NCM 103

FUNDAMENTALS OF NURSING

FINALS
 MEDICATION
ADMINISTRATION
 HELLO!
I am Professor

FINAL TERM - SUMMER

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Learning Outcomes
• Define the purpose of Medication Administration.
• Discuss the different Types of Drug Preparation
• Define selected terms related to the administration of
medications.
• Describe various routes of medication administration
• Discuss the Guidelines and Safe medication Administration
• State the rights to accurate medication administration
• Discuss the Types of Medication Errors
A medication is a substance administered for the
diagnosis, cure, treatment, or relief of symptom
or for prevention of disease.

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Prescription- the written direction for the
preparation and administration of a drug.

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 PURPOSE OF MEDICATION
Drugs can be administered for these purposes:

✘DIAGNOSTIC PURPOSE: to identify any disease

✘PROPHYLAXIS: to prevent the occurrence of
disease e.g., antibiotics – to prevent infection
✘THERAPEUTIC – to cure the disease

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 BRAND NAME OR TRADE NAME
– Is the name given by the drug manufacturer and identifies it
as property of the company.
It is given by the pharmaceutical company that markets the
drug. E.g., BENADRYL

GENERIC NAME
–It is derived from the chemical name .
- It is the drug’s active ingredient that makes it work
- E.g., Diphenhydramine HCl
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USES OF DRUGS
 USES OF DRUGS

✘PREVENTION – used as prophylaxis to prevent

disease
✘DIAGNOSIS- establishing the patient’s disease or
problem
✘SUPPRESSION – suppresses the signs and
symptoms and prevents the disease process from
progressing e.g., anticancer; antiviral drugs
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 USES OF DRUGS

✘TREATMENT – alleviate the symptoms for patients

with chronic disease e.g., Anti-asthmatic drugs.
✘CURE- complete eradication of disease. E.g.,
antibiotics
✘Enhancement aspects of health – achieve the best
state of health e.g., Vitamins, Minerals

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Type of Drug Preparations
 TYPES OF DRUG PREPARATION

✘ Aerosol spray or foam – A liquid, powder, or foam

deposited in a thin layer on the skin by air pressure
✘ Aqueous solution – One or more drug dissolved in water
✘ Aqueous suspension – One or more drugs finely divided
in a liquid such as water
✘ Caplet – A solid form, shaped like a capsule, coated and
easily swallowed

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 TYPES OF DRUG PREPARATION

✘ Capsule – A gelatinous container to hold a drug in powder,

liquid or oil form
✘ Cream – A non-greasy, semisolid preparation used on the
skin
✘ Extract – a concentrated form of a drug made from
vegetables or animals
✘ Gel or Jelly – a clear translucent semisolid that liquefies
when applied to skin
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 TYPES OF DRUG PREPARATION

✘ Liniment – A medication mixed with alcohol , oil, or soapy

emollient ad applied to the skin
✘ Lotion – A medication in a liquid suspension applied to the
skin
✘ Lozenge – A flat round or oval preparation that dissolves
and releases a drug when held I the mouth
✘ Ointment – A semisolid preparation of one or moe drugs
used for application to the skin and mucous membrane
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 TYPES OF DRUG PREPARATION

✘ Paste – A preparation like ointment , but thicker and stiff, that

penetrates the skin less than an ointment
✘ Pill - One or more drugs mixed with a cohesive material, in oval,
round or flattened shapes.
✘ Powder – A finely ground drug or drugs, some are used internally
others externally
✘ Suppository – One or more several drugs mixed with a firm bas such
as gelatin and shaped for insertion into the body (rectum) ; the base
dissolved gradually at body temperature , releasing the drug.
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 TYPES OF DRUG PREPARATION
✘ Syrup – An aqueous solution of sugar often used to disguise
unpleasant tasting drugs.
✘ Tablet – A powdered drug compressed into a had small disk; some
are readily broken along a scored line; others are enteric coated and
prevent them from dissolving in the stomach
✘ Tincture – An alcoholic or water-and-alcohol solution prepared from
drugs derived from plants
✘ Transdermal Patch - A semipermeable membrane shaped in the
form of a disk or patch that contains a drug to be absorbed through
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the skin over a long period of time.
EFFECTS OF DRUGS
 EFFECTS OF DRUGS
✘ Therapeutic effect – also referred as the desired effect , is the
primary effect intended, that is the reason the drug is prescribed.
✘ Side Effect – or secondary effect of a drug is one that is unintended
✘ - it is usually predictable and may be either harmless or potentially harmful.
✘ Adverse effects or reactions – are the more severe side effects and
may justify the discontinuation of the drug.
✘ Drug Toxicity – over dosage of the drug
✘ Drug Allergy – is an immunologic reaction to a drug.

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ROUTES OF ADMINISTRATION
 ROUTES OF ADMINISTRATION

✘ ORAL ADMINISTRATION – is the most

common, least expensive and most
convenient .
✘ SUBLINGUAL ADMINISTRATION – the drug is
placed under the tongue, where it dissolves in
a relatively short time . The drug is largely
absorbed in blood vessels on the underside of
the tongue.
✘ BUCCAL – means “ pertaining to the check‘”. It
is held in the mouth against the mucous
membranes of the cheeks until it dissolves.
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 ROUTES OF ADMINISTRATION
✘ PARENTERAL – The parenteral route is defined as other than through
the alimentary or respiratory tract; that is by needle.
⮚ SUBCUTANEOUS (HYPODERMIC) – into the subcutaneous tissue just
below the skin
⮚ INTRAMUSCULAR (IM) – into a muscle
⮚ INTRADERMAL (ID) – under the epidermis (into the dermis)
⮚ INTRAVENOUS (IV) – into a vein

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 DURATION OF ACTION

✘ ORAL ADMINISTRATION –With oral administration,

it typically ranges anywhere from 20 minutes to
over an hour, depending on the drug .
✘ SUBLINGUAL ADMINISTRATION –onset 1 to 3
minutes, duration 30 to 60 minutes
✘ BUCCAL – Buccal medicines should help
symptoms within 5 to 10 minutes.
✘ Suppositories are usually effective in about 20
minutes (usual range 10 to 30 minutes). Rarely the
laxative effect has been reported 45 minutes after
administration.

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 DRUG OF ACTION

Parenteral administration
generally acts more rapidly than topical
or enteral administration, with onset of
action often occurring in 15–30 seconds
for IV, 10–20 minutes for IM and
15–30 minutes for SC.

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 ROUTES OF ADMINISTRATION

✘ TOPICAL – are those applied to a circumscribed surface area of the body. They affect only
the area which they are applied.
✘ DERMATOLOGIC PREPARATIONS - APPLIED TO THE SKIN
✘ INSTILLATIONS AND IRRIGATIONS – APPLIED INTO THE BODY CAVITIES OR
ORIFICES, SUCH AS THE URINARY BLADDER, EYES, EARS, NOSE , RECTUM OR
VAGINA

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 ROUTES OF ADMINISTRATION

✘ TOPICAL – are those applied to a circumscribed surface area of the body. They affect only
the area which they are applied.
✘ DERMATOLOGIC PREPARATIONS - APPLIED TO THE SKIN

✘ TRANSDERMAL PATCHES - Select a clean , dry area that is free of hair.

Remove the patch from its protective covering, holding it without touching the
adhesive edges, and apply it by pressing firmly with the palm of hand for about 10secs.
Advise the client to avoid using a heating pad over the area to prevent an increase in
circulation and the rate pf absorption. Remove the patch at the appropriate time ,
folding the medicated side to the inside so it is covered.

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 ROUTES OF ADMINISTRATION

INHALATIONS – ADMINISTERED INTO THE RESPIRATORY TRACT BY A

NEBULIZER OR POSITIVE PRESSURE BREATHING APPARATUS.

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 ROUTES OF ADMINISTRATION

NEBULIZERS deliver most medications administered through inhaled

route. A nebulizer is used to deliver fine spray of medication or moisture
to a client.

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 ROUTES OF ADMINISTRATION

The metered-dose inhaler (MDI) is a pressurized container of

medication that can be used by the client to release the medication
through mouthpiece

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TYPES OF MEDICATION ORDERS
 4 TYPES OF MEDICATION ORDERS
✘ STAT ORDER – Indicates that the medication is to be given
immediately and only once . (e.g., Paracetamol 100mg IV stat)
✘ SINGLE ORDER – or one time order is for medication to be given once
at a specifies time (e.g., Senekot 10mg at HS)
✘ STANDING ORDER – may or may not have a termination date. The
standing order may be carried out indefinitely.
✘ PRN ORDER – or AS NEEDED order , permits the nurse to give a
medication when, in the nursing judgement, the client requires it.

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12 RIGHTS OF MEDICATION
ADMINISTRATION
 12 R’s OF MEDICATION ADMINISTRATION

✘ RIGHT CLIENT
✘ RIGHT DRUG
✘ RIGHT DOSE
✘ RIGHT ROUTE
✘ RIGHT TIME
✘ RIGHT ASSESSMENT
✘ RIGHT EVALUATION
✘ RIGHT DOCUMENTATION
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 12 R’s OF MEDICATION ADMINISTRATION

✘ RIGHT DRUG PRESENTATION

✘ RIGHT MOTIVATION AND APPROACH
✘ RIGHT TO REFUSE
✘ RIGHT OF THE CLIENT TO KNOW THE REASON OF THE DRUG TO BE
ADMINISTERED

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6 RIGHTS OF MEDICATION
ADMINISTRATION
(International Standard)
 6 R’s OF MEDICATION ADMINISTRATION

✘ RIGHT CLIENT
✘ RIGHT MEDICATION
✘ RIGHT DOSE
✘ RIGHT ROUTE
✘ RIGHT TIME
✘ RIGHT DOCUMENTATION

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TERMINOLOGIES AND
ABBREVIATIONS
 Abbreviations Meaning
STAT order Refers to any medication that is needed
IMMEDIATELY and is to be given only once
ASAP order Not as urgent as STAT
Should be available for administration to the
patient with 30minutes of the written order
SINGLE order For a drug that is to be given only once, and at a
specific time such as preoperative order
PRN order The nurse makes judgement, based on a patient
assessment, as to when such a medication is to
be administered
 Abbreviations Meaning
STANDING orders Written in advance situation that is to be carried
out under the specific circumstances.
Ac Before meals
AM Morning
BID Twice or two times a day 8AM , 6PM
Cap Capsule
Gtts/ Mgtts Drops/ microdrops
IM Intramuscular
Pc After meals, after eating
 Abbreviations Meaning
PO By mouth
PM Afternoon
PRN As needed/ necessary
QID Four times a day 8am, 12nn, 4pm, 8pm
Q2h, q4h, q6, q8, q12 Every ______ hours
Rx Prescription pad
STAT Immediately, at once
Ad lib As desired, as directed
 Abbreviations Meaning
NPO Nothing per orem
HS Hours of sleep 8PM
DAT Diet as tolerated
GLD General Liquid diet
SD Soft diet
SQ or SC Subcutaneous
SL Sublingual
MAR Medication Administration Record
 Abbreviations Meaning
RTC Round the Clock
VS Vital Signs
NVS Neuro Vital Signs
GCS Glasgow Coma Scale
CBR Complete Bed rest
BRAT/C diet Banana, Rice, Apple, Tea or Crackers
O.U Both eyes
O.S Left Eye
O.D Right eye
GUIDELINES IN GIVING
MEDICATIONS
GUIDELINES IN GIVING MEDICATIONS
✔ Nurses who administer medications are responsible for
their own actions. Question any order that is illegible or
that you consider incorrect. Call the person who
prescribed the medication for clarification.
✔ Be knowledgeable about the medications you
administer.
✔ Use only medications that are in a clearly labeled
container
GUIDELINES IN GIVING MEDICATIONS
✔ Do not use liquid medications that are cloudy or have
changed color.
✔ Calculate drug doses accurately.
✔ Administer only medications personally prepared.
✔ Before administering a medication, Identify the client
correctly.
✔ Do not leave medications at the bedside.
GUIDELINES IN GIVING MEDICATIONS
✔ When a medication is omitted for any reason, record
the fact together with the reason.
✔ When a medication error is made, report immediately
to the nurse in charge, the primary care provider or
both.
✔ Always check a medication’s expiration date.
Safe Medication
Administration
CHECK 3x for Safe Medication Administration
✔ Read the MAR and remove the medication from the client’s
drawer. Verify the client’s name and room number match
the MAR.
• Compare the label of the medication against the
MAR
• If the dosage does not match the MAR, determine if
you need to do a math calculation
• Check the expiration date of the medication
CHECK 3x for Safe Medication Administration
✔ While preparing the medication, look at the medication label
and check against the MAR

✔ Recheck the label on the container (e.g., vial, bottle) against

the MAR before returning to its storage place OR before
giving the medication to the client.
SAFETY CONSIDERATIONS
✔ Plan medication administration to avoid disruption

• Dispense medication in a quiet area

• Avoid conversation with others
• Follow agency’s no-interruption zone policy
SAFETY CONSIDERATIONS
✔ Prepare medications for ONE patient at a time
✔ Follow the Rights in giving medications
✔ Check that the medication has not expired
✔ Perform hand hygiene
✔ Check room for additional precautions
✔ Introduce yourself to the patient
✔ Confirm patient ID using two patient identifiers (e.g., name and date
of birth) and check against MAR
SAFETY CONSIDERATIONS
✔ Check Allergy band for any allergies and ask patient about type and
severity of reaction
✔ Complete necessary assessments (VS) and document on MAR
✔ Provide patient education as necessary
✔ If a patient questions or expresses concern regarding a medication,
stop and do not administer.
MEDICATION ERROR
MEDICATION ERROR
• Medication errors are unintended mistakes in the
prescribing, dispensing and administration of a
medicine that could cause harm to a patient.
• Medication errors can occur at all stages of the
medication administration process.
MEDICATION ERROR
• The four main types of medication errors that occur
with hospitalized clients:
• 1. Prescription errors (eg. Wrong drug or dose)
• 2. Transcription / interpretation error (eg.
Misinterpretation of abbreviations)
• Preparation errors ( eg. Calculation errors)
• Administration errors (Wrong dose, wrong time,
omission or additional dose)
 REFERENCE
• KOZIER AND ERB’S , FUNDAMENTALS OF NURSING (10TH
EDITION)
• http://www.nursing.pearsonhighered.com