1. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 1
 Tablet – small, solid dose of medication,
compressed or molded; may be any color, size or
shape.
 Lozenge/Troche – small oval, round or oblong
preparation containing a drug in a flavored or
sweetened base, which dissolves in the mouth &
releases the medication.
 Trans-Dermal Patch – unit dose of medication
NURSING SKILLS applied directly to the skin for diffusion through
skin & absorption into the bloodstream.
Medication
Liquid
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N  Elixir – medication in a clear liquid containing
water, alcohol, sweeteners & flavor.
 Syrup – medication combined in a water & sugar
solution.
 Suspension – finely divided, undissolved
MEDICATION particles in liquid medium that needs to be
shaken before use.
 Solution – a drug dissolved in another substance.
FUNCTIONS OF THE NURSE Semi-Solid
 Ointment – semi-solid preparation containing a
Dependent – Nursing Action carried out at the drug to be applied externally.
instruction or order of the Physician.  Liniment – medication mixed with alcohol, oil
Independent – Nursing Action carried out within the or soap, which is rubbed on skin.
legal scope of Nursing’s independent domain.  Lotion – drug particles in a solution for topical
Interdependent – Nursing action performed by the use.
Nurse in collaboration with other members of the  Suppository – easily melted medication
Health Care Team. preparation in a firm base such as gelatin that is
inserted in the body.
PHARMACOLOGY
 Study of actions of chemicals on Living Organisms. Drug Effects
 Study of drugs & the effects to the Person.
Primary (Therapeutic)
IMPORTANT THINGS TO NOTE BEFORE  Intended Effect of the drug.
ADMINISTERING DRUGS
Therapeutic Actions of Drugs
 Name of the Patient 1. Palliative : relieves the symptoms of a disease but does
 Name of the Drug not affect the disease itself.
Generic Name – the name assigned by the 2. Curative : treats a disease or condition.
manufacturer that 1st developed the drug. 3. Supportive : sustain body function until other treatment
Trade/Brand Name – selected by the drug of the body’s response can take over.
company that sells the drug & is copyrighted. 4. Substitutive : replaces body fluids or substances.
 Dose 5. Chemotherapeutic : destroys malignant cells.
 Route (Drug Preparation) 6. Restorative : returns the body to health.
 Timing & Frequency
 Doctor’s Orders/Signature Secondary (Side-Effect)
 Date  Not intended effect of the drug
 Allergy
FIVE RIGHTS  Rapidly-developing reaction.
The Right Drug with  Signs & Symptoms may appear on the skin,
The Right Dose through respiratory system or the GIT.
The Right Route at  Anaphylactic Reaction – life-threatening
The Right Time to reaction that may result in respiratory distress,
The Right Patient severe bronchospasm, tachycardia, hypotension
& cardiovascular collapse. May be treated by
Right Recording & Documentation epinephrine, bronchodilators & antihistamines.
Right Approach  Symptoms & signs of allergy to drugs:
Right Frequency Fever
Right to Refuse Diarrhea – GIT
Right Education Urticaria – Local Effect
Right Assessment Rash– Local Effect
Right Evaluation Nausea – GIT
Vomiting – GIT
The Right Drug  Toxicity
 Name  Overdose – taking in a lethal dose of medication.
Generic Name  Cumulative Effect
Trade Name  The body cannot metabolize one dose of the
drug before another dose is administered.
 Preparation  The drug is taken in more frequently than it
Solid is excreted & each new dose increases the
 Capsule – powder or gel form of an active drug total quantity in the body.
enclosed in a gelatinous container, may also be  May cause permanent damage to the
called liquigel. kidneys or liver.
 Pill – Mixture of a powdered drug with a
cohesive material; may be round or oval.
Foundations of Nursing Abejo
Medication

2. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 2
 Iatrogenic Effect DRUG PREPARATIONS
 The drug produces a disease condition.
 Examples: Chloramphenicol, which is taken for 1. Oral (Capsule, Pills, Tablets, Extended Release, Elixir,
Typhoid Fever, may cause Depression of the Bone Suspension, Syrup. )
Marrow functions, such as Anemia, 2. Topical. Drug is applied directly to the body site, usually, the
Thrombocytopenia, Neutropenia, skin or mucous membranes. ( Liniment, Lotions, Ointment,
 Idiosyncratic Effect Suppository, Transdermal Patch.)
 It is the unexpected peculiar response to drug, 3. Injectable. Introduction of medication into the body by a
either over response, under response, different syringe. ( Vials, Ampules, Pre-Filled Syringes. )
response than expected.
