Skills Enhancement

BSN Level 2

MEDICATION
ADMINISTRATION
 LEARNING OUTCOMES
• Identify the 12 rights of patients to medication
administration.
• Describe the various routes of medication
administration (oral, ID, IM, SQ)
• Demonstrate proper procedure in
administering medication applying the correct
principles across different routes and forms of
medications.
 Introduction
• Medication is a
substance used in the
– Diagnosis
– Treatment
– Cure
– Relief
– Prevention of health
alterations
 Prescription

Is the written direction

for the preparation and
administration of a
drug
• The nurse is responsible
for the following in
regard to medications:
– Preparation
– Administration
– Teaching
– Evaluating response
 Routes of Administration
Oral Parenteral
Swallow, Sublingual, Buccal ID, Sub-Q, IM, IV

Other Topical
Epidural, Intrathecal, Skin
Intraosseous, Transdermal patch
Intraperitoneal, Intrapleural, Instillation or irrigation
Intraarterial
Inhalation Intraocular
Nasal passages, oral Insertion of disk containing
passage, ET or trach med; drops
 Nurses Role in Medication
Administration
• Safe administration is vital and a MUST
• Nursing process provides a framework for
medication administration
• Clinical calculations must be handled without
error
– Conversions in and between systems
– Dose calculations
– Pediatric and elderly calculations
– ALWAYS double-check calculation and medication
with a second nurse on high alert meds (insulin,
heparin)
 Types of Orders

• Standing or Routine Medication Orders

• PRN Orders: as needed
• Single (one-time) Orders
• STAT Orders: within 15 mins
• Now Orders: up to 90 mins to administer
• Prescriptions: taken outside the hospital
 Components of Medication Orders
• Client’s full name
• Date and time that the order is written
• Medication name
• Dose
• Route
• Time and frequency of administration
• PRN orders must have a reason
• Signature
 Avoiding Errors
• Prepare drugs alone
• Don’t leave drugs alone
• Prepare and administer
• Lock med cart
• Supervise swallowing

10
Potential Medication Error
Before administering
any medication…
 12 Rights in Medication
Administration
• RIGHT CLIENT
• RIGHT DRUG
• RIGHT DOSE
• RIGHT ROUTE
• RIGHT TIME
• RIGHT ASSESSMENT
• RIGHT MOTIVATION/ APPROACH
• RIGHT OF THE CLIENT TO REFUSE 
• RIGHT OF THE CLIENT TO KNOW THE
REASON FOR THE DRUG
• RIGHT EVALUATION
• RIGHT DOCUMENTATION
• RIGHT DRUG PREPARATION
 Documentation
• Legal record – nurse initials
• When to record – nurse signature
– site of injection
• Information
– other information
– med name
– dosage
• Omitted drugs
– route – reason
– time – notify MD
• Refused drugs

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 Critical Thinking
• Knowledge: understand why you are giving a
med; if you don’t know, look it up
• Experience: skills become more refined
• Attitudes: take adequate time to prepare and
administer
• Standards: ensure safe practice
– 12 Rights
 Oral Drug Administration
• Any medication taken by mouth and
swallowed into the GI tract.
• Be sure the patient has an adequate level of
consciousness to prevent aspiration.
 General Principles of
Oral Administration
• Note whether to administer medication with food or
on empty stomach.
• Gather any necessary equipment.
• Have patient sit upright when not contraindicated.
• Place the medication into your patient’s mouth.
Allow self-administration; assist when needed.
• Follow administration with 4-8 ounces of water and
ensure that patient has swallowed the medication.
 Oral Drug Forms
• Capsules • Elixirs
• Tablets • Emulsions
• Pills • Lozenges
• Enteric coated/ • Suspensions
time release • Syrups
capsules and
tablets
 Equipment for
Oral Administration
• Medicine cup • Teaspoon
• Medicine dropper • Oral syringe
 Preparation
Wash Hands before preparing medications

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 Preparation
• Check each medication
against doctor’s order
• Know the side effects
• Prepare medications for one
patient at a time

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 Preparation
• Select proper medication
• Compare with doctor’s order again
• Check expiration dates
• Perform calculations if necessary
• Check each medication as it is prepared

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 Tablets
• Place unit dose-packaged meds in med cup
• Pour tablets into bottle cap and then into med
cup
• If necessary, break only scored tablets

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 Identify the Patient
3 Correct Methods

1. Check patient id band

2. Ask the patient his/her name

and birthday

3. Verify patient’s id with a staff member

who knows patient
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 Administration
• Carefully transport medications to bedside
• Keep medications in sight at all times
• See patient receives medication
at correct time

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 Administration
• Check patient’s allergies
• Assist patient to upright position
• Remain with patient until each medication has
been swallowed

