PARENTERAL MEDICATIONS exposure)

- narrow calibrated in tenths and hundredths

Parenteral Administration
NSG ALERT - Meds given in this route is
absorbed quickly and are irretrievable once
injected, the nurse must prepare and administer
them accurately and carefully
- ASEPTIC TECHNIQUE MUST BE USED
since injections are highly invasive procedure
of a mL
- used in administering drugs that needs
precise measurements or in small doses
d. Syringes of other sizes: 5,10, 20, 50 mL
- useful for adding medications to
intravenous solutions or for irrigating wounds

EQUIPMENT VARIATIONS ON THE TIP OF THE SYRINGE

Syringes
3 Parts: 1. LUER-LOK
- Tip - tip requires the
- Barrel needles to be twisted
- Plunger onto it to prevent
Parts of the syringe that must be kept sterile: accidental removal of the
- Tip needles
- Inside of the barrel
- Shaft of the plunger

KINDS OF SYRINGES

a. Hypodermic Syringe
b. Insulin Syringe
c. Tuberculin
d. Syringes of other sizes 2. NON-LUER-LOK
- has smooth graduated tip onto which
needles are slipped

ANOTHER TYPE OF SYRINGE

a. Hypodermic Syringe
- 2ml, 2.5ml, 3ml sizes
- has 2 scales: minim and
the mL
b. Insulin Syringe
- Designed for insulin: common is in 100-unit
calibrated scale

NEEDLES
- made of stainless steel and mostly
c. Tuberculin disposable
Syringe
-originally designed to PARTS:
administer tuberculin (TB
 - Hub: part which fits into the syringe
- Cannula or shaft: attached to the hub
- Bevel: slanted part at the tip of the needle

3 VARIABLE CHARACTERISTICS OF THE

NEEDLE USED FOR INJECTIOS
’
1. SLANT OR LENGTH OF THE BEVEL
-long > sharpest and causes less
discomfort; for IM and SC
- short > fir ID and IV injections (prevent:
occlusion inside)
2. LENGTH OF THE NEEDLE
- 1/2 - 2 inches; depends on client’s muscle
devt., wt, type of injection
3. GAUGE (DIAMETER OF THE SHAFT
- gauge #18 - #28
- NURSING ALRT: THE LARGER the
gauge #, the smaller the diameter
- SC> g.24-26
- IM> G. 20-22

PREVENTING NEEDLE STICK INJURIES

- Use appropriate puncture-proof disposal
containers for sharps (needles, blades, lancets,
broken wires etc)
- When recapping: Do “scoop method” or
“Fish hook technique” INTRADERMAL INJETIONS
- is the administration of drug into the
PREPARING INJECTABLE MEDICATIONS dermal layer of the skin just beneath the
epidermis
a. AMPULES - used for skin testing, TB screening and
- is a glass container usually designed to BCG vaccinations
hold a single dose of a drug - common sites: inner lower arm, upper
- made of a clear glass; has a constricted chest, back beneath the scapulae
neck
- some may have colored marks or dots
which indicates where they are pre-scored
- If not pre-scored, it should be filled with a
small file, then broken off at the neck
B. VIALS
- are small glass bottle with a sealed rubber
cap
- can come in single dose or multi-dose
- RECONSTITUTION - technique of adding
a solvent to a powdered drug to prepare if for
administration
- NURSING ALERT - before withdrawing
meds from vial, swab the rubber cap with a
disinfectant
 NEEDLE SIZE AND LENGTH
 Pinch tissue-length of the needle is half the
width of the skin fold
 45 angle 1 inch of tissue can be grasped
 90 angle 2 inches of tissue can be grasped

SITES
 Rotate injection sites

SUBCUTANEOUS INJECTIONS (SC OR SQ)

- administration of drugs into the subcutaneous
layer
- common sites: Outer aspect of the upper arms,
anterior aspect of the thighs, scapular areas of INTRAMUSCULAR (IM)
the upper back, upper ventrogluteal site and - Introduction of the medication into the muscle
dorsogluteal site tissue
- size of the needle depends on the ff:
- the muscle
- type of solution
- amount of adipose tissue covering the
muscle
- age of the client
INDICATIONS
- for rapid absorption of drugs because it is rich
with blood supply
INDICATIONS - to administer greater volume of fluid ( up to 3
1. Vaccines mL)
2. Pre-operative medications - medications that are irritating
3. Narcotics - ANGLE: 90
4. Insulin Common sites:
5. Heparin 1. Ventrogluteal site - the glutes medius muscle
ADVANTAGES which lies over the gluteus minimus
1. Drug is almost completely absorbed from the Advantages
tissue, this the amount of drug absorbed is - area contains no large nerves and blood
predictable vessels; contains less fat than the buttocks area
2. Drug generally acts in 30 minutes - is sealed off by bone
Position
 - back-lying or side lying to relax gluteal
muscles

VASTUS LATERALIS RECTUS FEMORIS

- thick and well-developed muscle both in adult - situated on the anterior aspect of the thigh
and children ADVANTAGE: Good for patients who administer
- site of choice: infants <7 mos old their own injections for they can reach the site
Rationale: absence of major blood easily
vessels or nerves on the area
- situated on the anterior lateral aspect of the
infant’s thigh (middle third)
- PositionL back-lying or sitting
DORSOGLUTEAL SITE
- composed of thick gluteal muscles of the
buttocks
- not to be used for children below 3 y.o unless
the child has been walking for at least 1 year
NURSING ALERT: Locate the site carefully to
Z-TRACK TECHNIQUE
avoid striking the sciatic nerve, major blood
- used for parenteral iron preparation (to seal the
vessels and more
drug deep into the muscle and prevent staining
POSITION: Prone or side-lying with the
of the skin)
upper knee flexed and in front of the lower leg
- retract skin laterally (use the ulnar side of the
non dominant hand to pull skin appx. 1 inch to
the side)
- don’t massage injection site

