Dose ordered

Principles for Nursing Practice
Medication Administration
Dr. Belal M. Hijji, RN, PhD
February 11, 2012
• By the end of this lecture, students will be able to:
– Discuss pharmacology applications in nursing
– Describe the Jordan Drug and Food Administration
guidelines for safe narcotics administration and control
– Recognise types of medications actions.
– Describe factors influencing choice of administration
– Correctly calculate a prescribed medication dosage,
and identify the five rights of medication
– Describe the roles of the pharmacist, physician, and
nurse in medication administration.
Pharmacology Applications in Nursing Practice
• Names:
– Generic: Acetaminophen
– Trade (brand): Tylenol
• Classification: Medications with similar characteristics
are grouped into classifications. Some medication have
more than one classification.
– Hypoglycemic agents
– Antihypertensive agents
• Forms:
– Tablets Capsules
– Solution Suppository
Lotion Ointment
Syrup Sustained
‫‪Jordan Drug and Food Administration Guidelines For Safe‬‬
‫‪Narcotics Administration And Control‬‬
‫يجب تحديد مسؤول التمريض في كل قسم من أقسام المستشفى ويتم تسليم العقاقير الخطرة لكل قسم‬
‫مقابل ضبط استالم وتسليم موقع من قبل الممرض المسؤول في القسم والصيدلي المسؤول في‬
‫المستشفى‪ .‬يجب أن يتم حفظ العقاقير الخطرة في خزانة محكمة االغالق‪.‬‬
‫على مسؤولي التمريض تسليم مفتاح خزانة العقاقير الخطرة فقط للممرض المسؤول في الورديات‬
‫يجب ان يكون هناك سجل خاص بالعقاقير الخطرة في المستشفى يسجل فيه اسم المريض ورقم ملفه‬
‫ورقم السرير واسم الطبيب الواصف للحقنة المخدرة واسم الممرضة وتوقيعها والتاريخ واسم الممرض‬
‫الشاهد على االعطاء‪ .‬ويجب على السجل أن يبين االستالم والتسليم بين الورديات وموقع من قبل‬
‫الممرضين المسؤولين‪.‬‬
‫تصرف العقاقير الخطرة من قبل الصيدلي المسؤول المعتمد فقط لرئيسة ممرضات القسم‪.‬‬
‫يجب على الممرض المسؤول اعطاء حقنة المادة المخدرة للمريض بعد التأكد من توقيع الطبيب على‬
‫الوصفة وعلى اضبارة المريض‪ ،‬وأن يوقع الممرض على االضبارة بعد االعطاء‪.‬‬
‫في حالة اعطاء المريض جزء من محتويات حقنة عقار خطر يجب اتالف الكمية المتبقية بحضور‬
‫الطبيب والذي يبين ذلك على الوصفة بتوقيعه مع التاريخ والوقت‪.‬‬
‫في حالة وقوع حادث كسر لحقنة يجب استدعاء الصيدلي المسؤول لمشاهدة الحادث وعمل محضر يبين‬
‫تفاصيل ما حدث وتوقيع الشهود عليه مع الصيدلي المسؤول‪ .‬وفي حالة عدم وجود الصيدلي ضرورة‬
‫استدعاء الطبيب المناوب لمشاهدة حادث الكسر وليقوم بالتوقيع على المحضر بعد توقيع الشهود وحفظ‬
‫الحقن المكسورة لدى الصيدلي المسؤول بعد ذلك من اجل اجراءات تبليغ مديرية الدواء ورفع تقرير عن‬
‫الحادثة فورا ً وحفظ نسخة لدى الصيدلي ونسخة في ملف المتسبب بحادثة الكسر‪.‬‬
Types of Medication Action
• Therapeutic: This is the expected or predictable
physiological response a medication causes. For
example, nitroglycerin reduces cardiac workload and
increases myocardial oxygen supply
• Side effects: This is predictable, unintended, secondary
effect. For example, asymptomatic blood loss, skin
• Adverse effects: Are generally severe responses to
medication. For example, when a client experiences
cardiac arrest following rapid administration of KCL.
• Toxic effects: These may develop after prolonged intake
of medication. For example, respiratory depression
caused by morphine.
Factors Influencing Choice of Administration
• Oral routes: Are convenient, comfortable, economic, and
rarely cause anxiety
– Disadvantages: Avoid in nausea & vomiting, reduced motility,
gastric suction, and reduced ability to swallow.
