Charity F. Zambrano, R.N.

• To prepare and administer medications safely, using subcutaneous, intramuscular, intradermal routes.

• Parenteral medication – medication that are given by injections or infusion directly into the body tissues. (ID, SC, IM).

MedicationMedication--is a substance administered for the is a substance administered for the

diagnosis, cure, treatment or relief of a diagnosis, cure, treatment or relief of a symptom or prevention of disease.symptom or prevention of disease.

RxPrescriptionPrescription

-is a written -is a written direction for the direction for the preparation and preparation and administration of a drug.administration of a drug.

Pharmacology is the study of the effect of drugs on living organisms.

PharmacokineticsPharmacokinetics is the study of is the study of absorption, distribution, absorption, distribution, biotransformation and biotransformation and excretion of drugs.excretion of drugs.

PharmacokinetiPharmacokineticscs

•ABSORPTIONABSORPTION – is the process by which a drug passes is the process by which a drug passes

from its from its sitesite of administration into the of administration into the bloodstream.bloodstream.

•DISTRIBUTIONDISTRIBUTION – is the transport of a drug from its site is the transport of a drug from its site

of absorption to its site of action.of absorption to its site of action.

•METABOLISMMETABOLISM//BIOTRANSFORMATIONBIOTRANSFORMATION

a sequence of chemical events that a sequence of chemical events that change a drug to a less active form change a drug to a less active form after it enters the body. Liver is the after it enters the body. Liver is the principal site of drug metabolism.principal site of drug metabolism.

•EXCRETIONEXCRETION is the process by which drugs are is the process by which drugs are eliminated from the body. Most eliminated from the body. Most important route of excretion for important route of excretion for

most drugs is kidneys.most drugs is kidneys.

A drug has different kinds of A drug has different kinds of names…names…

• Generic nameGeneric name = given before a drug = given before a drug becomes official.becomes official.

• Chemical nameChemical name = is the name by which a = is the name by which a chemist knows it; this name describes the chemist knows it; this name describes the constituents of the drug.constituents of the drug.

• Trademark or Brand nameTrademark or Brand name = given by the = given by the drug manufacturerdrug manufacturer

BRAND NAME

GENERIC NAME- MEFENAMIC ACID

PONSTAN

MANUFACTURER’S NAME

EFFECTS OF DRUGSEFFECTS OF DRUGS• Therapeutic effectTherapeutic effect

-is the primary effect intended, or the reason -is the primary effect intended, or the reason the drug is prescribed.the drug is prescribed.

• Side effectSide effect

-These are usually predictable and may be -These are usually predictable and may be either harmless or harmfuleither harmless or harmful. .

• Adverse effectAdverse effect

-A more severe side effects are called -A more severe side effects are called adverse adverse effectseffects that may justify for the discontinuation that may justify for the discontinuation of a drug.of a drug.

• Drug toxicityDrug toxicity

- results from overdosage, ingestion of a drug - results from overdosage, ingestion of a drug intended for external use.intended for external use.

• Drug allergyDrug allergy – an immunologic reaction to a drug. Can an immunologic reaction to a drug. Can

occur anytime from a few minutes to 2 occur anytime from a few minutes to 2 weeks. weeks.

Ex. Skin rashes, nausea and vomiting, Ex. Skin rashes, nausea and vomiting, pruritus, diarrheapruritus, diarrhea

EFFECTS OF DRUGSEFFECTS OF DRUGS

**

Anaphylactic reactionAnaphylactic reaction = severe allergic = severe allergic reaction usually occurs immediately after reaction usually occurs immediately after the administration of the drug. This the administration of the drug. This response can be fatal if the symptoms are response can be fatal if the symptoms are not noticed immediately and treatment is not noticed immediately and treatment is not obtained promptly. The earliest not obtained promptly. The earliest symptoms are: shortness of breath, acute symptoms are: shortness of breath, acute hypotension and tachycardia.hypotension and tachycardia.

Types of Drug PreparationTypes of Drug Preparation• CapletCaplet• CapsuleCapsule• Elixir/SyrupElixir/Syrup• Gel/JellyGel/Jelly• LinimentLiniment• LotionLotion• LozengesLozenges• OintmentOintment• PillPill• SuppositorySuppository• TabletTablet• Transdermal PatchTransdermal Patch

Types of Parenteral Drug Types of Parenteral Drug PreparationPreparation

AmpulesAmpules– made of glass made of glass

with a constricted with a constricted neck, usually neck, usually prescored prescored that that can be easily can be easily snapped off. snapped off.

Vials Vials

- it is a single or - it is a single or multidose container multidose container with a rubber seal at with a rubber seal at the top and a metal the top and a metal cap protector.cap protector.

Routes of AdministrationRoutes of Administration

OralOral sublingualsublingual buccalbuccalRectalRectalVaginalVaginalTopicalTopical dermatologic preparationsdermatologic preparations instillations & irrigationsinstillations & irrigations inhalationsinhalationsParenteralParenteral intramuscular (IM)intramuscular (IM) intradermal (ID)intradermal (ID) subcutaneous (SQ)subcutaneous (SQ) intravenous (IV)intravenous (IV)

Medication Medication OrdersOrders

TYPES:TYPES:

1. stat order1. stat order

2. single order2. single order

3. standing order3. standing order

4. PRN order4. PRN order

Patient's Name:Sebel Dyese

Room No. SR 2

DateJ uly 14, 2008 Demerol 100 mg IM stat

7:ooAm Seconal 100 mg po hs before surgery

Cefaclor 500 mg po tid x 7 days

Give Paracetamol 500mg/ tab 1 tab p.o. Q 4H PRN for fever

PTR No. 1434454

Dr. Gil Adilaido

UPHS-Dr. Jose G. Tamayo Medical CenterSto. Niño, Biñan Laguna

DOCTOR'S ORDER SHEET

Parts of Legal Doctor’s Parts of Legal Doctor’s Order Order

• Name Name of the patientof the patient

• Date and TimeDate and Time the order is written the order is written

• Name of the drugName of the drug to be administered to be administered

• Dosage Dosage of the drugof the drug

• RouteRoute of administration of administration

• Time or FrequencyTime or Frequency of administration of administration

• Signature of the physicianSignature of the physician writing the order writing the order

Nine (9) “Rights”ofNine (9) “Rights”of Medication Administration Medication Administration

• Right Right clientclient• Right Right medicationmedication• Right Right dosedose• Right Right timetime• Right Right routeroute• Right Right documentationdocumentation• Right Right approachapproach• Right educationRight education• Right to refuseRight to refuse

Three (3) “checks” ofThree (3) “checks” of MMedication edication AAdministration dministration RRecordecord

1. 1. Check the order of the doctorCheck the order of the doctor in the MAR in the MAR

2. 2. Check the drug in the MARCheck the drug in the MAR

before preparing it.before preparing it.

3. 3. Check the prepared drugCheck the prepared drug in the MAR before in the MAR before giving it to the client.giving it to the client.

MMedication edication AAdministration dministration RRecordecord

Patient's Name: Sebel Dyese (6-2) (2-10) (10-6)

Attending Physician: Dr.G. Adelaido STN Juan Dela CruzAge: 16 Sex: FRoom No: SR2

DATE Name, Dosage, Route, Frequency TIME

7/14/2008 Paracetamol 300mg/ 2ml 1amp. IV now. 7am

Aspirin 1 tab P.O. once dai ly after lunch. 1pm

Amoxici l l in 500mg/ cap 1cap. P.O. Q 8H 7am

3pm

11pm

Paracetamol 500mg/ tab 1 tab p.o. Q 4H

PRN for Temp. 38.6 ºc and above. 10:50am

`

D A T E

UPHS-Dr. Jose G. Tamayo Medical CenterSto. Niño, Biñan Laguna

Nurse on Duty

Specimen Signature

MMedicationedication CardsCards

Pt.Name: Pt.Name: Pt.Name:

Room No: Room No: Room No:

Medication: Medication: Medication:

Time: Time: Time:

8am

Signature Over Printed Name: Signature Over Printed Name: Signature Over Printed Name:

Date: Date: Date:

Pt.Name: Pt.Name: Pt.Name:

Room No: Room No: Room No:

Medication: Medication: Medication:

Time: Time: Time:

Signature Over Printed Name: Signature Over Printed Name: Signature Over Printed Name:

Date: Date: Date:

OD TID

UPH-Dr.JGTamayo Medical Center UPH-Dr.JGTamayo Medical Center UPH-Dr.JGTamayo Medical Center

PRN

BID QID

Q6H Q12H

8am - 1pm - 6pm

Q4HQ8H

UPH-Dr.JGTamayo Medical Center UPH-Dr.JGTamayo Medical Center UPH-Dr.JGTamayo Medical Center

8am-6pm8am-12nn-4pm-10pm

6am-12nn-6pm-12mn8am-8pm

HS

8am-12nn-4pm8pm-12mn-4am

8am-4pm-12mn

9pm

Parenteral Parenteral MedicationsMedications Intramuscular (IM)Intramuscular (IM)

Intradermal (ID)Intradermal (ID)

Subcutaneous (SC / SQ)Subcutaneous (SC / SQ)

Intravenous (IV) Intravenous (IV)

Because these medications absorbed quickly Because these medications absorbed quickly than oral medications, the nurse must prepare them than oral medications, the nurse must prepare them carefully and accurately. It requires the same nursing carefully and accurately. It requires the same nursing knowledge as for oral and other drug preparation; knowledge as for oral and other drug preparation; however, because injections are however, because injections are invasive procedureinvasive procedure, , aseptic techniqueaseptic technique must be used must be used to minimize the risk of to minimize the risk of infection. infection.

EquipmentsEquipments1.1. Syringes Syringes a. hypodermic syringesa. hypodermic syringes = 2ml, 2.5ml, 3ml,= 2ml, 2.5ml, 3ml, 5ml, 10ml5ml, 10ml b. insulin syringeb. insulin syringe c. tuberculinc. tuberculin syringesyringe

• 2. 2. NeedlesNeedles PartsParts:>Bevel:>Bevel >Shaft>Shaft >Gauge number>Gauge number >Hub>Hub 3 variable 3 variable

characteristics of a characteristics of a needle:needle:

a. slant or length of the a. slant or length of the bevelbevel

=SQ and IM, has =SQ and IM, has longer bevels, provide the longer bevels, provide the sharpest needles and sharpest needles and cause less discomfort.cause less discomfort.

=ID and IV, has short =ID and IV, has short bevelsbevels

b. Length of the shaft = commonly used b. Length of the shaft = commonly used needles varies from ½ to 2 inches. The needles varies from ½ to 2 inches. The appropriate needle length is chosen appropriate needle length is chosen according to the client’s muscle according to the client’s muscle development, weight and the type of development, weight and the type of injection.injection.

c. Gauge (diameter) of the shaft = varies c. Gauge (diameter) of the shaft = varies from #18 to #28. The larger the gauge from #18 to #28. The larger the gauge number, the smaller the diameter of the number, the smaller the diameter of the shaft.shaft.

Parts of hypodermic needle:

Intradermal InjectionsIntradermal Injections

An intradermal (ID) injection is the administration of a drug into the dermal

layer of the skin just beneath the epidermis. Usually only a small amount of

liquid is used, for example 0.1ml. This method of administration is frequently

used for allergy testing and tuberculosis (TB) screening.

SITES:SITES:

a. Inner lower arma. Inner lower arm

b. Upper chestb. Upper chest

c. Back beneath the c. Back beneath the scapulaescapulae

Subcutaneous injections (just beneath the skin)

Kinds of drugs commonly administered:

1. vaccines 2. preoperative

medications 3. narcotics 4. insulin 5. heparin

SQ Common Sites:

1. outer aspect of the upper arms

2. anterior aspect of the

thighs 3. abdomen 4. scapular areas of the

upper back 5. upper ventrogluteal

and dorsogluteal areas.

