1.

Guidelines in administration of Medications

The most common way people take medications is orally (by mouth). Depending on what your
physician prescribed, your oral medication can be swallowed, chewed or placed under your
tongue to dissolve.

A. How To Administer Tablets

1. When administering tablets to a patient it is generally best to advise them to swallow

their tablets whole with a glass of water (orange juice, tea or coffee are also frequently
suitable).
This is particularly important for modified release and enteric
coated preparations as chewing these tablets would render the formulation
ineffective.
2. If the tablet needs to be taken on an empty stomach, you should advise the patient of this
and explain it is important to ensure the drug is absorbed properly.
An empty stomach is usually found at least an hour before or after food.
3. Similarly, if the tablet is best taken with or after food, should remind your patient of this
and explain why it is important to do so.
4. Additionally, do not break, crush, or chew any capsule or tablet before swallowing. Many
medications are long-acting or have a special coating and are intended to be swallowed
whole.
5. Many patients experience difficulty swallowing their tablets, but simple interventions
can sometimes remedy the problem.

 Encourage your patient to tilt their head down rather than back when swallowing
their tablets as this will widen the oesophagus and may remedy difficulties
taking tablets.

EXAMPLE : Using Paracetamol

Paracetamol (acetaminophen) and Ibuprofen has been safely used for many years to help
with mild to moderate pain and fever for babies over 1 month of age, young children,
older children and adults.
Give the dose that is written on the bottle or pack for a child of your childs weight.
If your baby or child is taking some other medicine, check that it does not have
paracetamol in it, so that she doesn't get a bigger dose than she should
Paracetamol can be given every 4 hours - no more than 4 times a day.
If your child seems to need it for more than twenty-four hours, check with your doctor to
find out what is wrong.
Taking even the recommended dose for more than one or two days has caused liver
damage in some children who were quite unwell for other reasons.
Make sure your child gets plenty to drink while taking paracetamol.
Older children and adults weighing over 60kg, who are taking tablets should not have
more than eight 500 mg tablets in any 24 hour period
Paracetamol poisoning
Swallowing a lot of paracetamol mixture or tablets can harm a childs or adults liver, and
sometimes the kidneys.
Always store paracetamol and other medicines out of reach of children. It is best to keep
them in locked or child proof cupboards.
Do not take tablets out of foil wrapping until you are ready to take the tablets. The
wrapping is designed to be hard for children to open, so that they do not take many
tablets if they find them and want to try them.

 Always leave the child proof lid on a bottle of paracetamol mixture.

Paracetamol is also commonly taken by people who intend to harm themselves (suicide
attempts). Large amounts of paracetamol are very dangerous, but the effects do not show
until about 2 to 3 days after taking the tablets.
Acetylcystein is given as antidote for poison
B. How To Administer Capsule Medications

Capsules are easier to swallow and are used by manufacturers when the drug cannot be
compacted into a solid tablet. They are also useful when the drug needs to be mixed with oil or
other liquid to aid absorption in the body. It is normally a shell or container made of
gelatin that contains the drug.
There are two types of capsules, hard or soft.
Hard gelatin capsules - for persons with swallowing difficulties
Prepare the capsule as follows:
1. Gently ease open the capsule to release the powder.
2. Tip the powder into a beaker - be sure to obtain all the powder.
3. Mix the powder with 15-30mL of water.214
4. Draw up the solution in an oral or bladder-tipped syringe.
5. Administer the solution to the patient.
6. Rinse the beaker with water, and administer this also.
Soft gelatin capsules e.g. nifedipine - for persons with swallowing difficulties
Method one

1. Pinprick one end of the capsule.

2. Drain out the contents with a syringe.
3. Remove the needle from the syringe.*
4. Dilute if necessary
5. Administer to the patient.
Method two
1. Dissolve capsule in 15-30mL of warm (not hot) water.
2. Remove undissolved gelatin.
3. Draw up the solution in an oral or bladder-tipped syringe.
4. Administer the solution to the patient.
Example: Amoxicillin Capsule Guidelines of Administration
Amoxicillin capsules are used for treating infections caused by certain
bacteria
How to use amoxicillin capsules:
Use amoxicillin capsules as directed by your doctor. Check the label on the medicine for exact
dosing instructions.

