ADMINISTRATION OF MEDICATION

By Wubishet G

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 Objectives
• At the end of the session students will be able to
Define medication
Describe mechanism of drug action
Identify factors affecting drug metabolism
List the types of drug preparation
 Discuss drug measurement system
Identify principles of administering medication
Identify routes of medication administration
Discuss medication order

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 ADMINISTRATION OF MEDICATION

• 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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 ADMINISTRATION OF MEDICATION…

• Medications are substances prescribed by the client’s

health care practitioner
• This is to help in the diagnosis, treatment, relief,
mitigation or cure of the cause of the client’s health
alteration or
• In the prevention of an alteration

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 ADMINISTRATION OF MEDICATION…

• Drugs are chemicals that alter functions of living organism

with a potential for affecting health
• Therapeutic agents are drugs or medications that, when
introduced in to living organism, modify the physiologic
functions of that organism
• N.B All medications are drugs, but all drugs are not
medication.

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 ADMINISTRATION OF MEDICATION…
Pharmacology- is the study of interaction of drugs with
living organisms
 Physical and chemical properties

 methods of administration, absorption, distribution

mechanism of action, biotransformation
 Biochemical and physiological effects

 Knowledge of the history, source, and use of drugs

 clinical uses and adverse effects of drugs

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 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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 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
Metabolism:-metabolism or biotransformation is the
breakdown of the drug to an inactive form in the liver
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 Con’t….

• 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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 Factors Affecting Drug action
Body weight –wt and body surface area affect drug action.
=dosages are based on a weight
 Age of patient– Immaturity of organ function, particularly the
liver and kidneys, can affect the ability of infants and young
children to metabolize drugs
 Disease state- hepatic and renal disease can greatly affect drug
response
• Route of Administration- Intravenous administration of a drug
produces the most rapid drug action then IM>SC
• Sex: - this is due to the difference in body fat and fluid content
between male and female that will affect absorption and
distribution of drugs
• Genetic:-differences in ethnic or racial group may give different
response to the same medication.
• Time of administration, psychology,
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diet
Administration of Medication 10
 Drug preparations
[Link] Solids
• Tablets: compressed or molded substances, to be swallowed whole,
chewed before swallowing, or placed in the buccal pocket or under
the tongue (sublingual)
• Capsules: substances encased in either a hard or a soft soluble
container or gelatin shell that dissolves in the stomach
• Caplets: gelatin-coated tablets that dissolve in the stomach
• Powder and granules: finely ground substances
• Enteric-coated: coated tablets that dissolve in the intestines
• Time-release capsules: encased substances that are further enclosed
in smaller casings that deliver a drug dose over an extended period of
time
• Sustained-release: compounded substances designed to release a
drug slowly to maintain a steady blood medication level
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 [Link]

• Liniments: substances mixed with an alcohol, oil,

or soapy emollient that is applied to the skin
• Ointments: semisolid substances for topical use
• Pastes: semisolid substances, thicker than an
ointment, absorbed slowly through the skin
• Transdermal patches: contain medication that is
aborbed through the skin over an extended
period of time
• Suppositories: gelatin substances designed to
dissolve when inserted in the rectum, urethra, or
vagina
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 [Link]
• Solutions: contain one or more soluble chemical substances
dissolved in water
• Enemas: aqueous solutions for rectal instillation
• Douches: aqueous solutions that function as a cleansing or
antiseptic agent that may be dispensed in the form of a
powder with directions for dissolving in a specific quantity of
warm water
• Suspensions: particle or powder substances that must be
dissolved in a liquid (shaken vigorously) before administration
• Emulsion: a two-phase system in which one liquid is dispersed
in the form of small droplets throughout another liquid
• Syrups: substances dissolved in a sugar liquid
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 Con’t…
• Gargles: aqueous solutions
• Mouthwashes: aqueous solutions that may contain
alcohol, glycerin, and synthetic sweeteners and
surface-active flavoring and coloring agents
• Nasal solutions: aqueous solutions in the form of
drops or sprays
• Optic (eye) and otic (ear) solutions: aqueous
solutions that are instilled as drops
• Elixirs: nonaqueous solutions that contain water
varying alcohol content, and glycerin or other
sweete
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 [Link]
• Inhalations: drugs or dilution of drugs
administered by the nasal or oral respiratory
route for a local or systemic effect

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 Routes of Drug Administration
=The route of drug administration influences the action
of that drug on the body.
• Oral:- sublingual, buccal
• Parenteral:-
Intradermal
Subcutaneous
Intramuscular
Intravenous
• Topical
• Inhalation
• Intraocular
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 Oral Administration
• Definition: administration of medication by mouth
1. To prevent the disease and take supplement in order to
maintain health
2. To cure the disease
3. To promote the health
4. To give palliative treatment
5. To give as a symptomatic treatment
Purposes
When local effects on GI tract are desired
When prolonged systemic action is desired

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 …
Equipments required:
 Steel tray
 Drinking water in jug
 Dr’s prescription
 Medicine prescribed
 Medicine cup
 Pill crusher/ tablet cutter if needed
 Kidney tray/ paper bag (to discard the waste)

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 oral…
Advantage- the most common & least expensive route
-most convenient &safest route for clients
-doesn’t break skin barrier& doesn’t cause stress.
Disadvantages-
• unpleasant taste
• GI- irritation
• slow absorption than the other routes, such as injectable
drugs.
• may discolor or harm the teeth
• Inappropriate for those clients who can’t swallow, for
unconscious patients/mentally ill clients, those with
nausea&
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vomiting, etcAdministration of Medication 19
 Oral …

