RLE LECTURES MEDICATIONS

ARTURO G. GARCIA JR RN, MSN, U.S RN

MEDICATION- IS A SUBSTANCE ADMINISTERED FOR THE DIAGNOSIS, CURE, TREATMENT OR RELIEF OF A

SYMPTOMS OR FOR PREVENTION OF DISEASE.

PRESCRIPTION- WRITTEN DIRECTION FOR THE PREPARATION AND ADMINISTRATION OF A DRUG.

GENERIC NAME- GIVEN BEFORE A DRUG BECOME OFFICIALLY AN APPROVED MEDICATION.

OFFICIAL NAME- IS THE NAME UNDER WHICH IT IS LISTED IN ONE OF THE OFFICIAL PUBLICATIONS.

CHEMICAL NAME- THIS NAME DESCRIBES THE CONSTITUENT OF THE DRUG PRECISELY.

TRADE NAME - IS THE NAME GIVEN BY THE DRUG MANUFACTURER.

-USUALLY SELECTED TO BE SHORT AND EASY TO REMEMBER.

BRAND NAME- SOMETIMES CALLED THE TRADE NAME

EX. HYDROCHLOROTHIAZIDE (OFFICIAL NAME), ESIDRIX AND HYDRODIURIL (BRAND NAME)
ROUTES OF ADMINISTRATION:

1. ORAL- is the most common, least expensive, most convenient rout for most client.
2. SUBLINGUAL- a drug is placed under the tongue
3. BUCCAL- a medication is held in the mouth against the mucous membrane of the cheek
Until the drug dissolve.
4. PARENTERAL- defined as other than through the alimentary or respiratory tract, that is
by needle.
a. Subcutaneous (hypodermic) - into subcutaneous tissue, just below the skin.
b. Intramuscular- into a muscle
c. Intradermal- under the epidermis
d. Intravenous- into a vein.
5. TOPICAL- are those applied to a circumscribed surface area of the body.
TYPES OF MEDICATION ORDERS
1. STAT ORDER- indicates that the medication is to be given immediately and only once.
2. SINGLE ORDER- one time order is for medication to be given once at a specific time
3. STANDING ORDER- may or may not have a termination date, may be carried out indefinitely
until an order is written to cancel it, or it may be carried out for a specified number of days.
4. PRN ORDER- as needed order, permits the nurse to give a medication when, in the nurse
judgment, the client requires it.
ESSENTIAL PARTS OF A DRUG ORDER

 Full name of the client

 Date and time the order is written
 Name of the drug to be administered
 Dosage of the drug
 Frequency of administration
 Route of administration
 Signature of the person writing the order
TEN RIGHTS OF MEDICATION ADMINISTRATION

1. RIGHT MEDICATION
 The medication given was the medication ordered
2. RIGHT DOSE
 The dose ordered is appropriate for the client
 Double check calculations that appears questionable
 Know the usual dosage range of the medication
 Question a dose outside outside of the usual range
3. RIGHT TIME
 Give the medication at the right frequency and at the time ordered according to agency
policy.
 Medications given within 30 minutes before or after the scheduled time are considered
to meet the right time standard
4. RIGHT ROUTE
 Give the medication by the ordered route
 Make certain that the route is safe and appropriate for the client
5. RIGHT CLIENT
 Medication is given to the intended client
 Check the client identification band with each administration of a medication
 Know the agency’s name alert procedure when clients with the same or similar last name
are on the nursing unit.
6. RIGHT CLIENT EDUCATION
• Explain information about the medication to the client
7. RIGHT DOCUMENTATION
• Document medication administration after giving it, not before
• If a medication is not given, follows the agency policy for
documenting the reason why.
8. RIGHT TO REFUSE
• Adult client have the right to refuse any medication
• The nurse 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.
9. RIGHT ASSESSMENT
• Some medications require specific assessment prior to administration (e.g.
apical pulse, BP, 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?)
 PREPARING MEDICATIONS FROM AMPULES
EQUIPMENT:
 Ampule of sterile medication
 File (if ampule is not scored) and small medication gauze square or plastic ampule opener
 Antiseptic swabs
 Syringe
 Needle for administering the medications
 Filter needle for withdrawing medication from the ampule
IMPLEMENTATION

Preparation:
1. Check the medication administration record (MAR)
 Check the label on the ampule carefully against the MAR to make sure that the correct medication
is being prepared.
 Fallow the three checks for administering medications. Read the label on the medication
(1) When it is taken from the medication chart
(2) Before withdrawing the medication, and
(3) After withdrawing the medication
2. Organize the equipment.
Performance:
1. Perform hand hygiene and observe other appropriate infection control procedures.
2. Prepare the medication ampule for drug withdrawal.
 Flick the upper stem of the ampule several times with fingernail Rationale : this will bring all
medication down to the main portion of the ampule)
 Use an ampule opener or place a piece of sterile gauze or alcohol wipe between your thumb and
the ampule neck and break off the top by bending it toward you to ensure the ampule is broken
away from yourself and away from others. Rationale: The sterile gauze protects the fingers from
the broken glass, and any glass fragments will spray away from the nurse.

