NCM 106 - Pharmacology
PRINCIPLES OF MEDICATION
ADMINISTRATION
Medication – substance administered for
diagnosis, cure, treatment, relief or prevention
of disease
Legal and Ethical Consideration
• RA 9173 – Philippine Nursing Act of
2002
• Republic Act 3720 – an act ensuring
safety and purity of food, drugs and
cosmetics being available to the public
by creating the food and drug
administration which shall administer
and enforce laws pertaining thereto
• R.A. 6425: Dangerous Drugs Act –
stipulates sale administration, delivery
distribution and transportation of
prohibited drug is punishable by law
• ICN Code of Ethics for Nurses – guide
for action based on social values and
needs
o The code is regularly reviewed
and revised in response to the
• Summary sheet
• Physician’s order form
• Flow sheets
• Consent forms
• Graphic chart/record
• History and physical examination form
• Progress notes
Kardex Record
• Large index-type card usually kept in a
flip-file/separate folder that contains
pertinent information such as the
patient’s name, diagnosis, allergies, and
schedules of current medications,
treatment and NCP.
Medication Administration Record (MAR)
• List of all medications to be
administered
realities of nursing and health
care in changing the society. The
code makes it clear that inherent
in nursing is respect for human
rights, including the rights to life,
to dignity and to be treated with
respect
o Guides nurses in everyday
choices and supports their refusal
to participate in activities that
conflict with caring and healing
• Patient’s Chart – primary source of info
that is necessary in patient assessment
so that the nurse may create and
implement plans for the patient care
o Serves as a communications link
among and the members of the
health care team regarding the
patient’s status, care provided,
and progress
o Legal document
Content of the Patient’s Chart
• Nurses’ notes
• PRN medication record
• Nursing care plan
• Laboratory tests records
• Consultation reports
• Medication administration record (MAR)
• Patient education record
• Provided a space for recording the time
and medication is administered and who
gives it
Drug Distribution Systems
1. Unit-dose Systems – provide patient-
specific individually packaged
medications, which minimizes
nurse/caregiver drug product
manipulation (e.g., cutting in half) in
order to arrive at the correct dose prior
to administration. Such manipulation
could result in patient harm and
consume valuable caregiver resources.
NCM 106 - Pharmacology
2. Floor/Ward Stock – all medications but
the most dangerous or rarely used are
stocked at the nursing station in stock
container
3. Individual Prescription Order System
– medications are dispensed from the
pharmacy on receipt of a prescription or
drug order for an individual patient
4. Electronic Dispensing System –
computer-controlled dispensing system
that is supplied by the pharmacy daily
with stock medicines
Nurses’ Responsibilities
• Verification – once rx has been written,
the nurse interprets it and makes a
professional judgment on its
acceptability. It evaluates method of
administration, any allergies, and
patient’s condition.
• Transcription – transcribes order from
the physician’s order sheet on the
Kardex and MAR. Must sign the original
medication record to indicate the she
received, interpreted, and verified the
order.
Types of Doctor’s Order
• Verbal Order – should be whenever
possible. When accepted:
o Accurately enter in order sheet
and sign
o Read back order to physician
o Let AP sign order within 24hrs.
• Electronic Transmission of Patient
Orders – fax orders with signature
Principles in Administering Medication
1. Observe the 10Rs medication
administration
2. Practices asepsis
3. Nurse who administer medications are
responsible for their own actions.
Question any order that you consider
incorrect.
4. Be knowledgeable about medications
that you administer.
5. Keep narcotics and barbiturates in
locked place.
6. Use only medications that are in clearly
labeled containers
7. Return liquid that are cloudy or have
changed in color to the pharmacy
8. Before administering a med, identify the
client correctly.
9. Do not leave the medication at the
bedside.
10. If the pt vomits after taking oral
medication, report this to the nurse in
charge and/or physician
11. Pre-operative medications are usually
discontinued during post-operative
period unless ordered to be continued.
12. When a medication is omitted for any
reason, record the fact together with the
reason.
13. When a medication error is made, report
it immediately to the nurse in
charge/physician.
