Introduction

A Medication is a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention
of disease.
Prescription :The written direction for the preparation and administration of a medication .

names for a medication :

trade name (or brand name) name → given by the drug manufacturer and identifies it as property of that company
chemical name → the name by which a chemist knows it; this name describes the constituents of the drug
precisely.

Medications are often available in a variety of forms / Drug Preparations

Aerosol spray
Capsule
Cream
Gel or jelly
Lotion
Ointment
Suppository
Syrup
Tablet
Transdermal patch
 Essential Parts of a medication Order
• Full name of the client
• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug ( microgram (mcg) , milligram (mg) ,gram (g) , IU (international unit ,
milliliter (ML )
• Frequency of administration ( once daily , q12hrs ,q6hrs , q8hrs ,PRN , stat )
• Route of administration ( P.O , S/C ,I.M ,I.V )
• Signature of the individual writing the order
 Nurse role
• the nurse who administers the written medication order

• nurses should question any order that appears

unreasonable and refuse to give the medication until the
order is clarified.

• high-alert medications, including controlled substances

(DDA) which require the verification of two registered
nurses.
Common Abbreviations

AC Before meals

PC After meals

PRN When necessary

OD Once daily

BID Twice daily

TID Three times daily

QID Four times daily

Common Abbreviations

Qh Every hour

Q2h Every 2 hours

Q4h Every 4 hours

Q6h Every 6 hours

EOD Every other day

Stat Give now

1. Right medication
2. Right dose
3. Right time
4. Right route
5. Right client
6. Right client education
7. Right documentation
8. Right to refuse
9. Right assessment
10. Right evaluation
Note:
 Before doing the drug calculation, the nurse needs to convert
gram to milligrams or mcg to mg
Look at the number in the hundredths place. If this number is 5 or
greater, add 1 to the tenths place number. For
example, 1.67 = 1.7. If the number in the hundredths place is less
than 5, leave the number in the tenths place as is.
For example, 1.63 = 1.6.
The nurse must select the proper size syringe for the calculated
volume of medication(1-mL syringe, 3mL ,10mL , 20mL)
Medication Calculation
• Conversion Factors
• 1 gram = 1000 milligram
• 1 Liter = 1000 milliliter
• Then, Milli is1000 times smaller
• 1 grams = 100,00,00 microgram
• 1 Liter = 100,00,00 microliter
• Then, Micro is 100,00,00 times smaller
Metric Conversions

kilogram

gram

milligram

microgram

Divide by 1000 for each level up

Multiply by 1000 for each level down
What is the answer?
• Convert the following:
• 25 mg to gm
kilogram
•Divide by 1000 for
each level up gram

•Multiply by 1000 milligram

for each level down
microgram
What is the answer?
• 25 mg to gm
• Ask your self

• Are we moving up or down?

• Up

• Are we going to divide or multiply?

• Divide

• How many level(s)?// How many times will multiply or divide?

• One: Divide by 1000
What is the answer?
• 25 mg to gm

• 25 /1000 = 0.025 gm
 Calculating Dosage
1 gram (g) = 1000 mg
1 gram (g) = 1,000,000 mcg
1mg = 1000 mcg
1L = 1000 ml
500 mg = ? g
0.006 g = ? mg
2.5 L = ? mL

DXV
——— = amount to administer D = desired dose (i.e., dose ordered by
Dr)
H H = dose on hand (i.e., dose on label of
bottle ,ampule
V = vehicle (i.e., form in which the drug
What is the answer?
• 100 mcg to mg
• Are we moving up or down?
• Up

• Are we going to divide or multiply?

• Divide

• How many level (s)?// How many times will multiply or divide?
• One: Divide by 1000
What is the answer
• 100 mcg to mg

• 100/ 1000 = 0.1mg

What is the answer?
• 1.5 gm to mcg

• Are we moving up or down?

• Down

• Are we going to divide or multiply?

