Transcript Basic Nursing: Foundations of Skills and Concepts Chapter 24

MEDICATION
ADMINISTRATION
Prepared by:
Hikmet Qubeilat RN,MSc
Medication or Drug
is a chemical substance intended for use in the
diagnosis, treatment, cure, mitigation, or
prevention of a disease.
 When a drug is given to a client, there is an
intended specific effect.
 An assumption made by nurses before
administration of any medication is that the drug
will be safe for the client to consume if the dose,
frequency, and route are within the therapeutic
range for that drug.

Prescription:

The written direction for the preparation
and administration of a drug.
Medication Names
• Official name: name under which drug is
listed in official government publications
of drug standards( US Pharmacopeia).
• Chemical name: name that describes the
chemical composition of the drug.
• Generic name: shortened name given to
the drug by the developer; generic names
are not capitalized before become official.
• Brand name, trade name, or proprietary name:
name given to and registered by the
manufacturer
 The brand name is always capitalized and
may have a trademark symbol (™ or ®)
 A drug has only one generic name but may
have many trade names, depending on how
many companies manufacture it
Drug Action
A drug’s ability to combine with a cellular
drug receptor.
 Depending on the location of the cellular
receptor, the drug can have a local effect,
a systemic effect, or both.

Medication Management
Its purpose is to produce the desired drug
action by maintaining a constant drug
level.
 Drug action is based on the drug’s half-life
(the time it takes the body to eliminate
half of the blood concentration level of the
original drug dose).

Terms Relating to Drug Action
Onset of action (the time it takes for the
body to respond to a drug after
administration).
 Peak plasma level (the highest blood
concentration of a single drug dose before
the elimination rate equals the rate of
absorption).
 Plateau (maintenance of a certain level).

The 4 Properties of Drug Action

Absorption (passage of a drug from the site of
administration into the bloodstream).

Distribution (the movement of drugs from the blood into
body fluids and tissues).

Metabolism (the physical and chemical processing of a
drug by the body).

Excretion (the elimination of drugs from the body.
Dissolution:

is the rate at which a drug becomes a solution. After
ingestion, a pill, capsule, or caplet must disintegrate
before it can be dissolved and then absorbed by the
body for therapeutic use. The more rapid the rate of
dissolution, the more quickly the drug can be absorbed.
Drug Interaction
The effect one drug can have on another drug.
Side Effects and Adverse
Reactions
Drug Allergy.
 Drug Tolerance.
 Toxic Effect.
 Idiosyncratic Reaction.

Factors Influencing Drug Action
Genetic factors.
 Age.
 Height.

Weight.
 Physical
conditions.
 Mental conditions.

Medication Orders

All medication orders should contain:
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Client’s name
Date & Time
Name of Drug to be administered
Doasage
Route of administration
Time & frequency
signature of person ordering
Example:
Ahmad Ali -------------12\3\2009----7pm
(1)
(2)
Demerol 100 mg IM q 4 hrs
(3)
(4) (5) (6)
Dr. Saeed Mohammed
Types of Orders
Stat (those that should be administered
immediately).
 Single-Dose (one-time medications).
 Scheduled (administered routinely until
order is canceled by another order).
 PRN (on as-needed basis).

Examples of Medication Orders
• Standing

Example: Synthroid 0.1mg po qd
• Standing PRN

Example: Tylenol i or ii po q 4 hr for H/A
• Short-series order

Example: Prednisone 5 mg po tid x 3 days,
then 5 mg bid x 2 days then 5 mg qd x 5 days
Categories of Medication Orders,
• One time

Example: Demerol 50 mg IM @ 0800 in am
• Stat

Example: Valium 5 mg IV now
Five “Rights” of
Safe Drug Administration
Right drug.
 Right dose.
 Right client.
 Right route.
 Right time.

REALLY…THERE ARE 2 MORE!
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RIGHT TO KNOW – must explain each
drug to patient

RIGHT TO REFUSE – cannot make
patient take meds
Three Systems
of Weight and Measure
Metric (simple system based on units of
10).
 Apothecary (based on the weight of one
grain of wheat).
 Household (drops, teaspoons,
tablespoons, etc.).

