SKILLS LAB NOTES (August 30, 2022)

Administration of medications

A medication is a substance administered for the diagnosis, cure, treatment, or

relief of a symptom or for prevention of disease.

Pharmacology is the study of the effect of drugs on living organisms.

The written direction for the preparation and administration of a drug is called a
prescription.

Purpose of medication Drugs can be administered for these purposes:

• Diagnostic purpose: to identify any disease
• Prophylaxis: to prevent the occurrence of disease. eg:- heparin to prevent
thrombosis or antibiotics to prevent infection.
• Therapeutic purpose: to cure the disease.

Uses of Drugs
 Prevention - used as prophylaxis to prevent diseases e.g. vaccines;
fluoride-prevents tooth decay.
 Diagnosis - establishing the patient’s disease or problem e.g. radio
contrast dye; tuberculosis (Mantoux) testing.
 Suppression - suppresses the signs and symptoms and prevents the
disease process from progressing e.g. anticancer, antiviral drugs.
 Treatment - alleviate the symptoms for patients with chronic disease e.g.
Anti- asthmatic drugs.
 Cure - complete eradication of diseases e.g. anti-biotics, anti-helmintics.
 Enhancement aspects of health - achieve the best state of health e.g.
vitamins, minerals

Legal Aspects of Medication

 Preparation, dispensing and administration of medications are all covered
by laws in every country.
 Dangerous Drug Act – 1930 and The Narcotic Drugs and Psychotropic
Substances Act - 1985. It is an act that governs the procurement and use
of some drugs especially the narcotics e.g. morphine, pethedine, cocaine
etc. These drugs are prescription only drugs hence cannot be bought or
administered without prescription.
 Dangerous drugs are always kept under lock and key in the Dangerous
Drug Cupboard under the care of trusted senior nurses.
  It is worth knowing that nurses are responsible for their own actions
regardless of the presence of a written order. If a nurse gives an overdose
of a drug because it is written by a doctor, the error is accounted to the
nurse and not the doctor. The nurse should bear in mind that ALL
substances are poisons: there is none that is not a poison. The right dose
differentiates a poison from a remedy.

Drug Nomenclature
 One drug can have as much as 4 different names as follows:
 Chemical Name - any typical organic name; this precisely describes the
constituents of the drug
 E.g. N-(4-hydroxyphenyl) acetamide for paracetamol
 Generic Name - is given by the manufacturer who first develops the drug; it
is given before the drug becomes official. It is the name by which the drug
will be known throughout the world no matter how many companies
manufacture it. This name is usually agreed upon by the WHO. Often the
generic name is derived from the chemical name. E.g. acetaminophen
 Official Name – United States Adopted Name (USAN) or Japanese
Accepted Name (JAN). It will also apply for an International Nonproprietary
Name (INN) through the World Health Organization (WHO).

Classification of Medication
Medications may be classified according to:
 The body system that the medicine is targeted to interacts with; e.g.
cardiovascular medications, nervous system medication etc.
 Therapeutic usages of the medicine; e.g. antihypertensives ,neuroleptics,
 The diseases the medicine is used for; e. g. anticancer drugs, antimalaria
drugs antihelminthics etc.
 The action of the medication can also be used to classify the it; e.g. beta-
adrenergic blocking agents
 The overall effect of the medication on the body can also be a criteria for
its classification; e.g. sedatives, antianxiety drugs etc.

Storage of Medications
Medications are dispensed by the pharmacy to nursing units. Once delivered,
proper storage becomes the responsibility of the nurse. All medications must be
stored in a cool dry place (usually in cabinets, medicine carts or fridges)

All medications must be stored in a cool dry place (usually in cabinets, medicine
carts or fridges)
Principles of medication administration
 Principles include 3 checks and 10 Rights:
 3 checks are
1. Check when obtaining the container of medicine.
2. Check when removing the medicine from the container.
3. Check when replacing the container.

