1.

ADMINISTRATION OF MEDICATIONS
2. ADMINISTRATION OF MEDICATIONS • Alteration in health related to acute or chronic
conditions lead clients to seek relief of symptoms through various treatments options one of
which is the medication regime. Successful medical therapy depends on the partnership of the
patient and the medical staff (including the nurse). This increased collaboration among health
care providers demand in-depth understanding of drug, actions, interactions, therapeutic and
adverse effect and the exercise of judgment in drug administration.
3. ADMINISTRATION OF MEDICATIONS • Thus implementation of prescriptions or orders
of the physician/pharmacist involves far more than merely carrying out tasks. As an educated,
independently licensed health care provider, the nurse is always responsible for any care
given (including administration of drugs) whether prescribed by the physician or planned by
the nurse.
4. ADMINISTRATION OF MEDICATIONS • The nurses’ first responsibility is to understand
the ordered therapy, its goal for the patient and how it is to be carried out. If a physician orders
a medication and it is observed that the written dosage is ten times the usual dosage for that
medication, instead of giving the medication because “the doctor ordered it”, call the doctor
and discuss the order. More so since the patient’s state is not static, understand his condition
in relation to the medication. If an oral medication is prescribed for a vomiting patient, an
understanding nurse should inform the physician for change instead of just giving the drug just
because “the doctor wrote it”.
5. ADMINISTRATION OF MEDICATIONS • What is a drug? Drug is any substance other
than food which when administered alters the physiological process of the biological being. It
is a chemical substance intended for use in the diagnosis, treatment,cure,mitigation or
prevention of a disease. Drug is a general term used for both legal and illegal substances
(either than food) which alters physiological processes. Medication or medicine is more
appropriate for drugs used for therapeutic purposes.

6. ADMINISTRATION OF MEDICATIONS • Uses of Drugs • Prevention- used as

prophylaxis to prevent diseases e.g. vaccines; fluoride-prevents tooth decay. • Diagnosis-
establishing the patient’s disease or problem e.g. radio contrast dye; tuberculosis (Mantoux)
testing. • Suppression- suppresses the signs and symptoms and prevents the disease process
from progressing e.g. anticancer, antiviral drugs.
7. ADMINISTRATION OF MEDICATIONS • Treatment- alleviate the symptoms for patients
with chronic disease e.g. Anti-asthmatic drugs. • Cure- complete eradication of diseases e.g.
anti-biotics, anti-helmintics. • Enhancement aspectsof health- achieve the best state of health
e.g. vitamins, minerals
8. ADMINISTRATION OF MEDICATIONS • Legal Aspects of Medication • Preparation,
dispensing and administration of medications are all covered by laws in every country. • The
DDA - Dangerous Drug Act. It is an act that governs the procurement and use of some drugs
especially the narcotics e.g. morphine, pethedine, cocaine etc. These drugs are prescription
only drugs hence cannot be bought or administered without prescription. Dangerous drugs are
always kept under lock and key in the Dangerous Drug Cupboard under the care of trusted
senior nurses.
9. ADMINISTRATION OF MEDICATIONS • Section - 34 - Dangerous Drugs Record. • (1) A
person who supplies Class A or B, drugs shall keep on the premises from which he supplies
these drugs a book of the prescription to be known as the `Dangerous Drugs Record'.(2)
 Before any person supplies Class A drugs he shall record in the Dangerous Drugs Record the
following-(a) the name and quantity of the drug to be supplied;
10. ADMINISTRATION OF MEDICATIONS • (b) the name, and address, signature or
thumbprint of the person to whom it is supplied;(c) the signature of the person who supplies
the drug; and(d) the date of supply.(3) Where a drug is supplied under a prescription which is
retained by the supplier of the drug and an entry is made in the Dangerous Drug Record book
enabling the prescription to be referred to, no entry need be made in the Dangerous Drug
Record or any particulars specified in the prescription.
11. ADMINISTRATION OF MEDICATIONS • The procurement, supply, administration and
wastage (accidental during preparation of administration) are always under strict observation
through recording in the appropriate books and usually shift to shift handing over especially in
the wards. The student should be alert to institutional policies guiding the supply and
administration of Dangerous Drugs in the various hospitals where he/she may find him/herself.
12. ADMINISTRATION OF MEDICATIONS • It is worth knowing that nurses are responsible
for their own actions regardless of the presence of a written order. If a nurse gives an
overdose of a drug because it is written by a doctor, the error is accounted to the nurse and
not the doctor. The nurse should bear in mind that ALL substances are poisons: there is none
that is not a poison. The right dose differentiates a poison from a remedy.
13. Drug Nomenclature • One drug can have as much as 4 different names as follows: •
Chemical Name - any typical organic name; this precisely describes the constituents of the
drug • E.g. N-(4-hydroxyphenyl)acetamide for paracetamol
14. Drug Nomenclature • Generic Name - is given by the manufacturer who first develops
the drug; it is given before the drug becomes official. It is the name by which the drug will be
known throughout the world no matter how many companies manufacture it. This name is
usually agreed upon by the WHO. Often the generic name is derived from the chemical name.
