Chapter 3
Medication
Administration
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INJECTIONS
• Injections instill medications into body
tissues for systemic absorption.
• Injected drugs are more quickly
absorbed than oral medications.
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Actions
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Therapeutic effects
Side effects
Adverse effects
Toxic effects
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Routes of Administration of
Drugs
• Oral: sublingual, buccal
• Parenteral: intradermal,
subcutaneous, intramuscular,
intravenous
• Topical
• Inhalation
• Intraocular
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Clinical Calculations
• Conversions within systems
• Conversions between systems
• Formula:
Dose ordered x Amount on hand
Dose on hand
(OR)
What you Want x what it’s In / What
you’ve Got
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• If you have an ampoule of 500mg in 4ml,
and you need 200mg to be administered to
the patient. How many ml of drug to be
injected?
• The easy way to remember this is the
famous nursing equation:
• What you Want x what it’s In / What
you’ve Got
• In this instance:
• 200mg x 4ml / 500mg = 1.6ml
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• Prescription states 30 mg/hour. You have a
bag containing 250mg in 50ml. Therefore,
at what rate (ml/hr) do you set the pump?
• What you Want x what it’s In / What
you’ve Got
• 30 x 50 / 250 = 6ml
• Therefore the calculation shows that, to
give 30mg per hour, the infusion pump rate
would need to be set at 6ml per hour.
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Prescriber’s Role
• Types of orders
– Standing orders
– prn orders
– Single orders
– Stat orders
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Nurses Responsibilities
• Check for 6 Rights: Right drug, Right dose, Right route,
Right time, Right client , Right documentation
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Perform hand hygiene. (Rationale: to prevent the spread
of infection)
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Collect prescription and ensure that the client is
available and understandable to take the
medication.(Rationale: to secure informed-consent)
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Check the medicine as the points: name, components,
dose, expiry date(Rationale: to provide safe and efficient
medication)
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Prior to administration ensure you are knowledgeable
about the drug(s) to be administered. This should include:
therapeutic use, normal dosage, routes/forms, potential side
effects,
Continued……………….
• contra-indications.(Rationale: to ensure safety and wellbeing of client and enable you to identify any errors in
prescribing)
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Confirm identity of client verbally and with chart,
prescription, checking full name, age, date of birth: Right
client.(Rationale: to ensure that the correct drug is being
administered to the correct client)
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Ensure that the medication has not been given till that
time(Rationale: to ensure right dose)
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Nurse’s Role
• Six rights
• Triple-check before administration
• Client assessment
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Six Rights
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Right medication
Right dose
Right client
Right route
Right time
Right documentation
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Client’s Rights
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Information
Refusal
Careful assessment
Informed consent
Safe administration
Supportive therapy
No unnecessary medications
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Assessment
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Medical history
History of allergies
Medication data
Diet history
Perceptual or coordination problems
Current condition
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Nursing Diagnoses
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Deficient knowledge (medications)
Noncompliance (medications)
Disturbed sensory perception
Impaired swallowing
Ineffective therapeutic regimen
management
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Implementation
• Client and family teaching
• Medication orders: receipt,
transcription, communication
• Calculation and measurement
• Correct administration technique
• Recording
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Special Considerations
• Infants and children
• Older adults
– Self-prescribing
– Over-the-counter medications
– Misuse
– Noncompliance
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Oral Administration
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Presence of GI alterations
Ability to swallow
Use of gastric suction
Positioning
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Topical Administration
• Skin applications
– Use of gloves or applicators
– Preparation of skin
– Thickness of application
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Nasal Instillation
• Assessment of nares
• Client instruction and selfadministration
• Positioning
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Eye Instillation
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Drops, ointments, disks
Assessment of eyes
Asepsis
Positioning
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Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children
and adults
• Positioning
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Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Client positioning, comfort, and
hygiene
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Rectal Instillation
• Suppositories
• Use of gloves
• Client positioning, comfort, and
hygiene
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Inhalation
• Metered-dose inhalers (MDIs) and
dry powder inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister
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Parenteral Administration
• Equipment
– Syringes: sizes (volume), types
– Needles: length, gauge
– Disposable units: Tubex, Carpuject
– Ampules
– Vials
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SYRINGE
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Selecting the size of the needle
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IV injections – 21, 22., or 25G
IM injections – 22 to 23 Gauge
(18 to 25 G for oil based medication)
Subcutaneous injections - 25 Gauge
Intra dermal injections – 25 to 27G
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Parenteral Administration (cont’d)
• Mixing medications
– Determine compatibility of the
medications
– Do not contaminate one medication with
another
– Ensure the final dose is accurate
– Maintain aseptic technique
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Parenteral Administration (cont’d)
• Insulin
– Syringes and needle sizes
– Types of insulin
– Mixing of insulins
– Rotation of vials before withdrawal of
solution
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Administration of Injections
• Minimize discomfort
– Use smallest suitable needle
– Position client comfortably
– Select proper site
– Divert client’s attention
– Insert the needle quickly and smoothly
– Hold the syringe steady
– Inject the medication slowly and steadily
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Administration of Injections
(cont’d)
• Subcutaneous injections
– Sites: condition of area, rotation of use
– Amount of solution
– Length and gauge of needle
– Pinch or spread skin
– Angle of insertion
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Site for S.C injections
• 1. Outer aspect of the upper arm.
