2.

drug name (generic preferred)

Administration of Medications 3. drug dosage ex. Morphine 2mg IV STAT
4. frequency & duration of administration C. Right Dose
Medication 5. any special instructions for withholding or  Nurse must do:
- A substance administered for the diagnosis, adjusting dosage
• Calculate and check drug
cure, treatment, relief or prevention of 6. physician or other health care provider’s
dose accurately.
disease. signature or name if TO or VO
7. signature of licensed practitioner taking TO • Check PDR, drug
Types of Doctor’s Order: or VO package insert or drug handbook for
recommended range of specific
1. Standing Order- it is carried out until the drugs.
specified period of time or until it is Nurse must do:
discontinued by another order. • check med order is complete & • Check heparin, insulin
2. Single Order- it is carried out for one time legible. and IV digitalis doses with another
• know general purpose or action, nurse.
only.
dosage & route of drug
3. Stat Order- it is carried out at once or  Stock- method vs Unit-dose method
immediately. • compare drug card with drug label
4. PRN Order- it is carried out as the patient three times. D. Right Time
requires. 1. at time of contact with  Nurse must do:
drug bottle/ container • Administer drugs at
Principles in Administering Medications: 2. before pouring drug specified times.
3. after pouring drug • Administer drugs that
1. Observe the “10 Rights” of drug are affected by foods, before
4 Categories of Drug Orders: meals.
administration.
1. Standing Order / • Administer drugs that
5 Traditional Rights 5 Additional Rights Routine Order can irritate stomach, with food.
 ongoing order • Drug administration
1. right client 1. right assessment  may have may be adjusted to fit schedule of
2. right drug 2. right documentation special instructions to base administration client’s lifestyle, & activities. &
3. right dose 3. right to education  include PRN diagnostic procedures.
4. right time 4. right evaluation orders • Check expiration date.
5. right route 5. right to refuse • Antibiotics should be
ex. digoxin 0.2 mg PO q.i.d., maintain administered at even
A. Right Client blood level at 0.5 – 2.0 mg/ml intervals.
Nurse must do: 2. One-time (single) order E. Right Route
1. verify client  check ID bracelet & room  given only  Nurse must do:
number once, at a specific time • assess ability to
2. have client state his name swallow before giving oral meds.
ex. Cefixime 2mg IM at 7 AM on 12-1-05
3. distinguish between 2 client’s with same • Do not crush or mix
last names 3. PRN order meds in other substances before
B. Right Drug  given at client’s consultation with physician or
request & nurse’s judgement for need & pharmacist
medication order may be prescribed by:
1. Physician safety • Use aseptic technique
2. Dentist when administering drugs.
3. Podiatrist ex Mefenamic Acid 500mg q 4h PRN for • Administer drug at
4. Advanced practice registered nurse (APRN) pain appropriate sites.
4. STAT order • Stay with client until
Components of a drug order:  given once, oral drugs have been swallowed.
1. date & time the order is written immediately F. Right Assessment
Keith Nester A. Lavin
  get baseline data before drug
administration.
G. Right Documentation
 Immediately record appropriate info
• Name, dose, route,time &
date, nurse’s initial or signature
 Client’s response:
• narcotics
• analgesics
• antiemetics
• sedatives
• unexpected reactions to
meds.
 Use correct abbreviations & symbols.
H. Right to Education
 Client teaching :
• therapeutic purpose
• side-effects
• diet restrictions or
requirements
• skill of administration
• laboratory monitoring
 Principle of Informed Consent
I. Right Evaluation
 client’s response to meds.
• effectiveness
• extent of side-effects or
any adverse reactions.
J. Right to Refuse
 Nurse must do:
• determine, when
possible, reason for refusal.
• facilitate px’s
compliance.
• explain risk for refusing
meds & reinforce the reason for
medication.
• Refusal should be
documented immediately.
• Head nurse or health
care provider should be informed when
omission pose threat to px.
ALL MEDICATION ERRORS ARE SERIOUS OR
POTENTIALLY SERIOUS!!!!!!!!
Keith Nester A. Lavin
Medication Misadventures include: 18. Infants receive no more than 1 ml
1. administration of wrong medication & IV fluid. of solution by IM at 1 site & no more than 1
2. incorrect dose or rate ml subcutaneously. NEVER recap needles.
3. administration to the wrong patient 19. Give drugs last to client who need
4. incorrect route extra assistance.
5. incorrect schedule interval
20. Discard needles & syringes in
6. administration of known allergic drug or IV fluid appropriate containers.
7. omission of dose or discontinuation of med or 21. Follow appropriate drug disposal
IV fluid that was not discontinued. based on institution policy.
