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2. 2 OBJECTIVES: Define selected term related to the administration of medication. Define selected term related to the administration of medication. Describe various route of medication administration. Describe various route of medication administration. Identify essential part of medication orders. Identify essential part of medication orders. Outline list of steps of medication administration. Outline list of steps of medication administration. Identify the sites of medication administration. Identify the sites of medication administration. Describe essential steps in safety medication administration. Describe essential steps in safety medication administration.

3. 3 Definitions: Pharmacology: is the study of the effect of the drug on the body. Pharmacology: is the study of the effect of the drug on the body. Medication: is a substance administered for diagnosis, cure, treatment, mitigation or prevention. Medication: is a substance administered for diagnosis, cure, treatment, mitigation or prevention. Prescription: the written direction for the preparation and the administration of the drug. Prescription: the written direction for the preparation and the administration of the drug.

4. 4 One drug can have as many as names: The generic name: is given for the drug to being official name. The generic name: is given for the drug to being official name. The official name: is the name under which its listed in one in the official publication. The official name: is the name under which its listed in one in the official publication. The chemical name: is the name by which the chemist knows it. The chemical name: is the name by which the chemist knows it.

5. 5 Cont The trade mark or brand name: is name given by the drug manufacture The trade mark or brand name: is name given by the drug manufacture Example: hydrochlorothiazide (official name). Example: hydrochlorothiazide (official name). Esidrex (brand name) Esidrex (brand name)

6. 6 Therapeutic action of drugs: Palliative: relieve symptom of a disease but does not affect on a disease it self as morphine. Palliative: relieve symptom of a disease but does not affect on a disease it self as morphine. Curative: cure a disease or condition as penicillin. Curative: cure a disease or condition as penicillin. Supportive: support body function until treatment or body response can take over as aspirin. Supportive: support body function until treatment or body response can take over as aspirin.

7. 7 Cont Substitutive: replace body fluids or substance insulin. Substitutive: replace body fluids or substance insulin. Chemotherapeutic: destroy malignant cell as busulfan for leukemia. Chemotherapeutic: destroy malignant cell as busulfan for leukemia. Restorative: return body health as vitamin. Restorative: return body health as vitamin.

8. 8 Effect of drug: The therapeutic effect: is the primary effect intended that is the reason the drug is prescribed such as morphine sulfate is analgesia. The therapeutic effect: is the primary effect intended that is the reason the drug is prescribed such as morphine sulfate is analgesia.

9. 9 Cont: Side effect: secondary effect of the drug is one that unintended, side effects are usually predictable and may be either harmless for example digitalis increase the strength of myocardial contraction but it can have side effect inducing vomiting and nausea. Side effect: secondary effect of the drug is one that unintended, side effects are usually predictable and may be either harmless for example digitalis increase the strength of myocardial contraction but it can have side effect inducing vomiting and nausea.

10. 10 Cont: Drug toxicity: deleterious effect of the drug on an organism or tissue, result from overdose or external use. Drug toxicity: deleterious effect of the drug on an organism or tissue, result from overdose or external use. Drug allergy: is immunological reaction to a drug. Drug allergy: is immunological reaction to a drug.

11. 11 Cont Drug interaction: occur when administration of one drug before or after alter effect of one or both drug. Drug interaction: occur when administration of one drug before or after alter effect of one or both drug. Drug misuse: Is the improper use of common medications in way that lead to acute and chronic toxicity for example laxative, antacid and vitamins. Drug misuse: Is the improper use of common medications in way that lead to acute and chronic toxicity for example laxative, antacid and vitamins.

12. 12 Drug abuse: is an inappropriate intake of substance either continually or periodically. Drug abuse: is an inappropriate intake of substance either continually or periodically. Drug dependence: is a persons reliance on or need to take drug or substance there are two type of dependence: Drug dependence: is a persons reliance on or need to take drug or substance there are two type of dependence:

13. 13 Physiological dependence: is due to biochemical changes in the body tissue these tissue come to require substance for normal function. Physiological dependence: is due to biochemical changes in the body tissue these tissue come to require substance for normal function. Psychological dependence: is emotional reliance on a drug to maintain a since of wellbeing accompanied feeling of need. Psychological dependence: is emotional reliance on a drug to maintain a since of wellbeing accompanied feeling of need.

