MEDICATIONS

Objective:

1. Discuss different types and route of medication/dosage compilation.

2. Discuss the basic principles in the preparation of medications
3. Discuss the different ways on how to solve drug dosages and intravenous fluid rates

What is Medication?

• A medication is a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of
disease.
• In the health care context, the words medication and drug are generally used interchangeably.

Types of Drug Preparations

Aerosol spray or A liquid, powder, or foam deposited in a thin layer on the skin by
foam air pressure

Aqueous solution One or more drugs dissolved in water

Aqueous One or more drugs finely divided in a liquid such as water
suspension

Caplet A solid form, shaped like a capsule, coated and easily swallowed

Capsule A gelatinous container to hold a drug in powder, liquid, or oil form

Cream A nongreasy, semisolid preparation used on the skin

Elixir A sweetened and aromatic solution of alcohol used as a vehicle for

medicinal agents

Extract A concentrated form of a drug made from vegetables or animals

Gel or jelly A clear or translucent semisolid that liquefies when applied to the
skin

Liniment A medication mixed with alcohol, oil, or soapy emollient and

applied to the skin
Lotion A medication in a liquid suspension applied to the skin

Lozenge (troche) A flat, round, or oval preparation that dissolves and releases a
drug when held in the mouth

Ointment A semisolid preparation of one or more drugs used for application

(salve, unction) to the skin and mucous membrane

Paste A preparation like an ointment, but thicker and stiff, that

penetrates the skin less than an ointment

Pill One or more drugs mixed with a cohesive material, in oval, round,
or flattened shapes

Powder A finely ground drug or drugs; some are used internally, others
externally

Suppository One or several drugs mixed with a firm base such as gelatin and
shaped for insertion into the body (e.g., the rectum); the base
dissolves gradually at body temperature, releasing the drug

Syrup An aqueous solution of sugar often used to disguise unpleasant-

tasting drugs

Tablet A powdered drug compressed into a hard small disk; some are
readily broken along a scored line; others are enteric coated to
prevent them from dissolving in the stomach

Tincture An alcoholic or water-and-alcohol solution prepared from drugs

derived from plants

Transdermal A semipermeable membrane shaped in the form of a disk or patch

patch that contains a drug to be absorbed through the skin over a long
period of time

Parenteral ❑ Subcutaneous (hypodermic) —into the ❑

subcutaneous tissue, just below the skin
❑ Intramuscular (IM) —into a muscle
❑ Intradermal (ID) —under the epidermis (into the
dermis)
❑ Intravenous (IV) —into a vein.

Different Route of Administration

1. Oral 4. Intradermal
2. Sublingual 5. Subcutaneous
3. Suppositories 6. Intramuscular
Rights of Medication

1. RIGHT MEDICATION
 The medication given was the medication ordered.
2. RIGHT DOSE
 The dose ordered is appropriate for the client.
 Give special attention if the calculation indicates multiple pills/ tablets or a large quantity of a liquid medication. This can
be an indication that the math calculation may be incorrect.
 Double-check calculations that appear questionable.
 Know the usual dosage range of the medication.
 Question a dose outside of the usual dosage range.
3. RIGHT TIME
 Give the medication at the right frequency and at the time ordered according to agency policy.
 Medications should be given within the agency guidelines.
4. RIGHT ROUTE
 Give the medication by the ordered route.Make certain that the route is safe and appropriate for the client.
5. RIGHT CLIENT
 Medication is given to the intended client.
 Check the client’s identification band with each administration of a medication.
 Know the agency’s name alert procedure when clients with the same or similar last names are on the nursing unit.
6. RIGHT CLIENT EDUCATION
❑ Explain information about the medication to the client (e.g., why receiving, what to expect, any precautions).
7. RIGHT DOCUMENTATION
 Document medication administration after giving it, not before.
 If time of administration differs from prescribed time, note the time on the MAR and explain the reason and follow-
through activities (e.g., pharmacy states medication will be available in 2 hours) in nursing notes.
 If a medication is not given, follow the agency’s policy for documenting the reason why.
8. RIGHT TO REFUSE
❑ Adult clients have the right to refuse any medication.
❑ The nurse’s role is to ensure that the client is fully informed of the potential consequences of refusal and to communicate
the client’s refusal to the health care provider.
9. RIGHT ASSESSMENT
 Some medications require specific assessments prior to Administration (e.g., apical pulse, blood pressure, lab results).
 Medication orders may include specific parameters for administration (e.g., do not give if pulse less than 60 or systolic
blood pressure less than 100).
10. RIGHT EVALUATION
 Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the client experience any side effects or
adverse reactions?).

