Medication Administration
Medication: Concepts
1. Medications are available in a variety of forms.
2. The form of the medication determines its
route of administration.
3. The composition of a medication enhances it
absorption and metabolism.
4. Many medications come in several forms so be
certain to use the proper form.
Medication: Forms
Caplet – Shaped like a capsule and coated for
easier swallowing
Capsule – powder, liquid or oil in gelatin shell
Tablet – compressed powder
Enteric coated – dissolves in small intestine
Medication: Forms
Time release – granules with different coatings, or some
tablets that dissolve slowly
Lozenge – dissolves in mouth
Elixir – mixed with water or alcohol and a sweetener
Syrup – Medication dissolved
in a sugar solution
Medication: Forms
Suspension – drug particles in a liquid medium;
when left alone will settle in the bottom
Solution – Sterile preparation that contains water and
one or more dissolved compounds (IM,
SQ, or IV)
Lotion – liquid suspension for skin
Ointment – semisolid (salve another name)
Medication: Forms
Paste – semisolid, but thicker than ointment – slower
absorption
Transdermal disk or patch – semi-permeable membrane
disk or patch with drug applied to skin
Suppository – solid drug mixed with gelatin inserted into
body cavity to melt (rectum or vagina)
Medication: Pharmacokinetics
• Route: how enter the body
• Absorption: from site into blood
• Distribution: from blood into cells, tissues, or organs
• Action: how a medication acts
• Metabolism: changed to prepare for excretion
• Excretion: how they exit the body
This knowledge is used when selecting timing, route, risks, and
evaluating the response
Medication: Actions
Therapeutic Effect: expected Side effect:
or predicted physiological response that a predictable and often unavoidable
medication causes secondary effects produced at a usual
therapeutic dose
Adverse effect: unintended, Toxic effect: develop after
undesirable, and often unpredictable prolonged intake of a medication or
severe responses to medication when a medication accumulates in the
blood because of impaired metabolism
or excretion
Idiosyncratic reaction: Allergic reaction:
Unpredictable. A patient overreacts or Unpredictable. Repeated
underreacts to a medication or has a administration the patient develops an
reaction different from normal allergic response to it, its chemical
preservatives, or a metabolite
Medication: Routes
Oral Parenteral
Sublingual, buccal ID, Sub-Q, IM, IV
Epidural, Intrathecal (brain), Topical (ex. Nitro, fentanyl)
Intraosseous (bone),
Intraperitoneal (abdomen-
ex.chemo), Intrapleural (ex.
Chemo), Intraarterial (ex. Clot
dissolve)
Inhalation Intraocular
Medication: Factors Influencing Routes
• Oral: convenience vs. tolerance, easy to give, often
produces local or systemic effects
• Injections: infection risk, needle, bleeding, rapid
absorption
• Skin/topical: painless, caution w/abrasions, provides local
effects
• Transdermal: prolonged systemic effects
• Mucous membranes: sensitive, less pleasant,
• Inhalation: provides rapid effect for local respiratory
effect, potential serious side effects
Oral Route
Easiest and most
desirable route
Food may decrease
therapeutic effect.
Assess patient’s ability to
swallow
14
Oral Route
Buccal: inside mouth, cheek
Sublingual: under tongue area
Medication: Nasogastric tube
• Liquid form
• Dissolve in 15-30 ml.
warm water (avoid enteric
coated or time release)
• Flush tube with 15-30 ml
of water between
medications
• Flush afterwards with 30-
60ml
• If to suction, clamp 30 min
Nasal Instillation
• May self-administer
• Check nares for irritation
• Nasal packing for bleeding and certain surgeries may be used-
applied by provider
Eye instillation
Avoid the cornea.
Avoid the eyelids with
droppers or tubes to decrease
the risk of infection.
Use only on the affected eye.
Never allow a patient to use • Elderly may have difficulty with drops
another patient’s eye • Risk of transmitting infection from one
medication. eye to the other, do not touch any
part of the eye with eye applicator
• Apply ointment along lower eyelid,
drops into conjunctival sac
Ear instillation
Structures are very sensitive
to temperature.
Use sterile solutions.
Drainage may indicate
eardrum rupture.
Never occlude the ear canal.
Do not force medication into
an occluded ear canal.
Topical Medications
Skin
Use gloves and applicators.
Use sterile technique if the patient has an open wound.
Clean skin first—remove tissue and crusting.
Apply ointments and pastes evenly.
Follow directions for each type of medication.
Topical Medications
Transdermal patches:
Remove old patch before applying new.
Document the location of the new patch.
Ask about patches during the medication history.
Apply a label to the patch if it is difficult to see.
Document removal of the patch as well.
Topical Medications: Vaginal Instillation
• Vaginal: use gloves, privacy, patient may choose
to self-administer, may need pad to collect any
drainage
Topical Medications: Rectal Instillation
• Rectal: gloves, may need lubricant, rounded end
to ease administration, place past the internal
anal sphincter to prevent expelling, do not force
Administering via Inhalation
Aerosol spray, mist, or powder via handheld inhalers; used
for respiratory “rescue” and “maintenance”
Pressurized metered-dose inhalers (pMDIs)
Need sufficient hand strength for use
Breath-actuated metered-dose inhalers (BAIs)
Release depends on strength of patient’s breath .
