2. Medication administration is a basic nursing function
that involves skillful technique and consideration of the
clients’ development and safety.
Nurse administering medication is expected to have a
knowledge base concerning drugs, including: drug
names, preparations, classifications, adverse effects,
mechanisms of drug actions, and physiologic functions
that affect drug action
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3. Definitions of terms
Drugs is any substance that alters physiologic functions
with a potential for affecting health.
Medication is a drug that is used for therapeutic
/curative purpose
Also it is a substance administered for the ff purposes:
◦ Diagnosis, treatment, cure, relief, prevention
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4. The study that deals with chemicals that affects the
body’s functioning is called pharmacology.
Prescription: a written direction for the preparation or
administration of medication
N.B All medications are drugs, but all drugs are not
medication.
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5. Parts of the medication order
Consists of seven parts. These are:
Client’s name
Date & time the order is written
Name of the drug to be administered
Dosage of the drug
Route by which the drug is to be administered
Frequency of administration
Signature of a person writing the order
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6. Common abbreviations used in drug administration
Po …………..by mouth
bid ……………twice a day
ac……………before meal
tid ………….. 3x a day
Pc …………..after meal
hs ……………at bed time
Qd ………….every day
prn ………….as needed
Qod…..every other day
Qid……4x a day
Q2h ….…every 2hrs
Qhr……every hour
am……in the morning
Pm………after noon
IV…………Intravenous
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8. Nomenclature of drugs
One drug can have several names. These include:
The chemical name:-is a precise description of a drug’s
chemical composition; it identifies the drug’s atomic &
molecular structure.
The generic name: - is the name designed by the
manufacturer that first develops the drug.
It is often derived from the chemical name.
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9. The official name:-is the name by which the drug is
identified in the official publication.
The trade name:-also referred to as brand name or
proprietary name, is selected by the drug company that
sells the drug & is copyrighted.
A drug can have several trade names when produced by
different manufacturers.
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10. DRUG MEASUREMENT SYSTEM
Three systems of drug measurement systems are
used. These are:
The metric system
The apothecary’s system
The household system.
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11. The metric system
The most widely accepted and convenient/suitable
method.
The basic units of measurement are meter (linear), liter
(volume) & gram (weight)
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12. The apothecary system
Less convenient & precise than the metric system and
infrequently used.
Basic unit of weight is the grain.
The minim, dram, ounce, pint, & quart are used for
volume.
Roman numerals are used to express numbers and
quantities <1are written in fraction form (grain ¼)
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13. The household system
Used when accurate systems of measurements are not
required, because it is the least accurate one.
Units of measurement include: drops, teaspoon,
tablespoon, teacup, cups, glasses, etc.
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14. Classifications of drugs
Drugs can be classified from d/t perspectives. For
example;
◦ By body system affected by the drug(drugs that
affect the RS, the CVS),
◦ By the symptom relieved by the drug (antipain,
analgesics),
◦ By the clinical indications for the drug (antibiotics,
antifungal …)
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15. Effect of drugs
Drugs have several effects:
Therapeutic effect (desired effect)
the effect that we are intended on.
Side effect (untoward effect)
Secondary effect of drug which is not intended
E.g. Al(OH)3 -neutralize gastric acid
S/E: causes constipation
Usually S/Es are predictable and harmless or harmful
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16. Drug toxicity- result from administration of high doses
No drug is safe if administered inappropriate
Drug allergy -resulting from immunological reaction of
the body
◦ Leads to antigen-antibody reactions
◦ Called anaphylactic reaction
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17. Mechanism of drug action
Pharmacodynamics
The process by which drugs alter the cell physiology
One of the mechanisms of drug action is a drug receptor
interaction.
The drug fits the receptor sites as the key fits the lock
Some drugs act on cell membrane or alter the cellular
environment.
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18. Pharmacokinetics
The study of the movement of drug molecule in the
body.
Absorption:-is a process by which a drug is transferred
from its site of entry into the body to the blood stream.
Distribution:-after it has been absorbed into the blood
stream; the drug is distributed throughout the body.
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19. Metabolism:-metabolism or biotransformation is the
breakdown of the drug to an inactive form in the liver.
