FUNDAMENTALS OF NURSING PRACTICE
ADMINISTRATION OF MEDICATIONS
Before giving any medication, the nurse must:
- Know the drugs prescribed dose, methods of administration, actions, expected
therapeutic effect, possible interactions with other drugs and adverse effects.
- Know and use the institution’s administration procedures for the client's welfare and protection.
- Review the physician's order for completeness: the client's name, date of the order,
name of the drug, dose, route, time of administration, and the physician's signature.
- Discuss the medication and its actions with the client; re-check the medication order if the
client disagrees with the dose.
- Check the physician's order against the client's medication administration record (MAR) for
accuracy.
- Commonly used administration route are oral (usually absorbed in the GIT), topical
(applied to the skin or mucous membranes), and parenteral (administered by injection
with a needle).
- Medication can also be instilled into the eye or ear or administered by suppository.
- Medication may be given on a regular schedule, as a one-time dose, or as needed
To ensure the client's safety, the nurse adheres to the Ten Rights of medication administration:
Right drug
Right dose
Right client
Right route
Right time
Right documentation
Right approach
Right to know about the drug
Right to refuse
Right drug history
Essential parts of Drug Order:
Full name of the client
Date and time the order is written
Name of the drug to be administered
Dosage of the drug
Frequency of administration
Route of administration
Signature of the person writing the order
Types of Medication Action
Therapeutic Effect - primary effect
Side effect / Secondary effect - predictable, maybe harmless or potentially harmful
Adverse effect - more severe side effect and may justify the discontinuation of the drug
Toxic effect - results from over dosage, or buildup of the drug in the blood because of
impaired metabolism or excretion
Idiosyncratic effects — unexpected and maybe individual to a client
Allergic Reaction - Immunologic reaction
TYPES OF MEDICATION ORDER:
Stat - An order for a single dose of medication to be given immediately
Single Dose – medication to be given once at a specified time
Standing Order – may or may not have termination date may be carried out
indefinitely until an order is written to cancel it or may be carried out for a specified
number of days
PRN – permits the nurse to give a medication. When, in the nurse's judgment, the client
requires it
ROUTES OF DRUG ADMINISTRATION
1. ORAL
- Considered to be the most convenient, usually less expensive, and safe because skin is not broken
- Disadvantages includes:
Drugs may have unpleasant taste
Inappropriate to client with nausea and vomiting and cannot swallow Drugs may stain the teeth
Drugs may be aspirated by seriously ill patient
Administration:
Solid – capsules, pills, tablets or powder
Liquid – syrup, suspension, emulsion, elixir
Syrup – sugar based liquid medication
Suspension – water-based liquid medication, shake the bottle before use
2. SUBLINGUAL
- Drug that is placed under the tongue where it is dissolved
- Drug is rapidly absorbed
3. BUCCAL
- Medication is held in the mouth against re mucus membrane of the cheek until the drug is
dissolved
4. TROPICAL
- Application of the medication to a circumscribed area of the body
- Dermatologic preparation – applied to the skin
- Instillation and immigration - applied into the body cavities or orifices such urinary
bladder, eyes, ears, nose, rectum and vagina
- Inhalations - administrated in the respiratory tract by a nebulizer or positive pressure breathing
apparatus
5. PARENTERAL
- Administration of medication via needle
- Routes are as follows:
Subcutaneous – into the subcutaneous tissue, just below the skin
Intramuscular – into the muscle
Intradermal – under the epidermis (into the dermis)
Intravenous – into a vein
Intra-arterial – into to artery
Intracardiac – into the heart muscle
Intraosseous – into a bone
Intrathecal – into spinal canal
Epidural – into epidural space
Intrapleural – into the pleural space
Intradermal Injection
- Administration of the drug into the dermal layer of the skin beneath the epidermis
- Indicated for allergy and tuberculin testing and for vaccinations
- Needle at 10-to-15-degree angle level up
- Inject a small amount of drug slowly to form a wheal or bleb
- Do not massage the site of injection
Subcutaneous Injection
- Drugs that are administered Subcutaneously are vaccines, preoperative medications,
etc.
- Rotate sites of injection to minimize tissue damage
- Needle at 90degree angle
Intramuscular injection
- Do not inject on injured tissues, or in area where nodules, lumps, abscesses,
tenderness or other pathology are present
- Avoiding hitting the major blood vessels bone or sciatic nerve to prevent complications
- Vastus lateralis is the site of choice for IM injections for infants 1 year and younger
Intravenous Medication
- Medication enters the client’s bloodstream directly by way of vein
- It is appropriate when medications are too irritating to tissues to given by other routes
- Observe reaction
PREPARING MEDICATIONS FROM AMPULES
- Check the medication order
- Check the label of the ampule carefully against the MAR to make sure that correct medication is
being prepared
- Follow the three checks for administering medications. Read the label on medication (1),
when it is taken from the cart (2), before withdrawing the medication and (3) after
withdrawing the medication
- Check for expiration date
- Perform hand hygiene
- Flick the upper stem of the ampule several times
- Use an ampule opener or place a piece of sterile gauze or alcohol wipe between your thumb
and the ampule neck or around the ampule neck and break off the top by bending it toward
you to ensure the ampule is broken away from yourself and away from others
- Place the ampule on a flat surface
- Insert the needle into the center of the ampule. Hold the ampule slightly on its side if
necessary to obtain more than the ordered amount of medication
- Replace the filter needle with a regular needle, tighten the cap at the hub of the needle
and push solution into the needle.
PREPARING MEDICATIONS FROM VIAL
- Perform hand hygiene
- Mix the solution, if necessary, by rotating the vial between palms of the hands, not by shaking
- Remove the protective cap and clean the rubber cap with antiseptic wipes by rubbing it in
circular motion
- Insert the needle into the upright vial through the center of the rubber cap
- Withdraw the prescribed amount of medication using either the following.
Hold the vial down, move the needle tip so that it is below the fluid level and
withdraw the medications. Avoid drawing up the last drop of the vial, or
Invert the vial, ensure the needle tip is below the fluid level; and gradually withdraw
the medication
- Hold the syringe and vial at eye level to determine that the correct dosage of drug is drawn
into the syringe.
- If necessary, tap the syringe barrel to dislodge any air. bubbles present in the syringe