MODULE 2

III. PRINCIPLES OF DRUG ADMINISTRATION

III.1. Objective/s: At the end of this activity, the student/s will be able to:
A. Discuss drug administration as a safe, effective nursing care, utilizing the nursing process.
B. Describe the roles and responsibilities of the nurse regarding drug administration.
C. Explain how the rights of drug administration impact patient safety.
III.2. Learning Content:
The role of the nurse
 The primary role of the nurse in drug administration is to ensure that prescribed medications are
delivered in a safe manner. In the course of drug administration, we will collaborate closely with
physicians, pharmacists and of course their patients.
 The nurse’s responsibilities include the following:
1. What drug is ordered
 Name (generic and trade) and drug classification
 Intended use
 Effects on the body
 Contraindications
 Special considerations (e.g. how age, body weight, body fat distribution and individual
physiologic states affect pharmacologic responses).
 Side effects/ adverse effects
 How supplied, administered and nursing considerations
 The major goal is to limit the number of severities of adverse drug events.
 An allergic reaction is an acquired hyperresponsiveness of the body’s defense to a foreign
object
 Anaphylaxis is a severe type of allergic reaction that involves the massive, systemic release of
histamine and other chemical mediators of inflammation that can lead to life threatening shock.
The signs and symptoms include hypotension, tachycardia following drug administration.
The RIGHTS of DRUG ADMINISTRATION
The traditional FIVE RIGHTS of drug form the operational basis for a safe drug delivery.
 Right patient
 Right medication
 Right dose
 Right route of administration
 Right time of delivery
**Additional rights have been added over the years. Follow the link for enhancement
(https://www.slideshare.net/NaveenSharma45/drug-administration-44333770)
The three checks or drug administration
 Checking the drug with the MAR or the information medication system when removing it from the
medication drawer.
 Checking the drug when preparing it, pouring it, taking it out of the unit dose container or connecting the IV
tubing to the bag.
 Checking the drug before administering it to the patient.
***Despite all attempts to provide drug safety, errors continue to occur.
Drug Orders and Drug Schedules:
 Health providers use accepted abbreviations to communicate the directions and times for drug
administration.
 STAT (latin meaning immediately). A STAT order refers to any medications that is needed immediately. It
is often associated with emergency medications that are needed for life threatening situation s. the time
frame between writing the order and administration should be 5 minutes or less.
 ASAP(as soon as possible) should be within 30 minutes of the written order
 PRN( pro re nata) is administered as required by the patient’s condition. The nurse makes the judgement
based on her assessment as to when such a medication is administered.
 ***Orders not written as STAT, ASAP PRN, or NOW, are called routine orders. These are usually carried
out within 2 hours of the written orders.
 STANDING order is written in advance by the physician to be carried out under a specific situation. E.g.
surgical patients.
Systems Measurement
 Dosages are labeled and dispensed according to their weight or volume. Three system measurements are
used in pharmacology.
 The metric which is the most common
 The apothecary and the household systems are old older systems of measurements.
***The nurse should encourage the use of accurate medical dosing devices at home.

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Follow the link for more equivalent and converted measurements of this topic.
https://www.youtube.com/watch?v=aGMLRnWGanM

