Course Title: Foundation

of Professional Nursing
Course Code: NSC 202
Credit: 3 units
Medicatio
n
Learning Objectives
• Define selected terms related to the administration of medications.
• Describe legal aspects of administering medications
• Identify factors affecting medication action.
• Describe various routes of medication administration.
• Identify essential parts of a medication order.
• List and discuss the examples of various types of medication orders
• List six essential steps to follow when administering medication.
• State the “rights” to accurate medication administration
 Introduction
• A medication is a substance administered for diagnosis, cure, treatment, or
relief of a symptom or for prevention of disease.
• Medication and drug can used interchangeably
• The term drug also has the connotation of an illicitly obtained substance
such as heroin, cocaine, or amphetamines.
• Medications are usually dispensed on the order of primary care providers
and dentists
• In some countries nurse practitioners, advanced practice nurses may
prescribe drugs
• Nurses not only administer thousands of medications but also are
responsible for assessing their effectiveness and recognizing unfavorable
reactions to drugs
 Definition of Terms
• Prescription is the written direction for the preparation
and administration of a drug.
• The drug can have 4kinds of names (Generic,
trade/brand, official name and chemical name.
Pharmacology is the study of the effect of drugs on living
organisms
• Pharmacy is the art of preparing, compounding and
dispensing drugs as well as the place where drugs are
prepared and dispensed
 Definition of Terms
• A pharmacopoeia (also spelled pharmacopeia) is a book
containing a list of products used in medicine, with
descriptions of the product, chemical tests for
determining identity and purity, and formulas and
prescriptions.
• It is impossible to commit to memory all pertinent
information about a very large number of drugs, nurses
must have a reliable reference readily available.
 Definition of Terms
• The therapeutic effect of a drug, also referred to as the
desired effect, are the intended beneficial effects of the
drug.
• Side effect also known as adverse reaction are unwanted
undesirable effects of a drug.
• Side effects can vary from minor problems like a runny nose
to life-threatening events, such as a heart attack or liver
damage.
• Adverse reactions are used for the life threatening events
associated with medications or treatments that may require
discontinuity
 Definition of Terms
• Drug toxicity are harmful effects of a drug on an
organism or a tissue resulting from overdosage, wrong
route of administration, or buildup of the drug in the
blood because of impaired metabolism or excretion
(cumulative effect).
• Some toxic effects are seemingly immediate while some
may take weeks, months etc
• most drug toxicity is avoidable if careful attention is paid
to dosage and monitoring for toxicity.
 Definition of Terms
• A drug allergy is an immunologic reaction to a drug.
When a client is first exposed to a foreign substance
(antigen), the body may react by producing antibodies.
• A client can react to a drug in the same manner as an
antigen and thus develop symptoms of an allergic
reaction.
• Allergic reactions can be either mild or severe. A mild
reaction has a variety of symptoms, from skin rashes to
diarrhea
 Definition of Terms
• An allergic reaction can occur anytime from a few minutes to
2 weeks after the administration of the drug.
• Anaphylactic reaction is a severe allergic reaction that
usually occur immediately after the administration of a drug.
• This type of drug reaction can be fatal if the symptoms are
not noticed immediately and treatment is not obtained
promptly.
• The earliest symptoms are a subjective feeling of swelling in
the mouth and tongue, acute shortness of breath, acute
hypotension, and tachycardia.
 Definition of Terms
• Drug tolerance is a condition that occur when the body
get used to a medicine so that either more medicine is
needed for a therapeutic effect to occur.
• An idiosyncratic effect is one that is unexpected and may
be individual to a client. Under response and over
response to a drug may be idiosyncratic.
• A drug may have a completely different effect from the
normal one or cause unpredictable and unexplainable
symptoms in a particular client.
 Definition of Terms
• A drug interaction zone or both drugs. Drug interactions may
be beneficial or harmful.
• The effect of one or both drugs may be either increased
(potentiating effect) or decreased (inhibiting effect) of the
other.
• Drug misuse is the improper use of common medications in
ways that lead to acute and chronic toxicity. Over the counter
drugs and prescription drugs may be misused.