22. Discard unused solutions from
Guidelines for Correct Administration of ampules.
Medications 23. Store appropriately unused
A. Preparation solutions from open vials.
1. Wash hands before preparing 24. Write date & time opened & initials
meds. on label.
2. Check for allergies. 25. Keep narcotics in a double-locked
3. Check medication order with drawer or closet. Med cart – locked at all
physician’s orders, medicine sheet, & times when nurse is not around.
medication card. 26. Keys to narcotics drawer must be
4. Check label on drug container 3 kept by the nurse & not stored in drawer.
times. 27. Avoid contamination of one’s own
5. Check expiration date on drug skin or inhalation to minimize chances of
label. allergy.
6. Recheck drug calculation with C. Recording
another nurse. 28. Report drug error immediately to
7. Verify doses of drugs that are nurse manager & physician. Complete an
potentially toxic with another nurse or incident report.
pharmacist. 29. Charting: record drug given, dose,
8. With unit dose, open packet at time, route & your initials.
bedside after verifying client identification. 30. Record drugs promptly after given,
9. Pour liquid at eye level. esp STAT doses.
10. Dilute drugs that irritate gastric 31. Record effectiveness & results of
mucosa or give with meals. meds given, esp PRN meds.
32. Report to physician & record drugs
B. Administration
that were refused with reason for refusal.
11. Administer only those drugs that
33. Record amount of fluid taken with
you have prepared.
12. Identify the client by ID band or ID medications on input & ouput chart.
photo.
13. Offer ice chips when giving bad Behaviors to Avoid During Medication
tasting medicine. Administration:
14. Assist client to appropriate • Do not be distracted when preparing meds.
position. • Do not give drugs poured by others.
15. Provide only liquids allowed on the • Do not pour drugs from containers whose
diet. labels are partially removed or have fallen off.
16. Stay with client until meds are • Do not transfer drugs from one container to
taken. another.
17. Administer no more than 2.5 to 3 • Do not pour drugs into the hand.
ml of solution by IM at one site. • Do not give expired medications.
• Do not guess about drugs & drug doses. Ask
when in doubt.
• Do not use drugs that have sediment, are
discolored, or are cloudy (& shld not be).
• Do not leave medications by the bedside or
with visitors.
• Do not leave prepared medications out of
sight.
• Do not give drugs if the px says he has
allergies to the drug or drug group.
• Do not call the px’s name as the sole means of
identification.
• Do not give drug if the client states the drug is
different from drug he has been receiving.
Check the order.
• Do not recap needles. Use universal
precautions.
• Do not mix with large amount of food or
beverage that are contraindicated.
Forms & Routes for Drug Administration
A. Tablets & Capsules
• oral meds not given to pxs who
are:
o vomiting
o lack gag reflex
o comatose
• Do not mix with large amt of food
or beverage or contraindicated food or
infant formula
• Enteric- coated & timed-release
capsules must be swallowed whole.
• Administer irritating drugs with
food to lessen GI discomfort.
• Administer drugs on empty
stomach if food interferes with absorption.
• Drugs given sublingually or
bucally must remain in place until
fully absorbed.
• Encourage use of child-resistant
caps.
B. Liquids
• Forms : elixir, emulsions, suspensions
• read label if dilution or shaking is required.
• read the MENISCUS.
• refrigerate once reconstituted.
Keith Nester A. Lavin
C. Transdermal
• systemic effect
• more consistent blood levels &
avoid GI absorption problems associated
with oral products.
• patches should NOT be cut.
D. Topical
• Applied to skin with a glove, tongue
blade or cotton - tipped applicator.
• Apply to clean dry skin when possible.
• Do not contaminate the medication in a
container.
• Do not “double dipped” .
• Observed sterile technique when skin
is broken.
• Use firm strokes if medication is to be
rubbed in.
E. Instillations
• Eyedrops
1. wash hands
2. lie or seat down and look up
towards ceiling
3. remove any discharge by wiping
out from inner canthus
4. rest hand holding the dropper
against the client’s head.
5. gently draw skin down below
affected eye to expose conjunctival
sac
6. administer drops into center of the
sac
7. gently press lacrimal duct with
sterile cotton ball or tissue for
1 to 2 mins after instillation
8. keep eyes closed for 1 to 2 mins
following application
• Eye Ointment
1, 2, 3, 4,- same as above
5 . squeeze strip of ointment (abt ¼
inch, unless stated otherwise).
6. keep eyes close for 2-3 mins.
7. instruct px for blurred vision for a
short time.
8. apply at bedtime, if possible.
• Ear Drops
1. wash hands.
2. med should be at room temp.
3. sit up with head tilted slightly
toward unaffected side.
