Role of nurse in Medication Administration
Learn about the diagnosis, drug, other therapies and treatment
for the patient.
Administer medications and treatments and perform procedures
Properly monitor, document and report responses to medication,
treatment and procedures and communicate the same to other
health care professionals clearly and accurately.
Learn about the rational for medication prior to
administration, the effect of medication, and
treatment and should administer correctly at the same
Accurately and completely report and document
administration of medication and treatment.
Clarify for accuracy, then about non-efficiency and
contraindication by consulting with the doctors and
notify the ordering doctors when the nurse makes
decision not to administer the medicine or treatment.
While doing medication, nurses should consider for:
Follow institutional policy
Consider client’s desire and abilities
Correctly document all the actions related to
medication administration and medication errors
Aseptic technique should be followed while giving
Care should be taken to avoid needle-stick injuries,
which may transmit infectious diseases.
Care of medicine and medicine cupboard
Wards should have medicine cabinet for proper care of medicines
Cabinets should be large enough that it can accommodate all
medicines and should have separate compartment for tablets,
powders and ointments.
Cabinets should be in separate room near to nurses’ room as far
as possible. The room should be facilitated with sink and running
There should be proper lock system in the cupboards
and the key should be in easy access for doctors and
Bottles should be arranged alphabetically.
Poisonous medicines should be kept in separated
cupboard with separated lock and key. Senior sisters is
responsible for all those medicines
Register should be maintained to keep the account of
Drugs with unusual colour, ordour and consistency should be
returned to pharmacy to discard.
Oils such as Castrol oil, serum, vaccines and antibiotics such as
penicillin should be kept in fridge.
Emergency drugs should be kept separately in a tray or a box
which are portable in emergency.
When indenting for drugs, indent only the required quantity.
Medicine cabinet should be kept neat and clean.
Equipment should be cleaned and replaced after use.
All inventory of drug should be maintained in each shift. On daily
basis check, verify and document the proper temperature
Date of manufacture and expiry should be checked periodically.
The storage should not hinder the cleaning and should have
sufficient space for movement of stocks and handling.
“Protected from light” the product is to be stored
either in a container made of material that absorbs
actinic light sufficiently to protect the contents from
change induced by such light.
The area used for storage of IV fluids should have
adequate space and to prevent exposure to direct
Oxygen is a colorless, odorless
and tasteless gas that is essential
for the body to function properly
and to survive.
Hypoxia: Lack of oxygen availability
FiO2: Fraction of O2 in inspired gas
SpO2: Oxygen Saturation measured by pulse oxymetry
SaO2: Arterial Oxygen Saturation
The most accurate non-invasive
method for detecting hypoxia. It
is used to measure the
percentage of oxygenated
hemoglobin in arterial blood.
Blood gas analysis:
It is another very accurate method for detecting hypoxia.
It is used to measure the partial pressure of oxygen
(PaO2) and carbon dioxide in blood and also blood pH
and the concentration of the main electrolytes.
Indication for oxygen therapy:
Blue coloring of the tongue and gums (central
Inability to drink or feed (when due to respiratory
Grunting with every breath and depressed mental status
(i.e. drowsy, lethargic)
Short-term therapy (e.g. carbon monoxide poisoning) or
surgical intervention (e.g. post anesthesia recovery)
Insufficient oxygen in atmosphere
Congestive heart failure or impaired circulation to the
Normal Values and SpO2
Partial pressure of arterial oxygen (PaO2)
80 -100 mmHg - children/adults
50 - 80 mmHg - neonates
Partial pressure of arterial CO2 (PaCO2)
35 - 45 mmHg children/adults
pH = 7.35 -7.45
The normal range of oxygen saturation is 97-99%. The
main carrier for oxygen is hemoglobin. Each
hemoglobin carries 4 molecules of oxygen.
Methods of Oxygen Therapy
High flow nasal prong therapy
Mask- BiPap or CPAP
The prongs protrude 1 cm into
Used for low
Oxygen 24- 44% at 1-6L/min
(4%every liter /min)
A nasal cannula is a device that consists of a
plastic tube that fits behind the ears, and a set of
two prongs that are placed in the nostrils.
Nasal cannula is connected to an oxygen tank, a
portable oxygen generator or a wall connection in
Provides 28-100% O2.
Face tents are used to provide a controlled
concentration of oxygen ad increase moisture for
patients who have facial burn or a broken nose, or
who are claustrophobic
Difficult to achieve high levels of oxygenation
Face Mask (Hudson)
Most Commonly used Mask.
