MEDICATIONS

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 fo A liquid, powder, or foam deposited in a thin layer on the skin by air pressure
am

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

Gel or jell A clear or translucent semisolid that liquefies when applied to the skin
y

Liniment A medication mixed with alcohol, oil, or soapy emollient and applied to the skin

Lotion A medication in a liquid suspension applied to the skin

Lozenge (t A flat, round, or oval preparation that dissolves and releases a drug when held in the mo
roche) uth

Ointment A semisolid preparation of one or more drugs used for application to the skin and mucou
s membrane
(salve, un
ction)

A preparation like an ointment, but thicker and stiff, that penetrates the skin less than a
Paste
n ointment

One or more drugs mixed with a cohesive material, in oval, round, or flattened shape
Pill
s

Powder A finely ground drug or drugs; some are used internally, others externally

One or several drugs mixed with a firm base such as gelatin and shaped for insertion
Suppository into the body (e.g., the rectum); the base dissolves gradually at body temperature, re
leasing the drug

Syrup An aqueous solution of sugar often used to disguise unpleasant-tasting drugs

A powdered drug compressed into a hard small disk; some are readily broken along a
Tablet scored line; others are enteric coated to prevent them from dissolving in the stomac
h

Tincture An alcoholic or water-and-alcohol solution prepared from drugs derived from plants

Transdermal A semipermeable membrane shaped in the form of a disk or patch that contains a dr
 patch ug to 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.

Medication Routes:
A. Oral

B. Sublingual

C. Suppositories

D. Intradermal

E. Subcutaneous

F. Intramuscular

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.

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.

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).

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.

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?).

Administering an Intradermal Injection for Skin Tests

Administering an Intradermal Injection for Skin Tests

Administering Subcutaneous Injection

Administering Subcutaneous Injection

Administering an Intramuscular Injection

Administering an Ophthalmic and Otic Drugs

Basic Principles to the preparation and administration of medicine

 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.
 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”
  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.

 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.
 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)
 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.
 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.
 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.
 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

FREQUENC
HOUR
Y
O.D 8:00
8:00 – 4:00 (Antibiotic)
8:00 – 6:00 (Misc. Drugs)
B.I.D
8:00 – 8:00 (Tranquilizers/
sedatives)
T.I.D 8:00 – 1:00 – 6:00
Q.I.D 8:00 – 12:00
 4:00 - 8:00
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: 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)
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

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

[Link] 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.