Midication -Adiministration ppt.pptxvvhg

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Medication Administration
12/15/2023
Teddy T.

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General concepts of pharmacology
 Pharmacology: - is the study of the
effects of drugs on living organisms
 The terms drug and medication are often
used interchangeably by HCWs.
 Drug: - is any substance that alters
physiologic function, with the potential
affecting health.
 Medication: - a drug administered for its
therapeutic function.
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General concepts of pharmacology…
 A medication is a substance administered for the
diagnosis, cure, treatment, or relief of a symptom
or for prevention of disease.
 The written direction for the preparation
and administration of a drug is called a
prescription.
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General concepts of pharmacology…
 Pharmacodynamics – refers to the physiologic and biochemical
effects of the drug on the body.
 For a drug to achieve a therapeutic effect, it must proceed from
the point of entry into the body to the tissue with which it will
react.
 Pharmacokinetics refers to the study of the absorption,
distribution, metabolism, and excretion of drugs.
 So drug actions are depend on four properties: absorption,
distribution, metabolism & excretion
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Purpose of medication
Drugs can be administered for these purposes:
• Diagnostic purpose: to identify any disease
• Prophylaxis: to prevent the occurrence
of disease. Eg :- heparin to prevent thrombosis or
antibiotics to prevent infection.
• Therapeutic purpose : to cure the disease.
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Uses of Drugs
 Prevention- used as prophylaxis to prevent diseases
e.g. vaccines; fluoride-prevents tooth decay.
 Diagnosis- establishing the patient’s disease or
problem e.g. radio contrast dye; tuberculosis
(Mantoux) testing.
 Suppression- suppresses the signs and symptoms and
prevents the disease process from progressing e.g.
anticancer, antiviral drugs
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Uses of Drugs
 Treatment- alleviate the symptoms for patients
with chronic disease e.g. Antiasthmatic drugs.
 Cure- complete eradication of diseases e.g. anti
biotics, anti- helmintics.
 Enhancement aspects of health- achieve the best
state of health e.g. vitamins, minerals
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Legal Aspects of Medication
 Preparation, dispensing and administration of medications
are all covered by laws in every country.
 Dangerous Drug Act – 1930 and The Narcotic Drugs and
Psychotropic Substances Act - 1985.
It is an act that governs the procurement and use of some
drugs especially the narcotics e.g. morphine, pethedine,
cocaine etc. These drugs are prescription only drugs hence
cannot be bought or administered without prescription.
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Legal Aspects of Medication …
 Dangerous drugs are always kept under lock
and key in the Dangerous Drug Cupboard
under the care of trusted senior nurses.
 It is worth knowing that nurses are
responsible for their own actions regardless
of the presence of a written order.
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Legal Aspects of Medication …
 If a nurse gives an overdose of a drug because it is
written by a doctor, the error is accounted to the nurse
and not the doctor.
 The nurse should bear in mind that ALL substances are
poisons: there is none that is not a poison. The right
dose differentiates a poison from a remedy.
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Drug Nomenclature
 It can be identified by their chemical,
generic & official or trade names.
The chemical name is a precise description
of the drug’s composition (chemical
formula)
 Name by which a chemist knows the drug
The generic name
 Is the name assigned by manufacturer who
first develops the drug
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Drug Nomenclature…
trade/brand name
 When pharmaceutical companies market
the drug, they assign a proprietary name
called a trade/brand name
 Therefore, one generic drug may have
several trade names based on the number
of companies marketing the drug.
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Classification of Medication
Medications may be classified according to:
 The body system that the medicine is targeted to interacts
wit; e.g. cardiovascular medications, nervous system
medication etc.
 Therapeutic usages of the medicine; e.g. anti
hypertensives ,neuroleptics,
 The diseases the medicine is used for; e. g. anticancer
drugs, antimalaria drugs antihelminthics etc.
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Classification of Medication…
 The action of the medication can also be used to
classify the it; e.g. beta-adrenergic blocking
agents
 The overall effect of the medication on the body
can also be a criteria for its classification; e.g.
sedatives, antianxiety drugs etc
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Storage of Medications
 Medications are dispensed by the pharmacy
to nursing units. Once delivered, proper
storage becomes the responsibility of the
nurse. All medications must be stored in a cool
dry place (usually in cabinets, medicine carts
or fridges)
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Storage of Medications…
In less advanced countries, 3 cupboards are usually used for
drug storage.
 Cupboard I-used for drugs for external use only; e.g.
calamine lotion, detol, methylated spirit etc. These drugs
are contained in distinctive bottles, usually ridged with deep
colours (dark green, blue, brown) with red label marked
POISON and FOR EXTERNAL USE ONLY.
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 Cupboard II-contains drugs for internal use only e.g.
tablets, suspension, mixtures etc. All drugs must be
labelled.
 Cupboard III-contains the dangerous drug; drugs of
addiction. E.g. Morphine, pethedine etc. All drugs
should be kept away from direct sunlight and at a
temperature suggested by the manufacturer.
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 Another cupboard called the Emergency
Cupboard may be stationed at or near the nurses
bay for easy access. This cupboard contains drugs
for emergency situations e.g. aminophylline (for
asthma), hydralazine (for severe hypertension),
oxytocin (for maternal bleeding), intravenous
infusions (for rehydration) etc.
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DRUG ACTION
 Refers to a drug’s ability to combine with a cellular drug
receptor.
 Depending on the location of different cellular receptors
affected by a given drug, a drug can have a local effect,
systemic effect, or both local and systemic effects.
 Drug action is based on the half-life of a drug.
 Why repeated doses of drug is administered?
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DRUG ACTION…
 A drug’s half-life refers to the time it takes the
body to eliminate half of the blood
concentration level of the original drug dose.
 For example, if a drug has a half-life of 6 hours,
50% of the drug’s original dose is present in the
blood 6 hours after administration.
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Principles of medication administration
 Principles include 3 checks and 10 Rights:
 3 checks are
1. Check when obtaining the container of medicine.
2. Check when removing the medicine from the
container.
3. Check when replacing the container.
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Rights of Medication Administration
 Medication errors can be detrimental to patients.
To prevent these errors, these guidelines are –
the rights- are used in drug administration.
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1. Right Patient:
 correct identification of the client cannot be over
emphasized.
 This can be done by asking the client to mention
his/her full name which should be compared with
that on the identification bracelet or the patient’s
folder and medication/treatment chart for
confirmation.
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2. Right Medication:
 Beware of same and similar first and surnames to
prevent the error of administering one person’s
medication to another and vice versa.
 Right Medication: before administering any
medicine, compare name on medication
chart/medication order with that on the
medication at least 3 times-checking medication
label when removing it from storage unit,
compare medication label with that on treatment
chart and medication label and name on
treatment chart with patient’s name tag.
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3. Right Time
 Right Time: drug timing is very especially with some
drugs like antibiotics, antimalaria drugs etc. to
achieve cure and prevents resistance. Some drugs
must be given on empty stomach e.g. antituberculosis
drugs; and some after meals e.g. NSAIDS-these must
be noted and adhered to.
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3. Right Time…
 The interval of administration of drugs
should also be adhered to because it is
important for many drugs that the blood
concentration is not allowed to fall below a
given level and for others two successive
doses closer than prescribed might increase
blood concentration to a dangerous level
that can harm the patient.
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4. Right Dose
 This becomes very important when medications at
hand are in a larger volume or strength than the
prescribed order given or when the unit of
measurement in the order is different from that
supplied from the pharmacy.