Metric System
• Weight
• Volume
• Length
gram (g)
liter (L)
meter (M)
• Smaller and larger units in the metric system
can be indicated by attaching prefixes to the
basic units
 Kilo- is used to enlarge the basic unit 1000
times
Metric System, continued
• centi (cm) is used to diminish the basic unit by
100
• milli (mm), (mL), and (mg) diminishes the basic
unit by 1000
• The symbol µ micro (micrometer or 0.001
millimeter)
• The terms milliliter (ML) and cubic centimeter
(CC) are used interchangeably
Metric System, continued
• The metric system uses the Arabic numerals
that we all know, e.g., 1, 2, 3
• Abbreviations are placed after the number, as
in 50 mg or 500 mL
• Quantities less than 1 and fractions are written
in decimal form as in 0.25 mg, 1.25 mg, and
1.5 g
Basic Dimensional Analysis
Review

The doctor ordered Rocephin 750 mg IM x 1
dose. You have available a 5 mL vial labeled
“Rocephin 1 gram/2.5 mL” How many mL will
you administer? _________

We are looking for (calculating) mL
The order is 750 mg
Available concentration is 1 gram/2.5 mL
(Conversion) 1 gram = 1000 mg (the question
doesn’t tell us this; we have to know it)
The 5 mL tells us the size of vial (Extra info)
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Basic Dimensional Analysis
Review

The doctor ordered Rocephin 750 mg IM
x 1 dose. You have available a 5 mL vial
labeled “Rocephin 1 gram/2.5 mL” How
many mL will you administer? _________
2.5 mL 1 gram
750 mg
 mL = ---------- X ------------ X ----------- =
1 gram
1000 mg
Basic Dimensional Analysis
Review

1st, reduce commons
3
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2.5 mL
1 gram
750 mg
mL = ---------- X ------------ X ----------- =
1 gram
1000 mg
4
Basic Dimensional Analysis
Review
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2nd, do the math (follow UAMS rounding rules)
3
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2.5 mL
1 gram
750 mg
7.5
mL = ---------- X ------------ X ----------- = ------ = 1.875 = 1.9
1 gram
1000 mg
4
4
So, you would administer 1.9 mL
mL/hr Calculation

IVF: 1000 mL D5 ½ NS at 24 hour rate

1st, what are we looking for? We do have an
infusion pump, so it is mL/hr. Infusion pumps
always run in mL/hr!!
Remember
Total Volume Ordered
mL
------ =
hr
to use UAMS
rounding
rules
1000 mL
------------ = 41.66666 = 42 mL/hr
24 hr
Time to infuse total volume over
mL/hr
round to
whole
number
mL/hr Calculation

Now, what happens if the doctor orders
an amount of fluid to run over minutes
rather than 1 hour?
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
Remember, the pumps are calibrated for
mL/hr so you will need to plug the conversion
for hours/minutes into your formula
60 min = 1 hour
mL/hr Calculation

The doctor orders 100 mL IVPB to infuse
over 30 minutes. How many mL/hr do you
set the pump?
Total Volume to Infuse
mL 100 mL 60 min
------ = ---------- X --------- =
hr
30 min
1 hr
Conversion factor
Time to infuse total volume over
mL/hr Calculation

The doctor orders 100 mL IVPB to infuse
over 30 minutes. How many mL/hr do you
set the pump?
2
mL 100 mL 60 min 200
------ = ---------- X --------- = ----- = 200
mL/hr
1
hr
30 min
1 hr
1
gtt/min Calculation

You will use this formula when
you don’t have a pump to
infuse the ordered IV fluids!!

You will have to locate the
drop factor (found on the IV
tubing package)

Drop factor = how many drops
does it take to equal 1 mL
gtt/min Calculation

Standard macrodrip calibration

10, 15, or 20 gtt/mL
• Used for most adult IV sets
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Microdrip calibration set

60 gtt/mL
• Used in pediatrics or critical medication drips
Remember, the drop factor tells you how many drops needed to equal 1 mL
gtt/min Calculation

1000 mL D5W with 40 mEq KCL is to infuse
over 12 hours. The IV drop factor is 10 gtt/mL.
How many drops per minute will be given?

