indicated or ordered.
COMMON ROUTES
ORAL (PO)
It is the most common route
Most convenient
The easiest and most desirable way to administer medication
Usually less expensive
Inappropriate if patient cannot swallow and if GIT has reduced motility
Inappropriate for client with nausea and vomiting
Drug may have unpleasant taste
Drug may discolour teeth
Drug may irritate mucosa
Drug may aspirated by seriously ill patient
SUBLINGUAL
A drug that is placed under the tongue where it dissolves
When the medication is in capsule and ordered sublingually, aspirate the fluid from
capsule and place under the tongue
A medication given by the sublingual route should not be swallowed, or desired
effect will not be achieved.
Same as oral
Drug is rapidly absorbed in the bloodstream
If swallowed drug may inactivated by gastric juices.
Drug must remain under the tongue until dissolved and absorbed
Buccal
A medication is held in the mouth against the mucous membranes of the cheek until
the drug dissolves
The medication should not be chewed, swallowed or placed under the tongue
Patient should be taught to alternate the cheeks with each subsequent dose to
avoid mucosal irritation
Same as oral
Drug can be administered for local effect
Ensures greater potency because drug directly enters the blood and bypass the liver
If swallowed drug may inactivated by gastric juices.
Topical administrations
Is the application of a drug directly to the surface of the skin
Includes administration of drugs to any mucus membrane
Eye, nose, eras, vagina, urethra, colon, lungs
Dose forms for topical administration include:
Skin:
Creams, ointments, lotions, gels transdermal patches, disks
Eye or ear:
Solutions, suspensions ointments
Nose and lungs:
Sprays, powders
Local therapeutic effects
Not well absorbed into deeper layers of the skin or mucus membrane
Lower risk of side effects transdermal route effects steady level of drug in the
system
Sprays for inhalation through the nose may be for local or systemic effects.
RECTAL ROUTE
Used in children
Used in vomiting/unconscious
Higher concentrations rapidly achieved
Disadvantages:
Inconvenient
Absorption is slow and erratic
Irritation or inflammation of rectal mucosa can occur.
Parenteral administration
Parenteral therapy means giving of therapeutic agent including food outside the
alimentary tract.
Types of parenteral routes: intra dermal, subcutaneous, intra muscular, intravenous
Purpose:
To get rapid and systemic effect of the drug
To provide needed effect when the patient unconscious, unable to swallow due to
neurological or surgical alterations.
To give nourishment when it cannot be taken by mouth
Intradermal
Medicine when introduced in the dermis
10-15 degree angle
0.5ml or less of medication
Intramuscular
Deltoid
Expose upper and shoulder
Relax arm, flex elbow to find triangle-shaped deltoid muscle
Injection site in center of triangle
Dorsogluteal
Is composed of the thick gluteal muscle of the buttocks. ( Extreme caution: sciatic
nerve and major blood vessels)
Never use for kids less than 2 years old or small children with small body
mass/muscle
Position: the patient may be prone or side lying
Vastus lateralis
The vastus lateralis is the major muscle in the anterolateral thigh and is used most
often for IM injections in infants. By school-age and adolescence this site may be
more painful because of the development of the musculature
Ventrogluteal
The ventrogluteal muscles make up the other preferred site for IM injection in
infants, although this is a useful site for other age groups as well. These muscles
contain no important nerves or vessels and are accessible when the child is in a
variety of positions.
Gluteal region
The gluteal muscles are very small and poorly developed in the infant and young
toddler. It is not recommended as an injection site until the child has been walking
for at least one year since locomotion helps to develop the gluteal musculature.
Nurses responsibility in administration of parenteral medications
Check the physicians orders for the type of injections, dosage, and the route of
administration.
Check the diagnosis and age of injections.
Check the necessity for giving test dose.
Check the form of medication available and the correct method of administration.
The nurse must have the knowledge of anatomy and physiology of the body, it is
essential for safe administration of medication for parenteral route.
Medication preparation
Prior to administration check the MAR against the physicians orders, ensure that the
correct medication has been selected based on the medication order and label.
Verify the medication is stable based on visual examination for particulates or
discoloration, ensure the medication is not expired.
Medications must be prepared for one patient at a time.
Prior to medication preparation the nurse will perform hand hygiene using
antimicrobial soap and water for 60 seconds
Medication preparation area should be clean, have good lightning and located in a
closed area to avoid distraction.
Unit dose packages must be opened at the bedside. Medications that require
preparations i.e. measuring, crushing or bulk medications must be prepared in the
medication preparation area.
All drug containers taken to the bedside (including syringes of line flushes and other
medications prepared from vials and ampoules on patient care units outside of the
patients room) must be labelled with the drug name, date, time, strength and dose.
Medications are not to be left on trays, bedside tables, etc, unless ordered by a
physician.
The nurse should not administer medications prepared by another nurse.
A nurse is not to pour a medication from one bottle to another. A nurse is not to put
a medication back into a bottle.
Nurses are not authorized to re-label medication bottles or containers. Medication
which loses its label or which lacks a legible label must never be administered to
patients.
Each nurse should know the common dose, maximum dose, and how to compute
dosage.
All medications requiring refrigeration should be identified by pharmacy department
and place in the medication refrigerator i.e. reconstituted powder drugs.
MEDICATION AADMINISTRATION
Observe the 7 rights in medication administration
At the patients bedside, verify the patients name and medical record number on
the MAR and the ID band.
Give the drugs one by one
Check for contraindications to patient receiving the medication (i.e. allergies)
The nurse shall remain with the patient until the medicine is actually swallowed.
Always give the medicine prepared by yo rself.
Do not leave the medicine with the patient
Record the medications that are vomited by the patient, refused by the patient and
those drugs that are not administered to the patient and the reason for not giving
the medication.
PATIENTS RIGHT RELATED TO MEDICATION ADMINISTRATION
The patient has the right to considerate and respectful care, and the right to refuse
the medication.
To be informed of the medications name, purpose, action , potential and undesired
effects
To refuse a medication regardless of the consequences
To not receive unnecessary medications
Open multiple dose oral liquids should be properly labelled and kept in cool dry area
with an expiry date one month from date of opening.
Other open multiple dose containers (i.e. eye, ear, nose drops, creams, ointments,
nebulisation solutions etc.) should be properly labelled and kept in dry area , and
should be labelled with an expiry date one month from date of opening.
Drug stability
Drug stability means the ability of the pharmaceutical dosage form to maintain
physical, chemical, therapeutic and microbial properties during the time of storage
and usage by the patient.
Expiry dates
Expiry date means that drug cannot be used after this date due to the chance of
chemical degradation, harmful to patient or low potency.
It is important to comply with the storage conditions specified on the container
The stability of products is variable. A product which is stable in its container may
become unstable once the container is opened.
Factors affecting drug stability
Temperature: high temperature accelerate oxidation, reduction and hydrolysis
reaction which leads to drug degredation
pH: acidic and alkaline pH influence the rate of decomposition of most drugs. Many
drugs are stable between pH 4-8
Moisture: water catalyses chemical reactions as oxidation, hydrolysis and reduction
reaction. Water promotes microbial growth.
Light: affectsdrug stability through its energy or thermal effect which leads
oxidation.
Oxygen: exposure of drug formulations to oxygen affects their stability.
Drug Incompatibility: reactions between components of pharmaceutical dosage
forms itself or between these components and cover of the container.