• Multiply

• How many level (s)?// How many times will multiply or divide?
• Twice: multiply by 1000, then by 1000 another
time
What is the answer?
• 1.5 gm to mcg
• 1.5 * 1000 = 1500,

• 1500 * 1000 = 1500000mcg

Practice More
• 2000 mg = __________ g
• 50 g = ____________ mg
• 2 L = __________ mL
• 230 mcg = _________ mg
• 250 mg = __________ g
• 2.5 kg = __________ g
• 0.5 L = __________ mL
• 20 mg = __________ g
• 0.7 mg = __________ mcg
Practice More
• 0.9 L = mL
• 1000 mg = g
• 0.05 g = mg
• 100 mcg = mg
• 0.6 mg = mcg
• 1.0 mcg = mg
• 25 mg= g
• 0.03 g = mg
• 150 mcg = mg
• 200 mg = mcg
Basic formula

• D
• -- x Q = X
•A
• Where D (desired) is the dosage the physician ordered,
• A (available) is the dosage strength as stated on the medication label,
• and Q (quantity) is the volume in which the dosage strength is available
(e.g. tablets, capsules, milliliters).
practice

• Ceclor 500 mg PO b.i.d. We have available 250 mg capsules

• D=500mg
• A=250mg
• Q=1
• 500/250*1=2 caps
Practice more
• Paracetamol 500 mg 2tab Q 4 hours. Available dose 500mg tablets.

• D: 500mg
• A: 500 mg
• Q=1
• 500/500x1=1…the order is 2 tablets
2 tablets
More practice

• Ceclor 0.5 gm PO b.i.d. We have available 250 mg capsules :

• Now what is D:
• What is A=
• Q=
• Covert gm to mg
• caculate
• O.5g*1000=500mg
• 500mg/250mg*1=2 caps
practice
• Doctor’s Order: Nafcillin 500 mg PO BT; Available: Nafcillin 1 gm tab
(scored). How many tab will you administer per day?
• 500/1000x1= 1/2 tab
Ratio
• Is the relationship of two quantities.

• It may be expressed in the form of 1:10 or 1/10

• Example: For every twenty students there is one teacher.

• This means: The ratio of teacher in students is 1 in 20 or 1:20 or 1/20

Dr. order give paracetamol 20mg per Kg TID. syrup. Calculate how many mg
you will give the patient when patient weight is 10kg
20:1::?:10
20?=1*10
?=20*10
200mg
This is the desired dose….now you need to look for the rest ..available and
quantity and calculate the rest
practice
• Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap
will you administer for each dose to a 31 lb child?
• 1kg=2.2Ib
• Convert first
• Find the ratio of weight
• Calculate then using the basic formual
• Ikg=2.2Ib
31/2.2=14kg
1.8/12.5=0.144
0.144x14=2.016 close to 2 cap.
Proportion
• Is formed by using two ratios that are equal.
• Available Desired
• -------- : : ----------
H:V D:X
the dose on hand (H), and the vehicle (V), such as tablets, capsules,
milliliters; and the right side represents the desired dose (D) and the
unknown amount to be given (X). Multiply the means (V and D), and
the extremes (H and X), then solve for X.
• Example: 1/2 = 5/10
• The products of cross multiplication in a proportion are always equal
• The cross product (cross multiplication) is obtained by multiplying the
denominator of one ratio to the numerator of the other, as follows:
1 5
= 2*5=1*10
2 10
Relation to Medication Calculation
• With medications, a ratio usually refers to the concentration of the drug
(e.g. grams) in a solution (e.g. mL)

• Example: 50 mg/mL
Solving for ?
1 ? ? = unknown
3 9
RULE: To solve for ? cross multiply
3X?=9X1
3? = 9
Divide both sides of the equation by the number before the ?
Solving for ?
3? = 9
3 3

?=3
The Main Questions for Drug
Calculation
• What is the order?

• Do you need any equivalents (conversions)?

