Transcript ******* 1

King Saud university
Nursing College
Medical-Surgical department
NUR 213
MEDICATION PREPARATION AND
ADMINISTRATION
Out line :
• Terminologies in Drugs and Medications
• DRUG ORDER / Medication Administration
Record (MAR )
• Rights in giving medication
• Three checks of medication preparation
• BASIC GUIDELINES IN MEDICATION
ADMINISTRATION
• Routes of Medication Administration
• Different Types of Injections
Terminologies in Drugs and Medications
Drug : Any substance that alerts physiological function with the
potential for affecting health .
Medication : A drug administered for its therapeutic effect.
Dosage : The a mount of drug administer to a patient.
Route of administration : The means by witch drug administered
or enters the body ( oral , topical , Subcutaneous (SC) ,
intramuscular (IM) , intradermal (ID), intravenous (IV) ).
Frequency : The number of occurrences the medication is to be
administered .
Essential Parts of a Drug Order
• Full name of the patient and file
number
• Date and time of the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of the drug to administered
• Method of administration
• Signature and stamp of the physician
Medication Administration Record (MAR )
rights in giving medication (10
rights)
1-Right drug – the medication given was the
medication ordered and is appropriate for the
patient
2-Right patient - the client for whom it is intended
3-Right time – medication is given with the correct
frequency and at the right time ordered ( ( TID, BID,
OD)
Rights in giving medication
4-Right route – how the medication will be
administered and that the ordered route is
appropriate for the patient ( Oral, Sublingual, IV,
IM, SC, ID,per rectum, intravaginal )
5-Right dose / dosage – the medication is given in
the dose ordered and that the dose is appropriate
for the patient
Continue……..
6-Right to refuse
7-Right assessment
8-Right patient education
9-Right evaluation
10-Right documentation
Three checks of medication preparation
Check the label on the medication package
carefully against the MAR to make sure that the
correct medication is being prepared .
Follow the common rule :
1- When it is taken from the medication cart .
2-Before withdrawing the medication .
3- After the withdrawing the medication
Routes of Medication Administration
1- Oral : Given by mouth, designed to be swallowed (
Tablets, capsules, syrups).
• Measure liquid medication
by holding the medication
cup at eye level.
• Pour away from the label
and wipe the neck.
• Don’t use liquid
medication that are cloudy
or have changed in color
Routes of Medication Administration
2- Sublingual (SL) : Held under the tongue until they
dissolve
3- Topical : Placed on the skin surface , mucous
membranes or body cavities ( lotion, creams, ointments)
4- Ophthalmic : Medications are instilled in mucous
membranes of eye for various therapeutic effects.
Used to treat eye irritation (solutions and ointments)
OPHTHALMIC MEDICATIONS
• Check prescribed medication
order for number of drops (if a
liquid) and eye
Right eye = O.D.
Left eye = O.S.
both eyes = O.U
• Allow the patient to sit with
head tilted backward or to lie
in a supine position.
• Ask client to look up and
explain steps to client.
Routes of Medication Administration
5- Otic : Dropped or instilled into the ear to treat external ear
infections or to soften and remove ear wax
6- Nasal : Sprayed or instilled in the nose to treat nasal congestion
7- Rectal : placed in the rectum to treat systemic complaints or as
laxative to encourage bowel movement (suppositories, enema
fluids)
Continue....
8- Vaginal : Inserted vaginally for contraception, to help kill
bacteria in the vaginal area before gynecologic surgery , to treat
vaginal itching or infection, or to induce labor (liquids (douches),
creams, tablets, or suppositories)
9- Inhaled : Used to induce anesthesia during surgery and to treat
respiratory disorders , administered through nebulizer, ventilator.
10- Parenteral : Given by injection( Intramuscular (IM), Intradermal
(ID), Subcutaneous (SC) or infusion (Intravenous (IV), intraarterial
, intraspinal) .
DRUG PRESENTATION
Tablets
Topical
capsules
Ophthalmic
syrups
Otic
Nasal
Rectal
Inhaler
IV Medication
Ampules
Vials
Drawing Up Medication
From an Ampules
• Uncap the needle and
insert the needle into
the ampule. Avoid
touching the rim with
the needle.
Continue Drawing
Up Medication
From an Ampules
• Invert the ampule,
insert the needle into
the solution and
aspirate.
Drawing Up Medication From a Vial
• Insert the needle keeping
it above the solution
Continue Drawing Up Medication
From a Vial
• Invert the vial at
eye level
Continue Drawing Up Medication
From a Vial
• Hold the needle
upright and re-check
the syringe’s contents
for presence of air
Different Types of Injections
1- Intradermal injection (ID) :
Is the administration of drug into the dermal layer of the
skin just beneath the skin.
