1. Medication Administration

2. Mosby items and derived items © 2005 by Mosby, Inc.
Actions
Therapeutic effects
Side effects
Adverse effects
Toxic effects
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3. Routes of Administration
Oral: sublingual, buccal
Parenteral: intradermal, subcutaneous, intramuscular, intravenous
Topical
Inhalation
Intraocular
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4. Classification Routes of administration can broadly be divided into:
Topical: Drugs are applied topically to the skin or mucous membranes, mainly for local action.
Oral: used for systemic (non-local) effect, substance is given via the digestive tract.
Parenteral: A drug administered parenterally is one injected via a hollow needle into the body at various sites and to varying depth.
Rectal: Drugs given through the rectum by suppositories or enema.
Inhalation: The lungs provide an excellent surface for absorption when the drug is delivered in gaseous, aerosol or ultrafine solid particle form.

5. Routes of administration

6. 1- Topical route: I Skin A-Dermal – cream, ointment (local action)
B- Transdermal- absorption of drug through skin (i.e systemic action)
I. stable blood levels(controlled drug delivery system)
II. No first pass metabolism
III. Drug must be potent or patch becomes too large
II Mucosal membranes
• eye drops (onto the conjunctiva)
ear drops
intranasal route (into the nose)

7. 2 -Oral route (Cont.) Advantages:
1- Convenient - portable, no pain, easy to take.
2- Cheap - no need to sterilize, compact, multi-dose bottles, automated machines produce tablets in large quantities.
3- Variety - tablets, capsules, suspensions, mixtures .

8. 3- Buccal/Sublingual route:
Some drugs are taken as smaller tablets which are held in the mouth (buccal tablet) or under the tongue (sublingual tablet).
Buccal tablets are often harder tablets [4 hour disintegration time], designed to dissolve slowly.
E.g Nitroglycerin, as a softer sublingual tablet [2 min disintegration time], may be used for the rapid relief of angina.

9. 1- Holding the dose in the mouth is inconvenient.
3- Buccal/Sublingual route (Cont.)
Disadvantages
1- Holding the dose in the mouth is inconvenient.
2- Small doses only can be accommodated easily.

10. 4- Parenteral route:

11. 4- Parenteral route (Cont.)
A- Intravascular (IV): - placing a drug directly into blood stream. -May be - Intravenous (into a vein) or - intraarterial (into an artery). Advantages 1- precise, accurate and immediate onset of action, 100% bioavailability. Disadvantages 1- risk of embolism. 2- high concentrations attained rapidly leading to greater risk of adverse effects.

12. 4- Parenteral route (Cont)
B-Intramuscular :(into the skeletal muscle). Advantages 1- suitable for injection of drug in aqueous solution (rapid action) and drug in suspension or emulsion (sustained release). Disadvantages 1- Pain at injection sites for certain drugs.

13. 4- Parenteral route (Cont)
C- Subcutaneous (under the skin), e.g. insulin.
D- Intradermal, (into the skin itself) is used for skin testing some allergens.
E- Intrathecal (into the spinal canal) is most commonly used for spinal anesthesia .
F- Intraperitoneal, (infusion or injection into the peritoneum) e.g. peritoneal dialysis in case of renal insuffeciency.

14. 5-Rectal route: Most commonly by suppository or enema. Advantages
1- By-pass liver - Some of the veins draining the rectum lead directly to the general circulation, thus by-passing the liver. Reduced first-pass effect.
2- Useful - This route may be most useful for patients unable to take drugs orally (unconscious patients) or with younger children.
- if patient is nauseous or vomiting

15. 5- Rectal route (Cont.)
Disadvantages 1- Erratic absorption - Absorption is often incomplete and erratic. 2- Not well accepted.

16. 6- Inhalation route:
- Used for gaseous and volatile agents and aerosols.
- solids and liquids are excluded if larger than 20 micron. the particles impact in the mouth and throat. Smaller than 0.5 micron , they aren't retained.
Advantages
A- Large surface area
B- thin membranes separate alveoli from circulation
C- high blood flow
As result of that a rapid onset of action due to rapid access to circulation.

17. 6- Inhalation route (Cont.)
Disadvantages
1- Most addictive route of administration because it hits the brain so quickly.
2- Difficulties in regulating the exact amount of dosage.
3- Sometimes patient having difficulties in giving themselves a drug by inhaler.

18. Mosby items and derived items © 2005 by Mosby, Inc.
Metric System
Grams (g), milligrams (mg), kilograms (kg)
Liters (L), milliliters (ml)
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19. Household Measurements
Tablespoons
Teaspoons
Ounces
Cups
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20. Mosby items and derived items © 2005 by Mosby, Inc.
Prescriber’s Role
Types of orders
Single orders
Stat orders
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21. Mosby items and derived items © 2005 by Mosby, Inc.
Distribution Systems
Stock supply
Unit dose
Computer controlled
Mosby items and derived items © 2005 by Mosby, Inc.

