CHECKLIST FOR ADMINISTERING ORAL MEDICATION
STEPS RATIONALE
1. Silently recite a prayer for the success
of the procedure.
2. Assess for any contraindications to
the client receiving oral medication.
3. Assess client’s medical history, history
of allergies, medication history, and
diet history.
4. Review assessment and laboratory
data that may influence drug
administration.
5. Assess client’s knowledge regarding
health and medication usage.
6. Assess client’s preference for fluids.
7. Check accuracy and completeness of
each record with prescriber’s written
medication order.
8. Prepare medication:
8.1 Wash hands.
8.2 Arrange medication tray and cups in
medication preparation area or move
medication cart to position outside client’s
room.
8.3 Unlock medicine drawer or cart.
8.4 Prepare medication for one client at a
time. Keep all pages of records for one client
together.
8.5 Select correct drug from stock supply or
unit-dose drawer.
8.6 Calculate drug dose as necessary.
Double-check calculation.
8.7 To prepare tablets or capsules from a
floor stock bottle, pour required number into
bottlecap and transfer medication-to-
medication cup. Do not touch medication with
fingers. Extra tablets or capsules may be
returned to bottle. Break prestored
medications using a gloved hand or pill-
cutting device.
8.8 To prepare unit-dose tables or capsule,
place packaged table or capsule directly into
medicine cup. (Do not remove wrapper.)
8.9 Place tablets or capsules to be given to
To ask for guidance
Alteration in GI function interfere with
medication distribution, absorption, and
excretion.
Information reflects patient’s need for potential
responses to medication.
Data reveals the need to hold medication or
that medication is contraindicated.
Determines patient’s need for medication
education and guidance needed in drug
achieve drug adherence.
Fluids ease swallowing and facilitate absorption
from the GI tract.
The order is the most reliable source only legal
record of medication that the patient is to
receive.
Enhances time management and efficiency.
Prevent transfer of microorganisms.
Organization of equipment saves time and
reduces error.
Medication are safeguarded when in locked in
cabinet, cart, or computerized medication
dispensing system.
Preventing distractions limits preparation errors.
Reading labels and comparing the with
transcribed order reduces error.
Double checking reduces error.
Avoid contamination and waste of medication.
Wrapper maintains cleanliness of medication
and allows you to identify medication name and
dose at patient’s bedside.
Keeping medication that require pre
client at the same time in one medicine cup administration assessments separate from
unless client requires pre-administration other makes it easier to withhold medication, as
assessments. necessary.
8.10 If client has difficulty swallowing and the Large tablets are often difficult to swallow.
pill may be crushed, use a pill-crushing Ground tablet mixed with palatable soft food is
device. If a pill-crushing device is not usually easier to swallow.
available, place tablet between two
medication cups and grind with a blunt
instrument. Mix ground tablet in small amount
of soft food (e.g., custard or applesauce).
9. Prepare Liquids:
9.1 Remove bottle cap from container and This avoids contaminating the inside of the cap.
place cap upside down.
9.2 Hold bottle with label against palm of This prevents the label from becoming soiled
hand while pouring. and illegible because of spilled liquids.
9.3 Hold medication cup at eye level and fill to This method ensures accuracy of
desired level on scale. measurement.
9.4 Discard any excess liquid into sink. Wipe This prevents the cap from sticking.
lip and neck of bottle with paper towel.
9.5 Draw up volume of liquid medication of
less than 10 ml in syringe without needle.
9.6 When preparing narcotics, check narcotic
record for previous drug count and compare
with supply available.
9.7 Check expiration date on all medications. Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
9.8 Compare record with prepared drug and Reading labels and comparing them with
container. transcribed order reduces error.
9.9 Return stock containers or unused unit- Reading label of medications in multi-dose
dose medications to shelf or drawer and read containers reduces administration errors.
label again.
9.10 Do not leave drugs unattended. Nurse is responsible for safekeeping of drugs.
10. Administering medications:
10.1 Take medications to client at correct Ensures intended therapeutic effect and
time. complies with professional standards.
10.2 Identify client by comparing name on Ensure correct patient.
record with name on client’s identification
bracelet. Ask client to state name.
10.3 Explain to client the purpose of each Patient has the right to be informed.
medication and its action. Allow client to ask
any questions about drugs or she is receiving.
10.4 Assist client to sitting position or to side- Sitting position prevents aspiration during
lying position if sitting is contraindicated. swallowing.
11. Administer drugs properly:
11.1 Allow client to hold solid medications in Patients become familiar with medications by
hand or cup before placing in mouth. seeing each drug.
11.2 Offer water or juice to help client swallow Choice of fluid can improve fluid intake.
medications. Give client cold carbonated
water if available and not contraindicated.
11.3 For drugs administered sublingually, Medication is absorbed through blood vessels
instruct client to place medication under
longue and allow it to dissolve completely.
Caution client against swallowing tablet.
11.4 For drugs administered buccally, instruct
client to place medication in mouth against
mucous membranes of the cheek until it
dissolves. Avoid administering liquids until
medication has dissolved.
11.5 Mix powdered medication with liquids at
bedside and give to client to drink.
11.6 Caution client against chewing or
swallowing lozenges.
11.7 Give effervescent powders and tables to
client immediately after they have dissolved.
11.8 If the client is unable to hold
medications, place medication cup to client’s
lips and gently introduce each drug into the
mouth, one at a time.
11.9 If table or capsule falls to the floor,
discard it and repeat preparation.
11.10 Stay in room until client has completely
swallowed each medication. Ask client to
open mouth if you are uncertain whether
mediation has been swallowed.
11.11 When administering highly acidic highly
acidic medications, offer client a nonfat snack
if not contraindicated.
11.12 Assist client in returning to a
comfortable position.
11.13 Dispose of soiled supplies.
12. Wash hands.
13. Return to client’s room within 30
minutes to evaluate client’s response
to medication.
14. Ask client or family member to identify
drug name and explain purpose,
action, dosage, schedule, and
potential side effects of drug.
15. Notify prescribe if the client exhibits a
toxic effect or allergic reaction or if
there is an onset of side effects. If
either of these occurs, withhold further
doses of medication
16. Record administration (or withholding)
of oral medications.
of undersurface of the tongue.
Buccal medication act locally on mucosa or
systematically as they are swallowed in saliva.
Powdered medication often thicken and harden
making swallowing different.
Medication acts through slow absorption
through oral mucosa, not gastric mucosa.
Effervescent improves unpleasant taste often
relieves GI problems.
Administer single tablet or capsule eases
swallowing and decreases risk of absorption.
The medication is already considered
contaminated.
Ensures the patient received the ordered
dosage. If left unattended, some patient do not
take the medication causing risk to the health in
the patient.
Reduces gastric irritation.
Maintains patient’s comfort.
Reduce transmission of microorganisms.
Reduce transmission of microorganisms.
Evaluates the therapeutic effect of the
medication, allergic reaction and side effects.
Determines level of knowledge gained by the
patient and the family.
To make necessary implementation of care to
reduce risks of the toxic effect, allergic reaction
or if there is an onset of side effects. If either of
these occurs, withhold further doses of
medication
For documentation.
 CHECKLIST FOR RECONSTITUTING MEDICATION FROM POWDER

