Fundamentals of Nursing

RLE

Ana Rebancos Guballa RM,RN,MAN

 MEDICAL ASEPSIS

 Medical Asepsis maybe defined as the practice of

techniques and procedures designed to reduce the
number of microorganisms in an area or an object
and to decrease the likelihood of their transfer.
The practice of medical asepsis takes an added
importance in the presence of individuals who have
made more susceptible to infection by illness,
surgery or immunosuppression.
 TERMINOLOGIES:

 INFECTION - invasion and proliferation of the body tissues by

microorganism
 
ASEPSIS- absence of disease producing microorganism
• MEDICAL ASEPSIS – practices designed to reduce the number and
transfer of microorganism.
• SURGICAL ASEPSIS – practices that render and keep objects and
areas free from microorganisms.
 SEPSIS - presence of infection
 
 SEPTICEMIA - transport of an infection or the products of infection
throughout the body
 
 CARRIER - a person or animal who is without
signs of illness but harbors the pathogen
within his body that can be transferred to
another.
 CONTACT - a person or animal known or
believed to have been exposed to a disease
   RESERVOIR - the natural habitat for the
growth and multiplication of microorganism
 TRANSIENT FLORA - microorganism picked up by the
skin as a result of normal activity that can be removed
readily

 RESIDENT FLORA - the microorganism that normally

live on a person’s skin
 
  OPPORTUNISTIC PATHOGEN - causes disease only in a
susceptible host
 
 NOSOCOMIAL INFECTION - hospital acquired infection
 STERILIZATION - the process by which all microorganism including
their spores are destroyed
 
 DISINFECTANT - a substance intended for use on inanimate object
that destroy pathogens but generally not the spores.
 
 ANTISEPTIC - a substance usually intended for use on persons that
inhibit the growth of pathogens but not necessarily destroy them.

 CONTAMINATION - the process by which something is rendered

unclean or unsterile.

 DISINFECTION - The process by which pathogens are destroyed from

inanimate objects
 INFECTIOUS DISEASE - results from the invasion
and multiplication of microorganism in a host.
 
 ISOLATION - the separation of persons with
communicable disease from other persons so
that either direct/indirect transmission to
susceptible persons is prevented 

 ISOLATION TECHNIQUE - practices designed to

prevent the transfer of specific microorganisms
 How Microorganisms Spread

 1. Microorganisms move through space on air

currents
2. Microorganisms are transferred from one surface
to another whenever objects touch.
3. Microorganisms are transferred by gravity when
one item is held above another.
4. Microorganisms are released into the air on droplet
nuclei whenever a person breaths or speaks.
5. Microorganisms move slowly on dry surfaces but
very quickly through moisture.
 HANDWASHING

The single most important procedure for preventing the

transfer of microorganisms, and nosocomial infections.

If properly done, handwashing protects the patient, your

co-workers, you and your family.

For medical aseptic purposes, a vigorous ten-second

handwashing that includes a “rubbing together” of all
surfaces of lathered hands followed by rinsing under a
stream of water is recommended.
 
 Handwashing should be done:

• at the beginning of every shift

• before and after prolonged direct contact with
a patient
• before and after invasive procedures
• before and after contact with patients
• before and after touching wounds
• at the end of every shift
 Points to Remember:

1. Provide a wide base of support and move closer to the sink

during the activity.
2. Friction, running water and a cleansing agent are necessary
to remove microorganisms or other material that maybe
present on hands.
3. Assemble all articles needed near the sink.
4. Make sure that the uniform does not come in contact with
the sink throughout the activity.
5. Use lotion if needed for dry skin. In some settings, however,
lotions are not recommended because it can be an excellent
medium for bacterial growth
 Infection and Prevention Control
Standard Precautions
Used in the care of all hospitalized individuals
regardless of their diagnosis or infection status
that involve blood, body fluids, excretions and
secretions except sweat, non intact skin and
mucous membrane.
SP include
1. Hand hygiene
2. Use of personal protective equipment (PPE),
that includes gloves, gowns, eyewear and
masks
3. Safe injection practices
4. Safe handling of potentially contaminated
equipment in the client environment
5. Respiratory hygiene/ cough etiquette
 Transmission –Based Precaution
used in addition to standard precaution for
clients with known or suspected infection that
are spread in one of these three ways
a. Airborne precaution – used for clients known
to have or suspected of having serious illness
transmitted by airborne droplet nuclei smaller
than 5 microns. Ex. Measles, varicella,
tuberculosis
b. Droplet precaution – used for clients known
to have serious illness transmitted by particle
droplet larger than 5 microns. Ex. Diptheria,
pneumonia, pertussis, mumps
c. Contact precautions – used for clients known
to have serious illness easily transmitted by
direct client contact or contact with items in
the client’s environment. Ex. GI infection,
respiratory, skin or wound infection
 BODY MECHANICS

DEFINITION:
-is the coordinated effort to maintain balance,
posture and body alignment during moving
and performing activities of daily living.
 
 TERMINOLOGIES:

 Alignment - parts of an object in proper relationship to

one another.
 Balance - a state of equilibrium in w/c opposing factors
counteracts each other.
 Base of support- the area on w/c an object rests.
 Center of gravity - point at w/c all the mass of an
object is centered.
 Line of gravity - an imaginary, vertical line w/c passes
through the center of gravity
 Posture - position of the body characterized by balance,
w/out undue tension to muscles, joints, ligaments
 PRINCIPLES AND GUIDELINES
 The wider the base of support, the greater the stability.
 Before moving objects, increase stability by widening the base of
support.
 Move objects close to the center of gravity.
– Adjust working area to waist level; keep the body close to the area.
 Pulling creates less friction than pushing.
 Pull clients rather than push them whenever possible.
 Moving an object along a level surface requires less energy than
moving an object up in an inclined position.
 Avoid working against the gravity. Pull, roll, or turn objects
instead of lifting.
 The closer the line of gravity to the center of
the base of support, the greater the stability.
 When moving or carrying an object, hold them
as close as possible to your center of gravity
 The greater the friction against the surface,
the greater force required to move the object.
 Provide a smooth, firm surface before moving
a client on bed or you can use a pull sheet.
 
 BED MAKING

 
DEFINITION:
Bed making- is the preparation of bed w/ a new set of linens.
 
 PURPOSES:
1. To provide a comfortable and safe environment for the
client.
2. To provide a bed w/c is smooth and wrinkle-free, thus
minimizing skin irritation.
3. To promote bed rest by providing a clean and neat
environment for the client.
 TYPES OF BED

1. Close bed- an unoccupied bed w/c is covered to

the top
2. Open bed- an unoccupied bed w/ the top sheet
fanfolded, ready for occupancy of a newly-
admitted client.
3. Occupied bed- a bed w/c is made w/ the client
on it.
4. Surgical bed- an unoccupied bed ready to admit
a client recovering from anesthesia after
surgery.
 PRINCIPLES OF INFECTION CONTROL IN BEDMAKING

 Microorganisms move through space currents.