E.g. acetaminophen
15. Drug Nomenclature • Official Name – this is the name by which a drug is listed in official
publications such as USP (United States Pharmacopoeia), BP (British Pharmacopoeia), BPC
(British Pharmacopoeia Codex), and NF (National Formulary). The above mentioned
documents are sources of drug information.
16. Drug Nomenclature • Trade/Proprietary/BrandName - is the name given to drug by the
manufacturing company and so the company is the legal owner of that name. So, a single
generic name can be sold under ten different trade names. Because of this trade names
should not be used in writing prescriptions as it can e misleading (Kinaquine is from
Kinapharma Company, and Efpac from the Effah Pharmacy and by other names from other
Companies).
17. Classification of Medication Medications may be classified according to: • The body
system that the medicine is targeted to interacts wit; e.g. cardiovascular medications, nervous
system medication etc. • Therapeutic usages of the medicine; e.g. antihypertensives
,neuroleptics, • The diseases the medicine is used for; e. g. anticancer drugs, antimalaria
drugs antihelminthics etc.
18. Classification of Medication • The action of the medication can also be used to classify
the it; e.g. beta-adrenergic blocking agents • The overall effect of the medication on the body
can also be a criteria for its classification; e.g. sedatives, antianxiety drugs etc.
19. Forms of Drugs Solids • Capsule- powder, liquid or oil form of medication enclosed in a
gelatine shell. • Tablet-a powdered form of medication compressed into a hard small disk or
cylinder. May be a variety of colours or sizes. Enteric coated tablets are covered with a
substance that is insoluble in gastric acids, thus reducing the possible gastric irritation.
20. Tablets Capsule
21. Forms of Drugs • Lozenge-flat round preparation containing drug in a flavoured or
sweetened base that dissolves in the mouth to release the medication; it is also called troche.
• Suppository-one or more drugs mixed into a firm base, such a gelatin, designed for insertion
into a body cavity. The preparation melts at body temperature releasing the medication for
absorption
22. Forms of Drugs • Pill-a mixture of powdered drug with cohesive material in a round, oval,
or oblong shape. • Powder-a drug ground into fine particles from a solid for inhalation or
application to the skin.
23. Forms of Drugs Semi-solids • Ointment-semisolid preparation of one or more drugs
applied to the skin • Liniment-medication mixed with alcohol, oil or soapy emollient, which is
applied to the skin. • Paste-semisolid preparation, thicker and stiffer than ointment; absorbed
more slowly than ointment that penetrates through the skin.
24. Forms of Drugs • Cream-a non-greasy semi-solid preparation used on the skin • Gel or
Jelly- a clear translucent semi-solid that liquefies when applied to the skin
25. Forms of Drugs • Elixir-medication is a clear liquid containing alcohol, water,
sweeteners, and flavouring. Designed for oral use. • Lotion-drug in liquid suspension designed
for topical use. • Solution-a drug dissolved in another liquid substance; may be used orally,
parenterally, or externally • Suspension-fine drug particles dispersed in a liquid medium. Must
be shaken before use • Syrup-medication dissolved in a concentrated sugar solution to mask
unpleasant taste
26. Forms of Drugs • Tincture-an alcohol or water and alcohol solution prepared from drugs
derived from plants
27. Forms of Drugs • These form/preparations of drugs are packaged as ampoules, vials,
blister packs, sachets etc. • Aam • ampoules
28. Blister Packs Vials
29. Storage of Medications • Medications are dispensed by the pharmacy to nursing units.
Once delivered, proper storage becomes the responsibility of the nurse. All medications must
be stored in a cool dry place (usually in cabinets, medicine carts or fridges)
30. All medications must be stored in a cool dry place (usually in cabinets, medicine
carts or fridges)
31. Storage of Medications • In less advanced countries, 3 cupboards are usually used for
drug storage. • Cupboard I-used for drugs for external use only; e.g. calamine lotion, detol,
methylated spirit etc. These drugs are contained in distinctive bottles, usually ridged with deep
colours (dark green, blue, brown) with red label marked POISON and FOR EXTERNAL USE
ONLY.
32. Storage of Medications • Cupboard II-contains drugs for internal use only e.g. tablets,
suspension, mixtures etc. All drugs must be labelled. • Cupboard III-contains the dangerous
drug; drugs of addiction. E.g. Morphine, pethedine etc. All drugs should be kept away from
direct sunlight and at a temperature suggested by the manufacturer.
33. Storage of Medications • Another cupboard called the Emergency Cupboard may be
stationed at or near the nurses bay for easy access. This cupboard contains drugs for
emergency situations e.g. aminophylline (for asthma), hydralazine (for severe hypertension),
oxytocin (for maternal bleeding), intravenous infusions (for rehydration) etc.