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success
of the procedure.
ASSESSMENT
2. Review physician’s order; including
client’s name, drug name, form, route,
dosage, and time administration.
3. Review pertinent information related
to medication, including action,
purpose, side effects and nursing
implications.
PLANNING
4. Gather appropriate equipment.

5. Perform hand washing.

IMPLEMENTATION
6. Remove cap covering vial containing
powdered medication and vial
containing diluent. Label may specify
use of sterile water, normal saline, or
special diluent provided with the
medication.
7. Firmly swab both caps with alcohol
swab and allow to dry.
8. Draw up diluent into syringe with
needle.
9. Insert tip of needle through the center
of the rubber seal of vial of powdered
medication and inject diluent into vial.
10. Remove needle.
11. Mix medication by gently rolling vial
between hands until completely
dissolved.
12. Reconstituted medication in vial is
ready to be drawn into syringe.
13. Draw up medication into syringe.
EVALUATION
14. Check if you have drawn the correct
volume medication.
 CHECKLIST FOR PREPARING INJECTIONS (AMPULE, VIAL, VIAL CONTAINING
POWDER)
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success
of the procedure.
ASSESSMENT
2. Review specific drug action and
expected response, client’s
knowledge of drug action and nursing
responsibilities.
3. Assess client’s history allergy.
4. Check expiration of medication.
5. Check medication administration
record (MAR), medication card or
patient’s chart.
6. Follow the three checks for
administering medications. Read the
label on the medication:
a. When it is taken from the medication
chart.
b. Before withdrawing the medication.
c. After withdrawing the medication.
PLANNING
7. Organize the equipment.
8. Take note of the 6 R’s in medication
administration.
9. Perform hand washing.
IMPLEMENTATION
10. Prepare medication
10.1Ampule preparation
10.1.1 Tap top of ampule lightly and
quickly with finger until fluid moves
from neck of ampule.
10.1.2 Place small gauze pad around neck
ampule.
10.1.3 Snap neck of ampule quickly and
firmly while pointing it away from your body.
10.1.4 Draw up medication quickly.
10.1.5 Hold ampule upside down or set it on a
flat surface. Insert syringe or filter needle into
center of ampule opening. Do not allow
needle tip or shaft to touch rim of ampule.
10.1.6 Aspirate medication into syringe by
gently pulling back on plunger.
RATIONALE
To ask for guidance
Determines patient’s need for medication
education and guidance needed in drug
achieve drug adherence.
Information reflects patient’s need for potential
responses to medication.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
The order sheet is the most reliable source and
only legal record of medications that patient is
to receive. Ensures patient receives the correct
medications. Illegible MARs are a source of
medication errors.
To avoid medication error.
Enhances time management and efficiency.
To avoid medication error.
Reduce transmission of microorganisms.
Dislodges any fluid that collects above the neck
of ampule. All solution moves into lower
chamber.
Placing a pad around the neck of the ampule
protects your fingers from trauma as glass tip is
broken off.
Protects yuir fingers and ace from shattering
glass.
Broken rim of ampules is considered
contaminated. When ampule is inverted,
solution comes out if needle tip or shaft touches
rim of ampule.
Withdrawal of plunger creates negative
pressure within syringe , which puffs fluid into