• Handle linens carefully.
• Avoid shaking them or tossing them.
• Avoid throwing the linens on the floor to prevent the
spread of any bacteria either on the linens or on the floor.
 Microorganisms transfer from one surface to
another whenever one object touches another.
• Hold both soiled and clean linens away from your uniform
to prevent contamination of the clean linens by the uniform
and contamination of the uniform by the soiled linen.
 Proper Hand washing can remove harmful
microorganisms that can easily transfer from
one item to another.
• wash your hands before and after you
finish bed making
 PRINCIPLES OF BODY MECHANICS IN BEDMAKING

 A person/object is more stable if the center of gravity is

close to base of the support.
• when bending, bend with your knees, not with your back.
- to keep the center of gravity directly above and close to the
base of support and to help prevent fatigue.
 
 Face the direction of the task to be performed and turn
the entire body in one plane (rather than twisting).
• Position your entire body directly to the working area and avoid
twisting or overreaching.
- avoid twisting to prevent back strain or injury.
 Smooth and rhythmical movements at
moderate speed require less energy.
• Organize your work.
• Conserve steps by making a few steps around the bed
as possible.
- saves time and effort
 Working on a surface at an appropriate height
takes less energy to work.
• raising the bed to an appropriate height (waist level)
- to prevent fatigue.
 SPECIAL CONSIDERATIONS IN BEDMAKING

• Practice good body mechanics

• Strip one bed at a time
• Finish one side of the bed at a time
• Avoid over-reaching. It causes muscle
pain.
• Avoid fanning soiled linens. It may cause
contamination of the environment
• Confine surfaces of bed linen that has been in direct
contact w/ the client.
• Place bed linens in a pillow cases to be discarded into
the linen hamper.
• Keep soiled linens away from the uniform.
• Apply bed sheets in the following order:
– Bottom sheet - covers the mattress
– Rubber/plastic sheet - prevents soiling/wetting of the
mattress and bottom sheet
– Draw sheet - protects the client from the rubber/plastic sheet.
– Top sheet - covers the client
– Pillow cases - covers the pillow
• Make mitered corner to ensure neat bed.
• The smooth surface of the bed sheets should come in
contact w/ the client’s skin.
• For surgical bed:
• Place pillow against the head board
• Place towel on the head part
• Placement of rubber sheet and draw sheet depends on the type
of surgery
• Prepare the ff at the bedside: Iv pole, emesis basin, BP apparatus,
suction apparatus, oxygen device
• For occupied bed, maintain safety of the client.
Another nurse must stay on the other side of the bed
or put up the side rail on that side.
• Wash hands thoroughly after the procedure.
BED STRIPPING
-is the removal of the soiled linens from the bed.
 Special Considerations:
 Strip one side of the bed first before proceeding to the
other side.
 Always apply the principles of infection control when
removing contaminated linen.
– Fold linen into a bundle w/ soiled side turned inward.
– Use gloves when handling contaminated linens.
 Handle soiled linens properly. Don’t shake them. Don’t
put soiled linens on the floor.
 Strip one linen at a time.
Vital Signs
 THE VITAL SIGNS

• The vital signs or cardinal signs are body

temperature, pulse, respiration and blood
pressure (TPRBP).
• It serves as important indicators of the client’s
condition.
 BODY TEMPERATURE

 Body temperature is the balance between heat produced and

heat lost from the body.
 The heat regulating center is found in the hypothalamus.
  
A. TYPES OF BODY TEMPERATURE
 
1. Core Temperature
- The temperature of the deep tissues of the body.

2. Surface Temperature
- The temperature of the skin, subcutaneous tissue and fat.
B. FACTORS OF BODY HEAT PRODUCTION
 
1. Basal Metabolic Rate (BMR)
- The younger the person, the higher the BMR
- The older the person, the lower the BMR
*** Therefore, the older persons have lower body temperature than the younger
persons.
2. Muscle Activity
- Exercise, swimming, jogging etc… increases cellular metabolic rate.
*** Therefore, exercises increase body heat production. 
3. Thyroxine Output
- Hyperthyroidism is characterized by increased body temperature.
- It increases cellular metabolic rate (chemical thermogenesis).
4. Epinephrine, norepinephrine and sympathetic stimulation
- Increases the rate of cellular metabolism therefore increases body temperature.
5. Increased temperature of body cells (fever).
- Increases the rate of cellular metabolism. “Fever further causes fever.”
 
C. FACTORS AFFECTING HEAT LOSS
 
1. Radiation
- Heat transfers from the surface of one body to the surface of another without contact
between these two objects.
- Example: It feels warm in a crowded room
2. Conduction
- The transfer of heat from one surface to another.
- It requires temperature difference between the two surfaces
- Example: Application of moist wash cloth over the skin in TSB
3. Convection
- The dissipation of heat by air currents; heat transfer occurring in air movements
- Example: Exposure of the skin towards electric fan
4. Evaporation
- The continuous vaporization of moisture from the skin, oral mucous respiratory tract.
- Insensible heat loss
- Example: Tepid sponge bath increases heat loss by evaporation)
D. FACTOR AFFECTING TEMPERATURE

1. Season/ Environment
–Vasomotor nerve centers control the size of the blood vessels.
–Blood vessels constrict during cold seasons so that less heat is lost from the body.
–During summer, blood vessels in the skin dilate so that great volume of blood flows
through them. Heat is therefore loss from the body
2. Age
–The infant’s body temperature has underdeveloped heat regulation mechanism
causing variation in temperature.
–Older people have lower body temperature due to decreased thermoregulatory
controls, decreased subcutaneous fat, inadequate diet and sedentary activity.
3. Sex
–Increased progesterone level in female during ovulation raises body temperature.
4. Hormonal Activity
–Hormonal action of thyroxine, epinephrine and norepinephrine elevates during
extreme emotions (rage, fright, excitement) which raises body temperature.
 
5. Time of Day
– Lowest during early mornings and increases during the day due to food
metabolism and increased body activity.
– Highest temperature is usually reached between 8:00 PM to 12:00 MN;
and the lowest temperature is reached between 4:00-6:00 AM.

6. Exercise
– Strenuous activity increases metabolic rate thus, increasing the body
temperature.
– Sedentary people have lower body temperature due to decreased body
muscle activity. Rest and sleep decreases body temperature.
 
7. Food Intake
– A high caloric, energy giving food increases temperature.
– Fasting or starvation decreases temperature due to minimal
metabolism or less energy and heat production.
 E. ALTERATIONS IN BODY TEMPERATURE

1. Afebrile - Normal body temperature (36.4-37.4

0C)

2. Febrile/Pyrexia - Elevation in body temperature.

3. Hyperpyrexia - Very high fever (41 0C and above)
4. Hypothermia- Subnormal core body temperature.
 
 F. PATTERNS IN FEVER

1. Invasion
- Period when body temperature is rising
- Characterized by shivering or strong muscle
contractions resulting to shaking chills, increased
body metabolism, pale skin due to peripheral
vasoconstriction, “gooseflesh” appearance due
to contraction of erector pili muscles and feeling
of coldness.
2.Fastigium
- It is the stadium of fever
- Period when body temperature is at its highest peak
- Skin is warm to touch; peripheral vasodilation results in skin
flushing; individual is irritable, complains of headache, and feels
generalized weakness, body ache.
- Prolonged fever causes weight loss and anorexia, nausea,
vomiting, dehydration, convulsion or disorientation maybe
present.
3. Defervescence/Decline
- Period when elevated temperature returns to normal.
a. Crisis - sudden drop in temperature
b. Lysis - gradual drop in temperature over a period of days.
 
