DRUG ADMINISTRATION

INTRODUCTION

Different medications must be absorbed to be effective. For absorption, the drug must be
administered in proper manner. To choose a route of administration we need to relate the
dosage form, the advantages and disadvantages etc.

PURPOSE:
To provide safe and accurate medication administration. To instruct the parent/caregiver
about oral medication administration and the medication regime.

CONSIDERATIONS:

1. Secure parent’s/caregiver’s participation when administering medications to infants and

small children.

2. Hold or cuddle infants and small children to decrease combativeness.

3. Teach parent/caregiver age appropriate positioning of the child to secure cooperation and
decrease combativeness.

4. Allow small children the opportunity to take the medication themselves.

5. Use a dropper, an oral medication administration device, or a nipple device for infants and
young children.

6. When appropriate mix the medication in small amounts of food or liquid.

7. When possible have medication flavored with a chosen flavor.

8. DO NOT crush enteric coated and formulated slow release medications.

9. Praise and reward the child after the medication is taken.

10. At each visit complete a medication history for compliance, side effects, effectiveness of
the medication, medication changes and patient/caregiver knowledge.

EQUIPMENT:
Written patient medication guides (to be left in the home) Medication cup Oral medication
syringe Nipple Water (or other medication-compatible fluid) Spoon Pill crusher

PROCEDURE:

1. Check the physician’s order for the patient’s medications. It should include:

a. Name of the patient. b. Name of the medication. c. Medication dose, route and frequency.

2. Complete a medication history.

3. Instruct the parent/caregiver on the purpose, side effects, dosage and schedule of the
medication.

4. Wash hands and gather supplies.

5. Demonstrate preparation of the medication.

6. Demonstrate age appropriate administration of medication as needed.

7. Parent/caregiver does return demonstration of medication preparation/administration as

needed.

8. Provide the parent/caregiver with instructional medication handouts and teaching guides.
Topics should include: a. Medication name, both trade and generic. b. Purpose of the
medication. c. Dose and scheduling of administration times. d. Side effects. e. Normal
appearance of the medication. f. Special considerations for administration (with food or not).
g. When to call the visiting nurse or physician. h. Storage of the medication.

9. Teach the parent/caregiver techniques to promote compliance: a. Fit the medication into
the patient’s daily routine. b. Use calendars or checklists with medication times marked and
check off when it is given. c. Use appropriate medication containers. d. Request liquid
preparations, if needed or preferred by the child.

10. Report to the physician therapeutic effects, side effects or compliance issues.

11. Encourage the use of a consistent pharmacy.

12. Consult with your agency for guidelines for drugs not FDA approved.

AFTER CARE:
1. Document in the patient’s record: a. Medication administered, dose, time and route. b.
Patient’s tolerance to the procedure and response to the medication. c. Teaching and
instructions given to the parent/caregiver. d. Parent/caregiver response to teaching. e.
Communication with the physician.

