NURSING PROCESS IN

ADMINISTERING MEDICATIONS

Prepared By : GRP,
RN
ASSESSMENT
• The first step in the nursing process; it is
the systematic, organized collection of data
about the patient. Two key areas that need
to be assessed are the patient’s history
(past and present illness) and his physical
status
A. PAST HISTORY
• Chronic conditions • Level of understanding
• Drug use of disease and therapy
• Allergies • Previous medical record
• Level of education
• Social support
• Financial support
• Pattern of health care
B. PHYSICAL ASSESSMENT

• Weight
• Age
• Vital signs
• Sensory and cognitive
barriers
NURSING DIAGNOSIS
• Shows actual or potential alterations in
patient’s function based on the assessment
of the clinical situation
Common Nursing Diagnoses r/t
Drug Therapy:
• Ineffective health maintenance
• Risk for injury
• Noncompliance
• Knowledge deficit
• Ineffective management of therapeutic
regimen
PLANNING
• Includes goal setting, setting priorities and
determining nursing interventions
• For medications, planning includes activities as
discussing the client’s medication needs
• Nurses also formulate instructional objectives and
design client education programs to assist
individuals in the self-administration of drugs
In planning, focus on:
• Why the drug is needed
• How the drug is administered
• Common indications of adverse effects
• Best schedule to administer the drug
• Drug Interactions
IMPLEMENTATION
• Includes the nursing actions necessary to
accomplish the established goals. Client
education and teaching is our primary
responsibility
• For drug therapy, implementation includes all
aspects of medication administration (working
with the doctor, giving drugs as prescribed,
preparing drugs, calculating dosages, using
appropriate admin techniques, staying alert for
errors, documenting the drugs given)
IMPLEMENTATION
• 3 types of interventions frequently involved
in drug therapy:
– Drug administration
– Provision of comfort measures
– Patient/family education
Proper Drug Administration
Guidelines
• Administer medications as
prescribed
• Never give a drug poured
or prepared by somebody
else
• Never allow the med cart
or tray out of your sight
once you have prepared a
dose
• Never leave a drug at a
patient’s bedside; rather
watch the patient swallow
the drug
• Never return unwrapped or prepared drugs to the
stock supply
• Keep the medication cart locked at all times
• Follow standard precautions as appropriate
• Consider legal aspects associated with drug
therapy
• Consider ethical principles when dealing with
medication errors, meds during pregnancy, and
investigational protocols
• Medication errors can easily be caused by similar
sounding names, unclear orders, wrong route of
administration, and miscalculation of dosages;
take care to avoid these errors
Comfort Measures
• Placebo effect
• Manage anticipated adverse
• Lifestyle adjustment
Patient and Family Education
• Name, dose and action of the drug
• Timing of administration
• Special storage and preparation instruction
• Specific OTC drugs or alternative therapies to
avoid
• Special comfort and safety measures
• Specific points about drug toxicity
• Specific warning about drug discontinuation
Additional teaching tips:
• Provide written instructions
• Use colorful graphs and charts
• Encourage client and family to ask
questions
Nursing implications
• Ensure cleanliness of your hands, work
area, and supplies
• Ensure availability of supplies
• Ensure adequate lighting
• Decrease environmental distractions
EVALUATION
• Comparing the patient’s therapeutic goals with
his actual response to drug therapy
• in this phase, the nurse must be able to answer
the following questions:
– What therapeutic effects should the drug produce?
– What adverse reactions is the drug known to cause?
– By what mechanism of action does the drug work?
– What should the patient know about the drug
– Which therapeutic effects has the drug produced for
the patient? If none, or if the effects have been
insufficient, which issues may be involved?
12 “RIGHTS” OF DRUG
ADMINISTRATION
1. RIGHT CLIENT 9. RIGHT OF THE CLIENT
2. RIGHT DRUG TO KNOW THE
3. RIGHT DOSE REASON FOR THE
DRUG
4. RIGHT ROUTE
10. RIGHT EVALUATION
5. RIGHT TIME
11. RIGHT
6. RIGHT ASSESSMENT DOCUMENTATION
7. RIGHT MOTIVATION/ 12. RIGHT DRUG
APPROACH PREPARATION
8. RIGHT OF THE CLIENT
TO REFUSE
RIGHT CLIENT
• Check ID bracelet
• Have client state his or her name
• Address the person by name before giving
the drug
• Always double check orders that the client
questions
RIGHT DRUG
• Means that the right client
receives the drug that was
prescribed
• For hospitalized clients, the
drug orders are written on the
“doctor’s order sheet” and
signed by the duly authorized
person
• A telephone order (TO) for
medications must be cosigned
by the physician within 24
hours
• Check the drug label 3 times
before administering the
medication
COMPONENTS OF DRUG
ORDERS:
• Date and time the order is written
• Drug name
• Drug dosage
• Route of administration
• Frequency of administration
• Physician/ provider’s signature
Categories of Drug Orders
• Standing order- protocols derived from guidelines
created by healthcare providers for use in specific
settings, for treating certain diseases or sets of symptoms
• Standard order- may be an ongoing order, may be given
for a specific number of doses or days. May include prn
orders
• One time or single order- given once and usually at a
specific time
• PRN orders- given at the client’s request and nurse’s
judgment concerning need and safety
• Stat orders- given once immediately
RIGHT DOSE
• Refers to the dose prescribed for a
particular client

