MEDICATION ADMINISTRATION

(Week 3)

OBJECTIVES

 Describe various routes of medication administration and when it is most indicated.

 Identify essential parts of a medication order.
 List examples of various types of medication orders.
 Describe the cultural and legal considerations.
 State the “10 Rights” to accurate medication administration.

MEDICATION ADMINISTRATION
-the process by which a medicine is administered to a patient therapeutically.

MEDICATIONS OR MEDICINES
-are chemicals that are used for diagnosis, treatment, and prevention of disease/s.

“ALL MEDICINES ARE DRUGS, BUT NOT ALL DRUGS ARE MEDICINE.”

ROUTES OF ADMINISTRATION
-Small Therapeutic Molecules:
 Parenteral (Intravenous, Intramuscular, & Subcutaneous)
 Oral
 Nasal
 Ocular
 Transmucosal (Buccal, Vaginal, & Rectal)
 Transdermal
 ORAL ROUTE

Advantages include:

 Most convenient
 Usually least expensive
 Safe, does not break skin barrier
 Administration usually does not cause stress
 Some new oral medications are designed to rapidly dissolve on the tongue,
allowing for faster absorption and action

Disadvantages include:

 Drug may have unpleasant taste or odor

 Inappropriate when GI tract has reduced motility
 Inappropriate if client cannot swallow or is unconscious
 Cannot be used before certain diagnostic tests or surgical procedures
 Drug may discolour teeth, harm tooth enamel
 Drug may irritate gastric mucosa
 Drug can be aspirated by seriously ill clients

 SUBLINGUAL AND BUCCAL ROUTE

Advantages include:

 Same as for oral, plus:

 Drug can be administered for local effect
 More potent than oral route because drug directly enters the blood and bypasses
the liver.

Disadvantages include:

 If swallowed, drug may be inactivated by gastric juice

 Drug must remain under tongue until dissolved and absorbed
 May cause stinging or irritation of the mucous membranes
 Drug is rapidly absorbed into the bloodstream
 DRUG PREPARATION FOR THESE ROUTES
 SOLID

 Tablet (Sustained-release, Enteric-coated, and Effervescent)

 Capsule
 Caplet
 Pill
 Lozenge (e.g. Strepsils & Bactidon)
 Powder

 LIQUID

 Aqueous Solution (Liquid Medicine)

 Aqueous Suspension (Liquid medicine with Granules)
 Syrup
 Elixir
 Extract
 Tincture

USED IN ORAL MEDICATIONS:

 ORAL SYRINGE
 MEDICINE CUP
 DROPPER
 PILL CUTTER
 SPLITTER
 CRASHER
 MORTAR & PESTLE
 TOPICAL ROUTE

Topical applications are those applied to a circumscribed surface area of the body. They
affect only the area to which they are applied. Topical applications include the following:

1. DERMATOLOGIC PREPARATIONS

-applied to the skin.

2. INSTILLATIONS AND IRRIGATIONS

-applied into the body cavities or orifices, such as the urinary bladder,
eyes, ears, nose, rectum, or vagina.

3. INHALATIONS

-administered into the respiratory tract by nebulizer or positive pressure

breathing apparatus. Air, oxygen, and vapour are generally used to carry
the drug into the lungs.

 TOPICAL ROUTE (continuation)

Advantages include:

 Few side effects

 Painless

Disadvantages include:

 Drug can enter body through abrasions and cause systemic effects
 Leave residue on the skin that may soil clothes

DRUG PREPARATION FOR TOPICAL ROUTES:

 Cream
 Lotion
 Liniment
 Ointment
 Gel/Jelly
 TRANSDERMAL ROUTE

Advantages include:

 Prolonged systemic effect

 Few side effects
 Avoids GI absorption problems
 Onset of drug action faster than oral

Disadvantages include:

 Rate of delivery may be variable

 Verify that the previous patch has been removed and disposed of appropriately
to avoid overdose
 Medication leaves an oily or pasty substance on the skin sometimes soiling the
clothes

 MUCOUS MEMBRANES ROUTE

(Includes: Otic, Ophthalmic, Intraocular, Vaginal, and Rectal Routes)

Advantages include:

 Therapeutic effects provided by local application to involved sites

 Aqueous solution readily absorbed and capable of systemic effects
 Potential route of administration when oral route is contraindicated

Disadvantages include:

 Mucous membranes are highly sensitive to some medication concentrations

 Patients with ruptured eardrum cannot receive ear irrigations
 Insertion of vaginal and rectal suppositories can be embarrassing

DRUG PREPARATION FOR THESE ROUTES:

 Aqueous solution (Liquid Medicine)

 Aqueous Spray or Foam
 Cream
 Gel/Jelly
 Ointment
 Lotion
 Suppositories
 Vaginal Tablets
GIVEN VIA:

 Inhalation (For aqueous spray, Intranasal *can be oral*)

 Instillation (Dropping medicine into the mucous membrane)
 Irrigation (Flushing mucous membranes with large amounts of medicine)
 Insertion (Inserting medicines into the vagina or rectum)

UNDERSTANDING MEDICATION ORDER

MEDICATION ORDER

A written direction provided by a prescribing practitioner for a specific medication to be

administered to an individual.