14. 14 Cont : Drug habituation: denotes a mild form of psychological dependence. Drug habituation: denotes a mild form of psychological dependence. Illicit drug: also called street drug are those sold illegally. Illicit drug: also called street drug are those sold illegally.

15. 15 Common mild allergic response: Skin rash. Skin rash. Pruritus. Pruritus. Rhinitis. Rhinitis. Nausea and vomiting. Nausea and vomiting. Wheezing. Wheezing. Diarrhea. Diarrhea.

16. 16 Factor effecting medication action: Developmental factor such as older age and infants are deferent response of medication. Developmental factor such as older age and infants are deferent response of medication. Gender Gender Culture and genetic factor. Culture and genetic factor. Diet Diet Environment Environment Illness and disease Illness and disease Time of administration Time of administration

17. 17 Route of administration: Oral is the most common Oral is the most common Advantage: Least expensive and most convenient route for most clients. Least expensive and most convenient route for most clients. Safe, does not break the skin. Safe, does not break the skin.

18. 18 Oral medication

19. 19 Cont: Disadvantage: Inappropriate for client nausea and vomiting. Inappropriate for client nausea and vomiting. Drug may have unpleasant taste. Drug may have unpleasant taste. May cause irritation of gastro intestinal tract. May cause irritation of gastro intestinal tract. Drug may discolor teeth. Drug may discolor teeth. Drug can be aspirated by ill client. Drug can be aspirated by ill client.

20. 20 Sublingual: a drug placed under the tongue, where it dissolved. Sublingual: a drug placed under the tongue, where it dissolved.Advantage: Same as oral plus Same as oral plus Drug may administered for local effect. Drug may administered for local effect. Drug rapidly absorbed into blood stream. Drug rapidly absorbed into blood stream. More potent than oral. More potent than oral.

21. 21 Disadvantage: If swallowed drug may be inactive. If swallowed drug may be inactive. Drug must remain under the tongue until dissolved. Drug must remain under the tongue until dissolved. Baccal: pertaining to the cheeks. Baccal: pertaining to the cheeks. Rectal: can be used when drug objectionable taste Rectal: can be used when drug objectionable taste

22. 22 parenteral : Subcutaneous (SC): hypodermic into subcutaneous tissue, just below the skin. Advantage: onset drug action faster than oral.

23. 23 Type of injection degree:

24. 24 Disadvantage: Disadvantage: Must involve sterile technique because breaks skin barrier. Must involve sterile technique because breaks skin barrier. More expensive than oral. More expensive than oral. Can administer only small doses. Can administer only small doses. Slower than intramuscular injection. Slower than intramuscular injection. Some drug can irritate tissue and can cause pain. Some drug can irritate tissue and can cause pain.

25. 25 Sc injection site

26. 26 Intramuscular (IM): Intramuscular (IM): into in the muscle. into in the muscle. Characteristics : 2 to 5 ml syringe, 21 or 22 gauge and 1.1/5 inches. 2 to 5 ml syringe, 21 or 22 gauge and 1.1/5 inches. - Several factors can effect of needle: The muscle site. The muscle site. the type of solution. the type of solution. the amount of adipose tissue that covered of area. the amount of adipose tissue that covered of area. the age of the client. the age of the client.

27. 27 Advantage: Pain from irritating drugs is minimized. Pain from irritating drugs is minimized. Can administer large volume of drug. Can administer large volume of drug. Drug rapidly absorbed. Drug rapidly absorbed. Disadvantage: breaks skin barrier. breaks skin barrier. Can be anxiety producing. Can be anxiety producing.

28. 28 Common site of intramuscular injections: Ventrogluteal site: also known as von hochseter’s site which lies over the gluteus minimus is preferred site because the area contains no large nerve or blood vessels. Ventrogluteal site: also known as von hochseter’s site which lies over the gluteus minimus is preferred site because the area contains no large nerve or blood vessels.

29. 29 Provide greater thickness of gluteal muscle consisting gluteus medius and gluteus minimus. Provide greater thickness of gluteal muscle consisting gluteus medius and gluteus minimus. Contain less fat area. Contain less fat area. The clients position: On back, prone and side lying position. On back, prone and side lying position.

