MEDICATION ADMINISTRATION, CALCULATION
AND NURSING IMPLICATIONS
Prof. Rennard Christian De Perio,MN, RN
DRUG
• is any substance used to
diagnose, cure, mitigate, treat or
prevent a condition or disease
• Come from three main sources:
plants (e.g digoxin), animals (e.g
insulin), and synthetic chemicals
(e.g meperidine)
PHARMACOKINETICS
• Absorption
• Distribution
• Metabolism
• Excretion
TYPE OF MEDICATION ACTIONS:
• Therapeutic Effect
• Side effect
• Adverse effect
• Toxic effect
• Idiosyncratic effect
• Allergic reaction
• Iatrogenic effect
Types of medication orders:
• Stat order
• Single order
• Standing order
• Prn order
TYPES OF DRUG PREPARATION:
• Aqueous solution
• Aqueous suspension
• Capsule
• Elixir
• Extract
• Liniments
• Tablet /Syrup
• Suppository
• Cream
12 Rights of Medication Administration:
• Medication
• Dose
• Time
• Route
• Client
• Client education
• Right documentation
• Right to refuse
• Right assessment
• Right evaluation
• Right drug preparation
• Right reason
GENERAL PRINCIPLES FOR ALL MEDICATIONS
1. Verify all new or questionable orders on
the medication administration record
(MAR) against physician orders for
completeness.
2. Prepare medications in a quiet
environment.
3. Wash your hands. Observe universal
precautions, as appropriate.
4. Collect all necessary equipment including
straws, juice or water, stethoscope.
5. Review MAR for each client carefully to
ensure safety: note medication, dosage,
route, expiration date, and frequency.
6. Research drug compatibilities,
action, purpose, contraindications,
side effects, and appropriate routes.
7. Find medication for individual
client and calculate dosage
accurately. Confirm normal range of
dose, particularly in pediatrics.
8. Check expiration date on
medication and look for any changes
that may indicate decomposition
(color, odor, and clarity)
9. Compare label three times with the
medications to decrease risk of error.
[Link] removing package from drawer.
[Link] preparing medication
[Link] preparing medication
[Link] need for prn medications
[Link] sure medications are identified for
each client.
[Link] for any allergies and perform all
special assessment before
administration.
[Link] client’s identity by checking at
least two (2) of the three possible
mechanisms for identification to ensure
safety.
• Ask client his name.
• Check client’s identi-band
• Check bed tag (this is the least reliable
method)
[Link] privacy, if needed.
[Link] client of medication, any
procedure technique, purpose, and
client teaching as applicable.
[Link] with the client until medication is
gone; do not leave medication at
bedside
[Link] client as needed, and leave in
position of comfort.
[Link] medication within 30 mins. Of
prescribed time.
[Link] administration immediately in ink,
marking your initials in the appropriate
space
[Link] initials and document rationale if
drug is not administered.
[Link] any errors immediately and
complete appropriate institutional
documentation.
[Link] medications-all routes of
administration- must not be mixed
together unless compatibility is verified.
26. Observe for any reactions and document both
positive and negative responses
27. Observe the six rights of medication
administration:
– Right medication/drug
– Right dose
– Right client
– Right route
– Right time
– Right documentation
28. To ensure safety do not give a medication that
someone else prepared. Institution policies
may require having a colleague double check
medications such as insulin and heparin. If you
are unsure in any way, have a colleague verify.
ROUTES FOR
MEDICATION
ADMINISTRATION
Sublingual
– drug is placed
ORAL ROUTES under the tongue
where in a
relatively short
time, the drug is
Oral
largely absorbed
- drug is in the blood
swallowe vessels on the
d underside of the
tongue
Buccal
“pertaining to the cheek”,
a medication is held in the
mouth against the mucous
membranes of the cheek
until the drug dissolves
ORAL ROUTE
- most
convenient
- safe, does not
break skin
barrier Responsibilities:
Nursing
✔ Assess client’s knowledge level,
diet status, oral cavity, & ability to
swallow medication (intact gag
reflex).
✔ Sustained- action, buccal, or
sublingual, Enteric-coated tablets
should not be crushed.
✔ Sit client upright to enhance
swallowing
SUBLINGUAL/BUCCAL ROUTE
- Same as for oral
- Can be
administered for
local effect
- More potent than
oral route
Nursing
Responsibilities:
✔ Do not allow fluids
for 30 minutes
following
administration.
✔ Inform client the
drug may cause
stinging or
Special Considerations when giving
oral medications:
✔ In giving Iron or HCl : have
client use straw to prevent
staining teeth
✔ Use a calibrated dropper, nipple
or syringe to give medications
to an infant.