10.1.7 Keep needle tip under surface of
liquid. Tip ampule to bring all fluid within
reach of needle.
10.1.8 If air bubbles are aspirated, do not
expel air into ampule.
10.1.9 To expel excess air bubbles, remove
needle from ampule. Hold syringe with needle
pointing up. Tap side of syringe to cause
bubbles to rise toward needle. Draw back
slightly on plunger, the push plunger upward
to eject air. Do not eject fluid.
10.1.10 If syringe contains excess fluid, use
sink for disposal. Hold syringe vertically with
needle tip up and slanted slightly toward sink.
Slowly eject excess fluid into sink. Recheck
Fluid level in syringe by holding it vertically.
10.1.11 Cover needle with its safety sheath or
cap. Change needle on syringe or use filter
needle if you suspect medication is on needle
shaft.
10.2Vial containing a solution:
10.2.1 Remove cap covering top of unused
vial to expose sterile rubber seal, keeping
rubber seal sterile. If using a multi-dose vial
that has been used before, firmly and briskly
wipe surface of rubber seal with alcohol swab
and allow it to dry.
10.2.2 Pickup syringe and remove needle
cap. Pull back on plunger to draw amount of
air into syringe equivalent to volume of
medication to be aspirated from vial.
10.2.4 With vial on flat surface, Insert tip of
needle with beveled tip entering first through
center of rubber seal. Apply pressure to tip of
needle during insertion.
10.2.5 Inject air into vial’s airspace, holding
on to plunger. Hold plunger with firm
pressure; plunger may be forced backward by
air pressure within the vial.
10.2.6 Invert vial while keeping firm hold on
syringe and plunger. Hold vial between thumb
and middle fingers of nondominant hand.
Grasp end of syringe barrel and plunger with
thumb and forefinger of dominant hand to
counteract pressure in vial.
10.2.7 Keep tip of needle below fluid level.
10.2.8 Allow air pressure from vial to fill
syringe gradually with medication. Pull back
slightly on plunger to obtain correct amount of
syringe.
Precents aspiration of air bubbles.
Air pressure forces liquid out of ampule and
medication is lost.
Withdrawing plunger too far removes it from
barrel. Holding the syringe vertically allows fluid
to settle in bottom of barrel so it is not expelled.
Air at top of barrel and within needle is then
expelled.
/medication dose prepared accurately. Position
if needle allows medication to be expelled
without flowing down needle shaft.
Prevents contamination of needle. Filter
needles cannot be used for injection. Scooping
technique prevents needlestick injury.
Vial comes packaged with seal that cannot be
replaced after the cap removal.
Inject air first into vial to prevent buildup of
negative pressure in vial when aspirating
medication.
Center the seal is thinner and easier to
penetrate. Injecting beveled tip first and using
firm pressure prevent coring of rubber seal,
which could enter vial or needle.
Injecting air before aspirating fluid creates
vacuum needed to get medication to flow into
syringe. Injecting into airspace of vial prevents
formation of bubbles and inaccuracy in dose.
Inverting vial allows fluid to settle in lower half
of container. Position of hands prevents forceful
movement of plunger and permits easy
manipulation of syringe.
Prevents aspiration of air.
Positive pressure within vial forces fluid into
syringe.
solution.
10.2.9 When desired volume has been
obtained, position needle into vial’s air-space.
Tap side of syringe barrel carefully to
dislodge any air bubbles. Eject any air
remaining at top of syringe into vial.
10.2.10 Remove needle from vial by pulling
back on barrel of syringe.
10.2.11 Hold syringe at a 90-degree angle at
eye level to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to dislodge
any air bubbles. Draw back slightly on
plunger, the push plunger upward to eject air.
Do not eject fluid.
10.2.12 If medication is to be injected into
client’s tissue, change needle to appropriate
gauge and length according to route or
medication.
10.2.13 For multidose vial, make label that
includes date of mixing, concentration of drug
per milliliter, and your initials.
10.3Vial containing a powder
(reconstituting medications):
10.3.1 Remove cap covering vial of powdered
medication and cap covering vial of proper
diluent.
10.3.2 Pick up syringe and remove needle
cap. Pull back on plunger to draw amount of
air into syringe equivalent to volume of
medication to be aspirated from vial.
10.3.3 3. With vial on flat surface, insert tip of
needle with beveled tip entering first through
center of rubber seal. Apply pressure to tip of
needle during insertion.
10.3.4 Inject air into vial’s airspace, holding
on to plunger. Hold plunger with firm
pressure; plunger may be forced backward by
air pressure within the vial.
10.3.5 Invert vial while keeping firm hold on
syringe and plunger. Hold vial between thumb
and middle fingers of nondominant hand.
Grasp end of syringe barrel and plunger with
thumb and forefinger of dominant hand to
counteract pressure in vial.
10.3.6 keep tip needle below fluid level.
10.3.7 Allow air pressure from vial to fill
syringe gradually with medication. Pull back
slightly on plunger to obtain correct amount of
Forcefully striking barrel while needle is
inserted in vial bends needle. Accumulation of
air displaces medications and causes plunger
to separate from barrel, resulting in loss of
medications.
Accidentally pulling plunger rather than barrel
causes plunger to separate from barrel,
resulting in loss of medications.
Holding syringe vertically allows fluid to settle
in bottom of barrel so it is not expelled.
Inserting needle through rubber stopper dulls
beveled tip. New needle is sharper.
Ensures that future doses will be prepared
correctly.
Not all drug manufacturers guarantee that caps
of unused vials are sterile.
Inject air first into vial to prevent buildup of
negative pressure in vial when aspirating
medication.
Center the seal is thinner and easier to
penetrate. Injecting beveled tip first and using
firm pressure prevent coring of rubber seal,
which could enter vial or needle.
Injecting air before aspirating fluid creates
vacuum needed to get medication to flow into
syringe. Injecting into airspace of vial prevents
formation of bubbles and inaccuracy in dose.
Inverting vial allows fluid to settle in lower half
of container. Position of hands prevents forceful
movement of plunger and permits easy
manipulation of syringe.
Prevents aspiration of air.
Positive pressure within vial forces fluid into
syringe.
solution.
10.3.8 When desired volume has been
obtained, position needle into vial’s air-space.
Tap side of syringe barrel carefully to
dislodge any air bubbles. Eject any air
remaining at top of syringe into vial.
10.3.9 Remove needle from vial by pulling
