Drug Administration

Panum Blok II/2014

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Learning Outcomes
1 Discuss your responsibilities regarding drug
administration.
2 Identify the seven rights of drug administration.
3 Explain how to administer an intradermal,
subcutaneous, or intramuscular injection
4 Explain what information you need to teach the
patient about drug use, interactions, and adverse
effects.

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Introduction
Drug administration is
very important and can
be a dangerous duty
Given correctly restore
patient to health
Given incorrectly
patients condition can
worsen
Medical assistant must
Understand principles of
pharmacology
Understand fundamentals of
drug administration
Routes
Dosage calculations
Techniques for injection
Seven rights
Patient education

You should be familiar with the medications frequently

prescribed in your practice.
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Preparing to Administer a Drug
Drugs
Local effect applied
directly to skin, tissue,
or mucous membranes
Systemic effect given
by routes that allow the
drug to be absorbed or
distributed into the
bloodstream
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Pay close attention
Dose
Route
Form of medication
Medical assistant
Close attention to detail
Strong patient
assessment skills
Expert technique
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Preparing to Administer a Drug (cont.)

Assessment
Injection site
Drug allergies
Patient condition be alert
to changes that can affect
drug therapy
Consent forms

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Preparing to Administer a Drug (cont.)

Rules for administration
Give only drugs the doctor orders use drug reference, if
necessary

Wash your hands

Prepare in a well-lit area
Focus on task; avoid distractions

Calculate the dose carefully

Do not leave a prepared drug unattended never give a

drug that someone else has prepared

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Preparing to Administer a Drug (cont.)

Rules for administration
Identify patient properly

Physician should be in the office

Observe patient following administration

Discard any ungiven medications properly

Report error to physician immediately

Document properly

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Preparing to Administer a Drug (cont.)

Seven Rights of Drug Administration
1. Right patient
2. Right drug
3. Right dose
4. Right time
5. Right route
6. Right technique
7. Right documentation

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Apply Your Knowledge

How do you properly identify the patient before
administering a drug?
ANSWER: To ensure that you have the right patient, you
should check the name and date of birth on the patient record
and ask the patient to state his/her name and date of birth.

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Techniques for
Administering Drugs
Oral
Tablets, capsules, lozenges, and
liquids
Slower absorption through GI tract

Buccal or sublingual
Buccal placed between the cheek and
gum
Sublingual placed under the tongue
Faster absorption; bypasses GI tract
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Techniques for
Administering Drugs (cont.)
Parenteral
Administration of substance into a muscle or vein
Fast absorption; bypasses GI tract
Safety risks
Rapid administration; rapid action
Exposure to bloodborne pathogens
Methods of injection
Intradermal (ID)
Subcutaneous (SC)
Intramuscular (IM)
Intravenous (IV)

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Techniques for
Administering Drugs (cont.)
Needles
Available in different gauges the
smaller the number, the larger the
gauge (inside diameter)
Length long enough to penetrate the
appropriate layers of tissue
Syringes
Barrel
Plunger
With or without needle
Calibrated in milliliters or units

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Techniques for
Administering Drugs (cont.)
Parenteral drug packaging
Ampule glass or plastic container that is sealed
and sterile (open with care)

Cartridge small barrel prefilled with sterile drug

Vial small bottle with rubber diaphragm that

can be punctured by needle

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Techniques for
Administering Drugs (cont.)
Methods of injection
Intradermal Intramuscular
Into upper layer of skin More rapid absorption
Used for skin tests Less irritation of tissue
Larger amount of drug
Subcutaneous Z-track method
Provides slow,
sustained release and Intravenous
longer duration of
action Not usually given by
medical assistants
Rotate sites

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Educating the Patient About

Drug Administration
How to read the prescription drug label

Interactions
Drug-drug interactions
Drug-food interactions

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Educating the Patient About

Drug Administration (cont.)
Adverse effects
Report changes
Recognize significant
adverse effects

Instructions on taking the

drug
At the right time
In the right amount
Under the right
circumstances

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Apply Your Knowledge

What should you instruct the patient about regarding
drug administration?
ANSWER: The patient should be taught how to read the
prescription label, drug-drug and drug-food interactions,
adverse effects, and how to take the drug correctly.

