Download Parenteral Medication

ADMINISTRATION OF MEDICATIONS
ADMINISTRATION OF MEDICATIONS

Alteration in health related to acute or chronic
conditions lead clients to seek relief of symptoms
through various treatments options one of which is
the medication regime. Successful medical therapy
depends on the partnership of the patient and the
medical staff (including the nurse). This increased
collaboration among health care providers demand
in-depth understanding of drug, actions, interactions,
therapeutic and adverse effect and the exercise of
judgment in drug administration.
ADMINISTRATION OF MEDICATIONS

Thus implementation of prescriptions or
orders of the physician/pharmacist
involves far more than merely carrying
out tasks. As an educated, independently
licensed health care provider, the nurse is
always responsible for any care given
(including administration of drugs)
whether prescribed by the physician or
planned by the nurse.
ADMINISTRATION OF MEDICATIONS

The nurses’ first responsibility is to understand the
ordered therapy, its goal for the patient and how it is to
be carried out. If a physician orders a medication and it
is observed that the written dosage is ten times the
usual dosage for that medication, instead of giving the
medication because “the doctor ordered it”, call the
doctor and discuss the order. More so since the
patient’s state is not static, understand his condition in
relation to the medication. If an oral medication is
prescribed for a vomiting patient, an understanding
nurse should inform the physician for change instead of
just giving the drug just because “the doctor wrote it”.
ADMINISTRATION OF MEDICATIONS

What is a drug? Drug is any substance other
than food which when administered alters the
physiological process of the biological being. It
is a chemical substance intended for use in the
diagnosis, treatment, cure, mitigation or
prevention of a disease. Drug is a general term
used for both legal and illegal substances
(either than food) which alters physiological
processes. Medication or medicine is more
appropriate for drugs used for therapeutic
purposes.
ADMINISTRATION OF MEDICATIONS
Uses of Drugs
 Prevention- used as prophylaxis to
prevent diseases e.g. vaccines; fluorideprevents tooth decay.
 Diagnosis- establishing the patient’s
disease or problem e.g. radio contrast dye;
tuberculosis (Mantoux) testing.
 Suppression- suppresses the signs and
symptoms and prevents the disease process
from progressing e.g. anticancer, antiviral
drugs.

ADMINISTRATION OF MEDICATIONS
Treatment- alleviate the symptoms for
patients with chronic disease e.g. Antiasthmatic drugs.
 Cure- complete eradication of diseases
e.g. anti-biotics, anti-helmintics.
 Enhancement aspects of healthachieve the best state of health e.g.
vitamins, minerals

ADMINISTRATION OF MEDICATIONS


Legal Aspects of Medication
Preparation, dispensing and administration of
medications are all covered by laws in every
country.

The DDA - Dangerous Drug Act. It is an act
that governs the procurement and use of some
drugs especially the narcotics e.g. morphine,
pethedine, cocaine etc. These drugs are
prescription only drugs hence cannot be bought
or administered without prescription. Dangerous
drugs are always kept under lock and key in the
Dangerous Drug Cupboard under the care of
trusted senior nurses.
ADMINISTRATION OF MEDICATIONS
Section - 34 - Dangerous Drugs Record.
 (1) A person who supplies Class A or B, drugs
shall keep on the premises from which he
supplies these drugs a book of the prescription
to be known as the `Dangerous Drugs Record'.

(2) Before any person supplies Class A drugs he
shall record in the Dangerous Drugs Record
the following(a) the name and quantity of the drug to be
supplied;
ADMINISTRATION OF MEDICATIONS

(b) the name, and address, signature or thumbprint of
the person to whom it is supplied;
(c) the signature of the person who supplies the drug;
and
(d) the date of supply.
(3) Where a drug is supplied under a prescription
which is retained by the supplier of the drug and an
entry is made in the Dangerous Drug Record book
enabling the prescription to be referred to, no entry
need be made in the Dangerous Drug Record or any
particulars specified in the prescription.
ADMINISTRATION OF MEDICATIONS

The procurement, supply, administration and
wastage (accidental during preparation of
administration) are always under strict
observation through recording in the
appropriate books and usually shift to shift
handing over especially in the wards. The
student should be alert to institutional
policies guiding the supply and
administration of Dangerous Drugs in the
various hospitals where he/she may find
him/herself.
ADMINISTRATION OF MEDICATIONS

It is worth knowing that nurses are
responsible for their own actions
regardless of the presence of a written
order. If a nurse gives an overdose of a
drug because it is written by a doctor, the
error is accounted to the nurse and not
the doctor. The nurse should bear in mind
that ALL substances are poisons: there is
none that is not a poison. The right dose
differentiates a poison from a remedy.
Drug Nomenclature

One drug can have as much as 4
different names as follows:
Chemical Name - any typical organic
name; this precisely describes the
constituents of the drug
 E.g. N-(4-hydroxyphenyl)acetamide for
paracetamol

