MODULE- DRUG ADMINISTRATION

Topic1: Drugs and Solutions

One of the many responsibilities of a nurse is to carry out medication order from the
physician. Nurses have a duty to the patient to know the actions and indications of all
medications they administer, including safe dosage ranges, adverse reactions,
monitoring parameters, and nursing implications.

Introduction on Drugs
Pharmacology
 Greek: pharmakon means “drugs” and logos means “science”
 the study of the effect of drugs on living organisms

Pharmacy and Its Pharmacist

 it is the art of preparing, compounding, & dispensing drugs
 it is the place where drugs are prepared & dispensed

Pharmaceutical Drug
 any chemical substance intended for use in the medical diagnosis, cure,
treatment, or relief of a symptom or for prevention of diseases

Sources of Drugs
 Natural Sources – drugs derived from plants and animals (found in nature)
Ex: opium, digitalis, iron, NaCl, Insulin, and Vaccines
 Synthetics – drugs that are produced and comes from starting materials not
found in nature
Ex: Sulfonamides (antibiotic), Propoxyphene HCl

Drug Classifications
 OTC (Over-the-Counter) Drugs – may be available without special restrictions or
doesn’t need any prescription from the doctors for it to be purchased; legally safe
for the layperson to use when taken according to directions provided by the
manufacturer
Ex: Paracetamol, Acetaminophen, Aspirin
 POM (Prescription Only Medicine) Drugs – must be prescribed by a licensed
medical practitioner
 Ex: Antibiotics
 BTC (Behind-the-Counter) – BTCs do not require a prescription, but must be kept
in the dispensary, not visible to the public, and only be sold by a pharmacist or
pharmacy technician. Unlike a prescription medication, BTC would allow a
patient to access drugs after an assessment and decision by a pharmacist.
Ex: Birth Control Pills

Drug Names
 Chemical Name – describes the drugs molecular structure and identifies its
chemical structure
 Generic Name – is the drug’s official name; it is also the complete copy the
branded drugs
 Trade Name (Brand Name) – Name given by the drug manufacturer; it also
known as “the first of its kind”
Note: Branded drugs are produced first before the generic drug. That is why generic
drugs are much cheaper compared to branded drugs. Brand-name drugs are
typically more expensive because of the higher initial costs to develop, market, and
sell a brand-new drug while generic drugs will not undergo the same process as
compared with branded drugs.
Note: generic names are written with a small initial letter while brand names are written
with a capital initial letter as seen on the image above.

Drug Effects
Therapeutic effect is always accompanied with unlikely effect
 Local Drug Effect – point of contact & generally does not affect tissues in other
areas
Ex: Topical (skin/mucous membranes) application of anti-inflammatory drugs
(Hydrocortisone) on inflamed area of the skin.
 Systemic Drug Effect – drug affects the different body systems; administration of
medication so that the entire body is affected
Ex: Oral medications usually causes systemic effects.
 Therapeutic Effects – these are desired effects, intended effects, and or primary
effects; this effect is the reason why the drug is prescribed
Ex: Decongestants are prescribed to decongest the airway

Kinds of Therapeutic Benefit

 Palliative – Relieves the symptoms of a disease but does not affect the disease
itself
 Chemotherapeutic – Destroys malignant cells
 Curative – Cures a disease or condition
 Restorative – Returns the body to health
 Supportive – Supports body function until other treatments or the body’s
response can take over
 Substitutive – Replaces body fluids or substances

Side Effects
 “secondary effects”
 An effect that are not intended but are usually predictable
Ex: (1) Digitalis – this drug is given to improve myocardial contractions while its
side effects are feeling nauseous and vomiting. (2) Antibacterial – this drug is
given to kill bacteria while its side effects are diarrhea and stomach upset.
Adverse Effects
 “Adverse Reactions”
 More severe side effects
Ex: Digitalis – a/r: visual problems, including blurry vision and yellow halos
Toxicity
 Deleterious effects of a drug to an organism; results from:
o Overdosage
o Ingestion
o Buildup of drug due to impaired excretion/metabolism (cumulative effect). It is
common to patients with kidney (organ for excretion) and liver (organ for
metabolism) problems.
Ex: Morphine Sulfate (narcotic analgesic) – overdosage of this drug results to
respiratory depression (s/sx: decreased respiratory rate)

Idiosyncratic Effects
 An unexpected and may be individualized effect
 An unexplainable effect
 Idiosyncratic drug reactions are adverse drug reactions that do not occur in most
patients at any dose and do not involve the known pharmacological properties of
the drug. These are drug reactions that occur rarely and unpredictably amongst
the population.
Ex: Idiosyncratic drug-induced liver injury (DILI) is a significant adverse effect of
antitubercular therapy with isoniazid (INH)

Other Related Terminologies

 Allergy – When a client is first exposed to a foreign substance the body may
react by producing antibodies
o an immunologic reaction to a drug
o can range to mild – severe
Ex: skin rashes, pruritus, rhinitis, angioedema

COMMON MILD ALLERGIC RESPONSES

SYMPTOM DESCRIPTION/ RATIONALE

Skin rash Intraepidermal vesicle rash/urticarial wheal/macular eruption

Rash is generalized over the body
Pruritus Itching of the skin with or without rash
Angioedema Edema due to increased permeability of the blood capillaries
Rhinitis Excessive watery discharge from the nose
Lacrimal tearing Excessive tearing
Nausea, vomiting Stimulation of these centers in the brain
Wheezing and Shortness of breath and wheezing on inhalation/exhalation
Dyspnea d/t accumulated fluids and swelling of the respiratory tissues
Diarrhea Irritation of the mucosa of the large intestine
 Anaphylaxis (Anaphylactic Reaction)
o A severe allergic reaction; usually immediate
Ex: swelling of mouth (see image below) & tongue, acute SOB, hypotension,
tachycardia

