Medication Administration

 This is the NURSE’S RESPONSIBILTY

 Understand need to know vs nice to know
o Generic drug names (typically longer ones) are used on the NCLEX
 There is only one per drug
 We are tested based on generic name
o Trade name
 Could have multiple of these names per drug due to branding
 Drug Nomenclature
o Chemical name—identifies drug’s atomic and molecular structure
o Generic name—assigned by the manufacturer that first develops the drug
o Official name—name by which the drug is identified in official
publications USP and NF
o Trade name—brand name copyrighted by the company that sells the
drug
 Routes of Administration
o Oral
 Most frequent route
o Sublingual
 Under tongue
o Buccal
 In cheek
o Rectal
 SIMS lateral position for administration
 Ex: anal suppositories
o Vaginal
 Have PT lie on their back and take it at night so it doesn’t melt and
leak out when they are moving around
o Topical
 Wash hands before and after applying to skin
o Transdermal
 Administered via patch (ex: nicotine)
o Parenteral (Injectable)
 Subcutaneous
 Under the skin, deep into the subcutaneous tissue (ex: PPD
Test, insulin)
 Give at 45 or 90 degree angle
 Intramuscular
 In muscle
 Intradermal
 Angle is 5-15 degrees
 Intravenous
 In the veins
o Inhalation
 Ex; albuterol
 Types of Medication Orders
o Stat order
 Carry out immediately
 Morphine Sulfate10 milligrams IV stat
 Administer medication as fast as you can get the meds
 Given the med from a STAT order only ONE time
o Single Order
 One-time order
 Seconal 100mg hs before surgery
 Ex: meds administered prior to surgery
 A STAT order is technically a single order
 Hs= hours of sleep
o Given at night time in the hospital, usually around 9
pm
o Routine order
 Orders carried out by nurses until HCP cancels them
o Standing order
 Carry until cancelled by another order
 Multiple vitamins daily
 KCl twice daily x 2 days
 These orders are pre-written out on a sheet (for protocol purposes
almost) so you do no need to go see what HCP would want in the
emergent situation (ex: stroke alert)
o PRN order
 As needed
 Amphojel 15 mL prn
 HCP must give the reason as to why the PT has PRN medications
 So the medication isn’t used to treat pain when the Tylenol
was prescribed for the PT’s fever
 Parts of the Medication Orders
o Full name of patient
 Include Pt’s Diagnosis and allergies
o Date & time order is written
 Write the time throughout the shift
o Name of drug to be administered
o Dosage of the drug
o Route of administration
o Frequency of administration
o Signature of person writing
 HCP must sign
 ****ALL OF THESE COMPONENTS MUST BE PRESENT OTHERWISE THE ORDER IS
DEEMED INCOMPLETE
o INCOMPLETE MED ORDERS CANNOT BE GIVEN
o PRN orders are usually separated
 Medication Dispensing/Supply Systems
o Stock supply
 Pharmacy is responsible for restocking pyxis (medication cart) in
medication room
 When using the pixis, look at the patient’s name and medication we
want… then take the medication out
  DNA is used as the password for nurses when username/passwords
are not sufficient
o Individual unit dose supply
o Medication cart
o Computerized automated dispensing system
o Bar-code enabled medication cart
 Medication itself has barcode and so does the PT wristband
 They have to match!
 Drug Classifications
o Effect of body system
o Chemical composition
o Clinical indication
o Therapeutic action
 Mechanisms of Drug Actions
o Drug-receptor interaction—drug interacts with one or more cellular structures to alter cell
function
o Drug-enzyme interaction—combines with enzymes to achieve desired effect
o Acting on cell membrane or altering cellular environment
 Factors Affecting Drug Absorption
o Route of administration
o Lipid solubility
o pH
o Blood flow
o Local conditions at site of administration
o Drug dosage
 Side Effects & Adverse Effects
o ALL NURSES are responsible for asking about medication allergies before
administering medication to the PT
 Even if no allergies are documented on their chart when notes were
taken by another nurse or someone else, YOU always need to ask
them yourself!
 Make it a habit to ask
 If they do tell you about allergies ask follow up questions
 What happens when you are exposed to an allergen?
o Rxn could be just a side effect of medication
o What is the difference between:
 Side effects
 Adverse effects
 Nurses responsibility to discontinue the medication
o You DO NOT NEED a HCP’s orders to cancel
medication if PT has adverse effects
 EX: IV antibiotic over 30 minutes, if you notice an adverse rxn
in the first few minutes of administration…Stop the
medication and monitor patient unti then are doing OK
then contact HCP and inform them
 Incident report: written for any unnormla activity in hospital (PT
falls, Rxn, etc)
 Written in a “matter of fact” statement
o Do not say “PT was on the floow… incident report was
written” within your notes
 o You should write the report and give it to your
supervisor
 Don’t include it in your notes that incident
report was written or not
 Adverse Effects of Medications
o Iatrogenic disease
o Allergic effects
o Toxic effects
o Idiosyncratic effects
o Drug interactions
 Drug Allergy
o Define allergy
o Name some examples of allergies
o Name signs and symptoms of allergies
o What is the nurse’s role in patient’s with allergies?
 Variables Influencing Medication Effects
o Developmental considerations
o Weight
 If you do not include the weight of th PT, pharmacy wont give you
the meds to administer
 Meds are given in mg/kg
o Sex
o Genetic and cultural factors
o Psychological factors
o Pathology
o Environment, timing of administration
 Double check any medication
 If HCP gives you wrong dose and you administer it, it is your
fault, not the HCP