Take amoxicillin capsules by mouth with or without food. If stomach upset occurs, take
with food to reduce stomach irritation.

To clear up your infection completely, take amoxicillin capsules for the full course of
treatment. Keep taking it even if you feel better in a few days.

If you miss a dose of amoxicillin capsules, take it as soon as possible. If it is almost time
for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not
take 2 doses at once.

Do NOT use amoxicillin capsules if:

you are allergic to any ingredient in amoxicillin capsules or another penicillin antibiotic
(eg, ampicillin)

C. How To Administer Liquid Medications

Liquid medications are good for children and adults (especially older adults) who are not able to
swallow tablets or capsules. Many liquid medications, are made for children and are flavored to
mask the taste of the medication.
1. Before measuring the proper dose of liquid medication, make sure to shake the bottle as
some of the medication may have settled at the bottom. It is important to shake the bottle for at
least 10 seconds before use

2. Most often, you will be told to measure the medication using a teaspoon (please remember
that teaspoons are smaller than tablespoons).
3. To a physician and pharmacist, a teaspoon means 5 ml (milliliters) of medication. Many
household teaspoons are different sizes and hold more or less than 5 ml.
4. Measure your liquid medication carefully! Ask your pharmacist for a spoon, medicine cup,
medicine dropper, or a syringe without a needle meant specifically for measuring
medications.
5. If the medication has been prescribed for an infant or young child, make sure to speak with
your pediatrician about the proper dosage, or amount, of liquid medication for your
child.

6. Do not take this medicine if you have/had an allergic reaction to paracetamol

7. Take special care with this medicine if you have: kidney problems/liver problems,

including those due to drinking too much alcohol.

8. If you get any of the following side effects, stop taking this medicine and see your

doctor as soon as possible (bruising more easily, sore throat or other signs of infection
(these may be signs of a blood disorder, severe pain in the abdomen and back, with fever
(high temperature), loss of appetite, nausea and vomiting (these may be signs of pancreas
inflammation)
9. Do not drink alcohol while taking paracetamol. This is because taking alcohol and

paracetamol together can increase the risk of liver damage.

10. Pregnancy and breast-feeding If you are pregnant, planning to become pregnant or are

breast-feeding, talk to your doctor or pharmacist before taking this medicine.

D. Guidelines in Powder Medication Administration

1. Oral Suspension

Tap bottle until all powder flows freely. Add approximately 1/3 of the total amount of water for
reconstitution and shake vigorously to wet powder. Add remainder of the water and again shake
vigorously.
After reconstitution, the required amount of suspension should be placed directly on the tongue
for swallowing.
NOTE: SHAKE ORAL SUSPENSION WELL BEFORE USING. Keep bottle tightly closed.
Any unused portion of the reconstituted suspension must be discarded after 14 days.
Refrigeration is preferable, but not required.
2. Cocaine is benzoylmethyl ecgonine, a crystalline alkaloid from the coca plant. It
acts as a stimulant, appetite suppressant, and anesthetic.

 Cocaine is used because it produces euphoria, is a stimulant, suppresses appetite, and can
be used as a pain reliever
Powdered cocaine is most commonly snorted through the nose, though it may be
dissolved in water and injected.
Snorted cocaine produces a high within 3-5 minutes after use. Injected cocaine produces
an effect within 15-30 seconds.
It is highly addictive and leads to tolerance sometimes after one use, so increasing doses
of cocaine can cause high.
Pregnancy is contraindicated because it can harm the fetus and can cause abruption
placenta

E. Guidelines in Suppository Administration

Suppositories can be used as an administration route for medication, or as a route to administer

a laxative to evacuate the rectum. For many children or young people, using the rectal route
can be a very distressing experience.
Preparation

Give full explanation of the procedure to the child/young person and parent/carer(s)
Explanation of the procedure should alleviate anxiety.

Ensure that the environment where the procedure is to take place is private.

If the suppository is prescribed as a laxative, ensure a toilet, commode or bedpan is

available
The suppository should evacuate the rectum of stool within 20 minutes.

If the suppository is a means of administering medication, ask the child/young person to

try and go to the toilet to open their bowels first
If the rectum is empty there is a better chance that the medication will be fully
absorbed.

Gather equipment together

o

suppository and prescription chart

lubricating jelly

disposable gloves

wipes

Administration of suppository
1.