Drug Nomenclature

Generic Name - is given by the
manufacturer who first develops the drug;
it is given before the drug becomes
official. It is the name by which the drug
will be known throughout the world no
matter how many companies manufacture
it. This name is usually agreed upon by the
WHO. Often the generic name is derived
from the chemical name. E.g.
acetaminophen
Drug Nomenclature

Official Name – this is the name by
which a drug is listed in official
publications such as USP (United States
Pharmacopoeia), BP (British
Pharmacopoeia), BPC (British
Pharmacopoeia Codex), and NF (National
Formulary). The above mentioned
documents are sources of drug
information.
Drug Nomenclature

Trade/Proprietary/Brand Name - is the
name given to drug by the manufacturing
company and so the company is the legal
owner of that name. So, a single generic name
can be sold under ten different trade names.
Because of this trade names should not be
used in writing prescriptions as it can e
misleading (Kinaquine is from Kinapharma
Company, and Efpac from the Effah Pharmacy
and by other names from other Companies).
Classification of Medication
Medications may be classified according to:
 The body system that the medicine is
targeted to interacts wit; e.g. cardiovascular
medications, nervous system medication
etc.
 Therapeutic usages of the medicine; e.g.
antihypertensives ,neuroleptics,
 The diseases the medicine is used for; e. g.
anticancer drugs, antimalaria drugs
antihelminthics etc.
Classification of Medication
The action of the medication can also be
used to classify the it; e.g. beta-adrenergic
blocking agents
 The overall effect of the medication on
the body can also be a criteria for its
classification; e.g. sedatives, antianxiety
drugs etc.

Forms of Drugs
Solids
 Capsule- powder, liquid or oil form of
medication enclosed in a gelatine shell.
 Tablet-a powdered form of medication
compressed into a hard small disk or
cylinder. May be a variety of colours or sizes.
Enteric coated tablets are covered with a
substance that is insoluble in gastric acids,
thus reducing the possible gastric irritation.
Tablets
Capsule
Forms of Drugs

Lozenge-flat round preparation containing
drug in a flavoured or sweetened base that
dissolves in the mouth to release the
medication; it is also called troche.

Suppository-one or more drugs mixed
into a firm base, such a gelatin, designed for
insertion into a body cavity. The preparation
melts at body temperature releasing the
medication for absorption
Forms of Drugs

Pill-a mixture of powdered drug with
cohesive material in a round, oval, or
oblong shape.

Powder-a drug ground into fine particles
from a solid for inhalation or application
to the skin.
Forms of Drugs
Semi-solids
 Ointment-semisolid preparation of one
or more drugs applied to the skin
 Liniment-medication mixed with alcohol,
oil or soapy emollient, which is applied to
the skin.
 Paste-semisolid preparation, thicker and
stiffer than ointment; absorbed more
slowly than ointment that penetrates
through the skin.
Forms of Drugs

Cream-a non-greasy semi-solid
preparation used on the skin

Gel or Jelly- a clear translucent semisolid that liquefies when applied to the
skin
Forms of Drugs
Elixir-medication is a clear liquid containing
alcohol, water, sweeteners, and flavouring.
Designed for oral use.
 Lotion-drug in liquid suspension designed
for topical use.
 Solution-a drug dissolved in another liquid
substance; may be used orally, parenterally, or
externally
 Suspension-fine drug particles dispersed in
a liquid medium. Must be shaken before use
 Syrup-medication dissolved in a
concentrated sugar solution to mask
unpleasant taste

Forms of Drugs

Tincture-an alcohol or water and
alcohol solution prepared from drugs
derived from plants
Forms of Drugs
These form/preparations of drugs are
packaged as ampoules, vials, blister packs,
sachets etc.
 Aam


ampoules
Vials
Blister Packs
Storage of Medications

Medications are dispensed by the pharmacy
to nursing units. Once delivered, proper
storage becomes the responsibility of the
nurse. All medications must be stored in a
cool dry place (usually in cabinets, medicine
carts or fridges)
All medications must be stored in a cool dry place
(usually in cabinets, medicine carts or fridges)
Storage of Medications

In less advanced countries, 3 cupboards are
usually used for drug storage.

Cupboard I-used for drugs for external
use only; e.g. calamine lotion, detol,
methylated spirit etc. These drugs are
contained in distinctive bottles, usually
ridged with deep colours (dark green, blue,
brown) with red label marked POISON and
FOR EXTERNAL USE ONLY.
Storage of Medications
Cupboard II-contains drugs for internal
use only e.g. tablets, suspension, mixtures
etc. All drugs must be labelled.
 Cupboard III-contains the dangerous
drug; drugs of addiction. E.g. Morphine,
pethedine etc.
All drugs should be kept away from direct
sunlight and at a temperature suggested
by the manufacturer.