 2. Fastigium
- It is the stadium of fever
- Period when body temperature is at its highest peak
- Skin is warm to touch; peripheral vasodilation results in skin
flushing; individual is irritable, complains of headache, and feels
generalized weakness, body ache.
- Prolonged fever causes weight loss and anorexia, nausea,
vomiting, dehydration, convulsion or disorientation maybe present.
 
3. Defervescence/Decline
- Period when elevated temperature returns to normal.
a. Crisis - sudden drop in temperature
b. Lysis - gradual drop in temperature over a period of days.
 G. TYPES OF FEVER

1. Intermittent Fever
- Temperature alternates regularly between periods of pyrexia
and period of normal or subnormal temperature.
2. Constant/ Continuous Fever
- Temperature remains constantly high during the day and may
vary slightly but does not fall below the moderately high fever.
3. Relapsing Fever
- Temperature is elevated for several days and there will be one
or two days of normal temperature which are irregularly spaced.
4. Remittent Fever
- Temperature fluctuates several degrees above normal but does
not reach normal temperature between fluctuations.
 MEASUREMENT OF BODY TEMPERATURE

  1. Oral Temperature
Most convenient route; normal range is 36.1 to 37.4 0C
Bulb temperature is placed at the left or right posterior pockets of the fold of
the mucous membrane in the underside of the tongue which has a rich supply
of blood vessels for 3-8minutes. Lips should be tightly closed.
If patient has smoked, chewed gums, or has taken something hot or cold, allow
30 minutes before taking oral temperature to allow time for oral tissues to
return to normal temperature.
Contraindicated in:
– Babies and young children
– Unconscious, confused and irrational patients
– Patients with diseases and surgery of the oral cavity
– Patients with difficulty breathing through the nose
– Patients with cough
2.Rectal Temperature
 Most accurate and reliable
 Normal range is 36.7 to 37.8 0C
 Insert 1 ½ inches of the lubricated rectal thermometer into the anus and leave in place for one
to three minutes

 Indications:
– Very young patients
– Unconscious, irrational, confused patients
– Patients who are highly febrile
 Contraindications:
 Patients with rectal diseases/ surgery
 Patients with impacted feces, constipation, diarrhea
 Patients with abnormal growth in the anus
3. Axillary Temperature
• Safest way of obtaining body temperature but least accurate
• Normal range is 35.6 to 36 0C
• Leave in place for 5-10 minutes or more
4. Tympanic
 Pull the pinna slightly upward and backward for an
adult
 Point the probe slightly anteriorly, toward the
eardrum
 Insert the probe slowly using circular motion until
snug
5. Temporal
 Brush hair aside if covering the temporal artery
area. With the probe on the center of the
forehead
 CONVERSION

Fahrenheit scale is named after a German physicist, Gabriel Daniel

Fahrenheit
Centigrade scale is named after a Swedish scientist, Anders Celsius

Formulas:
 
1. Centigrade to Fahrenheit F = (9X 0C) + 32
0

5
 
2. Fahrenheit to Centigrade C = (5x 0F)-32
0

9
 
Special Considerations
Stay with patient when taking the temperature
Remember that the temperature is usually taken
by mouth unless otherwise ordered or
contraindicated
Provide individual thermometer for each patient
Use only oral thermometer for taking oral
temperature and rectal thermometer for taking
rectal temperature
 THE PULSE

The wave felt caused by the expansion

and distention of the arterial walls as the
blood is forced into the aorta and then
into the smaller arteries each time the
heart beats.
 A. CHARACTERISTICS OF PULSE

 
1. Rate
- The number of pulsations per minute
- Normal pulse rate: 60-80 beats/min.
Tachycardia - over 100 beats per minute
Bradycardia - below 60 beats per minute.
2. Rhythm
- Pattern of beats or interval between beats
- It is the regularity with which pulsation occurs
Regular - time between beats is essentially the same
Arrythmia - interval between beats is irregular
 
 3. Volume
- Size or amplitude of blood pushed against the wall of the artery during
ventricular contraction.
- Normal - If compressed artery is full to touch & pulsations are strong.
- Imperceptible - If pulsation cannot be felt
- Thready/Feeble - If pulsations can be easily obliterated.
- Bounding - If pulsations reaches a higher level than normal then
disappears again.
4. Tension / elasticity
- The compressibility of the arterial wall.
- High tension - Obliterated only by relatively great pressure
- Low tension - Easily obliterated, even under slight pressure.
 
PULSE SITES
1. Radial artery - Inner aspect of the wrist on the
thumb side
2. Temporal artery - Superior and lateral to the eye
3. Carotid artery - Side of the neck near the angle of
the jaw
4. Brachial artery - Inner aspect of the biceps muscle, a
few centimeters below the axilla on the inner aspect of
the arm
5. Femoral artery - Middle of the groin
6. Popliteal artery - Behind the knee, along the center of
the popliteal space
7. Posterior tibial artery - The groove between the Achilles
tendon and the tibia just behind the medial malleolus
then pressing towards the tibia
8. Dorsalis Pedis/Pedal pulse - At the instep of the foot on
an imaginary line drawn from the middle of the ankle to
the interdigital space between big and second toes from
the dorsum of the foot in a line between the big or first
and second toes.
9. Apical - Point of maximal impulse (PMI)
Located at the Left midclavicular line 5th intercostal space
Apical-Radial Pulse
– Apical pulse is counted at the apex of the heart
while another nurse counts on the radial pulse.
This is done simultaneously for one full minute

Pulse Deficit
- The difference between the apical and
radial pulses.
 C. VARIATIONS IN PULSE RATE

1. Age
- The normal for Newborn: 120 -160 beats per minute
Adult: 60 - 80 beats per minute.
2. Activity or Exercise
- Increased activity means increased need for oxygen by the muscles which results to
an increased heart rate in an effort to deliver oxygen through the blood stream.
3. Emotions
- Fear, worry, perception of pain, stimulate the sympathetic system hence
contractility of the heart will also increase and pulse too will increase.
4. Heat or Temperature
- When body temperature is elevated pulse rate tends to raise about 10 beats per
minute for every degree of temperature elevation.
5. Positioning
- Horizontal position increases heart and pulse rates.
 