We calculate drops/minute because we don’t
have a pump and it doesn’t make sense for
the nurse to stand at the bedside and count
drops for one hour; the nurse counts drops for
1 minute and then a second minute to verify
that the correct drops are infusing to deliver the
ordered amount over 1 hour
gtt/min Calculation

1000 mL D5W with 40 mEq KCL is to
infuse over 12 hours. The IV drop factor is
10 gtt/mL. How many drops per minute
will be given?
What we’re looking for Doctors Order
Conversion Factor
Remember, this
is not in the
question, we
have to know it
gtt
10 gtt 1000 mL
1 hr
----- = -------- X ------------ X ---------- =
min 1 mL
12 hr
60 min
10 gtt/mL is the tubing that we have on hand
gtt/min Calculation

1000 mL D5W with 40 mEq KCL is to
infuse over 12 hours. The IV drop factor is
10 gtt/mL. How many drops per minute
will be given?
Use UAMS rounding
5
rules; round gtt/min
to nearest whole
number
100
gtt
10 gtt 1000 mL
1 hr
500
----- = -------- X ------------ X ---------- = ------- = 13.888 = 14
min 1 mL
12 hr
60 min
36
6
6
gtt/min Calculation

The doctor orders furosemide (Lasix) 20
mg in 50 mL of NS. Infusion time is 30
minutes. Drop factor is 60 gtt/mL. How
many gtt/min will you give?
What we’re looking for
Doctors Order
gtt
60 gtt 50 mL
----- = -------- X --------- =
min 1 mL
30 min
Note that the 20 mg
dose doesn’t matter
and we don’t need
the hour/minute
conversion factor
60 gtt/mL is the tubing that we have on hand
gtt/min Calculation

The doctor orders furosemide (Lasix) 20
mg in 50 mL of NS. Infusion time is 30
minutes. Drop factor is 60 gtt/mL. How
many gtt/min will you give?
2
gtt
60 gtt 50 mL 100
----- = -------- X --------- = ----- = 100 gtt/min
min 1 mL 130 min 1
gtt/min Calculation

250 mL D5W is to infuse at 10 mL/hr. The
IV drop factor is 60 drops per mL. How
many drops per minute will this IV run?
1
gtt
60 gtt 10 mL
1 hr
10
----- = -------- X -------- X --------- = ---- = 10 gtt/min
min 1 mL
1 hr
60 min 1
1
mL/hr Calculation
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The doctor ordered 1000 mL D5NS to infuse
over 8 hours. The drop factor is 15 drops per
mL. How many mL/hr will the IV run?
This is what the question
ask us to calculate
This is what the
mL 1000 mL doctor ordered
---- = ------------ = 125 mL/hr
hr
8 hr
Note that we did not
need the drop factor
or hour/minute
conversion
Unit Calculation

The doctor ordered Heparin 4000 units SQ. Available is
Heparin 5000 units per mL. How many mL will the nurse
administer?

Use basic calculations to do this problem; Heparin is
ordered in units but is available in mL, so we will
calculate mL
Note: you must spell
1 mL
4000 units
mL = -------------- X ------------- =
5000 units
out the word unit, it is
no longer acceptable
to use the abbreviation
“u”
Unit Calculation

The doctor ordered Heparin 4000 units SQ. Available is
Heparin 5000 units per mL. How many mL will the nurse
administer?
4
1 mL
4000 units 4
mL = -------------- X ------------- = ----- = 0.8 mL
5000 units
5
5
What type of syringe will you use to administer the Heparin?
Units—Heparin

The doctor ordered Heparin 2000 units
SC NOW. Pharmacy sends a vial labeled,
Heparin 5000 units per mL. How many
mL do you administer?
2

1 mL
2000 units
2
mL = -------------- X --------------- = ---- = 0.4 mL
5000 units
5
5
Units—Insulin
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Use Insulin syringes to administer insulin
Do not use tuberculin syringes
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Insulin syringes
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1 mL in size
Some are ½ mL in size (if the dose of insulin is less than 50 units)
• This makes it easier to see the small lines
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Calibrated in units (1 unit) = hundredths (0.01 mL)
Marked U-100
• This means there are 100 units of insulin in each mL of the medicine
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
Make sure that the bottle of insulin is also marked U-100
Insulin is available in a 10 mL vial

