Routes of Drug Administration Preparation
✓ Check the date on the medication order and verify its
The general classifications of common routes of drug
administration are:
✓ Oral
✓ Sublingual
✓ Rectal
✓ Parenteral
✓ Topical
✓ Buccal
Oral administration is the introduction of medicines into the
body through the mouth.
Advantages:
1. The easiest and most desirable way to administer
medication
2. Most convenient
3. Safe, does nor break skin barrier
4. Usually less expensive
Disadvantages:
1. Inappropriate if client cannot swallow and if GIT has
reduced motility
2. Inappropriate for client with nausea and vomiting
3. Drug may have unpleasant taste
4. Drug may discolor the teeth
5. Drug may irritate the gastric mucosa
6. Drug may be aspirated by seriously ill patient.
Drug Forms:
1. Solid - tablet, capsule, pill, powder
2. Liquid - syrup, suspension, emulsion, elixir, milk, or
other alkaline substances.
3. Syrup - sugar-based liquid medication
4. Suspension - water-based liquid medication. Shake
bottle before use of medication to properly mix it.
5. Emulsion - oil-based liquid medication
6. Elixir- alcohol-based liquid medication.
After administration of elixir, allow 30 minutes to elapse
before giving water. This allows maximum absorption of
the medication.
"Never crush Enteric-Coated or Sustained Release Tablet”
Crushing enteric-coated tablets – allows the irrigating
medication to come in contact with the oral or gastric
mucosa, resulting in mucositis or gastric irritation.
Crushing sustained-released medication – allows all the
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
Equipment
The following must be prepared prior to administration of
oral medications:
✓ medication tray
✓ medication cards
✓ drinking glass with water
✓ towel if necessary
accuracy. It should contain the following:
◆ Patient’s name
◆ Name of the drug and dosage
◆ Time for administration
◆ Route of administration, for example, oral (p.o.)
✓ Wash hands to lessen the number of microorganisms,
thus keeping medications and equipment clean and
preventing transfer of microorganisms from one patient
to another.
✓ Compare the label of the medication container against
the order on the medication card. If these are not
identical, recheck the patient’s chart.
✓ Prepare the correct amount of medication for the
required dose, without touching the container and
contaminating the medication.
✓ Place the prepared medication(s) and medication card
together on the tray or cart.
Administration
✓ The surest check is to compare the medication card
against the physician’s order. Any discrepancies in the
order should be clarified with the responsible nurse or
the physician.
✓ Identify the patient by comparing the name on the
medication card and asking the name of the patient and
the date of birth.
✓ Explain to the patient the purpose of the medication
and how it will help, using language that he or she can
understand.
✓ Assist the patient to a sitting position or, if not possible,
to a lateral position. These positions facilitate
swallowing and prevent aspiration.
✓ Include relevant information about effects, e.g., tell the
patient receiving a diuretic that he or she can expect an
increase in frequency of urination
✓ Take the required assessment measures, e.g., pulse and
respiratory rates or blood pressure
✓ RESPIRATORY RATE IS taken prior to administering
narcotics, since narcotics depress the respiratory center.
If the rate is below 12, the responsible physician should
be consulted.
✓ Give the patient sufficient water or juice to swallow the
medication if appropriate.
✓ Fluids ease swallowing and facilitate absorption. Some
medications, e.g., antacids, cough syrups, and oils are
not diluted.
✓ If the patient has difficulty swallowing, have him or her
place the medication on the back of the tongue before
taking the water.
✓ Stimulation of the back of the tongue produces the
swallowing reflex.
✓ If the medication is harmful to tooth enamel or irritating
to the oral mucous membrane, e.g., liquid iodine
preparations, have the patient use straw and drink
water following the medication.
✓ If the patient says that the medication you are about to
give is different from what he or she has been receiving,
do not give the medication without checking the original
order.
✓ Stay with the patient until all medications have been
swallowed.
✓ Wash hands.
✓ Record the medication given, dosage, time, any
complaints of the patient, and the signature of the
nurse.
✓ Return to the patient within 30 minutes to evaluate the
effect of the medication, e.g., relief of pain.
Sublingual Administration
1. A drug that is placed under the tongue, where it
dissolves.
2. When the medication is in capsule and ordered
sublingually, the fluid must be aspirated from the
capsule and placed under the tongue.
3. A medication given by the sublingual route should not
be swallowed, or desire effects will not be achieved
Advantages
1. Same as oral
2. Drug is rapidly absorbed in the bloodstream
Disadvantages
1. If swallowed, drug may be inactivated by gastric juices.
2. Drug must remain under the tongue until dissolved and
absorbed
✓ There are liquids that often contain an insoluble powder,
e.g., calamine lotion, and need to be shaken before use.
