Medication Administration

Learning objectives:
Describe
the
legal
aspects
of
drug
administration.
Describe routes of drug administration.
Identify essential parts of drug order.
Recognize abbreviations commonly used in
medication order.
Identify
the
RIGHTS
of
medication
administration.
Describe essential steps for safely administering
enteral and parenteral medications.

Medication

MEDICATION is a substance administered

for the diagnosis, treatment, relief and
prevention of health alterations.

Types Of Drug PreparationSolids

Solids
P
C
S
L
T

Types Of Drug PreparationSolid

Pills- one or more drugs mixed with a cohesive material

in oval, round or flattened shape.

Capsule- a gelatinous container to hold a drug in
powder, liquid or oil form.
Suppository- one or several drugs mixed with a firm
base such as gelatin and shaped for insertion into
the body.
Lozenges- a flat, round or oval preparation that
dissolves and releases a drug when held in the
mouth.
Tablet- a powdered drug compressed into a hard small
disc; some are easily broken along a scored line;
others are enteric-coated to prevent them from
dissolving in the stomach.

Types Of Drug PreparationSemisolid

Cream- a non-greasy, semisolid preparation used on

the skin.

Gel or jelly- a clear or translucent semisolid that

liquefies when applied to the skin.
Ointment- a semisolid preparation of one or more
drugs used for application to the skin and mucous
membrane.

Types Of Drug Preparation

L
E
E
S
S

Solutio
n

Types Of Drug PreparationSolution

Lotion- an emollient liquid used in the skin.
Emulsions- a liquid medication prepared

in fatty

substance.

Elixirs-

a sweetened and aromatic solution of

alcohol used as a vehicle for medicinal agents.

Suspension-

one or more drugs finely divided in a

liquid such as water.

Syrup-

an aqueous solution of sugar often used to

disguise unpleasant taste of drug.

Types Of Drug Preparation

Transdermal patch- a semi-permeable membrane

shaped in the form of a disk or patch that contains
a drug to be absorbed by the skin over a lengthy
period of time.

Prescription

PRESCRIPTION is the written direction for

the preparation and administration of a
drug.

Parts of a Prescription

1.Descriptive information about the client

2.Date on which the prescription was written
3.The Rx symbol
4.Medication name, dosage and strength
5.Route of administration
6.Dispensing instruction for the pharmacist.
7.Direction for the administration.
8.MDs signature

Essential Parts Of A Doctors Order

1.
2.
3.
4.
5.
6.

Full name of a client

Date the order is written
Name of the drug to be administered
Dosage and frequency of the drug
Route of administration
Signature of the physician

Types Of Medication Orders

STANDING ORDER
Medication that may or may not have a termination date.
Order that can be carried out indefinitely until an order is
written to cancel or discontinue the medication, or it may
be carried out for a specified number of days .

SINGLE ORDER
Medication given once at a specified time

STAT ORDER
Medication is to be given immediately and only once.

PRN ORDER
Permits the nurse to give a medication when, in the
nurses judgment, the client requires it.

Legal Aspects Of Medication

administration
knowledge-knowledge-knowledge
Rights of
Nurse
knowledge-knowledge-knowledge-knowledge-knowledge
RX

knowledge-knowledge-knowledge-knowledge-knowledge-knowledge
Rights of

APs order
knowledge-knowledge-knowledge-knowledge-knowledge-knowledge
PT

knowledge-knowledge-knowledge-knowledge-knowledge-knowledge
Drugs and
knowledge-knowledge-knowledge-knowledge-knowledge-knowledge
dosage
its effects

knowledge-knowledge-knowledge-knowledge-knowledge-knowledge
knowledge-knowledge-knowledge-knowledge-knowledge
Safe
administration

Route

knowledge-knowledge-knowledge-knowledge

Legal Aspects Of Administering

Drug
CARRYING OUT A PHYSICIANS ORDER
Nurses are expected to analyze medications
ordered by the physician.
It is the nurses responsibility to seek clarification
of ambiguous or seemingly erroneous orders from
the prescribing physician.
Clarification from any other source is unacceptable
and regarded as a departure from competent
nursing practice.