DELTOID
- Found on the lateral aspect of the upper arm,
2-3 fingerbreadths below the acromion process
- not used often for IM injections because of its
INTRAVENOUS MEDICATIONS
close proximity to the radial nerve and artery
- injecting medications into the vein
- considered for use in adults because of rapid
- has a rapid effects in the patient’s body
absorption
- lessens discomfort
- can accommodate up to 1mL
https://youtu.be/QfJTg_X_NVk
 DRUGS NAMES
DRUGS ADMINISTRATION CHEMICAL NAME
-described the drugs molecular structure and
PHARMACOLOGY identifies its chemical structure
- Greek: pharmakon means “drugs” and logos - ex: 4 amino-1 hydroxybutylidene
means “science” GENERIC NAME
- the study of the effect of drugs on living - is the drug’s official name
organisms -ex: Alendronate sodium
TRADE NAME
THE BASICS ON DRUG - name given by the drug manufacturer
ADMINISTRATION - ex: Cefalin

PHARMACY AND ITS PHARMACIST COMMON DRUG’S GENERIC NAME AND

- it is the art of preparing, compounding, and BRAND NAMES
dispensing drugs Generic Name Brand Name
- it is the place where drugs are prepared and Ibuprofen Advil, Medicol, Midol,
dispensed Skelan
Mefenamic Acid Dolfenal, Gardan,
MEDICATION vs DRUGS Mefenax,
Ponstan/Ponstan SF,
PHARMACEUTICAL DRUG Revalan
- A.K.A medicine, medication or medicament Metoprolol Betaloc, Cardiosel,
- as ant chemical substance intended for use in Cardiostat, Neobloc
the medical diagnosis, cure, treatment or Paracetamol Alvedon, Biogesic,
prevention of disease Calpol, Saridon,
Tempra, Tylenol
SOURSE OF DRUGS Salbutamol Asmalin, Librentin,
Natural sources Resdil, Ventar,
-Opiums Ventolin
-Digitalis
-Iron PHARMACOPOEIA
-NaCl - A book containing a lost of products used in
-Insulin medicine, with descriptions, of the product,
-Vaccines chemical tests for determining identity and
Synthetics purity, and formulas and prescriptions
-Prophoxyphene HCL
-Sulfonamides DRUG EFFCTS
Therapeutic effects is always accompanied with
DRUG CLASSIFICATION unlikely effect
OTC DRUGS LOCAL DRUG EFFECT
-over-the-counter drugs - point of contact and generally does not affect
- may be available without special restrictions tissues in ither areas
POM DRUGS SYSTEMIC DRUG EFFECT
- prescription only medicine - drug affects the different body systems
- must be prescribed by a licensed medical
practitioner THERAPEUTIC EFFECTS
BTC DRUGS “desired effects:
- BTMS do not require a prescription but must “intended effects”
be kept in the dispensary, not visible to the “primary effects”
public, and only be sold by a pharmacist or - this effect is the main reason why the drugs is
pharmacy technician prescribed
 therapy
KINDS OF THERAPEUTIC BENEFIRS - ex: hepatotoxicity, Renal toxicity, Biliary
obstructions, Fetal malformations
PALLATIVE
- relieved the symptoms of a disease but does DRUG INTERACTIONS
not affect the disease itself - occurs when the administration of one drug,
alters the effect of one or both
CURATIVE - EFFECT: increased or decreased
- cures a disease or the condition
POTENTIATING
RESTORATIVE a. ADDITIVE
- returns the body to health - when two of the same type of drug
SUPPORTIVE increase the action of each other
-supports body function until other treatments or - ex: codeine +aspirin
the body’s response can take over b. Synergestic
SUBSTITUTIVE - when two different drugs increase the
-replaces body fluids or substances action of one or another drug
- ex: the effects of probenecid to penicilin
SIDE EFFECTS
“secondary effects” DRUG MISUSE
- An effect that is not intended but are usually - The improper use of common medications
predictable in ways that lead to acute chronic toxicity
Ex: Digitalis - improved myocardial contractions - Laxatives, anatcids, vitamins, cold and
S/e: nausea/vomiting cough meds etc.
- The inappropriate intake of substance,
TOXICITY either continually or periodicaaly
-Deleterious effects of a drugs to an organism 1. Drug dependence
results from: 2. Drug habituation
a. Overdose
b. Ingestion PHARMACODYNAMICS
c. Build up of drug due to impaired - The process by which a drug changes or
excretion/metabolism alters the body
- RECEPTOR: a CHON located at the
IDIOSYNCRATIC EFFECTS surface of the cell membrane which may
- an unexpected and may be individualized serve as binding site of drugs
effect
- an unexplainable effect PHARMACOLOGC EFFECTS
AGONIST
OTHER RELATED TERMINOLOGIES - drug that produces the same type of response
as the physiologic or endogenous substances
DRUG ALLERGY - ex: epinephrine-like drugs increase HR
- an immunologic reaction to a drug ANTAGONIST
- mild-severe - drugs that inhibits the cell function by
- ex: skin rashes, pruritus, rhinitis, angioedema occupying receptor sites
- ex: Narcan, use to counter the effects of
ANAPHYLACTIC REACTION opiates
- a severe allerguc reactions; usually immediate
- SYMPTOMS: swelling of mouth and tongue, HALF - LIFE
acute SOB, hypotension, tachycardia - The time interval required for the body’s
elimination processes reduce the concentration
LATROGENIC DISEASE of the drug in the body by one-half
- disease caused unintentionally by medical - EX: Probenecid 500 mg
Half - life: 8 hours active form
Upon administration: 100% - Metabolites, the product of the process
After 8 hours: 50% - site: liver
Another 8 hours (16 hours): 25%
EXCRETION
KEY TERMS - process by which metabolites and drugs are
eliminated from the body
ONSET OF ACTION MODES
- The time after administration when body a. Kidneys
initially responds to drug b. Feces
PEAK PLASMA LEVEL c. Breath
- the highest plasma level achieved by a single d. Perspiration
dose when elimination rate equals absorption e. Saliva
rate f. Breastmlik

