CATEGORIES OF

DRUG ORDER
J U D I T H B . L U T R A N I A , L P T, R N , M A N
STAT Order – refers to any medication that is needed immediately,
and should to be given once.
• associated with emergency medications that are needed for
life-threatening situations.
• “stat” from the Latin word “statim” (immediately)
• Time frame: should be given or administered in 5 minutes or
less.
Example: Morphine sulfate 2 mg IV stat.
One Time/Single order – a drug that is to be given only
once, and at a specific time.
e.g.Versed 2 mg IM at 7 am
• PRN order – from the Latin words “pro re nata” (as the
occasion arises) or to be given as needed or administered
as required by the patient’s condition.

Example Tylenol 650 mg q 3 – 4 H PRN for headache

 Standing order – is written in advance of the situation
which is to be carried out under specific circumstances.
- maybe an ongoing order or maybe given for a
specific number of doses or days. May include PRN orders

Example: Digoxin 0.2 mg PO q.d.

Colace 100 mg PO q.d., PRN
ROUTE OF ADMINISTRATION

ENTERAL ROUTE
• Drugs given orally and those administered through
nasogastric or gastrostomy tubing.
ORAL
• most common, most convenient and usually the least
costly of all routes.
• safest route because of the skin barrier is not
compromised and enter the system fairly controlled
manner.
• E.g. Tablets and capsules – most common forms and
also patient prefer because of their ease of use.
 BUCCAL

• the tablet or capsule is place in the oral cavity between the gums and the cheek.
• absorbed slowly from the mucous membranes of the mouth.
• Preferred for sustained-release delivery because of its greater mucosal surface area.
• Advantages: avoid first pass metabolism by the liver and the enzymatic processes.
• do not cause irritation.
• E.g. : Troches and Lozenges – intended for local use rather than systemic effect
SUBLINGUAL

• these are small tablets that are place under the tongue
and allowed to dissolve slowly.
• because of its rich blood supply, it results in rapid
action of medication.
• Ix: for people who have difficulty swallowing or to
patients who cannot be given drugs rectally.
• E.g. Nitroglycerines (Isoket, Nitorol, Nitrostat, Plendil,
Vastarel) indicated for Angina.
SUBLINGUAL
NASOGASTRIC & GASTROSTOMY

NGT – is a soft flexible tube, used for short term

treatment inserted by the way of the nasopharynx with the
tip lying in the stomach.
Gastrostomy tube- is surgically placed directly into the
patient’s stomach, indicated for long term treatment.
 METHODS IN CHECKING THE LOCATION OF
NASOGASTRIC TUBE
Method 1
• Aspirate part of the stomach contents using a bulb syringe.
Return of stomach contents confirms correct placement.
Method 2
• Place a stethoscope over the stomach area; listen as 5 to 10
ml (adult) (0.5-5 ml) of air are inserted. A gurgling sound
should be heard if the nasogastrci tube is properly placed.
Method 3
• Place the unclamped NG tube next to the ear and
listen for any crackling noise. If the crackling sounds
are heard, the tube may be on the lungs. Remove and
reinsert.
TOPICAL ADMINISTRATION
Applied locally to the skin or the membranous
linings of the ears, nose, respiratory tract, urinary
tract, vagina and rectum
TRANSDERMAL
Effective means of applying drugs directly to the surface of the skin
with the intent that they will be absorbed through the dermal layer
and into either the subcutaneous tissues or the peripheral circulation
• provide a slow controlled release of the drug into the body that
is effective in maintaining plasma levels of the drug at a relatively
constant level for prolonged period of time.
• E.g. Nitro-patch (nitroglycerin- anti anginal) Nicotine patch (to
quit smoking)
 OPTHALMIC ADMINISTRATION
• used to treat local conditions of the eye and surrounding structures.
• Ix: excessive dryness, infections, glaucoma, and dilation of the pupil during
eye surgery or examination.
• Available in the forms of drops, creams, and medicated disks.
• E.g.
– Gentamycin cream
– Pilocarpine HCL (miotic- glaucoma – decrease IOP)
– At SO4 – (mydriatics- Ix: gtalucoma – dilates the pupil)
– Eye Mo (tetrahydrozoline HCL) – relief of eye redness and
discomforts.
 ADMINISTERING MEDICATIONS
Ophthalmic:

Technique used: (sterile or clean?) Sterile

Where to instill? Lower conjunctival sac

Maximum number of drops at a time: Two

Interval between 5 minutes for proper

instillations? absorption
 ADMINISTERING MEDICATIONS
Ophthalmic:
Gently but not tightly to avoid
Closing of eyes:
spillage
To prevent systemic absorption:
Press firmly on nasolacrimal duct for at least 30 secs.
OTIC ADMINISTRATION

• treat conditions of the ear, including infections

and soften blockage of the auditory canal
• eardrops and irrigations.
• E.g. auralgan (otitis media)
Otic:

Solution temperature: Warm/ body temperature

Using hot/cold soln: Nausea, vertigo, pain

Posn: Side-lying with ear being treated up

Straighten ear canal: pinna down & back: 0-3 y.o.

Straighten ear canal: pinna up & back: Above 3

Otic:

Where to instill: Along side of auditory canal

To assist medication flow: Press on tragus

Pos’n after: Side-lying for another 5 minutes

To prevent spillage:
Place cotton loosely at auditory canal for 15-20 mins
Nasal Administration
• use for both local and systemic drug administration
• excellent absorptive surface.
Advantages:
– ease of use
– avoidance of first-pass effect and digestive enzymes
Disadvantages:
– potential damage to the cilia/ nasal mucosa
– Mucosal irritation
– Mucous secretions may affect drug absorption
• E.g.
–Salinase – NSS (colds or stuffy nostrils)
–Beconase Nasal Spray (Allergic rhinitis)
–Neozep vaporizing rub (stuffy nose)
 ADMINISTERING MEDICATIONS
Nasal:

Usual purpose: Astringent effect (shrinking effect)

Position: Head tilted back (sit/lie)

Upon inhalation: Administer the spray

Position after: Keep head tilted back for an

additional 5 minutes
Daily sprays: Use alternate nares
VAGINAL ADMINISTRATION
• use to deliver medications for treatment of local
infections and to0 relieve pain and swelling
• Available in supp., creams, jellies, or forms
• E.g.
–Betadine vaginal supp. (candidiasis, trichomoniasis)
–Flagystatin vaginal supp. (metronidazaole, Ix: infectious
vaginitis, trichomonal vaginitis)
–Estriol cream ( Ovestin, Ix: atrophy of the lower
vaginal tract R/T estrogen deficiency)
RECTAL ADMINISTRATION

• less favorable because many drugs are absorbed poorly or

incompletely and irritation of the rectal mucosa may occur.
Adv.: avoidance of first-pass effect and digestive enzymes absorption
is slower than any other routes.
Ix: safe and effective to patients who are comatose or who are
experiencing nausea and vomiting.
• Available in suppository forms / given via enema.
• E.g. chlorpromazine rectal supp. (thorazine) for vomiting.
PARENTERAL ADMINISTRATION
• invasive delivery of drugs via a needle into the skin
layers, subcutaneous tissues, muscles, or veins.
• Advanced parenteral administrations includes
administration into the arteries,body
cavities(intrathecal), and organs (intracardiac)
• Advantages:
–Provide more rapid administration to target
tissues.
–Rapid onset
• Disadv:
Chance of infection or potential introduction of
pathogenic microbes directly into the blood or body tissues
when sterility is not maintained.
PREPARATION AND ADMINISTRATION OF
MEDICATIONS BY THE PARENTERAL ROUTE
Equipments
 Syringe: parts
1. Barrel-the outer portion on which calibration for the
measurement of the drug volume are located
2. Plunger-the inner, cylindrical portion that fits snugly into
the barrel.
 The tip-is the portion that holds the needle. There are two
types of tips, the plain tip and the LuerLock
 Needle
The needle parts are the hub, shaft, and beveled tip.
The needle gauge is the diameter of the hole through the
needle. The larger the number ( which indicate the
gauge), the smaller the hole. 15g, 18g, 20g, 22g, 23g, 25g,
26g
 SELECTION OF SYRINGE AND
NEEDLES
route volume gauge length