 Iatrogenic (Iatrogenic Disease)

o Disease caused unintentionally by medical therapy
Ex: Hepatotoxicity, Renal toxicity, Biliary obstructions, Fetal malformations
(Iatrogenic Skin Injury)

 Drug Interaction (when two or more drugs are being given to the patient)
o occurs when the administration of one drug, alters the effect of one or both
o Effect: increased (potentiating effect) or decreased (inhibiting effect)
Ex: There are drugs that when they are combined together would either have a
potentiating effect (means that a drug can amplify the effect of another drug) or
inhibiting effect (means that a drug can prevent/stop the effect of another drug
from taking place).
o Potentiating effect
 Additive – When two of the same type of drug increase the action of each
other
Ex: Codeine (narcotic analgesic) + Aspirin (Nonsteroidal Anti-
inflammatory drug) = pain killer and anti-inflammatory
 Synergistic – When two different drugs increase the action of one or
another drug
Ex: ampicillin (antibiotic) + sulbactam (beta-lactamase inhibitor) =
prolonged action of the antibiotic
Parts of Prescription
 Superscription
o Descriptive patient information (name, age, address)
o Date prescribed
o Rx symbol
 Inscription
o Name & dosage strength of prescribed medication
 Subscription
o Dispensing instructions for the pharmacist
 Signatura
o Directions for the client
 Prescriber’s signature
o Signature of the one who prescribed the drug

SUPERSCRIPTION

INSCRIPTION

SUBSCRIPTION

SIGNATURA

PRESCRIBER’S
SIGNATURE

Superscription: Information of the patient

Inscription: cephalexin (Ceporex) 500mg tab
Subscription: #21 (number of tablets)
Signatura: 1 tablet 3x a day for 7 days
Prescriber’s Signature: Signature and license no. of the doctor who prescribed
Learning Activity: Identify and label the following parts of this prescription. Write your
answers on the blank space provided below.

Superscription:

Inscription:

Subscription:

Signatura:

Prescriber’s Signature:
Types of Medication Order
 Stat Order – medication should be given immediately & only once
Ex: Morphine sulfate 10mg IV STAT
 Single Order – (One-Time Order) medication to be given once at a specified time
Ex: Diphenhydramine 10mg slow IV push 30 mins prior to transfusion of 1st unit
of PRBC (packed red blood cells)
 Standing Order – may or may not have a termination date; may be carried out
indefinitely
Kalium Durule 2 tabs p.o three times a day after meals x 3 days
 PRN Order – (As-Needed Order) permits the nurse to give a medication when, in the
nurse’s judgment, the client requires it.
Ex: Paracetamol 500mg/tab 1tab p.o. every 4hrs PRN for fever (to be given for
temperature >37.8 C)  this means that you are only allowed to administer
Paracetamol if the client is febrile with an interval of at least 4 hours (if you have
given paracetamol at around 4pm, you should not give paracetamol before 8pm
even if the patient is febrile therefore you can perform tepid sponge bath to the
patient).

Medication Tickets (San Pedro Hospital)

In every hospital institution, they make use of medication ticket to make it easier for them
to carry out doctor’s order when it comes to drug administration to the patients.
Medication tickets are based from the medical order or doctor’s order sheet found in the
patient’s chart. The color coding of these tickets depends on the institution’s policy.
Since we have San Pedro Hospital as our school-based hospital, the following color-
coded tickets are patterned to that institution (see images below).

Note: Always make sure to verify the medication ticket to your patient’s chart specifically
to the Medical Order Sheet then to the Medication Sheet (both of which can be found in
the patient’s chart) just to be sure that you are administering the right drug to the right
patient with the right dose.

 White Medication Ticket

o Is used for Oral Medication (p.o. meds) – It is the administration of medications
by mouth and is needed to be swallowed.

June 30, 2020 203 – bed 4

35

Juan dela Cruz

mefenamic acid (Dolfenal) 500mg TID

6 – 12 – 6
p.o.

Amie Perez de Jesus, RN

 Blue Medication Ticket
o Is used for Parenteral Medication – It is the administration of medication into the
body tissues other than the alimentary tract.

June 30, 2020

203- bed 4
35

Juan dela Cruz

amoxicillin 500mg IVTT q6ᵒ

6 – 12 – 6 – 12
IVTT

Amie Perez de Jesus, RN

o Is used for Nursing (treatment) Procedures – An example of a procedure is CBG

(Capillary Blood Glucose) monitoring to check for the glucose level of the blood.

203- bed 4 June 30,20220

35

Juan dela Cruz

CBG Monitoring q6ᵒ

5 – 11 – 5 – 11

Amie Perez de Jesus, RN

 Red Medication Ticket
o Is used for STAT (to be given immediately or with no delay) Medication. When
carrying out STAT order, remember to put the date and time administered at the
back; tear the ticket halfway; and flip it backwards when placing it on your
medication tray.
o It Is also used for Single Order Medication.
o Note: once given, tear the Red Medication Ticket Halfway; indicate the time it
was given as well at the back

203-bed 4 June 30,2020

4
35

Juan dela Cruz

paracetamol 500mg i tab NOW

p.o.

