Drug administration

 DRUGS are chemical substances derived from
different sources (living or non-living) which are
used to alter or change the functions of cells or
organs.
 Administration of drug means a process of
entering the medicines or drugs in the body.

1) Time and frequency of medication
administration:
AC-before a meal
PC-after meal
OD-once a day
HS-at a bed time
OM-early morning
ON-each night

PPN-when required
SOS-if necessary
BID/BD-twice a day
TDS/TID-three times aday
QID-four times aday
STAT-immediately
QH-hourly
NPO-nothing per oral

2) Abbreviation regarding route
PO- per oral
IM- intra muscular
IV- intra vascular
ID- intra dermal
SC- subcutaneous
PV- per vaginal
PR- per rectum
NG- naso gastric

3) Abbreviation regarding the preparation of drugs
mist- mixture
Tr./tinct- Tincture
Syp-Syrup
sp- sprit
lot- lotion
liq- liquid
inf- infusion
Fl- Fluid

1. Chemical name :known by the chemist, usually
it indicates the ingredients of the drugs.
E.g. chemical name of ibuprofen is 2-4 propionic
acid.
2. Generic name : name given by the
manufacturer who first develop the drug. It is
similar than the chemical name , from which it is
derived.
e.g. generic name includes ibuprofen, paracetamol

3. Official name : name by which the drug is
identified in the official publication. It is approved
drugs. It is same as the generic name .
4. Trade name: registered name given by the
manufacturer and is the copyright. One drug may
have several trade or brand name .
e.g. trade name of paracetamol is calpol, crocin,
niko, etc.

 Right drug
 right dose
 Right patient
 Right time
 Right route
 Right documentation
3 CHECKS OF MEDICATIONS:
 Cardex with medication
 Before giving to patient
 Before replacing

A nurse must need to administer a correct
medication.
For that a nurse must :
 Read the physician's order in medicine cardex
 Read the medication order carefully
 select the right drugs from the cupboard
 Check the medication label against medication
administration record for 3 times i.e .
- before remove each drug from storage area
-before prepare each drug
-before administer each drug
 Look for the colour, ordour and consistency of
drug

 The right dose how much of the medication you
are supposed to give the individual at the one time
for this a nurse must know that
1000mg = 1 gm
1000gm = 1 kg
1000ml = 1litre
 Liquid medicines are given in a vial or ampulae
sometimes the vial may contain more than the dose
you need to give.
 Formula:

a) Fried’s formula=
(infant’s dosage < 1 year)
Infant’s age in months * average adult dose
150 months
b) young’s rule =
(child dosage of 1-12 years)
Child’s age in years * AAD
Child’s age in years +12

c) Clark’s rule =
Wt of child in pounds * AAD
150 pounds
d) Surface area rule =
Surface area of child in (sq.m) * AAD
1.73
e) Parenteral doses =
Volume to Dose ordered * quantity in
Be given Dose available hand(ml)

f) IV fluid flow rate per minute =
Total volume to be infused(ml) * drop factor
Total time in minutes
(time in hour * 60)
g) Insulin dosage =
What we want * no. of division on given
What we have syringe
h) Ordered dose of medication in microgram/min
=
Vol. to be infused * concentration
Wt(kg) * 60 min

i) Concentration =
dose of medication (mg) * 1000
Vol. to be infused

Fluid replacement formula in burn patient :
a) Consensus formula:
Ringer lactate (RL) or Normal saline (NS): 2-4 ml *
kg body weight * TBSA(Total Body Surface Area)%
- Half amount in first 8 hours
- Remaining half in next 16 hours
b) Brooke army formula :
RL/NS = 1.5 ml * kg body weight * TBSA %
Colloids= 0.5 * kg body weight * TBSA %
5% Dextrose = 2000 ml for insensible loss
- Day 1st : half amount in 1st 8 hrs, remaining ½ in next
16 hrs
- Day 2nd : half of colloids and ½ of electrolytes

c) Parkland and Baxter formula:
RL : 4 ml * kg body weight * TBSA%
- Day 1ST :half amount in 1st 8 hrs, remaining ½ in next
16 hrs
- Day 2nd :varies, colloids are added
d) Evans formula :
Colloids: 1 ml * kg body weight * TBSA%
RL/NS : 1 ml * kg body weight * TBSA %
5% Dextrose : 2000 ml for insensible loss
-Day 1st : half amount in 1st 8 hrs, remaining ½ in next 16
hrs
-Day 2nd :half of 1st colloids and of electrolytes + all of
insensible fluid replacement

Before giving a medication make sure that you are
giving it to the right patient .
Always have to identifiers to confirm that you have
right patient .
 Check the medication card against the patient name ,
bed and other identification.
 Ask the patient tell you his or her name,
 For the unconscious patient or children use an
identification tag and ask patient relatives
 Prepare medication to the individual at a time
 Give the medication to the individual as soon as you
prepare it
 Dont talk to others and ask them not to talk to you
when giving medication

 Always provide medication at the given time a
ordered. For routinely ordered medications such as
antibiotics, 30 mins before or after the schedule
time is commonly acceptable.
 Read physician's order
 Know the hospital routines for intervals
 Give near the time ordered, 15 mins before or after
the designated time
 Know abbreviation for time as AC,PC and BD

