Medication and Medication • Aqueous solution = one or more drugs

dissolved in water.
Administration
• Caplet = a solid form, shaped like a
• Medication = a substance administered
capsule, coated and easily swallowed.
for the diagnosis, cure, treatment, or
relief of a symptom or for prevention of • Capsule = a gelatinous container to hold
disease. (In the healthcare context, the a drug in powder, liquid, or oil form.
words medication and drug are
• Cream = a nongreasy, semisolid
generally used interchangeably)
preparation used on the skin.
• Prescription = the written direction for
• Elixir = a sweetened and aromatic
the preparation and administration of a
solution of alcohol used as a vehicle for
drug.
medicinal agents.
• Generic name = is given before a drug
• Gel or jelly = a clear or translucent
becomes officially an approved
semisolid that liquefies when applied to
medication. It is generally used
the skin.
throughout the drug’s use.
• Liniment = a medication mixed with
• Official name = the name after which it
alcohol, oil, or soapy emollient and
is listed in one of the official
applied to the skin.
publications.
• Lozenge (troche) = a flat, round, or oval
• Chemical name = the name by which
preparation that dissolves and releases
describes the constituents of the drug
a drug when held in the mouth.
precisely.
• Ointment = a semisolid preparation of
• Brand name = the name given to a drug
one or more drugs used for application
by a manufacturer. Also called “trade
to the skin and mucus membrane.
name”.
• Powder = a finely ground drug or drugs;
• Pharmacology = is the study of the
some are used internally, others
effect of drugs on living organisms.
externally.
• Pharmacy = is the art of preparing,
• Suppository = one or several drugs
compounding, and dispensing drugs. It
mixed with a firm base such as gelatin
also refers to the place where drugs are
and shaped for insertion into the body
prepared and dispensed.
(e.g., the rectum); the base dissolves
• Pharmacist = a person licensed to gradually at body temperature,
prepare and dispense drugs and to releasing the drug.
make up prescriptions.
• Syrup = an aqueous solution of sugar
Types of Drug Preparation often used to disguise unpleasant-
tasting drugs.
• Aerosol spray or foam = a liquid,
powder, or foam deposited in a thin
layer on the skin by air pressure.
• Tablet = a powdered drug compressed
into a hard small disc; some are readily
broken along a scored line; others are
enteric-coated to prevent them from
dissolving in the stomach.
• Transdermal patch = a semipermeable
membrane shaped in the form of a disc
or patch that contains a drug to be
absorbed through the skin over a long
period.
Types of Doctor’s Order
• STAT order = indicates that the
medication is to be given immediately
and only once.
• Single order = or “one-time order”, is for
medication to be given once at a
specified time.
• Standing order = may or may not have a
termination date. A standing order may
be carried out indefinitely until an order
is written to cancel it, or it may be
carried out for a specified number of
days.
• PRN order = permits the nurse to give a
medication when, in the nurse’s
judgment, the client requires it. The
nurses should use good judgment about
when the medication is needed and
when it can be safely administered.
Effects of the Drug
• Therapeutic effect = the primary effects
intended, that is the reason the drug is
prescribed. Also called the “desired
effect”.
• Side effect = the effect of the drug that
is unintended. Also called “secondary
effect”.
• Drug allergy = the immunologic reaction
to the drug.
• Anaphylactic reaction = a severe allergic
reaction which usually occurs
immediately following administration of
the drug.
• Drug tolerance = a decreased
physiologic response to the repeated
administration of a drug or chemically
related substance. Excessive increase in
the dosage is required in order to
maintain the desired therapeutic effect.
• Drug abuse = inappropriate intake of a
substance, either continually or
periodically.
• Drug dependence = it is a person’s
reliance to take a drug or substance.
Intense physical or emotional
disturbance is produced if the drug is
withdrawn.
• Addiction = it is due to biochemical
changes in the body tissues, especially
the nervous system. These tissues come
to require the substance for normal
functioning. Also called “physical
dependence”.
• Drug interaction = effects of one drug
are modified by the prior or concurrent
administration of another drug, thereby
increasing or decreasing the
pharmacological action.
• Drug antagonism = conjoint effect of
two drugs is less than the drug acting
separately.
• Drug synergism = the combined effects
of drugs are greater than the sum of
each agent acting independently.
Therapeutic Actions of Drugs
• Palliative = relieves the symptoms of a
disease but not affect the disease itself.
• Curative = treats the disease condition.
• Supportive = sustains body functions
until other treatment of the body’s
response can take over.
• Substitutive = replaces body fluids or
substances
• Chemotherapeutic = destroys malignant
cells.
• Restorative = returns the body to
health.
Routes of Administration
• Oral = administration of drug is
swallowed
– Advantage: least expensive,
most convenient route, skin is
not broken with injection
– Disadvantage: unpleasant taste
of the drugs, irritation of the
gastric mucosa, irregular
absorption from the
gastrointestinal tract, slow
absorption, and in some cases,
harm to the client’s teeth.
Reminder!
– Never crush enteric-coated or
sustained-release tablets.
Crushing enteric-coated tablets
allows the irritating medication
to come intact with the oral or
gastric mucosa, resulting in
mucositis or gastric irritation.
• Sublingual = is placed under the tongue,
where it dissolves
– The medication should not be
swallowed because the
medication is absorbed in the
blood vessels on the underside
of the tongue.
– Advantage: may be more potent
than oral route because drug
directly enters the blood and
bypasses the liver.
– Disadvantage: drug must
remain under the tongue until
dissolved and absorbed. Drug is
rapidly absorbed in the
bloodstream.
• Buccal = means “pertaining to the
cheeks”.
– A medication, usually a tablet, is
held in the mouth against the
mucous membranes of the
cheek until the drug dissolves.
• Parenteral = is defined as other than
through the alimentary or respiratory
tract; that is by needle.
– Routes for parenteral
administration:
• Intradermal = under the
epidermis (into the
dermis)
• Subcutaneous
(hypodermic) = into the
subcutaneous tissue,
just below the skin
• Intramuscular = into a
muscle
• Intravenous = into a
vein
 • INTRADERMAL
-under the epidermis (into the dermis)
- Indicated for allergy and using a tuberculin
syringe
- The sites are the inner lower arm, upper chest
and back, and beneath the scapula.
- The sites are the inner lower arm, upper chest
and back, and beneath the scapula.
- Needle at 10 – 15 degree angle; bevel up.
-Inject a small amount of drug slowly over 3 to 5
seconds to form a wheal or bleb.
- Do not massage the site of injection to prevent
irritation of the site, and to prevent absorption
of the drug into the subcutaneous.
• SUBCUTANEOUS (HYPODERMIC)
-into the subcutaneous tissue, just below the
skin.
-Drugs administered subcutaneously are as
follows: Vaccines (measles), insulin, heparin.
- Sites of administration:
– Outer aspects of the upper arm,
anterior aspect of the thighs,
abdomen, scapular areas of the
upper back, and ventrogluteal
and dorsogluteal areas.
– Rotate sites of injection to
minimize tissue damage.
– Use 5/8 needle for adults when
the injection is administered at
45 degree angle; ½ is used at a
90 degree angle.
– For thin patients: 45 degree
angle.
– For obese patients: 90 degree
angle of needle.
– Aspirate before injection of
medication to check if blood
vessel had been hit. If blood
appears when pulling back the
plunger of the syringe, remove
the needle and discard the
medication and equipment.
– Do not aspirate and massage
when heparin and insulin are
administered.
• INTRAMUSCULAR
-into a muscle
-Needle length is 1’’, 1 ½’’, 2’’ to reach
the muscle layer.
-Inject the medication slowly to allow
the tissue to accommodate the volume.
1. Ventrogluteal muscle
-The site is in the gluteus medius muscle, which
lies over the gluteus minimus.
-It is the preferred site for IM injections because
of the area:
-Contains no large nerves or blood vessels.
-To locate the site, the nurse places the heel of
the hand on the client’s greater trochanter, with
the fingers pointing toward the client’s head.
The right hand is used for the left hip, and the
left hand for the left hip.
- With the index finger on the client’s anterior
superior iliac spine, the nurse stretches the
middle finger dorsally (toward the buttocks),
palpating the iliac crest.
-The triangle formed by the index finger, the
third finger, and the iliac crest is the injection
site.
2. Dorsogluteal muscle
-This site is composed of the thick
gluteal muscles of the buttocks.
-The site should not be used for children
under 3 years old unless the child has
been walking for at least 1 year.
-The midwife must choose the site
carefully to avoid striking the sciatic
nerve, major blood vessels, and bone.
*Reminder!
-Avoid hitting the sciatic nerve to
prevent paralysis known as “sciatica
paralysis”.
- The nurse palpates the posterior
superior iliac spine, then draws an
imaginary line to the greater trochanter
of the femur. This line is lateral to and
parallel to the sciatic nerve. The
injection is lateral and superior to this
line.
- The client needs to assume a prone
position with the toes pointed inward or
a side-lying position with the upper
knee flexed and in front of the lower
leg. These positions promote muscle
relaxation and therefore minimize
discomfort from the injection.
3. Vastus lateralis muscle
-It is recommended as the site of choice
for intramuscular injections for infants 1
year and younger.
-Because there are no major blood
vessels or nerves in the area, it is
desirable for infants whose gluteal
muscles are poorly developed.
-This site is recommended for the
administration of hepatitis B vaccine for
newborns.
-It is situated on the anterior lateral
aspect of the infant’s thigh.
-The landmark is established by dividing
the area between the greater
trochanter of the femur and the lateral
femoral condyle into thirds and
selecting the middle third.
-The client can assume a back-lying or a
sitting position.
4. Rectus femoris muscle
-Belongs to quadriceps muscle group
and is situated on the anterior aspect of
the thigh.
-Advantage: clients who administer
their own injections can reach this site
easily.
-Disadvantage: may cause considerable
discomfort for some people.
 5. Deltoid muscle
-It is found on the lateral aspect of the
upper arm.
- This site is recommended for the
administration of hepatitis B vaccine for
adults.
-The nurse should carefully administer
medication using this site because it is
very close to the radial nerve and radial
artery.
- Advantage: rapid absorption
- The upper landmark for the deltoid
site is located by the nurse placing four
fingers across the deltoid muscle with
the first finger on the acromion process.
IM injection technique
-The z-track technique has been found to be less
painful than the traditional injection technique.
-Procedure:
– Pull the skin to the side using
the ulnar side of the
nondominant hand (under
some circumstances, such as for
an emaciated client or infant,
the muscle may be pinched).
– Inject the medication using your
dominant hand (as if holding a
pencil).
– Hold the barrel of the syringe
steady with your nondominant
hand.
– Aspirate. If no blood, place back
your nondominant hand pulling
the skin, and inject the
medication.
– Withdraw the needle and apply
gentle pressure at the site.
Topical
-application of medication to a circumscribed
surface area of the body. They affect only the
area to which they are applied. Topical
applications include the following:
-Dermatologic preparations = applied to the
skin
-Wash and dry the area well before application
to facilitate absorption.
-Use gloves when applying the medication over
a large surface.
-Instillation and irrigations = applied into the
body cavities or orifices, such as urinary bladder,
eyes, ears, nose, rectum, or vagina.
Ophthalmic instillation
-instillation of medications through the
eyes.
-Position the client either sitting or
lying.
-Use a sterile technique.
-Clean the eyelids and eyelashes with
sterile cotton balls moistened with
sterile normal saline from the inner to
the outer canthus.
-Instill eye drops into the lower
conjunctival sac.
-Avoid dropping the solution onto the
cornea directly because it causes
discomfort.
-Instruct the patient to close the eyes
gently ad apply gentle pressure using
your finger in the inner canthus to
prevent systemic absorption of the
medication.
 Otic instillation
• instillation of medications to or
irrigation of the ear.
– Warm the solution first at room
temperature.
– Place the client if side-lying
position with the ear being
treated uppermost.
– Strengthen the auditory canal.
Pull the pinna upward and
backward for clients over 3
years of age. For 3-year-olds
below, pull the pinna
downward and backward.
– Instill the eardrops on the side
of the auditory canal to allow
the drops to flow in and to
continue to adjust to body
temperature.
– Press gently the tragus of the
ear to assist the flow of
medication into the ear canal.
– Ask the client to remain in as
side-lying position for about 5
minutes more to prevent
spillage of the medication out
of the ear.
Nasal instillation
• Used to administer medication for
treatment of infections in the nasal
cavity or sinuses.
• Have the client blow the nose prior to
nasal instillation.
• Assume back lying position, or sit up
and lean head back.
• Elevate the nares slightly by pressing
the thumb against the client’s tip of the
nose. While the client inhales, squeeze
the bottle.
• Keep head tilted backward for 5
minutes after instillation of nasal drops.
Vaginal
-Use an applicator or sterile gloves when
administering cream jelly, foam, or suppository.
Rectal
• The suppository medication needs to be
refrigerated so as not to soften.
• Use gloves for insertion.
• Have the client lie on the left side and
breathe through the mouth to relax the
anal sphincter.
• Insert the suppository as far high as
possible as the finger can reach to
ensure the suppository is inserted past
the internal anal sphincter
• Client should remain on the side for 20
minutes after injection to promote
adequate absorption of the medication.
Inhalations
• administered into the respiratory tract
by a nebulizer.
– Semi or high-Fowler’s position
to enhance full chest expansion
allowing deeper inhalation of
medication.
– Shake the canister several times
to mix the medication and
ensure uniform dosage delivery.
• 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
medication. This allows delivery of the
 medication more accurately into the
bronchial tree rather than being
trapped in the oropharynx then
swallowed.

• Instruct client to hold breath for 10

seconds to enhance complete
absorption of the medication.

The Ten “Rights” of Medication

Administration:

• Right medication
• Right dose
• Right time
• Right route
• Right client
• Right client education
• Right documentation
• Right to refuse
• Right assessment
• Right evaluation