Introduction

The variety of drugs used in the treatment of diseases has increased dramatically in the past two
or three decades and continues to increase as medical researchers discover more chemicals that
produce highly sophisticated effects on specific tissues and cells.
These substantial advances in pharmacology have had an effect on nursing practice. Nurses are
not only expected to know a great deal about the drugs given to their patients, they , along with
physicians and pharmacists are held legally responsible for safe and therapeutic effects of drugs.
Nurses must therefore be knowledgeable about the action of drugs and accurate in administering
them.
This learning material discusses the basic principles and procedure of medication
administration. It is intended for Level I students during the second semester of each calendar
school year. After this, the students will be able to apply basic concepts and principles in drug
administration.
Pre-requisite knowledge and skills

Use of the nursing process as a mechanism for facilitating safe medication administration is
learned. Particular emphasis is placed on the assessment process.

Instructural Objectives:
 The Learning Activities/Course Content

Lesson 1

Medication Administration
Drug-also called medicine or medication is a substance used in the diagnosis, treatment, cure,
relief or prevention of disease

Naming of Drugs:
composition
the drug
publications
facturer markets a drug

Abbreviations Related to Drug Administration

Types of Medications
layer of the skin by air pressure
such as water
oil form
source
applied to the skin
skin
and releases a drug when held in the mouth
application to the skin or mucous membrane
penetrate the skin less than an ointment
round or flattened shape
gelatin and shaped for insertion into a body cavity
sant-tasting drugs
drugs derived from plants
form of a disk or patch that contains a drug to be used for a
a longer period of time

Routes of Administration:
Route Advantages Disadvantages
Oral >most convenient >inappropriate for clients
>usually least expensive with nausea & vomiting
>safe, does not break >drugs may have unpleasant
skin barrier taste/odor
>administration usually >inappropriate if client cannot
does not cause stress swallow or unconscious
>cannot be used before certain
diagnostic tests or surgical
procedures
>drug may discolor teeth,
harm tooth enamel
>drug may irritate gastric
mucosa
>drug can be aspirated by
seriously ill patients

Sublingual >same as for oral >if swallowed, drug maybe

>drug can be adminis- inactivated by gastric juices
tered for local effect >drugs must remain under
>drug is rapidly absorbed tongue until dissolved and
into the bloodstream absorbed
>ensures greater potency
because drug directly
enters the blood and
bypasses the liver

Buccal (cheek) >same as for sublimgual >same for sublingual

Rectal >can be used when drug >dose absorbed is unpredicta-

hasobjectionable taste ble
or odor
>drug releases at slow,
steady rate

Vaginal >provides local the- >limited use

rapeutic effect

Topical >provides a local effect >maybe messy and may soil

(dermatologic, >few side effects clothes
Instillations, >drugs can rapidly enter body
Irrigations through abrations and cause
systemic effects

Transdermal >prolonged systemic >leaves residue on the skin

effect that may soil clothes
>few side effects
>avoids GIT absorption
problems

Subcutaneous >onset of drug action >must involve sterile tech-

faster than normal nique because breaks skin
barrier
>more expensive than oral
>can administer only small
volume
>slower than IM administra-
tion
>some drugs can irritate
tissue and cause pain
>can be anxiety producing

Intramuscular >pain from irritating >can be anxiety producing

drugs is minimized >breaks skin barrier
>can administer larger
volume
>drug is rapidly absorbed

Intradermal >absorption is slow (an >amount of drug must be

advantage in testing small
allergies) >breaks skin barrier

Intravenous >rapid effect >limited to highly soluble

drugs
>drug distribution inhibited
by poor circulation
Inhalation >introduces drug through- >drug intended for localized
out the respiratory tract effect can have systemic
effect or use only for the
respiratory system

Other routes which are less commonly used for parenteral administration:

Medication/drug order-a written prescription for a drug

Components:

Types of Medication Orders:

Steps in Transcribing the Medication Order:

Nursing Considerations in Drug Administration

The RIGHTS of administering drugs:

Lesson 2
Methods of Medication Administration

Medication is to be applied.
Not allow partient to chew or swallow medication

Purposes:
Principles for Safe and Effective Administration of Parenteral Medications:

Routes of Parenteral Medication

Purpose: deposit medication in the muscular layer

Sites: deltoid, gluteal, ventral and lateral thigh muscles
Angle of needle: 90 degrees
Length of needle: 1-3 inches
Syringe: 3 ml, gauges 21, 22, 23

Purpose: use for injecting medication into the tissues

Below the dermal layer of the skin
Sites: upper portion of deltoid, anterior surface of the
Thigh
Angle of Injection: 45 degrees
Length of needle: 5/8 inch
Syringe: 3 ml, gauge 25

Purpose: for immediate effects

Sites: veins of the arms
Needle Gauge: 18 for thick solutions; 20-22 for thinner,
Aqueous solution

Purpose: skin testing, small amounts only

Sites: Volar surface of the arms
Angle of Injection: 10 degrees
Syringe: tuberculin syringe, U100 insulin syringes
Needle Gauge: 25, 27, 29

Locating Injection Sites

Note: Patient should be in recumbent or in a Sim’s position or is sitting upright.

Needles and Syringes

Parenteral Solutions

Medications for injection are dispensed in:

Steps in withdrawing medication from an ampule:

The solute in the vial is mixed with a diluents (sterile wa-

ter or sterile normal saline) before the drug is drawn up into
the syringe.

Steps in withdrawing medication from a Vial:

Steps in administering parenteral medications:

Lesson 3
Calculation of Medication Dosage

Dosage of medications vary according to a number of factors such as age, weight, severity of
illness and the condition of the individual. These must be carefully considered when one is to
administer the right dose of medication because any error can be very detrimental to a patient’s
well-being.

In this light, it is imperative for the nurse to compute accurately the correct dosage, specifically
in situations wherein the dose prescribed by the physician is not the amount supplied by the
pharmacy. To be able to calculate the dosage of medications accurately, the nurse must be
equipped with the knowledge of the fundamentals of mathematics.

The following mathematical formula could help the nurse in the calculations of medications.

Formula for the Computation of Drug Dosage:

____________X Q = q

S
D-desired dose
S-stock dose
Q-quantity of the solution or the amount of diluents used
q-amount to be given to the patient

Formula for the Computation of Drug Dosage for Children

Weight of child in lbs.

Child dose=__________________ X adult dose
150 (average adult weight)

Age of child (yrs)

Child dose=__________________X adult dose
Age of child (yrs) + 12

Age of child in months

Infant’s dose= ________________ X adult dose
150

Formula for the Computation of Infusion Rate (drops per minute)

Total vol. of infusionXfluid drip factor

Flow rate=_______________________________
Number of hours to be infusedX60

Drip factor:
Macrodrip-regular IV infusion set-delivers 20 gtts/cc

Microdrip-delivers 60 gtts/cc, used for children for a more

Precise control of the flow rate

Selected Metric Doses and Apothecary Equivalents

Weight Measures Liquid Measures

Metric Apothecary Metric Apothecary

(approx)
30 grams 1 ounce 1000 ml 1 quart (2 pints)
15 grams 4 drain 500 ml 1 pint (16 oz)
5 grams 75 grain 250 ml 8 fluid oz
1 gram 15 grain 30 ml 1 fluid oz
60 mg 1 grain 15 ml 4 drain
1 mg 1/60 grain 1 ml 15 minims
1 mg 1000 mcg 4000 ml 1 gallon

Common Household Equivalents

1 quart-----------------------4 cups
1 pint-------------------------2 cups
1 cup--------------------------8 ounce
1 tbsp-------------------------3 tsp
1 tbsp-------------------------60 gtts
1 glass-------------------------240 cc
1 cup---------------------------200 cc
1 cc-----------------------------15 gtts

Apothecary Measurements

60 minims---------------------1 fluidram
8 fluidrams--------------------1 fluid oz
1 pint---------------------------16 fluid oz
2 pints--------------------------1 quart
4 quarts------------------------1 gallon

Metric Measurements

10 mm--------------------------1 cm
10 cm---------------------------1 dm
10 dm---------------------------1 meter
1 ml-----------------------------1 cc
10 cc----------------------------1 dl
1000 ml------------------------1 liter
1000 gm-----------------------1 kg
1 kg-----------------------------2.2 lbs
1 pound------------------------16 oz

