MEDICATION ADMISITRATION

TERMINOLOGIES
 Medication ( Drugs ) – is a substance administered for the diagnosis, cure,
treatment or relief of a symptom or for prevention of disease.
 Prescription – is the written direction for the preparation of a drug. It is a legal
document which not only instructs in the preparation and provision of medicine or
device but indicates that the prescriber takes responsibility for the clinical care of the
pt and the outcomes that may or may not be achieved.
 Generic name – is given before a drug becomes official.
 Official name – is the name under which it is listed in one of the official
publications.
 Chemical name – is the name by which a chemist knows it; this name describe the
constituents of the drug.
 Brand name or Trademark – given by manufacturer
Parts of a Prescription:

4 main components are:

1. Superscription
2. Inscription
3. Signa or signature
4. Subscription

Sample Prescription

Lawrence Merry, M.D. (A)

4th Street and Jones Ave.
Holly, GA 00111
Phone #-001-555-2176

Patient Name (B) __________________ Date ___________

Address_______________________

Rx Amoxicillin 250 mg #30 (C/D)

Sig: 1 cap po tid x 10 days (E/F)

L. Merry, M.D. (G) Refill ________ (H)

DEA# (I)

Line A: Prescript ions are preprinted with the physicia n’s name, address, and phone
number.

Line B: The patient heading includes the patient’s name and address, date the
prescript ion was written, and the patient’s age if a child.

Line C: Superscript ion contains the symbol Rx, meaning “take” or “recipe”

Line D: Inscript ion specifies the name and the strength of the drug and the quantit y to be
included.

Line E: Signa or signature gives the direct ions for taking the medicat ion.

Line F: Subscript ion gives direct ions to the pharmacist for filling the prescrip t ion.

Line G: Signature of the physician.

Line H: Refill line designates the number of refills permitted. This line should NEVER
be left blank.
 TERMINOLOGIES
 Pharmacology – is the study of the effect of drugs on living organism.
 Pharmacy – is the art of preparing, compounding and dispensing drugs.
 Pharmacist – is a person licensed to prepare and dispense drugs and to
make up prescriptions.
 Pharmacopoeia – is a book containing a list of products used in
medicine, with descriptions of the product, chemical tests for determining
identity and purity and formulas and prescriptions.
 Pharmacodynamics – is the process by which a drug alters cell
physiology.
 TERMINOLOGIES
 Pharmacokinetics – is the study of the absorption, distribution,
biotransformation and excretion of drugs.
 Absorption – is the process by which a drug passes into the bloodstream.
 Distribution – is the transportation of the drug from its site of
absorption to its site of action.
 Biotransformation (detoxification or metabolism) – process by
which a drug is converted to a less active form.
 Excretion – is the process by which metabolites and drugs are eliminated
from the body.
 12 RIGHTS OF MEDICATION ADMINISTRATION
1. Right Drug :The medication given was the medication ordered.
2. Right Patient: medication is given to the intended patient. Check for identification
band before administering the medicine. Know the hospital alert procedures on
patients with similar names.
3. RightTime : give the medication at the right frequency and at the time ordered.
4. Right Dose : the dose ordered is appropriate for the patient. Give special attention if
the calculation indicates multiple pills / tablets or a large quantity of a liquid medication.
Double check calculations that appear questionable. Know the usual dosage range of
the medication.
5. Right Route : give the medication by the ordered route. make sure that the route is
safe and appropriate for the patient.
 CONT…..
6. 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 reason (e.g.
pharmacy states that medication will be available in 2 hours ) in nursing notes.
- if medication is not given, follow the hospital policy for documenting the reason why.
7. Right Client Education
8. Right to Refuse
9. Right Assessment
10. Right Evaluation
11.Right to Reason
12.Right Expiration Date
LEGAL ASPECTS OF DRUG ADMINISTRATION

 Drug administration is controlled by law;

 It is important for nurses:
1) know the nursing acts and limitation of their functions.
2) be able to recognize the limits of their own knowledge and skills.
UNDER THE LAW, NURSES ARE RESPONSIBLE FOR THEIR OWN ACTIONS
REGARDLESS OF WHETHER THERE IS A WRITTEN ORDER.
TYPES OF DRUG ADMINISTRATION

 Aerosol Spray - a liquid or powder deposited on a thin layer of the skin by air
pressure
 Aqueous Solution / Suspension – drugs dissolved in water
 Capsule – a gelatinous container to hold a drug in powder, liquid or oil form
 Caplet – a solid form, shaped like a capsule, coated and easily swallowed
 Cream – a non-greasy semi-solid preparation used on the skin
 Elixirs – a sweetened and aromatic solution of alcohol used as a vehicle for
medicinal agent
CONT…..
 Extract – a concentrated form of a drug made from vegetables and 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
 Lozenges (troche) – a flat, round ,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 to
the skin
CONT…..

