Administration of Medication

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objective: - At the end of the chapter learner will be
able to:-
1. Perform medication withdrawing from a vial and
ampoule
2. apply rights of medication administration
3. Identify necessary equipment for administering
medication via SC, ID, IM and IV.
4. administer medication and fluid with acceptable
technique
5. re-demonstrate how to administer drug via different
routes
6. Apply the necessary steps to carry out the proper
mixing of drugs
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Medication administration is a basic nursing function that
involves skillful technique and consideration of the clients’
development and safety. Nurse administering medication
is expected to have a knowledge base concerning drugs,
including: drug names, preparations, classifications,
adverse effects, mechanisms of drug actions, and
physiologic functions that affect drug action.
The nursing process can be applied to the fundamental
nursing skills of medication administration. Assessment
entails a comprehensive medication history as well as
ongoing assessment of the client’s response during and
after drug therapy.
The terms drugs and medication may be used
interchangeably, but there is slight difference b/n the two.
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Drug:-is any substance that alters the
physiologic function of the body, with
the potential of affecting health.

Medication: -is a drug that is used for

therapeutic/curative purpose.

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Therapeutic agents are drugs or medications
that, when introduced in to living organism,
modify the physiologic functions of that
organism.
The study that deals with chemicals that affects
the body’s functioning is called pharmacology.

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 Cont…

• Drug metabolism in the human body is

accomplished in four basic stages:
– absorption, transportation, biotransformation, and
excretion.
• For a drug to be completely metabolized, it must
first be given in sufficient concentration to produce
desired effect on body tissues.
• When this “Critical drug concentration” level is
achieved, body tissue change.

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 MECHANISM OF DRUG ACTION

1. PHARMACODYNAMICS
• Drugs act at the cellular level to achieve their desired
effect.
The process by which drugs alter the cell physiology is
called pharmacodynamics.
One of the mechanisms of drug action is a drug receptor
interaction.
The drug fits the receptor sites as the key fits the lock.

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Drugs may also combine with enzymes to
achieve the expected effect, which is referred
to as drug enzyme interaction.
Some drugs act on cell membrane or alter the
cellular environment.

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 Cont…

2. PHARMACOKINETICS
Pharmacokinetics is the study of the movement of
drug molecule in the body in relation to drug’s
absorption, distribution, metabolism and
excretion.

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 Cont…
• Absorption:-is a process by which a drug is
transferred from its site of entry into the body
to the blood stream.
• Distribution:-after it has been absorbed into
the blood stream; the drug is distributed
throughout the body.

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 Cont…
• Metabolism:-metabolism or
biotransformation is the breakdown of the
drug to an inactive form in the liver.
• Excretion:-after it is broken down into inactive
form, elimination of the drug from the body
occurs. Most drugs are excreted by the kidney.

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 FACTORS AFFECTING DRUG ACTION

• Genetic:-differences in ethnic or racial group may give

different response to the same medication.
• Age:-infants or children are more responsive to
medication because of the immaturity of their organs,
so they accommodate only small dose.
• Older people are also very responsive because of
aging.

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 Cont…
• Sex: - this is due to the difference in body fat
and fluid content between male and female
that will affect absorption and distribution of
drugs and also may be due to hormonal
fluctuation/variation.
• Weight:-wt and body surface area can affect
drug action.

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 ADVERSE DRUG EFFECT

• Therapeutic effect is the desired effect in

medication administration.
• Drug reaction may be unpredictable and harmful.
• Adverse effects are effects that are not intended
or desired.
• Written instructions encourage patient’s
compliance with medication regimen.

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 Parts of the medication order
The medication order consists of seven parts.
These are:
• Client’s name
• Date & time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Route by which the drug is to be administered
• Frequency of administration
• Signature of a person writing the order

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 Nomenclature of drugs

One drug can have several names. These include:

• The chemical name:-is a precise description of a drug’s
chemical composition; it identifies the drug’s atomic &
molecular structure.
• The generic name: - is the name designed by the
manufacturer that first develops the drug. Often the
generic name is derived from the chemical name.

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• The official name:-is the name by which the
drug is identified in the official publication.
• The trade name(brand name or proprietary
name), is selected by the drug company that
sells the drug & is copyrighted. A drug can have
several trade names when produced by
different manufacturers.