Remove the childs nappy or underwear or ask the young person to do this themselves.

2.

Ask the child/young person to lie on their left side with knees bent up to their
abdomen(This position offers the easiest access to the rectum.)

3.

Infants can lie on their back with feet and legs held up (This position is easiest to
maintain with an infant.).

4.

Some children/young people can be taught how to insert suppositories into their own
rectum and would find this easier to do in a squatting position.

5.

Perform a clinical hand wash (To adhere to standard infection control precautions).

6.

Put on disposable gloves

7.

Open the suppository and lubricate the end. Holding the suppository between index
finger and thumb, locate the anus and gently insert the suppository with the index finger.
The suppository should be fully inserted into the rectum against the wall of the rectum
(Lubrication of the suppository will make insertion easier.
; Fully inserting the suppository against the wall of the rectum will allow it to be retained
longer and therefore be more effective).

8.

Suppositories are usually placed rounded end first. In some cases the suppository is
expelled before medication is absorbed. If this is the case it has been suggested that
placing the suppository blunt end first prevents the suppository from being expelled from
the rectum

9.

Ask the child to retain the suppository as long as possible (The longer the suppository is
retained the better the result, and the more medication is absorbed.).

10.

If the suppository is used to evacuate the rectum, sit the child on the toilet, commode or
bedpan to empty the bowel. If the child/young person is unable to sit on the toilet/bedpan
either a nappy can be put on or an incontinence sheet placed under the child (Sitting on
the toilet or commode allows the most effective position to empty the rectum).

11.

If the suppository is for medication purposes eg analgesia; wipe excess lubricating jelly
off the perineum and replace the childs nappy or underwear or ask the young person to
do this themselves if able (Absorption rates of medication in suppository form are
variable and can take anything up to one hour.).

12.

Dispose of packaging and equipment in the appropriate waste disposal bag, in line with
hospital waste disposal policy.

13.

Document administration on the appropriate medicine chart

14.

Document the outcome of the suppository if used as a laxative. Document the

effectiveness of the suppository if used as a medicine

Issues to consider regarding suppository administration

Using the rectal route in children/young people can be distressing. Due consideration
should be taken and full explanation should be given to the parents and child.

If a child has had surgery on the rectum, nothing should be placed into the rectum without
the express permission of medical staff (Any anastomosis could be damaged and
haemorrhage could occur if rectal biopsies have been taken.).

The rectal route for medication should not be used for children with oncological
conditions or who are otherwise immunocompromised (Children who have lowered
immunity are susceptible to bacteria within the rectum and are at higher risk of
infection.).

Rectal medication for children with inflammatory bowel disease should be confined to
local treatments for that disease eg steroid preparation (The rectum may be very inflamed
and friable, perforation of the bowel may occur.).

Consider the effect that rectal administration might have on the child psychologically
(Full explanation must be given and the support of a parent or carer is vital during the
procedure.)

F. Guidelines in Inhalations Administration

Many medications are available as inhaled treatments like Ventolin HFA Inhalation Aerosol
indicated for the treatment or prevention of bronchospasm in patients aged 4 years and older with
reversible obstructive airway disease.. Inhaled methods deliver medication directly to the airway,
which is helpful for lung diseases.
1. How to Assemble the Nebulizer and Air Compressor
Place the compressor where it can safely reach its power source and where you
can reach the ON/OFF switch.
Wash your hands prior to preparing each treatment.
Use a clean nebulizer.
Measure the correct dose of medication and other solutions prescribed by your
physician. Add these to the nebulizer.
Connect the air tubing from the compressor to the nebulizer base.
Attach a mouthpiece to the nebulizer.
2. Taking the Nebulized Treatment
Put the mouthpiece in your mouth between your teeth and close your lips around
it.

 Hold the nebulizer in an upright position. This prevents spilling and promotes
nebulization.
Assure deep breathing throughout the treatment. This allows the medication time
to deposit in the airway.
Push the top of the canister all the way down while you breathe in deeply and
slowly through your mouth.

After the spray comes out, take your finger off the canister. After you have
breathed in all the way, take the inhaler out of your mouth and close your mouth.

Hold your breath for about 10 seconds, or for as long as is comfortable.Breathe

out slowly as long as you can.
If your healthcare provider has told you to use more sprays, wait 1 minute and
shake the inhaler again. Repeat Steps 2 through Step 6.

