2.

drug name (generic preferred)

Administration of Medications 3. drug dosage ex. Morphine 2mg IV STAT
4. frequency & duration of administration C. Right Dose
Medication 5. any special instructions for withholding or  Nurse must do:
- A substance administered for the diagnosis, adjusting dosage
• Calculate and check drug
cure, treatment, relief or prevention of 6. physician or other health care provider’s
dose accurately.
disease. signature or name if TO or VO
7. signature of licensed practitioner taking TO • Check PDR, drug
Types of Doctor’s Order: or VO package insert or drug handbook for
recommended range of specific
1. Standing Order- it is carried out until the drugs.
specified period of time or until it is Nurse must do:
discontinued by another order. • check med order is complete & • Check heparin, insulin
2. Single Order- it is carried out for one time legible. and IV digitalis doses with another
• know general purpose or action, nurse.
only.
dosage & route of drug
3. Stat Order- it is carried out at once or  Stock- method vs Unit-dose method
immediately. • compare drug card with drug label
4. PRN Order- it is carried out as the patient three times. D. Right Time
requires. 1. at time of contact with  Nurse must do:
drug bottle/ container • Administer drugs at
Principles in Administering Medications: 2. before pouring drug specified times.
3. after pouring drug • Administer drugs that
1. Observe the “10 Rights” of drug are affected by foods, before
4 Categories of Drug Orders: meals.
administration.
1. Standing Order / • Administer drugs that
5 Traditional Rights 5 Additional Rights Routine Order can irritate stomach, with food.
 ongoing order • Drug administration
1. right client 1. right assessment  may have may be adjusted to fit schedule of
2. right drug 2. right documentation special instructions to base administration client’s lifestyle, & activities. &
3. right dose 3. right to education  include PRN diagnostic procedures.
4. right time 4. right evaluation orders • Check expiration date.
5. right route 5. right to refuse • Antibiotics should be
ex. digoxin 0.2 mg PO q.i.d., maintain administered at even
A. Right Client blood level at 0.5 – 2.0 mg/ml intervals.
Nurse must do: 2. One-time (single) order E. Right Route
1. verify client  check ID bracelet & room  given only  Nurse must do:
number once, at a specific time • assess ability to
2. have client state his name swallow before giving oral meds.
ex. Cefixime 2mg IM at 7 AM on 12-1-05
3. distinguish between 2 client’s with same • Do not crush or mix
last names 3. PRN order meds in other substances before
B. Right Drug  given at client’s consultation with physician or
request & nurse’s judgement for need & pharmacist
medication order may be prescribed by:
1. Physician safety • Use aseptic technique
2. Dentist when administering drugs.
3. Podiatrist ex Mefenamic Acid 500mg q 4h PRN for • Administer drug at
4. Advanced practice registered nurse (APRN) pain appropriate sites.
4. STAT order • Stay with client until
Components of a drug order:  given once, oral drugs have been swallowed.
1. date & time the order is written immediately F. Right Assessment
Keith Nester A. Lavin
  get baseline data before drug Medication Misadventures include: 18. Infants receive no more than 1 ml
administration. 1. administration of wrong medication & IV fluid. of solution by IM at 1 site & no more than 1
G. Right Documentation 2. incorrect dose or rate ml subcutaneously. NEVER recap needles.
3. administration to the wrong patient 19. Give drugs last to client who need
 Immediately record appropriate info
4. incorrect route extra assistance.
• Name, dose, route,time & 5. incorrect schedule interval
date, nurse’s initial or signature 20. Discard needles & syringes in
6. administration of known allergic drug or IV fluid appropriate containers.
7. omission of dose or discontinuation of med or 21. Follow appropriate drug disposal
 Client’s response: IV fluid that was not discontinued. based on institution policy.
• narcotics
22. Discard unused solutions from
• analgesics Guidelines for Correct Administration of ampules.
• antiemetics Medications 23. Store appropriately unused
• sedatives A. Preparation solutions from open vials.
• unexpected reactions to 1. Wash hands before preparing 24. Write date & time opened & initials
meds. meds. on label.
 Use correct abbreviations & symbols. 2. Check for allergies. 25. Keep narcotics in a double-locked
H. Right to Education 3. Check medication order with drawer or closet. Med cart – locked at all
 Client teaching : physician’s orders, medicine sheet, & times when nurse is not around.
• therapeutic purpose medication card. 26. Keys to narcotics drawer must be
4. Check label on drug container 3 kept by the nurse & not stored in drawer.
• side-effects
times. 27. Avoid contamination of one’s own
• diet restrictions or
5. Check expiration date on drug skin or inhalation to minimize chances of
requirements
label. allergy.
• skill of administration 6. Recheck drug calculation with C. Recording
• laboratory monitoring another nurse. 28. Report drug error immediately to
 Principle of Informed Consent 7. Verify doses of drugs that are nurse manager & physician. Complete an
I. Right Evaluation potentially toxic with another nurse or incident report.
 client’s response to meds. pharmacist. 29. Charting: record drug given, dose,
• effectiveness 8. With unit dose, open packet at time, route & your initials.
• extent of side-effects or bedside after verifying client identification. 30. Record drugs promptly after given,
any adverse reactions. 9. Pour liquid at eye level. esp STAT doses.
10. Dilute drugs that irritate gastric 31. Record effectiveness & results of
J. Right to Refuse mucosa or give with meals. meds given, esp PRN meds.
 Nurse must do: 32. Report to physician & record drugs
B. Administration
• determine, when that were refused with reason for refusal.
11. Administer only those drugs that
possible, reason for refusal. 33. Record amount of fluid taken with
you have prepared.
• facilitate px’s 12. Identify the client by ID band or ID medications on input & ouput chart.
compliance. photo.
• explain risk for refusing 13. Offer ice chips when giving bad Behaviors to Avoid During Medication
meds & reinforce the reason for tasting medicine. Administration:
medication. 14. Assist client to appropriate • Do not be distracted when preparing meds.
• Refusal should be position. • Do not give drugs poured by others.
documented immediately. 15. Provide only liquids allowed on the • Do not pour drugs from containers whose
• Head nurse or health diet. labels are partially removed or have fallen off.
care provider should be informed when 16. Stay with client until meds are • Do not transfer drugs from one container to
omission pose threat to px. taken. another.
17. Administer no more than 2.5 to 3 • Do not pour drugs into the hand.
ALL MEDICATION ERRORS ARE SERIOUS OR ml of solution by IM at one site. • Do not give expired medications.
POTENTIALLY SERIOUS!!!!!!!!

