PRINCIPLES FOR ALL MEDICATION  3rd: Check bed tag (this is least reliable method

14. Provide privacy if needed.

1. Verify all new or questionable orders. 15. Inform client of medication, any procedure, technique, purposes,
2. Prepare medications in a quiet environment. and client teaching as applicable.
3. Perform hand hygiene. Observe standard precautions as 16. Stay with the client until medication is taken. Do not leave
appropriate. medication at bedside.
4. Collect all necessary equipment including straws, juice, water or 17. Give the medication within 30mins of prescribed time.
stethoscope. 18. Assist client if needed and leave in a comfortable position.
5. Review the medication administration record carefully to ensure 19. Chart administration immediately in ink, marking your initials in
safety, note: the appropriate space.
 Medication dosage 20. Document the rationale if the drug is not administered.
 Route 21. Report any errors immediately and complete appropriate
 Expiration date institutional document.
 Frequency 22. Liquid medications (all routes of administration) MUST NOT be
6. Research drug incompatibilities, action, purpose, mixed together unless of compatibility is verified.
contraindications, side effects and appropriate routes. 23. Prepare drugs for administration in a quiet, well-lit area.
7. Calculate the dosage accurately. Confirm normal range of dose, 24. Never remove a drug from an unlabeled container or from a
particularly in pediatrics. container whose label is illegible.
8. Check expiration date. Look for changes that indicate for 25. Do not let hands touch capsules or tablets.
decomposition (color, odor, clarity) 26. Always observe aseptic technique when handling syringes and
9. Compare label three times with the medication to decrease risk needles.
for error: 27. Be alert for drugs with similar names.
 1st: When removing package from the drawer. 28. Replace the caps of drug containers immediately after the drug is
 2nd: Before preparing the medication removed.
 3rd: After preparing medication 29. Return drugs requiring special storage to the storage area
10. Check need for pm medications. immediately after they are prepared for administration.
11. Be sure medications are identified for each client. 30. Evaluate patient’s response to the drug. Document both negative
12. Check for any allergies and perform all special assessment before and positive reactions.
administration 31. Observe the ten rights in drug administration.
13. Confirm identity by checking at least two of the three possible 32. To ensure safety, do not give a medication that someone else
mechanism for identification. prepared.
 1st: Ask client his name 33. When using a unit dose system:
 2nd: Check client’s identity-band
  Do not remove the wrappings of the unit dose until the
drug reaches the bedside of the patient who is to receive
it. 8.
 After administering the drug, the nurse charts
immediately on the unit dose drug form.
 Iron – have client use straw to prevent staining of the
teeth.
Use gloves if you place your finger in client’s mouth.
Special Concerns

1. Use a calibrated dropper, or syringe to give medications to infant.

 Keep infant at 45 degree angle.
1. Special assessment: diet status, level of knowledge, oral cavity  See if medication is available in liquid form if child is
and ability to swallow. unable to swallow.
2. Use mortar and pestle to crush tablets, if appropriate.  Be sure not to use child’s favorite food as this may result
 Enteric coated tables should not be crushed. Only scored in distrust.
tablets can be broken. 2. For rectal suppository
3. Capsule content may be mixed with food, except time-release  Insert suppository, tapered end first (approximately 2
capsules. inches)
4. Give medication with 60-100 ml of water or juice, unless  Hold buttocks together
contraindicated (e.g. cough syrup)  Encourage to retain suppository for 15-20 minutes to
5. Preparation of liquid medications: allow suppository to melt.
 Shake to mix.
 Pour away from bottle label Administration of Nasal Medication
 Read liquid amount at meniscus (eye level) 1. Have client blow nose to clear mucus
 Do not administer alcohol-based products (e.g elixirs) to 2. Position client so that head can be tilted back to aid a
alcohol-dependent persons gravitational flow
6. Sit client upright to ensure swallowing 3. Push up on tip of nostril
7. Have client swallow medication except: 4. Place dropper or atomizer angled slightly upward just inside
 Sublingual route – DO NOT swallow fluid for 30mins nostril (careful not to touch nose with applicator)
following administration 5. Remind client to keep head tilted for 5mins.
 SL; from the Latin for “under the 6. Inform that drops may produce an unpleasant taste.
tongue” by which substances 7. Instruct just to wipe nose not blow
diffuse into the blood through 8. If client aspirates and begins to cough, let the client sit upright.
tissues under the tongue. 9. If client is an infant, lay infant on his/her back.
 Buccal route – medication between cheek and gum. No
fluid after administration.
 Administration of Ophthalmic Solution 2. Cleanse area of old medication using gauze pads with soap and
warm water.
1. Check solution for color and clarity 3. Use gloves and gauze, tongue depressors or sterile applicator if
2. Warm solution in hands before administration integument is broken.
3. Have client lie on back or sit with head turn to affected side. 4. Spread medication over the site evenly and thinly
4. Cleanse eyelid and eyelashes with sterile gauze pad soaked with 5. If necessary, cover area loosely with a dressing
physiologic saline.
5. Have client look up Special Concerns
6. Keep eye open by gently pulling down the skin below the eye to
expose the lower conjunctival sac. 1. When applying nitroglycerin ointment, take client’s blood
7. Place drops into lower conjunctiva near outer canthus (less pressure 5 minutes before and after application
sensitive than cornea) 2. Wash hands after applications to prevent self-absorption
8. If using ointment, squeeze into lower conjunctiva (from inner to 3. When using transdermal patches, use glove to avoid inadvertent
outer canthus) drug absorption. Place patch in area with little hair.
 Let client blink 2-3 times.
Parenteral Route
 Ophthalmic medications are for individual clients only.
Angles for inserting injections:
Administration of Otic Medications
a. Intramuscular – 90 degrees
1. Warm medication in hands before administering. b. Subcutaneous – 45 degrees
2. Have client slightly tilt head at unaffected side to aid gravitational c. Intravenous – 25 degrees
flow
d. Intradermal – 10-15 degrees
3. Clean outer ear using a wet gauze pad
4. Straighten ear canal by pulling pinna Subcutaneous Route
 Up and back for adults
 Down and back for infants and children under 3 years old 1. Use size 25-27 G, ½ - 1 inch needle, maximum volume is 1.5
5. Maintain position of ear for 5-10 minutes until medication has ml
totally reached inner ear. 2. Pinch skin to form SC fold
3. Insert needle at 45 degree angle in thigh or arm (to avoid
Administration of Topical Agents entering muscle)
4. 90 degree angle in the abdomen
1. Provide privacy and expose only appropriate area to provide
comfort
Possible sites: d. Deltoid – only for small volumes (0.5 – 1ml); use for
immunizations in toddles, older children and adults but NOT for
a. Lateral aspects of upper arm infants; check site carefully, axillary nerve lies beneath deltoid
b. Anterior thigh muscle
c. Abdomen: 2 inches away from umbilicus e. Dorsogluteal – not preferred due to proximity to sciatic nerve
d. Back, in scapular area
Z-track Technique
Intradermal Route
1. For irritating solutions; needle size 20-22 G
1. Use size 26-27 G 1-inch needle on a 1 ml or tuberculin syringe 2. Pull away skin away from the site laterally with non-dominant
(volume will be approximately 0.1 ml) hand to ensure medication enters muscle
2. Stretch skin taut 3. Wait 10 seconds after injecting medication before withdrawing
3. Insert needle 10-15 degrees angle needle
4. Release skin; do not massage (seals needle track)
Possible sites:
5. Encourage physical activity
a. Ventral mid-forearm
Possible sites:
b. Scapula
c. Upper chest a. Gluteus medius: Best but may use other sites except deltoid.
 When wheal appears, remove the needle, and do not
massage it