34. Storage of Medications • In advanced hospitals, use is made of computer controlled
dispensing units for a more secure storage of medications. This is made possible through soft
wares on computers which has patient’s particulars and medication orders. With a password,
 the nurse selects the medication needed; the drawer with the medication opens and the drug
is delivered.
35. Storage of Medications • Some medications such as insulin, vaccines and ATS (anti-
tetanol serum) must be stored in medication refrigerators to preserve their potency.
36. ROUTES OF DRUG ADMINISTRATION • The route of drug administration is the path by
which a drug is brought into contact with the body. • Drugs are introduced into the body by
several routes; it is paramount for the nurse to ensure that the pharmaceutical preparation is
appropriate for the route specified
37. Enteral– administering medication through the gastro-intestinal route; e.g. • Oral •
Sub-lingual • Rectal
38. 2. Parenteral Route • Intravenous • Intramuscular • Intrathecal • Intradermal •
Subcutaneous etc.
39. Routes Of Drug Administration 3. Topical Route (usually for local effect) • On the skin •
Nasally • On the cornea • In the ear etc. 4. Inhalation [Pls Read and make notes on 3 and 4
above]
40. Enteral Route Drug is administered through the gastro-intestinal route • Oral route – it is
the most commonly used route for most drugs because it is • Safe • Convenient • Least
expensive
41. Routes Of Drug Administration • The medicine is swallowed with fluid or is given
through a tube. This route is contra-indicated in patient on nil per os, or patients with
operations of the GIT. 2. Sub-lingual; the drug is placed under the tongue to dissolve slowly
and be absorbed.
42. Routes Of Drug Administration • drugs can also be administered into the buccal cavity
(into the superior posterior aspect of the cheek next to the molars. Drugs administered
through these routes act quickly due to the thin and large vascularisation which permits quick
absorption into the blood stream
43. Routes Of Drug Administration 3. Drugs can also be administered into the rectum. The
suppository gradually dissolves at body temperature and releases the drug which is then
absorbed through the mucous .Rectal administration of drug is contraindicated in diarrhoea,
rectal prolapse or rectal surgeries.
44. Routes Of Drug Administration Parenteral Route – this means introduction of
medicines by injection into body tissues or blood vessels. Because this is an invasive
procedure, sterile technique must always be applied. It has the following advantages: • Rapid
and predictable absorption • By pass GIT enzymes and gastric acid hence used for drugs that
can be destroyed by gastric acid and GIT enzymes
45. Routes Of Drug Administration • Can be used for unconscious and uncooperative
patients. However, it • Needs strict asepsis • Pain is associated with the injection • More
expensive • Self administration is difficult because it is difficult/needs skilled person • Difficulty
in correcting overdose errors • Risk of infection or local irritation
46. Routes Of Drug Administration • Intramuscular injection- the drug is administered into
the muscle and it passes through capillary walls to enter the blood stream. Advantages • More
rapid absorption than subcutaneous injection; onset of action is about 10 -15 minutes •
Absorption can be hastened by drug preparation (aqueous is faster than oil)
47. Routes Of Drug Administration • More painful than SQ. • Vasoconstriction cannot be
used to slow down preparation Subcutaneous Route-drug is injected beneath the skin to
permeate capillary wall and enter the blood stream Advantages • Slow absorption rate (onset
of action about 20minutes)
48. Routes Of Drug Administration • Rate of absorption can be altered by preparation of
drug (oil preparations are slow to be absorbed, local vasoconstriction. Disadvantages • Only
smaller volumes can be administered compared to IM injections • Irritating drugs may produce
severe pain and local necrosis.
49. Routes Of Drug Administration • Intravenous Route- drug is administered directly into
the blood stream. Advantages • Rapid onset of action within 1-2 minutes • Most irritating
substances may be given • Very large volumes of drug may be given • Preferred route of
medication in emergencies • 100% bioavailability of drug.
50. Routes Of Drug Administration • Dangerous complications e.g. embolism and
immediate toxic effects • Very technical; getting the vein regulating the right dose per minute •
Requires greater care.
51. Routes Of Drug Administration Topical Applications-medications are applied to the skin
or mucous membrane for local effect or for absorption into the blood stream. Although a large
number of topical drugs are applied to the skin, other topical drugs include the eye, nose, ear,
rectal and vaginal preparation. Creams, lotions, ointments etc. are usually for local effects,
however, small amounts are absorbed into the system resulting in systemic effects
52. Routes Of Drug Administration Inhalations-gaseous and volatile substances such as
anaesthetic agents, oxygen are administered by inhalation using nebulizers positive pressure
apparatus. The drugs are almost immediately absorbed into systemic circulation due to larger
surface area, high vascularization and high permeability
53. Routes Of Drug Administration Advantages • Drug is delivered close to the target
tissue if local action is desired • There is rapid absorption if systemic effect is desired.