 Careful and correct calculation is important to prevent
over or under dosage of the medication.
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5. Right Route
 An acceptable medication order must specify the
route of medication. If this is unclear, the
prescriber should be contacted to clarify or
specify it.
 The nurse should never decide on a route
without consulting the prescriber.
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6. Right to information on drug/client
education
 The patient has the right to know the drug
he/she is taking, desired and adverse effects and
all there is to know about the medication.
 The charter on patient’s right made this clear.
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7. Right to Refuse Medication
 The patient has the right to refuse any
medication. However, the nurse is obliged to
explain to patients why the drug is prescribed
and the consequences refusing medication.
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8. Right Assessment
 Some medications require specific assessment
before their administration e.g. checking of
vital signs. Before a medication like Digoxin is
administered the pulse must be checked.
Some medication orders may contain specific
assessments to be done prior to medication.
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9. Right Documentation
 Documentation should be done after
medication and not before.
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10. Right Evaluation
 Conduct assessment to ascertain drug
action, both desired an side effect.
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Medication order
 The drug order, written by the physician, should
has 7 essential parts for administration of drugs
safely.
1. Patients full name.
2. Date and time.
3. Drug name.
4. Dosage.
5. Route of administration.
6. Time and frequency of administration.
7. Signature of physician.
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Types of Medication Orders
 Four types of medication orders are commonly used:
1. Stat order: A stat order indicates that the medication
is to be given immediately and only once. e.g: morphine
sulfate 10 milligrams IV stat.
2. Single order: The single order or one-time order
indicates that the medication is to be given once at a
specified time. e.g: Seconal 100 milligrams at bedtime.
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Types of Medication Orders…
3. Standing order: Standing order is written in advance
carried out under specific circumstances. (e.g: amox twice
daily × 2 days)
4. PRN order: “PRN” is a Latin term that stands for “pro re
nata,” which means “as the thing is needed.” A PRN order
or as-needed order, permits the nurse to give a medication
when the client requires it. (e.g., Amphojel 15 mL prn)
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Terminologies and abbreviations
used in prescriptions of medications
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Abbreviations Meaning
STAT order • refers to any medication that is needed immediately and
is to be given only once
• often associated with emergency medications that are
needed for life-threatening situations
• comes from the Latin word "statim" meaning
immediately
• should be administered within 5 minutes or less of
receiving the written order
ASAP order • not as urgent as STAT
• as soon as possible
• should be available for administration to the patient
with 30 minutes of the written order
Single order • for a drug that is to be given only once, and at a specific
time, such as a preoperative order
PRN order • latin "pro re nata"
• administered as required by the patient's condition
• the nurse makes the judgment, based on patient
assessment, as to when such a medication is to be
administered
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Abbreviations Meaning
Routine orders • orders not written as STAT, ASAP, NOW or PRN
• these are usually carried out within 2 hours of the time
the order is written by the physician
Standing order • written in advance of a situation that is to be carried
out under specific circumstances. example: set of
postoperative PRN prescriptions that are written for all
patients who have undergone a specific surgical
procedure "Tylenol elixir 325mg PO every 6 hours PRN
sore throat“
• standing orders are no longer permitted in some
facilities because of the legal implications of putting all
patients into a single treatment category
ac • before meals
AM • morning
bid • twice per day
Cap • capsule
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Drug forms
 Medications are available in variety of
forms. The form of the medication
determines its route of administration.
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Drug forms…
 Drug forms can be of three types;
– Solid eg: tablet, capsule
– Liquid eg: syrup, eye drops
– Semi solid eg: ointment, lotion
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Drug forms…
 Tablet: It is the powdered medication
compressed into hard disk or cylinder.
 Capsule: Medication covered in gelatin
shell.
 Gel or jelly: A clear or translucent semisolid
that liquefies when applied to the skin.
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Drug forms…
 Lozenge: A flat, round, or oval
preparation that dissolves and
releases a drug when held in the
mouth.
 Lotion: Drug particles in a solution
for topical use.
 Ointment: Semisolid preparation
containing a drug to be applied
externally
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Drug forms…
 Powder: Single or mixture of
finely ground drugs.
 Solution: A drug dissolved in
another substance.
 Suspension: Finely divided,
undissolved particles in a
liquid medium; should be
shaken before use.
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Drug forms…
 Syrup: Medication
combined in a water and
sugar solution.
 Suppository: An easily
melted medication
preparation in a firm base
such as gelatin that is
inserted into the body
(rectum, vagina, urethra)
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Drug forms…
 Transdermal patch: Unit dose of medication
applied directly to skin for diffusion through
skin and absorption into the bloodstream.
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Route of administration
Different route of drug administration are;
 Oral
 Parenteral
 Topical
 Inhalation
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Oral route
 Oral route: Medications are given by mouth.
 Sublingual Administration: Some medications
are readily absorbed when placed under the
tongue to dissolve.
 Buccal Administration: Administration of a
medication by placing in the mouth against
the mucous membranes of the cheek untilit
dissolves.
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Parenteral Routes
 Parenteral Routes: Parenteral administration
involves injecting a medication into body tissues.
The following are the four major sites of injection:
1. Intradermal (ID): Injection into the dermis just
under the epidermis.
2. Subcutaneous (SC): Injection into tissues just
below the dermis of the skin.
3. Intramuscular (IM): Injection into a muscle.
4. Intravenous (IV): Injection into a vein.
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Parenteral Routes
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Topical Routes
 Topical: Medications applied to the skin
and mucous membranes (eye, ears, nose,
mouth, vagina, urethra, rectum).
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Inhalation Route
 Inhalation Route: Administer inhaled medications
through the nasal and oral passages or
endotracheal or tracheostomy tubes.
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Broad Classification of drugs
A drug may be classified by the chemical type of the
active ingredient or by the way it is used to treat a
particular condition. Eg:
 Analgesics: to reduce pain
 Antipyretics: to reduce fever
 Antibiotics: to treat bacterial infection
 Anti viral: to treat viral infection
 Antihypertensive : to treat hypertension
 Antidiabetic: to treat diabetes
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Types of Medication Action
 Therapeutic Effects
 Side Effects/Adverse Effects
 Toxic Effects
 Allergic Reactions
 Idiosyncratic Reactions
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Types of Medication Action
 Therapeutic Effects: The therapeutic effect is the
expected or predicted physiological response that a
medication causes. E.g: paracetamol reduces pain,
fever and inflammation
 Side Effects/Adverse Effects: Every medication cause
some harm to patient.
– Side effects are predictable and often unavoidable
secondary effects produced at a usual therapeutic
dose. – E.g: nausea, loss of appetite, stomach pain
– Adverse effects are undesirable and unpredictable
severe responses to medication.
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Types of Medication Action…
 Toxic Effects: Toxic effects develop after
prolonged intake of a medication or when a
medication accumulates in the blood because
of impaired metabolism or excretion. E.g: liver
damage or kidney damage
 Allergic Reactions: unpredictable
immunological responses to a medication. Eg:
paracetamol produces rashor swelling as
allergic reaction.
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Types of Medication Action…
 Idiosyncratic Reactions: a patient overreacts
or underreacts to a medication or has a
reaction different from normal. For example,
a child who receives Benadryl becomes
extremely agitated or excited instead of
drowsy.
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Systems of drug measurement
Different systems available are;
 Metric system
 Household system
 Apothecary system
 Solutions
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Systems of drug measurement…
 Metric system : In this system, metric units
are used. Eg: milligram, gram, milliliter, liter
etc
 Household system: Household measures
include drops, teaspoons, tablespoons or
cups for measuring medications. Their
disadvantage is their inaccuracy. Household
utensils such as teaspoons and cups vary in
size.
