UNIT 2: purpose is to avoid errors (e.g.

, omissions,
PHARMACOLOGY duplications, dosing errors, drug interactions).

SAFETY AND QUALITY IN PHARMACOTHERAPY DISPOSAL OF MEDICATIONS

14 Rights of Administration General guidelines include the following:

1. Follow specific information on the drug label or drug
1. Right Drug/Medication insert. Unless specifically instructed, do not flush
2. Right Client/Patient medications down the toilet, where they will pollute the
3. Right Route environment and may be a danger to humans and
4. Right Dose animals.
5. Right Frequency/Time 2. It is recommended that you remove the drug from its
6. Right Assessment original container and dispose of it in a sealed bag with
7. Right Approach an undesirable substance such as used cat litter or
8. Right Education used coffee grounds. This method is intended to make
9. Right Evaluation medications less attractive to people and animals.
10. Right Documentation
11. Right to Refuse 3. Before disposing of medication containers, all
12. Right Principle of Care identifying information should be removed or obscured.
13. Right Prescription
14. Right Nurse Clinician
SHARPS SAFETY

NURSES’ RIGHTS WHEN ADMINISTERING The Occupational Safety and Health Administration
MEDICATIONS (OSHA) Needlestick Safety and Prevention Act of 2000
resulted from the American Nurses Association’s
(1) the right to a complete and clear order; (ANA) campaign, Safe Needles Save Lives.

(2) the right to have the correct drug, route (form), and
dose dispensed;
(3) the right to have access to information;
(4) the right to have policies to guide safe medication
administration
(5) the right to administer medications safely and to
identify problems in the system; and
(6) the right to stop, think, and be vigilant when
administering medication.
These rights can assist in increasing the safety of
medication administration.
THE TWO MOST FREQUENTLY USED METHODS
TO DISPENSE DRUGS
1. Stock Drug Method – the drugs are dispensed to
all patients from the same containers.
DOSAGE FORMS: TO CRUSH OR NOT TO CRUSH
Some medications can be crushed; consult with the
health care provider or pharmacist. Do not crush any
medication that has the suffix ER, SR, XR, SA, CR,
MR, or XL; these are extendedrelease or sustained-
release drugs, and crushing will change the location
and speed of absorption.
PREGNANCY CATEGORIES
The purpose of the changes is to optimize informed
decision making for pregnant patients and for patients
of childbearing age who may wish to become
pregnant. Both the pregnancy and lactation
subsections will have three principal components: risk
summary, clinical considerations, and a data section.

2. Unit Dose Method - drugs are individually wrapped

and labeled for single doses for each patient.

Informed Consent - a principle of which is the

individual having the knowledge necessary to make a
decision. An informed patient and family is critical to
preventing medication errors.

Medication Reconciliation - is the process of

comparing a patient’s medication orders to all of the
medications that the patient has been taking. The
 HIGH-ALERT MEDICATIONS LOOK-ALIKE DRUG NAMES

1. IV adrenergic agents

2. IV adrenergic antagonists

3. IV antiarrhythmics

4. IV inotropic agents

5. IV moderate sedation agents

6. anesthetic agents

7. antithrombotic agents

8. cardioplegic solutions

9. chemotherapeutic agents,

10. dextrose (hypertonic >20%)

11. dialysis solutions

12. epidural or intrathecal agents

13. Hypoglycemics

14. liposomal forms of drugs

15. moderate sedation agents

16. narcotics/opiates

17. neuromuscular blocking agents.

18. IV radiocontrast agents

19. total parenteral nutrition solutions

20. sterile water for injection inhalation and irrigation in

containers of >100 mL

21. and sodium chloride for injection (hypertonic,

>0.9% concentration).

SOUND-ALIKE DRUG NAMES

▪ Nurses should be aware that certain drug names

sound alike and are spelled similarly.

▪ Some drugs’ spellings look alike or sound alike but

have different chemical drug structures and are
prescribed for different health problems. PHARMACOLOGY ABBREVIATION

▪ When ordering drugs, make sure the spelling of the

drug is correct, and be extremely careful when
administering drugs whose names look alike.

Caution: Physicians’ handwriting of drug names.

GUIDELINES FOR CORRECT ADMINISTRATION OF
MEDICATIONS

Preparation

1. Wash before preparing medications.

2. Check for drug allergies; check the assessment

history and Kardex.

