This document discusses the administration of medication presented by an assistant professor. It defines administration of medication as dispensing medicine to patients for therapeutic purposes. It outlines the rights and principles of medication administration including the right patient, drug, dose, route, time, documentation, and reason. It also discusses terminology related to pharmacology, pharmacotherapeutics, pharmacodynamics, pharmacokinetics, and components of prescriptions. Guidelines for safe administration and factors that can influence medication errors are presented.

1. ADMINISTRATION
OF
MEDICATION
PRESENTED By:- Mr. MADAN MOHAN GUPTA,
ASSISTANT PROFESSOR, FACULTY OF
NURSING, RAMA UNIVERSITY, KANPUR

2. FACULTY OF NURSING

3. Definition
Administration of medication refers to dispensing of
medicine or drug to a patient for remedial and
diagnostic purposes.

4. • To Promote Health
• To Prevent Illness.
• To Help In Diagnosis.
• To Alleviate Illness.
• Therapeutic Purpose.
Purpose of administration of
medication

5. Rights/Principles of Medication
Administration:-
The rights of medication administration are following:
 The Right Patient (Identification)
 Right drug
 Right dose
 Right route
 Right time
 Right Documentation
 Right reason
 The right of the parents and child to know

6. Terminology
 Pharmacology is the study of the action or effect of
chemical substances on living systems. It refers to
the study of origin, chemical structure, preparation,
administration, action, metabolism and excretion of
drugs.
 Pharmacotherapeutics- It deals with the relative
effects of drugs in human systems for various
disorders.
 Pharmacodynamics- it is the study which deals
with theories of drug action. Pharmacodynamics is
the study of how drugs have effects on the body.

7.  Pharmacokinetics- is the study of how drugs
enter the body, reach their site of action, are
metabolized and eliminated from the body.
 Absorption- it is the passage of drug molecules
into the blood and it depends on the physical
Properties of the drug, route of administration and
interaction with drugs.
 Distribution- after absorption drug is distributed
within the body and ultimately to the specific site of
action.
 Excretion- when drug is metabolized they exit the
body through the kidneys, liver, bowels, and
exocrine glands

8.  Metabolism- after reaching to the site of action
drug is metabolized into inactive form detoxified and
degraded chiefly by liver and by others like lungs,
kidneys, blood and intestine.
 Drug- it is the substance used in the diagnosis,
treatment, cure, relief or prevention of disease.
 Generic name- This name is proposed by the
company that first propose the drug. it is the name
given before a drug becomes official.
 Official name- it is the name under which it is
listed in one of the official publications.

9.  Chemical name- it is the name by which a chemist
knows it and indicates the ingredients of the drug. It
provide an exact description of drugs composition.
Example- acetyl salicylic acid- asprin
 Trademark/ brand name- is the name given by the
drug manufacturer. A drug may have many different
trade name
 Therapeutic effect:- Therapeutic effect refers to the
response(s) after a treatment of any kind, the results of
which are judged to be useful or favorable.
 Side effects- unintended but anticipated secondary
effects which may be harmless or injurious.
 Toxic effect- usually develop after a prolonged intake
of high dose of medication due to accumulation of drug
in blood because of impaired metabolism or excretion

10.  Idiosyncratic reaction: is a highly unpredictable
response that may be manifested by an over
response, under response, or atypical response. For
example, 1 of 40,000 clients will develop aplastic
anemia after receiving chloramphenicol (an
antibiotic).
 Lethal effect- excess amount of drugs in the body
causes lethal effect that may result in death also.
 Allergic reaction: – it is an unpredictable
immunological; response after an exposure to initial
dose of medication. It may be mild to severe.

11.  Drug abuse- it is inappropriate intake of
substances either continually or periodically. It
has two main facets drug dependence and drug
habituation.
 Cumulative effect: The state in which a
series of repeated actions have an effect greater
than the sum of their individual effects; noted
especially in the repeated administration of
drugs

12. Prescription of Drugs
Rx: A medical prescription: The symbol "Rx"
is usually said to stand for the Latin word
"recipe" meaning "to take." It is customarily
part of the superscription (heading) of a
prescription.
The prescription is one of the most important
therapeutic transactions between physician and
patient. The word "prescription" derives from pre
(before) and "script" (writing written) which denotes
that it is an order that must be written down before
or for the prescription and administration of drug

13. “A medical prescription (Rx) is an order (often in
written form) issued by a qualified health care
professional (e.g. physician and dentist) in the
form of instruction that govern the plan care for an
individual patient”.
 The nurse should identify all current prescription
drugs and describe:
 Why the drug was prescribed and by whom
 The drug’s dosage, route, and frequency
 The client’s knowledge of the drug’s action: side
and adverse effects

14. Types of prescription
 Simple prescription: Those written for a single
component or prefabricated product and not
requiring compounding or admixture by the
pharmacist.
 Compound or complex prescription: Those
written for more than a single component and
requiring compounding.
 E-prescriptions (electronic prescription): The
use of electronic means for the generation and
transmission of prescriptions is used and accepted in
some countries.