 Pharmacokinetics
o Absorption
 Drug is transferred from site of entry into bloodstream
o Distribution
 Drug is distributed throughout the body
o Metabolism
 Drug is broken down into an inactive form
o Excretion
 Drug is excreted from the body
 Nurse’s Role: Pharmacokinetics
o Classification
o Mechanism of Action
 What are you giving this drug for: PT may ask why they are
receiving this medication and you need to know the answer
o Use
o Side Effects or Adverse Reactions
 Understand the these rxns so that you don’t get alarmed and neither
does the patient
 Ex: medication that turns urine red
  Educate the patient and be aware of it yourself so if the urine
does become red no one freaks out and calls the doctor
o Contraindications
 Means the med should not be given to this patient for another
reason
 (ex: order for penicillin but PT is allergic to penicillin
o Nursing Assessment/Management
 We are supposed to assess everything going on in PT before
administering medication
 Ex: check K+ levels before administering K+
o Patient Education
 Patient EDU is KEY nursing responsibility
 Medical Record Documentation
 DOCUMENT EVERTHING
 MAR= Medication Administration Record
o Give medication, treatment, and/or assessment  document it ALL
 Document normal vital signs bc it shows that you assessed vital signs
at all, even if nothing abnormal was found
o Name of the medication
o Dosage
o Route and time of administration
 Do not document until after you actually administer meds
o Nurse’s initials
o Intentional or inadvertently omitted drugs
o Refused drugs
 In pediatrics, parents have no right to refuse drugs for their kids
 Adult PT has rights to refuse meds
 Educate PT on advantages of taking the medication
 Document that patient education was completed
o Medication errors
 If you make often medication errors  fired
 Hospitals will not fire you for nonrecurring medication errors
because they want and encourage you to inform HCP and write
incident report
 If you don’t tell the HCP death of PT may occur because if
the HCP is not notified they cannot adjust the medications to
save the PT’s life if they have no knowledge of the error
o Nurses are “gatekeepers” between doc and PT
 Type of Medication Errors
o More people die in hospitals from med errors than the number of people
who die on the highway from accidents
o Inappropriate prescribing of the drug
 Fact check the pharmacy, the HCP, AND your own work
o Extra, omitted, or wrong doses
o Administration of drug to wrong patient
 o Administration of drug by wrong route or rate
o Failure to give medication within prescribed time
o Incorrect preparation of a drug
o Improper technique when administering drug
o Giving a drug that has deteriorated
 Nurse’s Role: Medication Errors
o AVOID DISTRACTIONS
o Check patient’s condition immediately; observe for adverse effects
o Notify nurse manager and physician
o Write description of error and remedial steps taken on medical record
o Complete special form for reporting errors
 Nurse’s Role: Checks of Medication Administration
o Read the label:
 Just like reading a nutritional label!
 When the nurse reaches for the container or unit dose package
 Immediately before pouring or opening medication
 When replacing the container to the drawer or shelf
 Controlled Substances
o Kept under lock
o Special inventory forms
o Counts of controlled substances
 Federal offense
o Procedures for discarding
 Partial dose wastes remaining medication
 Pyxis asks you for witness
 Disposal of excess should be done before you leave
medication room or before you enter the PT’s toom
 **Role of the Witness not just to put in your username and
password
 -you have a responsibility to follow up through the entire
process
o HCP order review, removal from pyxis, ensure drug
and mount of drug is correct…verified partial dose
leftovers are disposed of properly
o Documentation requirements
 Name of patient receiving
 Amount used
 Hour given
 Documented AFTER
 Medication Administration Process
o Identify the patient
 2 identifiers
 name a birthdate when looking at wristand
o Inform the patient
  The color of the drug (brand) may be different then the color and
shape of the same medication they take at home, inform patient that
this difference is possible and is due to different brand names
 DOUBLE CHECK to ensure drug info is correct though
o Administer the drug
 Monitor to ensure drug is effective
o Provide adjunctive interventions as indicated
o Record the drug administered
o Evaluate the patient’s response to the drug
 Was the goal met?
 Medication Administration “Rights”
o “Six Rights” General rights
 Right medication
 Right dose
 Right time
 Right route
 Right patient
 Right documentation
o Other “Rights”
 Right assessment
 Right patient education
 Right to refuse
 Right evaluation
 Right HCP
o ****if you aren’t following all of these, you are committing medication
error!
 Oral Medication Administration
o Crush the pill if PT cannot swallow and pill is able to be crushed
 Don’t mix the powder in with all of the pudding or applesauce in the
case they get full and don’t finish all the food
o If pill cannot be crushed… ask pharmacy for a liquid or suspension form of
the medication
 Liquid can be given via cup or syringe
 Parenteral Medications
o Common nursing procedure
o Absorbed more quickly than oral
 Careful and accurate administration
o Aseptic technique
 Prefilled Unit-Dose Systems
o Prefilled syringes ready for use
o Prefilled sterile cartridges and needles that require the attachment of a reusable holder before use
 Syringes and Needles
o Most syringes do not come with the needle attached (other than insulin
needles)
 This is so that you can choose length and width of needly based off
medication to be administered
o Syringe Review
 Syringe Tips
 Luer-Lok
 Non-Luer-Lok
o Needle Review
 Parts
 Hub
 Cannula or shaft
 Bevel
 Characteristics
 Slant or length of bevel
 Length of the shaft
 Gauge
 Ampules, Vials, Mixing Medications, Intradermal Injections, Subcutaneous
Injections
Ampules if you broke ampule, use special filtered needle to pull up medication to
ensure small glass particles are removed…then normal needle is put on to administer
the drug to the PT
Some medications come in these ampules instead of coming in vials