Or

 Place the antiseptic wipe packet over the top of the ampule before breaking off the top.
Rationale: This methods ensures that all glass fragments fall into the packet and reduces the risk
of cuts.
 Dispose of the top of the ampule in the sharps container.
3. Withdraw the medication.
 Place the ampule on a flat surface
 Attach the filter needle to the syringe. Rationale: The filter needle prevents glass particles from
being withdrawn with the medication.
 Remove the cap from the filter needle and insert the needle into the center of the ampule. Do
not touch the rim of the of the ampule with the needle tip or shaft. Rationale: This will keep the
needle sterile. Withdraw the amount of drug required for the dosage.
 With a single dose ampule, hold the ampule slightly on its side, if necessary, to obtain more than
the ordered amount of medication.
 Dispose of the filter needle by placing in a sharp container.
 If giving an injection replace the filter needle with a regular needle, tighten the cap at the hub of
the needle, and push solution into the needle, to the prescribed amount.
 PREPARING MEDICATIONS FROM VIALS

EQUIPMENT:

 Vial of sterile medication

 Antiseptic swab
 Safety needle and syringe
 Sterile water or normal saline, if drug is in powdered form

IMPLEMENTATION
Preparation:

1. Check the medication administration record (MAR)

 Check the label on the ampule carefully against the MAR to make sure that the correct medication
is being prepared.
 Fallow the three checks for administering medications. Read the label on the medication
(1.) When it is taken from the medication chart
(2) Before withdrawing the medication, and
(3) After withdrawing the medication
2. Organize the equipment.
 PERFORMANCE

1. Perform hand hygiene and observe other appropriate infection control procedures
2. Prepare the medication vial for drug withdrawal.
 Mix the solution, if necessary, by rotating the vial between the palms of the hand, not by shaking.
Rationale: Some vials contain aqueous suspensions, which settle when they stand. In some
instances, shaking is contraindicated because it may cause the mixture to foam.
 Remove the protective cap, or clean the rubber cap of a previously opened vial with an antiseptic
wipe by rubbing in a circular motion. Rationale: The antiseptics cleans the cap and reduces the
number of microorganism.
3. Withdraw the medication.
 Attach a filter needle, as agency practice dictates, to draw up premixed
liquid medications from multi-dose vials. Rationale: Using the filter needle
prevents any solid particles from being drawn up through the needle.
 Ensure that the needle is firmly attached to the syringe
 Remove the cap from the needle, then draw up into the syringe the amount
of air equal to the volume of the medication to be withdrawn.
 Carefully insert the needle into the upright vial through the center of the
rubber cap, maintaining the sterility of the needle.
 Inject air to the vial, keeping the bevel of the needle above the surface of
the medication. Rationale: The air will allow the medication to be drawn out
easily because negative pressure will not be created inside the vial. The bevel
is kept above the medication to avoid creating bubbles in the medication.
 Withdraw the exact amount of medication using either of the following methods:
a. Hold vial down (i.e., with the base lower than the top), move the needle tip so that it is below
the fluid level, and withdraw the medication. Avoid drawing up the last drops of the vial.
Rationale: Proponents of this method say that keeping the vial in the upright position while
withdrawing the medication allows particulate matter to precipitate out of the solution.
Leaving the last few drops reduces the chance of withdrawing foreign particles.
Or
b. Invert the vial, ensure the needle tip is below the fluid level: and gradually withdraw the
medication. Rationale: Keeping the tip of the needle below the fluid level prevents air from
being drawn into the syringe.
 Hold the syringe and the vial at eye level to determine that the correct dosage of drug is drawn
into the syringe. Eject air remaining at the top of the syringe into the vial.
 When the correct volume of medication plus a little more (e.g., 0.25 ml) is obtained, withdraw the
needle from the vial, and replace the cap over the needle using the scoop method, thus
maintaining its sterility.
 If, necessary, tap the syringe barrel to dislodge the air bubbles present in the syringe. Rationale:
The tapping motion wil cause the air bubbles to rise to the top of the syringe where they can be
ejected out of the syringe.
 If giving an injection, replace the filter needle, if used, with a regular or safety needle of the correct
gauge and length. Eject air from the new needle and verify correct medication volume before
injecting the client.
VARIATIONS: PREPARING AND USING MULTIDOSE VIALS

 Read the manufacturer’s directions.