15. Types of prescription
 In-patient prescription: a medication order form
used in the hospital setting. In addition, other forms
may be used within a hospital by specialized units
such as infectious disease, cardiac care, pediatrics,
and others.
 Narcotic prescription: contains a narcotic
substance or other habit forming drugs. It must
contain in addition to the contents of the simple
prescription, the address of the patient, the narcotic
registry number of the prescriber. Such prescription
should be written by ink or typewriter. The
quantities of the narcotic substance must be written
in words and numbers.

16. Components of prescriptions
A prescription consists of the following parts:-
 Prescriber’s name, degree, address and telephone
number. In the case of prescriptions coming from a
hospital or a multicenter clinic, the hospital or clinic’s
name, address and telephone numbers appear at the
top. In such a case, the physician’s name and degree
would appear near his/her signature.
 Patient’s name, address, age, and the date of
prescription.
 The Superscription, which is represented by the
Latin sign (Rx). This sign represents ‘‘take thou’’ or
‘‘you take’’ or ‘‘recipe.’’ Sometimes, this sign is also
used to denote the pharmacy itself.

17.  The Inscription is the general content of the
prescription. It states the name and strength of the
medication, either as its brand or generic name. In
the case of compounded prescriptions, the
inscription states the name and strength of active
ingredients
 The Subscription represents the directions to the
dispenser and indicates the type of dosage form or
the number of dosage units.
 The prescriber’s signature.

18.  The Sign, also known as transcription represents the
directions to the patient. These directions are written
in English or Latin or a combination of both.
 The refill directions, in which the information about
how many times, if authorized, a prescription can be
refilled is provided.
 Other information, such as ‘‘Dispense as Written.’

19. Safe drug administration
Nurses must administer numerous drugs daily in a
safe and efficient manner. The nurse should
administer drugs in accord with nursing standards
of practice and agency policy. The safe storage and
maintenance of an adequate supply of drugs are
other responsibilities of the nurse. The nurse
documents the actual administration of medications
on the medication administration record, or MAR.
The MAR is a medical record form that contains the
drug’s name, dose, route, and frequency of
administration. Drug data are entered either by the
nurse when transcribing the order (handwritten onto
the form) or by the pharmacist when dispensing the
order.

20. Guidelines for Safe Administration of Medications
To protect the client from medication errors, nurses
have traditionally used as a guideline the ‘‘5 rights’’ of
drug administration. The 5 rights help prevent
medication error; however, errors can still occur even
when nurses diligently follow the 5 rights.
 The Right Patient (Identification)
 Right drug
 Right dose
 Right route
 Right time

21. Medication errors
A medication error is any preventable event that may
cause or lead to inappropriate medication use or
patient harm while the medication is in the control
of the health care professional, patient, or consumer.
Such events may be related to professional practice,
health care products, procedures, and systems,
including prescribing; order communication;
product labeling, packaging, and nomenclature;
compounding; dispensing; distribution;
administration; education; monitoring; and use.

22. Nurses have learned the five rights as a guideline to
safe administration of medications. If the nurses are
not following the 5 rights of safe drug administration
then the medication errors can be happened.
Medication errors must be reported in a timely
manner. Nurse must inform the prescribing
practitioner of the error made. Event reports are
required in some institutions to document medication
errors

23. Factors that may influence medication errors
Factors associated with health care professionals
 Lack of therapeutic training
 Inadequate drug knowledge and experience
 Inadequate knowledge of the patient n Inadequate
perception of risk
 Overworked or fatigued health care professionals
 Physical and emotional health issues
 Poor communication between health care
professional and with patients

24. Factors associated with the work
environment
 Workload and time pressures
 Distractions and interruptions (by both
primary care staff and pt.)
 Lack of standardized protocols and
procedures
 Insufficient resources
 Issues with the physical work environment
(e.g., lighting, temperature and ventilation)

25. Factors associated with patients
 Patient characteristics (e.g., personality, literacy
and language barriers)
 Complexity of clinical case, including multiple
health conditions, poly pharmacy and high-risk
medications
Factors associated with medicines
 Naming of medicines
 Labelling and packaging

26. Factors associated with computerized
information systems
 Difficult processes for generating first prescriptions
(e.g. drug pick lists, default dose regimens and
missed alerts
 Difficult processes for generating correct repeat
prescriptions
 Lack of accuracy of patient records
 Inadequate design that allows for human error

27. Factors associated with tasks
 Repetitive systems for ordering, processing and
authorization
 Patient monitoring (dependent on practice, patient,
other health care settings, prescribe Primary-
secondary care interface.
 Limited quality of communication with secondary
care.

28. Preventing medication errors
The following strategies to reduce medication errors in
primary care
 Educating primary care providers about common causes
of medication errors;
 Providing simple tools to assist primary care providers in
safe medication prescribing and use process;
 Considering how patients can be actively involved in
medicine management
 Providing patient engagement tools to address non-
adherence
 Ensuring that pharmacists actively review prescriptions;

29.  Encouraging and supporting use of medication
reconciliation by clinicians.
 Completely write out the prescription, including the
drug name and dosage regimen. The full dosage
regimen includes the dose, frequency, duration, and
route of administration of the drug to be
administered.
 When writing out a dose, do not use a trailing zero
and do use a leading zero.

30.  For veterinarians, when calling in or writing out a
human drug prescription for animals, verbally state
or write out the entire prescription because some
pharmacists may be unfamiliar with veterinary
abbreviations.
 Use a computerized prescription system and
electronic delivery of prescriptions to minimize
misinterpretation of handwriting.

31.  Institutions should educate healthcare providers and
other employees on proper use of abbreviations.
 Report adverse events that stem from medication errors
or abbreviations errors to the FDA; these events can be
used to further inform and expand recommendations for
safety.
 Practitioners, including physicians, nurses, pharmacists,
physician assistants and nurse practitioners, should be
very familiar with the abbreviations used in medical
practice and in prescription writing. All drug names,
dosage units, and directions for use should be written
clearly to avoid misinterpretation

32. Forms of Drugs
Following a different drug formulation available:-

33.  Tablets: These are most common forms of drugs
available in the market. They are economical, easy to
handle and consume by the patient. They can be
swallowed with a glass of water. They are of different
shapes like circular, rectangular etc. They are also of
different type like film coated, sugar coated ones etc.
 Capsules: These are similar to tablets in the ease of
administration. They have two gelatin shells in which
active drug ingredients are packed. They are also
quite popular like tablets but are comparatively
expensive to make. The advantage is they can include
liquid form of drug and also incompatible
formulations in their shells.

34.  Chewable tablets: These are similar to tablets in
appearance but they are large in size with attractive
color, odor and sweet taste. They are meant to be
chewed in the mouth for the drug to release and
show its effects. Eg: Antacid tablets.
 Powders: These are solid dosage forms and are in
powder format. They are used for dusting and
external applications like on wounds, cuts, skin
infection etc

35.  Solutions: These are very popular formulations.
Here the drug is dissolved in a suitable solvent.
Swallowing of fixed volume of liquid solution
provides sufficient drug needed for cure by the body.
These solutions are clear liquids but can have color,
taste and also acceptable odor. These are commonly
used for old age patients and children. The
advantage is faster on set of action and also better
absorption of drug in comparison to tablets. Eg: Oral
syrups. eye drops, ear drops, nasal drops etc.

36.  Emulsions: This is an interesting formulation where in
water insoluble drug is made into liquid formulation by
addition of soap like emulsifying agent. This emulsifying
agent disperses the water insoluble drug as fine particles or
goblets within the water by forming a film or cover around
the drug particles.
 Suspensions: These are liquid formulation but the
difference is they have fine solid particles dispersed in an
aqueous liquid. These formulations tend to form cream
when kept undisturbed for long time. Hence they have a
label “shake well before use.” This helps the settled
cream to disperse for uniform dosing of drug.
 Gases: Pure gases like oxygen, carbon dioxide
and nitrogen are also used as drug.

37.  Ointments: These are semi solid dosage forms. They can
be solutions, suspensions or even emulsions but have high
viscosity. They are intended for application on skin and
other surface by spreading. They are easy to use and have
an advantage of local effect to minimize adverse effects of
drugs.
 Aerosols: These are powder or liquid formulations which
are applied by spraying. The formulation is released as
gaseous dispersion and so can reach deeper locations like
respiratory tract
 Suppositories: These are solid dosage forms which are
intended for insertion in the anus. They release drug slowly
and good for local action.

38. Forms of drug preparation
1. Oral solids
 Tablets: compressed or molded substances to be swallowed
whole, chewed before swallowing, or placed in the buccal
pocket or under the tongue (sublingual)
 Capsules: substances encased in either a hard or a soft
soluble container or gelatin shell that dissolves in the stomach
 Caplets: gelatin-coated tablets that dissolve in the stomach
 Enteric-coated: coated tablets that dissolve in the intestines
 Time-release capsules: encased substances that are
further enclosed in smaller casings that deliver a drug dose
over an extended period of time
 Sustained-release: compounded substances designed to
release a drug slowly to maintain a steady blood medication
level

39. 2. Topical
 Liniments: substances mixed with an alcohol, oil, or soapy
emollient that are applied to the skin
 Ointments: semisolid substances for topical use like
Cream, gel, liniment or balm, lotion, or ointment, etc.
 Pastes: semisolid substances, thicker than an ointment, that
are absorbed slowly through the skin
 Transdermal patches: contain medication that is absorbed
through the skin over an extended period of time
 Suppositories: gelatin substances designed to dissolve when
inserted in the rectum, urethra, or vagina
 Ear & eye drops
 Powder/Talc

40. 3. Inhalants:- Inhalations: drugs or dilution of drugs
administered by the nasal or oral respiratory route for a local or
systemic effect
4. Solution
 Solutions: contain one or more soluble chemical substances
dissolved in water
 Enemas: aqueous solutions for rectal instillation
 Douches: aqueous solutions that function as a cleansing or
antiseptic agent that may be dispensed in the form of a
powder with directions for dissolving in a specific quantity of
warm water
 Suspensions: particle or powder substances that must be
dissolved in a liquid (shaken vigorously) before
administration