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 PARENTERAL DRUG
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ADMINISTRATION
Fundamentals in Nursing 28
 Parenteral Routes
• Intradermal injection
• Subcutaneous injection
• Intramuscular injection
• Intravenous access
• Intraosseous infusion
Syringes and Needles

Syringe Hypodermic needle

 Kinds of Parenteral
Drug Containers
• Glass ampules
• Single and multidose vials
• Nonconstituted syringes
• Prefilled syringes
• Intravenous medication fluids
 Ampules and Vials

Vials
Ampules
 Information on Drug Labels
• Name of medication
• Expiration date
• Total dose and concentration
Obtaining Medication from a Glass
Ampule
Hold the ampule upright and tap its
top to dislodge any trapped solution.
Place gauze around the thin neck…
…and snap it off with your thumb.
Draw up the medication.
Obtaining Medication
from a Vial
Confirm the vial label.
 Prepare the syringe
and hypodermic needle.
Cleanse the vial’s rubber top.
Insert the hypodermic needle into
the rubber top and inject the air
from the syringe into the vial.
 The nonconstituted
drug vial actually
consists of two vials,
one containing a
powdered medication
and one containing a
liquid mixing solution.
Nonconstituted drugs come in separate vials.
Confirm the labels.
 Remove all solution from the
vial containing the mixing solution.
Cleanse the top of the vial containing the
powdered drug and inject the solution.
 Agitate or shake the vial
to ensure complete mixture.
 Prepare a new syringe
and hypodermic needle.
Withdraw the appropriate
volume of medication.
Withdraw the appropriate volume
of medication.
 Injection technique
• Giving an injection safely is considered to be a
routine activity. However, it requires knowledge of
anatomy and physiology, pharmacology, psychology,
communication skills and practical expertise.
• A safe injection is one that does not harm the
recipient, does not expose the provider to any
avoidable risks and does not result in waste that is
dangerous for the community.

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 INJECTION
• It is an infusion method of putting fluid into
the body, usually with a syringe and a
hollow needle which is pierced through the skin to a
sufficient depth for the material to be administered
into the body.
• Syringe – a device made of a hollow tube and a
needle that is used to force fluids into or take fluids
out of the body

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 RULES IN NEEDLE SYRINGE SELECTION
• When looking at a needle package, the first number is the gauge or
diameter of the needle (ex: 18, 20) and the second number is the length
(ex: 1, 11/2)
• As the gauge number becomes larger, the size of the needle becomes
smaller.
• The length of the needle is directed by the size of the patient, the
selected insertion site and the tissue you are trying to reach. (Ex: An IM
injection in an emaciated person would require a shorter needle than
the same injection in an obese patient.)
• The size of the syringe is directed by the amount of medication to be
given. If the amount is less than 1ml, use a 1ml syringe. If the amount of
the medication is equal to the size of the syringe, you may go up to the
next size to prevent awkward movements when deploying the plunger.
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 GAUGE OF THE NEEDLE SYRINGE

The larger the gauge, the smaller the size

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 INJECTION TECHNIQUE

INTRADERMAL INJECTION
SUBCUTANEOUS INJECTION
INTRAMUSCULAR INJECTION

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 INJECTION TECHNIQUE

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 INTRADERMAL INJECTION
• It is the introduction via needle of tiny amounts of fluid into
layers of skin. 
• It provides a local, rather than systemic effect.
• Syringe used is 1ml tuberculin syringe because of a very small
amount of drug needed.
• Needle used is a short (1/4 to 5/8 inch), fine gauge (g25-27).
Indications:
• For diagnostic purposes (allergies and sensitivities to drugs)
• For administering tuberculin testing

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 INTRADERMAL INJECTION
• Most commonly used site: Inner surface of the forearm
• Subscapular region of the back can be used as well as the
deltoid region.

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 INTRADERMAL INJECTION
REMEMBER:
•Mixture of drug and water for skin testing: 0.9cc of distilled
water/sterile water and 0.1cc of the drug.
•Inject the solution intradermally and just enough to form a
wheal.
•Encircle the site correctly and write the time when to
check the injection site to determine reaction to the drug.
•Check the site after 30 minutes for signs of reaction.
•If negative, document it as ANST (-); if positive, ANST (+)

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 INTRADERMAL INJECTION
REMEMBER:
•A positive result may be manifested by any of the
following:
– Reddening of the site accompanied with marked
elevation
– Increase in circumference of the wheal
– Presence of itchiness on the site

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 PROCEDURE: id
• Prepare the medication to be used for skin testing (e.g
ampule or vial)
• Aspirate 0.9cc of distilled water/sterile water and 0.1cc of the
drug using the tuberculin syringe with the aspirating needle.
• Mix the drug and the distilled water in the syringe.
• Replace the aspirating needle with g25 needle.
• Expel excess air.
• Place the syringe on the tray together with the wet and dry
cotton balls.

