University of Northern Philippines

COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Nursing Care Management 109 (Skills)

MEDICATION

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– a substance administered for the diagnosis, cure, treatment, or relief of symptom or
prevention of disease
The Therapeutic Actions of
Drugs
Drug Type Description Examples
Palliative * supporting people with * analgesics
life-limiting and terminal (to treat
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illnesses pain)
Curative *Antibiotics
for bacterial
* refers to infections
health care practices

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that treat patients with the
Supportive
intent of curing them, not *Allopurino
just reducing their pain or
l (Zyloprim)
stress
prevents
Substitutive the buildup
* to prevent or treat as early
of uric acid
as possible the symptoms of in the body
a disease, side effects
Chemotherapeuti caused by treatment of a
disease, and psychological,
c *Altretamin
social, and spiritual
e
problems related to a
disease or its treatment.

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Restorative
* type of cancer treatment * Vitamins
that uses one or more anti-
cancer drugs as part of a
standardized chemotherapy
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regimen.

* drug or agent that restores

or revives by improving
health or strength, or
increasing energy. 

Process of Administering Medications

*when administering any drug, regardless of the route of administration, the nurse
must do the following:

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

1. Identify the client – use at least two identifiers (give at least 2) -* name & medical
record number
2. Inform the client – explain the intended action as well as any side effect or adverse
effects that might occur * to prevent anxiety
3. Administer the drug – read the MAR carefully and perform the three checks
a. The first check is when the medications are pulled or retrieved from the automated
dispensing machine, the medication drawer, or whatever system is in place at a
given situation
b. The second check is when preparation of the medications for administration takes
place
c. The final check occurs at the patient’s bedside just before medications are given.
This is also an outstanding opportunity to teach the patient about the medications
4. Provide adjunctive interventions as needed – give physical assistance or guidance*
techniques that can complement other medical treatments such as relaxation and
hypnosis
5. Document the administered drug – record the facts in the chart * always document
the drugs administered after they have been given and not before, the medication
administration record is very important communication tool between nurses and
other health care team members and to prevent medication error.
6. Evaluate the client’s response to the drug – behaviors that reflect the action or lack
of action of a drug and its untoward effects * Evaluating the outcome of the
medication on the patient's health status

10 RIGHTS OF MEDICATION ADMINISTRATION

1. The right medication - The first right of drug
administration is to check and verify if it’s the
right name and form
2. The right dose – Check the medication sheet
and the doctor’s order before medicating
3. The right patient – Ask the name of the client
and check his/her ID band before giving the
medication.
4. The right route - Check the order if it’s oral,
IV, SQ, IM, etc.
5. The right time and frequency -
Check the order for when it
would be given and when was
the last time it was given.
6. The right documentation –
Make sure to right the time and
any remarks on the chart
correctly.
7. The right reason – Secure a
copy of the client’s history to
drug interactions and allergies
8. The right to refuse –Give the
client enough autonomy to
refuse the medication after

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

thoroughly explaining the

effects.
9. The right patient education -

M.Z.C.A.- R.N. - M.A.N.

Provide enough knowledge to
the patient of what drug he/she
would be taking and what are
the expected therapeutic and
side effects.
10. The right evaluation – Review any medications previously given or the
diet of the patient that can yield a bad interaction to the drug to be given.
M.Z.C.A.- R.N. - M.A.N.

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M.Z.C.A.- R.N. - M.A.N.
Mild Allergic Reactions:
a. Urticaria – Another name for hives. Raised, itchy areas of skin that are
usually a sign of an allergic reaction.
b. Eczema –common skin condition marked by itchy and inflamed patches of
skin. 
c. Pruritus –  unpleasant sensation of the skin that provokes the urge to scratch.
d. Rhinitis –  inflammation and swelling of the mucous membrane of the nose,
characterized by a runny nose and stuffiness and usually caused by the
common cold or a seasonal allergy.

Identify the parts medication label

A. Generic Name
B. Manufacturer
C. Total Units
D. Form of medication
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

E. Dose
F. Storage condition
G. Usual dose
H. Expiration date

A B C
- R.N.- M.A.N.