41.  Emulsion: a two-phase system in which one liquid is
dispersed in the form of small droplets throughout another
liquid
 Syrups: substances dissolved in a sugar liquid
 Gargles: aqueous solutions
 Mouthwashes: aqueous solutions that may contain alcohol,
glycerin, and synthetic sweeteners and surface-active
flavoring and coloring agents
 Nasal solutions: aqueous solutions in the form of drops or
sprays
 Optic (eye) and otic (ear) solutions: aqueous solutions that are
instilled as drops
 Elixirs: Non aqueous solutions that contain water, varying
alcohol content, and glycerin or other sweeteners

42. Legal responsibilities of nurse
 Under the law nurse are responsible for their own
actions regardless of a written order. All the
nurses must know the maximum and minimum
dose of every drug that they administered.
 Nurse have ethical & legal responsibility to
understand the problem of person using drug
improperly.
 The nurse should ensure that patient had a
complete information regarding, benefit ,side
effects, and toxic effects of the medication.

43.  Nurse should know about the restricted use of
narcotics, which should be kept in safe custody. All
account should be maintained for the
administration of these drugs.
 When involve in the experimental drug
programme the nurse legal obligation is to fully
informed about any investigational medication,
which she will be administering to a patient.

44. Mechanism of absorption of drugs
Absorption:- Absorption is the passage of drug
molecules into the blood. Most of the drugs, except
those applied topically for local effect, must enter the
systemic circulation to exert a therapeutic effect.
Factor influencing the absorption: –
Route of administration
Ability of the drug to get absorbed
Condition at the site of absorption
Oral route of administration of medicine causes
slower absorption whereas IV injections produce
most rapid absorption.

45. Route has different influence on drug absorption
depending on the physical structure of the tissues.
Skin is relatively slow in the absorption, whereas the
mucus membrane and respiratory airway allow
quick drug absorption because of high vascularity of
the area.
 Solutions and suspensions already in a liquid state
are absorbed more rapidly than capsules and tablets.
 After the drug is absorbed it is distributed within the
body to tissues and organs and ultimately to its
specific site of action.

46. When a drug reaches its site of action it is
metabolized into an inactive form that is more easily
excreted. This biotransformation occurs within the
liver. Lungs, kidneys, blood and intestine also
metabolise drugs.
Excretion- after drugs are metabolized they exit the
body through kidneys, liver, bowel, lungs and
exocrine glands, the exocrine glands excrete liquid
soluble drugs

47.  Then it metabolize an inactive form that is more
easily excreted. These biotransformation occur
under the influence of enzymes that detoxify,
degrade and remove biological active chemicals.
 Most biotransformation occur in liver, kidney,
lungs and intestine.
 Excretion- after drug are metabolized they exit
the body through kidney, liver, bowel, exocrine
gland.

48. Factors influencing drug action
 Body size
 Age
 Sex: females required less dosages
 Species and races
 Route and Time of drug administration
 Environmental factors like smoking, alcoholism etc.
 Body weight & Surface area
 Genetic factors
 Pathological conditions
 Diet & Nutritional status
 Psychological effects like grief, tension, stress etc

49. Terminologies and abbreviations used in
prescription of medications
Abbreviation Definition
a.c. or ac before meals
p.c. or pc after meals
Am Before noon
Pm After noon
Alt.die Alternate days
o.m Each morning
o.d Daily/ once in a day
o.n Each night
h.s At Bed time
h.n Tonight
c.m Coming morning
s.o.s If necessary in emergency
p.r.n. or prn When required
b.i.d/ bd Twice a day
t.i.d / tds Three times a day
Qid/ q4h Four times in a day
Qhs Before bed
stat At once
Rep. Repeat
h hour
q every
Q6H Every 6 hourly
po Per orally
DA Right ear
AS Left ear
AU Each ear
H Hypodermic
Inj Injection
IM Intramuscular
IV Intra venous
SC / SQ Sub coetaneous
od (oculus dexter) Right eye
os (oculus sinister) Left eye
OU Both eyes
Os mouth
tbsp tablespoon
5X a day five times a day
q.6h every six hours
qod every other day
Tab Tablet
Qd Every day
q3h Every 3 hours
gt (gutta) Drop
syr Syrup
Alt.h Alternate hours
Cap Capsule
Rx Treatment/ advice for
c with

50. Route of administration
A route of administration in pharmacology is the path
by which a drug, fluid, poison, or other substance is taken
into the body. The various routes of drug administration
are:
 Oral- most common ,convenient, less expensive, and
safe for most of patient.
 Sublingual or buccal- drug is placed under the tongue
for slow absorption
Advantage-Drug can be administered for local effect &
rapidly absorbed in blood steam
Disadvantage- Drug may remain under the tongue
until dissolve or absorbed

51. Topical application: application of drug on the skin
usually by friction rubbing(topical)
Advantages:-
 It can show local effect. That is the drug acts only at
the site of application and not on whole body like in
oral route.
 Rapidly absorbed. Ex: Powders, ointments, lotions
etc.

