Medication

Administration
Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia University
Define selected terms related to the
administration of medications.
 Medication

 Substance administered for the diagnosis,

treatment, or relief of a symptom or for the
prevention of diseases
 Used interchangeably with the word drug
 Drug also has the connotation of an illegally
obtained substance
 Prescription

 Written directions for the preparation and

administration of a drug
 Generic name of a drug

 Name given before a drug becomes officially

approved as a medication
 Official name of a drug

 Name under which it is listed in one of the official

publications
 Chemical name of a drug

 Name by which a chemist knows the drug

 Trade or brand name

 Name given by the drug manufacturer

 Usually short and easy to remember
 Pharmacology

 Study of the effect of drugs on living

organisms
 Pharmacy
 Art of preparing, compounding, and dispensing
drugs
 Also refers to the place where drugs are prepared
 Describe legal aspects of
administering medications.
Legal Aspects of Administering
Medications
– Nursing practice acts
– Responsibility for actions
– Question any order that appears
unreasonable
– Refuse to give the medication until the order
is clarified
 Controlled Substances
– Kept under lock
– Special inventory forms
– Documentation requirements
– Counts of controlled substances
– Procedures for discarding
 Nurses need to know how nursing practice
acts in their areas define and limit their
functions and be able to recognize the
limits of their own knowledge and skills.
Under the law, nurses are responsible for
their own actions regardless of whether
there is a written order. Therefore, nurses
should question any order that appears
unreasonable and refuse to give the
medication until the order is clarified.
 Another aspect of nursing practice
governed by law is the use of controlled
substances. Controlled substances are
kept under lock. Special inventory (list of
items) forms are used for recording the
use of these substances
 The information usually required on these
forms include the name of the client, date
and time of administration, name of the
drug, dosage, and signature of the person
who prepares and gives the drug. The
name of the primary care provider who
ordered the drug may also be listed.
 A verifying signature of another RN may be
required by the agency when a drug is
administered. Careful inventory control is
maintained. When a portion or all of a controlled
substance is discarded, the nurse must ask
another nurse to witness the discarding. In most
agencies, counts of controlled substances are
taken at the end of each shift and the count
total should tally with the total at the end of the
last shift minus the number used.
Identify physiologic factors and
individual variables affecting
medication action.
Factors Affecting Medication Action

– Developmental
– Gender
– Cultural, ethnic, and genetic
– Diet
– Environment
– Psychologic
– Illness and disease
– Time of administration
 Medication action may be affected by
developmental factors, gender, culture,
ethnicity, genetics, diet, environment,
psychologic factors, illness and disease,
and time of administration.
 The nurse needs to be aware of
developmental factors. Pregnant women
must be careful about taking medications,
especially in the first trimester, because of
the possible adverse effects on the fetus.
Infants usually require smaller doses
because of their body size and the
immaturity of their organs.
 Older adults have different responses to
medications due to physiologic changes
that accompany aging and because they
may be prescribed multiple drugs and
incompatibilities may occur.
 Gender differences in medication action are
chiefly related to the distribution of body fat and
fluid and hormonal differences. In addition, most
research studies on medications have been done
on men.
 In addition to gender, a client’s response
to drugs is also influenced by genetic variations
such as size and body composition
(pharmacogenetics).
 Ethnopharmacology is the study of the
effects of ethnicity on response to
prescribed medications. Cultural factors
and practices (values and beliefs) can also
affect a drug’s action; for example, an
herbal remedy may speed up or slow
down the metabolism of certain drugs
(see Culturally Competent Care).
 The diet may contain nutrients that can
interact with medications and increase or
decrease action.
 It is important to consider the effects of a
drug in the context of the client’s
personality, milieu (surroundings ), and
environmental conditions (e.g.,
temperature, noise).
 Psychologic factors, such as a client’s
expectations about what a drug can do,
can affect the response to the medication.
 Illness and disease can affect how a
client responds to a medication. For
example, aspirin can reduce body
temperature of a feverish client but has no
effect on body temperature of a client
without a fever.
 Time of administration is important
because medications are absorbed more
quickly if the stomach is empty; however,
some medications irritate the
gastrointestinal tract and are given after a
meal.
 Routes of Medication
Administration
– Oral (PO)
– Sublingual (SL)
– Buccal
– Parenteral
 Subcutaneous (SC)
 Intramuscular (IM)
 Intradermal (ID)
 Intravenous (IV)
 Intra-arterial (IA)
 Intracardiac (IC)
 Intraosseous (IO)
 Intrathecal (intraspinal) (IT) (IS)
 Epidural (ED)
 Intra-articular
 Topical