 Unexplained response
Drug Interaction DRUG CLASSIFICATIONS
 Effects of one drug are modified by the prior on
concurrent administration of another drug. Thereby 1. Body Systems
increasing or decreasing the pharmacological effect. - Drugs that affect the bodily systems, such as the
Drug Antagonism Digestive System, Cardiovascular System, etc.
 Conjoint effect of two drug is less than the effect of 2. Symptoms Relieved
drug acting separately - Ex: Fever, Colds, Cough, etc.
Drug Summation 3. Clinical Indication of the Drug
 The combined effect of two drugs produces a result - Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive.
equals the sum of the individual effects of each agent.
Drug Synergism
 The combined effects of drugs is greater than the sum
of each individual agent acting independently
Drug Potentiation PHARMACOKINETICS
 The concurrent administration of two drugs in which
one drug increases the effect of the other drug. - Study of the movement of drug molecules in the body.
Drug Tolerance Absorption.
 A decreased physiologic response to the repeated  The process by which a drug is transferred from its
administration of a drug or chemically related site of entry into the body to the bloodstream.
substance. Factors That Affect Drug Absorption
 Excessive increase in the dosage is required in order
to maintain the desired therapeutic effect.  Route of Administration.
 Injected medications are usually absorbed more
Drug Abuse rapidly than oral medications
 Inappropriate intake of a substance, either continually
or periodically.  Drug Solubility.
 Liquid medications are absorbed more rapidly than
Drug Dependence solid preparations, as liquid medications do not have
 It is person’s reliance or a need to take a drug or to be dissolved by the gastric juices.
substance.
 Intense physical or emotional disturbance is produced  pH.
if drug is withdrawn.  Acidic drugs are well absorbed in the stomach.
 Basic drugs remain ionized or insoluble in an acid
Drug Addiction environment.
 It is due to biochemical changes in the body tissues,  They can only be dissolved in the Small Intestines.
especially the nervous system. These tissues come to
require the substance from normal functioning.  Local Conditions at the Site of Administration.
 The more extensive the absorbing surface, the greater
Drug Habituation the absorption of the drug, thus, a more rapid effect
 It is the emotional reliance on a drug to maintain a will occur.
sense of well being, accompanied by feelings of need  Food in the stomach can delay the absorption of some
or cravings for drug. medications or enhance the rate of absorption of
other drugs.
 Drug Dosage.
 A higher dose than the normal is usually given when a
DRUG NOMENCLATURE patient is in acute distress and the maximum
therapeutic effect is desired as quickly as possible.
 Chemical Name : Precise description of the drug’s  A maintenance dose is a lower dosage that becomes
chemical composition. the usual or daily dosage
 Generic Name : The name assigned by the
manufacturer that first develops the drug. Often  Serum Drug Levels.
derived from the Chemical Name.  After a drug has been absorbed, its serum level can be
 Official Name : The name by which the drug is monitored by drawing blood and measuring the
identified in the official publication. drug’s peak & trough levels.
 Trade Name :Also referred to as the Brand Name or
Proprietary Name. Selected by the drug company that  Blood Flow.
sells the drug & is copyrighted. A drug can have  Rich blood supply enhances absorption.
several Trade Names but the same Generic Name.
 Pain
 Stress
Foundations of Nursing Abejo
Medication

3. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 3
 Antagonist, drug will attempt to attach but because
attachment is uneven, there is no drug response.
Metabolism
 Also called Biotransformation.
 The breakdown of the drug to an inactive form.
 The liver is the primary site for drug metabolism.
 Physiologic changes or presence of a Liver disease
may complicate the process.
Factors That Affect Drug Metabolism
 Age
 Nutrition
 Liver enzymes involved in metabolism rely on
adequate amount of amino acids, lipids, vitamins and
carbohydrates.
 Insufficient amount of major body hormones
Distribution
 After a drug has been absorbed into the bloodstream, it
is distributed throughout the body.
 Drug accumulates in specific tissues for its action to
take place.
 Distribution depends on the rate of perfusion and
capillary permeability to the drug.
Excretion
 After the drug is broken down to an inactive form,
excretion of the drug from the body occurs.
 The Kidneys excrete most of the drugs. ( most
important route of excretion )
 The Lungs excrete gaseous substances such as inhaled
anesthesia.
 Many drugs are also excreted through the intestines.
Factors That Affect Drug Excretion
 Renal Excretion
 Carried out by glomerular filtration and tubular
secretion, which increases quantity of drug excreted.
