Medications

Medication
Objective:
Discuss different types and route of medication/dosage compilation.
Discuss the basic principles in the preparation of medications
Discuss the different ways on how to solve drug dosages and intravenous
fluid rates

What is Medication?

A medication is a substance administered for the diagnosis, cure, treatment, or

relief of a symptom or for prevention of disease.

In the health care context, the words medication and drug are generally used
interchangeably.

Rights of Medication
RIGHT MEDICATION
 The medication given was the medication ordered.

RIGHT DOSE
 The dose ordered is appropriate for the client.
 Give special attention if the calculation indicates multiple pills/ tablets or a large
quantity of a liquid medication. This can be an indication that the math calculation
may be incorrect.
 Double-check calculations that appear questionable.
 Know the usual dosage range of the medication.
 Question a dose outside of the usual dosage range.

RIGHT TIME
 Give the medication at the right frequency and at the time ordered according to
agency policy.
 Medications should be given within the agency guidelines.

RIGHT ROUTE
 Give the medication by the ordered route.
 Make certain that the route is safe and appropriate for the client.

RIGHT CLIENT
 Medication is given to the intended client.
 Check the client’s identification band with each administration of a medication.
 Know the agency’s name alert procedure when clients with the same or similar last
names are on the nursing unit.

RIGHT CLIENT EDUCATION

 Explain information about the medication to the client (e.g., why receiving, what to
expect, any precautions).

RIGHT DOCUMENTATION
 Document medication administration after giving it, not before.
 If time of administration differs from prescribed time, note the time on the MAR and
explain the reason and follow-through activities (e.g., pharmacy states medication will
be available in 2 hours) in nursing notes.
 If a medication is not given, follow the agency’s policy for documenting the reason
why.

RIGHT TO REFUSE
 Adult clients have the right to refuse any medication.
 The nurse’s role is to ensure that the client is fully informed of the potential
consequences of refusal and to communicate the client’s refusal to the health care
provider.

RIGHT ASSESSMENT
 Some medications require specific assessments prior to Administration (e.g., apical
pulse, blood pressure, lab results).
 Medication orders may include specific parameters for administration (e.g., do not
give if pulse less than 60 or systolic blood pressure less than 100).

RIGHT EVALUATION
 Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the
client experience any side effects or adverse reactions?).
Basic Principles to the preparation and administration of medicines
• A physician’s order is required before administering any drug. A written order is
preferred, but a phone or verbal order maybe necessary at all times. In this case, the
nurse writes the order and reads to the doctor who must countersign the order
immediately as possible.

• Nurses administering drugs are responsible for their actions. Verify all new or
questionable orders on medication chart against the doctors’ orders.

• Students are not allowed to take verbal or phone order.

• Wash your hands and maintain aseptic technique before and after preparing
medication.

• Prepare medication in quiet environment.

• Collect all necessary equipment including measuring cups, stethoscope as

necessary.

• Be knowledgeable of the drugs you administer. Review medication chart for each
client carefully to ensure safety. “NOTE MEDICATION, DOSAGE, ROUTE AND
FREQUENCY”
• Research drug compatibilities, action purpose, contraindications, side effects and
appropriate routes.

• Find medication for individual clients and calculate dosage accurately.

• Check expiration date on medication and look for any changes that may indicate
decomposition (color, odor and clarity.
• Compare label three times with medication to decrease the risk of error:
a. When removing package from drawer
b. Before preparing medication
c. After preparing medication

• Check the need for PRN medication.

• Be sure medications are identified for each client.

• Check for any allergies before administration.

• Use meds that are in clearly labeled containers from the pharmacy (don’t give if there
is no label). Keep all narcotics and barbiturates in a locked place.

• Return to the pharmacy and don’t use liquids that are discolored or muddy.

• Confirm client’s identity by checking at least 2 of the 3 possible mechanisms for

identification to ensure safety:
a. Ask client his name
b. Check patient’s ID band
c. Check the bed tag (least reliable method)

• Provide privacy if needed.

• Inform client of any procedure, medication, technique, purpose and client teaching as
applicable.

• Stay with the client until medication is gone, don’t leave medication at bedside.
• Assist client as needed and leave position of comfort.