3. Check medication order with health care provider’s

orders, Kardex, medicine sheet, or medicine card.

4. Check label on drug container three times.

5. Check expiration date on drug label, card, and

Kardex; use only if date is current.

6. Recheck drug calculation of drug dose with another

nurse as needed or by agency policy.

7. Verify doses of drugs that are potentially toxic with

another nurse or pharmacist.

8. Pour tablet or capsule into the cap of the drug

container. With unit dose, open packet at bedside after
verifying patient identification.

9. Pour liquid at eye level. The meniscus (the lower

curve of the liquid) should be at the desired dose.

10. Dilute drugs that irritate the gastric mucosa (e.g.

potassium, aspirin), or give with meals.

Administration

11. Administer only drugs that you have prepared. Do

not prepare medications to be administered by another
person.

12. Identify the patient by ID band or ID photo.

13. Offer ice chips to numb the patient’s taste buds
when giving bad-tasting drugs.
14. When possible, give bad-tasting medications first,
followed by pleasant-tasting liquids.
15. Assist the patient to an appropriate position,
depending on the route of administration.
16. Provide only amounts and kinds of liquids allowed
on the diet.
17. Stay with the patient until the medications are
taken.
18. Administer no more than 2.5 to 3 mL of solution
intramuscularly at one site. Infants receive no more
than 1 mL of solution intramuscularly at one site and
no more than 1 mL subcutaneously. Never recap
needles (Universal Precautions).
19. When administering drugs schedules at the same
time to a group of patients, give drugs last to patients
who need extra assistance.
20. Discard needles and syringes in appropriate
containers.
21. Drug disposal is dependent on agency policy and
state law. For example, discard drugs in the sink or
toilet, not in the trash can. Controlled substances must
be returned to the pharmacy. Some disposals need
signatures of witnesses; refer to agency policy.
22. Discard unused solutions from ampules.
23. Appropriately store (some require refrigeration)
unused stable solutions from open vials.
24. Write date and time opened and your initials on the
label.
25. Keep narcotics in a double-locked drawer or closet.
Medication carts must be locked at all times when a
nurse is not in attendance.
26. Keys to the opioids drawer must be kept by the
nurse and not stored in a drawer or closet.
27. Keep opioids in a safe place, out of reach of
children and others in the home.
28. Avoid contamination of one’s own skin or inhalation
to minimize chances of allergy or sensitivity
development.
Recording
29. Report drug error immediately to the patient’s
health care provider and to the nurse manager.
30. Complete an incident report.
31. Charting: record drug given, dose, time, route, and
your initials.
32. Record drugs promptly after given, especially
STAT doses.
33. Record effectiveness and results of medication
administered, especially PRN medications.
34. Report to the patient’s health care provider and
record drugs that were refused with the reason for
refusal.
35. Record amount of fluid taken with medications on
input and output chart.
BEHAVIORS TO AVOID DURING MEDICATION
ADMINISTRATION
 Do not be distracted when preparing
medications.
 Do not give drugs poured by others.
 Do not pour drugs from containers with labels
that are difficult to read or whose labels are
partially removed or have fallen off.
 Do not transfer drugs from their original,
labelled container to another for storage.
 Do not pour drugs into the hand.
 Do not give medications for which the
expiration date has passes.
 Do not guess about drugs and drug doses.
Ask when in doubt.
 Do not use drugs that have sediments; and
discoloured, or are cloudy (and should not be).
 Do not leave medications by the bedside or
with visitors.
 Do not leave prepared medications out of
sight.
 Do not give drugs if the patient says he or she
has allergies to the drug or drug category.
 Do not call the patient’s name as the sole
means of identification.
 Do not give drug if patient states drug is
different from drugs he or she has been
receiving. Check order.
 Do not recap needles. Use Universal
precations.
 Do not mix drugs with large amount of foors or
beverages.
MEDICATION ADMINISTRATION
Self-Administration of Medication
SAM means that the nurse gives the patient the
appropriate medications and instructions that are kept
at the bedside and then go home with the patient on
discharge. Patients are responsible for taking their
medication according to the instructions.
FORMS AND ROUTES FOR DRUG
ADMNISTRATION
A variety of forms and routes are used for the
administration of medications, including:
UNIT 2:
1. Sublingual MEDICATION ADMINISTRATION

