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OBJECTIVES:OBJECTIVES:

Define selected term related to the Define selected term related to the administration of medication.administration of medication.

Describe various route of medication Describe various route of medication administration.administration.

Identify essential part of medication orders.Identify essential part of medication orders. Outline list of steps of medication Outline list of steps of medication

administration.administration. Identify the sites of medication administration.Identify the sites of medication administration. Describe essential steps in safety medication Describe essential steps in safety medication

administration. administration.

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Definitions:Definitions:

Pharmacology: is the study of the effect of Pharmacology: is the study of the effect of the drug on the body.the drug on the body.

Medication: is a substance administered Medication: is a substance administered for diagnosis, cure, treatment, mitigation for diagnosis, cure, treatment, mitigation or prevention.or prevention.

Prescription: the written direction for the Prescription: the written direction for the preparation and the administration of the preparation and the administration of the drug.drug.

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One drug can have as many as One drug can have as many as names:names:

The generic name: is given for The generic name: is given for the drug to being official name.the drug to being official name.

The official name: is the name The official name: is the name under which its listed in one in under which its listed in one in the official publication.the official publication.

The chemical name: is the name The chemical name: is the name by which the chemist knows it.by which the chemist knows it.

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Cont Cont

The trade mark or brand name: is name The trade mark or brand name: is name given by the drug manufacture given by the drug manufacture

Example: hydrochlorothiazide (official Example: hydrochlorothiazide (official name).name).

Esidrex (brand name) Esidrex (brand name)

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Therapeutic action of drugs:Therapeutic action of drugs:

Palliative: relieve symptom of a Palliative: relieve symptom of a disease but does not affect on a disease but does not affect on a disease it self as morphine.disease it self as morphine.

Curative: cure a disease or Curative: cure a disease or condition as penicillin.condition as penicillin.

Supportive: support body function Supportive: support body function until treatment or body response until treatment or body response can take over as aspirin.can take over as aspirin.

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Cont Cont

Substitutive: replace body fluids or Substitutive: replace body fluids or substance insulin.substance insulin.

Chemotherapeutic: destroy Chemotherapeutic: destroy malignant cell as busulfan for malignant cell as busulfan for leukemia.leukemia.

Restorative: return body health as Restorative: return body health as vitamin.vitamin.

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Effect of drug:Effect of drug:

The therapeutic effect: is the primary The therapeutic effect: is the primary effect intended that is the reason the effect intended that is the reason the drug is prescribed such as morphine drug is prescribed such as morphine sulfate is analgesia.sulfate is analgesia.

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Cont:Cont:

Side effect: secondary effect of the Side effect: secondary effect of the drug is one that unintended, side drug is one that unintended, side effects are usually predictable and effects are usually predictable and may be either harmless for example may be either harmless for example digitalis increase the strength of digitalis increase the strength of myocardial contraction but it can myocardial contraction but it can have side effect inducing vomiting have side effect inducing vomiting and nausea. and nausea.

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Cont: Cont:

Drug toxicity: deleterious effect of Drug toxicity: deleterious effect of the drug on an organism or tissue, the drug on an organism or tissue, result from overdose or external use.result from overdose or external use.

Drug allergy: is immunological Drug allergy: is immunological reaction to a drug.reaction to a drug.

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Cont Cont

Drug interaction: occur when Drug interaction: occur when administration of one drug before or administration of one drug before or after alter effect of one or both drug.after alter effect of one or both drug.

Drug misuse: Is the improper use of Drug misuse: Is the improper use of common medications in way that common medications in way that lead to acute and chronic toxicity for lead to acute and chronic toxicity for example laxative, antacid and example laxative, antacid and vitamins.vitamins.

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Drug abuse: is an inappropriate intake Drug abuse: is an inappropriate intake of substance either continually or of substance either continually or periodically.periodically.

Drug dependence: is a persons Drug dependence: is a persons reliance on or need to take drug or reliance on or need to take drug or substance there are two type of substance there are two type of dependence:dependence:

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Physiological dependence: is due to Physiological dependence: is due to biochemical changes in the body biochemical changes in the body tissue these tissue come to require tissue these tissue come to require substance for normal function.substance for normal function.

Psychological dependence: is Psychological dependence: is emotional reliance on a drug to emotional reliance on a drug to maintain a since of wellbeing maintain a since of wellbeing accompanied feeling of need.accompanied feeling of need.