• Give medication within 30 min. of prescribed time.

• If the client vomits after taking the medication, report to the nurse in charge or to the
doctor (same if there’s an adverse effect after taking the drug).

• Pre-op meds are discontinued post operatively or after the operation unless it is
ordered continued.

• Liquid medications – all routes of administration must not be mixed together unless
compatibility is verified.

• Chart administration immediately in ink, marking your initials in appropriate spaces.

Observe for any reactions.

• Circle initials and document rationale if drug is not administered. If the medicine is
omitted for any reason, document the fact together with the reason why it is
discontinued.
• If there is a medication error, report at once to the nurse and physician.

• To ensure safety, do not give a medication that someone else prepared.

• Observe the 10 rights of drug administration.

Standard timing medicine administration

FREQUENC
HOUR
Y
O.D 8:00
8:00 – 4:00 (Antibiotic)
8:00 – 6:00 (Misc.
Drugs)
B.I.D
8:00 – 8:00
(Tranquilizers/sedative
s)
T.I.D 8:00 – 1:00 – 6:00
8:00 – 2:00
Q.I.D
8:00 – 2:00
HS 8:00
Q8H 8:00 – 4:00 – 12:00
Stat Immediately
PRN When necessary
Computation of Drug Dosages

10. For oral medication in solid form (tablets, caplets, capsules etc.)

Desired dose = Quantity of drug

Stock dose
(D/S=Q)

Example: Give Paracetamol 250mg/tab, 1 tablet every 6 hours for fever.

Desired: Paracetamol 250mg/tab

Stock dose: Paracetamol 500mg/tab
250mg/tab
500mg/tab

Answer =0.5 tablet

You will give 0.5 or half tablet of Paracetamol 500mg to achieve the desired dose of 250
mg.

2. For oral/parenteral medications in liquid form:

Desired dose x dilution =Quantity of drug

Stock dose
(D/S x Dilution=Q)

Example:
Give Cefuroxime 375mg IV q 8hrs via soluset to run for 30 minutes.

Desired: Cefuroxime 375 mg

Stock: Cefuroxime 750 mg
Dilution: 10 ml sterile water

Cefuroxime 375mg
Cefuroxime 750mg
=0.5 X 10 ml (dilution)

Answer =5ml
Give 5ml of diluted 750mg Cefuroxime q 8hrs.
Intravenous fluid

These are liquids given to replace water, sugar and salt that a person may need when
he is not able to do so orally.

Types:

Isotonic Solutions
- They have solute concentrations that are different than those of your cells. This
means that there is no concentration gradient across the cell membrane, which
means that your cells neither expand nor shrink in the presence of an isotonic
solution. They contain am electrolyte balance similar to that of plasma in the
blood stream.
-
Example:
• Normal Saline Solution
• Lactated Ringer’s Solution

Hypotonic Solutions
-They have solute concentrations lower than those of your cells. This means that, in
an effort to balance the solute concentration, water will rush into the cell, causing it to
expand.

Example:
• 0.45 NaCl Solution
• 0.3 NaCl Solution

Hypertonic Solutions
-They have higher solute concentrations than those of your cells. In order to balance
the solution, water will flow out of the cell, causing it to shrink.

Example:
• D5LR
• D10W
• D5NSS
• D5NM

How to compute IV fluid rate:

• A. gtts/min= Volume in cc x drop factor
no. of hours x 60 minutes
• B. cc/hr = volume in cc or gtts/min
no. of hours
• C. duration in hours= volume in cc
cc/hr

Example:
 How long will a 100 ml infusion of Sodium bicarbonate last if it is running at 42 drops
per minute? DF=20/ml
Drop rate: 42 drops/minute, DF is 20 drops/ml
If we divide 42 drops per minute by 20 drops/ml we have 42/20=2.1 ml/min

So we have: 100ml/2.1 ml/min

Answer: 47.6 minutes

The infusion will run for 47.6 minutes

A patient is to be given 1000 ml IV using an infusion pump with a drip factor of 15

drops/ml. The infusion starts at 8am. If the drip rate was set at 25 drops/minute at what
time would the infusion finish?