2. Buccal  Oral
 Treatment
3. Oral (tablets, capsules, liquids, suspensions, elixirs)  Parenteral
4. Transdermal

5. Topical ORAL DRUG ADMINISTRATION

6. Instillation (drops and sprays) Eighty percent of all drugs consumed are given orally.
7. Inhalation Oral drugs are available in:
8. Nasogastric and gastrostomy tubes 1. Tablet
9. Suppositories 2. Capsule
3. Powder
10. Parenteral 4. Liquid form

TECHNOLOGICAL ADVANCES Oral medications have the following advantages:

 Pain-free delivery of insulin through patch (1) the patient frequently can take oral medications
 Insulin pumps that deliver insulin based on without assistance
monitoring of serum glucose levels
(2) the cost of oral medications is usually less than
 Drugs implanted in contact lenses
when given via other routes (e.g., parenteral), and
 Intelligent infusion technology that programs IV
infusions based on scanned information. (3) oral medications are easy to store
 Electronic order entry system
 Computerized unit dose dispensing cabinets
 Bar code technologies that scan medications
Oral medications have the following
and reconcile them with patient ID band
disadvantages:
 Electronic medication administration records
(1) variation in absorption as a result of food in the GI
tract and pH variation of GI secretions

(2) irritation of the gastric mucosa by certain drugs

(e.g., potassium chloride), and

(3) destruction or partial inactivation of the drugs by

liver enzymes.

TABLETS, CAPSULES, AND LIQUIDS

Tablets – come in different forms and drug strengths.

Most tablets are scored and thus can be readily broken
when half of the drug amount is needed.

Capsules - are gelatin shells that contain powder or

time-release pellets (beads)

Sustained release (pellet) - capsules and controlled-

release capsules should not be crushed and diluted,
because the medication will be absorbed at a much
faster rate than indicated by the manufacturer

Enteric-coated (hard-shell) - tablets must not be

crushed, because the medication could irritate the
gastric mucosa. Enteric-coated drugs pass through the
stomach into the small intestine where the drug’s
coating dissolves and then absorption occur.
Liquid form - when the patient has difficulty taking
tablets, the liquid form of the medication is given. The
liquid form can be in a suspension, syrup, elixir, or
tincture.
- poured into a medicine cup that is calibrated in
ounces, teaspoons, tablespoons, and milliliters
MEDICINE CUP READING
Meniscus - is the slightly concave curved line of a
dose of liquid. The bottom of the meniscus should be
used to measure the desired dose of medication.
DRUGS ADMINISTERED VIA NASOGASTRIC TUBE
 Oral medications can be administered through
a nasogastric tube but should not be mixed
with the entire tube feeding solution.
 Mixing the medications in a large volume of
tube feeding solution decreases the amount of
drug the patient receives for a specific time.
 The medication should be diluted in 1 ounce
(30 mL) of warm water unless otherwise
instructed, administered through the tube,
 and followed with extra water to ensure that
the drug reaches the stomach and is not left in
the tube.
 Check the policy at your institution.
ENTERAL FEEDING
Oro Gastric Tube (OGT)
Percutaneous Endoscopic Gastrostomy (PEG)
Percutaneous Endoscopy Gastrostomy Tube (PEG
Tube; Non-balloon G-tube)

NGT Tube

1. Transdermal Patch - is stored in a patch placed on

TREATMENT ADMINISTRATION the skin and absorbed through skin, having a systemic
effect.
 Inhalation
 Nebulization Transdermal drugs provide more consistent blood
 Patches levels than oral and injection forms and avoid GI
 Suppositories absorption problems associated with oral products.
 Eye & Ear Drops
Transdermal patches should be rotated to different
sites and not reapplied over the exact same area when
changed.
Eye Drops/Ointment
Additionally, the area should be thoroughly cleansed
before administration of a new transdermal patch. This
practice will prevent errors in overdosing the patient.