Complimentary and Alternative Medicine

Holism = combined mental, emotional, spiritual relationship and environmental components

Humanism = the mind and body are indivisible, people have the power to solve their own
problems, people, people are responsible for the patterns of their lives, and well-being is a
combination of personal satisfaction and contributions to the larger community
Nursing is in a unique position to take a leadership role in integratingalternative healing
methods into western health care systems.
Balance = consists of mental, physical, emotional, spiritual and environmental components
Physical aspects = optimal functioning of all body systems
Emotional aspects = the ability to feel and express the entire range of human emotions
Mental aspects = feelings of self-worth, a positive identity, sense of accomplishment, and the
ability to appreciate and create
Spiritual aspects = moral values, a meaningful purpose in life, and a feeling of connectedness to
others and a divine source
Environmental aspects = physical, biologic, economic, social and political conditions
Spirituality =Includes the drive to become all that one can be, and is bound to intuition,
creativity, and motivation
It is the dimension that involves relationship with oneself, with others, and with a higher power
It is that which gives people meaning and purpose in their lives; it involves finding significant
meaning in the entirety of life, including illness and death
Energy = viewed as the force that integrates the body, hand, and spirit; it is that which connects
everything
Healing environments = are synthesis of the medical-curing approach and the nursing healing
approach
Nursing has always focused on creating environments for those who have been entrusted to our
care
We create healing environments when we use our hands, heart and mind to provide holistic
nursing care
We create healing environments when we empower others by providing the knowledge, skills
and support that allow them to tap into their inner wisdom and make healthy decisions for
themselves

Healing Modalities
A. Systematized Health Care practices
1. Ayurveda
Indian system of medicine which seeks to treat and integrate body, mind and spirit
Illness is viewed as a state of imbalance among the body’s systems
Emphasizes the interdependence of the health of the individual quality of societal life
Mentally healthy people have good memory, comprehension, intelligence, and reasoning ability
Emotionally healthy people experience evenly, balanced emotional, states and a sense of well-
being or happiness
Physically healthy people have abundant energy with proper functioning of the senses, digestion
and elimination
Spiritually healthy people have a sense of aliveness or richness of life, developing in the
direction of their full potential, and are in good relationships with themselves, other people and
the larger cosmos
Environmentally healthy people have minimal economic, social and political stress

Preventive and therapeutic approach in Ayurveda:

2. Traditional Chinese Medicine
Based on the premise that the body’s vital energy or qi (chee) circulates through pathways
Disease is described as an imbalance or interruption in the flow of qi
The mind, body and spirit and emotions are never separated
3. Native American Healing
Spirituality and medicine are inseparable
The only healer is the one who created all things
Health is viewed as a balance or harmony of mind and body
4. Curanderismo = a cultural healing tradition found in Latin America
It utilizes western biomedical beliefs, treatment and practice

B. Botanical Healing
1. Herbal medicine – use of herbs or plants in treating illness
Some herbal remedies are synthesized into modern drugs:
a. Digoxin from foxglove
b. Quinine from Peruvian bark
c. Aspirin from willow tree bark
d. Morphine from opium poppy
e. Cocaine from coca leaves
2. Aromatherapy – the therapeutic use of essential oils of plants in which the odor or fragrance
plays an important part
The chemical found in the essential oils are absorbed into the body, resulting in physiologic or
psychological benefit
Essential oils are extracted from plants and are massaged into the skin, inhaled, placed in baths,
used as compresses or mixed into ointments
Different oils may calm, stimulate, improve sleep, change eating habits or boost the immune
system
3. Homeopathy – a self-healing system, assisted by small doses of remedies or medicines which
is useful in a variety of acute and chronic disorders
Natural healing compounds are prepared through a process of serial dilution, the compound is
first dissolved in a water-alcohol mixture called the “mother tincture”
The homeopathic belief is that the more the substance is diluted, the more potent it becomes as
a remedy
4. Naturopathy – not only a system of medicine but also a way of life with emphasis on client
responsibility, client education, health maintenance, and disease prevention
The goal of treatment is the restoration of health and normal body function, rather than the
application of a particular therapy
C. Nutritional Therapy – consists of consumption of specific types of diets or supplements,
including vitamins, mineral, amino acids, herbs and other botanicals and miscellaneous
substances such as enzymes and fish oils for the purpose of preventing or treating illness

