HA LEC - FINALS

➢ When the drug is under patent protection,

ADMINISTRATION OF the company markets the drug under its
trade name. When the drug is no longer
MEDICATION protected by patent, the company may
market its product under either the
OUTLINE
generic or trade name.
• Terminologies
➢ One drug may be manufactured by
• Legal Aspects of Drug
several companies and have several
Administration
trade names.
• Actions of Drugs on the Body ➢ The official name is the name under
• Routes of Administration which a drug is listed in one of the official
• Medication Orders publications.
- Types of Medication Orders ➢ The chemical name is the name by
- Essential Parts of a Drug Order which a chemist knows it; describes the
- Basic Formula constituents of the drug precisely.
- Ten Rights Of Medication
Administration Pharmacology – study of the effect of drugs on
• Administering Oral Medication living organisms
• Parenteral Medications Pharmacy – the art of preparing, compounding
- Equipment used in this route and dispensing drugs.
- Intradermal Injections
- Subcutaneous Injections
- Intramuscular Injections LEGAL ASPECTS OF DRUG
- Intravenous Injections ADMINISTRATION

• Nurses need to (a) know how nursing

TERMINOLOGIES practice acts in their areas define and
Medication – a substance administered for the limit their functions and (b) be able to
diagnosis, cure, treatment, or relief of a recognize the limits of their own
symptom or for prevention of disease. knowledge and skill.
• To function beyond the limits of nursing
Prescription – written direction for the practice acts or one’s ability is to
preparation and administration of a drugs endanger clients’ lives and leave oneself
➢ One drug can have as many as four kinds open to professional negligence lawsuits.
of names: GENERIC NAME, TRADE Under the law, nurses are responsible
NAME (BRAND NAME), OFFICIAL for their own actions regardless of
NAME, and CHEMICAL NAME. whether there is a written order. If a
➢ The generic name is assigned by the primary care provider writes an incorrect
United States Adopted Names (USAN) order (e.g., morphine 100 mg instead of
Council morphine 10 mg), a nurse who
➢ The trade name is the name given by the administers the written incorrect dosage
drug manufacturer and identifies it as is responsible for the error as well as the
property of that company. primary care provider. Therefore, nurses

1|
HA LEC - FINALS
should question any order that appears ➢ Adverse effects – more severe side
unreasonable and refuse to give the effects.
medication until the order is clarified.
• Drug Toxicity – results from
overdosage, ingestion of a drug intended
for external use, or buildup of the drug in
the blood because of impaired
metabolism or excretion (cumulative
effect) (ex. Respiratory depression due to
cumulative effect of morphine sulfate in
the body.)
• Drug Allergy – an immunologic reaction
to a drug. When a client is first exposed
to a foreign substance (antigen), the
body may react by producing antibodies;
can be either mild or severe with
symptoms from skin rashes to diarrhea.

➢ Anaphylactic reaction – severe

allergic reaction that occurs
immediately after the administration
EFFECTS OF DRUGS
of drug and could be fatal if symptoms
• Therapeutic Effect of a Drug – also are not noticed immediately. Earliest
referred to as the desired effect, is the symptoms include swelling in mouth
primary effect intended; the reason why and tongue, acute shortness of
the drug is prescribed. (ex. Therapeutic breath, acute hypotension, and
effect of morphine sulfate is analgesia; tachycardia.
diazepam: relief of anxiety)
• Drug Tolerance – exists in a person who
exhibits an unusually low physiological
• Side Effect – also known as secondary response to a drug and who requires
effect; unintended and they are usually increases in the dosage to maintain a
predictable and may either be harmless given therapeutic effect
or potentially harmful (ex. Digitalis • Cumulative Effect – the increasing
increases the strength of myocardial response to repeated doses of a drug
contractions (desired effect), but it can that occurs when the rate of
have the side effect of inducing nausea & administration exceeds the rate of
vomiting. metabolism or excretion.
• Idiosyncratic Effect - one that is
➢ Some side effects are tolerated for unexpected and may be individual to a
the drug’s therapeutic effect. client.

2|
HA LEC - FINALS
ROUTES OF ADMINISTRATION

ACTIONS OF DRUGS ON THE BODY 1. Oral – most common, least expensive,

and most convenient route for most
• The action of a drug in the body can be clients; drug is swallowed in this route.
described in terms of its half- life, the The major disadvantage can include an
time interval required for the body’s unpleasant taste of the drugs, irritation of
elimination processes to reduce the the gastric mucosa, irregular absorption
concentration of the drug in the body by from the GI tract, slow absorption, and
one-half. For example, if a drug’s half-life could sometimes be harmful to the
is 8 hours, then the amount of drug in the client’s teeth.
body is as follows:

Initially: 100%
After 8 hours Initially: 100%

After 8 hours: 50%

After 16 hours: 25%

After 24 hours: 12.5%

After 32 hours: 6.25%

• Onset of action - the time after

administration when the body initially
responds to the drug
• Peak plasma level - the highest plasma
After 16 hours: 25%
level achieved by a single dose when the 2. Sublingual – placed under the tongue; in
elimination rate of12.5%
After 24 hours: the drug equals the ab- a short time, the drug is largely absorbed
sorption rate
After 32 hours: 6.25% half-life) - the into the blood vessels on the underside
• Drug half-life (elimination of the tongue; medication should not be
time required for the elimination process swallowed.
to reduce the concentration of the drug to 3. Buccal – pertaining to the cheek;
one-half what it was at initial medication is held in the mouth against
administration the mucous membranes of the cheek
• Plateau - a maintained concentration of a until the drug dissolves. The drug may act
drug in the plasma during a series of locally on the mucous membranes of the
scheduled doses. mouth or systemically when it is
swallowed in the saliva.

3|
HA LEC - FINALS
3. Standing Order – may or may not have
4. Parenteral – non-oral route of a termination date and may be carried out
administration, that is by needle; could be indefinitely (ex. Multiple vitamins daily)
subcutaneous (hypodermic, until an order is written to cancel it or it
intramuscular, intradermal (under the may be carried out for a specified number
epidermis or into the dermis) , or of days.
intravenous (vein). The main advantage 4. Prn Order – as-needed order; permits
of this route is fast absorption. the nurse to give a medication when, in
5. Topical – applied to a circumscribed the nurse’s judgment, the client requires
surface area of the body. They affect only it.
the area to which they are applied (ex.
Dermatologic preparations: skin;
Instillations and Irrigations: body cavities B. ESSENTIAL PARTS OF A DRUG ORDER
or orifices.
• Full name of the client
• Date and Time the order is written
MEDICATION ORDERS • Name of the drug to be administered
A. TYPES OF MEDICATION ORDERS • Dosage of the Drug (amount, frequency,
strength)
1. Stat Order – indicates that the • Frequency of Administration
medication is to be given immediately • Route of Administration
and only once. • Signature of the person writing the order
2. Single Order – One-time order; for
medication to be given once at a
specified time C. BASIC FORMULA

• D = desired dose (i.e., dose ordered by

primary care provider)
• H = dose on hand (i.e., dose on label of
bottle, vial, ampule)
• V = vehicle (i.e., form in which the drug
comes, such as tablet or
liquid).

4|
HA LEC - FINALS

• The ratio and proportion method is most D. TEN RIGHTS OF MEDICATION

often used for calculating dosage ADMINISTRATION
problems:
1. Right Medication – the medication was
H: V:: D: x
the medication ordered.
2. Right Dose – the dose is appropriate for
the client.
3. Right Time – give the medication at the
right frequency and at the time ordered
according to agent policy.
4. Right Route – give the medication by the
ordered route.
5. Right Client – medication is given to the
intended client.
6. Right Client Education – explain
information about the medication to the
client.
7. Right Documentation – document
medication administration after giving it,
not before.
8. Right to Refuse – adult clients have the
right to reuse any medication.
9. Right Assessment – some medications
require specific assessments prior to
administration (ex. Apical pulse, blood
pressure, lab results).
10. Right Evaluation - conduct appropriate
follow-up

5|
HA LEC - FINALS

ADMINISTERING ORAL MEDICATION

6|
HA LEC - FINALS

7|
HA LEC - FINALS

8|
HA LEC - FINALS

9|
HA LEC - FINALS
scale and in sixteenths of a minim on
the other scale
PARENTERAL MEDICATIONS

• Nurses give parenteral medications

intradermally (ID), subcutaneously,
intramuscularly (IM), or intravenously
(IV).

A. EQUIPMENT USED IN THIS ROUTE

1. Syringes – the tip or inside of the barrel

as well as the shaft of the plunger should
not touch any unsterile object.

➢ Hypodermic Syringe - comes in 3

and 5-mL sizes
➢ The choice of syringe depends on
many factors such as medication,
location of injection, and type of 2. Needles – made of stainless steel and
tissue. most are disposable. A dull or damaged
➢ Insulin Syringe – the scale is needle should never be used. It has three
specifically designed for insulin; all parts: the hub, which fits onto the
insulin syringes are calibrated on the syringe; the cannula or shaft, which is
100-unit scale in North America attached to the hub; and the bevel, which
➢ Tuberculin Syringe – designed to is the slanted part at the tip of the needle.
administer tuberculin solution; a
narrow syringe calibrated in tenths
and hundredths of a milliliter on one

10 |
HA LEC - FINALS
to the sterile dry powder, thus
providing a single dose of 2 mL. The
volume of the drug powder was 0.5
mL. Therefore, the 1.5 mL of water
plus the 0.5 mL of powder results in 2
mL of solution. In other instances, the
addition of a solution does not
increase the volume. There- fore, it is
important to follow the manufacturer’s
directions.

