Al-Zaytoonah University of Jordan

Faculty of Nursing
Fundamental of nursing /Theory
Course No. 0301113

Dr. Hana AbuSnieneh

Dr. Majdi Alzobi

Medications
 Learning objectives
After completion of this lecture, the students will be able to:
}Define selected terms related to the administration of medications.
}Describe legal aspects of administering medications.
}Identify physiologic factors and individual variables affecting
medication action.
}Describe various routes of medication administration.
}Identify essential parts of a medication order.
}Recognize abbreviations commonly used in medication orders.
}List six essential steps to follow when administering medication.
}State the ten "rights" to accurate medication administration.
}Describe essential steps in safely administering medications.
 Introduction

• Medication: Substance administered for

diagnosis, cure, treatment, or relief of symptom
or for prevention of disease.
• Drug: Same as medication but also refers to
illegally obtained substance.
• Prescription: Written direction for preparation
and administration of a drug.
• Generic Name: Name used throughout the
drug's lifetime.
• Trade (brand) Name: Given by drug
manufacturer (brand name).
 Introduction

• Official Name: Name by which drug is listed in

official publications.
• Chemical Name:
▪ Name by which a chemist knows it.
▪ Describes constituents of the drug precisely.
• Pharmacology
▪ Study of effect of drugs on living organisms.
• Pharmacy
▪ Prepares, makes, and dispenses drugs as ordered.
• Pharmacist
▪ Person who prepares, makes, and dispenses
drugs as ordered.
Legal Aspects of Administering Medications

• Nursing practice acts

• Recognizing limits of own knowledge and skill
• Take responsibility for actions.
• Question any order that appears unreasonable.
• Refuse to give medication until order is clarified.
• Controlled Substances
▪ Kept under lock
▪ Special inventory forms
Documentation requirements
▪ Procedures for discarding
▪ End-of-shift counts of controlled substances
 Effects of Drugs
• Therapeutic Effect = Desired effect
▪ Reason drug is prescribed.
• Side Effect = Secondary effect
▪ Unintended, usually predictable
▪ May be harmless or harmful
• Adverse Effect
• More severe side effect.
▪ May justify discontinuation of a drug.
• Drug Toxicity
▪ Results from overdose, ingestion of external -use drug
• Drug Tolerance
▪ Need increasing doses to maintain therapeutic effect.
• Drug Interaction: One drug affecting effect of another.
 Routes of Administration
1. Oral: the drug is swallowed
▪ Most common, least expensive, most
convenient.
2. Sublingual
▪ Not to be swallowed, but dissolved.
▪ Under the tongue.
3. Buccal
▪ Cheek
 Routes of Administration
4. Parenteral: by needle
▪ Subcutaneous (SC) - Hypodermic
▪ Intramuscular (IM)
▪ Intradermal (ID)
▪ Intravenous (IV)
▪ Less common (Intrathecal/Intraspinal,
Epidural & Intracardiac).
5. Topical
▪ Dermatologic preparations.
▪ Installations and irrigations (eys, ears)
▪ Inhalations
 Types of Medication Orders

1. Stat Order (only one )

▪ Medication administration immediately and
only once.

▪ Such as Morphine Sulfate 10 milligrams IV stat

2. Single Order( one time)

▪ Medication administration at once at specified
time.

▪ Such as Zinacef 100 mg before surgery.

 Types of Medication Orders

3. Standing Order (Regular)

▪ Indefinitely, such as multiple vitamins daily

▪ Specified number, such as KCL twice daily × 2
days.
4. PRN Order (as needed order)

▪ “When necessary"

▪ Such as Revanin 15 mL PRN

▪ When patients require it
▪ Set limit for interval between doses
Essential Parts of a Medication Order

• Full name of client

• Date and time order is written
• Name of drug to be administered
• Dosage of drug
• Frequency of administration
• Route of administration
•Signature of person writing the
Order.
Common Abbreviations used in
Medication Orders

• ac : before meals

• pc: after meals

• bid: twice a day

• hs: at bed time
• ID: intradermal
• IM: intramuscular

• IV: intravenous
• PO: per oral (by mouth)
 Common Abbreviations used in
Medication Orders
• PRN: when needed

• q: every (e.g., q 6 hrs: every 6 hours)

• tid: three times a day

• qid: four times a day
• qod: every other day

• SC: subcutaneous
• stat: at once
• susp: suspension
• tab: tablet
Converting Units of Weight and Measure

• Converting weights within the metric system

▪ Gram (g), Milligram (mg), and Microgram (mcg)
only units used for dosages.
▪ Divide or multiply and move decimal points
▪ Put a 0 in front of decimal point if less than 1
(0.5 g).
▪ Pounds to kilograms
• 2.2 lb = 1 kg
▪ Example: Erythromycin 500 mg is ordered, it is
supplied in liquid form containing 250 mg in 5 ml
250 mg/5 ml = 500 mg/ x
X = 10 ml
Figure 35–7 Basic metric measurements of volume and weight.
Process of Administering Medications

• Identify the client

• Inform the client

• Administer the drug

• Provide adjunctive interventions as indicated
(clients may need help when receiving medications such
as with repositioning the patient for an IM injection)

• Record the drug administered.