 Drugs
Factors That Affect Drug Distribution  Probenecid, prevent the excretion of penicillin.
 Antacid, prevent elimination of ASA
 Plasma-Protein Binding  Blood Concentration Level
 Medications connect with plasma protein in the  Half-Life
vascular system.
 Clients with reduced plasma protein such as kidney or
liver disease could receive a heightened drug effect.
 Volume Distribution VARIABLES INFLUENCING THE EFFECT OF A
 Client with edema has an enlarged area in which a MEDICATION
drug can be distributed and may need an increased
dose. 1. Developmental Considerations
 Barriers to Drug Distribution  During pregnancy, most medications are
 Blood Brain Barrier contraindicated due to its possible adverse effects on
 Placental Barrier the fetus.
 Obesity  Certain drugs have a Teratogenic Effect, which are
 Receptor Combination known to have a potential to cause developmental
 A receptor is an area on the cell wall ( protein or defects in the embryo or fetus.
nucleic acid ) where drug attaches and response takes  Breastfed infants are also at a risk for adverse effects
place. from the drugs in the mother’s body.
 Agonist, drug will connect itself to the receptor site
and cause pharmacological response.
Foundations of Nursing Abejo
Medication

4. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 4
 Children are given smaller doses of medication  In certain circumstances (emergencies), a verbal order from
because the immaturity of their organs are responsive physician may be given to RN or pharmacist
to the medication.  Unless specific orders to the contrary are written, all drugs
 Older Adults are also responsive to medication that may have been ordered while at home are discontinued
because their bodies have experienced physiologic  Explain to patient and family how the patient’s drug plan is
changes associated with the aging process. to be implemented
 Small body size, reduced weight & reduced body  In some inpatient facilities, patients keep medications at
water also alter distribution. bedside and learn or continue to administer as they would
 Drugs are excreted more slowly from the body as a at home
result of changes in kidney functions of Older people.  Promotes patient’s independence
 Nurse should be aware when patients are allowed to do this
2. Weight  Notation should be made on patient’s care plan
 Expected responses to drugs are based largely on those  When patient has had surgery or is transferred to another
reactions that occur when the drugs are given thealthy clinical service or another health agency, it is general
adults (18-65 years old, 150 lb.) practice that all orders related to drugs are discontinued and
 Drug doses for children are calculated by weight or new ones written
Body Surface Area.  Check that all medications are appropriately reordered
3. Sex
 The difference in the distribution of body fat & fluids TYPES OF MEDICATION ORDERS
in men & women is a minor factor affecting the action
of some drugs. 1. Standard Order
 Carried out until cancelled by another order.
4. Genetic & Cultural Factors  The Physician specifies that a certain order is to be
 Asian patients may require smaller doses of a drug carried out for a stated number of days or times. Once
because they metabolize it at a slower rate. the stated period has passed, the order is cancelled
 African Americans appear to require larger doses of automatically.
some medications that are used to lower blood
pressure. 2. PRN Order
 Herbal treatments that are popular in some cultures  As needed, or only when necessary.
may interfere with or counteract the action of  Commonly written for post-operative pain medication.
prescribed medication.
3. Stat Order
5. Psychological Factors  Carried out immediately and for one time only.
 The patient’s expectations of the medication affects
the response to the medication. 4. Single Order
 Placebo is a pharmacologically inactive substance.  The medication is only ordered once, at a time
 Some patients appear to have the same response with specified by the Physician.
the placebo as with an active drug.
5. Self-Terminating
6. Pathology
 The presence of a disease may affect the drug action. PARTS OF A MEDICATION ORDER
 Pathologic conditions that involve the Liver may slow
themetabolism & alter the dosage of the drug needed 1. Patient’s Name
to reach a therapeutic level. 2. Date & Time when the Order was written.
3. Name of the Drug to be administered.
7. Environment 4. Dosage of the Drug
 Sensory deprivation and overload may affect drug 5. Route by which the Drug is to be administered.
responses. 6. Frequency of administration of the Drug.
 Nutritional state may also affect the body’s reaction to 7. Signature of the Person/Physician writing the Order.
certain drugs.