• Self prescribed medications such as antacids, vitamins,
headache/pain remedies, cold and cough medications are
often overused
 Definition of Terms
• Drug abuse is the inappropriate intake of a substance,
either continually or periodically for the purpose of
creating pleasurable effects on the brain.
• Drug dependence is a person’s reliance on or need to
take a drug or substance.
• Pharmacodynamics is the mechanism of drug action and
the relationships between drug concentration and
responses in the body.
• Pharmacokinetics is the study of the absorption,
distribution, biotransformation, and excretion of drug.
ASSIGNMENT
• Write about the pharmacokinetics of an oral
medication.
• Absorption
• Distribution
• Biotransformation, and
• Excretion of the oral drug.
• Drugs may have natural (e.g., plant, mineral, and animal)
sources, or they may be synthesized in the laboratory.
• Drugs were derived from the three natural sources only,
but more drugs are being produced synthetically.
• Drugs vary in strength and activity, but must be pure and
of uniform strength for predictability in dosages and effect.
• Hence drugs have been standardized to ensure uniform
quality .
 Actions of Drugs on the Body
• The duration of the action of a drug is known as its half life
• The half life of a drug is the time interval required for the
body’s elimination processes to reduce the concentration
of the drug in the body by half.
• The purpose of most drug therapy is to maintain a
constant drug level in the body, hence the reason for the
repeated doses for the drug to maintain the drug level in
the body.
 Actions of Drugs on the Body
• The route of medication administration may influence the
blood plasma concentration levels
• The key terms related to drug actions are:
1. Onset of action: the time after administration when the
body initially responds to the drug
2. Peak plasma level: the highest plasma level achieved by a
single dose when the elimination rate of the drug equals the
absorption rate
 Actions of Drugs on the Body
3. Drug half-life (elimination half-life): the time required for
the elimination process to reduce the concentration of the
drug to one-half what it was at initial administration
4. Plateau: a maintained concentration of a drug in the
plasma during a series of scheduled doses.
Factors Affecting Medication
Action
• Developmental Factors:
• Pregnant women must be very careful about taking
medications.
• Drugs taken during pregnancy pose a risk throughout
the pregnancy, but with the highest risk during the
first trimester(three months), due to the formation of
vital organs and functions of the fetus during this
time.
 Factors Affecting Medication
Action
• Developmental Factors: Foetus, Infants, Adolescent, adults older
adults
• Gender: male and female differences in the distribution of body fat,
fluid and hormonal differences.
• Cultural, Ethnic and Genetic Factors: genetic variations, gender, size
and body composition
• Diet
• Environment
• Psychological factors
• Illness and Disease
• Time of Administration
 LEGAL ASPECTS OF DRUG
ADMINISTRATION
• Nurses need to:
know how nursing practice acts in their areas define
and limit their functions
be able to recognize the limits of their own knowledge
and skill.
Know that to function beyond the limits of nursing
practice and one’s ability is to endanger clients’ lives
and risk negligence lawsuits
• Legally, nurses are responsible for their actions regardless
of the prescription
 LEGAL ASPECTS OF DRUG
ADMINISTRATION
• There are statutory protocols for the use of
controlled substances
• The controlled substances are kept in a locked
drawer or a computer controlled dispensing system
• The inventory of the number available and use per
shift is verified at the end of each shift
• discrepancies that cannot be rectified must be
reported and accounted for
LEGAL ASPECTS OF DRUG
ADMINISTRATION
• There are special inventory 4. number available and number
forms for recording the use indicated
of controlled substances 5. name and signature of the
containing person that prescribed and
administered.
1. the name of client, 6. Some hospitals may require
2. date and time of counter signature of a senior nurse
administration for the administration of such
drugs.
3. the name of the drug, and 7. The verification of 2 registered
dosage. nurses
TYPES OF DRUG PREPARATIONS
 TYPES OF DRUG PREPARATIONS
• 1. Syrup • 9. Injection or Parenteral Preparations
• 2. Suspension • 10. Powder
• 3. Drops • 11. Topical Medication
• 4. Emulsion • 12. Suppositories
• 5. Solution • 13. Aerosol
• 6. Elixir • 14. Inhalation Powder
• 7. Capsule • 15. Transdermal Patch or Implant
• 8. Tablets • 16. Extract
https://www.gosh.nhs.uk/conditions-and-treatments/medicines-information/types-medicines/
 ROUTES OF ADMINISTRATION
• Oral administration is the most common, least expensive, and
most convenient route for most clients.