 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
CONT…..

 Syrup – an aqueous solution of sugar often used to disguise unpleasant

tasting drugs
 Tablet – a powdered drug compressed into a hard small disc; some are
readily broken along a scored line
 Tincture - an alcoholic or water- and alcohol solution prepared from
drugs derived from plants
 Transdermal Patch – a semi-permeable membrane shaped in the form
of a disc or patch that contains a drug to be absorbed through the skin
over a long period of time
THERAPEUTIC ACTIONS OF DRUGS

1) Palliative
- relieves the symptoms of a disease but does not affect the disease itself. (e.g. morphine sulfate – for pain )
2) Curative
- cures a disease or condition (e.g. penicillin – for infection)
3) Supportive
- supports body function until other treatments or body’s response can take over (e.g. ASA – for high body temp)
4) Substitutive
- replaces body fluids or substances (e.g. thyroxine for hypothyroidism, insulin for DM)
5) Chemotherapeutic
- destroys malignant cells (e.g. Busulfan for leukemia)
6) Restorative
- returns the body to health (e.g. vitamins, other supplements)
EFFECTS OF DRUGS

1) Therapeutic Effect – also referred to as desired effect, is the primary effect intended that is the
reason the drug is prescribed.
2) Side Effect – also referred to as secondary effect, is the effect of drug that is unintended, can be
harmless or harmful
adverse effect – more severe side effect
3) Drug Toxicity – is the deleterious effects of a drug of an organism or tissue
causes ;- over dosage of drugs
- ingestion of drugs intended for external use
- build up of the drug in the blood because of
impaired metabolism or excretion
CONT…..

4) Drug Allergy – is an immunologic reaction to drug.

Anaphylactic reaction – a severe allergic reaction usually occurs immediately after the
administration of a drug.
5) Drug Tolerance – a condition in which successive increases in the dosage of a drug are
required to maintain a give desired effect ( tobacco, ethyl alcohol)
6) Drug Interaction – a beneficial or harmful interaction of one drug with another drug.
7) Iatrogenic Disease – caused unintentionally by medical therapy.
DRUG MISUSE
- Drug abuse - Drug habituation ( addiction )
ROUTES OF ADMINISTRATION
 ORAL
-most common, least expensive, safe method, convenient route. Disadvantages are unpleasant taste of
the drug, irritation of the gastric mucosa, irregular absorption from GI tract, slow absorption and harm
to the client teeth.
 SUBLINGUAL
- drug is placed under the tongue
- quickly absorbs into the blood vessels
- should not be swallowed
 BUCCAL
- pertaining to the cheeks
- the drug is held in the mouth against the mucous membranes of the cheek until the drug dissolves
CONT…..

 PARENTERAL
- drug administration occurring outside the alimentary tract; injected into the body through some route other than
alimentary canal or respiratory tract.
Subcutaneous ( hypodermic ) – into the subcutaneous tissue just below the skin
Intramuscular – into a muscle
Intradermal – under the epidermis
Intravenous – into a vein
Intra-arterial – into an artery
Intracardiac – into the heart muscle
Intraosseous – into a bone
Intrathecal or Intraspinal - into the spinal canal
Epidural - into the epidural space
Intra- articular – into a joint
CONT…..

 TOPICAL
- applied to a circumscribed surface area of the body.They affect only the area to which they
are applied.
a) Dermatologic preparations – applied to the skin
b) Instillations and Irrigations – applied into body cavities or orifices such as the urinary
bladder, eyes, ears, nose, rectum, vagina
c) Inhalations – administered into the respiratory tract by a nebulizer or positive pressure
breathing apparatus. Air , oxygen and vapor are generally used to carry the drug into the
lungs.
MEDICATION ORDERS

- usually the order is written, although telephone and verbal orders are
acceptable in some hospitals.
- should be the order of a physician
THE NURSE IS RESPONSIBLE AND HELD ACCOUNTABLE FOR
QUESTIONING ANY MEDICATION ORDER, IF IN THE NURSES
JUDGEMENT THE ORDER IS IN ERROR.
- clarification from the doctor is necessary.
 PARTS OF A MEDICATION ORDER