Amie Perez de Jesus, RN

Routes of Administration of Therapeutic Agents:

How therapeutic agent is administered Route
Having Swallowed Oral Administration
Placing agent under the tongue Sublingual
Having inhale the agent Inhalation
Inserting therapeutic agent into:
 Vagina Vaginal Administration
 Rectum Rectal Administration
Placing the agent on the skin Topical Application
Dropping agent into the mucous Instillation
Flushing mucous membrane with large Irrigation
amounts of therapeutic agent

Parenteral Administration Where it is administered

Intracutaneous or intradermal Corium (dermal layer)
Hypodermic / subcutaneous Subcutaneous tissue
Intramuscular Muscle tissue
Intravenous Vein
Intrathecal or Intraspinal Subarachnoid space of spinal
Intraperitoneal Peritoneal cavity
Intracardiac Heart
Intra-articular Cavity of a joint
Types of Drug Preparation
 Solids
1. Tablets – A powdered drug
compressed into a hard, small
disk; some are readily broken
along a scored line; others are
enteric coated to prevent them
from dissolving in the stomach.

1.3. Enteric-Coated Tablets – An enteric

1.1. Buccal Tablet – placed
between cheek & gum;
administration involves
placing a drug between your
gums and cheek, where it
also dissolves and is
absorbed into your blood
coating is a polymer barrier applied
on oral medication that prevents its
dissolution or disintegration in the
gastric environment. This helps by
either protecting drugs from the
acidity of the stomach; the stomach
from the detrimental effects of the
drug; or to release the drug after
the stomach (usually in the upper
tract of the intestine).

1.2. Coated Tablets – (sugar-

coated or film-coated
tablets) Tablets can be
covered with a layer to
protect them against
external influences, such as
dampness or bacteria.
Coated tablets are smooth,
colored, and often shiny.
They go down easier when
you swallow and are
tasteless.
 1.7. Chewable Tablets – contain a base
of flavored and/or sugar alcohol
often used for children

1.4. Sublingual Tablets– tablets which

easily melt in the mouth, dissolve
rapidly and with little or no residue;
administration involves placing a
drug under your tongue to dissolve
and absorb into your blood through
the tissue there

1.8. Scored Tablets – tablets whose

surfaces have been grooved or
scored

1.5. Effervescent– granular effervescent

salts and/or other materials that
release gas

2. Capsules – A gelatinous container to

hold a drug in powder, liquid or oil
form

1.6. Prolonged Action/Sustained

Release – A.K.A. prolonged-release
(PR), slow release (SR), sustained
action (SA), extended-release (ER);
designed to be released &
absorbed in stages or gradually
over time
3. Caplets – smooth, coated, oval-
shaped medicine tablet intended to
be tamper-resistant; it is a capsule +
tablet

7. Patches (Transdermal Patch) – A

4. Lozenges (Troches) – a flat, round,
or oval preparation that dissolves
and releases a drug when held in
the mouth
semipermeable membrane shaped
in the form of a disk or patch that
contains a drug to be absorbed
through the skin over a long period
of time

5. Pellets – dry medication that

resemble like a powder, but particles
are larger than powders

8. Granules – Some medicines come

as granules and are given by mouth
(orally). They can usually be mixed
in with a small amount of food, or in
water or juice.

6. Pill – One or more drugs mixed with

a cohesive material, in oval, round,
or flattened shape (Birth control Pills
see image on the other column)
9. Powders – Finely ground drug, some
are used internally others, externally.
Measured doses of solid medication
in powdered form usually dissolve in
water before ingestion.
10. Dusts – Very fine powders maybe
applied topically to the skin or mucus
membrane or by inhalation
Semi Solids
1. Suppository – One or several drugs
mixed with a firm base such as a
gelatin and shaped for insertion into
the body (e.g. rectum); the base
dissolves gradually at body
temperature, releasing the drug
2. Pastes – a preparation like an
ointment, but thicker and stiff, that
penetrates the skin less than an
ointment
3. Ointments – a semi-solid preparation
of one or more drugs used for
application on skin or mucous
membrane; oil based
4. Creams – Nongreasy, semi solid
preparation used for the skin
5. Gel (Jelly) – A clear or translucent
semisolid that liquefies when applied
to the skin
 3. Liniments – a medication mixed with
alcohol, oil, or soapy emollient and
applied to the skin

4. Elixirs – a sweetened & aromatic

6. Foams – a liquid, powder, or foam solution of alcohol used as a vehicle
deposited in a thin layer on the skin for medicinal agents
by air pressure

 Liquids
1. Lotions – a medication in a liquid
suspension applied to the skin
5. Tinctures – An alcoholic or water-
and-alcohol solution prepared from
drugs derived from plants

2. Solutions – one or more drugs

dissolved in water; clear and
homogenous
6. Extracts – a concentrated form of a
drug made from vegetables or
animals
7. Aromatic Waters – Aromatic waters
are clear aqueous solution saturated
with volatile Oils (e.g. rose oil,
Peppermint oil, or other aromatic or
volatile substances eg. Camphor).
Their odors and taste are of those of
the drugs or volatile substances from
which they are prepared.
10. Oils/emulsions – fine droplets of an
oil in water or water in oil; must be
shaken vigorously before usage
since they separate into layers after
standing a long period of time

