Medication administration

1. Fundamentals of Nursing I
BSN 103

2. TOPIC 6 – Medication Administration
Dr. Kusrini Kadar

3. Related PLO & CLO
• PLO 2 - Integrate core scientific knowledge to provide therapeutic,
holistic care that is culturally appropriate, safe and tailored to the
needs of the individual patient.
• CLO 4 - Explain basic nursing skills essential for delivery of nursing
care.

4. Learning Outcome
• Discuss the nurse’s role and responsibilities in medication administration.
• Explain the physiologic outcomes of medication actions.
• Describe factors to consider when choosing routes of medication
administration.
• Summarize common medication forms and routes.
• Identify the six rights of medication administration and apply them in clinical
settings.
• Describe measures for administering medications safely.
• List the common abbreviation used in relation to administration of medication.
• Understand the calculation of drug.
• Develop knowledge regarding medication assessment

5. Introduction
• Administration of medication is a basic nursing function that involves
knowledge and skill.
• The safe and accurate administration is the most important
responsibility of nurse.
• Improper administration can cause harmful effects.
• A nurse will need theoretical knowledge of pharmacology and
practical knowledge about safe procedures.

6. Cont’d
Some basic points regarding drugs:
• Name of the drug
• Classification
• Route and time of administration
• Principles of drug action
• Dosage
• Medication standards
• Types and forms of drugs
• Sources of information about medication
• Sources of information about medication
• System of medication distribution
• Medication order
• Prescription and non prescription medication
• Weights and measures used
• Preparation of solution and calculation
• Storing of medication
• Factors affecting safety
• Abbreviation and symbols used
• Rules of administration
• Legal aspects, nurse practice acts, clients rights
• Institutional policies
• Nurses role.

7. Pharmacological Concepts
• Medication names
• Classification
• Medication Forms

8. Drug Names
• Chemical name is the exact description of the drug’s chemical
composition and molecular structure. For example, 2-(p-
isobutylphenyl) propionic acid is the chemical name of the anti-
inflammatory drug ibuprofen. The chemical name is rarely used in
nursing practice.
• Generic name is assigned by the United States Adopted Name Council
(USAN Council) when the developing manufacturer is ready to market
the drug. This is usually similar to the chemical name, but in a simpler
form. It is derived form chemical name. E.g. Morphine Sulphate,
ibuprofen etc.

9. Cont’d
• Official name is also the generic name that is listed in publications
such as the United States Pharmacopeia (USP) and National
Formulary (NF). For example, ibuprofen is both a generic and an
official name.
• Brand and (trade or proprietary) name is what the drug is sold as in
stores. The brand name is easily recognized because it begins with a
capital letter and sometimes has a registration mark (®) at the upper
right of the name. Different manufacturers of the same medication
may give the medication different brand names. For example, Advil,
Nuprin, and Motrin are all brand names for ibuprofen.

10. Drug Classifications
• By usage—why the drug is used
• By body system—where the drug works
• By chemical or pharmacological class—what the drug is made of
• A drug can be placed in more than one category in a classification
system. Classified by usage, for example: ibuprofen (Motrin) can be
an analgesic, anti-inflammatory, and an antipyretic agent.
• A drug can act on more than one body system, as well; in fact, most
do. For example, diazepam (Valium) is used for its anti-anxiety effects,
but it also decreases the activity of the intestinal system and other
smooth muscles.

11. Prescription and Non-prescription
drugs
• Prescription drugs require a written order from a healthcare provider
(e.g., physician or advanced practice nurse) who is licensed by the
state to prescribe or dispense drugs.
• Nonprescription, or over-the-counter (OTC), drugs may be purchased
without a prescription and are assumed to be safe for the general
population if consumers follow the manufacturer’s directions.

12. Medication Forms

14. Pharmacokinetics As the Basis of
Medication Actions
• Pharmacokinetics is the study of how medications enter the body,
reach their site of action, metabolize, and exit the body.
• Absorption
• Distribution
• Metabolism
• Excretion

16. Types of Medication Action
• Therapeutic effects
• Side effects
• Allergic reaction, nausea,
vomiting
• Adverse effects
• Toxic effects.
• Idiosyncratic reactions
• Allergic reactions

17. Medication Order
• 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 individual writing the order

18. Types of Medication Orders
• A STAT order
• The single order
• The standing order
• A prn order, or as-needed order, e.g., morphine sulfate 2 mg IV PRN
every 3 hours for incisional pain)

19. Routes of Administration
• Oral
• Sublingual
• Buccal
• Parenteral (IV, IM, ID, Sub-Q)
• Topical
• Intraocular
• Inhalation

20. Factors Influencing Routes
• Oral: convenience vs. tolerance, easy to give, often produces local or
systemic effects
• Injections: infection risk, needle, bleeding, rapid absorption
• Skin/topical: painless, caution w/abrasions, provides local effects
• Transdermal: prolonged systemic effects
• Mucous membranes: sensitive, less pleasant,
• Inhalation: provides rapid effect for local respiratory effect, potential
serious side effects

21. Oral Medication Administering
Gather equipment
Check medication
order
Know the drug
action
Wash your hands
Prepare for the
drug
Recheck each
medication
Identify the patient
carefully
Assist patient to an
upright position
Administer the
medication
Remain with
patient until the
medication is
swallowed
Wash hands
Document each
medication given
Check the patient
within 30 minutes
to verify response
to drug

22. Injectable Medication

23. The sites for intramuscular
medications are
Gluteus maximus,
Deltoid muscle,
Vastus lateralis,
Rectus femoris muscle, and
Ventrogluteal muscle.