• A safe method, the drug is swallowed
• The oral route is contraindicated when the client is vomiting, has
gastric or intestinal suction, unconscious and on nothing by mouth
• The major disadvantages can include an unpleasant taste of the
drugs, irritation of the gastric mucosa, irregular absorption from
the GI tract, slow absorption, and, in some cases, harm to the
client’s teeth.
 ROUTES OF ADMINISTRATION
• Sublingual administration places the drug under the
tongue, where it dissolves, the drug is largely absorbed
into the blood vessels on the underside of the tongue.
• The medication should not be swallowed.
• Buccal administration means a medication (e.g., a tablet) is
held in the mouth against the mucous membranes of the
cheek until the drug dissolves.
• The drug may act locally on the mucous membranes of the
mouth or systemically when it is swallowed in the saliva
 ROUTES OF ADMINISTRATION
• Clients who cannot take anything by mouth but
have either a nasogastric or gastrotomy tube in
place can utilize the tubes provided they are not
for gastric draining.
• The oral medications can be administered
through the tubes to the stomach crushed and
mixed with water or the appropriate fluid for
the purpose.
 ROUTES OF ADMINISTRATION
• The parenteral route is defined as routes other than through the
alimentary or respiratory tract; that is, by needle.
• The main advantage is fast absorption.
• The following are some of the more common routes for
parenteral administration:
• Subcutaneous (hypodermic)—into the subcutaneous tissue, just
below the skin
• Intramuscular (IM)—into a muscle
• Intradermal (ID)—under the epidermis (into the dermis)
• Intravenous (IV)—into a vein.
 ROUTES OF ADMINISTRATION
• The parenteral route requires the use of syringes and needles to
withdraw medication form ampoules and vials.

SYRINGE NEEDLE
 ROUTES OF ADMINISTRATION
• The parenteral route requires the use of syringes and needles to
withdraw medication form ampoules and vials.

Ampoules Vials
ROUTES OF ADMINISTRATION
ROUTES OF ADMINISTRATION
 ROUTES OF ADMINISTRATION

Body sites commonly used for

intradermal injections Body sites commonly used for subcutaneous
Injections
ROUTES OF ADMINISTRATION
• Common sites for intramuscular injections are Deltoid, Ventrogluteal,
vastus lateralis, others are dorso gluteal and rectus femoris
 ROUTES OF ADMINISTRATION
• The parenteral route: Some of the less commonly used routes for
parenteral administration are
• intra-arterial (into an artery),
• intracardiac (into the heart muscle),
• intraosseous (into a bone),
• intrathecal or intraspinal (into the spinal canal),
• intrapleural (into the pleural space),
• epidural (into the epidural space), and
• intra-articular (into a joint).
• Sterile equipment and sterile drug solution are essential for all
parenteral therapy
 ROUTES OF ADMINISTRATION
• The Topical route requires applications to be applied to a
circumscribed surface area of the body.
• They affect only the area to which they are applied.
• Topical applications include the following:
• Dermatologic preparations—applied to the skin
• Instillations and irrigations—applied into body cavities or orifices,
such as the urinary bladder, eyes, ears, nose, rectum, or vagina
• Inhalations—administered into the respiratory tract by a nebulizer
or positive pressure breathing apparatus.
• Air, oxygen, and vapor are generally used to carry the drug into the
lungs.
 Medication Orders
• A physician usually determines the client’s medication
needs and orders medications, although in some settings
nurse practitioners and physician assistants now order
some drugs.
• Prescriptions are often referred to as orders in clinical
practice
• The nurse should consider the policy in your area of
practice for the nurses capability to have prescriptive
ability and the class of drug for which they may prescribe.