6. Presence of Illness or disease.
7. Drugs
- Stimulants increase pulse rate while depressants decrease pulse
rate. 
8. Sex
- Women has faster pulse rates (7-8 beats faster) compared to men
9. Time of the Day
- Pulse rate is lowest in the morning on awakening and increases later
in the day.
10. Body Built
- Tall, slender persons have slower pulse rate than short stout persons.
11. Blood Volume and Components
- Excessive blood loss causes pulse rate to increase in an effort to keep
cells supplied with nutrients and oxygen.
 D. TYPES OF PULSE

1. Bigeminal pulse
- A pulse in which the beats occur in pairs followed by a pause
2. Collapsing Pulse
- Pulse strikes weakly against the finger then subsides abruptly
3. Corrigan’s Pulse/Water Hammer Pulse
- A bouncy pulse with a full extension followed by sudden collapse
4. Dicrotic Pulse
- Has two marked expansions in one beat of the artery
5. Labile Pulse
- Its rate and other characteristics are normal when patient is resting, but increases
when he sits up, stands, or exercise
6. Wiry Pulse
- Small, tense and upon palpation, it feels like a cord or wire
 
 THE RESPIRATION

 
The act of breathing
It is the continuous process of drawing in oxygen and expelling carbon
dioxide. Normal breathing is automatic and effortless
Controlled by respiratory centers, a. medulla oblongata b. chemoreceptors
Ventilation – movement of air in and out of the lungs.
Two-Phases:
Inspiration/ Breathing-in Phase – lasts to 1 to 1.5 seconds
- The diaphragm and external intercostals muscles contract enlarging the
chest cavity causing the person to take in air.
Expiration/ Breathing-out Phase – lasts to 2-3 seconds
- The diaphragm and external intercostals muscles relax thereby decreasing
the size of the chest cavity and forcing air out of the lungs
 
A. FACTORS THAT REGULATE RESPIRATION

1. The Respiratory Center in the Medulla Oblongata

- Sends out motor nerve impulses to cause the
contraction of the chest muscles, necessary for respiration
2. The Nerve Fibers of the Autonomic Nervous System
- Sensory impulses travel to the respiratory center
through the vagus nerve from the lungs and larynx
3. Chemical Composition of the Blood
- If blood contains small amount of carbon dioxide and a
greater amount of oxygen, respiration will be weak and
slow in rate and vice-versa.
 B. FACTORS THAT INFLUENCE VARIATIONS IN RESPIRATION

1. Age
- Newborn has higher respiratory rate than older people.
2. Sex
- Female have slightly rapid respiratory rate than males.
3. Strong Emotions
- Hormones are secreted in large amount which tends to
stimulate respiratory rate.
4. Disease Process
- It tends to increase respiratory rate as a compensatory
mechanism to lessen pain and hasten dissipation or loss.
 5. Exposure to Extremes of Temperature.
- Cold application makes breathing and deeper while hot
application increases breathing.
6. Ingestion of toxins, caffeine, and stimulants
- Increases respiratory rate due to its sympathetic effect.
7. Changes in Altitude
- The higher the place, the more you grasp for breath because
air does not provide enough oxygen for the blood to absorb
and circulate.
8. Ingestion of food and exercise
- It increases metabolism, therefore increasing need for
oxygen, thus, respiratory rate is increased.
 
 TYPES OF RESPIRATION

1. Apnea Temporary cessation of breathing

2. Eupnea Normal respiration

3. Dyspnea Difficulty in respiration

4. Polypnea Abnormal increase in respiratory rate

5. Bradypnea Abnormal decrease in respiratory rate

Inability to breathe when in lying or horizontal

6. Orthopnea
position

7. Hyperventilation A very deep rapid respiration

8. Hypoventilation Shallow and slow respiration

9. Hyperpnea Increase in rate and depth of respiration

Breathing involving chiefly the muscles of the

10. Abdominal Breathing
abdomen and diaphragm

11. Costal Breathing Breathing accomplished chiefly by the rib muscles

12. Diaphragmatic Breathing Breathing accomplished chiefly by the diaphragm

13. Kussmaul’s Respiration Paroxysmal breathing (diabetic coma)

14. Stertorous Respiration Noisy breathing as in snoring

15. Cheyne-Stoke’s Respiration with alternating periods of hyperpnea

Respiration and apnea
Hypoxemia: Decreased oxygenation in the
  blood.
Hypoxia: Decreased oxygenation in the
tissues

Hyperventilation Very deep rapid respirations

Hypoventilation Very shallow respiration

 C. ABNORMAL SOUNDS IN RESPIRATION

1. Wheezing
- This is due to constricted airways as in asthma
- high pitched musical sound on expiration
2. Stridor
- A harsh crowing sound heard on inspiration due to
acute constriction of the trachea
3. Rales/ Ronchi
- Bubbling or crackling or fizzing sounds evident in
patients with lung disease
- Also known as crackles.
 
 THE BLOOD PRESSURE

 - The force produced by the volume of blood

pressing on the resisting walls of the arteries.

Systole
- The working period of the heart; the heart
contracts and pumps blood out into the
circulation.
Diastole
- The resting period of the heart; the time when
the heart is filling with blood, which will be
pumped out during the next systole.
Hypertension
- Abnormally high blood pressure for two different but subsequent
visits. It is noted with diastolic readings greater than 90 mm Hg
and systolic readings greater than 140 mm Hg.
Hypotension
- Abnormally low blood pressure for two different but subsequent
visits. It is considered present when the systolic blood pressure
falls to 90 mm Hg or below.
Orthostatic Hypotension
- Also known as postural hypotension; it occurs when sudden
change in position causes a decrease in blood pressure.
Pulse Pressure
- It is the difference between systolic and diastolic blood pressure
measurements. Pulse pressure between 30-50 mm Hg is
considered within normal range.
Korotkoff sounds
- Sounds heard over an artery distal to the blood pressure cuff.
 A. FACTORS INFLUENCING BLOOD PRESSURE
1. Age
- Blood pressure rises with age. Arteries lose their
elasticity and become more rigid (arteriosclerosis)
resulting in even greater resistance to the heart’s
effort to fill the arteries with blood or arteries may
fill with fat deposits (atherosclerosis) that
interferes with the amount of blood that can be
contained within the arteries. Thus blood pressure
is increased.
2. Time of Day
- Blood pressure tends to be lowest in the morning
than later during the day.
3. Sex
- Women have lower blood pressure than men.
4. Exercise and Activity
- Increases during periods of activity or exercise through regular
exercise helps maintain blood pressure within normal range.
5. Emotions and Pain
- Strong emotions and pain tends to make blood pressure rise.
6. Miscellaneous Factors
- A person has lower blood pressure when lying down than when
sitting or standing. Blood pressure rises when the urinary
bladder is full and when the legs are crossed. It rises when a
person uses tobacco, drinks a caffeinated beverage or is cold.