Intramuscular Route

1. Needle size 18-23 G, 1-2 inches needle; maximum volume is 5ml.

Sites for IM injections:

a. Ventrogluteal – anterior-superior iliac spine, iliac crest, greater

trochanter of the femur
b. Vastus Lateralis – preferred site for immunization of infants.
Muscle is well developed and not located near major nerves or
blood vessels.
c. Rectus Femoris (medial thigh) – a handbreath above knee and
below greater trochanter; good site for infants and self-injection
 PHASES OF DRUG ACTIVITY  To decrease the effects of the stomach’s acid barrier, and the
direct effects of certain foods, ORAL drugs ideally should be given
Dose Disintergration of dose from dissolution of drug 1 hour before or 2 hours after a meal.
(Pharmaceutical Phase)
Drug Absorption of Various Dosage Forms

Oral Preparations: (fastest to slowest)

Absorption, Distribution, Metabolism, Elimination (Pharmacokinetic Phase)
a. Liquid, elixirs, syrups f. coated tablets
b. Suspension solutions g. enteric - coated
c. Powders
Drug receptor interaction (Pharmacodynamic Phase)
d. Capsules
e. Tablets

Effect Bioavailability

Pharmaceutics  A term used to express the extent of drug absorption

 Refers to the percentage of the administered drug that reaches
 The study of how various drugs form influence pharmacokinetic the systemic circulation and eventually its site of action
and pharmacodynamic activities  Significance: differences in bioavailability leads to variable drug
 Pharmaceutic phase or dissolution refers to the reduction of drugs responses
in slid form into smaller particles and their dissolution into a liquid  Dangers of Drugs with a Narrow Therapeutic Range: a relatively
to facilitate absorption. small change in the drug level in those type of drugs can produce
 After ingestion, solid drug (tablet or capsule) must first a significant change in the response.
disintegrate into smaller particles  A small decline in drug level = Therapeutic failure; A small
 Smaller particles are dissolved into liquid, ready for absorption in increase in drug level = Toxicity
the gastrointestinal tract
Bioequivalent
Always remember that…
 If two medications have the same bioavailability and the same
 Drugs in liquid form are more rapidly available for GIT absorption concentration of active ingredient.
than solids.  Examples: Paracetamol & Biogesic
 Food in the GIT may interfere pharmaceutics Furosemide & Lasix
 Milk, alcohol, and protein speed up the breakdown of many drugs Captopril & Capoten
 Others may chemically bind drugs or block their absorption.
 Factors Influencing Drug Effects
a. Weight:
Recommended dosage of a drug is based on drug evaluation
studies:
 Targeted at a 150 pound person
 Doses are adjusted by patient’s weight
 Toxic effects may occur at the recommended dosage if
the person is very small
b. Age
 Children have immature systems for handling drugs
 Older adults undergo many physical changes that are part
of aging process
 Bodies may respond differently in all aspects of
pharmacokinetics

Pediatric Dosages

Fried’s Rule:

Infant’s dose (<1 year) = infant’s age (in months)

150 months x average adult dose

Young’s Rule:

Child’s dose (1-12 years) = child’s age (in years)

Child’s age (in years) + 12 x average adult dose