Administration

of
Drugs
 A) Administering Oral Medication
Check Equipment:-
1-medication cart 2-medication tray 3- Disposable medication cups
4- glass of water 5- drugs (capsules or tablet) 6-liquied

STEP CASES
1 2 3 Rationale
1) Checks the written order.
2) Compares the written order to the transcribed
information on the medication Kardex or card.
3) Reviews drug-related information, if
unknown.
4) Reads the chart to obtain health information.
5) If an agency uses a manual recording system for
controlled substances, check the record for the
previous drug count and compare it with the
supply available
6) Remove the next available tablet and drop it in
the medicine cup
7) Place the prepared medication and MAR together
on the medication cart
8) Recheck the label on the container before
returning the bottle, box, or envelope to its
storage place
9) Reads and compares the drug label with the This third check
medication card or Kardex at least three times further reduces
before administering a medication. the risk of error.
10) Avoid leaving prepared medications unattended This precaution
prevents
potential
mishandling
errors.
11) Check the room number against the MAR This is another
safety measure
to ensure that
the nurse is
entering the
correct client
room
12) Washes hands.
13) Introduce self and verify the client’s identity
 14) Assist the client to a sitting position or, if not These positions
possible, to a side-lying position facilitate
swallowing and
prevent
aspiration

15) If not previously assessed, take the required

assessment measures, such as pulse and
respiratory rates or blood pressure.
16) . Explain the purpose of the medication and how it
will help, using language that the client can
understand. Include relevant information about
effects
17) Fills a glass with fresh water.
18) Administer the medication at the correct time.
19) Helps the client take the medication.
20) If the client says that the medication you are : The nurse must
about to give is different from what the client has see the client
been receiving, do not give the medication swallow the
without first checking the original order medication
before the drug
administration
can be recorded
21) Stay with the client until all medications have
been swallowed
22) Washes hands.
23) Record the medication given, dosage, time, any
complaints or assessments of the client, and your
signature
24) Reassesses the client within 30 minute.

Key
3 = Satisfactory
2 = Unsatisfactory
1= Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
 B) Administering Eye Medication
Check Equipment:-
1-client MAR 2-medication tray 3-eye drops medication
4- Clean cotton gauze 5- disposable gloves &tissue

STEP CASES
1 2 3 Rationale
1) Checks the written medical order.
2) Compares the written prescription with the
MAR for drug name ,dose, and strength
3) Check client allergy status
4) Know the reason why the client is receiving the
medication, the drug classification,
contraindications, usual dose range, side effects.
5) Washes hands.
6) Checks the identification of the client.
7) Explains the procedure to the client.
8) Provide for client privacy
9) Assesses the status of the eye(s).
10) Positions the client appropriately.
11) Clean the eyelid and the eyelashes. If not removed,
12) • Apply clean gloves. • Use sterile cotton balls material on the
moistened with sterile irrigating solution or sterile eyelid and lashes can
normal saline, and wipe from the inner canthus to be washed into the
the outer canthus. eye. Cleaning toward
the outer canthus
prevents
contamination of the
other eye and the
lacrimal du
13) Before administering the eye medication. • Check Checking medication
the ophthalmic preparation for the name, data is essential to
strength, and number of drops if a liquid is used prevent a medication
error
14) Instruct the client to look up to the ceiling. Give
the client a dry sterile absorbent pad.
15) Expose the lower conjunctival sac by placing the Placing the fingers on
thumb or fingers of your nondominant hand on the cheekbone
the client’s cheekbone just below the eye and minimizes the
 gently drawing down the skin on the cheek possibility of
touching the cornea,
avoids putting any
pressure on the
eyeball, and prevents
client from blinking
or squinting
16) Holding the medication in the dominant hand,
place hand on client’s forehead to stabilize hand.
Hold the dropper 1 to 2 cm (0.4 to 0.8 in.) above
the sac.
17) Instills the prescribed amount of medication
within the conjunctival sac without touching
any structures of the eye.
18) Allows the lid to gently close.
19) Applies light pressure to the inner canthus.
20) Wipes away any excess medication.
21) Returns the medication container to its stocked
location.
22) Washes hands.
23) Records the medication administration.
24) Returns to reassess the client in a reasonable
period of time.