Safe medication
administration
Questioning the doctors order:
1. Question any order a client questions.
2. Question any order if the clients situation has
changed.
3. Question and record any verbal orders to avoid
miscommunications.
4. Question any order that is illegible, unclear or
incomplete.

Clinical guidelines in drug

administration:
1. Nurses who administer the medication are
responsible for their own actions. Question any
order that you consider incorrect.
2. Be knowledgeable about medications that you
administer.
3. Controlled drugs should be kept in a locked
cabinet.
4. Use only medications that are in a clearly
labeled container.
5. Return liquid medications that are cloudy or
have changed color to the pharmacy.
6. Before administering a medication, identify the
client correctly using the appropriate means of
identification.

Clinical guidelines in drug

administration:
7. Do not leave the medication at bedside.
8. If a client vomits after administering the medication,
report this to the nurse in charge or physician.
9. Take special attention when administering certain
medication, such as anticoagulants, insulin and other
medication.
10. Most hospital policy requires new order for
medication after surgery of a client.
11. When a medication error is made, report it
immediately to the nurse in charge or to the
physician.
12. When a medication error is committed, report it
immediately to the nurse in charge or to the
physician.

Common abbreviations used in medication

orders:

ac
ad lib
agit
aq

before meals
as desired
shake, stir
water

aq dest
bid

distilled water
twice a day
with

Common abbreviations used in medication

orders:

cap
comp
dil
elix
fl oz
g,gm,Gm, G
gr
gtt

capsule
compound
dilute
elixir
fluid ounce
gram
grain
drop

Common abbreviations used in medication

orders:

h
hs
IM
IV
Kg/kg
L
M/m
Mcg/ug
no.

an hour
at bedtime
intramuscular
intravenous
kilogram
Liter
mix
microgram
Number

Common abbreviations used in medication

orders:

non rep
NPO

OD
OS
OU
pc
po
prn

do not repeat
nothing per mouth
right eye
left eye
both eyes
after meals
by mouth
when needed

Common abbreviations used in medication

orders:

q
q AM
qh/ q1h
q2h
q3h
q4h

q6h
qhs
qid
qod
qs

every
every morning
every 1 hour
every 2 hours
every 3 hours
every 4 hours
every six hours
every night at bedtime
four time a day
every other day
sufficient quantity

Common abbreviations used in medication

orders:

rept
Rx

Sc/ SQ

Sig
Sos
ss
stat
sup/supp
susp

tid
Tr/tinct

may be repeated
take thou
Without
subcutaneous
label
if it is needed
one half
at once
suppository
suspension
three time a day
tincture

Pharmacology
PHARMACOLOGY is the study of the effect of
drugs on living organisms.

Pharmacist is a person licensed to prepare

and dispense drugs.
Pharmacy is the art of preparing,
compounding and dispensing drugs.

Pharmacopeia

PHARMACOPEIA is a book containing a list of

products used in medicine, with descriptions of the
product, chemical tests for determining the
identity, purity and formula for certain mixtures.

Actions Of Drugs On The Body

ACTIONS OF DRUGS ON THE BODY

Onset of action
Drug half-life
Peak plasma level
Plateau

Effects Of Drugs

I.
II.
III.
IV.
V.
VI.

Therapeutic effect
Side effect
Drug toxicity
Drug allergy
Drug tolerance
Drug interaction

Therapeutic Effect
THERAPEUTIC EFFECT

Palliative- relieves the symptoms of the disease

but does not affect the disease itself.
Curative- cures a disease or condition.
Supportive- supports body functions until the
bodys response can take over.
Substitutivereplaces
body
fluids
or
substances.
Chemotherapeutic- destroys malignant cells.
Restorative- returns the body to health.

Side Effect

SIDE EFFECT is the unintended effect of a

drug. Side effects are usually predictable
and may be either harmless or potentially
harmful.

Drug Toxicity

DRUG TOXICITY is the deleterious effect of

a drug on an organism or tissue which
results from over dosage, ingestion of a
drug intended for external use and build
up of drug in the blood because of
impaired metabolism or excretion.

Drug Allergy
DRUG ALLERGY- immunologic reaction to a drug.

