Administration of drugs/Medication

Fundamental of nursing BSc Nursing I year

1. ADMINISTRATION OF MEDICATION PRESENTED By:- Mr. MADAN MOHAN GUPTA, ASSISTANT PROFESSOR, FACULTY OF NURSING, RAMA UNIVERSITY, KANPUR

2. FACULTY OF NURSING

3. Administration of medication refers to dispensing of medicine or drug to a patient for remedial and diagnostic purposes.

4. To Promote Health To Prevent Illness. To Help In Diagnosis. To Alleviate Illness. Therapeutic Purpose .

5. The rights of medication administration are following: The Right Patient (Identification ) Right drug Right dose Right route Right time Right Documentation Right reason The right of the parents and child to know

6. Pharmacology is the study of the action or effect of chemical substances on living systems. It refers to the study of origin, chemical structure, preparation, administration, action, metabolism and excretion of drugs. Pharmacotherapeutics - It deals with the relative effects of drugs in human systems for various disorders. Pharmacodynamics - it is the study which deals with theories of drug action . Pharmacodynamics is the study of how drugs have effects on the body.

7. P harmacokinetics - is the study of how drugs enter the body, reach their site of action, are metabolized and eliminated from the body. Absorption - it is the passage of drug molecules into the blood and it depends on the physical Properties of the drug, route of administration and interaction with drugs. Distribution- after absorption drug is distributed within the body and ultimately to the specific site of action . Excretion- when drug is metabolized they exit the body through the kidneys, liver, bowels, and exocrine glands

8. Metabolism- after reaching to the site of action drug is metabolized into inactive form detoxified and degraded chiefly by liver and by others like lungs, kidneys, blood and intestine . Drug- it is the substance used in the diagnosis, treatment, cure, relief or prevention of disease. Generic name- T his name is proposed by the company that first propose the drug . it is the name given before a drug becomes official . Official name - it is the name under which it is listed in one of the official publications.

9. Chemical name - it is the name by which a chemist knows it and indicates the ingredients of the drug. I t provide an exact description of drugs composition. Example- acetyl salicylic acid- asprin Trademark/ brand name- is the name given by the drug manufacturer. A drug may have many different trade name Therapeutic effect:- Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. Side effects- unintended but anticipated secondary effects which may be harmless or injurious. Toxic effect - usually develop after a prolonged intake of high dose of medication due to accumulation of drug in blood because of impaired metabolism or excretion

10. Idiosyncratic reaction: is a highly unpredictable response that may be manifested by an over response, under response, or atypical response. For example, 1 of 40,000 clients will develop aplastic anemia after receiving chloramphenicol (an antibiotic ). Lethal effect- excess amount of drugs in the body causes lethal effect that may result in death also. Allergic reaction: – it is an unpredictable immunological; response after an exposure to initial dose of medication. It may be mild to severe.

11. Drug abuse - it is inappropriate intake of substances either continually or periodically. It has two main facets drug dependence and drug habituation. Cumulative effect: The state in which a series of repeated actions have an effect greater than the sum of their individual effects; noted especially in the repeated administration of drugs

12. Rx: A medical prescription: The symbol "Rx" is usually said to stand for the Latin word "recipe" meaning "to take." It is customarily part of the superscription (heading) of a prescription. The prescription is one of the most important therapeutic transactions between physician and patient. The word "prescription" derives from pre (before) and "script" (writing written) which denotes that it is an order that must be written down before or for the prescription and administration of drug

13. “ A medical prescription (Rx) is an order (often in written form) issued by a qualified health care professional (e.g. physician and dentist) in the form of instruction that govern the plan care for an individual patient”. The nurse should identify all current prescription drugs and describe: Why the drug was prescribed and by whom The drug’s dosage, route, and frequency The client’s knowledge of the drug’s action: side and adverse effects

14. Simple prescription: Those written for a single component or prefabricated product and not requiring compounding or admixture by the pharmacist. Compound or complex prescription: Those written for more than a single component and requiring compounding. E-prescriptions (electronic prescription): The use of electronic means for the generation and transmission of prescriptions is used and accepted in some countries.