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 Classifications of drugs
• Drugs can be classified from d/t perspectives. For
example;
– By body system affected by the drug(drugs that affect the
respiratory system, the cardiovascular system),
– By the symptom relieved by the drug (antipain, analgesics),
– By the clinical indications for the drug (antibiotics,
antifungal …)

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 Common abbreviations used in drug
administration.
Abbreviations meanings
Po ……………………..by mouth
bid ………………………twice a day
tid ………………..…….. three times a day
Qid ………………….....four times a day
ac…………………………before meal
Pc ………………………..after meal
hs ………………………at bed time
Qd …………………….every day
prn …………………….as needed
Qod ……………………every other day

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 Abbreviation cont…
OS ...................left eye
OD ………….…………right eye
OU ……………both eyes
Q2h …………every 2 hours
Qhr …………...every hour
am ………. …in the morning
Pm …………...after noon
IV……………Intravenous
IM…………….Intramuscular
ID…………….Intradermal
SC…………….Subcutaneous
Stat……………once onlly
KVO…………keep vein open

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 TYPES OF PREPARATION
Medications are prepared in various forms.
The most desirable form of medication for any
client is determined by the disease process
being treated, age of the person, ability of the
client to swallow etc.
Accordingly, there are –
• oral preparation
• topical preparation
• parentral preparation, etc.

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 .

1. Oral preparation:-these are medications

prepared to be swallowed by mouth.
There are different forms of oral preparation.
– Capsule:-small hollow digestible case usually
made of gelatin, filled with a drug to be swallowed
by the patient.

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 – Tablets - a small disc or flat round piece of dry drug
containing one or more drugs made by compressing
a powdered form of drug(s)
– Emulsion-oil based preparation
– Enteric coated- prepared to be dissolved and
absorbed in the intestine.
– Lozenges-sweet medicinal tablet containing sugar
that dissolve in the mouth so that the medication is
applied to the mouth and throat

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 Oral prep. Cont.

• Powder-finely ground drugs

• Syrup-sugar containing medicine dissolved in water
• Suspension-liquid medication with undissolved
solid particles in it and should be shacked before
administration.
• Elixir-liquid form of drug
• Effervescence - drugs given of small bubbles of gas.
• Gargle - mildly antiseptic solution used to clean the
mouth or throat.

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 .

2. Topical preparation (externally):- drugs to be

applied directly to the skin or mucus membrane.
There are d/t types of topical preparation:
• Cream=non greasy/oily, semi solute preparation
• Ointment=semi solute than cream, for external use
on skin, conjunctiva, etc.

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• Paste=thicker & stiffer than ointment
• Lotion=clear, suspension, emollient liquid
• Gel or jelly=clear, translucent form.
• Suppository=prepared to be inserted through
the rectum/ anus, & vagina

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 3. Parentral preparation: - prepared to be
.

injected using needle.

• Glass capsule:-contain liquid drugs
• Vials (glass bottle):-may contain powder
dissolved before administration

• Ampoule:-glass flask/container containing a

single dose medication for parentral
administration.

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 DRUG MEASUREMENT SYSTEM
1. The metric system:-the metric system of drug
measurement system is the most widely
accepted and convenient/suitable method.
The metric system is the decimal system in which
each unit can be divided into multiples of 10.
The basic units of measurement are;
meter (linear),
liter (volume) &
gram (weight).

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 Cont…
2. The apothecary system:-less convenient & precise
than the metric system and infrequently used.
In this system the basic unit of weight is the grain.
The minim, dram, ounce, pint, & quart are used for
volume.
In this system Roman numerals are used to express
numbers (grain x )and quantities less than one are
written in fraction form (grain ¼)

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 Cont…
3. The household system:-used when accurate
systems of measurements are not required,
because it is the least accurate one.
Units of measurement include: drops,
teaspoon, tablespoon, teacup, cups, glasses,
etc.

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 Approximate metric system equivalents

Metric Apothecary
Household
5 ml 1 fluid dram 1 teaspoonful
10 ml 2 fluid drams 1 dessert spoonful
15 ml 4 fluid drams 1 table spoonful
30 ml 1 fluid ounce 1 ounce

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 Drug Dose Calculations
Several formulas may be used when calculating
drug doses.
One formula uses ratios based on the dose on
hand and the dose desired.
Dose on hand ₌ Dose desired
Quantity on hand Quantity desired
Eg. If a health care practitioner wants to
administer Amoxicillin 625 mg po TID and the
dose preparation is 250mg/5ml solution how
much volume would you administer.

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 Answer:
Dose on hand= 250mg .

Quantity on hand= 5ml

Dose desired = 625mg
Quantity desired =?
Dose on hand ₌ Dose desired
Quantity on hand Quantity desired
Quantity desired= DD × QOH = 625mg × 5ml
DOH 250 mg
=12.5 ml

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 Pediatric Dosages

• The body surface area method of determining

pediatric doses is based on the body surface
area of an adult weighing 150 lb.
• The body surface area of an adult weighing 150
lb. is 1.73 square meters.

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The approximate child dose is calculated as;
approximate child dose
= Body surface area of child × adult dose
Body surface area of adult
approximate child dose
= Body suface area of child (M²) × adult dose
1.73 m²

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 Dosage cont…

A most commonly used formula is Clark’s formula

for children 2years or younger.
This formula assumes that the average adult
weight is 150lb (68kg) and is calculated as
follows.