Put the cap back on the mouthpiece after every time you use the inhaler. Make
sure it snaps firmly into place

Occasionally tapping the side of the nebulizer helps the solution drop to where it

can be misted.
G. Guidelines in Injections Administration

Injection Safety Guidelines From CDC

1. Never administer medications from the same syringe to more than one patient, even if the
needle is changed.
2. After a syringe or needle has been used to enter or connect to a patients IV it is
contaminated and should not be used on another patient or to enter a medication vial.
3. Never enter a vial with a used syringe or needle.
4. Never use medications packaged as single-dose vials for more than one patient.
5. Assign medications packaged as multi-dose vials to a single patient whenever possible.
6. Do not use bags or bottles of intravenous solution as a common source of supply for more
than one patient.
7. Follow proper infection control practices during the preparation and administration of
injected medications.
8. Wear a surgical mask when placing a catheter or injecting material into the spinal canal or
subdural space
Glucagon Preparation and Intramuscular Injection
A. Reconstitute glucagon
1. Two vial package
a. Inspect package and both vials insuring correct medication, dose, and expiration date is
current. b. Remove flip-off seals from vials
c. Wipe rubber stoppers with alcohol prep-pad
d. Using sterile 3 ml IM syringe, remove needle protector from syringe
e. Draw plunger back to 1ml (cc) mark (syringe now contains 1ml of air)
f. Pierce the center of the stopper of the vial containing the diluting solution with the needle
of the syringe
g. Turn the vial upside down and inject the 1 ml of air from the syringe into the vial
h. Keeping the tip of the needle in the diluent, withdraw fluid from vial into the syringe
i. Remove syringe from vial and pierce the center of the stopper of the vial containing 1mg
powdered glucagon with the syringe
j. Inject all of the diluent into the glucagon
k. Remove the syringe from the vial and maintain sterility
l. Shake the vial gently until the glucagon dissolves and the solution becomes clear. Note:
glucagon should be clear and water-like in consistency. It should be utilized immediately

after reconstituting. m. Follow the above procedure and withdraw slightly more of the
medication than the ordered dose
n. Replace the needle with an appropriate size safety engineered needle
o. With the needle pointing upward, gently tap the syringe to move any air bubbles to the top.
Gently advance the syringe to the 1 ml mark.

2. Vial and syringe kit

a. Inspect vial and filled syringe insuring right medication, dose and expiration date
b. Remove flip-off seals from vial
c. Wipe rubber stoppers with alcohol prep-pad
d. Pierce the center of the stopper of the vial containing the diluting solution with the needle
of the syringe
e. Inject all of the diluent into the glucagon
f. Remove the syringe from the vial and dispose in sharps container
g. Shake the vial gently until the glucagon dissolves and the solution becomes clear. Note:
glucagon should be clear and water-like in consistency. It should be utilized immediately
after reconstituting.
h. Wipe rubber stopper with alcohol prep-pad
i. Using sterile 3 ml IM syringe, remove needle protector from syringe
j. Draw plunger back to 1ml (cc) mark (syringe now contains 1ml of air)
k. Pierce the center of the stopper of the vial containing the glucagon solution
l. Turn the vial upside down and inject the 1 ml of air from the syringe into the vial
m. Keeping the tip of the needle in the solution, withdraw fluid from vial into the syringe
n. Replace the needle with an appropriate size safety engineered needle
o. With the needle pointing upward, gently tap the syringe to move any air bubbles to the top.
Gently advance the syringe to the 1 ml mark. (Children less than 20 kg (44 lbs) a dose of 0.5
mg is used). p. Note: Dosage established by medical control must be administered.