IM (IM (Intramuscular Intramuscular Injections)Injections) -injections -injections into muscle tissueinto muscle tissue

Absorbs more quickly than subcutaneous Absorbs more quickly than subcutaneous injections because of the greater blood supply injections because of the greater blood supply to the body muscles.to the body muscles.

Several factors indicate the size and length Several factors indicate the size and length of the needle to be used:of the needle to be used:

1. muscle1. muscle

2. type of solution2. type of solution

3. amount of adipose tissue covering the 3. amount of adipose tissue covering the musclemuscle

4. age of the client4. age of the client

Selected body sites:Selected body sites:• 1. 1. Ventrogluteal siteVentrogluteal site Position:Position: >back>back >prone>prone >side-lying>side-lying Position client on his or her side with the Position client on his or her side with the

knee bent and raised slightly toward the knee bent and raised slightly toward the chest.The trochanter will protrude, which chest.The trochanter will protrude, which facilitates locating the ventrogluteal site.The facilitates locating the ventrogluteal site.The nurse places the heel of the hand on the nurse places the heel of the hand on the client’s greater trochanter, with the fingers client’s greater trochanter, with the fingers pointing towards the client head.pointing towards the client head.

With the index With the index finger on the client’s finger on the client’s anterior superior iliac anterior superior iliac spine, the nurse spine, the nurse stretches the middle stretches the middle finger dorsally(toward finger dorsally(toward the buttocks), the buttocks), palpating the crest of palpating the crest of the ilium and then the ilium and then pressing below it. The pressing below it. The triangle formed by triangle formed by the index finger, the the index finger, the third finger, and the third finger, and the crest of the ilium is crest of the ilium is the injection site.the injection site.

• 2. 2. Vastus lateralis siteVastus lateralis site = = situated on the anterior lateral situated on the anterior lateral aspect aspect

of the thigh. The land-of the thigh. The land-

mark is established bymark is established by

dividing the area bet-dividing the area bet-

ween the greater tro-ween the greater tro-

chanter of the femur &chanter of the femur &

the lateral femoral intothe lateral femoral into

thirds & selecting thethirds & selecting the

middle third.middle third.

• 3. 3. Dorsogluteal siteDorsogluteal site = palpate the = palpate the posterior superior iliac spine, then draws posterior superior iliac spine, then draws an imaginary line to the greater an imaginary line to the greater trochanter of the femur. This line is trochanter of the femur. This line is lateral to and parallel to the sciatic nerve.lateral to and parallel to the sciatic nerve.

•

4. 4. Deltoid SiteDeltoid Site - found on the lateral aspect - found on the lateral aspect of the upper arm.of the upper arm.

Place the 4 finger acrossPlace the 4 finger across

the deltoid muscle with the the deltoid muscle with the

first finger on the acromionfirst finger on the acromion

process. The top of the process. The top of the

axilla is the line that marksaxilla is the line that marks

the lower border landmark.the lower border landmark.

A triangle w/in these boun-A triangle w/in these boun-

daries indicates the deltoiddaries indicates the deltoid

muscle about 5cm below muscle about 5cm below

the acromion process. Pinchthe acromion process. Pinch

grasp technique can reducegrasp technique can reduce

discomfort of an IM inj.discomfort of an IM inj.

• 5. 5. Rectus FemorisRectus Femoris = used occasionally for = used occasionally for IM injections. Situated on the anterior aspect IM injections. Situated on the anterior aspect of the thigh. of the thigh.

The advantage of The advantage of this is that clients whothis is that clients who need to administer theirneed to administer their own injection can reachown injection can reach this site easily. this site easily. Disadvantage is that it Disadvantage is that it may cause discomfortmay cause discomfort for some client.for some client.

Intravenous (IV)Intravenous (IV) – needle is injected – needle is injected into the vein. Direct IV, IV push,IV into the vein. Direct IV, IV push,IV infusion. This is the most rapid route infusion. This is the most rapid route of absorption of medications.of absorption of medications.

