SULTAN KUDARAT STATE UNIVERSITY

COLLEGE OF NURSING BATCH 2025

PHARMACOLOGY- NCM 106
PROF. CESAR NALLOS, RN, MAN

INDIVIDUAL PRESCRIPTION ORDER SYSTEM

Drug Administration ● Medications are dispensed from the pharmacy on
receipt of a prescription or drug order for an
PATIENTS CHARTS individual patient
● Primary source of information that is necessary in
patient assessment so that the nurse may create ELECTRONIC DISPENSING SYSTEM
and implement plans for patient care ● A computer- controlled dispensing system that is
● Serves as a communications link among all the supplied by the pharmacy daily with stock
members of the health care team regarding the medicines
patient's status, care provided, and progress
NURSES’ RESPONSIBILITIES
CONTENTS OF PATIENT’S CHART VERIFICATION
● Summary sheet ● Once Rx has been written, the nurse interprets it
● Physician's order form and makes a professional judgment on its
● Flow sheets acceptability
● Consent forms ● Evaluates method of administration, any allergies,
● Graphic chart/record patient's condition
● History and physical examination form
● Progress notes TRANSCRIPTION
● Nurses' notes ● Transcribes order from the physician's order sheet
● PRN Medication Record onto the Kardex and MAR.
● Nursing Care Plan ● Must sign the original medication record to indicate
● Laboratory Tests Record that she received, interpreted, and verified the order
● Consultation Reports Medication Administration
Record (MAR) TYPES OF DOCTOR’S ORDER
● Patient Education Record
VERBAL ORDERS
● Should be avoided whenever possible.
KARDEX RECORD
● When accepted:
● Large index-type card Usually kept in a flip- file or ○ Accurately enter in order sheet and sign
separate folder that contains pertinent information ○ Read back order to physician
such as the patient's name, diagnosis, allergies, ○ Let AP sign order within 24 hrs
schedules of current medications, treatments and
NCP ELECTRONIC TRANSMISSIONS OF PATIENT’S ORDERS
● Fax orders with signatures
MEDICATION ADMINISTRATION RECORD (MAR)
● List of all medications to be administered
● Provides a space for recording the time the PRINCIPLES IN ADMINISTERING MEDICATIONS
medication is administered and who gives it 1. Observe the 10 Rs of Medication Administration
2. Practice asepsis
DRUG DISTRIBUTION SYSTEMS 3. Nurses who administer medications are responsible
for their own actions. Question any order that you
● Unit-dose systems provide patient-specific, consider incorrect.
individually packaged medications, which minimizes 4. Be knowledgeable about medications that you
nurse/caregiver drug product manipulation (e.g., administer.
cutting in half) to arrive at the correct dose before 5. Keep narcotics and barbiturates in locked place.
6. Use only medications that are in clearly labeled
administration. Such manipulation could result in
containers.
patient harm and consume valuable caregiver 7. Return liquid that are cloudy or have changed in
resources. color to the pharmacy.
8. Before administering a medication, identify the
FLOOR OR WARD STOCK client correctly.
9. Do not leave the medications at the bedside.
● all medications but the most dangerous or rarely 10. If the client vomits after taking oral medication,
used are stocked at the nursing station in stock report this to the nurse in charge and/or physician.
containers 11. Pre-operative medications are usually discontinued
during the post-operative period unless ordered to
be continued.
12. When a medication is omitted for any reason,
record the fact together with the reason.

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13. When a medication error is made, report it

immediately to the nurse in charge/or physician. DRUG FORMS FOR ORAL ADMINISTRATION
● Powder
EQUIPMENT IN ORAL MEDICATION ADMINISTRATION ● Capsule
UNIT DOSE OR SINGLE DOSE ● Lozenge
● A single unit package is one that contains one ● Enteric-coated tablet
discrete pharmaceutical dosage form, i.e., one ● Tablet
tablet, one 2-ml volume of liquid, one 2-g mass of ● Gel Capsule
ointment, etc. ● Liquid: syrup, suspension, emulsion, elixir, milk, or
● A unit dose package is one that contains the other alkaline substances
particular dose of the drug ordered for the patient. ● Syrup: sugar-based liquid > medication
● A single unit package is also a unit dose or single ● Suspension: water-based liquid medication. Shake
dose package if it contains the particular dose of the bottle before use of medication to properly mix it
drug ordered for the patient. A unit dose package ● Emulsion: oil-based fiquid medication
could, for example, contain two tablets of a drug ● Elixir: alcohol-based liquid medication. After
product. administration of elixir, allow 30 minutes to elapse
before giving water. This allows maximum
EQUIPMENT absorption of the medication.
● Soufflé cup
● Medicine cup IMPORTANT
● Medicine dropper "NEVER CRUSH ENTERIC-COATED OR SUSTAINED
● Teaspoon RELEASE TABLET!!"
● Oral syringe
● Nipple ● Crushing enteric-coated tablets - allows the
irrigating medication to come in contact with the oral
EQUIPMENT IN PARENTERAL MEDICATION or gastric mucosa, resulting in mucositis or gastric
ADMINISTRATION irritation.
● Syringe ● Crushing sustained-released medication - allows
○ Insulin all the medication to be absorbed at the same time,
○ Tuberculin resulting in a higher than expected initial level of
○ Pre-filled medication and a shorter than expected duration of
● IV Administration Set action.
● Volume- controlled Burette Set
SUBLINGUAL