***Note: A rise or fall of 20-30 mm Hg in a person’s usual blood

pressure is considered normal.
 EQUIPMENT USED TO OBTAIN BLOOD PRESSURE

1. Sphygmomanometer
- It is used to measure the pressure of blood within the artery.
It includes a pressure manometer, an occlusive cloth or vinyl
cuff that encloses an inflatable rubber bladder, and a pressure
bulb with a release valve that inflates the bladder. Should
cover not more than 2/3 of the arm when in use
-The two types of manometers
* Aneroid manometers have the advantage of being safe,
lightweight, portable and compact.
* Mercury manometers once the gold standard, are less
common because they contain mercury, a hazardous
substance.
2. Stethoscope
- An instrument that carries sound from the body to the examiner’s ears;
and it magnifies sounds.
- The five major parts of the stethoscope are the 1. earpieces, 2.
binaurals, 3. tubing, 4. bell chestpiece, and 5. diaphragm chestpiece.
- The plastic or rubber earpieces should fit snugly in the nurse’s ears. The
binaural should be angled and strong enough so the earpieces stay firmly
in the ears without causing discomfort.
- The polyvinyl tubing should be flexible and 30-40 com (12 to 18 inches)
in length. Longer tubing decreases the transmission of sound waves.
Stethoscopes can have single or dual tubes.
- The chest piece consists of a bell and a diaphragm. The diaphragm is
the circular, flat portion covered with a thin plastic disk while the bell is
the bowl-shaped chestpiece usually surrounded by a rubber ring.
 
 Classification of Blood Pressure
Systolic BP Diastolic BP
Category (mmhg) (mmhg)

Normal 120 80

Prehypertension 120 - 139 80 -89

Hypertension , stage 1 140 - 159 90 - 99

Hypertension , stage 2 160 above 100 above

 Medication
Administration
 DEFINITION OF TERMS
 
Medication
– a substance administered for the diagnosis, cure, treatment, relief, or
prevention of disease.
Chemical Name
– the name which describes the constituents of drugs precisely.
Brand Name
– the name given to a drug by the manufacturer. It is also called trademark.
Pharmacology
– the study of the effects of drugs living organism.
Pharmacokinetics
– is the study on how medications enter the body, reach their site of action, are
metabolized, and exit the body.
Posology
- the study of the dosage or amount of drugs given in the treatment of disease.
Prescription
- written direction for the preparation and administration of
drug
Pharmacy
- is the art of preparing, compounding and dispensing drugs
Pharmacist
- prepares, makes and dispenses drugs as ordered by a
physician
Pharmacopoeia
- is a book containing a list of products used in medicine, with
description of the product, chemical test to determine
identity and purity and formulas and prescription
 Legal Aspects of Drug Administration
Nurses needs to
a. Know how nursing practice acts in their areas,
define and limit their functions
b. Be able to recognize the limits of their own
knowledge and skill
- under the law nurses are responsible for their
own actions regardless of whether there is a
written order.
- controlled substance are kept in a locked cabinet.
 MEDICATIONS ORDERS

Single Order – it is carried out for one time only; for a medication to be given once at a specified
time.
Examples: Phenergan 50 mg @ 10 am before surgery.
Dulcolax 10 mg 4 tabs @ h.s.
Stat Order – it is carried out at once or immediately; indicates that the medication is to be given
immediately and only once.
Examples: Nubain 5 mg IM “stat”
Biogesic 500 mg p.o. stat
Standing Order – it is carried out until the specified period of time, or until it is discontinued by
another order; it may or may not have a termination date; may be carried out indefinitely.
Examples: Multivitamins 1 tab daily
Claritin 10 mg p.o. BID
Ampicin 250 mg IV q 8 hr ANST
Demerol 25 mg IM q 4 hr for 2 days
Ponstan 500 mg p.o. TID x 6 doses
 
PRN Order – it is carried out as the patient requires;
it permits the nurse to give a medication when in
his/her judgment the patient requires it; the nurse
must use good judgment as to when the
medication is needed and when it can be safely
administered.
Examples: Tylenol 2 tablets PRN for headache.
Biogesic 500 mg p.o. q 4 hrs PRN for fever.
Hemostan 250 mg IM q 6 hours for bleeding.
 PARTS OF LEGAL DOCTOR’S ORDER

1. Name of patient
2. Name of drug
3. Dose of drug
4. Route of administration
5. Time and/or frequency
6. Signature of the physician
*** refer to manual 1, p.156, for common
abbreviations
 DRUG FORMS

 
 Drugs are available in different forms or
preparations. The form of the drug determines
its route of administration. The composition of
a drug is designed to enhance its absorption
and metabolism within the body.
Solid Forms Description
Shaped like capsule and coated for
Caplet
ease of swallowing.
Medication in powder, liquid, or oil
Capsule
form encased in gelatin gel.
Contains one or more medications,
Pill
shaped into globules, ovoid, or oblong.
Powdered medication compressed into
Tablet
hard disk or cylinder.
Tablet that is coated so that is does
Enteric-coated not dissolve in stomach, meant for
internal absorption
Tablet or capsule that contains small
particles of a drug coated with
Sustained release
materials that requires a varying
amount of time to dissolve.
Medication that dissolves in mouth, not
Troche (lozenge or pastille)
meant for ingestion.
 Drugs mixed with gelatin and shaped for insertion into a body
Suppository cavity. The suppository is meant to dissolve (when it reaches
body temperature), releasing the drug.
Particles of drug that are reconstituted with water, dissolved,
Powder
and administered parenterally. The solution must be sterile.
Liquid Forms Description
Concentrated drug form made by removing the active portion of
Extract
a drug from its other components.
Clear fluid containing water and or alcohol, usually has
Elixir
sweetener added.
Medication dissolved in concentrated sugar solution; may
Syrup
contain flavoring to make it more palatable.
Tincture Alcohol or water medication solution.
Preparation that contains water with one or more dissolved
Solution compound. Can be used orally, parenterally, or externally into
body organ or cavity.
Aqueous One or more substances dissolved in water.
Glycerite Solutions of medication combined with glycerin for external use.
Aqueous medication sprayed and absorbed in the mouth and
Aerosol
upper airway, not meant for ingestion.
Finely divided drug particles dispersed in liquid medium, when
Suspension suspension is left standing, particles settle at the bottom of
container.
Semisolid Forms Description

Ointment, cream
Nongreasy, semisolid preparation.
unguent, salve

Oily liquid containing alcohol, oil, or soapy

Liniment
emollient

Emollient liquid that can be clear solutions,

Lotion suspension, or emulsion applied externally to
protect the skin.

Medication preparation that is thick and had

Paste
poor skin penetration.
Other Forms Description

Medication contained within semi-permeable

Transdermal disk or membrane which allows medications to be
patch absorbed through the skin slowly over long
period.

Disk (similar to a contact lens) embedded with

drug that is inserted to the client’s eyes; when
Intraocular disk
moistened by ocular fluid, releases medication
for up to one week.
PHARMACOKINETIC (ADME)

1. Absorption
- refers to the passage of medication molecules into the blood from its site of
administration.
2. Distribution
- after the medication is absorbed, it is distributed within the body to the tissues and organs
and ultimately to its specific site of action.
3. Metabolism
- after medication reaches its site of action, it become metabolized to less active or inactive
form that is easily excreted.
Biotransformation – also called detoxification or metabolism, a process by which a drug is
converted to a less active form, occurs in the liver, lungs, kidneys, blood, and intestines
( products of this process is called metabolites)
4. Excretion
- after medication are metabolized, they exit the body through the kidneys, liver, bowel,
lungs, mammary gland, and endocrine glands.
 