– Dermatological
– Instillations and irrigations
– Inhalation
– Ophthalmic, otic, nasal, rectal, and vaginal
 Routes of medication administration
include oral, sublingual, buccal,
parenteral, and topical.
 In oral administration the drug is
swallowed. It is the most common, least
expensive, and most convenient route for
most clients
 In sublingual administration a drug is
placed under the tongue, where it
dissolves.
 Buccal means “pertaining to the cheek.” In
buccal administration a medication is held
in the mouth against the mucous
membranes of the cheek until the drug
dissolves.
 Some common routes for parenteral
administration include subcutaneous
(hypodermic), 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 an artery;
 intracardiac, into the heart muscle;
intraosseous, into the bone;
 intrathecal or intraspinal, into the spinal
canal;
 epidural, into the epidural space; and
intra-articular, into a joint.
 Topical applications are those applied
to a circumscribed surface area of the
body. Routes for topical applications
include dermatologic, applied to the skin;
instillations and irrigations, applied into
body cavities or orifices such as the
urinary bladder, eyes, ears, nose, rectum,
or vagina
 ophthalmic, otic, nasal, rectal, and vaginal
topical preparations; and inhalations,
administered into the respiratory system
by a nebulizer or positive pressure
breathing apparatus.
 Parts of a Medication Order

– Full name of the client

– Date and time the order written
– Name of drug to be administered
– Dosage
– Frequency of administration
– Route of administration
– Signature of person writing the order
Types of Medication Orders and
Examples
– Stat order
 Demerol 100 mg IM stat
– Single order
 Seconal 100 mg hs before surgery
– Standing order
 Multivitamin 1 capsule po daily
 Demerol 100 mg IM q 4 h x 5 days
– prn order
 Amphojel 15 mL prn
 A stat order indicates that the medication
is to be given immediately and only once
(e.g., Demerol 100 mg IM stat).
 The single order or one-time order is
for medication to be given once at a
specified time (e.g., Seconal 100 mg hs
before surgery).
 The standing order may or may not have a
termination date, may be carried out indefinitely
(e.g., multiple vitamins daily) until an order is
written to cancel it, or may be carried out for a
specified number of days (e.g., Demerol 100 mg
IM q4h × 5 days).
 A prn order or as-needed order permits
the nurse to give a medication when, in the
nurse’s judgment, the client requires it (e.g.,
Amphojel 15 mL prn).
State systems of measurement that
are used in the administration of
medications.
 Systems of Measurement