TRANSCRIPTION OF MEDICATION ORDERS
8. Timing of Administration  Kardex
 The presence of food in the stomach delays the  Medication Sheet or Medication Administration
absorption of orally administered medications. Record
 Medication Card
MEDICATION ORDERS Questioning Medication Order
 Any drug order suspected to be in error should be
 No medication may be given to a patient without a
questioned
medication order from a physician or, in some states, a
 Suspected error should be noted and reported
nurse practitioner
 On occasion, nurse may not think there is an error but may
 Orders are written on a form designed specifically for a
not understand why medication has been prescribed
physician’s order, which becomes a permanent part of the
 Ask how order relates to patient’s care plan
patient’s record
 May prevent medication error if wrong med has been
 Many facilities use a computer-generated pharmacy order
ordered
system and can receive a medication order by fax from the
 Confusion over placement of decimal point can be
physician
prevented by always having a zero precede the decimal for
 Physician enters drug order into computer, computer sends
clarity (no need for zero after decimal – can cause
order directly to pharmacy and enters order into patient’s
confusion if decimal is unclear or missed completely)
permanent record
 Drug to which patient is allergic may inadvertently be
 Prevent any guessing when handwriting is illegible or drug
prescribed
names are similar
 Notation should be made in patient’s record of past adverse
 Provides physicians with recommended doses of
reactions
medication, indicates laboratory tests that monitor action of
 Do not administer and question when, in nurse’s judgment,
drug, and lists potential interactions that may occur.
patient is allergic
 Patient may wear wristband indicating specific allergies
Foundations of Nursing Abejo
Medication

5. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 5
 Drug may be ordered that would potentially interact with
another med patient is taking
 All unfamiliar meds should be verified before
administering
 Guessing is a gross carelessness action – checking with
person that wrote the order is the only safe procedure
 Nurses have the right to refuse to administer any
medication that, based on their knowledge and experience,
may be harmful to patient
 Must notify physician of refusal
Caring for Controlled Substances Safely
 Controlled substances are kept in a locked drawer or
container as a safety measure
 Narcotics or controlled substances may be ordered
only by physician (sometimes, nurse practitioners
registered with Dept. of Justice)
 Record must be kept for each narcotic administered
 Forms are kept with narcotics
 Information required:
 receiving patient’s name
 hour narcotic was given
 name of physician prescribing narcotic
 name of nurse administering narcotic
 Narcotics are checked daily
 Amount on hand is counted and each dose used
must be accounted for on the narcotic record
 Nurse has a secure i.d. code that provides access
into the system, Identifies patient by name or i.d.
number, and verifies count for each drug as it is
removed
 Count that does not check properly must be
reported immediately
 If for any reason a narcotic prepared for
administration has to be discarded, a 2nd nurse should
act as witness, and that person should also sign the
narcotic sheet
 also document with a witness any time a full dosage is
not given and some of the narcotic needs to be
disposed of
PREPARATION AND ADMINISTRATION
OF DRUGS
Definition :
GENERAL INSTRUCTIONS:
Drug or medicine is a chemical agent which acts to maintain,
improve and restore physiologic processes of the body.  Be sure doctors order is complete & well understood before
carrying it out.
Purposes in general:  Know the client’s condition & all other factors related to the
proper use of the drug.
- To maintain and promote health
 Be alert for signs of allergy & idiosyncrasy manifested by the
- To restore physiologic processes client.
- To aid in diagnosis  Know the purpose & therapeutic effect of each drug ordered.
- To provide palliative effect  Be familiar with standard abbreviations & symbols
- To supply substances which is deficient. (Ex. Insulin) commonly used.
- To help prevent disease  Verbal orders are accepted in extreme emergencies.
 Observe the ―RIGHTS‖ in giving medications.
Assessment for all medications administration:  Always clarify doubtful /unclear order before executing it
 Verify if drug is to be delayed or omitted for specific period
- Client’s diagnosis
of time
- Client’s medication  Do not leave medicine with the client to take by himself
- Client’s allergies to medication  Do not give drug that shows physical changes or
- Specific drug action deterioration
- S/S of side effects or adverse reaction  Report an error in medication immediately to the nurse in
- Client’s age & developmental stage charge.
- Problems in self-administering a medication (e.g. poor  The nurse who prepares the medication must be responsible
eyesight, unsteady hands) for administering and recording it. Never endorse it to
another nurse.
- Client’s ability to cooperate during administration
 Always observe asepsis in preparing and administering
- Client’s knowledge of & learning needs about medication drugs.
 Always use the corresponding medication card for each drug
prepared and administered.
Foundations of Nursing Abejo
Medication

6. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 6
ROUTES FOR ADMINISTERING DRUGS serious clients are scheduled medications.
last)
A. ORAL ROUTE – having the Patient Swallow the 3. Wash your hands Handwashing
medication removes
microorganisms that
Advantages Disadvantages can cause infection.