That means there are 1000 units of insulin in the entire bottle
Units—Insulin
Note the large numbers
(20, 30, 40 and so on)
These represent units, not mL
The doctor will order insulin
doses in units, not mL
The orange cap covers the
You have to rotate the syringe to
needle; the white cap on the
its side to see the small lines.
other end must be taken off in
Each line represents “1 unit”.
order to expose the plunger
There are a total of 100 units or
1 mL in this syringe
Unit Calculation

You have Humulin -R insulin available in
a bottle labeled U-100. The doctor orders
Humulin-R insulin 16 units. How many
units will you administer?

16 units, (that’s what the doctor ordered)

Now, what if the question asked, how
many mL will you administer?
Unit Calculation

You have Humulin -R insulin available in
a bottle labeled U-100. The doctor orders
Humulin-R insulin 16 units. How many mL
less than 1 mL, round
will you administer?
to the nearest
hundredth
1 mL
16 units
16
mL = ------------ X ----------- = ----- = 0.16 mL
100 units
100
Medication Forms
Routes for Administering Medication
•PO
•Sub-ling - SL
•Topical
•Inhalants
Oral
Under the tongue
Sprays, creams,
suppositories
Nebulizers
Routes for Administering Medication
Parenteral:
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Intramuscular (IM)
Intravenous (IV)
Subcutaneous (SQ)
Intradermal (ID)
Transdermal
ROUTES

ORAL OR PO
DO NOT GIVE TO PATIENTS WHO:
ARE VOMITING
ARE COMATOSE
LACK A GAG REFLEX
ARE NPO
HAVE FEEDING TUBES
HAVE NG TUBES (UNLESS NG TUBE CAN BE
CLAMPED)
INTRADERMAL SITES

USUALLY CHOSEN SO THAT LOCAL
REACTION CAN BE OBSERVED…
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LIGHTLY PIGMENTED
HAIRLESS
USUALLY FOREARM
THINK TB TESTING
INTRAMUSCULAR INJECTIONS
NO MORE THAN 4ml IN SINGLE
INJECTION SITE (ADULT WITH WELL
DEVELOPED MUSCLES)
 CHILDREN & ELDERLY – MAY LIMIT
TO 1 – 2ml
 USUALLY 1&1/2 INCH, 21 TO 23
GAUGE NEEDLE

Peripheral IV Access 
Hand veins
 Superficial
dorsal
 Basilic
 Cephalic

Arm veins
 Radial (wrist)
 Cephalic
 Basilic
 Median cubital
 Median
Common IV Sites
Metacarpal, cephalic, basilic, and
median veins and their branches
 More distal sites should be used
first, with more proximal sites used
subsequently.
 Feet / leg sites require MD order
 Avoid arm on mastectomy side

Selecting the Site

Consider
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Condition of the vein
Type of fluid or medication to be infused
Duration of therapy
Patient’s age and size
Whether patient is left or right handed
Patient’s medical history and current health status
Skill of the person performing the venipuncture
Selecting the Site

Avoid areas
•
•
•
•
•
that are painful to palpation
where the vein is hard or lumpy
below an infiltrated IV site
Veins too small for the selected IV catheter
That interfere with ability to perform ADL’s
Choosing the correct size
catheter

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
Smaller the gauge* (diameter) = less
trauma
Catheters that are too big invite
complications
Gauge must match the type of fluid to
be administered
* the larger the #, the smaller the diameter (gauge)
Tips for Success

Having difficulty finding a good vein?
Apply warm moist soaks
 Apply warm towel or washcloth (DO NOT
microwave)
 Let gravity help you! Have patient hang
arm over side of bed.