back on barrel of syringe.
10.3.10 Hold syringe at a 90-degree angle at
eye level to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to dislodge
any air bubbles. Draw back slightly on
plunger, then push plunger upward to eject
air. Do not eject fluid.
10.3.11 Insert tip of needle through center of
rubber seal of powdered medication. Inject
diluent into vial. Remove needle.
10.3.12 Mix medication thoroughly. Roll vial
palms, Do not shake.
10.3.13 Read label carefully to determine
dose after reconstitution.
EVALUATION
10.3.14 Dispose of soiled supplies. Place
broken ampule and/or used vials and used
needle in puncture-proof and leak-proof
container.
10.3.15 Clean work area.
10.3.16 Wash hands.
Forcefully striking barrel while needle is
inserted in vial bends needle. Accumulation of
air displaces medications and causes plunger
to separate from barrel, resulting in loss of
medications.
Accidentally pulling plunger rather than barrel
causes plunger to separate from barrel,
resulting in loss of medications.
Holding syringe vertically allows fluid to settle
in bottom of barrel so it is not expelled.
Diluent begins to dissolve and reconstitute
medication.
Ensures proper dispersal of medication
through solution. Shaking produces air bubbles.
Avoid medication errors.
Prevents accidental injury to staff. Controls
transmission of infection.
Reduce transmission of microorganisms
Reduce transmission of microorganisms
 CHECKLIST FOR ADMINISTERING INJECTIONS (SQ, ID &IM)
INDICATIORS/STATEMENTS
1. Silently recite a prayer for the success
of the procedure.
ASSESSMENT
2. Review specific drug action and
expected response, client’s
knowledge of drug action and nursing
responsibilities.
3. Assess client’s history allergy.
4. Check expiration date of the
medication.
5. Check medication administration
record (MAR), medication card or
patient’s chart.
6. Follow the three checks for
administering medications. Read the
label on the medication:
a. When it is taken from the medication
cart.
b. Before withdrawing the medication.
c. After withdrawing the medication.
PLANNING
7. Organize the equipment.
8. Prepare correct medication dose from
ampule or vial. Check carefully. Be
sure all air is expelled.
9. Take note of 6R’s in medication
administration.
10. Explain procedure and rationale to the
client and significant others. Tell client
the injection will cause a slight burning
or sting.
11. Provide privacy.
12. Perform hand washing.
13. Keep sheet or grown draped over
client’s body parts not requiring
exposure.
IMPLEMENTATION
14. Select appropriate injection site.
Inspect skin surface of site for bruises,
inflammation, or edema:
a. For subcutaneous (SQ) injections:
Palpate sites for masses or
tenderness. Avoid these areas. For
RATIONALE
To ask for guidance
Determines patient’s need for medication
education and guidance needed in drug
achieve drug adherence.
Information reflects patient’s need for potential
responses to medication.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
The order sheet is the most reliable source and
only legal record of medications that patient is
to receive. Ensures patient receives the correct
medications. Illegible MARs are a source of
medication errors.
To avoid medication error.
Enhances time management and efficiency.
Ensures intended therapeutic effect and
complies of the medication to be given to the
patient.
Prevent medication errors.
Help minimize patient’s anxiety.
Respects dignity of patients while area is
injected is exposed.
Reduce transfer of microorganisms.
Provides privacy to the patients.
Injection sites need to be free of abnormalities
that interfere with medication absorption.
Subcutaneous injections are sometime
mistakenly given in muscle especially in
abdomen and thigh sites,. Appropriate size and
 daily insulin injections, rotate site
daily. Check that needle is correct size
by grasping skinfold at site with thumb
and forefinger. Measure fold from top
to bottom.
b. For intramuscular (IM) injections: Note
integrity and size of muscle and
palpate for tender or hard areas.
Avoid these areas. If injections are
given frequently, rotate sites.
c. For intradermal (ID) injections: Note
lesions or discoloration for forearm.
Select site three to four finger widths
below antecubital space and a hand
width above wrist.
15. Assist client to a comfortable position:
a. For SQ injections: Have client relax
arm,
b. leg, or abdomen, depending on site
chosen.
c. For IM injections: Have client lie flat,
on side, or prone, depending on site
chosen.
d. For ID injections: Have client extend
e. elbow and support it and forearm on
flat surface.
f. Talk with client about subject of
interest.
16. Relocate site using anatomical
landmarks.
17. Cleanse site with an antiseptic swab.
Apply swab at center of site and rotate
outward in a circular direction for
about 5 cm.
18. Hold swab or gauze between third and
fourth fingers of non-dominant hand.
19. Remove needle cap or sheath from
needle by pulling it straight off.
20. Hold syringe between thumb and
forefinger of dominant hand:
a. For SQ and IM injections: Hold as
dart, with palm down.
b. For ID injections: Hold with bevel
of needle pointing up.
21. Administer injection:
21.1SQ injection:
21.1.1 For average-size client,
needle and angle of injection ensure medication
is injected in subcutaneous tissue.
Ventrogluteal site is preferred sites for adults.
This site is also preferred for children who are
receiving viscous and irritating solutions.
An ID sites needs to be clear so you can see
results of skin test and interpret them correctly.
Relaxation of site minimizes discomfort.
Reduces strain on muscle and minimizes
discomfort of injections.
Reduces strain on muscle and minimizes
discomfort of injections.
Stabilize injection sites for easiest accessibility
Stabilize injection sites for easiest accessibility
Distraction recues anxiety.
Injection into correct anatomical sites prevents
injury to nerves, bones, and blood vessels.
Mechanical action of swab removes secretions
containing microorganisms.
Gauze or swab remains readily accessible
when needle is withdrawn.
Preventing needle from touching sides of cap
prevents contamination
Quick, smooth injections requires proper
manipulation of syringe parts.
With bevel up, medication is less likely to be
deposited into tissues below dermis.
Pinching skin elevates subcutaneous tissue
and desensitizes area.
 spread skin tightly across
injection site or pinch skin
with non-dominant hand.
21.1.2 Inject needle quickly and Quick, firm insertion minimizes discomfort.
firmly at a 45- degree
angle, then release skin, if
pinched.
21.1.3 After needle enters site,
grasp lower end of syringe
barrel with non-dominant
21.1.4 hand. Move dominant hand
to end of plunger. Avoid