4. child: pull auricle down & back.
(after 3yo ,same as adult)
adult: pull up & back.
5. instill prescribed drops.
6. do not contaminate dropper.
7. maintain position for 2-3 minutes.
• Nose Drops & sprays
1. have client blow nose.
2. tilt head back for drops to
reach frontal sinus.
tilt head to affected side to reach
ethmoid sinus.
3. Administer prescribed
number of drops or sprays.
Some sprays, close 1 nostril, tilt
head to closed side & hold breath
or breathe thru nose for 1 minute.
4. Keep head tilted backward
for 5 minutes after instillation.
F. Inhalations
• Semi-fowlers or high-fowler’s position.
• Teach correct use of nebulizer &
metered-dose inhalers.
G. Parenteral
administration of medications by needle.
a) Intradermal (ID)- under the epidermis
(into the dermis).
b) subcutaneous (SC)- in the
subcutaneous tissue (also, hypodermic).
c) intramuscular (IM)- into the muscle.
d) intravenous (IV)- into a vein.
e) intraarterial- into an artery.
f) intraosseous- into the bone.
Equipment.
Nurses use syringes and needles to
withdraw medications from ampoules and vials.
Syringes
Have three parts: the tip, which connects
with the needle; the barrel, or outside part, on
which the scales are printed; and the plunger
which fits inside the barrel.
Needles
 Have three parts: the hub, which fits into
the syringe; the cannula, or shaft, which is
attached to the hub; and the bevel, which is the
slanted part at the tip of the needle
Slant or length of bevel
The bevel of the needle may be short or
long. Longer bevels provide the sharpest needles
and cause less discomfort. They are commonly
used for subcutaneous and intramuscular
injections. Short bevels are used for intradermal
and intravenous injections because a long bevel
can become occluded if it rests against the side of
the blood vessel.
Length of the shaft.
The shaft length of commonly used needle
varies from ½ to 2 inches.
Gauge
The gauge varies from #18 to #28. The
larger the gauge the smaller the diameter of the
shaft. Smaller gauges produces less tissue trauma,
but larger gauges are necessary for viscous
medications such as penicillin
Intradermal (ID)
- indicated for allergy and tuberculin testing
and for vaccination.
SITES:
- inner lower arm
*Left arm- for tuberculin test
* Right arm- for all other test
- Upper chest
- Back, beneath the Scapula
What to observe?
- less hairy Needle gauge #
- less pigmented - #25,26,27
- less vascularized Needle length
- less keratinized - 3/8”, 5/8”,1/2”
• The site are the inner lower arm, upper
chest and back, and beneath the scapula.
• Indicated for allergy and tuberculin testing
and for vaccinations.
• Use the needle gauge 25, 26, 27: needle
length 3/8”, 5/8” or ½”
• Needle at 10–15 degree angle; bevel up.
• Inject a small amount of drug slowly over 3
to 5 seconds to form a wheal or bleb.
Keith Nester A. Lavin
• Do not massage the site of injection. To
prevent irritation of the site, and to prevent
absorption of the drug into the
subcutaneous.
Subcutaneous – vaccines, heparin, preoperative
medication, insulin, narcotics.
• The site:
 outer aspect of the
upper arms
 anterior aspect of
the thighs
 Abdomen
 Scapular areas of
the upper back
 Ventrogluteal
 Dorsogluteal
• Only small doses of medication should be
injected via SC route.
• Rotate site of injection to minimize tissue
damage.
• Needle length and gauge are the same as
for ID injections
• Use 5/8 needle for adults when the
injection is to administer at 45 degree
angle; ½ is use at a 90 degree angle.
• For thin patients: 45 degree angle of
needle
• For obese patient: 90 degree angle of
needle
For heparin injection:
• do not aspirate.
• Do not massage the injection site to
prevent hematoma formation
For insulin injection:
• Do not massage to prevent rapid
absorption which may result to
hypoglycemic reaction.
• Always inject insulin at 90 degrees angle to
administer the medication in the pocket
between the subcutaneous and muscle
layer. Adjust the length of the needle
depending on the size of the client.
• For other medications, aspirate before
injection of medication to check if the
blood vessel had been hit. If blood appears
on pulling back of the plunger of the
syringe, remove the needle and discard the
medication and equipment.
Intramuscular
• Needle length is 1”, 1 ½”, 2” to reach the
muscle layer
• Clean the injection site with alcoholized
cotton ball to reduce microorganisms in the
area.
• Inject the medication slowly to allow the
tissue to accommodate volume.
Sites:
Ventrogluteal site
 The area contains no large nerves,
or blood vessels and less fat. It is farther
from the rectal area, so it less
contaminated.