• Where are you going? (or what are you being asked to give?)
Examples
• The doctor prescribed 60mg of Pethidene, IM.
You have Pethidene 100mg in 1 ml. How many ml will you give?
100 mg 60 mg
1 ml ? ml
• Cross multiplication
Examples
• 100 mg * ? Ml = 60mg * 1 ml
• To know the answer, divide by the number before the ?
• 100 mg * ? Ml 60 mg * 1 ml
100 mg 100 mg

• Answer is 0.6 ml
Examples
• Order: Phenobarbital Elixir 75 mg daily. Available dose: 15 mg/mL. How
many Ml you will administer?
• 15 mg 75mg
1 ml ? ml

• Cross multiplication
Examples
• 15 mg * ? Ml = 75 mg * 1 ml
• To know the answer, divide by the number before the ? 5
• 15 mg * ? Ml 75 mg * 1 ml
15 mg 15 mg
1
• The answer is 5 ml
Examples
• Order: Coumadin 10 mg daily. Available dose: 2.5 mg/tablet. How many
tablets you will administer?

• 2.5 mg 10 mg
1 tab ? tab

• Cross multiplication
Examples
• 10 mg * 1 tab = 2.5 mg * ? Tab
• To know the answer, divide by the number before the ?
• 10 mg * 1 tab = 2.5 mg * ? tab
2.5 mg 2.5 mg

• The answer is 4 tab

Examples
• Order: Zarotin syrup 0.5 gm daily. Available dose: 250 mg/5 mL. How
many ml you will administer?
• 250 mg 0.5 gm
5 ml ? ml
• What you should do before cross multiplication?
• Make ALL the units consistent
Examples
• Conversion
• Are we moving up or down?
• Down

• Are we going to divide or multiply?

• Multiply

• How many level (s)?// How many times will multiply or divide?
• Once: multiply by 1000
• 0.5 gm *1000 = 500 mg
Examples
• 250 mg 0.5 gm 250 mg 500 mg
5 ml ? ml 5 ml ? ml
• Cross multiplication

• 5 ml * 500mg = 250 mg * ? ml
• To know the answer, divide by the number before the ?
Examples
• 5 ml * 500mg = 250 mg * ? ml
250 mg 250 mg

• The answer is: 10 ml

Examples
• The order is to give lasix 40 mg PO twice daily. Lasix is available as 80
mg/10 ml. How many ml you give daily?
• 80 mg 40 mg
10 ml ? ml
• Cross multiplication
• 80 mg * ? ml = 10 ml * 40 mg
• To know the answer, divide by the number before the ?
Examples
• 80 mg * ? ml = 10 ml * 40 mg
80 mg 80 mg
• Answer is: 5 ml
• But this is for one dose
• The patients is taking the medication twice daily
• Then the final answer is 5 ml * 2 = 10 ml
Examples
• The order is Digoxin 0.05 mg PO daily. The Digoxin labeled as 50 mcg/ 1
ml. How many ml you will give?
• 50 mcg 0.05 mg
1 ml ? ml

• What you should do before cross multiplication?

• Make ALL the units consistent
Examples
• Are we moving up or down?
• Down

• Are we going to divide or multiply?

• Multiply

• How many level (s)?// How many times will multiply or divide?
• Once: multiply by 1000
• 0.05 gm *1000 = 50 mcg
Examples
• 50 mcg 0.05 mg 50 mcg 50 mcg
1 ml ? ml ml ? ml

• The answer is ??
Exercises for practice
Order: Erythromycin 500 mg
On hand: 250 mg in 5 mL
D = 500 mg H = 250 mg V = 5 mL

Order: Lanoxin (digoxin) 0.5 mg daily.

On hand: Lanoxin (digoxin) 250 mcg/tab

Order: Lanoxin 0.25 mg

On hand: Lanoxin 0.125 mg tablet

Order: Diflucan (fluconazole) 0.4 g

On hand: Diflucan (fluconazole) 200 mg tablets

Order: Daypro (oxaprozin) 1.8 g PO once daily each morning

On hand: Daypro (oxaprozin) 600 mg per caplet
Practice More
• Order: Lasix 160 mg daily. Available Dose: 40 mg/tablet. How many
tablet will you administer?