21.1.5 moving syringe while

slowly
21.1.6 pulling back on plunger to
21.1.7 aspirate drug. If blood

21.1.8 appears in syringe, remove

needle, discard medication
and syringe, and repeat
procedure. Do not aspirate
when giving heparin.
21.1.9 Inject medication slowly.
21.2IM injection: Z- track creates zigzag path through tissues
21.2.1 Position non-dominant that seals needle tract to avoid tracking of
hand at proper anatomical medication.
and marks and pull skin
down to administer in a Z-
track. Inject needle quickly
into muscle at a 90-degree
angle.
21.2.2 If client’s muscle mass is Ensures medication reaches muscle mass.
small, grasp body of
muscle between thumb
and fingers.
21.2.3 Avoid moving syringe while Disrupt the flow of medication to the correct
slowly pulling back on site/.
plunger to aspirate drug.
21.2.4 Inject medication slowly. Minimizes discomfort.
21.2.5 Wait 10 seconds, then Allows for the medication to absorbed into
smoothly and steadily muscle before removing the syringe rather than
withdraw needle while leaking back our through tract that needle
placing antiseptic swab or created.
dry gauze gently above or
over injection site.
21.3ID injection: Needle pierces tight skin more easily,
21.3.1 With non-dominant hand,
 stretch skin across
injection site with forefinger
or thumb.
Ensures the needle tip is in dermis.
21.3.2 Place needle against
client’s skin and insert it
slowly at a 5 to 15-degree
angle until resistance is
felt. Advance needle
through epidermis
approximately 3 mm below
skin surface so that needle
tip
21.3.3 Inject medication slowly. Slow injection minimizes discomfort at site.
Remove needle and begin
again if no resistance is
felt.
22. Withdraw needle while applying Support of tissue around injection site
alcohol swab or gauze gently over minimizes discomfort during needle withdrawal.
site.
23. Do no massage site after SQ injection Massage causes underlying tissue damage.
of heparin or insulin or after ID
injection. Apply bandage over ID site.
24. Assist client to comfortable position. Gives patient sense of well-being.
25. Discard uncapped needle enclosed in Prevents injury to patient and health care
safety shield and attached syringe into personnel. Recapping needles increases risk if
puncture and leak proof receptacle. If needlestick injury.
unable to leave client’s bedside, use a
one-handed technique to recap
needle.
26. Wash hands. Reduces the transfer of medications.
EVALUATION
27. Stay with client and observe for any Dyspnea, wheezing, and circulatory collapse
immediate reactions. are signs of severe anaphylactic reaction,
which is life threatening.
28. Ask client to explain purpose and To evaluate clients perception regarding
effects of medication. medication administered.
29. For ID injections, use skin pencil and Pencil marks makes sites easy to find. Result of
draw circle around perimeter of skin testing are read at various times on the
injection site. Check site within 48 to basis of type of medication used or type of skin
72 hours of injection. testing completed.
30. Record medication administration. For documentation
31. Record and report client’s response to For documentation
injection and any undesirable effects
caused by the medication.

CHECKLIST FOR ADMINISTERING INJECTIONS (SQ, ID & IM)

 INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure.
ASSESSMENT
2. Review specific drug action and expected
response, client's knowledge of drug action
and nursing responsibilities.
3. Assess client's history of allergy.
4. Check expiration date of the medication.
5. Check the medication administration record
(MAR), medication card or patient's chart.
6. Follow the three checks for administering
medications. Read the label on the
medication:
a. When it is taken from the medication cart
b. Before withdrawing the medication.
c. After withdrawing the medication.
PLANNING
7. Organize the equipment.
8. Prepare correct medication dose from
ampule or vial. Check carefully. Be sure all air
is expelled.
9. Take note of the 6 R's in medication
administration.
10. Explain procedure and rationale to the
client and significant others. Tell client the
injection will cause a slight burning.
11. Provide privacy.
12. Perform hand washing.
13. Keep sheet or gown draped over client's
body parts not requiring exposure.
IMPLEMENTATION
14. Select appropriate injection site. Inspect
skin surface of site for bruises, inflammation,
or edema
A. For subcutaneous (SQ) injections: Palpate
sites for masses or tenderness. Avoid these
areas. For daily Insulin injections, rotate site
daily. Check that needle is correct size by
grasping skinfold at site with thumb and
forefinger. Measure fold from top to bottom.
B. For intramuscular (IM) injections: Note
integrity and size of muscle and palpate for
tender or hard areas. Avoid these areas. If
injections are given frequently, rotate sites.
C. For Intradermal (ID) injections: Note
lesions or discoloration of forearm. Select site
three to four finger widths below antecubital
space and a hand width above wrist.
15. Assist client to a comfortable position:
A. For SQ injections: Have client relax am,
leg, or abdomen, depending on site chosen.
B. For IM injections: Have client lie flat, on
side, or prone, depending on site chosen.
C. For ID injections: Have client extend elbow
and support it and forearm on flat surface.
D. Talk with client about subject of interest.
16. Relocate site using anatomical landmarks.
17. Cleanse site with an antiseptic swab.
Apply swab at center of site and rotate
outward in a circular direction for about 5 cm.
18. Hold swab or gauze between third and
fourth fingers of nondominant hand.
19. Remove needle cap or sheath from
needle by pulling it straight off.
20. Hold syringe between thumb and
forefinger of dominant hand:
a. For SQ and IM injections: Hold as dart, with
palm down.
b. For ID injections: Hold with bevel of needle
pointing up.
21. Administer injection:
21.1 SQ injection:
21.1.1 For average-size client, spread skin
tightly across injection site or pinch skin with
nondominant hand.
Inject needle quickly and firmly at a 45-
degree angle, then release skin, If pinched.
After needle enters site, grasp lower end of
syringe barrel with nondominant hand. Move
dominant hand to end of plunger Avoid
moving syringe while slowly pulling back on
plunger to aspirate drug. If blood appears in
syringe, remove needle, discard medication
and syringe, and repeat procedure. Do not
aspirate
21.1.4 Inject medication slowly.
21.2 IM Injection:
21.2.1 Position nondominant hand at proper
anatomical landmarks and pull skin down to
administer in a Z-track. Inject needle quickly
into muscle at a 90-degree angle.
21.2.2 If client's muscle masses is small,
grasp body of muscle between thumb and
fingers.
21.2.3 Avoid moving syringe while slowly
pulling back on plunger to aspirate drug.
21.2.4 Inject medication slowly
21.2.5 Walt 10 seconds, then smoothly and
steadily withdraw needle while placing
antiseptic swab site.
21.3.1 With nondominant hand, stretch skin
across Injection site with forefinger or thumb.
21.3.2 Place needle against client's skin and
inset it slowly at a 5- to 15-degree angle until
resistance is felt. Advance needle through
epidermis approximately 3 mm below skin
surface so that needle tip can be seen
through skin.
21.3.3 inject medication slowly. Remove
needle and begin again if no resistance is felt.
21.3.4 While injecting medication, notice that
a small bleb approximately 6 mm in diameter
appears on skin's surface.
22. Withdraw needle while applying alcohol
swab or gauze gently over site.
23. Do no massage site after SQ injection of
heparin or insulin or after ID injection. Apply
bandage over ID site.
24. Assist client to a comfortable position.
25. Discard uncapped needle or needle
enclosed in safety shield and attached
syringe into puncture-and leak-proof
receptacle. If unable to leave client's bedside,
use a one-handed technique to recap needle.
26. Wash hands.
EVALUATION
27. Stay with client and observe for any
immediate reactions.
28. Ask client to explain purpose and effects
of medication.
29. For ID injections, use pencil Nd draw
circle around perimeter of injection site.
Check site within 48 to 72 hours of injection .
30. Record medication administration
31. Record and report clients response to
injection and any undesirable effects caused
by the medication.