Storage of Medications

Another cupboard called the Emergency
Cupboard may be stationed at or near the
nurses bay for easy access. This cupboard
contains drugs for emergency situations e.g.
aminophylline (for asthma), hydralazine (for
severe hypertension), oxytocin (for maternal
bleeding), intravenous infusions (for
rehydration) etc.
Storage of Medications

In advanced hospitals, use is made of
computer controlled dispensing units for
a more secure storage of medications.
This is made possible through soft wares
on computers which has patient’s
particulars and medication orders. With a
password, the nurse selects the
medication needed; the drawer with the
medication opens and the drug is
delivered.
Storage of Medications

Some medications such as insulin, vaccines
and ATS (anti-tetanol serum) must be
stored in medication refrigerators to
preserve their potency.
ROUTES OF DRUG ADMINISTRATION
The route of drug administration is the
path by which a drug is brought into
contact with the body.
 Drugs are introduced into the body by
several routes; it is paramount for the
nurse to ensure that the pharmaceutical
preparation is appropriate for the route
specified

1.
Enteral– administering medication
through the gastro-intestinal route; e.g.

Oral

Sub-lingual

Rectal
2. Parenteral Route

Intravenous

Intramuscular

Intrathecal

Intradermal

Subcutaneous etc.
Routes Of Drug Administration
3. Topical Route (usually for local effect)

On the skin

Nasally

On the cornea

In the ear etc.
4. Inhalation
[Pls Read and make notes on 3 and 4 above]
Enteral Route
Drug is administered through the gastrointestinal route
1.
Oral route – it is the most commonly used
route for most drugs because it is

Safe

Convenient

Least expensive
Routes Of Drug Administration

The medicine is swallowed with fluid or is
given through a tube. This route is contraindicated in patient on nil per os, or
patients with operations of the GIT.
2. Sub-lingual; the drug is placed under the
tongue to dissolve slowly and be
absorbed.
Routes Of Drug Administration

drugs can also be administered into the
buccal cavity (into the superior posterior
aspect of the cheek next to the molars.
Drugs administered through these routes
act quickly due to the thin and large
vascularisation which permits quick
absorption into the blood stream
Routes Of Drug Administration
3. Drugs can also be administered into the
rectum. The suppository gradually
dissolves at body temperature and
releases the drug which is then absorbed
through the mucous . Rectal
administration of drug is contraindicated
in diarrhoea, rectal prolapse or rectal
surgeries.
Routes Of Drug Administration
Parenteral Route – this means introduction
of medicines by injection into body tissues
or blood vessels. Because this is an invasive
procedure, sterile technique must always be
applied.
It has the following advantages:
 Rapid and predictable absorption
 By pass GIT enzymes and gastric acid hence
used for drugs that can be destroyed by
gastric acid and GIT enzymes
Routes Of Drug Administration
Can be used for unconscious and
uncooperative patients.
However, it
 Needs strict asepsis
 Pain is associated with the injection
 More expensive
 Self administration is difficult because it is
difficult/needs skilled person
 Difficulty in correcting overdose errors
 Risk of infection or local irritation

Routes Of Drug Administration
Intramuscular injection- the drug is
administered into the muscle and it passes
through capillary walls to enter the blood
stream.
Advantages
 More rapid absorption than subcutaneous
injection; onset of action is about 10 -15
minutes
 Absorption can be hastened by drug
preparation (aqueous is faster than oil)
1.
Routes Of Drug Administration
More painful than SQ.
 Vasoconstriction cannot be used to slow
down preparation
Subcutaneous Route-drug is injected beneath
the skin to permeate capillary wall and
enter the blood stream
Advantages
 Slow absorption rate (onset of action about
20minutes)

Routes Of Drug Administration

Rate of absorption can be altered by
preparation of drug (oil preparations are
slow to be absorbed, local vasoconstriction.
Disadvantages
 Only smaller volumes can be administered
compared to IM injections
 Irritating drugs may produce severe pain and
local necrosis.
Routes Of Drug Administration

Intravenous Route- drug is administered
directly into the blood stream.
Advantages
 Rapid onset of action within 1-2 minutes
 Most irritating substances may be given
 Very large volumes of drug may be given
 Preferred route of medication in
emergencies
 100% bioavailability of drug.
Routes Of Drug Administration

Dangerous complications e.g. embolism
and immediate toxic effects

Very technical; getting the vein regulating
the right dose per minute

Requires greater care.
Routes Of Drug Administration
Topical Applications-medications are applied
to the skin or mucous membrane for local
effect or for absorption into the blood
stream. Although a large number of topical
drugs are applied to the skin, other topical
drugs include the eye, nose, ear, rectal and
vaginal preparation.
Creams, lotions, ointments etc. are usually for
local effects, however, small amounts are
absorbed into the system resulting in
systemic effects
Routes Of Drug Administration
Inhalations-gaseous and volatile substances
such as anaesthetic agents, oxygen are
administered by inhalation using
nebulizers positive pressure apparatus.
The drugs are almost immediately absorbed
into systemic circulation due to larger
surface area, high vascularization and high
permeability
Routes Of Drug Administration
Advantages

Drug is delivered close to the target
tissue if local action is desired

There is rapid absorption if systemic
effect is desired.