Child dose =
wt of child in pound × Usual adult dose
150pound

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 Intravenous medication calculation

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 IV flow rates are calculated in drops/min.
To calculate IV drip rate you can use the following
formula.
Drops per min.=
amount of solution(ml) × drip rate factor gtt/ml
time in minute
1ml= 15-20 gtt/ml drop, this is the drip rate factor.
So use 15 gtt/ml for adult size cannula(green)
20 gtt/ml for pediatrics size cannula(yellow)

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 Example
Q. If you want to administer 1 liter of normal saline for
an admitted adult over 8 hour, what will be the drop
per minute to administer the solution over the given
time.
Soln. Amount of solution= 1liter= 1000ml
Time given = 8 hr= 480min.
Drops per min.=
amount of solution(ml) × drip rate factor
time in minute
Drops per min.= 1000ml × 15 gtt/ml
480min
=31.25~31drop/min

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 Maintaining safety when administering medication

Safety is of the most importance in preparing and

implementing drug administration.
The nurse observes;
the three checks and the ten rights when
administering medication.

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The three checks:-the label on the medication
container should be checked three times during
medication preparation.
• When the nurse reaches for container or unit dose
package.
• Immediately before pouring or opening the
medication and
• When replacing the container to the drawer or
shelf or prior to giving the unit dose to the client.

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 The five rights of medication administration
• The five rights ensure accuracy when administering
medications. These five rights are:
– Right client/pt
– Right drug/medication
– Right dosage
– Right route
– Right time
– Right documentation
– Right client/pt education
– Right refuse
– Right assessment
– Right
• The nurse gives the right medication for a right client
in a right dosage through the right route at the right
time.

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 ROUTES OF DRUG ADMINISTRATION
Pharmaceutical preparations are generally
designed for one or two specific route of
administration.
The route of administration should be indicated
when the drug is ordered.
When administering the drug, the nurse should
ensure that the pharmaceutical preparation is
appropriate for the route specified.

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 Routes of Medication Administration

1. Topical
• Dermatological
• Instillations and irrigations
• Inhalation
• Ophthalmic, otic, nasal, rectal, and vaginal

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 2. systemic
• Oral (PO)
– Swallowing
– Sublingual (SL)
– Buccal
– Enteral Instillation
• Suppository
• Parenteral
– Subcutaneous (SC)
– Intramuscular (IM)
– Intradermal (ID)

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 –Intravenous (IV)
–Intra-arterial (IA)
–Intracardiac (IC)
–Intraosseous (IO)
–Intrathecal (intraspinal) (IT) (IS)
–Epidural (ED)
–Intra-articular

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 1. Oral(po)
Drugs given orally are intended for absorption in the
stomach & small intestine.
Advantage-
• Most common & least expensive route
• Most convenient &safest route for clients
• Doesn’t break skin barrier& doesn’t cause stress.
Disadvantages
• Unpleasant taste
• GI- irritation
• May discolor or harm the teeth

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 Oral cont…
Purpose
a. When local effects on GI tract are desired
b. When prolonged systemic action is desired
Contra- indications
1. For a patient with nausea & vomiting, unconscious
patients.
2. When digestive juices inactivate the effect of the
drug.
3. When there is inadequate absorption of the drug,
which leads to inaccurate determination of the
drug absorbed.
4. When the drug is irritating to the mucus membrane
of the alimentary canal.

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Sublingual and Buccal Drug Administration
• Sublingual and buccal drugs are types of oral
medications.
• Certain drugs are given by these routes to prevent
their destruction or transformation in the stomach
or small intestines.
• Drugs given by these routes are quickly absorbed by
the mucosa’s thin epithelium and the abundant
blood supply.
E.g. Nitroglycerine-a drug for treatment of angina
pectoris (severe chest pain)

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• In sublingual administration a drug is placed
under the tongue, where it dissolves.

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• Buccal means “pertaining to the cheek.”
• In buccal administration a medication is held
in the mouth against the mucous membranes
of the cheek until the drug dissolves.

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 Sublingual buccal

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 Enteral Instillation of Drugs

• Enteral instillation is the delivery of drugs

through a gastrointestinal tube.
• The nurse should crush the tablet into minute
particles and dissolve the crushed tablet in 15
to 30 ml of warm water before instillation
unless contraindicated.

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• Position the client as appropriate; clients with
an NG tube should be placed on the right side
with the head of the bed slightly elevated for
at least 30 minutes after the instillation.

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 2. Suppository
Administration of medication in to the anus
Purpose
• To produce a laxative effect. (bowel
movement),suppository is used frequently instead
of enema since it is inexpensive.
• To produce local sedative in the treatment of
hemorrhoids or rectal abscess.
• To produce general sedative effects when
medications cannot be taken by mouth
• To check rectal bleeding

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 .