Allergic reaction may either be mild or severe.

A mild reaction has a variety of symptoms from
skin rashes or diarrhea. It can occur anytime
from a few minutes to 2 weeks after the
administration of the drug.

Anaphylactic reaction- is a severe form of

allergic reaction usually occurs immediately
after the administration of drug.

Common Mild Allergic Reaction

COMMON MILD ALLERGIC REACTION
Skin rash- either an intraepidermal vesicle rash or a
rash typified by an urticarial wheal or macular
eruption, rash is usually generalized over the body.

Common Mild Allergic

Reaction
Pruritus

Rhinitis

Common Mild Allergic

Reaction
Angioedema

Common Mild Allergic

Reaction

Lacrimal tearing
Nausea and vomiting
Wheezing and dyspnea
Diarrhea

Drug Tolerance

DRUG TOLERANCE- exists in a person who

requires increase in dosage to maintain given
therapeutic effect. Drugs that commonly produce
tolerance are opiates, barbiturates, ethyl alcohol
and tobacco.

Drug Interaction

DRUG
INTERACTION
occurs
when
the
administration of one drug, before, at the same
time or after another drug alters the effect of one
or both drugs.

Potentiating effect- increased effect

Inhibiting effect- decreased effect
Iatrogenic effect- disease caused unintentionally by
medical therapy due to drug therapy.

Rights Of Medication
Administration

RIGHT
RIGHT
RIGHT
RIGHT
RIGHT
RIGHT
RIGHT
RIGHT
RIGHT
RIGHT

patient
assessment
time
education
to refuse
drug
dose
route
evaluation
documentation

MUST s in drug administration

Keep all medicines in locked cupboards or

carts.
Remove drugs from bedside unless there is a
doctors order.
Keep narcotics in double locked cabinets.
Counting is a must.
Keep all poisonous solutions and materials in
a secure area away from medicines.

MUST s in drug administration

Clearly label and separate topical medicines

from parenteral and oral medicines.
Provide complete instructions to patient
regarding medicines to be used at home.
Have another nurse check mathematical
calculations for dosages of drugs such as
insulin before administering to patient.
Report any errors in the administration of
medicines to the charge nurse immediately.

Routes Of Drug Administration

Topical, Instillation and

Irrigation
Topical
Medication applied on the circumscribed surface area of
the body. They affect only the area to which they are
applied.
Dermatologic preparation- applied to the skin.

Instillations and irrigation- applied into body

cavities or orifice such as eyes, ears, nose, rectum
or vagina.
Inhalations- administered into the respiratory tract
by nebulizers or positive pressure breathing
apparatuses

Enteral Route

Enteral Route

Oral
The most common route for administration,
least expensive and most convenient for the
client.
Safe method since the skin is not broken after
administration unlike injections.
Disadvantages- unpleasant taste of the drug,
irritation of gastric mucosa, irregular absorption
from the GIT, slow absorption and harm to the
clients teeth.

Enteral Route
Buccal
Medication is held in the mouth against mucous
membrane of the cheek until the drug dissolves.
The drug may act locally on the mucous
membranes of the mouth or systematically
when it is swallowed in the saliva.
Sublingual
The drug is placed under the tongue, where it
dissolves.
The medication should not be swallowed.

Enteral Route

Parenteral

Parenteral
Parenteral- absorption of drug is faster

Subcutaneous- into the SQ tissue, under the skin.

Intramuscular- into a muscle
Intradermal- into the dermis ( under the epidermis)
Intraarterial- into an artery
Intracardiac- into the heart muscle
Intraosseous- into a bone
Intrathecal/Intra-spinal- into the spinal canal

Parts of the skin

Parenteral

Intradermal Injections
INDICATIONS:
Vaccines, Tuberculin test and allergy test.
SITE:
Inner lower arm
Upper chest
Back beneath the scapula
AMOUNT:
Usually only a small amount of liquid is used.
NEEDLE:
gauge 25, 26 and 27.
- 5/8 inch long

Intradermal Injections

After the site is cleaned, the skin is held tautly, and

the syringe is held at about a 15 degree angle to
the skin with the bevel of the needle upward.
The drug produces a small bleb just under the skin.
The needle is then withdrawn quickly, and the site
is very lightly wiped with an antiseptic swab.
The area is not massaged because the medication
may disperse into the tissue or out through the
needle insertion site.
ID are absorbed slowly through blood capillaries in
the area.