Ear Drops/Ointment
Rectal Tube Types of Parenteral Routes:

 Intradermal ID (under the skin)

 Subcutaneous SubQ (into the fatty tissue)
 Intramuscular IM (within the tissue)
 Z-track technique
 Intravenous IV (in the vein)
 Intraosseous (in the bone)

Intramuscular Subcutaneous Intradermal

Systemic Effect Systemic Effect Local Effect
Usually more
rapid effect of Sustained effect; Used for
drug than absorbed mainly observation of an
Foley Catheter Tube with subQ route through inflammatory
capillaries; (allergic) reaction
• Used for usually slower in to foreign protein
solutions in onset than with
oils and deep IM IM route
for irritating drugs

Preferred areas
are lightly
Locations are pigmented, thinly
chosen for Locations for keratinized,
adequate muscle subQ injection and hairless,
size and minimal should be rotated such as the
major nerves to avoid overuse ventral mid-
and blood of an individual forearm,
vessels in the site. clavicular area of
area. the chest, or
scapular area of
the back

The ventrogluteal Needle: 25- to Needle: 25- to

Suppositories is the preferred 27-gauge; 1 27-gauge; 3 8
site for adults 2 to 5 8 inch long to 5 8 inch long
and toddlers with
gluteal Syringe: 1 to 3 Syringe: 1 mL
muscle mL (usually calibrated
development 0.5 to 1 mL
associated with injected
firmly established
walking.

Z-Track
Injection Intravenous Intraosseus
Technique
PARENTERAL ADMINISTRATION
Local effect Systemic Effect Systemic Effect
When medications cannot be taken by mouth because Prevents Fluids,
of: medication from More rapid than crystalloids,
leaking back into IM or subQ blood products,
(1) an inability to swallow the subQ tissue. routes and medications
It is frequently administered via
(2) a decrease level of consciousness advised for intraosseous
medications that (IO) infusion into
(3) an inactivation of the drug by gastric juices cause visible and the bone marrow
(4) a desire to increase the effectiveness of the drug, permanent skin enter circulation
the parenteral route may be the route of choice discoloration through the
network of
 venous sinusoids

Accessible
The gluteal site is peripheral veins
preferred (e.g., cephalic or
cubital vein of
arm; dorsal vein
of hand) are Used when IV
preferred .When access is not
possible, ask possible; it is
the patient about removed within
preference. Avoid 24 hours.
needless body Contraindications
restriction. In include fracture
newborns, the in insertion
veins of the feet, limb, infection at
lower legs, and insertion site
head may also
be used after the
previous sites
have been
exhausted
Needle: 25- to
27-gauge; 1 2 to Location:
5 8 inch long proximal tibia and
humerus
Syringe: 1 to 3 sternum
mL (usually 0.5
to 1 mL injected) Vial - is usually a small glass container with a self-
sealing rubber top. Some are multiple-dose vials, and
when properly stored, they can be used over time.

Ampule - is a glass container with a tapered neck for

snapping open and using only once.

Powdered Drug Reconstitution

Certain drugs lose their potency in liquid form;

therefore manufacturers package these drugs in
powdered form. They are reconstituted using a diluent
(bacteriostatic water or saline) before administration.

Drug labels in vials and ampules provide the

following information:

(1) generic and brand name of the drug,

(2) drug dose in weight (milligrams, grams,

milliequivalents) and amount (millilitres),

(3) expiration date, and

(4) directions about administration. If the drug is in

powdered form, mixing instructions and dose
equivalents (e.g., milligrams equal millilitres) may be
given

THE SYRINGE

1. Syringes are available in various types and

sizes, the most common of which are the 3-mL
and 5-mL tuberculin, insulin, and metal and
plastic syringes for prefilled cartridges.
2. Glass syringes may be used in the operating
room and on special instrument trays. The tip
of the syringe and inside of the plunger should
remain sterile.

Different Kinds of Syringes:

1. Needleless syringes – used primarily for

intermittent infusion therapy to irrigate the intermittent
infusion device for maintaining patency and to
administer IV medication through the IIV tubing device.

2. Tuberculin syringe – is a 1mL slender syringe with

marking in tenths (0.1) and hundredths (0.01). It is also
marked in minims.

3. Insulin syringe – has the capacity of 1mL;

however, insulin is measured in units, and insulin
dosage must not be calculated in millilitres. Insulin
syringes are calibrated as 2-unit marks, and 100 units
equal to 1 mL.
Needle size has two components: gauge (diameter of
the lumen) and length.
The larger the gauge number, the smaller the diameter
of the lumen, and the smaller the gauge, the larger the
diameter of the lumen.
The most common gauge numbers of needles range
from 18 to 26. Needle length varies from 3 8 inch to 2
inches.
INTRADERMAL INJECTIONS
Intradermal injections - usually used for skin testing
to diagnose the cause of an allergy or to determine the
presence of a microorganism. The choice of syringe for
intradermal testing is the tuberculin syringe with a 25-
gauge needle.
The inner portion of the forearm is frequently used for
diagnostic testing because there is less hair in the area
and the test results are more visible. The upper back
may also be used as a testing site. The needle is
inserted with the bevel pointing upward at a 10- to 15-
degree angle. Do not aspirate. Test results are read 48
to 72 hours after the intradermal injection. A reddened
or raised area is a positive reaction.