• Contra- indications
For a patient with nausea & vomiting, unconscious
patients.
When digestive juices inactivate the effect of the
drug.
When there is inadequate absorption of the drug,
which leads to inaccurate determination of the
drug absorbed.
When the drug is irritating to the mucus membrane
of the alimentary canal.
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Administering oral medications through a Nasal-Gastric tube
• Administering through a nasal-gastric tube is a process that
administer oral medication through a nasal-gastric tube instead of
mouth.
Purpose:
• as “Administering oral medication”
Equipments required:
1. Client’s kardex and chart
[Link] prescribed
[Link] cup
[Link] or another fluids as needed
[Link] crusher if an order to crush medications has been obtained
[Link] gloves: if available
7. Large syringe (20-30mL)
8. Small syringe (3-5mL)
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 Parentral route
Parentral=outside alimentary canal
• Medications that are given by injection or infusion
• These may be injected into ID, SC, IM, IV, intra lesional
tissue, intra spinal, intra osseous etc.
• Medications given by parentral route usually absorbed
completely and begin acting faster than medications given
by other routes.
• These medications are given through the skin; by passing
the skin barrier & makes infection more likely if aseptic
technique is not used when preparing and administering
parentral medications.
• Complications may occur if not given into the intended
tissue
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 Routes of Administration…
• Intradermal (ID):- is administration of medication under epidermis,
into the dermis layer of the skin.
 It is a common route for diagnostic purpose such as the tuberculin
skin test (mantoux test )
 For therapeutic purpose
 ID injection may also be given like in vaccination - BCG ,Rabies for PEP
=small doses administered, usually less than 0.5ml (0.1, 0.01ml).
 has the longest absorption period (slow absorption) of all parentral
routes
• Site of Injection
The inner part of the forearm (midway between the wrist and
elbow.
Upper arm, at deltoid area for BCG vaccination
Rarely the upper back.
Its disadvantage is it breaks
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skin barrier
Administration of Medication 23
 Sub-Cutaneous (SC) or hypodermic
 Injecting of drug under the skin in the sub- cutaneous tissue,
(under the dermis)=between dermis and muscle;
-Because there is subcutaneous tissue all over the body, various
sites are used for SC injection:
-used to administer insulin, heparin, adrenalin (0.5ml) and
certain immunizations (measles vaccine)
 Ordinarily no more than 1ml of solution is given
subcutaneously.
 The needle is inserted at 45 degree angle to the body
 *Sc injection sites need to be rotated in an orderly fashion to
minimize tissue damage, aid absorption, and avoid
discomfort for pts receiving repeated doses.
• Purpose:
 To obtain quicker absorption than oral administration
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
 …
• Site of Injection
Outer part of the upper arm
lower abdominal wall below the costal margin to the iliac
crest.
The anterior aspect of the thigh
Upper back
• If repeated injections are given, the nurse should rotate the
site of injection
• So that each succeeding injection is about 5 cm away from
the previous one
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 Intra- Muscular Injection
It is an introduction of a drug into a body's system via
the muscles.
Absorption is rapid than SC and ID-route, because of
the greater blood supply to the muscle
4ml is considered the maximum dose to be given
intramuscularly on one site for an adult with well
developed muscle

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 …
• A volume of 1 to 2ml is usually recommended for adults
with less developed muscle.
• Usually a 2 to 5ml syringe and 21-or 22 gauge needle is
used for IM injection.
• Deltoid muscle accommodates small volume of medication,
small sized & gauged needle than other sites of IM
injection.
• Purpose
To obtain quick action next to the intra- venous route
To avoid an irritation from the drug if given through
other route.
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 IM injection sites
• Select a safe site, one that is away from large nerves,
bones, and blood vessels.
• When care is not taken, common complications include:
abscess, necrosis and skin slough, nerve injury (paralysis),
pain and periostitis (infection of the membrane covering
the bone)
• Common sites for IM injection are: deltoid muscle (upper
arm), ventrogluteal (hip), dorsogluteal, vastus lateralis (on
thigh), rectus femoralis (thigh).
• The needle is inserted at 90 degree angle to the body
• Disadvantages- it breaks skin integrity
- Pain and anxiety may develop.
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 COMMON INTRAMUSCULAR
INJECTION SITES AND MUSCLES
Site Muscle
• Dorsogluteal Gluteus maximus
• Ventrogluteal Gluteus medius
• Anterolateral aspect of thigh Vastus lateralis
• Upper arm Deltoid
 The needle for IM injection should be long
• Strict aseptic technique should be observed
• Injection should not be given in inflamed areas

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 Injection site
– Deltoid muscle
Location: upper arm
Landmarks: Acromion Process, axillary fold
Muscle mass: triangle apex at axillary line and base of
triangle 2-3 finger breadths below acromion process.
Injection area: in the middle of the triangle / into belly
of the muscle mass.
Avoid Brachial artery & Radial nerve (BARN)

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 Deltoid • Should not be
used in infants or
children because
of the muscle’s
small size.
• Injection volume
should not
exceed 1ml in the
adult

• Rarely used for

hospitalized
patients.
Primarily used for
immunizations.
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 Ventrogluteal Site
• The ventrogluteal site uses the gluteus medius and
gluteus minimus muscles in the hip for injection.
• This site has several advantages over the dorsogluteal
site:
 it has no large nerves or blood vessels, and it is usually
less fatty and cleaner because fecal contamination is
rare at this site.
 The ventrogluteal site is also safe for use in children.