D. Manual Healing Methods

1. Chiropractic
A form of alternative medicine mostly concerned with the diagnosis and treatment of
mechanical disorders of the muscoskeletal system especially the spine
Based on the action that the relationship between the body’s structure(spine) and its function (as
coordinated by the nervous system) affects health

2. Massage - Manual manipulation of soft body tissues (muscle, connective tissue, tendons and
ligaments) to enhance a person’s health and well-being – reduce stress and anxiety, relax
muscles, rehabilitate injuries, reduce pain

3. Acupuncture and Acupressure – techniques of applying pressure or stimulation to specific

points on the body (acupuncture points), to relive pain, cure certain illnesses and promote
wellness
Acupuncture uses needles whereas acupressure uses finger pressure
Reflexology – a form of acupressure most commonly performed on the feet but the hands or
ears may also be manipulated

E. Mind-Body Therapy
1. Yoga – a group of physical, mental and spiritual practices or disciplines which originated in
ancient India
It is a way of life that includes ethical models for behavior and mental and physical exercises
aimed at producing spiritual enlightenment

2. Meditation – a process that anyone can use to calm themselves, cope with stress, and for
those with spiritual inclinations, feel as one with god or the universe
3. Hypnotherapy – application of hypnosis in a wide variety of medical and psychologic
disorders
Hypnosis – a trance state or an altered state of consciousness in which the individual
concentration is focused and distraction is minimized

4. Guided imagery – state of focused attention, like hypnosis, that encourages changes in
attitudes, behavior and physiologic reactions
Help us learn how to stop troublesome thoughts and focus on images that help us relax and
decrease the negative impact of stressors

5. Biofeedback – method for learned control of physiologic responses of the body

A relaxation technique that used electronic equipment to amplify the electrochemical energy
produced by body responses

6. Qigong and T’ai Chi – therapies that focus on movement, body awareness, and breathing and
their purpose to maintain health as well as to correct a specific problem
Qigong – a Chinese discipline consisting of breathing and mental exercises combined with body
movement
T’ai Chi – arose out of qigong and is a discipline that combines physical fitness, meditation, and
self-defense

7. Pilates – method of physical movement and exercise designed to stretch, strengthen and
balance the body, in particular the core or center including the abdominal region

F. Spiritual Therapy
1. Faith and Prayer
Faith – refers to our beliefs and expectations about life, ourselves, and others. Refers to a belief
in a supreme being who listens and responds to people who cares about their well-being
Prayer – a form of communication and fellowship with the Deity or Creator. Active process of
appealing to a higher spiritual power, specifically for health reasons

G. Miscellaneous Therapies
1. Music Therapy – quiet, soothing music without words is often used to induce relaxation

2. Humor and Laughter

Humor

Laughter
“laughter is the best medicine”

3. Infrared Photoenergy Therapy – safe and effective treatment to improve sensory impairment
associated with peripheral neuropathy
The treatments are given with the Anodyne Therapy System 3-5 times a week for 2 weeks
? increases energy inside cells, as well as by improving circulation

4. Detoxifying Therapies
Detoxification – the belief that physical impurities and toxins must be cleared from the body to
achieve better health
Hydrotherapy – use of water as a healing treatment
Used to decrease pain, decrease fever, reduce swelling, reduce cramps, induce sleep and
improve physical and mental tone
Colonics or colon therapy – procedure for washing the inner wall of the colon by filling it with
water or herbal solutions and then draining it
Chelation therapy – introduction of chemicals into the bloodstream that bind with heavy metals
in the body.

5. Animal-assisted Therapy – the use of specifically selected animals as a treatment modality in

health and human service settings (for people with variety of physical or psychological
conditions)
Ex. Throwing an object for a dog to retrieve increases upper extremity rom ambulating with a
dog improves mobility
Therapeutic horseback riding to increase sensory processing and improve posture, balance and
mobility
6. Horticultural Therapy/gardening/Healing garden – an adjunct therapy to occupational and
physical therapy
Stimulates the 5 sense, provides leisure activities, improves motor function, provides a sense of
achievement and improve self-esteem.

References: