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Module four
Drug administration
Oral medication
Sublingual medication
Topical medications
Eye medications
Ear medications
Respiratory medications
Suppository medications
Parenteral medications
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Drug administration
 Medication or drugs are given to exert specific physiologic effects on the
body.
 They play an important role in preventing, treating, and curing illness,
their administration has become one of the most important, complex and
risk-laden aspects of nursing care.
 Side effects, adverse effects, toxic effects.
 Route of administration orally (mouth), topically ( skin, eye, ear),
mucosally 9 mouth, lung, nose, rectum, vagina), parenteral injection
( intradermal, SC, IM, IV) .
 Effects: local, systematic.
 Absorption: movement from the administration site into the bloodstream.
 Transportation: to the site of action.
 Metabolism: the drug is converted by enzymes into a less active form that
can be excreted.
 Most drugs are metabolized in the liver.
 Excretion: elimination from the body. The kidneys are the most important
route
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Drug administration cont’d
 Medication are prescribe by physician.
 Medication order includes the name of the drug, the dose, the
route, frequency.
 Most medications have more than one name: the generic name is
the patented official name, while the trade name is created by the
particular manufacturer and is capitalized.
1.
2.
3.
4.
5.
6.
7.
The 7 rights
Right Medication
Right Dose
Right Rout
Right Time (b.i.d, t.i.d, q.i.d. q8h)
Right Client
Right information
Right Documentation
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Drug administration cont’d
Rationale:

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
To administer medications safely following Dr.’s orders.
To identify potential sources of error.
To administer medications following the rights.
Assessment:
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Assess continued validity of order ( renewal order e.g. narcotic).
Check the medication sheet is consistent with original Dr’s order.
Check interactive effect of medication with other drugs client is
receiving.
Check compatibility of 2 medications being physically combined in
solution.
Check that medication is designed for route being used.
Check laboratory data, serum drug levels, and client assessment
data (VS, WT, Ht, allergy) to ensure safe parameters for drug
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administration.
Oral medication
Most common
Safe, convenient, and cost effective.
GI provide a large surface area for drug absorption.
some drugs cannot be absorbed or are destroyed by enzymes or
the acidity ( low PH) of this environment.
 Can be given through a nasogastric or gastrostomy tube.
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Rationale:
 To provide the most common, easiest, and least expensive route of
administering medication.
 To provide sustained drug action and increase absorption time.
 To provide oral liquid medication to client who has difficulty
swallowing pills.
 To provide oral medication mixed with food for client who is fluid
restricted.
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 to provide oral medication via feeding tube.
Oral medication
Assessment
 Check that client is not NPO for diagnostic or therapeutic purposes.
 Assess that client is alert, cooperative, and able to swallow.
 Check that medication to be taken with food or on empty stomach.
 Assess that volume of fluid required to dilute medication is
acceptable considering any fluid restriction.
 Check VS, lab data, or other parameters affected by medication to
be given.
 Make sure that medication and tube feeding scheduling allow for
medication to be given on empty stomach.
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Oral medication
Tablets and capsules:
Equipment



Pill from bottle or in unit dose packaging
Cups
Water or other liquid for swallowing medication
1.
Leave tablet or capsule medication in unit dose
packaging. To Maintain identity of the drug, if not
taken can be returned to client’s medication box.
Procedure:
1.
Dispense bottled tablet or capsule into bottle lid,
then drop from lid into client’s medication cup.
2.
Place client in setting position; assess VS if indicated.
Facilitate swallowing.
3.
Open unit dose package, place pill in cup, and hand cup
to client. Provide water, make sure client swallows
medication.
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Liquids:
Oral medication
Equipment


Liquid medication in bottle
Calibrated cups
1.
Shake bottle if indicated. To suspend medication that has settled.
Procedure:
1.
2.
Remove bottle lid and place upside down. To prevents
contamination of lid .
Hold calibrated medication cup at eye level, or place on firm surface
with calibrations at eye level.
A.
Hold bottle so that label will not be soiled if medication drips
onto bottle, and pour prescribed amount of medication into
calibrated cup.
B.
Administer medication per skill for administering oral tablets or
capsules.
C.
Provide water following medication, unless topical effect is
intended
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Topical medication

Topical agents are commonly used for a local effect.

Dermal medications (lotions, creams) are applied to rashes,
lesions, or burns of the skin for their local anti-inflammatory,
anti-infective, or anesthetic effect.

Slow absorption through the skin (transdermally), access the
circulation for a systemic effect.

The advantage is that much less drug is lost to metabolism in GI
tract or liver before it reach the bloodstream.

