PYRAMID POINTS
CHAPTER 17:
ADMINISTRATION OF
MEDICATION AND
INTRAVENOUS SOLUTIONS
PYRAMID POINTS
I. Medication Administration
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Assess medication order
Ask client about medication allergies
Assess client’s understanding of medications, intravenous
(IV) solutions ordered
Assess client concerns about medications
Assess five rights prior to and during administration process
Assess vital signs prior to, during, and after administration,
depending on medication
Document administration of medication and client’s response
to medication
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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II. Drug Measurement Systems
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Metric system
• Basic units are meter, liter, gram
 Apothecary and household systems
• Common apothecary units include grain, dram, ounce
• Common household units include tablespoon, teaspoon,
minim, drop
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Additional common drug measures
• Milliequivalent (mEq) expresses the number of grams of
a medication contained in 1 milliliter (mL) of a normal
solution
• Unit measures medication in terms of action, not physical
state
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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III. Conversions
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Between metric units
• Convert larger to smaller, multiply by 1000, or move
decimal point three places to right
• Convert smaller to larger, divide by 1000, or move
decimal point three places to left
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Between household and metric systems
• First step in calculation of dosages can use method of
ratio and proportion
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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IV. Celsius and Fahrenheit Temperature
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To convert Fahrenheit to Celsius: Subtract 32 from
temperature in °F; divide result by 1.8
To convert Celsius to Fahrenheit: Multiply
temperature in °C by 1.8; then add 32
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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V. Medication Labels
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Always check expiration dates
Contains generic and trade name
Check medication label against physician’s orders,
medication administration record
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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VI. Medication Orders
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Need to be written using accepted abbreviations, acronyms,
symbols as well as per agency guidelines
If nurse has any questions or sees inconsistencies, contact
person who wrote order immediately
Components of complete medication order
• Name of client
• Date, time when order written
• Name of medication
• Dosage of medication
• Medication route
• Time, frequency of administration
• Signature of person writing order
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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VII. Oral Medications
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Scored tablets: Contain indented mark for breakage into partial
doses if needed
Enteric-coated tablets: Covering on medication that delays
absorption until medication reaches small intestine
Capsules: Contain powdered or oily medication in gelatin cover
Liquids: Contain specific amount of medication in a given amount of
solution
Medicine cup: Capacity of 30 mL or 1 ounce; calibrated to measure
teaspoons, tablespoons, fluid drams; pour medication while cup is
at eye level
Syringes: Used for volumes less than 5 mL
Calibrated droppers: Used for infants, children; calibrations in mL,
drops, or minims
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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VIII. Parenteral Medications
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Injection route, including IV, intramuscular (IM),
subcutaneous, or intradermal
Single-use ampules, single- and multiple-dose vials,
premeasured syringes and cartridges
No more than 3 mL IM or 1 mL subcutaneous should be
administered in one site
Always question, verify excessively large or small volumes of
medication
Standard 3-mL syringe used to measure most medications;
calibrated in tenths of a milliliter
Calibrations on syringe read from top black ring on syringe,
not middle or bottom ring
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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VIII. Parenteral Medications (continued)
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Prefilled medication cartridge
Standard medication doses rounded to nearest tenth
Volumes larger than 3 mL, use 5-mL syringe calibrated in
fifths
Syringes available in 10-, 20-, and 50-mL sizes
Tuberculin syringe holds 1 mL and is calibrated in
hundredths of a mL; each one tenth marked on the metric
scale
Insulin syringe
• When combining regular and NPH insulin, draw regular insulin
first, then NPH
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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IX. Injectable Medications in Powder Form
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Used if medication is unstable when stored in
solution form
Powders must be dissolved with sterile diluent,
usually sterile water or normal saline; follow
directions that accompany the vial
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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X. Calculating the Correct Dosage
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Double-check dosage and question an order that calls for
more than three tablets
Double-check parenteral dosages and question an order that
has amount that is too large a dose
Nurse is legally responsible for medications administered,
even if incorrect dose was prescribed
All dose measures must be in same medication system
Round standard injection doses to tenths; measure in 3-mL
syringe
Round small critical amounts or children’s dosages to
hundredths; measure in 1-mL tuberculin syringe
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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XI. Percentage and Ratio Solutions
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Percentage solutions
• Express number of grams of medication per 100 mL of
solution
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Ratio solutions
• Express number of grams of medication per total
milliliters of solution
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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XII. Calculating Medications
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Commonly used formula
• Desired/available  quantity = amount per dose
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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XIII. Intravenous Flow Rates
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Monitor IV flow rate every 30 minutes for adult,
every 15 minutes for child
 If IV is running slow, collaborate with physician to
increase flow rate appropriately
 Don’t speed up IV rate to catch up if infusion is
behind schedule
 When increasing IV rate, assess cardiac and
respiratory systems for signs of cardiac overload
 Rate flow of IV generally measured as mL/hr
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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continued …
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Volume per hour calculated in drops per minute
IV tubing size directly correlated with drops/mL,
which affects flow rate
IV flow rate formula
• Total volume  drop factor divided by time in minutes =
drops per minute
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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XIV. Electronic Flow Rate Regulators
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Controller
• Works on same principle of gravity as regular IV drip; flow rate
maintained by rapid compression and decompression of IV
tubing by machine
• Height of solution bag is critical; thus, solution bag must be
maintained at height of 36 inches above controller
• Flow rate set on controller as mL/hr
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Pump
• Physically pumps fluids against resistance; gravity not a factor
• Height of solution bag is not a factor
• Flow rate set as mL/hr
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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XV. Calculation of Infusions Ordered by Unit
Dose
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Most common medications measured by units are
heparin sodium and regular insulin
Calculate by determining amount of medication
per 1 mL; then determine infusion rate (mL/hr)
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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The client is to receive 1000 mL of D5W at a rate of 100 mL/hr.
The drop factor is 10 drops/mL. The nurse adjusts the flow rate
to deliver how many drops per minute?
1. 10 drops
2. 13 drops
3. 17 drops
4. 20 drops
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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The physician orders an intramuscular dose of 250,000 units of
penicillin G benzathine (Bicillin). The label on the 10-mL ampule
sent from the pharmacy reads penicillin G benzathine (Bicillin),
300,000 units/mL. How much medication will the nurse prepare
to administer the correct dose?
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2.
3.
4.
0.25 mL
0.8 mL
1.5 mL
8 mL
FUNDAMENTAL SKILLS:
Administration of Medication and Intravenous Solutions
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