● A drug that is placed under the tongue, where it

dissolves.
● When the medication is in capsule and ordered
sublingually, the fluid must be aspirated from the
capsule and placed under the tongue.
● A medication given by the sublingual route should
not be swallowed, or desired effects will not be
achieved
ENTERAL/ ORAL ADMINISTRATION

ADVANTAGES
ADVANTAGES
● Same as oral
● The easiest and most desirable way to administer
● Drug is rapidly absorbed in the bloodstream
medication
● Most convenient
DISADVANTAGES
● Safe, does not break skin barrier
● If swallowed, drug may be inactivated by gastric
● Usually less expensive
juices..
● Drug must remain under the tongue until dissolved
DISADVANTAGES
and absorbed
● Inappropriate if client cannot swallow and if GIT has
reduced motility
● Inappropriate for client with nausea and vomiting. DERMATOLOGIC
● Drug may have unpleasant taste.
● Includes lotions, liniment and ointments, powder
● Drug may discolor the teeth.
● Drug may imitate the gastric mucosa.
● Drug may be aspirated by seriously ill patient.

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● Before application, clean the skin thoroughly by ● Press gently bur firmly a few times on the tragus of
washing the area gently with soap and water, the ear to assist the flow of medication into the ear
soaking an involved site, or locally debriding tissue canal.
● Use surgical asepsis when open wound is present. ● Ask the client to remain in side lying position for
● Remove previous application before the next about 5 minutes
application. ● At times the MD will order insertion of cotton puff
● Use gloves when applying the medication over a into outermost part of the canal. Do not press cotton
large surface (e.g large area of burns). into the canal. Remove cotton after 15 minutes.
● Apply only thin layer of medication to prevent
systemic absorption. NASAL INSTALLATIONS

OPHTHALMIC ● Nasal Instillations are instilled for their astringent

effects (to shrink swollen mucous membrane), to
● includes instillation and irrigation loosen secretions and drainage or to treat infections
○ B.1. Instillation-to provide an eye of the nasal cavity or sinuses. • Decongestants,
medication that the client requires. steroids, calcitonin.
○ B.2. Irrigation - To clear the eye of noxious
or other foreign materials. PROCEDURE FOR NASAL INSTILLATION
● Have the client blow the nose prior to nasal
PROCEDURE FOR OPTHALMIC ADMINISTRATION instillation
● Position the client either sitting or lying. ● Assume a back lying position, or sit up and lean
● Use sterile technique head back.
● Clean the eyelid and eyelashes with sterile cotton ● Elevate the nares slightly by pressing the thumb
balls moistened with sterile normal saline from the against the client's tip of the nose. While the client
inner to the outer canthus inhales, squeeze the bottle.
● Instill eye drops into lower conjunctival sac. ● Keep head tilted backward for 5 minutes after
● Instill a maximum of 2 drops at a time. Wait for 5 instillation of nasal drops.
minutes if additional drops need to be administered. ● When the medication is used on a daily basis,
This is for proper of the medication. alternate nares to prevent irritation.
● Avoid dropping a solution onto the cornea directly, ● Instruct the client to hold breath for 10 seconds. To
because it causes discomfort. enhance complete absorption of the medication.
● Instruct the client to close the eyes gently. Shutting ● If bronchodilator, administer a maximum of 2 puffs,
the eyes tightly causes spillage of the medication. for at least 30 second interval.
● For liquid eye medication, press firmly on the ● Administer bronchodilator before other inhaled
nasolacrimal duct (innet cantus) for at least medication. This opens airway and promotes
30seconds to prevent systemic absorption of the greater absorption of the medication.
medication ● Wait at least 1 minute before administration of the
second dose or inhalation of a different medication
OTIC by MDI
● Instruct client to rinse mouth, if steroid had been
● Instillation - to remove cerumen or pus or to remove administered. This is to prevent fungal infection.
foreign body
VAGINAL
PROCEDURE FOR OTIC ADMINISTATION
● Warm the solution at room temperature or body DRUG FORMS:
temperature, failure to do so may cause vertigo, ● Tablet liquid (douches).
dizziness, nausea and pain. ● Jelly, foam and suppository
● Have the client assume a side- lying position (if not
contraindicated) with ear to be treated facing up. VAGINAL IRRIGATION
● Perform hand hygiene. Apply gloves if drainage is ● is the washing of the vagina by a liquid at low
present. pressure. It is also called douche
● Straighten the ear canal:
● 0-3 years old: pull the pinna downward and PROCEDURE FOR VAGINAL JELLY, FOAM AND
backward SUPPOSITORY
● Older than 3 years old: pull the pinna upward and ● Close room or curtain to provide privacy.
backward ● Assist client to lie in dorsal recumbent position to
● Instill eardrops on the side of the auditory canal to provide easy access and good exposure of vaginal
allow the drops to flow in and continue to adjust to canal, also allows suppository to dissolve without
body temperature escaping through orifice.

