Kozier & Erb's

Fundamentals of Nursing
Concepts, Process, and Practice
Eleventh Edition

Chapter 35
Medication Administration

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Learning Outcomes (1 of 2)
• Discuss legal aspects of administering medications.
• List examples of various types of medication orders.
• Identify ways on communicating medication order.
• Review medication abbreviations commonly used in the clinical
setting
• Describe various routes and sites of medication administration.
• abbreviations used in medication
• List six essential steps to follow when administering medication.
• State the "rights" to accurate medication administration.

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Legal Aspects of Administering
Medications (1 of 2)
• Nursing practice acts
• Recognizing limits of own knowledge and skill
• Take responsibility for actions
• Question any order that appears unreasonable
• Refuse to give medication until order is clarified

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Medication Orders
• Ordered by physicians
– Sometimes nurse practitioners, physician assistants depending
on state laws and agency policies
• Verbal and telephone orders
• Abbreviations, acronyms, and symbols

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Types of Medication Orders (1 of 2)
• Stat order • Standing order
– Medication is to be given – May or may not have a
immediately and only termination date
once – Indefinitely, such as multiple
– Such as morphine sulfate vitamins daily
10 milligrams IV stat – Specified number, such as
KCl twice daily × 2 days
• Single order (One time
order)
– Medication is to be given • PRN order (As needed Order)
once at a specified time
– Permits the nurse to
– Such as Seconal 100 mg administer the medication
hs before surgery when, in nurse’s judgement ,
the client requires it
– Such as Amphojel 15 mL prn

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Communicating a Medication Order
• Written on chart, provided by phone or verbally
• Copied to Kardex or MAR, or on computer printout
• The nurse should question the primary care provider about any
order that is ambiguous , unusual (abnormally high dosage) or
contraindicated by the client’s condition

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Communicating a Medication Order
• If an order seems inappropriate
– Contact primary care provider
– Document in notes when PCP called, what was communicated,
how PCP responded
– Or, document attempts to reach PCP and reason for withholding
drug
– If medication given, document client condition before and after
dose
– If needed, document factual information on incident report

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Medication Abbreviation

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Medication Abbreviation

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Routes of Administration
1. Oral
– Most common, least expensive, most
convenient
3. Buccal
– Preferred unless digestive problem (e.g., • Held in the mouth
nausea and vomiting) against the mucus
membrane of the
2. Sublingual
Cheek
– Placed under the tongue
– Not to be swallowed, but dissolved

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Routes of Administration
4. Parenteral - Absorbed more quickly than oral route
– Careful and accurate administration
– Aseptic technique
a. Intradermal (ID)
b. Subcutaneous (hypodermic)
c. Intramuscular (IM)
d. Intravenous (IV)

– Less common
a. Intrathecal/ intraspinal
b. Epidural
c. Intracardiac
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Routes of Administration - Parenteral
1. Intradermal (ID) 2. Subcutaneous (hypodermic)

- Very small amounts • injected into the Subcutaneous

administered just below tissue just below the skin (Ex.
epidermis ( Ex. Allergy Vaccines, insulin, heparin)
testing)

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Routes of Administration (2 of 3)
3. Intramuscular (IM)
–Into the muscle
–Absorbed more quickly
than subcutaneous
because muscle is more
vascular
–Large volumes can be
tolerated.

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 Sites for Intramuscular Injections
1. Ventrogluteal site

• Preferred site
• No large nerves, vessels
• Side-lying position most accessible.

• 2. Dorsogluteal site
• Not preferred, should be avoided
• Close to sciatic nerve and superior gluteal
nerve
• Complications have occurred.
• Numbness , Pain, Paralysis

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Sites for Intramuscular Injections
3. Vastus lateralis site

 Best for infants, young children

4.Rectus femoris site

• Easily accessible to clients who

administer their own injection
• May cause discomfort for some people

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Intramuscular Injections

5. Deltoid site

• Close to radial nerve, artery

• No more than 1 mL of solution
can be administered
• Ex. Hepatitis B vaccine

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Routes of Administration (2 of 3)
• Parenteral ( cont..)
4. Intravenous (IV)
• Route appropriate for rapid
effect (direct to bloodstream)
or for medication that irritates
tissue
• Large-volume infusions
–Safest, easiest
–Main danger is
hypervolemia

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Intravenous Medications (2 of 3)
• Volume-Controlled Infusions
– Set such as Buretrol, Soluset, Volutrol,
and Pediatrol
– Often used with children, older clients
when volume administered is critical
and must be carefully monitored

• Intravenous Push (bolus)

– Undiluted and used in emergency
– Errors may not be corrected and
drug may irritate the lining of
blood vessels.

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Preparing Injectable Medications (1 of 4)
• Ampules and Vials
– Ampule
▪ Glass container designed to hold a single
dose of a drug
▪ Must be broken at constricted neck to access
medication
– Vial
▪ Small glass bottle with sealed rubber cap
▪ Must be pierced with needle and air must be
injected before medication is withdrawn
– Reconstitution
▪ Adding diluents to powdered drug to
reconstitute
– Single- or multi-dose

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Topical Medications
1. Percutaneous - applied to the 2. Nasal Medications
skin ( Transdermal patch, ointment,
cream)

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Topical Medications (2 of 9)
3. Installations and irrigations - applied into the body cavities or
orifice ( urinary bladder, eyes, ears, nose, rectum, vagina)
• Ophthalmic Medications - Liquid or ointment medication is administered
into the eye

• Otic Medications - Administer medication to external auditory canal

– Position of canal varies with age.

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Topical Medications
5. Rectal Medications
4. Vaginal Medications
– Inserting a rectal
– Creams, jellies, foams, or suppositories
suppository
– Infections or discomfort
▪ Assist client to left
lateral or left Sims
position

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Inhaled Medications (1 of 3)
• Nebulizers
–Fine spray (fog or mist)
• Dry powder inhaler (DPI)
• Metered-dose inhaler (MDI)
–Extender, extender spacer

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Nasogastric and Gastrostomy
Medications
• Nasogastric tube
• gastrostomy tube

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Administering Medications Safely
• Always assess health status
• Take medication history
– Include OTC drugs and supplements, allergies, normal eating
habits
• Include client's illness or current condition, intended drug and route

• Assess ability to self-administer

• Assess socioeconomic factors
– Transportation
– Money for medication

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Process of Administering Medications
1. Identify the client
2. Inform the client
3. Administer the drug
4. Provide adjunctive interventions as indicated
5. Record the drug administered
6. Evaluate the client's response to the drug

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 Ten rights of Medication
Administration
1. Right medication 6. Right client education
2. Right dose 7. Right documentation
3. Right time 8. Right to refuse
4. Right route 9. Right assessment
5. Right client 10. Right evaluation

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Box 35–6 Ten “Rights” of Medication
Administration
Box 35–6 Ten “Rights” of Medication
Administration
Box 35–6 Ten “Rights” of Medication
Administration
Box 35–6 Ten “Rights” of Medication
Administration