54. Abbreviations used in drug administration • a.c before meals • aq water • bd or bid
twice a day • g gram • im intramuscular • iv intravenous • p.c after meals • tid three times a
day • qid four times a day • h hourly
55. MEDICAL ORDERS A prescription is a written instruction from a licensed prescriber
concerning the form and dosage of a drug to be issued to a patient. It is a medication order.
However, in certain situations, a verbal order may be given directly or through the telephone.
Medication orders may be written on the client’s medical records sheets (folder) or on a legal
prescription pads
56. Medical Orders Types of Medication Orders Generally, there are 2 types of orders: •
Standing orders • Self-terminating orders
57. Medical Orders • Standing orders are carried out until it is cancelled by another order;
that is until the prescriber discontinues or modifies the dosage or frequency with another order
or until a prescribed number of days has elapsed as determined by the agency policy. • E.g.
Insuline 10U SC qd at 1800 (6pm). This order has no limit and must be continued until it
(order) is modified or discontinued.
58. Medical Orders • A prn order, like IM Morphine 15mg q4h prn, is a standing order; there
is no direction as to when it should be stopped. The order does not specify the number of
days or number of dosages of the drug to be received. • Self-terminating Order: this order
specifies the number of days or the number of dosages of the drug the client is to receive.
59. Medical Orders • E.g. Caps Tetracycline 250mg PO q6h x 5 days. This implies that on
the 5th day, when patient receives the 20th dosage, the order ends; the day (time) of the first
dose marks day 1. • A stat order is an order for a single dose of a medication but it must be
given immediately; as soon as possible. This ‘once and immediately’ order is usually given in
emergency or serious situations.
60. Medical Orders A medication order must have the following: 1.The full name of the
patient: writing the full name of the patient prevents a state of confusion when two patients
 bear the same first or last name. Also, the patient’s number (In-patient or out-patient) may be
added and also the ward if on admission.
61. Medical Orders • Date and Time the order is written: this is important to establish when
an order is given and when it was carried out. It also helps to determine when an order
automatically terminates. • The Form and Name of the drug: the name and form of the drug to
be administered should be written using preferably the generic name. In cases where trade
names are used which nurse is not familiar with, clarification should be sought from the
prescriber or the pharmacopoeia.
62. Medical Orders 4. Dosage of the drug: dosage of the drug includes the amount,
frequency or time(s) of administration and the strength. E.g. • Caps Tetracycline 500mg tid x 5
days; 500mg (amount), tid (frequency). • IVF 50% (strength) Dextrose 5ml (amount) nocte
(time) x 2 days (duration).
63. Medical Orders 5. Route of Administration and special directives about its administration.
Since it is possible for one drug to have several possible routes of administration, it is
important that the route preferred by the prescriber is stated in the order. If for any reason a
prescribed route is contraindicated in the patient, the nurse should notify the prescriber rather
than choosing another route on his/her own accord.
64. Medical Orders • Special directives may include ‘ give slowly over 20, 30, 40 etc.
minutes; take before, after or with meals; etc. 6. Signature of the Prescriber: the signature
makes the medical order a legal request. Without it, the order is invalid. NB: for medical orders
taken verbally, the nurse signs it, to be co-signed by the prescriber later.
65. Dose Calculation and Conversions • When prescriptions are issued for medication
orders to be carried out, it becomes necessary at times to calculate doses to be given
especially when the drugs are dispensed in lager doses or strengths; or the units are different.
66. Dose Calculation and Conversions • Measurements (units) can be in the • Metric
system e.g. gram (g), meter (m) etc. • Apothecary System e.g. grain (gr), minim (m), pint (pt). •
Household System e.g. drop (gtt), teaspoon (tsp) or tablespoon (tsp)
67. Metric 1ml 15ml 30ml 500ml 1000ml 4000ml Apothecary 15 minims 4 fluid drams 1fluid
ounce 1pint 1 quart 1gallon Household 15 drops (gtt) 1tablespoon 1fluid ounce 1pint 1 quart
1gallon
68. Dose Calculation and Conversions Metric 1mg 60mg 1g 4g 30g 500g 1000g (1kg)
Apothecary 1/60 grain (gr) 1grain (gr) 15 grains (gr) 1 dram (D) 1ounce 1.1 pound (lb) 2.2 (lb)
69. Dose Calculation and Conversions Trial Question 1 If a prescription given orders Inj.
Cephalexin 500mg IV qid x 2 days but the pharmacy dispenses 2g in 10ml, the dose to be
administered is ………… Trial Question 2 If Inj. Heparin 10000 units SC is ordered but 40,000
units per ml vial is supplied from the pharmacy, how many millilitres should be administered?
70. Dose Calculation and Conversions • The paediatric dose of any medication is usually
smaller than the adult dose. Several rules have been devised to calculate the infants’ and
children’s dosages such as Young’s Rule, Clark’s Rule and Fried’s Rule. These rule give
approximate dosages. Fried’s Rule consider children under one year and so considers the
adult age to be 150 months which is 12½ years.