• SC, IM, IV, ID routes: Are used when oral routes are C/I.
Absorption is more rapid than with oral and topical
routes. IV route is valuable in critically ill clients.
– Disadvantages: Risk of infection, expensive, not suitable for
clients with bleeding tendencies, risk of tissue damage with SC
injections, IV and IM routes are dangerous due to rapid
absorption, and anxiety.
• Topical routes: Provide local or systemic effect, painless,
limited side effects, prolonged systemic effects
(transdermal), rapid relief for local respiratory problems.
– Disadvantages: Skin abrasions facilitate rapid absorption and
systemic effects, clothes soiling, rectal and vaginal applications
are embarrassing, ruptured eardrum cannot receive irrigations,
suppositories are C/I in rectal bleeding and rectal surgery, some
inhalation agents can cause serious systemic effects such as
cardiac arrhythmias due to salbutamol inhalation.
Dosage Calculation
• When preparing solid and liquid forms:
– Dose ordered x Amount on hand = Amount to administer
Dose on hand
– Example (1): Give Demerol 50 mg (dose ordered) IM. Each
ampoule contains 100 mg (dose on hand) in 1 ml (amount on
hand). How many ml should be given?
• 50 x 1 = 0.5 ml (amount to administer)
– Example (2): The doctor’s order is 0.125 mg PO of Digoxin.
Each tablet contains 0.25 mg. How many tablets should be
• 0.125 x 1 = 0.5 tablet
– Example (3): Give Erythromycin suspension 250 mg PO. Each 5
ml contains 125 mg. What amount would you give?
• 250 x 5 = 10 ml, OR
5 ml
125 mg
250 mg
Rights of Medication Administration
• Right medication: When preparing medication, compare the
label of the medication container with a physician’s wellwritten and clear order.
Handwritten prescriptions can be difficult to decipher [‫]يكتشف معنى شيء غامض‬.
For example, in the following prescription the drug name Avandia was
incorrectly interpreted as Coumadin.
• Only administer the medication you
• Right dose:
– Chances for errors increase when a medication must be
prepared from a larger volume or strength than needed.
– When performing medication calculations or conversion, check
the calculated dose with another nurse.
– After calculations, prepare the medication using standard
measurement devices such as graduated cups, syringes, and
scaled droppers.
– When it is necessary to break a scored tablet, the break should
be even. Unevenly broken tablet should be discarded
– When crushing a tablet, the crushing device should always be
completely cleaned
• Right client: To ensure safe medication administration,
the right client must be identified. This can be done by:
– Matching client identification details on his/ her bracelet with
those on the prescription chart
– Asking the client to state his/ her full name
• Right route:
– Consult the physician if the route of administration is not
specified or not recommended
– When administering injections, it is important to prepare them
from preparations designed for parenteral use. The injection of a
liquid designed for oral use can cause sterile abscess formation
or fatal systemic effects.
• Right time: The timing a medication is to be administered
at is at the discretion of the physician. For example:
Give Augmentin 375 mg every 8 hour (q8h)
Give iron tablet 3 times a day (tid) after meals
Give valium 10 mg IM preoperatively
Give Demerol 50 mg IM stat
All routinely prescribed medications should be given within 30
minutes of the times ordered.
• However, sometimes the nurse should judge the proper
time when a medication is to be administered. For
– PRN (Pro Re Nata) sleeping or pain medications
The roles of Prescriber, Pharmacist, and Nurse in
Medication Administration.
• Prescriber’s role:
– The prescriber could be a physician or an advanced
practice nurse
– Institutional policies vary regarding the personnel who
can take verbal or telephone orders.
– Common abbreviations are often used when writing
orders. These include AC (before meals), ad lib (as
desired), BID (twice a day), HS (hour of sleep), PC
(after meals), prn (when needed), and od or qd (every
– However, the current recommendation is that
abbreviations should not be used because of the high
number of medication errors related to their use.
• Pharmacist’s role is to:
– Prepare and distributes prescribed medications
– Assess the medication plan and evaluate the client’s
medications-related needs
– Fill prescription accurately and ascertaining their validity
• Nurse’s role is to:
– Administer medication correctly to clients
– Assess client ability to self medicate
– Determine whether a client should receive medication at a given
– Monitor the effect of prescribed medications
– Provide education to client and family regarding medication
administration and monitoring