FACTORS AFFECTING ITS ACTIONS

-Developmental
-Gender
PLATEU - distribution of body fats
- a maintained concentration of a drug in in the - hormones
plasma during series of schedules doses - Culture
- Practices and beliefs

- Genetic Factors
-pharmacogenetics

-Diet
- Environment
- Illness and Disease
- Time of administration

CLASSIFICATION OF DRUGS
PRESCRIPTION DRUGS
- Bear, on labeling the prescription legend RD
PHARMACOKINETICS - Prescribed by physicians, dentists,
- study if the absorption, distribution, veterinarians or legally authorized health
biotransformation and excretion of drugs practitioners
ABSORPTION PARTS OF PRECRIPTION
- the process by which drug passes into the a. SUPERSCRIPTION
bloodstream - Descriptive patient information (name, age,
- the first step in the movement of drug into the address)
rate of absorption is variable - Date prescribed
- RX symbol
DISTRIBUTION b. INSCRIPTION
- the transportation of drug from its site of action - Name and dosage strength of prescribed
- drugs are distributed most at vascularized medication
organs C. SUBSCRIPTION
- Dispensing instructions for the pharmacist
BIOTRANSFORMATION d. SIGNATURA
AKA “DETOXIFICATION” “METABOLISM” - Direction for the client
- Process by which drug is converted to a less e. PRESCRIBER’S SIGNATURE
 - permits the nurse to give a medication when
the nurse’s judgment, the client requires it

- EXAMPLES:
a. Ampicillin 0.59 (bid x7 days)
b. Codeine I grain PO (STAT)
c. Aspirin I tab (prn for tem > 38 c)
d. Dulcolax I supp hs( before surgery)

TYPES OF DRUG PREPARATION

SOLIDS

TYPES OF TABLETS

BUCCAL
NON-PRESCRIPTION DRUGS - placed between cheeks and gums
OTC - OVER THE COUNTER DRUGS
- Legally acquired by the client w/o a ENTERIC COATED
prescription order - designed to pass the stomach without
- Legally safe for the layperson to use when dissolving
taken according to directions provided by the
manufacturer SUBLINGUAL
- under the tongue
INVESTIGATIONAL DRUGS
- in order to fulfill the requirements of BFAD, a EFFERVESCENT
manufacturer who wishes to market a new drug - granular effervescent salts and/or other
must undergo wide array of animal studies and materials that release gas
clinical testing of the drug

ILICIT DRUG/ STREET DRUGS PROLONGED ACTION/ SUSTAINED

- Distributed legally
- These may be:
- Drugs that are not legal for sale under any
circumstances
- Drugs which may be sold legally under
certain circumstances with a prescription
TYPES OF MEDICATION ORDER
STAT ORDER
- medication should be given immediately and
only once
SINGLE ORDER (ONE TIME ORDER)
- medication to be given once at the specified
time
STANDING ORDER
- may or may not have a termination date; may
be carried out indefinitely
PRN ORDER (as needed order)
RELEASE
- designed to be release and absorbed in stages
or gradually over time
CHEWABLE TABLETS
- contains a base of flavoured and/or sugar
alcohol often used for children
SCORED TABLETS
- whose surfaces have been grooved or scored
CAPSULES
- small two-part containers that are usually
made of gelatin substances that is designed to
dissolved In the stomach or GIT
CAPLETS
- smooth, coated, oval shaped medicine tablet
intended to be tamper-resistant
- capsule + tablet
TROCHES
- hard, circular or oblong disks that consist of a
medication in a candy-like base
PELLETS
- dry medication that resemble like a powder,
but particles are larger than powders
PILL
- one or more drugs mixed with a cohesive
materia, in, oval, round or flattened shape
PATCHES
- small adhesive path that may be applied to
intact skin near the treatment site
GRANULES
- EX: Oral Rehydration Solution
POWDERS
- finely grounded drug, some are used internally
others, externally
- measured doses of solid medication in
powdered form usually dissolve in water before
ingestion
DUSTS
- very fine powders maybe applied topically to
the skin or mucus membrane or by inhalation
- a liquid powder, or foam deposited in a thin
layer on the skin by air pressure
LIQUIDS
LOTIONS
- a medication in a liquid suspension applied to
the skin
SOLUTIONS
- one ore more drugs dissolved in water
- clear and homogenous
LINIMENTS
- a medication mixed with alcohol, oil or soapy
emollient and applied to the skin
ELIXIRS
- a sweetened and aromatic solution of alcohol
used as a vehicle for medicinal agents
TINCTURES
- alcoholic or water-and-alcohol solution
prepared from drugs derived from plants
EXTRACTS
- a concentrated form of a drug made from
vegetables or animals
AROMATIC WATERS
- alcoholic solutions of volatile drug