CHECKLIST FOR ADMINISTERING TOPICAL MEDICATIONS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure.
ASSESSMENT
2. Review physician's order for client's name,
name of drug, strength, time of
administration, site of application.
3. Review pertinent information related to the
administration of the medication such as
action, purpose, side effects and nursing
implications.
4. Assess condition of client’s skin. Cleanse
skin if necessary, to visualize adequately.
5. Determine whether client has known
allergy to latex or topical agent. Determine
whether client is physically able to apply
medication
PLANNING
7. Identify client and introduce yourself to the
client.
8. Explain procedure and rationale to the
client and significant others.
9.Gather appropriate equipment
10. Perform hand washing.
IMPLEMENTATION
11. Apply topical creams, ointments, and oil-
based lotions.
11.1 Wear gloves. Exposed affected area
while keeping unaffected areas covered.
11.2 Wash affected area, removing all
debris, and previous medications.
11.3 Soak area with plan warm water to
removed crusted tissues.
11.4 Pat skin or allow to air dry.
11.5 If skin is excessively dry and flaking,
apply topical agent while skin is still damp.
11.6 Remove gloves and apply new dean
gloves.
11.7 Place medication in the palm of gloved
hand and soften by rubbing briskly between
hands
11.8 Once medication is thin and smooth
smear it evenly over skin surface, using long
and even strokes that follow direction of the
hair growth.
11.9 Explain to client that skin may feel
greasy.
12. Ensure client’s comfort and safety.
13. Perform hand washing.
14. Report and record nursing intervention.
EVALUATION
15. Evaluate condition of skin
16. Observe client's ability to apply
medication.
17. Evaluate learning needs of client and
family.
18. Identify unexpected outcomes and
intervene as necessary

CHECKLIST FOR INSTILLING EYE AND EAR MEDICATIONS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of To ask for guidance
the procedure.
ASSESSMENT
2. Review physician's order for client's name, To avoid medication error.
name of drug. concentration, number of drops
(if liquid) time and eye or ear.
3. Review pertinent information related to the
administration of the medication such as
action, purpose, side effects and nursing
implications.
4. Assess condition of external eye or ear
structures.
5. Determine whether client has symptoms of
discomfort or hearing or visual impairment.
6. Determine whether client has any known
allergies to medications.
7. Assess client's ability to manipulate or hold
dropper.
PLANNING
8. Identify client and introduce yourself to the
client.
9. Explain procedure and rationale to the
client and significant others.
10. Gather appropriate equipment.
11. Perform hand washing
IMPLEMENTATION
12. Compare the medication card with the
label of medication.
13. Review the six rights of medication.
14. Verify client's identification. This ensures that the right client receives the
right medication.
15. Apply gloves.
16. Ask client to lie supine or sit back in chair If not removed, material on the eyelid and
with neck slightly hyperextended for eye lashes can be washed into the eye. Cleaning
drops. For eardrops, position client on the toward the outer canthus prevents
side or sitting in chair with affected ear facing contamination of the other eye and the
up. Gently wash away drainage from inner lacrimal duct.
and outer canthus.
17. Instill eyedrops. Checking medication data is essential to
prevent a medical error.
17.1 Apply gloves. Hold cotton balls or
cleanse tissue in nondominant hand on
client's cheekbone just below lower eyelid
17.2 With tissue or cotton resting below lower
lid, gently press downward with thumb or
forefinger against bony orbit, exposing
conjunctival sac.
17.3 Ask client to look at celling. The person is less likely to blink if looking up.
While the client looks up, the cornea is
partially protected by the upper eyelid. A
sponge is needed to press on the
nasolacrimal duct after a liquid instillation to
prevent systemic absorption or to wipe
excess ointment from the eyelashes after an
ointment is instilled.
17.4 Rest dominant hand gently on clients
forehead, and
17.5 Drop prescribed number of medications
drops into conjunctival sac.
17.6 If client blinks or close eyes or if drops
land on outer lid margins, repeat procedure.
17.7 After instilling drops, ask client to close
eye gently.
18. To instill eye ointment.
18.1 Apply gloves. Ask client to look up.
18.2 Apply thin stream of ointment along
upper fid margin on inner conjunctiva.
18.3 Have client close eyes and rub lid lightly
in circular motion with cotton ball, if rubbing is
not contraindicated.
18.4 If excess medication is on eyelid, gently
wipe it from inner to outer canthus.
19. If client needs an eye patch, apply clean
one by placing it Over affected eye so entire
eye is covered. Tape securely
20. Instill eardrops.
20.1 Apply gloves if drainage is present
20.2 Hold bottle in hand. Position client with
affected ear facing up.
20.3 Straighten ear canal by pulling auricle
upward and outward (adult) or down and back
(child).
20.4 If cerumen or drainage occludes
outermost portion of ear canal, wipe out
gently with cotton-tipped applicator, taking not
to force wax inward.
20.5 Instill prescribed drops holding dropper
1/2 inch above ear canal.
20.6 Ask client to remain in side-lying position
5- 10 minutes and apply gently massage or
pressure to ear with finger.
EVALUATION
21. Evaluate effects of the medication
22. Note client's response to instillation and
observe for side effects.
23. Evaluate client's ability to self-evaluate.
24. Identify unexpected outcomes and
intervene as necessary.