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 Apothecary system : It is older system. The
basic unit of weight in the apothecary
system is the grain (gr) and the basic unit of
volume is the minim. The other units of
weight are the dram, the ounce, and the
pound. The units of volume are the fluid
dram, the fluid ounce, the pint, the quart,
and the gallon.
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 Solutions: A solution is a given mass of
solid substance dissolved in a known
volume of fluid or a given volume of liquid
dissolved in a known volume of another
fluid. For example, a 10% solution is 10 g of
solid dissolved in 100 mL of solution.
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Converting Measurements Units
 Conversion within one system
 Conversion between systems
 Dosage Calculation
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Conversion within one system
 To convert measurements within one system
simply divide or multiply. • Eg: To change
milligrams to grams ,divide by 1000, moving the
decimal 3 points to the left. 1000 mg = 1 g,350
mg = 0.35 g
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Conversion Between Systems
 To convert measurements from one system
to another system the nurse should be
familiar with the equivalent values of all the
systems.
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Dose Calculations
1. Calculating dose of solid medications First convert
the drug amount to the same units and then use the
formula.
 Stock strength is the amount written on the drug
cover.
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Dose Calculations…
2. Calculating dose of liquid medications First
convert the drug amount to the same units and
then use the formula
For example, cephalexin (anti-infective cephalosporin) 500
mg PO q.i.d. (dose desired) is ordered by the health care
practitioner; the dose on hand is 250 mg/5 ml. The
formula is as follows:
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3. Calculating drip rates First convert volume to
milliliters and then use this formula
 Drop factor is the drops per milliliter given to the
patient.
 Drop factor for macro set is 15 and micro set is 60
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 4. Calculating dose according to body weight Total
dose = prescribed dose x patient’s weight
 5. Calculating dose according to body surface area
Total dose = prescribed dose x patient’s body
surface area
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Pediatric dosage calculations
Dosage calculations in pediatrics are based on age body
surface area and body weigh
 Young’s rule
Child’s dose = Age of child x adult dose
Age of child + 12
 Clark’s rule
Child’s dose = weight of child x adult dose
150 pounds(Ib)
 Fried’s rule
Child’s dose = Age in months x adult dose
150
 Body surface area rule (BSA) rule
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FACTORS AFFECTING DRUG ACTION
 Body Size
 Pregnancy
 Lactation
 Age –Pediatric & Geriatric
 Genetic Factors
 Disease States –Kidney & Liver
 Routes of Drug Administration
 Environmental Factors
 Psychological Factors
 Tolerance & Resistance
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FACTORS AFFECTING MEDICATION ACTION
 Various factors affects the action of the medicine.
1. Developmental Factors
a. Pregnancy : Most drugs are contraindicated because
of their possible adverse effects on the fetus.
b. Infants usually require small dosages because of
their body size and the immaturity of their organs.
c. In adolescence or adulthood, allergic reactions may
occur.
d. Old age have different responses to medications due
to aging.
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2. Gender
 Different action can occur in men and
women due to the distribution of body
fat and fluid and hormonal differences.
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3. Cultural, Ethnic, and Genetic Factors
 Genetic differences in the production of
enzymes that affect drug metabolism.
Cultural factors and practices (e.g., values
and beliefs) can also affect a drug’s
action.
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4. Diet
 Nutrients can affect the action of a
medication. For example, vitamin K,
found in green leafy vegetables, can
counteract the effect of an anticoagulant
such as warfarin
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5.Environment
 Environmental temperature may also
affect drug activity. When environmental
temperature is high, the peripheral blood
vessels dilate, thus increase the action of
vasodilators.
 A client who takes a sedative or analgesic
in a busy, noisy environment may not
benefit as fully as if the environment
were quiet and peaceful.
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6. Psychological Factors
A client’s expectations about what a drug can do
can affect the response to the medication.
7. Illness and Disease
Drug action is altered in clients with circulatory,
liver, or kidney dysfunction.
8. Time of Administration
The time of administration of oral medications
affects the speed with which they act.
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Safety in Administering medications
 The safe and accurate administration of
medication is one of the major responsibility
of a nurse.
 Read the physician’s orders of the drug.
 If the order is not clear consult the physician.
 Consider the age and weight of the patient.
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Safety in Administering medications…
 The nurse must have thorough knowledge of
drugs that is administered by her .
 Look for the colour, odour and consistency
of the drug before administration.
 Follow 10 rights and 3 checks in drug
administration.
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 Calculate the drug dosage accurately.
 Identify the patient correctly.
 Observe for the symptoms of over dosage
of the drugs before it is administered.
 Give the drugs one by one
 Stay with the patient until he has taken the
medicine completely.
 Do not leave the medicine with the patient.
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 The nurse should always assess a client’s health
status and obtain a medication history prior to
giving any medication.
 The medication history includes information
about the drugs the client is taking currently or
has taken recently. And the history of drug
allergies.
 The nurse should clarify with the client any side
effects, adverse reactions, or allergic responses
due to medications.
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 The nurse has to identify any problems the
client may have in self-administering a
medication.
 For example, a client with poor eyesight, may
require special labels for the medication
container.
 The nurse needs to consider socioeconomic
factors for all clients.
 Medication errors must be reported according
to the policy of the hospital.
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Medication error
 Medication errors are unintended mistakes
in the prescribing, dispensing and
administration of a medicine that could
cause harm to a patient.
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Medication error…
 Medication errors can occur at all stages of the medication
administration process.
 The four main types of medication errors that occur with
hospitalized clients:
1. Prescription errors(eg. Wrong drug or dose)
2. Transcription/ interpretation error (eg. Misinterpretation
of abbreviations)
3. Preparation errors(eg. Calculation error
4. Administration errors (eg. Wrong dose, wrong time,
omission , or additional dose).
Most medication errors occur during the administration stage.
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Causes of medication error
 Human factors
◦ Heavy staff workload and fatigue
◦ Inexperience, lack of training, poor handwriting, and oral orders
◦ Workplace factors
◦ Poor lighting, noise, interruptions, excessive workload
 Pharmaceutical factors
◦ Excessive prescribing
◦ Confusing medicine nomenclature, packaging, or labeling
◦ Increased number or quantity of medicines per patient
◦ Frequency and complexity of calculations needed to prescribe,
dispense, or administer a medicine
◦ Lack of effective policies and procedures.
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Causes of medication error…
 Errors in medication administration often arise due to combination
of factors that are :
 Poor communication between pharmacists and nurses.
 Lack of knowledge in drug administration.
 Multiple interruptions the nurse have during preparing
medication.
 Stress an fatigue.
 Poor working conditions.
 Carelessness from nurse.
 Medication errors should not happen. But they occur due to the
fact that every human being is capable to doing mistake here and
those that happen where you work- can add to your knowledge
and skill.
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How mistakes are made?
Medication errors fall into these categories:
 Omission: the patient fails to receive unordered drug dose.
 Wrong dose: the patient receives a dose that’s at least 5%
more or less than the dose ordered.
 Extra dose: the patient receives more doses tan the doctor
ordered.
 Unordered drug: the patient receives a drug that wasn’t
ordered for him.
 Wrong route
 Wrong time: the patient receives a drug too early or too
late.
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Ways to Prevent Medication Errors
 Don’t administer any drug-including over the counter drug,
without a doctor’s order.
