Nurses role and responsibilities in administration of oral medication

Presented By: Sonia M.Sc. Nursing-1st Year

Introduction
The safe and accurate administration of medicine is the nurse`s most important and prime responsibility. Drugs are the primary means of therapy for the clients with health problems. But the drugs have potential for causing problems if not administered properly. So while administering, the client`s response to therapy should be monitored promptly and accurately, and client should be educated regarding the selfadministration of drugs while getting discharged.

 The nurses bear the sole responsibility and accountability while administering the drugs. Under the law, the nurses are responsible for their actions regardless of whether there is a written order. If the physicians prescription appears unreasonable or wrong, the nurses should clarify with the doctor who prescribed the drug and get it clarified before administering.

Definition

Medication may be defined as a substance used to promote health, to prevent disease to diagnose a disease to alleviate or cure diseases.

Objectives
Nature of the drug i.e. the name, classification, types of preparations, effects, dosage, absorption and excretion, routes of administration, time of administration and indications. Essential parts of a medication order. Abbreviation and symbols used in writing a medication order. Weights and measures used. Preparation of solutions and calculation of fractional doses. Storing of medication. Factors of safety in the administration of medications. Rules for administration of medications. Ethical and legal aspects. Nurses role in the administration of medication.

Names of the drug:

Chemical name:
It provides an exact description of the medications composition and molecular structure. Usually it indicates the ingredients of the drug. These are rarely in clinical settings.

e.g. acetyl-para-aminophenol, which is commonly known

as paracetamol.

Generic or non-proprietary name:

Generic name is the name assigned by the manufacturer who first developed the drug and is assigned by the United States adopted names council. Each drug has only one generic name. E.g. Morphine sulphate, ibuprofen.

Trade name or brand name: It is the registered name assigned by the manufacturer and is copyrighted. One drug may be manufactured by many companies and so may be known by several different trade name. E.g. Paracetamol have different trade name Crocin , metacin.

Classification of drugs:
Classification of drugs according to their actions:
Analgesics : Drugs used to relieve pain

Antipyretics : Drugs which reduce fever Anti inflammatory: those helps to reduce the inflammation Antacids: to decrease the activity of the gastric secretions Antibiotics: to destroy or inhibit the growth of microorganisms Diuretics: which increase the flow of urine. Antiseptic: a substance that inhibits the growth of bacteria

Hypoglycemic: drugs that lowers the blood sugar level. Antiemetics: drugs relieving or preventing the nausea and vomiting. Narcotics: a drug that produces complete insensibility Sedatives: lessen the body activity. Bronchodilators: medicines which relax muscles of the bronchioles by reducing the smooth muscle spasm. Myotics: contract the pupil of the eye.

Forms of medications
Aqueous solution: one or more drugs dissolved in water. Capsule: powdered drugs or liquids within gelatine container. Lozenge: Drugs in a flavoured or sweet base that is released as the base dissolves in the mouth to which a soothening material is added. It helps to relieve the tickling sensation at the back of throat. Elixir: clear fluid containing water and/or alcohol; designed for oral use: usually has sweetener added. Enteric coated tablet: tablet for oral use coated with materials that do not dissolve in stomach; coatings dissolve in intestine, where medication is absorbed.

Liniment: preparation usually containing alcohol, oil, or soapy emollient that is applied to skin. Lotion: medication in liquid suspension applied externally to protect skin. Ointment; semisolid, externally applied preparation, usually containing one or more medications. Paste: semisolid preparation, thicker and stiffer than ointment; absorbed through skin more slowly than ointment. Pill: Drug in powder form mixed in a cohesive material. These are single dose units made by mixing the powdered drug with the liquid such as syrup and rolling the mixture into round or oval shape.