30. 30 Ventrogluteal site:

31. 31 Cont:

32. 32 Vastus latralis site: is usually thicker and well developed in adult, children and infant 7 months because no major blood vessel sand nerve in the area. is usually thicker and well developed in adult, children and infant 7 months because no major blood vessel sand nerve in the area.

33. 33 It established by dividing the area between the greater trochanter of the femur and the lateral femoral condyle into third and selects the middle third. It established by dividing the area between the greater trochanter of the femur and the lateral femoral condyle into third and selects the middle third. Patient may in supine position or sitting position. Patient may in supine position or sitting position.

34. 34 Vastus latralis:

35. 35 Vastus latralis:

36. 36 Vastus latralis:

37. 37 Dorsogluteal site: is composed of the thick gluteal muscle of the buttocks, Because the site developed by walking, the site not be used or children under three years. is composed of the thick gluteal muscle of the buttocks, Because the site developed by walking, the site not be used or children under three years. The nurse must choose the injection site carefully to avoid striking the sciatic nerve and blood vessels. The nurse must choose the injection site carefully to avoid striking the sciatic nerve and blood vessels.

38. 38 The nurse palpates the posterior iliac spine, and then draws an imaginary line to the greater trochenter femur. The nurse palpates the posterior iliac spine, and then draws an imaginary line to the greater trochenter femur.

39. 39 Dorsogluteal site:

40. 40 Dorsogluteal site:

41. 41 Deltoid muscle: Deltoid muscle: is found on the lateral aspect of the upper arm its not used frequently because it is relatively small and very clause to the radial nerve and radial artery. But no more 1ml can be administered for example: hepatitis B vaccine. is found on the lateral aspect of the upper arm its not used frequently because it is relatively small and very clause to the radial nerve and radial artery. But no more 1ml can be administered for example: hepatitis B vaccine. The method of establishing the deltoid site is to place four fingers across the deltoid muscle.

42. 42 Deltoid muscle:

43. 43 Rectus femoris site: Rectus femoris site: Which belongs to the quadriceps muscle group. It’s situated on the anterior aspect of the thigh Which belongs to the quadriceps muscle group. It’s situated on the anterior aspect of the thigh

44. 44 Rectus femoris site:

45. 45 intradermal (ID): intradermal (ID): is the administrating of a drug into the dermal layer of the skin just beneath the epidermis, usually small amount of liquid is used for example 0.1ml. is the administrating of a drug into the dermal layer of the skin just beneath the epidermis, usually small amount of liquid is used for example 0.1ml. characteristic of needle may use: characteristic of needle may use: short and fine, 25,26 and 27 gauge. ¼ to 5/8 inch long. short and fine, 25,26 and 27 gauge. ¼ to 5/8 inch long.

46. 46 intradermal (ID):

47. 47 Common sites: Common sites: Inner lower arm. Inner lower arm. Upper chest. Upper chest. On the back beneath the scapula. On the back beneath the scapula. Notes: Intradermal injection are absorbed slowly through blood capillaries, the area not massaged because the medication may disperse. Notes: Intradermal injection are absorbed slowly through blood capillaries, the area not massaged because the medication may disperse.

48. 48 Advantage: absorption is slow (this advantage test for allergy). Advantage: absorption is slow (this advantage test for allergy). Disadvantage: amount of drug administered must be small. Disadvantage: amount of drug administered must be small. Breaks skin barrier. Breaks skin barrier.

49. 49 Intravenous (IV): in to the vein. Intravenous (IV): in to the vein. Large amount of drug can administer. Large amount of drug can administer. Advantage: Advantage: rapid effect. rapid effect. Disadvantage: Disadvantage: limited to highly soluble drug. limited to highly soluble drug. Break skin barrier. Break skin barrier. Drug distribution inhibited by poor circulation. Drug distribution inhibited by poor circulation.

50. 50 Inhalation: introduce drug through respiratory tract. introduce drug through respiratory tract.Topical: Topical applications are those applied to circumscribed surface area of the body. They effect only the area to which they are applied. Topical applications are those applied to circumscribed surface area of the body. They effect only the area to which they are applied.