SUBCUTANEOUS INJECTIONS
Drugs injected into the subcutaneous (subQ) or fatty
tissue are absorbed slowly because there are fewer
blood vessels in fatty tissue. The amount of drug
solution administered subQ is generally 0.5 to 1 mL at
a 45-, 60-, or 90-degree angle.
The two types of syringes used for subQ injections
are the:
1. Tuberculin syringe (1 mL), calibrated in 0.1 mL and
0.01 mL, and the 3-mL syringe, calibrated in 0.1 mL.
The needle gauge commonly used is 25 or 26, and the
length is 3 8 to 5 8 inch.
2. Insulin is also administered subQ.
INSULIN INJECTIONS
 Insulin should be administered with an insulin
syringe, which is calibrated to correspond with
the 100 units of insulin.
 Insulin bottles and syringes are color coded to
avoid error.
 The 100 units/mL (or U-100) insulin bottle and
the 100 units/mL syringe are coded orange.
Administering insulin with a tuberculin syringe
should be avoided.
 Insulin is administered subQ at a 45-, 60-, or
90-degree angle into the subQ tissue. The
subQ absorption rate of insulin is slower
because there are fewer blood vessels in the
fatty tissue than in muscular tissue. The angle
for administering insulin depends on the
amount of fatty tissue. For an obese person,
the angle may be 90 degrees; for a very thin
person, the angle may be 45 to 60 degrees.
Types of Insulins:
1. Insulins are clear (regular or crystalline insulin) and
2. cloudy (NPH) because of the substance protamine,
which is used to prolong the action of insulin in the
body.
Only clear (regular) insulin can be given IV as well as
subQ. The source of insulin is human (Humulin).
Insulin is categorized as:
 rapid-acting
 fast-acting
 intermediate-acting
 long-acting
 commercial premixed insulin
 Rapid-acting (Humalog, Aspart, Apidra) and
fast-acting (Humulin R) regular insulin can be
given both intravenously and subcutaneously.
 Intermediate-acting and long-acting insulins
can only be administered subcutaneously.
Fast-acting insulin (regular or Humulin R insulin) -
is also clear but takes longer to start working
compared with rapidacting insulins. It is administered
15 to 30 minutes before meals and is effective for 6 to
8 hours. It is usually given before the meal, but it is
sometimes given during or after the meal. Humulin R
and Novolin R are brand names for fast-acting human
insulin.
Intermediate-acting insulin (NPH, Humulin N,
Novolin N) - is administered 30 minutes before the
meal (breakfast) and becomes effective in 1 to 2 hours.
Its duration of action in the body is 12 to 18 hours. This
type of insulin contains protamine, which prolongs the
action in the body. It is cloudy because of the
protamine added to the regular insulin. It can only be
given subcutaneously. Humulin N can be mixed with
Humulin R (regular insulin) or rapid-acting insulin in the
same syringe.
Long-acting insulin - acts within 1 to 2 hours and
lasts in the body for 18 to 24 hours. The Levemir vial is
tall and has a green top. The Lantus vial is taller and
narrower than the other types of insulin. It has a purple
top and purple print on the label. Levemir is usually
administered in the evening or at bedtime; however, it
can be administered once or twice a day
subcutaneously. Lantus is usually administered at
bedtime, and the incidence of nocturnal hypoglycemia
is not common. Some patients report more pain at the
injection site with long-acting insulins than with
Humulin N or NPH insulin.
Lantus and Levemir cannot be mixed with other
insulins or given intravenously.
Commercially premixed combination insulins - has
become popular for patients with diabetes who mix
fast-acting and intermediate-acting insulins. Examples
are two groups: the rapid-acting and intermediate-
acting insulins are Novolog mix 70/30 and Humalog
mix 75/25. The fast-acting and intermediate-acting
insulins are Humulin 70/30, Novolin 70/30, and
Humulin 50/50 (see Figure 14D-12). They are available
in vials or pens that resemble a fountain pen (Figures
14D-12 and 14D-13). Some patients need less than 30
units of Humulin R and more Humulin N, so these
combinations of insulins cannot be used. They must
mix their insulins according to the prescribed units of
insulin.
A. Rapid Acting Insulins