Solution: liquid preparation that may be used orally, parenterally, or externally; can also be instilled into body organ or cavity. Suppository: solid dosage form mixed with gelatine and shaped in form of pellet for insertion into body cavity; melts when it reaches body temperature, releasing medication for absorption. Syrup: medication dissolved in concentrated sugar solution; may contain flavouring to make medication more palatable. Tablet: powdered dosage form compressed into hard disks or cylinders; in addition to primary medication, contains binders, disintegrators, lubricants, and fillers.

 Powder: a finely ground form of drug or drugs. Some are used internally and some are used externally. Plaster: solid preparation used as a counter irritant or as an adhesive externally. Spirits: a concentrated alcoholic solution of volatile substance. Tincture: alcoholic ( water or alcohol base) solution prepared from drugs derived from plants Glycerite: Solution of drug combined with glycerin for external use; contains atleast 50% glycerin.

Abbreviations
ABBREVIATIONS a.c p.c a.m. p.m. alt.die o.m. o.d. o.n. h.s. h.n. c.m. p.r.n. s.o.s. b.d.(b.i.d.) t.i.d. (t.d.s.) q.i.d. stat rep. a.d. MEANING Before meals After meals Before noon After noon Alternate days Each morning Daily (once a day ) Each night At bed time Tonight Tomorrow morning When required If necessary, in emergency Twice a day Three times a day Four times a day At once Repeat Every day

ABBREVIATIONS @ non rep noct q. q.h. q-2h, t.i.n. aq aq dest dil fl inf Liq Lot mist pil Syr. Inj. Tab. Caps. Elix

MEANING At the rate of Not to be repeated Night Every Every hour Every two hourly Three times a night Water Distilled water Dilute Fluid Infusion Liquid Lotion Mixture Pill Syrup Injection Tablet Capsule Elixir

Abbreviations aa ad c cc gr gtt m kg mg OZ S CM Gm Ml Lb L Gal tsp

Meaning Of each Upto With Cubic centimetre Grain A drop Minim Kilogram Milligram Ounce Without Centimetre Gram Millilitre Pound Litre Gallon Tea spoonful

Abbreviations amt no. td.sp. wt. m.m. M.eq. Dl IU MIU U MM mM sec Min < >

Meaning Amount Number Tablespoon Weight Millimetre Milli equivalent Decilitre International unit Mini International Unit Unit Millimole Micromole Second Minute Lessthan greater than

Regarding Hours Of Administration

Q.4H Q.6 H T.D.S B.D O.D. H.S Q.8 H Q.12 H Every 4 Hours (6 times a day) Every 6 Hours (4 times a day) Thrice a day Twice a day Once a day At bed time Every 8 Hours (3 doses) Every 12 Hours 10-02-06/ 10-02-06 09-03-09-03 09-03-09 09-09 08am or 06 am 09pm 06-02-10 or 08-04-12 09-09

Weights and Measures

Unit 1 Dram 1 Dram 1 Dram 1 Dram 1 ounce 1 ounce 1 ounce 1 ounce 1 ounce 1 teaspoon 1 teaspoon 1 tablespoon 1 tablespoon 1 tablespoon 1 tablespoon Approximate Value 60 minims 60 grains 4 grams 4 ml or 1 teaspoonful 30 grams 8 teaspoonful 30 ml 480 grains 8 drams 4 to 5 ml 60 Drops 4 drams 4 teaspoon 15 ml ounce

Unit 1 tea cupful 1 tea cupful 1 gallon 1 Meter 1 meter 1 meter 1 glassful 1 glassful 1 litre 1 litre 1 litre 1 gram 1cc 1 pound 1 pound 1 kg

Approximate Value 5 ounces 150 ml 4000 ml 39.4 inches 100 cms 1000mm 8 ounces 250 ml 1000 ml 40 ounces 2 pints 1000mgm 1 ml 480 grams 16 ounces 1000 grams

Pharmacokinetics as the Basis of Medication Actions

Absorption: It refers to the entry of drugs into the
blood from its site of administration. Factors affects the medication absorptions are: Route of administration. site of administration Concentration of the drug and its dosage.