 Withdraw an equivalent amount of air from the vial before adding the diluent, unless otherwise
indicated by the directions.
 Add the amount of sterile water or saline indicated in the directions.
 If a multi-dose is reconstituted, label the vial with the date and time it was prepared, the amount
of drug contained in each mil iliter of solution, and your initials. Rationale: Time is an important
factor to consider in the expiration of these medications.
 Once the medication is reconstituted, store it in a refrigerator or as recommended by the
manufacturer.

ADMINISTERING ORAL MEDICATIONS

PURPOSE
 To provide a medication that has systemic effects or local effects on the gastrointestinal
tract or both.

ASSESSMENT
 Allergies to medications
 Clients ability to swallow the medications
 Presence of vomiting or diarrhea that would interfere with the ability to absorb the
medication
 Specific drug action, side effects, interaction and adverse reactions
 EQUIPMENT
 Disposable medication cup: small paper or plastic cups for tablets and capsules, waxed or
plastic calibrated medication cup for liquids
 Pill crusher/cutter
 Straws to administer medications that may discolor the teeth or to facilitate the ingestion
of liquid medication for certain client
 Drinking glass and water or juice
 Applesauce or pudding to use for crushed medications for clients who may choke on
liquids
 IMPLEMENTATION
Preparation

1. Know the reason why the clients is receiving the medication, the drug classification,
contraindications, usual dosage range, side effects, and nursing consideration for
administering and evaluating the intended outcomes for the medication.
2. Check the medication administration record (MAR)
 Check the MAR for the drug name, dosage, frequency, route of administration, and
expiration date for administering the medication if appropriate. Rationale: Certain
medications (e.g. narcotics, antibiotics) have specified time frame at which they expire
and need to be reordered by the primary care provider.
 If the MAR is unclear or pertinent information is missing compare the MAR with the most
recent prescribers written order.
 Report any discrepancies to the charge nurse or the prescriber, as agency policy dictates.
3. Verify the client’s ability to take the medication orally.
 Determine whether the client can swallow, Is NPO, is nauseated or
vomiting, has gastric suction, or has diminished or absent bowel sounds
4. Organize the supplies.
 Assemble the MAR for each client together so that medications can be
prepared for one client at a time. Rationale: Organization of supplies saves
times and reduces the chance
 Performance:

1. Perform hand hygiene and observe other appropriate infection control procedures.
2. Unlock the dispensing system
3. Obtain appropriate medication
 Read the MAR and take the appropriate medication from the shelf, drawer, or
refrigerator. The medication may be dispense in the bottle, box, or unit-dose package.
 Compare the label of medication container or unit-dose package against the order on the
MAR. Rationale: This is a safety check to ensure that the right medication is given. If these
are not identical, recheck the prescriber’s written order in the client chart. If there is still
a discrepancy, check with the nurse in charge or the pharmacist.
 Check the expiration date of the medications to the pharmacy. Rationale: Outdated
medication are not safe to administer
 Use only medications that have clear, legible label to ensure
accuracy.

 4. Prepare the medication

 Calculate the medication dosage accurately
 Prepare the correct amount of medication for the required dose,
without contaminating the medication. Rationale: Aseptic
technique maintains drug cleanliness.
 While preparing the medication, recheck each prepared drug and
container with the MAR again. Rationale: This second safety check
reduces the chance of error.

5. Provide for client privacy

 6. Prepare the client
 Check the client’s identification band. Rationale: This ensures that
the right client receives the medication
 Assist the client to a sitting position or if not possible, to a side lying
position. Rationale: These position facilitate swallowing and prevent
aspiration.
 If not previously assessed, take the required assessment measures,
such as pulse and respiratory rates or blood pressure. Take the
apical pulse rate before administering digitalis preparation. Take
blood pressure before giving antihypertensive drugs. Take the
respiratory rate prior to administering narcotics: Rationale: Narcotics
depress the respiratory center. If any of the findings are above or
below the predetermined parameters, consult the primary care
provider before administering the medication.
7.Explain the purpose of the medication and how it will help, using
language that the client can understand. Include relevant information
about effects; for example, tell the client receiving diuretics to expect
an increase in urine output. Rationale: Information can facilitate
acceptance of and compliance with the therapy.

8.Administer the medication at the correct time.