Vials – some hospitals have needleless systems in place

-to get medication from a vial, put air in syringe then invert and push air into vial so
drug is forced into syringe

Mixing Medications – heparin=high risk medication (blood thinner med)

Insulin syringes have bright yellow/orange caps and the measurement is in UNITS
All other syringes have mL not UNITS

Mixing insulin
-R=regular (clear)
-non regular(looks cloudy)
****Regular is always pulled up first… so cloudy residue doesn’t contaminate the clear
meds in the vial
Intradermal Injections –Know the different sites
-tell PT how often/the importance of rotating locations

Subcutaneous Injection
******KNOW these areas of subcutaneous injection
BOOK:

 Intramuscular Injections
o Know and understand where to give it in the right place

o Ventrogluteal
o Vastus lateralis
o Dorsogluteal
o Rectus femoris
o Deltoid
 Dorsogluteal Site
o Close to the sciatic nerve and superior gluteal nerve
o Complications occurred
 Numbness
 Pain
 Paralysis
o More subcutaneous tissue
o Use of dorsogluteal site should be removed from injection practice
 Deltoid
o Don’t give a lot of medication to a PT with a small deltoid via the deltoid
o **Check book for the amount of medication that can safely be administered
intramuscularly
 Patient can request location of injection but if it is not a designated site use your
knowledge and training to decide on the best location
 Z-track Method
o Used for medications that are irritating
o Avoids straight line of entry so it can’t ooze

o
 Intravenous Medications
o Methods to administer medications intravenously
 Large-volume infusion of intravenous fluids
 Intermittent intravenous infusion (piggyback or tandem setups)
 Volume-controlled infusion (often used with children)
 Intravenous push or bolus
 Intermittent injection ports (device)
 Opthalmic Installations
 Otic Instillations
o Adults up and back
o Children down and back

 Ear Drop Administration

 Nasal Medications
o Instilled to shrink swollen mucus membranes
o Loosens secretions and facilitate drainage
o Treat infections of the nasal cavity and sinuses
 Suggested patient blows nose first
  Seated position with head tilt back
 Client holds the tip of the container just inside the nares
 Inhales as the spray enters the nasal pass
 Vaginal Instillations
o

o
 Rectal Suppository
o Assist patient to left lateral or left Sims’ position
o Upper leg flexed
o Expose the buttocks
o Put a glove on the hand used to insert the suppository
o Unwrap the suppository
o Lubricate the smooth rounded end
o Lubricate the glove index finger
o Encourage the patient to relax by breathing through the mouth
o Insert the suppository gently into the anal canal
o Avoid embedding in feces
o Press buttocks together for a few minutes
o Ask patient to remain in the left lateral or supine position for at least 5
minutes
 Mastered Dose Inhaler (MDI)
o Client teaching a patient to use an MDI
o Remove the mouthpiece cap
o Exhale comfortably
o Hold canister upside down
o Press down once and inhale slowly and deeply through the mouth
o Hold your breath for 10 seconds or as long as you can
o Remove inhaler away from mouth
o Exhale slowly through pursed lips
o Repeat the inhalation if ordered
o Rinse mouth with tap water
o Clean MDI mouthpiece after each use