Rights of Medication Administration

Medication errors can be detrimental to patients. To prevent these errors, these
guidelines are - the rights- are used in drug administration.
1. Right Patient: correct identification of the client cannot be over
emphasized. This can be done by asking the client to mention his/her full
name which should be compared with that on the identification bracelet or
the patient’s folder and medication/treatment chart for confirmation.
2. Right Medication:  Beware of same and similar first and surnames to
prevent the error of administering one person’s medication to another and
vice versa.  Right Medication: before administering any medicine,
compare name on medication chart/medication order with that on the
medication at least 3 times-checking medication label when removing it
from storage unit, compare medication label with that on treatment chart
and medication label and name on treatment chart with patient’s name tag.
3. Right Time: drug timing is very especially with some drugs like antibiotics,
antimalaria drugs etc. to achieve cure and prevents resistance. Some
drugs must be given on empty stomach e.g. antituberculosis drugs; and
some after meals e.g. NSAIDS-these must be noted and adhered to.
• The interval of administration of drugs should also be adhered to
because it is important for many drugs that the blood concentration is not
allowed to fall below a given level and for others two successive doses
closer than prescribed might increase blood concentration to a dangerous
level that can harm the patient.
4. Right Dose: This becomes very important when medications at hand are in
a larger volume or strength than the prescribed order given or when the
unit of measurement in the order is different from that supplied from the
pharmacy. Careful and correct calculation is important to prevent over or
under dosage of the medication.
5. Right Route: An acceptable medication order must specify the route of
medication. If this is unclear, the prescriber should be contacted to clarify
or specify it. The nurse should never decide on a route without consulting
the prescriber.
6. Right to information on drug/client education: The patient has the right to
know the drug he/she is taking, desired and adverse effects and all there is
to know about the medication. The charter on patient’s right made this
clear.
 7. Right to Refuse Medication: The patient has the right to refuse any
medication. However, the nurse is obliged to explain to patients why the
drug is prescribed and the consequences refusing medication.
8. Right Assessment: Some medications require specific assessment before
their administration e.g. checking of vital signs. Before a medication like
Digoxin is administered the pulse must be checked. Some medication
orders may contain specific assessments to be done prior to medication
9. Right Documentation: should be done after medication and not before.
10. Right Evaluation: Conduct assessment to ascertain drug action, both desired an
side effect.

Medication order
The drug order, written by the physician, should has 7 essential parts for
administration of drugs safely.
1. Patients full name.
2. Date and time.
3. Drug name.
4. Dosage.
5. Route of administration.
6. Time and frequency of administration.
7. Signature of physician.

Types of Medication Orders

 Four types of medication orders are commonly used:
1. Stat order: A stat order indicates that the medication is to be
given immediately and only once. e.g: morphine sulfate 10
milligrams IV stat.
2. Single order: The single order or one-time order indicates that
the medication is to be given once at a specified time. e.g:
Seconal 100 milligrams at bedtime.
3. Standing order: Standing order is written in advance carried out
under specific circumstances. (e.g: amox twice daily × 2 days)
4. PRN order: “PRN” is a Latin term that stands for “pro re nata,”
which means “as the thing is needed.” A PRN order or as-
needed order, permits the nurse to give a medication when the
client requires it. (e.g., Amphojel 15 mL prn)

Terminologies and abbreviations used in prescriptions of medications

STAT order
 refers to any medication that is needed immediately and is to be given only
once
  often associated with emergency medications that are needed for life-
threatening situations
 comes from the Latin word "statim" meaning immediately
 should be administered within 5 minutes or less of receiving the written
order
ASAP order
 not as urgent as STAT
 as soon as possible
 should be available for administration to the patient with 30 minutes of the
written order
Single order
 for a drug that is to be given only once, and at a specific time, such as a
preoperative order
PRN order
 latin "pro re nata"
 administered as required by the patient's condition
 the nurse makes the judgement, based on patient assessment, as to when
such a medication is to be administered
Routine orders
 orders not written as STAT, ASAP, NOW or PRN
 these are usually carried out within 2 hours of the time the order is written
by the physician
Standing order
 written in advance of a situation that is to be carried out under specific
circumstances. example: set of postoperative PRN prescriptions that are
written for all patients who have undergone a specific surgical procedure
"Tylenol elixir 325mg PO every 6 hours PRN sore throat"
 standing orders are no longer permitted in some facilities because of the
legal implications of putting all patients into a single treatment category
ac
 before meals
AM
 morning
bid
 twice per day
Cap
 capsule
gtt
 drops
h or hr
 hours
IM
 intramuscular
IV
 intravenous
no
 number
pc
 after meals, after eating
PO
 by mouth
PM
 afternoon
PRN
 when needed/necessary
qid
 four times per day
q2h, q4h, q6h, q8h, q12h
 every __ hours
Rx
 take
STAT
 immediately, at once
tid
 three times per day
ad lib
 as desired, as directed
tab
 tablet