Indicated for higher concentration
than nasal prongs
Usually applied short term
Patient exhales through ports on sides
It delivers 35% to 60% oxygen at 6-10
Flow must be at least 5 L/min
Provides 40 to 60 % O2 concentration
Used to provide moderate oxygen concentration
It’s efficiency depends on how well mask fits and
patient’s respiration demands
Readily available on most hospital units and
provides higher oxygen for patients
Indicated for precise
concentration of O2
Flow rates from 2- 14L/min
Often used in patients who retain
The only O2 delivery device that
delivers a specific percentage of
Converts nitrogen from air into
Suitable for low flow of O2 1-
Unable to be used for O2 flow
Non‐rebreathing masks are
similar to the simple
semi‐rigid plastic masks with
the addition of a reservoir
bag, which allows the oxygen
to be delivered at
concentrations between 60%
and 90% when used at flow
rates of 10–15 L/min
High flow Nasal Cannula
Similar to nasal cannula
High‐flow oxygen therapy
allows the accurate delivery
of oxygen therapy of up to
100% FiO2 at a flow rate of
up to 60 L/min
A machine that generates a
controlled flow of blended air and
oxygen into a patient’s airway.
1. Oxygen cylinder with
2. Opening key
3. Humidifier with sterile
4. Nasal prongs/ face mask
5. Rubber tubing
6. Lubricant lotion
7. Gauze pads/ pieces
8. Cylinder strep
9. Cotton balls
10. A bowl of water
Steps of Oxygen Therapy
Verify the prescription for O2 administration by the doctor
Check for patient’s identification and confirm the patient
Explain the procedure and purpose of oxygen therapy
Perform complete respiratory assessment for hypoxia,
monitor respiratory rate, rhythm and strength and also
Perform hand hygiene
Fill the humidifier with sterile water for injection up to
the label line.
Join the oxygen tubing and nasal cannula/ face mask
to flow meter to source. Use extension tubing for
ambulatory clients for easy movement.
Turn the flow meter on at the prescribed flow rate. If a
patient has COPD, check doctor’s order for the
amount of required oxygen and the expected
Check for bubbling in the humidifier
Should not be given without prescription of doctor as
oxygen is a medicine
Place the oxygen cylinder in upright position and
chain it properly or in the oxygen holder.
Ensure adequate amount of water in humidifier, at
least one third.
Avoid changing the flow rate with the nasal prong in
Oxygen can catch fire. So, avoid any sparks and fire
and no smoke near the oxygen cylinder.
Oxygen delivery systems should be placed 1.5 meters
from the heat source
Secure the electric equipment at home and in hospital
as a small spark can also cause fire accidents.
High flow oxygen therapy should be closely monitored
with formal assessments
Fire extinguisher should be placed close to the room.
Cylinder should be checked for not to be empty as it
may cause dangerous effect as oxygen supply to the
Assess patient for oxygen toxicity
It means administration drugs by
inhalation and directly deliver
therapeutic dose into lungs.
It uses nebulizer which transports
medications to the lungs by means
of mist inhalation
• Device used to convert liquid drugs into aerosol droplets
suitable for the patient to inhale.
• Uses oxygen, compressed air or ultrasonic power to break up
• To add moisture to oxygen delivery system
• To soften thick sputum and prevent mucus plugging
• To administer various drugs to the airways
• To relief respiratory insufficiency
• To relieve inflammation and allergic responses
• To relieve post-operative complications
In some cases, nebulization is restricted or avoided due to possible
untoward results or rather decreased effectiveness such as:
• Patients with unstable and increased blood pressure
• Individuals with cardiac irritability (may result to dysrhythmias)
• Persons with increased pulses
• Unconscious patients (inhalation may be done via mask but the
therapeutic effect may be significantly low)
Advantage of nebulization
A convenient way of delivering high doses of inhaled
In acute severe asthma, oxygen can be used to nebulize
It can be used by any age group
• Medicine cardex
• Nebulizer and
• Nebulizer connecting tubes
• Compressor oxygen tank
• Mouthpiece/ face mask
• Respiratory medication to be
• Normal saline solution
• Medicines prescribed by the
• Kidney tray
• Sputum mug
• Cotton balls
• Clean water
Check for doctor’s order for the
Prepare equipment and assemble at
Explain the procedure and position
the patient appropriately (sitting or
Assess and record breath sounds, respiratory status, pulse
rate and other significant respiratory functions
Teach patient the proper way of inhalation
Slow inhalation through the mouth via the mouth piece
Short pause after the inspiration
Slow and complete exhalation
Slow resting breaths before another deep inhalation
Place the medication in the nebulizer while adding the
amount of saline solution ordered.
Attach the nebulizer to the compressed gas source
Attach the connecting tubes and mouthpiece to the
Turn the machine on (notice the mist produced by the
Offer the nebulizer to the patient, offer assistance until he is
able to perform proper inhalation (if unable to hold the
nebulizer (pediatric/geriatric/special cases], replace the
mouthpiece with mask
Continue until medication is consumed. It usually takes 15
Clean the face of the patient with clean face towel.
Encourage patient to cough after several deep breaths.