 ROUTES OF ADMINISTRATION
Definition It is the way of getting a drug onto or into the body. It is chosen based on
the effect upon the speed and efficiency with the drug action.
CLASSIFICATION 1. Enteral  Oral  Rectal 2. Topical  Otic  Nasal  Ophthalmic
3. Parenteral  Intravascular  Intramuscular  Subcutaneous  Inhalation
. ENTERAL Desired effect is nonlocal, it is systemic Substance is given via
digestive tract
It is supplied in many forms as :  Liquids  Powders  Tablets  Capsules The
equipments used are:  Medicine cup  Spoon  Plastic oral syringe  Dropper 
Nipple without bottle
TABLETS & CAPSULES PROCEDURE
• Crush the tablet (for children under 5-6 years) • Mix with pleasant tasting liquid •
Never mix tablet with food
FOR AN OLDER CHILD • Place tablet at the back of tongue • Tell child if there is
medicine in food
LIQUIDS It should be given with proper equipment as mentioned in packet. Drop
size may vary from one to another. Do not use syringe for parental administration.
PROCEDURE • Shake well before use • While using dropper direct liquid directly to
posterior side of mouth • Slowly in small amounts • Allow child to swallow
In case of nipple without bottle: • Fill nipple by keeping medication directly • Place
infant in upright position In case of tube feeding: • Medicine should be in liquid form
• Check tube placement before and after administration • Flush tube before and after
to maintain patency
ADVANTAGES • Most convenient and commonly used route • Ease and safety of
administration • Active ingredient is in powder or granule form which dissolve in GI
tract • Sub linguinal administration has rapid onset (< 5 minutes)
DISADVANTAGES • Delayed onset • Destruction of drug by GI fluids, food or
drink in stomach • Not indicated in patients with nausea, sedated or unable to swallow
RECTAL ADMINISTRATION
It is not a preferred route for administration in children as it may be irritating and
unpredictable. Method is invasive and upsetting. It is used when child is vomiting or
receiving nothing by mouth. Suppositories and enemas are two types of rectal
administration of medication
SUPPOSITORY This drug delivery system is inserted into rectum, vagina or urethra
where it dissolves or melts. Suppositories are inserted as solids it dissolves to deliver
medicine which is received later by blood vessels. Example : glycerin paracetamol
diclofenac
PROCEDURES
 Ensure the child in side lying position  Insert suppository into the rectum quickly
but gently  Insert suppository above anal sphincter  Use index finger for insertion
FOR AN INFANT OR CHILD UNDER 3 YEAR OF AGE
 Use fifth finger for insertion  To prevent expulsion of suppository, hold buttocks
together for several minutes
ENEMAS Usually used for cleaning the bowel, it has laxative action. In the case of
diseases, drug is administered as enema.
ADVANTAGES Could be administered in unconscious patients and children.
Useful for nauseous patient and children Easy to terminate exposure Relieve
constipation or haemorrhoids
DISADVANTAGES Absorption is slow and unpredictable in effectiveness
Irregular drug absorption Inconvenience.
TOPICAL
It is the application of the drug directly to the surface of skin. it includes
administration of drugs to any mucous membrane. In this type of administration, the
desired effect is local.  Eye  Nose  Ear  Lungs  Urethra  Colon
The dosage forms include:  Creams  Solutions  Ointments  Lotions  Gels 
Tran dermal patches  Sprays  powders
OPHTHALMIC MEDICATION  They are supplied in the forms of drops or
ointments  Ensure medication is at room temperature  administer when child is not
crying..
PROCEDURE  place child in supine position  Slightly hyperextend neck with
head lower than body  Rest the heel of your hand to stabilize on child’s forehead 
Retract the lower eyelid & place medication in conjunctival sac.
For ointment, apply medication on a thin ribbon from inner canthus outward without touching
eye or eyelash  For an older child, we should instruct child to gently close the eyes to allow
medication to be dispersed.
OTIC MEDICATIONS Typically they are in the form of drops. This root is upsetting
because child cannot see the procedure.. • Ensure that medication is at room temperature. •
Cold ear drops cause pain & vertigo
PROCEDURE • Place child in supine or side lying position with affected ear exposed. • Pull
pinna downward & back in children under 3 years. • Pull pinna upward and back in children
over 3 years
Instill medication using dropper •Have the child remain in the same position for several
minutes. •Massage the area anterior to promote passage of medication
NASAL ADMINISTRATION
These medications are typically drops & sprays Additional help may be needed to keep
child’s position.
PROCEDURE • Position child in supine position with hyper extended head to ensure that
the drops will flow back to nares. • A pillow or folded towel can be used to facilitate the
hyper extension. • Place thee tip of the dropper just at or inside nasal opening
Bottle should not touch the nares • After installations, maintain child’s head in
hyperextension for 1 minute.
FOR NASAL SPRAYS • Position the child upright • Place tip of spray bottle just
inside nasal opening and tilted to back. • Squeeze the container for instillation
ADVANTAGES
• Local therapeutic effects • Lower risk of side effects • It offer steady level of drug in
the system
DISAVANTAGES • Messiness • Irregular drug absorption • Improper technique
leads to risk of side effects • Alter drug efficacy
It is an infusion by means of needle or catheter inserted into the body. Any method of
administration that does not involve passage through the digestive tract is called
parenteral . Intra muscular Intra venous Intra-arterial Intra-cardiac
 Intra-thecal  Intraosseous- into bone marrow  Intrapleural  Intraperitoneal 
Intra-articular  Intradermal (Intracutaneous)  Subcutaneous route (Hypodermic
It is placing the drug directly into blood stream. It would be intravenous or intra
arterial. It is used when we need a rapid response. For administration in pediatrics an
IV device should be inserted peripherally or centrally. Insertion is traumatic but it is
less compared to the pain of multiple injections.
 Peripheral Sites: -vein in hand or forearm -scalp vein or foot vein in infant
(possible but central IV site preferred in neonates)  Central IV Sites: subclavian vein
into superior vena cava -central line inserted peripherally -umbilical vein in neonates
Different methods could be taken for administration including :  large volume
infusion pumps  syringe pumps are accurate for small volume delivery  volumetric
infusion devices (Buretrol) used for small total fluid requirements and slow rates of
administration
 Place the child in supine position  Seek the help of other nurses to hold the child 
Check the patency of IV line  Choose the area for IV administration (Scalp vein is
best for infant & toddler. Others sites are hand, foot antecubital fossa)  Meditation
should be diluted appropriately  It should be given at the rate of over 2 – 3 minutes 
Watch for irritation to small veins or any adverse reactions.
ADVANTAGES  Complete and rapid drug absorption with rapid onset of action 
Immediate access to cardiovascular system  Useful in neonates with little muscle
mass  Less painful route for frequent injections  Administer drugs which cannot be
given by another route
DISADVANTAGES
 Rapid drug/fluid delivery means immediate onset of adverse reactions  inability to
withdraw infused solutions  Risk infusion of air, microorganisms, pyrogens and
particulate matter  Risk sepsis (infection), phlebitis (venous irritation),
extravasations/infiltration (leaking outside of the vein)
certain types of chronic obstructive pulmonary disease.These medications are usually
nebulized into a water vapor and breathed with normal respiration.
 Shake canister well  “Prime” by pressing down and activating a practice dose. 
Insert canister into a mouthpiece or spacer to reduce the amount of drug deposited on
the back of the throat.  Breathe out and hold spacer between lips making a seal 
Activate & take a deep slow inhalation.  Hold breath briefly &slowly exhale
through nose
Rapid absorption takes place.  Rapid onset of action takes place.  This route has
minimum side effects.  No first pass effect takes place  This method is easy. 
Fewer doses is required
Special apparatus is required.  Irritation of the respiratory tract may take place. 
Cooperation of the patient is required.  Airway must be patent.