• Rectal suppositories are cone-shaped masses of

substances designed to melt at body
temperature and to produce the intended effect
at a slow and steady rate of absorption.
• Suppositories provide a safe and convenient
route for administering drugs that interact
poorly with digestive enzymes or have a bad
taste or odor.

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• They are also used to relieve nausea and
vomiting.
• Suppositories are also used to induce
relaxation, relieve pain and local irritation,
reduce fever, and stimulate peristalsis and
defecation in clients who are constipated.

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 .

Rectal suppositories are contraindicated in

• cardiac clients because insertion may
stimulate the vagus nerve, causing cardiac
dysrhythmias (abnormal heart patterns).
• rectal or prostate surgery because they may
cause pain on insertion

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Procedure
With index finger of dominant hand, gently insert
suppository through anus, past the internal
sphincter, and place against rectal wall, 10 cm
for adults or 5 cm for children and infants.
Keep client flat on back or on side for 5 minutes.

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 .

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 Kinds of Suppositories Used:
1. Bisacodyl is commonly ordered for its laxative action.
It stimulates the rectum and lubricates its contents.
Normally 15 minutes is needed to produce bowel movement.
2. Glycerin or suppository for bringing about bowel movement.
If soap suppository is used cut a splinter of soap 2-6 cm.
loch and wash it in hot water to smooth the rough edges before
administration.
3. Bismuth - for checking diarrhea.
4. Opium, sodium barbital etc. for sedation

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 Vaginal Instillations

• Medications inserted into the vagina are in the

form of suppositories, creams, gels,
ointments, foams, or douches.
• These medications may be used to treat
inflammation, infections, and discomfort, or as
a contraceptive measure.
• Sterile technique is usually required

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 3. Parentral route:

parentral means outside the intestine or

alimentary canal.
Medications that are given by injection or
infusion are called parentral route.
These may be injected into ID, SC, IM, IV, intra
lesional tissue, intra spinal, etc.

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Medications given by parentral route usually
absorbed completely and begin acting faster
than medications given by other routes.
These medications are given through the skin;
bypassing the skin barrier & makes infection
more likely if aseptic technique is not used

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 Syringes and Needles
Syringe

Hypodermic needle

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6/27/2020
 Draw up the medication.

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 A) Intradermal Injection

is administration of medication under epidermis,

into the dermis layer of the skin.
The drug’s dosage for an ID injection is usually
contained in a small quantity of solution (0.01
to 0.1 ml).

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The ID route has the longest absorption period
(slow absorption) of all parentral routes,
for this reason, it is used for diagnostic
procedures, such as;
the tuberculin skin test, and
tests to determine sensitivity to various substances
,
because the body’s reaction to these substances is
easily visible.

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• Sites commonly used are inner surfaces of
forearm, the dorsal aspect of upper arm, & the
.

upper back.
• The needle is inserted at 15⁰ angle to the skin
for intradermal injection.

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 Equipments-
• Tray
• file
• Receiver
• A vial or ampoule of sterile medication
• Vial of diluents (when necessary)
• Alcohol swab
• Dry sterile gauze
• Marking pen
• Sterile syringe and needle (1 cc syringe with short
bevel, 25 to 27 gauge needle)

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 Procedure-
• Refer the chart, be sure that you have the right
patient
• Explain in the procedure to the patient
• Remove the vial cap (using file)
• Clean the rubber top of the vial with alcohol
swab

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• Tighten needle with syringe remove needle
guard
• Pull back on plunger to fill syringe with an
amount of air equal to amount of solution to
be with drawn.
• Insert needle into up-right vial.
• Inject air into bevel

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 procedure. Cont..

• Invert vial and extract/withdraw the desired

amount of medication (touching only syringe
barrel and plunger tip)
• Expel any air bubbles
• Recheck the amount of medication in the syringe
• Turn vial in up-right position and remove needle
• select the site of injection
• get hold of the arm and locate the site of injection

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 procedure. Cont..

• Clean the area with an alcohol swab, using

the circular motion; cleanse the area from
inside to out side.
• Group the patients arm and gently pull the
skin taut
• Place the needle close to the skin, side up.

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• Insert the needle at a 10° to 15° angle until
resistance is felt, and advance the needle
approximately 3 mm below the skin surface;
• The needle’s tip should be visible under the
skin.
• Inject medication slowly and with draw the
needle
• Wipe the injection site gently with sterile
gauze, do not massage the area.
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 procedure. Cont..
• Check for the immediate reaction of the skin
(10-15 minutes later for tetanus, 20-30
minutes later for penicillin).
• Chart the date and time of administration of
the drug

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 Intradermal Injections

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 B) Subcutaneous (SC) or hypodermic

is administration of medication into the

subcutaneous tissue, just below the skin.