B. Perform the IM injection using a safety engineered needle

1. Cleanse the injection site using an alcohol prep-pad
2. Raise the injection site by pinching or stretching the flesh
3. Insert the needle into the selected and cleansed injection site at a 90 degree angle
4. Aspirate slightly by attempting to withdraw the plunger of the syringe. If no blood is seen
to aspirate into the syringe, use light pressure to depress the plunger and inject all the
medication. If blood is seen to aspirate, a second site must be used
5. Depress the plunger to administer the injection
6. Withdraw the needle from the injection site
7. Wipe the injection site with an alcohol prep-pad
8. Properly dispose of the syringe and needle assembly in an appropriate sharps container and
place a band-aid over the injection

H. Guidelines in Administration (Ophthalmic Medication)

Procedure for instilling eye drops

1. Position the patient comfortably, either sitting or lying down (semi-prone or
recumbent) with the head supported
2. Wash hands before and after instilling eye drops to prevent cross infection
and to remove drug residue from the hands
3. Some local policies require that non-sterile gloves are used when instilling
eye drops or ointment and that an aseptic non-touch technique is used for
first postoperative dressing and application of eye drops (Shaw et al, 2010)
4. Cleaning the eye may be required, for example when there are crusty or
purulent deposits on the eyelids. Clean the lids with non-woven or cotton
wool swabs dipped in cooled boiled water or sterile saline solution (cotton
wool is contraindicated when there are sutures on the skin)
5. Establish that you have the correct eye drops and that they have not expired
6. Gently agitate the bottle before use to make sure the drug is properly mixed
7. Warn the patient the drops will sting transiently when administered (Andrews,
2006)
8. Instil the eye drop into the space (fornix) created by gently pulling down the
lower lid (Fig 1)
9. Ask the patient to look up this helps to ensure the eye drop does not land
directly onto the sensitive cornea
10.Once the eye drop is instilled, release the eyelid, using a tissue or swab to
dab any excess from the cheek
11.Avoid holding the tissue too close to the eye, to prevent the drug wicking
away from the eye
12.Where multiple drops and/or ointment are prescribed for one or both eyes,
the order of administration is important to ensure maximum therapeutic
effect of each (Andrews, 2004) (see Table 1)
13.Only one drop of each drug is required; more than this will create overflow
onto the cheek. Ideally, five minutes should elapse between administration of
a different eye drop to achieve maximum therapeutic effect (Andrews, 2006)
Closed eye technique Alster et al (2000) recommended a technique for patients who
find it difficult to have drops instilled directly into the eye, for example, children or
older people:
1. Ask the patient to lie flat or with their head tilted back
2. Administer a drop of the medication onto the closed eyelid in the nasal corner
3. Ask the patient to open the eye and close it gently once the drug has entered
it

How to Use Eye Ointments and Gels Properly

1Wash your hands thoroughly with soap

and water.

2Avoid touching the tip of the tube against your eye or anything else - the
medication and its container must be kept clean.

3Holding the tube between your thumb and forefinger, place it as near to
your eyelid as possible without touching it.

4Brace the remaining fingers of that hand against your face.

5Tilt your head forward slightly.
6While tilting your head back, pull down
the lower lid of your eye with your index
finger to form a pocket.

7Squeeze ribbon of ointment or gel into the pocket made by the lower eyelid. Remove your
index finger from the lower eyelid.

8Blink your eye gently; then close your eye for 1 to 2 minutes.

9With a tissue, wipe any excess ointment or gel from the eyelids and lashes.
With another clean tissue, wipe the tip of the tube clean.

10

Replace and tighten the cap right away.

11

Wash your hands to remove any

medication.

Remember

Follow directions carefully

Do not miss doses
Your eyesight may be cloudy after using the ointment or gel
Store medications out of reach of children

I.

Guidelines in Administration (Otic Medication)

Otic medications, which are available in liquid form, are placed in the external ear canal sing a
dropper. Otic drops are sometimes applied to soften cerumen, enabling it to be :cleansed from the
canal. The ear canal is not treated with sterile technique unless the 7-mpanic membrane is ruptured
and draining.
PREPARATION
Gather supplies

EQUIPMENT AND SUPPLIES:

Medication.
Cotton ball.
PROCEDURE:Clean Gloves
1- Have another nurse, an assistant, or the parent restrain the child in a supine position with the
head turned as appropriate for administration (Figure 7-8).
2- Don gloves.
3- For the child less than 3 years of age: Gently pull the pinna straight back and downward to
straighten the ear canal. For the older child: Pull the pinna back and upward.
4- When the pinna is in the proper position, instill the drops into the ear.
5- Keep the child in the same position for a few minutes. Gently rub the area just anterior to the ear.
Irrigation of the ear is performed to remove cerumen or a foreign body. Frequently the child has
symptoms of otitis media but the canal cannot be visualized. Always ask the parent if there has been
any drainage from the ear and examine the ear with an otoscope. If there is drainage, contact the
physician before irrigating the ear. Be sure to check with the otoscope after about 1 minute of
irrigation to observe the effects of treatment.
Performing an Ear Irrigation
PREPARATION:
1. Check the physicians orders for the type of fluid to be administered.
EQUIPMENT AND SUPPLIES
Ordered solution, warmed to room temperature
Irrigating syringe (bulb or Asepto) with tubing or water pik.
Clean gloves.