 Distribution: After a medication is absorbed, it is distributed within the body to tissues and organs and ultimately to its specific site of action

Metabolism: After a medication reaches its site of action, it becomes metabolized into a less active or inactive form that is more easily excreted.

The liver degrades many harmful chemicals before they become distributed to the tissues. Excretion: After the medications are metabolized, they exit the body through the kidneys, liver, bowel, lungs and exocrine glands. The kidneys are the main organs for medication excretion.

Types of medication actions

Therapeutic effects: It is the expected or predictable physiological response a medication causes. Each medication has a desired therapeutic effect for which it is prescribed. For e.g. analgesic for pain. Side effects: side effects are the unintended, secondary effects a medication predictably will cause. Side effects may be harmless or injurious. Adverse effects: adverse effects are generally considered severe response to medications. For e.g. a client may become comatose when a drug is ingested

Toxic effects: Toxic effects may develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Excess amounts of a medication within the body may have lethal effects, depending on the medications action. Idiosyncratic reactions; medications may cause unpredictable effects such as an idiosyncratic reaction in which a client overreacts or under reacts to a medication or has a reaction different from normal.

Allergic reaction: these are another unpredictable response to a medication; they make up 5% to 10% of all medication reactions. A client can become sensitized immunologically to the initial dose of a medication. With repeated administration, the client may develop allergic reactions to the medications

Mild allergic reactions:

Urticaria: raised irregularly shaped eruptions with varying sizes and shapes. Rash: Small, raised vesicles that are usually reddened; often distributed over entire body. Pruritus: Itching of the skin; accompanies more rashes. Rhinitis: Inflammation of mucous membranes lining nose; causes swelling and clear; watery discharge. Medication interaction: It is common in individuals taking several medications. When two medications have a synergistic effect, or act synergistically, the effect of the two medications combined is greater than the effect of the medications given separately.

Dosage
A dose is the amount of drug administered at one time. Minimum dose: is the smallest quantity of the drug that will produce an effect in the body.
Maximum dose: is the largest quantity of the drug that can be administered at one time without producing harm to the body. Lethal dose: is larger than the maximum dose which will have poisonous effect on the patient.

Factors modify the dosage of the drugs

Age Habituation Weight Addiction Sex Physical condition Route of administration Tolerance

Terms associated with medications Actions

Term Meaning

onset

Time it takes after a medication is administered for it to produce a response

Time it takes for a medication to reach its highest effective concentration Minimum blood serum concentration of medication reached just before the next scheduled dose.

peak
Trough

Duration Time during which the medication is present in concentration great enough to produce a response Plateau Blood serum concentration of a medication reached and maintained after repeated fixed doses

Routes of Administration
ORAL ROUTES
SUBLINGUAL ADMINISTRATION BUCCAL ADMINISTRATION

Parenteral routes
Intradermal : into the dermis. subcutaneous : into the subcutaneous tissue. Intramuscular: into the muscle. Intravenous : into the vein. intrathecal : into the spinal cavity. Intraosseous : into the bone marrow. Intra arterial : into the artery.

Instillation: putting drug in liquid form into a body cavity. Insertion : introducing solid forms of drugs into the body orifices. Implantation: planting solid drugs into the body tissues. Inhalation: inhales fumes into the lungs to have a local or systemic effect.

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Sublingual administration of tablet

Systems of Medication Measurements:

Metric System: It is a decimal system. It is most logically organized. It can be easily be converted and computed through simple multiplication and division. The basic units of measurement in the metric system are the Meter (length) Litre (volume)
Gram (weight)

Equivalents of measurement:
Metric
1ml 4-5 ml 16ml 30 ml 240 ml

Household
15 drops 1 teaspoon (tsp) 1 tablespoon 2 tablespoons 1 cup

480 ml 960 ml
3840ml

1 pint 1 quart
1 gallon

Dose calculation:
The following formula used for dose calculations for preparing solid and liquid forms:
Dose ordered Dose on hand x amount on hand =amount to administer

The dose ordered is the amount of medication prescribed.