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Site of Injection
• Outer part of the upper arm
• The abdomen below the costal margin to the
iliac crest.
• The anterior aspect of the thigh

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 SC cont..

• The needle is inserted at 45 degree angle to the

body.
• But the angle of needle insertion is determined
by;
– the size of the needle,
– the client’s size,
– the amount of tissue that can be grasped or
bunched, etc.

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• For sc injection a 25 gauge needle is used, a
3/8 inch needle is inserted at 90 degree angle
for adult; and a 1/2 inch needle is inserted at
45 degree angle for a child.

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 SC cont…

Sc injection sites need to be rotated in an

orderly fashion to minimize tissue damage, aid
absorption, and avoid discomfort for pts
receiving repeated doses.

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This route is used to administer;
insulin,
heparin,
adrenalin (0.5ml) and
certain immunizations (measles vaccine).
Ordinarily no more than 1ml of solution is given
subcutaneously.

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 Equipment -.

1. Disposable syringe and needle

2. Small tray
3. Medication
4. Ampoule of sterile water if medication must
be dissolved
5. Cotton balls soaked with alcohol.
6. File
7. Receiver
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 Procedure -

• Wash hands
• Fit part of the syringe together firmly without
touching the tip of the syringe.
• Never touch the needle also.
• If medication is in ampoule, disinfect the neck
of the ampoule and the file with the cotton
ball.

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• Fill ampoule at the base of neck and
snap/break top off, holding the cotton ball
over neck to protect fingers.
• Carefully insert the needle into the ampoule,
being careful that it doesn't touch the glass,
draw up dosage ordered.

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 procedure. Cont..

• If medication is to be mixed with water, open

sterile water for injection ampoule first as
described above, draw up required amount of
water and mix well and then draw up
medication.
• Expel the air from the syringe

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• Clean the site (usually it is in upper arms,
thighs or abdomen)
• Grasp the area between your thumb &
forefinger to tense it.
• Insert the needle elevate about 45 - 60 angle.
• Pierce the skin quickly & advance the needle

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 procedure. Cont..

• Aspirate to determine that the needle has not

entered a blood vessel
• Inject the drug slowly.
• After injecting withdraw the needle
• Chart the amount and time of administration
immediately.
• Watch for undesired reaction (side effect of
the drug) etc.
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 C. Intera- Muscular Injection

• It is an introduction of a drug into a body's

system via the muscles.
Purpose
• To obtain quick action next to the intra-
venous route
• To avoid an irritation from the drug if given
through other route.
Absorption is rapid than SC-route, because of
the greater blood supply to the muscle.
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 .

The maximum volume to inject is on the basis of

the site and the client’s muscle development:
• 4 ml for a large muscle (gluteus medius) in a well
developed adult
• 1 to 2 ml for less developed muscles in children,
elderly, and thin clients
• 0.5 to 1.0 ml for the deltoid muscle
When more than 4 ml is ordered, the medication
can be divided into two different sites.
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 IM injection sites
Common intramuscular injection sites and
muscles
Site Muscle
Dorsogluteal Gluteus maximus
Ventrogluteal Gluteus medius
Anterolateral thigh Vastus lateralis
Upper arm Deltoid

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 Ventrogluteal (Gluteus medius)
The primary site for administering an IM injection in
clients over 7 months old is the ventrogluteal
(VG) site.
The gluteus medius is a well-developed muscle,
free of major nerves and large blood vessels.
Place palm of left hand on right greater trochanter
so that index finger points toward anterosuperior
iliac spine;
spread first and middle fingers to form a V; injection
site is the middle of the V.
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 .

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 Dorsogluteal
Is one of the earliest site of IM injection site at
the dorsal site of the gluteus.
These sites should be avoided in infants and
children. There is a risk of striking the sciatic
nerve.
Place hand on iliac crest and locate the
posterosuperior iliac spine.
Draw an imaginary line between the trochanter
and the iliac spine; the injection site is the
outer quadrant.

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 Vastus lateralis:
• Identify greater trochanter; place hand at
lateral femoral condyle; injection site is middle
third of anterior lateral aspect.
• Is most of the time used for infants

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 Deltoid
Locate the lateral side of the humerus from two
to three finger widths below the acromion
process in adults or one finger width below the
acromion process in children.

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 Equipment:
• Disposable syringe and needle
• Cotton balls soaked in alcohol(swab)
• Small tray
• Medication
• Ampoule of sterile (if drug is to be dissolved)
• Fill
• Receiver.