 Always check the label to identify a drug. Don’t rely on the
drugs color, shape, or location in the medication cassette.
 Check the label against the doctors order and the patient’s
medication administration record (MAR) three times: when
obtaining the drug, when preparing the dose, and when
returning the container to storage or discarding it.
 When you check the drug name, pay particular attention to
the spelling many drugs have similar names. If you have any
doubts about the drug you are giving, call the doctor or
pharmacist.
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Ways to Prevent Medication Errors…
 Check expiration dates, and return out dated drugs to the
pharmacy.
 Prepare drugs in a quiet , well-lit area where you will not be
distracted.
 Ask another nurse or a pharmacist to double check your
dosage calculations.
 Don’t give drugs another nurse has prepared.
 The nurse should have verified the dosage before giving the
drug-and she should to followed a basic administration rule,
“If you don’t know a drug and it’s dosage, don’t give it until
you find out (Martha, 1995)
 Don’t try to interpret illegible handwriting even in ask the
physician
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Ways to Prevent Medication Errors…
 Identify the patient by his ID band- don’t just ask his
name or check his bed number.
 Use appropriate documentation system Documentation
on the MAR (Medication Administration record helped
prevent errors.
 That’s because the nurse have the chance to check
previous therapy, read any notes that apply to a specific
patient, and see what occurred the last time the drug was
given.
 Store preparations meant for external use separately
from other medications, and make sure they are labeled
for external use only (Carr, 1996).
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Enteral Drug Administration
 The delivery of any medication that is
absorbed through the gastrointestinal tract.
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Oral Medication
 Oral medication can be by ingestion,
sublingual administration (place the pill or
direct spray between the underside of the
tongue and the floor of the oral cavity)or
buccal (place the medication between the
patient’s cheek and gum).
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Oral Medication…
 Advantages:
 Convenient - portable, no pain, easy to take.
 Cheap - no need to sterilize
 Variety - tablets, capsules, suspensions
 Disadvantage
 Sometimes inefficient
 Not suitable for unconscious patient
 May cause irritation to gastric mucosa, nausea
 First pass effect
 Effect too slow for emergencies
 Unpleasant test of some drugs etc.
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Oral Medication…
Purpose
• To provide local effects
• To prolong systemic action
• To prevent the disease
• To give palliative treatment
• To give symptomatic treatment
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Teddy 100
Oral Medication…
Contraindication
• Vomiting.
• Patient with gastric or intestinal suction.
• Patient who are unable to swallow.
• Patient on NPO.
• Unconscious patient
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Teddy 101
Oral Medication…
 A tray or trolley should be set with:
 Drug to be administered
 Water in a jug
 Glass on a saucer all in the tray
 Spoons
 Mortar and pestle (when necessary)
 Towel
 Straw
 Spatula
 Patient’s folder/treatment chart and pen
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Teddy 102
Oral Medication…
 Equipment
A trolley containing
1. A bowl of water for used
medication cup.
2. Towel
3. Measuring spoon.
4. A jag of water (bed side
water).
5. Mortar and pestle to
crush and powder the
tablet if necessary
6. Kidney dish and paper bag
to discard the waste
7. Chart and medication
card.
8. Ordered medication.
9. Straw if necessary.
10. Glass
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Oral Medication…
 Producer
1. Explain the procedure to the patient
2. Wash hands
3. Prepare your tray and take it to the patients room
4. Begin by checking the order.(Read the label 3 times)
5. If the patient is allowed to sit assist him to sit
6. Place solution and tablets in a separate container
7. If suspension, shake the bottle well before pouring.
8. Take it to the patient’s bed side.
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Oral Medication…
9. Keep the medication insight at all times.
10. Identify the patient carefully using all precautions
(patient’s name, bed number…).
11. First give little water to moisten the mouth and
then give the medicine one at a time.
12. Remain with the patient until each medicine is
swallowed.
13. Offer additional fluid as necessary unless contra-
indicated.
14. Remove the towel and wipe the face with it
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Oral Medication…
 15. Position the patient for good body alignment
16. Take all articles to the utility room. /wash dry all
articles and put
them in their proper place.
17. Wash hands
18. Recode the medication given, reaction
observed, refused or omitted immediately
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Buccal/Sublingual route
Some drugs are taken as smaller tablets which are held in the
mouth under the tongue (sublingual tablet).
Advantages
 Avoid hepatic first pass - The liver is by-passed thus there is
no loss of drug by first pass effect for buccal administration.
 Bioavailability is higher.
 Rapid absorption - Because of the good blood supply to the
area, absorption is usually quite rapid.
 Drug stability - pH in mouth relatively neutral ( stomach -
acidic). Thus a drug may be more stable.
Disadvantages
 Holding the dose in the mouth is inconvenient.
 Small doses only can be accommodated easily.
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Administering sublingual medication
 Definition: - Is a medication that is placed under
the tongue and allowed to dissolve completely
Purpose
• To provide local effects
• To prolong systemic action
• To prevent the disease
• To give palliative treatment
• To give symptomatic treatment
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Teddy 108
Administering sublingual medication…
 Indication
• Patient with gastric and intestinal problems
• Patients with gastric and intestinal surgery
 Contra indication
• Patients with nausea and vomiting
• Oral surgery
• Unconscious patient.
• Patients with gastric and intestinal
suctioning
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Precaution
 Tell the patient not to drink liquid and smoke for an hour because some tablets
take up to an hour to dissolve.
 Tell the patient to keep the medication in place until it dissolves completely to
insure absorption
 Tell the patient to avoid chewing the tablet or touching the tablet with the
tongue to prevent accidental swallowing.
 When the client is receiving repeated doses of a buccal medication, the nurse
should indicate the site, such as right buccal cavity, to prevent irritation of the
same site.
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Teddy 110
 Equipment's
A trolley containing
1. A bowl of water for used medication cup.
2. Towel
3. Kidney dish and paper bag to discard the waste
4. Chart and medication card.
5. Ordered medication.
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Procedure
1. Explain the procedure to the patient and assess the client’s
knowledge of the drug and its action
2. Wash hands
3. Prepare your tray and take it to the patients room
5. If the patient is allowed to sit assist him to sit
6. Take it to the patient’s bed side.
7. Keep the medication insight at all times.
8. Identify the patient carefully using all precautions (patient’s name,
bed number…).
9. Don non-sterile gloves.
10. To give a drug sublingually, ask the client to open the mouth and lift
the tongue; place the drug under the client’s tongue.
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Teddy 112
11. To give a drug buccally, instruct the client to open the mouth
wide, and place the tablet between the client’s cheek and teeth.
12. Remove the towel and wipe the face with it If necessary
13. Position the patient for good body alignment
14. Take all articles to the utility room. /wash dry all articles and put
them in their proper place.
15. Wash hands
16. Recode the medication given, reaction observed, refused or
omitted immediately
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Teddy 113
Topical Medication Applications
 Drugs are applied topically to the skin or
mucous membranes, mainly for local action.
– Skin Applications
– Nasal Instillation
– Eye Instillation
– Ear Instillation
– Rectal Instillation
– Vaginal instillation
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Teddy 114
Skin Applications
 Skin applicants are applied using gloves.
Before applying medications, clean the skin
thoroughly.
 When applying skin applicants, spread the
medication evenly over the involved surface
and cover the area well.
 Topical skin or dermatologic preparations
include ointments, pastes, creams, lotions,
powders, sprays, and patches.