Bravo!
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Special Considerations
Pediatric patients
Physiology and immature body systems may
make the drug effects less predictable
Require dosage adjustments and careful
measurements of doses
Observe pediatric patients closely for adverse
effects and interactions
Administration sites and techniques may differ

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Special Considerations (cont.)

Pregnant patients
Remember that you are caring
for two patients

Giving the mother a drug also

gives it to the baby

Check drug information sources

for pregnancy drug risk categories

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Special Considerations (cont.)

Patients who are breast-feeding
Some drugs are excreted in
breast milk

Ingestion can be dangerous

because baby cant metabolize
or excrete drugs

Check drug information sources

for contraindication during
lactation
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Special Considerations (cont.)

Elderly patients
Age-related changes
affect
Absorption
Metabolism
May have increased risk of
Distribution
Drug toxicity
Excretion
Adverse effects
Lack of therapeutic effects

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Special Considerations (cont.)

Patients from different cultures
Can affect a patients understanding of drug
therapy and compliance with it

Obtain drug information sheets

in the languages that are commonly
spoken by patients in your office

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Apply Your Knowledge

What do children and the elderly have in
common in relation to drug administration?

ANSWER: Both have alterations in metabolism and

absorption of drugs requiring adjustments in
dosages.

Fantastic!
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INJECTIONS
Parenteral administration of medications
Administered by injection
An invasive procedure
Performed using aseptic techniques
Requires certain skills
Has a rapid effect

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Intramuscular injection
Skeletal muscle highly vascular and its
capillaries contain small pores that enables
substances of small molecular weight to pass
through into the bloodstream

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Intramuscular injection
Several muscles of the body have
considerable mass and are able to be injected
with quantities of up to several millilitres of
fluid, generally without undue discomfort

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Intramuscular injection
The gluteus medius of the buttocks is the best
muscle to use in this respect
The deltoid muscle has a richer blood supply
so good for rapid absorption, but size limit
should be no more than 1-2 ml

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Intramuscular injection
Intramuscular injections are not always given
for quick action
If the drug is mixed with an oil absorption is
slower. This type of injection is known as
depot

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Intramuscular injection
Exercise causes an increase in skeletal muscle
blood flow improves absorption of a drug
Main danger from im injection is damage to
nerves, especially in gluteal injections
Pain and sterile abscess can occur with im

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Intramuscular (IM) Tissue

90Angle

Dermis

Fatty Tissue
(SubQ)

Muscle Tissue

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Intramuscular Sites

Deltoid
Injection
Site
Vastus Lateralis

Injection
Site

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Characteristics of Intramuscular
sites
Vastus lateralis
Lacks major nerves and blood vessels
Rapid drug absorption
Used for volumes up to 5mls

Ventrogluteal
A deep site situated away from major nerves and blood vessels
Less chance of contamination incontinent clients or infants.
Safe site for injections up to 4mls

Deltoid
Easily accessible but muscle not well developed in most clients. Used for small
amounts of medications.
Not used in infants or children with underdeveloped muscles.
Potential for injury to radial and ulnar nerves or brachial artery.
Not recommended for amounts more than 2mls

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A. Landmark for ventrogluteal site

B. Locating IM injection for ventrogluteal site.

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A. Landmarks for vastus lateralis site

B. Giving IM injection in vastus lateralis

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A. Landmarks for Deltoid site

B. Giving IM injection in deltoid muscle

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Intramuscular injections
Provides faster medication absorption,
because of greater vascularity of muscle
Less danger of tissue damage when
medications enter deep into the muscle
Risk of injecting into directly into blood
vessels

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Intramuscular Sites
Site selection depends on
persons age
muscle development
Use deltoid muscle for older children, adults
(toddlers only if adequate muscle mass)
Use anatomical landmarks to locate site
Well developed person can tolerate 3mls without
severe discomfort