 Most convenient  Inappropriate for client 4. Gather necessary equipment. Make
 Usually less expensive with N & V sure medicine glasses are clean and
 Safe, does not break skin  Drugs may have dry.
barrier unpleasant taste and odor 5. Check medication 3 times before
 Administration usually  Inappropriate when GIT taking to the client:
does not cause stress has reduced motility. o When taking the medication
 Inappropriate if client from the storage area Rechecking can lead
cannot swallow. o Before placing medication to accuracy in
 Cannot used before into the medicine rack/glass medication
certain diagnostic test or o Before placing medicine to the
surgical procedure storage area
 May discolor teeth, harm 6. Place medication in each separate Mixing liquid
tooth enamel. container with the corresponding medicine can reduce
 May irritate gastric card behind each medicine glass. concentration and
mucosa. strength of the drug.
 Can possible aspirated. 7. Observe the 5 Rights in
administering medications:
Drug Forms for Oral Administration: o Right client
o Right drug
Solid: tablet, capsule, caplet, lozenges, pill, powder o Right dose
Liquid : syrup, suspension, emulsion, elixir, milk or o Right time
other alkaline substances. o Right route
8. Correctly calculate dose if
Enteric coated tablets should not be crush before necessary
administration. 9. Set the medicine glass at eye level
Other forms of oral medication that should not be chewed when pouring
or crushed: 10. Ascertain client’s identity before
SR – Sustained Release administering medications. Check
XL – Extended Release room or bed or card, call out
CR/CRT – Controlled Release client’s name, check I.D., wrist
SA – Sustained Action band
o LA – Long Acting 11. Give medications one at time. Give Liquid and cough
Do not administer enteric – coated with antacids, milk or liquid medications and cough syrup syrup does not need
another alkaline substance last water follow up
Suspension are never administered through IV
If patient vomits within 20 – 30 minutes of taking the drug, 12. Elevate client’s head to prevent The client might
notify the physician. Do not re-administer the drug aspiration. forget or might
without doctor’s orders. ignore taking the
medicines
Administration of Oral Medication 13. Remain with the client until all The client might
medications have been swallowed. forget or might
Definition: Never leave any medications at ignore taking the
Oral Medication is the administration of drugs by client’s side, for client to take as he medicines
mouth for systemic effect. It may be in the form of pills, tablets, pleases
capsules and liquid. 14. File medicine card on the card rack.
15. Wash hands Prevents spread of
Objectives infection
 To prepare & administer the most common, least 16. Record all medications given right
expensive route of administering medication safely after administration.
 To provide a sustained drug action and increased 17. Check client 30 min to 1 hour later
absorption without feelings of nausea and vomiting. for effects of medication.
Equipments:
 Medication tray with medication B. SUBLINGUAL ROUTE – drugs that is placed under the
 Medicine card tongue, where it dissolves.
 Mortar and pestle for crushing pill
 Water, juice or milk (if not contraindicated by drug C. BUCCAL ROUTE – a medication is held in the mouth
absorption) against the mucous membranes of the cheek until the drugs
dissolves
PROCEDURE RATIONALE
1. Check medicine cards with Advantages Disadvantages
physician’s order sheet or client’s Counter checking Sublingual / Buccal Sublingual / Buccal
chart for written orders or any prevents error in  Most convenient  Inappropriate for client
changes in the order. medication  Usually less expensive with N & V
2. Arrange the medicine cards in the  Safe, does not break skin  Drugs may have
medication tray according to the barrier unpleasant taste and odor
following: Systemic way will  Administration usually  If swallowed, drug may
o Location of the client facilitate lesser error does not cause stress be inactivated by gastric
o Time of administration and minimize time  Can be administered for juice.
o Condition of client (more involved in local effect  Drug must remain under
Foundations of Nursing Abejo
Medication

7. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 7
 Drugs is rapidly absorbed the tongue until dissolved taking to the client:
into the bloodstream. and absorbed. o When taking the medication
 Ensures greater potency from the storage area Rechecking can lead
because drug directly o Before placing medication to accuracy in
enters the blood and into the medicine rack/glass medication
bypass the liver o Before placing medicine to the
storage area
6. Place medication in each separate
container with the corresponding
card behind each medicine glass.
7. Observe the 5 Rights in
administering medications:
o Right client
o Right drug
o Right dose
o Right time
o Right route
8. Correctly calculate dose if
necessary
9. Place client in supine position or sit Provide easy access
back in chair with head slightly to eye and
hyperextended minimizes drainage
of medication
through the tear
duct.