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 Procedure-

• Proceed as with hypodermic injection

• Best site for injection should be area upper,
outer quadrant of the buttocks (gluteal
muscle)
• Hold the syringe 900 to the area to be injected

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• After inserting the needle into the buttocks,
pull back on plunger (three times) before
injecting solution, to see that the needle has
not hit a blood vessel.
• If any blood return withdraw and inject in a
different site.
• After injecting the solution, withdraw needle
quickly; and massage the area gently.
• This aids in the absorption of the medication.
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 Z-Track Injection
place the client in the prone position then pull
the skin to one side, insert the needle at a 90°
angle and administer the medication.
waits 10 seconds and withdraws the needle at
the same angle of insertion; the site should
not be massaged because massaging could
cause tissue irritation.
The former method increases the risk of leakage
into the needle track and the subcutaneous
tissue.
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 .

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 Note:

1. The needle for i.m. Injection should be long

2. Strict aseptic technique should be observed
throughout the procedure.
3. Injection should not be given in areas such as
inflamed, edematous, those containing moles
and pus.

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 Complication
• Fibrosis
• Nerve damage (paralysis)
• Abscess
• Tissue necrosis
• Muscle contraction
• Gangrene
• Pain
• Necrosis and skin slough
• Periostitis (infection of the membrane
covering the bone).
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 D) Intravenous (IV)

It is the introduction of a drug in solution form

into a vein.
Often the amount is not more than 10.ml. at a
time.

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Purpose
• When the given drug is irritating to the body
tissue if given through other routes.
• When quick action is desired.
• When it is particularly desirable to eliminate
the variability of absorption.
• When blood drawing is needed
(exsanguinations)
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 IV cont…
Advantage-
• large volume can be given
• getting rapid effect.
• The route is used to administer fluid/nutrition if
the pt can’t feed by mouth.
Disadvantage
• The drugs prepared for IV administration is
expensive
• Limited to highly soluble medications.
• Drug distribution is inhibited by poor circulation.
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 Equipment-
• Tray
• Medication
• Sterile needle and syringe
• Tourniquet
• Antiseptic swabs
• Receiver
• Treatment chart.
• Towel and rubber sheet
• Glove
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 Procedure:-
• Prepare the try and the medication
• Explain the procedure to the patient
• Position the patient properly
• Expose the arm and apply the tourniquet
• Ask patient to open and close his fist
• Palpate the vein and clean with antiseptic
swab the site of the injection (which is mainly
the midcubital vein of the arm)

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• Hold the needle at about 25 - 300 angle in line
with the vein and puncture a bit below the
point where the needle will pierce the vein.
• Draw back to check whether you are in the
vein or not (blood return should be seen if you
are in the vein

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 Procedure. Cont..

• Once you know that you are in the vein release

the tourniquet gently , and inject (instil) the
medication slowly.
• Check the patients pulse in between, any
complaint from the patient should not be
ignored.

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• As the needle is removed apply pressure over
the site with swab and the forearm is flexed so
as to collapse the vein and prevent bleeding.
• Watch the patient for minutes before leaving
him
• Chart the medication given, the amount, time
& the reaction of the patient.

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 Complication
• Infiltration (swelling and discomfort at the IV
site)
• Phlebitis (inflammationof a vein).
• Air embolism(introduction of air in to the
circulation)

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 Intravenous injection (therapy)

Definition: - it is an introduction of a large

amount of fluid (solution) into the blood
stream through a vein.
Purpose: -
• To maintain fluid and electrolyte balance and
restore acid-base balance, in case of shock,
• To introduce medication through the vein,
particularly antibiotics.

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• Site of injection: - Usually one of the large
superficial veins in front of the upper arm is
used or vein on the inner aspect of the ankle.

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 Equipment:-
• Sterile solution (I.V. fluid) with infusion set.
• Bandage and scissors
• Rubber and towel
• Receiver
• Tourniquet
• I.V. stand
• Antiseptic cotton swabs
• Padded arm board
• Adhesive tape
• Medication chart
Preparation of the patient: - since an infusion therapy
takes several hours to complete, the patient should first
be made comfortable/informed.

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 Procedure:-
• Prepare the necessary equipment and take to the
patient's bedside.
• Cut adhesive strips about 8 cm. in length and
attach on outside of infusion set or on the stand.
• Explain the procedure to the patient.
• Open the infusion set and connect it with the bag.
Run the fluid through the tube and needle to
remove the air.
• Fix screw (clamp) on the tubing to control the flow
of the fluid.
• Invert the bottle and hang on the stand.
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 Procedure. Cont..

• Place rubber and towel under the arm. Put

tourniquet into position about 3 cm. above the
intended site of entry.
• Clean the skin over the vein to be injected with
antiseptic cotton swabs.
• Hold needle at 30 degree angle in line with the vein,
pierce the skin and puncture the vein by supporting
the patient's arm with other hand.
• Release the tourniquet when the needle is in the
vein.
• Apply adhesive straps over the end of the needle &
tubing, to prevent pull on the needle.
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 Procedure. Cont..