B. Fast-acting Insulins
C. Intermediate-Acting Insulins
D. Long-acting insulins
E. Combinations
E1. Rapid – and Intermediate-Acting Insulins
E2. Fast – and Intermediate-Acting Insulins
INTRAMUSCULAR INJECTIONS
 Intramuscular (IM) injection are absorbed more
rapidly than those given by subQ. injection.
 The volume of solution for an IM injection is
0.5 to 3 mL, with the average being 1 to 2 mL.
 A volume of drug solution greater than 3 mL
causes increased muscle tissue displacement
and possible tissue damage. Occasionally 5
mL of selected drugs, such as magnesium
sulfate, may be injected into a large muscle,
such as the dorsogluteal.
 A dose greater than 3 mL is usually divided
and given at two different sites.
 The needle gauges for IM injections are 19
and 20 for thick solutions and 20 and 21 for
thin solutions.
 IM injections are administered at a 90-degree
angle. The needle length depends on the
amount of adipose (fat) and muscle tissue; the
average needle length is 11 2 inches.
INTRAVENOUS (IV) FLUID THERAPY
Intravenous (IV) fluid - is used to administer fluids
that contain water, dextrose, vitamins, electrolytes, and
drugs.
- Increasing number of drugs are administered by the
IV route for direct absorption and fast action.
- Some drugs are given by IV push (bolus).
- Many drugs administered IV irritate the veins, so
these drugs are diluted in 50 to 100 mL of fluid.
- Other drugs are delivered in a large volume of fluid
over a specific period, such as 4 to 8 hours.
Two methods are used to administer IV fluids and
drugs:
1. Continuous IV Infusion – replaces fluid loss,
maintains fluid balance, and serves as a vehicle for
drug administration.
2. Intermittent IV Infusion - is used primarily to give
IV drugs.
Nurses have an important role in the preparation
and administration of IV solutions and IV drugs.
The nursing functions and responsibilities during
drug preparation include the following:
 Knowing IV sets and their drop factors
 Calculating IV flow rates
 Mixing and diluting drugs in IV fluids
 Gathering equipment
 Knowing the drugs and the expected and
untoward reactions
Nursing responsibilities continue with assessment of
the patient for effectiveness and untoward effects of
the therapy and assessment of the IV site.

Intermittent IV Therapy

 The drug solution is usually infused over a

period of 15 minutes to 1 hour.
 Separate tubing for IV drugs, the secondary
IV line set, is inserted into
 a port (rubber stopper) of the IV connector on
The health care provider orders the type and amount
the continuous, or primary IV line set.
of IV solution in liters over a 24-hour period or in
milliliters per hour. The nurse calculates the IV flow
rate according to the drop factor, the amount of fluids
to be administered, and the time period.

Intravenous Set

Drop factor – the number of drops per millilitre, is

normally printed on the packaging cover of the IV set.

Macrodrip set – a set that delivers large drops per

millilitre (10 to 20 gtt/mL),

Microdrip (minidrip) – set, is one that delivers small

drops per millilitre (60 gtt/mL).

Macro and Micro drip Tubing

Two IV sets available to administer IV drugs are:

(1) the calibrated cylinder (chamber) with tubing, such

as the Buretrol, Volutrol, and Soluset; and

(2) the secondary IV set, which is similar to a regular

IV set except the tubing is shorter

At times, IV fluids are given at a slow rate to keep vein

open (KVO), also called to keep open (TKO).

The reasons for ordering KVO include:

a. a suspected or potential emergency situation for

rapid administration of fluids and drugs

b. the need for an open line to give IV drugs at

specified hours.

For KVO, a microdrip set (60 gtt/mL) and a 250-mL IV

bag may be used. KVO is usually regulated to deliver
10 mL/h.