15. In-patient prescription: a medication order form used in the hospital setting. In addition, other forms may be used within a hospital by specialized units such as infectious disease, cardiac care, pediatrics, and others. Narcotic prescription : contains a narcotic substance or other habit forming drugs. It must contain in addition to the contents of the simple prescription, the address of the patient, the narcotic registry number of the prescriber. Such prescription should be written by ink or typewriter. The quantities of the narcotic substance must be written in words and numbers.

16. A prescription consists of the following parts:- Prescriber’s name, degree, address and telephone number. In the case of prescriptions coming from a hospital or a multicenter clinic, the hospital or clinic’s name, address and telephone numbers appear at the top. In such a case, the physician’s name and degree would appear near his/her signature. Patient’s name, address, age, and the date of prescription. The Superscription, which is represented by the Latin sign (Rx) . This sign represents ‘‘take thou’’ or ‘‘you take’’ or ‘‘recipe.’’ Sometimes, this sign is also used to denote the pharmacy itself.

17. The Inscription is the general content of the prescription. It states the name and strength of the medication, either as its brand or generic name . In the case of compounded prescriptions, the inscription states the name and strength of active ingredients The Subscription represents the directions to the dispenser and indicates the type of dosage form or the number of dosage units. The prescriber’s signature.

18. The Sign, also known as transcription represents the directions to the patient. These directions are written in English or Latin or a combination of both. The refill directions, in which the information about how many times, if authorized, a prescription can be refilled is provided. Other information, such as ‘‘Dispense as Written .’

19. Nurses must administer numerous drugs daily in a safe and efficient manner. The nurse should administer drugs in accord with nursing standards of practice and agency policy. The safe storage and maintenance of an adequate supply of drugs are other responsibilities of the nurse. The nurse documents the actual administration of medications on the medication administration record, or MAR. The MAR is a medical record form that contains the drug’s name, dose, route, and frequency of administration. Drug data are entered either by the nurse when transcribing the order (handwritten onto the form) or by the pharmacist when dispensing the order.

20. To protect the client from medication errors, nurses have traditionally used as a guideline the ‘‘5 rights’’ of drug administration. The 5 rights help prevent medication error; however, errors can still occur even when nurses diligently follow the 5 rights . The Right Patient (Identification ) Right drug Right dose Right route Right time

21. A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

22. Nurses have learned the five rights as a guideline to safe administration of medications. If the nurses are not following the 5 rights of safe drug administration then the medication errors can be happened . Medication errors must be reported in a timely manner. Nurse must inform the prescribing practitioner of the error made. Event reports are required in some institutions to document medication errors

23. Factors associated with health care professionals Lack of therapeutic training Inadequate drug knowledge and experience Inadequate knowledge of the patient n Inadequate perception of risk Overworked or fatigued health care professionals Physical and emotional health issues Poor communication between health care professional and with patients

24. Factors associated with the work environment Workload and time pressures Distractions and interruptions (by both primary care staff and pt.) Lack of standardized protocols and procedures Insufficient resources Issues with the physical work environment (e.g., lighting, temperature and ventilation)

25. Factors associated with patients Patient characteristics (e.g., personality, literacy and language barriers) Complexity of clinical case, including multiple health conditions, poly pharmacy and high-risk medications Factors associated with medicines Naming of medicines Labelling and packaging

26. Factors associated with computerized information systems Difficult processes for generating first prescriptions (e.g. drug pick lists, default dose regimens and missed alerts Difficult processes for generating correct repeat prescriptions Lack of accuracy of patient records Inadequate design that allows for human error

27. Factors associated with tasks Repetitive systems for ordering, processing and authorization Patient monitoring (dependent on practice, patient, other health care settings, prescribe Primary-secondary care interface. Limited quality of communication with secondary care .

28. T he following strategies to reduce medication errors in primary care Educating primary care providers about common causes of medication errors; Providing simple tools to assist primary care providers in safe medication prescribing and use process; Considering how patients can be actively involved in medicine management Providing patient engagement tools to address non-adherence Ensuring that pharmacists actively review prescriptions ;

29. Encouraging and supporting use of medication reconciliation by clinicians. Completely write out the prescription, including the drug name and dosage regimen. The full dosage regimen includes the dose, frequency, duration, and route of administration of the drug to be administered. When writing out a dose, do not use a trailing zero and do use a leading zero .

