Medication/
Medication Administration
Medication
A Drug is
Any substance that alters
physiologic function, with the
potential of affecting health.
A Medication is
A substance used in the diagnosis,
treatment, cure, relief, or prevention
of health alteration.
Indications
Drugs can be administered for these purposes:
Diagnostic
purposes. e.g. assessment of liver
function or diagnosis of myasthenia gravis.
Prophylaxis .e.g. heparin to prevent
thrombosis or antibiotics to prevent infection.
Therapeutic purposes. e.g. replacement of
fluids or vitamins, supportive purposes (to
enable other treatments, such as
anesthesia), palliation of pain and cure (as in
the case of antibiotics).
Mild allergic reactions
Skin
rash: Small, raised vesicles that are usually
reddened; often distributed over entire body.
Pruritus: itching of the skin with or without rash.
Angioedema: edema due to increased the
permeability of the blood capillaries.
Rhinitis: Inflammation of mucous membranes
lining nose; causes swelling and clear, watery
discharge.
RIGHTS OF ADMINISTRATION 10
OF MEDICATION
The Right Medication.1
when administering medications, the nurse compares
the label of the medication container with medication
. form
The nurse does this 3 times:
a. Before removing the container from the drawer or
shelf
b. As the amount of medication ordered is removed
from the container
c. Before returning the container to the storage
Right Dose when performing medication. 2
calculation or conversions, the nurse should have
another
Right Client an important step in administering. 3
medication safely is being sure the medication is
. given to the right client
To identify the client correctly: The nurse check the
medication administration form against the clients
identification bracelet and asks the client to state his
or her name to ensure the clients identification
.bracelet has the correct information
RIGHT ROUTE if a prescribers order does. 4
nor designate a route of administration, the
nurse consult the prescriber. Likewise, if the
specified route is not recommended, the
nurse should alert the prescriber
.immediately
RIGHT DOCUMENTATION. 6
Documentation is an important part of safe
medication administration
a. The documentation for the medication should
clearly reflect the clients name, the name of the
ordered medication,the time, dose, route and
frequency
b. Sign medication sheet immediately after
administration of the drug
RIGHT TIME. 5
a. the nurse must know why a medication is
ordered for certain times of the day and whether
the
time schedule can be altered
b. each institution has are commended time
schedule for medications ordered at frequent
interval
c. Medication that must act at certain times are
given priority (e.g insulin should be given at a
precise interval before a meal )
CLIENTS RIGHT RELATED TO
MEDICATION ADMINISTRATION
a. To be informed of the medications name,
purpose, action, and potential undesired
.effects
b. To refuse a medication regardless of the
consequences
c. To have a qualified nurses or physicians
assess medication history, including allergies
d. To be properly advised of the experimental nature of
medication therapy and to give written consent for
its use
e. To received labeled medications safely without
discomfort in accordance with the six rights of
.medication administration
f. To receive appropriate supportive therapy in relation
to medication therapy
g. To not receive unnecessary medications
II Practice Asepsis wash hand before and after
preparing the medication to reduce transfer of
.microorganisms
III Nurse who administer the medications are
responsible for their own action. Question any
order that you considered incorrect (may be
unclear or appropriate)
IV Be knowledgeable about the medication that
you administer
A FUNDAMENTAL RULE OF SAFE DRUG
ADMINISTRATION IS: NEVER ADMINISTER
AN UNFAMILIAR MEDICATION
.V Keep the Narcotics in locked place
VI Use only medications that are in clearly
labeled containers. Relabeling of drugs are the
.responsibility of the pharmacist
VII Return liquid that are cloudy in color to the
pharmacy
VIII Before administering medication, identify the
client correctly
X Do not leave the medication at the bedside.
Stay with the client until he actually takes the
.medications
X The nurse who prepares the drug administers
it.. Only the nurse prepares the drug knows what
the drug is. Do not accept endorsement of
.medication
XI If the client vomits after taking the medication,
.report this to the nurse in-charge or physician
XII Preoperative medications are usually
discontinued during the postoperative period
.unless ordered to be continued
XIII- When a medication is omitted for any reason,
.record the fact together with the reason
XIV When the medication error is made, report it
immediately to the nurse in-charge or physician.