 Medication Orders
• Usually medical orders are written, although telephone
and verbal orders are acceptable in some circumstances
and agencies
• Note that for all verbal or telephone orders the nurse
must first write down the order and then read it back,
verbatim, to the prescribing care provider
• Encourage the prescribing care provider to provide the
correct spelling of the drug, using aids such as “D as in
Daniel.”
 Medication Orders
• It is also important for the provider to pronounce
numbers separately. For example, the number 18 should
be stated as “one eight” to avoid confusion with the
number 80
• Nursing students need to know the state and agency
policies about medication orders.
 Types of Medication Orders
• 1. A stat order: is a one –time order indicating that the
medication is to be given immediately and only once.
(e.g. I/V omeprazole 40mg stat)
• 2. A single order (one time order): is a prescription for a
medication to be administered only once at a specified
time. (e.g. IV Ceftriaxone 1g ½ to 2hours before surgery)
• 3. A routine order: is a prescription that is followed until
another order cancels it. (Tab Lisinopril 10mg daily)
 Types of Medication Orders
• 4. A standing order: is also referred to as an order set or
a protocol. Standing orders are standardized
prescriptions for nurses to implement to any patient in
clearly defined circumstances without the need to
initially notify a provider. E.g. The protocol for patients
visiting an urgent care clinic reporting chest pain is to
administer 4chewable aspirin, establish intravenous IV
access and obtain an ECG.
 Types of Medication Orders
• 5. A PRN order: is also referred to as needed order, a
prescription for medication to be administered when it is
requested by, or as needed by, the patient.
• It permits the nurse to give the medication when in the
nurse’s judgment the client requires it.
• PRN orders are typically administered based on patient’s
symptoms, pain, nausea or itching.
• e.g. Tab lorazepam 1mg prn
 Types of Medication Orders
• 6. A Titration order: is the prescription that adjusts the
dosage of a medication gradually until a desired
therapeutic effect is achieved.
• This order involves the careful monitoring of the
patient’s response to the medication and making dose
adjustments based on their individual’s needs, clinical
condition and tolerance to the drug
• e.g. Tab 20mg once daily for the first 2days, 10mg daily
for the next 2days, then 5mg daily for 1week.
 Essentials of a Medication Order
• A prescription should have 7 essential parts:
1. The client’s full name
2. Date and time date the order was written
3. The name of the drug(s) to be administered
4. Dosage of the drug
5. Frequency of administration
6. Route of administration
7. Signature of the person writing the order
 Communicating a Medication Order
• Prescriptions are written in the client’s chart
• Telephone and verbal prescriptions are expected to be
ratified by the prescriber
• Prescribed medications are copied to the drug chart
depending on the hospital polices
• The nurse should always question the person that
prescribed unusual, ambiguous medications or
contraindicated in some client’s condition
•
 Communicating an inappropriate Medication Order
• When the nurse judges a primary care provider–ordered
medication inappropriate, the following actions are required:
• Contact the primary care provider and discuss the rationale for
believing the medication or dosage to be inappropriate.
• Document in notes the following: when the primary care provider
was notified, what was conveyed to the primary care provider, and
how the primary care provider responded.
• If the primary care provider cannot be reached, document all
attempts to contact the primary care provider and the reason for
withholding the medication.
• If someone else gives the medication, document data about the
client’s condition before and after the medication.
Converting Weights and
Measures between Systems
• When preparing client medications, a nurse may need
to convert weights or volumes from one system to
another
• The units of weight most commonly used in nursing
practice are the gram, milligram and kilogram. In
other spaces grain and the pound are inclusive.
Administering Medications
Safely
Process of Administering
Medications
• When administering any drug, regardless of the route of
administration, the nurse must do the following:
1. Identify the client
2. Inform the client
3. Administer the drug after performing the checks
4. Provide necessary assistance, information and
counsel as indicated
5. Record/document the drug administered
 Check Three Times for Safe Medication Administration
FIRST CHECK
• Read the medication chart and remove the medication(s) from the
client’s drawer.
• Verify that the client’s name and other identification match.
• Compare the label of the medication against the prescription on the
chart.
• If the dosage does not match determine if you need to do a math
calculation.