NURSING IMPLICATION:
• Be familiar with the various measurement
system and the conversion from one
system to another
Measuring devices:
• Medication cups
• Dropper
• Syringe
– Tuberculin
– Insulin
– General purpose
• For use in
administering .50-50ml
of medication
Nursing Implication:
• Always use the appropriate measuring
device and read it correctly
• Always measure the volume of a liquid
medication at the lowest point of the
meniscus
• Shake all suspensions and emulsions
• When measuring drops of medication
with a dropper, always hold the dropper
vertically and close to the medication cup
• Do not attempt to divide unscored tablets
and do not administer tablets which have
been broken unevenly along the scoring
When preparing to administer an
injectable medication:
• Determine the exact volume of
drug to be administered
• Select the right type and size of
syringe and needle
• When removing a drug from a
multiple dose vial, wipe the
stopper on the vial with an
alcohol sponge
• Inject an amount of air into the
vial equal to the volume of fluid
to be removed and withdraw
the required amount of liquid
• If there are air bubbles in the syringe, these
must be removed by holding the syringe with
the needle toward the ceiling and tapping the
syringe with your finger to move the air bubbles
toward the hub. They should be expelled by
gently pushing on the plunger.
• When medication is in a glass ampule, flick the
top of the ampule to be sure all medication is in
the larger bottom portion. Wrap the neck of the
ampule with dry gauze pad and snap off the top
RIGHT ROUTE
• Is necessary for adequate or appropriate
absorption
• Includes the correct route of administration,
and administration in such a way that the
client is able to take the entire dose of the
drug and receive maximal benefit from it
Nursing implications
• Be sure to know the prescribed route by which a
medication is to be administered
• If no route is specified in the order, the prescribing
physician should be questioned about the intended route
• Always gain the client’s cooperation, before attempting to
administer a dose of medication
• Consider the client’s developmental level during
administration of medication
• Assess the client’s ability to swallow prior to administering
oral medications
• Use aseptic technique when administering drugs
especially parenteral ones
RIGHT TIME
• The time at which the
prescribed dose
should be
administered
Nursing Implication
• To achieve maximum effectiveness, medications are scheduled to be
administered at a specific time
• Administer drugs that are affected by foods, such as tetracycline and
penicillin before meals
• Administer drugs such as potassium and aspirin after meals or with
food
• It is the nurse’s responsibility to check whether the client is scheduled
for diagnostic purposes such as endoscopy, fasting blood sugar etc.
• Check the expiration date. Discard the medication or return to
pharmacy if the date is passed
• Antibiotics should be administered at even intervals throughout a 24-
hour period to maintain therapeutic blood level
RIGHT DOCUMENTATION
• Requires that the nurse immediately record
the appropriate information about the drug
administered
• right documentation includes the drug,
dosage, route, time, and the client’s
response
Nursing implication:
• Be sure to document the
medication and the time it
was administered

• Document site location

after administering
intradermal,
subcutaneous, or
intramuscular injection
• Document the effectiveness of medication
administered within:
1. 30 minutes to 1 hour for oral meds
2. 20 min for intramuscular meds
3. 10-15 min for intravenous bolus meds
• Delay in charting could result in forgetting to
chart the medication
• Documentation is also the primary evidence for
insurance companies
• Right documentation as not only a legal
requirement but also a safety responsibility of
the nurse
CLIENT’S RIGHT TO EDUCATION

• This right is a principle

of informed consent
which is based on the
individual’s having the
knowledge to make a
decision
Patient teaching topics:
• Name of medication
• Purpose of medication
• How and when to take medication
• How to monitor drug’s effectiveness
• Drugs/foods that may cause interactions
• Possible adverse effects
• Signs and symptoms to bring to the doctor’s
attention
• Storing and handling
RIGHT OF THE CLIENT TO REFUSE
MEDICATION
• Clients can and do refuse medications

NURSING IMPLICATIONS:
• Be sure to assess client’s reason for refusing medication
• If knowledge deficit underlies client’s reason for refusal.
Provide appropriate explanation for why medication is
ordered
• Document if client refuses medication and client reason
• Secure consent and report or inform the physician