 Absorbent pads.
Basin.
1- Examine the ear with an otoscop.
2- Position the child on the back. Don gloves. For the child less than 3 years of age, gently pull the
pinna straight back and slightly downward. For the older child, pull the pinna back and upward.
RATIONALE: These maneuvers straighten the ear canal.
3 Place an emesis basin under the ear to be irrigated. Place a waterproof pad on the bed under
the head.
4 Draw 20 mL of warm ordered solution into a syringe with the tubing attached.
5 Gently flush the solution into the ear canal, catching the draining fluid with the emesis basin.
6 Alternately, use a water pik at the lowest setting to flush the ear.
7 Repeat according to prescribers orders.
8 Reexamine the ear with an otoscope and record changes from the treatment. 9- Dry the childs
ear, cheek, and neck

J.

Administration of Nasal Medication

Medications instilled into the nares drain into the back of the mouth and throat, and may
cause sensations of difficulty in breathing, tickling, or bad taste. After instillation of the drops,
the child should be observed for choking or vomiting. Saline nose drops are sometimes
given to young infants who have respiratory disorders to clear the nasal passages.

Administering a Nasal Medication:

1Blow your nose gently.

2Wash your hands thoroughly with soap and water.

3Check the dropper tip to make sure that it is not chipped or cracked.
4Avoid touching the dropper tip against your clean nose.
5Tilt your head as far back as possible, or lie down
on your back on a flat surface (such as a bed) and
hang your head over the edge.

6Place the correct number of drops into your nose.

7Bend your head forward toward your knees and

gently move it left and right.

8Remain in this position for a few minutes.

9Clean the dropper tip with warm water. Cap the bottle right away.
10

Wash your hands to remove any medication.

Remember

Follow directions carefully

Do not miss doses
Use nose drops only as long as directed
Store medications out of reach of children

K. Guidelines in Administration of Topical Medication

Topical administration may be used:

To treat inflammatory conditions of the skin (eg corticosteroids, immunodulators).

To treat fungal, viral or bacterial infections of the skin (e.g. anti-fungals, anti-virals,
antibacterials).

To treat dryness of the skin (eg emollients).

To prevent sun damage (eg sunblocks).

To produce superficial analgesia (eg local anaesthetic creams).

Assessment

Inquire if the child/ young person has any known drug allergies, and ensure these are
documented in the health care record

Administration
Gather the following equipment:
topical cream/ointment
silver foil bowls

plastic spoon
apron
gloves (ensure non latex

1. Wash hands and put on apron and gloves

2. Check topical cream/ointment with prescription chart adhering to hospital medicine
administration policy for identifying correct patient
3. Apply patient named sticker onto cream tube/bottle
4. If cream/ointment does not come in a tube or pump dispenser, decant sufficient cream for
that administration into a silver foil bowl with plastic spoon
5. Ensure the childs/young persons skin is cleansed thoroughly with a disposable
washcloth and prescribed soap substitute
6. If the child/young person is having a bath prior to topical administration, a bath emollient
should be used to reduce water loss from skin and preventing dryness.
7. The bath water must be lukewarm in temperature to reduce discomfort to sensitive skin
8. The emollient bath preparation should be poured into the bath (see individual
preparations for guidelines on quantity).
9. The patient should bathe for no longer than 10 minutes
10. Sodium laureth sulphate free aqueous cream or emulsifying ointment may be applied
liberally as a soap substitute
11. Pat skin dry gently, rather than rubbing, as this creates heat and friction
12. Before administering any cream/emollient to the skin, wash hands and apply non-sterile
gloves
13. After the bath, the emollient preparation should be applied to the skin immediately.
Cream or ointment formulas may be used
14. With the named patients emollient, apply generously to the skin in the direction of hair
growth
15. Steroid creams (used to reduce inflammation) should be applied directly to affected
areas