CHECKLIST FOR INSERTING RECTAL AND VAGINAL MEDICATIONS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of To ask for guidance
the procedure.
ASSESSMENT
2. Review physician's order, including client's To avoid medication error.
name, drug name, form (cream or
suppository), route, dosage, and time of
administration.
3. Review pertinent information related to
medication, including action, purpose, side
effects and nursing implications.
4. Inspect condition of external genitalia and
vaginal canal or rectum (May be done just
before insertion).
5. Encourage client to ask clarification during
communication
PLANNING
6. Verify nursing interventions using
physician's order or nursing care plan
7. Identify client and introduce yourself to the
client.
8. Explain procedure and rationale to the
client and significant others.
9. Gather appropriate equipment
10. Perform hand washing.
IMPLEMENTATION
11. Create a climate of warmth and
acceptance.
12. Address the client by name.
13. Use questions appropriately
a. Ask one at a time
b. Allow time to answer.
c. Use open-ended questions
14. Use clear and concise statements.
15. Focus on understanding the client,
providing feedback, assisting problem solving.
16. Adjust time allowed based on client's
needs.
17. Summarize what was discussed.
18. Ensure client's comfort and safety.
19. Perform hand washing.
20. Report and record nursing intervention.
EVALUATION
21. Observe responses towards
communication.
22. Request for feedback from the client.
23. Verify if information obtained is accurate.
24. Identify unexpected outcomes and
intervene as necessary.

CHECKLIST FOR STARTING AN INTRAVENOUS INFUSION

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure.
ASSESSMENT
2. Assess client's status.
3. Verify prescriber's order for V therapy.
4. Check solution label.
5. Encourage client to ask clarification during
procedure.
PLANNING
6. Identify client and introduce yourself to the
client
7. Explain procedure and rationale to the
client and significant others.
8.Gather appropriate equipments
9. Perform hand washing and put on a
disposable glove.
IMPLEMENTATION
10. Create a climate of warmth and
acceptance.
11. Address the client by name.
12. Choose site. Use distal veins of hands
and arms first
13. Choose IV cannula or catheter.
14. Connect infusion bag and IV tubing and
run solution through tubing to displace air,
cover end of tubing.
15. Raise bed to comfortable working height
and position for patent adjust lighting. Position
patient's am below heart level to encourage
capillary filling. Place protective pad on bed
under patient's arm.
16. Apply tourniquet 6-8 inches above the
injection site. Palpate for a pulse distal to the
tourniquet. Ask patient to open and dose first
several times or position patient's am in a
dependent position to distend a vein.
17. Ensure Apply alcohol swab for 2-3
minutes in a circular motion , moving outward
from injection site. Allow to dry.
18. With hand not holding the venous access
device, steady patient's arm and use finger or
thumb to pull skin taut over vessel.
19. Holding needle bevel up at 5-25 degrees
angle, depending on the depth of the vein,
pierce skin to reach but not penetrate vein.
20. Decrease angle of needle further until
nearly parallel with skin. then enter vein either
directly above or from the side in one quick
motion.
21. H backflow of blood is visible, straighten
angle and advance needle. Advance needle
% venipuncture. Hold needle hub and slide
catheter over the needle into the vein. Never
reinsert needle into the plastic catheter or pull
the catheter back into the needle.
22. Remove needle while pressing lightly on
the skin over the catheter tip, hold catheter
hub in place.
23. Release tourniquet and attach infusion
tubing, open clamp enough to allow drip.
24. Slip a sterile 2 inches x 2 inches gauze
pad under the catheter hub.
25. Anchor needle firmly in place with tape.
26. Cover the insertion site with a transparent
dressing or sterile gauze, tape in place with
non-allergenic tape but do not encircle
extremity.
27. A padded approximate length arm board
may be applied to an area of flexion.
28. Calculate infusion rate and regulate flow
of infusion.
EVALUATION
29. Document site, cannula, size and type,
number of attempts at insertion, time,
solution, IV rate.
30. Ask patient what he/she feels after the
procedure.
31. Check for the flow of the infusion.
32. Discard materials used.

CHECKLIST FOR ADMINISTERING PERIPHERAL INTRAVENOUS INFUSION

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure
ASSESSMENT
2. Review client's medical record for order.
Follow "6 R's " for administration of
medications.
3. Observe client for signs and symptoms
indicating fluid or electrolyte imbalances.
4. Assess client's prior experience with
Intravenous (IV) therapy.
5. Assess laboratory data and client’s
allergies and other risk factors.
PLANNING
6. Explain procedure to client.
7. Assist client to a comfortable sitting or lying
position.
8. Perform hand washing.
9. Organize equipment on bedside stand or
overbed table.
10. Change client's gown to a more easily
removable gown with snaps at shoulder, if
available.
IMPLEMENTATION
11. Open sterile packages and maintain a
sterile technique throughout.
12. Check IV solution. Make sure prescribed
additives (e.g., potassium, vitamins) have
been added. Check solution for color, clarity,
and expiration date. Check bag for leaks.
13. Open Infusion set.
14. Place roller clamp about 2 to 4 cm below
drip chamber and move roller clamp to "off
position.
15. Remove protective sheath over IV tubing
port.
16. Insert infusion set into fluid bag or bottle.
Remove protector cap from tubing insertion
spike and insert spike into opening of IV bag.
Cleanse rubber stopper on bottled solutions
with anti-septic and insert spike into black
rubber stopper of IV bottle.
17. Prime infusion tubing by filling with IV
solution. Compress drip chamber and
release, allowing it to fill one third to one half
fl.
18. Remove tubing protector cap and slowly
release roller damp to allow fluid to travel
from drip chamber through tubing lo needle
adapter, return roller damp to "off position
after tubing is primed.
19. Clear tubing of air bubbles Firmly tap IV
tubing where air bubbles are located. Check
entire length of tubing to ensure that all air
bubbles are removed.
20. Replace tubing cap protector on end of
tubing.
21. Optional: Prepare heparin or normal
saline lock for infusion. Use a sterile
technique to connect the IV plug to the loop or
short extension tubing. Inject 1 to 3 ml normal
saline through the plug and through the loop
or short extension tubing
23. Place tourniquet 10 to 15 cm above
insertion site. Check presence of distal pulse.
24. Select well-dilated vein. Foster vein
dilation with the following techniques:
24.1 Stroke the extremity from distal to
proximal sites below the proposed
venipuncture site.
24.2 Tell client to open and close the first of
the arm where the site has been selected.
24.3 Lower the extremity on which the site
has been selected.
25. Release tourniquet temporarily. Clip
excess hair at site,
26. Cleanse insertion site using firm, circular
motion, and povidone iodine solution. Refrain
from touching cleansed site. Allow the site to
dry for at least 2 minutes. If client is allergic to
iodine, use 70% alcohol and allow site to dry
for 60 seconds.
27. Perform venipuncture. Anchor vein by
placing thumb over vein and stretching skin
against the direction of insertion 7 to 10 cm
distal to the site.
27.1Over-the needle catheter. Insert over-the-
needle catheter with bevel up at 20- to 30-
degree angle slightly distal to actual site and
in the direction of the vein.
27.2 Needleless V catheter safety device:
Insert using same technique as for over-the-
needle catheter.
28. Look for blood return through tubing of
butterfly needle or flashback chamber of over-
the-needle catheter. Lower needle until
almost flush with skin. Advance butterfly
needle until hub rests at venipuncture site.
Advance over-the-needle catheter 1/4 inch
into vein and then loosen stylet. Advance
catheter into vein until hub rests at
venipuncture site. Do not reinsert the stylet
once it is loosened.
29. Stabilize the catheter with one hand by
placing pressure on the hub or on the vein
above insertion site. Release tourniquet and
remove stylet from over-the-needle catheter,
do not recap the stylet. Slide the catheter off
the stylet while gliding the protective guard
over the stylet.
30. Connect needle adapter of administration
set or heparin lock o hub of over-the-needle
catheter or butterfly tubing. Do not touch point
of entry of needle adapter.
31. Bloodless method: Hold pressure over tip
of inserted catheter with thumb. With index
finger and thumb, remove cap and attach
tubing to catheter hub.
32. Release roller clamp slowly to begin
infusion at a rate to maintain patency of IV
line.
33. Secure IV catheter or needle: Place
narrow piece of tape under catheter hub with
sticky side up and cross tape over catheter.