Excretion:-after it is broken down into inactive form,
elimination of the drug from the body occurs.
Most drugs are excreted by the kidney and lungs are the
primary route of excretion for gaseous substances, such
as inhalation anesthesia.
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20. FACTORS AFFECTING DRUG ACTION
Age
Sex
Weight
Genetic
Illness and disease
Time of administration
Environment, psychology, diet
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21. TYPES OF PREPARATION
Medications are prepared in various forms.
The most desirable form of medication for any client is
determined by the:
Disease process being treated
Age of the person
Ability of the client to swallow etc.
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22. Accordingly, there are
Oral preparation
Topical preparation
Parentral preparation, etc.
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23. Oral preparation
These are medications prepared to be swallowed by
mouth. There are different forms of oral preparation.
Capsule:-gelatinous container, may contain liquid
Emulsion-oil based preparation
Enteric coated- prepared to be dissolved and absorbed
in the intestine.
Lozenges-dissolved & absorbed in the mouth like
candy.
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24. Powder-finely ground drugs
Syrup-sugar sweetened (acquous solution of sugar)
Suspension-is liquid form, shacked before
administration.
Elixir-liquid form of drug
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25. Topical preparation
Drugs to be applied directly to the skin or mucus
membrane. There are d/t types of topical preparation:
Cream=non greasy/oily, semi solute preparation
Ointment=semi solute than cream, for external use on
skin, conjunctiva, etc.
Paste=thicker & stiffer than ointment
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26. Lotion=clear, suspension, emollient liquid
Gel or jelly=clear, translucent form.
Suppository=prepared to be inserted through the
rectum/ anus, & vagina
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27. Parentral preparation
Prepared to be injected using needle.
Glass capsule:-contain liquid drugs
Vials (glass bottle):-may contain powder dissolved
before administration
Ampoule:-glass flask/container containing a single dose
medication for parentral administration.
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28. Safety when administering medication
Safety is of the most importance in preparing and implementing
drug administration.
The nurse observes the three checks and the five rights when
administering medication.
The three checks:-the label on the medication container should be
checked three times during medication preparation.
When the nurse reaches for container or unit dose package.
Immediately before pouring or opening the medication and
When replacing the container to the drawer or shelf or prior to
giving the unit dose to the client.
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29. The five rights of medication administration
The five rights ensure accuracy when administering
medications. These five rights are:
◦ Right client/pt
◦ Right drug/medication
◦ Right dosage
◦ Right route
◦ Right time
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30. N.B The nurse gives the right medication for a
right client in a right dosage through the
right route at the right time.
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31. ROUTES OF DRUG ADMINISTRATION
The route of administration should be indicated when the
drug is ordered.
When administering the drug, the nurse should ensure
that the pharmaceutical preparation is appropriate for the
route specified.
There are different routes of administration
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32. Oral
Drugs given orally are intended for absorption in the
stomach & small intestine.
Advantage-most common & least expensive route
most convenient &safest route for clients
doesn’t break skin barrier& doesn’t cause stress.
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33. Disadvantages
unpleasant taste
GI- irritation
may discolor or harm the teeth
Inappropriate for those clients who can’t swallow,
for unconscious pts/mentally ill clients,
those with nausea& vomiting
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34. After oral administration, drug action has a slower
onset and a more prolonged but less effect
Equipment
Medication tray - Towel
A bowl of water for used drug cup - Medicine glasses.
Medication cup - measuring spoon
Jug of water chart and medication card
Ordered medication
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35. Sublingual
The tablet is placed under the client’s tongue.
This area is reach in superficial blood vessels that allows
the drug to be absorbed relatively rapidly into
bloodstream for quick systemic effect.
E.g. Nitroglycerine-a drug for treatment of angina
pectoris
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36. Parentral route
Parentral means outside the intestine or alimentary
canal.
These may be injected into ID, SC, IM, IV, intra lesional
tissue, intra spinal, etc.
Medications given by parentral route usually absorbed
completely and begin acting faster than medications
given by other routes.
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37. The following are some of the more common routes for
parentral administration.