To implement necessary measures immediately.
This may prevent any adverse effects of the
.drug
Right Drug. 1
Right Drug. 1
Routes of administration
Topical administration:
Medications applied to the skin and
mucous membranes generally have local
effects.
Applied to skin.
Rectal.
Otic.
Optic.
Nasal.
Continue
Routes of administration
Oral route.
Sublingual route
Parentral route
Intravenous route.IV
Intramuscular.IM
Intradermal.ID
Subcutaneous.SQ
Assessment For Reactions
Assessment needs vary
and depend on route
and medication. Always
assess pt after giving
drugs that affect RR,
HR, BP, LOC, blood
sugar and pain. These
approximate time table
will help guide you in
your assessment.
Approximate Onset
IV
3 5 min
IM
3 20 min
SC
3 20 min
PO
30 45 min
Essential Parts of a Drug
Order
Full
name of the patient and file number
Date and time of the order is written
Legible writing
Name of the drug to be administered
Dosage of the drug
Frequency of the drug to administered
Method of administration
Signature and stamp of the physician
Always Check for
1.
2.
3.
The indication of the
drug before
administering (refer to
Drug Hand Book).
The medication sheet is
up to date.
For allergies and assess
for reactions to drugs
not previously taken by
the pt.
Triple Checking
Check label when
obtaining medication
from storage.
do side-by-side
comparison of the
medication with the
written order and the
medication sheet.
Recheck one last time
after preparation with a
witness, just before
administration.
ADMINISTERING OPHTHALMIC
MEDICATIONS
Definition:
Medications are instilled in mucous membranes
of eye for various therapeutic effects.
Purpose:
To treat infection.
To relieve inflammation.
To treat eye disorders such as glaucoma.
To diagnose such as foreign bodies and
corneal abrasions.
Preparation Of
OPHTHALMIC MEDICATIONS
Gather Equipments
Medication bottle with sterile dropper
or ointment tube.
Small guze squares or cotton balls.
Eye patch and tape (optional).
Disposable gloves.
2. Explain the need and reason for
instilling drops or ointment.
1.
Continue Preparation Of
OPHTHALMIC MEDICATIONS
3. Allow the pt to sit with head tilted
backward or to lie in a supine position.
4. Ask client to look up and explain steps
to client.
Instill eye drops
1.
2.
Identify pt. Compare name on
medication sheet with pt ID band . Ask
pt to state name.
Check prescribed medication order for
number of drops (if a liquid) and eye
Rt. = O.D.
Lt. = O.S.
both = O.U.
Instill eye drops continue
Wash Hands
4. With dominant hand resting on
clients forehead, hold filled
medication eye dropper or ophthalmic
solution approximately 1-2 cm (1/23/4 in) above conjunctival sac
3.
Instill eye drops continue
5. pull the lower lid down to
expose the conjunctival
sac. have the pt look up
and away, then squeeze
the prescribed numbers of
drops into the sac. Release
the patient's eyelid, and
have him/ her to blink to
distribute the medication.
6. If drops land on outer lid
margins, repeat procedure
Instilling Eye Ointment
Gently lay a thin strip of the
medication along the
conjunctival sac from the
inner canthus to the outer
canthus. avoid touching the
tip of the tube to the
patient's eye. then release
the eye lid and have the
patient roll his eye behind
closed lids to distribute the
medication.
Administration of oral
medication
Definition:
Drugs given by the oral or gastric route are
absorbed into the bloodstream through the
gastric or intestinal mucosa. Usually the
patient swallows the drug.
Forms of oral medications:
Tablets.
Capsules.
Liquid drugs like syrup
Also available as powder, granules or oil.
Continue
Administration of oral
medication
Purpose:
Uses basic safety factors of drug
administration in preparing and
administering medications.
Avoids client injury due to drug errors.
Delivers medication for absorption
through alimentary tract for oral
medication.
Preparation of Oral
Medication
Wash
hands
Gather equipment:
a. Medication Sheet
b. Medication tray
c. Glass of water or preferred liquid
d. Drinking straw
e. Pill Crusher device
Oral Drug Administration
Unlock
the medication cart or drawer.