• Position the client in prone or side-lying.
 When in prone position, curl the
toes inward.
 When side-lying position, flex the
knee and hip. These ensure relaxation of
gluteus muscles and minimize discomfort
during injection.
• To locate the site, place the heel of the
hand over the greater trochanter, point the
index finger toward the anterior superior
iliac spine, then abduct the middle (third)
finger. The triangle formed by the index
finger, the third finger and the crest of the
ilium is the site.
Dorsogluteal site
• Position the client similar to the
ventrogluteal site
• The site should not be use in infant under 3
years , because the gluteal muscles are not
well developed yet.
• To locate the site, the nurse draw an
imaginary line from the greater trochanter
to the posterior superior iliac spine. The
injection site id lateral and superior to this
line.
 • Another method of locating this site is to
imaginary divide the buttock into four
quadrants. The upper most quadrant is the
site of injection. Palpate the crest of the
ilium to ensure that the site is high enough.
• Avoid hitting the sciatic nerve, major blood
vessel or bone by locating the site
properly.
Vastus Lateralis
• Recommended site of injection for infant
• Located at the middle third of the anterior
lateral aspect of the thigh.
• Assume back-lying or sitting position.
Rectus femoris site –located at the middle third,
anterior aspect of thigh.
Deltoid site
• Not used often for IM injection because it is
relatively small muscle and is very close to
the radial nerve and radial artery.
• To locate the site, palpate the lower edge
of the acromion process and the midpoint
on the lateral aspect of the arm that is in
line with the axilla. This is approximately 5
cm (2 in) or 2 to 3 fingerbreadths below the
acromion process.
IM injection – Z tract injection
• Used for parenteral iron preparation. To
seal the drug deep into the muscles and
prevent permanent staining of the skin.
• Retract the skin laterally, inject the
medication slowly. Hold retraction of skin
until the needle is withdrawn
• Do not massage the site of injection to
prevent leakage into the subcutaneous.
GENERAL PRINCIPLES IN PARENTERAL
ADMINISTRATION OF MEDICATIONS
1. Check doctor’s order.
2. Check the expiration for medication – drug
potency may increase or decrease if outdated.
3. Observe verbal and non-verbal responses
toward receiving injection. Injection can be
painful.client may have anxiety, which can
increase the pain.
4. Practice asepsis to prevent infection. Apply
disposable gloves.
Keith Nester A. Lavin
5. Use appropriate needle size. To minimize tissue
injury.
6. Plot the site of injection properly. To prevent
hitting nerves, blood vessels, bones.
7. Use separate needles for aspiration and injection
of medications to prevent tissue irritation.
8. Introduce air into the vial before aspiration. To
create a positive pressure within the vial and allow
easy withdrawal of the medication.
9. Allow a small air bubble (0.2 ml) in the syringe to
push the medication that may remain.
10. Introduce the needle in quick thrust to lessen
discomfort.
11. Either spread or pinch muscle when
introducing the medication. Depending on the size
of the client.
12. Minimized discomfort by applying cold
compress over the injection site before introduction
of medicati0n to numb nerve endings.
13. Aspirate before the introduction of medication.
To check if blood vessel had been hit.
14. Support the tissue with cotton swabs before
withdrawal of needle. To prevent discomfort of
pulling tissues as needle is withdrawn.
15. Massage the site of injection to haste
absorption.
16. Apply pressure at the site for few minutes. To
prevent bleeding.
17. Evaluate effectiveness of the procedure and
make relevant documentation.
Intravenous
The nurse administer medication intravenously by
the following method:
• As mixture within large volumes of IV fluids.
• By injection of a bolus, or small volume, or
medication through an existing intravenous
infusion line or intermittent venous access
(heparin or saline lock)
• By “piggyback” infusion of solution containing
the prescribed medication and a small volume
of IV fluid through an existing IV line.
• Most rapid route of absorption of
medications.
• Predictable, therapeutic blood levels of
medication can be obtained.
• The route can be used for clients with
compromised gastrointestinal function or
peripheral circulation.
• Large dose of medications can be
administered by this route.
• The nurse must closely observe the client
for symptoms of adverse reactions.
• The nurse should double-check the six
rights of safe medication.
• If the medication has an antidote, it must
be available during administration.
• When administering potent medications,
the nurse assesses vital signs before, during
and after infusion.
Nursing Interventions in IV Infusion
• Verify the doctor’s order
• Know the type, amount, and indication of IV
therapy.
• Practice strict asepsis.
• Inform the client and explain the purpose of IV
therapy to alleviate client’s anxiety.
• Prime IV tubing to expel air. This will prevent
air embolism.