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Teddy 115
Procedure for Applying Skin Preparations
 POWDER
Make sure the skin surface is dry. Spread
apart any skinfolds, and sprinkle the powder
until the area is covered with a fine thin layer
of powder. Cover the site with a dressing if
ordered.
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Teddy 116
Procedure for Applying Skin Preparations…
LOTION
 Shake the container before use. Put a little
lotion on a small gauze dressing or gauze
pad, and apply the lotion to the skin by
stroking it evenly in the direction of the hair
growth.
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Teddy 117
CREAMS, OINTMENTS, PASTES
 Take the medicine in gloved hands. Spread
it evenly over the skin using long strokes in
the direction of the hair growth. Apply a
sterile dressing if ordered by the physician.
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Teddy 118
AEROSOL SPRAY
 Shake the container well to mix the contents.
Hold the spray container at the recommended
distance from the area (usually about 15 to 30
cm. Cover the client’s face with a towel if the
upper chest or neck is to be sprayed. Spray the
medication over the specified area.
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Teddy 119
TRANSDERMAL PATCHES
 Select a clean, dry area that is free of hair. Remove
the patch from its protective covering, holding it
without touching the adhesive edges, and apply it by
pressing firmly with the palm of the hand for about
10 seconds.
 Advise the client to avoid using a heating pad over
the area to prevent an increase in circulation and the
rate of absorption.
 Remove the patch at the appropriate time, folding the
medicated side to the inside so it is covered.
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Teddy 120
Direct application of liquids Gargle
 Gargling is the act of bubbling a liquid in
mouth to reduce the sore throat. The head
is tilted back, allowing a mouthful of liquid
to sit in the upper throat.
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Teddy 121
Rectal route
Rectal suppository – a conical mass to be introduced in to the rectum usually
containing medication (easily melted at body temperature).
Advantages
 Used in children
 Little or no first pass effect
 Used in vomiting/ unconcious patient
 High concentration rapidly achieved
Disadvantages
 inconvenient.
 Irritation of rectal mucosa may occur
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Teddy 122
Administering rectal medications…
Purpose:
 To produce laxative effect (bowel movement).
 To produce local sedative in the treatment of
hemorrhoids or rectal abscess.
 To produce general sedative effects when
medications cannot be taken by mouth.
 To stop rectal bleeding and to relieve pain and
soothe tissue irritated by diarrhea.
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Teddy 123
Equipment –
1. Suppository (as ordered)
2. Water soluble lubricant/k-y jelly
3. Gauze square
4. Glove or finger cot
5. Toilet paper
6. Receiver for soiled swabs
7. Bed pan, if the Rx is in order to produce defection
8. Screen
9. Mackintosh and towel
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Teddy 124
Procedure
1. Explain the procedure to the patient and assess the client’s
knowledge of the drug and its action
2. Wash hands
3. Prepare the equipment's
5. Screen the patient and put on gloves
6. Assist the client to the sim’s position or the left lateral position
with the upper leg flexed
7. Fold back the bed linen to expose the rectum
8. Apply small amount of lubricant to the smooth rounded end of the
suppository to reduce mucosal irritation. Lubricate the gloved
index finger
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Teddy 125
9. Instruct the client to breathe through the mouth.
10. Insert the suppository in to the client’s anal canal at least 4 inches (10
cm) for an adult and 5cm (2 inches) for a child. This position ensures
placement of the suppository above the
client’s internal sphincter and maximizes medication absorption
(lubrication makes the insertion easier)
11. Ask the client to maintain the position for 15-20 minutes to resist urge
to defecate and
maintaining the position allows time for the medication to melt.
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Teddy 126
12. Press the folded tissue against anus for a few
minutes until the pt’s urge to expel the suppository
has passed.
13. Clean the anus with a toilet paper
14. Dispose of gloves and wash hands
15. Document the time, type, or given medication.
Indicate the strength or dosage of the drug
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Teddy 127
 Follow up phase
Check on the client 20-30 minutes and
document client’s response or result of the
Rx and the reaction of the pt to the Rx.
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Teddy 128
AdministeringVaginal Medications
 Definition: is an insertion of suppositories into the
vagina canal
 Purpose
• To treat or prevent infection
• To remove an offensive or irritating discharge
• To reduce inflammation
• To relieve vaginal discomfort
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Teddy 129
AdministeringVaginal
Medications…
 Equipment
1. Medication administration record (MAR)
2. Non-sterile gloves
3. Prescribed vaginal suppository
4. Water-soluble lubricant/k-y jelly
5. Disposable applicator
6. Tissue
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Teddy 130
AdministeringVaginal Medications…
 Procedures
1. Check with the client and the chart for known allergies or
medical conditions that would contraindicate the use of the
drug.
2. Gather necessary equipment.
3. Check the MAR against written health care practitioner
orders.
4. Wash your hands.
5. Follow the five rights of medication administration. Check
the client’s identification band.
6. Ask the client to void.
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Teddy 131
7. Position the client in a dorsal recumbent position with
knees flexed and hips rotated laterally or in a Sims’
position if the client cannot maintain the dorsal
recumbent position.
8. Don non-sterile gloves.
9. Explain procedure to patient. If client plans to self-
administer, be very specific with
instructions. Provide for privacy.
10. Assess perineal area, inspect vaginal orifice, note any
odor or discharge from the vagina, and inquire about any
problems such as itching or discomfort.
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Teddy 132
11. If secretion or discharge is present, cleanse the perineal area
with soap and water.
12. Remove suppository from the foil wrapper and, if applicable,
insert into applicator tip. Apply a small amount of lubricant to
rounded tip of suppository. If not using an
applicator, apply a small amount of lubricant to gloved index
finger.
13. With non-dominant hand, spread labial folds. Insert the
suppository into the vaginal canal at least 2 inches (5 cm) along
the posterior wall of the vagina or as far as it will go. If
using an applicator, insert as described above and depress
plunger to release suppository.
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Teddy 133
14. Wipe the perineum with clean, dry tissue
15. Instruct the client to remain in bed for 15
minutes.
16. Wash applicator under cool running water to
clean (warm water promotes coagulation of
protein secretions) and return to appropriate storage
in the client’s room.
17. Remove gloves, turning them inside out; dispose
of gloves in the proper receptacle. Wash
hands.
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Teddy 134
18. Record on the MAR the drug’s name dosage,
route, and date and time of administration;
document any evidence of discharge or odor from the
vagina.
19. Check with the client in 15 minutes to ensure that
the suppository did not slip out and to
allow the client to verbalize any problems or concerns.
20. Observe for effectiveness of the medication;
inspect the condition of the vaginal canal
and external genitalia between applications.
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Teddy 135
Instillation of drug
 Instillation is the administration of liquid
form of drug drop by drop.
 Different drug instillations are;
– Nasal Instillation
– Eye Instillation
– Ear Instillation
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Teddy 136
Nasal Instillation
 Administration of medicine drop by drop
into nose.
 Articles
– Tray
– Dropper
– Gloves
– Medicine
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Teddy 137
Nasal Instillation…
• Perform hand washing.
 Instruct the patient to clear or blow nose gently.
 Position the patient. Supine position with head
backward.
 Take the medicine in dropper.
 Administer the nasal drops.
 Have patient remain in supine position 5 minutes.
 Replace the articles and document the procedure.
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Teddy 138
Eye Instillation
 Administration of medicine drop by drop into eyes.
Articles
– Tray
– Bowl
– Cotton swabs
– Dropper
– Gloves
– Medicine
– Kidney tray
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Teddy 139
Eye Instillation…
 Perform hand washing.
