MEDICATIONS
By: Mrs. Mae G. Mallorca, R.N., M.A.N
Ms. Jo Maree Pearl J. Oyco, R.N.
Medication
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 foam A liquid, powder, or foam deposited in a thin
layer on the skin by air pressure
Aqueous solution One or more drugs dissolved in water
Aqueous suspension One or more drugs finely divided in a liquid
such as water
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
Types of Drug Preparations
A clear or translucent semisolid that liquefies when
Gel or jelly
applied to the skin
A medication mixed with alcohol, oil, or soapy
Liniment
emollient and applied to the skin
A medication in a liquid suspension applied to the
Lotion
skin
A flat, round, or oval preparation that dissolves and
Lozenge (troche)
releases a drug when held in the mouth
Ointment A semisolid preparation of one or more drugs used
(salve, unction) for application to the skin and mucous membrane
A preparation like an ointment, but thicker and
Paste
stiff, that penetrates the skin less than an ointment
Types of Drug Preparations
An alcoholic or water-and-alcohol solution
Tincture
prepared from drugs derived from plants
A semipermeable membrane shaped in the
form of a disk or patch that contains a drug to
Transdermal patch be absorbed through the skin over a long
period of time
❑ Subcutaneous (hypodermic) —into the
subcutaneous tissue, just below the skin
❑ Intramuscular (IM) —into a muscle
Parenteral ❑ Intradermal (ID) —under the epidermis
(into the dermis)
❑ Intravenous (IV) —into a vein.
Rights of Medication
RIGHT MEDICATION
❑ The medication given was the medication ordered.
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.
Rights of Medication
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.
RIGHT ROUTE
❑ Give the medication by the ordered route.
❑ Make certain that the route is safe and appropriate for
the client.
Rights of Medication
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.
RIGHT CLIENT EDUCATION
❑ Explain information about the medication to the client
(e.g., why receiving, what to expect, any precautions).
Rights of Medication
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.
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.
Rights of Medication
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).
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?).
Examples of types and routes of
drug administration
TABLET
CAPSULE
Examples of types and routes of
drug administration
Examples of types and routes of
drug administration
Examples of types and routes of
drug administration
Syringe
Different types of syringes
Different types of syringes
Different types of syringes
Different types of syringes
Different types of syringes
Disposal of syringes and needles
Administering an Intradermal
Injection for Skin Tests
Administering an Intradermal
Injection for Skin Tests
Administering Subcutaneous
Injection
Administering Subcutaneous
Injection
Administering Subcutaneous
Injection
Administering an
Intramuscular Injection
Administering an
Intramuscular Injection
Administering an
Intramuscular Injection
Administering an
Intramuscular Injection
Administering an
Intramuscular Injection
Administering an Ophthalmic
and Otic Drugs
PRINCIPLES TO
THE
PREPARATION
AND
ADMINISTRATION
OF MEDICINES
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.
Basic Principles to the preparation and administration of medicines
• 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”
Basic Principles to the preparation and administration of medicines
• 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.
Basic Principles to the preparation and administration of medicines
• Compare label three times with medication to
decrease the risk of error:
a. When removing package from drawer
b. Before preparing medication
c. After preparing medication
• Check the need for PRN medication.
• Be sure medications are identified for each client.
• Check for any allergies before administration.
Basic Principles to the preparation and administration of medicines
• 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)
Basic Principles to the preparation and administration of medicines
• 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.
Basic Principles to the preparation and administration of medicines
• 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.
Basic Principles to the preparation and administration of medicines
• 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.
Basic Principles to the preparation and administration of medicines
• 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 – 2:00
Q.I.D
8:00 – 2:00
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,
capsules etc.)
Desired dose = Quantity of drug
Stock dose
(D/S=Q)
EXAMPLE:
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.
Intravenous fluid
These are liquids given to replace water, sugar and salt
that a person may need when he is not able to do so orally.
Types:
*Isotonic
*Hypotonic
*Hypertonic
Isotonic Solutions
• They have solute concentrations that are different than
those of your cells. This means that there is no
concentration gradient across the cell membrane, which
means that your cells neither expand nor shrink in the
presence of an isotonic solution. They contain am
electrolyte balance similar to that of plasma in the blood
stream.
• Example:
• Normal Saline Solution
• Lactated Ringer’s Solution
Hypotonic Solutions
• They have solute concentrations lower than those of your
cells. This means that, in an effort to balance the solute
concentration, water will rush into the cell, causing it to
expand.
• Example:
• 0.45 NaCl Solution
• 0.3 NaCl Solution
Hypertonic Solutions
• They have higher solute concentrations than those of your
cells. In order to balance the solution, water will flow out
of the cell, causing it to shrink.
• Example:
• D5LR
• D10W
• D5NSS
• D5NM
How to compute IV fluid rate:
• A. gtts/min= Volume in cc x drop factor
• no. of hours x 60 minutes
• B. cc/hr = volume in cc or gtts/min
• no. of hours
• C. duration in hours= volume in cc
• cc/hr
Example:
• How long will a 100 ml infusion of Sodium bicarbonate last
if it is running at 42 drops per minute? DF=20/ml
• Drop rate: 42 drops/minute, DF is 20 drops/ml
• If we divide 42 drops per minute by 20 drops/ml we have
42/20=2.1 ml/min
• So we have: 100ml/2.1 ml/min
• Answer: 47.6 minutes
• The infusion will run for 47.6 minutes
A patient is to be given 1000 ml IV using an infusion pump
with a drip factor of 15 drops/ml. The infusion starts at
8am. If the drip rate was set at 25 drops/minute at what
time would the infusion finish?
If we divide 25 drops per minute by 15 drops/ml, we get
1.67ml/min.
Then we divide 1000ml by 1.67ml/min we get 600 mins.
600mins/ 60min= 10 hours
8 am plus 10 hours= 6pm
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.