B. INTRADERMAL INJECTIONS
• Refers to the administration of a drug
into the dermal layer of the skin just
beneath the epidermis.
• This method is usually done for
allergy testing and tuberculosis
screening.
• The left arm is commonly used for TB
screening and the right arm is used
3. Ampules and Vials – frequently used to for all other tests.
package sterile parenteral medications.
C. SUBCUTANEOUS INJECTIONS
➢ An ampule is a glass container • Used for vaccines, insulin, and
usually designed to hold a single dose heparin.
of a drug; it is made of clear glass and • Common sites are the outer aspect of
has a distinctive shape with a the upper arms and the anterior
constricted neck aspect of the thighs as these areas
➢ To access the medication in an are convenient and normally have
ampule, the ampule must be broken good blood circulation.
at its constricted neck. • Other sites include the abdomen,
➢ A vial is a small glass bottle with a scapular area of the upper back, and
sealed rubber cap; varies from single- the upper ventrogluteal and
dose to multiple-dose vials. dorsogluteal areas
➢ To access the medication in a vial, the • The type of syringe used for
vial must be pierced with a needle. In subcutaneous injections depends on
addition, air must be injected before the medication being given. Generally
withdrawing the medication. Failure to a 1- or 2-mL syringe is used for most
do so leaves a vacuum within the vial subcutaneous injections. However, if
that makes withdrawal difficult insulin is being administered, an
➢ Single-dose vial - Instructions for insulin syringe is used; if heparin is
preparing a single-dose vial state that being administered, a prefilled
1.5 mL of sterile water is to be added cartridge may be used.

11 |
HA LEC - FINALS
• Subcutaneous injection sites need to be ➢ Dorsogluteal Site - this site is close
rotated in an orderly fashion to minimize to the sciatic nerve and the superior
tissue damage, aid absorption, and gluteal nerve and artery. As a result,
avoid discomfort. This is especially complications (e.g., numbness, pain,
important for clients who must receive paralysis) occurred if the nurse
repeated injections, such as those with injected a medication near or into the
diabetes. sciatic nerve; not a recommended
site.
D. INTRAMUSCULAR INJECTIONS ➢ Rectus Femoris Site – used only
occasionally for IM injections. Its chief
• Injections into muscle tissue advantage is that clients who
• Absorbed more quickly than administer their own injections can
subcutaneous injections because of reach this site easily. Its main
greater blood supply to the body disadvantage is that an injection here
muscles. may cause considerable discomfort
• A major consideration in the for some people.
administration of IM injections is the ➢ Deltoid Site – found on the lateral
selection of a safe site located away from aspect of the upper arm. It is not used
large blood vessels, nerves, and bone. often for intramuscular injections
because it is a relatively small muscle
➢ Ventrogluteal Site – it is located in and is very close to the radial nerve
the gluteus medius muscle, which lies and radial artery.
over the gluteus minimus. ➢ The nurse locates the upper landmark
➢ The ventrogluteal site is the preferred for the deltoid site by placing four
site for intramuscular injections fingers across the deltoid muscle with
because the area: (1) contains no the first finger on the acromion
large nerves or blood vessels, (2) process. The top of the axilla is the
provides the greatest thickness of line that marks the lower border
gluteal muscle consisting of both landmark. A triangle within these
the gluteus medius and gluteus boundaries indicates the deltoid
minimus, (3) is sealed off by bone, muscle about 5 cm (2 in.) below the
(4) contains consistently less fat acromion process.
than the buttock area, thus
eliminating the need to determine E. INTRAVENOUS MEDICATIONS
the depth of subcutaneous fat.
➢ Vastus Lateralis Site – is usually • IV medications enter the client’s
thick and well developed in both bloodstream directly by way of a
adults and children. It is vein.
recommended as the site of choice • Appropriate when a rapid effect is
for intramuscular injections for infants required
and young children because it is the • Methods for administering
largest muscle mass. medications intravenously include
the following:

12 |
HA LEC - FINALS
1. Large-volume infusion of
intravenous fluid
2. Intermittent intravenous infusion
(piggyback or tandem setups)
3. Volume-controlled infusion (often
used for children)
4. Intravenous push (IVP) or bolus
5. Intermittent injection ports
(device).

* Review checklist regarding mixing

and preparing medications up to IM
injection

* Not included in this transes: Topical

Medications, Skin Applications,
Opthalmic Instillations, Nasal
Medications, Vaginal Medications,
Rectal Medications, Inhaled
Medications, and Irrigations.

13 |