Dry powder inhalers (DPIs)
Activated by patient’s breath
Produce local effects such as bronchodilation
Some medications create serious systemic side effects.
Administering via Inhalation
Inhalers: spacer used when pt. unable to do correctly
Administering Injections
Each injection route differs based on the types of tissues
the medication enters.
Before injecting, know:
The volume of medication to administer
The characteristics and viscosity of the medication
The location of anatomical structures underlying the injection
site
If a nurse does not administer injections correctly,
negative patient outcomes may result.
Minimizing Patient Discomfort
Use a sharp-beveled needle in the smallest suitable length
and gauge.
Select the proper injection site, using anatomical landmarks.
Apply a vapocoolant spray or topical anesthetic to the injection
site before giving the medication, when possible.
Divert the patient’s attention from the injection through
conversation using open-ended questioning.
Insert the needle quickly and smoothly to minimize tissue
pulling.
Hold the syringe steady while the needle remains in tissues.
Inject the medication slowly and steadily.
Injections: Intramuscular
Faster absorption than subcutaneous route
Many risks, so verify the injection is justified
Needles
Very obese: 3 inches; use different route
Thin: ½ to 1 inch
Amounts:
Adults: 2 to 5 mL can be absorbed
Children, older adults, thin patients: up to 2 mL
Small children and older infants: up to 1 mL
Smaller infants: up to 0.5 mL
Injections: Intramuscular (cont’d)
Assess the muscle before giving the injection.
Properly identify the site by palpating bony landmarks.
Be aware of potential complications with each site.
The site needs to be free of tenderness.
Aspirate to ensure not in a blood vessel.
Minimize discomfort.
Insertion angle is 90 degrees.
Landmarks: Ventrogluteal IM
Three Landmarks: Greater Trocanter, Anterior iliac spine, iliac crest
Ventrogluteal IM Injection
Vastus Lateralis Site for IM Injection
Deltoid Site for IM Injection
Z-Track Method in IM Injections
Decreases skin irritation & Seals the medicine in
Medication Administration
Injections: Subcutaneous
Medication is placed in loose connective
tissue under the dermis.
Absorption is slower than with IM
injections.
Administering low-molecular-weight
heparin requires special considerations.
A patient’s body weight indicates the depth
of the subcutaneous layer.
Choose the needle length and angle of
insertion based on the patient’s weight and
estimated amount of subcutaneous tissue.
Subcutaneous Injections
Comparison of Angles of Insertion for
Injections
Injections: Intradermal
Used for skin testing (allergies)
Slow absorption from dermis
Skin testing requires the nurse to be able to clearly see the
injection site for changes.
Use a tuberculin or small hypodermic syringe for skin testing.
Angle of insertion is 5 to 15 degrees with bevel up.
A small bleb will form as you inject; if it does not form, it is
likely the medication is in subcutaneous tissue, and the results
will be invalid.
Types of Syringes
Parts of a Syringe
Parts of the Needle
Types of Needles
Needle With Plastic Guard
Medication Administration
Parenteral
Medication Administration
Parenteral (cont’d)
If two medications are compatible, they can be mixed in
one injection if the total dose is within accepted limits, so
the patient receives only one injection at a time.
Mixing medications
Mixing medications from a vial and an ampule
Prepare medication from the vial first.
Use the same syringe and filter needle to withdraw medication from
the ampule.
Mixing medications from two vials
Types of Orders in Acute Care Agencies
Standing or routine: prn:
Administered until the dosage is Given when the patient
changed or another medication is requires it
prescribed
Single (one-time): STAT:
Given one time only for a specific Given immediately in an
reason emergency
Now: Prescriptions:
When a medication is needed right Medication to be taken
away, but not STAT outside of the hospital
Medication: Orders
Patientsfull name
Date and time order
written
Drug name
Dosage
Route
Time and frequency
Signature of provider
Medication Administration
Pharmacist’s role
Prepares and distributes medication
Distribution systems (unit dose or automatic medication
dispensing system [AMDS])
Area for stocking and dispensing medication
Nurse’s role
Assess patient’s ability to self-administer, determine whether
patient should receive, administer medication correctly, and
closely monitor effects; do not delegate this task.
Medications: Seven Rights
Right patient: 2 identifiers (compare name/ID
with MAR)
Right drug: need order, match MAR
Right dose
Right route
Right time: institutional
Right documentation: after it is given
Right to refuse
Medication: Nurse Role
1. Follow 7 rights
2. Read labels 3x and compare to MAR
3. Use at least 2 patient identifiers
4. Avoid interruption
5. Double check calculations, verify with another RN, follow
policy
6. Question unusual doses
7. Record after medication given
8. Report errors, near-misses
9. Participate in programs designed to reduce error
10. Patient education about medications
Medication Errors
Report all medication errors.
Patient safety is top priority when an error occurs.
Documentation is required.
The nurse is responsible for preparing a written
occurrence or incident report: an accurate, factual
description of what occurred and what was done.
Nurses play an essential role in medication
reconciliation.
Medication Errors: How does it happen?
• Inaccurate prescribing
• Giving the wrong medication
• Using the wrong route
• Giving at the wrong time
• Extra doses
• Omission of scheduled dose