Subcutaneous or hypodermic:-into the subcutaneous
tissue, just below the skin.
Because there is subcutaneous tissue all over the body,
various sites are used for SC injection:
E.g. outer aspects of the upper arm, anterior aspects of
the thigh, lower abdominal wall, and upper back
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38. This route is used to administer insulin, heparin,
adrenalin and certain immunizations (measles).
Ordinarily no more than 1ml of solution is given
subcutaneously.
The needle is inserted at 45 degree angle to the body.
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39. Equipment
1. Disposable syringe and needle
2. Small tray
3. Medication
4. Ampoule of sterile water if medication must be dissolved
5. Cotton balls soaked with alcohol.
6. File
7. Receiver
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40. Intradermal (ID)
Administration of medication under epidermis, into the
dermis layer of the skin.
It is used for administration of small doses, usually less
than 0.5ml (0.1, 0.01ml).
A 0.6 -1.3cm, 26- or 27 gauge needle is used.
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41. The ID route has the longest absorption period (slow
absorption) of all parentral routes
Sites commonly used are inner surfaces of forearm, the
dorsal aspect of upper arm, & the upper back.
The needle is inserted at 15 degree angle to the skin for
intradermal injection
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42. Equipments
Tray, file
Receiver
A vial or ampoule of sterile medication
Vial of diluents (when necessary)
Alcohol swab, Dry sterile gauze
Marking pen
Sterile syringe and needle
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43. Intramuscular (IM)
Administration of medication into the muscle.
Absorption is rapid than SC-route, because of the greater
blood supply to the muscle.
Large volume of fluid or medication can be injected
without causing discomfort.
4ml is considered the maximum dose to be given IM on
one site for an adult with well developed muscle.
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44. A volume of 1 to 2ml is usually recommended for adults
with less developed muscle.
Deltoid muscle accommodates small volume of
medication, small sized & gauged needle than other sites
of IM injection
Common sites for IM injection are: deltoid muscle
(upper arm), ventrogluteal muscle (hip), vastus lateralis
(on thigh), rectus femoralis (thigh).
The needle is inserted at 90 degree angle to the body
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45. Disadvantages-it breaks skin integrity
- Pain and anxiety may develop.
Equipment:
1. Disposable syringe and needle
2. Cotton balls soaked in alcohol
3. Small tray, Medication
5. Ampoule of sterile (if drug is to be dissolved)
6. Fill, Receiver.
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46. Intravenous (IV)
administration of medication through veins.
It is the most dangerous route of drug administration,
because the drug is placed directly into the blood stream,
it cannot be recalled nor its action be slowed.
It would be the route chosen in an emergency situation
when immediate absorption is required.
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47. Advantage
◦ large volume can be given
◦ getting rapid effect.
◦ Used to administer fluid/nutrition if the pt can’t feed
by mouth.
Disadvantage–the drugs prepared for IV administration
is expensive
◦ Limited to highly soluble medications.
◦ drug distribution is inhibited by poor circulation.
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49. Less common parentral routes of administration
Intra-arterial
◦ Inject directly in to the arteries
◦ Commonly used for diagnostic purposes
Intra-cardiac
◦ Inject directly in to the muscle of hearts e.g.
adrenaline
◦ Used for emergency medication
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50. Intra-osseous
◦ Inject directly in to the bone including areas of
ossification particularly joint area
◦ Used in chronic infection of bone e.g. Osteomyelitis
Intra-thecal/ intra-spinal
◦ Inject directly in to spinal column
◦ commonly used for diagnostic purposes
◦ for medication administration on lumbar region
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51. INTRAVENOUS INJECTION (THERAPY)
It is an introduction of a large amount of fluid into the
blood stream through a vein.
Purpose: -
To maintain fluid and electrolyte balance and restore
acid-base balance, in case of shock, haemorrhage and
other metabolic disorders.
To introduce medication through the vein, particularly
antibiotics.
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52. Site of injection: - Usually one of the large superficial
veins in front of the upper arm is used or vein on the
inner aspect of the ankle.
Preparation of the patient: - since an infusion therapy
takes several hours to complete, the patient should first
be made comfortable/informed.