Keith Nester A. Lavin

• Do not guess about drugs & drug doses. Ask C. Transdermal 1. wash hands.
when in doubt. • systemic effect 2. med should be at room temp.
• Do not use drugs that have sediment, are • more consistent blood levels & 3. sit up with head tilted slightly
discolored, or are cloudy (& shld not be). avoid GI absorption problems associated toward unaffected side.
• Do not leave medications by the bedside or with oral products. 4. child: pull auricle down & back.
with visitors. • patches should NOT be cut. (after 3yo ,same as adult)
• Do not leave prepared medications out of adult: pull up & back.
sight. D. Topical 5. instill prescribed drops.
• Do not give drugs if the px says he has • Applied to skin with a glove, tongue 6. do not contaminate dropper.
allergies to the drug or drug group. blade or cotton - tipped applicator. 7. maintain position for 2-3 minutes.
• Do not call the px’s name as the sole means of • Apply to clean dry skin when possible. • Nose Drops & sprays
identification. • Do not contaminate the medication in a 1. have client blow nose.
• Do not give drug if the client states the drug is container. 2. tilt head back for drops to
different from drug he has been receiving. • Do not “double dipped” . reach frontal sinus.
Check the order. • Observed sterile technique when skin tilt head to affected side to reach
• Do not recap needles. Use universal is broken. ethmoid sinus.
precautions. • Use firm strokes if medication is to be 3. Administer prescribed
• Do not mix with large amount of food or rubbed in. number of drops or sprays.
beverage that are contraindicated. Some sprays, close 1 nostril, tilt
E. Instillations head to closed side & hold breath
Forms & Routes for Drug Administration or breathe thru nose for 1 minute.
• Eyedrops
A. Tablets & Capsules 4. Keep head tilted backward
1. wash hands
• oral meds not given to pxs who for 5 minutes after instillation.
2. lie or seat down and look up
are: F. Inhalations
towards ceiling
o vomiting 3. remove any discharge by wiping • Semi-fowlers or high-fowler’s position.
o lack gag reflex out from inner canthus • Teach correct use of nebulizer &
o comatose 4. rest hand holding the dropper metered-dose inhalers.
• Do not mix with large amt of food against the client’s head. G. Parenteral
or beverage or contraindicated food or 5. gently draw skin down below administration of medications by needle.
infant formula affected eye to expose conjunctival a) Intradermal (ID)- under the epidermis
• Enteric- coated & timed-release sac (into the dermis).
capsules must be swallowed whole. 6. administer drops into center of the b) subcutaneous (SC)- in the
• Administer irritating drugs with sac subcutaneous tissue (also, hypodermic).
food to lessen GI discomfort. 7. gently press lacrimal duct with c) intramuscular (IM)- into the muscle.
sterile cotton ball or tissue for d) intravenous (IV)- into a vein.
• Administer drugs on empty
1 to 2 mins after instillation e) intraarterial- into an artery.
stomach if food interferes with absorption.
8. keep eyes closed for 1 to 2 mins f) intraosseous- into the bone.
• Drugs given sublingually or
bucally must remain in place until following application
Equipment.
fully absorbed.
• Eye Ointment Nurses use syringes and needles to
• Encourage use of child-resistant withdraw medications from ampoules and vials.
caps. 1, 2, 3, 4,- same as above
5 . squeeze strip of ointment (abt ¼ Syringes
inch, unless stated otherwise). Have three parts: the tip, which connects
B. Liquids with the needle; the barrel, or outside part, on
• Forms : elixir, emulsions, suspensions 6. keep eyes close for 2-3 mins.
which the scales are printed; and the plunger
• read label if dilution or shaking is required. 7. instruct px for blurred vision for a which fits inside the barrel.
• read the MENISCUS. short time.
• refrigerate once reconstituted. 8. apply at bedtime, if possible. Needles