• Clean the insertion site of IV needle from
center to the periphery with alcoholized cotton
ball to prevent infection.
• Shave the area of needle insertion if hairy.
• Change the IV tubing every 72 hours. To
prevent contamination.
• Change IV needle insertion site every 72 hours
to prevent thrombophlebitis.
• Regulate IV every 15-20 minutes. To ensure
administration of proper volume of IV fluid as
ordered.
• Observe for potential complications.
Types of IV Fluids
Isotonic solution – has the same concentration as
the body fluid
• D5 W
• Na Cl 0.9%
• plainRinger’s lactate
• Plain Normosol M
Hypotonic – has lower concentration than the
body fluids.
• NaCl 0.3%
Hypertonic – has higher concentration than the
body fluids.
  D10W • Notify physician • Physical therapy may be required
Note: apply splint with the fingers free to move.
 D50W Superficial Thrombophlebitis – it is due to Speed Shock – may result from administration of
 D5LR o0veruse of a vein, irritating solution or drugs, clot IV push medication rapidly.
formation, large bore catheters. • To avoid speed shock, and possible cardiac
 D5NM
Assessment: arrest, give most IV push medication over 3 to
• Pain along the course of vein 5 minutes.
Complication of IV Infusion
Infiltration – the needle is out of nein, and fluids • Vein may feel hard and cordlike
• Edema and redness at needle insertion site. BLOOD TRANSFUSION THERAPY
accumulate in the subcutaneous tissues.
Assessment: • Arm feels warmer than the other arm
Nursing Intervention: Objectives:
Pain, swelling, skin is cold at needle site, pallor of
the site, flow rate has decreases or stops. • Change IV site every 72 hours • To increase circulating blood volume after
• Use large veins for irritating fluids. surgery, trauma, or hemorrhage
Nursing Intervention: • Stabilize venipuncture at area of flexion.
• Change the site of needle • Apply cold compress immediately to relieve
• To increase the number of RBCs and to
maintain hemoglobin levels in clients with
• Apply warm compress. This will absorb edema pain and inflammation; later with warm
compress to stimulate circulation and severe anemia
fluids and reduce swelling.
promotion absorption. • To provide selected cellular components as
Circulatory Overload – Results from “Do not irrigate the IV because this could push clot replacements therapy (e.g clotting factors,
administration of excessive volume of IV fluids. into the systemic circulation’ platelets, albumin)
Assessment:
• Headache Air Embolism – Air manages to get into the Nursing Interventions:
• Flushed skin circulatory system; 5 ml of air or more causes air • Verify doctor’s order. Inform the client and
• Rapid pulse embolism. explain the purpose of the procedure.
• Increase BP Assessment: • Check for cross matching and typing. To
• Weight gain • Chest, shoulder, or backpain ensure compatibility
• Syncope and faintness • Hypotension • c. Obtain and record baseline vital signs
• Pulmonary edema • Dyspnea • d. Practice strict Asepsis
• Increase volume pressure • Cyanosis • e. At least 2 licensed nurse check the label of
• SOB • Tachycardia the blood transfusion
• Coughing • Increase venous pressure Check the following:
• Tachypnea • Loss of consciousness • Serial number
Nursing Intervention • Blood component
• shock
Nursing Interventions: • Do not allow IV bottle to “run dry” • Blood type
• Slow infusion to KVO • “Prime” IV tubing before starting infusion. • Rh factor
• Place patient in high fowler’s position. To • Turn patient to left side in the trendelenburg • Expiration date
enhance breathing position. To allow air to rise in the right side of • Screening test (VDRL, HBsAg, malarial smear)
the heart. This prevent pulmonary embolism. - this is to ensure that the blood is free from blood-
• Administer diuretic, bronchodilator as ordered
carried diseases and therefore, safe from
Nerve Damage – may result from tying the arm transfusion.
Drug Overload – the patient receives an
too tightly to the splint. • Warm blood at room temperature before
excessive amount of fluid containing drugs.
Assessment transfusion to prevent chills.
Assessment:
• Numbness of fingers and hands • Identify client properly. Two Nurses check the
• Dizziness
Nursing Interventions client’s identification.
• Shock
• Massage the are and move shoulder through • Use needle gauge 18 to 19. This allows easy
• Fainting
its ROM flow of blood.
Nursing Intervention
• Instruct the patient to open and close hand
• Slow infusion to KVO.
several times each hour.
• Take vital signs
Keith Nester A. Lavin
• Use BT set with special micron mesh filter. To
prevent administration of blood clots and
particles.
• Start infusion slowly at 10 gtts/min. Remain at
bedside for 15 to 30 minutes. Adverse reaction
usually occurs during the first 15 to 20
minutes.