71. Dose Calculation and Conversions Fried’s Rule for children under 1year Infant dose =
age of child in months x Adult Dose 150 months Young’s Rule assumes a person under 12½
years is a child; for children over 1year. Child’s Dose= Age of child in years x Adult Dose Age
of child in years +12
72. Dose Calculation and Conversions Clark’s Rule calculates the dose of a child base on
his/her weight and have an advantage over the other rules in that it can be used for children of
 all ages. An average adult weight of 150 pounds is (approx. 68kg). Can be used for children of
all ages. Child’s Dose = weight of child (in pounds) x Adult dose 150
73. Dose Calculation and Conversions • Clarks Rule calculates the dose of a child based
on his or her weight and it have an advantage over the other rules n that it can be use for
children of all ages. An average adult weight of 150pounds [approx.65kg] is used Childs Dose
= Weight of child in pounds × Adult Dose 150months
74. Dose Calculation and Conversions The Body Surface Area (BSA) method of
calculating drug doses is widely used for two types of patients: • Cancer patients • Paediatric
patients. The BSA calculations are done in two ways: 1. Using the standard chart which
features the weight, BSA and dose to be taken,
75. Dose Calculation and Conversions 2. Calculation using the formula Patient’s dose =
Patient’s BSA (m²) X Drug Dose (mg) 1.73 m² The average adult is considered to have a BSA
of 1.73m².The BSA of an individual is determined by drawing a straight line connecting the
person’s height and weight. The point at which the line intersects the centre column indicates
the person’s BSA in square meters.
76. Dose Calculation and Conversions E.g. If the adult dose of a drug is 100mg, calculate
the approximate dose for a child with a BSA of 0.83m², using the equation above. Ans 48mg.
77. Nomograph to Determine BSA
78. Rights of Medication Administration Medication errors can be detrimental to patients.
To prevent these errors, these guidelines are -the rights- are used in drug administration. 1.
Right Patient: correct identification of the client cannot be over emphasized. This can be done
by asking the client to mention his/her full name which should be compared with that on the
identification bracelet or the patient’s folder and medication/treatment chart for confirmation.
79. Rights of Medication Administration • Beware of same and similar first and surnames
to prevent the error of administering one person’s medication to another and vice versa. 2.
Right Medication: before administering any medicine, compare name on medication
chart/medication order with that on the medication at least 3 times-checking medication label
when removing it from storage unit, compare medication label with that on treatment chart and
medication label and name on treatment chart with patient’s name tag.
80. Rights of Medication Administration 3. Right Time: drug timing is very especially with
some drugs like antibiotics, antimalaria drugs etc. to achieve cure and prevents resistance.
Some drugs must be given on empty stomach e.g. antituberculosis drugs; and some after
meals e.g. NSAIDS-these must be noted and adhered to.
81. Rights of Medication Administration • The interval of administration of drugs should
also be adhered to because it is important for many drugs that the blood concentration is not
allowed to fall below a given level and for others two successive doses closer than prescribed
might increase blood concentration to a dangerous level that can harm the patient..
82. Rights of Medication Administration 4. Right Dose: this becomes very important when
medications at hand are in a larger volume or strength than the prescribed order given or
when the unit of measurement in the order is different from that supplied from the pharmacy.
Careful and correct calculation is important to prevent over or under dosage of the medication.
83. Rights of Medication Administration 5. Right Route: an acceptable medication order
must specify the route of medication. If this is unclear, the prescriber should be contacted to
clarify or specify it. The nurse should never decide on a route without consulting the
prescriber.
84. Rights of Medication Administration 6. Right to information on drug/client education;
the patient has the right to know the drug he/she is taking, desired and adverse effects and all
there is to know about the medication. The charter on patient’s right made this clear. 7. Right
 to Refuse Medication: the patient has the right to refuse any medication. However, the nurse
is obliged to explain to patients why the drug is prescribed and the consequences refusing
medication.
85. Rights of Medication Administration 8. Right Assessment: some medications require
specific assessment before their administration e.g. checking of vital signs. Before a
medication like Digoxin is administered the pulse must be checked. Some medication orders
may contain specific assessments to be done prior to medication • 9. Right Documentation:
documentation should be done after medication and not before.
86. Rights of Medication Administration • 10. Right Evaluation; conduct assessment to
ascertain drug action, both desired an side effect.
87. Rights of Medication Administration • Drug Administration For convenience, especially
when many patients are to receive medication at a given time. The patient should be known
and folders arranged in the order in which the medications would be dispensed.