BASIC PRINCIPLES TO THE PREPARATION AND ADMINISTRATION OF MEDICINES

• A physician’s order is required before administering any drug. A written order is preferred, but a phone or verbal order
maybe necessary at all times. In this case, the nurse writes the order and reads to the doctor who must countersign the
order immediately as possible.
• Nurses administering drugs are responsible for their actions. Verify all new or questionable orders on medication chart
against the doctors’ orders.
• Students are not allowed to take verbal or phone order.
• Wash your hands and maintain aseptic technique before and after preparing medication.
• Prepare medication in quiet environment.
• Collect all necessary equipment including measuring cups, stethoscope as necessary.
• Be knowledgeable of the drugs you administer. Review medication chart for each client carefully to ensure safety. “NOTE
MEDICATION, DOSAGE, ROUTE AND FREQUENCY”
• Research drug compatibilities, action purpose, contraindications, side effects and appropriate routes.
• Find medication for individual clients and calculate dosage accurately.
• Check expiration date on medication and look for any changes that may indicate decomposition (color, odor and
clarity.
• Compare label three times with medication to decrease the risk of error:
a. When removing package from drawer
b. Before preparing medication/when pouring
c. After preparing medication/before returning to the cart or shelf
• Check the need for PRN medication.
• Be sure medications are identified for each client.
• Check for any allergies before administration.
• Use meds that are in clearly labeled containers from the pharmacy (don’t give if there is no label). Keep all narcotics and
barbiturates in a locked place.
• Return to the pharmacy and don’t use liquids that are discolored or muddy.
• Confirm client’s identity by checking at least 2 of the 3 possible mechanisms for identification to ensure safety:
a. Ask client his name
b. Check patient’s ID band
c. Check the bed tag (least reliable method)
• Provide privacy if needed.
• Inform client of any procedure, medication, technique, purpose and client teaching as applicable.
• Stay with the client until medication is gone, don’t leave medication at bedside.
• Assist client as needed and leave position of comfort.
• Give medication within 30 min. of prescribed time.
• If the client vomits after taking the medication, report to the nurse in charge or to the doctor (same if there’s an adverse
effect after taking the drug).
• Pre-op meds are discontinued post operatively or after the operation unless it is ordered continued.
• Liquid medications – all routes of administration must not be mixed together unless compatibility is verified.
• Chart administration immediately in ink, marking your initials in appropriate spaces. Observe for any reactions.
• Circe initials and document rationale if drug is not administered. If the medicine is omitted for any reason, document the
fact together with the reason why it is discontinued.
• If there is a medication error, report at once to the nurse and physician.
• To ensure safety, do not give a medication that someone else prepared.
• Observe the 10 rights of drug administration.

STANDARD TIMING MEDICINE ADMINISTRATION

FREQUENCY HOUR

O.D 8:00
8:00 – 4:00 (Antibiotic)
B.I.D 8:00 – 6:00 (Misc. Drugs)
8:00 – 8:00 (Tranquilizers/sedatives)
T.I.D 8:00 – 1:00 – 6:00
8:00 – 12:00
Q.I.D
4:00 - 8:00
HS 8:00
Q8H 8:00 – 4:00 – 12:00
Stat Immediately
PRN When necessary

Computation of Drug Dosages

1. For oral medication in solid form (tablets, caplets, etc.)

Desired dose = Quantity of drug
Stock dose
(D/S=Q)

EXAMPLE
Give Paracetamol 250mg/tab, 1 tablet every 6 hours for fever.
Desired: Paracetamol 250mg/tab
Stock dose: Paracetamol 500mg/tab
250mg/tab
500mg/tab
Answer =0.5 tablet
You will give 0.5 or half tablet of Paracetamol 500mg to achieve the desired dose of 250 mg.

2. For oral/parenteral medications in liquid form:

 Desired dose x dilution =Quantity of drug
Stock dose
(D/S x Dilution=Q)

EXAMPLE:
Give Cefuroxime 375mg IV q 8hrs via soluset to run for 30 minutes.
Desired: Cefuroxime 375 mg
Stock: Cefuroxime 750 mg
Dilution: 10 ml sterile water
Cefuroxime 375mg
Cefuroxime 750mg
=0.5 X 10 ml (dilution)
Answer =5ml
Give 5ml of diluted 750mg Cefuroxime q 8hrs.