SEMI-SOLIDS SYRUPS
- drugs dissolved in a solution of sugar and then
SUPPOSITORY flavored to disguise unpleasant taste
- shape like a cylinder or cone which melts
gradually in body temperature SUSPENSIONS
- drugs that have been mixed with a liquid, but
PASTES not dissolved
- a preparation like an ointment but thicker and
stiff, that penetrates the skin less than an OILS/EMULSIONS
ointment - fine droplets of an oil in water or water in oil
- must be shaken vigorously before usage since
OINTMENTS they separate into layers after standing a long
- used for application on skin or mucous period of time
membrane
- oil-based ROUTES OF ADMINISTRATION OF
THERAPEUTIC AGENTS
CREAMS
- non greasy preparation used for the skin HOW THERAPEUTIC ROUTE
AGENTS IS
FOAMS ADMINISTERED
Having swallowed Oral Administration
Placing agent under Sublingual
the tongue
Having inhale the Inhalation
agent
Inserting therapeutic
agent into: Vaginal administration
Vagina Rectal Administration
Rectum
Placing the agent on Topical application
the skin
Dropping agent into Instillation
the mucous membrane
Flushing mucous
membrane with large Irrigation
amounts of the
therapeutic agent

PARENTERAL
ADMINISTRATION
Corium Intracutaneous or
intradermal
Subcutaneous tissue Hypodermic/
subcutaneous
Muscle Tissue Intramuscular
Vein Intravenous
Subarachnoid space of Intratheral or
spinal Intraspinal
Peritoneal cavity Intraperitoneal
Heart Intracardiac
Cavity of a joint Intra-articular
 APOTHECARY SYSTEM
- older than the metric system, was brought to
the United States from England during the
colonial period
- originates in England and is based on the
weight of a single grain of wheat
- the basic unit of weight then is called the
FREQUENCY grain

OD Once a day
B.I.D Twice a day
T.I.D Three times a day
Q.I.D Four times a day
A.C. Before meals
P.C. After meals
HS Hours of sleep
RTC Round the clock
Q12 HOUSEHOLD MEASUREMENTS
Q4 - uses as units such items as a teaspoon, table
Q4 rtc spoon, cup, pint, quart, and medicine dropper
Q6 - basic units of measurements for weight are the
Prn q4 ounce and the pound
- basic units for volume are the teaspoon,
T.I.d ac
tablespoon, ounce, pint, quart, and gallon
OD a.c.
OD p.c.
TABLE OF EQUIVALENTS
Q12
VOLUME
SYSTEMS OF MEASUREMENT

METRIC SYSTEM
- devised by the french in the latter part of the
18th century
- used exclusively in the United States
Pharmacopeia
- Metric Systems is a logical, easy to understand
measurement system based on units of 10

WEIGHT
 The medicine container is labeled Lopressor 50
mg per tablet. Calculate 1 dose.
EXAMPLE: Convert 0.5 grams to milligram - The drug order reads: Lopressor 100 mg P.O.
0.5 grams x 1,000 mg = 500 mg bid.
- Calculating Drug Dosages
3 Steps Are: Step 1 Convert. No conversion is necessary.
- Convert The units are in the same system (metric) and
- Compute the same size (mg)
- Critically Think Step 2: Compute

APPLY THE FORMULA METHOD D

A=---------------- x V
D H
A = ------------ X V
H 100 mg
------------ x 1 tablet = 2 x 1 tablet
D = desired or prescribed dosage of the 50 mg
medication
H = dosage of medication available or on hand ANSWER: 2 tablet; given orally twice daily
V = volume or quantity that the medication is
available in such as one tablet or milliliters
A = amount of medication to administer
ADMINISTRATION OF MEDICATION
EXAMPLE: The physician prescribed 100 mg of ORAL ROUTE - PER OREM
a medication. The medication is available in
50mg tablets ADMINITERING MEDICATION

- a grave responsibility entrusted to the nurse

- the doctor by written order will indicate:
SOLUTION a. Drug name
b. Amount of the drug per dose
100 mg c. The number of doses (tables, capsules,
= --------------- x 1 tablet etc)
50 mg d. The route by which to administer the
drug and
100 mg/ 50 mg x 1 tablet = 2 tablet (to e. The frequency or number of times a day
administer) the drug is to be taken
Ex. Demerol 100 mg IM q4h x 5 days