 The route means how and where the medication
goes into the body
 Read physician's order carefully to ensure the
route
 No abbreviation as IV,Im, po
 If any errors occurs it should be immediately
reported to the ward sister and physician

 Accurate documentation about the name of the
drug. dose , route , time and signature of the nurse
is required to ensure that it is prepared and
administered safely. Failure to document or
incorrect documentation can be considered a
medication error in itself and cause an error as well

1. Therapeutic effects
2. Local and systematic effects
3. Adverse effects
4. Side effects
5. Effects on different systems

 It is the effect which is desired or the reason a drug
is prescribed.
 These are the medication’s desired and intentional
effects.
 The drugs are administered for the following
purposes:
• To promote health
• To prevent disease
• To diagnose disease
• To treat or cure a disease
• To alleviate the disease

 Local effects of a drug are expected when they are
applied topically to the skin or mucus membrane
 A drug used for systemic effect must be absorbed
into the blood stream to produce the desired effect
in the various systems and body parts.

 It is any effect other than the therapeutic effect
 Some adverse effects are minor, whereas some
other may cause very serious health problems.
 It may be more in a very seriously ill client or a
client who receives more medication.

 Side effects are the minor adverse effects
 It can be harmful or harmless.
 These are the effects other than the principal action
desired.
 The followings are the side effects as:
- Allergic reactions( skin rashes, diarrhea,
shortness of breath,nausea, vomitting, pruritis, etc)
- Atropine like side effects (tachycardia,
dryness of mouth, urinary retention,liver damage,
etc)

a) Effects on the urinary system:
certain drugs may cause renal damage which is
characterized by anuria, oliguria, haematuria,
albuminuria, etc
b) Effects on the cardiovascular system:
arrhythmias, hypotension, hypertension, syncope,
shock, etc
c) Effects on the nervous system:
abnormal involuntary movements as tremor, chorea,
dystonia; stimulation of the CNS as anxiety,
nervousness, insomnia, headache; depression of the
CNS as dizziness, vertigo, fatigue, drowsiness, etc

d) Effects on the gastrointestinal system:
nausea, vomiting, anorexia, constipation, diarrhea,
distension, abdominal pain, malaena, etc

 Tolerance : it occurs when a client develops
decreased response to a drug, requiring increased
dosage to achieve the therapeutic effects.
 Synergism : synergistic effect occurs when a
combination of medications are given. In it, the
combination of medications may be less or more
than what would be expected of each drugs.
 Antagonism : it results in decrease drug
effectiveness. Sometimes food influences a drug

 Interaction : medication interaction occurs when a
medication’s effects are altered by the concurrent
presence of other medications or food. The
interaction can result in the following.
 Toxicity :high levels of the drug in the blood
stream produce toxic effects.

 To be informed of the medication’s name, purpose,
action and potential undesired effects
 To refuse a medication regardless of the
consequences
 To have qualified nurses or physician’s assess a
medication history including allergies
 To be properly advised of the experimental nature
of medication therapy and to give written consent
for its use
 To receive appropriate supportive therapy in
relation to medication therapy

 Right to complete and clearly written order
 Right to have the correct drug route and dose
dispensed
 Right to have access to information
 Right to have policies on medications
administration
 Right to administer medications safely and to
identify problems in the system
 Right to stop think and be vigilant when
administering medications

 Oral medication
 Intradermal
 Subcutaneous
 Intramuscular
 Rectal and Vaginal routes

 Oral medication means the administration of
medication by mouth ensuring that the patient
swallow the medicine, It is the most common route
of drug administration.
 PURPOSE
- To provide a medicine that has systemic or local
effect on the gastro intestinal tract

 It is safe ,convenient and effective method.
 No pain while giving drug
 No need of trained person
 Cheap
 Easy to administer

 Unpleasant test
 Drug may absorb slowly
 Patient may not swallow the medicine sometimes
 May cause vomiting or diarrhea

 Alteration in the gastrointestinal tract like
vomiting
 Surgical resection if the portion of GI tract
 Patient with gastric suction/ aspiration
 Prior to certain surgery / test
 NPO status
 Unconscious/confused patient
 Patient unable to swallow

 A trolley
 A tray containing:
- a bowel of clean water
- dropper or ounch glass
- feeding cup or measuring cups or spoon
- crusher
- medicine spatula
- towel
- kidney tray
- paper bag
- medicine cup
- scissors
- cotton ball or gauze piece
- medicine card

Preliminary assessment
 Check the diagnosis and age of the client
 Check the purpose of medication
 Check the identification of the client as the name,
bed no., age , sex
 Check the physician’s orders
 Check the nurses record for the time at which the
last dose was given
 Check the symptoms of overdosage, any
contraindications, side effects, routes of drugs

 Check the form of the drug available and the
correct methods of administration
 Check the consciousness of the client
 Check the abilities and limitations in swallowing
the medication
 Check the articles

Preparation of the client:
 Explain the procedure
 Assist in comfortable position i.e. in sitting
position. A lateral position is the next safest and
easiest position because the patient lying on the
back may aspirate. Unless contraindicated, raise
the head end with extra pillows to provide a
propped up position.
 Give a mouth wash, if necessary
 If the medication is ill tasting, prepare a drink as
lemon juice to mask the taste of the medication
 Protect the bed ,clothes and garments with a towel
placed under the chin across the chest.

:S.
N.
STEPS OF
PROCEDURE
REASON
1.
2.
Wash hands
Read the physician’s orders
and compare it with the
medicine card. Make sure
that all the medicines are
copied correctly
To prevent cross
infection.
To ensure safety in the
administration of the
medicine. The
physician’s order on the
chart is the only legal
sources; medicine cards
are used only for
convenience and they
may be misplaced or
lost.

S.N
.
STEPS REASON
3.
4.
Keep in mind the 3
checks and 6 rights of
medication. After
reading the medicine
card, take the correct
medicines and check for
entire label including the
expiry date.
Measure the medication
and calculate the doses
and check with cardex
The first safety check to
prevent the possibility of
pouring the wrong
medication and to avoid
the use of expiry
medicines.
To prevent overdose of
medications.

S.N
.
STEPS REASON
5. Take the medicine as
follows:
-Shake the tablets and
capsules into lid of the
container first and then
into the medicine cups.
Take the required no. do
not touch with hands
- Pour liquids from the
side of the bottle away
from the label. Hold the
measuring cup at the eye
level
It prevents the drugs
coming in contact with
hands.
It prevents spoiling of
the label.

S.N
.
STEPS REASON
6.
7.
Wipe the mouth of the
bottle and close the
bottle tightly. Return
containers back into the
shelf. Recheck the
medicine bottle with
cardex.
Place the card with
medication on the tray.
No medicine should be
kept without medicine
card.
Wiping the bottle keeps
the container clean. The
containers should be
replaced immediately to
maintain the order of the
medicine cabinet.
Proper identification of
each medication assures
accurate administration
of correct medication to
correct client.

S.N
.
STEPS REASON
8.
9.
Prepare each medication
into separate containers.
Do not mix medicines .
Lock the medicine
cabinet and take
medicines to bedside
Mixing medication in a
single container is
hazardous. If
medications spills, client
refuses one or more
drugs or if a medication
is withheld, it will be an
embarrassing situation
for the nurse.

S.N
.
STEPS REASON
10.
11.
12.
Identify the client with
the medicine card. Ask
client for his name or
else verify identification
of the client
Administer medicines:
-Give the water to
moisten the mouth
- give medicines one at a
time and verify that
medications are
swallowed
Replace the medicines
For right patient and it is
2nd check of medication.
Helps in swallowing of
solid medications.
One medicines at a time
enables the client to
swallow easily.
It is 3rd check of
medication.

After medication care of the client and articles:
 Remove the towel and wipe the face with it
 Position the client for good body alignment . Tidy
up the bed.
 Take all articles to the utility room. Wash and dry
all articles and replace them in their proper places.
 Wash hands
 Record medications given and record any reactions
observed after the administration of the medicines.
 Return the medication cards to the storage area.

 A syringe and a needle are essential to give
parental medication (injectable medication)

 Tuberculin : It is 1 ml syringe that are calibrated
with 0.1 ml marking and supplied with a small
gauze (26-28 gauze) and short about 0.5 inch
needle. It is used to administer tuberculin or
sensitivity test.
 Insulin syringe : It is a special syringe which is
graduated to 40 , 80 or 100 unit. It is made in 0.5
ml size with very small gauze needle. it is used to
give insulin.
 Standard syringe : they are supplied in 3,5,20,50
ml sizes, without with needles 18, 21, 22, 23 or 25
gauze which are 0.5 to 3 inches long.

S.
N.
ROUTES
OF
ADMINIST
RATION
SIZE OF
SYRINGE
SIZE OF NEEDLE
1.
2.
Intradermal
Subcutaneou
s
1 ml calibrated in
0.01 ml units
(tuberculin
syringe)
1 ml calibrated in
40 or 80 units
(insulin syringe)
or 2,3 ml syringes
calibrated in 0.1
ml
26 or 27 gauge
diameter and 3/8 to
5/8 inch length
25 gauge and ½ to
5/8 inch

S.
N.
ROUTES
OF
ADMINIST
RATION
SIZE OF
SYRINGE
SIZE OF NEEDLE
3.
4.
Intramuscula
r
Intravenous
2.5 ml calibrated
in 0.2 ml
Size depends
upon the amount
of fluid to be
injected
21,22, 23 gauge; 1
to 2 inches length
18 to 21 gauge and 1
to 2 inch

1. The knowledge of the anatomy and physiology
of the body is essential for the safe
administration of the injection.
- to avoid injury to the underlying tissues
- to minimize the pain
- to aid in drug absorption
2. If carelessly given, injection are means of
introducing infection into the body.
3. Drugs that change the chemical composition of the
blood, will endanger the life of the client, if not
used cautiously.

4. Any unfamiliar situation produces anxiety.
5. Once a drug is injected it is irretrievable. Antidote
may be available for particular medications but the
best antidote is prevention.
6.Organization and planning results in the economy
of time, materials and comfort.

 Intradermal injection is administration of
medication into the dermal layer of the skin.
Tuberculin is used sides upper arm inner aspect of
fore arm and upper back of scapula.It is given in
15 degree angle.
PURPOSE :
 To perform sensitivity test
 To perform tuberculin test
 To administer vaccination
 To obtain a local effect at the site of injection of
local anesthesia

 It means introduction of the medicine into the
subcutaneous tissue insulin syringe or 1 ml syringe
is used. It is used for administrating insulin heparin
or certain immunization. It is given in 45 degree
angle.
PURPOSE :
 To administer medication in smaller dose
 To slow drug absorption
 To obtain prompt action that is not obtained by
oral administration
 To provide certain vaccination as MR

 Outer aspect of upper arm
 Posterior chest wall below the scapula
 Anterior abdominal wall from below the breast to
iliac crests
 Anterior and lateral aspects of thigh

 ADVANTAGES :
-Absorption is slow and constant
-Fast than oral route
 DISADVANTAGES :
-May lead to abscess formation
-Absorption is limited by the blood flow

 It is an introduction of medicine into the muscle
tissue in the form of solution. It is absorbed
intermediately i.e. slower than intravenous but
rapidly then s/c injection. 25ml syringe is
commonly used which is calibrated in21, 22, 23
gauze and 1-2 inches of needle.

 ADVANTAGES:
-Absorption is rapid than subcutaneous route
-Oily preparation can be used
-Slow releasing drug can be given
 DISADVANTAGES:
- Painful produce that penetrates the skin
- May cause nerves and vein damage

 Deltoid
 Ventrogluteal
 Dorsogluteal
 Rectus femoral
 Vastus lateralis

 It is located on the lateral aspect of the thigh. It is
the area between mid anterior thigh and mid lateral
thigh, one hand’s breath from below the greater
trochanter to one’s hand breath above knee.

 Identify the greater trochanter of the femur and the
posterior superior iliac spine. Draw an imaginary
line between these two bony landmarks. Site will
be the upper and outer quadrant or divide the
buttocks into 4 regions by imaginary lines. Select
the site at the upper and outer quadrant for IM
injection.

 Locate the lower edge of the acromion process and
form a rectangle. The deltoid area is used to inject
very small quantities of non- irritating drugs.
Otherwise most of the IM injection are given in
gluteal site.

 Place the tip of the index finger on the anterior
superior iliac spine of the client, the middle finger
just below the iliac crest. The “V” shaped area in
which the injection can be given.

 Abscess
 Allergic reaction
 Numbness
 Infection
 Bleeding
 Hematoma

 A tray containing:
- syringes and needles of various size
- cotton swab and gauze pieces in sterile container
- bowl with water
- kidney tray
- Paper bag
-water for injection
- filer to cut the ampoule
-gloves
-small tray

Procedure :
1.Select the medication. Read the physician’s order
and copy it to medicine card. Compare the label,
doses, expiry date, soon.
2.Wash hands
3.Prepare the medication:
- Select appropriate syringe and needle
- Check whether they are in good working condition
- Obtain spirit swab
- Select the solvent

- Recheck the order, medicine card with the label of
the medicine and expiry date, etc
- Calculate the dosage, the amount of solvent to be
added to obtain the required dosage. If premixed,
ascertain the amount of the solution to be drawn
for injection.
- Take the solvent in the syringe and introduce it
into vial or ampoule of medication after cleaning
the top, and opening them directed.
- Mix the powder with solvent by rotating the vial in
palm of hand.

- When mixed well, take out the required amount of
solution in the syringe. Change the needle that is
used for piercing the rubber stopper. Cover the
needle with a cover.
4. Keep the syringe with medication the sterile tray
and cover it. Check the order in the medicine card
and compare it with the label of medication. Make
sure that you have taken right medicine and right
dose.
5. In multi-dose vial, reconstitute the label with
identifying data: client’s name, dose, date, time,
and the signature of the nurse who prepared it.

6. Return the medicine to its proper place (refrigerate
it if necessary)
7. Carry the medication to the client.
8. Identify the client(….)
9. Prepare the site for the injection.
- Select the site
- Clean the site with spirit swab, using surgical
asepsis
- See that the client is in a comfortable position and
completely relaxed

10. Inject the medication.
For IM injection :
 Spread the tissue between the thumb and forefinger to
make the skin taut. Needle is inserted at 90 degree
angle, holding the syringe in the right hand, using a
steady push on the needle. With the right hand on the
syringe, aspirate blood by pulling back the piston with
left hand. If blood appears in the syringe, quickly
withdraw the needle. If no blood comes, give
medication slowly by pushing the piston. Remove the
needle quickly and massage the site for quick
absorption.
 Practice Z- track and air lock techniques to prevent
tissue damage.

For SC injection:
 Much controversy exists among the nurse about
the length of the needle and the angle of insertion
for the sc injection. 45 degree is used with a needle
of ¾ inch long or longer for an average client.
 The technique of giving sc injection is:
- use only non-irritating medications.
- use only small quantity of medication.
- deposit the medications in a fold formed by
picking up a layer of skin and fat.
-be sure to insert needle beyond the thickness of
the skin in sc tissue

To give ID injection :
It is used for skin test to detect any allergies. The
skin is held taut, by grasping it under the forearm.
With the bevel of the needle facing up, insert the
needle at 10-15 degree to the skin. The needle
enter between 2 layers i.e. the bevel should be
practically visible through the skin. Inject the
medicines slowly, to produce wheel on the skin.
Take out the needle quickly and do not massage
the area.

To give IV injection :
 Locate the vein and apply tourniquet between the
site choosen and the heart to obliterate the venous
circulation. Ask the person to clench and unclench
hands. By pulling the skin taut, place the needle in
line with the vein in an angle of 45 degree. Follow
the course of vein and insert the needle into vein.
When back flow of blood occurs into the syringe,
release the tourniquet and inject the medication
slowly. Apply pressure at the site after needle is
removed.

 Inspect the area for bleeding .
 Keep patient in comfortable position.
 Ask the client to take rest for 15 min to 1 hour as
some drug may produce allergic reaction.
 If the client develops pain, redness, induration at
the site then apply warmth. Inspect the area for
abscess formation.
 Replace the articles respectively.
 Wash hands
 Record and report if any allergic reaction occurs.

 RECTAL ROUTE: Drugs in solid forms such as
suppositories or in liquid forms such as enema are
given in the rectal route. It is mostly used in old
patients.

 Advantages :
- Used in unconscious or uncooperative patients.
-It avoids nausea and vomiting.
-Drugs cannot be destroyed by enzymes.
 Disadvantages :
- Usually not acceptable
- Failure occurs if not inserted correctly.

VAGINAL ROUTE:
 It is a route of administrating medication inside a
vagina.
 Vaginal tablets, creams suppository and vaginal
ring are used.
Purposes :
 To treat fungal infection of reproductive tract as
vaginitis.
 To treat uterine prolapsed with the use of pessary
ring.

 Introduction of drugs directly into the blood
stream is called I/V injection.

 To have a fast action of medication as in
emergency
 To give medicine those are irritating or ineffective
when given by other route.
 To introduce large amount of medication.Eg
blood,fluid.
 To introduce a drug for diagnostic purposes. Eg
IVP.
 To increase the volume of circulating fluid in the
treatment of shock or haemorrage.

 Immediate action take place.
 Preferred in emergency situation.
 Preferred in unconscious patient.
 Large volume of fluids might be injected.
 Blood plasma or fluids might be injected.

 Method is risky.
 Infection might occur
 Not suitable for oily preparation
 Painful

PROCEDURES:
 check the physician orders and identiify the patient
 explain the proccedure and take conscent
 check the patient's history of drug allergies
 wash hands
 prepare medication, assemble equipment at bed
side
 place patient in comfortable postion

 if necessary, wear gloves
 select a site for IVadministration
 apply a tourniquet on the upper arm , 2 cm above
site of the patient
 ask the patient to clench and unclench the bond
 clean the skin of the site with alcohol
 pull the skin taut and place the needle in line with
vein at 15 degree to 45 degree

 insert the needle a bit below the point where the
needle will pierce the vein
 when the back flow of blood occurs into the
syringe, release the tourniquet and inject medicine
very slowly
 as you remove the needle , press the vein with the
swab at the puncture site to prevent bleeding
 assist the patient to a comfortable position.
 observe the patient for any allergic reaction.
 replace articles . discard the syringe and needle
into the appropriate receptacles. Dont recap the
needle.

 remove gloves and wash hands
 record medication administration, amounts , dose ,
site, patient response and nurse response.
 observe the patient closely for adverse reaction
during administration and for several minutes
there after.
 NOTE : If veinpuncture is present or IV canula is
there then , carefully administer the medicine
slowly.

 14G = grey
 16G = white
 18G = green
 20G = pink
 22G = blue
 24G = yellow

Cannulization site on upper extremities:
 Basilic vein
 Cephalic vein
 Median cubital vein
 Superficial median vein of forearm
 Cephalic vein
 Metacarpal vein
 Dorsal venous arch
 Palmal digital vein

Cannulization site on lower extremities:
 Great saphaneous vein
 Dorsal plexus
 Dorsal arch
Others than extremities :
 Scalp vein – infant or long term cancer
 Jugular vein in neck region – CVP line
 Subclavicle vein
 Temporal vein
 Frontal vein
 Femoral vein

Drugs may be applied to the external surfaces ,the skin
and the mucous membranes. Topical route includes ;
 Enepidermic route : when the drugs is applied to the
outer skin ,it is called the enepidermic route of drug
administration. Eg: plasters, creams ,ointments.
 Epidermic route(innunition): when the drug is
rubbed into the skin. Eg oil massage.
 Insufflations: when the drug is finely powered form is
blown into the body cavities or spaces with special
nebuliser, the method is known as insufflations.

 Instillation : Liqiud may be poured into the body
by a dropper into the conjunctival sac, ear, nose
and wounds . solids may also be administered .
 Irrigation or douching: This method is used for
washing a cavity . Eg: urinary bladder , uterus ,
vagina and urethra
 Painting/ swabbing : Drugs are simply applied in
the form of lotion on cutaneous or mucosal
surfaces of buccal, nasal cavity and other internal
organs

 Insertion : It means introducing solid forms of
drug into the body orifices. Eg: rectal and vaginal
suppositories
 Inhalation : Drug introduced into the in the form
of vapour are called inhalation. Eg : o2 inhalation
steam inhalation etc.

 An inhalation is the administration of liquid
medications by drop . This method is used for
administration of liquid medication into eye, ear
and nose.