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● Use applicator or sterile gloves for vaginal ○ outer aspect of the upper arms
administration of medications. ○ anterior aspect of the thighs
○ Abdomen
PROCEDURE FOR VAGINAL IRRIGATION ○ Scapular areas of the upper back
● Empty the bladder before the procedure ○ Ventrogluteal
● Position the client on her back with the hips higher ○ Dorsogluteal
than the shoulder (use bedpan)
● Irrigating container should be 30 cm (12 inches) PROCEDURE
above ● Only small doses of medication should be injected
● Ask the client to remain in bed for 5-10 minute via SC route.
following administration of vaginal suppository, ● Rotate site of injection to minimize tissue damage.
cream, foam, jelly or irrigation. ● Needle length and gauge are the same as for ID
injections
RECTAL ● Use 5/8 needle for adults when the injection is to
administer at 45 degree angle; ½ is use at a
● Can be used when the drug has objectionable taste 90degree angle.
or odor., ● For thin patients: 45 degree angle of needle
● For obese patient: 90 degree angle of needle
PROCEDURE FOR INTRA-RECTAL
● Need to be refrigerated so as not to soften. For heparin injection:
● Apply disposable gloves ● Do not aspirate.
● Have the client lie on left side and ask to take slow ● Do not massage the injection site to prevent
deep breaths through mouth and relax anal hematoma formation
sphincter.
● Retract buttocks gently through the anus, past For other medications:
internal sphincter and against rectal wall, 10 cm ● Aspirate before injection of medication to check if
(4inches) in adults, 5 cm (2 in) in children and the blood vessel had been hit. If blood appears on
infants. May need to apply gentle pressure to hold pulling back of the plunger of the syringe, remove
buttocks together momentarily. the needle and discard the medication and
● Discard gloves to proper receptacle and perform equipment.
hand washing.
● Client must remain on side for 20 minute after For insulin injection
insertion to promote adequate absorption of the ● Do not massage to prevent rapid absorption which
medication. may result to a hypoglycemic 'reaction
● Always inject insulin at 90 degrees angle to
PARENTERAL administer the medication in the pocket between the
subcutaneous and muscle layer. Adjust the length
● Administration by needle of the needle depending on the size of the client.

A. INTRADERMAL C. INTRAMUSCULAR
● Under the epidermis. ● Needle length is 1", 12", 2" to reach the muscle
● The site are the inner lower arm, upper chest and layer
back, and beneath the scapula. ● Clean the injection site with alcoholized cotton ball
● Indicated for allergy and tuberculin testing and for to reduce microorganisms in the area.
vaccinations.
● Use the needle gauge 25, 26, 27: needle length ● Inject the medication slowly to allow the tissue to
3/8", 5/8" or " accommodate volume.
● Needle at 10-15 degree angle; bevel up.
● Inject a small amount of drug slowly over 3 to 5 SITES
seconds to form a wheal or bleb. ● Ventrogluteal site
● Do not massage the site of injection. To prevent ● The area contains no large nerves, or blood vessels
imitation of the site and absorption of the drug into and less fat. It is farther from the rectal area, so it
the subcutaneous. less contaminated.
● Position the client in prone or side-lying.
● When in prone position, curl the toes inward.
● When side-lying position, flex the knee and hip.
B. SUBCUTANEOUS These ensure relaxation of gluteus muscles and
● vaccines, heparin, preoperative medication, insulin, minimize discomfort during injection.
narcotics. ● To locate the site, place the heel of the hand over
● The site: the greater trochanter, point the index finger toward