Ophthalmic (eye) medications.

Otic (ear) medications.

Nasal drops.
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Topical medication
Rationale:
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To reduce inflammation\congestion or itching.
To provide local analgesic or anesthesia.
To apply agent that stops, slows, or prevents growth of microorganisms
To provide appropriate surface for drug absorption.
to decrease intraocular pressure.
To prepare for diagnostic or therapeutic procedures.
Assessment:
 Assess that selected area for application( e.g. , chest, buttocks, or
extremity) is consistent with manufacturer’s recommendation.
 Check that area for application is clean, dry, hairless, and intact.
 Assess status of area being treated ( e.g., rash, character and amount
of any drainage).
 Assess client’s subjective rating of discomfort.
 Assess potential systematic effect if medication intended for topical
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effect is absorbed.
Equipment
Topical medication

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Medication tube or patch
Permanente paper for past
Clean gloves
1.
Locate and remove previous medication patch prior to
applying new dose. Dispose the used patch in biohazard box.
Cleanse selected site if indicated. Clip hair if necessary.
2.
3.
Place prescribed medication directly on measuring paper.
4.
5.
Remove protective covering from patch.
Clean plastic wrap
Tape
Procedure:
Applying medication to clean , dry, hairless, intact skin.
Alternate application sites with each dose of medication
(prevent skin irritation).
Apply patch immediately after removing protective cover.
Label patch with date, time, and your initials.
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Equipment
Ophthalmic drops
O.S.= left eye
O.D.= right eye
O.U.= Both eyes

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Prescribe ophthalmic (eye) drops
Cotton ball or tissue
Clean gloves
1.
Tilt client’s head slightly backward. Give tissue to client for
wiping off excess medication and ask client to look up. The
cornea is protected as client looks up.
2.
Place ocumeter 0.5-1 inch above eyeball with dominant hand.
This position reduces risk of dropper touching eyeball and
causing injury.
3.
Stabilize hand holding ocumeter as necessary. Place
nondominant hand on cheekbone and hand holding ocumeter
on top.
4.
5.
Expose lower conjunctival sac by pulling down on cheek.
Procedure:
Without touching client’s lids or lashes, drop prescribed
number of drops into center of conjunctival sac.
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Equipment
Ophthalmic drops

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Prescribe ophthalmic (eye) ointment
Tissue
Clean gloves
1.
Expose lower conjunctival sac by pulling down on
cheek. This creates a trough for medication
application.
2.
Place tube tip 0.5-0.75 inch above eyeball with
dominant hand. Without touching client’s lids or
lashes, squeeze ribbon ointment along the middle
third of the inside edge of the lower
3.
Ask client to close eyelids gently to move eyes. It
distributes medication over conjunctival surface.
Procedure:
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Equipment
Otic Medication

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Prescribe otic (ear) drops
Dropper
1.
Prepare client for instillation of ear medication by
positioning on side, with ear to be treated uppermost, as
follows:
Procedure:
1.
Warm medication bottle in your hand to body temp. Fill
medication dropper with prescribe amount of medication. (cold
medication can cause nausea or vertigo).
2.
3.
lift auricle upward and backward. Straightens the ear canal.
4.
Instruct client to remain on side for 5-10 min following
instillation
Instill medication drops, holding dropper slightly above ear. To
protect dropper from contamination.
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Equipment
Nasal Medication

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Prescribe medication
Dropper
tissue
1.
Fill dropper with prescribe amount of medication
and instruct client to tilt head back. To reach the
sinuses.
2.
Place dropper just inside naris and instill correct
medication dosage.
3.
4.
5.
Repeat skill in other naris.
Procedure:
Wipe away any excess medication with tissue.
Instruct client not to sneeze or blow nose to keep
head tilted for 5 min .
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Mucosal Medication

Administer for local (topical) or systemic Transmucosal).

The blood vessels in lungs, mouth, nose, rectum, vagina.

Mucosal absorption helps ensure that the drug reaches the
bloodstream before it is lost to metabolism in the GI tractor liver.

Sublingual SL ( under the tongue) medications are absorbed rapidly
and completely due to the vast network of capillaries in that area.

Nebulizer.