Intermittent Infusion Adapters

 5. Infusion Set (with Y-Port)

Infusion Sets
6. IV Set with Flow Regulator Microdrip
1. Infusion Set (I.V. Set)

2. Measured Volume Administration Set (Burrete

Set) Direct Intravenous Injections

 Medications that are given by the IV injection

route are calculated in the same manner as
medications for intramuscular (IM) injection.
 This route is often referred to as IV push.
 Clinically, it is the preferred route for patients
with poor muscle mass or deceased circulation
or for a drug that is poorly absorbed from the
tissues.
 Medications administered by this route have a
rapid onset of action, and calculation errors
3. Blood Set can have serious, even fatal, consequences.
 The nurse must read drug information inserts
carefully and must give attention to the amount
of drug that can be given per minute.

Electronic Intravenous Regulators

Pumps are electronic intravenous (IV) regulators

used in hospitals and some community settings. The
electronic IV regulators are set to deliver a prescribed
rate of IV solution. If the flow rate is obstructed, an
alarm sounds.
4. Platelet Set A. Gravity Devices

 Pressure for the infusion

 The height of the liquid above the infusion site

B. Pump System

 Volumetric pumps
 Syringe pumps
 Patient-controlled analgesia (PCA) pumps
 Anaesthesia pumps
 Syringe drivers
 Pumps for ambulatory use
1. Pumped systems – volumetric or syringe pumps memory log, which enables the clinician to determine
are the most common. when, and how often, the patient has made a demand
and what total volume of drug has been infused over a
a) Volumetric pumps – these pumps are the given time.
preferred choice for medium and large volume
intravenous or enteral infusions, although
some are designed specifically to operate at
low flow rates for neonatal use. The rate given
in millilitres per hour (typical range 1-999
mL/hour). Typically, most volumetric pumps
will perform satisfactorily at rates down to 5
mL/hour. A syringe pump should be used for
Anaesthesia pumps – these are syringe pumps
rates lower than 5 mL/hour or when short-term
designed for use in anaesthesia or sedation and must
accuracy is required.
be used only for this purpose; they are unsuitable for
any other use. They should be restricted to operating
and high dependency areas. They should be clearly
labelled ‘Anaesthesia Pump’ and restricted to
operating theatres and high dependency areas.

Syringe Pumps – these are used to administer drugs

or infusions in small or medium volumes, and are
calibrated for delivery in millilitres per hour, typically
0.1 to 99 mL/hour. Syringe pumps have better short-
term accuracy than volumetric pumps and are
Pump for ambulatory use - ambulatory pumps have
therefore typically more superior when delivering drugs
been designed to allow patients to continue receiving
at rates below 5 mL/hour. Syringe pumps are used
treatment or therapy away from a hospital, thereby
extensively where small volumes of highly
leading a normal life during treatment. The size and
concentrated drugs are required at low flow rates –
design of these pumps means patients can carry them
usually in intensive care settings.
around in a form of holster. These are miniature
versions of syringe pumps which are battery driven.
They deliver their dose in bursts, not in an even flow
rate, almost like a continual sequence of micro
boluses.

Patient-controlled analgesia (PCA) pumps – PCA

pumps are typically syringe pumps, as the total volume
of drug infused can usually be contained in a single-
use syringe. The difference between a PCA pump and
a normal syringe pump is that patients are able to
deliver a bolus dose themselves. Immediately after
delivery the pump will refuse to deliver another bolus Syringe drivers – these pumps are designed to
until a pre-set time has passed. The pre-set bolus size deliver drugs accurately over a certain period of time
and lockout time, along with background (constant (usually 24 hours).
drug infusion) are pre-programmed by the doctor.
Once programmed, access to the control of the pump
is usually restricted. A feature of most PCA pumps is a
Advantage: Being small and compact, can be carried
easily by the patient, and avoid the need for numerous
injections throughout the day.
Errors involving the incorrect setting of IV pumps are
among the most common errors reported. These errors
involve volumetric infusion pumps as well as syringe
driver and patient-controlled analgesic pumps. Due to
the wide variety of uses for these devices, errors in
setting the correct drug administration rates may
involve narcotic analgesics, insulin, heparin,
cardiovascular drugs, and cancer chemotherapy
agents.
It is important that calculations involving dosing
and setting infusion rates are checked before
using any infusion device.
NURSING IMPLICATIONS FOR ADMINISTRATION
OF PARENTERAL MEDICATIONS
Sites
 Ventrogluteal site is preferred for IM injections
in adults and toddlers with gluteal muscle
development associated with firmly
established walking.
 For toddlers not walking alone for at least 1
year, the vastus lateralis is preferred.
 Do not use the dorsogluteal site for IM
injections in children.
Equipment
 The syringe size should approximate the
volume of medication to be administered.
 Use the tuberculin syringe for amounts <0.5
mL.
 Use the filter needle to draw up the medication
form a glass vial or ampule. Change the
needle before administration to prevent tissue
irritation from any glass fragment or
medication left on the needle.
Technique
 Wash hands and wear gloves.
 Correctly identify the patient.
 Explain to the patient what is going to be done.
Gain the patient’s cooperation. Allow the
patient time to cooperate, if possible.
 Demonstrate empathy and concern for patient
and family. Allay anxiety, and encourage
expression of feelings.
 Position the patient.
 Follow the rights of medication administration.
 Inspect the skin before each injection.
 Inject medication slowly to minimize tissue
damage.
 Stabilize skin during needle removal to reduce
pain.
 Do not administer injections if sites are
inflamed, edematous, or lesioned (e.g., moles,
scars)
 Rotate the injection site to enhance absorption
of the drug. Document the injection site.
 Observe patient for drug effectiveness. Report
any untoward reactions immediately.
 Multiple products are available to reduce pain
of parenteral medication administration, such
as EMLA, lidocaine, and tetracaine in topical
patch, and “shot buster” – a mechanical device
based on the gate control theory of pain
management.
SAFETY: PREVENTING MEDICATION ERRORS
Medication Administration
 Remove foil-backed patches before magnetic
resonance imaging (MRI) and in code
situations when using AED equipment to
prevent burns.
 Observe sterile technique when the skin is
broken. Take precautions to avoid medication
stains.
 Use firm strokes if the medication is to be
rubbed in.
Nursing Interventions
 Prepare equipment and environment; wash
hands.
 Check for allergies and other assessment
data.
 Check drug label three times; check expiration
date; apply rights of medication administration.
 Be certain of drug calculation; verify dose with
another RN or licensed personnel as
necessary.
 Pour liquids at eye level on flat surface.
 Avoid contact with topical and inhalation
preparations.
 Verify patient identification.
 Administer only drugs you have prepared.
  Assist the patient to appropriate position.  -mide: diuretics
 Discard needles and syringes in “sharps”  -mycin: antibiotics
container. Do not recap needles.  -nium: neuromuscular blockers
 Keep all drugs stored properly, especially  -olol: beta blockers
related to temperature, light, and moisture.  -pam: anti-anxiety agents
 Follow agency policy related to discarding  -pine: calcium channel blockers
drugs and controlled substances.  -pril: ace inhibitors
 Report drug errors immediately.  -sone: steroids
 Document all appropriate information in a  -statin: antihyperlipidemics
timely manner.  -vir: anti-virals
 Record effectiveness of drugs administered,  -xacin: antibiotics
side effects or adverse effects, and reason for  -zide: diuretics
any drugs refused.  -zine: antipsychotics

COMMON MEDICATION CLASSIFICATIONS AND

ACTIONS

 Antacids – Reduce hydrochloric acid located

in the stomach
 Antianemics – Increases the production of
red blood cells
 Anticholinergics – Decreases oral secretions
 Anticoagulants – Prevents the formation of
clots
 Anticonvulsants – Management of seizures
or bipolar disorders
 Antidiarrheals - Reduce water in bowels and
gastric motility
 Antihistamines – Block the release of
histamine
 Antihypertensives – Decreases blood
pressure
 Anti-infectives – To get rid of infections
 Bronchodilators – Dilates the bronchi and
bronchioles
 Diuretics – Increase excretion of
water/sodium from the body
 Laxatives - Loosens stools and increases
bowel movements
 Miotics - Constricts pupils of the eye
 Mydriatics – Dilates the pupils
 Narcotics/analgesics – Relieves pain

PHARMACOLOGY SUFFIXES

 -amil: calcium channel blockers

 -caine: local anesthetics
 -cycline: antibiotics
 -dine: anti-ulcer agents (H2 histamine
blockers)
 -done: opioid analgesics
 -ine: antidepressants, calcium channel
blockers
 -ide: oral hypoglycemics
 -pam: anti-anxiety agents
 -oxacin: broad spectrum antibiotics