Key
3= Satisfactory
2 = Unsatisfactory
1 = Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
 Administering Ear Medication

ASSESSMENT:
• Appearance of the pinna of the ear and meatus for signs of redness and abrasions
• Type and amount of any discharge

Check Equipment:-
• Client’s MAR or computer printout
• Clean gloves
• Clean gauze
• Correct medication bottle with a dropper
• Cotton ball

STEP CASES
1 2 3 Rationale
1) Checks the written order
2) Check the MAR
• Check the MAR for the drug name, strength,
number of drops, and prescribed frequency.
• Check client allergy status.
. Compare the label on the medication container
with the medication recorded and expired date.

3) Prepare equipment.
4) Washes hands
5) Checks the client’s identification.
6) Provides privacy.
7) Explain to the client what you are going to do
8) Prepare the client in good position
9) Apply gloves if infection is suspected. This removes any discharge
Use a clean washcloth or gauze to wipe the pinna present before the instillation
and auditory meatus so that it will not be washed
into the ear canal
10) Straighten the auditory canal. Pull the pinna The auditory canal is
upward and backward for clients over 4 years of straightened so that the
age. solution can flow the entire
length of the canal
 11) Warm the medication container in your hand, or This promotes client comfort
place it in warm water for a short time and prevents nerve
stimulation and pain
12) Instills the prescribed number of drops.
13) Presses on the tragus a few times after : Pressing on the tragus
instilling the medication. assists the flow of medication
into the ear canal
14) Insert a small piece of cotton loosely at the
meatus of the auditory canal for 15 to 20 minutes
15) Instructs the client to maintain his position for
at least 5 minutes.
16) Removes equipment and disposes or returns it
to the appropriate location .
17) Washes hands.
18) Charts the drug administration.
19) Returns in 30 minutes to remove the cotton
wick and reassess the client.

Key
3= Satisfactory
2 = Unsatisfactory
1= Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
D) Applying Topical Medication
Check Equipment:
1- Medication cart 2-medication tray 3- topical medication 4- Clean
cotton gauze 5- disposable gloves &tissue

STEP CASES
1 2 3 Rational
1) Review physician's order for client's name,
name of drug, time of administration, and site
of application.
2) Gather the equipment correctly.
3) Wash your hand.
4) Provide privacy for the client.
5) Explain the procedure to the client.
6) Wash affected area (sterile technique for non-
intact skin and clean technique for the intact).
7) Pat skin dry or allow area to air dry.
8) Apply appropriate amount of medication over
the site.
9) For Transdermal Patches:
10) Choose a clean, dry, not oily, and area that is
free of hair.
11) Avoid previously used sites for at least 1
week.
12) Remove the old patch if present.
13) Remove the patch from its protective covering
correctly.
14) Press firmly with the palm of one hand for 10
seconds.
15) Advise the patient not to use heating pads
anywhere near the site.
16) Date and initial patch and note time.
17) For Aerosol Spray:
18) Shake the container.
19) Hold the spray away from area 15 to 30 cm.
20) Client face is covered when the area is near to
the face.
21) Spray the medication appropriately over the
area.
 22) Documentation is appropriate.
23) Medicated Powder::
24) Dry the skin surface thoroughly.
25) The area is appropriately dusted with layer of
powder.
26) Cover the area appropriately if ordered.
27) Documentation is appropriate.

Key
3 = Satisfactory
2 = Unsatisfactory
1 = Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
Administration of Intradermal Injections
Check Equipment:-
1- Vial or ampule of the correct medication 2- alcohol swab 3-Client’s MAR or computer printout
, medication form and Kardex 4- disposable gloves 5-Epinephrine on hand in
case of allergic anaphylactic reaction
5- syring 1cc with needle #25- to #27-gauge safety needle that is 1/4 to 5/8 inch long

STEP Rationale
1 2 3
1. . Perform hand hygiene and observe other
appropriate infection prevention procedures.