• Monitor vital signs. Altered vital signs indicate
adverse reaction.
• Do not mixed medications with blood
transfusion. To prevent adverse effects
• Do not incorporate medication into the blood
transfusion
• Do not use blood transfusion line for IV push of
medication.
• Administer 0.9% NaCl before, during or after
BT. Never administer IV fluids with dextrose.
Dextrose causes hemolysis.
• Administer BT for 4 hours (whole blood, packed
rbc). For plasma, platelets, cryoprecipitate,
transfuse quickly (20 minutes) clotting factor
can easily be destroyed.
Complications of Blood Transfusion
Allergic Reaction – it is caused by sensitivity to
plasma protein of donor antibody, which reacts
with recipient antigen.
Assessments
• Flushing
• Rush, hives
• Pruritus
• Laryngeal edema, difficulty of breathing
Febrile, Non-Hemolytic – it is caused by
hypersensitivity to donor white cells, platelets or
plasma proteins. This is the most symptomatic
complication of blood transfusion
Assessments:
• Sudden chills and fever
• Flushing
• Headache
• Anxiety
Septic Reaction – it is caused by the transfusion
of blood or components contaminated with
bacteria.
Assessment:
• Rapid onset of chills
Keith Nester A. Lavin
• Vomiting 8. Blood container, tubing, attached label, and
• Marked Hypotension transfusion record are saved and returned to the
• High fever laboratory for analysis.
Circulatory Overload – it is caused by
administration of blood volume at a rate greater
than the circulatory system can accommodate.
Assessment
• Rise in venous pressure
• Dyspnea
• Crackles or rales
• Distended neck vein
• Cough USING SAFETY MEASURES WHILE PREPARING DRUGS
• Elevated BP 1. Three Checks and Five Rights
- label on medication should be checked 3
Hemolytic reaction - It is caused by infusion of times during preparation
incompatible blood products. - when nurse reaches for container or unit
Assessment dose package
• Low back pain (first sign). This is due to - immediately before pouring or opening
inflammatory response of the kidneys to medication
incompatible blood. - when replacing container to drawer or
• Chills shelf or before giving unit dose medication
• Feeling of fullness
• Tachycardia Right medication to right patient in the right
• Flushing dosage through the right route at the right time
• Tachypnea
• Hypotension 2. Caring for Controlled Substances Safely
- controlled substances are kept in a locked
• Bleeding
drawer or container as a safety measure
• Vascular collapse
- narcotics or controlled substances may be
• Acute renal failure ordered only by physician (sometimes, nurse
practitioners registered with Dept. of Justice)
Nursing Interventions when complications - record must be kept for each narcotic
occurs in Blood transfusion administered
- forms are kept with narcotics
1. If blood transfusion reaction occurs. STOP THE - information required: - receiving
TRANSFUSION.
patient’s name, hour narcotic was given, name of
2. Start IV line (0.9% Na Cl ) physician prescribing narcotic, name of nurse
3. Place the client in fowlers position if with SOB
administering narcotic
and administer O2 therapy. - narcotics are checked daily
4. The nurse remains with the client, observing - amount on hand is counted and each
signs and symptoms and monitoring vital signs as dose used must be accounted for on the narcotic
often as every 5 minutes. record
5. Notify the physician immediately. - nurse has a secure i.d. code that provides
6. The nurse prepares to administer emergency access into the system, identifies patient by name
drugs such as antihistamines, vasopressor, fluids, or i.d. number, and verifies count for each drug as
and steroids as per physician’s order or protocol. it is removed
7. Obtain a urine specimen and send to the - count that does not check properly must
laboratory to determine presence of hemoglobin as be reported immediately
a result of RBC hemolysis.
 - if for any reason a narcotic prepared for
administration has to be discarded, a 2nd nurse
should act as witness, and that person should also
sign the narcotic sheet
- also document with a witness any time a
full dosage is not given and some of the narcotic
needs to be disposed.