 Take the medication to the client within the period of 30 minutes
before or after the scheduled time
 Give the client sufficient water or preferred juice to swallow the
medication. Before using juice, check for any food and medication
incompatibilities. Rationale: Fluid ease swallowing and facilitate
absorption from the gastrointestinal tract. Liquid medications other
than antacids or cough preparation may be diluted with 15 ml (1/2
oz.) of water to facilitate absorption.
 If the client is unable to hold the pill cup, use the pill cup to introduce the medication into
the client’s mouth, and give only one tablet or capsule at a time. Rationale: Putting the
cup to the client’s mouth maintains the cleanliness of the nurse’s hands. Giving
medication at a time eases swallowing.
 If an older child or adult has difficulty swallowing, ask the client to place the medication
on the back of the tongue before taking the water. Rationale: Stimulation of the back of
the tongue produces the swallowing reflex.
 If the medication has an objectionable taste, ask the client to suck a few ice chips
beforehand, or give the medication with juice or applesauce, or bread if there are no
contraindications. Rationale: The cold of the ice chips will desensitize the taste buds, and
juices or bread can mask the taste of the medication.
 If the client says that the medication you are about to give is different from what the
client has been receiving, do not give the medication without first checking the original
order. Rationale: Most clients are familiar with the appearance of medications taken
previously. Unfamiliar medications may signal a possible error.
 Stay with the client until all medications have been swallowed. Rationale: The nurse must
see the client swallowed the medicine before the drug medication can be recorded. The
nurse may need to check the client’s mouth to ensure that the medication was swallowed
and not hidden inside the cheek. A primary care provider’s order or agency policy is
required for medication left at the bedside.
9. Document each medication given.
 Record the medication given, dosage, time, any complaints or
assessment of the client, and your signature.
 If medication was refused or omitted, record this fact on the
appropriate record, document the reason, when possible, and the
nurse’s actions according to agency policy.

10. Dispose of all supplies appropriately.

 Replenish stocks (e.g., medication cups) and return the cart to the
appropriate place.
 Discard used disposable supplies.
11. Evaluate the effects of the medication.
 Return to the client when the medication is expected to take
effect (usually 30 minutes) to evaluate the effects of the medication
on the client.

 EVALUATION
 Conduct appropriate follow-up
 Observe for desired effect ( e.g., relief of pain or decrease in body
temperature)
 Note any adverse effects ( e.g., nausea, vomiting, skin rash,
change in vital signs)
 Relate to previous findings, if available.
 Report significant deviations from normal to the primary care
provider.
 NASOGASTRIC AND GASTROSTOMY MEDICATIONS
For clients who cannot take anything by mouth (NPO) and have a nasogastric tube or a gastrostomy
tube in place, an alternative route for administering medications is through the nasogastric tube or
gastrostomy tube. A nasogastric tube (NGT) is inserted by way of the nasopharynx and is placed into the
client’s stomach for the purpose of feeding the clients or to remove gastric secretions.
PROCEDURES/GUIDELINES

• Always check with the pharmacist to see if the client’s medications

come in a liquid form because these are likely to cause tube
obstruction.
• If medications do not come in liquid form, check to see if they may
be crushed. (Note that the enteric coated, sustained action,
buccal, and sublingual medications should never be crushed.)
• Crush a tablet into a fine powder and dissolve in at least 30 ml of
warm water. Cold liquids may cause client discomfort. Use only
water for mixing and flushing. Some medications are mixed with
other fluids, such as normal saline, in order to maximize dissolution.
Nurses are encouraged to consult with a pharmacist
• Read medication labels carefully before opening a capsule. Open
capsules and mix the contents with water only with the pharmacist
advice
• Do not administer whole or undissolved medications because they
will clog the tube.
• Assess tube placement
• Before giving the medication, aspirate all the stomach contents and
measures the residual volume. Check agency policy if residual
volume is greater than 100 ml.
• When administering the medications
 Remove the plunger from the syringe and connect the syringe to a pinched or kinked tube.
Pinching or kinking the tube prevents excess air from entering the stomach and causing
distention.
 Put 15 to 30 ml (5-10 ml for children) of water into the syringe barrel to flush the tube before
administering the first medication. Raise or lower the barrel of the syringe to adjust the flow as
needed. Pinch or clamp the tubing before all the water is instil ed to avoid excess air entering the
stomach.
 Pour liquid or dissolved medication into the syringe barrel and allow to flow by gravity into the
enteral tube.
 If you are giving several medications, administer each one separately and flush with at least 15 to
30 ml (5 ml for children) of tap water between each medication.
 When you have finished administering all medications, flush with another 15 to 30 ml (5 to 10 ml
for children) of warm water to clear the tube.

 If the tube is connected to suction, disconnect the suction, disconnect the suction and keep tube
clamped for 20 to 30 minutes after giving the medication to enhance absorption.