 Position the patient. Ask patient to lie supine or sit
back in chair with head slightly hyperextended.
 Wipe the eyes with cotton balls from inner canthus
to outer canthus.
 Take the medicine.
 Expose the lower conjunctival sac by placing the
thumb or fingers of nondominant hand on the
client’s cheekbone just below the eye and gently
drawing down the skin on the cheek.
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Teddy 140
Eye Instillation…
 Administer the medication drops into
conjunctival sac.
 After instilling drops, ask patient to close
eye gently.
 Replace the articles and document the
procedure.
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Teddy 141
Ear Instillation
 Administration of medicine drop by drop
into ear.
Articles
 Tray
 Dropper
 Gloves
 Medicine
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Teddy 142
Ear Instillation…
 Perform hand washing.
 Place patient in side-lying position.
 Straighten ear canal by pulling auricle down and
back (children younger than 3 years) or upward and
outward (children 4 years of age and older and
adults).
 Instill prescribed drops holding dropper 1 cm above
ear canal
 Ask patient to remain in side-lying position 2 to 3
minutes.
 Replace the articles and document the procedure.
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Teddy 143
Irrigation
 Some medications are used to irrigate or
wash out a body cavity. Commonly used
irrigating solutions are sterile water, saline,
or antiseptic solutions on the eye, ear and
bladder.
 Irrigations cleanse an area.
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Teddy 144
Eye irrigation
 An eye irrigation is administered to wash
out the conjunctival sac to remove
secretions or foreign bodies or to remove
chemicals that may injure the eye.
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Teddy 145
Eye irrigation…
Articles
 Sterile irrigating solution warmed to 37⁰ C (98.6 F)
 Disposable gloves
 Cotton balls
 Sterile irrigating set (sterile container and irrigating
tube or irrigating syringe)
 Emesis basin or kidney tray
 Mackintosh
 Towel
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Teddy 146
Eye irrigation…
Procedure
 Explain procedure to the client.
 Arrange all articles.
 Wash hands.
 Have the client sit or lie with the head tilted toward the side of
the affected eye. Protect the client and the bed with mackintosh.
 Clean the lids and the lashes with a cotton ball moistened with
normal saline or the solution ordered for the irrigation. Wipe
from the inner canthus to the outer canthus. Discard the cotton
ball after each wipe.
 Place the emesis basin at the cheek on the side of the affected
eye to receive the irrigating solution.
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Teddy 147
Eye irrigation…
 Expose the lower conjunctival sac.
 Hold the irrigator about 2.5cm(1 inch) from the eye.
Direct the flow of the solution from the inner canthus
to the outer canthus along the conjunctival sac.
 Irrigate until the solution is clear or all of the solution
has been used.
 Dry the area after the irrigation with cotton balls or a
gauze sponge. Offer a towel to the client if the face and
neck are wet.
 Wash hands.
 Replace all articles and document the procedure.
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Teddy 148
Ear irrigation
 An ear irrigation is administered to wash
the external ear canal to remove secretions
or foreign bodies that may obstruct the ear.
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Teddy 149
Ear irrigation…
 Articles
• Sterile irrigating solution warmed to 37⁰ C (98.6 F)
• Disposable gloves
• Cotton balls
• Sterile irrigating set (sterile container and
irrigating tube or irrigating syringe)
• Emesis basin or kidney tray
• Mackintosh
• Towel
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Teddy 150
Ear irrigation…
 Procedure
• Explain procedure to the client.
• Arrange all articles.
• Wash hands.
• Protect the client and the bed with mackintosh.
• Explain that the client may experience a feeling of
fullness, warmth, and, occasionally, discomfort when the
fluid comes in contact with the tympanic membrane.
• Assist the client to a sitting or lying position with head
tilted toward the affected ear.
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Teddy 151
Ear irrigation…
 Place the emesis basin under the ear to be
irrigated.
 Fill the syringe with solution.
 Straighten the ear canal.
 Administer the fluid.
 Continue instilling the fluid until all the
solution is used or until the canal is
cleaned.
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Teddy 152
Ear irrigation…
 Assist the client to a side-lying position on
the affected side for the complete drainage
of the fluid.
 Dry the area after the irrigation with cotton
balls or towel.
 Wash hands.
 Replace all articles and document the
procedure.
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Teddy 153
Bladder irrigation
 Bladder irrigation is done to wash out the
bladder and sometimes to apply a
medication to the bladder lining.
 Two method;
– Open method
– Closed method
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Teddy 154
Closed bladder irrigation
 Wash hands.
 Apply clean gloves and cleanse the port with antiseptic
swabs.
 Connect the irrigation tubing to the input port of the three
way catheter.
 Irrigate the bladder by allowing the irrigating fluid into
bladder.
 Adjust the flow rate. The irrigated fluid back from the
bladder is collected in urinary bag.
 Wash hands.
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Teddy 155
Open bladder irrigation
 Wash hands.
 Apply clean gloves and cleanse the port with
antiseptic swabs.
 Disconnect catheter from drainage tubing and
place the catheter end in the sterile basin. Place
sterile protective cap over end of drainage tubing.
 Draw the prescribed amount of irrigating solution
into the syringe.
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Teddy 156
Open bladder irrigation…
 Insert the tip of the syringe into the catheter opening.
 Gently and slowly inject the solution into the catheter.
 Remove the syringe and allow the solution to drain back into
the basin.
 Continue to irrigate the client’s bladder until the total amount
to be instilled has been injected or when fluid returns are
clear.
 Remove the protective cap from the drainage tube and wipe
with antiseptic swab.
 Reconnect the catheter to drainage tubing.
 Remove and discard gloves.
 Perform hand hygiene.
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Teddy 157
Inhalation medications
 Nebulizers deliver most medications administered
through the inhaled route. A nebulizer is used to
deliver a fine spray of medication or moisture to a
client.
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Teddy 158
Inhalation medications…
 The metered-dose inhaler (MDI) is a pressurized
container of medication that can be used by the
client to release the medication through a
mouthpiece.
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Teddy 159
Parenteral Administration of Medications
 Parenteral administration of medications is
the administration of medications by injection
into body tissues.
 When medications are administered this way,
it is an invasive procedure that is performed
using aseptic techniques.
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Teddy 160
Equipment
To administer parenteral medications, nurses
use syringes and needles to withdraw
medication from ampules and vials.
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Teddy 161
Syringes
 Syringes have three parts:
1. The tip, which connects
with the needle
2. The barrel, or outside
part, on which the scales
are printed
3. The plunger, which fits
inside the barrel
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Teddy 162
Syringes…
 Several kinds of syringes are available in differing
sizes, shapes, and materials. Syringes range in sizes
from 1 to 60 ml.
 A nurse typically uses a syringe ranging from 1 to 3
mL in size for injections (e.g. subcutaneous or
intramuscular).
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Teddy 163
Syringes…
 Insulin syringes are available in sizes that
hold 0.3 to 1 mL and are calibrated in units.
 The tuberculin syringe has a capacity of 1
mL.
 5 ml syringe
 3 ml syringe
 Tuberculin syringe
 Insulin syringe
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Teddy 164
Needles
 Most needles are made of
stainless steel, and all are
disposable.
 A needle has three parts:
1. The hub, which fits onto
the tip of a syringe
2. The shaft, which connects
to the hub
3. The bevel, the tip of the
needle
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Teddy 165
Needle size
 19 gauge
 20 gauge
 21 gauge
 23 gauge
 25 gauge
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Teddy 166
Needle size…
 The gauge varies from 18 to 30.Use longer
needles for IM injections and a shorter needle for
subcutaneous injections.