22. Parts of the Order Patient name Date and time Drug name Drug dosage
Route
Frequency
Signature

23. Problems with Orders Allergies Steps Drug book Pharmacist Physician
Supervisor

24. Drug Administration 3 checks obtaining the container removing the med
replacing the container

25. Nurse’s Role Six rights Triple-check before administration
Client assessment

26. Six Rights Right medication Right dose Right client Right route
Right time
Right documentation

27. Client’s Rights Information Refusal Careful assessment
Informed consent
Safe administration
Supportive therapy
No unnecessary medications

28. Assessment Medical history History of allergies Medication data
Diet history
Perceptual or coordination problems
Current condition

29. Assessment (cont’d) Attitude about medication use Knowledge of therapy
Learning needs

30. Nursing Diagnoses Deficient knowledge (medications)
Disturbed sensory perception
Impaired swallowing
Ineffective therapeutic regimen management

31. Planning Goals and outcomes Setting priorities Continuity of care
– Example:
Client will verbalize therapeutic and adverse effects of medications
Setting priorities
Continuity of care

32. Implementation Client and family teaching
Medication orders: receipt, communication
Calculation and measurement
Correct administration technique
Recording

33. Special Considerations
Infants and children
Older adults
Self-prescribing
Over-the-counter medications
Misuse
Noncompliance

34. Evaluation Client response to medications
Client and family ability to administer medications

35. Oral Administration Presence of GI alterations Ability to swallow
Positioning

36. Topical Administration
Skin applications
Use of gloves or applicators
Preparation of skin
Thickness of application

37. Nasal Instillation Assessment of nares
Client instruction and self-administration
Positioning

38. Eye Instillation Drops, ointments, disks Assessment of eyes Asepsis
Positioning

39. Ear Instillation Assessment of ear canal Warming of solution
Straightening of canal for children and adults
Positioning

40. Vaginal Instillation Suppositories, foams, creams
Use of gloves and applicator
Client positioning, comfort, and hygiene

41. Rectal Instillation Suppositories Use of gloves
Client positioning, comfort, and hygiene

42. Inhalation Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
Client assessment and instruction
Use of spacer
Determination of doses in canister

43. Irrigation
Medications used to wash out a body cavity delivered with a stream of solution (sterile water, saline, or antiseptic)
Asepsis

44. Parenteral Administration
Equipment
Syringes: sizes (volume), types
Needles: length, gauge
Disposable units: Tubex, Carpuject
Ampules
Vials

45. Parenteral Administration (cont’d)
Mixing medications
Determine compatibility of the medications
Do not contaminate one medication with another
Ensure the final dose is accurate
Maintain aseptic technique

46. Parenteral Administration (cont’d)
Insulin
Syringes and needle sizes
Types of insulin
Mixing of insulins
Rotation of vials before withdrawal of solution

47. Administration of Injections
Minimize discomfort
Use smallest suitable needle
Position client comfortably
Select proper site
Divert client’s attention
Insert the needle quickly and smoothly
Hold the syringe steady
Inject the medication slowly and steadily

48. Administration of Injections (cont’d)
Subcutaneous injections
Sites: condition of area, rotation of use
Amount of solution
Length and gauge of needle
Pinch or spread skin
Angle of insertion

49. Administration of Injections (cont’d)
Intramuscular injections
Sites: landmarks, condition of area
Amount of solution
Length and gauge of needle
Angle of insertion
Aspiration
Air-lock method
Z-track technique

50. Administration of Injections (cont’d)
Sites
Ventrogluteal
Vastus lateralis
Deltoid

51. Administration of Injections (cont’d)
Intradermal injections
Skin testing
Sites
Length and gauge of needle
Angle of insertion
Formation of small bleb

52. Prevention of Needle Sticks
Needleless devices
Sharps disposal
One-handed recapping technique

53. Intravenous Administration
Large volume infusions
Bolus injection
Volume-controlled infusions
Mini-infusor pump

54. Avoiding Errors Prepare drugs alone Don’t leave drugs alone
Prepare and administer
Lock med cart
Supervise swallowing

55. Steps in Administration
3 checks
6 rights
Assessment
Patient position
Fluids
Keep meds in wrappers
Offer separately

56. Administering Narcotics
Definition
Record
Patient name
Amount
Time
Physician
Nurse signature
Waste/witness
Count
Discrepancies

57. Documentation Legal record When to record Information Omitted drugs
med name
dosage
route
time
nurse initials
nurse signature
site of injection
other information
Omitted drugs
reason
notify MD
Refused drugs

58. Medication Errors
Reasons for occurrence
Steps if error takes place