52.  Implantation- it is planting or putting in of solid
drugs into the body tissue.
 Insertion- introducing a solid form of drug into
the body orifices.
Advantage- Provide local and therapeutic effect
Disadvantage- Drugs have to be preserved at low
temperature.

53.  Inhalation & nebulization- this method have
local and systemic effect by nebulizer or ventilator to
carry the drug into the lungs by breath.
Advantage-
 Rapid localized relief
 Can be administered to an unconscious client
Disadvantage-
 Used only for respiratory system

54.  Instillation- it is putting of drug in liquid form in a
body cavity or body orifices e.g.- Eye, rectum
Advantage-
 Provide local and therapeutic effect
 Drug released at slow rate
Disadvantage-
 Limited use
 Dose absorbed is unpredictable

55.  Parentral route- Parental administration
involves giving drug by a route through injection
in body tissue. It is giving of the medication
outside the elementary tract. It is a method of
delivering the drug directly into the blood stream
without having to pass the oral or alimentary
mucous layer. These are

56. Types of parentral routes
 Intra-venous injection: This route delivers drug
directly into the blood veins. The formulation is
given as a single lump or slowly by drip over a period
of hours. It is route which shows fastest action
compared to all others. This route is regularly used
in times of emergency and critical care.

57.  Intramuscular: Here the drug is given directly
into the large skeletal muscles. The drug is released
slowly from the sites of injection as the blood flows
through. Since the muscle has less sensory nerves,
irritant drugs can be given without pain.

58.  Intra-peritoneal: Administration of drugs into
the peritoneal cavity is called intra-periotneal
injection. This method is less used in humans but
widely used in research animals used for drug
testing. The injection is done at the abdominal
region below the skin into peritoneal cavity.

59.  Subcutaneous: Here drug is injected just below
the skin. This route is used for vaccines, disease
diagnosis etc. The drug is deposited into the loose
subcutaneous tissue which has many nerves. So
irritant drug must be avoided as it can be painful.
The rate of drug absorption is slower than that from
intramuscular injection. It is of different types like

60.  Intrathecal: Here drug is administered into the
spinal cord.
 Epidural: The drug is injected near the spinal
cord such that it affects the local nerves. Mostly
used in anesthesia during surgery, delivery etc
 Intra-dermal injection: Here drug is given
into the skin so it form a small bulge. Used for
vaccination and drug allergy testing.
 Intracardiac: The injection is directly given
into the heart.

61.  Intra-osseous:- The injection is done directly into
the bone marrow. The needle has to pass through the
solid bone and reach the marrow. This is route is
possible in children as the large bones are not
completely hardened and are a bit soft to allow the
penetration of the needle.

62. Types of medication orders
 Stat Orders: A stat order is an order for a single dose of
medication to be given immediately. Stat drugs are often
prescribed in emergency situations to modify a serious
physiological response; a stat dose of nitroglycerin may
be ordered for a client experiencing chest pain.
 Single-Dose Orders: Single-dose orders are one-time
medications or may require the administration of drops
or tablets over a short period of time. The nurse should
administer single-dose orders only once, either at a time
specified by the prescribing practitioner or at the earliest
convenient time

63.  Standing Orders: Standing orders are also
referred to as scheduled orders because they are
administered routinely as specified until the order is
canceled by another order.
 prn Orders: A drug may be ordered on a prn (given
as needed) basis as circumstances indicate. The drug
is administered when, in the nurse’s judgment, the
client’s condition requires it.
 Routine order: -Given within 2 hours of being
written and carried out on schedule.

64.  Verbal and telephone orders:-

65. Parts of the drug order
All orders should be written clearly and legibly, and the drug order
should contain seven parts:
 The name of the client
 The date and time when the order is written
 The name of the drug to be administered
 The dosage
 The route by which it is to be administered and special directives
about its administration
 The time of administration and frequency
 The signature of the prescribing practitioner writing the order
Drug prescriptions written in settings other than acute care
facilities may also specify whether the generic or trade name of the
drug is to be dispensed, the quantity to be dispensed, and how
many times the prescription can be refilled.

66. Administration of oral medication
 Definition: Administration of medicine
through mouth for prophylactic and
therapeutic effects.

67. Purpose
 To promote health- e.g. iron supplement, vitamin,
calcium etc
 To prevent illness e.g. vaccines
 To help in diagnosis e.g. barium used in x-ray,
contrast medicine
 To alleviate illness e.g. analgesics
 Therapeutic purpose e.g. antibiotics for infection
 To prevent the disease and take supplement in order
to maintain health
 To cure the disease
To give as a symptomatic treatment

68. Contraindication
 For unconscious patient.
 For uncooperative patient.
 After oral and gastric surgeries.
 Oral cancer.
 Before diagnostic tests and operation.