• Order: Allopurinol 150 mg daily. Available Dose: 300 mg/tablet. How

many tablet will you administer?

• Order: Zarotin syrup 0.5 g daily. Available Dose: 250 mg/5 mL. How
many mL will you administer?
Practice More
• Order: Erythromycin 500 mg. Available Dose: 0.25 g/5
mL. How many mL will you administer?

• Order: Robaxin 0.3 g IM. Available Dose: 100 mg/mL for

injection. How many mL will you administer?

• Order: Compazine 15 mg IM. Available Order: 5 mg/mL

for injection. How many mL will you administer?
Topical Medications
• Percutaneous
• Transdermal patch
• Clean skin before applying
• Wear gloves
Routes of Administration
Liquid Medication

• Thoroughly mix the medication before pouring. Discard any

medication that has changed color or turned cloudy, the
exception being oral suspensions.

• Remove the cap and place it upside down on the countertop.

• Hold the bottle so the label is next to your palm and pour the
medication away from the label.

•When giving small amounts of liquids (less than 5 mL),

prepare the medication in a specially designed oral syringe.
Administering nasal spray vedio

https://youtu.be/R178eS66nD8?si=f1MlH-Pz8MnDIhQ-
  Metered-dose
. Shake the inhaler vigorously for 3 to 5 seconds to mix inhaler (MDI)
the medication evenly.

• Exhale comfortably (as in a normal full breath).

• Hold the canister upside down.

. Hold the MDI 2 to 4 cm (1 to 2 in.) from the open

mouth OR Placing an MDI in mouth with lips sealed
around the mouthpiece correctly.

.Press down once on the MDI canister (which releases

the dose) and inhale slowly (for 3 to 5 seconds) and
deeply through the mouth.
• Hold your breath for 10 seconds or as long as possible
 MDI with
spacer.
 Rectal suppository
 privacy

 instruct the client to remain lying down for 15-30

minutes for absorption of the medication.
Inserting Rectal Suppository
• Assist client to left lateral or left Sims’ position
• Upper leg flexed
• Expose buttocks
• Put glove on hand used to insert the suppository
• Unwrap suppository
• Lubricate smooth rounded end
 Inserting Rectal Suppository (cont'd)
• Lubricate gloved index finger
• Encourage client to relax by breathing through the mouth
• Insert suppository gently into the anal canal
• Avoid embedding in feces
• Press buttocks together for a few minutes
• Ask client to remain in left lateral or supine position for at least 5 minutes
Figure 35-56 Inserting a rectal suppository beyond the internal sphincter and along the rectal wall.
Vaginal suppository
 Wash your hands thoroughly.
 privacy
 place patient dorsal recumbent position
 Vaginal suppositories are inserted 2-3 inch into the vaginal orifice
 instruct the client to remain lying down for 15-30 minutes for absorption of the medication.
 Vaginal creams/suppositories are best administered at bedtime.
 wash hands
Ampules and Vials preparation
Parenteral Medications
• Parenteral administration is common nursing procedure
• Absorbed more quickly than oral route
• Careful and accurate administration
• Aseptic technique
F ig u re 3 5 -1 5
T h e th re e p a rts o fa s y rine g.
Figure 35-22. The parts of a needle.
Preparing Injectable Medications
• Ampules
• Vials
• Reconstitution – adding diluent to powdered drug to reconstitute
Breaking the neck of an ampule using a gauze pad
breaking the neck of an ampule using an ampule opener.
Figure 35–31 A filter needle, A, or a filter straw, B, prevents glass from being withdrawn with the medication.