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 PROCEDURE: id
• Confirm again patient’s identity.
• Locate the appropriate site for skin testing.
• Cleanse the medial surface of the forearm by using firm, circular
motion from inner to outer portion.
• Allow the skin to dry before injecting the drug.
• Place hand in non-dominant hand of the patient.
• Remove needle cap and holds syringe at 15 degrees angle from
skin with bevel up.
• Stretch the skin and tell the patient that he/she will feel a prick
as needle is inserted.

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 PROCEDURE: id
• Inject the solution intradermally and just
enough to form a wheal.
• Remove the needle quickly but gently at
the same angle used for injection.
• Wipe with dry cotton ball but do not
press the injection site.
• Encircle the site correctly and write the
time when to check the injection site to
determine reaction to the drug. Check
the site after 30 minutes.

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 SUBCUTANEOUS INJECTION
• Subcutaneous tissue lies between the epidermis and the
muscle.
• Subcutaneous route is used for slow, sustained absorption of
medication.
• SC or SQ

Indications:
• Used commonly for insulin injections
• Heparin

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 SUBCUTANEOUS INJECTION
• Common sites used for SQ route:
– Outer aspect of the upper arm
– Abdomen(from below the
costal margin to the iliac crests)
– Anterior aspects of the thigh
– Upper back
– Upper ventral or dorsogluteal
area

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 SUBCUTANEOUS INJECTION
REMEMBER:
•Hold syringe in the dominant hand
between the thumb and forefinger.
•Inject the needle quickly at an angle
of 45 to 90 degree, depending on the
amount and turgor of the tissue and
the length of the needle.

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 INTRAMUSCULAR INJECTION
• The intramuscular (IM) route injection delivers medication into
well perfused muscle, providing rapid systemic action and
absorbing relatively large doses.
• Gastric disturbances do not affect the medication.
• Clients does not need to be conscious to receive the
medication.
• Absorption occurs even more rapidly than with SQ route
because of greater vascularity of muscle tissue.
• Irritating drugs are commonly given IM because very few nerve
endings are in deep muscle tissues.

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 SITES ACCEPTABLE FOR IM INJECTION

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 INTRAMUSCULAR INJECTION
REMEMBER:
•3cc syringe can be used for IM injection
with g22 or 23 needle; 1-2 inches long
•Position the needle at 90˚ angle.
•Do not forget to aspirate the plunger
once injected to check for blood. (To
determine if a blood vessel was hit)
•Inject medication slowly (To minimize
pain)

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 INTRAMUSCULAR INJECTION
REMEMBER:
•Apply pressure to site and massage
after (To prevent hematoma on the
injection site and prevent oozing of
blood and for proper absorption of the
medicine)

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 PROCEDURE: IM INJECTION
• Prepare needed materials aseptically.
• Check the label of the drug three times.
• Prepare the medication.
• Position the patient and locate the site correctly.
• Cleanse the site using circular motion from inner to outer
portion and allow it to dry.
• Place a swab between fingers of non-dominant hand.
• Pinch or spread tissue and insert needle quickly at 90
degrees angle in a dart-like position.

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 PROCEDURE: IM INJECTION
• Pull back the plunger to check for blood.
• Inject the medication slowly if no blood appears.
• Withdraw needle quickly.
• Apply pressure and dry cotton ball to the site and
massage.
• Leave the client in a comfortable position.
• Leave the client in a comfortable position.

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 Z TRACK INJECTION

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Withdraw the appropriate volume
of medication.
Intradermal
Injection
 Assemble and prepare
the needed equipment.
Check the medication.
Draw up the medication.
Prepare the administration site.
Pull the patient’s skin taut.
 Insert the needle, bevel up at
a 10-degree to 15-degree angle.
Monitor the patient.
Subcutaneous Injection

45º
Subcutaneous Injection Sites
 Prepare the equipment.

© Scott Metcalfe
 Check the medication.

© Scott Metcalfe
 Draw up the medication.

© Scott Metcalfe
 Prep the site.

© Scott Metcalfe
Insert the needle at a 45-degree angle.

© Scott Metcalfe
 Remove the needle and
cover the puncture site.

© Scott Metcalfe
 Monitor the patient.

© Scott Metcalfe
 Intramuscular Injection Sites
• Deltoid
• Dorsal gluteal
• Vastus lateralis
• Rectus femoris
Intramuscular Injection

90º
Intramuscular Injection Sites
 Prepare the equipment.

© Scott Metcalfe
 Check the medication.

© Scott Metcalfe
 Draw up the medication.

© Scott Metcalfe
 Prepare the site.

© Scott Metcalfe
 Insert the needle at a 90-degree angle.

© Scott Metcalfe
 Remove the needle and
cover the puncture site.

© Scott Metcalfe
 Monitor the patient.

© Scott Metcalfe
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