• Adjust the rate of flow

• Stay with the pt. for some time to see if the
solution is running into the vein at the desired
speed and to see the reaction of the patient.

• Eg. What is the rate of flow for one

bag/1000cc/ normal saline to be administered
over 2hours in 35 years old male patient?

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N.B.
• Infusion bottle (bag) should be labelled with
the date, time infusion is started, drops per
minute and any added medication.
• Inspect the drip frequently and watch for any
signs of a reaction. Stop the drip if reaction
occurs.
• Inspect the site of injection to see that the
drip is not leaking.
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 Reconstituting medications
Medications are reconstituted by adding the
proper diluents (sterile water for injection &
0.9% sodium chloride solution) to a powdered
medication.
Vials of powdered medication can be packaged
along with vials of the proper type and volume
of diluents.

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 E) Topical administration
when a drug is applied directly to the body sites,
it is called topical application.
• Topical applications are usually intended for
direct (local) action on a particular site,
although some systemic effects may also occur.
• The action depends on the type of tissue & the
nature of the agent.
• A topical medication is applied locally to the
skin or to mucus membrane in areas such as
the eye, internal ear canal, vagina and rectum.
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 Skin application
The process of applying medication to the skin is
called inunctions.
The followings are topical preparations applied to
the skin:
• Powders:-are used to promote drying of the skin
and prevent friction on the skin.
• Ointments:-provide prolonged contact of
medication on skin and soften the skin.
• Creams& oils:-lubricate and soften the skin &
prevent drying of the skin.
• Lotions:-protect & soothe the skin.
• Aerosol spray
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 Ophthalmic drops/ointments
Eye drops:-instillation of eye drops is performed
for their local effects; such as pupil dilation or
constriction when examining the eye or for
treating infections like trachoma.
• The type & amount of solution depends on
the purpose of instillation.

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• Ointments:-used to treat local infections &
irritation of the eye.
• After application the eye should be closed and
the client is instructed to move the eye ball to
spread the ointment.

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Eye Drop Administration
Use a medication dropper to place the dosage on
the conjunctival sac.

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 Ear instillation

• Drugs in solution form are placed in the

auditory canal for their local effect.
• They are used to soften wax, relive pain, apply
local anesthesia, destroy microorganisms, or
destroy an insect lodged in the ear canal,
which can cause almost intolerable discomfort
to the client.
• Sterile technique is used to prevent infection
in case of ruptured tympanic membrane
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Aural Medication Administration
Manually open the ear canal and administer the appropriate dose.

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 Nasal instillation

• Used to treat sinus infections and nasal

congestion/obstruction.
• Medications that have a systemic effect such
as vasopressin may also be prepared as nasal
instillation.
• Medications that are instilled by drops may
also be applied to the nasal mucus membrane
by using a spray.

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 Nasal Medication Administration

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 BLOOD TRANSFUSION
A blood transfusion is the infusion of whole
blood or a blood component such as blood
plasma, RBCs, or platelets into the venous
circulation.
Whole blood is infrequently used because the
various components can be easily separated
and used for replacement therapy.
The person receiving the blood is called
recipient and that give the blood is called
donor.
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 FFP blood

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 Blood typing and cross matching
• Before blood can be given to a person, it must
be determined that the blood of the donor and
that of the recipient are compatible.
• If incompatible clumping and hemolysis of the
recipient’s blood cells results and death can
occur.
• The laboratory examination to determine a
person’s blood type is called typing.
• The process of determining compatibility is
called cross-matching.
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 Blood types
• The four main blood groups in the ABO system
of blood typing are: A, B, AB, and O.
• Blood type is an inherited trait and it is
determined by the type of antigen and
antibody present in the blood.
• Antigen is a substance that causes the
formation of antibody.
• Antibody is a protein substance that develops
in response to the presence of antigen in the
body.
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 Blood types cont…

• People who have ‘A’ blood group have ‘A'

antigen and ‘B’ antibody (agglutinins) on their
RBCs;
• people who have ‘B’ blood group have ‘B’
antigen and ‘A' antibody.
• Those who have ‘AB’ blood group have both
‘A’ and ‘B’ antigen and no antibody on their
RBCs.

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• Those who have ‘O’ blood group have no
antigen and have both ‘A’ and ‘B’ antibodies
(agglutinins)
• So people who have ‘O’ blood group are called
universal donors and those who have ‘AB’
blood group are called universal recipient.

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 Rh-factors

• The Rh-factor is an inherited antigen in human

blood. There are 5 antigens in Rh-system but
the one designed D is of first concern.
• A person whose blood contains D antigen is
called Rh-positive, and an Rh negative person
lacks D antigen.