• Ear Drops
Keith Nester A. Lavin
 Have three parts: the hub, which fits into • Do not massage the site of injection. To • For other medications, aspirate before
the syringe; the cannula, or shaft, which is prevent irritation of the site, and to prevent injection of medication to check if the
attached to the hub; and the bevel, which is the absorption of the drug into the blood vessel had been hit. If blood appears
slanted part at the tip of the needle subcutaneous. on pulling back of the plunger of the
syringe, remove the needle and discard the
Slant or length of bevel Subcutaneous – vaccines, heparin, preoperative medication and equipment.
The bevel of the needle may be short or medication, insulin, narcotics.
long. Longer bevels provide the sharpest needles • The site: Intramuscular
and cause less discomfort. They are commonly • Needle length is 1”, 1 ½”, 2” to reach the
used for subcutaneous and intramuscular
 outer aspect of the
upper arms muscle layer
injections. Short bevels are used for intradermal • Clean the injection site with alcoholized
and intravenous injections because a long bevel  anterior aspect of cotton ball to reduce microorganisms in the
can become occluded if it rests against the side of the thighs area.
the blood vessel.  Abdomen • Inject the medication slowly to allow the
Length of the shaft. tissue to accommodate volume.
The shaft length of commonly used needle  Scapular areas of
Sites:
varies from ½ to 2 inches. the upper back
Gauge  Ventrogluteal Ventrogluteal site
The gauge varies from #18 to #28. The
larger the gauge the smaller the diameter of the  Dorsogluteal  The area contains no large nerves,
shaft. Smaller gauges produces less tissue trauma, • Only small doses of medication should be or blood vessels and less fat. It is farther
but larger gauges are necessary for viscous injected via SC route. from the rectal area, so it less
medications such as penicillin • Rotate site of injection to minimize tissue contaminated.
damage. • Position the client in prone or side-lying.
• Needle length and gauge are the same as  When in prone position, curl the
Intradermal (ID) for ID injections toes inward.
- indicated for allergy and tuberculin testing • Use 5/8 needle for adults when the
and for vaccination. injection is to administer at 45 degree  When side-lying position, flex the
SITES: angle; ½ is use at a 90 degree angle. knee and hip. These ensure relaxation of
- inner lower arm gluteus muscles and minimize discomfort
*Left arm- for tuberculin test • For thin patients: 45 degree angle of during injection.
* Right arm- for all other test needle • To locate the site, place the heel of the
- Upper chest • For obese patient: 90 degree angle of hand over the greater trochanter, point the
- Back, beneath the Scapula needle index finger toward the anterior superior
What to observe? iliac spine, then abduct the middle (third)
- less hairy Needle gauge # For heparin injection: finger. The triangle formed by the index
- less pigmented - #25,26,27 finger, the third finger and the crest of the
• do not aspirate.
- less vascularized Needle length ilium is the site.
• Do not massage the injection site to
- less keratinized - 3/8”, 5/8”,1/2” prevent hematoma formation
Dorsogluteal site
• The site are the inner lower arm, upper • Position the client similar to the
For insulin injection:
chest and back, and beneath the scapula. ventrogluteal site
• Do not massage to prevent rapid
• Indicated for allergy and tuberculin testing • The site should not be use in infant under 3
absorption which may result to
and for vaccinations. years , because the gluteal muscles are not
hypoglycemic reaction.
• Use the needle gauge 25, 26, 27: needle well developed yet.
• Always inject insulin at 90 degrees angle to
length 3/8”, 5/8” or ½” • To locate the site, the nurse draw an
administer the medication in the pocket
• Needle at 10–15 degree angle; bevel up. imaginary line from the greater trochanter
between the subcutaneous and muscle
to the posterior superior iliac spine. The
• Inject a small amount of drug slowly over 3 layer. Adjust the length of the needle
injection site id lateral and superior to this
to 5 seconds to form a wheal or bleb. depending on the size of the client.
line.