2. Prepare the medication from the vial or ampule

for drug withdrawal.

3. Prepare the client • Prior to performing the This ensures that the
procedure, introduce self and verify the client’s right client receives the
identity using agency protocol.
medication
4. keep the privacy

5. Selected appropriate injection site.

6. Avoid using sites that are tender, inflamed, or

swollen and those that have lesions.

7. Apply gloves as indicated by agency policy.

8. Cleanse the skin at the site using a firm circular

motion starting at the center and widening the circle
outward. Allow the area to dry thoroughly.

9- Prepare the syringe for the injection. • Remove

the needle cap while waiting for the antiseptic to
dry

10 Expel any air bubbles from the syringe. Small A small amount of air
bubbles that adhere to the plunger are of no will not harm the
consequence. tissues

11. Grasp the syringe in your dominant hand, close The possibility of the
to the hub, holding it between thumb and medication entering
forefinger. Hold the needle almost parallel to the
the subcutaneous
skin surface, with the bevel of the needle up.
tissue increases when
using an angle greater
than 15°.
12. Inject the fluid. • With the nondominant hand, : Taut skin allows for
pull the skin at the site until it is taut. For example, if easier entry of the
using the ventral forearm, grasp the client’s dorsal
needle and less
forearm and gently pull it to tighten the ventral skin.
discomfort for client
13. Insert the tip of the needle far enough to place
the bevel through the epidermis into the dermis.
The outline of the bevel should be visible under the
skin surface.

14. Stabilize the syringe and needle. Inject the This verifies that the
medication carefully and slowly so that it produces a medication entered the
small wheal on the skin.
dermis.
15 Withdraw the needle quickly at the same angle Massage can disperse
at which it was inserted. Activate the needle safety the medication into the
device. Apply a bandage if indicated.
tissue or out through
the needle insertion
site
16. Dispose of the syringe and needle into the sharp Do not recap the
container. needle in order to
prevent needlestick
injuries.
17. Remove and discard gloves then Perform hand
hygiene.

18. Circle the injection site with ink to observe for

redness or induration , per agency policy.

19. Document all relevant information. Record the

 testing material given, the time, dosage, route, site,
and nursing assessments.

Key
3 = Satisfactory
2= Unsatisfactory
1 = Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
 Administration Of Medication ( Subcutaneous
ASSESSMENT

• Allergies to medication

• Specific drug action, side effects, and adverse reactions

• Client’s knowledge and learning needs about the medication injections.

Check Equipment:-
1- medication 2- alcohol swab 3-medication form and kardex or MAR. 4- disposable
gloves
5- syring 1cc with needle with an subcutaneous bevel

STEP CASES
0 1 2 Radical
1) Check doctor order.
2) 1. Check the MAR. • Check the label on the
medication carefully against the MAR to make
sure that the correct medication is being Follow
the three checks for administering medications.
Read the label on the medication.
(1) when it is taken from the medication cart,
(2) before withdrawing the medication,
(3) after withdrawing the medication prepared.