Intradermal Injections

ID injection

SQ Injections
INDICATIONS:
Vaccines, Pre-operative meds, narcotics, heparin
and insulin.
SITE:
Outer aspect of upper arm
Anterior aspects of thigh
Back beneath the scapula
AMOUNT:
2 ml.
NEEDLE:
gauge 25
5/8 inch long and inch long

SQ Injections

Only small doses of medication should be

injected via the SQ route.
SQ injections need to be rotated in an
orderly fashion.
A 5/8 inch needle is used for adults when
the injection is administered at a 45 degree
angle; a inch needle is used at a
90degree angle.

SQ injection sites

SQ injection

IM Injections
INDICATIONS:
Use for larger amount of medication

SITE:

Deltoid
Ventrogluteal site
Dorsogluteal
Vastus lateralis
Rectus femoris

AMOUNT:
2 ml.- 5ml
NEEDLE:
gauge 21 or 22
1 inch long

IM Injections

An adult of average size can usually safely tolerate

up to 3 ml of medication in the large dorsogluteal
or vastus lateralis muscle.
As the size of the muscle decreases, the maximum
amount of medication that can be safely injected
also decreases.
Factors that indicate the size and length of the
needle to be use:

muscle
type of solution
amount of adipose tissue covering the muscle
age of the client.

IM Injection Sites
1. Ventrogluteal site
The ventrogluteal site is the preferred site for IM
injection because the area contains no large
nerves or blood vessels and less fat than the
buttock area.
Site is suitable for infants, children and adults. It is
particularly suitable for immobilized clients, whose
dorsogluteal muscle may be atrophying.
The position of the client can be back or side lying
position with the knee and hip flexed to relax the
gluteal muscles.

IM Injection SitesVentrogluteal

IM Injection Sites
2. Dorsogluteal
The dorsogluteal site is composed of the thick gluteal
muscles of the buttocks.
The dorsogluteal site can be used for adults and for
children with well-developed gluteal muscles.
The nurse must choose the site carefully to avoid striking
the sciatic nerve, major blood vessels or bone.
Palpating the ilium and the trochanter is important; visual
calculations alone can result in an injection that is placed
too low and injures other structures.

IM Injection SitesDorsogluteal

IM Injection SitesDorsogluteal

IM Injection Sites
3. Vastus lateralis
The vastus lateralis muscle is usually thick and well
developed in both adults and children.
It is increasingly recommended as the site of choice
for IM injections for infants because there are no
major blood vessels or nerves in the area.
It is situated on the anterior lateral aspect of the
thigh.
The middle third of the muscle is suggested as the
site. It is established by dividing the area between the
greater trochanter of the femur and lateral femoral
condyle into thirds and selecting the middle third.
The client can assume a back-lying or a sitting
position for an injection on this site.

IM Injection Sites
4. Rectus femoris
Belongs to the quadriceps muscle group. It is
situated on the anterior aspect of the thigh.
This site can be used for occasional injections for
the infants and children and for adults when other
sites are contraindicated.
Its chief advantage is that the clients who
administer their own injections can reach this site
easily.
Its main disadvantage is that an injection may
cause considerable discomfort for some people.
The client assumes a sitting position for an injection
at this site.

IM Injection Sites

IM Injection Sites
5. Deltoid
The deltoid is found on the lateral aspect of the upper arm.
It is not used often for IM injections because it is relatively
small muscle and is very close to the radial nerve and radial
artery.
It is sometimes considered for use in adults and children
over 18 months of age because of rapid absorption from the
deltoid area.
To locate the densest part of the muscle, the nurse palpates
the lower edge of the acromion and the midpoint on the
lateral aspect of the arm that is in line with the axilla. A
triangle within these boundaries indicates the deltoid muscle
about 5 cm ( 2 inches) below the acromion process.

IM Injection Sites- Deltoid

IM injection sites

Thank You