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 …
• To locate the ventrogluteal site:
– Place the palm of the hand on the greater trochanter
and the index finger on the anterior-superior iliac
spine
– Move the middle finger away from the index finger as
far as possible along the iliac crest.
– Inject into the center of the triangle formed by the
index finger, middle finger, and iliac crest.

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 Ventrogluteal muscle
Location: lateral (ventral)
side of the hip

Landmarks: Iliac crest,

anterosuperior illiac
spine, greater
trochanter of femur

Muscle mass: Gluteus

medius and
minimus

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Dorsogluteal site
Inject above and outside a line drawn from the posterior superior iliac
spine to the greater trochanter of the femur(Z-track ).
 Or, divide the buttock into quadrants and inject in the upper outer
quadrant, about 5 to 7.6 cm below the iliac crest. Insert the needle at a 90-
degree angle This site is avoided in clients younger than 3 years
because their muscle is not sufficiently developed.

If the dorsogluteal site is not identified correctly,

damage to the sciatic nerve with subsequent paralysis of
the leg can result. To locate the appropriate landmarks

Divide the buttock into four imaginary quadrants.

Palpate the posterior iliac spine and the greater

trochanter.

Draw an imaginary diagonal line between the two

landmarks.

Insert the needle superiorly and laterally to the

midpoint of the diagonal line.
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 Vastus Lateralis

 Identify the greater trochanter

and the lateral femoral condyle

 Select the site using the middle

third and the anterior lateral
aspect of the thigh.
• Or divide thigh into thirds, inject
into bottom of top 1/3

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12/29/2024 Administration of Medication 37
 Traditional (upper outer quadrant)

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 Contraindication
 IM injections may be contraindicated in clients with:-
 Impaired coagulation mechanisms
 Occlusive peripheral vascular disease
 Edema
 Shock
 After thrombolytic therapy
 during myocardial infarction
 These conditions impair peripheral absorption

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 Intravenous (IV)
• I.V. Injections
It is the introduction of a drug in solution form into a
vein.
Often the amount is not more than [Link]. at a time
It is the most dangerous route of drug administration
because the drug is placed directly into the blood stream
the route chosen in an emergency situation when
immediate absorption is required
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 iv
• There are several ways to administer medications
intravenously. Examples are-
- By adding the drug into IV- infusion solutions
-By direct IV-bolus or push
-By volume controlled infusion (often used for
children)
-By intermittent IV-infusion:-the drug is mixed with
small IV-solution such as 50-100ml & given over short
period of time at the prescribed intervals.

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 iv
Advantage- large volume can be given
-getting rapid effect.
-The route is used to administer fluid/nutrition if
the patient 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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 Routs of administration …
• Sites for IV injection
Dorsal Venous network
Dorsal metacarpal Veins
Cephalic Veins
Radial vein
Ulnar vein
Median cubital vein
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12/29/2024 Administration of Medication 44
 Routs of administration …
• Purpose

When the given drug is irritating to the body tissue if

given through other routes.
When quick action is desired.
When it is particularly desirable to eliminate the
variability of absorption.
When blood drawing is needed

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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
• 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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 INTRAVENOUS INJECTION (THERAPY)

 Definition:-it is an introduction of a large amount of fluid

(solution) 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. Ex. glucose, saline, blood, plasma &
large quantities of serum etc.
 To introduce medication through the vein, particularly
antibiotics.
 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.
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 …
Equipment
1. Sterile solution (I.V. fluid) as ordered with infusion set
2. Rubber and towel
3. Receiver
4. Antiseptic cotton swabs
5. Padded arm board
6. Bandage and scissors
7. Tourniquet
8. I.V. Stand
9. Adhesive tape
10. Medication chart
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N.B. …
1. Infusion bottle (bag) should be labelled with the date,
time infusion is started, drops per minute and any added
medication.
2. Inspect the drip frequently and watch for any signs of a
reaction. Stop the drip and notify immediately if reaction
occurs.
3. Inspect the site of injection to see that the drip is not
leaking.

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 Routs of administration …

 Topical Drug administration:-

• Topical drugs are usually given

 To relieve pruritus (itching)

 To protect the skin

 To prevent or treat an infection

 To provide local anesthesia or

 To create a systemic effect.

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 Topical Medications…

 Intraocular
 It is used for administering Ophthalmic
Medications
• Purposes:
– Instillation
To provide an eye medication the client
requires
– Irrigation
 To clear the eye of noxious or other foreign
material or excessive secretion in the
preparation for surgery
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 Administer Topical Medications…

Ear Medications
• Eardrops may be instilled
 To soften ear wax

 To produce anesthesia

 To treat infection or inflammation or

 To facilitate removal of a foreign body,

such as an insect.
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 Administer Topical Medications…

• Contraindications of ear drop

Signs of drainage
Perforated tympanic membrane.

• If the tympanic membrane is damaged, all

procedures must be performed using
sterile aseptic technique

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 Administer Topical Medications…

Nasal Instillations
• Nasal drugs are administered to produce
one or more of the following effects:
 To shrink swollen mucous membranes,
 To loosen secretions and facilitate
drainage
 To treat infections of the nasal cavity or
sinuses.

12/29/2024 Administration of Medication 54

 Administer Topical Medications…

 Rectal Instillations
o Rectal instillations can be in the form of
enemas, suppositories and ointments.
• Rectal ointments are used to treat local
conditions and
• Symptoms such as pain, inflammation, and
itching caused from hemorrhoids.
• Rectal suppositories are cone-shaped substances
designed to melt at body temperature

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 Administer Topical Medications…

Vaginal Instillations

• Medications inserted into the vagina are in

the form of suppositories, creams, gels,
ointments, foams, or douches.
• Are used to treat inflammation, infections,
and discomfort or as a contraceptive
measure.
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 Administer Topical Medications…

 Inhalation

– Inhalation is the act of drawing in of gas

vapor or steam into the lungs for
therapeutic purposes
– It could be in dry, moist or vapour form.

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 Inserting a Nasogastric Tube
Purposes
• To administer tube feedings and medications to
clients unable to eat by mouth or swallow a
sufficient diet without aspirating food or fluid
into the lungs= gastric gavage
• To establish a means for suctioning stomach
contents to prevent gastric distention, and
vomiting= Gastric aspiration
• To remove laboratory contents for laboratory
analysis
• To lavage (wash) the stomach in case of
poisoning or overdose of medication
 Before commencing nasogastric feeding,
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determine the type, amount and frequency of
Purpose
• To maintain or restore nutritional
status.
• To administer medication
Indication
For patient who
• Loss their consciousness
• Laryngeal operation
• Oral operation
• Confusion or delirium

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 Equipment
• Large or small bore tube (plastic or rubber)
• Solution basin filled with warm water (if plastic
tube is used) or ice (if rubber tube is used)
• Adhesive tape (2.5 cm wide)
• Disposable gloves
• Water soluble lubricants
• Facial tissues
• Glass of water and drinking straw or medication
cup with water
• 20 to 50 ml syringe with an adaptor

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– Emesis basin
• Stetoscope
• Clamp (optional)
• Suction apparatus (if required)
• Gauze square or plastic specimen bag and
elastic band
• Safety pin and elastic band
• Infant seat, towel, or pillow
• Restrain or hand mitts (for infants and young
children)
• 5mL or 12 mL, syringes
12/29/2024 61
 Procedure
[Link] the procedure to the patient. The passage of tube is not
painful but is unpleasant. Wash hands
[Link] the patient in a high fowlers position, if health permits to
support head on pillow, semi-Fowler’s position for comatose
clients.
[Link] infant, place in infant seat or with rolled towel or pillow under
the head and shoulders.
4. Place the towel across the chest. A diaper can be used for an
infant.
[Link] the client to hyperextend the head, and using a flash light
observe the intactness of the tissue of the nostrils.
[Link] the nares for any obstructions or deformities by asking
the client to breath through one nostril while occluding of the
other.
[Link] the nostril that has the greater airflow.
[Link] one of the infant’s nares, and feel for air passage from
the other.
[Link] 12/29/2024
a rubber tube is being used, place it on ice. This stiffens62 the
tube, facilitating the insertion. If a plastic tube is being used,
[Link] how far to insert
• obtain the client's NEX measurement (length from nose to
earlobe to the xiphoid process [tip of the sternum];and
marks the tube appropriately.
-This length approximate the distance from the
nares to stomach.
-Mark this length with adhesive tape, if the tube
does not have marking.
[Link] the tip of the tube well first 4 inches
with water solution lubricant or water to ease
insertion.
[Link] the tube with its natural curve toward the client
in to the selected nostril. Ask the client to hyperextend
the neck, and gently advance the tube toward 63the
12/29/2024
12/29/2024 64
[Link] the tube along the floor of the nostril
and toward the ear on that side.
[Link] the tube meets resistance, withdraw it,
rubricate it and insert it in the other nostril.
(The tube should never be forced against
resistance)
[Link] the tube reaches the oropharynix
(throat) the client will feel the tube in the throat
and may gag or retch.
 Ask the client to tilt the head forward and
encourage the client to drink and swallow. If the
client gags, stop passing the tube momentary.
Have the client rest, take a few breaths, and
take
12/29/2024 sips of water to calm the gag reflex. 65
[Link] the cooperation with the client, pass the tube 5
to 10 cm with each swallow, until the indicated
length is inserted.
[Link] the client continuous to gag and the tube does
not advance with each swallow, with draw it slightly,
and inspect the throat by looking through the mouth.
(The tube may be coiled in the throat. If so withdraw
it until it is straight, and try again to insert it).
[Link] certain correct placement of the tube:
- Aspirate stomach content, and check their acidity
and measure with chemstrip pH(1-3 for stomach),
PH>7 shows in RT
- Ascultate air insufflations with 10ml air
Belching often indicates that the tip is still in the esophagus.
- If the signs do not indicate placement in the
stomach,
12/29/2024
advance the tube 5 cm, and repeat the test
66
[Link] the tube by taping it to the bridge of the
client’s nose
- Cut 7.5 cm of tape, and split it length wise at one end,
leaving 2.5 cm tab at the end
- Place the tape over the bridge of the client’ nose and
bring the split ends under the tubing and backup over
the nose.
-For infants or small children, tape the tube to the area
between the end of the nares and the upper lip, as
well as to the cheek.
[Link] the tube to the suction source or feeding
apparatus as ordered, or clamp the end of the tubing.
[Link] relevant information, means by which
correct placement was determined and client
responses.
12/29/2024 67
[Link] a plan for providing daily nasogastric
tube care
- Inspect the nostril for discharge and irritation
- Clean the nostril and tube with moistened
cotton tipped applicators
- Give frequent mouth care
[Link] suction is applied, ensure that the patency
of both the nasogastric and suction tubes in
maintained
[Link] all relevant information:
- Type of tube inserted
- Data and time of tube insertion
- Color
12/29/2024
and amount of gastric contents 68
 NASOGASTRIC TUBE FEEDING
• Before commencing nasogastric feeding, determine the type
amount, and frequency of feedings.
Purposes
• To restore or maintain nutritional status
• To administer medications
Equipment
- Correct amount of feeding solution
- Pacifier
- 20 to 50 mL syringe with an adapter
- Emesis basin
- syringe (for an intermittent feeding)
- Calibrated plastic feeding bag and a drip chamber, which can be
attached to the tubing or
- Pre-filled bottle with a drip chamber, tubing, and a flow regulator
clamp.
- Measuring container from which to power the feeding (if using
bulb syringe)
12/29/2024 69
 Procedure/Intervention
1. Prepare the client and the feeding
- Explain the patient about the feeding
- Provide privacy
- Position the patient in Fowler’s position in
bed or sitting position in a chair
- Position a small child or infant in your lap,
and provide a pacifier during feeding
2. Assess tube placement. Attach the
syringe to the open end of the tube,
aspirate alimentary secretions. Check the
PH.
12/29/2024 70
3. Assess residual feeding contents
- Aspirate all the stomach contents, and measure
the amount prior to administering the feeding. If
50 mL or more undigested formula is withdrawn
in adults, or 10 ml or more in infants, check with
the nurse in charge before proceeding.
- Reinstill the gastric contents in to the stomach if
this is the agency or physician’s practice.
Remove the syringe bulb or plunger, and pour
the gastric contents via the syringe in to the
nasogastric tube.
4. Administer the feeding
Before administering feeding:
a) Check the expiration date of the feeding
b)12/29/2024
Warm the feeding to room temperature 71
5. Rinse the feeding tube immediately before all
the formula has run through the tubing:
- Instill 60 mL of water the feeding tube
- Be sure to add the water before the feeding
solution has drained from the neck of a bulb
syringe or from the tubing of an administration
set. Before adding water to a feeding bag or
prefilled tubing set, first clamp and disconnect
both feeding and administration tubes.
6. Clamp and cover the feeding tube
- Clamp the feeding tube before all of the water is
instilled
- Cover the end of the feeding tube with gauze
held
12/29/2024 by an elastic band 72
7. Ensure client comfort and safety
- Pin the tubing to the clients gown
- Ask the client to remain sitting upright in
Fowler’s position or in slightly elevated
right lateral position for at least 30
minutes.
8. Dispose of equipment appropriately
- If the equipment is to be reused, wash
with soap and water so that it is ready for
reuse.
- Change the equipment every 24 hours or
according to the agency’s policy.
12/29/2024 73
9. Document all relevant information
- Document the feeding, including amount, and
kind of solution taken, duration of feeding and
assessment of client.
- Record the volume of the feeding and water
administered on the client’s intake and out put
record.
10. Monitor the client for possible problems:
- Carefully assess clients receiving tube feeding
for problems
- To prevent dehydration, give the client
supplemental
12/29/2024
water in addition to the prescribe
74
 Gastric Aspiration
Defn: - Aspiration is the withdrawal of fluid or gas from a cavity by suction.
Purpose
– To prevent or relieve intestinal distention following abdominal operation.
– In case of gastro intestinal obstruction to remove the stomach or gastric
contents.
– To keep the stomach empty before an emergency abdominal operation is
done.
– To aspirate the stomach contents for diagnostic purposes.
Types of gastric aspiration
• There are two types of gastric aspiration
• Intermittent method: - Suction is done as condition requires and as ordered.
• Continuous method: - the nasogastric tube is attached to the drainage bag.
There are two ways of supplying suction.
– Simple suction by the use of a syringe.
– An electric suction machine.
12/29/2024 75
• Gastric lavage
• This is the irrigation or washing out of the
stomach.

• Purpose
– To remove alcoholic, narcotic or another
poising which has been swallowed.
– To cleanse the stomach before operation.

– To relieve congestion there by stimulating

peristalsis.
– For diagnostic purpose.
12/29/2024 76
12/29/2024 77
• Equipment
 Large or small bore tube (plastic or rubber)
 Solution basin filled with warm water
 Adhesive tape (2.5 cm wide)
 Disposable gloves
 Water soluble lubricants
 Facial tissues
 Glass of water and drinking straw or
medication cup with water
 20 to 50 ml syringe with an adaptor
12/29/2024 78
  Basin
 Stethoscope
 Clamp (optional)
 Suction apparatus (if required)
 Gauze square or plastic specimen bag
and elastic band
 Safety pin and elastic band
 Infant seat, towel, or pillow
 Restrain or hand mitts
 5-mL or 12 mL, syringes
12/29/2024 79
 GastrostomyFeedings
A gastrostomy feeding is the installation of
liquid nourishment through a tube that enters a
surgical opening (called a gastrostomy)
through the abdominal wall in to the stomach.
• A feeding tube passes through a surgical
opening on the abdomen directly into the
stomach.
• Gastrostomy is preferred for prolonged
enteral nutrition support (longer than 4
weeks).
• Regurgitation and aspiration are less likely
to occur with gastrostomy than NG
feedings.
12/29/2024 80
 • To create the gastrostomy an exit wound is
created in the left upper abdomen.
• It allows clients greater mobility than gastric or
duodenal tube feeding and enables client to feed
themselves.
• Feeding is administered at room temperature
unless the order specifies.
• When the incision heals (10-14 days) the tube can
be removed and reinserted for each feeding.
• The surgical opening is sutured tightly around the
catheter to prevent leakage.
• These feedings are usually temporary measures.
Indications
– Esophageal obstruction
– Removed esophagus
– Gastric distention and vomiting.
12/29/2024 81
Purpose
– To feed patient abdominally when there is surgery in the mouth and esophagus.
– Cancer of the esophagus.
Necessary Equipment
- The correct amount of feeding solution is usually 200-800 ml.
- A large bulb syringe.
- A graduated container to hold the feeding.
- A graduated container with 60 ml of water to flush the tubing.
For a tube sutured in place:
- Some 4 X 4 gauze squares to cover the end of the tube.
For tube insertion
- Water soluble lubricant to lubricate the tube
- Clean disposable gloves
- A tubing clamp
- A moisture proof bag
For cleaning the periostomal skin and dressing the stoma:
- Mild soap and water
- Petrolatum or other skin protect ant
- 4 x 4 gauze squares
- Abdominal
12/29/2024 pads 82
INTERVENTION
- Assess bowel sounds to determine intestinal activity, abdominal distension
at least daily, the correct placement of the tube before feedings; presence
of diarrhoea, constipation or flatulence.
- Provide privacy for the technique.
- Assist the client to fowler's position in bed, a sitting position on a chair or
sitting is contraindicated, a slightly elevated right lateral position to
promote digestion and prevent oesophageal reflex.
- If tube is not in place, lubricate the insertion end of the tube to insert 10-15
cm in to the ostomy opening.
- Use gloves when removing the ostomy dressing.
- To administer the feeding solution, hold the syringe 7-15 cm above the
ostomy opening.
- Slowly pour the solution in to the syringe, and allow it to flow through the
tube by gravity.
- Just before all the food runs through and the syringe is empty, add 30 ml of
water to rinse the tube and preserve its patency.
- If the tube is sutured in place, hold it up right, remove the syringe and then
clamp the tube to prevent leakage.
After the feeding, have the client remain in the sitting position or a slightly
elevated right
12/29/2024 83
Lateral position for at least 30 minutes to prevent leakage and enhance
 SAFETY
Oral > SC > IM > IV
High Low

CONVENIENCE
Oral > SC > IM > IV
High Low

COST
IV > IM > SC > ORAL
Hig Low
h
 Oxygen Administration:

• Administration of oxygen is a process of providing the 02

supply to patient for the treatment of low concentration of
02 in the blood
Purpose
• To provide and maintain a normal supply of O2 for blood, and
tissues
 O2 may be administered in three ways.
 By mask
 Nasal Catheter
 Tent

12/29/2024 Administration of Medication 85

 Indications for oxygen therapy
• To correct hypoxemia
V/Q mismatch Anoxia -No oxygen availability in tissues
Hypoxia - Lack of oxygen availability in
↓ diffusion tissues
hypoventilation Hypoxaemia- Lack of oxygen in the blood
• To ↑ dissolved oxygen
Anemia
Cyanide and CO poisoning
• ↑ oxygen demand
high altitude
Shivering
Hyperthermia
• Increased myocardial work
• Acute head injury
• Giving O2 by mask

12/29/2024 Administration of Medication 87

 Administration Of 02 By Nasal Catheter
• This is very common method of 02 administrations in
hospital settings.
• A catheter is inserted into the nostril reaching up to the
uvula and is held in place by adhesive tapes

12/29/2024 Administration of Medication 88

 Oxygen Administration …
• Giving oxygen by nasal catheter.
• There are different kinds of catheters,

A fine catheter
A spectacle frame, which carries two, places
of rubber tubing and is worn by the patient.
Two soft rubber catheters connected by y
shaped connection to the tube on O2
apparatus
Patient's receiving oxygen by catheter
12/29/2024 Administration of Medication 89
 Oxygen Administration …

 Things which are stimulating secretions must

be removed.
 Oxygen dries and irritates mucous membrane,
therefore, should be passed through water
(Humidified) before it is administered by
catheter.
• Administration of oxygen by catheter gives
freedom of movement to the patients receiving
12/29/2024 Administration of Medication 90
 Administration Of Oxygen By The Tent Method
 The oxygen tent method consists of a canopy
over the patients bed, that cover the patient fully or
partially.
 Oxygen tent is made up of plastic material,
transparent and prevent absorption of oxygen.
 The lower part of the canopy is tucked under the
bed to prevent the escape of oxygen.
 Oxygen tent provides the environment for the
patient with controlled oxygen concentration,
12/29/2024 Administration of Medication 91
 Precautions to be Taken When Oxygen
administration
• Oxygen supports combustion.
• There fore there is no smoking within 3 meters of
oxygen equipment.
• Lighted matches, cigarettes, electric lights, nylon
clothing, electric pads, should be forbidden.
• Alcohol must not be applied to the patient's skin
• The catheter tip and the cylinder itself must not
be lubricated with Administration
12/29/2024
Vaseline or oil or any kind
of Medication 93
 Precautions to be Taken …

• Cylinders must be handled carefully as the oxygen

is under pressure.
• The fine adjustment should always be closed when
the main tap is turned on.
• Check that there is no obstacle in the patient's
airway before firing oxygen in order to prevent
patient's from suffocation.
• The doctor will order the rate of flow.

12/29/2024 Administration of Medication 94

 Types of Medication Orders
• The health care practitioner prescribes
medications in different ways, depending on
their purpose.
• Prescription: a written direction for the
preparation or administration of medication
• Medications can be prescribed as stat, single-
dose, standing and prn orders.

12/29/2024 Administration of Medication 95

 Types of Medication Orders…
 A stat order:- is an 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
• Eg. stat dose of nitroglycerin may be ordered for a client
experiencing chest pain
 Single-dose Orders:- is a one-time medications or may
require the administration of drops or tablets over a short
period of time
• 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
12/29/2024 Administration of Medication 96
 Types of Medication Orders…
 Standing Orders:- Are referred to as scheduled orders
because they are administered routinely as specified until
the order is canceled by another order.
• The standing orders stay in effect until the health care
practitioner discontinues or modifies the dosage or
frequency with another order
=E.g. TTC 250mg PO QID for 7days
• The purpose of a standing medication order is to maintain
the desired blood level of the medication.

12/29/2024 Administration of Medication 97

 Types of Medication Orders…
 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.

• Before administering a prn medication, the nurse must

thoroughly assess the client, using both objective and
subjective data in determining the appropriateness of
administering the medication.
12/29/2024 Administration of Medication 98
• This type of order is commonly written for analgesics,
 Common abbreviations used in drug administration
 Po …………..by mouth
Qod…..every other day

 bid ……………twice a day

Qid……4x a day
 Q2h ….…every 2hrs
 ac……………before meal
 Qhr……every hour

 tid ………….. 3x a day am……in the morning

 Pc …………..after meal Pm………after noon

IV…………Intravenous

 hs ……………at bed time IM…………….Intramuscular

 Qd ………….every day

 prn ………….as needed ID…………….Intradermal

 hrly………………... Hourly SC…………….Subcutaneous

 Stat……………. Immediately

 Supp……………. Suppository Tab…………….. Tablet

12/29/2024 Administration of Medication 99
cap ……………… capsule
 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

• Time of administration frequency

• Signature of a person writing the order

12/29/2024 Administration of Medication 100
 Systems of Measuring the dose
• the nurse should have a knowledge of weight and
volume measurement systems.
 The metric system

• The most widely accepted and convenient/suitable

method.
• The metric, or decimal, system is a simple system of
measurement based on units of 10.
• The basic units of measurement are meter (linear), liter
(volume) & gram (weight)
• e.g. gram(g), milligram), kilograms (kg),Liters (L),and
12/29/2024 Administration of Medication 101
 Systems of Measuring the dose…
 The apothecary system
• Is based on the weight of one grain of wheat.
Therefore, the basic unit of weight is the grain
(gr), and the basic unit of volume is the minim
(the approximate volume of water that weighs a
grain).
• The grain is expressed in fractions such as
morphine gr 1/4. The minim (m) is the smallest
unit of volume.
• Less convenient & precise than the metric
system and infrequently used.
• Roman numerals are used to express numbers
and
12/29/2024
quantities <1are written in fraction form
Administration of Medication 102
 Systems of Measuring the dose…

 The household system

• similar to the apothecary system of liquid
measures and is the least accurate of the three
systems.
• The units of liquid measure are drop (gtt),
teaspoon (tsp), tablespoon (Tbsp), cup, and
glass etc
• Household units are often used to inform
clients of the size of a liquid dose.
• Used when accurate systems of measurements
are not required, because it is the least
accurate
12/29/2024 one. Administration of Medication 103
 Dose calculation
• Several formulas may be used by the nurse
when calculating drug doses.
• One formula uses ratios based on the dose on
hand and the dose desired.
• Formula:

Dose on hand = dose desired

Quantity on hand X (quantity
desired)
E.g. If Ampicillin 500mg PO q.i.d is ordered &
supplied in a liquid preparation containing
Administration of Medication 104
 Dose calculation …
• The formula is as follows:
Volume to be given = Dosage ordered X
Volume on hand
Dosage on hand
 250 mg (dose on hand)= 500 mg(dose desired)
5 ml (dose on hand) x (dose desired)
250 x = 5 × 500
X =5ml × 500
250
x = 10 ml

12/29/2024 Administration of Medication 105

 …

• For example, the health care practitioner orders

heparin (anticoagulant) 10,000 units SC; the
dose on hand is 40,000 units/ml: how much
volume of heparin is administered?
 40,000units (dose on hand)= 10,000units(dose desired)
1ml (dose on hand) x (dose desired)
40,000x = 10,000
X =10,000
40,000
x = 0.25ml
• Give procaine penicillin 800,000IU IM BID from
a vial containing procaine penicillin 4 million IU
dissolved
12/29/2024
in 10ml. What is the volume106 of
Administration of Medication
 …
• 2.2 lb = 1 kg
• 1 g (gm, Gm) = 1,000 mg
• 60 milligrams (mg) = 1 grain (gr)
• 1 tsp = 5 mL
• 1 tbsp = 15 mL
• 3 teaspoons (t) = 1 tablespoon (T)
• 1 cubic centimeter (cc) = 1 milliliter (ml)=
• 1 cc = 15 drops (gtt)
• 1 inch (in) = 2.5 centimeters (cm)

12/29/2024 Administration of Medication 107

 IV Drip calculations
• Review of formulas:
Volume_ X drop factor = rate
time in minutes 1
- All administration sets are calculated as gtts/min where
the drop factor calibration is provided on the
packaging.
Total ml ordered = ml/hr
# of hours
• Number of hrs. over which sol. is to be administered x
60 minutes
1ml = 15 drops(15-20drops)
1gtt = 1drop
• If 1000ml of 5% D/w is to run for 24 hrs, how many drops per
minutes should it run?
1000 ml. x 15 gtt/ml.
24 x 60 min
12/29/2024 1000 x 15Administration
gtt. = of Medication 10 gtt/min 108
Ex2: Infuse 500 mL of NS IV over 4 hours.
• Drop factor: 15gtt/mL
 How many gtt/min will you regulate the IV?

= 500 mL (volume) x 15 (drop factor)

4 hr x 60 minutes (must convert to minutes)
=7500/240=31.25=31gtt/min
• A formula is used to calculate how many drops per
minute (gtt/min) to regulate the roller clamp.
• Volume: This is the total amount of mL to be infused.
• Time: This is the total time in minutes the fluid needs to
be delivered.
• Drop factor: Each brand of IV tubing has a predetermined
amount of fluid per drop (gtt). This amount of fluid is
called the drop factor. Common drop factors include
12/29/2024 Administration of Medication 109
10gtt/mL, 12gtt/mL, 15gtt/mL or 60gtt/mL.
 Safe Drug Administration

• Nurses must administer numerous drugs daily

in a safe and efficient manner.
• The nurse documents the actual administration
of medications on the medication
administration record, or MAR.
• The MAR is a medical record form that contains
the drug’s name, dose, route, and frequency of
administration
12/29/2024 Administration of Medication 110
 Five rights of drug administration
• Remember the five R’s
 Right medication
 Right dose
 Right client
 Right route
 Right time
=Appropriate information, right to refusal,
documentation & Waste disposal critical element of
drug administration considered
• The nurse gives the right medication for a
right client in a right dosage through the
right route at the right time.
12/29/2024 Administration of Medication 111
 Five right…
Right medication
– When administering a medication, the nurse
should check the label written on the
container from the MAR at least three times
before giving the drug
 The right dose:-
– The nurse must know how to calculating
doses and having them double checked
before administration.
 Right Client
 The nurse should correctly identify the client
by asking the client to state his or her full
name and checking
12/29/2024 Administrationthe client’s identification
of Medication 112
 Five rights…
 Right Route
• The nurse should consult the health care
practitioner
whenever a route is not identified in the
prescription,
when the route indicated differs from the
recommended one, or
when the nurse questions the choice of route
prescribed.
 Right Time
 Medications are generally ordered on a
schedule.
12/29/2024
Nurses are responsible for knowing why
Administration of Medication 113 a
 Always

Always keep the bottle tightly closed.

Clean and keep the label of the bottle clear.
Keep medication away from light.
Cheek their expiration date.
Keep the rim of the bottle clean.
Give your undivided attention to your work
while preparing and giving medications.

12/29/2024 Administration of Medication 114

 Always…
• Never give medications from unlabeled
container
• Never return a dose once poured from the
bottle.
• Check your patient's vital sign
 May be necessary before and after
administrating some drugs e.g. digitals,
ergometrine.
12/29/2024 Administration of Medication 115
• Never give medicine that some one poured or
• Triple-check before administration
• Information
• Refusal
• Careful assessment
• Informed consent
• Safe administration
• Supportive therapy
• No unnecessary medications are also the
important
12/29/2024
patient Administration
rightsof Medication 116
 Blood Transfusion
 It is the giving of blood to a patient through a
vein
• To counteract severe hemorrhage and replace the
blood loss.
• To prevent circulatory failure in operation where
blood loss is considerable
• In severe burns to make up for blood lost by
burning
• For treatment of severe anemia due to cancer,
marrow aplasia and similar conditions.
• To provide clotting factors normally present in
blood,
12/29/2024
which may be absent as a result of disease
Administration of Medication 117
 Equipment used during blood transfusion

• Bottle containing blood, with the patient

name, blood group and Rh factor.
• Blood giving set
• Sterile forceps in a sterile jar
• Sterile syringes and needle
• Alcohol swabs
• Sterile gauze

12/29/2024 Administration of Medication 118

 Equipments …

– Rubber sheet and towel

– Tourniquet
– Arm splint
– Bandages and scissors
– Adhesive tape
– Receiver for dirty swabs
– I.V pole (stand)
– Patient's chart.
12/29/2024 Administration of Medication 119
 …

• During blood transfusion:-

• Always remember to have anti- histamine
injection ready in case a patient has
reaction from the blood.
• Be familiar with the most usual symptoms
of blood reactions which are:-

12/29/2024 Administration of Medication 120

Adverse reactions to blood transfusion

• Immediate • Late Reaction

 Dyspnea
Reaction:
 Renal shut down
Headache
in severe cases
Backache
 Heamaturia
Chills  Chest pain
Pyrexia  Rigor (rigidity)

Rash of the skin

12/29/2024 Administration of Medication 121
 THE END

12/29/2024 Administration of Medication 122