69. Preparation of the patient
 Explain the procedure.
 Check the identification of the patient of the patient.
 Check the diagnosis.
 Be sure for the purpose of giving medication.
 Confirm the previous dose given or not.
 Check for any contraindication before giving any
medication.
 Check the method and nature of administration of the
drug.
 Check the patient is able to swallow. Assist the patient
is able to a sitting position, if possible.
 Protect the patient’s clothing with a towel.

70. Preparation of the articles: A tray containing:
 Dr’s prescription with prescribed Medication
 A medicine glass (ounce glass), a teaspoon or a
dropper.
 A glass or feeding cup with drinking water.
 A duster or a towel.
 Mortar and pestle.
 A kidney tray and a paper bag.
 Medication recording card
 Pill crusher/ tablet cutter if needed

71. Procedure
 Wash hands with water and soap
 Read the physician’ prescription and enter it in the
medicine card. Make sure that all the medicines are
entered correctly.
 Take out the medicine from the shelf after reading the
medicine card.
 Check the medicine table thrice, check the expiry date of
the medicine.
 Take out tablets or capsules from the bottle into the lid of
the container first.
 Pour syrup from the side of the bottle away from the
label. Do not pour an excess amount and wipe the mouth
of the bottle with a clean duster and close it tightly.
 Do not touch with hands.
 Take the tray to the bed side.

72.  Place the card with medicine on the tray.
 Explain the procedure to the patient/client and the
family.
 Identify the patient: By calling out his name ob by
asking the patient to repeat his name.
 Verify identification with the nurses’ record and
medicine chart.
 Provide proper & comfortable position to the patient.
 Instruct the patient to take a deep breath and
consume little water if necessary.

73.  Administer the medicine by instructing the
patient/client to consume the medication and water
thereafter as much as possible.
 Stay with the patient until he has swallowed the
medicine & observe for any side effects as desired
duration.
 Replace all the articles at their appropriate place and
wash Hands.
 Record the medications in the medication card.

74. After care of the patient and articles:
 Remove the towel and wipe the face with it.
 Position the patient for good body alignment .tidy
up the bed.
 Repeat the articles to the utility room.
 Wash hands.
 Recording the medication.
 Observe any expected and unexpected reactions.
 Returns the medication card to the storage area.

75. Nurse’s responsibility in administrating oral
medications
Before administration of the drug:
 Identify the patient by checking the medication card.
 Check the physician prescription before preparing the
drug.
 Check the label of containers thrice before preparing the
drug.
 Check the expiry date.
 Always use a calibrated measure while prepare the drug.
 Shake the liquid medicine before pouring into ounce
glass; pour it away from the label.
 Wipe the mouth of the bottle, close it tightly and replace
it at the proper place.

76.  Hold the ounce glass at eye level and place the thumb on
the neck of the ounce glass to which medicine is to be
poured. Read the lower level of the meniscus in the
ounce glass.
 When taking the tablets or capsules do not touch them
with the hands, drop them from the container to its lid
and them to the medicine cup.
 Do not put back the medicine once it is taken out of the
container.
 Do not use the medicine if there is change in color, odour
or consistency.
 Prepare the drug just before the time of administration
and do not leave the drug in the medicine tray

77. Nurse’s responsibility in administrating oral
medications
During administration of medication: Observe
the right of medication:
Right patient-
 Read the patient’s name on his medicine Chart.
 Read the physician’s prescription
 Call the patient by name and ask him to repeat the
name.

78. Right Drug:
 Read the physician’s order.
 Make sure that the drug is written correctly in the
medicine card.
 Take care of the drug whose names sound alike.
 Check the drug thrice as mentioned before.
 Avoid conservation or anything that distracts the
mind while preparing or administering the drug.
 Be sure of the trade names of the medicine. If
doubtful, confirm it.
 Avoid accepting verbal orders. In an emergency get
written orders as soon as possible.

79. Right Time:
 Give the medicine near the prescribed time.
 Give the medicine before food if it is so prescribed, or
at bed time or in the normal hours as ordered by the
physician.
 Verify schedule of medication with order.
 Date
 Time
 Specified period of time
 Check last dose of medication given to patient.
 Administer medication within 30 minutes of
schedule

80. Right Dose:
 Check the instruction to confirm the correct dose.
 Check the patient’s age and weight to get the correct.
 Dose measure accurately
 The medicine should be carried to the patient without
Spilling it out of the container.
 Check the expiry date of the drug before administration.
Right Method
 Check the physician‘s note to determine the route of
administration.
 Be sure the medicine is given to the patient in preposition.
 Stay with the patient until he has swallowed the medicine.
 Never leave the medicine with the patient.
 Any mistake in giving the medicine must be reported
immediately.

81. Right Education
 Inform patient of medication being administered.
 Inform patient of desired effects of medication.
 Inform patient of side effects of medication.
 Ask patient if they have any known allergies to
medication.
Right Evaluation
 Assess patient for any adverse side effects.
 Assess patient for effectiveness of medication.
 Compare patient’s prior status with post medication
status.
 Document patient’s response to medication

82. Nurse’s responsibility in administrating oral
medications
After administration of drug:
 Record only the medicine, which you have
administrated.
 Record the date, time, name and dose of the drug.
 Never record the medication before it is given.
 Record the effect observed.