Equipment in Oral Medication
Administration
• Unit dose/Single dose
o Single unit package – one that
contains one discrete
pharmaceutical dosage form, i.e.,
one tablet, one 2-ml volume of
liquid, one 2-g mass of ointment,
etc.
o Unit dose package – one that
contains the particular dose of
drug ordered for the patient.
o Single unit package is also a
unit dose or single dose
package if it contains the
particular dose of the drug
ordered for the patient. A unit
dose package could, for example,
contain two tablets of a drug
product
• Soufflé cup
• Medicine cup
• Medicine dropper
• Teaspoon
NCM 106 - Pharmacology
• Oral syringe
Equipment in Parenteral Medication
Administration
• Syringe – insulin, tuberculin, pre-filled
• IV Administration Set
• Volume-Controlled Burette Set
Medication Administration (5)
1. Oral Administration – orally, by mouth,
safe, convenient and least expensive
Advantages
• Easiest and most desirable way to
administer medication
• Most convenient
• Safe, does not break skin barrier
• Usually less expensive
Disadvantages
• Inappropriate if pt. cannot swallow and if
GIT has reduced motility
• Inappropriate for pt. with nausea and
vomiting
• Drug may have unpleasant taste
• Drug may discolor teeth
• Drug may irritate gastric mucosa
• Drug may be aspirated by seriously ill
pt.
Drug Forms for Oral Administration
• Liquid: Syrup, suspension, emulsion,
elixir, milk, or other alkaline substances
o Syrup: sugar-based liquid
medication
o Suspension: water-based liquid
medication. Shake bottle before
use
o Emulsion: oil-based liquid
medication
o Elixir: alcohol-based liquid
medication. After administration
of elixir, allow 30 mins to elapse
before giving water. This allows
max. absorption of medication
• Solid: tablet, capsule, powder, lozenge,
gel capsule, enteric-coated tablets
Important:
“NEVER CRUSH ENTERIC-COATED or
SUBSTANCES RELEASED TABLETS!”
Crushing enteric-coated tablets – allows
irrigating med to come in contact with the
oral/gastric mucosa, resulting to
mucositis/gastric irritation
Crushing sustained-released medication –
allows all medication to be absorbed at the
same time resulting in a higher than expected
initial level of medication and a shorter than
expected duration of action
2. Sublingual
o Placed under the tongue, where it
dissolves
o When medication is in capsule and
ordered sublingually, the fluid must
be aspirated from the capsule and
placed under the tongue
o Medication given by the sublingual
route should not be swallowed or
desired effects will not be achieved
Advantages:
• Same as oral
• Drug is rapidly absorbed in the
bloodstream
Disadvantages:
• If swallowed, drug may be inactive by
gastric juices
• Drug must remain under the tongue until
dissolved and absorbed
3. Topical – application of medication to a
circumscribed area of the body (6)
o A. Dermatologic – includes lotion,
liniment and ointment, powder
 Before application, clean the
skin thoroughly by washing the
area gently with soap and water,
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soaking an involved site, or
locally debriding tissue
 Use surgical asepsis when open
wound is present
 Remove previous application
before the next application
 Use gloves when applying the
medication over a large surface
(e.g., large are of burns)
 Apply only thin layer of med to
prevent systemic absorption
o B. Ophthalmic – by eyes; includes
instillation and irrigation
 Instillation – provide eye
medication that the pt requires
 Irrigation – clear the eye of
noxious/other foreign materials
o C. Otic – by ears;
 Instillation – remove cerumen or
pus or remove foreign body
o D. Nasal Instillation
 Instilled for their astringent
effects (shrink swollen mucous
membrane), loosen secretion
and facilitate drainage/treat
infection of the nasal cavity or
sinuses
 Decongestants, steroids and
calcitonin.
o E. Inhalation – use of nebulizer,
metered-dose inhaler
o F. Vaginal – through vagina
 Drug forms: tablets liquid
(douches); jelly, foam and
suppository
 Vaginal irrigation – washing of
the vagina by a liquid at low
pressure, also called douche.
Procedure for Ophthalmic Administration:
• Position pt. either sitting or lying
• Use sterile technique
• Clean eyelid and eyelashes with sterile
cotton balls moistened with sterile
normal saline from inner to outer
canthus
• Instill eye drops into lower conjunctival
sac
• Avoid dropping solution onto the corner
directly, bcs it causes discomfort
• Instruct pt. to close eye gently. Shutting
eyes tightly causes spillage of
medication
• For liquid eye medication, press firmly
on the nasolacrimal duct
Procedure for Otic Administration
• Warm solution at room temp. or body
temp., failure to do so may cause
vertigo, dizziness, nausea and pain
• Have the pt. assume a side-lying
position (of not contraindicated) with ear
to be treated facing up.