Patient Education


Explain the procedure PRIOR to
venipuncture
Have patient report:
 Burning, bleeding, swelling at site
 IV dressing becomes wet or leaks
 Pump alarms
Complications
Infection
 Infiltration
 Phlebitis
 Fluid volume excess
 Bleeding

IV Push and IV Bolus
• IV Push: method of giving concentrated doses of
medication directly into the vein( is administered
over 1 to 5 minutes)
• IV Bolus: concentrated dose of medication or fluid,
frequently given intravenously
• Admixture: The result of adding a medication to a
container of intravenous fluid
Speed Shock


Rapid infusion of medication of
fluid into the circulation causes
toxic concentrations to
accumulate
Drugs can cause a shock-like
syndrome
Slower-than-ordered
Infusion Rates


Deprives the patient of fluids and
medications
Always check infusion rates against
orders at beginning of shift, and after
secondary infusions (I.e., antibiotics) to
insure proper rate is maintained
Blood Component Therapy

Products

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Whole blood
PRBCs / Washed
PRBCs
Plasma / FFP
Platelets
Cryoprecipitates
Albumin
Blood Administration –
Nursing Responsibilities

Knowledge of
correct administration techniques
 Possible complications
 Agency polices & procedures

Correct administration
 Patient / family education

Blood Administration –
Nursing Responsibilities

Assessment
 Patient history
• Reactions
• # of pregnancies
• Comorbidities
• Culture, religion
 Physical assessment
• Vital signs
• Respiratory –
auscultation
• Cardiac – edema / HF
symptoms

Patient Education


s/s transfusion
reaction
Risk of infection
Frequency of Administration
• Each hospital maintains a schedule of hours for
administration of medications that is set up by
the hospital nursing service
• You are required to learn the hours that are
standard for your hospital
• Note: Standard prn orders are never assigned a
time, because the drugs are administered as
they are needed by the patient
Qualifying Phrases
• When a doctor wishes a drug to be
administered only for specific conditions, a
qualifying phrase will be part of the medication
order
• Not all orders contain qualifying phrases
• Examples of commonly used phrases:
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


For severe pain
For stomach spasms
For N/V
While awake
For insomnia
The Importance of Monitoring
The nurse must always carefully monitor
client reactions to medications and ensure
that clients are appropriately educated as
to the actions, side effects, and
contraindications of all medications they
are receiving.
 Clients receiving IV therapy or blood
transfusions require constant monitoring
for complications.
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Responsibilities of Nurses
Regarding Drug Administration

Nurses are both legally and morally
responsible for correct administration of
medications.They must:
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Follow institutional policy.
Consider clients’ desires and abilities.
Foster compliance.
Correctly document all actions related to medication
administration and medication errors.
BEHAVIORS TO AVOID DURING MEDICATION
ADMINISTRATION
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DO NOT BE DISTRACTED
DO NOT GIVE OR HOLD MEDS DISPENSED BY OTHERS
DO NOT POUR FROM CONTAINERS WITHOUT LABELS OR
DIFFICULT TO READ LABELS
DO NOT GIVE EXPIRED DRUGS
DO NOT GUESS ABOUT DOSAGES OR DRUGS
DO NOT LEAVE BY THE BEDSIDE, OR UNATTENDED
ANYWHERE
DO NOT GIVE IF THE CLIENT STATES ALLERGIES OR HAS
CONCERNS ABOUT THE DRUG
DO NOT MIX WITH FOOD OR LIQUIDS IF
CONTRAINDICATED
YOUR RESPONSIBILITIES AS A
STUDENT NURSE

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PROPER TECHNIQUE – SEE SYLLABUS
RESEARCH – MUST LOOK UP ALL DRUGS
PRIOR TO GIVING TO PATIENT
SOURCES OF INFORMATION: DRUG
HANDBOOK, DRUG CARDS, PHARM
BOOK, MICROMEDIX (on hospital intranet)
Documentation of Drug
Administration

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A critical element of drug administration is
documentation.
The standard is “if it was not documented it was
not done.”
The nurse should document that a drug has
been given after the client has received the
drug.
Never sign a medication out before you give it.
Serious Medication Errors:
EXAMPLES:
Overdose
 Medication given to the wrong client
 Medication given via the wrong route
Inform your supervisor
Call the doctor as soon as possible.
Strictly observe the client
Document what happen, actions and
interventions taken

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Remember a few important points:
Always wash your hands before giving
medication.
 NO ORDERS = DO NOT GIVE
MEDICINE
 Medication is ALWAYS to be kept in a
locked area.