83. Advantages of oral drug administration
 Ease of administration as even the patient can take
medicine on his own without others help.
 The chances of taking improper dose are absent.
 This is non-painful, inexpensive & safe route.
 Also dosing by this route allows no wastage of drug.

84. Disadvantages of oral drug administration
 In case of emergency this route is not preferred.
 Inappropriate for the patient with oral surgery,
altered consciousness.
 Unpleasant taste, discoloration of tooth.
 Cannot be given before surgery
 Drug may be inactivated by gastric juices result in
poor absorption.

85. Administration of Parenteral medications
Parentral administration involves giving drug by a
route through injection by a body tissue.
Parenteral refers to the path by which medication
comes in contact with the body. Parenteral
medications enter the body by injection through the
tissue and circulatory system. Injection medications
are absorbed more quickly. Parenteral medications
can be effective and safe when prepared and
administered correctly. However, because they are
invasive and absorbed readily and quickly into the
body, there are numerous risks associated with
administering them.

86. General Principles of Parenteral Medication
Administration
 Check doctor's order
 Check the expiration for medication - drug potency may
increase or decrease if outdated
 Observe verbal and non-verbal responses toward receiving
injection. It can be painful, client may have anxiety, which
can increase the pain
 Practice asepsis to prevent infection. Apply disposable
gloves
 Use appropriate needle size. To minimize tissue injury
 Plot the site of injection properly. To prevent hitting nerves,
blood vessels, bones
 Use separate needles for aspiration and injection of
medications to prevent tissue irritation
 Introduce air into the vial before aspiration. To create a
positive pressure within the vial and allow easy withdrawal
of the medication

87.  Allow a small bubble (0.2 ml) in the syringe to push the
medication that may remain
 Introduce the needle in quick thrust to lessen discomfort
 Either spread or pinch muscle when introducing the
medication. Depending on the size of the client
 Minimized discomfort by applying cold compress over the
injection site before introduction of medication to numb
nerve endings
 Aspirate before introduction of medication. To check if
blood vessel had been not hit.
 Support the tissue with cotton swabs before withdrawal of
the needle. To prevent discomfort of pulling tissues as
needle is withdrawn
 Massage the site of injection to haste absorption
 Apply pressure at the site for few minutes. To prevent
bleeding
 Evaluate effectiveness of the procedure and make relevant
documentation

88. Types of Parental therapy
Parental administration involves giving drug by a
route through injection by a body tissue. It is giving
of the medication outside the elementary tract. It is a
method of delivering the drug directly into the blood
stream without having to pass the oral or alimentary
mucous layer.
There are four routes for parenteral medications
these are:-Intradermal (ID), Subcutaneous (SC or SQ),
Intramuscular (IM) & Intravenous ( IV)

91. Intra muscular injection
In this route the drug is given directly into the large
skeletal muscles. The drug is released slowly from the
sites of injection as the blood flows through. Since the
muscle has less sensory nerves, irritant drugs can be
given without pain.
 Advantage – can administered large amount
 Disadvantage- can irritate tissue and cause pain,
Effect is slow than I/V & Small amount to be
administered.

94. Sites of injection
The upper arm:
 The deltoid muscle is the most common site for vaccines.
This muscle is in the upper arm near the shoulder.
 It can only receive small volumes of medication, usually 1
milliliter or less. Therefore, doctors do not use it for
drugs that require larger quantities.
 People self-administering medication rarely use the
deltoid, as an injection site, because it is difficult for
them to reach.
 To find the deltoid muscle, a person feels for the bone at
the top of the upper arm. Two finger-widths below this,
there is a triangular muscle. The needle should enter the
triangle's center.

95. The Hip:-
 Healthcare professionals often give intramuscular
injections into the ventrogluteal muscle of the hip.
 This muscle is a very safe injection site for adults and
infants more than 7 months old because it is thick and
located away from major nerves and blood vessels. But
it can be challenging to self-administer medication
into the hip.
 To locate the ventrogluteal muscle on someone else,
place the heel of the hand on the hip, with the fingers
pointing toward the head. The thumb should point
toward the groin.
 Position the index and middle fingers into a V then
administer the shot in the middle of the V

96. The thigh:
 Typically, people who need to self-administer
injections use the vastus lateralis muscle in the thigh.
 To locate the correct spot, imagine dividing the thigh
vertically into three equal parts.
 Give the injection into the outer top part of the
middle section.

97. The buttocks:
 Before doctors began using the hip as an injection
site, they used the dorsogluteal muscles in the
buttocks.
 They tend to avoid using these muscles now because
of the potential risk of injury to the sciatic nerve.
 People should avoid self-administering medications
into the dorso gluteal muscles

98. Intravenous injection: This route delivers drug
directly into the blood veins. The drug is given slowly
by drip over a period of hours. It is routing which shows
fastest action compared to all others. This route is
regularly used in times of emergency and critical care.
 Advantage – rapid effect
 Disadvantage- drug distribution is slow if there is
poor circulation & direct infection can be introduced.