SHOULD CONTAIN:
 Full name of the client
 Date and time the order is written
 Name of the drug to be administered
 Dosage of the drug
 Frequency of administration
 Route of administration
 Signature of the person writing the order

TYPES OF MEDICATION ORDER

1. Standing/Routine Order

-May or may not have a termination date

-May be carried out indefinitely until an order is written to cancel it
-Or it may be carried out for a specified number of days

2. As Needed Order (PRN Order)

-Permits the nurse to give a medication when, in the nurse’s judgment, the client
requires it
-The nurse must use good judgment about when the medication is needed and
when it can be safely administered
-Often ordered with the term “PRN” or a condition (“for”)

3. Single Dose Order

 -Medication to be given once at a specified time or situation

4. Stat Order

-Indicates that the medication is to be given immediately and only once

5. Now Order

-Used when a patient needs a medication quickly but not right away as in the stat
order
-The nurse has a maximum of 90 minutes to complete a Now Order given only at
one time

DOSAGE CALCULATIONS

Math calculations done for preparing appropriate doses of medicines, taking into account
conversions of WEIGHTS AND MEASURES. Mistakes are one of the sources of MEDICATION
ERRORS.

1. Be familiar with the systems of measurement

2. Check the available dose and the desired dose
3. Check if there is a need for conversion
(Always round off to the nearest tenths for decimal)
10 RIGHTS OF PATIENTS IN MEDICATION:

1. Right Patient
2. Right Medication
3. Right Dose
4. Right Time
5. Right Route
6. Right Assessment
7. Right Documentation
8. Right to Education
9. Right Evaluation
10. Right to Refuse

MEDICATION DISPENSING SYSTEMS

 MEDICATION CART

-is on wheels, allowing the nurse to move the cart to outside the client’s room
-the cart contains small numbered drawers that correlate to the room numbers on
the nursing unit
-the small drawer is labelled with the name of the client currently in that room and
holds the client’s medications for the shift or 24 hrs.

 AUTOMATION OF MEDICATION ADMINISTRATION

-client records are all in the computer

-no longer requires the use of medicine tickets
-uses AUTOMATED DISPENSING SYSTEM (ADS) wherein MEDICATION
ADMINISTRATION RECORD (MAR) of the patient is encoded. The
system uses scanner or an AUTOMATED…

 MEDICATION ADMINISTRATION RECORD (MAR)

SOME PRACTICE GUIDLELINES:

 Nurses who administer medications are responsible for their own actions.
 Be knowledgeable about the medications you administer.
 Use only medications that are in a clearly labelled container. Always check for expiration
date.
 Do not use liquid medications that are cloudy or any drug that have color changes.
 Calculate drug doses accurately.
 Administer only medications personally prepared.
 Before administering a medication, always identify the client correctly.
 Do not leave medications at the bedside.
 Review agency protocol on administration of narcotics.
In preparing medications, separate narcotics from other drugs to remind you necessary
assessment must be done prior to administration.
 Break only scored tablets if necessary to obtain the correct dosage.
 Check if agency requires the pharmacy to split the medication or if nurses can do
it.
If nurses are allowed, use a cutting or splitting device to cut the medication.
 If the client has difficulty swallowing, check if the medication can be crushed then
crush accordingly.
 Check the agency policy (as to how…)
CHECKING OF MEDICATION

GENERAL PROCESS OF ADMINISTERING DRUGS

1. Identify and verify the client.
 Use at least two methods of identifying the client.
2. Inform/Educate the client on the medication to be administered.
3. Administer the drug appropriately.
 Check the drug thrice.
 Follow the manufacturer’s direction and agency protocol of drug administration.
4. Provide adjunctive interventions as indicated.
5. Record the drug administered.
DOSAGE CALCULATIONS NURSING PRACTICE PROBLEMS
& COMPREHENSIVE NCLEX REVIEW
(YouTube Video)