25. What are the complications of
intramuscular injections?
It’s normal to experience some discomfort after an
intramuscular injection. But certain symptoms may
be a sign of a more serious complication as following
severe pain at
the injection
site
tingling or
numbness
redness,
swelling, or
warmth at
the injection
site
drainage at
the injection
site
prolonged
bleeding
signs of an
allergic
reaction, such
as difficulty
breathing or
facial swelling

26. Z-Track Injections Overview
The Z-track method is a type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue
(underneath the skin).
During the procedure, skin and tissue are pulled and held firmly while a long needle is inserted into the muscle.
After the medication is injected, the skin and tissue are released.
When you insert a needle into the tissues, it leaves a very small hole, or track.
Small amounts of medication can sometimes leak backwards through this track and be absorbed into other tissues.
Pulling the skin and tissue before the injection causes the needle track to take the shape of the letter “Z,” which gives the procedure its name.
This zigzag track line is what prevents medication from leaking from the muscle into surrounding tissue.

27. Purpose
of Z-Track
Injection
The Z-track method is not often recommended
but can be particularly useful with medication
that must be absorbed by muscle to work.
It also helps to prevent medication from
seeping into the subcutaneous tissue and
ensures a full dosage.
Some medications are dark colored and can
cause staining of the skin.
• If this is a side effect of the medication you will be taking,
the doctor may recommend using this technique to
prevent injection site discoloration or lesions.

28. Z-Track Injection Sites
Z-track injections can be performed at any intramuscular injection location, though the thigh
and buttocks are the most common sites.
Thigh (vastus lateralis muscle):
• Divide the upper thigh in thirds. Use the middle third, on the outside or middle of the muscle for the injection.
Hip (ventrogluteal):
• Place the heel of your hand on the head of the greater trochanter (hip bone) with your thumb pointing toward the
abdomen.
• Extend your index finger up to the anterior superior iliac spine then spread your other fingers back along the iliac crest.
• Insert the needle in the “V” formed between your index and third fingers.

29. Preparing for Z-Track Injection
It is important that the correct size needle is used.
healthcare team will advise patient on which needle and syringe to use, taking pt weight, build, and
age into consideration.
Be sure to check if patient have a bleeding disorder.
In an adult, the most commonly used needles are one inch or one and a half inches long, and 22 to
25 gauge thick.
Smaller needles are typically used when injecting a child.

31. Dose Calculation
• System of measurement
• Metric system – it is necessary to
convert drug dosages to a different unit
in the metric system
• Household system – used more in
community setting (client’s home)
• The household system is not as
accurate as the metric system because
of the lack of standardization of spoons,
cups, and glasses.
• E.g. a teaspoon is considered to be
equivalent to 5 mL or three teaspoons
equal one tablespoon.

32. Methods for Computing Drug Dosages
• Formula methods
• Example: Amoxicillin,
625 mg PO, is ordered.
It is supplied as a liquid
preparation containing
250 mg in 5 mL. How
much does the nurse
administer?

34. Common Nursing Interventions When
Administering Medications
1. Perform hand hygiene per policy and procedure
2. Preparing the medication in medication preparation room and position
the medication cart outside the patient’s room.
3. Verify with at least 5 rights (right patient, right medication, right dose,
right route, right time) and do triple checks
• First check: When removing the medication from a drawer.
• Second check: When preparing the medication, such as placing an unopened oral
medication in a medicine cup, pouring a liquid, or filling a syringe.
• Third check: Just before opening the package of an oral medication at the
bedside or just after preparation of a liquid or parenteral medication.

35. 4. Verify the expiration date on a medication package
5. Introduce yourself and state that you are there to administer
medication
6. Ask the patient to state his or her name and birth date and verify
the response against the MAR and wristband
7. Teach about the medications being administered and ask whether
the patient has any questions to ensure understanding about the
medications being administered and support motivation to take the
medication.
8. Assist the patient into a comfortable position for the prescribed
route, such as sitting or Fowler’s for oral medications or side lying
for IM injections.

36. 9. Assess for therapeutic and nontherapeutic responses to a
medication before administering another dose (e.g., stools are not
loose when receiving a stool softener or laxative.)
10. Hold a medication if it is no longer appropriate or if an adverse
response occurred to prevent patient injury.
11. Notify the primary health-care provider if a nontherapeutic
response occurs that is more serious than a minor side effect
12. Document administration of medications, only after medications
are administered, in the clinical record or MAR or according to
facility policy and procedure.