Keith Nester A. Lavin

 • Another method of locating this site is to 5. Use appropriate needle size. To minimize tissue • Large dose of medications can be
imaginary divide the buttock into four injury. administered by this route.
quadrants. The upper most quadrant is the 6. Plot the site of injection properly. To prevent • The nurse must closely observe the client
site of injection. Palpate the crest of the hitting nerves, blood vessels, bones. for symptoms of adverse reactions.
ilium to ensure that the site is high enough. 7. Use separate needles for aspiration and injection • The nurse should double-check the six
• Avoid hitting the sciatic nerve, major blood of medications to prevent tissue irritation. rights of safe medication.
vessel or bone by locating the site 8. Introduce air into the vial before aspiration. To • If the medication has an antidote, it must
properly. create a positive pressure within the vial and allow be available during administration.
easy withdrawal of the medication. • When administering potent medications,
Vastus Lateralis 9. Allow a small air bubble (0.2 ml) in the syringe to the nurse assesses vital signs before, during
• Recommended site of injection for infant push the medication that may remain. and after infusion.
• Located at the middle third of the anterior 10. Introduce the needle in quick thrust to lessen
lateral aspect of the thigh. discomfort. Nursing Interventions in IV Infusion
11. Either spread or pinch muscle when
• Assume back-lying or sitting position. • Verify the doctor’s order
introducing the medication. Depending on the size
of the client. • Know the type, amount, and indication of IV
Rectus femoris site –located at the middle third, therapy.
12. Minimized discomfort by applying cold
anterior aspect of thigh. • Practice strict asepsis.
compress over the injection site before introduction
of medicati0n to numb nerve endings. • Inform the client and explain the purpose of IV
Deltoid site therapy to alleviate client’s anxiety.
13. Aspirate before the introduction of medication.
• Not used often for IM injection because it is To check if blood vessel had been hit. • Prime IV tubing to expel air. This will prevent
relatively small muscle and is very close to 14. Support the tissue with cotton swabs before air embolism.
the radial nerve and radial artery. withdrawal of needle. To prevent discomfort of • Clean the insertion site of IV needle from
• To locate the site, palpate the lower edge pulling tissues as needle is withdrawn. center to the periphery with alcoholized cotton
of the acromion process and the midpoint 15. Massage the site of injection to haste ball to prevent infection.
on the lateral aspect of the arm that is in absorption. • Shave the area of needle insertion if hairy.
line with the axilla. This is approximately 5 16. Apply pressure at the site for few minutes. To • Change the IV tubing every 72 hours. To
cm (2 in) or 2 to 3 fingerbreadths below the prevent bleeding. prevent contamination.
acromion process. 17. Evaluate effectiveness of the procedure and • Change IV needle insertion site every 72 hours
make relevant documentation. to prevent thrombophlebitis.
IM injection – Z tract injection • Regulate IV every 15-20 minutes. To ensure
• Used for parenteral iron preparation. To Intravenous administration of proper volume of IV fluid as
seal the drug deep into the muscles and The nurse administer medication intravenously by ordered.
prevent permanent staining of the skin. the following method: • Observe for potential complications.
• Retract the skin laterally, inject the • As mixture within large volumes of IV fluids.
medication slowly. Hold retraction of skin • By injection of a bolus, or small volume, or Types of IV Fluids
until the needle is withdrawn medication through an existing intravenous Isotonic solution – has the same concentration as
• Do not massage the site of injection to infusion line or intermittent venous access the body fluid
prevent leakage into the subcutaneous. (heparin or saline lock)
GENERAL PRINCIPLES IN PARENTERAL • By “piggyback” infusion of solution containing • D5 W
ADMINISTRATION OF MEDICATIONS the prescribed medication and a small volume • Na Cl 0.9%
1. Check doctor’s order. of IV fluid through an existing IV line.
2. Check the expiration for medication – drug • plainRinger’s lactate
potency may increase or decrease if outdated.
3. Observe verbal and non-verbal responses
• Most rapid route of absorption of • Plain Normosol M
