NURS 203 Instructor Lab Guide: Week 1 Lab 1

Lab Name: Medication Administration-Oral, Topical, Ophthalmic, Otic, Rectal

Total Time Allotted: 2 hours

Objectives:

 Utilize the "rights" of accurate medication administration.

 Administer various routes of medications.
 Implement nursing actions to prevent drug errors, including correct dosage calculations.
 Document the administration of medications.

Skills to be Performed/Topics:

 Skill 35-1 Administering oral medication

 Skill 35-10 (p 813-815) Administering Ophthalmic Instillations
 Skill 35-11 (p 815-817) Administering Otic Instillations
 Skill 35-12 (p 818-820) Administering Vaginal Instillations
 Client Teaching (p 822) Using a metered-dose inhaler

Pre-work Required by Students :

 Complete didactic and lab modules for Medication Administration

 Review:
o Table 35-1 (pg. 751) Types of Drug Preparation
o Table 35-4 Allergic Responses
o Table 35-5 Routes of administration
o Table: 35-6 Do Not Use List
o Box: 35-1 Essential Parts of a Drug Order
o Box 35-6 10 Rights of Medication Administration
 Answer the need to know & critical thinking questions on this guide and submit to
Canvas at least one hour prior to coming to lab
 ATI Pre-work completed and submitted 1 hour prior to lab:
o Skills modules 2.0
o Medication Administration 1
o Medication Administration 2
o Enemas
o Dosage calculations modules:
o Safe medication Administration
o Oral Medication

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

o Active learning templates NURSING SKILLS for: Oral medication

administration, Topical medication administration, Rectal medication
administration, Ophthalmic medication administration, Otic medication
administration

Need to Know

 Stat order: A stat order indicates that the medication is to be given immediately and only
once

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 760). Pearson Education. Kindle Edition.
 Single order: one-time order is for medication to be given once at a specified time

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 760). Pearson Education. Kindle Edition.
 Standing order: may or may not have a termination date. A standing order may be
carried out indefinitely

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 760). Pearson Education. Kindle Edition.
 PRN order: or as-needed order, permits the nurse to give a medication when, in the
nurse’s judgment, the client requires it

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 760). Pearson Education. Kindle Edition.
 Oral: Oral administration is the most common, least expensive, and most convenient
route for most clients. In oral administration, the drug is swallowed.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 758). Pearson Education. Kindle Edition.
 Sublingual: placed under the tongue, where it dissolves. In a relatively short time, the
drug is largely absorbed into the blood vessels on the underside of the tongue.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 758). Pearson Education. Kindle Edition.
 Buccal: means “pertaining to the cheek.” In buccal administration, a medication (e.g., a
tablet) is held in the mouth against the mucous membranes of the cheek until the drug
dissolves

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 759). Pearson Education. Kindle Edition.
 Topical: those applied to a circumscribed surface area of the body. They affect only the
area to which they are applied.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 759). Pearson Education. Kindle Edition.
 Dermatologic: preparations—applied to the skin

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 759). Pearson Education. Kindle Edition.
 Inhalations: 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.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 759). Pearson Education. Kindle Edition.
 Pruritis: Itching of the skin with or without a rash

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 753). Pearson Education. Kindle Edition.
 Angioedema: Edema due to increased permeability of the blood capillaries

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. 753). Pearson Education. Kindle Edition.
 Anaphylaxis: A severe reaction is called anaphylaxis and can produce respiratory
collapse if emergency treatment is not immediately instituted.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals

of Nursing (Kozier)) (p. A9). Pearson Education. Kindle Edition.

Medication Administration Critical Thinking Questions:

What are the 10 rights for accurate medication administration? (p. 773)
Right Dose, Right Time, Right Route, Right Client, Right Education, Right Documentation,
Right to Refuse, Right Assessment, Right Evaluation
Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of
Nursing (Kozier)) (p. 773). Pearson Education. Kindle Edition.