Abbreviations used in drug administration
◦ a.c
◦ aq
◦ bd or bid
◦ g
◦ im
◦ iv
◦ p.c
◦ tid
◦ qid
◦ h
before meals
water
twice a day
gram
intramuscular
intravenous
after meals
three times a day
four times a day
hourly
MEDICAL ORDERS
A prescription is a written instruction from
a licensed prescriber concerning the form
and dosage of a drug to be issued to a
patient. It is a medication order. However,
in certain situations, a verbal order may
be given directly or through the
telephone.
Medication orders may be written on the
client’s medical records sheets (folder) or
on a legal prescription pads
Medical Orders
Types of Medication Orders
Generally, there are 2 types of orders:
 Standing orders
 Self-terminating orders
Medical Orders
Standing orders are carried out until it is
cancelled by another order; that is until the
prescriber discontinues or modifies the
dosage or frequency with another order or
until a prescribed number of days has
elapsed as determined by the agency policy.
 E.g. Insuline 10U SC qd at 1800 (6pm). This
order has no limit and must be continued
until it (order) is modified or discontinued.

Medical Orders

A prn order, like IM Morphine 15mg q4h
prn, is a standing order; there is no
direction as to when it should be stopped.
The order does not specify the number of
days or number of dosages of the drug to
be received.

Self-terminating Order: this order specifies
the number of days or the number of
dosages of the drug the client is to receive.
Medical Orders

E.g. Caps Tetracycline 250mg PO q6h x 5
days. This implies that on the 5th day, when
patient receives the 20th dosage, the order
ends; the day (time) of the first dose marks
day 1.

A stat order is an order for a single dose of
a medication but it must be given
immediately; as soon as possible. This ‘once
and immediately’ order is usually given in
emergency or serious situations.
Medical Orders
A medication order must have the following:
1.The full name of the patient: writing the
full name of the patient prevents a state of
confusion when two patients bear the same
first or last name. Also, the patient’s number
(In-patient or out-patient) may be added and
also the ward if on admission.
Medical Orders
2.
3.
Date and Time the order is written: this
is important to establish when an order is
given and when it was carried out. It also
helps to determine when an order
automatically terminates.
The Form and Name of the drug: the
name and form of the drug to be
administered should be written using
preferably the generic name. In cases
where trade names are used which nurse is
not familiar with, clarification should be
sought from the prescriber or the
pharmacopoeia.
Medical Orders
4. Dosage of the drug: dosage of the drug
includes the amount, frequency or time(s) of
administration and the strength. E.g.
Caps Tetracycline 500mg tid x 5 days;
500mg (amount), tid (frequency).

IVF 50% (strength) Dextrose 5ml (amount)
nocte (time) x 2 days (duration).

Medical Orders
5. Route of Administration and special
directives about its administration. Since it is
possible for one drug to have several
possible routes of administration, it is
important that the route preferred by the
prescriber is stated in the order. If for any
reason a prescribed route is contraindicated
in the patient, the nurse should notify the
prescriber rather than choosing another
route on his/her own accord.
Medical Orders

Special directives may include ‘ give slowly
over 20, 30, 40 etc. minutes; take before,
after or with meals; etc.
6. Signature of the Prescriber: the
signature makes the medical order a legal
request. Without it, the order is invalid.
NB: for medical orders taken verbally, the
nurse signs it, to be co-signed by the
prescriber later.
Dose Calculation and Conversions

When prescriptions are issued for
medication orders to be carried out, it
becomes necessary at times to calculate
doses to be given especially when the drugs
are dispensed in lager doses or strengths; or
the units are different.
Dose Calculation and Conversions
Measurements (units) can be in the
1. Metric system e.g. gram (g), meter (m)
etc.

2.
Apothecary System e.g. grain (gr),
minim (m), pint (pt).
3.
Household System e.g. drop (gtt),
teaspoon (tsp) or tablespoon (tsp)
Metric
1ml
15ml
30ml
500ml
1000ml
4000ml
Apothecary
15 minims
4 fluid drams
1fluid ounce
1pint
1 quart
1gallon
Household
15 drops (gtt)
1tablespoon
1fluid ounce
1pint
1 quart
1gallon
Dose Calculation and Conversions
Metric
1mg
60mg
1g
4g
30g
500g
1000g (1kg)
Apothecary
1/60 grain (gr)
1grain (gr)
15 grains (gr)
1 dram (D)
1ounce
1.1 pound (lb)
2.2 (lb)
Dose Calculation and Conversions
Trial Question 1
If a prescription given orders Inj. Cephalexin
500mg IV qid x 2 days but the pharmacy
dispenses 2g in 10ml, the dose to be
administered is …………
Trial Question 2
If Inj. Heparin 10000 units SC is ordered but
40,000 units per ml vial is supplied from the
pharmacy, how many millilitres should be
administered?
Dose Calculation and Conversions