E F G H
M.Z.C.A.

D
Definition of the parts:

A. The
chemical na
me of a drug
B. a person
or company that makes goods for sale.
C. the amount of drug in tablets form
D. the type of medicine
E. quantity of medicine prescribed to be taken at one time
F. specified for storing the product e.g. temperature, humidity, etc.
G. a specific amount or weight of medication
H. a previously determined date after which something should no longer be
used

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

M.Z.C.A.- R.N. - M.A.N.

PREPARING PARENTERAL MEDICATIONS
- Injectable medications can be prepared by withdrawing the medication from
an ampule or vial into a sterile syringe.

There are four routes for parenteral administration:

• Subcutaneous injection: * type of injection, a short needle is used
to inject a drug into the tissue layer between the skin and the muscle.
• Intramuscular (IM): * used to deliver a medication deep into the
muscles
• Intradermal (ID) injection: * shallow or superficial injection of a
substance into the dermis, which is located between the epidermis and
the hypodermis
• Intravenous (IV) injection or infusion: * therapy that delivers fluids directly

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into a vein.

AMPULE – is a glass container usually designed to

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hold a single dose of a drug.

Types of ampules and its description:

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a. * funnel type
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b. * close/sealed type

c. * straight stem

NOTE: Preparing medications from ampules and vials involves knowledge and use of
sterile technique. These techniques are not delegated to UAP.

Equipment:
• Medication administration record (MAR) or computer printout
• Ampule or sterile medication
• File (if ampule is not scored), small sterile gauze
• Alcohol swab
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

• Syringe, filter needle

• Needle for administering the medication
• Sharps with engineered sharps injury protection (SESIP) safety needle for
injection
• Puncture-proof container for disposal of syringes, needles, and glass

Assessment: RATIONALE
1. Check accuracy and completeness of each MAR or computer printout with
prescriber’s written medication order.
Question: What to check before medication administration?
patient identification, medication, dosage, time, and route

2. Assess patient’s medical and medication history.

3. Assess patient’s history of allergies * prevent the prescription and
administration of drugs inducing allergic reactions and will
improve patient safety
4. Review medication reference information for:
a. knowledge of the drugs a patient has taken in the past.
b. drug effects should always be on the list of differential diagnoses
c.to take the opportunity to educate the patient about their medications
d. to help avoid preventable errors in prescribing
5. Assess patient’s body build, muscle size, and weight if giving subcutaneous or
intramuscular (IM) medication. * Allows you to administer drug properly
and monitor patient's response

Planning: RATIONALE
Question: why do you need to prepare the medication with
proper dosage and without air bubbles in the syringe barrel?
- Preparing the proper dosage for a medication means
you’re giving the right amount of medication to treat
the said illness or condition of the patient avoiding
from overdosing the patient or giving insufficient
amount of it will not take effect or even cause side
effect depending on what medication or drug effect it
is. And preparing it without air bubbles will prevent
from giving the patient embolism if it is given through
IV and also air bubbles takes up the space from the
syringe that might cause inaccurate dosage of the
medication that is being administered.

Performance: RATIONALE
1. Perform hand hygiene * Good hand hygiene will reduce the risk of things
like flu, food poisoning and healthcare associated infections being
passed from person to person.
2. Prepare the medication ampule for drug withdrawal
a. Flick the upper stem of the ampule several times with fingernail * to
unseat any fluid lodged at top.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

b. Use an ampule opener or place a piece of sterile gauze or alcohol wipe

between your thumb and the ampule neck or around the ampule neck, and
break off the top by bending it toward you to ensure that the ampule is

M.Z.C.A.- R.N. - M.A.N.

broken away from yourself and away from others * ampule opener guides
the user’s pressure in the correct direction, reducing the chance of
shattering keeping the hands safe
c. Or place the antiseptic wipe packet over the top of the ampule before
breaking off the top * to prevent from getting injured
M.Z.C.A.- R.N. - M.A.N.