A B
Withdrawing a medication from A, an ampule on a flat surface .
Withdrawing a medication from B, from an inverted ampule.
1 Injecting air into a vial.
2 Withdrawing a medication from a vial that is held with the base down.
3 Withdrawing a medication from an inverted vial.
https://youtu.be/mFKj3_Wk8m8?si=AtqJOx0NYJCgsMis
https://youtu.be/6buCd7-nt_0?si=8m7YCUxhiqxbrQXG
Parenteral Medications
intradermally (ID)
 To provide a medication that the client requires for allergy testing and TB screening
Perform hand hygiene (infection prevention procedure).
 Prepare the medication from the vial or ampule for drug withdrawal.
 introduce self and verify the client’s identity using agency protocol.
 Explain to the client that the medication will produce a small
Wheal like a blister. The client will feel a slight prick as the needle enters the skin
 Select a site ( the forearm about a hand’s width above the wrist and three or four finger
widths below the antecubital space).
 Avoid using sites that are tender, inflamed, or swollen and those that have lesions.
 Apply gloves as indicated by agency policy.
 Cleanse the skin at the site using a firm circular motion starting at the center and widening
the circle outward. Allow the area to dry thoroughly.
Intradermal Injections
• Intradermal injection
• Very small amounts administered just below epidermis
• Allergy testing/ do the allergy test for Zidime the drug you prepared earlier.
• Tuberculosis
Body sites commonly used for intradermal injections .
Subcutaneous Injections
• Injected just beneath skin
• Vaccines, insulin, heparin
• Syringe depends on medication given, thickness of skin fold

• Dr. order: give 20units insulin S/C every morning/ OD….practice

Figure 35-33 Body sites commonly used for subcutaneous injections .
Inserting a needle into the subcutaneous tissue using 90- and 45-degree angles .
Administering a subcutaneous injection into pinched tissue. Photographer: Elena Dorfman.
Intramuscular Injections
• Intramuscular – absorbed more quickly than subcutaneous because
muscle more vascular; large volumes can be tolerated
• Size of syringe varies (adult standard is 1.5 inches, 21 or 22 gauge)
• Factors determining size and length: muscle, type of solution, adipose
tissue, age
Intramuscular Injections (cont’d)
• Ventrogluteal
• Vastus lateralis
• Dorsogluteal
• Rectus femoris
• Deltoid
Figure 35-35 Landmarks for the ventrogluteal site for an intramuscular injection.(Custom Medical Stock
Photo)
Figure 35-36 Administering an intramuscular injection into the ventrogluteal
site.Photographer: Jenny Thomas.
Figure 35-37 The vastus lateralis muscle of an infant’s upper thigh, used for intramuscular injections.
Custom Medical Stock Photo, Inc.
Figure 35-39 A, Determining landmarks and B, administering an intramuscular injection into the vastus lateralis site.

A
Figure 35-39 (continued) A, Determining landmarks and B, administering an intramuscular injection into the vastus lateralis site.

B
Figure 35-40 Landmarks for the rectus femoris muscle of the upper right thigh, used for
intramuscular injections. (Custom Medical Stock Photo, Inc.)
Figure 35- 41 A method of establishing the deltoid muscle site for an intramuscular injection.
Figure 35- 43 Administering an intramuscular injection into the deltoid site.
Intramuscular Injection Technique
(Z-Track)
• Less painful
• Decreases leakage of irritant medication into subcutaneous tissue
• Traps medication in muscle layer
1 Inserting an intramuscular needle at a 90-degree angle using the Z-track method: A, skin
pulled to the side; B, skin released. Note: When the skin returns to its normal position after the
needle is withdrawn, a seal is formed over the intramuscular site. This prevents seepage of the

medication into the subcutaneous tissues and subsequent discomfort .

2 Holding the syringe between the thumb and forefinger. Note that the nurse is using the Z-track technique.
3 In addition to pulling the skin to the side, the nondominant hand is holding the barrel of the syringe to avoid it from moving while the dominant hand

aspirates by pulling back on the plunger .