Prepare one clients medication at a
time.
Calculate correct drug dose. Take time.
Double check calculation.
If the client has difficulty in swallowing,
grind tablets in a pill crusher until
smooth. Mix it with drinks or soft food.
Continue Oral Drug
Medication
Measure liquid medication
by holding the medication
cup at eye level. Pour
away from the label and
wipe the neck.
Re-check each medication
with the MAR and
physician order.
Dont use liquid
medication that are
cloudy or have changed in
color.
Continue Oral Drug
Medication
Ask
the patient his or her
name with a staff witness.
Assist the patient to a
comfortable position.
Administer the medication
Remain with the client
until he or she has taken
all medication
Wash hands
Continue Oral Drug
Medication
Record
medication
administration.
Sign after giving the
medication
Counter sign with another
nurse for high risk medication.
If client refuses the
medication, record according to
the hospital policy.
check the client after 30
minutes
Giving Medication
Through an NG Tube
Holding
the nasogastric
(NG) tube at a level some
what above the patient's
nose, pour up to 30 ml of
the diluted medication into
the syringe barrel. Hold the
at a slight angle and add
more medication before the
syringe empties. rise the
tube slightly higher to
increase the flow rate.
Continue Giving
Medication Through an
NG Tube
After
you've
delivered the whole
dose, position the
patient on her/ his
side, head slightly
elevated.
EAR (OTIC) INISTILLATION
Definition:
Instill liquid medication into external
auditory canal for such therapeutic effects.
Purpose:
To treat infection and inflammation.
To soften cerumen for removal.
To produce local anesthesia.
To aid in removal of foreign body trapped in
the ear.
Preparation for
EAR (OTIC) INISTILLATION
Wash
hands
Gather Equipment:
2 or 3 cotton balls or tissue.
Disposable gloves.
Medication record or card.
Medication to be administered.
Positioning The Client For
Eardrop Instillation
Before instilling eardrops,
have the client lie on his
or her side. Then
straighten the ear canal
to help the medication
reach the eardrum. For
adult, gently pull the
auricle up and back. For
young child and infant,
gently pull down and
back
The Transdermal Patch
(A)
First bend the
patch to break the
seal
(B)
Remove protective
covering and
apply to the skin
IV Medication
Ampules
Vials
Drawing Up Medication
From an Ampules
Wash
hands and
gather
equipment.
Grasp the stem
with an alcohol
swab
Continue Drawing
Up
Medication
From an Ampules
Snap
off the
ampoules neck
away from the
hands and face
Continue Drawing
Up
Medication
From an Ampules
Uncap
the needle
and insert the
needle into the
ampule. Avoid
touching the rim
with the needle.
Continue Drawing
Up
Medication
From an Ampules
Invert
the
ampule, insert
the needle into
the solution and
aspirate.
Continue Drawing
Up
Medication
From an Ampules
Remove
the needle
cap and draw an
amount of air into
the syringe that is
equal to the amount
of medication that
will be withdrawn
from the vial
Drawing Up Medication From a Vial
Insert the needle
keeping it above the
solution
Continue Drawing Up
Medication
From a Vial
Invert
the vial at
eye level
Continue Drawing Up
Medication
From a Vial
Hold
the needle
upright and recheck the
syringes contents
for presence of air
Intradermal Injection
When to Aspirate
(IM & SC injection)
The reason for aspiration before
injection a medication is to ensure
that the needle is not in a blood
vessel. If blood appears in the
syringe, withdraw the needle, discard
the syringe, and prepare a new
injection.
When Not To Aspirate
When administering SC heparin/ insulin,
it is recommended that you do NOT
aspirate. Because of the anticoagulant
properties of heparin, aspiration could
damage surrounding tissue and cause
bleeding and bursting.
Subcutaneous Injection
Sites
Subcutaneous Injection
Assist
client to
comfortable
position
Apply alcohol
swap and rotate
outward in
circular direction
Subcutaneous Injection
Intramuscular Injection
Intramuscular Injection
Intramuscular Injection
Intradermal Administration
Used
for allergy and tuberculin skin testing
Site: inner forearm (may use back and upper
chest)
Volume:
0.01-0.05 ml
Equipment: gloves, TB syringe (1ml, 25-27g,
or inch needle), alcohol swab.