10. Clean the eyelid /lashes if
D. TOPICAL ROUTE – Inserting or rubbing drug onto the necessary using a cotton soak in
Skin or Mucous Membrane. sterile saline. Wiping from inner to
outer canthus, one cotton for each
a) Dermatologic ( includes lotions, liniments, eyes.
ointments, pastes and powders )
 Wash and pat dry area well before application to Eye Drops
facilitate absorption of drugs.
 Use surgical asepsis when open wound is present. 11. Squeeze prescribed dose in the Ensure correct
 If the skin has lesions, wear gloves or use tongue eyedropper dosage
depressor to apply medications. 12. Place a tissue below the lower lid Cotton or tissue
 Apply only a thin layer of medication absorbs medication
that escapes eye
b) Ophthalmic / Eye Medication 13. Hold eyedropper one-half to three- Helps prevent
fourth inch above eyeball with accidental contact of
Administration of Eye Medication dominant hand dropper with eye,
thus reducing risk of
Objectives injury and transfer
 To provide an eye medication the client requires to of infection.
treat an infection or other reason.
14. Gently press downward with thumb Prevents pressure
or forefinger against bony orbit. and trauma to
Considerations
Exposes lower conjunctival sac by eyeball and prevents
 The eye is the most sensitive organ to which the nurse
pulling down on cheek. fingers from
applies medications. Care must be taken to prevent
touching eye.
instilling medication directly into cornea.
 Instilling wrong concentration may cause local
15. While client looks up, drop Prevent damage
irritation of the eyes as well as systemic effects
prescribed dose into center of the directly to the
conjunctival sac. cornea. Reduces
Equipment
stimulation of blink
 Medication bottle with eye dropper or ointment tube
reflex
 Cotton ball or tissue
 Eye patch or tape (optional) 16. While client closes and move eyes, Prevents overflow of
place finger on either side of the medication into
nasolacrimal duct for 1 minute. nasal passage and
PROCEDURE RATIONALE
possible systemic
1. Check medicine cards with
effect.
physician’s order sheet or client’s Counter checking
chart for written orders or any prevents error in
changes in the order. medication
2. Arrange the medicine cards in the
medication tray according to the
following: Systemic way will
a. Location of the client facilitate lesser error
b. Time of administration and minimize time
c. Condition of client (more involved in
serious clients are scheduled medications.
last)
3. Wash your hands Handwashing
removes
microorganisms that
can cause infection.
4. Gather necessary equipment.
5. Check medication 3 times before
Foundations of Nursing Abejo
Medication

8. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 8
PROCEDURE RATIONALE
Eye Ointment 1. Check medicine cards with
physician’s order sheet or client’s Counter checking
17. Separate client’s eyelids and grasp chart for written orders or any prevents error in
lower lid, exert downward pressure changes in the order. medication
over the cheek. 2. Arrange the medicine cards in the
18. Instruct patient to look up medication tray according to the
19. Apply ointment along insidebedge Distributes following: Systemic way will
of the lower eyelid from inner to medication without a. Location of the client facilitate lesser error
outer canthus. traumatizing eye b. Time of administration and minimize time
20. Wipe excess medication Promtes comfort and c. Condition of client (more involved in
facilitate cleanliness serious clients are scheduled medications.
last)
3. Wash your hands Handwashing
removes
microorganisms that
can cause infection.
4. Gather necessary equipment.
5. Check medication 3 times before
taking to the client:
o When taking the medication
from the storage area Rechecking can lead
o Before placing medication to accuracy in
into the medicine rack/glass medication
o Before placing medicine to the
21. Place client in comfortable position storage area
22. Wash hands 6. Observe the 5 Rights in
23. Assess for possible drug reaction administering medications:
24. Documentation o Right client
o Right drug
o Right dose
Eye Irrigation o Right time
o Right route
 Have patient sit or lie with head tilted toward side of 7. Warm medication by running warm Prevents nausea and
affected eye water over the bottle. vertigo that may
 Clean from inner toward outer canthus to prevent debris occur if the
entering lacrimal ducts medication is too
 Expose lower conjunctival sac, hold irrigator about 2.5 cm cold
(1‖) from eye, direct flow from inner to outer canthus 8. Correctly calculate dose if
 Irrigate until solution is clear or all of the solution has been necessary
used 9. Place the client in side- lying Provide easy access
 Use only enough force to remove secretions gently position with the affected ear to ear for instillation
 Avoid touching any part of eye facing up. The nurse should of medicine.
 Dry area with cotton balls or gauze sponge stabilize the client’s head with his Stabilizing the head
 Chart irrigation, appearance of eye, drainage, and patient’s or her hand. promotes safety.
response 10. Fill medication dropper with
prescribed amount of medication.