– Metric
– Apothecary
– Household
List six essential steps to follow
when administering medication.
 Six Essential Steps for
Administering Medications
– Identify the client
– Inform the client
– Administer the drug
– Provide adjunctive interventions as indicated
– Record the drug administered
– Evaluate the client’s response to the drug
 1. When administering any drug,
regardless of the route of administration,
the nurse must identify the client, inform
the client, administer the drug, provide
adjunctive interventions as indicated,
record the drug administered, and
evaluate the client’s response to the drug.
 The nurse must use at least two client
identifiers whenever administering
medications. Acceptable identifiers may be
the person’s name, an assigned
identification number, a telephone
number, a photograph, or another
personal identifier.
 If the client is unfamiliar with the
medication, the nurse should explain the
intended action as well as any side effects
or adverse reactions that might occur. It is
also very important to listen to the client.
 Before administering the drug, the nurse
should read the medication administration
record (MAR) carefully and perform three
checks with the labeled medication (See
Box 35–3). In addition the ten “rights” of
medication administration must be
observed
 The nurse should provide adjunctive
interventions as indicated. Clients may
require physical assistance in assuming
positions for parenteral medications or
may need guidance about measures to
enhance drug effectiveness and prevent
complications.
 The nurse must record the drug
administered, following agency
regulations.
 In order to evaluate the client’s
response to the drug, the nurse should
know the kinds of behavior that reflect the
action or lack of action of the drug and its
untoward effects (both minor and major)
for each medication the client is receiving.
 The nurse may also report the client’s
response directly to the nurse manager
and primary care provider.
 Ten “Rights” of Accurate
Medication Administration
– Right medication (Drug)
– Right dose
– Right time
– Right route
– Right client
– Right documentation
– Right client education
– Right to refuse
– Right assessment
– Right evaluation
Describe physiologic changes in
older adults that alter
medication administration and
effectiveness
.
–Elder Considerations
– Altered memory
– Decreased visual acuity
– Decrease in renal function
– Less complete and slower absorption from the
gastrointestinal tract
– Increased proportion of fat to lean body mass
– Decreased liver function
– Decreased organ sensitivity
– Altered quality of organ responsiveness
– Decrease in manual dexterity
 Physiologic changes in older adults that
alter medication administration and
effectiveness include altered memory;
decreased visual acuity; decreased renal
function, resulting in slower elimination of
drugs and higher drug concentration in
the bloodstream for longer periods; less
complete and slower absorption from the
gastrointestinal tract;
 increased proportion of fat to lean body
mass, which facilitates retention of fat-
soluble drugs and increases the potential
for toxicity; decreased liver function,
which hinders biotransformation of drugs;
 decreased organ sensitivity, which means
that the response to the same drug
concentration in the vicinity (surrounding
region) of the target organ is less in older
people than in the young; altered quality
of organ responsiveness, resulting in
adverse effects becoming pronounced
before therapeutic effects are achieved
 and decreased manual dexterity due to
arthritis and/or decreased flexibility .
 Outline steps required to
administer oral medications
safely.
 Prior to administering oral medications,
the nurse should assess for allergies to
medications ,the client’s ability to swallow
the medication;
 presence of vomiting or diarrhea; specific
drug action, side effects, interactions, and
adverse reactions; the client’s knowledge
of and learning needs about the
medication; and determine if assessment
data influences administration of the
medications.
 In preparation for administering the
medication, the nurse should know the
reason why the client is receiving the
medication, the drug classification,
contraindications, usual dosage range,
side effects, and nursing considerations
for administering and evaluating the
intended outcomes for the medication.
The nurse should check the MAR, verify
the client’s ability to take medication
orally, and organize the supplies.
 Outline steps required for nasogastric and
gastrostomy tube medication
administration.
 Nasogastric/Gastrostomy Tube Medication
Administration
– Check with the pharmacist for a liquid form
– Check to see if medication may be crushed
– Crush a tablet into a fine powder and dissolve
in at least 30 mL of warm water
– Open capsules and mix the contents with
water only with the pharmacist’s advice
– Do not administer whole or undissolved
medications
– Assess tube placement
– Aspirate stomach contents and measure the
residual volume
 Nasogastric/Gastrostomy Tube
Medication Administration
– Remove the plunger from the syringe and
connect the syringe to a pinched or kinked
tube
– Put 15 to 30 mL (5 to 10 mL for children) of
water into the syringe barrel to flush the
tube before administering the first
medication
– Pour liquid or dissolved medication into the
syringe barrel and allow to flow by gravity into
the enteral tube
– Administer each medication separately and
flush with at least 15 to 30 mL water between
each medication
– When you have finished administering all
medications, flush with another 15 to 30 mL
(5 to 10 mL for children) of warm water to
clear the tube
– If the tube is connected to suction, disconnect
the suction and keep the tube clamped to
enhance absorption
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