88. Rights of Medication Administration Administration of drug entails five interrelated
steps: • Identification of the patient • Administration of the drug • Adjunctive nursing
interventions • Recording • Evaluation of effectiveness of the drug
89. Enteral Drug Administration • The delivery of any medication that is absorbed through
the gastrointestinal tract
90. Oral Medication Oral medication can be by ingestion, sublingual administration (place
the pill or direct spray between the underside of the tongue and the floor of the oral cavity)or
buccal (place the medication between the patient’s cheek and gum). p
91. Oral Medication A tray or trolley should be set with: • Drug to be administered • Water in
a jug • Glass on a saucer all in the tray • Spoons • Mortar and pestle (when necessary) •
Towel • Straw • Spatula • Patient’s folder/treatment chart and pen
92. Gastric Tube Administration • Gastric tubes provide access directly to the GI system.
93. Rectal Administration • The rectum’s extreme vascularity promotes rapid drug
absorption. • Medications do not travel through the liver, and are not subject to hepatic
alteration.
94. Parenteral Medication Drug administration outside of the gastrointestinal
tract.Parenteral medication is an invasive procedure and so must be carried out observing the
standard infection prevention measures sterile techniques. Equipment The Syringe is one of
the equipment for administration of parenteral medication.
95. Parenteral Medication All syringes have • A tip which connects with the needle • A barrel
which has the calibration • The plunger which fits inside the barrel. Syringes come in different
shapes, sizes and colours. They may be made of glass or rubber or metal.
96. Syringes and Needles
97. Parenteral Medication
98. Parenteral Medication • The standard syringes come in 2, 3, 5 and 10cc sizes. There
are the 50, 60 and 100cc syringes which are not for injection but for adding large amounts of
sterile solutions to infusions or irrigating wounds. • The Insulin Syringes are designed specially
for use with the ordered dose of insuline. An insuline may come in concentrations of u100/cc,
u80/cc, u40/ccetc.
99. Parenteral Medication • The insuline syringe should always match the concentration of
the insuline. The syringes usually have a permanently attached needles that are thin (26-
30)and short (¼").
100. Parenteral Medication • Tuberculine Syringe, caliberated in tenths and hundredths of a
cubic centimeter on one side and in sixteeths of a minim on the other side, is a narrow
syringe. This syringe originally designed for tuberculin injections can also be used for small
and precise doses especially in children. It is used for doses of 0.5ml or less. .
101. Parenteral Medication • Prefilled single dose syringes are already filled with a drug. If
the dose ordered is lesser, the excess is expelled before administration.
102. Parenteral Medication • The Needles are usually made of stainless steel and are usually
disposable. They may be packaged with the syringe or separately. However, some special
needles for surgery or special procedures may be reused and hence are sterilizes after each
use.
103. Parenteral Medication • A needle has 3 parts: • The hub; the larges part which fits onto
the syringe • The cannular/shaft/stem; the long part which connects to the hub • The bevel is
the slanted part at the end of the shaft. The bevel may be short or long. The longer the bevel,
the sharper the needle.
104. Parenteral Medication • The length of the bevel selected is based on the type of
injection to be given. The long bevels are sharp and produce less pain when injected into
subscutaneous and muscle tissues. Short bevel needles are used for intradermal and
intravenous injection to pervent occlusion of the bevel with tissue. • A filter needle has a filter
inside the needle to prevent drawing up particles of glass or rubber in ampoules or vials. •
Before injection, the filter needle should be changed with one without it.
105. Parenteral Medication • Needles for injection has 3 variables: • The slant of the bevel, •
The length of the cannular • The gauge/diameter of the cannular. • The larger the gauge
number, the smaller the diameter of the shaft. The shaft varies from 3/8 to 5 inches while
gauge varies from no. 14 to 30.
106. Parenteral Medication • Thick and oily preparations need larger needle hose than
aqueous one and thicker muscles need longer needle shaft. The choice of needle, thus,
depends on muscle mass, type of injection the type of parenteral route for the injection
107. Parenteral Medication • Ampoules and Vials Because parenteral drug administration is
an invasive procedure, parenteral injections (preparations) are sterile. Drugs that deteriorate
in solution are dispensed in tablets or powders and dissolved in solution immediately before
injection.
108. Parenteral Medication • So left over from such preparation should not be used
especially if they are discoloured after some hours. Ampoules and vials are frequently used to
package parenteral medication • An ampoule is a glass container usually designed to hold
single dose of a drug. It is made of clear glass in a particular shape with a constriction at the
neck (may be coloured) for easy opening.
109. Parenteral Medication • Because frequently the drug will be both above the constriction
an and in the main portion of the ampoule, one should flick the upper portion (above the
constriction) severally with the finger nails to bring all medication to the main portion of the
ampoule before snapping it open after filling the neck.
110. Parenteral Medication • A sterile gauze placed around the neck before breaking prevent
cuts form the glass. • A single or multiple-dose glass bottles with a sealed rubber cap is called
a vial. They are usually covered with a soft metal cap that can be easily removed. The rubber
capping must be cleaned with antiseptic(e.g. methylated spirit) swab before a needle is
inserted. • The nurse should consider the use of a filter needle to withdraw medication
111. Withdrawing medication from Ampoules • Wash and dry hands • Select appropriate
ampoule • Select the appropriate needle and syringe • Take ampoule and observe for expiry
date, cloudiness (return to pharmacy if noticed) • While holding the ampoule flick at its
 neck/stem repeatedly with the fingernails to return trapped contents to the base of the
ampoule. • File if not scored at the neck
112. Withdrawing medication from Ampoules • Wrap a sterile gauze at the neck of the
ampoule and gently snap open. • Tilt ampoule slightly to one side, uncap needle on syringe
and insert needle below the level of the drug • Gently pull on the plunger to draw medicine into
the syringe • Change needle used in withdrawing drug • Expel air.