medications.
toward receiving injection. Injection can be • Predictable, therapeutic blood levels of
painful.client may have anxiety, which can Hypotonic – has lower concentration than the
medication can be obtained. body fluids.
increase the pain. • The route can be used for clients with
4. Practice asepsis to prevent infection. Apply • NaCl 0.3%
compromised gastrointestinal function or Hypertonic – has higher concentration than the
disposable gloves. peripheral circulation. body fluids.
Keith Nester A. Lavin
  D10W • Notify physician • Physical therapy may be required
Note: apply splint with the fingers free to move.
 D50W Superficial Thrombophlebitis – it is due to Speed Shock – may result from administration of
 D5LR o0veruse of a vein, irritating solution or drugs, clot IV push medication rapidly.
formation, large bore catheters. • To avoid speed shock, and possible cardiac
 D5NM
Assessment: arrest, give most IV push medication over 3 to
• Pain along the course of vein 5 minutes.
Complication of IV Infusion
Infiltration – the needle is out of nein, and fluids • Vein may feel hard and cordlike
• Edema and redness at needle insertion site. BLOOD TRANSFUSION THERAPY
accumulate in the subcutaneous tissues.
Assessment: • Arm feels warmer than the other arm
Nursing Intervention: Objectives:
Pain, swelling, skin is cold at needle site, pallor of
the site, flow rate has decreases or stops. • Change IV site every 72 hours • To increase circulating blood volume after
• Use large veins for irritating fluids. surgery, trauma, or hemorrhage
Nursing Intervention: • Stabilize venipuncture at area of flexion.
• Change the site of needle • Apply cold compress immediately to relieve
• To increase the number of RBCs and to
maintain hemoglobin levels in clients with
• Apply warm compress. This will absorb edema pain and inflammation; later with warm
compress to stimulate circulation and severe anemia
fluids and reduce swelling.
promotion absorption. • To provide selected cellular components as
Circulatory Overload – Results from “Do not irrigate the IV because this could push clot replacements therapy (e.g clotting factors,
administration of excessive volume of IV fluids. into the systemic circulation’ platelets, albumin)
Assessment:
• Headache Air Embolism – Air manages to get into the Nursing Interventions:
• Flushed skin circulatory system; 5 ml of air or more causes air • Verify doctor’s order. Inform the client and
• Rapid pulse embolism. explain the purpose of the procedure.
• Increase BP Assessment: • Check for cross matching and typing. To
• Weight gain • Chest, shoulder, or backpain ensure compatibility
• Syncope and faintness • Hypotension • c. Obtain and record baseline vital signs
• Pulmonary edema • Dyspnea • d. Practice strict Asepsis
• Increase volume pressure • Cyanosis • e. At least 2 licensed nurse check the label of
• SOB • Tachycardia the blood transfusion
• Coughing • Increase venous pressure Check the following:
• Tachypnea • Loss of consciousness • Serial number
Nursing Intervention • Blood component
• shock
Nursing Interventions: • Do not allow IV bottle to “run dry” • Blood type
• Slow infusion to KVO • “Prime” IV tubing before starting infusion. • Rh factor
• Place patient in high fowler’s position. To • Turn patient to left side in the trendelenburg • Expiration date
enhance breathing position. To allow air to rise in the right side of • Screening test (VDRL, HBsAg, malarial smear)
the heart. This prevent pulmonary embolism. - this is to ensure that the blood is free from blood-
• Administer diuretic, bronchodilator as ordered
carried diseases and therefore, safe from
Nerve Damage – may result from tying the arm transfusion.
Drug Overload – the patient receives an
too tightly to the splint. • Warm blood at room temperature before
excessive amount of fluid containing drugs.
Assessment transfusion to prevent chills.
Assessment:
• Numbness of fingers and hands • Identify client properly. Two Nurses check the
• Dizziness
Nursing Interventions client’s identification.
• Shock
• Massage the are and move shoulder through • Use needle gauge 18 to 19. This allows easy
• Fainting
its ROM flow of blood.
Nursing Intervention
• Instruct the patient to open and close hand
• Slow infusion to KVO.
several times each hour.
• Take vital signs
Keith Nester A. Lavin
• Use BT set with special micron mesh filter. To • Vomiting 8. Blood container, tubing, attached label, and