How to administer
Injection site location Angel administration Aspiration before Milliliter (ml)
administration or not administer

Intradermal epidermis 15 degree not Up to 0.5ml

Subcutaneous (SC) Subcutaneous tissue 45 or 90 degree not Up to 2ml

Intramuscular (IM) muscles 90 degree Depends on the From 1 to 5ml

muscle depends on the
muscle

Intravenous (IV) veins 45 degree not Open venous

The difference between IM Sites
Source Lippincott procedure, 2020

Dorsogluteal Vastus lateralis Deltoid Ventrogluteal

Milliliter injection Up to 5ml Up to 5 ml Up to 2ml Up to 5 ml

medication any any immunization Any

Aspirate before Aspirate Aspirate Do not Aspirate Aspirate

administer

Massage after yes yes no Yes

Z method yes yes yes yes

Intravenous (Bolus) Injection
 Inform patient and gain consent.
 Assess IV site for signs of phlebitis or infection.
 Clean hands and don gloves to prevent cross infection.
 Gather equipment required for giving IV injection.
 With a second team member, observe medication order or cross check according to “5 rights”.
 Prepare the medication as DR order (doze)
 Clean injection port with alcohol swab and allow to air dry.
 Administer medication slowly or in accordance with instructions.
 Ask the patient to report any pain or discomfort during or following the injection.
 Flush the cannula using normal saline (or recommended fluid based on drug recommendations).
 Whilst flushing, observe the cannula entry site and surrounding area for any sign of swelling, phlebitis ,extravasation.
Dispose of sharps in sharps container
 perform hand hygiene.
 Document on medication chart that medication has been administered
Inserting a Short Peripheral Catheter\ IV cannula
 factors may affect the choice of vein and catheter \ cannula size
 how long the client is likely to have the IV
 what kinds of fluids will be infused
 what medications the client will be receiving or is likely to receive.
 introduce self
 verify the client’s identity
 Explain to the client what you are going to do
 Prepare equipment
 Perform hand hygiene
 Put on clean gloves
 provide for client privacy.
 Assist the client to a comfortable position, either sitting or Lying
 Expose the limb to be used
IV site is labeled
with date, time,
size of catheter,
and initials.
 Starting an Intravenous Infusion
PURPOSES
• To supply fluid when clients are unable to take in an adequate volume of fluids by mouth
• To provide salts and other electrolytes needed to maintain electrolyte balance or\and provide glucose (dextrose) the main
fuel for metabolism
• To provide water-soluble vitamins and medications

 the nurse first verifies the order indicating the type of solution, the amount to be administered, the rate of flow or time
over which the infusion is to be completed
 any client allergies
https://youtu.be/4ntqS_R1r70?si=gzt_Wn0wiPE2nKyC
 Flow Rate calculation

Drops per minute = Total infusion volume x drop factor

―――――――――――――――――

Total time of infusion in min.

Macrodrops drop factors of 10, 12, 15, or 20 drops/mL

microdrip sets is always 60 drops/mL

(total infusion volume)

ml \ hr = ――――――――――
(total infusion time)
the manual rate-flow regulator.

Programmable multichannel infusion pump.

Documentation
 amount and type of solution used, including any additives (e.g., kind and amount of medications)
 the date and time the infusion started
 flow rate
 the client’s general response
 At least every 4 hours, check the skin status at IV site (warm temperature and absence of pain, redness, or swelling)
Signs and Symptoms of Common Local Complications of Infusion Therapy
INFILTRATION
• Coolness of skin around site
• Skin blanching, tautness (i.e., client states it feels “tight”)
• Edema at, above, or below the insertion site
• Leakage at insertion site
• Absence of or “pinkish” blood return
• Difference in size of opposite hand or arm
EXTRAVASATION
Same as infiltration and can also include:
• Burning, stinging pain
• Redness followed by blistering, tissue necrosis, and ulceration
PHLEBITIS
• Redness at the site
• Skin warm
• Swelling
• Palpable cord along the vein
• Increase in temperature