113. Withdrawing Medication from an Vial • Wash and dry hands • Take the vial and
observe for expiry date, direction for mixing • Withdraw the appropriate diluents into a syringe
• with a dissecting for remove metal or rubber cap covering the rubber stopper • Clean with
swap containing methylated spirit • Introduce needle through the middle of the rubber and
release diluent into the vial.
114. Withdrawing Medication from an Vial • Shake or roll between the palms till clear
solution free from lump is obtained. • Placing the syringe in the centre of the rubber stopper,
inject air into the vial. • Invert the vial and keep the needle bevel in the solution • With syringe
at eye level, ensure the desired dose is drawn up. • Slowly and gently, withdraw needle from
the vial and re-cap on a levelled surface
115. Withdrawing Medication from an Vial • Using ink, mark the current date, time and
initials on the vial • Label the syringe with drug, dose, date and time if not to be used
immediately • Wash and dry hands.
116. Withdrawing Medication from an Vial • If withdrawing medication from two vials
(multiple-dose) and mix in one syringe, draw up from the multiple vial first then the single vial
to prevent contamination of the multiple-dose vial. • In case of insulin, draw up the regular
insulin first before the short acting one.
117. Withdrawing Medication from an Vial
118. Intradermal Injection • An intradermal (intracutaneous) injection is the administration of
a drug into the dermal layer of the skin just beneath the epidermis. Only small volumes of drug
are administered by this route; about 0.01-0.1ml. • This route is indicated typically for
diagnosis of tuberculosis (tuberculin testing), testing for allergens and for vaccinations (e.g.
BCG)
119. Intradermal Injection • Needle gauge 25-27 with short bevel is used; about 3/8 -1/2
inches are used with the tuberculin syringe for accurate measurement. • Sites for injection are
the inner aspect of the fore arm, upper chest, upper back beneath the scapular.
120. Intradermal Injection
121. Intradermal Injection
122. Intradermal Injection Procedure • Wash and dry hands • Position client comfortably •
Select injection site and inspect for oedema, redness or tenderness or sites of previous
injection • With antiseptics swab, clean site • While holding swab between fingers of non-
dominant hand, pull cap off from the needle
123. Intradermal Injection • With thumb and forefinger of non-dominant hand, stretch skin
over the selected site and insert needle at an angle of 5°-15°, bevel up to about 1/8 inch
below the skin. • Do not aspirate; push plunger slowly to inject the drug to form a small bleb
under the skin surface. • Gently withdraw needle while applying gentle pressure with the
antiseptic swab; do not massage
124. Intradermal Injection • Make patient comfortable, than him and discard equipment as
appropriate • Document.
125. Subcutaneous Injections (Sc, SQ)
126. Subcutaneous Injections (Sc, SQ) • It is the administration of drug into the
subcutaneous tissue; between the dermis and the muscle. It is usually used for insulin and
anticoagulant administration. • Sites used usually are lateral and anterior aspects of the upper
arm and thigh, upper back below the scapulae. • Drug is slowly absorbed; hence if repeated
doses are given, the sites should be rotated to prevent hard painful lumps from developing as
a result of irritation and poor absorption of the drug
127. Subcutaneous Injections (Sc, SQ) Procedure • Wash and dry hands • Assemble the
equipment needed with right syringe and needle. • Prepare and load drug • Position patient,
clean site with antiseptic swab • Hold swab in a non-dominant fingers, pull cap from needle •
With syringe in between thumb and forefingers of the dominant hand
128. Subcutaneous Injections (Sc, SQ) • Pinch the skin with non dominant hand • Inject
needle quickly and firmly at an angle of 45°-90°, release skin and grasp tip of syringe with non
dominant hand and pull back the plunger to ascertain that needle is not in vein (if in vein,
blood will be drawn into the syringe on pulling back the plunger). • In the absence of blood in
syringe, push plunger gently but firmly to inject drug
129. Subcutaneous Injections (Sc, SQ) • Withdraw needle while applying pressure to the site
• Massage site if acceptable and settle him comfortably • Discard equipment as appropriate •
Wash and dry hands • document
130. Intramuscular Injection (IM) • It is the administration of into the muscle tissue . The
volume of medication to be administered IM vary, but usually, 5ml is considered as the
maximum for large muscles e.g. gluteal muscle. • However, babies, the elderly and emaciated
patients are unable to tolerate this amount; 2ml is usually the maximum for them
131. Intramuscular Injection (IM) • Large healthy muscles free from abscesses, necrotic
tissue, sloughing and damaged nerves and skin should be used. • When a number of
injections are to received, the sites should be rotated so that muscles are not overused or
over irritated. • The length of the needle and gauge id selected based on the volume and
thickness (viscosity) of the medication and the muscle size.