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Cont : Cont :

Drug habituation: denotes a mild Drug habituation: denotes a mild form of psychological form of psychological dependence.dependence.

Illicit drug: also called street drug Illicit drug: also called street drug are those sold illegally. are those sold illegally.

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Common mild allergic response:Common mild allergic response:

Skin rash.Skin rash.Pruritus.Pruritus.Rhinitis.Rhinitis.Nausea and vomiting.Nausea and vomiting.Wheezing.Wheezing.Diarrhea.Diarrhea.

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Factor effecting medication actionFactor effecting medication action::

Developmental factor such as older age Developmental factor such as older age and infants are deferent response of and infants are deferent response of medication.medication.

GenderGender Culture and genetic factor.Culture and genetic factor. DietDiet EnvironmentEnvironment Illness and diseaseIllness and disease Time of administration Time of administration

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Route of administration:Route of administration:

Oral is the most commonOral is the most common

AdvantageAdvantage:: Least expensive and most Least expensive and most

convenient route for most clients.convenient route for most clients. Safe, does not break the skin.Safe, does not break the skin.

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Oral medication Oral medication

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Cont: Cont:

Disadvantage:Disadvantage: Inappropriate for client nausea and Inappropriate for client nausea and

vomiting.vomiting. Drug may have unpleasant taste.Drug may have unpleasant taste. May cause irritation of gastro May cause irritation of gastro

intestinal tract.intestinal tract. Drug may discolor teeth.Drug may discolor teeth. Drug can be aspirated by ill client.Drug can be aspirated by ill client.

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Sublingual:Sublingual: a drug placed under the a drug placed under the tongue, where it dissolved.tongue, where it dissolved.

Advantage:Advantage: Same as oral plusSame as oral plus Drug may administered for local Drug may administered for local

effect.effect. Drug rapidly absorbed into blood Drug rapidly absorbed into blood

stream.stream. More potent than oral.More potent than oral.

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Disadvantage:Disadvantage: If swallowed drug may be inactive.If swallowed drug may be inactive. Drug must remain under the tongue Drug must remain under the tongue

until dissolved.until dissolved.

Baccal:Baccal: pertaining to the cheeks. pertaining to the cheeks.

Rectal:Rectal: can be used when drug can be used when drug objectionable taste objectionable taste

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parenteral : parenteral :

Subcutaneous (SC):Subcutaneous (SC): hypodermic into hypodermic into subcutaneous tissue, just below the subcutaneous tissue, just below the skin.skin.

Advantage:Advantage: onset drug action faster onset drug action faster than oral.than oral.

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Type of injection degree:Type of injection degree:

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Disadvantage:Disadvantage:

Must involve sterile technique Must involve sterile technique

because breaks skin barrier.because breaks skin barrier. More expensive than oral.More expensive than oral. Can administer only small doses.Can administer only small doses. Slower than intramuscular injection.Slower than intramuscular injection. Some drug can irritate tissue and Some drug can irritate tissue and

can cause pain.can cause pain.

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Sc injection site Sc injection site

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Intramuscular (IM):Intramuscular (IM):

into in the muscle.into in the muscle.

Characteristics :Characteristics : 2 to 5 ml syringe, 21 or 22 gauge and 2 to 5 ml syringe, 21 or 22 gauge and

1.1/5 inches.1.1/5 inches.

- Several factors can effect of needle:- Several factors can effect of needle: The muscle site.The muscle site. the type of solution.the type of solution. the amount of adipose tissue that covered of the amount of adipose tissue that covered of

area.area. the age of the client.the age of the client.

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Advantage:Advantage: Pain from irritating drugs is Pain from irritating drugs is

minimized.minimized. Can administer large volume of Can administer large volume of

drug.drug. Drug rapidly absorbed.Drug rapidly absorbed.

DisadvantageDisadvantage:: breaks skin barrier.breaks skin barrier. Can be anxiety producing.Can be anxiety producing.

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Common site of intramuscular Common site of intramuscular injections:injections:

Ventrogluteal site: also known as Ventrogluteal site: also known as von hochseter’s site which lies over von hochseter’s site which lies over the gluteus minimus is preferred site the gluteus minimus is preferred site because the area contains no large because the area contains no large nerve or blood vessels.nerve or blood vessels.

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Provide greater thickness of gluteal Provide greater thickness of gluteal muscle consisting gluteus medius and muscle consisting gluteus medius and gluteus minimus.gluteus minimus.

Contain less fat area. Contain less fat area.