8. Syrups – drugs dissolved in a

solution of sugar and then flavored
to disguise unpleasant taste

9. Suspensions - drugs that have been

mixed with a liquid, but not dissolved
Frequency of Administration (Abbreviations)
Usual Timing
Abbreviation Meaning
(San Pedro Hospital)
6am; 8am; (depends on the medical
OD Once a day
order)
b.i.d. Twice a day (bis in die) 10am – 6pm
t.i.d. Three times a day (ter in die) 6am – 12nn – 6pm
q.i.d. Four times a day (quater in die) 6am – 10am – 2pm – 6pm
a.c. Before meals (ante cibum) 5am or 5am-5pm or 5am-11am-5pm
p.c. After meals (post cibum) 7am or 7am-7pm or 7am-1pm-7pm
HS Hours of Sleep 9pm
It means all day and all night with
RTC Round the clock appropriate frequency of drug
administration
q12˚ Every 12 hours 6am – 6pm
You are only to give the medication
q4˚ Every 4 hours
every after 4 hours
q4˚ RTC Every 4 hours round-the-clock 6am-10am-2pm-6pm-10pm-2am
q6˚ Every 6 hours 6am – 6pm
You are only to give the medication
prn q4˚ As needed every 4 hours every after 4 hours as NEEDED
only
Three times a day before
t.i.d. a.c. 5am – 11am – 5pm
meals

Administering Medication
 The doctor by written order will indicate:
o drug name;
o amount of the drug per dose;
o the number of doses (tables, capsules, etc.);
o the route by which to administer the drug; and
o the frequency or number of times a day the drug is to be taken
Ex.: Demerol 100 mg IM q4˚ x 5 days

Consideration in Administration
1. The general principles related to drug administration.
2. The various types of drugs and their uses.
3. The minimum and maximum dosage of drugs.
4. The most effective means of administration and its expected effect.
5. S/sx (signs and symptoms) which would indicate patient idiosyncrasy or allergy.
6. Various factors which must be considered in determining the method and time of
administration of drugs.
7. Those factors which may modify the drug action.
8. The nurse should also know the new drugs which are continually appearing in the
market.

General Information about Drug Administration

1. Doctors should order in writing the name of the drug, amount, time and frequency of
giving as well as the method of administration.
2. Verbal orders should be accepted only in extreme emergencies. A written order must
be obtained as soon as the emergency has been controlled.
3. If a physician orders a drug over the telephone, a registered nurse must take down
the information. On the next visit, the physician signs the written record of the verbal
order.
4. The nurse should inform the doctor of any known patient’s allergies.
5. The nurse should recognize commonly used abbreviations and symbols utilized in
medication administration.
6. The nurse should bear in mind the accuracy in the measurement of drugs is vital
especially in pediatric doses where a relatively small error become magnified.
7. The nurse should know the usual therapeutic as well as side effects of each drug.
8. The physician must be notified immediately in case of error.
9. The nurse should question an order which in her judgment is erroneous. She should
tactfully clarify the order with the physician who made it.
10. The nurse should be knowledgeable of the patient’s diagnosis or tentative diagnosis.
11. Each type of drug preparation usually requires a specific method of administration.
12. The route of administration of the drug affects the optimal dosage of the drug.
(Optimal dosage of drugs administered by injection may be different from those
administered orally).
13. The safe administration of medication requires a knowledge of anatomy and
14. physiology as well as knowledge of the drug and the reason it has been prescribed.
15. The method of administration of drug is partially determined by the age of the patient,
level of consciousness and the disease process. Any difficulties encountered when
administering medicines should be reported.
16. Appropriate precautionary measures should be taken to avoid errors and accidents
in the preparation and the administration of therapeutic agents.
17. Physiologic activities of the body can be maintained, improved or in some instances
restored by the administration of therapeutic agents.
18. Persons vary in the way they metabolize injected or ingested agents or the way they
react to agents applied externally. Each patient has his own needs for explanations
and support with respect to the administration of medicines. Some people want to
know about their medicines, others prefer not to. The amount of knowledge that a
person requires is dependent upon individual circumstances.

General Rules in the Administration of Medicines

1. Observe the “ten rights” (Joyce Kee) in giving each medication:
1.1 Right Patient
1.2 Right Drug
1.3 Right Dose
1.4 Right Time
1.5 Right Route
1.6 Right Assessment
1.7 Right Documentation
1.8 Patient’s Right to Education
1.9 Right Evaluation
1.10 Patient’s Right to Refuse
2. Consult the clinical instructor or the head nurse if a written order is not clear as to
meaning, not legible or not signed by the doctor.
3. Wash hands thoroughly before measuring and preparing medication.
4. Make certain that all equipment is clean.
5. When giving pills or tablets, place in proper container directly from the bottle. Do not
touch them with your hands.
6. Determine if medication is to be delayed or omitted for a specific length of time, as
for x – ray examination or basal metabolic test, blood chem, and / or in cases where
the drug/s can adversely affect the patient’s vital signs or condition.
7. Never leave the medicine cabinet unlocked. Never leave your cart of medicine tray
out of your sight.
8. Do not return to stock any excess medicine or medicine refused by a patient.
9. Do not use a drug which is discolored, has precipitated, is contaminated or expired.
10. Provide drinking straws for irritating drugs and for those likely to stain the teeth i.e.
iodine and iron preparations.
11. Do not pour a drug from one bottle to another.
12. Never give two or more drugs at one time, unless ordered.
13. Do not permit one patient to carry medicine to another patient.
14. Know the minimum and maximum dose for the medication being given.
15. Report immediately to the CI or nurse-in-charge any error in medication.
16. Always provide a drink of fresh water to the patient immediately after giving an oral
medication, unless water is contraindicated.
17. The nurse who prepares a medicine should also give it and do the necessary
recording.
18. Do not recap needles (Infection Control) instead use the fish-hook technique.
19. Enteric Coated Drugs should never be powdered or crushed before administration.
20. Buccal and sublingual medication should be allowed to dissolved completely before
the patient drinks or eats.
21. Suspension and emulsion should be immediately administered after shaking and
pouring in the bottle.
22. Cough syrups are never diluted and followed up with water.
23. Sedatives are given with warm milk to increase or hasten desired effect of drug when
not contraindicated.
24. Never use milk or any juice to mask the taste of the medicine to a child for she/he
may develop unpleasant association and refuse them in the future.