CHECKLIST FOR ADMINISTERING MEDICATIONS BY IV BOLUS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure.
ASSESSMENT
2. Review specific drug action and expected
response, client's knowledge of drug action
and nursing responsibilities.
3. Assess client's history of allergy.
4. Check expiration date of the medication.
5. Check the medication administration record
(MAR). medication card or patient's chart.
PLANNING
6. Organize the equipment
7. Prepare medication from vial or ampule.
Check dilution instructions. Apply a small-
gauge needle to syringe
8. Take note of the 6 R's in medication
administration.
9. Explain procedure and rationale to the
client and significant others with a smile. Tell
client the injection will cause a slight
10. Provide privacy
11. Perform hand washing.
12. Apply disposable gloves.
IMPLEMENTATION
13. Determine that IV fluids are infusing at
proper rate.
14. Procedure for existing line:
14.1 Select injection port of tubing closest to
needle insertion site.
14.2 Cleanse injection port with antiseptic
swab
14.3 Connect syringe to IV line.
14.4 Occlude IV line by pinching tubing above
port.
14.5 Continue to occlude tubing while
injecting medication slowly.
14.6 Release tubing. Withdraw syringe and
recheck IV rate.
15. Dispose of all equipment property.
16. Remove and dispose of gloves.
17. Wash hands
EVALUATION
18. Stay with client and observe for any
immediate reactions.
19. Observe client closely for adverse
reactions during and for several minutes after
administration.
20. Record medication administration

ADDING MEDICATIONS TO INTRAVENOUS FLUID CONTAINERS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of
the procedure
ASSESSMENT
2. Check prescriber's order to determine type
of intravenous (IV) solution to use and type of
medication and dosage.
3. Collect necessary information for safe
administration of the drug
4. Assess for the compatibility of multiple
medications in a single IV solution.
5. Assess client's systemic fluid balance.
6. Assess client's history of allergies
7. Assess IV insertion site for signs of
infiltration or phlebitis.
8. Assess client's understanding of the
purpose of the drug therapy
PLANNING
9. Assemble supplies in medication room.
10. Prepare prescribed medication from vial
or ampule.
11. Explain procedure with a smile to the
client to gain participation
IMPLEMENTATION
11. Add medication to new container.
11.1 Locate injection port
11.1.1 Solutions in bags: Locate medication
injection port on plastic IV solution bag.
11.1.2 Solutions in bottles: Locate injection
site on IV solution bottle, which is often
covered by a metal or plastic cap.
11.2 Wipe off port or injection site with alcohol
or antiseptic swab.
11.3 Remove needle cap or sheath from
syringe and insert needle through center of
injection port or site.
11.4 Inject medication.
11.5 Withdraw syringe from bag or bottle.
11.6 Mix medication and IV solution by
holding bag or bottle and turning it gently end
to end.
11.7 Complete medication label with name,
dose of medication, date, time, and initials.
Stick label on bottle
12. Bring assembled items to client's bedside.
13. Identity client.
14. Explain procedure to client and alert client
to expected sensations.
15. Regulate infusion at ordered rate.
16. Add medication to existing container.
17. Prepare vented IV bottle or plastic bag:
17.1 Check volume of solution remaining in
bottle or bag.
17.2 Close off IV infusion clamp.
17.3 Wipe off medication port with an alcohol
or antiseptic swab.
17.4 Insert syringe needle through injection
port and inject medication.
17.5 Lower bag or bottle from IV pole and
gently mix. Rehang bag
17.6 Complete medication label and stick it to
bag or bottle.
17.7 Regulate infusion to desired rate.
18. Properly dispose of equipment and
supplies. Do not cap needle of syringe.
Discard sheathed needles as a unit with
needle covered.
19. Wash hands.
EVALUATION
20. Observe client for signs and symptoms of
drug reactions.
21. Observe client for signs and symptoms of
fluid volume excess.
22. Periodically return to client's room to
assess IV insertion site and rate of infusion.
23. Observe client for signs or symptoms of
IV infiltration.
24. Record solution and medication added to
parenteral fluid on appropriate form and
report and side effects observed.