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56. Formula for computing drug dosage
Some times drugs are prepared and supplied in the
amount ordered
Not prepared and supplied in the exact quantity and the
nurse must do a dosage calculation to determine what
quantity medication the client is to receive
The dosage must be in the same unit of measurement
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57. Several formulas can be used to calculate drug dosage.
One of these formulas is used to set up proportions.
Dose on hand = dose desired
Quantity on hand X (quantity desired)
E.g. If Erythromycin 500mg is ordered & supplied in a
liquid preparation containing 250mg in 5ml, how much
volume of erythromycin is administered?
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58. Volume to be given = Dosage ordered X Volume on hand
Dosage on hand
E.g. Give procaine penicillin 800,000IU IM BID from a vial
containing procaine penicillin 4 million IU dissolved in
10ml. What is the volume of procaine penicillin to be
injected?
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59. Intravenous medication calculation
To infuse a medication for a set time, the nurse needs to
calculate the appropriate rate of flow for the medication.
IV flow rates are calculated in drops/min.
To calculate IV drip rate, the nurse can use the following
formula
ml of solution X drip rate factor = drops/min
Hrs to administer 60(min/hr)
1ml= 15-20drop, this is the drip rate factor
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60. E.g. If you are ordered to administer 1L of Normal saline
over 4hours, what would be the flow rate?
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61. TOPICALADMINISTRATION
Drug is applied directly to the body sites.
Usually intended for direct (local) action on a particular
site
Applied locally to the skin or to mucus membrane in
areas such as the eye, internal ear canal, vagina and
rectum.
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62. Skin application
The process of applying medication to the skin is called
inunctions.
Powders:-are used to promote drying of the skin and
prevent friction on the skin.
Ointments:-provide prolonged contact of medication on
skin and soften the skin.
Creams& oils:-lubricate and soften the skin & prevent
drying of the skin.
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63. Ophthalmic drops/ointments
Eye drops:-instillation of eye drops is performed for their
local effects; such as pupil dilation or constriction when
examining the eye or for treating infections like
trachoma.
Ointments:-used to treat local infections & irritation of
the eye. After application the eye should be closed and
the client is instructed to move the eye ball to spread the
ointment
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64. Nasal installation:-used to treat sinus infections and
nasal congestion/obstruction
Vaginal suppositories:-medications are applied directly
to the vagina to
Treat or prevent infection
Remove an offensive or irritating discharge
Reduce inflammation & relieve vaginal discomfort.
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65. Rectal suppositories: - are used primarily for their local
action, such as a laxative & fecal softener.
NB: Use disposable gloves to insert rectal & vaginal
suppositories to prevent contamination.
The client should remain in that position for 5min,
unless it is for laxative purpose (35-45min), or until the
client feels urge to defecate.
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66. Ear installation
Are placed in the auditory canal for their local effect.
Used to soften wax, relive pain, apply local anesthesia,
destroy microorganisms, or destroy an insect lodged in
the ear canal
sterile technique is used to prevent infection in case of
ruptured tympanic membrane.
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67. MEDICATION ORDER
Medications can be prescribed as stat, single-dose,
standing, and PRN orders.
Stat Orders
Order for a single dose of medication to be given
immediately.
Stat drugs are often prescribed in emergency situations
to modify a serious physiological response
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68. Single-dose Orders
One-time medications or may require the administration
of drops or tablets over a short period of time.
The nurse should administer single-dose orders only
once, either at a time specified by the health care
practitioner or at the earliest convenient time.
These drugs are often prescribed in preparation for a
diagnostic or therapeutic procedure
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69. Standing Orders
Also referred to as scheduled orders
They are administered routinely as specified until the
order is canceled by another order.
The purpose of a standing medication order is to
maintain the desired blood level of the medication
E.g. lente insulin 16IU SC daily in the morning and 8IU in
the evening
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70. PRN Orders
A drug may be ordered on a PRN (as needed) basis as
circumstances indicate.
The drug is administered when, in the nurse’s judgment,
the client’s condition requires it.
This type of order is commonly written for analgesics,
antiemetics, and laxatives.
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