CONSIDERATIONS IN ADMINISTRATION

1. The general principles related to drug

administration
2. The various types of drugs and their uses
3. The minimum and maximum dosage of
drugs
4. The most effective means of administration
and its expected effect
5. S/sx which would indicate patients
idiosyncrasy or allergy
6. Various factors which must be considered in
determining the method and time o
administration of drugs
7. Those factors which may modify the drug
action
8. The nurse should also know the new drugs
which are continually appearing in the
market
GENERAL INFORMATION
- Doctors should order in writing the name of the
drug, amount time and frequency of giving as
well as the method of administration
- Verbal orders should be accepted only in
extreme emergencies. A written order must be
obtained as soon as the emergency has been
controlled
- If a physician orders a drug over the telephone
a registered nurse must take down the
information. On the next visit the physician signs
the written record of the verbal order
- The nurse should inform the doctor of any
known patient’s allergies
- The nurse should recognize commonly used
abbreviations and symbols utilized in medication
administration
- The nurse should bear in mind the accuracy in
the measurement of drugs in vital especially in
pediatric doses where a relatively small error
become magnified.
- The nurse should know the usual therapeutic
as well as side effects of each drugs.
- The physician must be notified immediately in
case of error
- The nurse should question an order which in
her judgment is erroneous. She should tactfully
clarify the order with the physician who made it.
- The nurse should be knowledgeable of the
patient’s diagnosis or tentative diagnosis
- Each type of drug preparation usually requires
a specific method of administration
- The route of administration of the drug affect
the optimal dosage of the drug. (Optimal dosage
of drugs administered by injection may be
different from those administered orally)
- Requires a knowledge of anatomy and
physiology as well as knowledge of the drug and
the reason it has been prescribed
- The method of administration of drug is
partially determined by the age of the patient,
level of consciousness and the disease process.
Any difficulties encountered when administering
medicines should be reported
- Appropriate precautionary measure should be
taken to avoid error and accidents in the
preparation and the administration of therapeutic
agents.
- Physiologic activities of the body can be
maintained, improved in some instances
restored by the administration of therapeutic
agents
- Persons very in the way they metabolize
injected or ingested agents or the way they react
to agents applied externally
- Each patient has his own needs for
explanations and support with respect to the
administration of medicines. Some people want
to know about their medicines, other prefer not
to. The amount of knowledge that a person
requires is dependent upon individual
circumstances
GENERAL RULES IN THE ADMINISTRATION
OF MEDICINES
Observe the “ten rights” (Joyce Kee) in giving
each medication:
1) The right patient
2) The right drug
3) The right dose
4) The right time
5) The right route
6) The right assessment
7) The right documentation
8) The patient’s right to education
9) The right evaluation
10) The patient’s right to refuse
- Consult the clinical instructor or the head nurse
if a written order is not clear as to meanin, not
legible or not signed by the doctor
- Wash hand thoroughly before measuring and
preparing medication
- Make certain that all equipment are clean
- When giving pills or tablets, place in proper
container directly from the bottle. Do not touch
them with your hands.
- Determine if medication is to be delayed or
omitted for a specific length of time, as for x –
ray examination or basal metabolic test, blood
chem, and/or in cases where the drug/s can
adversely affect the patient’s vital signs or
condition.
- Never leave the medicine cabinet unlocked.
Never leave your cart or medicine tray out of
your sight.
- Do not return to stock any excess medicine or
medicine refused by a patient.
- Do not use a drug which is discolored, has
precipitated, is contaminated or outdated.
- Provide drinking straws for irritating drugs and
for those likely to stain the teeth e.g. iodine and
iron preparation.
- Do not pour a drug from one bottle to another.
- Never give two or more drugs at one time,
unless ordered.
- Do not permit a patient to carry medicine to
another patient.
- Know the minimum and maximum doses for
the medication being given.
- Report immediately to the CI or nurse- in-
charge any error in medication.
- Always provide a glass of fresh water to the
patient immediately after giving an oral
medication, unless water is contraindicated.
- The nurse who prepares a medicine should
also give it and do the necessary recording.
- Recap needles using the fish-hook technique,
(Infection Control) if necessary.
- Enteric coated drugs should never be
powdered or crushed before administration.
- Buccal and sublingual medication should be
allowed to dissolved completely before the
patient drinks or eats.
- Suspension and emulsion should be
immediately administered after shaking and
pouring in the bottle.
- Cough syrups are never diluted and followed
up with water.
- Sedatives are given with warm milk to increase
or hasten desired effect of drug when not
contraindicated.
- Never use milk or any juice to mark the taste of
the medicine to a child for she/he may develop
unpleasant association and refuse them in the
future.
Rules in Measuring Medication
1. Measure the exact amount of drug ordered
with a calibrated equipment.
2. Do not converse with anyone while preparing
a medication.
3. Ensure adequate lighting.
4. Make sure that the medicine glass is dry
before pouring or measuring a medication.
5. Cleanse the mouth of every bottle after use
and before replacing the cap.
6. Hold the medicine glass at eye level and
place thumb nail of the hand holding the glass at
the level of the scale of the desired fluid volume
7. Measure accurately liquid medication. Check
that the scale is even with the fluid level at its
surface or base of meniscus
8. Use of dropper: The size of the drops varies
according to the size of the dose in the medicine
dropper , the angle at which the dropper is held
and the viscosity of the liquid. Use of syringe:
Draw up small volumes (less than 10 ml) with
syringe without needle, unless drug has its own
specific measuring device.
Rules Regarding Labels
1. Give medication only from clearly labeled
containers.
2. For each dose of medicine prepared, read
the label three times: before/after locating the
bottle from the medicine box, before preparing
the desired amount of drug and before returning
the bottle to the medicine box.
A. Oral
1. Liquids – after locating the bottles from the
medicine box, before preparing the desired
amount of drug and before returning the bottle to
the medicine box.
2. Tablet, Pills and Capsules – after locating the
tablet/pills/capsules from the medicine box;
before placing in the medicine glass and before
opening the unit pack.
B. Parenteral – after locating in the
vial/ampule; before withdrawing the medicine
from vial/ampule and after withdrawing the
medicine from vial/ampule.
3. Never give a drug with an effaced label and
from an unmarked bottle or box.
4. Pour medicine from the bottle on the side
opposite the label.
5. Labels on medicine containers should be
changed only by the pharmacist.
6. If a drug has two commonly used names,
both names should appear in the label.
7. Take note of the expiry date marked on the
label.
4. Thou shalt measure the drug accurately.
5. Thou shalt only think of what thou art doing.
6. Thou shalt use the medication ticket always.
7. Thou shalt give the drug promptly.
8. Thou shalt give the drug to the right patient.
9. Thou shalt report errors promptly.
10. Thou shalt chart only what thou hath given.