132. Intramuscular Injection (IM) • In babies and young children, quadriceps muscles on the
anterior and lateral aspects of the thighs are best to guard against damaging the large sciatic
nerve at the gluteal muscle.
133. Intramuscular Injection (IM) • Dorsogluteal Site utilizes the gluteus maximus muscle for
injection. The get the injection site, the buttock is divided into four (4) quadrants with and
imaginary line. The exact site is the upper outer aspect of the upper outer quadrant of the
buttocks. • Venterogluteal site uses the gluteus medius and gluteus minimus for injection. It is
a very desirable site because there are neither large nerves nor large blood vessels in the
area; and it also it has less fatty tissues. Because it is far from the rectum, there is less risk of
contamination and abscess formation
134. Dorsogluteal Site Venterogluteal site Sites for IM injections
135. Intramuscular Injection (IM) • To locate the site, the nurse’s opposite hand rests on the
patient’s opposite hip, fingers pointing towards (patient’s) head. The index finger is placed on
the anterior superior iliac spine, the middle finger stretched dorsally pressing just below the
iliac crest to form a V; a triangle is formed between the two (index and middle) fingers and the
crest of the ilium which is the injection site thus the middle of the triangle.
136. Intramuscular Injection (IM) • Quadriceps Site uses the rectus femoris and
vastuslateralis. The latter is located at the anterior aspect of the thigh. The site for site is
midway between the greater trochanter of the femur and the knee. • Deltoid normally for
smaller volumes of drug than the other muscles mentioned earlier. It is lateral to the humerus;
injection site about 1-2 inches below the acromium process
137. Quadriceps Site Deltoid Injection site
138. Intramuscular Injection (IM) Procedure • As for subcutaneous injection but the needle is
introduced deeper into the muscle at 90° angle.
139. Intravenous Therapy • Intravenous therapy is the administration of fluids, electrolytes
nutrients and medication through the intravenous route. Objectives • To supply fluids when
patients are unable to take it liberally • To provided salts needed to maintain electrolyte
balance • To provide nutrients e.g. glucose, protein (albumen and vitamins)
140. Intravenous Therapy • Administer drugs for rapid actions or when drugs are irritating to
the tissues Sites for intravenous therapy The site chosen for intravenous infusion depends on:
• Type of infusion • Duration for the infusion • Age of the patient.
141. Intravenous Therapy For adults, the veins on the arm are: • Basilic vein • Median cubital
vein • Dorsal veins • Median vein • Radial vein • Cephalic vein
142. Intravenous Therapy On the foot, the veins are; • Great saphenous vein • Dorsal plexus
143. Intravenous Therapy Duties of the Nurse during IV Therapy • Explain the need for the IV
therapy, what to expect, duration of the therapy, activities permitted during the procedure and
observations to be made. • Help patient to maintain activities of daily living; bathing and
grooming, feeding etc. • Observation should be made on the flow rate, patency of the tubing,
infusion site, level of fluid in the infusion bag/bottle, patient’s comfort and reaction to therapy.
144. Intravenous Therapy • Change dressing on the IV line as may be necessary.
145. Intravenous Therapy Complications to observe for during IV therapy: • Infiltration escape
of fluid into subcutaneous tissue due to dislodgement of the needle causing swelling and pain.
Gross infiltration may result in nerve compression injury which can result in permanent loss of
function of extremity or in case of irritating medications (vesicant), significant tissue loss,
permanent disfigurement or loss of function may result. When there is infiltration, the site
should be changed.
146. Intravenous Therapy • Phlebitis is the inflammation of the vein. This may result from
mechanical trauma due to the insertion too big a needle (for small vein) or leaving a device in
place for a long time. Chemical trauma result s from irritation from solutions or infusing too
rapidly. This manifests as pain or burning sensation along the vein. On observation, there may
be redness, increased temperature over the course of the vein. • The site should be changed
and warm compress should be applied.
147. Intravenous Therapy • Circulatory Overload; the intravascular fluid compartment
contains more fluid than normal. This occurs when infusion is too rapid or excess volume is
infused. This manifests as dyspnoea, cough, frothy sputum and gurgling sounds on aspiration.
• Embolism; obstruction of the blood vessels by travelling air emboli or clot of the blood. It is
fatal.
148. Intravenous Therapy • Flow rate is the volume of intravenous fluid to be infused over a
set period of time as prescribed by the prescriber. The flow rate should also be observed for
and bottles or bags changed before blood is drawn up the infusion set or air enters the tube.
Flow rate has to be calculated as: • Total amount of fluid to be infused X drop factorTotal time
in minutes
149. Intravenous Therapy Factors influencing flow rate are: • Position of the extremity •
Patency of the tubing and • Height of the infusion bottle/bag.