99. Subcutaneous injection
In this the drug is injected just below the skin. This
route is used for vaccines, disease diagnosis etc. The
drug is deposited into the loose subcutaneous tissue
which has many nerves. So irritant drug must be
avoided as it may be painful. The rate of drug
absorption is slower than that from intramuscular
injection.
 Advantage – test dose for checking sensitivity of pt.
 Disadvantage- absorption is slow

100. Intra-dermal injection
In this the drug is given into the capillary-rich layer just below
epidermis. In this the drug’s dosage contained in a small
quantity of solution (0.01 to 0.1 ml). Commonly used sites for ID
injection are the Inner aspect of the forearm (upper chest and
upper back beneath the scapula). It is used for
 Vaccination/ immunizations
 Drug allergy testing
 Administer local anesthetics
 Diagnostic tests
Advantage- Rapid action
Disadvantage- requires sterile technique, required more
experience personnel & Break skin barrier

102. Complication of injection
 Infection- due to improper sterilization
 Pyrogenic reaction- due to pyrogens presence in
fluids.
 Allergic reaction
 Tissue trauma
 Pain & swelling
 Circulatory overload- due to large quantity of
fluids

103. Syringes and Needles
A needle syringe is a device used for injecting, removing or
infusing fluids. They are most commonly known in health
care settings for injecting medications and for use in
removing blood from the body.
Needles Available in different gauges – the smaller the
number, the larger the gauge (inside diameter)
Length – long enough to penetrate the appropriate layers
of tissue
Most of the health organization used disposable syringe
that are inexpensive and easy to use. Syringes coming in a
no of sizes from 0.5 to 60 ml
Syringes can differ in size and type, and they can be made
of glass or plastic. The syringe chosen usually depends on
its intended purpose.

104. Types of Syringes
Syringes are available in several different varieties. Most
syringes are disposable. Syringes are available either with or
without an attached needle. The volume of medication the
syringe can hold determines the size of the syringe you should
select.
 Standard- comes in 3ml,5 and 10ml
 Insulin syringe- 0.5 to 1 ml and are calibrated in unit
insulin syringe that hold 0.5ml, designed especially for use
with the ordered dose of insulin
 Tuberculin syringe- It has a long thin barrel with a pre
attached thin needle. Syringe with capacity of 1ml. It is used
for preparing a small precise dose for the infants and young
children. Tuberculin syringe, use to administer small or
precise doses such as pediatric dosages. It Should be used
for doses of 0.5ml or less

106. The Parts of a Syringe
The syringe consists of a plunger, barrel, hub, needle and
the needle's protective cover. It is important that all parts
of a syringe coming into contact with the body be kept free
of contamination. Syringes consist the following
parts:
 Plunger
 Barrel
 Hub
 Needle- protective cap
The Plunger: - The plunger is located at the end of the
syringe and can be made of clouded or colored glass or
plastic. Its purpose is to fill or empty the barrel. The
plunger is pulled back to fill the barrel and is pushed
forward for emptying.

107. The Barrel: - The barrel is the part of the syringe that
contains the fluid, whether it is a medication, blood or
a solution drawn from the body. The barrel can range
in size from 0.5 mL to 60 ml.
The Hub/tip: - It is at one end of the needle and is
the part that attaches to the syringe. The hub also
functions to lock the needle in place while using the
syringe for its desired function.

108. The Needle: - The needle consists of the shaft, lumen and
bevel. Needles vary in length, size of the shaft and size of the
lumen. A needle has three parts, the hub, the shaft, and the
bevel.
 The shaft is the metal's length and is usually chosen
depending upon the route and site of administration,
physical mass of the client, and the thickness of the
medication.
 The lumen, also known as the bore, is the hollow space
within the needle. The diameter of the lumen is known by
the needle's number gauge. The lumen is chosen with the
same specifications as the shaft.
 The last part of the needle, the bevel, is the pointed end
and determines the needle's sharpness.

113. Protective Cover/Cap: -
 The protective cover/cap is provided to maintain the
needle's sterility. Needle sticks are a common way of
transporting infections to health care providers and
clients.
 The needle's bevel is covered to limit the amount of
accidents that could happen involving needles and to
ensure that only the intended client receives the
needle stick. In an attempt to reduce contamination
and increase safety, most needles are disposable and
are thrown out after a single use.

114. Needle Size-is designated by length & gauge
 The length of a needle is measured in inches from
the juncture of the hub and the shaft to the tip of the
point. Needle lengths range from 3/8 inch to 31/2
inches; some special use needles are even longer.
 The gauge of a needle, used to designate the size of
the lumen, ranges from 27 (the finest) to 13 (the
largest).

116. Parenteral Drug Packaging
 Ampule – glass or plastic container that is sealed and
sterile (open with care).
 Vial – small bottle with rubber diaphragm that can be
punctured by needle.