Drug forms
Medications are available in variety of forms. The form of the medication
determines its route of administration.
 Drug forms can be of three types;
– Solid eg: tablet, capsule
– Liquid eg: syrup, eye drops
– Semi solid eg: ointment, lotion
 Tablet: It is the powdered medication compressed into hard disk or
cylinder.
 Capsule: Medication covered in gelatin shell.
 Gel or jelly: A clear or translucent semisolid that liquefies when applied to
the skin.
  Lozenge: A flat, round, or oval preparation that dissolves and releases a
drug when held in the mouth.
 Lotion: Drug particles in a solution for topical use.
 Ointment: Semisolid preparation containing a drug to be applied externally.
 Powder: Single or mixture of finely ground drugs.
 Solution: A drug dissolved in another substance.
 Suspension: Finely divided, undissolved particles in a liquid medium;
should be shaken before use.
 Syrup: Medication combined in a water and sugar solution.
 Suppository: An easily melted medication preparation in a firm base such
as gelatin that is inserted into the body (rectum, vagina, urethra)
 Transdermal patch: Unit dose of medication applied directly to skin for
diffusion through skin and absorption into the bloodstream.

Route of administration
Different route of drug administration are;
• Oral
• Parenteral
• Topical
• Inhalation

Oral route: Medications are given by mouth.

• Sublingual Administration: Some medications are readily absorbed when
placed under the tongue to dissolve.
• Buccal Administration: Administration of a medication by placing in the
mouth against the mucous membranes of the cheek until it dissolves.
Parenteral Routes: Parenteral administration involves injecting a medication into
body tissues.
The following are the four major sites of injection:
1. Intradermal (ID): Injection into the dermis just under the epidermis.
2. Subcutaneous (SC): Injection into tissues just below the dermis of
the skin.
3. Intramuscular (IM): Injection into a muscle.
4. Intravenous (IV): Injection into a vein.

Needle Size
 18 gauge
 20 gauge
 21 gauge
 23 gauge
 25 gauge
Intradermal Injections
- The administration of a drug into the dermal layer of the skin just beneath
the epidermis. Usually only a small amount of liquid is used, for example
0.1mL. This method of administration is frequently used for allergy testing
and tuberculosis (TB) screening.
o Use a tuberculin or small hypodermic syringe for skin testing.
o The angle of insertion for an intradermal injection is 5 to 15 degrees.
o After injecting the medication, a small bleb resembling a mosquito
bite appears on the surface of the skin.
o
Subcutaneous Injections
- The subcutaneous injection sites include:
o The outer posterior aspect of the upper arms
o The abdomen
o The anterior aspects of the thighs
o The scapular area of the upper back
o The upper ventral or dorsal gluteal areas

Intramuscular Injections
- The angle of insertion for an IM injection is 90 degrees. 2 to 5 ml of
medication can be administered into a larger muscle for an adult.
- Sites for IM injections are:
o Ventrogluteal
 Injection is given to gluteus medius muscle
 Position client in prone or side lying position with the knee
bent and raised slightly toward the chest
 The nurse places the heel of the hand on the client’s greater
trochanter, with the fingers pointing towards the client head
 Point the thumb toward the patient’s groin and the index finger
toward the anterior superior iliac spine; extend the middle
finger back along the iliac crest toward the buttock. The index
finger, the middle finger, and the iliac crest form a V-shaped
triangle; the injection site is the center of the triangle.
o Dorsogluteal
 Injection is given to the gluteus maximus muscle
 Position the client in prone position
 Draw an imaginary to divide the buttocks into 4 equal
quadrants.
o Vastus lateralis
 The muscle is located on the anterior lateral aspect of the
thigh
  The landmark is established by dividing the area between the
greater trochanter of the femur & the lateral femoral into thirds
& selecting the middle third
o Deltoid
o Rectus femoris

Medication Ticket

White Stat

Red PRN

Yellow OD

Orange BID

Dark yellow q 6 , q 8

Blue TID

Green OD HS

Pink RTC , q 4