Rules in Measuring Medication

1. Measure the exact amount of drug ordered with a calibrated equipment.
Ex: Medicine glass/cup and medicine dropper
2. Do not converse with anyone while preparing a medication. Always focus whenever
your preparing your medication and avoid any distractions.
3. Ensure adequate lighting to accurately measure and prepare medications.
4. Make sure that the medicine glass is dry before pouring or measuring a medication
to avoid any unnecessary drug-drug interaction.
5. Cleanse the mouth of every bottle after use and before replacing the cap.
6. Hold the medicine glass at eye level and place thumb nail of the hand holding the
glass at the level of the scale of the desired fluid volume.
7. Measure accurately liquid medication. Check that the scale is even with the fluid
level at its surface or base of meniscus.
8. Use of dropper: The size of the drops varies according to the size of the dose in the
medicine dropper, the angle at which the dropper is held and the viscosity of the
liquid.
9. Use of syringe: Draw up small volumes (less than 10 ml) with syringe without
needle, unless drug has its own specific measuring device.
Rules Regarding Labels
1. Give medication only from clearly labeled containers.
2. For each dose of medicine prepared, read the label three times: before/after
locating the bottle from the medicine box, before preparing the desired amount of
drug and before returning the bottle to the medicine box.
2.1. Oral
2.1.1 Liquids – after locating the bottles from the medicine box; before preparing
the desired amount of drug; and before returning the bottle to the medicine
box.
2.1.2 Tablets, Pills, and Capsules – after locating the tablet/pills/capsules from
the medicine box; before placing in the medicine glass; and before
opening the unit pack.
2.2 Parenteral – after locating in the vial/ampule; before withdrawing the medicine
from vial/ampule and after withdrawing the medicine from vial/ampule.
3. Never give a drug with an effaced (destroyed) label and from an unmarked bottle or
box.
4. Pour medicine from the bottle on the side opposite the label.
5. Labels on medicine containers should be changed only by the pharmacist.
6. If a drug has two commonly used names, both names should appear in the label.
7. Take note of the expiry date marked on the label.

Rules for Giving Medication

1. Give the medication within 30 minutes before or after the schedule for which it is
ordered.
2. Always identify the patient before giving the medication. Verify the patient’s
response with his/her ID Band. i.e. “Good morning sir/ma’am, may I know your
name? Maayong buntag ma’am/sir, unsa atong ngalan?”
3. If the medication is refused or cannot be administered, notify the CI /head nurse, and
record accordingly on the patient’s chart.
4. Remain at the bedside until the patient has taken the medicine.
5. Administer only those medicines which you have prepared.
6. Never give two drugs together, unless specifically ordered to do so. Different drugs
taken at the same time may form a chemical compound that can be injurious to the
patient or will render the drug inactive or less effective.
7. When a patient goes to the Operating Room, all orders for medication are
automatically discontinued. New orders for post – operative medications will be
written by the doctor.
8. When special tests are being done, medications due at the particular time are
omitted. They are resumed when next dose is due. (This is true of BID, TID, QID
orders, etc.). Medications given once a day are also administered.
9. Nurses should listen carefully to the patient who questions the addition or deletion of
a medication. If a patient questions the drug or dose you prepared to administer,
recheck the order.
10. Medicine ticket for Stat order should be torn halfway after the drug is administered.
Inform NOD.

Rules for Recording Drugs Administered (Documentation)

1. Record if an ordered medication is refused and if it cannot be administered for
whatever reason.
2. Record each dose of medicine soon after it is administered.
3. Use standard abbreviations in recording medications.
 4. Never record medication before it has been administered.
5. Record only those medicines which you have administered.
6. Record time, kind, dose, and route of drug given.
7. Record effect (beneficial or untoward) of medication.
8. Affix your initials on the appropriate space of the medication sheet for those
medications you actually have administered. If delayed or first dose of drug is to
be given, indicate the time above your initial
The Medication Sheet of San Pedro Hospital
Let’s get to know the Medication Sheet
This part of the medication sheet (see image below) is where the name of the
patient, the ward, the room and bed number, can be seen. Usually, if the patient is
endorsed to your ward, you will be creating the patient’s chart. When filling up the
information part of the medication sheet, use either black or blue pen.