ROUTES OF DRUG ADMINISTRATION

The three categories of routes of routes of administration:
 Enteral
 Topical
 Parenteral
A. The enteral route includes drugs given orally and those administered through nasogastric or
gastrostomy tubes. Oral drug administration is the most common, most convenient and usually the
least costly of all routes. It is considered to be the safest route because the skin barrier is not
compromised. Medications administered through this method is takes advantage of the oral mucosa,
stomach or small intestines.
A.1.Tablets and capsules are the most common form of drugs. It is easy to use. Some are
scored for more individualized dosing.
 Crushing tablets and opening capsules are done to make it more palatable to children.
 However, the nurse should take note of the manufacturer’s instructions if it is permissible.
Enteric coated tablets (they have a hard-waxy coating) are designed to dissolve in the
alkaline environment of the small intestine. They must never be crushed. -
Sustained-release tablets or capsules are designed to dissolve very slowly. This releases
the medication over an extended period of time and results in longer duration of action for the
medication. They are called extended-release (XR), long-acting (LA) or slow release (SR).
these allow convenience for once or twice a day dosing. Extended-release medications must
never be crushed or opened.
A.2. Sublingual and Buccal Drug Administration
 Sublingual route- the medication is placed under the tongue and allowed to dissolve slowly. Because of the
rich blood supply in this region, the SL route results in a rapid onset of action. SL drugs are formulated as
disintegrating drug or soft gelatin capsules filled with liquid drug.
 Buccal route – the drug is placed in the oral cavity between the gum and the cheek. Instruct the patient not
to manipulate the medication with the tongue otherwise, it will be displaced and be rapidly absorbed.
 The buccal route is preferred over the SL route for extended release drugs.
 They do not cause irritation generally and are small enough not to cause any discomfort to the patient.
 Nasogastric and gastrostomy Drug Administration
 A nasogastric (NG) tube is a soft flexible tube inserted by way of the nasopharynx with the tip lying in the
stomach. The NG tube is used for short-term treatment.

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  A gastrostomy (G) tube is surgically placed directly into the patient’s stomach. This is for patients
requiring long term treatment.
A.3. Topical Drug Administration
 Topical drugs are applied locally to the skin or the membranous linings of the eye, ear, nose,
respiratory tract, urinary tract, vagina and rectum.
These include the following:
 Dermatologic preparation- drugs applied to the skin, the topical route most commonly used.
Formulations include creams, lotions, gels, powders, and sprays.
 Instillation and irrigations-drugs applied into the body cavities or orifices. These include the
eyes, ears, nose, urinary bladder, rectum and vagina.
 Inhalation drugs applied to the respiratory tract by inhalers, nebulizers, or positive pressure
breathing apparatuses.
***Drugs applied topically produce local effect, which have lesser side effects, absorbed slowly
and amounts reaching the general circulation are minimal.
***Some drugs are given topically to provide for slow to the release and absorption of the drug to
the general circulation. These are given for their systemic effect .
***These topical drugs should not be applied to abraded or denuded skin, unless directed to do so.
 Transdermal Delivery System
 The use of transdermal patches provides an effective means of delivering certain medications.
 They contain a specific amount of drug, the rate of delivery and the actual dose received may be
varied.
 Patches are changed on a regular basis, using a site rotation routine.
 Before applying a new transdermal patch, the nurse should verify that the previous patch has been
removed and disposed of appropriately.
 Ophthalmic Administration
 It is used to treat local conditions of the eye and surrounding structures.
 Ophthalmic drugs are available in the form of eye irrigations, drops, ointments, and medicated
disks.
 Otic Administration
 This route is used to treat local conditions of the ear, including infections and soft blockages of the
auditory canal.
 Otic medications include eardrops and irrigations which are usually ordered for cleaning purposes.
 Nasal Administration
 Used for both local and systemic drug administration
 The nasal mucosa provides an excellent adsorptive surface
 There can be potential; damage to the cilia within the nasal cavity and mucosal irritation is
common. In addition, presence of mucus secretion may affect drug absorption.
 Drops or sprays are used for their local astringent effect, which is to shrink or loosen mucous
membrane or to loosen secretions and facilitate drainage.
 The nose can also provide the route to reach the sinuses and eustachian tube. Proper positioning
must be observed in instilling medications.
 Vaginal Administration- it is administration for treating local infections and to relieve vaginal pain
and itching. w
 Vaginal medications are inserted as suppositories, creams, foams, or jellies.
 It is important for the nurse to explain the treatment and provide privacy
 Before inserting the patient should be instructed on emptying the bladder/void to lessen both the
discomfort and the possibility of irritating the vaginal lining.
 The patient should be offered a perineal pad following the administration
 Rectal Administration-used for local or systemic drug administration.
 It is safe and effective means of delivering drugs to patients who are comatose or who are
experiencing nausea and vomiting.
 Rectal drugs are normally in the form of suppository, although a few laxatives and diagnostic
agents are given via enema.
 Absorption is slower than other routes but it is steady and reliable provided the patient can retain
the medication.
A.4. Parenteral Drug Administration: this refers to the dispensing of medications other than oral or topical
 This route delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles or veins. More
advanced parenteral delivery includes administration into the arteries, body cavities (intrathecal) and body
organs (intracardiac).
 It is much more invasive than topical or enteral
 Because of the potential for introducing microorganisms in the body, aseptic technique is strictly observed
 The nurse must know the equipments and techniques in the preparation and administration of injectable
products
 The nurse must know the correct anatomical locations for parenteral administration and safety procedures
regarding hazardous equipment disposal
Intradermal and Subcutaneous Administration