The paediatric dose of any medication is
usually smaller than the adult dose. Several
rules have been devised to calculate the
infants’ and children’s dosages such as
Young’s Rule, Clark’s Rule and Fried’s Rule.
These rule give approximate dosages.
Fried’s Rule consider children under one year
and so considers the adult age to be 150
months which is 12½ years.
Dose Calculation and Conversions
Fried’s Rule for children under 1year
Infant dose = age of child in months x Adult Dose
150 months
Young’s Rule assumes a person under 12½ years is
a child; for children over 1year.
Child’s Dose= Age of child in years x Adult Dose
Age of child in years +12
Dose Calculation and Conversions
Clark’s Rule calculates the dose of a child base
on his/her weight and have an advantage over
the other rules in that it can be used for
children of all ages. An average adult weight of
150 pounds is (approx. 68kg). Can be used for
children of all ages.
Child’s Dose = weight of child (in pounds) x Adult dose
150
Dose Calculation and Conversions

Clarks Rule calculates the dose of a child
based on his or her weight and it have an
advantage over the other rules n that it can
be use for children of all ages. An average
adult weight of 150pounds [approx.65kg] is
used
Childs Dose = Weight of child in pounds × Adult Dose
150months
Dose Calculation and Conversions
The Body Surface Area (BSA) method
of calculating drug doses is widely used
for two types of patients:
 Cancer patients
 Paediatric patients.
The BSA calculations are done in two ways:
1. Using the standard chart which features
the weight, BSA and dose to be taken,
Dose Calculation and Conversions
2. Calculation using the formula
Patient’s dose = Patient’s BSA (m²) X Drug Dose (mg)
1.73 m²
The average adult is considered to have a BSA
of 1.73m².The BSA of an individual is
determined by drawing a straight line
connecting the person’s height and weight.
The point at which the line intersects the
centre column indicates the person’s BSA in
square meters.
Dose Calculation and Conversions
E.g. If the adult dose of a drug is 100mg,
calculate the approximate dose for a child
with a BSA of 0.83m², using the equation
above.
Ans 48mg.
Nomograph to Determine BSA
Rights of Medication Administration
Medication errors can be detrimental to patients.
To prevent these errors, these guidelines are the rights- are used in drug administration.
1. Right Patient: correct identification of the
client cannot be over emphasized. This can be
done by asking the client to mention his/her
full name which should be compared with that
on the identification bracelet or the patient’s
folder and medication/treatment chart for
confirmation.
Rights of Medication Administration
Beware of same and similar first and surnames
to prevent the error of administering one
person’s medication to another and vice versa.
2. Right Medication: before administering any
medicine, compare name on medication
chart/medication order with that on the
medication at least 3 times-checking medication
label when removing it from storage unit,
compare medication label with that on
treatment chart and medication label and name
on treatment chart with patient’s name tag.

Rights of Medication Administration
3. Right Time: drug timing is very
especially with some drugs like antibiotics,
antimalaria drugs etc. to achieve cure and
prevents resistance. Some drugs must be
given on empty stomach e.g.
antituberculosis drugs; and some after
meals e.g. NSAIDS-these must be noted
and adhered to.
Rights of Medication Administration

The interval of administration of drugs
should also be adhered to because it is
important for many drugs that the blood
concentration is not allowed to fall
below a given level and for others two
successive doses closer than prescribed
might increase blood concentration to a
dangerous level that can harm the patient..
Rights of Medication Administration
4. Right Dose: this becomes very
important when medications at hand are
in a larger volume or strength than the
prescribed order given or when the unit
of measurement in the order is different
from that supplied from the pharmacy.
Careful and correct calculation is
important to prevent over or under
dosage of the medication.
Rights of Medication Administration
5. Right Route: an acceptable medication
order must specify the route of
medication. If this is unclear, the
prescriber should be contacted to clarify
or specify it. The nurse should never
decide on a route without consulting the
prescriber.
Rights of Medication Administration
6. Right to information on drug/client
education; the patient has the right to
know the drug he/she is taking, desired and
adverse effects and all there is to know
about the medication. The charter on
patient’s right made this clear.
7. Right to Refuse Medication: the patient
has the right to refuse any medication.
However, the nurse is obliged to explain to
patients why the drug is prescribed and the
consequences refusing medication.
Rights of Medication Administration
8. Right Assessment: some medications
require specific assessment before their
administration e.g. checking of vital signs.
Before a medication like Digoxin is
administered the pulse must be checked.
Some medication orders may contain
specific assessments to be done prior to
medication
 9. Right Documentation: documentation
should be done after medication and not
before.
Rights of Medication Administration

10. Right Evaluation; conduct
assessment to ascertain drug action, both
desired an side effect.
Rights of Medication Administration
Drug Administration
For convenience, especially when many
patients are to receive medication at a
given time. The patient should be known
and folders arranged in the order in
which the medications would be
dispensed.