Rules for Giving Medications

1. Give the medication within 30 minutes before

or after the schedule for which it is ordered.
2. Always identify the patient before giving the
medication.
3. If the medication is refused or cannot be
administered, notify the CI /head nurse, and
record accordingly on the patient’s chart.
4. Remain at the bedside until the patient has
taken the medicine.
5. Administer only those medicines which you
have prepared.
6. Never give two drugs together, unless
specifically ordered to do so. Different drugs
taken at the same time may form a chemical
compound that can be injurious to the patient or
will render the drug inactive or less effective.
7. When a patient goes to the Operating Room,
all orders for medication are automatically
discontinued. New orders for post – operative
medications will be written by the doctor.
8. When special tests are being done,
medications due at the particular time are
omitted. They are resumed when next dose is
due. (This is true of BID, TID, QID orders, etc.).
Medications given once a day are also
administered.
9. Nurses should listen carefully to the patient
who questions the addition or deletion of a
medication. If a patient questions the drug or
dose you prepared to administer, recheck the
order.
10. Medicine ticket for Stat order should be torn
halfway after the drug is administered. Inform
NOD.

TEN COMMANDMENTS:
1. Thou shalt know thy drug.
2. Thou shalt read the label three times.
3. Thou shalt clarify thy doubts.
 HEAT AND COLD APPLICATION pain, contractures, open wounds
- 2 forms: DRY AND MOIST
DEFINITION
DRY - applies locally (heat conduction)
- Body temperature a. Hot water bottles
- Hypothalamus is the thermoregulatory center b. Electric pads
- Heat loss from the skin by: c. Aquathermia pad
- Radiation d. Dispose heat pack
- Conduction MOIT
- Convection a. Compress
- Evaporation b. Hot pack
c. Soak
HEAT APPLICATION - Used for body, for local d. Sitz bath
and systemic effects
SYSTEMIC EFFECT
CRITERIA HEAT COLD (local pain done in a large body area)
VASODILATI VASODILATI
ON ON Increase C.O. and pulmonary vent. Due to
Capillary Increase Decrease increase Peripheral Vasodilation which diverts
Permiability large supplies of blood (internal) organs and
Cellular Increase Decrease produces decrease blood pressure
Metabolism SX: Fainting, evident much in pt with circulatory
Muscle Relaxes Relaxes Dec. disturbances: arteriosclerosis
Muscle
contractility COLD APPLICATION
Inflammation Increase bld. Decreases. - more recent than heat therapy
flow Slows bact’l - effects are opposite with heat
growth - decrease temperature of skin and underlying
Pain Dec. By Dec. By tissue can cause vasoconstriction
relaxing numbing the
muscles area Decrease blood flow
Effect Sedative Local Decrease oxygen supply, metabolites, waste
effect anesthetic removal
effect SX: Skin pallor, bluish discoloration, coolness
Joints Dec, stiffness Dec. bleeding Decrease blood flow - help control bleeding
Prolonged exposure - cell deprivation and
PHYSIOLOGIC RESPONSE subsequent damage to tissues
SX: bluish-purple mottled appearance of skin
LOCAL EFFECTS OF HEAT numbness, stiffness, pallor, blister and pain
- causes vasodilation (skin is red and warm) INDICATED - sprains, strains, fractures
- increase blood flow to the affected area - Rational - limit after injury swelling and
- increase oxygen, nutrients and antibodies bleeding
- Heat increase inflammatory, process by using
both the action of phagocytic cells that ingest SYSTEMIC EFFECTS
foreign materials.
- Heat promotes soft tissue healing and increase - Blood pressure increase due to blood is
suppuration shunted from the cutaneous to internal blood
- Heat increase blood flow, dissipates heat. vessels
- WARNING: increase capillary permeability, SX: shivering - a generalized effect of prolongs
edema formation or increasing existing edema cold (is normal to warm patient’s body)
- Indicated: joint stiffness from arthritis, low back
- Thermal tolerance APPLICATION
a. Body part
- back of hand and foot - not very 1. The first 24 hours after traumatic injury
temperature sensitive 2. Active hemorrhage or bleeding
- inner aspect of wrist, forearm, neck, 3. Non-inflammatory edema
perineal are are temp sensitive 4. Localized malignant tumor
b. Size of exposed body part 5. Skin disorder that causes redness abundant
- larger area exposed to both lower blisters
tolerance 6. Open wound
c. Individual tolerance 7. Impaired circulation
- affected by age and condition of skin, 8. Allergy or hypersensitivity
nervous system and circulatory system
- very young and old - low tolerance pt’s TEMPERATURE FOR HOT AND COLD
with neurosensory impairment may be with APPLICATION
high tolerance yet greater risk for injury.
d. Length of exposure Very Cold Below 15 Ice bags
- ppl feel hot and cold while skin (59F)
temperature changes after period od time, Cold 15-18C (59- Cold pack
tolerance increase 65)
e. Intactness of skin - injured skin are more Cool 18-27C (65- Cold
sensitive to temperature variation 80) Compress
Tepid 27-37C (80- Alcohol
PRECAUTIONS (specific conditions) 98) sponge bath
a. Neurosensoy impairment Warm 37-40C (98- Warm bath;
b. Impaired mental status 105) aquathermia
c. Impaired circulation Hot 40-46C (105- Hot soak;
d. Immediately after injury or surgery 115) irrigations
e. Open wound Very Hot Above 46C Hot water
(above 115) bags for adults
g. Adaption
h. Rebound phenomenon DRY HEAT AND COLD
- Heat produces maximum vasodilation a. Hot water bag - used in the home
in 20-30mins. Beyond 30-45 brings tissue inexpensive yet dangerous
congestion and blood vessel constrict. Risk 1) Normal adult - 52C (125F)
for burns 2) Debilitated/unconscious - 40.5-46C
- Cold produces maximum constriction (105-115F)
15 degree (60F) beyond 16 vasodilation 3) Child under 2 y.o - 40.5-46C (105-115F)
begins (protective mesh) b. Aquathermia pad - aquatic pad, K-pad
i. Applying heat and cold (pad constructed with tubes containing water,
- Conduction - hot water bags, electric pad is attached by tubing to an electrically
pads powdered control unit that has an opening for
- Radiation, heat lamsp, heat cradles, water and tem gauge
apply dry heat c. Hot and cold packs - commercially
- Conduction - hot compresses, sitz prepared provide heat/cold at designated time.
bath, soak provides most heat Prep depend on manufacturer (squeezing,
striking)
d. Electric pads - p/v constant, even heat,
are light weigh can be molded to a body part.
May burn pt if setting is too high
e. Heat Cradle - metal frame with a row of
25-watt bulbs. Cradle pace over pt and cover
CONTRAINDICATIONS WITH USE OF HEAT
with blanket the bath
- pt assessed every 10 minutes - Fan may be used to incorporate air
- heat is provided by radiation movement (decrease pts temp by convection)
f. Heat Lamp - gooseneck lamp with a 60- - Some requires M.D order other without
watt bulb. Lamp placed 45-60 cm (18-24 inches)
from the area to be heated. Heat is provided is
by radiation
g. Ice bag, ice glove, ice collar - either filled
with ice chips or with ROH based solution (pv
cold to specific area)