The dose on hand is the weight or volume of medication available in units supplied by the pharmacy; it may be expressed on the medication label as the contents of a tablet or capsule or as the amount of medication dissolved per unit volume of liquid.

The amount on hand is the basic unit or quantity of the medication that contains the dose on hand. For solid medications the amount on hand may be one capsule; the amount of liquid on hand may be a millilitre or litre depending on the container.

The amount to administer is the actual amount of medication the nurse will administer. The amount to administer is always expressed in the same unit as the amount on hand.

Example:
The prescriber orders the client to receive morphine 2mg IV. The medication is available in a vial containing 10 mg per millilitre. So the formula applied is

2mg/ 10mg x 1ml =0.2 ml

Common reasons for Measurement Conversion

Converting fluids ounces to milliliters for

measurement of intake and output Converting body weight from pounds to kilograms and vice versa Converting volume equivalents to calculate IV flow rates and prepare wound irrigation solutions, enema, or bladder irrigations.

Pediatric dosage
Most of the drug are available in adult dose. For paediatric dose: Youngs Rule: ( for children over 1 year of age to 12 years) Age of the child in years X adult dose = childs dose Age of the child in years +12
Clarks rule: according to the weight of the child, therefore it can be used for children of all ages. Weight of the child in pounds X adults dose = childs dose 150

Where Do Errors Occur?

Prescribing Transcribing Dispensing Administering 39% 11% 12% 38%

Ways to prevent medication administration errors:

Read the medication labels carefully many products come in similar containers, colors and shapes.

Be aware of medications with similar names many medication names sound alike.

When new or unfamiliar medication is ordered, consult resource if prescriber is also unfamiliar with drug, there is greater risk of inaccurate dosages being ordered Do not administer medication ordered by nickname or unofficial abbreviation Know client with same last names. Also have clients state their full names Do not confuse equivalents.

Essentials of a medication order:

Name of the patient Name of the drug Dosage of the drug The method of administration The date The signature of the physician

Types of orders
Standing orders or routine medication orders Prn orders Single order (one time) Stat orders

Nurses role:
Knowledge Experience Attitudes Standards

Right medication
Compares the medication recording form or with the prescribers written orders. Make sure the drug copied correctly on the medication card Be careful of drugs whose names sound alike. When administering medications, the nurse compares the label of the medication container with the medication form. The nurse does this three times: -Before removing the container from the drawer or shelf -As the amount of medication ordered is removed from the container - Before returning the container to storage

Look for the colour, odour and consistency of the drug. Unusual characteristics of the drugs should be questioned. Administer medicine only from a clearly labelled container. Avoid conversation or anything that distracts the mind Be familiar with the trade names. If there is doubt consult the physician or at least seniors or medicine books. Avoid accepting the verbal orders. Verbal orders are accepted only in emergencies. Always identify the patient before giving medication.

Make sure that the drug has not been discontinued by the physician. Nurses administer only the medications they prepare. If an error occurs, the nurse who administers the medication is responsible for the error. Clients who self-administer medications should keep them in their original labelled containers, separate from other medications, to avoid confusion.

Right dose
Read the physician orders to know the correct dose. Consider the age and weight of the patient. This may help to find an error in the physicians order. Know the minimum and maximum dose of the medicine administered. Calculate the fractions of dosage correctly. Measure accurately. Use ounce glasses instead of teaspoons to measure ounces. Have the medicine card or written order before you when you prepare the drug. Avoid conversation or anything that distracts the mind.

Consider how many tablets or capsules are required for the dose. Make sure that the medicine glasses are dry before pouring or measuring the medications. Hold the ounce glass at the eye level and place the thumb at the mark up to which the medicine is to be poured. Help the patient to take all the medicine that is ordered for him. The medicine should be carried to the patient without spilling it out of the container.