Juan dela Cruz San Lorenzo 303-1

This part of the medication sheet (see image below) contains the medications
that were prescribed to the patient together with the date ordered, frequency of
administration, and route (PO). So, before this is filled up, the nurse will always check
the medical order to have a basis on what to transcribe on this sheet. The nurse will use
either black or blue pen when transcribing the medication including the part where the
dates are written. Fill in the dates up to the last box.
Now for the “Date Administered/Signature,” what the nurse on duty (NOD) writes
on these boxes (just right below the dates) are their initials. The color of pen used to
write their initials are based on their shift – Black for 7/3 shift; Blue for 3/11 shift; and
Red for 11/7 shift. In the image below, there are three nurses, each with their
corresponding shifts.

7/3 7/4 7/5 7/6 7/7 7/8 7/9

07/3/20 amoxicillin (Amoxil) 6am VYG VYG

500mg q6° p.o. for 12nn

7 days 6pm MKR MKR MKR

1 2 3 4 5 6 7 12mn VYG VYG

07/3/20 phenytoin (Dilantin) 10am ANA ANA ANA

50mg p.o. BID 6pm

Note: You ONLY write your initials on the boxes which corresponds to the date and time
you have administered the drug. Never write your initials on the blank spaces if it does
not correspond to the date and time you administered the drug. If you see another initial
written on your supposed to be box, report to the Clinical Instructor or verify if that
person (who owns the initial) gave the drug to the patient to avoid doubling of drug
administered. If all of the boxes have been filled-up with initials, it is your prerogative to
add another medication sheet on top of the previous medication sheet. Do not discard
the used-up medication sheet.
 If you have noticed the encircled series of numbers on the MEDICATION
column, that indicates the number of doses the patient received amoxicillin. The only
time that you can encircle the particular number is that if the patient completed the dose.
Based on the doctor’s order, the patient should receive amoxicillin 500mg for 4 times in
a day. So, on the fourth administration of the medication, you encircle the number using
the appropriate color of pen – who ever administers the fourth dose should be the one
encircling the number. This will help identify if the patient already completed the required
number of doses.
Note: Antibiotics, when ordered by a physician, should be completed in a specific
number of days.

7/3 7/4 7/5 7/6 7/7 7/8 7/9

07/3/20 amoxicillin (Amoxil) 6am VYG VYG

500mg q6° p.o. for 12nn

7 days 6pm MKR MKR MKR

1 2 3 4 5 6 7 12mn VYG VYG

07/3/20 phenytoin (Dilantin) 10am ANA ANA ANA

50mg p.o. BID 6pm

This part of the medication sheet contains PRN medications (see image below).
Let’s discuss first the PRN medication portion. Remember that PRN medications are
drugs which are prescribed by the physician and are given to the patient when a certain
condition is met. In the example below, the physician ordered paracetamol i tab. q4° for
temperature > 37.6°C. This means that you will only administer the medication if the
patient’s temperature is above 37.6°C with an interval of 4 hours every administration. In
the example below, there are times wherein you are tasked to monitor the patient’s vital
signs (VS) every two hours. Paracetamol was initially given at 2pm. Now let’s say the
patient got febrile or had a temperature of more than 37.6°C when you checked his VS
at 4pm. You will not administer paracetamol to the patient because it increases the risk
of acetaminophen toxicity. Instead of administering paracetamol, you can help decrease
the patient’s temperature by performing tepid sponge bath (TSB) until the 4-hour-interval
elapses.

7/3 7/4 7/5 7/6 7/7 7/8 7/9

2pm 12mn
07/3/20 paracetamol q4° ANA VGY
8pm
500mg i tabfor MKR

Temp>37.6°C
 Lastly, I present to you the Single Order and STAT medications portion of the
medication sheet. This part of the medication sheet contains urgent medications to be
administered without delay and single order medications. In this example,
diphenhydramine (an antihistamine drug) is administered to the patient 30 minutes prior
to blood transfusion of PRBC. This is a case of Single Order medication – it doesn’t
necessarily mean that the nurse will administer it immediately once the drug is available
but should be given 30 minutes prior to transfusion of the PRBC considering that it is
ready to be transfused to the patient.

07/3/20 diphenhydramine 10mg 7/3@10pm ANA ANAntone

MKR
MKR MKReyes
slow IV push 30 minutes VGY VGYap

prior to transfusion of 1st unit

of PRBC

For STAT medication order, make sure that it is carried out immediately right
after the order is given by the physician. Do not forget to write the date and time at the
back of the Red Medication Ticket once the drug is administered so as not to forget the
details when transcribing in the medication sheet. Remember to use the appropriate
color of pen when writing your initial.

The last two columns basically contain the initials and last name of the nurse
administrating the medication. This will help identify whoever administered the drug at a
given time and date.

7/3 @2:16pm ANA ANAntone

07/3/20 nifedipine (Adalat) 5mg SL ANA
MKR MKReyes
now VGY VGYap
 Juan dela Cruz San Lorenzo 303-1

7/3 7/4 7/5 7/6 7/7 7/8..7/9

07/3/20 amoxicillin (Amoxil) 6am VYG VYG

500mg q6° p.o. for 12nn ANA ANA ANA

7 days 6pm MKR MKR MKR

1 2 3 4 5 6 7 12mn VYG VYG

07/3/20 phenytoin (Dilantin) 10am ANA ANA ANA

50mg p.o. BID 6pm MKR MKR MKR

7/3 7/4 7/5 7/6 7/7 7/8 7/9

07/3/20 paracetamol q4° 2pm 12mn

ANA VGY
8pm
500mg i tabfor MKR

Temp>37.6°C

07/3/20 diphenhydramine 10mg slow 7/3@10pm MKR

ANA ANAntone
IV push 30 minutes prior to MKR MKReyes
transfusion of 1st unit of PRBC VGY VGYap