Usually only a small amount of liquid is used e.g. 0.1 ml .
Purposes of ID :
1- Allergy testing .
2- Tuberculosis (TB) screening
Common sites for ID Injection :
1- inner lower arm .
2- upper chest
3- the back
beneath the
scapula
AMINISTRATION OF ID INJECTION
• Site: inner forearm (may use back and upper chest)
• Volume: 0.01-0.05 ml
• Equipment: gloves, TB syringe (1ml, 25-27g, ⅝ or ½
inch needle), alcohol swab.
• Administration angle: 10-15°
• DO NOT massage.
Continue…
2- Subcutaneous injection : Place the medication
into the subcutaneous tissue, between the dermis
and the muscle.
Common medication inserted through S.C route:
1- Vaccine
2- Insulin
3- Heparin
Common sites for S.C injection
1- Outer aspects of the upper arm.
2- Anterior aspects of the thigh .
3- Abdomen (around umblica ) .
4- The scapular areas .
5- Upper ventrogluteal &
dorsogluteal .
Subcutaneous Administration
• Volume: up to 1ml
• Equipment: TB or Insulin syringe
(25-27g, ½ to⅝ inch needle),
gloves, alcohol swab.
• Administration Angle: 45° or 90
• Hold needle like “dart”
• DO NOT ASPIRATE.
Continue…
3- Intramuscular (IM) injections : Are used to promote
rapid drug absorption and to provide an alternate route
when the drug is irritating to subcutaneous tissue
Common sites for IM injection are :
1- Ventrogluteal site
2- Vastus lateralis site
3- Deltoid muscle site
4- Dorsogluteal site
IM Administration
• Administered into a muscle or muscle group
• Volume: up to 4ml
• Equipment: gloves, 1-5 ml syringe, needle
(18-23 g, ⅝ to 3 inch needle), alcohol swab
• RN is responsible to chose needle size and
gauge.
• Administration angle: 90°
IM Administration
Aspirate for blood.
If no blood, instill medication slow and steady
Quickly remove needle.
DO NOT RECAP.
Massage site with alcohol swab
Sites of IM injection
Ventrogluteal site
Sites of IM injection
Vastus lateralis site
Common sites of IM Injection
Deltoid muscle site
Ventral Gluteal
Dorsogluteal Site
Most dangerous site
because of sciatic
nerve location
Z-track IM Administration
• Method used with irritating
medications
– Iron
• Used to “trap” medication in
muscle and prevent “tracking”
of solution through tissues.
 Displace skin laterally 1-1 ½
inches from injection site
 While holding skin, insert
needle with a darting motion,
at a 90° angle.
Medication Calculation
Medications are frequently ordered in large or smaller
units than those held in stock . If so , dose of medication
should be calculated by using the following formula :
X (Amount ) = D ( Desired dose ) x Q ( Quantity )
S ( Stock available)
Common measurement units:
I- Metric measurement :
1gm= 1000 milligrams (mg ).
1mg = 1000 microgram ( ug ).
1 microgram = 0.001 milligrams.(mg ).
1 milligram (mg ) = 0.001( gm )
Exercise (1) :
A patient is ordered 500mg of metformin hydrochloride
, ward stock is 1000mg/tablet. How many tablets
should be given ?
X (Amount ) = D ( Desired dose ) x Q ( Quantity )
S ( Stock available)
X (__ tab ) = D ( 500 mg )
S ( 1000 mg )
0.5 tablet or half tablet
Exercise (2) :
An injection of a drug 1 g is ordered ,stock on hand is
500mg/ ml .What volume should be drawn up ?
X (Amount ) = D ( Desired dose ) x Q ( Quantity )
S ( Stock available)
X (__ ml ) = D ( 1 gm) x Q ( 1 ml )
S ( 500 mg)
X (__ ml ) = D (1,000 mg) X Q ( 1 ml )
S ( 500 mg )
X (__ ml ) = 2 X Q ( 1 ml ) = 2 ml
Learning video
IM injesctio
https://www.youtube.com/watch?v=mWAek8UigLs
https://www.youtube.com/watch?v=Ip2hbl_k_vc
https://www.youtube.com/watch?v=Ip2hbl_k_vc
https://www.youtube.com/watch?v=JxZkyGRy7-s
https://www.youtube.com/watch?v=w4EMfuLsC10
subQ injection
https://www.youtube.com/watch?v=HKQl1-AmYtc
Intradermal injection
https://www.youtube.com/watch?v=f3w-MlDAdg0
Z-track IM Administration
https://www.youtube.com/watch?v=7GqUFFz9Ou4