Medication

Administration
 Objectives
▸ At the end of the learning experience, the students will be able to:

1. Describe various routes of medication administration and when it

is most indicated;
2. Identify essential parts of a medication order;
3. List examples of various types of medication orders;
4. Describe the cultural and legal considerations.
5. State the “10 rights” to accurate medication administration;

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Medication Administration
The process by which a medicine is
administered to a patient therapeutically.
1
 “

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 Medications or Medicines

▸ are chemicals that are used for diagnosis, treatment and

prevention of disease/s

All medicines are drugs but

not all drugs are medicines.
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☺
 Routes of
Administration
For small therapeutic
molecules, various routes for
drug administration are
parenteral (intravenous,
intramuscular, and
subcutaneous), oral, nasal,
ocular, transmucosal (buccal,
vaginal, and rectal), and
transdermal.
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 Oral Route
Advantages include:
▸ Most convenient
▸ Usually least expensive
▸ Safe, does not break skin
barrier
▸ Administration usually does
not cause stress
▸ Some new oral medications
are designed to rapidly
dissolve on the tongue,
allowing for faster
absorption and action
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 Oral Route
Disadvantages include:
▸ Drug may have unpleasant taste
or odor
▸ Inappropriate when GI tract has
reduced motility
▸ Inappropriate if client cannot
swallow or is unconscious
▸ Cannot be used before certain
diagnostic tests or surgical
procedures
▸ Drug may discolor teeth, harm
tooth enamel
▸ Drug may irritate gastric mucosa
▸ Drug can be aspirated by seriously
ill clients
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 Sublingual and Buccal Ruote
Advantages include:
▸ Same as for oral, plus:
▸ Drug can be administered for local
effect
▸ More potent than oral route because
drug directly enters the blood and
bypasses the liver
Disadvantages include:
▸ If swallowed, drug may be inactivated
by gastric juice
▸ Drug must remain under tongue until
dissolved and absorbed.
▸ May cause stinging or irritation of the
mucous membranes
▸ Drug is rapidly absorbed into the
bloodstream

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 Drug Preparation for these routes:
Solid
▸ Tablet (Sustained-
release, Enteric
coated, Effervescent)
▸ Capsule
▸ Caplet
▸ Pill
▸ Lozenge
▸ Powder
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 Drug Preparation for these routes:
Liquid
▸ Aqueous Solution (Liquid
Medicine)
▸ Aqueous Suspension
(Liquid Medicine with
Granules)
▸ Syrup
▸ Elixir
▸ Extract
▸ Tincture
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 Used in oral medications:

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 Used in oral medications:

DO NOT CRUSH
SUSTAINED-RELEASE AND
ENTERIC COATED TABLETS

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 Topical Route
Topical applications are those applied to a circumscribed surface area of the body. They
affect only the area to which they are applied. Topical applications include the following:

01 Dermatologic preparations ✔ Applied to the skin

02 Instillations and irrigations

✔ Applied into body cavities or orifices, such as the
urinary bladder, eyes, ears, nose, rectum, or vagina

✔ Administered into the respiratory tract by a

03 Inhalations
nebulizer or positive pressure breathing
apparatus. Air, oxygen, and vapor are generally
used to carry the drug into the lungs.
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 Topical Route

Advantages include:
▸ Few side effects
▸ Painless

Disadvantages include:
▸ Drug can enter body through abrasions
and cause systemic effects
▸ Leaves residue on the skin that may
soil clothes

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 Drug Preparation for topical route:

▸ Cream
▸ Lotions
▸ Liniment
▸ Ointment
▸ Gel / Jelly

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 Transdermal Route
Advantages include:
▸ Prolonged systemic effect
▸ Few side effects
▸ Avoids GI absorption problems
▸ Onset of drug action faster than oral

Disadvantages include:
▸ Rate of delivery may be variable
▸ Verify that the previous patch has been
removed and disposed of appropriately
to avoid overdose
▸ Medication leaves an oily or pasty
substance on skin sometimes soiling
the clothes

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 Mucous Membranes Route
Includes: Intranasal, Otic, Opthalmic,
Intraocular, Vaginal, Rectal Routes
Advantages include:
▸ Therapeutic effects provided by local
application to involved sites
▸ Aqueous solution readily absorbed and
capable of systemic effects
▸ Potential route of administration when
oral route is contraindicated

Disadvantages include:
▸ Mucous membranes are highly
sensitive to some medication
concentrations
▸ Patients with ruptured eardrum cannot
receive ear irrigations
▸ Insertion of vaginal and rectal
18 suppositories can be embarrassing.
 Drug Preparation for these routes:
Given via:
▸ Aqueous Solution (Liquid
Medicine) ✔ Inhalation
For aqueous spray
▸ Aqueous spray or foam Intranasal (can be oral*)
▸ Cream ✔ Instillation
Dropping medicine into the
▸ Gel / Jelly mucous membrane
▸ Ointment ✔ Irrigation
Flushing mucous membranes
▸ Lotion with large amounts of
▸ Suppositories medicine

▸ Vaginal Tablets ✔ Insertion

Inserting medicines into the
vagina or rectum
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 Understanding Medication Order

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 Understanding Medication Order

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 Medication Order
▸ A written direction provided by a prescribing practitioner for
a specific medication to be administered to an individual.

