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Chapter 13
Administration Procedures
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Safeguards in
Administering Medications
• Oral medications:
– Hand washing
– Wear gloves when possible exposure to blood or
body secretions
• Injections
– Hand washing and gloves
– DO NOT recap needles
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General Safeguards in
Administering Medications (cont.)
• Hand washing and gloves
– Heparin locks, IV catheters, IV needles
– Secondary administration sets or IVPB sets
– Application of medication to mucous membranes
– Skin applications
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Masks
• Strict or respiratory isolation procedures
• Splash directly into face, eyes, or mucous membranes
• Aerosolization of fluids
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Needles
• Discard in appropriately labeled, puncture-proof
containers
• DO NOT break, bend, or recap needles after use
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Mobile Cart System
• Place the patient’s drawer on the top of cart. Read each
medication order and choose unit dose from the drawer
and compare the label with the order.
• After comparing the order with the unit measure,
compute the dose. Then open or prepare the unit dose
and pour the amount.
• Label the unit dose, read the order again, and verify the
dose. After preparing all the patient’s medications, read
the name on the medicine sheet, check the patient’s ID
band, and administer the drugs.
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Oral Medications
• Check expiration dates
• Check for allergies
• Check with MD if certain drugs are administered when
patient is NPO
• Do not touch stock medications with hands
• Do not break tablets that are not scored
• Do not crush enteric-coated tablets
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which medication can be broken in half or opened when
a patient has difficulty swallowing the oral medications?
A. Time-released capsule
B. Enteric-coated tablet
C. Film-coated tablet
D. Scored tablet
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
D. Scored tablet
– A scored tablet can be broken in half. Don’t crush
enteric-coated or film-coated tablets, and don’t open
capsules. Doing so would compromise the medication
in a time-released capsule.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Liquid Medications
• Shake liquid medications thoroughly before pouring
• Pour liquids at eye level
• Wipe the lip of the bottle with a paper towel before
recapping
• Disguise liquids if distasteful or irritating
– Juice
– Straw
• Don’t dilute liquid cough medicines
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Parenteral Route
• Adult maximum one site
– 3 mL
– 2 mL deltoid
• Angle of insertion
– IM 90 degree
– SC 45 degree and 90 degree subcutaneous fat and
needle short
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Needles for Injection
• Subcutaneous: 25, 26, 28 gauge
• IM children and emaciated patients: 25, 26, 28 gauge
• Intradermal: 26 gauge or other fine needle
• IM injections: 22 and 23 gauge
• IV therapy: 20 and 21 gauge
• Blood transfusion: 16 and 18 gauge
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Preparing the Dose
• Vials
• Ampules
• Unit dose cartridge and holder
• Unit dose prefilled syringes
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IM Injection Sites
• Adult
– Dorsogluteal
– Ventrogluteal
– Vastus lateralis
– Deltoid
• Children
– Vastus lateralis
• Dorsogluteal over 5 years of age
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Question
Is the following statement true or false?
• The preferred site for a toddler who has been walking for
two months is the dorsogluteal site.
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Answer
False
– The preferred site for infants is the vastus lateralis.
After the child has been walking for more than a
year, you can use the dorsogluteal site; however,
that site is not recommended for children younger
than 5 years.
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Administering Injections
• General principles
• Subcutaneous heparin
• Subcutaneous insulin
• Z track technique for intramuscular injections
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Medication Administration Techniques
• Skin and mucous membrane
• Ear drops
– Adult: Pinna up and back
– Child: Pinna down and back
– Rest on unaffected side for 10 to 15 minutes
• Eye drops or ointment
– Drops: lower conjunctival sac
– Ointment: spread inner to outer cantus of eye
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Nasogastric Route
• HOB elevated 30 degrees
• Check placement
– 15 mL of air
– Aspirate stomach contents
– Check acidity of stomach contents
• Flush at least 30 mL of warm water to ensure patency
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Medication Administration Techniques
• Nose drops
• Rectal suppository
• Respiratory inhaler
• Skin applications
• Nitroglycerin ointment
• Transdermal disks, patches, and pads
• Sublingual tablets
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Question
A patient is experiencing chest pain and takes a
nitroglycerin sublingual tablet. What is the maximum
number of tablets the patient can take before calling the
physician?
A. One
B. Two
C. Three
D. Four
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Three
– The most common sublingual medication is
nitroglycerin, which is prescribed to alleviate
symptoms of angina pectoris. If a patient does not
feel relief within 5 minutes, the patient can
administer a second and then a third tablet at 5minute intervals. If the pain continues after 15
minutes, the physician must be notified.
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Medication Administration Techniques
• Vaginal suppository or tablet
• Vaginal cream
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Neonatal and Pediatric Considerations
• Offer popsicle to numb taste buds
• Mix with pureed fruit, ice cream syrup
• Pinch nostril close and drink medication through a straw
• Distract child with conversation or toy
• Use decorative adhesive bandage to cover injection site
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Geriatric Considerations
• Offer popsicle to numb taste buds
• Mix with pureed fruit, ice cream syrup
• Injections
– Predetermine injection site
– Insert the needle quickly
– Inject the medication slowly
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