Medication &
Medication
Administration
Mohammed Bien M. Kulintang,
RN, LPT
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.
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 Approximate Onset
depend on route and
medication. Always assess IV 3 5 min
pt after giving drugs that
affect RR, HR, BP, LOC, IM 3 20 min
blood sugar and pain.
These approximate time SC 3 20 min
table will help guide you
in your assessment. 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
Medication Rights
Right patient
Right medication
Right dose
Right time
Right route
Right frequency
Right documentation
Basic Guidelines
Assess the patient's history for allergies,
drug-drug or drug-food interactions, and
drug contraindications, and notify the
physician if any exists.
Follow Infection Control Policy during the
entire process of Medication
Administration.
Patients must be correctly identified by
using 2 identifiers; complete name and
file number checked against the ID
band. Do not identify patient using
room or bed number.
Gather or review assessment data that may
influence drug administration. This may
include vital signs, lab data, drug serum
levels, or patient's behavior. If any
patient data indicates that a medication
should not be administered, or if the
patient no longer requires the
medication, notify the physician before
administering the drug.
To the maximum extent possible, only
administer medications you have
personally prepared, unless the
medication has been supplied in a unit
of use package.
Do not administer medications from
containers that are unmarked or
illegible. Do not give medications that
have changed color, appearance, or
from which the container is broken or
crusted.
Always check medication expiration dates.
Tablets and capsules should be
maintained in their wrappers and
opened at the bedside immediately
prior to use.
With each drug, inform the patient of the
drugs name, purpose, action, and
potential side effects
The medication order shall be written in the
physician order sheet and transcribe in the
Medication Sheet.
Medications shall be double checked by a
witness during preparation and
administration
The nurse and the witness sign the
medication sheet after administration.
Any order that is incomplete, illegible, or
of any concern should be clarified prior
to administration
In situations such as
Not given-
Not tolerated-
Refused-
Notify the physician and justify the
reason in the Interdisciplinary Progress
Notes.
Do not leave medications unattended and
accessible to patients, family or visitors
Remain with the patient while they take
medications. Inhalers are to be used
while the nurse is observing for proper
technique, unless an order exists for
patient to take their own medication.
Always Check for
1. The indication of the
drug before
administering.
2. The medication sheet
is up to date.
3. 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
1. 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.
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. Identify pt. Compare name on medication
sheet with pt ID band . Ask pt to state
name.
2. 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
3. Wash Hands
4. With dominant hand resting on clients
forehead, hold filled medication eye
dropper or ophthalmic solution
approximately 1-2 cm (1/2-3/4 in)
above conjunctival sac
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
ContinueDrawing Up Medication
From an Ampules
Snap off the
ampoules neck
away from the hands
and face
ContinueDrawing Up Medication
From an Ampules
Uncap the needle
and insert the needle
into the ampule.
Avoid touching the
rim with the needle.
ContinueDrawing Up Medication
From an Ampules
Invert the ampule,
insert the needle into
the solution and
aspirate.
ContinueDrawing 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 re-check
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