Administration angle: 10-15
Intradermal Administration
Prepare medication
Gather supplies
Identify site
Don gloves
Cleanse site with alcohol
Pull skin taut
Insert needle with bevel up at 10-15
degree angle inch.
Needle should be visible under skin
Intradermal Administration
Push plunger to instill medication creating a
wheal under skin
Withdraw needle at same angle inserted.
Cover site with gauze for bleeding. DO NOT
massage.
DO NOT RECAP. Activate safety feature.
Place needle in sharps container uncapped.
Subcutaneous
Administration
Administered into subcutaneous tissue that
lies between the skin and the muscle.
Common subcutaneous injections are
heparin, lovenox and insulin
Onset: within a half hour
Volume: up to 1ml
Equipment: TB or Insulin syringe (25-27g,
to inch needle), gloves, alcohol swab.
Administration Angle: 45 or 90
Subcutaneous Administration
Subcutaneous
Administration
Prepare medication
Gather supplies
Identify site
Don gloves
Cleanse site with
alcohol
Bunch the skin
Hold needle like dart
Subcutaneous
Administration
Pierce skin with quick motion at 45-90
degree angle.
DO NOT ASPIRATE.
Inject medication slowly
Quickly remove needle
DO NOT RECAP. Activate safety feature.
Place needle in sharps container uncapped.
Intramuscular
Administration
Administered
into a muscle or muscle
group
Onset: variable
Volume: up to 4ml
Equipment: gloves, 1-5 ml syringe,
needle (18-23 g, to 3 inch needle),
alcohol swab
RN is responsible to chose needle
size and gauge.
Administration angle: 90
Intramuscular
Administration Deltoid
Palpate lower edge of
acromion process.
Place 4 fingers across the
deltoid muscle with the
top finger along the
acromion process. This
forms the base of a
triangle.
Draw an imaginary line at
the axilla. This forms the
apex of the triangle.
Injection site is the
center of the triangle,
3 finger widths (1-2
inches) below the
acromion process.
Deltoid Injection Site
Intramuscular
Administration Vastus
Lateralis
One hand above the knee.
One hand below the greater
trochanter.
Locate midline of anterior
thigh and midline of lateral
thigh.
Injection site is the lateral
area of the thigh
Intramuscular
Administration Ventral
Gluteal
Palm of hand on greater
trochanter of femur.
Index finger on anterior
superior iliac spine (hip bone).
Middle finger extended toward
iliac tubercle.
Injection site lies within the
triangle formed by the index
and middle fingers
Intramuscular
Administration Dorsal
Gluteal
Locate the posterior iliac
spine.
Locate the greater trochanter.
Draw an imaginary line
between these two
landmarks.
Injection site is above and
lateral to the line.
Most dangerous site
because of sciatic nerve
location
Intramuscular
Administration
Prepare medication
Gather supplies
Identify site
Don gloves
Cleanse site with alcohol
Pull skin taut
Hold needle like dart
Insert quickly at a 90 angle
Intramuscular
Administration
Stabilize needle
Aspirate for blood
If no blood, instill medication slow and steady
Quickly remove needle.
DO NOT RECAP. Activate safety feature.
Place needle in sharps container uncapped.
Massage site with alcohol swab
Remove gloves
Z-track IM Administration
Method
used with irritating
medications
Vistaril
Iron
Used
to trap medication in muscle
and prevent tracking of solution
through tissues.
Z-track IM Administration
Prepare medication
Change needle after drawing up med
Gather supplies
Identify site
Don gloves
Cleanse site with alcohol
Displace skin laterally 1-1 inches from
injection site
While holding skin, insert needle with a
darting motion, at a 90 angle.
Z-track IM Administration
Stabilize needle with thumb and forefinger.
Aspirate.
If no blood, then inject medication slowly and
steady
Wait 10 seconds
Quickly withdrawal needle
Then release skin
Cover site with swab and DO NOT
MASSAGE
DO NOT RECAP. Activate safety feature.
Place needle in sharps container uncapped
Remove gloves