1) Patient’s name
2) Date and time the order is written
3) Name of drug to be administered
4) Dosage of drug
5) Route by which the drug is to be administered
6) Frequency of administration of the drug
7) Signature of a person writing the order
 STANDARD TIME OF ADMINISTRATION
a.c. -6a.m.-11a.m.-5p.m.
p.c. -8a.m.-1p.m.-6p.m.
o.d. -8a.m.
b.i.d. -
8a.m.-6p.m.
t.i.d. -
8a.m.-1p.m.-6p.m.
q.i.d. -
8a.m.-12p.m.-4p.m.-8p.m
q4H - 8a.m.-12p.m.-4p.m-8p.m.-12m.n.-
4a.m.-10a.m.-2p.m.-6p.m.-10p.m.-2a.m.-
6a.m.
q6H - 6a.m.-12p.m.-6p.m.-12m.n.
8a.m.-2p.m.-8p.m.-2a.m.
10a.m.-4p.m.-10p.m.-4a.m.
CONT…..
q8H - 8a.m.-4p.m.-12m.n.
10a.m.-6p.m.-2a.m.
12p.m.-8p.m.-4a.m.
q12H - 2a.m.-2p.m.
4a.m.-4p.m.
6a.m.-6p.m.
8a.m.-8p.m.
10a.m.-10p.m.
12a.m.-12p.m.
H.S. - 8p.m.
 TYPES OF MEDICATION ORDERS

1) STAT ORDER – indicates that the medication is to be given immediately and only
once. (e.g. Demerol 100 mg IM stat )
2) SINGLE ORDER – or one-time order is for medication to be given once at a
specified time ( Seconal 100 mg HS before surgery )
3) STANDING ORDER – may or may not have a termination date. Maybe carried out
indefinitely (e.g. Multivitamins daily )until an order is written to cancel it, or maybe
carried out to a specified number of days (e.g. Demerol 100 mg IM q4h X 5 days )
4) PRN ORDER – or as needed order, permits the nurse to give a medication when, in
the nurses judgment the patient requires it. ( e.g. Plasil 1 amp PRN)
 PROCESS OF ADMINISTERING MEDICATIONS

1) Identify the patient.

2) Inform the patient.
3) Administer the drugs.
4) Provide adjunctive interventions as indicated. ( e.g. pt may need help when
receiving medication, positioning, guidance about measures to enhance drug
effectiveness such as drinking fluids)
5) Record the drug administered.
6) Evaluate the client’s response to the drug.
NURSING RESPONSIBILITIES FOR ADMINISTERING DRUGS

 Assessment of the patient and clear understanding of why the patient is

receiving a particular medication.
 Preparing the medication to be administered ( e.g. checking labels,
preparing injections, observing proper asepsis techniques with needles
and syringes ).
 Accurate dosage calculations.
 Administration of the medication (proper injection techniques, aids to
help swallowing, topical methods ).
CONT…..

 Documentation of medications given.

 Monitoring patients reaction and evaluating the patient’s response.
 Educating the patient regarding his or her medications and medication
regimen.
 THE ROUTES OF ADMINISTRATION INCLUDE THE FOLLOWING
ROUTES:
 Oral  Rectal
 Subcutaneous  Nasal
 Intramuscular  With a nasogastric or
 Intravenous or gastrostomy tube
parenteral  Inhalation
 Buccal  Intradermal
 Sublingual  Transdermal
 Topical  Intra-cardial
 Ophthalmic  Intra-articular
 Otic  Intrathecal
 Vaginal
 EDUCATING THE CLIENT ABOUT MEDICATIONS

Clients and significant others should be taught about all aspects of the medications that they are taking.
The content of this teaching and education should minimally include:
 The purpose of the medication
 The dosage of the medication
 The side effects of the medication
 The possible adverse effects of the medication
 How and where the medication should be safely stored, such as in the refrigerator or in a dark place,
for example
 The importance of and the method for checking the medication's label for the name, dose, and
expiration date
 EDUCATING THE CLIENT ABOUT MEDICATIONS
 Special instructions such as shaking the medication, taking the medication with meals or between meals
and on an empty stomach, for example
 When to call the doctor about any side effects
 The importance of taking the medication as instructed
 The need to continue the medication unless the doctor discontinues it
 Information about foods, supplements and other medications, including over the counter medications
and preparations, that can interact with the ordered medication
 The safe disposal of unused and expired medications
 The importance of keeping medications in a secure place that would not place a curious child or a
cognitively impaired adult at risk for taking medications not intended for them
 The proper and safe disposal of any biohazardous equipment such as used needles that the client uses
for insulin and other medications
 CLIENTS AT RISK FOR MEDICATION ERRORS AND OTHER MEDICAL
ERRORS