11. Prepare client for instillation as Straightening of ear
follows: canal provides direct
c) Otic ( Ear ) Medication Infants: draw the auricle gently access to deeper
 Includes instillations and irrigations downward and backward. external ear
 Instillations: Adults / Children : lift pinna upward structures.
To soften earwax and backward
To reduce inflammation 12. Instill the medicine into the ear Forceful instillation
To treat infection canal holding the dropper 1 cm of medicine into
To relive pain above ear canal occluded canal can
 Irrigations: cause injury to
To remove cerumen or pus eardrum.
To apply heat 13. Ask the client to maintain the Allows complete
To remove a foreign body or object position for 2-5 minutes. Apply distribution of
gentle massage or pressure to medication. Pressure
Administration of Ear Medication tragus of ear with finger. and massage moves
medication inward.
Objectives 14. Place client in comfortable position
 To soften earwax so that it can be readily removed at 15. Wash hands
a later time 16. Assess for possible drug reaction
 To provide local therapy to reduce inflammation, 17. Documentation
destroy infective organism.
 To relieve pain
Equipment
 Medication bottle with dropper
 Cotton tipped applicator
 Cotton ball
Foundations of Nursing Abejo
Medication

9. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 9
A. Nasal Sprays
Gently insert the bottle tip into one
nostril as shown in drawing A.
Keep head upright. Sniff deeply while
squeezing the bottle. Repeat with other
nostril.
Tilt your head (or have the patient tilt his or her head) to
B. Pump Nasal Sprays
the side as shown in drawing A. Or lie down with the
affected ear up as shown in drawing B.
Prime the pump before using the first
time. Hold the bottle with the nozzle
Guidelines for Removing Excessive/ Impacted Cerumen between the first two fingers and thumb
on the bottom of the bottle.
 Place 5 to 10 drops of the cerumen-softening solution into
the ear canal, and allow it to remain for at least 15 minutes.
Tilt the head forward.
 Prepare a warm (not hot) solution of plain water or other
solution as directed by your doctor. Eight ounces of
Gently insert the nozzle tip into one
solution should be sufficient to clean out the ear canal.
nostril as shown in drawing B. Sniff
 To catch the returning solution, hold a container under the
deeply while depressing the pump once.
ear being cleaned. An emesis basin is ideal because it fits
the contour of the neck.
Repeat with other nostril.
 Tilt the head down slightly on the side where the ear is
being cleaned.
C. Nasal Inhalers
 Gently pull the earlobe down and back to expose the ear
canal as shown in drawing A.
Warm the inhaler in hand just before use.
 Place the open end of the syringe into the ear canal with the
tip pointed slightly upward toward the side of the ear canal,
Gently insert the inhaler tip into one
as shown in the drawing. Do not aim the syringe into the
nostril as shown in drawing C. Sniff
back of the ear canal. Make sure the syringe does not
deeply while inhaling.
obstruct the outflow of solution.
 Squeeze the bulb gently—not forcefully—to introduce the
Repeat with other nostril.
solution into the ear canal and to avoid rupturing the
eardrum.
Wipe the inhaler after each use. Make
(Note: Only health professionals trained in aural
sure the cap is tightly in place between
hygiene should use forced water sprays [e.g., Water Pik]
uses. Discard after 2-3 months even if the
to remove cerumen.)
inhaler still smells medicinal.
 Do not let the returning solution come into contact with the
eyes.
 If pain or dizziness occurs, remove the syringe and do not
If broncholilator, administer a max. of 2 puffs for at least 30
resume irrigation until a doctor is consulted.
second interval.
 Make sure all water is drained from the ear to avoid
predisposing to infection from water-clogged ears.
D. Nasal Drops
 Rinse the syringe thoroughly before and after each use,
and let it dry.
Squeeze the bulb to
 Store the syringe in a cool, dry place (preferably, in its
withdraw medication
original container) away from hot surfaces and sharp
from the bottle.
instruments.
 Do this procedure twice daily for no longer than 4
Lie on bed with head
consecutive days.
tilted back over the
side of the bed as
shown in drawing D.
Place the
recommended number of drops into one nostril. Gently tilt
head from side to side.
Repeat with other nostril. Lie on bed for a couple of minutes
after placing drops in the nose.
Do not rinse the dropper.
d) Nasal Medication
 Nasal instillation ( nose drops ) usually are
e) Vaginal Medication
instilled for their astringent effect .