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3. Withdraw the medication
a. Place the ampule on a flat surface
b. Attach the filter needle to the syringe * filter needles prevent the
accidental administration of small glass fragments when drawing up
medicines from the ampule
c. Remove the cap from the filter needle and insert the needle into the center
of the ampule. Do not touch the rim of the ampule with the needle shaft *
to prevent contamination
d. With a single dose ampule, hold the ampule slightly on its side, if
necessary, to obtain more than the ordered amount of medication

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e. If giving an injection, replace the filter needle with a regular needle,
tighten the cap at the hub of the needle, and push solution into the needle,
tot the prescribed amount

VIALS - is a single- or multi-dose plastic or glass container with a rubber seal at the
M.Z.C.A.- R.N. - M.A.N.

top.

Note: A multi-dose vial contains several doses of a medication and

thus can be used several times, although only for a single patient. When using
a multi-dose vial, write the date that the vial is opened on the vial label.

Question: how long does a multi-vial be used? the vial should be dated and
discarded within 28 days

Reconstitution – * The process of adding a diluent to a dry ingredient to make it a

liquid.

Two preparations of powdered drugs:

A. Single dose vial – * A single-dose or single-use vial is a vial of liquid
medication intended for parenteral administration (injection or infusion)
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

that is meant for use in a single patient for a single case, procedure,
injection

M.Z.C.A.- R.N. - M.A.N.

B. Multi Dose Vial – * a vial of liquid medication intended for parenteral
administration (injection or infusion) that contains more than one dose
of medication.

Equipment:
- MAR
- Vial or sterile medication
- Antiseptic swabs
- Safety needle and syringe
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- Sterile water or normal saline, if drug is powdered form

Preparation: (Same with preparing medication from ampules)

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RATIONALE
Performance:
1. Perform hand hygiene and observe other appropriate infection control
procedures
2. 2. Prepare the medication vial for drug withdrawal
a. Mix the solution, if necessary, by rotating the vial between the palms of
the hands, not by shaking. * rotating the vial between palms produces heat
which help on dissolving the medication, shaking the vial can cuase harm
to some medicines or it can sause break down altering its action
b. Remove the protective cap, or clean the rubber cap of a previously opened
vial with an antiseptic wipe by rubbing in a circular motion. * to maintain
sterility
3. Withdraw the medication

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a. Attach a filter needle, as agency practice dictates, to draw up premixed
liquid medications from multi dose vials * filter needle prevents small
particles from the medication or pieces of rubber from the rubber top of
the vial from causing localized tissue irritation, necrosis or phlebitis
b. Ensure that the needle is firmly attached to the syringe
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c. Remove the cap from the needle, then draw up into the syringe the
amount of air equal to the volume of the medication to be withdrawn
d. Carefully insert the needle into the upright vial through the center of the
rubber cap, maintaining the sterility of the needle.
e. Inject the air into the vial, keeping the bevel of the needle above the
surface of the medication. * to maintain sterility
f. Withdraw the prescribed amount of medication by holding the vial down,
move the needle tip so that it is below the fluid level and withdraw the
medication. Avoid drawing up the last drops of the vial. * to prevent air
bubbles in the syringe
g. Or; invert the vial, ensure the needle tip is below the fluid level; gradually
withdraw the medication. * to withdraw the correct does and to prevent air
bubbles in the syringe

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

h. Hold the syringe and vial at eye level to determine that the correct dosage
of the drug is drawn into the syringe. Eject air remaining at the top of the
syringe into the vial

M.Z.C.A.- R.N. - M.A.N.

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i.

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When correct volume of medication plus a little more is obtained,
withdraw the needle from the vial, and replace the cap over the nee
j. ecessary, tap the syringe barrel to dislodge any air bubbles present into the
syringe * to prevent injecting an air bubble which can cause harm to the
patient (embolism)
k. In giving an injection, replace the filter needle, if used, with a regular or a

M.Z.C.A.- R.N. - M.A.N.

safety needle of the correct gauge and length. Eject air from the new
needle
l. and verify correct medication volume before injecting the client
M.Z.C.A.- R.N. - M.A.N.

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