Right client:
Read the physicians order to make sure for whom the medicine is ordered. Read the patients name on the patients chart and on the medicine card. Call the patient by name and ask him to repeat his name. Be very careful if the patient is deaf or otherwise does not understand your language.

Right route
If a prescribers order does not designate a route of administration, the nurse consults the prescriber. If the specified route is not the recommended route, the nurse should alert the prescriber immediately. Know the route of administering the medications. E.g. oral, parenteral or rectal etc. Know the abbreviations used to designate the route of administration Never leave any medicine with the patient An error in the medication should be reported immediately

Right time
Read the physicians orders. Know the hospital routines for the intervals. Know the abbreviations for the time. Give the medicine near the time ordered Give the medicine as ordered in relation to the food intake Give the medicines according to the actions expected. E.g. sleeping pills are given at bed time, the diuretics are given in morning hours.

Right documentation
Medication error can result from inaccurate documentation. So, nurses should ensure appropriate documentations. The documentation clearly reflect the clients name, the name of the ordered medications, the time the medication was administered, the medications dosage, route, and frequency. If any of these piece is missing the nurse should verify the order with the prescriber.

Nurses six rights for safe medication administration

The right to a complete and clearly written order The right to have the correct drug route and dose dispensed The right to have access to information The right to have policies on medication administration The right to administer medications safely and to identify problems in the system The right to stop, think, and be vigilant when administering medications

Maintaining the clients rights

To be informed of the medications name, purpose, action and potential undesired effects To refuse a medication regardless of the consequences To have qualified nurses or physicians assess a medication history, including allergies To be properly advised of the experimental nature of medication therapy and to give written consent for its use. To receive labelled medications safely without discomfort in accordance with the six rights of medication administration To receive appropriate supportive therapy in relation to medication therapy To not receive unnecessary medications.

Ethical and legal aspects

Under the law nurses are responsible for their own actions regardless of a written order. It is expected to know for all nurses the minimum and maximum dose of every medicine that they administer. The nurse should know the law about the use of narcotics. The narcotics should be kept under the safe custody of nurses and an account should be maintained for the administration of these drugs. Narcotics should be stocked only by the persons/ institutions who possess licence to do so. The nurses responsibility includes prevention of medication errors by observing the five-rights of giving medications.

Ethical and legal aspects

Charting the administration of medication. The nurse should know what is and what is not acceptable practice in her own institutions. Leaving medications at the bedside of the patient is strictly prohibited. When she involves in the experimental drug programme she has the legal obligation to be fully informed about any investigational medications which she will be administering to a patient.

Storing of medicines
To stock the medicines, each ward should be provided with a medicine cabinet. It should be large enough to accommodate all drugs to be stocked in ward. As far as possible, the medicine cabinet should be kept in a separate room adjacent to the nurses room.

 Adequate lighting should be provided within the cabinet to read the labels clearly. There should be separate compartments for different categories of drugs- for mixtures, tablets, powders. Drugs used for external use should be kept separate from the drugs used for internal use. The container should be arranged alphabetically, so that it is easy to find them.

Poisonous drugs should be kept in a separate cupboard which must have separate lock and key.
A senior nurse should be responsible for the medicines in the poisonous cupboard. A register should be maintained to keep the account of the poisonous drugs. A daily inventory should be taken to prevent theft of narcotics. All the poisonous drugs should be marked poison in red ink.

No drug should be stored without labels. Even for a day. All the containers should have labels written neatly and legibly. All medicine containers should be kept closed always.

The drugs that are unusual in colour, odour and consistency should be returned to the pharmacy and replaced with fresh ones.
Check the expiry date of every drug and make use of it before its expiry

The drugs which are destroyed in the room temperature such as vaccines, sera, antibiotics should be kept in the refrigerators. Emergency drugs should be kept in a place where they are readily obtainable for emergency use.