✓ They have a soothing effect on the skin.
✓ Lotions are not rubbed on because rubbing irritates the
rash.
Emollients
✓ They also soothe the skin or mucous membranes.
✓ They are fatty or oily substances, e.g., olive oil or liquid
petroleum.
✓ They are applied in the same manner as lotions.
Liniments
✓ Liniments are liquids that usually contain an anodyne
(pain reliever) or a rubefacient (agent that reddens the
skin).
✓ Liniment should be at room temperature.
✓ A cold liniment causes discomfort and vasoconstriction
of the area rather than dilation.
Ointments
✓ These are semisolid preparations of a medication in a
base, e.g., petrolatum.
✓ These are usually applied with a tongue blade or with
gloves if the area is large.
✓ Sterile technique is essential if there are open wounds

Buccal Administration Pastes

✓ These are similar to ointments but tend to absorb
1. A medication is held in the mouth against the mucous secretions and penetrate the skin less than ointments.
membranes of the cheek until the drug dissolves. ✓ An example is zinc oxide paste, which is used to protect
2. The medication should not be chewed, swallowed, or excoriated areas from urine and feces.
placed under the tongue (e.g sustained release ✓ Pastes are applied in the same manner as ointments.
nitroglycerine, opiates, antiemetic, tranquilizer,
sedatives)
3. Client should be taught to alternate the cheeks with Powders
each subsequent dose to avoid mucosal irritation ✓ Powders are non absorbable finely ground medications,
usually applied to protect the skin.
Advantages ✓ Examples are talcum powder and cornstarch.
1. Same as oral
2. Drug can be administered for local effect Steps
3. Ensures greater potency because drug directly enters 1. Before application, clean the skin thoroughly by washing
the blood and bypass the liver the area gently with soap and water, soaking an
involved site, or locally debriding tissue.
Disadvantages 2. Use surgical asepsis when open wound is present.
1. If swallowed, drug may be inactivated by gastric juice 3. Remove previous application before the next
application.
Topical Administration 4. Use gloves when applying the medication over a large
surface. (e.g. large area of burns)
Application of medication to a circumscribed area of the 5. Apply only thin layer of medication to prevent systemic
body. absorption.
1. Dermatologic
2. Ophthalmic Ophthalmic Administration - includes instillation and
3. Otic Instillation irrigation
4. Nasal instillation
5. Inhalation Steps
6. Vaginal 1. Instillation – to provide an eye medication that the
client requires.
Dermatologic preparations include lotions, emolients, 2. Irrigation – To clear the eye of noxious or other foreign
liniments, ointments, pastes, and powders. materials.
3. Position the client either sitting or lying.
Lotions
4. Use sterile technique.
5. Clean the eyelid and eyelashes with sterile cotton balls
moistened with sterile normal saline from the inner to
the outer canthus.
6. Gently pull down the lower eyelid exposing the
conjunctival sac using your finger and sterile 2x2 gauze
sponge.
7. Instruct the patient to look up toward the ceiling to
prevent blinking at the approach of medication
container.
8. Hold the dropper solution container or ointment tube 1
to 2 cm above the conjunctival sac.
9. Instill the prescribed number of drops or a 1cm line of
ointment onto the inner surface of the lower lid. Do not
let the dropper or tube touch the patient’s eye.
10. Release the lower lid. Instruct the patient to close the
eye for a few seconds and move the eyeball to
distribute the medication.
11. Instill a maximum of 2 drops at a time. Wait for 5
minutes if additional drops need to be administered.
This is for proper absorption of the medication.
12. Avoid dropping a solution onto the cornea directly,
because it causes discomfort.
13. For liquid eye medication, press firmly on the
nasolacrimal duct (inner cantus) for at least 30 seconds
to prevent systemic absorption of the medication.
Otic Instillation – to remove cerumen or pus or to remove
foreign body
Steps
1. Warm the solution at room temperature or body
temperature, failure to do so may cause vertigo,
dizziness, nausea and pain.
2. Have the client assume a side-lying position (if not
contraindicated) with ear to be treated facing up.
3. Perform hand hygiene. Apply gloves if drainage is
present.
4. Straighten the ear canal:
✓ 0-3 years old: pull the pinna downward and
backward
✓ Older than 3 years old: pull the pinna upward and
backward
5. Instill eardrops on the side of the auditory canal to allow
the drops to flow in and continue to adjust to body
temperature
6. Press gently but firmly a few times on the tragus of the
ear to assist the flow of medication into the ear canal.
