Basic Nursing: Foundations of

Skills & Concepts

MEDICATION
ADMINISTRATION

Ns. Dally Rahman, M.Kep, Sp.Kep.MB

Medication Management

n Requires the collaborative efforts of many

health care providers.
n Nurses are responsible for administering
medications.
n Medication administration requires
specialized knowledge, judgment, and
nursing skills.
Drug Standards and Legislation

n A drug is a chemical substance intended

to elicit a specific effect.
n Standards are set to ensure drug
uniformity in:
n Strength.
n Purity.
n Efficacy.
n Safety.
n Bioavailability (readiness to produce a drug effect).
Standards

n The United States Pharmacopeia and the

National Formulary (USP and NF) are
books of drug standards for use in the
United States.
Legislation: The FDA

n The Food and Drug Administration (FDA)

tests all drugs for toxicity before granting
a company the right to market a drug.
Drug Nomenclature

n Drugs are usually referred to by their

generic name (not capitalized) or by their
trade name (always capitalized).
Drug Action

n A drug’s ability to combine with a cellular

drug receptor.
n Depending on the location of the cellular
receptor, the drug can have a local effect,
a systemic effect, or both.
Pharmacology

n The study of the effects of drugs on living

organisms.
Medication Management

n Its purpose is to produce the desired drug

action by maintaining a constant drug
level.
n Drug action is based on the drug’s half-life
(the time it takes the body to eliminate
half of the blood concentration level of the
original drug dose).
Terms Relating to Drug Action

n Onset of action (the time it takes for the

body to respond to a drug after
administration).
n Peak plasma level (the highest blood
concentration of a single drug dose before
the elimination rate equals the rate of
absorption).
n Plateau (maintenance of a certain level).
Routes of Drug Absorption

n Oral.
n Topical.
n Inhalants.
n Parenteral (injectable).
n Intradermal (into the dermis).
n Subcutaneous (into the subcutaneous tissue).
n Intramuscular (into the muscle).
n Intravenous (into a vein).
Pharmokinetics

n The study of the absorption, distribution,

metabolism, and excretion of drugs to
determine the relationship between the
dose of a drug and the drug’s
concentration in biological fluids.
 The 4 Properties of Drug Action

n Absorption (passage of a drug from the site of

administration into the bloodstream).

n Distribution (the movement of drugs from the blood into

body fluids and tissues).

n Metabolism (the physical and chemical processing of a

drug by the body).

n Excretion (the elimination of drugs from the body.

Drug Interaction

n The effect one drug can have on another

drug.
Side Effects and Adverse
Reactions

n Drug Allergy.
n Drug Tolerance.
n Toxic Effect.
n Idiosyncratic Reaction.
Food and Drug Interactions

n Certain drugs may interfere with the

absorption, excretion, or use in the body
of one or more nutrients.
n Certain foods may increase or decrease
the absorption of a drug into the body.
n Other foods may alter the chemical
actions of drugs, preventing their
therapeutic effect on the body.
Factors Influencing Drug Action

n Genetic factors. n Weight.

n Age. n Physical
n Height. conditions.
n Mental conditions.
Medication Orders

n All medication orders should contain:

n Client’s name
n Date & Time
n Name of Drug to be administered
n Doasage
n Route of administration
n Time & frequency
n signature of person ordering
Types of Orders

n Stat (those that should be administered

immediately).
n Single-Dose (one-time medications).
n Scheduled (administered routinely until
order is canceled by another order).
n PRN (on as-needed basis).
Three Systems
of Weight and Measure

n Metric (simple system based on units of

10).
n Apothecary (based on the weight of one
grain of wheat).
n Household (drops, teaspoons,
tablespoons, etc.).
Five “Rights” of
Safe Drug Administration

n Right drug.
n Right dose.
n Right client.
n Right route.
n Right time.
Documentation of Drug
Administration

n A critical element of drug administration is

documentation.
n The standard is “if it was not documented
it was not done.”
n The nurse should document that a drug
has been given after the client has
received the drug.
Drug Supply and Storage

n Scheduled drugs for each client are

usually dispensed in a unit dose form.
n Certain drugs may be stock supplied
(dispensed and labeled in large
quantities) and stored in the medication
room.
n Narcotics and controlled substances must
be administered in accordance with
Medication Compliance

n The client’s understanding of why a

medication was ordered and how a
medication can decrease the likelihood of
getting a disease or how it can lessen the
effects of an existing disease.
n Clients refusing medication or adjusting
the scheduling or dose are noncompliant.
Responsibilities of Nurses
Regarding Drug Administration

n Nurses are both legally and morally

responsible for correct administration of
medications.They must:
n Follow institutional policy.
n Consider clients’ desires and abilities.
n Foster compliance.
n Correctly document all actions related to medication
administration and medication errors.
Assessment

n Drug History (Allergies, Prescription

Drugs taken, Over-the-Counter Drugs
used).
n Medical History (Biographical data,
Lifestyle and beliefs, Sensory and
cognitive status).
n Physical Examination.
n Diagnostic and Laboratory Data.
Nursing Diagnosis

n Health Maintenance, Altered.

n Knowledge Deficit.
n Management of Therapeutic Regimen,
Ineffective.
n Physical Mobility, Impaired.
n Sensory/Perceptual Alterations.
n Swallowing, Impaired.
Nursing Interventions
Primary nursing interventions related to
medication management are:

n Assessment.

n Administration.

n Teaching.
Oral Drugs

n Oral medications should be poured and

measured at eye level to ensure
accuracy.
Parenteral Drugs

n Although the physician will determine the

dose and route of a parenteral drug, the
nurse is responsible for choosing the
correct gauge and length of the needle to
be used.
Equipment to Administer
Parenteral Drugs

n Syringes (three basic parts: the hub, the

barrel, the plunger).
n Needles (three basic parts: the hub, the
cannula, or shaft, and the bevel).
n Ampules (glass containers of single-dose
drugs).
n Vials (glass, single- or multiple-dose
rubber-capped drug containers).
Intradermal Injection

n Injections typically used to diagnose

tuberculosis, identify allergens, and
administer local anesthetics.
Subcutaneous Injection

n Injections into the subcutaneous tissue,

between the dermis and the muscle.

n Commonly used in the administration of

medications such as insulin and heparin.
Intramuscular Injection

n Used to promote rapid drug absorption

and to provide an alternate route when
the drug is irritating the subcutaneous
tissue.
Intravenous Therapy

n Requires parenteral fluids (hypotonic fluid,

isotonic fluid, hypertonic fluid)
n Special equipment needed:
n Administration set.
n IV pole.
n Filter.
n Regulators to control IV flow rate.
n Established venous route.
Blood Transfusion

n To replace blood loss (deficit) with whole

blood or blood components.
n Special equipment needed:
n Administration set.
n IV pole.
n Filter.
n Regulators to control IV flow rate.
n Established venous route.
The Importance of Monitoring

n The nurse must always carefully monitor

client reactions to medications and ensure
that clients are appropriately educated as
to the actions, side effects, and
contraindications of all medications they
are receiving.
n Clients receiving IV therapy or blood
transfusions require constant monitoring
for complications.
Topical Medications

n Eye medications. n Respiratory

n Ear medications. inhalants.
n Nasal instillations. n Rectal instillations.
n Vaginal
instillations.