• intradermal • 0.01-0.2 ml • 25-27 g • 3/8-1/2 in

• Subcutaneous • 0.5- 1ml • 25-27 g • Individualized
• Intramuscular • 0.5-2 ml • 20-22 g • Individualized
• intravenous • 1-2000 ml • 20-22 g • ½- 1 ¼ in
• ( solution) ( butterfly)
• 15-19 g
• (blood) • ½-2
in(regular
needle)
INTRADERMAL (ID) INJECTION
• administered into the dermis layer of the skin to produce wheal
• limited to very small volumes of drug, usually 0.01-0.2 ml.
• Adv.
1. means of route for patients who are unable to take oral
medications.
2. Avoid first-pass effect and digestive enzymes.
3. Medications are more easily absorbed because of more
blood vessels on the dermal layer.
• Disadv.
1. small volume can be administered
2. Injections can cause pain and swelling.
• Ix:
– 1. employed for allergy sensitivity test disease screening.
– 2. for local anaesthetic delivery prior to venous cannulation.
– 3.Vaccinations
– 4. Desensitization injections.
ADMINISTRATION OF MEDICATION BY
THE INTRADERMAL ROUTE
Intradermal route(sensitivity test)
Technique:
1. Check with the patient before starting the testing to be sure
that he or she has taken any antihistamines or anti-
inflammatory agents.
2. Cleanse the selected area thoroughly with antiseptic pledget.
Use circular motions starting at the planned site of injection,
continuing outward in widening circular motions to the
periphery.
3. Prepare the designated solutions for injection using aseptic
technique. Usual volume is between 0.1 ml of medication added to
0.9 ml of normal saline solution.
4. Insert the needle at a 45˚ angle with the needle bevel upward.
Inject the agent so that a small bleb will appear on the surface of
the skin.
5. Chart the times and agents injected.
6. Follow direction for the time of the reading of the skin test
performed. A positive reaction will result in development of a
wheal
 ADMINISTERING MEDICATIONS

Intradermal Injection:

Sites: Inner lower arm, upper

chest/back, beneath scapulae
 ADMINISTERING MEDICATIONS
Intradermal Injection:
Don’t massage the
To massage or not to massage? site after

Needle gauge: 25-27

Needle 3/8” to ½”
length:

Upon insertion, needle is at… 10-15 degree angle,

bevel up
SUBCUTANEOUS INJECTION (SC OR SQ)
• Injection is delivered to the deepest layer of
the skin.
• Volume of administration: 0.5-1.0 ml.
• Sites of injections :
1. outer aspect of the arms, in the area
above the triceps muscles
2. Middle 2/3’s of the anterior thigh area
 3. Subscapular areas of the upper back
4. Upper dorsogluteal areas
5. Abdominal areas above the iliac crest, below
the diaphragm, 1.5 - 2 Inches out of the umbilicus.
• Advantages:
– Administration of drug which requires slower, more
prolonged release into the systemic circulation.
• E.g. insulin
– Easy route of parenteral administration and provide
rapid absorption.
– Can be performed by patients themselves providing
they are properly trained.
– Administration site for clients who are unable to take
oral medications.
– Avoid first-pass effect.
Disadvantages:
– Small volume can be administered
– injections can cause pain and swelling
• Ix: Insulin, heparin, vitamins, some vaccines
• Nursing considerations:
– Rotate the injection sites to promote absorption, minimize
tissue damage and alleviate discomfort.
– When performing SC injections, it is not necessary to
aspirate prior to injection (heparin)
– Do not rub the injection site.
Method 1:
Grasp the skin area of the site selected,
spread, hold firmly, and insert the needle
quickly at a 45˚ degree angle; aspirate
and slowly inject the medication.