• Check the expiration date of the medication.
SECOND CHECK
• While preparing the medication (e.g., pouring, drawing up, or placing
unopened package in a medication cup), look at the medication label
and check against the chart.
THIRD CHECK
• Recheck the label on the container (e.g., vial, bottle, or unused unit-
 Important aspects of Medication
Administration
• Certain aspects of medication administration are important for
the nurse to check each time a medication is administered.
• These are referred to as the “rights.”
1 RIGHT CLIENT
• Medication is given to the intended client.
• Check the client’s identification band with each administration
of a medication.
• Know the agency’s name alert procedure when clients with the
same or similar last names are on the nursing unit.
 Important aspects of Medication
Administration
2.RIGHT MEDICATION
• The medication given was the medication ordered
3. RIGHT DOSE
• The dose ordered is appropriate for the client.
• Give special attention if the calculation indicates multiple pills/ tablets
or a large quantity of a liquid medication.
This can be an indication that the math calculation may be incorrect.
• Double-check calculations that appear questionable.
• Know the usual dosage range of the medication.
• Question a dose outside of the usual dosage range
 Important aspects of Medication
Administration
4 RIGHT TIME
• Give the medication at the right frequency and at the time
ordered according to agency policy.
• Medications should be given within the agency guidelines.
5. RIGHT ROUTE
• Give the medication by the ordered route.
• Make certain that the route is safe and appropriate for the
client
 Important aspects of Medication
Administration
6. RIGHT DOCUMENTATION
• Document medication administration after giving it, not
before.
• If time of administration differs from prescribed time,
note the time on the medication chart and explain the
reason and follow-through activities (e.g., pharmacy states
medication will be available in 2 hours) in nursing notes.
• If a medication is not given, follow the agency’s policy for
documenting the reason why.
 Important aspects of Medication
Administration
7. RIGHT CLIENT EDUCATION
• Explain information about the medication to the client (e.g.,
why receiving, what to expect, any precautions).
8. RIGHT TO REFUSE
• Adult clients have the right to refuse any medication.
• The nurse’s role is to ensure that the client is fully informed of
the potential consequences of refusal and to communicate the
client’s refusal to the health care provider.
 Important aspects of Medication
Administration
9. RIGHT ASSESSMENT
• Some medications require specific assessments prior to
administration (e.g., apical pulse, blood pressure, lab results).
• Medication orders may include specific parameters for
administration (e.g., do not give if pulse less than 60 or systolic
blood pressure less than 100).
10. RIGHT EVALUATION
• Conduct appropriate follow-up (e.g., was the desired effect
achieved or not? Did the client experience any side effects or
adverse reactions?).
 Important aspects of Medication
Administration
•Nurses who administer medications are responsible for their
own actions.
• Question any order that is illegible or that you consider
incorrect, Call the person who prescribed the medication for
clarification.
• Be knowledgeable about the medications you administer. You
need to know why the client is receiving the medication. Look
up the necessary information if you are not familiar with the
medication.
• Federal laws govern the use of narcotics and barbiturates.
Keep these medications in a locked place.
 Important aspects of Medication
Administration
• Use only medications that are in a clearly labeled
container.
• Do not use liquid medications that are cloudy or
have changed color.
• Calculate drug doses accurately. If you are
uncertain, ask another nurse to double-check your
calculations.
• Administer only medications personally prepared.
 Important aspects of Medication Administration
•Before administering a medication, identify the client correctly
using the appropriate means of identification.
• Do not leave medications at the bedside, with certain
exceptions (e.g., nitroglycerin, cough syrup). Check agency
policy.
• If a client vomits after taking an oral medication, report this
to the nurse in charge, or the primary care provider, or both.
• Take special precautions when administering certain
medications; for example, have another nurse check the
dosages of anticoagulants, insulin, and certain IV preparations.
 Important aspects of Medication
Administration
• Most hospital policies require new orders from
the primary care provider for a client’s post-surgery
care.
• When a medication is omitted for any reason,
record the fact together with the reason.
• When a medication error is made, report it
immediately to the nurse in charge, the primary
care provider, or both.
• Always check a medication’s expiration date