3) Wash your hands and observe other

appropriate infection prevention procedures
(e.g., clean gloves).
4) Prepare the medication observing safety
guidelines for administration including sex
rights .
5) Identify the patient before giving medication. This ensures that the
right client receives
the right medication
6) Explain the technique to the patient. Information can
facilitate acceptance
of and adherence to
the therapy.
7) provide privacy.
8) Assist the patient to comfortable position. : A relaxed position
Select the appropriate site using anatomic of the site minimizes
landmark. discomfort
9) Select a site free of tenderness, hardness, These condition
swelling, scarring, itching, burning, or localized could hinder the
inflammation. Select a site that has not been absorption of the
used frequently medication and may
also increase the
likelihood of injury
and discomfort at the
injection site.
10) Apply clean gloves
11) Clean the skin with an alcohol swab. As The mechanical
agency protocol indicates, clean the site with an action of swabbing
antiseptic swab. Start at the center of the site removes skin
and clean in a widening circle to about 5 cm (2 secretions, which
in.). contain
microorganisms. •
Place and hold the
swab between the
third and fourth
fingers of the
nondominant hand,
or position the swab
on the client’s skin
above the intended
site
12) Remove the needle cap while waiting for the : The needle will
antiseptic to dry. Pull the cap straight off to become
avoid contaminating the needle by the outside contaminated if it
edge of the cap touches anything but
the inside of the cap,
which is sterile
13) Dispose of the needle cap
14) Hold the syringe as if you were holding a
pencil.
15) Insert the needle quickly at the correct angle.
The usual rule is 45° for the thin patient and
90° for obese.
16) Transfer your thumb to the end of the
plunger and slowly inject the medication.
17) Withdraw the needle quickly, and at the
same angle at which you inserted it.
18) If bleeding occurs, apply pressure to the site
with dry sterile gauze until it stops. Bleeding
rarely occurs after subcutaneous injection.
19) Don’t massage the site.
20) Lock the safety syringe in sharps container.
 21) Properly dispose of gloves.
22) Wash your hands
23) Document administration on medication
form including the site of administration.
24) . Assess the effectiveness of the medication at
the time it is expected to act and document it.

Key
3= Satisfactory
2= Unsatisfactory
1= Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..
 Intramuscular Injections

Student Name:……………………… ID #....................................

Check Equipment:-
1- medication 2- alcohol swab 3-medication form and kardex 4- disposable gloves
5- syring ( 3-5cc) with needle 1 1/2 inches and #21 or #22 gauge, a #23- to #25- gauge needle 1 inch
long is commonly used for the deltoid muscle .6- kidney shape receiver.
ASSESSMENT
• Client allergies to medication(s)
• Specific drug action, side effects, and adverse reactions
• Client’s knowledge of and learning needs about the medication
• Tissue integrity of the selected site
• Client’s age and weight to determine site and needle size
• Client’s ability or willingness to participate
• Determine whether the size of the muscle is appropriate to the amount of medication to be injected

STEP CASES
1 2 3 Rationale
1) Check doctor order.
2) Check the MAR.
3) • Check the label on the medication carefully
against the MAR to make sure that the correct
medication is being prepared.
4) • Follow the three checks for administering the
medication and dose. Read the label on the
medication (1) when it is taken from the
medication cart, (2) before withdrawing the
medication, and (3) after withdrawing the
medication. • Confirm that the dose is correct.
5) Organize the equipment
6) Wash your hands.
7) Prepare the medication from the ampule or vial
for drug withdrawal.
8) Withdraw medication from an ampule or vial.
• Whenever feasible, change the needle on the
syringe before the injection.
9) Identify the patient before giving medication.
10) Explain the technique to the patient. This ensures that the
right client receives the
medication.
11) Don gloves and provide privacy.
12) Assist the patient to comfortable position.
 Selects the appropriate site using anatomic
landmark.
13) Clean the skin with an alcohol swab. Start at This prevents entry of
the site and move outward with a circular bacteria into the
motion start at the center and move outward injection site
about 5 cm (2 in.). Allow the area to dry.
14) Remove the needle cover and discard without
contaminating the needle.
15) . Inject the medication using the Z-track
technique. • Use the ulnar side of the
nondominant hand to pull the skin approximately
2.5 cm (1 in.) to the side.
16) Holding the syringe between the thumb and Using a quick motion
forefinger (as if holding a pen), pierce the skin lessens the client’s
quickly and smoothly at a 90° angle and insert discomfort. Holding the
the needle into the muscle. syringe like a pen or
pencil reduces
accidental depression
of the plunger and
inadvertent
administration of the
medication while the
needle is being inserted
17) Hold the barrel of the syringe steady with your If the needle is in a
nondominant hand and aspirate by pulling small blood vessel, it
back on the plunger with your dominant hand. takes time for the
Aspirate for 5 to 10 seconds. If no blood blood to appear. If
appears, inject the medication at slow and blood appears in the
steady rate syringe, withdraw the
needle, discard the
syringe, and prepare a
new injection. This step
determines whether
the needle has been
inserted into a blood
vessel.
18) Withdraw the needle smoothly at the same angle This minimizes tissue
of insertion injury. Release the skin
19) Apply gentle pressure at the site with a dry Use of an alcohol swab
sponge may cause pain or a
burning sensation.
20) It is not necessary to massage the area at the site Massaging the site may
of injection cause the leakage of
medication from the
site and result in
irritation
21) If bleeding occurs, apply pressure with a dry
 sterile gauze until it stops
22) Don’t recap the needle. Place the uncapped
needle and syringe in an appropriate container.
Use a safety syringe, if available.
23) Assist the patient to apposition of comfort.
24) Remove gloves and wash your hands.
25) Document administration on medication form
including the site of administration.
26) Assess the effectiveness of the medication at the
time it is expected to act.