Drug Forms: tablet, cream , jelly, foam, suppository
Administration of Nasal Medication
Vaginal Irrigation ( Douche ) : is the washing of vagina by a
Objectives liquid.
 To shrink swollen mucous membrane
 To loosen secretions and facilitate drainage.
 Empty the bladder before the procedure
 To treat infections of the nasal cavity or sinuses.
 Position and drape the client.
 Instillation : back lying position with knees flexed
and hips rotated laterally.
 Irrigation : back lying position with the hips higher
Equipment than the shoulder ( use bedpan )
 Medication bottle with dropper or spray container
 Facial tissue
Foundations of Nursing Abejo
Medication

10. Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 10
Guidelines for Applying Vaginal Antifungal Products Administration of Rectal Suppository
 Start treatment at night before going to bed. Lying down  Gently squeeze the suppository to determine if it is firm
will reduce leakage of the product from the vagina. enough to insert. Chill a soft suppository by placing it in
 Wash the entire vaginal area with mild soap and water, and the refrigerator for a few minutes or by running it under
dry completely before applying the product. cool running water.
 Vaginal cream: (If prefilled applicators are being used, skip  Remove the suppository from its wrapping.
to step 4.) Unscrew the cap; place the cap upside down on  Dip the suppository for a few seconds in lukewarm water to
the end of the tube. Push down firmly until the seal is soften the exterior.
broken. Attach the applicator to the tube by turning the  Lie on your left side with knees bent or in the knee-to-chest
applicator clockwise. Squeeze the tube from the bottom to position (see drawings A and B). Position A is best for self-
force the cream into the applicator. Squeeze until the inside administration of a suppository. Small children can be held
piece of the applicator is pushed out as far as possible and in a crawling position.
the applicator is completely filled with cream.
 Remove the applicator from the tube.
 Vaginal tablets/suppositories: Remove the wrapper and
place the product into the end of the applicator barrel.
 While standing with your feet slightly apart and your knees
bent, as shown in drawing A, or while lying on your back
with your knees bent, as shown in drawing B, gently
insertthe applicator into the vagina as far as it will go
comfortably.
 Relax the buttock just before inserting the suppository to
ease insertion. Gently insert the tapered end of the
suppository high into the rectum. If the suppository slips
out, it was not inserted past the anal sphincter (the muscle
that keeps the rectum closed). 4‖ – adults, 2‖ – children and
infants)
 Continue to lie down for a few minutes and hold the
buttocks together to allow the suppository to dissolve in the
rectum. The parent/caregiver may have to gently hold a
 Push the inside piece of the applicator in and place the
child’s buttocks closed.
cream as far back in the vagina as possible. To deposit
 Remember that the medication is most effective when the
vaginal tablets/suppositories, insert the applicator into the
bowel is empty. Try to avoid a bowel movement after
vagina and press the plunger until it stops.
insertion of the suppository for 30 minutes up to 1 hour so
 Remove the applicator from the vagina.
that the intended action can occur.
 After use, recap the tube (if using cream). Then clean the
applicator by pulling the two pieces apart and washing
them with soap and warm water.
E. ENTERAL TUBE ROUTE – administration of medicine
 If desired, wear a sanitary pad to absorb leakage of the
via nasogastric tube.
vaginal antifungal. Do not use a tampon to absorb leakage.
 Continue using the product for the length of time specified
in the product instructions. Use the product every day
ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING
without skipping any days, even during menstrual flow.
TUBE
 Use liquid meds or meds that can be crushed and combined
f) Rectal Medication
with liquid
 Drugs administered rectally exert either a local or
 Bring liquid med to room temp
systemic effect on the gastrointestinal mucosa.
 Remove clamp from tube, checking for tube placement
before administering drug
Considerations
 Flush tube with 15 – 30 mL water (5 – 10 mL for children)
 Rectal medication is a convenient and safe method of
before giving meds and immediately after
giving certain medications but not as reliable as oral or
 Give meds separately and flush with water between each
parenteral routes in terms of drug absorption and
drug
distribution.
 Disconnected from suction and clamped 20 – 30 minutes
 Improper placement can result in expulsion of the
after administration
suppository before medication dissolves and is
 Disconnect continuous tube feeding, leaving tube clamped
absorbed into the mucosa.
for short period of time
 Never force a suppository into a mass of fecal
 Document water intake and liquid med on I & O chart
material. It may be necessary to administer a small
cleansing enema before a suppository can be inserted.
 Do not cut the suppository into sections to divide the
dosage, the active drug may not be distribute evenly
within the suppository.
Foundations of Nursing Abejo
Medication