Reassess patient status from breath sounds, respiratory
status, pulse rate and other significant respiratory
functions needed. Compare and record significant
changes and improvement. Refer if necessary
Attend to possible side effects and inhalation reactions
Dissemble, clean and replace articles
Record and report the finding the condition of the
1. Closely monitor all clients receiving
bronchodilators for signs of increased heart
rate, nervous agitation and restlessness
2. Patient Teaching
• proper way of doing the therapy to facilitate
effective results and prevent complications
(demonstration is very useful
• Emphasize compliance to therapy
• report untoward symptoms immediately for
To increase blood volume aftersurgery, trauma, or
To increase the numberof red blood cells in a patientwith
severe chronic anemia.
To provide platelets to patients with low platelet counts
due to treatmentwith chemotherapy.
To provide clotting factors in plasma for patients with
hemophilia or disseminated intravascular coagulopathy
To replace plasma proteins such as albumin.
To replace fresh frozen plasma in case of DIC.
Rate of infusion for components of blood
PRODUCTS INFUSION RATES
Whole blood and red blood cells 1 unit over 2-3 hours
Platelets 30- 60 minutes
Fresh frozen plasma 200ml/hourorslowly
Cryoprecipitate 1-2 ml/min
⚫ Whole blood and Packed Red blood cells:-
⚫ For acute blood loss with hypovolemia
⚫ Exchange transfusion
⚫ Untreated DIC
⚫ Thrombotic Thrombocytopenic
Preparation of Equipemnts
⚫ A Clean tray containing,
A blood request form, blood group and cross match report
Blood product in the containerfor transfusion along with the compatibility
forms and blood details.
Blood administration setwith filter
Normal salineor heparin flush to flush in caseof block in the line.
Adhesive tape to secureIV line
A sterile traycontaining emergencymedications
Verify the physicians order forthe transfusion.
Explain the procedure to the patient.
Ensure that theconsent formsaresigned.
Informabout the side effects (dyspneoa, chills, headache, chest
pain, itching) to the patient and ask him/her to report to the
Obtain baselinevital signs.
Obtain the blood product from the blood bank and ensurethat
it is initiated within 30 minutes.
Verifyand record the blood productand identify the patient
Patient name, blood group, and Rh type
Cross – matchcompatibility
Donor blood groupand Rh type
Unit and hospital number
Expiration date and timeon blood bag
Type of blood product compared with physicians or
qualified practitioners order
Presenceof clots in blood
Instruct the patient toempty the bladder.
Wash hands and puton gloves.
Open blood administration kit/set and move roller
clamps toa closed position and administer prescribed
for single- tubing set:
Spike blood unit.
Squeeze drip chamberand allow the filter to fill with
Open roller clampsand allow tubing to fill with blood
to the hub.
Prime another IV tubing with normal saline and
piggyback it to the blood administration setwith a
needleand secure all connectionswith tape.
For dubble-tubbing set:
Spike the second into the normal saline bag or bottle.
Squeeze thedrip chamberand allow the filterto fill
with normal saline.
Attach tubing tovenous catheterusing sterile
precautions and open lowerclamp.
Infuse the blood ata rate of 2-5 ml/min according to
the physicians order.
Remain with the patient for the first 15-30 minutes,
monitoring vital sighs every 5 minutes for 15 minutes,
theevery 15 minutes for 1 hour, and then hourly until 1
hourafter the infusion iscompleted.
After the blood has been infused, allow the tubing to
clearwith normal saline.
Appropriately dispose off bag, tubing and gloves.
Document the procedure.
RECORDING AND REPORTING
⚫Record thedate and timeof blood transfusion.
⚫Mention the details of the transfusion including type
of blood, blood group, bag number, starting time,
ending time, flow rate, and any adverse reactions
during the transfusions.
⚫Record thevital signs before, during and after the
A. Observe for signs of transfusion reaction.
B. Observe the patientand laboratoryvalues to
determine response to transfusion.
C. Monitor IV siteand statusof infusion each time
when vital signsare taken.
COMPLICATIONS SIGNS AND
1. Allergicreactions Rashes, flushing, hives,
• Stop the infusion
Sudden chills, fever ,
• Keepvein open with the
3. Septic reaction Rapid onset of chills,
• Notify the physicians
4. Circulatoryoverload Cough, dyspnea,
distended neck veins,
and as perorder.
5. Hemolytic reaction Low back pain,
⚫11.03.2021 , 10.00 am
⚫Explained the procedure to the patient. Ensured that
the consent form was signed. Instructed the patient to
empty the bladder. Checked for bag number, grouping
⚫After premedication, whole blood (as prescribed)
B+ve, bag no.****was transfused to Mr. X at ……am.
Vitals were monitored frequently and the patientwas
observed for transfusion reactions. The transfusion
ended at ….pm. Patient felt comfortable.