Rights of Medication Administration
Administration of drug entails five
interrelated steps:
 Identification of the patient
 Administration of the drug
 Adjunctive nursing interventions
 Recording
 Evaluation of effectiveness of the drug
Enteral Drug Administration


The delivery of any medication that is
absorbed through the gastrointestinal
tract
Oral Medication
Oral medication can be by ingestion, sublingual
administration (place the pill or direct spray
between the underside of the tongue and
the floor of the oral cavity)or buccal (place
the medication between the patient’s cheek
and gum).
p
Oral Medication
A tray or trolley should be set with:
 Drug to be administered
 Water in a jug
 Glass on a saucer all in the tray
 Spoons
 Mortar and pestle (when necessary)
 Towel
 Straw
 Spatula
 Patient’s folder/treatment chart and pen
Gastric Tube Administration

Gastric tubes provide access directly to
the GI system.
Rectal Administration
The rectum’s extreme vascularity
promotes rapid drug absorption.
 Medications do not travel through the
liver, and are not subject to hepatic
alteration.

Parenteral Medication
Drug administration outside of the
gastrointestinal tract. Parenteral medication
is an invasive procedure and so must be
carried out observing the standard infection
prevention measures sterile techniques.
Equipment
The Syringe is one of the equipment for
administration of parenteral medication.
Parenteral Medication
All syringes have
 A tip which connects with the needle
 A barrel which has the calibration
 The plunger which fits inside the barrel.
Syringes come in different shapes, sizes and
colours. They may be made of glass or
rubber or metal.
Syringes and Needles
Parenteral Medication
Parenteral Medication
The standard syringes come in 2, 3, 5 and
10cc sizes. There are the 50, 60 and 100cc
syringes which are not for injection but for
adding large amounts of sterile solutions to
infusions or irrigating wounds.
 The Insulin Syringes are designed
specially for use with the ordered dose of
insuline. An insuline may come in
concentrations of u100/cc, u80/cc, u40/cc
etc.

Parenteral Medication

The insuline syringe should always match
the concentration of the insuline. The
syringes usually have a permanently attached
needles that are thin (26-30)and short (¼").
Parenteral Medication

Tuberculine Syringe, caliberated in tenths and
hundredths of a cubic centimeter on one side and
. in sixteeths of a minim on the other side, is a
narrow syringe. This syringe originally designed for
tuberculin injections can also be used for small and
precise doses especially in children. It is used for
doses of 0.5ml or less.
Parenteral Medication

Prefilled single dose syringes are already
filled with a drug. If the dose ordered is
lesser, the excess is expelled before
administration.
Parenteral Medication

The Needles are usually made of stainless
steel and are usually disposable. They may be
packaged with the syringe or separately.
However, some special needles for surgery
or special procedures may be reused and
hence are sterilizes after each use.
Parenteral Medication
A needle has 3 parts:
 The hub; the larges part which fits onto
the syringe
 The cannular/shaft/stem; the long part
which connects to the hub
 The bevel is the slanted part at the end
of the shaft. The bevel may be short or
long. The longer the bevel, the sharper the
needle.

Parenteral Medication



The length of the bevel selected is based on the
type of injection to be given. The long bevels are
sharp and produce less pain when injected into
subscutaneous and muscle tissues. Short bevel
needles are used for intradermal and intravenous
injection to pervent occlusion of the bevel with
tissue.
A filter needle has a filter inside the needle to
prevent drawing up particles of glass or rubber in
ampoules or vials.
Before injection, the filter needle should be
changed with one without it.
Parenteral Medication
Needles for injection has 3 variables:
 The slant of the bevel,
 The length of the cannular
 The gauge/diameter of the cannular.
 The larger the gauge number, the smaller
the diameter of the shaft. The shaft varies
from 3/8 to 5 inches while gauge varies
from no. 14 to 30.

Parenteral Medication

Thick and oily preparations need larger
needle hose than aqueous one and
thicker muscles need longer needle shaft.
The choice of needle, thus, depends on
muscle mass, type of injection the type of
parenteral route for the injection
Parenteral Medication

Ampoules and Vials
Because parenteral drug administration is
an invasive procedure, parenteral injections
(preparations) are sterile. Drugs that
deteriorate in solution are dispensed in tablets
or powders and dissolved in solution
immediately before injection.
Parenteral Medication
So left over from such preparation should
not be used especially if they are
discoloured after some hours. Ampoules and
vials are frequently used to package
parenteral medication
 An ampoule is a glass container usually
designed to hold single dose of a drug. It is
made of clear glass in a particular shape
with a constriction at the neck (may be
coloured) for easy opening.

Parenteral Medication

Because frequently the drug will be both
above the constriction an and in the main
portion of the ampoule, one should flick
the upper portion (above the
constriction) severally with the finger
nails to bring all medication to the main
portion of the ampoule before snapping it
open after filling the neck.
Parenteral Medication
A sterile gauze placed around the neck
before breaking prevent cuts form the glass.
 A single or multiple-dose glass bottles with a
sealed rubber cap is called a vial. They are
usually covered with a soft metal cap that
can be easily removed. The rubber capping
must be cleaned with antiseptic(e.g.
methylated spirit) swab before a needle is
inserted.
 The nurse should consider the use of a filter
needle to withdraw medication

Withdrawing medication from Ampoules
Wash and dry hands
 Select appropriate ampoule
 Select the appropriate needle and syringe
 Take ampoule and observe for expiry date,
cloudiness (return to pharmacy if noticed)
 While holding the ampoule flick at its
neck/stem repeatedly with the fingernails to
return trapped contents to the base of the
ampoule.
 File if not scored at the neck

Withdrawing medication from Ampoules
Wrap a sterile gauze at the neck of the
ampoule and gently snap open.
 Tilt ampoule slightly to one side, uncap
needle on syringe and insert needle
below the level of the drug
 Gently pull on the plunger to draw
medicine into the syringe
 Change needle used in withdrawing drug
 Expel air.