51. 51 Types of medication order: A state order: indicates that the medication is to be given immediately and only once. A state order: indicates that the medication is to be given immediately and only once. Example: volterin 75mg Im state. Example: volterin 75mg Im state. The single order dose: is for medication to be given once at the specified time. The single order dose: is for medication to be given once at the specified time. Example seconal 100mg hs before surgery. Example seconal 100mg hs before surgery.

52. 52 The standing order: may or may not have a termination date The standing order: may or may not have a termination date Example volterin 75mg IM q4h * 5 days. Example volterin 75mg IM q4h * 5 days. A PRN order: as needed order permits the nurse to give a medication when, in the nurse judgment, the client requires it. A PRN order: as needed order permits the nurse to give a medication when, in the nurse judgment, the client requires it. Example: panadol 500mg PRN. Example: panadol 500mg PRN.

53. 53 The drug order has seven essential parts: - Full name of the client - Full name of the client 2- Date &time the order is written 2- Date &time the order is written 3- Name of the drug to be administered 3- Name of the drug to be administered 4- Dosage of the drug 4- Dosage of the drug 5- Method of administration. 5- Method of administration. 6- Frequency of drug. 6- Frequency of drug. 7- Signature of the physician or nurse practitioner 7- Signature of the physician or nurse practitioner

54. 54 Five 'Rights' of drug administration 1- Right drug 1- Right drug 2- Right dose 2- Right dose 3- Right time 3- Right time 4- Right route 4- Right route 5- Right client. 5- Right client.

55. 55 Right Medication. Read the medication record, and take the appropriate medication from the shelf, drawer, or refrigerator. Read the medication record, and take the appropriate medication from the shelf, drawer, or refrigerator. Compare the label of the medication container against the order. If these are not identical, recheck the client’s record. If there is still a discrepancy, check with the delegating nurse. Compare the label of the medication container against the order. If these are not identical, recheck the client’s record. If there is still a discrepancy, check with the delegating nurse.

56. 56 Right Time. Give the medication at the right time. Right Time. Give the medication at the right time. Right Route. Give the medication by the ordered route - eye drop or ointment. Right Route. Give the medication by the ordered route - eye drop or ointment.

57. 57 Right Dose. Checking medication data is essential to prevent a medication error. Check the eye preparation for the name, strength, and number of drops if a liquid is used. If ointment is used, discard the first bead. The first bead of ointment from a tube is considered to be contaminated. Checking medication data is essential to prevent a medication error. Check the eye preparation for the name, strength, and number of drops if a liquid is used. If ointment is used, discard the first bead. The first bead of ointment from a tube is considered to be contaminated.

58. 58 Right Client. Right Client. Identify the client by name. Identify the client by name. Explain to the client it is time for their eye medication administration. Explain to the client it is time for their eye medication administration. Explain the technique to the client. The administration of eye medication is not usually painful. Ointments are often soothing to the eye, but some liquid preparations may sting initially. Explain the technique to the client. The administration of eye medication is not usually painful. Ointments are often soothing to the eye, but some liquid preparations may sting initially.

59. 59 Parts of prescription: Descriptive information about the client: name, address and age. Descriptive information about the client: name, address and age. Dates Dates The Rx symbol, meaning “take thou”. The Rx symbol, meaning “take thou”. Medication name, dose Medication name, dose

60. 60 Route of administration. Route of administration. Dispensing instruction. Dispensing instruction. Direction of administration. Direction of administration. Refill Refill Prescriber’s signature. Prescriber’s signature.

61. 61 Clinical guide line for administering medication. Nurses who administer medication are responsible for their own action. Nurses who administer medication are responsible for their own action. Be knowledgeable about medication. Be knowledgeable about medication. Use medication that are a clearly labeled. Use medication that are a clearly labeled. Don’t use liquid medication that are cloudy. Don’t use liquid medication that are cloudy. Before administration the drug identify the patient correctly. Before administration the drug identify the patient correctly. Do not leave the medication on the bed side. Do not leave the medication on the bed side. If the client vomits the drug report this and inform doctor. If the client vomits the drug report this and inform doctor.

62. 62 Cont: Take special precaution when administrating certain medication such as heparin. Take special precaution when administrating certain medication such as heparin. Most hospital policies require new orders from the physician. Most hospital policies require new orders from the physician. When a medication error is made, report immediately to the nurse in charge or to the physician. When a medication error is made, report immediately to the nurse in charge or to the physician.

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