 
 Factors affecting medication
absorption:
Factors Effective
(fastest to slowest)
Intravenous
Route of administration Mucous membrane and respiratory
airways
Orally
Skin
Ability of the medication Solutions and suspensions are absorbed
to dissolve (forms of faster in the intestinal tract than tablet
medications) or capsules
Blood flow to the site of The more the blood supply, the faster the
administration absorption.
 When medication is in contact with large
surface area, the medication will be
Body surface area
absorbed at a faster rate. (Intestines have
more surface area than the stomach).

Medications that are highly lipid soluble are

Lipid solubility of absorbed more easily. They easily cross
medication the cell membrane because it is made up
of lipid layers.

Some medications are absorbed more easily

Presence of foods in when administered between meals
the stomach. because food can change the structure of
the medication and impairs its absorption.
 Factors affecting medication
distribution:
Factors Effect
The more vascularized the tissue or organ, the
faster the distribution. Impaired circulatory
Circulation
system (ex. CHF) impairs delivery of the
medications in the intended sites.
Blood-brain barriers allows only fat-soluble
Membrane medications to pass into the brain and cerebral
Permeability spinal fluid.
Placental barrier is non-selective.
Most medication binds to serum protein (e.g.
Albumin). When they bind to this protein,
Protein –binding medication cannot exert any pharmacological
activity. The unbound or “free” medication is the
active form of medication.
 DRUG RESPONSES

1.Onset of drug action

– period of time it takes after a drug is administered for it to produce a
therapeutic effect.
2.Peak of action
– time it takes for a drug to reach its higher effective concentration, or
peak level.
3.Duration of action
– period of time it takes after a drug is administered for it to produce a
therapeutic effect.
4.Plateau
– blood serum concentration reached and maintained after repeated,
fixed doses.
 
 
 DRUG ACTIONS

 
Therapeutic Effect – it is the intended or desired physiological
response a drug causes.
Examples: Morphine sulfate, an analgesic used to relive pain
(single effect).
Acetaminophen creates analgesia, reduces inflammation, and
reduces fever (multiple effect).
Side Effect – expected, well-known reaction resulting in little or no
changes in client management. May be harmless or harmful.
Example: Codeine phosphate, administered for analgesia,
constipation is common.

Adverse Effect – generally considered severe responses to

medication.
Example: A patient became comatose when a drug is ingested.
Toxic Effect – caused by accumulation of the drug in the
blood due to impaired metabolism or excretion after
prolonged intake of high dosage.
Examples: Morphine sulfate toxic level can cause
respiratory depression.
 
Idiosyncratic – unpredictable effects in which a client
overreacts or underreacts to a drug of has a reaction
different from normal.
Examples: Ativan, an antianxiety medication, when given
to an older adult may cause agitation and delirium.

Allergic Reaction – an immunologic response in which the

drug may act as antigen which causes the body to produce
antibodies to be produced. May be mild or severe.
 Mild Allergic Reactions
Symptoms Description
Urticaria Raised, irregularly shaped skin eruptions with varying
sizes and shapes; eruptions have reddened margins and
pale centers.
Eczema Small, raised vesicles that are usually reddened often
(rash) distributed over the entire body.
Pruritus Itching of the skin; accompanies most rashes.
Rhinitis Inflammation of mucus membranes lining the nose,
causing swelling and a clear watery discharge.
Wheezing Constriction of smooth muscles surrounding bronchioles
that decreases diameter of airway occurs primarily on
inspiration because of severely narrowed airways;
development of edema in the pharynx and larynx further
obstruct airflow.
Angioedema An acute, painless, dermal, subcutaneous, or submucosal
swelling of short duration involving the face, neck, lips,
hands, feet, genitalia, or viscera
Fever Abnormal elevation of the body temperature above 37oC
 
* Drug Tolerance – when there is a decreased physiological response
after repeated administration of a drug or chemically related
substances
 
* Psychological Dependence – the client desires the medication or
drug for some benefit other than the intended effect
Examples: The use of marijuana thinking it will cause relaxation.
 
* Physical Dependence – involves physiological adaptation to a drug
that manifest itself by intense physical disturbance when drug is
withdrawn.
Examples: Repeated use of codeine for reducing mild to moderate
pain.
 
* Drug Dependence – when client receives the same drug for a long
period of time and require higher dose to produce the same
effect.
EQUIVALENTS OF MEASUREMENTS
1 gr = 60 mg
1 g = 1000 mg 16 gr
=
1000 mcg (μg) = 1 mg
1000 g = 1 kg = 2.2 lb
1 mL or ml (1 cc) = 15- 15 drops
=
16minims
4-5 ml = 1 tsp
15 ml = 3 tsp = 1 tbsp
30 ml = 1 fluid oz
240 ml = 8 fluid oz = 1 cup
1000 ml = 1L
Metric Apothecary Household
1 ml 15-16 mn 15 gtts
4-5 ml 1 fl dram 1 tsp
15 ml 4 fl dram 1 tbsp
30 ml 1 fl oz 2 tbsp
240 ml 8 fl oz 1 cup
480 ml 1 pt 1 pt
960 ml 1 qt 1 qt
3840 1 gal 1 gal
 FORMULA FOR COMPUTATION OF DOSAGE

 
1. Solid Medications
 
Dose Ordered = Amount of Drug to Administer
Dose at Hand
 
 
2. Liquid/Parenteral Medication
 
Desired Dose x Dilution = Quantity of Drug
Stock Dose
 
Note: Universal dilution is 2.0 ml.
 TEN RIGHTS OF MEDICATION ADMINISTRATION

 
1.Right Drug.
Means that the client receives the drug that was prescribed
Nursing Implications:
– Check that the medication order is complete and legible. If order is
not complete or legible notify supervisor and physician.
– Note the reason for which the client is receiving the medication.
– Check drug label 3 times before administering the drug.
– Kardex should include the date the medication was ordered and
any last due.
Do not administer a medication someone else has prepared
2.Right Amount.
Determines the amount of drug to be administered
Nursing Implications:
– Be familiar with the various measurements systems and
the conversions from one system to another.
– Calculate drug dose correctly. When in doubt, drug dose
should be recalculated and checked by another nurse.
– Always use the appropriate measuring device and read it
correctly.
– When measuring a drug from multiple dose vial, inject an
amount of air equal to the amount of fluid to be
withdraw.
 
3. Right Patient.
Identify the right recipient of drug.
Nursing Implications:
– Verify client by checking the ID band.
– Check tag on patient’s bed.
– Ask patient to state his/her name (if physically
able).
– Ask the patient to tell you the name of their child.
– Address the person by name before administering
the drug.
– Always double check orders which patient
questions (appearance, dosage, or method of
administration.)
4.Right Time.
 Time at which the prescribed dose should be
administered.
Nursing Implications:
– To achieve maximum therapeutic effectiveness,
medication is scheduled to be administered at
specified time.
– Check expiration date. Discard the medication or
return it to the pharmacy if date has passed.
• Check whether the client is scheduled for any
diagnostic procedure that would
contraindicate the administration of medicine
5.Right Route.
Necessary for adequate absorption.
• Nursing Implications:
– Use aseptic technique when administering drugs.
 