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the anterior superior iliac spine, then abduct the ● The route can be used for clients with compromised
middle (third) finger. The triangle formed by the gastrointestinal function or peripheral circulation.
index finger, the third finger and the crest of the lium ● Large dose of medications can be administered by
is the site. this route.
● The nurse must closely observe the client for
Deltoid site symptoms of adverse reactions
● Not used often for IM injection because it is ● The nurse should double-check the rights of safe
relatively small muscle and is very close to the medication.
radial nerve and radial artery ● If the medication has an antidote, it must be
available during administration.
Dorsogluteal site ● When administering potent medications, the nurse
● Position the client similar to the ventrogluteal site assesses vital signs before, during and after
● The site should not be use in infant under 3 years, infusion.
because the gluteal muscles are not well developed
yet. GENERAL PRINCIPLES
● To locate the site, the nurse draw an imaginary line 1. Check doctor's order.
from the greater trochanter to the posterior superior 2. Check the expiration for medication-drug potency
iliac spine. The injection site is lateral and superior may increase or decrease if outdated.
to this line. 3. Observe verbal and non-verbal responses toward
receiving injection. Injection can be painful. Client
● Another method of locating this site is to imaginary
may have anxiety, which can increase the pain.
divide the buttock into four quadrants. The upper 4. Practice asepsis to prevent infection. Apply
most quadrant is the site of injection. Palpate the disposable gloves.
crest of the ilium to ensure that the site is high 5. Use appropriate needle size. To minimize fissue
enough. injury.
6. Plot the site of injection properly. To prevent hilling
● Avoid hitting the sciatic nerve, major blood vessel or nerves, blood vessels, bones.
bone by locating the site properly. 7. Use separate needles for aspiration and injection of
medications to prevent tissue irritation.
Vatus Lateralis 8. Introduce air into the vial before aspiration. To
● Recommended site of injection for infant create a positive pressure within the vial and allow
easy withdrawal of the medication.
● Located at the middle third of the anterior lateral 9. Allow a small air bubble (0.2 ml) in the syringe to
aspect of the thigh. push the medication that may remain.
● Assume back-lying or sitting position. 10. Introduce the needle in quick thrust to lessen
discomfort.
Rectus femoris site 11. Either spread or pinch muscle when introducing the
medication. Depending on the size of the client.
● located at the middle third, anterior aspect of thigh 12. 1Minimized discomfort by applying cold compress
over the injection site before introduction of
IM injection-Z tract infection medication to numb nerve endings.
● Used for parenteral iron preparation. To seal the 13. Aspirate before the introduction of medication. To
drug deep into the muscles and prevent permanent check if blood vessel had been hit.
14. Support the tissue with cotton swabs before
staining of the skin. withdrawal of needle. To prevent discomfort of
● Retract the skin laterally, inject the medication pulling tissues as needle is withdrawn.
slowly. Hold retraction of skin until the needle is 15. Massage the site of injection to haste absorption.
withdrawn 16. Apply pressure at the site for few minutes. To
prevent bleeding.
● Do not massage the site of injection to prevent
17. Evaluate effectiveness of the procedure and make
leakage into the subcutaneous. relevant documentation.

D. INTRAVENOUS
The nurse administer medication intravenously by the NURSING ADMINISTRATION IN IV INFUSION
following method: ● Verify the doctor's order
● As mixture within large volumes of IV fluids. ● Know the type, amount, and indication of IV
● By injection of a bolus, or small volume, or therapy.
medication through an existing intravenous infusion ● Practice strict asepsis.
line or intermittent venous access (heparin or saline ● Inform the client and explain IV therapy’s purpose to
lock) alleviate the client's anxiety.
● By "piggyback" infusion of solution containing the ● Prime IV tubing to expel air. This will prevent air
prescribed medication and a small volume of IV embolism.
fluid through an existing IV line. ● Clean the insertion site of IV needle from center to
● Most rapid route of absorption of medications. the periphery with alcoholized cotton ball to prevent
● Predictable, therapeutic blood levels of medication infection.
can be obtained. ● Shave the area of needle insertion if hairy.