Withdrawing Medication from an Vial






Wash and dry hands
Take the vial and observe for expiry date,
direction for mixing
Withdraw the appropriate diluents into a
syringe
with a dissecting for remove metal or
rubber cap covering the rubber stopper
Clean with swap containing methylated spirit
Introduce needle through the middle of the
rubber and release diluent into the vial.
Withdrawing Medication from an Vial
Shake or roll between the palms till clear
solution free from lump is obtained.
 Placing the syringe in the centre of the
rubber stopper, inject air into the vial.
 Invert the vial and keep the needle bevel in
the solution
 With syringe at eye level, ensure the desired
dose is drawn up.
 Slowly and gently, withdraw needle from the
vial and re-cap on a levelled surface

Withdrawing Medication from an Vial
Using ink, mark the current date, time and
initials on the vial
 Label the syringe with drug, dose, date
and time if not to be used immediately
 Wash and dry hands.

Withdrawing Medication from an Vial

If withdrawing medication from two vials
(multiple-dose) and mix in one syringe,
draw up from the multiple vial first then the
single vial to prevent contamination of the
multiple-dose vial.

In case of insulin, draw up the regular
insulin first before the short acting one.
Withdrawing Medication from an Vial
Intradermal Injection

An intradermal (intracutaneous) injection is
the administration of a drug into the dermal
layer of the skin just beneath the epidermis.
Only small volumes of drug are administered
by this route; about 0.01-0.1ml.

This route is indicated typically for diagnosis
of tuberculosis (tuberculin testing), testing
for allergens and for vaccinations (e.g. BCG)
Intradermal Injection

Needle gauge 25-27 with short bevel is
used; about 3/8 -1/2 inches are used with
the tuberculin syringe for accurate
measurement.

Sites for injection are the inner aspect of
the fore arm, upper chest, upper back
beneath the scapular.
Intradermal Injection
Intradermal Injection
Intradermal Injection
Procedure
 Wash and dry hands
 Position client comfortably
 Select injection site and inspect for oedema,
redness or tenderness or sites of previous
injection
 With antiseptics swab, clean site
 While holding swab between fingers of nondominant hand, pull cap off from the needle
Intradermal Injection
With thumb and forefinger of non-dominant
hand, stretch skin over the selected site and
insert needle at an angle of 5°-15°, bevel up
to about 1/8 inch below the skin.
 Do not aspirate; push plunger slowly to
inject the drug to form a small bleb under
the skin surface.
 Gently withdraw needle while applying
gentle pressure with the antiseptic swab; do
not massage

Intradermal Injection
Make patient comfortable, than him and
discard equipment as appropriate
 Document.

Subcutaneous Injections (Sc, SQ)
Subcutaneous Injections (Sc, SQ)
It is the administration of drug into the
subcutaneous tissue; between the dermis and
the muscle. It is usually used for insulin and
anticoagulant administration.
 Sites used usually are lateral and anterior
aspects of the upper arm and thigh,
upper back below the scapulae.
 Drug is slowly absorbed; hence if repeated
doses are given, the sites should be rotated
to prevent hard painful lumps from
developing as a result of irritation and poor
absorption of the drug

Subcutaneous Injections (Sc, SQ)
Procedure
 Wash and dry hands
 Assemble the equipment needed with
right syringe and needle.
 Prepare and load drug
 Position patient, clean site with antiseptic
swab
 Hold swab in a non-dominant fingers, pull
cap from needle
 With syringe in between thumb and
forefingers of the dominant hand
Subcutaneous Injections (Sc, SQ)
Pinch the skin with non dominant hand
 Inject needle quickly and firmly at an angle
of 45°-90°, release skin and grasp tip of
syringe with non dominant hand and pull
back the plunger to ascertain that needle is
not in vein (if in vein, blood will be drawn
into the syringe on pulling back the plunger).
 In the absence of blood in syringe, push
plunger gently but firmly to inject drug

Subcutaneous Injections (Sc, SQ)
Withdraw needle while applying pressure
to the site
 Massage site if acceptable and settle him
comfortably
 Discard equipment as appropriate
 Wash and dry hands
 document

Intramuscular Injection (IM)
It is the administration of into the muscle
tissue . The volume of medication to be
administered IM vary, but usually, 5ml is
considered as the maximum for large
muscles e.g. gluteal muscle.
 However, babies, the elderly and
emaciated patients are unable to tolerate
this amount; 2ml is usually the maximum
for them

Intramuscular Injection (IM)

Large healthy muscles free from abscesses,
necrotic tissue, sloughing and damaged nerves
and skin should be used.