Key
3= Satisfactory
2 = Unsatisfactory
1 = Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..

H) Intravenous Therapy

ASSESSMENT

• Inspect and palpate the IV insertion site for signs of infection, infiltration, or a dislocated
catheter.

• Inspect the surrounding skin for redness, pallor, or swelling.

• Palpate the surrounding tissues for coldness and the presence of edema, which could
indicate leakage of the IV fluid into the tissues.

• Take vital signs for baseline data if the medication being administered is particularly potent .
Check Equipment:-
o Client’s MAR
o Medication in vial or ampule
o needle for withdrawing medication from an ampule or vial
o Sterile syringe (3 to 5 mL)
o Antiseptic swabs
o Clean gloves.
o Normal saline

STEP CASES
1 2 3 Rationale
1) Check doctor order.
2) Check the MAR. • Check the label on the
medication carefully against the MAR to make sure
that the correct medication is being prepared.
• Follow the three checks for correct medication and
dose. Read the label on the medication (1) when it is
taken from the medication cart, (2) before
withdrawing the medication, and (3) after
withdrawing the medication.
• Calculate the medication dosage accurately and the
recommended delivery rate (e.g., 20 mg over 1
minute).
• Confirm that the route is correct.
.
3) Organize the equipment.
4) Wash your hands.
5) Identify the patient before giving medication.
6) Explain the technique to the patient.
7) . Prepare the medication. • Prepare the : It is important to have the
medication into a syringe according to the correct dose and the
manufacturer’s direction correct dilution,
1) . Perform hand hygiene and apply clean gloves This reduces the
transmission of
microorganisms and
reduces the likelihood of
the nurse’s hands
contacting the client’s
blood
9) . Provide for client privacy
10) Prior to performing the procedure, introduce self
and verify the client’s identity using agency protocol.
11) Explain the purpose of the medication and how it Information can facilitate
will help acceptance of and
 adherence to the therapy.
9)Clean the needleless injection port with the
antiseptic swab)
10) Insert the first saline needleless syringe into the The presence of blood
injection port and flush with 1 to 2 mL, then aspirate confirms that the catheter
for a blood return is in the vein
11)Flush the remaining saline into the vascular
access device1)
12)Administer the medication by IV
13) Observe the area above the IV catheter for
puffiness or swelling. This indicates infiltration into
tissue, which would require removal of the IV
catheter.
14) Observe the client closely for adverse reactions.
Remove the syringe when all medication is
administered
15) Clean the needleless connector or injection port
with a new antiseptic swab.
16) Attach the second saline syringe, and flush at the The saline injection flushes
same time frame as the medication the medication through the
catheter
17) Wash your hands.
18) Documentation: date, time of
given ,medication name ,dose ,signature.

Key
3= Satisfactory
2 = Unsatisfactory
1 = Not Performed

Documentation:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………….

Student signature: …………………….. Date: …………………..

Instructor signature: ………………….. Date: …………………..