If we divide 25 drops per minute by 15 drops/ml, we get 1.67ml/min.

Then we divide 1000ml by 1.67ml/min we get 600 mins.
600mins/ 60min= 10 hours

Answer= 10 hours
8 am plus 10 hours= 6pm

Administering Intradermal Injection

PROCEDURE
 
1.Organize the equipment
2. Wash hands & observe other appropriate infection control procedure
3. Prepare the medication from the vial or ampule for drug withdrawal.
4. Prepare the client by checking the ID band
5. Explain to the client that the medication will produce a small wheal, sometimes
called a bleb or wheal.
6. Provide for client’s privacy
7. Select & clean the site
8. Avoid using sites that are tender, inflamed or swollen, and those that have
lesions
9. Cleanse the skin at the site using firm circular motion, starting at the center &
widening the circle outward. Allow the area to dry thoroughly.
10. Prepare the syringe for the injection
11. Remove the needle cap while waiting for alcohol or antiseptic to dry
  
12. Expel any air bubbles from the syringe
 
13. Hold the syringe in your dominant hand, holding it thumb & forefinger
14. Hold the needle almost parallel to the skin surface, with bevel of the needle up
15. Inject the fluid
With the non-dominant hand, pull the skin at the site until it is taut
  
17. Insert the tip of the needle far enough to the place bevel through the
epidermis into the dermis
 
18. The outline of the needle of the bevel should be visible under the skin surface
 
19. Stabilize the syringe & needle, and inject the medication carefully & slowly, so
that it produces small wheal on the skin.
 
20. Withdraw the needle quickly at the same angle that is was inserted
21. Do not massage the area
 
 
22. Dispose the syringe & needle safely
 
 
23. Circle the injection site with ink to observe for redness or indurations, write
name of drug injected & time due.
 
 
24. Document all relevant information
 
 
25. Record the testing materials given, the time dosage, route, site & nursing
assessment

Administering Intramuscular Injection

PROCEDURE
 
1.Organize the equipment
2. Wash hands & observe other appropriate infection control procedure
3. Prepare the medication from the vial or ampule for drug withdrawal.
4. Whenever feasible, change the needle on the syringe before injection
5. Invert the syringe uppermost and expel all excess air
6. Provide for client’s privacy
7. Prepare the client by checking the ID band
8. Assist the client to a supine, lateral, prone or sitting position, depending on the
chosen site.
9. Obtain assistance in holding an uncooperative client
10. Explain the purpose of medication & how it will help, using language that the
client can understand, include relevant information about effects of the
medication.
11. Select, locate & clean
12. Select the site free of skin lesions, tenderness, swelling, hardness or localized
inflammation, and one that has been used frequently.
13. If injections are to be frequent, alternate sites. Avoid using the same site twice
in a row.
14. Locate the exact site for injection
15. Clean the site with an antiseptic swab or alcohol. Using a circular motion,
start at the center & move outward about 5cm (2in)
16. Transfer and hold the swab between the 3rd & 4th finger of your non dominant
hand in readiness for needle withdrawal, or position the swab on the client’s skin
about the intended site. Allow skin to dry prior to injection of medication.
17. Prepare the syringe for injection
18. Remove the needle cover without contaminating the needle
19. Withdraw unit-dose medication, take caution to avoid dripping medication on
the needle prior to injection
20. Inject the medication
21. Holding the syringe in a dart like position, pierce the skin quickly & smoothly
at 90 degrees angle & insert the needle into the muscle
22. Hold the barrel of the syringe steady with your non dominant hand, aspirate
by pulling back on the plunger with your dominant hand.
 
23. If blood appears on the syringe, withdraw the needle & discard & prepare a
new injection
 24. If blood does not appear, inject the medication steadily & slowly while
holding the syringe steady. 
 
25. After the injection, wait 10 seconds
 
26.Withdraw the needle smoothly at the same angle of insertion
 
27. Applied gentle pressure at the side with a dry cotton balls
 
28. If bleeding occurs apply pressure with a dry cotton balls until it stops
 
29. Discard the uncapped needle & disposed syringe into the proper receptacle
wash hands.
 
30. Document all relevant information such as time of administration, the drug
name, route, the dose & client’s reaction.