 The risk factors associated with medication errors and other medical errors such as wrong patient or wrong site
surgery are discussed below:
 Developmental disorders: The same concerns and interventions described above for infants and children apply
to those with developmental disorders, as specific to the degree of their developmental delay.
 Psychiatric disorders: Patients/residents/clients with a psychiatric disorder are at risk for medications as based
on their psychiatric mental health disorder and the medications that they may be taking. Some psychotropic
medications have sedating effects and the client may be delusional and out of touch with reality.
 Infants and children: These young children are at risk for medication errors because they are not able to ask
questions about medications and procedures; they may not even be able to state their name. The support and
presence of the family is one way to prevent medication errors among this high risk population.
 Language barriers: People with language barriers may not understand what you are saying or asking and, you may
not know what they are saying or asking you in another language, therefore, the use of interpreters, family or
friends, pictures and drawings should be used to overcome a language barrier.
 CLIENTS AT RISK FOR MEDICATION ERRORS AND OTHER
MEDICAL ERRORS
 Cognitive impairments: Clients who are confused, disoriented, demented or with delirium are at
risk for all types of errors because of the challenges associated with accurate patient identification and
the hazards of impaired cognition.Again, patient identification is highly important, and it is also
beneficial to communicate with the client in a way that is understandable to them using pictures and
drawings and to encourage the participation of the significant other(s) in all aspects of care.
 Decreased levels of consciousness: Patients who are not alert, awake and oriented to time, place
and person are also at high risk. At times, a family member or friend who is visiting this
patient/resident/client can assist with the two unique identifier processes and also serve as a person
to question you about questionable medications and to ask questions of you.
 Sensory disorders:Assistive devices, such as eyeglasses and hearing aids, must be consistently
provided to the sensory impaired person in order to protect their safety.Additionally, the use of large
print or Braille reading materials and magnifying glasses may be helpful for the visually impaired; and
speaking loudly while facing the patient with an auditory impairment may offer some protection
against medication errors.
 AGE SPECIFIC ROUTE, FORM AND DOSAGE
CONSIDERATIONS

 Infants: Use a syringe, dropper or nipple for oral liquid medications, use the vastus lateralis, rectus
femoris and ventrogluteal muscle sites for intramuscular injections and not the deltoid or the gluteus
maximus muscles because these muscles have not yet developed in the infant and dosages are based
on the infant's weight in kilograms (kg).
 Toddlers: Liquid oral medications are given with a spoon or a cup, the vastus lateralis, rectus femoris
and ventrogluteal sites are used for intramuscular injections, the gluteus maximus muscle can be used
after the toddler has been walking for at least a year, flavors can be used to improve the taste of oral
medications, and the dosages continue to be based on kilograms of weight.
 Preschool and school age children:These children are usually able to take capsules and tablets, the
gluteus maximus muscle and the deltoid muscle can now be used for intramuscular injections, in
addition to the vastus lateralis, rectus femoris and ventrogluteal intramuscular injection sites, and
dosages continue to be based on kilograms of weight.
 AGE SPECIFIC ROUTE, FORM AND DOSAGE
CONSIDERATIONS

 Adolescents:Adolescents get adult dosages, routes and forms of medications.

 The Elderly:Adult dosages may be decreased because the normal physiological changes of the aging
process make this age group more susceptible to side effects, adverse drug reactions, and toxicity and
over dosages. Renal function is decreased which can impair the elimination and clearance of
medications, the liver function can be decreased, absorption in the gastrointestinal tract may be
decrease, and the distribution of medications can be decreased because the elderly client may have
decreased serum albumin, for example.All of these factors increase the elderly client's risk for side
effects, adverse drug reactions, and toxicity and over dosages. For example, the risk of toxicity is
increase when the elderly client is taking aminoglycosides, thiazides, a nonsteroidal anti-inflammatory
medication, heparin, long acting benzodiazepines, warfarin, isoniazid and many antiarrhythmics.
Nurses must, therefore, begin a new medication with the lowest possible dosage and then increase the
dosage slowly over time until the therapeutic effect is achieved.The initial dosage may be as low as 1/2 of
the recommended adult dosage.
 EVALUATING THE APPROPRIATENESS AND ACCURACY OF
MEDICATION ORDERS FOR THE CLIENT
All medication orders are evaluated by the nurse in terms of their accuracy and appropriateness of the
order.
Some of the things that are considered and evaluated include:
 The completeness of the medication order
 The accuracy of the medication order
 The appropriateness of the medication order
 Client allergies
 The client's health condition
 The client's pertinent laboratory findings
 Other client data like vital signs, for example
The doctor must be notified whenever the nurse has any concerns or problems with these
things.