07/3/20 nifedipine (Adalat) 5mg SL now 7/3 @2:16pm ANA

Learning Activity: Below is the physician’s order for patient Juan dela Cruz during your
3-11 shift. Carry out the orders and document the necessary on the Medication Sheet
below.
MEDICAL ORDER
NAME: Juan dela Cruz WD:_San Lorenzo_RM & BED NO: 303-1
Date
4/25/19 Please admit under my service and start the following.
Cefalexin 125mg 5mL p.o. T.I.D. for 5 days
Mefenamic Acid 500mg Ṫtab p.o. B.I.D.
Paracetamol 120mg 0.5mL p.o. PRN for fever 𝑞̅4°
Kremil S Ṫ tab p.o. now.
Berroca Ṫ tab p.o. OD
VS 𝑞̅4° and record
Refer accordingly
Dr. Reyes

MEDICATION SHEET
NAME: WD: RM & BED NO:
DATE FREQUENCY/
MEDICATION DATE ADMINISTERED/SINATURE
ORDERED TIME

DATE FREQUENCY/
PRN MEDICATION DATE ADMINISTERED/SINATURE
ORDERED TIME

DATE/TIME
DATE SINGLE ORDER/STAT ADMINISTERED/ SIGNATURE NURSES PRINTED
ORDERED MEDICATION SIGNATURE (INITIAL) NAME
Drug Computation Step 1: Identify the variables
Safe nursing care mandates accuracy in Desired dose (D) = 1gm
the calculation of dosages and solution Drug on hand (H) = 250mg
rates. In this section you will get a brief Vehicle (V) = (1) capsule
review of basic arithmetic calculations
Step 2: convert the necessary
and a review of the ratio and proportion
measurement
method that is used for the calculation
1gm = 1000mg
of dosages and solutions.
Step 3: use the formula
Basic Formula
Amount to give = 1000mgx (1) capsule
_D_x V = Amount to give
250mg
H
where: D = desired dose
1000mg_ x (1) capsule = 4 capsules
H = drug on hand; dose on hand
250mg
V = vehicle; form and amount in
Note: always indicate the unit of which
which drug comes (tablet,
you are going to administer to your
capsule, liquid)
patient.
Note: Your desired dose is basically what
the doctor ordered; drug on hand is the
available drug; and vehicle is the type of
preparation of the drug.

Example 1: The doctor ordered

phenytoin (Dilantin)50mg p.o. TID. The
watcher of the patient procured
phenytoin (Dilantin) 125mg/5ml. What
will be the correct dosage will you
administer to your patient?

Step 1: Identify the variables

Desired dose (D) = 50mg
Drug on hand (H) = 125mg
Vehicle (V) = 5ml

Step 2: Use the formula given

Amount to give = _50mg_x 5ml
125mg

_50mg_ x 5ml = 2ml

125mg

Example 2: The doctor ordered

paracetamol 1gm p.o. BID. The
pharmacist dispensed paracetamol
250mg per capsule. What will be the
correct dosage will you administer to
your patient?
Parenteral Medication
This refers to the path which medication comes in contact with the body.
Parenteral medications enter the body by injection through the tissue and circulatory
system. Injection medications are absorbed more quickly and are used with patients who
are nauseated, vomiting, restricted from taking oral fluids, or unable to
swallow.Medications given in this route is irretrievable once injected, the nurse must
prepare & administer them ACCURATELY and CAREFULLY.ASEPTIC TECHNIQUE
MUST BE USED since injections are highly invasive procedures.

Equipment  Hypodermic Syringe – 2ml,

 Syringes 2.5ml, 3ml sizes
o 3 parts:
 Tip
 Barrel
 Plunger
o Parts of the syringe that must be
kept sterile:
 Tip
 Inside of the barrel  Insulin Syringe – designed
 Shaft of the plunger for insulin: common is in
100-unit calibrated scale

o Kinds of Syringes
 Tuberculin Syringe – originally
designed to administer tuberculin
(TB exposure); narrow, calibrated in
tenths and hundredths of ml; used in
administering drugs that needs
precise measurements or in small
doses

Variations on the tip of the syringe

 Syringes of other sizes: 5, 10, 20, 50
1. Luer lock – tip requires the needle to
mL- useful for adding medications to
be twisted onto it to prevent
intravenous solutions or for irrigating
accidental removal of the needle
wounds

2. Non Luer lock (Luer slip) – has
smooth graduated tip onto which
needles are slipped
3. Prefilled Syringe – a disposable
syringe that is already loaded with
substance to be injected; a single
dose of medication to which a
needle has been fixed by the
manufacturer
Needles
 Made of stainless steel and mostly
disposable
 Parts:
 Hub: part which fits into the
syringe
 Cannula or shaft: attached to the
hub
 Bevel: slanted part at the tip of
the needle
3 Variable Characteristics of a
Needle:
1. Slant or Length of Needle. The bevel
of the needle may be short or long.
Longer bevels provide the sharpest
needles and cause less discomfort.
They are commonly used for
subcutaneous or intramuscular
injections. Short bevels are used for
intradermal and intravenous
injections because a long bevel can
become occluded if it rests against
the side of a blood vessel.
2. Length of Shaft. The shaft length of
commonly used needles varies from
9mm to 50mm. This depends on the
person’s muscle development,
weight, and the type of injection.
3. Gauge (or diameter) of the shaft. It
varies from #18 to #28. The larger
the gauge number, the smaller the
diameter of the shaft. Smaller
gauges produce less tissue trauma,
but larger gauges are necessary for
viscous medications, such as
penicillin.
Note: SC = g.24-26; IM = g. 20-22
Needle Stick Injury
 One of the most potentially
hazardous procedures that health
care personnel face is using and
disposing of needles and sharps.
 Needlestick injuries are wounds
caused by needles that accidentally
puncture the skin
 This injury presents a major risk for
infection with hepatitis B virus, HIV,
and many other pathogens.