prevent administration of blood clots and • Marked Hypotension transfusion record are saved and returned to the
particles. • High fever laboratory for analysis.
• Start infusion slowly at 10 gtts/min. Remain at
bedside for 15 to 30 minutes. Adverse reaction Circulatory Overload – it is caused by
usually occurs during the first 15 to 20 administration of blood volume at a rate greater
minutes. than the circulatory system can accommodate.
• Monitor vital signs. Altered vital signs indicate Assessment
adverse reaction. • Rise in venous pressure
• Do not mixed medications with blood • Dyspnea
transfusion. To prevent adverse effects • Crackles or rales
• Do not incorporate medication into the blood • Distended neck vein
transfusion • Cough USING SAFETY MEASURES WHILE PREPARING DRUGS
• Do not use blood transfusion line for IV push of • Elevated BP 1. Three Checks and Five Rights
medication.
- label on medication should be checked 3
• Administer 0.9% NaCl before, during or after Hemolytic reaction - It is caused by infusion of times during preparation
BT. Never administer IV fluids with dextrose. incompatible blood products. - when nurse reaches for container or unit
Dextrose causes hemolysis. Assessment dose package
• Administer BT for 4 hours (whole blood, packed • Low back pain (first sign). This is due to - immediately before pouring or opening
rbc). For plasma, platelets, cryoprecipitate, inflammatory response of the kidneys to medication
transfuse quickly (20 minutes) clotting factor incompatible blood. - when replacing container to drawer or
can easily be destroyed. • Chills shelf or before giving unit dose medication
• Feeling of fullness
Complications of Blood Transfusion • Tachycardia Right medication to right patient in the right
• Flushing dosage through the right route at the right time
Allergic Reaction – it is caused by sensitivity to • Tachypnea
plasma protein of donor antibody, which reacts • Hypotension 2. Caring for Controlled Substances Safely
with recipient antigen. - controlled substances are kept in a locked
• Bleeding
Assessments drawer or container as a safety measure
• Vascular collapse
• Flushing - narcotics or controlled substances may be
• Acute renal failure ordered only by physician (sometimes, nurse
• Rush, hives
• Pruritus practitioners registered with Dept. of Justice)
Nursing Interventions when complications - record must be kept for each narcotic
• Laryngeal edema, difficulty of breathing occurs in Blood transfusion administered
Febrile, Non-Hemolytic – it is caused by - forms are kept with narcotics
1. If blood transfusion reaction occurs. STOP THE - information required: - receiving
hypersensitivity to donor white cells, platelets or TRANSFUSION.
plasma proteins. This is the most symptomatic patient’s name, hour narcotic was given, name of
2. Start IV line (0.9% Na Cl ) physician prescribing narcotic, name of nurse
complication of blood transfusion 3. Place the client in fowlers position if with SOB
Assessments: administering narcotic
and administer O2 therapy. - narcotics are checked daily
• Sudden chills and fever 4. The nurse remains with the client, observing - amount on hand is counted and each
• Flushing signs and symptoms and monitoring vital signs as dose used must be accounted for on the narcotic
• Headache often as every 5 minutes. record
• Anxiety 5. Notify the physician immediately. - nurse has a secure i.d. code that provides
6. The nurse prepares to administer emergency access into the system, identifies patient by name
Septic Reaction – it is caused by the transfusion drugs such as antihistamines, vasopressor, fluids, or i.d. number, and verifies count for each drug as
of blood or components contaminated with and steroids as per physician’s order or protocol. it is removed
bacteria. 7. Obtain a urine specimen and send to the - count that does not check properly must
Assessment: laboratory to determine presence of hemoglobin as be reported immediately
• Rapid onset of chills a result of RBC hemolysis.
Keith Nester A. Lavin
 - if for any reason a narcotic prepared for - do not transfer medication from one - prevents contamination
administration has to be discarded, a 2nd nurse container to another i. Remain with patient until each medication is
should act as witness, and that person should also swallowed
sign the narcotic sheet 1. Steps / Rationales - only by physician’s order can medication
- also document with a witness any time a a. Know actions, special nursing considerations, be left at bedside