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• It is important that an Rh-negative person
receives blood from another Rh-negative
person.
• If Rh-positive blood is injected into the Rh-
negative person, the recipient develops anti-
Rh agglutinins which cause reaction and
hemolysis.

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• Rh is of special importance during pregnancy
because Rh incompatibility b/n mother and
infant/fetus blood is often the problem when
the infant has hemolytic disease.

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 Selection of blood donors

• Infection prevention is achieved by careful

screening for TTI of public health importance
• Testing for ABO and Rh type identification
• Screen the blood/donor for HBV,HCV,HIV and
syphilis
– Syphilis- Rapid Plasma Reagent (RPR)
– Hepatitis B Virus –HbsAg
– Hepatitis C Virus-Anti hepatitis C Virus
antibody test
– HIV- Rapid tests
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 Indications of blood transfusion

• Clients with anemia

• Clients with cardiovascular failure
• Clients with GI-bleeding
• Excessive bleeding/blood loss secondary to
injury or trauma, delivery, APH, burn etc
• To provide clotting factors normally present in
blood, which may be absent as a result of
disease.
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 Equipments-
• Bottle containing blood, with the patient name, blood group and
Rh. Factor and expiry date.
• Blood giving set
• Sterile syringes and needle
• Cannula No. 20 (1) for child cannula no. 23 (1)
• Sterile swabs
• I.V. stand
• Mackintosh
• Towel
• Emergency medicine
• anti- histamine injection
• Sphygmomanometer tray
• Antiseptic lotion
• Adhesive plaster
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 PROCEDURE-

• Explain procedure to patient

• Before blood transfusion is administered, the
nurse has to check the blood group & RH-
factor if cross match of the donor's & the
recipient’s blood is done and is compatible and
other blood born pathoges.
• Needle or cannulais insereted like IV infusion.
• It should be kept in position with adhesive
tape and fully comfortable.
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 Procedure. Cont..

• In small child or in case of difficult patient splint

must be needed. It should be securely placed with
a proper bandage.
• Regulate the rate of flow from 40-45 drops/gtts per
minute or accordinglly.
• Note any untoward/problematic reaction, if chill or
shivering or any other complication occurred; stop
the infusion and irrigate the tubing with sterile fluid.
• Record on the chart time, amount of blood given
and vital signs.

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 Note

• Blood should be used within 21 days of its

withdrawal date, if sodium citrate is used it can
be used until 36 days.
• Vital signs should be taken and recorded just
before starting the transfusion.
• Store blood at 1-6 °c ,continuously monitor
and record T0 at least every 4 hourly

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• Blood exposed to unacceptable temperature
for unknown period should be discarded.
• Do not warm the blood before using it as it
raises the temperature of the blood and
encourage the growth of the bacteria.
• Blood should not stay out side refrigerator
more than 4 hours.

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 TRANSFUSION REACTIONS
Be familiar with the most usual symptoms of blood
reactions which are:-
Immediate Reaction:
a) Headache d) Backache
b) Chills e) Pyrexia
c) Rash of the skin (urticaria )
Late Reaction
a) Dyspnea d) Renal shut down in
b) Heamaturia severe cases
c) Chest pain e) Rigor (rigidity)
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 Nursing Interventions in Transfusion Reaction

 Discontinue the transfusion but continue IV

line with 0.9% Normal saline
The symptoms are treated and vital signs are
monitored.
The
The reaction is documented according to the
institution’s policy.
Collect important samples from the patient
including blood and urine.
Don’t discard the transfusion bag before
sending to culture
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 Risks of blood transfusion
• Raised pulse
• Pyrexia reaction
• Difficulty in breathing
• Thrombosis
• Oedema
• Haematoma
• Cough
• Sepsis
• Cardiac and respiratory distress
• Air embolism
• Renal failure
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 Anaphylaxis

• Definition
– Immunologically mediated reaction to antigen causing
systemic symptoms
• Potentially life threatening
• Frequent Antigens
– Antibiotics
– Latex
– Anaesthetic agents
– Colloid fluids

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• Diagnosis
– Collapse
– Difficulty breathing
– Wheeze
– Angio--oedema
Angio
– Urticaria

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 Management Anaphylaxis
• Prevention
– Avoid unnecessary drugs particularly iv
– Take drug history
• Adequate staff training and facilities

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 Immediate Management 1

 Remove trigger agent

– Stop injection or infusion of drug
– Remove triggering materials
 Remember latex allergy
 Chlorhexidine
– Summon assistance

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 Immediate Management 2
• Basic life support
– Check airway, breathing, circulation
– Oxygen
• Give adrenaline (0.5-
(0.5-1mg im
im))
• Elevate legs
• (Give intravenous fluids)

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 Subsequent Management
• Antihistamines
– Chlorpheniramine iv
• Steroids
– Hydrocortisone iv
• Intensive care unit
• Immunological Testing

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 Thank you!

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