Preventing Needle Stick Injury

 Use appropriate puncture-proof
disposal containers for sharps
(needle, blades, lancets, broken
wires etc.)
 When recapping: Do
“SCOOPMETHOD” or “Fish hook
Technique” (see video)

o If not pre-scored, it should be

filed with a small file, then
Preparing Injectable Medications broken off at the neck
 Ampules

 Vials
o Are small glass bottle with a
sealed rubber cap
o Can some in single dose or
multi-dose
o Reconstitution – Technique of
adding a solvent to a powdered
o A glass container usually drug to prepare it for
designed to hold a single dose of administration
a drug
o Made of clear glass; has a
constricted neck
o Some may have colored marks
or dots which indicate where
they are pre-scored
 o Vials with plastic cap

Nursing Alert: Before withdrawing

meds from vial, swab the rubber cap
with a disinfectant.
Preparing Medications from Ampules
(See video)
Insert the needle to the ampule making
sure that the needle does not touch the
opening of the ampule. Turn it upside
down and withdraw the medication
inside.
Preparing Medications from Vials
(See video)
1. Before inserting the needle to the
vial, draw the plunger of the syringe
back to the point where it is equal to
the amount drug you’re going to
withdraw. Insert the needle and
introduce air to the vial.
2. Once air is introduced, place the vial
upside down and withdraw the
amount of drug to be administered.
Introducing of air will ease the
withdrawal of drug as it creates a
vacuum effect.
Intradermal Injections (ID)
 It is the administration of drug into
the dermal layer of the skin just
beneath the epidermis.
 Purpose/indications: used for skin
testing, TB screening & BCG
vaccinations
 common sites:
o inner lower arm, upper chest,
back beneath the scapulae
 Reassessment of injection site
occurs after 30 minutes.
Subcutaneous Injections (SC or SQ)
 Administration of drugs into the
subcutaneous layer
 Common sites:
o Outer aspect of the upper arms
o Anterior aspect of the thighs
o Abdomen
 o Scapular areas of the upper
back
o Upper ventrogluteal site and
dorsogluteal site
o to administer greater volume of
fluid (up to 5 ml)
o medications that are irritating
 Common Sites:
o Ventrogluteal site
 the gluteus medius muscle
which lies over the gluteus
minimus
 Advantages: area contains
no large nerves & blood
vessels; contains less fat
than the buttocks area; is
sealed off by bone
 Position: back-lying or side
lying with knee & hip flexed
to relax gluteal muscles

 Indications: o Vastus Lateralis site

o Vaccines  thick and well-developed muscle
o Pre-operative medications both in adult and children
o Narcotics  Site of choice: infants < 7 mos.
o Insulin old; Rationale: absence of major
o Heparin blood vessels or nerves on the
 Advantages: area
o Drug is almost completely
absorbed from the tissue, thus
the amount of drug absorbed is
predictable
o Drug generally acts in 30
minutes

Intramuscular Injections (IM)

 introduction of the medication into
the muscle tissue
 size of the needle depends on the ff:
o the muscle
o type of solution
o amount of adipose tissue
covering the muscle
o age of the client
 Indications:
o for rapid absorption of drugs
because it is rich with blood
supply
  situated on the anterior lateral
aspect of the infant’s thigh
(middle third)
 Position: back-lying or sitting
Injection Site
o Dorsogluteal site
 composed of thick gluteal
muscles of the buttocks
 not to be used for children below
3 y.o. unless the child has been
walking for at least 1 year
 Nursing Alert: Locate the site
carefully to avoid striking the
sciatic nerve, major blood
vessel, and bone.
 Position: prone or side-lying with
the upper knee flexed and in
front of the lower leg
o Deltoid
 found on the lateral aspect of the
upper arm, 2-3 fingerbreadths
below the acromion process
 not used often for IM injections
because of its close proximity to
the radial nerve & artery
 considered for use in adults
because of rapid absorption
 can accommodate up to 1mL
o Rectus Femoris
 situated on the anterior aspect of
the thigh
 advantage: good for patients
who administer their own
injections for they can reach the
site easily
Z-Track Technique
 used for Parenteral iron preparation
(to seal the drug deep into the
muscle & prevent staining of the
skin)
 Retract skin laterally (use the ulnar
side of the non-dominant hand to
pull skin appx. 1 inch to the side)
 Don’t massage injection site.
Note: Z-track technique prevents
leakage into subcutaneous tissue and
decreases the chance of local irritation.
Intravenous Medications
 Injecting medications into the vein
 has a rapid effect on the patient’s
body
 lessens discomfort

Pull or push the skin 2-3cm away from

the injection site with the non-dominant
hand.

Pierce the skin at 90° and depress the

plunger slowly. If resistance occur,
pause then resume depressing the
plunger.

Withdraw the needle, then release the

skin.