The medicine cabinet should always be kept neat and clean and all equipment should be kept clean and dry after their use.
The oily medicines should be kept in a separate tray or on a piece of waterproof paper to prevent soiling the shelf.

Policies on drug administration

Check physicians prescription as it provides information and specific instructions for medication administration.
Remember to check six rights for administering the medications. To minimize the chances of contaminations and infections use clean/ sterile technique in preparing medications and handling equipments. Ensure that the patient has no history of drug allergy. Ensure that the drug has not already been administered because such errors could result in lethal dosage.

To avoid errors check the name of the drug, dosage and expiry date against drug prescription and drug label.

Calculate drug dosages accurately.

Administer those drugs which are personally prepared.

Institute necessary observations and measures before drug administration, e.g. BP measurement before anti hypertensive administration. Do not leave medication at patients bed side.

Do not save parts of tablets to be used later. Do not administer medication ordered by nickname or unofficial abbreviations. Record the procedure with the patients response including the side effects. Monitor after effects and report abnormal findings to the physician. In case if an error is made report to nurse in-charge and physician as this, could help to minimize the effect of error.

Preliminary assessment
Check the diagnosis and age of the client. Check the purpose of the medications. Check the identification of the patient. Check the physicians order for correct name, dosage and method of administration of the drug. Check the nurses record for the time at which the last dose was given. Check the symptoms of over dosage of the drug administered due to the cumulative effect of the drug. ( checking pulse before giving digoxin). Check for any contraindications present in the patient for an oral intake of the medications. Check the form of the drug available and the correct method of administration.

Administering oral medication

Definition:

Administration of medication by mouth. Oral medication administration includes buccal and sublingual.
To provide a medication that has systemic or local effect on gastrointestinal tract. To building up general health and supplementing diet. To therapeutic and symptomatic treatment of diseases.

Contraindications
Alteration in gastrointestinal tract like vomiting Reduced gastrointestinal motility (after general anaesthesia, bowel inflammation, etc) Surgical resection of a portion of gastrointestinal tract Inability to swallow (e.g. patients with neuromuscular disorders, oesophageal strictures, mouth lesions) Patients with gastric suction / aspiration. Prior to certain tests / surgery. Unconscious / confused patients. Patients on NPO STATUS. PATIENTS WITH POOR GAG REFLEX.

ARTICLES REQUIRED A Trolly. A tray containing: A bowl of clean water. Ounce glass, teaspoon etc. Drinking water in a glass. Mortar and pestle. Towel and Tissue paper. Kidney tray and paper bag. Medication card.

RATIONAL To take different medications and articles to the bedside. To wash the medicine glass. To measure the medication. To offer to the client after the medicine is given to him. To crush and powder the tablets if necessary. To wipe the outside of the bottle after pouring the medications. To discard the wastes. To write the medication order from the client order sheet. To write on medicine card.

sharp Pencil

General Instructions
Always give medicines from a written order signed by doctor. Medicine bottle should be clearly labelled. Never give medicine from unlabelled bottles. Never give expired medicines. Do not keep labelled poisonous drugs on the medicine trolley. Always keep them under lock and key. Never give medicine in empty stomach unless ordered. Preferably give in between the meals. Keep 5 Rs in mind, i.e. right patient, right time, right drug, right dose and right route. Shake the liquid medicine well before pouring it into medicine glass.

 Always check the label of medicine thrice before taking out from the bottle, before pouring out in the glass, again, before replacing the bottle. Pour medicine away from label to avoid spilling on the label. Never give the medicine which is prepared by others. Record the time and the medicine given and put the signature. Ensure that patient take medicine in front of you before you leave him. Do not handle tablets, pills and capsules with bare hands. If any time, one dose is missed by the patient due to some investigation etc. do not give the missed dose without consulting the doctor.

Preparation of the client: Explain the procedure to the client. discuss the need for medicine.