30. For veterinarians, when calling in or writing out a human drug prescription for animals, verbally state or write out the entire prescription because some pharmacists may be unfamiliar with veterinary abbreviations. Use a computerized prescription system and electronic delivery of prescriptions to minimize misinterpretation of handwriting.

31. Institutions should educate healthcare providers and other employees on proper use of abbreviations. Report adverse events that stem from medication errors or abbreviations errors to the FDA; these events can be used to further inform and expand recommendations for safety. Practitioners, including physicians, nurses, pharmacists, physician assistants and nurse practitioners, should be very familiar with the abbreviations used in medical practice and in prescription writing. All drug names, dosage units, and directions for use should be written clearly to avoid misinterpretation

32. Following a different drug formulation available:-

33. Tablets :  These are most common forms of drugs available in the market. They are economical, easy to handle and consume by the patient. They can be swallowed with a glass of water. They are of different shapes like circular, rectangular etc. They are also of different type like film coated, sugar coated ones etc. Capsules : These are similar to tablets in the ease of administration. They have two gelatin shells in which active drug ingredients are packed. They are also quite popular like tablets but are comparatively expensive to make. The advantage is they can include liquid form of drug and also incompatible formulations in their shells .

34. Chewable tablets:  These are similar to tablets in appearance but they are large in size with attractive color, odor and sweet taste. They are meant to be chewed in the mouth for the drug to release and show its effects. Eg : Antacid tablets. Powders:  These are solid dosage forms and are in powder format. They are used for dusting and external applications like on wounds, cuts, skin infection etc

35. Solutions:  These are very popular formulations. Here the drug is dissolved in a suitable solvent. Swallowing of fixed volume of liquid solution provides sufficient drug needed for cure by the body. These solutions are clear liquids but can have color, taste and also acceptable odor. These are commonly used for old age patients and children. The advantage is faster on set of action and also better absorption of drug in comparison to tablets. Eg : Oral syrups. eye drops, ear drops, nasal drops etc.

36. Emulsions:  This is an interesting formulation where in water insoluble drug is made into liquid formulation by addition of soap like emulsifying agent. This emulsifying agent disperses the water insoluble drug as  fine particles  or goblets within the water by forming a film or cover around the drug particles. Suspensions:  These are liquid formulation but the difference is they have fine solid  particles dispersed in an aqueous liquid. These formulations tend to form cream when kept undisturbed for long time. Hence they have a label “ shake well before use .” This helps the settled cream to disperse for uniform dosing of drug . Gases:  Pure gases like oxygen, carbon dioxide and nitrogen are also used as drug.

37. Ointments:  These are semi solid dosage forms. They can be solutions, suspensions or even emulsions but have high viscosity. They are intended for application on skin and other surface by spreading. They are easy to use and have an advantage of local effect to minimize adverse effects of drugs . Aerosols:  These are powder or liquid formulations which are applied by spraying. The formulation is released as gaseous dispersion and so can reach deeper locations like respiratory tract Suppositories :  These are solid dosage forms which are intended for insertion in the anus. They release drug slowly and good for local action.

38. 1. Oral solids Tablets: compressed or molded substances to be swallowed whole, chewed before swallowing, or placed in the buccal pocket or under the tongue (sublingual) Capsules : substances encased in either a hard or a soft soluble container or gelatin shell that dissolves in the stomach Caplets: gelatin-coated tablets that dissolve in the stomach E nteric-coated : coated tablets that dissolve in the intestines Time-release capsules: encased substances that are further enclosed in smaller casings that deliver a drug dose over an extended period of time Sustained-release: compounded substances designed to release a drug slowly to maintain a steady blood medication level

39. 2. Topical Liniments: substances mixed with an alcohol, oil, or soapy emollient that are applied to the skin Ointments: semisolid substances for topical use like Cream ,  gel ,  liniment  or  balm ,  lotion , or  ointment , etc. Pastes: semisolid substances, thicker than an ointment, that are absorbed slowly through the skin Transdermal patches: contain medication that is absorbed through the skin over an extended period of time Suppositories: gelatin substances designed to dissolve when inserted in the rectum, urethra, or vagina Ear & eye drops   Powder/Talc