MOIST HEAT AND COLD

a. Compresses - either warm/cold
- is a moist gauze dressing applied
frequently to an open wound.
- HOT compress are ordered, solution
heated to the temp ordered/agency protocol
(If with skin break)
- Sterile technique (sterile materials; gloves)
- Sterile thermometer ( if not poss. Measure
in a small basin some contents of that water and
discard after)
- Hot compress applied hasten healing
- Cold compress prevent/ decrease
bleeding, decrease inflammation
b. Packs - is a moist cloth applied to the
body part. May be hot/cold. Unsterile, after
application, usually covered with moisture
resistant material (plastic wrap) contains
moisture, prevent transfer mircoorganism
- Hot pack - relieve muscle spasms/pain
- reduce pressure of acccumulated fluid
in a tissue/joint, congestion in underlying
organ
- Cold Packs - prevent swelling of the
tissues
c. Soaks - immersing a body part in a
solution or wrapping a part in a gauze dressing
and then saturating the dressing with a solution.
d. Sitz Bath - 40-43C / 105-110F
- Hip Bath - soak pt pelvic area in a
special tub/chair. Usually immersed from the
midthighs to the iliac crest or umbilicus.
Duration 15-20 minutes
e. Cooling Sponge Baths - 18-32C / 65-90F
Purpose - decrease pt fever through
heat loss by air conduction and vaporation
- H2O AND ROH - before due to
removes body heat rapidly yet drying effect
f. Tepid Sponge Bath - water temp is
32C(90F) beginning of the bath lowered
gradually to 18C(65F) by adding ice chips during CATHERIZATION
URINARY ELIMINATION

URINARY SYSTEM
- a system of organs that produce and excrete
urine, the liquid waste product of the body
Components:
- Kidneys
- Ureters
- Bladder
- Urethra

FUNCTIONS OF THE URINARY SYSTEM

- Ureters - transport urine from kidneys to the
urinary bladder
- Bladder - stores urine
- Urethra - discharges urine from the body
- Kidneys - excrete waste in urine, regulated
blood volume and composition, helo regulate
blood pressure, synthesize glucose, release
erythropoietin and participate in vitamin D
sysnthesis
 f. Protein (albumin) absent
g. Glucose: none
h. Ketones: none
i. Blood: up to 2 RBCs
j. Microscopic Exam:
- RBC: 1-2/ low power field
- WBC: 0.4/low power field
- Bacteria: none

Normal urine may be light yellow to light amber

in color ad may be clear or slightly cloudy

Urine colors indicates of pathology include dark

amber, red and brown. Color such as green and
blue are usually associated with the ingestion of
drugs or dyes

Turbidity is evaluated by holding the specimen

in front of the line of printed material. Urine may
be graded as clear, slightly cloudy, cloudy or
turbid.

Urine which is cloudy or turbid may indicate an

abnormality and should be determined
microscopically
URINARY TRACT INFECTION
- defined as the inflammation of the urinary PROBLEM IN URINARY ELIMINATION
epithelium in response to colonization with
pathogen Altered Urine Composition
- cause by E.oli; Staphylococcus; Proteus; a. RBC (hematuria)
Klebsiella b. Pus (pyuria)
c. Bacteria
NORMAL URINE d. Albumin (abuminuria)
e. Protein (proteinuria)
Urine Studies f. Glucose (glucosuria)
ROUTINE URINALYSIS g. Ketones (ketonuria)
a. pH: 4.6-8.0
b. Appearance: clear ALTERED URINARY PRODUCTION
c. Color: amber/straw
d. Odor: aromatic Normal range of Urine Output (30-60 cc/hour)
e. Specific gravity: 1.010-1.025 a. Polyuria - more than 100 cc/hr
 b. Oliguria - less than 30 cc/hr
c. Anuria - less than 10cc/hr or more