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  Advantage: Can be given to patient who are unable to take meds orally. Disadvantage: only small
volumes can be injected and may cause pain and swelling.
 Intradermal (ID)- an injection that is administered into the dermis layer of the skin.
 Because there is more blood vessels in the dermis, drugs are more easily absorbed
 It is usually employed for allergy and disease screening or for local anesthetic delivery prior to
venous cannulation.
 It is limited to small volumes of 0.1 to 0.2 mL
 The usual sites for ID injections are the non-hairy skin surfaces of the upper back, over the scapulae,
the high upper chest, and the inner forearm.
 Subcutaneous (SC or SQ) injection is delivered to the deepest layers of the skin. Insulin, heparin
vitamins, some vaccines and other medications are given in this area because the sites are easily
accessible and provides rapid absorption
 Body sites ideal for SC injections:
i. outer aspect of the upper arms. In the area above the triceps muscle
ii. middle two-thirds of the anterior thigh area
iii. subscapular areas of the upper back
iv. upper dorsogluteal and ventrogluteal areas
v. abdominal areas, above the iliac crest and below the diaphragm, 1.5 to 2 inches out from the
umbilicus.
 Subcutaneous doses are small in volume, usually 0.5 to 1 mL. the needle size varies according to
patient’s quantity of body fat.
 It is important to rotate injection sites in an orderly and documented manner to promote absorption,
minimize tissue damage and alleviate discomfort
 When performing SC injections, it is not necessary to aspirate prior to injection.
 Note that insulin and tuberculin syringes are not interchangeable

THIS IS AN EXAMPLE OF A TUBERCULIN SYRINGE

This is the link where you can appreciate the difference of an insulin and a tuberculin syringe
https://www.youtube.com/watch?v=9TmCyAjaxs8