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

So you have received an order for your patient that you think is inappropriate. What will
be your first step?
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.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 762). Pearson Education. Kindle Edition.
What is medication reconciliation and what are the 2 times the nurse performs this?
the process of creating the most accurate list possible of all medications a patient is taking—
including drug name, dosage, frequency, and route—and comparing that list against the
physician’s admission, transfer, and/or discharge orders, with the goal of providing correct
medications to the patient at all transition points within the hospital. All facilities accredited by
The Joint Commission must have protocols and processes in place for medication reconciliation,
particularly in the following transition areas: on admission, during transfer between units, and at
discharge.
Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of
Nursing (Kozier)) (p. 769). Pearson Education. Kindle Edition.
What are the parts for a drug order? How do written, versus verbal, vs telephone orders
differ? (p. 761)
Descriptive information about the client: name, address, and sometimes age • Date on which the
prescription was written • The Rx symbol, meaning “take thou” • Medication name, dosage, and
strength • Route of administration • Dispensing instructions for the pharmacist, for example,
“Dispense 30 capsules” • Directions for administration to be given to the client, for example,
“take on an empty stomach” • Refill and/or special labeling, for example, “Refill × 1”

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 761). Pearson Education. Kindle Edition.

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

What is the reason for using a lubricant such as K-Y jelly when inserting a suppository?
lubricant reduces irritation of the mucosa.
Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of
Nursing (Kozier)) (p. 820). Pearson Education. Kindle Edition.
When a suppository is given to a patient who is lying in bed, in what position should the
patient be placed?
Assist the client to a left lateral or left Sims’ position, with the upper leg flexed.
Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of
Nursing (Kozier)) (p. 820). Pearson Education. Kindle Edition.
What is the rationale for removing the old medication patch before placing a new one?
Duplication of patches may cause adverse reactions. Remove the old patch and clean the skin
thoroughly before applying a new one.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 812). Pearson Education. Kindle Edition.
What is the rationale for placing time, date, and initial on a patch?
It is important to keep track of the transdermal patches. Some patches are clear and may be
difficult to see and, as a result, be overlooked.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 812). Pearson Education. Kindle Edition.
What is the rationale for not touching the eye drop vial against the eye?
When instilled into the conjunctival sac, drops will not harm the cornea as they might if dropped
directly on it. The dropper must not touch the sac or the cornea.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 814). Pearson Education. Kindle Edition.

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

What is the rationale for holding the lacrimal duct when giving certain eye drops?
Pressing on the nasolacrimal duct prevents the medication from running out of the eye and down
the duct, preventing systemic absorption.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 814). Pearson Education. Kindle Edition.
What is the rationale for counting narcotics and controlled substances on a regular basis
and before removing a medication from the pyxis?
If an agency uses a manual recording system for controlled substances, check the narcotic record
for the previous drug count and compare it with the supply available. Some medications,
including narcotics, are kept in plastic containers that are sectioned and numbered.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 777). Pearson Education. Kindle Edition.
How does food in the stomach affect the rate of absorption of medications?
Some orally administered medications are absorbed more quickly if the stomach is empty,
whereas other medications have a more rapid absorption when administered with food.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 757). Pearson Education. Kindle Edition.
A patient has a history of decreased liver function and kidney function. What would the
nurse need to know before administering a new oral medication that the provider has
ordered?
Decreased liver function hinders biotransformation of drugs

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 774). Pearson Education. Kindle Edition.

June 7, 2020
 NURS 203 Instructor Lab Guide: Week 1 Lab 1

Your patient has a gastrostomy tube. Why is it important to make sure the medications are
not administered whole or undissolved through the tube?
Always check with the pharmacist to see if the client’s medications come in a liquid form
because these are less likely to cause tube obstruction.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 780). Pearson Education. Kindle Edition.

There are 3 times medications are checked prior to administration. What are the 3 times?
Read the MAR and remove the medication(s) from the client’s drawer. Verify that the client’s
name and room number match the MAR. • Compare the label of the medication against the
MAR. • If the dosage does not match the MAR, 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 MAR. THIRD CHECK Recheck the label on the
container (e.g., vial, bottle, or unused unit-dose medications) against the MAR before returning
to its storage place OR before giving the medication to the client.

Berman Audrey. Kozier & Erb's Fundamentals of Nursing (2-downloads) (Fundamentals of

Nursing (Kozier)) (p. 772). Pearson Education. Kindle Edition.

June 7, 2020