 It is a method of administering eye medication
inside the eye by instillation.
 PURPOSES
- To treat infection
-To instill medication before examination or eye
surgery
-To dilate /contract pupil
-To lubricate eyes
-To relieve pain and itching

Articles :
 -Disposable gloves
 -sterile cotton balls soaked in a sterile normal
water
 -medication
 -Dry cotton balls
 -Dry sterile dressing pad and proper tapes
 -kidney tray

 Identify the patient and assess for allergy to
medicines, lesions, exudate, erythema or swelling,
location and nature of any discharge, level of
consciousness and willingness to cooperate and
use of contact lens.
 Check medication order for preparation, strength
of medication, no of drops, frequency of
instillation of medication and eye to be treated.
 Assemble all needed equipment.
 Check the patient’s identification.
 Explain the procedure.

 Assist the patient to a comfortable position, sitting or
lying with the head slightly hyper extended.
 Obtain assistance for immobilizing in case of young
children.
 Wash hands and do sterile gloving.
 Clean the eyelids and lashes with a sterile moistened
cotton ball, wipe from inner canthus to outer
canthus. Discard cotton balls after each wipe.
 Place the basin or kidney tray at the cheek on the side
of affected eye.
 Instruct the patient to look up the ceiling. Give the pt a
dry sterile absorbant cotton ball.

 Expose the lower conjunctival sac by placing thumb or
fingers of your non- dominant hand just below the eye
on the zygomatic arch and gently draw the skin on the
cheek. If the tissues are edematous, handle the tissue
carefully to avoid damaging them.
 For liquid medication;
-Draw the required amount of medication into the
dropper
-Discard the first drop of medication
-Approach the eye from the side and instill the
correct no of drops in the center of the lower lid
holding dropper 1-2 cm above the eye.

 For ointment :
-Discard the first bead of ointment
-Hold the tube above the conjunctival sac, squeeze
2 cm of ointment from tube into the lower
conjuctival sac from the inner to outer canthus
 Instruct pt to close eyelid and not to squeeze them
shut
 Instruct to press on the nasolacrimal duct for
atleast 30 sec after instilling liquid medications
 Clean the eyelid as needed from inner to outer
canthus

 Apply an eye pad if required and secure it with
tape and instruct pt not to rub the eye
 Assess the pt’s response
 Replace the medications and articles
 Wash hands
 Document administration pf medication, no of
drops, pts response etc

 It is a method of administering ear drops into
auditory canal to produce local effect.

 -To soften ear wax
 -To reduce localized inflammation and destroy
infective organism in the external ear canal
 -To clean the ear
 -To relieve the pain
 -To facilitate removal of foreign body
 -To kill an insect lodged in the ear
 -To anesthesize

 -Rupture of tympanic membrane
ARTICLES
 -Disposable gloves
 -cotton tipped applicators
 -medication bottle with dropper
 -cotton balls
 -kidney tray or paper bag
 -Bowl with normal saline

 Assess the pt for allergy to medications, types and
amount of discharge, complaints of discomfort;
ability to cooperate during procedure, the pt’s
knowledge about medication to be administered
 Check medication order for name, dose, time,
amount and ear to be treated
 Identify the pt and explain the procedure, purposes
and position during and after instillation
 Obtain assistance in case of children or infants to
immobilize them
 Assist the pt in side lying position with ear being
treated uppermost

 Clean meatus of ear canal , using cotton tipped
applicator. Use normal saline if necessary.
 Warm the container in hand or by placing it for a short
time in warm water.
 Fill ear dropper partially with medication
 Straighten auditory canal. For infants or children less
than 3 years, pull pinna down and back. For an adult
or child older than 3 years, pull pinna upward and
backward.
 Instill correct no of drops alongside of the ear canal by
holding the dropper one cm above the ear canal. It
reduces risk of rupture of tympanic membrane

 Press gently and firmly a few times on the tragus
of the ear
 Instruct pt to remain in side- lying position for
about 5 minutes
 Plug the ear with cotton loosely at the meatus of
auditory canal for 15-20 min. The cotton helps to
remain medications when pt is upright
 Assess for pt’s comfort, response and check for
discharge/ drainage from the ear
 Replace medication and articles
 Wash hands
 Document

 It is the process by which a liquid is introduced
into the nasal cavity by drop
PURPOSES
 - To treat allergies
 - To treat nasal congestion
 -To treat virus infections
 -To give local anaesthesia

Articles :
-Prepared medication with clean droppers
-Pen light
-Gloves
-Facial tissues
-Small pillows
-Kidney tray
-Medication card

 Identify the pt
 Review the physician’s order
 Assess the pt’s history of HTN, heart disease, DM,
and hyperthyroidism. These conditions can
contraindicated use of decongestants that stimulate
CNS side effects of transient HTN, tachycardia,
palpitation and headache.
 Determine whether the pt has any known allergic
to nasal instillations.
 Perform hand washing
 Inspect the conditions of the nose and sinuses
using a pen light. Palpate sinuses for tenderness.