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Never administer vaccines into the buttock

May administer large doses of immune
globulin into buttock of older children or
adults

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Intramuscular Needle
Gauge: 23 or sometimes 25 in very thin patients

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Intramuscular Injection Technique

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Z Track
For irritating preparations such as iron
Minimises irritation and staining by sealing
the medication in muscle tissue
Preference site ventogluteal

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Z Track
New needle should be applied after preparation of injection
Swab site
Pull overlying skin and subcutaneous tissue approx 2.5-3.5
cm to the side
Holding skin taut inject deep into the muscle
The needle remains inserted for 10 seconds to allow
medications to disperse evenly
Withdraw needle and release the skin

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SUBCUTANEOUS INJECTIONS

Medication injected beneath the skin into connective

tissue or fat under dermal layer
Medication should not be irritating to the tissue can
cause
Severe pain
Tissue necrosis
Tissue sloughing
Slow absorption and can provide sustained effect
Unusual to use syringe greater than 5ml for a sc or im
Larger volumes create discomfort

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HYPODERMIS OR
SUBCUTANEOUS LAYER
This is the deepest skin layer. Connects or binds
the dermis above it to the underlying organs
Mainly composed of loose fibrous connective
tissue and fat (adipose) cells
Interlaced with blood vessels
Hypodermis in females usually 8% thicker than
in males
Absorption is slower as subcutaneous tissue is not
richly supplied with blood

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Subcutaneous (SubQ) Tissue

45 Angle

Dermis

Fatty Tissue
(SubQ)

Muscle Tissue

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SUBCUTANEOUS INJECTION
SITES
Deltoid

Abdomen

Thighs

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Subcutaneous injections
Inspect skin for masses or tenderness
Site should be free from infection scars and
bony prominences
Long term therapy rotate injection site
Only small doses of water soluble
medications should be given

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Subcutaneous Sites

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Sites recommended for Subcutaneous

Injections

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Subcutaneous injections
Best sc injections site are the outer posterior
aspect of the upper arms, the abdomen from
below the costal margins to the iliac crests
and the anterior aspects of the thigh
Site most recommended for heparin is the
abdomen

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Subcutaneous injections
The injection site should be free from lesions
Bony prominences
Large underlying muscles
Nerves
Should be given at least 2.5cm away from last
injection

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Subcutaneous injections
Thin patients may have insufficient tissue
Upper abdomen is the best site with this type of
patient
If 5cm of tissue can be grasped needle should be
inserted at 90 degrees
If 2.5cm of tissue can be grasped the needle should
be inserted at 45 degrees

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Pucker or slightly stretch skin

Swab ( not necessary for insulin as it may assist
with the formation of necrotic tissue)
Insert needle with a firm quick approach
Remove needle quickly
Re-swab site Do not rub particularly after insulin
administration
Check patient

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Giving Subcutaneous injections in the

abdomen

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Subcutaneous Needle
Gauge 25

Length 5/8 inch

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Prepare equipment
Check medication (follow principles )
Draw up medication
Prepare site
Inject needle
45 angle for most SC injections
90 (straight in ) for insulin

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Charting Medications
Progress notes
Administration
Special problems
New symptoms
Patients statements
Patient tolerance
Be sure to have the right chart
Be specific and accurate

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I
Apply Your Knowledge M
1. You administer a medication to Mr. Max. What and where P
should you chart?
R
ANSWER: You should chart in the progress notes the
date, time, dosage, route, and name of the medication, as E
well as how well the patient tolerated it. S
S
I
V
E
!
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In Summary
Medical assistant
Administer drugs safely and effectively
Conversions and calculations
Patient assessment
Observe general rules
Follow seven rights of drug administration

Be aware of patients needing special considerations

Be aware of nonpharmacologic methods for managing

pain control

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Words are the

most powerful
drug used by
mankind.
~Rudyard Kipling

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