• Perform hand hygiene. Apply gloves if
drainage is present.
• Straighten ear canal
o 0-3 y/o: pull pinna downward and
backward
o 3y/o up: pull pinna upward and
backward
• Instill ear drop on side of the auditory
canal to allow drops to flow in and
continue to adjust to body temp.
• Press gently but firmly a few times on
the tragus of ear to assist flow of
medication into the ear canal
• Ask pt. to remain in side lying position
for about 5 mins.
• At times the MD will order insertion of
cotton puff into outermost part of the
canal. Do not press cotton into the
canal. Remove cotton after 15 mins.
Procedure for Nasal Instillation
• Have pt. blow the nose prior to nasal
instillation
• Assume a back lying position or sit up
and lean head back
• Elevate nares slightly by pressing thumb
against client’s tip of nose. While the pt.
inhales, squeeze the bottle
NCM 106 - Pharmacology
• Keep head tilted backward for 5 mins.
after instillation of nasal drops
• When medication is used on a daily
basis, alternate nares to prevent
irritation
Procedure for Nasal Inhalation
• Semi/high fowler’s position or standing
position. To enhance full chest
expansion allowing deeper inhalation of
the medication
• Shake canister several times. To mix
the med and ensure uniform dosage
delivery
• Position the mouthpiece 1-2 inches from
the pt. open mouth. As the pt. starts
inhaling, press canister down to release
1 dose of med. This allows delivery of
med more accurately into bronchial tree
rather than being trapped in oropharynx
then swallowed
• Instruct pt. to hold breath for 10 secs. To
enhance complete absorption of the
med
• If bronchodilator, administer a max. of 2
puffs, for atleast 30 secs
interval\administer bronchodilator before
other inhaled med. This opens airway
and promotes greater absorption of med
• Wait atleast 1 min before administration
of the 2nd dose or inhalation of a
different medication by MDI
• Instruct pt. to rinse mouth, if steroid had
been administered. This is to prevent
fungal infection
Procedure for Vaginal Jelly, Foam and
Suppository
• Close room or curtain to provide privacy
• Assist pt. to lie in dorsal recumbent
position to provide easy access and
good exposure of vaginal canal, also
allows suppository to dissolve without
escaping through orifice
• Use applicator or sterile gloves for
vaginal administration of medications
Procedure for Vaginal Irrigation
• Empty bladder before procedure
• Position the pt. on her back with hips
higher than the shoulder (use bedpan)
• Irrigating container should be 30 cm (12
inches) above
• Ask pt. to remain in bed for 5-10 mins
flowing administration of vaginal
suppository, cream, foam, jelly or
irrigation
4. Rectal – rectally; can be used when the
drug has objectionable taste or odor
Procedure for Intra-rectal
• Need to be refrigerated as not to soften
• Apply disposable gloves
• Have pt. lie on left side and ask to take
slow deep breaths through mouth and
relax anal sphincter
• Retract buttocks gently through the
anus, past internal sphincter and against
rectal wall,10 cm (4 inches) in adults, 5
cm (2 inches) in children and infants.
May need to apply gentle pressure to
hold buttocks together monetarily
• Discard gloves to proper receptacle and
perform hand washing
• Pt. must remain on side for 20 mins
after insertion to promote adequate
absorption of medication
5. Parenteral – administration of
medication by needle. (4)
o A. Intradermal – under the
epidermis
 Site are inner lower arm, upper
chest and back, and beneath
scapula
 Indicated for allergy and
tuberculin testing and for
vaccinations
 Use needle gauge 25, 26, 27:
needle length 3/8”, 5/8” or ½”
 Needle at 10-15 degrees angle;
bevel up
NCM 106 - Pharmacology
 Inject small amount of drug
slowly over 3-5 sex. To form a
wheal or bleb
 Do not massage site of injection.