 Explain to pt for positioning , procedure and sensation
to expect.
 Arrange supplies and medications at bedside
 Apply gloves if pt has nasal drainage
 Instruct pt to clear or blow the nose gently unless
contraindicated. Remove mucous and secretions
 Assist pt in supine position
 Support the pt’s head with non-dominant hand
 For access to posterior pharynx tilt pt’s head backward
 Instruct pt to breath through mouth. Mouth breath
reduces chance of aspirating nasal drops.

 Hold dropper 1 cm above nares and instill the
prescribed no of drops towards midline of ethmoid
bone.
 Have the pt remain in supine position for 5 min
 Give cotton swab to wipe
 Assist the pt to comfortable position after
medications is absorbed
 Dispose the soiled supplies in a proper container
and wash hands
 Observe the pt for 15-30 min for onset of side
effects
 Record it.

 Blood transfusion consists of administration of
compatible donor's whole blood or any of its
components to correct/ treat any clinical condition.
PURPOSE :
 To restore circulating blood volume
 To correct platelet and coagulation factor
deficiencies
 To correct anemia

A clean tray
containing :
- blood transfusion
set
- normal saline
- blood
- IV canula
- sterile gauze
- Torniquet
- Adhensive tape
- scissor
- Rolles bandage
and splint
- Infusion stand
- Kidney tray
- Disposable gloves
- specimen container

 Check the physician’s order
 Identify the pt and explain the procedure
 Take vital signs
 Obtain informed consent from the pt to minimize the
institution’s legal risk
 Check types and cross match has been completed and
that blood is ready in blood bank
 Encourage the patient to empty bowel and bladder
before blood transfusion
 Keep pt in comfortable position
 Ensure privacy
 Document the pt’s pre-transfusion vital signs

 Wash hands
 Don disposable gloves
 If canula is already inserted determine patency of
the pt’s IV and begin infusion of normal saline and
large peripheral vein and initial infusion of NS
solution using blood transfusion set. NS helps in
reducing risk of hemolysis of blood in contact with
tubing.
 Inspect the blood product by 2 nurses:
- identification of the no
- blood group and type

- expiry date
- compatibility
- pt’s name and identification data
- abnormal color, clots, excess air, etc
 Warm the blood with blood warmer or immerse
partially in tepid water (96.6 degree F). Cold blood
can cause hypothermia and cardiac arrhythmias
 Blood product is found to be correct, stop the
saline solution , remove insertion spike from saline
container and insert spike into blood container

 Start blood product slowly at the rate of 25-50 ml
i.e. 7-14 drops per min per hour for first 15 min,
stay with pt and check vital signs every 15 min.
transfusion reaction usually occur in this period.
 Increase the infusion rate if no adverse reactions
are noticed. The flow rate should be within safe
limits. Flow rate is determined by the physician’s
instruction and the pt’s condition
 Assess the condition every 30 min and if any
adverse effect is observed, stop transfusion and
start saline.

 If no reaction occurs , complete transfusion
 Dispose blood product
 Record the following: product and volume
transfused, identification no and blood group, time
of started and completed, name and signature of
staff and as per the hospital policy, remove the
level from the blood bag and paste it on the
patient’s record file.
 Assist pt in comfortable position.

POINTS TO BE REMEMBERED
 Do not administer medication through the same
line
 Should be completed over 4 hours of time
 Gently rotate the blood bag periodically to prevent
clumping of cells
 Cover the blood bag with towel when it hangs on
the IV stand
 Pre medication such as anti allergic medicine may
be prescribed
 Don't immerse blood bag fully into water that may
cause hemolysis

 Oxygen therapy is the administration of oxygen as
a medical intervention which can be for a variety
of purpose in both acute and chronic patient care.

 To increase oxygen saturation in tissue where the
saturation levels are too low due to illness or
injury.
 To monitor the ability of cells to carry out the
normal metabolic function.
 To reduce effects of anoxaemia
 To decrease respiratory distress

A) Nasal cannula
 Nasal cannula is a device to administer oxygen
therapy. It is 7-14 feet long with two small prongs
to insert into each nares. It has a plastic piece at
neck that slides up under the patient's chin to
tighten the tubing and keep it in place. It delivers
oxygen concentration of 22% to 50% with flow
rate from 1 to 6 lit/min but practically 1-4 lit/min.
It is used for patients who are noncritical with
minor breathing problems and for patients who
cannot or will not wear an oxygen mask. It
administors low flow oxygen.

B) . Simple Mask
 It is used for providing moderate flow rate for a
short period of time. It is composed of a plastic
mask that fits snugly over the patient mouth and
nose. It delivers oxygen concentrations of 40% to
60% with flow rates from 6 to 10 l/min . when
using this mask, consider humidification to keep
the patient's mucous membranes from drying.

C) Partial Rebreather Mask
 It is similar to as simple face mask but equipped
with a reservior bag for the collection of first part
of the patient's exhaled air. It delivers 70% to 90%
of O2 with flow rates from 6 to 15 L/min through
the cannula.

D) Nonrebreather mask
 It is used to deliver high flow rates and high
concentration of oxygen. It has a reservoir bag
that is inflated with pure oxygen between the mask
and the bag is another one way valve that allows
the patient to breathe in the oxygen supplied by the
source as well as oxygen from reservoir. It delivers
O2 concentration of 60% to 95% with flow rates
from 10 to 15 min

E) Venturi mask
 It is used for critically ill patient who require
administration of specific concentration of oxygen.
It delivers oxygen concentration from 24% to 60%
with the flow rates from 4 to 10 lit/min. It is
commonly used for patients who have COPD and
humidification is usually unnecessary.
F) Face Tent
 It is often used as an alternative to an aerosal
mask. It delivers oxygen concentrations of 28% to
100% with the flow rate from 8 to 12 L/min.