• 2. Posterior chest wall below the scapula.
• 3. Anterior abdominal wall from below the
breast to the iliac crest.
• 4. The anterior and lateral aspect of the
thigh.
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Sites of Subcutaneous injections
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Insulin pens - Types
• Reusable pens
• Disposable pens
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Insulin pens
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Insulin pens
• Advantages and Disadvantages of Insulin
Pens
• The reasons why some insulin users prefer insulin pens
include:
• Insulin pens are portable, discreet, and convenient for
injections away from home.
• They save time because there is no need to draw up insulin
from a bottle - it is already pre-filled in the self-contained
cartridge.
• They usually let you set an accurate dose by the simple
turn of a dosage dial, and that may make it easier to set an
accurate dose for people who have vision or dexterity
problems.
Insulin pens
• There are also reasons why insulin pens are not right for all users,
including:
• Insulin in pens and cartridges is often more expensive than insulin in
bottles for use in syringes.
• Some insulin is wasted when pens are used: one to two units of insulin
are lost when the pen is primed before each injection;
• Not all insulin types are available for use in insulin pen cartridges.
• Insulin pens do not let you mix insulin types, which means that if the
insulin mixture you need is not available as a pre-mix, two injections
must be given - one for each type of insulin.
• Insulin pens should only be used for self-injection. This is because the
pen needle must be removed from the pen after each injection, and
there is no way to completely protect the person giving the injection
from getting accidentally stuck by the needle while he or she is
removing it from the pen.
Administration of Injections
(cont’d)
• Intramuscular injections
– Sites: landmarks, condition of area
– Amount of solution
– Length and gauge of needle
– Angle of insertion
– Aspiration
– Air-lock method
– Z-track technique
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Contraindications
• IM injections may be contraindicated in
clients with;
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Impaired coagulation mechanisms
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Occlusive peripheral vascular disease
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Edema
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Shock
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After thrombolytic therapy
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during myocardial infarction
Administration of Injections
(cont’d)
• Sites
– Dorsogluteal
– Ventrogluteal
– Vastus lateralis
– Deltoid
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Dorso gluteal site
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Deltoid site
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Administration of Injections
(cont’d)
• Intradermal injections
– Skin testing
– Sites
– Length and gauge of needle
– Angle of insertion
– Formation of small bleb
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Prevention of Needle Sticks
• Needleless devices
• Sharps disposal
• One-handed recapping technique
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Intravenous injections
• Definition
• Intravenous injection is defined as the
parentral administration of bolus medication
directly into the vein through the existing
IV line.
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Methods of infusion
• There are three methods of
administrating intravenous drugs
• Continuous infusion
• Intermittent infusion
• Direct Intermittent injection
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Continuous infusion
• Continuous infusion may be defined as the
intravenous delivery of medication or fluid
at a constant rate over a prescribed time
period, ranging from 24hours to days, to
achieve a controlled therapeutic response.
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Intermittent infusion:
• Intermittent infusion is the administration of
a small volume infusion i.e. 50-250ml over
a period of between 20mins and two hours.
This may be given as a specified dose at one
time or at repeated intervals during 24hours.
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Direct intermittent injection:
• This involves the injection of a drug from a
syringe into the injection port of the
administration set or directly into a vascular
access device.
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Intravenous Administration
• Large volume infusions
• Bolus injection
• Volume-controlled infusions
Piggyback
– Tandem
– Volume-control set
– Mini-infusor pump
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Purposes
• To administer large volume of fluid.
• Rapid absorption is achieved.
• In emergencies fast- acting medications can be
delivered quickly.
• Establishes continuous fluid infusions.
• To establish constant therapeutic blood levels.
• Medications that are highly alkaline and irritating
to subcutaneous tissue are given intravenously.
• IV therapy is used primarily for fluid replacement
in patients unable to take oral fluids.
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Articles required
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1.Medication chart
2. Sterile syringe (1)
3. Sterile needle (1)
4. Second needle (optional)
5. Spirit swab
6.Ampoule of medication prescribed
7.Ampoule cutter if available (1)
8.Kidney tray (1)
9. Steel Tray (1)
10.Container for discards if possible (1)
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