✔ If using an NG or stomach tube
for medication administration,
check for correct placement
before administration & follow
medication with water. Be sure
to check for food interaction.
GENERAL PRINCIPLES IN GIVING
PARENTERAL MEDICATIONS
✔ Always means an injection route.
✔ Packed in single-use ampules, in
single- & multiple-use rubber
stoppered vials & in premeasured
syringes & cartridges.
✔ The nurse should not administer
more than 3ml per intramuscular
or 1ml per subcutaneous injection
site.
✔ When mixing a powder, use a filter
needle when drawing up a
medication. Reconstitute according
to manufacturer’s
recommendations
GENERAL PRINCIPLES IN GIVING
PARENTERAL MEDICATIONS
✔ Select appropriate size, avoid
bruised or tender areas; rotate
sites as much as possible.
✔
PARENTERAL ROUTES
- Defined as other than through
the alimentary tract; that is by
needle (injection)
1. Subcutaneous
2. Intradermal
3. Intramuscular
4. Intravenous
SUBCUTANEOUS ROUTE
- Used to administer drugs in small
volumes (<2 ml)
- Highly effective in administering
vaccine medications such as insulin, etc.
Site: Upper posterior arm, upper
back, low back, anterior lateral
thigh, and abdomen
Needle Gauge: 25-28 g
Needle Length: 3/8 – 5/8 ”
Angle: 90° or 45° for very thin
patients
INTRADERMAL ROUTE
-Slow absorption
Sites: Inner forearm, chest and
back
Needle Gauge: 27-30 g
Needle Length: 1/4 – 3/8 ”
Angle: 10° to 15°
Volume: 0.1-0.2 ml
Note: When wheal appears,
remove needle; DO NOT
MASSAGE SITE.
INTRAMUSCULAR ROUTE
-Can administer larger vol. than SC
- Drug is rapidly absorbed
Sites: Deltoid, ventrogluteal,
vastus lateralis, and dorsogluteal
muscles, rectus femoris
Needle Gauge: 18-23 g
Needle Length: 1 – 1 1/2 ”
Angle: 90°
Volume: Up to 3 ml; small muscles
(deltoid) maximum 1 ml
Insert picture of IM sites
Z-TRACK INJECTION
- IM variation, used for irritating
solutions
Sites: Deltoid, ventrogluteal, vastus
lateralis, and dorsogluteal muscles,
rectus femoris
Needle Gauge: 20-22 g
Needle Length: replace needle used to
draw up medication with one 2-3 inches
long
Angle: 90°
Note: 0.1-0.2 ml
Volume:
✔ Pull skin away from site laterally
with nondominant hand.
✔ Wait 10 seconds after injecting
medication before withdrawing
needle.
INTRAVENOUS ROUTE
- Rapid effect
( See separate discussion for in
depth information about IV
administration)
TOPICAL ROUTE
- Those applied to a circumscribed
surface area of the body
1) Dermatologic Preparations – applied
to the skin
2) Instillations & Irrigations – applied
into the body cavities or orifices.
3) Inhalations – administered into the
respiratory tract by a nebulizer or
positive pressure breathing
apparatus.
TRANSDERMAL ROUTE
- Active ingredients are
delivered across the skin
for distribution
- Few systemic effect
- Avoids GI absorption
problem
- Often promotes healing to
an injured area of the
body
INHALATION ROUTE
- Introduces throughout the
respiratory tract
- Rapid localized relief
Nursing Responsibilities: (steps)
✔ Assess px’s Vital Signs before &
after treatments.
✔ Have client inhale and exhale
deeply
✔ Have client place lips around
mouthpiece without touching &
inhale medication until lungs are
fully inflated.
✔ Have client remove mouthpiece,
hold breath as long as able, then
OPTHALMIC ROUTE
- Medications administered in
the eye using irrigations or
instillations.
Important Nursing Responsibilities: (steps)
✔ Warm solution in hands before
administration.
✔ Have client lie on back or sit with head
turned to affected side.
✔ Cleanse the eyelid & eyelashes with
sterile gauze pad. Have client look up.
✔ Assist client in keeping eye open.
✔ Place necessary no. of drops in lower
conjunctiva near the outer canthus.
✔ If using ointment, squeeze from inner to
outer canthus.
✔ Have client blink 2-3x. Wipe away excess
OTIC ROUTE
- Medications administered in the
external auditory canal using
irrigations or instillations.
Important Nursing Responsibilities: (steps)
✔ Warm medication prior.
✔ Have client turn to UNAFFECTED side.
✔ Clean outer ear using a wet gauzed pad.
Assess.
✔ Straighten ear canal by:
❖ Adults – Pull pinna up & back
❖ Infants & children under 3 y.o – Down
& back
OTIC ROUTE
Nursing Responsibilities: (cont)
✔ Instill necessary no. of drops along
side of canal without touching ear
with dropper.
✔ Maintain position of ear until
medication has totally entered
✔ Have client remain on side for 5-10
mins.
NASAL ROUTE
- Nasal instillations (nose drops &
sprays) usually are instilled for their
astringent effect, to loosen
secretions & facilitate drainage or to
treat infections of the nasal cavity or
sinuses.
Nursing Responsibilities: (steps)
✔ Have client blow nose to clear
mucus.
✔ Positon client so that the head can
be tilted back.
✔ Push up on tip of nostril. Place
dropper or atomizer angled
slightly upward just inside the
nostril.
NASAL ROUTE
Nursing Responsibilities: (cont)
✔ Squeeze atomizer quickly & firmly
or instill correct number of drops.
✔ Remind clients to keep head tilted
for 5 mins.
✔ Leave tissues with client; instruct
client to wipe nose, not blow.
RECTAL ROUTE
- Insertion of medications into the
rectum in the form of
suppositories.
- Conventional and safe method
Nursing Responsibilities: (steps)
✔ Assess client’s bowel function &
ability to retain suppository or
enema.
✔ Remove suppository from
refrigerator.
✔ Position client left laterally or Left
Sims’ with the upper leg flexed.
✔ Put on glove or finger cot.
RECTAL ROUTE
Nursing Responsibilities: (steps) cont.
✔ Moisten suppository with water-
soluble lubricant
✔ Insert suppository, tapered end first,
approx. 2 inches
✔ Hold buttocks together.
✔ Encourage client to retain
suppository for 10-20 mins.
✔ If drug administered via enema,
have client retain solution for 20-30
mins.
VAGINAL ROUTE
- Medications or instillations, are
inserted as creams, jellies, foams, or
suppositories to treat infection or to
relieve vaginal discomfort (e.g itching
or pain)
Nursing Responsibilities: (steps)
✔ Provide privacy. Put on gloves.
✔ Have client void.
✔ Place client on a bedpan in
DORSAL RECUMBENT position
with hips and knees flexed.
✔ Cleanse perineum with warm,
soapy water, working from
outer to inner position.
VAGINAL ROUTE
Nursing Responsibilities: (steps) cont.
✔ Moisten applicator tip with water-
soluble lubricant.
✔ Separate labia to insert applicator
approx. 2 inches, angled downward
and back.
✔ Instill medication.
✔ If giving douche, dry client’s buttocks;
otherwise have client remain in
position approx. 15-20 mins.
✔ Wash applicator with warm, soapy
water.
✔ Provide client with pads if needed.
DRUG
CALCULATIONS
Systems of Measurement
• Metric System – meter, liter,
gram
• Apothecary System– grain,
dram, minim, and ounce
• Household- drop, teaspoon,
tablespoon, ounce, pint, and
cup
• Additional common drug
measures- Milliequivalent
(mEq), Unit
Metric Apothecaries Househol
d
1ml 15 minims 15gtts
4-5ml 1 fluid dram 1
teaspoon
15 ml 4 fluid drams 1
tablespo
on
30 ml 1 fluid ounce
60 mg 1 grain
Standard Formula for Calculating a
Medication Dosage
D__ x V = x or
S
• Legend:
• D (desired)- is the dosage that the
health care provider prescribed
• A /S (Available or Stock) -dosage
strength as stated on medication label
• Q / V (Quantity or volume) or form- in
which the dosage strength is available,
such as tablets, capsules or ml.
Dosage Calculation in Children (pediatric doses)
1. Body Surface Area (BSA)
Surface area of child (m²) x normal adult
dose
1.7 m²
2. By weight (mg/kg)
Formulas for Intravenous Calculations
Flow rates
Total volume x Drop Factor = gtts/
minute
Time in mins.
Infusion Time
Total volume to infuse = Infusion
Time
ml/hr being infused
Number of ml/ hr
Total vol. in ml = Number of
ml/hr
No. of hrs
References:
• Kozier & Erb’s Fundamentals of
Nursing, 8th Edition, Vol. 1
• Saunders Comprehensive Review, 6th
Edition by Linda Anne Silvestri, PhD, RN
• Potter P, Perry A, Stockert P, Hall: A
Fundamentals of Nursing, ed 8, St.
Louis, 2013, Mosby.
• NCLEX-RN Review, 3rd Edition by Alice M.
Stein, RN, MA & Judith C. Miller, RN,
MSN