G) Oxygen Tent
 Oxygen tent and hoods are usually used for
pediatric patients who have airway inflammation,
croup or other respiratory infections. It delivers
28% to 855 oxygen concentration with the flow
rate of 5 to 12L/min
H) Normal resuscitation
 It is used to provide high concentration of oxygen
to a patient prior to a procedure, such as suctioning
or incubating and during respiratory or cardiac
arrest. It consists of a mask, a self inflating bag
that is compressed to ventilate the patient and an
oxygen post where the oxygen tubing is connected.

 In humidifier, water is used to prevent the entry of
dry air which causes skin break down and dry the
mucosal membrane of nasal canal.
 In some cases water is not used as in:
- hypothermia
-pleural effusion
-atelectasis

Articles :
 O2 cylinder with flow meter with humidifier and
regulator
 Cylinder stand
 Key
 Nasal cannula , Oxygen mask with connecting
tubes
 Gauze pads/cotton
 A bowl with plain water to check Oxygen flow
 Tape and scissors

 Determine the need for oxygen therapy and verify
order
 Assess for vital signs, level of consciousness, lab
values
 Wash hands
 Set up o2 equipment and humidifier. Attach tubing to
humidifier
 Check flow meter
 Position patient on semi fowler's position
 Regulate flow meter to prescribed level. Ensure proper
functioning.
 Clean nostrils

 To administer O2 by nasal cannula:
- Place tips of cannula to patient's nose and adjust
around ear for fitting.
- Put gauze pads over ears
 To administer O2 by face mask:
- Guide the mask to patient face and fit meter piece
of mask to shape of nose
- Secure elastic band around the patient's head
- Apply gauze pads behind ears
- Reserve the mask and dry skin every 2-3 hourly

 To administer using O2 tent:
- Select the tent as per the patient comfort.
- Tuck the edge of tent under mattress securely
-Pad the metal frame that supports the canopy
- Reset the flow meter
-Maintain tight fitting canopy whenever possible
- Check the child's temperature routinely as moisture
may result in hypothermia.

 Always administer prescribed Oxygen dose with
care to avoid o2 toxicity
 Change nasal cannula 8 hourly
 Don't discontinue O2 therapy abruptly.
 Promote safety measures as
- No smoking
- No flaming
- No fires and burns
- No oil

 Place fire alarms
 Store O2 cylinder at a low temperature
 Never decrease or increase oxygen flow when the
nasal cannula is in patient’s nostrils
 Don't use electrical appliances near O2
 Ensure humidifier bottle at least 1/3 full with
sterile water
 Donot use drugs or alcohol while taking O2
therapy

 It is a method of introducing drug through
respiratory tract to produce rapid localized effect.

a) Drug Inhalation
 It means inhalating dry gases to produce
generalized anesthesia or lypnosis. Eg. ether,
chloroform.
b) Wet/ Moist Inhalation
 It means inhaling warm and moist air as it is mixed
with water. Vapours may be plain or medicated.
Eg. stem inhalation, nebulization , Oxygen
inhalation.

It is a deep breathing of warm and moist air into the
lung for local effect on air passage or for a
systemic effect.
Purpose :
 To relieve inflammation and congestion of mucous
membrane
 To soften thick mucous that helps in expulsion
 To relieve coughing
 To prevent dryness
 To improve breathing

It is the process of medication administration via
inhalation. It utilizes a nebulizer that transports
medications to the lungs.
Purpose :
 To administer medication
 To liquify and remove thick secretion
 To relief dyspnea
 To reduce inflammation
 To prevent post operative complication

Respiratory problem as
 Bronchospasm
 Chest tightness
 Excessive and thick mucus secretion
 Respiratory congestion
 Pneumonia
 Asthma
 COPD

 check physician's order and identify patient
 monitor vital signs
 explain procedure and take consent
 assemble equipment at bed side
 position patient comfortably in semi- fowler's
 wash hands
 add prescribed amount of medication and saline to
nebulizer.

 connect tubing to compressor
 place mask on patient's face and instruct to inhale
deeply and slowly, hold breathe then, exhale it
 continue until medication is consumed or for
atleast 15 min
 after completion encourage to cough
 release patient condition
 record medication used and clean nebulizer
 wash hands.

 Nurses are responsible for ensuring safety and
quality of patient case at all times.
 The roles and responsibilities of nurse are :-
 Nurse must know the rights of medication i.e right
drug, right dose, right patient, right time, right
documentation, right route.
 She should know about the nature of drug name ,
classification, types of preparation, effects, doses,
routes and time of administration
 Preparations of solutions and calculation of doses

 Storage of medication
 Ethical and legal aspects
 Abbreviation and symbols used in administrating
drugs
 Nurse and patient's right
 Rules of administrating the medication
 Know the purpose of medication
 Check the physician's order before administration
 Know the history of allergy
 Know the differences between generic and brand
name of drugs.

Drug administration

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