3. Identifying the Patient
- positive identification of patient is
essential to safe drug administration
- check carefully to see that right drug is
being given to right patient
- patients usually wear identification
bracelets
- ask patient to state his/her name, if
possible
- check current photograph of resident, if
available, which is usually displayed above
resident’s bed
- verify patient i.d. with other healthcare
providers
ADMINISTERING ORAL MEDICATIONS
- check patient to ensure medication was
they actually take meds (make sure they don’t
“cheek” it
- preparation forms include solid (tablets,
capsules, pills)
- some tablets are scored for easy breaking
if partial quantity is needed
- enteric-coated tablets and extended-
release forms (SR = sustained release, XL =
extended release, CR/CT = controlled release, SA =
sustained action, LA =
long-acting) should not be chewed or crushed
- certain narcotics can be administered in a
lollipop or oral-transmucosal form liquids (elixirs,
spirits, suspensions, syrups)
- water-based and alcohol-based solutions
- can be administered via syringe between
gum and cheek
- if label becomes difficult to read or
accidentally comes off, container should be
returned to pharmacy
- never give a medication from a bottle
without a label
- care should be taken when pouring to
prevent unnecessary loss
Keith Nester A. Lavin
- do not transfer medication from one
container to another
1. Steps / Rationales
a. Know actions, special nursing considerations,
safe dose ranges, purpose of administration, and
adverse effects of medication to be administered.
- aids nurse in evaluating therapeutic
effect, can also be used to educate patients about
their medication
b. Prepare medication for administration in
medication area
- facilitates error free administration and
saves time
c. Prepare medications for one patient at a time
- prevents errors in medication
administration
d. Hold liquid medication bottles with label against
the palm. Use appropriate measuring device when
pouring, read amt. of medication at bottom of
meniscus at eye level
- label is needed for additional safety
check, also may indicate monitoring of certain vital
signs
- liquid may drip onto label making it
difficult to read
e. When all medications for one patient have been
prepared recheck once again with medication
order before taking them to patient – keep
medications in sight at all times
- 3rd check to ensure accuracy and to
prevent errors
f. Identify patient carefully: check name on i.d.
band, ask patient his/her name, verify patient’s i.d.
with staff members who know patient
- most reliable method, requires an answer
from patient
- do not use name on door or over bed –
these may be inaccurate
g. Check allergy bracelet or ask patient about
allergies – explain purpose and action of each
medication to patient
- assessment is prerequisite to
administration of medication
h. Offer water or other permitted fluids with
pills, capsules, tables, and some liquid measures –
If capsule or tablet falls to floor, it must be
discarded and a new one administered
- facilitates swallowing of solid drugs
- encourages patient’s participation
- prevents contamination
i. Remain with patient until each medication is
swallowed
- only by physician’s order can medication
be left at bedside
j. Record each medication given on medication
chart – record refused or omitted drugs, record
narcotic administration and any additional required
forms
- prompt recording avoids possibility of
accidentally repeating administration
- verifies reason medication was omitted
and ensure physician is aware of patient’s
condition
k. Check patient within 30 minutes to verify his/her
response to medication
ADMINISTERING MEDICATIONS TO CHILDREN
- children younger than 5 yrs have difficulty
swallowing tablets and capsules
- in addition to understanding medication
order and reason for medication, caregiver should
be able to
demonstrate any special techniques involved in
administering prescribed drugs
- use dropper for infants or very young
children
- place medication between gum and cheek
to prevent aspiration
- crush uncoated tablets or empty soft
capsule and mix med with soft food (potatoes,
pudding, cooked
or hot cereal)
- proper absorption may not occur
- if med has objectionable taste, warn child
- failing to warn is likely to decrease child’s
trust in nurse
- take care when selecting food – item
should not be essential part of child’s diet
- child may refuse food associated with
meds
- offer child flavored ice pop or frozen fruit
bar immediately before taking meds
- numbs tongue, making take less evident
- praise child for job well done after
administration
ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING
TUBE
 - use liquid meds or meds that can be
crushed and combined with liquid
- bring liquid med to room temp
- remove clamp from tube, checking for
tube placement before administering drug
- flush tube with 15 – 30 mL water (5 – 10
mL for children) before giving meds and
immediately after
- give meds separately and flush with
water between each drug
- disconnected from suction and clamped
20 – 30 minutes after administration
- disconnect continuous tube feeding,
leaving tube clamped for short period of time
- document water intake and liquid med on
I & O chart
ADMINISTERING INTRADERMAL INJECTION
- if necessary, withdraw med from ampule
or vial
- select area on inner aspect of forearm
that is not heavily pigmented or covered with hair
- forearm is convenient and easy, hair or
lesions may interfere with assessments
- cleanse area using aseptic technique
- use nondominant hand to spread skin