full dosage is not given and some of the narcotic safe dose ranges, purpose of administration, and j. Record each medication given on medication
needs to be disposed. adverse effects of medication to be administered. chart – record refused or omitted drugs, record
- aids nurse in evaluating therapeutic narcotic administration and any additional required
3. Identifying the Patient effect, can also be used to educate patients about forms
- positive identification of patient is their medication - prompt recording avoids possibility of
essential to safe drug administration b. Prepare medication for administration in accidentally repeating administration
- check carefully to see that right drug is medication area - verifies reason medication was omitted
being given to right patient - facilitates error free administration and and ensure physician is aware of patient’s
- patients usually wear identification saves time condition
bracelets c. Prepare medications for one patient at a time k. Check patient within 30 minutes to verify his/her
- ask patient to state his/her name, if - prevents errors in medication response to medication
possible administration
- check current photograph of resident, if d. Hold liquid medication bottles with label against ADMINISTERING MEDICATIONS TO CHILDREN
available, which is usually displayed above the palm. Use appropriate measuring device when - children younger than 5 yrs have difficulty
resident’s bed pouring, read amt. of medication at bottom of swallowing tablets and capsules
- verify patient i.d. with other healthcare meniscus at eye level - in addition to understanding medication
providers - label is needed for additional safety order and reason for medication, caregiver should
check, also may indicate monitoring of certain vital be able to
ADMINISTERING ORAL MEDICATIONS signs demonstrate any special techniques involved in
- check patient to ensure medication was - liquid may drip onto label making it administering prescribed drugs
they actually take meds (make sure they don’t difficult to read - use dropper for infants or very young
“cheek” it e. When all medications for one patient have been children
- preparation forms include solid (tablets, prepared recheck once again with medication - place medication between gum and cheek
capsules, pills) order before taking them to patient – keep to prevent aspiration
- some tablets are scored for easy breaking medications in sight at all times - crush uncoated tablets or empty soft
if partial quantity is needed - 3rd check to ensure accuracy and to capsule and mix med with soft food (potatoes,
- enteric-coated tablets and extended- prevent errors pudding, cooked
release forms (SR = sustained release, XL = f. Identify patient carefully: check name on i.d. or hot cereal)
extended release, CR/CT = controlled release, SA = band, ask patient his/her name, verify patient’s i.d. - proper absorption may not occur
sustained action, LA = with staff members who know patient - if med has objectionable taste, warn child
long-acting) should not be chewed or crushed - most reliable method, requires an answer - failing to warn is likely to decrease child’s
- certain narcotics can be administered in a from patient trust in nurse
lollipop or oral-transmucosal form liquids (elixirs, - do not use name on door or over bed – - take care when selecting food – item
spirits, suspensions, syrups) these may be inaccurate should not be essential part of child’s diet
- water-based and alcohol-based solutions g. Check allergy bracelet or ask patient about - child may refuse food associated with
- can be administered via syringe between allergies – explain purpose and action of each meds
gum and cheek medication to patient - offer child flavored ice pop or frozen fruit
- if label becomes difficult to read or - assessment is prerequisite to bar immediately before taking meds
accidentally comes off, container should be administration of medication - numbs tongue, making take less evident
returned to pharmacy h. Offer water or other permitted fluids with - praise child for job well done after
- never give a medication from a bottle pills, capsules, tables, and some liquid measures – administration
without a label If capsule or tablet falls to floor, it must be
- care should be taken when pouring to discarded and a new one administered ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING
prevent unnecessary loss - facilitates swallowing of solid drugs TUBE
- encourages patient’s participation