Suppositories: are cone – shape masses of solid medicated substance
for introduction into the rectum or vagina either for local or
systemic effects. They are usually refrigerated and , when
administered , melt at body temp for slow absorption. Best at bed
time for retention and absorption.
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Equipment
sublingual Medication
 Prescribe tablet
 Stethoscope and sphygmomanometer( if
indicated)
Procedure:
1.
2.
Assess preadministration VS.
Place or have client place medication under tongue. Explain
that client should not swallow drug or eat, smoke, or drink
until medication is completely absorbed.
3.
Evaluate client for desired drug action including relief of
pain, and the side effects
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Equipment


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n
1.
Metered dose inhaler
Prescribe medication
Metered dose inhaler (MDI) dispenser
Tissues
Procedure:
Insert medication canister (stem down) into longer
part of metered dose dispenser.
2.
Hold canister upright and shake to mix medication
with propellant before each MDI puff. If not, little
or no medication will be delivered.
3.
Instruct client to remove mouthpiece and hold
inhaler 2 inches away from mouth, while he is
setting or standing. Why? When inhaler is held in
mouth , medication droplets are swallowed rather
than mist being inhaled into airway.
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Metered dose inhaler
n
4.
Procedure cont’d:
Instruct client to exhale through pursed lips. This
will increase exhaled volume, allowing room for a
greater inspiratory volume.
5.
Instruct client to depress inhalation device,
releasing a puff of medication, while inhalation
slowly 3-5 sec and deeply through mouth. with deep
, slow inhalation, medication goes to lower
respiratory tract.
6.
Instruct client to hold breath for 10 sec and slowly
exhale through pursed lips
7.
Provide tissues. Medication may stimulate coughing.
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Rectal suppositories
n
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1.
2.
3.
4.
Equipment
Prescribed suppository
Water- soluble lubricant
Paper towel
Clean gloves
Procedure :
Squeeze dollop of lubricant onto paper towel.
Remove foil wrapper from suppository.
Moisten suppository tip with warm water or lubricant
place client in Sims’ position ( lying on left side with top leg
flexed.
5.
Instruct client to bear down in order to identify anal opening and
insert suppository into rectal canal beyond anal sphincter (4 inc).
6.
Instruct client to lie quietly for 15 min, to promote drug
absorption
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Injections=
IM, SC, ID
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Administration of medication by the
parenteral route or injection exposes the
body to 2 foreign objects: the hypodermic
needles and medication being injected.
Require sterile technique, need special skills
Faulty technique and misdirected injection
can hamper the medication’s effectiveness
and cause permanent injury to the client.
Parenterally administration medications
enter the blood stream readily, have a more
rapid onset of action when compared to the
oral route, and have a potential for serious
local or systemic complication.
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
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The intradermal site is used to determine a
client’s immune Response to small quantity of
injected antigen.
Subcutaneous injections are administered
into fatty tissue where there are few blood
vessels, slowing absorption. The abdominal
site offers the quickest absorption, followed
by the arm, then the leg.
Intramuscular injections .
Intravenous are injected directly into the
circulation, bypassing all barriers to
absorption, therefore effects are
immediate.
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
Parenteral medication come in vials, ampules.

Not all medication are appropriate for all injection routes.

Powder drugs
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Injection preparation
Syringes and needles are available in a variety of sizes; appropriate
equipment is selected depending on client factors, medication type,
and the desired site of administration.
Some medication ( heparin & insulin) need special syringes.
Needles vary in diameter ( gauge): the large the number, the
smaller the gauge. Smaller- gauge needles are used for ID & SC
injection. While large gauge used for deep penetration to inject
medication into muscle. disposing needles.
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Withdrawing medication from a vial
Rationale:

To achieve rapid onset of drug action.

To ensure adequate drug absorption and predictable results.
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To provide medication to clients who are NPO.

To prepare medication for injection using sterile technique.
Assessment:

Check type and volume of medication ordered.
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Assess appropriate site for administering medication.
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Check the total volume to be administered is close to capacity of
selected syringe.
Check that needle length and gauge are appropriated for the
client’s size and selected site for injection.
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Withdrawing medication from a vial
Equipment:

Medication in vial

Syringe of closest capacity to hold medication.

Appropriate size needle
Procedure:
1.
Select appropriate syringe size: capacity should closed
accommodate volume to be administered. Facilitates
handling and accuracy in preparation.
–
Assemble syringe and needle, maintaining sterility.
Infection/abscess
–
Remove vial cap and cleanse rubber top of vial with alcohol
swab.
–
Remove needle guard. Pull back on plunger of syringe to fill
with an amount of air equal to amount of solution to be
withdrawn.
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Withdrawing medication from a vial
Procedure cont’d:
2.
Insert needle into upright vial and inject air into vacant
area of vial, keeping needle bevel above surface of
medication. If air is injected into the medication, bubbles
may form, making drug withdrawal more difficult. Air
creates positive pressure in the vial, allowing withdrawal
of medication.
3.
Invert vial and pull on the plunger tip to extract desired
amount of medication. Expel any air from syringe at this
time, tapping side of syringe below air bubble. Tapping
below bubble makes it rise to needle hub area . expelling
air facilitates validation of dose withdrawn.
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Withdrawing medication from a vial
Procedure cont’d:
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Recheck amount of medication in syringe; turn vial
upright and remove needle.