DIFFERENT TYPES OF SYRINGE

INSULIN PEN

PARTS OF SYRINGE AND NEEDLE Insulin syringe

TUBERCULIN SYRINGE PREFILLED SYRINGE

 SYRINGE DISPOSAL CONTAINERS

INTRADERMAL INJECTION

INTRAMASCULAR INJECTION
SUBCUTANEOUS INJECTION
OTIC MEDICATION ADMINISTRATION
 OPTHALMIC MEDICATION ADMINISTRATION

Administering Intradermal Injection procedure

1. Organize the equipment

2. Wash hands & observe other appropriate infection control procedure
3. Prepare the medication from the vial or ampule for drug withdrawal.
4. Prepare the client by checking the ID band
5. Explain to the client that the medication will produce a small wheal, sometimes called a bleb or wheal.
6. Provide for client’s privacy
7. Select & clean the site
8. Avoid using sites that are tender, inflamed or swollen, and those that have lesions
9. Cleanse the skin at the site using firm circular motion, starting at the center & widening the circle outward. Allow
the area to dry thoroughly.
10. Prepare the syringe for the injection
11. Remove the needle cap while waiting for alcohol or antiseptic to dry
12. Expel any air bubbles from the syringe
13. Hold the syringe in your dominant hand, holding it thumb & forefinger
14. Hold the needle almost parallel to the skin surface, with bevel of the needle up
15. Inject the fluid
16. With the non dominant hand, pull the skin at the site until it is taut
17. Insert the tip of the needle far enough to the place bevel through the epidermis into the dermis
18. The outline of the needle of the bevel should be visible under the skin surface
19. Stabilize the syringe & needle, and inject the medication carefully & slowly, so that it produces small wheal on
the skin.
20. Withdraw the needle quickly at the same angle that is was inserted.
21. Do not massage the area
22. Dispose the syringe & needle safely
23. Circle the injection site with ink to observe for redness or indurations, write name of drug injected & time due.
24. Document all relevant information
25. Record the testing materials given, the time dosage, route, site & nursing assessment

Administering Intramuscular Injection Procedure

1.Organize the equipment
2. Wash hands & observe other appropriate infection control procedure
3. Prepare the medication from the vial or ampule for drug withdrawal.
4. Whenever feasible, change the needle on the syringe before injection
5. Invert the syringe uppermost and expel all excess air
6. Provide for client’s privacy
7. Prepare the client by checking the ID band
 8. Assist the client to a supine, lateral, prone or sitting position, depending on the chosen site.
9. Obtain assistance in holding an uncooperative client
10. Explain the purpose of medication & how it will help, using language that the client can understand, include
relevant information about effects of the medication.
11. Select, locate & clean
12. Select the site free of skin lesions, tenderness, swelling, hardness or localized inflammation, and one that has
been used frequently.
13. If injections are to be frequent, alternate sites. Avoid using the same site twice in a row.
14. Locate the exact site for injection
15. Clean the site with an antiseptic swab or alcohol. Using a circular motion, start at the center & move outward
about 5cm (2in)
16. Transfer and hold the swab between the 3rd & 4th finger of your non dominant hand in readiness for needle
withdrawal, or position the swab on the client’s skin about the intended site. Allow skin to dry prior to injection of
medication.
17. Prepare the syringe for injection
18. Remove the needle cover without contaminating the needle
19. Withdraw unit-dose medication, take caution to avoid dripping medication on the needle prior to injection
20. Inject the medication
21. Holding the syringe in a dart like position, pierce the skin quickly & smoothly at 90 degrees angle & insert the
needle into the muscle
22. Hold the barrel of the syringe steady with your non dominant hand, aspirate by pulling back on the plunger with
your dominant hand.
23. If blood appears on the syringe, withdraw the needle & discard & prepare a new injection
24. If blood does not appear, inject the medication steadily & slowly while holding the syringe steady.
25. After the injection, wait 10 seconds
26.Withdraw the needle smoothly at the same angle of insertion
27. Applied gentle pressure at the side with a dry cotton balls
28. If bleeding occurs apply pressure with a dry cotton balls until it stops
29. Discard the uncapped needle & disposed syringe into the proper receptacle wash hands.
30. Document all relevant information such as time of administration, the drug name, route, the dose & clients
reaction.