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 Intramuscular Administration (IM): delivers medication into specific muscles. Because muscle tissue has a
rich blood supply, medication moves quickly into blood vessels to produce a more rapid onset of action than
with oral, ID or SC administration.
 The nurse considers the following in giving IM injections:
 Injection sites must be located away from bone, large blood vessels and nerves.
 The size and length of needle are determined by body size and muscle mass, the type of drug to
be administered, the amount of adipose tissue overlying the muscle, and the age of the patient.
 The four common sites for IM injections:
 Ventrogluteal site: The most preferred site for IM injections. This area provides the greatest
thickness of gluteal muscles, contains no large blood vessels or nerves, it is sealed by bone and contains
less fat than the buttock area, thus eliminating the need to determine the depth of subcutaneous fat.
 This is suitable for children and infants over 7 months of age.
 Deltoid site: used in well-developed teens and adults for volumes of medications not to exceed 1
mL. Because of the proximity of the radial nerve, the deltoid is not generally used except for small vaccines,
such as for Hep B.
 Dorsogluteal site: Used for adults and for children who have been walking for at least 6 months.
The site is safe as long as the nurse appropriately locates the injection landmarks to avoid puncture or
irritation of the sciatic nerve and blood vessels.
 Vastus lateralis site: Usually thick and well developed in both adults and children, the middle third
of the muscle is the site for IM injections.
Intravenous Administration (IV): medications and fluids are administered directly into the bloodstream and
are immediately available for use by the body.
 The IV route is used when a very rapid onset of action is desired.
 The three basic types of IV administration:
 Large-volume infusion- for fluid maintenance, replacement or supplementation.
Compatible drugs maybe mixed into a large-volume IV container.
 Intermittent infusion- small amount of solution that is arranged tandem or piggy-
back to the primary large-volume infusion.
 Used to instill adjunct medication such as antibiotics or analgesics over for a
short period of time.
 IV bolus (push) administration- concentrated dose delivered directly to the
circulation via syringe to administer single-dose medications. They may be given through an
intermittent injection port or by direct IV push.
***Although the IV route offers the fastest onset of drug action, it is also the most dangerous. Once injected, the
medication cannot be retrieved. Patients who are receiving IV injections must be closely monitored for adverse
reactions. These reactions may occur immediately after injection, others may take hours or days to appear.
***Antidotes for drugs that can cause potentially dangerous or fatal reactions must always be readily available.

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CONGRATULATIONS LEARNER, you have reached the end of module II. At this point, you have gained knowledge
about safe drug administration. The linkages are given for your additional references and sources of the topic.

Learning Activities: I. Make a tickler for your drug administration abbreviations in table format. You will be using this for
your hospital exposures in the future. Provide additional drug administration abbreviations in the table. Example
Abbreviation Meaning
ac before meals
pc

II. Look around your environment and search for a prescription pad that is written by a physician. The
sample given is a prescription pad with its part. Does the prescription you are looking and holding at
this point resemble like this?

Definition of Prescription

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  an order to take certain medications
 Health care program implemented by a physician or other medical practitioner in the form of
instructions that govern the plan of care for an individual patient.
 An order for medication issued by properly licensed medical practitioner, dentist or veterinarian.
A. First, it isn't the letters "Rx". That's just a common shorthand for a symbol which is actually

What you are seeing is a capital Roman letter R, which stands for recipe, the
imperative form of the verb "to receive" (from which comes the word recipient). In other words, the symbol is
a command, meaning in effect "take this". The symbol itself dates from medieval times, and has come down
to us to signify "prescription" and sometimes even "medicine" in a generic sense:

B. The Signa or Sig- the directions for use, the drug amount, frequency and route of administration.
Example: 1 cap t.i.d. pc
C.

***Sometimes nurses are asked to fill out the prescription form of the doctor while the physician talks to the client. As
future nurses, you must know how to fill out properly the prescription form.
1. Dr. Kim Mugtar, an ENT specialist came for an early follow up on his patient, Mr. Chiong Go, 20 years old, with a
moderate ear infection. You accompanied Dr. Kim Mugtar and he asked you to write the following on his prescription
pad.
Augmentin one 875 mg tablet every 12 hours for ten days. The generic name for Augmentin is
amoxicillin/clavulanate potassium. Transcribe the order io this empty prescription pad. Provide other details
as needed/necessary

2. Dr. Kim Mugtar saw another patient, Mr. Tim Mackey, 49 years old with upper respiratory tract infection (URTI).
Transcribe this order. Vibramycin 200 mg IV q 12 hours, vial #2. Generic name is doxycycline monohydrate.
Provide other details as needed/necessary

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III. Research on the different drug forms and write a brief description.

Example: Tablet
Tablets may be defined as the solid unit dosage form of medicament or medicaments with
suitable excipients. Tablets are prepared either by molding or by compression. It comprises a
mixture of active substances and excipients, usually in powder form, pressed or compacted
from a powder into a solid dose.

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