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● Change the IV tubing every 72 hours. To prevent 3. Drug Overload- the patient receives an excessive
contamination. amount of fluid containing drugs
● Change IV needle insertion site every 72 hours to
prevent thrombophlebitis.
Assessment Nursing Interventions
● Regulate IV every 15-20 minutes. To ensure
administration of proper volume of IV fluid as ● Dizziness ● Slow infusion to KVO.
ordered. ● Shock ● Take vital signs
● Observe for potential complications. ● Fainting ● Notify physician

TYPES OF IV FLUIDS
Isotonic solution
● has the same concentration as of the body fluid 4. Superficial Theombophlebitis- it is due to overuse
○ D5 W of a vein, irritating solution or drugs, clot formation,
○ Na Cl 0.9% large bore catheters.
○ Plain Ringer’s lactate
○ Plain Normosol Assessment Nursing Interventions

Hypertonic ● Pain along the course ● Change IV site every

● has higher concentration than the body fluids of vein 72 hours
● Vein may feel hard and ● Use large veins for
○ DIOW cordlike
○ D50W ● Edema and redness at imitating fluids
○ DSLR needle insertion site. ● Stabilize venipuncture
○ D5NM ● Arm feels warmer than al area of flexion.
the other arm ● Apply cold compress
Hypotonic immediately to relieve
● has lower concentration than the body fluids pain and inflammation;
○ Nacl 0.3% later with warm
compress to stimulate
COMPLICATION OF IV INFUSION circulation and
promotion absorption.
1. Infiltration- the needle is out of vein, and fluids
● "Do not imigate the IV
accumulate in the subcutaneous tissues.
because this could
push clot into the
Assessment Nursing Interventions systemic circulation”

● Pain ● Change the site of

● Swelling needle
● Skin is cold at needle 5. Air Embolism- Air manages to get into the
● Apply warm compress.
site circulatory system; 5 ml of air or more causes air
● Pallor of the site This will absorb edema
● Flow rate has fluids and reduce embolism.
decreased or stopped swelling
Assessment Nursing Interventions
2. Circulatory Overload- results from administration
● Chest, shoulder, or ● Do not allow IV bottle
of excessive volume of IV fluids. backpain to "run dry"
● Hypotension ● "Prime" IV tubing
● Dyspnea
Assessment Nursing Interventions ● Cyanosis before starting
● Tachycardia infusion.
● Headache ● Slow infusion to KVO ● Increase venous ● Turn patient to left side
● Flushed skin ● Place patient in high pressure
● Rapid pulse in the trendelenburg
fowler's position. To ● Loss of consciousness
● Increase BP position. To allow air to
● Weight gain enhance breathing rise in the right side of
● Syncope and faintness ● Administer diuretic, the heart. This prevent
● Pulmonary edema bronchodilator as pulmonary
● Increase volume ordered
pressure embolismpush clot into
● SOB the systemic
● Coughing circulation”
● achypnea
● Shock

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6. Nerve Damage- may result from tying the arm too

tightly to the splint. LEGAL AND ETHICAL CONSIDERATIONS

● RA 9173- Philippine Nursing Act of 2002

Assessment Nursing Interventions
● REPUBLIC ACT 3720
● Numbness of fingers ● Massage that are and ○ An act to ensure the safety and purity of
and hands move the shoulder foods, drugs, and cosmetics being made
through its ROM available to the public by creating the Food
● Instruct the patient to and Drug Administration which shall
open and close their administer and enforce the laws pertaining
hand several times thereto.
each hour. ● R.A. 6425- Dangerous Drugs Act
● Physical therapy may ○ It stipulates that the sale administration,
be required Note: delivery distribution, and transportation of
apply splint with the prohibited drugs is punishable by law
fingers free to move. ● The Philippine Constitution.
● Food and Drug Administration
● By-Laws of the Philippine Nurses Association
● The ICN Code of Ethics for Nurses
7. Speed Shock- may result from the administration of
○ A guide for action based on social values
IV push medication rapidly.
and needs.
● To avoid speed shock, and possible cardiac arrest,
○ The Code is regularly reviewed and
give most IV push medication over 3 to 5 minutes.
revised in response to the realities of
nursing and health care in a changing
society. The Code makes it clear that
inherent in nursing is respect for human
rights, including the right to life, dignity and
to be treated with respect.
○ The ICN Code of Ethics guides nurses in
everyday choices and it supports their
refusal to participate in activities that
conflict with caring and healing.

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