Should contain:
• Full name of the client
• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of administration
• Route of administration
• Signature of the person writing the order
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 Types of Medication Order
✔ may or may not have a termination date. A standing order may be carried out
1 Standing/Routine Order indefinitely until an order is written to cancel it, or it may be carried out for a
specified number of days
✔ permits the nurse to give a medication when, in the nurse’s judgment,

2 As needed Order (PRN order)

the client requires It. The nurse must use good judgment about when the
medication is needed and when it can be safely administered.
✔ Often ordered with the term “PRN” or a condition (“for”)

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✔ Medication to be given once at a specified time or
Single Dose Order
situation

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✔ indicates that the medication is to be given
Stat Order
immediately and only once
✔ Used when a patient needs a medication
quickly but not right away as in a STAT

5 Now Order
order
✔ The nurse has a maximum of 90 minutes to
complete a Now order given only at one
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 ✔ Paracetamol 500mg/tab 1tab
PO q4 RTC
Standing / ✔ KCl drip of PNSS 1L + 40
Meqs KCl to run for 8 hours
Routine Order x 3 cycles
✔ Furosemide 40mg IVTT q8
with BP precautions

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 ✔ Clonidine 75mcg/tab 1tab SL
As needed/ q6 for BP ˃ 150/90 mmHg
✔ Metoclopromide 10mg IVTT
PRN Order q8 PRN for vomiting

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 ✔ Ranitidine 50mg/ampule 1
ampule IVTT 1 hour prior to
surgery
Single Dose ✔ Diphenhydramine HCl
Order 50mg/capsule 1 capsule 30
minutes prior to blood
transfusion

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 ✔ Tranexamic Acid 500mg/
ampule 2ampules IVTT
Stat Order STAT

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 ✔ Tranexamic Acid
500mg/ampule 2 ampules
Now Order IVTT now

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 Medication Tickets

oral meds Nebulization and

(Standing or PRN) Procedures

Blue Red Ticket

Ticket

White Ticket Pink

Ticket

Parenteral medications STAT and Now meds

(PO or IVTT)

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 Timeliness of Medication Adminstration

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 Dosage Calculations
✔ Math calculations done for preparing appropriate doses
of medicines, taking into account conversions of
WEIGHTS AND MEASURES. Mistakes are one of the
sources of MEDICATION ERRORS.

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 Dosage Calculations…

1. Be familiar with
the systems of
measurement
2. Check the
available dose
and the desired 3. Check if there is
dose a need for
conversion

*always round off

to the nearest
tenths for decimal
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 Medication Order:
• Paracetamol 250mg/5mL 3/4
tsp PO q4 for fever
✔ Available: Paracetamol
250mg/5ml syrup
✔ Desired: 3/4 tsp serving of 3.8mL
PCM 250mg/5mL
Need for conversion? YES!
1 teaspoon is 5ml
3/4 teaspoon is 3.75mL
Round off, give 3.8mL

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 Medication Order:

• MFA 500mg/capsule PO QID

2 capsules
✔ Available: MFA 250mg

✔ Answer: 2 capsules

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 Medication Order:

• Amoxicillin 100mg PO TID

✔ Available: Amoxicillin
250mg/5mL 2 mL
✔ Answer: 2mL

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 Medication Order:

• One liter PNSS to infuse

over 24 hours using a
microdrip.
42 gtts/min
✔ Calculate the flow rate.

✔ 1000mL x 60gtts/mL
1440 min
✔ 41.66/ 42 gtts/min
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 10 Rights of Patients in Medication
1. Right Patient
2. Right Medication
3. Right Dose
4. Right Time
5. Right Route
6. Right Assessment
7. Right Documentation
8. Right to Education
9. Right Evaluation
10. Right to Refuse

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 Medication Dispensing Systems
▸ Medication cart
▹ The medication cart is on wheels,
allowing the nurse to move the cart to
outside the client’s room.
▹ The cart contains small numbered
drawers that correlate to the room
numbers on the nursing unit.
▹ The small drawer is labeled with the
name of the client currently in that room
and holds the client’s medications for
the shift or 24 hours

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 Automation of Medication Administration
▸ Client records are all in the
computer
▸ No longer requires the use of
medicine tickets
▸ Uses Automated Dispensing
System (ADS) wherein
Medication Administration
Record (MAR) of the patient is
encoded. The system uses
scanner or a Automated
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Dispensing Cabinet (ADC) with a
 Medication Administration Record
(MAR)

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 ▸ Nurses who administer medications are
responsible for their own actions.
▸ Be knowledgeable about the
medications you administer.
▸ Use only medications that are in a
clearly labeled container. Always check
for expiration date. Some
▸ Do not use liquid medications that are
cloudy or any drug that have color
changes.
Practice
▸ Calculate drug doses accurately. Guidelines:
▸ Administer only medications
personally prepared.
▸ Before administering a medication,
always identify the client correctly.
▸ Do not leave medications at the
bedside.
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 ▸ Review agency protocol on
administration of narcotics.
In preparing medications, separate
narcotics from other drugs to remind
you necessary assessment must be
done prior to administration
▸ Break only scored tablets if
necessary to obtain the correct
dosage. Other
▸ Check if agency requires the Important
pharmacy to split the medication or Considerations
if nurses can do it.
If nurses are allowed, use a cutting or
splitting device to cut the medication.
▸ If the client has difficulty
swallowing, check if the medication
can be crushed then crush
accordingly.
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▸ Check the agency policy as to how
 Checking of Medication

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 General Process of Administering
Drugs
1. Identify and verify the client.
✔ Use at least two methods of identifying the client
2. Inform/Educate the client of the medication to be
administered.
3. Administer the drug appropriately.
✔ Check the drug thrice.
✔ Follow manufacturer’s direction and agency protocol of drug
administration
4. Provide adjunctive interventions as indicated.
5. Record the drug administered.

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 Thanks!
Any questions?

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