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Teddy 167
Preventing needle stick injuries
 One of the most potentially hazardous
procedures that health care personnel face
is using and disposing of needles and
sharps.
 Needle stick injuries present a major risk for
infection with hepatitis B virus, human
immunodeficiency virus (HIV), and many
other pathogens.
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Teddy 168
Preventing needle stick injuries…
 Use appropriate puncture-proof disposal
containers to dispose of uncapped needles and
sharps.
 Never throw sharps in wastebaskets.
 Never recap used needles
 When recapping a needle, Use a one handed
“scoop” method.
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Teddy 169
Preventing needle stick injuries…
 This is performed by
a) placing the needle cap and syringe with needle
horizontally on a flat surface.
b) inserting the needle into the cap, using one hand.
c) then using your other hand to pick up the cap and
tighten it to the needle hub.
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Teddy 170
Cannula
 A cannula is a flexible tube that can be
inserted into the body. A venous cannula is
inserted into a vein, for the administration
of intravenous fluids, for obtaining blood
samples and for administering medicines.
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Teddy 171
Cannula…
Types of cannula are
 IV cannula pen-like model.
 IV cannula with wings model.
 IV cannula with injection part model.
 IV cannula y-type model.
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Teddy 173
Routes of parenteral therapies
 Intra-dermal
 Subcutaneous
 Intramuscular
 Intra Venous
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Teddy 174
Intradermal Injections
 An intradermal (ID) injection is the administration
of a drug into the dermal layer of the skin just
beneath the epidermis.
 Usually only a small amount of liquid is used, for
example 0.1ml.
 This method of administration is frequently used
for allergy testing and tuberculosis (TB) screening.
 Use a tuberculin or small hypodermic syringe for
skin testing.
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Teddy 175
Intradermal Injections…
 The angle of insertion for an intradermal
injection is 5 to 15 degrees
 After injecting the medication, a small bleb
resembling a mosquito bite appears on the
surface of the skin.
12/15/2023

Teddy 176
Subcutaneous Injections
The subcutaneous injection sites
include
 The outer posterior aspect of the
upper arms
 The abdomen
 The anterior aspects of the
thighs
 The scapular areas of the upper
back
 The upper ventral or dorsal
gluteal areas.
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Teddy 177
Subcutaneous Injections…
 Kinds of drugs commonly
administered:
1. Vaccines
2. preoperative medications
3. Narcotics
4. Insulin
5. Heparin
 Only small volumes (0.5 to 1.5 mL)
of medications are given
subcutaneously.
 The angle of insertion for a
subcutaneous injection is 45
degrees
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Teddy 178
Intramuscular Injections
 The angle of insertion for an IM injection is 90
degrees. 2 to 5 ml of medication can be
administered into a larger muscle for an adult.
 Sites for IM injections are
i. Ventrogluteal
ii. Dorsogluteal
iii. Vastus Lateralis
iv. Deltoid
v. Rectus Femoris
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Teddy 179
Ventrogluteal site
 Injection is given to gluteus
medius muscle.
 Position client in prone or side
lying position with the knee
bent and raised slightly toward
the chest.
 The nurse places the heel of the
hand on the client’s greater
trochanter, with the fingers
pointing towards the client
head.
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Teddy 180
Ventrogluteal site…
 Point the thumb toward the patient’s groin and the index
finger toward the anterior superior iliac spine; extend the
middle finger back along the iliac crest toward the buttock.
 The index finger, the middle finger, and the iliac crest form
a V-shaped triangle; the injection site is the center of the
triangle.
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Teddy 181
Dorsogluteal site
 Injection is given to the gluteus maximus muscle.
 Position the client in prone position. Draw an
imaginary line to divide the buttocks into 4 equal
quadrants.
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Teddy 182
Vastus Lateralis
 The muscle is located on the anterior lateral aspect
of the thigh.
 The land- mark is established by dividing the area
between the greater trochanter of the femur & the
lateral femoral into thirds & selecting the middle
third.
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Teddy 183
Deltoid Site
 Found on the lateral aspect of the upper arm.
 Locate the site by placing four fingers across the
deltoid muscle, with the top finger along the
acromion process.
 The injection site is then three finger widths below
the acromion process.
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Teddy 184
Rectus Femoris
 it is used occasionally for IM injections.
Situated on the anterior aspect of the thigh.
12/15/2023

Teddy 185
Z-Track Method in Intramuscular
Injections
 When administering IM injections, the Z-
track method be used to minimize local skin
irritation by sealing the medication in muscle
tissue.
 The Z-track method has been found to be a
less painful technique, and it decreases
leakage of irritating medications into the
subcutaneous tissue
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Teddy 186
Z-Track Method in Intramuscular
Injections
 For administering in Z-track method pull the
overlying skin and subcutaneous tissues
approximately 2.5 to 3.5 cm laterally or downward.
 Hold the skin in this position until you administer
the injection.
 With the needle at a 90-degree angle to the site
administer the medicine.
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Teddy 187
Intravenous Administration
 Needle is injected into the vein. Direct IV or
IV push, IV infusion. This is the most rapid
route of absorption of medications.
 Angle of insertion is 25 degree.
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Teddy 188
Intravenous Administration…
 For adults, the veins on the
arm are:
a) Basilic vein
b) Median cubital vein
c) Dorsal veins
d) Median vein
e) Radial vein
f) Cephalic vein
 On the foot, the veins are;
a) Great saphenous vein
b) Dorsal plexus
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Teddy 189
Parts of an IV infusion set
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Teddy 190
Complications to observe for during IV
therapy:
 Infiltration: escape of fluid into subcutaneous
tissue due to dislodgement of the needle
causing swelling and pain. Gross infiltration
may result in nerve compression injury which
can result in permanent loss of function of
extremity or in case of irritating medications
(vesicant), significant tissue loss, permanent
disfigurement or loss of function may result.
 When there is infiltration, the site should be
changed.
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Teddy 191
therapy:
 Phlebitis is the inflammation of the vein. This may
result from mechanical trauma due to the
insertion too big a needle (for small vein) or
leaving a device in place for a long time. Chemical
trauma result s from irritation from solutions or
infusing too rapidly. This manifests as pain or
burning sensation along the vein. On observation,
there may be redness, increased temperature
over the course of the vein.
 The site should be changed and warm compress
should be applied
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Teddy 192
therapy:
 Circulatory Overload; the intravascular fluid
compartment contains more fluid than
normal. This occurs when infusion is too
rapid or excess volume is infused. This
manifests as dyspnoea, cough, frothy
sputum and gurgling sounds on aspiration.
 Embolism; obstruction of the blood vessels
by travelling air emboli or clot of the blood.
It is fatal.
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Teddy 193
Duties of the Nurse during IV Therapy
 Explain the need for the IV therapy, what to
expect, duration of the therapy, activities
permitted during the procedure and observations
to be made.
 Help patient to maintain activities of daily living;
bathing and grooming, feeding etc.
 Observation should be made on the flow rate,
patency of the tubing, infusion site, level of fluid in
the infusion bag/bottle, patient’s comfort and
reaction to therapy.
 Change dressing on the IV line as may be
necessary.
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Teddy 194
Respond appropriately to the signs of
pain
 Pain:-
 It is an unpleasant sensory and emotional experience associated
with actual or potential tissue damage (Merskey & Bogduk,
1994).