Legal aspects of drug medication:Legal aspects of drug medication:

Republic Act 9173 “The Philippine Nursing Act “The Philippine Nursing Act of 2002”of 2002”

Section 28 Article VI: Nursing care includes, but Section 28 Article VI: Nursing care includes, but not limited to, traditional and innovative not limited to, traditional and innovative approaches, therapeutic use of self, executing approaches, therapeutic use of self, executing health care techniques and procedures, health care techniques and procedures, essential primary health care, comfort essential primary health care, comfort measures, health teachings, and administration measures, health teachings, and administration of written prescription for treatment, therapies, of written prescription for treatment, therapies, oral topical and parenteral medications…oral topical and parenteral medications…

• - requires that the drugs be written in their Generic - requires that the drugs be written in their Generic Names.Names.

• Republic Act 6675

Intravenous (IV)Intravenous (IV) – needle is – needle is injected into the vein. Direct IV, IV injected into the vein. Direct IV, IV push,IV infusion. This is the most push,IV infusion. This is the most

rapid route of absorption of rapid route of absorption of medications.medications.

Abbreviation ExplanationAbbreviation Explanation ac before mealsac before meals pc after mealspc after meals po or PO by mouthpo or PO by mouth cap capsulecap capsule dil dissolve, dilutedil dissolve, dilute h hourh hour hs at bedtime/hours of sleephs at bedtime/hours of sleep kg or Kg kilogramkg or Kg kilogram l or L literl or L liter OD right eyeOD right eye OS left eyeOS left eye OU both eyesOU both eyes

Common Abbreviations in Drug Common Abbreviations in Drug AdministrationAdministration

Common Abbreviations in Drug Common Abbreviations in Drug AdministrationAdministration

prn when neededprn when needed q everyq every qAM every morningqAM every morning q2h every two hoursq2h every two hours qod every other dayqod every other day stat immediatelystat immediately tab tablettab tablet susp suspensionsusp suspension supp suppositorysupp suppository CBR complete bed restCBR complete bed rest BRP bathroom privilegesBRP bathroom privileges ad lib freely, as desiredad lib freely, as desired

od once a dayod once a day bid twice a daybid twice a day tid three times a daytid three times a day qid four times a day qid four times a day

gr grain gr grain gtt drop gtt drop mcg or ug microgrammcg or ug microgram cc mlcc ml******Some abbreviations above are not anymore Some abbreviations above are not anymore

accepted/or discouraged internationally, due to high accepted/or discouraged internationally, due to high medication errors/confusion in medication orders. Yet, it medication errors/confusion in medication orders. Yet, it is still used in the Philippines.is still used in the Philippines.

INSTEAD… INSTEAD… we are encourage to use the full wordwe are encourage to use the full word..

Common Abbreviations in Drug AdministrationCommon Abbreviations in Drug Administration

Formula for computation of dosage:Formula for computation of dosage:

• Oral medications: solidsOral medications: solids Desired doseDesired dose

= quantity of drug= quantity of drug

Stock Dose Stock Dose

(D/S=Q)(D/S=Q)

ex: ex: An antihypertensive agent, An antihypertensive agent, minoxidil(Loniten)5mg p.o is ordered. Stock is minoxidil(Loniten)5mg p.o is ordered. Stock is 2.5mg/tab. 2.5mg/tab.

How many tablets should be administered?How many tablets should be administered?

Answer: D= 5mgAnswer: D= 5mg = =

S = 2.5mg/tabletS = 2.5mg/tablet

2 tablets2 tablets

Formula for computation of dosage:Formula for computation of dosage:• Oral medications: Liquid preparationsOral medications: Liquid preparations Desired doseDesired dose

X Dilution = X Dilution = Quantity of drugQuantity of drug Stock Dose Stock Dose

ex: ex: Paracetamol 250mg / 5 ml , give 500 mg P.O Paracetamol 250mg / 5 ml , give 500 mg P.O every 4 hours RTC. every 4 hours RTC.

Answer: D= 500mgAnswer: D= 500mg X 5ml X 5ml

S = 250 mgS = 250 mg

= 10 ml= 10 ml

Medication Error Leads Medication Error Leads to a patient’s Death!to a patient’s Death!

GOOD LUCK!GOOD LUCK!

THANK YOU FOR THANK YOU FOR LISTENING!LISTENING!