taut over injection site
- place needle almost flat against patient’s
skin, bevel side up, and insert needle into skin so
that point can be seen through skin (approx. 1/8”)
- inject agent while watching for small
wheal or blister – if none, withdraw needle slightly
- do not massage area
- assess patient for comfort
- chart administration as well as site of
injection
- observe area for reaction at ordered
intervals (usually 24- to 72-hours)
- aspiration is not recommended
ADMINISTERING SUBCUTANEOUS INJECTION
- if necessary, withdraw med from ampule
or vial
- identify patient carefully
- have patient assume appropriate position:
injection into tense extremity causes discomfort
- outer aspect of upper arm = patient’s
arm should be relaxed and at body’s side
- anterior thighs = patient may sit or lie
with leg relaxed
Keith Nester A. Lavin
- abdomen = patient may lie in
semirecumbent position
- ensure site of choice is not tender and is
free of lumps or nodules
- clean area
- grasp and bunch area surrounding
injection site or spread skin at site
- provides easy, less painful entry
- thin patients should have their skin
bunched to create skin fold
- with dominant hand, inject needle at 45 -
90° angle with dart-like action
- after needle is in place, release tissue
- aspirate if recommended - if blood
appears, withdraw needle
- do not aspirate when giving insulin or any
form of heparin
- massage area gently, except with heparin
or insulin, apply small bandage if necessary
- chart administration including injection
site
- evaluate patient’s response within
specified times
ADMINISTERING INTRAMUSCULAR INJECTION
- if necessary, withdraw med from ampule
or vial
- do not add air to syringe
- identify patient carefully
- have patient assume appropriate
position:- ventrogluteal = patient may lie on back
or side with hip and knee flexed
vastus lateralis = patient may lie on back or
may assume sitting position
deltoid = patient may site or lie with arm relaxed
dorsogluteal = patient may lie prone with toes
pointing inward or on side with upper leg flexed
and placed in front of lower leg
- ensure site is not tender and is free of
lumps or nodules
- spread skin at site using nondominant
hand
- quickly dart needle into tissue at 72- to
90° angle
- aspirate – if blood is present, discard
needle, syringe, and med - - prepare new sterile
setup and inject at another site
- gently apply pressure at site with small,
dry sponge
- chart administration including injection
site
- evaluate patient within appropriate time
frame
EYE INSTILLATIONS AND IRRIGATIONS
- applications to eye seldom are placed
directly onto eyeball
- applications intended to act on eye or lids
are placed onto, or instilled or irrigated into, lower
conjunctival sac
- sterile application
1.Eyedrops – instilled for local effects (pupil
dilation or constriction when examining, for
treatment, or controlling intraocular pressure for
glaucoma)
- type and amt of solution depend on
purpose of instillation
- hold dropper close to eye but avoid
touching eyelids or lashes
- administer prescribed number of drops
- apply gentle pressure to inner canthus to
prevent eyedrops from flowing into tear duct
- instruct patient not to rub
- chart administration
- evaluate for response
2. Eye Irrigation
- have patient sit or lie with head tilted
toward side of affected eye
- clean from inner toward outer canthus to
prevent debris entering lacrimal ducts
- expose lower conjunctival sac, hold
irrigator about 2.5 cm (1”) from eye, direct flow
from inner to outer canthus
- irrigate until solution is clear or all of the
solution has been used
- use only enough force to remove
secretions gently
- avoid touching any part of eye
- dry area with cotton balls or gauze
sponge
- chart irrigation, appearance of eye,
drainage, and patient’s response
ADMINISTERING SUBLINGUAL AND BUCCAL MEDICATIONS
sublingual – tablet is placed under patient’s
tongue
buccal – medication is administered between the - be sure patient understand he/she is to
cheek and gum retain suppository, usually 30 – 40 minutes after
insertion.
- these areas are rich in superficial blood
vessels, allowing relatively rapid absorption into
the bloodstream for quick systemic effect
- should not be swallowed but rather held
in place so that complete absorption can occur

ADMINISTERING TOPICAL MEDICATIONS

topical – drug is applied directly to body site

- applied for direct action at particular site,

although some systemic effect may occur
- if application site is a cavity (nose) or is
enclosed (eye), mechanical applicator is needed to
introduce drug

inunction - ointment preparation is rubbed into

skin for absorption
- cleaning skin thoroughly with soap or
detergent to enhance absorption
- when indicated, apply local heat to
improve blood circulation and promote absorption

RECTAL SUPPOSITORIES
suppository – conical or oval solid substance
shaped for easy insertion into body cavity and
designed to melt at body temperature

- functions include fecal softener

(constipation), direct action on nerve endings in
rectal mucosa (weak
muscle tone or poor intervention), and carbon
dioxide when moistened (liberates gas, distends,
stimulates elimination impulses)
- have patient lie on either side and pie-fold
top lines over him/her
- lubricate suppository and fingertips to
reduce irritation
- separate buttocks and have patient relax
by breathing through mouth during insertion
- introduce suppository well beyond
internal sphincter (4” – adults, 2” – children and
infants)
- avoid embedding suppository in fecal
mass
- correct placement is between stool and
rectal mucosa

Keith Nester A. Lavin