 It is the most common reason for seeking health care.
 It occurs with many disorders, diagnostic tests, and treatments.
 It disables and distresses more people than any single disease.
Since nurses spend more time with the patient in pain than do
other health care providers, nurses need to understand the
pathophysiology of pain, the physiologic and psychological
consequence of acute and chronic pain, and the methods used
to treat pain.
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Teddy 195
Respond appropriately to the signs of
pain
 Pain threshold: the point at which a stimulus
is perceived as painful
 nociceptor: a receptor preferentially
sensitive to a noxious stimulus
 pain tolerance: the maximum intensity or
duration of pain that a person is willing to
endure
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Teddy 196
Causes of pain
 Disease process
 Burn
 Trauma/injury
 Neuralgia
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Teddy 197
Types of Pain
 Pain is categorized according to its duration,
location, and etiology.
 Three basic categories of pain are generally
recognized:
Acute pain
Chronic (nonmalignant) pain and
Cancer-related pain
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Teddy 198
ACUTE PAIN
 Usually of recent onset and commonly associated with a
specific injury
 acute pain indicates that damage or injury has occurred.
 Pain is significant in that it draws attention to its existence
and teaches the person to avoid similar potentially painful
situations.
 If no lasting damage occurs and no systemic disease exists,
acute pain usually decreases along with healing.
 In a situation where healing is expected in 3 weeks and the
patient continues to suffer pain , it should be considered
chronic and treated with interventions used for chronic
pain.
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Teddy 199
CHRONIC (NONMALIGNANT) PAIN
 Chronic pain is constant or intermittent pain that persists
beyond the expected healing time and that can seldom be
attributed to a specific cause or injury.
 It may have a poorly defined onset, and it is often difficult
to treat because the cause or origin may be unclear.
 Although acute pain may be a useful signal that something
is wrong, chronic pain usually becomes a problem in its
own right.
 Chronic pain may be defined as pain that lasts for 6 months
or longer, although 6 months is an arbitrary period for
differentiating between acute and chronic pain.
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Teddy 200
CANCER-RELATED PAIN
 Pain associated with cancer may be acute or chronic.
 Pain in the patient suffering from cancer can be
directly associated with the cancer (eg, bony
infiltration with tumor cells or nerve compression), a
result of cancer treatment (eg, surgery or radiation),
or not associated with the cancer (eg, trauma).
 Most pain associated with cancer, however, is a
direct result of tumor involvement.
 A cancer pain algorithm developed as a set of
analgesic guiding principles appears
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Teddy 201
Pain scale measurement
 Visual Analogue Scales
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Teddy 202
Guidelines for Using Pain
Assessment Scales
 Using a written scale to assess pain may not be
possible if the person is seriously ill, is in severe
pain, or has just returned from surgery.
 In these cases, the nurse can ask the patient, “On
a scale of 0 to 10, 0 being no pain and 10 being
pain as bad as it can be, how bad your pain is
now?” For patients who have difficulty with a 0 to
10 scale, a 0 to 5 scale may be tried. Whichever
scale is used, it should be used consistently.
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Teddy 203
Key Definitions
 Averse drug reaction (ADR)
A noxious and unintended response to a medicine that
occurs at normal therapeutic doses used in humans for
prophylaxis, diagnosis, or therapy of disease, or for the
modification of physiologic function
The word “effect” is used interchangeably with “reaction.”
 Side effect
Any unintended effect of a pharmaceutical product
occurring at normal therapeutic doses and is related to its
pharmacological properties.
Such effects may be well-known and even expected and
require little or no change in patient management.
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Teddy 204
Key Definitions…
 Serious adverse effect
Any untoward medical occurrence that occurs at any dose and
results in death, requires hospital admission or prolonged
hospital stay, results in persistent or significant disability, or is
life threatening
 Adverse drug event
Any untoward medical occurrence that may be present during
treatment with a medicine but does not necessarily have a
causal relationship with this treatment. Adverse drug events
include medication errors and overdoses.
 Causality
The probability that a particular medicine is responsible for an
isolated effect or ADR.
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Teddy 205
Key Definitions…
 Signal
Reported information on a possible causal relationship
between and adverse event and a medicine, the relationship
being previously unknown or incompletely documented.
Usually more than one signal report is required to generate a
signal, depending on the seriousness of the event and the
quality of the information.
 Prescribing error
Incorrect medicine ordering by a prescriber
 Medication error
Administration of a medicine or dose that differs from the
written order
12/15/2023

Teddy 206
Key Definitions…
 Negligence
Medical decision making or care below the accepted standards
of practice
 Adverse Drug Reactions
Patient injury caused by a medicine taken in therapeutic doses
 Type A—Exaggerated pharmacological response
◦ Pharmacodynamic (e.g., bronchospasm from beta-blockers)
◦ Toxic (e.g., deafness from aminoglycoside overdose)
 Type B—Non pharmacological, often allergic, response
◦ Medicine-induced diseases (e.g., antibiotic-associated colitis)
◦ Allergic reactions (e.g., penicillin anaphylaxis)
◦ Idiosyncratic reactions (e.g., aplastic anemia with chloramphenicol)
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Teddy 207
Key Definitions…
 Type C—Continuous or long term (time
related)
◦ Osteoporosis with oral steroids
 Type D—Delayed (lag time)
◦ Teratogenic effects with anticonvulsants or lisinopril
 Type E—Ending of use (withdrawal)
◦ Withdrawal syndrome with benzodiazepines
 Type F—Failure of efficacy (no response)
◦ Resistance to antimicrobials
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Teddy 208
Managing ADRs
 Step 1. Evaluate the nature of the event.
Obtain a detailed history of the patient.
Identify and document the clinical reaction. Look up
suspected medicines and known ADRs in the literature and
match them with the reactions described by the patient
 Classify the severity of the reaction.
◦ Severe—fatal or life threatening
◦ Moderate—requires antidote, medical procedure, or
hospitalization
◦ Mild—symptoms require discontinuation of therapy
◦ Incidental—mild symptoms; patient can chose whether to
discontinue treatment or not
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Teddy 209
Managing ADRs…
 Step 2. Establish the cause.
◦ Use the Naranjo algorithm (or other system) to
assess the patient’s reaction.
◦ Evaluate the quality of the medicine.
◦ Check for a medication error.
 Step 3. Take corrective and follow-up
action.
 Corrective action will depend on cause and
severity
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Teddy 210
Managing ADRs…
 Severe ADRs
◦ Educate and monitor prescribers.
◦ Change the formulary or standard treatment
guideline if necessary to substitute a medicine
that is safer or that is easier to use by staff.
◦ Modify patient monitoring procedures.
◦ Notify drug regulatory authorities and
manufacturers.
◦ All ADRs
 Educate and warn patients
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Teddy 211
Recording and transcribing order
 Transcription: Certified staff copy info from HCP order
and pharmacy label on to med sheet
Correct Transcription of Orders
 Read every word on the script.
 Fax the script to the pharmacy.
 When the medication is received from the pharmacy,
check to make sure that it is the correct medication.
 Write each word on the MAR that is on the medication
label.
 Recheck your transcription word for word to make sure
that it was transcribed correctly.
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Teddy 212
Recording and transcribing
order…
Documentation
 Complete
 Accurate
 Clear
 Ink only
 Include date and time
 Sign your name
Correcting Documentation
 Draw a single line through mistake
 Write the word “error” and initial
 No scribbling, “marking over”, erasing or using “white out”
12/15/2023

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