The clients position:The clients position: On back, prone and side lying position.On back, prone and side lying position.

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Ventrogluteal site: Ventrogluteal site:

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Cont:Cont:

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Vastus latralis siteVastus latralis site: : is usually thicker and well is usually thicker and well

developed in adult, children and developed in adult, children and infant 7 months because no infant 7 months because no major blood vessel sand nerve major blood vessel sand nerve in the area.in the area.

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It established by dividing the It established by dividing the area between the greater area between the greater trochanter of the femur and the trochanter of the femur and the lateral femoral condyle into lateral femoral condyle into third and selects the middle third and selects the middle third.third.

Patient may in supine position Patient may in supine position or sitting position. or sitting position.

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Vastus latralis:Vastus latralis:

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Vastus latralis:Vastus latralis:

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Vastus latralis:Vastus latralis:

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Dorsogluteal site:Dorsogluteal site:

is composed of the thick gluteal muscle is composed of the thick gluteal muscle of the buttocks, Because the site of the buttocks, Because the site developed by walking, the site not be developed by walking, the site not be used or children under three years.used or children under three years.

The nurse must choose the injection site The nurse must choose the injection site carefully to avoid striking the sciatic carefully to avoid striking the sciatic nerve and blood vessels.nerve and blood vessels.

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The nurse palpates the posterior iliac The nurse palpates the posterior iliac spine, and then draws an imaginary spine, and then draws an imaginary line to the greater trochenter femur. line to the greater trochenter femur.

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Dorsogluteal site:Dorsogluteal site:

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Dorsogluteal site:Dorsogluteal site:

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Deltoid muscle:Deltoid muscle:

is found on the lateral aspect of the upper is found on the lateral aspect of the upper arm its not used frequently because it is arm its not used frequently because it is relatively small and very clause to the radial relatively small and very clause to the radial nerve and radial artery. But no more 1ml can nerve and radial artery. But no more 1ml can be administered for example: hepatitis B be administered for example: hepatitis B vaccine.vaccine.

The method of establishing the deltoid site is to The method of establishing the deltoid site is to place four fingers across the deltoid muscle. place four fingers across the deltoid muscle.

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Deltoid muscle:Deltoid muscle:

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Rectus femoris site:Rectus femoris site:

Which belongs to the quadriceps Which belongs to the quadriceps muscle group. It’s situated on the muscle group. It’s situated on the anterior aspect of the thigh anterior aspect of the thigh

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Rectus femoris site:Rectus femoris site:

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intradermal (ID):intradermal (ID): is the administrating of a drug into is the administrating of a drug into

the dermal layer of the skin just the dermal layer of the skin just beneath the epidermis, usually beneath the epidermis, usually small amount of liquid is used for small amount of liquid is used for example 0.1ml. example 0.1ml.

characteristic of needle may use:characteristic of needle may use: short and fine, 25,26 and 27 gauge. ¼ short and fine, 25,26 and 27 gauge. ¼

to 5/8 inch long.to 5/8 inch long.

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intradermal (ID):intradermal (ID):

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Common sites:Common sites: Inner lower arm.Inner lower arm. Upper chest.Upper chest. On the back beneath the scapula.On the back beneath the scapula. Notes: Intradermal injection are Notes: Intradermal injection are

absorbed slowly through blood absorbed slowly through blood capillaries, the area not massaged capillaries, the area not massaged because the medication may disperse.because the medication may disperse.

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Advantage:Advantage: absorption is slow (this absorption is slow (this advantage test for allergy).advantage test for allergy).

DisadvantageDisadvantage: amount of drug : amount of drug administered must be small.administered must be small.

Breaks skin barrier.Breaks skin barrier.

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Intravenous (IV):Intravenous (IV): in to the vein. in to the vein. Large amount of drug can administer.Large amount of drug can administer. Advantage:Advantage: rapid effect.rapid effect. Disadvantage:Disadvantage: limited to highly soluble drug.limited to highly soluble drug. Break skin barrier.Break skin barrier. Drug distribution inhibited by poor Drug distribution inhibited by poor

circulation.circulation.

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Inhalation:Inhalation: introduce drug through respiratory introduce drug through respiratory

tract.tract.

Topical:Topical: Topical applications are those Topical applications are those

applied to circumscribed surface applied to circumscribed surface area of the body. They effect only area of the body. They effect only the area to which they are applied.the area to which they are applied.

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Types of medication order:Types of medication order:

A state order: indicates that the A state order: indicates that the medication is to be given immediately medication is to be given immediately and only once.and only once.