Method 2:
Grasp the skin area of the site selected
and create a small roll. Insert the needle
quickly at a 90˚ angle, aspirate and
slowly inject the medication
 ADMINISTERING MEDICATIONS
Subcutaneous:
Vaccines, insulin, heparin,
Meds given SQ:
narcotics
Dosage: 0.5-1mL

When injecting at 45 degrees: 5/8 needle

When injecting at 90 degrees: 1/2 needle

Needle gauge: 25-27

 ADMINISTERING MEDICATIONS
Subcutaneous:
For thin patients: 45 degree angle of needle

For obese patients: 90 degree angle of needle

For heparin injection: Do not aspirate nor massage

Inject @ 90 degree but don’t

For insulin injections:
massage

For other injections: Aspirate before injecting

INTRAMUSCULAR INJECTION

• Delivers medication by penetrating a needle through

the dermis and subcutaneous tissue into the muscle
layer.
• Deposits the medication deep within the muscle
mass.
 ADMINISTERING MEDICATIONS

Intramuscular:

Gauge: 20-23

Length: 1-2 inches

Possible sites: Gluteal, Vastus lateralis, deltoid

SITES OF INJECTIONS
A. Ventrogluteal site – suitable for children over 7
mos. of age.
• Adv.:
–greatest thickness of gluteal muscle
–Contains no large blood vessels/nerves
–Sealed off by bones
–Contains less fat
ADMINISTERING MEDICATIONS
Intramuscular: VENTROGLUTEAL SITE
 ADMINISTERING MEDICATIONS

Intramuscular: VENTROGLUTEAL SITE

Hand heel over greater trochanter

Place index finger over ASIS

Abduct middle finger

Triangle formed below crest is the site

 ADMINISTERING MEDICATIONS

Intramuscular: VENTROGLUTEAL SITE

 ADMINISTERING MEDICATIONS

Intramuscular: VENTROGLUTEAL SITE

Von Hochsteter’s Site: Ventrogluteal Vessel-free

Ventrogluteal: formed is the V site

Muscle: Gluteus medius

Degree of contamination:
Lesser since it’s farther from rectal area
B. Deltoid – used in well developed teens and
adults for volumes not to exceed 1ml.

• Disadv: It is not usually used because the

radial nerve lies beneath the deltoid
muscle Ix: Hepatitis B Vaccine
 ADMINISTERING MEDICATIONS

Intramuscular: DELTOID MUSCLE

Acromion
Process (2
inches
below)
 ADMINISTERING MEDICATIONS

Intramuscular: DELTOID MUSCLE

Acromion Process

Midpoint between AP & axillary fold

Site is approx 2 inches from AP

 ADMINISTERING MEDICATIONS

Intramuscular: DELTOID MUSCLE

Deltoid: 0.5 – 2 mL

Risks:
Relatively small muscle;
possible injury to radial
nerve & artery

Gluteus Medius: 1-5 mL

C. Dorsogluteal Site
 used for adults and for children who have been
walking for at least 6 mos.

 Not to be used for children under 3 years old

because the muscles are not yet developed for
walking.
 ADMINISTERING MEDICATIONS
Intramuscular: DORSOGLUTEAL SITE

Imaginary line
from PSIS to GT
 ADMINISTERING MEDICATIONS

Intramuscular: DORSOGLUTEAL SITE

4 quadrants–
Upper outer
quadrant
 ADMINISTERING MEDICATIONS

Intramuscular: DORSOGLUTEAL SITE

Contraindicated age: Below 3 years old

Risks: Injury to sciatic nerve/ major blood vessel

D. Vastus lateralis
 usually thick and well developed in both
adults and children.
 It is the preferred site of injection for
infants;
 it is also the good site for injection for
healthy, ambulatory adults.
 ADMINISTERING MEDICATIONS
Intramuscular: VASTUS LATERALIS

Vital fact:

Recommended
site for infants

CHULOU H. PENALES, RN
E. Rectus femoris
 it is used in both children and adults, especially for self-
injection
Z-tract Method
appropriate for medications that are particularly
irritating or that stain the tissue.