7. Ask the client to remain in side lying position for about 5
minutes
8. 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 minutes.
Nasal instillations usually are instilled for their :
astringent effects (to shrink swollen mucous membrane),
to loosen secretions facilitate drainage
to treat infections of the nasal cavity or sinuses.
decongestants, steroids, calcitonin.
Steps
1. Have the client blow the nose prior to nasal instillation
2. Assume a back lying position, or sit up and lean head
back.
3. Elevate the nares slightly by pressing the thumb against
the client’s tip of the nose. While the client inhales,
squeeze the bottle.
4. Keep head tilted backward for 5 minutes after
instillation of nasal drops.
5. When the medication is used on a daily basis, alternate
nares to prevent irritations
Inhalation – use of nebulizer, metered-dose inhaler (MDI)
Steps
1. Semi or high-fowler’s position or standing position. To
enhance full chest expansion allowing deeper inhalation
of the medication
2. Shake the canister several times to mix the medication
and ensure uniform dosage delivery
3. Position the mouthpiece 1 to 2 inches from the client’s
open mouth. As the client starts inhaling, press the
canister down to release one dose of the medication.
4. This allows delivery of the medication more accurately
into the bronchial tree rather than being trapped in the
oropharynx then swallowed
5. Instruct the client to hold breath for 10 seconds to
enhance complete absorption of the medication.
6. If bronchodilator, administer a maximum of 2 puffs, for
at least 30 second interval. Administer bronchodilator
before other inhaled medication.
7. This opens airway and promotes greater absorption of
the medication.
8. Wait at least 1 minute before administration of the
second dose or inhalation of a different medication by
MDI
9. Instruct client to rinse mouth, if steroid had been
administered. This is to prevent fungal infection.
Vaginal Administration – drug forms: tablet liquid (douches),
jelly, foam and suppository.
Steps
1. Close room or curtain to provide privacy.
2. Assist client 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.
3. Use applicator or sterile gloves for vaginal
administration of medications.
Rectal administration can be used advantageously when:
✓ the stomach is non-retentive
✓ when the medicine has an objectionable taste or odor
✓ when it can be changed by digestive enzymes.
Steps
1. Need to be refrigerated so as not to soften.
2. Apply disposable gloves.
3. Have the client lie on left side and ask to take slow deep
breaths through mouth and relax anal sphincter.
4. Retract buttocks gently through the anus, past internal
sphincter and against rectal wall, 10 cm (4 inches) in
adults, 5 cm (2 in) in children and infants.
5. May need to apply gentle pressure to hold buttocks
together momentarily.
6. Discard gloves to proper receptacle and perform hand
washing.
7. Client must remain on side for 20 minute after insertion
to promote adequate absorption of the medication.
Parenteral Administration - the administration of medication
by needle.
✓ This literally means “beside the intestine.”
✓ It refers to all the ways that drugs are administered with
a needle.
✓ The drug may be injected into tissues or fluids of the
body.
⚫ Intradermal – under the epidermis.
✓ Sites:
inner lower arm
upper chest and back
and beneath the scapula.
✓ Indicated for allergy and tuberculin testing and for
vaccinations.
✓ Use the needle gauge 25, 26, 27
✓ Needle at 10–15 degree angle; bevel up.
✓ Inject a small amount of drug slowly over 3 to 5 seconds
to form a wheal.
✓ Do not massage the site of injection. To prevent
irritation of the site, and to prevent absorption of the
drug into the subcutaneous.
⚫ Subcutaneous
✓ Sites:
outer aspect of the upper arms
anterior aspect of the thighs
Abdomen
Scapular areas of the upper back
Ventrogluteal
Dorsogluteal
✓ Identify the patient and explain the procedure.
✓ Select a site free of tenderness, hardness, swelling,
scarring, itching, burning, or localized inflammation.
Select a site that has not been used frequently.
✓ Provide privacy.
✓ Only small doses of medication should be injected via SC
route.
✓ Rotate site of injection to minimize tissue damage.
✓ Needle length and gauge are the same as for ID
injections
✓ Use 5/8 needle for adults when the injection is to
administer at 45 degree angle; ½ is use at a 90 degree
angle.
✓ For thin patients: 45 degree angle of needle
✓ For obese patient: 90 degree angle of needle
✓ For heparin injection: Do not aspirate. Do not massage
the injection site to prevent hematoma formation.
✓ For insulin injection: Do not massage to prevent rapid
absorption which may result to hypoglycemic reaction.