Example: volterin 75mg Im state.Example: volterin 75mg Im state.

The single order dose: is for The single order dose: is for medication to be given once at the medication to be given once at the specified time.specified time.

Example seconal 100mg hs before Example seconal 100mg hs before surgery.surgery.

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The standing orderThe standing order: may or may not : may or may not have a termination datehave a termination date

Example volterin 75mg IM q4h * 5 days.Example volterin 75mg IM q4h * 5 days.

A PRN orderA PRN order: as needed order permits : as needed order permits the nurse to give a medication when, in the nurse to give a medication when, in the nurse judgment, the client requires the nurse judgment, the client requires it.it.

Example: panadol 500mg PRN.Example: panadol 500mg PRN.

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The drug order has seven essential The drug order has seven essential parts:parts:

- Full name of the client- Full name of the client 2- Date &time the order is written2- Date &time the order is written 3- Name of the drug to be 3- Name of the drug to be

administeredadministered 4- Dosage of the drug4- Dosage of the drug 5- Method of administration.5- Method of administration. 6- Frequency of drug.6- Frequency of drug. 7- Signature of the physician or nurse 7- Signature of the physician or nurse

practitionerpractitioner

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Five 'Rights' of drug Five 'Rights' of drug administrationadministration

1- Right drug1- Right drug 2- Right dose2- Right dose 3- Right time3- Right time 4- Right route4- Right route 5- Right client.5- Right client.

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Right Medication.Right Medication. Read the medication record, and take Read the medication record, and take

the appropriate medication from the the appropriate medication from the shelf, drawer, or refrigerator.shelf, drawer, or refrigerator.

Compare the label of the medication Compare the label of the medication container against the order. If these container against the order. If these are not identical, recheck the client’s are not identical, recheck the client’s record. If there is still a discrepancy, record. If there is still a discrepancy, check with the delegating nurse.check with the delegating nurse.

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Right Time.Right Time. Give the medication Give the medication at the right time.at the right time.

Right Route.Right Route. Give the medication Give the medication by the ordered route - eye drop or by the ordered route - eye drop or ointment.ointment.

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Right Dose.Right Dose. Checking medication data is Checking medication data is

essential to prevent a medication essential to prevent a medication error. Check the eye preparation for error. Check the eye preparation for the name, strength, and number of the name, strength, and number of drops if a liquid is used. If ointment drops if a liquid is used. If ointment is used, discard the first bead. The is used, discard the first bead. The first bead of ointment from a tube is first bead of ointment from a tube is considered to be contaminated.considered to be contaminated.

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Right Client.Right Client. Identify the client by name.Identify the client by name. Explain to the client it is time for Explain to the client it is time for

their eye medication administration.their eye medication administration. Explain the technique to the client. Explain the technique to the client.

The administration of eye medication The administration of eye medication is not usually painful. Ointments are is not usually painful. Ointments are often soothing to the eye, but some often soothing to the eye, but some liquid preparations may sting liquid preparations may sting initially.initially.

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Parts of prescription:Parts of prescription:

Descriptive information about the Descriptive information about the client: name, address and age.client: name, address and age.

DatesDates The Rx symbol, meaning “take The Rx symbol, meaning “take

thou”.thou”. Medication name, dose Medication name, dose

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Route of administration.Route of administration. Dispensing instruction.Dispensing instruction. Direction of administration.Direction of administration. RefillRefill Prescriber’s signature. Prescriber’s signature.

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Clinical guide line for Clinical guide line for administering medication.administering medication.

Nurses who administer medication are Nurses who administer medication are responsible for their own action.responsible for their own action.

Be knowledgeable about medication.Be knowledgeable about medication. Use medication that are a clearly labeled.Use medication that are a clearly labeled. Don’t use liquid medication that are cloudy.Don’t use liquid medication that are cloudy. Before administration the drug identify the Before administration the drug identify the

patient correctly.patient correctly. Do not leave the medication on the bed Do not leave the medication on the bed

side.side. If the client vomits the drug report this and If the client vomits the drug report this and

inform doctor.inform doctor.

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Cont: Cont:

Take special precaution when Take special precaution when administrating certain medication administrating certain medication such as heparin.such as heparin.

Most hospital policies require new Most hospital policies require new orders from the physician.orders from the physician.

When a medication error is made, When a medication error is made, report immediately to the nurse in report immediately to the nurse in charge or to the physician. charge or to the physician.

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