• Evaluate the client's response to the drug.

Box 35–6 Ten “Rights” of Medication
Administration
 Practice Guidelines for
Safe Administration of Medications
• Nurses who administer medications are
responsible for their own actions. Question any
order that you consider illegible (unreadable) or
incorrect.
• Be knowledgeable about the medications you
administer.
• Laws govern the use of narcotics, keep these
medications in a locked place such as the DDA
(Dangerous Drugs Act) cabinet.
• Use only medications that are in a clearly labeled
container.
• Do not use liquid medications that are cloudy or
have changed color.
 Practice Guidelines for
Safe Administration of Medications

• Calculate drug doses accurately; if uncertain,

double check with another nurse.
• Administer only medications personally prepared
• Before administering a medication, identify the
client correctly (ID bracelet and ask client to state
his name).
• Do not leave medications at the bedside.
• When a medication error is made, report it
immediately to the nurse in-charge, the physician.
 Oral Medications

• NPO “nothing by mouth” or Latin “nil per os”

• Oral most common route

• Preferred unless digestive problem (e.g.,

nausea and vomiting).

 Nasogastric and Gastrostomy
Medications
• Nasogastric tube, gastrostomy tube
• Practice guidelines
• Check with pharmacist a liquid form
• Check to see if medication can be crushed
• Crush tablet into fine powder and dissolve in at
least 30 mL of warm water
• Do not administer whole or undissolved
medications.
• Assess tube placement
• Aspirate stomach contents and measure residual
volume then administer medication.
Nasogastric and Gastrostomy Medications
Nasogastric and Gastrostomy Medications

• Practice Guidelines
▪ When administering medication:
• Remove plunger from the syringe
• Connect syringe to pinched or kinked tube
• Put 15–30 mL (5–10 mL for children) of water
into syringe barrel to flush the tube.
• Pour liquid or dissolved medication into syringe
barrel and allow to flow by gravity into the
enteral tube.
• After administration of all medications, flush
with another 15–30 mL of warm water (5–10
mL for children) to clear the tube.
 Parenteral Medications

• Parenteral administration is a common

nursing procedure.

• Absorbed more quickly than oral route.

▪ Careful and accurate administration.

• Aseptic technique.
 Equipment
• Syringes
▪ Parts
• Tip, which connects with needle
• Barrel
• Plunger
▪ Hypodermic
Syringes vary
▪ Insulin Syringe
▪ Common problems with insulin pen:
• Needle stick injuries
• Errors in technique
• Using the pen like a vial
• Using the pen for more than one client
 Equipment
• Syringes
▪ A: Luer-Lok Syringe
• Requires needle to be twisted onto it.
▪ B: Non-Luer-Lok Syringe
• Has smooth graduated tip
• Needles are slipped onto it.

A B
Box 35–8 Avoiding Puncture Injuries
 Preparing Injectable Medications
• Ampules and Vials
▪ Ampule
•Glass container designed to hold
a single dose of a drug.
• Must be broken at constricted neck to access
medication.
▪ Vial
• Small glass bottle with sealed rubber cap
• Must be pierced with needle and air must
be injected before medication is withdrawn.
▪ Reconstitution
• Adding diluents to powdered drug to reconstitute
▪ Single- or Multi-dose
Skill 35–2 (continued) Preparing Medications
from Ampules
Mixing Medications in one syringe
▪ Can be done with compatible drugs (e.g., two types
of insulin).
▪ Push amount of air equal to dose into first vial
▪ Push amount of air equal to dose of second drug
into second vial
▪ Withdraw correct amount of drug from second vial
▪ With newly attached, sterile needle, carefully
withdraw correct amount of drug from first vial.
 A. Intradermal Injections

• Very small amounts administered just below

epidermis (into the dermis)

• E.g.:

• Allergy testing

• Tuberculosis testing
Figure 35–32 Body sites commonly used for intradermal (ID)
injections.
 Skill 35–5 (continued) Administering an
Intradermal Injection for Skin Tests

Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
 B. Subcutaneous Injections

• Injected just beneath skin (into subcutaneous tissue)

• E.g. Vaccines, Insulin, Heparin
• Syringe depends on medication given, thickness
of skin fold.
• Sites need to be rotated in an orderly fashion to
minimize tissue damage, aid absorption.
•Aspiration no longer
Recommended.
Figure 35–33 Body sites commonly used for subcutaneous (SC)
injections.

Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
 Skill 35–6 (continued) Administering a
Subcutaneous Injection

Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
 C. Intramuscular Injections

• Absorbed more quickly than subcutaneous

because muscles are more vascular.
▪ Large volumes can be tolerated.
• Size of syringe varies.
▪ Adult standard is 1.5 inches, 21 or 22 gauge
Factors determining syringe size and length
▪ Muscle
▪ Type of solution
▪ Adipose tissue
▪ Age of client
 Intramuscular Injections

• Ventrogluteal Site

▪ Preferred

• No large nerves, vessels

• Sealed off by bone

▪ Side-lying position most accessible

• Vastus Lateralis Site

▪ Best for infants, young children

 Landmarks for the ventrogluteal site for an
Figure 35–35
intramuscular injection.

Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
 The vastus lateralis muscle of an infant's upper
Figure 35-37
thigh, used for intramuscular injections.

Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
 Intramuscular Injections

• Dorsogluteal Site
▪ Not preferred, should be avoided
▪ Close to sciatic nerve and superior gluteal
nerve.
• Complications have occurred.
• Numbness
• Pain
• Paralysis
 Intramuscular Injections

• Rectus Femoris Site

▪ Easily accessible to clients who administer
their own injection.
▪ May cause discomfort for some people

• Deltoid Site

▪ Close to radial nerve, artery

▪ No more than 1 mL of solution can be
administered.
▪ Hepatitis B vaccine
Rectus Femoris Site
Deltoid Site
 D. Intravenous Medications

• Route appropriate for rapid effect (direct to

bloodstream) or for medication that irritates
tissue.

• Large-volume infusions

▪ Safest, easiest

▪ Main danger is hypervolemia

▪ Often used with children, older clients when
volume administered is critical and must be
carefully monitored.
 Intravenous Medications
• Intravenous Push
▪ Or bolus
▪ Undiluted and used in emergency
▪ Errors may not be corrected and drug may
irritate lining of blood vessels.
• Intermittent Infusion Devices
▪ For clients receiving long-term therapy
▪SASH flushing procedure
(Saline, Administer
medication, Saline, Heparin)
 4.Topical Medications

• Percutaneous

• Transdermal patch

• Skin applications

▪ Clean skin before applying

▪ Wear gloves
▪ Use surgical asepsis in presence of open
wound.
 Topical Medications

• Ophthalmic Medications
▪ Liquid or ointment medication into eye
• Irrigation
• Instillation
 Topical Medications
• Otic Medications
▪ Administer medication to external auditory
canal
• Irrigation
• Instillation
▪ Position of canal varies with age.
 Topical Medications

• Nasal Medications
▪ Shrink swollen mucus membranes
▪ Loosen secretions and facilitate drainage
▪ Treat infections of nasal cavity and sinuses
▪ For Self-administration:
▪ Suggest that client should blow nose first
▪ Client in seated position with head tilted back
▪ Client holds tip of container just inside the
nares
▪ Inhales as spray enters the nasal passage
 Topical Medications

• Vaginal Medications

▪ Creams, jellies, foams, or suppositories

▪ Infections or discomfort
 Topical Medications
• Rectal Medications- Inserting a rectal suppository
▪ Assist client to left lateral or left Sims position
▪ Upper leg flexed & Expose buttocks
▪ Put glove on hand used to insert the suppository
▪ Unwrap suppository
▪ Lubricate smooth rounded end
▪ Lubricate gloved index finger
▪ Encourage client to relax by breathing through the mouth
▪ Insert suppository gently into the anal canal
▪ Avoid embedding in feces
▪ Press buttocks together for a few minutes
▪ Ask client to remain in left lateral or supine position for at
least 5 minutes .
 5. Inhaled Medications

• Nebulizers

▪ Fine spray (fog or mist)

• Metered-dose inhaler
▪ Extender, extender spacer
Metered-dose Inhaler
 Inhaled Medications

• Metered-Dose Inhaler (MDI)

▪ Client teaching

• Remove mouthpiece cap

• Exhale comfortably

• Hold canister upside down

• Press down once and inhale slowly and
deeply through the mouth
• Hold breath for 10 seconds or as long as one
can
 Inhaled Medications

• Metered-Dose Inhaler (MDI)

▪ Client teaching

• Remove inhaler away from mouth

• Exhale slowly through pursed lips

• Repeat inhalation if ordered

• Rinse mouth with tap water

•Clean MDI mouthpiece after
each use