Assist the client in sitting position. ,because a person lying on the back may aspirate the drug and fluids when swallowing. unless contraindicated.
Give mouthwash, if necessary. Protect the bed clothes and garments with a placed towel under the chin.

Administer Medications

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Procedure
Nursing action
1. Wash hands.

Rationale
.To prevent cross infection.

2. Read the physicians order and compare it with the medicine card. Make sure that all the medicines are entered correctly.

To ensure safety in the administration of the medicine. The physicians order on the chart is the only legal source; medicine cards are used only for convenience and they may be misplaced or lost.
To check the possibility of pouring a wrong medicine. Any medication with an expiry date over should not be used.

3. Take out the appropriate medicine from the shelf after reading the medicine card. Compare the level with the medicine card. Remember to read the entire label including the expiry date. 4. With medication card in sight, measure the medication. Calculate dose if necessary.

To ensure the right ,accurate and valid medicine.

Nursing action 5. Take the medicine as follows: (a) Shake the tablets and capsules into lid of the container first and then into the medicine cups. Take the required number.

Rationale

(a) Dont touch with hands. (a) Pour liquid from the side of the bottle away from the label. Hold the measuring cup at the eye level and place the thumbnail at the correct measurement mark and pour the medicine with care. Do not pour the excess of medicine into the container.

Shaking the medication into the lid of the container prevents the drugs coming in contact with the hands. It enables us to get the required number of tablets or capsules. Extra tablets if any can be put back into the container. To prevent contamination. Pouring from the side of the bottle prevents spoiling of the label. Placing the thumb on the marking locates the correct dose. To prevent contamination of the drug never pour medication back into the bottle.

Nursing action 6. Wipe the mouth of the bottle and close it tightly. 7. Place the card with medication on the tray. No medicine should be kept without medicine card. 8. Prepare each medication into separate containers. Do not mix medicines.

Rationale Wiping keeps the bottle clean .it avoids contamination of the drug. To assure accurate administration of correct medication to correct client.

Mixing medications in a single container is hazardous. If medication spills, client refuses one or more drugs or if a medication is withheld, it will be an embarrassing situation for the nurse.

9. Lock the medicine cabinet and take the medicines to the bedside.

Nursing action 10. Identify the client with the medicine card. Methods available are:

Rationale

Not infallible. Clients may occupy -Read the name on the door or at the another bed without prior permission. bedside. Confused clients may answer to -Call client by name, in a questioning another name. voice to get a response. It is one of the correct method. -Ask the client to repeat his name . This is also a correct method of -Verify identification with staff identification. member who knows the client.

Nursing action

Rationale

11. Administer medicines. -Give the water or fluid to moisten the mouth. -Give medications one at a time. Stay with the client until he has taken the medication. Check the clients mouth when indicated to verify that medications are swallowed. -Provide water to drink after the medicine are administered. -Place the ounce glass in the bowel of water. .

Helps in the swallowing of the solid medications. Administering medicines one by one enables the client to swallow them easily. Staying with the client until he has taken the medications ensures the medication is taken. Unless the nurse has seen the client swallow the drug, she should not record that the drug was administered. There is a possibility for the client not taking the medicine left with the client or he may save many doses and harm himself by taking them all at a time.

SPECIAL CONSIDERATION
1. Administer medication which can irritate the stomach mucosa with a light snack or following a meal, e.g. aspirin, brufen, 2. Administer medication with a light snack or following a meal if required. 3. Administer medication with water and avoid fruit juice, milk, etc. with medications. 4. Do not administer water after giving syrup.

Termination of the procedure

After care of the patient, articles and storage of articles: Give a comfortable position with a proper body alignment after the procedure. Remove all the articles to the utility room. Wash and dry all the articles. Replace all the articles in a proper place. Wash hands. Record medications given and omitted on the nurses record. Record the reason for omission. Record any reactions observed after administration of the medicine.