6.Right Documentation.
• The nurse immediately record the appropriate
information about the drug administered. These are
the name of drug, volume, drop rate (IV), dose,
route, time and date and nurse initials or signature.
• Nursing Implications:
– Do not record if drug is not administered and why.
– Do not record a medication until after it has been given.
• Do not record in the nurses notes that an incident
report has been completed when a medication
error has occurred
7.Right Assessment.
• Requires that appropriate data are collected prior to
drug administration.

8.Right To Education.
• Requires that the client receives accurate and
thorough information about the drug and how it
relates to his/her particular situation. Client
information includes therapeutic purpose, possible
side effects of the drug, diet restrictions or
requirements, skill administration and laboratory
monitoring.
9.Right Evaluation.
• Requires that the effectiveness of the medication be
administered by client’s response to the medication; it is
appropriate to determine the extent of side effects and
adverse reaction.
 
10.Right To Refuse Medication.
• Nurse Implications:
– Nurse should determine the reason for refusal to take reasonable
measures to facilitate the client’s taking the medication.
– Explain the risk of not taking the medication, when medication is
refused.
– Document immediately.
 PRINCIPLES FOR GIVING MEDICATIONS

 
 Observe the “10 RIGHTS” of drug administration.
 Practice asepsis.
 Nurse who administer medication are responsible for
their own actions.
 Questions any order that you consider incorrect.
 Be knowledgeable about medications that you administer.
 Keep narcotics and barbiturates in locked place.
 Do not leave medication at bedside.
 Use only medications that are from clearly labeled container from
pharmacy.
 Return liquid that are cloudy or have changed in color to the
pharmacy.
 Before administering a medication, identify the client correctly.
 If the patient vomits after taking an oral medication, report this
to the nurse in charge and/or physician.
 Pre-operative medications are usually discontinued during the
post-operative period unless ordered to be continued.
 When a medication is omitted for any reason, record the fact
together with the reason.
 When a medication error is made, report it immediately to the
nurse in charge and/or physician.
 GENERAL RULES FOR GIVING MEDICATIONS

1. Know the “10 Rights”. Give the right dose of the right medicine to the right
patient at the right time with the right method of administration, right
approach and right recording.
2. Always verify the written order that is not clear as to meaning, not legible or
not signed by the doctor.
3. Receive written orders only. Receiving verbal orders should be minimized as
much as possible. Students cannot receive verbal orders.
4. Make certain that all equipment used are dry and clean.
5. When giving pills or tablets, place in proper container directly from the bottles.
Do not touch then with your hands.
6. Determine the medication is to be omitted or delayed for a specific length of
time for x-ray or basal metabolism test, e.g. FBS.
7. Never leave the medicine cabinet unlocked.
8. Do not return to stock supply excess medicine or medicine refused by a patient.
9. Know:
a. action of the drug
b. toxic effect
c. minimum or maximum dose
d. why it is to be given to this patient
e. nature of the drug
f. time of administration with respect to meals before administering the
medicines.
10. Do not use a drug that differs from normal color, odor, or
consistency. This implies that every nurse must be familiar with the
different characteristics (physical) and properties of the different drugs or
at least familiar with the drug before giving it to the patient.
11.Provide drinking tubes for irritating drugs and for those likely to stain
the teeth.
12.Do not permit one person to carry medicines to another
13.Any error in medication should be reported
immediately to the nurse in-charge.
14. Always provide a drink of fresh water to the
patient immediately after giving an oral
medication unless water is contraindicated.
15. The nurse who prepares the medicine should
give it and do the necessary recording.
16. Observe the patient after the administration of
any medicine.
 
 GUIDES TO THE ADMINISTRATION OF SOME SPECIFIC AGENTS

A.Cough syrups are given undiluted in small amount and in frequent doses. Do not
give water after the cough syrup.
B.Laxatives or cathartics are given in between meals and on an empty stomach;
those that act quickly should be given just before breakfast, and those requiring
a longer time for action should be given at night.
C.Bitter unpleasant tasting drugs are given in capsule form, as a coated pill or in
effervescent preparations.
D.Oils are given in encapsulated form when possible. Oils taken in liquid form
should be chilled as cold to lessen sensitivity of the taste buds and helps to
disguise the unpleasant taste oils of a very disagreeable flavor, such as castor
oil, should be mixed with orange juice and a small amount (1/4 teaspoon) of
sodium bicarbonate. The mixture should be given to the patient while it is
effervescing
 E. Drugs that will be destroyed by digestive juices are given in
enteric-coated pills.
F. Drugs are given several hours after meals for rapid action.
G. Drugs to aid digestion are given one-half hour before meals.
H. Iron, mercury and iodide preparations are given well diluted.
They should be given through a glass tube or a straw as they
discolor, and are destructive to the teeth.
I. Sedatives are given with warm milk to increase and hasten the
desired effect of the drug.
J. Bitter stomachics, given to stimulate the appetite, should be
given undiluted and with no attempt to disguise their taste.
 
 RULES FOR MEASURING MEDICATIONS

1. Wash hands thoroughly before measuring medications.

2. Make sure that the medicine glasses are dry before
pouring the medication.
3. Measure the exact amount of the drug ordered using a
calibrated medicine glass.
4. Do not converse with anyone while preparing a
medication.
5. Cleanse the mouth of each medicine bottle before
replacing it after use.
6. Measure drops if drops are ordered. Use minims glass if
minims are ordered.
7. Holding the medicine glass at eye level, place the
thumbnail of the hand holding the glass at the height of
the graduated glass to which medicine is to be poured.
Measure the dose from the bottom of the concave
meniscus.
8. Pour the medicine from the bottle of the opposite side of
the labels. Prevent drops from running to the label.
9. Measure only one oral medication into each medicine
glass.
10.Allow no interruption during the process of measuring
drugs.
 RULES FOR READING LABEL

 
1. Give medicine only from clearly labeled containers.
2. For each dose of medicine prepared, read the labels three times:
a. once before getting the container from the cabinet
b. once before pouring the drug
c. once after pouring, before replacing in the medicine cabinet.
3. Never give a drug from an unmarked container, bottle, or box.
4. Pour medicine from the bottle on the side opposite the label.
5.Labels on medicine containers should be changed only by the
pharmacist.
6. If a drug has two commonly used names, both names should a
ppear on the label.
 RULES FOR GIVING MEDICATIONS

1. Give the medication at the time for which it was

ordered.
2. Always identify the patient before giving the
medication.
3. If medication is refused or cannot be administered,
notify the head nurse.
4. Remain at the bedside until the patient had taken the
medication.
5. Administer only medications that you have measured
and poured
6. Never give the two drugs together, unless specifically
ordered to do so. Different drugs taken at the same
time may form a chemical compound that can be
injurious to the client.
7. When a patient is operated or delivers a baby, all
medication are discontinued. New orders for post-
operative therapy will be given by the doctors.
8. When special tests are being done, medications due at
that particular time are omitted. They are reused when
next due.
9. A mistake in medication should be reported
immediately to the nurse in-charge.
 RULE FOR RECORDING DRUGS ADMINISTERED