✓ 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 the size of the client.
⚫ Intramuscular
✓ Sites
Ventrogluteal site
Dorsogluteal site
Vastus Lateralis
Rectus femoris site
Deltoid site
✓ The intramuscular injection route is ordered frequently
for medications that irritate subcutaneous tissue.
✓ The speed of absorption is faster than by the
subcutaneous route because of the greater blood supply
to the body muscles.
✓ The exact amount of medication that any muscle can
comfortably absorb at once will vary, but usually 3 ml is
considered the maximum for a large muscle.
✓ Babies, the elderly, and emaciated patients are usually
unable to tolerate this amount, usually 2 ml is the
maximum volume for them
✓ Nurses must use their own judgment as to safe
maximum volume, considering the size of the muscle,
health of the muscle, adequacy of the blood supply,
viscosity or irritant properties of the drug.
✓ Needle length is 1”, 1 ½”, 2” to reach the muscle layer
✓ Clean the injection site with alcoholized cotton ball to
reduce microorganisms in the area.
✓ Inject the medication slowly to allow the tissue to
accommodate volume.
• Ventrogluteal
• Administration - The area contains no large nerves,
or blood vessels and less fat. It is farther from the
rectal area, so it less contaminated.
• Position: Prone or side-lying.
• Administration
When in prone position, curl the toes inward.
When side-lying position, flex the knee and hip. These ensure
relaxation of gluteus muscles and minimize discomfort during
injection.
Dorsogluetal
Is in the thick muscle of the buttocks.
Avoid striking the sciatic nerve, major blood vessels or bone.
Outer aspect of the upper outer quadrant of the buttock,
about 5 to 8 cm (2 to 3 inches) below the iliac crest:
Administration
Position the client similar to the ventrogluteal site
The site should not be used in infant under 3 years because
the gluteal muscles are not well developed yet.
Administration
To locate the site, the nurse draw an imaginary line from the
greatertrochanter to the posterior superior iliac spine. The
injection site is lateral and superior to this line.
Administration
Another method of locating this site is to imaginary divide
the buttock into four quadrants. The upper most quadrant is
the site of injection. Palpate the crest of the ilium to ensure
that the site is high enough.
Avoid hitting the sciatic nerve, major blood vessel or bone by
locating the site properly.
Administration
To administer an injection into the dorsogluteal site, the
nurse has to make the patient assume a prone position with
toes pointing medially.
Administration
A sidelying position can also be used, with the upper leg
flexed at the thigh and the knee and placed in front of the
lower leg.
Both these positions promote relaxation of the gluteal
muscles, which reduces the pain of injection.
Vastus lateralis
Recommended site of injection for infant
Located at the middle third of the anterior lateral aspect of
the thigh.
Assume back-lying or sitting position.
Muscle is usually thick and well developed in both adults and
children.
Recommended as site of choice for IM injections
There are no major blood vessels or nerves in the area.
located at the middle third, anterior aspect of thigh.
This site is on the anterior aspects of the thigh. It can be used
for infants, children, and adults when other sites are
contraindicated
Administration
Not used often for IM injection because it is relatively small
muscle and is very close to the radial nerve and radial artery.
Administration
To locate the site, palpate the lower edge of the acromion
process and the midpoint on the lateral aspect of the arm
that is in line with the axilla.
This is approximately 5 cm (2 in) or 2 to 3 fingerbreadths
below the acromion process.
The nurse administers medication intravenously by the
following method:
As mixture within large volumes of IV fluids.
By injection of a bolus, or small volume, or medication
through an existing intravenous infusion line or intermittent
venous access (heparin or saline lock)
By “piggyback” infusion of solution containing the prescribed
medication and a small volume of IV fluid through an existing
IV line.
Most rapid route of absorption of medications.
Predictable, therapeutic blood levels of medication can be
obtained.
The route can be used for clients with compromised
gastrointestinal function or peripheral circulation.
Large dose of medications can be administered by this route.
The nurse must closely observe the client for symptoms of
adverse reactions.
The nurse should double-check the six rights of safe
medication.
If the medication has an antidote, it must be available during
administration.
When administering potent medications, the nurse assesses
vital signs before, during and after infusion.
Types of IV Fluids
Isotonic solution – has the same concentration as the body
fluid
D5 W
Na Cl 0.9%
Plain Ringer’s lactate
Plain Normosol M
Hypotonic – has lower concentration than the body fluids.
NaCl 0.3%
Hypertonic – has higher concentration than the body fluids.
D10W
D50W
D5LR
D5NM