To prevent irritation of site and to
prevent absorption of drug into
subcutaneous
o B. Subcutaneous – vaccines,
heparin, preoperative medication,
insulin and narcotics
 Site: outer aspect of upper arm
o Anterior aspect of thighs
o Abdomen
o Scapular areas of upper
back
o Ventrogluteal
o Dorsogluteal
 Procedure:
o Only small doses should
be injected via SC routes
o Rotate site of injection to
minimize tissue damage
o Needle length and gauge
are same for ID injection
o Use 5/8 needle for adults
when injection is to
administer at 45 degree
angle: ½ is use at a 90
degree angle
o For thin pt.: 45 degree
angle of needle
o For obese pt.: 90 degree
of needle
 For heparin injection:
o Do not aspirate
o Do not massage injection
site to prevent hematoma
formation
 For other medication:
o Aspirate before injection of
medication to check if
blood vessels had been
hit. If blood appears on
pulling back plunger of the
syringe, remove the
needle and discard
medication and equipment
 For Insulin injection:
o Do not massage to
prevent rapid absorption
which may result to
hypoglycemic reaction
o Always inject insulin at 90
degrees angle to
administer the medication
in the pocket between the
subcutaneous and muscle
layer. Adjust the length of
the needle depending on
size of the pt.
o C. Intramascular
 Needle length is 1”, 1 ½”, 2” to
reach muscle layer
 Clean site with alcoholized
cotton ball to reduce
microorganism in area
 Inject medication slowly to allow
tissue to accommodate value
 Sites:
o Ventrogluteal
 Area contains no large
nerves, blood vessels
and less fat. It is
farther from rectal
area, so it is less
contaminated
 Position pt. in prone,
curl and toes inward
 When side lying
position, flex knees
and hip. This ensures
relaxation of gluteus
muscles and
minimizes discomfort
during injection
 To locate site, place
heel of hand over the
greater trochanter,
point the index finger
toward the anterior
superior iliac spine,
then abduct the middle
finger. The triangle
formed by the index
NCM 106 - Pharmacology
finger, the third finger
and the crest is the
ilium is the site
 Another method of
locating site is to
imaginary divide
buttocks into 4
quadrants. The upper
most is the site of
injection. Palpate the
crest of the ilium to
ensure that the site is
high enough
 Avoid hitting sciatic
nerve, major blood
vessel or bone by
locating the site
properly
o Vastus Lateralis
 Recommended site for
infant
 Located at the middle
third of the anterior
lateral aspect of thigh
 Assume back-
lying/sitting position
o Rectus femoris site
o Located at the middle
third, anterior aspect of the
thigh
o IM Injection – Z tract injection
 Used for parenteral preparation.
To seal the drug deep into the
muscle and prevent permanent
staining of skin
 Retract skin laterally, inject
medication slowly. Hold
retraction of skin until the needle
is withdrawn
 Do not massage site of injection
to prevent leakage into the
General Principles in Parenteral
subcutaneous
Administration of Medication
o D. Intravenous – through veins
 Nurse administer medication
intravenously by ff. methods
o Mixture within large
volumes of IV fluids
o By injection of a bolus, or
small volume, or
medication through an
existing intravenous
infusion line or intermittent
venous access
(heparin/saline lock)
o By “piggyback” infusion of
solution containing
prescribed medication and
a small volume of IV fluid
through an existing IV line
o Most rapid route of
absorption of medication
o Predictable, therapeutic
blood levels of medication
can be obtained
o Route can be used for pt.
within compromised
gastrointestinal function or
peripheral circulation
o Large dose of medication
can be administered by
this route
o The nurse must closely
observe the pt. for
symptoms to adverse
reactions
o The nurse should double-
check the 6 right of safe
medication
o If the medication has an
antidote, it must be
available during
administration
o When administrating
potent medication, the
nurse assesses vital signs
before, during and after
infusion
1. Check doctor’s order
2. Check the expiration for medication –
drug potency may increase/decrease if
outdated
NCM 106 - Pharmacology
3. Observed verbal/non-verbal responses
toward receiving injection. Injection can
be painful. Pt. may have anxiety, which
can increase pain
4. Practice asepsis to prevent infection.
Apply disposable gloves
5. Use appropriate needle size. To
minimize tissue injury
6. Plot site of injection properly. To prevent
hitting nerves, blood vessels and bones
7. Use separate needles for aspiration and
injection of medication to prevent tissue
irritation
8. Introduce air into vial before aspiration.
To create positive pressure within the
vial and allow easy withdrawal of
medication
9. Allow a small air bubble (0.2 ml) in
syringe to push medication that may
remain
10. Introduce needle in quick thrust to
lessen discomfort
11. Either spread or pinch muscle when
introducing medication. Depending on
the size of pt.