ALTERED URINARY FREQUENCY

a. Frequency
b. Nocturia - increased urinary frequency at
night
c. Urgency - urge to void but difficulty in 2 way or retention or foley cath
voiding
d. Incontinence
e. Retention
f. Dysuria - painful urination
g. Hesitancy - difficulty in initiating voidin of
at least 5 seconds
h. Pollakuria - frequent, scanty urination

CLINICAL SIGNS OR URINARY RETENTION

a. Discomfort in the pubic area
b. Bladder distension
c. Inability to void or frequent voiding of
small volumes
d. A disproportionately small amount of
output in relation to fluid intake
e. Increasing restlessness and feeling of
need to void

NURSING INTERVENTIONS TO INDUCE

VOIDING
1. Provide privacy (most effective)
2. Encourage increased OFI (unless
contraindicated) CHF, CRF
3. Assist the patient in the anatomical
position of voiding
4. Serve clean, warm and dry bed pan or
urinal
5. Allow the patient to listen to the sound of
running water
6. Dangle fingers of patient in warm water
7. Pour water over the perineum 3 way catherter for Cystoclysis ( for continuous
8. Provide adequate tome for voiding bladder irrigation) - for BPH, or for instilling
9. Perform Crede’s maneuver as ordered medications into the bladder
- If bladder is distened C/I crede’s. Only
if with difficulty in voiding and without
distention
10. Administer cholinergic as ordered
11. Last resort: Urinary Catherization

TYPE OF CATHETER:
Straight - for urine specimen, also for one time
removal of urine from bla dder
SURGICAL ASEPSIS

SURGICAL ASEPSIS
- a system of practices to remove all
microorganisms from an object/ are and to
prevent new microorganisms from
contaminating it.
Sterilization - complete elimination of all
microorganisms including spores from an item
or area
5 METHOS OF STERILIZATION
1. Moist Heat - use of steam under pressure
where temperature exceeds boiling point.
Ex: Autoclave - most efficient methods but
not for sharp instruments
2. Dry Heat Sterilizer - operates like an oven
used to sterilize sharp instruments
3. Boiling Water - least expensive and least
efficient because some spores resist boiling
point.
4. Chemical
A. Gas Autoclave
B. Disinfectant - used to eliminate microbes
on inanimate objects; harmful to tissues
Ex: Lysol, cidex
C. Antiseptic - used on skin/tissues
Ex: Betadine, ROH 70%, hydrogen peroxide
10%. Both have bactericidal and bacteriostatic
properties
5. Radiation - used to sterilize drugs, foods,
and other heat sensitive items.
- Makes us of ionizing radiation to penetrate
deeply into objects
- Disadvantage: highly expensive and can
cause sterility among personnel
INDICATION FOR STERILE TECHNIQUE
- When skin is intentionally perforated/ incised
like in DR or OR
- When skin is disease or injured ( burn)
- When a catheter or surgical instruments is
inserted into a body cavity that is considered
sterile
STERILE FIELD
- A microorganism free are establish a sterile
field by:
a. Using the innermost side of a sterile
wrapper
b. Using a sterile drape
Maintain a sterile field by:
a. Wrapping equipment in a variety of
materials like plastic, paper, glass
DO’S AND DONT’S
a. Do keep your hands above your waist
b. Don’t reach over the sterile field
c. Don’t touch anything on the sterile field with
your bare hands
d. Don’t talk over the sterile field
e. Don’t turn your back on the sterile field
PRINCIPLES OF SURGICAL ASEPSIS
a. All objects in the sterile field must be sterile
b. Sterile objects become unsterile when
touched by unsterile objects
c. Sterile items that are out of vision or below
the waist level of the nurse must be considered
unsterile
d. Sterile object become unsterile by prolongs
exposure to airborne microorganisms
e. Fluids flow in the direction of gravity
f. Moisture that passes through a sterile object
draws microorganisms from unsterile surfaces
above or below it to the sterile surface by
capillary action
g. The edges of a sterile field are considered
unsterile
h. The skin cannot be sterilized and is therefore
unsterile
i. Conscientiousness alertness and honesty ae
essential qualities in maintaining surgical
asepsis.
BASIC PRINCIPLES OF ASEPTIC
TECHNIQUE
a. All materials in contact with the surgical
wound and used within the sterile field must be
sterile
b. Sterile surfaces or articles may touch other
sterile surfaces or articles and remain sterile;
contact with unsterile objects at any point
renders a sterile are contaminated
c. Gowns of the surgical team are considered
sterile in front the chest to the level of the sterile
field.
d. Sterile drapes are used to create a sterile
field. Only the top surface of a draped table is
considered sterile.
e. Items should be dispensed to a sterile field by
methods that preserve the sterility of the items
and the integrity of the sterile field.
f. The movements of the surgical team are from
sterile to sterile areas and from unsterile to
unsterile areas. Scrubbed persons and sterile
items contact only sterile areas; circulating
nurse and unsterile field items contact only
unsterile areas.
g. Movements around a sterile field must not
cause contamination of the field. Sterile areas
must be kept in view during movement around
the area. At least a 1-foot distance from the
sterile field must be maintained to prevent
inadvent contamination
h. Whenever a sterile barrier is breached, the
area must be considered contaminated. A tear
or puncture of the drape permitting access to an
unsterile surface underneath renders the area
unsterile. Such a drape must be replaced.
i. Every sterile field should be constantly
monitored and maintained. Items of doubtful
sterility are considered unsterile. Sterile field
should be prepared as close as possible to the
time of use.

Additional principles
- Tables are sterile only at table level
- Unsterile persons avoid reaching over a sterile
field; sterile persons avoid learning over an
unsterile area.