Keith Nester A. Lavin

 - use liquid meds or meds that can be - abdomen = patient may lie in - chart administration including injection
crushed and combined with liquid semirecumbent position site
- bring liquid med to room temp - ensure site of choice is not tender and is - evaluate patient within appropriate time
- remove clamp from tube, checking for free of lumps or nodules frame
tube placement before administering drug - clean area
- flush tube with 15 – 30 mL water (5 – 10 - grasp and bunch area surrounding EYE INSTILLATIONS AND IRRIGATIONS
mL for children) before giving meds and injection site or spread skin at site - applications to eye seldom are placed
immediately after - provides easy, less painful entry directly onto eyeball
- give meds separately and flush with - thin patients should have their skin - applications intended to act on eye or lids
water between each drug bunched to create skin fold are placed onto, or instilled or irrigated into, lower
- disconnected from suction and clamped - with dominant hand, inject needle at 45 - conjunctival sac
20 – 30 minutes after administration 90° angle with dart-like action - sterile application
- disconnect continuous tube feeding, - after needle is in place, release tissue
leaving tube clamped for short period of time - aspirate if recommended - if blood 1.Eyedrops – instilled for local effects (pupil
- document water intake and liquid med on appears, withdraw needle dilation or constriction when examining, for
I & O chart - do not aspirate when giving insulin or any treatment, or controlling intraocular pressure for
form of heparin glaucoma)
ADMINISTERING INTRADERMAL INJECTION - massage area gently, except with heparin - type and amt of solution depend on
- if necessary, withdraw med from ampule or insulin, apply small bandage if necessary purpose of instillation
or vial - chart administration including injection - hold dropper close to eye but avoid
- select area on inner aspect of forearm site touching eyelids or lashes
that is not heavily pigmented or covered with hair - evaluate patient’s response within - administer prescribed number of drops
- forearm is convenient and easy, hair or specified times - apply gentle pressure to inner canthus to
lesions may interfere with assessments prevent eyedrops from flowing into tear duct
- cleanse area using aseptic technique ADMINISTERING INTRAMUSCULAR INJECTION - instruct patient not to rub
- use nondominant hand to spread skin - if necessary, withdraw med from ampule - chart administration
taut over injection site or vial - evaluate for response
- place needle almost flat against patient’s - do not add air to syringe
skin, bevel side up, and insert needle into skin so - identify patient carefully 2. Eye Irrigation
that point can be seen through skin (approx. 1/8”) - have patient assume appropriate - have patient sit or lie with head tilted
- inject agent while watching for small position:- ventrogluteal = patient may lie on back toward side of affected eye
wheal or blister – if none, withdraw needle slightly or side with hip and knee flexed - clean from inner toward outer canthus to
- do not massage area vastus lateralis = patient may lie on back or prevent debris entering lacrimal ducts
- assess patient for comfort may assume sitting position - expose lower conjunctival sac, hold
- chart administration as well as site of deltoid = patient may site or lie with arm relaxed irrigator about 2.5 cm (1”) from eye, direct flow
injection dorsogluteal = patient may lie prone with toes from inner to outer canthus
- observe area for reaction at ordered pointing inward or on side with upper leg flexed - irrigate until solution is clear or all of the
intervals (usually 24- to 72-hours) and placed in front of lower leg solution has been used
- aspiration is not recommended - ensure site is not tender and is free of - use only enough force to remove
lumps or nodules secretions gently
ADMINISTERING SUBCUTANEOUS INJECTION - spread skin at site using nondominant - avoid touching any part of eye
- if necessary, withdraw med from ampule hand - dry area with cotton balls or gauze
or vial - quickly dart needle into tissue at 72- to sponge
- identify patient carefully 90° angle - chart irrigation, appearance of eye,
- have patient assume appropriate position: - aspirate – if blood is present, discard drainage, and patient’s response
injection into tense extremity causes discomfort needle, syringe, and med - - prepare new sterile
- outer aspect of upper arm = patient’s setup and inject at another site ADMINISTERING SUBLINGUAL AND BUCCAL MEDICATIONS
arm should be relaxed and at body’s side - gently apply pressure at site with small, sublingual – tablet is placed under patient’s
- anterior thighs = patient may sit or lie dry sponge tongue
with leg relaxed

Keith Nester A. Lavin

buccal – medication is administered between the - be sure patient understand he/she is to
cheek and gum retain suppository, usually 30 – 40 minutes after
insertion.
- these areas are rich in superficial blood
vessels, allowing relatively rapid absorption into
the bloodstream for quick systemic effect
- should not be swallowed but rather held
in place so that complete absorption can occur

ADMINISTERING TOPICAL MEDICATIONS

topical – drug is applied directly to body site

- applied for direct action at particular site,

although some systemic effect may occur
- if application site is a cavity (nose) or is
enclosed (eye), mechanical applicator is needed to
introduce drug

inunction - ointment preparation is rubbed into

skin for absorption
- cleaning skin thoroughly with soap or
detergent to enhance absorption
- when indicated, apply local heat to
improve blood circulation and promote absorption

RECTAL SUPPOSITORIES
suppository – conical or oval solid substance
shaped for easy insertion into body cavity and
designed to melt at body temperature

- functions include fecal softener

(constipation), direct action on nerve endings in
rectal mucosa (weak
muscle tone or poor intervention), and carbon
dioxide when moistened (liberates gas, distends,
stimulates elimination impulses)
- have patient lie on either side and pie-fold
top lines over him/her
- lubricate suppository and fingertips to
reduce irritation
- separate buttocks and have patient relax
by breathing through mouth during insertion
- introduce suppository well beyond
internal sphincter (4” – adults, 2” – children and
infants)
- avoid embedding suppository in fecal
mass
- correct placement is between stool and
rectal mucosa

Keith Nester A. Lavin