When a number of injections are to received, the
sites should be rotated so that muscles are not
overused or over irritated.

The length of the needle and gauge id selected
based on the volume and thickness (viscosity) of
the medication and the muscle size.
Intramuscular Injection (IM)

In babies and young children, quadriceps
muscles on the anterior and lateral
aspects of the thighs are best to guard
against damaging the large sciatic nerve at
the gluteal muscle.
Intramuscular Injection (IM)
Dorsogluteal Site utilizes the gluteus maximus
muscle for injection. The get the injection site,
the buttock is divided into four (4) quadrants
with and imaginary line. The exact site is the
upper outer aspect of the upper outer
quadrant of the buttocks.
 Venterogluteal site uses the gluteus medius
and gluteus minimus for injection. It is a very
desirable site because there are neither large
nerves nor large blood vessels in the area; and it
also it has less fatty tissues. Because it is far
from the rectum, there is less risk of
contamination and abscess formation

Dorsogluteal Site
Venterogluteal site
Sites for IM injections
Intramuscular Injection (IM)

To locate the site, the nurse’s opposite hand
rests on the patient’s opposite hip, fingers
pointing towards (patient’s) head. The index
finger is placed on the anterior superior iliac
spine, the middle finger stretched dorsally
pressing just below the iliac crest to form a V;
a triangle is formed between the two (index
and middle) fingers and the crest of the ilium
which is the injection site thus the middle of
the triangle.
Intramuscular Injection (IM)


Quadriceps Site uses the rectus femoris
and vastus lateralis. The latter is located at
the anterior aspect of the thigh. The site for
site is midway between the greater
trochanter of the femur and the knee.
Deltoid normally for smaller volumes of
drug than the other muscles mentioned
earlier. It is lateral to the humerus; injection
site about 1-2 inches below the acromium
process
Quadriceps Site
Deltoid Injection site
Intramuscular Injection (IM)
Procedure
 As for subcutaneous injection but the
needle is introduced deeper into the
muscle at 90° angle.
Intravenous Therapy

Intravenous therapy is the administration of
fluids, electrolytes nutrients and medication
through the intravenous route.
Objectives
 To supply fluids when patients are unable to
take it liberally
 To provided salts needed to maintain
electrolyte balance
 To provide nutrients e.g. glucose, protein
(albumen and vitamins)
Intravenous Therapy

Administer drugs for rapid actions or when
drugs are irritating to the tissues
Sites for intravenous therapy
The site chosen for intravenous infusion
depends on:
 Type of infusion
 Duration for the infusion
 Age of the patient.
Intravenous Therapy
For adults, the veins on the arm are:
 Basilic vein
 Median cubital vein
 Dorsal veins
 Median vein
 Radial vein
 Cephalic vein
Intravenous Therapy
On the foot, the veins are;
 Great saphenous vein
 Dorsal plexus
Intravenous Therapy
Duties of the Nurse during IV Therapy
 Explain the need for the IV therapy, what to
expect, duration of the therapy, activities
permitted during the procedure and
observations to be made.
 Help patient to maintain activities of daily
living; bathing and grooming, feeding etc.
 Observation should be made on the flow
rate, patency of the tubing, infusion site, level
of fluid in the infusion bag/bottle, patient’s
comfort and reaction to therapy.
Intravenous Therapy

Change dressing on the IV line as may be
necessary.
Intravenous Therapy
Complications to observe for during IV
therapy:
 Infiltration escape of fluid into subcutaneous
tissue due to dislodgement of the needle causing
swelling and pain. Gross infiltration may result in
nerve compression injury which can result in
permanent loss of function of extremity or in
case of irritating medications (vesicant), significant
tissue loss, permanent disfigurement or loss of
function may result. When there is infiltration, the
site should be changed.
Intravenous Therapy

Phlebitis is the inflammation of the vein. This
may result from mechanical trauma due to the
insertion too big a needle (for small vein) or
leaving a device in place for a long time.
Chemical trauma result s from irritation from
solutions or infusing too rapidly. This manifests
as pain or burning sensation along the vein. On
observation, there may be redness, increased
temperature over the course of the vein.

The site should be changed and warm compress
should be applied.
Intravenous Therapy

Circulatory Overload; the intravascular
fluid compartment contains more fluid than
normal. This occurs when infusion is too
rapid or excess volume is infused. This
manifests as dyspnoea, cough, frothy sputum
and gurgling sounds on aspiration.

Embolism; obstruction of the blood vessels
by travelling air emboli or clot of the blood.
It is fatal.
Intravenous Therapy


Flow rate is the volume of intravenous fluid
to be infused over a set period of time as
prescribed by the prescriber. The flow rate
should also be observed for and bottles or
bags changed before blood is drawn up the
infusion set or air enters the tube. Flow rate
has to be calculated as:
Total amount of fluid to be infused X drop factor
Total time in minutes
Intravenous Therapy
Factors influencing flow rate are:
 Position of the extremity
 Patency of the tubing and
 Height of the infusion bottle/bag.