Replace needle guard using the scoop method. The
scoop method is not necessary when recapping a
sterile needle, but encourages development of a safe
habit.

Recheck medication label and dosage against
medication record and any dose calculation.

Dispose of or replace equipment appropriately.
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Withdrawing medication from an ampule
Equipment:

Medication in ampule

Syringe of closest capacity to hold medication.

Appropriate size needle
Procedure :
1.
Tap stem of the ampule, or, holding stem tip, briskly flick
wrist to move all medication to ampule base.
2.
Using alcohol swab or dry gauze square, grasp and snap off
stem of ampule, breaking away from you. (prevent injury)
3.
Remove syringe needle guard and insert needle into ampule
without touching side of ampule neck. Prevent
contamination.
4.
If needle is long enough, withdraw appropriate amount of
medication. Tilt or invert ampule if needle is short. Then
return ampule to upright position and remove syringe.
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Intradermal injection

ID route, just under the top layers of the skin.

Used to inject a very small ( e.g. 0.1ml) volume of a substance
( antigen) to elicit a client’s immune or sensitivity response.

Inner aspect of the forearm is typically used for this type of
testing.

Alternate sites include the upper arm, upper chest, and shoulder
blade areas.

The client’s reaction to the substance indicating immune or
allergic response is monitored at the injection site ( e.g. noting
induration indicating immune response to tuberculin PPD).

ID also use to administer a local anesthetic prior to a venipuncture
procedure.
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Rationale:

Intradermal injection
Immune, diagnostic, anesthetic.
Assessment:
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Assess for previous exposure to TB, previous positive skin test, or
previous BCG vaccination ( PPD is contraindicated in these
situation).
assess that site is free of dermatitis.
Assess that skin dry at planned injection site.
Assess that client is not allergic to local anesthetic (e.g. lidocaine)
Equipment:
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Unit dose (1 ml) tuberculin syringe with ¼-in to 5/8- in – long
needle ( small 25-27 gauge).
Medication( 0.1 ml Purified Protein Derivative antigen- PPD)
Dry gauze square
Pen
Clean gloves
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Procedure:
Intradermal injection
1.
Select lesion- free injection site on hairless
undersurface, upper third of forearm ( for skin
testing) or site selected for venipuncture. Use
alcohol swab to cleanse area with circular
motion, moving from inside outward, and allow
alcohol to dry. Prevent contamination.
2.
Remove needle guard.
3.
Grasp client’s outer forearm to gently pull skin
tight on undersurface for skin testing.
4.
Hold syringe almost parallel to skin and, with
bevel facing up, insert needle tip ( about 1/8 in)
. rationale: bevel up facilitates visualization of
injected substance.
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Intradermal injection
Procedure cont’d:
5.
Do not aspirate. There is no risk of intravascular
injection with correct intradermal technique.
6.
Slowly inject medication, observing for wheal
( blister) formation and blanching at site. Rationale:
wheal formation indicates proper injection. If no
wheal develop, injection was given too deeply.
7.
Withdraw needle at same angle as inserted. Do not
recap.
8.
Pat site with dry gauze. Do not massage area.
Massage could disperse medication.
9.
Use pen to mark injection site for future
assessment; if more than one test is being
performed, number injection site and record
number and corresponding antigen in client’s record.
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Subcutaneous Injection=SC

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Administered into the fatty tissue under the
skin, where there are few blood vessels and
nerves.
This site can be used only for medications that
are not irritating to tissue.
Drugs absorption is slower than when
administered into muscle.
The most common sites used are the outer
surface of upper arm, the anterior thigh, and the
abdomen ( avoiding the area 1.5 in around
umbilicus).
Alternate site include the ventrodorsal gluteal
area and scapular areas of the upper back.
Typically a small amount ( less than 2 ml) of
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medication is injected.
Type of injection degree:
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Sc injection site
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deltoid muscle-2 fingers widths down from the acromion
process; the bottom edge is at an imaginary line drawn
from the axilla
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ventro gluteal muscle - With thumb toward the umbilicus, place palm
of hand on the greater trocanter, index finger on the anterior
superior iliac spine, and the middle finger on the iliac crest.
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Vastus lateralis-Place one hand below the greater
trocanter and one hand above the lateral femoral condyle;
mid-lateral thigh.
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DORSAL GLUTEAL-Draw an imaginary line between the
greater trochanter and the posterior superior iliac spine;
at the middle of the imaginary line, go up about one inch
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Subcutaneous Injection=SC
Rationale:


To deliver small amount of a nonirritant medication.
To avoid hematoma formation.
Assessment:

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Check that the volume of drug to be administered is less
than 2 ml
Check that the drug to be administered is nonirritating.
Check results of lab. Tests ( PTT) for specific medication.
Equipment:
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syringe 3ml with 5/8 in needle ( small 25-29 gauge).
Medication vial or ampule
Alcohol swabs
Clean gloves
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Subcutaneous Injection=SC
Procedure:

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Select site for injection, alternating sites for each
injection. This prevents repeated trauma to tissue.
Avoid area around umbilicus .
With selected site fully exposed, cleanse area with
alcohol swab using circular motion moving from
inside outward. Allow alcohol to dry. This prevent
alcohol from tracking into tissue with injection.
Remove needle guard
Use thumb and forefinger to gently grasp SC
tissue ( pinch and inch) on posterior- lateral
aspect, mid-upper arm ( or other appropriate site).
Holding syringe like a dart or between thumb and
force finger , insert needle at 45-90 degree angle.
Angle varies with amount of SC tissue, selected
site, nd needle length.
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Subcutaneous Injection=SC
Procedure cont’d:
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Hold syringe barrel with dominant hand,
and, with same hand, aspirate by pulling
back on plunger. If no blood appears,
administer injection. If blood appears,
withdraw syringe, discard, and prepare
new injection.
Inject medication slowly.
Wait 10 sec, then withdraw needle
quickly ( prevent medication leakage).
Do not recap.
Release tissue and gently massage
injection site with alcohol swab( Aids
absorption(
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Intramuscular Injection=IM
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Given deeply into muscle, which is rich with blood
vessels, for rapid drug absorption.
May be more painful than others because nerves are
more plentiful in muscle.
Because of blood vessels and nerves it needs skills.
Well- defined anatomic landmarks are used for
individual injection site selection to avoid accidental
intravascular deposition of drug and to prevent nerve
injury.
Injection less than 4ml for a large muscle.
Needle length and gauge selection is based on the
drug, the client’s size, and the selected site for
injection.
Muscles used for injection include the ventrogluteal,44
vastus lateralis, dorsogluteal, and deltoid.
Intramuscular Injection=IM

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Ventrogluteal site is preferred for injection because its
relative lack of large nerves, blood vessels, and fat.
Suitable for most age groups.
Vastus lateralis of the thigh, thick and well developed,
lack of large nerves, blood vessels . The injection site
should be confined to the middle third of the muscle.
Common in pediatric clients.
dorsogluteal site is the more difficult to locate and the
least desirable of all IM injection sites because major
blood vessels and the sciatic nerve are located there.
Deltoid is a small muscle mass located in the upper arm
near the shoulder, close to major vessels and the radial
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nerve.
Intramuscular Injection=IM
Rationale:

For rabid absorption

To administer medication that are too irritating to be given SC

To provide medication to client who are NPO, nauseated, or
vomiting.
Assessment:

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Check type and volume of drug to be given.
Assess client’s size and age.
Assess status of previous injection site.
Assess relevant VS, lab
Check that selected site is free of local tissue damage.
Check that selected site is clearly visible for identification of
landmarks and safety of administration.
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Intramuscular Injection=IM
Equipment:

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Syringe 3ml with 1.5 in needle ( small 21-23 gauge).
Medication vial or ampule
Alcohol swabs
Clean gloves
Procedure:
1. Fully expose area to select site for injection, alternating site for
2.
3.
4.
each injection. Rationale: facilitates visualization and palpitation of
landmarks.
Cleanse area with alcohol swab using circular motion, moving from
inside outward. Allow alcohol to dry. Rationale: prevent tracking of
alcohol into the tissue.
Remove needle guard.
Use thumb and forefinger to spread skin taut, or grasp muscle in a
small client to increase mass. Rationale: to ensure needle placement
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in the muscle belly.
Intramuscular Injection=IM
Procedure cont’d:
5.
Insert needle at 90 degree angle into muscle belly, using
a quick darting motion. Rationale: this angle facilitates
medication reaching muscle.
6.
Pull back on plunger to aspirate for presence of blood. If
blood returns, discard and prepare a new injection.
7.
Inject medication slowly.
8.
Withdraw needle at same angle as inserted. Retract
needle if using safety syringe or do not recap needle.
9.
Press site with gauze.
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