12. Minimized discomfort by applying cold
compress over the site before
introduction of medication to numb
nerve endings
13. Aspirate before the introduction of
medication. To check if blood vessels
had been hit
14. Support tissue with cotton swabs before
withdrawal of needle. To prevent
discomfort of pulling tissues as needle is
withdrawn
15. Massage site of injection to haste
absorption
16. Apply pressure at site for few minutes.
To prevent bleeding
17. Evaluate effectiveness of procedure and
make relevant documentation
Nursing Intervention in IV Infusion
o Verify the doctor’s order
o Know the type, amount, and indication
of IC therapy
o Practice strict asepsis
o Inform the pt. and explain the purpose of
IV therapy to alleviate pt. anxiety
o Prime IV tubing to expel air. This will
prevent air embolism
o Clean insertion site of IV needle from
center to the periphery with alcoholized
cotton bal to prevent infection
o Shave the area of insertion if hairy
o Change IV tubing every 72hrs to prevent
contamination
o Change IV needle insertion site ever
y72 hrs to prevent thrombophlebitis
o Regulate IV ever y25-20 mins to ensure
administration of proper volume of IV
fluid as ordered
o Observed for potential complication
Types of IV Fluids (3)
1. Isotonic solution – same concentration
as body fluids (effects: balance)
• D5 W
• Na CI 0.9%
• Plain Ringer’s lactate
• Plain Normosol
2. Hypertonic solution – higher
concentration than body fluids (effects:
cells shrink)
• D10W
• D502
• D5LR
• D5NM
3. Hypotonic solution – low concentration
as body fluids (effects: cells swell)
• NaCI 0.3%
Complication of IV Infusion (5)
1. Infiltration – needle is out of vein, and
fluids accumulate in subcutaneous
tissues
• Assessment:
o Pain
o Swelling
o Skin is cold at needle site
o Pallor of the site
NCM 106 - Pharmacology
o Flow rate has
decreased/stopped
• Nursing intervention
o Change site of needle
o Apply warm compress. This
will absorb edema fluids and
reduce swelling
2. Circulatory overload – results from
administration of excessive volume of IV
fluids
• Assessment:
o Headache
o Flushed skin
o Rapid pulse
o Increased BP
o Weight gain
o Syncope and faintness
o Pulmonary edema
o Increase volume pressure
o SOB
o Coughing
o Tachypnea
o shock
• Nursing Intervention
o Slow infusion to KVO
o Place pt. in high fowler’s
position to enhance breathing
o Administer diuretic,
bronchodilator as ordered
3. Drug overload – pt. receives excessive
amount of fluids containing drugs
• Assessment:
o Dizziness
o Shock
o Fainting
• Nursing Intervention
o Slow infusion to KVO
o Take vital signs
o Notify physician
4. Superficial Thrombophlebitis – due to
overuse of vein, irritating solution or
drugs, clot formation, large bore
catheter
• Assessment:
o Pain along course of vein
o Vein may feel hard and
cordlike
o Edema and redness at needle
insertion site
o Arm feels warmer than the
other arm
• Nursing Intervention
o Change IV site every 72 hrs
o Use large veins for irritating
fluids
o Stabilized venipuncture at area
of flexion
o Apply cold compress
immediately to relieve pain and
inflammation; later with warm
compress to stimulate
circulation and promotion
absorption
5. Air Embolism – air manages to get into
circulatory system; 5ml of air or more
causes air embolism
• Assessment:
o Chest, shoulder, or back pain
o Hypotension
o Dyspnea
o Cyanosis
o Tachycardia
o Increase venous pressure
o Loss of consciousness
• Nursing intervention
o Do not allow IV bottle to “run
dry”
o “Prime” IV tubing before
starting infusion
o Turn pt. to left side in
trendelenburg position to allow
air to rise in right side of heart
to prevent pulmonary
embolism
6. Nerve Damage – results from tying arm
too tightly to splint
• Assessment:
o Numbness of fingers and
hands
• Nursing Intervention
o Massage area and move
shoulder through its ROM
o Instruct pt. to open and close
hand several times each hour
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o Physical therapy may be
require. Note: apply splint with
the finger free to move
7. Speed shock - result from
administration of IV push medication
rapidly
• To avoid speed shock and possible
cardiac arrest, give most IV push
medication over 3-5 minutes