1. Record if an ordered medication is refused or cannot be administered.

2. Record each dose of medication soon after it has been administered.
3. Use only standard abbreviations in recording.
4. Record only those medicines that you have administered. No one can
record for someone else.
5. Record the time, kind and dose of drug given.
6. Observe carefully the effects of the drug, especially any unusual effects
and record these in the chart. Notify the nurse in charge in case of toxic
side effects right away so that the doctor can be notified.
7. Never record a medication as given before is has been administered.
 MAKING OF MEDICATION CARD

1. Print client’s name, name of drug, route, dosage, time &

frequency (color coded), room and bed number on the face of the
card in ink and should be deciphered easily.
2. Cards are signed by the person who made them, and
countersigned by the head nurse or her representative.
3. When the head of the nurse or staff makes the card, it is still
necessary to have another graduate nurse to countersign this
card.
4. When the card is lost or is to be renewed, the back of the card,
should contain the date of this medicine or treatment ordered
then the date it was renewed, followed by the signature of the
one who made the card and signature of the graduate who
checked it.
6.Indicate channels of administration for parenteral drugs
as “IM” for intramuscular, “IV” for intravenous, “ST” for
skin testing.
7. All medicines ordered are put on medicine cards except
STAT orders, single dose orders, pre-operative
medications and series orders.
8. Make a medicine slip for single, STA, series and pre-
operative orders. Slips contain the same information
found in cards.
9. All medicine cards are kept in designed pockets in the
medicine room.
10. Use only standard abbreviations.
 Example of Medication Card Color Code

ColorFrequency Time
White OD 8 am
Pink TID 8 am, 1 pm, 6 pm
Blue q4o, q6 o, q8 o, q12 o
Yellow BID 8 am, 6 pm
Green QID 8 am, 12 pm,4 pm,8 pm
Orange PRN
Red stat
 
METHODS OF ADMINISTERING DRUGS
Route Advantages Disadvantages
inappropriate for patient
Oral  Most convenient. with nausea, vomiting
 Usually less has gastric or intestinal
Introduction of suction, unconscious or
expensive.
medicine into the  Safe, does not
unable to swallow.
 Drugs may have
body by/through break skin barrier. unpleasant odor and
the mouth.  Administration taste.
 Inappropriate if client
usually does not can’t swallow or is
cause stress. unconscious.
 Cannot be used before
certain diagnostic tests
or surgical procedure.
 May discolor teeth
enamel.
 May irritate gastric
mucosa.
 Drugs can be aspirated
Sublingual
A medication is  Same as oral,
placed under the plus…
tongue, where it  Drug can be
 If swallowed, the
will be dissolved. administered for
drug may be
local effect.
inactivated by the
 Drug is rapidly
gastric juice.
absorbed into the
 Drug must remain
blood stream.
under the tongue
 Ensure greater
until dissolved and
potency because
absorbed.
drug directly enters
the blood and
bypass the liver.
Buccal
A medication is held in
the mouth against the
 Same as oral,
mucous membranes of  Same as sublingual.
sublingual.
the cheek until the
drug dissolves.
Ophthalmic
Instillations -- to
provide an eye
 Provides
medication the client
therapeutic effects
requires
by local application.
Irrigations -- to  Highly sensitive to
 Aqueous solutions
clear the eyes of drug
are readily
noxious or other concentrations.
absorbed and
foreign materials or
capable of causing
excessive secretions or
systemic effects.
in preparation for
surgery.
Otic
Instillations:
1. To soften the
earwax
 Same as  Same as
2. To reduce
ophthalmic. ophthalmic.
inflammation
3. To treat infection
4. To relieve pain
Irrigations:
1. To remove
cerumen pus
2. To apply heat
3. To remove a
foreign object
Nasal
Nose drops are usually
instilled for their:
 Same as
 astringent effect (to
ophthalmic, plus
shrink the swollen
 Same as  Danger of
mucous membrane)
ophthalmic. aspiration
 to loosen secretions
pneumonia with oil-
 facilitate drainage
based solutions.
 treat infection of
the nasal cavity or
sinuses.

Dermatologic
Administration of  Provides primarily  Can be absorbed by
medication in the skin local effect person applying it if
area.  Painless gloves are not
 Limited side effects. worn.
Vaginal
Vaginal irrigation
(douche) – is the
washing of the vagina  Same as
by a liquid at low  Same as ophthalmic, plus
pressure. ophthalmic.  Insertions causes
embarrassment.

Rectal
Administration of  Can be used when  Same as vaginal,
medication in the the drug has plus
rectum. objectionable taste  Dose absorbed is
or odor. unpredictable.
 Parenteral Administration
SYRINGES AND NEEDLES
 
Needles
• Dr. Alexander Wood invented the hypodermic needle.
• It is made of stainless steel and range from 3/8 to 3 inches
in length.
• The gauge of the needle is based on the diameter of the
bore. The smallest is the 27.
• The bigger the gauge the smaller the needle is.
 
• Parts of Needles
– Hub is the largest part that connects to the barrel
of the syringe.
– Stem, cannula or shaft is the long narrow path.
– Borebevel or beveled tip is the slanted portion at
the end of cannula where the fluid is ejected.
 Short or small level – used when there is a danger
that a larger level is occluded
 Longer level – provides a sharper needle and is
used for subcutaneous and intramuscular
injection.
Parts of Syringe
– Barrel is the outer portion on which calibration for the
measurement of the drug is located.
– Plunger is the inner cylindrical portion that fits snugly into
the barrel.
– Tip is the portion that holds the needle.
 
Syringe Calibration
– Minims (16 minims = 1 ml)
– Millimeters or Cubic Centimeters
– Unit (100 U or U-100 = 1 ml)
 
 PARENTERAL DOSE

 Ampule
– A glass container that usually contains a single dose of medication.
– The container may be scored or have a darkened ring round the
neck.
– This marking is the location at which the ampule is broken open for
withdrawing the medication.
Vials
– Glass container that contain one or more doses of a sterile
medication.
– The mouth of the vial is covered with a thick rubber diaphragm
through which the needle must pass to remove the medication.
– The medication in the vials may be solution or sterile powder to be
reconstituted
 Mixed-O-Vials
– Glass container with two compartments. The lower chamber contains the
drug (solute) and the upper chamber contains the sterile diluent (solvent).
– At the time of use, pressure is applied on the top rubber diaphragm
plunger. This forces the solvent and the rubber stopper to fall into the
bottom chamber, dissolving the drug.
Large-Volume Solution Containers
– Available in both glass and plastic containers in a variety of types and
concentrations. The volume ranges from 100 to 1000 ml.
Small-Volume Solution Containers
- Are used for medicines such as antibiotics that are administered
by intermittent infusion through an apparatus known as tandem
set-up, piggyback, or IV rider. These medicines are given by a
setup secondary to the primary setup. This contains 50 - 250 ml.