40. 3. Inhalants:- Inhalations : drugs or dilution of drugs administered by the nasal or oral respiratory route for a local or systemic effect 4. Solution Solutions: contain one or more soluble chemical substances dissolved in water Enemas: aqueous solutions for rectal instillation Douches: aqueous solutions that function as a cleansing or antiseptic agent that may be dispensed in the form of a powder with directions for dissolving in a specific quantity of warm water Suspensions: particle or powder substances that must be dissolved in a liquid (shaken vigorously) before administration

41. Emulsion: a two-phase system in which one liquid is dispersed in the form of small droplets throughout another liquid Syrups: substances dissolved in a sugar liquid Gargles: aqueous solutions Mouthwashes: aqueous solutions that may contain alcohol, glycerin, and synthetic sweeteners and surface-active flavoring and coloring agents Nasal solutions: aqueous solutions in the form of drops or sprays Optic (eye) and otic (ear) solutions: aqueous solutions that are instilled as drops Elixirs: Non aqueous solutions that contain water, varying alcohol content, and glycerin or other sweeteners

42. Under the law nurse are responsible for their own actions regardless of a written order. All the nurses must know the maximum and minimum dose of every drug that they administered. Nurse have ethical & legal responsibility to understand the problem of person using drug improperly. The nurse should ensure that patient had a complete information regarding, benefit ,side effects, and toxic effects of the medication.

43. Nurse should know about the restricted use of narcotics, which should be kept in safe custody. All account should be maintained for the administration of these drugs. When involve in the experimental drug programme the nurse legal obligation is to fully informed about any investigational medication, which she will be administering to a patient.

44. Absorption:- A bsorption is the passage of drug molecules into the blood. Most of the drugs, except those applied topically for local effect, must enter the systemic circulation to exert a therapeutic effect. Factor influencing the absorption: – Route of administration Ability of the drug to get absorbed Condition at the site of absorption Oral route of administration of medicine causes slower absorption whereas IV injections produce most rapid absorption .

45. Route has different influence on drug absorption depending on the physical structure of the tissues. Skin is relatively slow in the absorption, whereas the mucus membrane and respiratory airway allow quick drug absorption because of high vascularity of the area . Solutions and suspensions already in a liquid state are absorbed more rapidly than capsules and tablets. After the drug is absorbed it is distributed within the body to tissues and organs and ultimately to its specific site of action.

46. When a drug reaches its site of action it is metabolized into an inactive form that is more easily excreted. This biotransformation occurs within the liver. Lungs, kidneys, blood and intestine also metabolise drugs. Excretion- after drugs are metabolized they exit the body through kidneys, liver, bowel, lungs and exocrine glands, the exocrine glands excrete liquid soluble drugs

47. Then it metabolize an inactive form that is more easily excreted. These biotransformation occur under the influence of enzymes that detoxify, degrade and remove biological active chemicals. Most biotransformation occur in liver, kidney, lungs and intestine. Excretion- after drug are metabolized they exit the body through kidney, liver, bowel, exocrine gland.

48. Body size Age Sex: females required less dosages Species and races Route and Time of drug administration Environmental factors like smoking, alcoholism etc. Body weight & Surface area Genetic factors Pathological conditions Diet & Nutritional status Psychological effects like grief, tension, stress etc

49. Abbreviation Definition a.c. or ac before meals p.c. or pc after meals Am Before noon Pm After noon Alt.die Alternate days o.m Each morning o.d Daily/ once in a day o.n Each night h.s At Bed time h.n Tonight c.m Coming morning s.o.s If necessary in emergency p.r.n. or prn   When required b.i.d/ bd Twice a day t.i.d / tds Three times a day Qid/ q4h Four times in a day Qhs Before bed stat At once Rep. Repeat h hour q every Q6H Every 6 hourly po Per orally DA Right ear AS Left ear AU Each ear H Hypodermic Inj Injection IM Intramuscular IV Intra venous SC / SQ Sub coetaneous od (oculus dexter) Right eye os (oculus sinister) Left eye OU Both eyes Os mouth tbsp tablespoon 5X a day five times a day q.6h every six hours qod every other day Tab Tablet Qd Every day q3h Every 3 hours gt (gutta) Drop syr Syrup Alt.h Alternate hours Cap Capsule Rx Treatment/ advice for c with

50. Route of administration A route of administration in pharmacology is the path by which a drug , fluid, poison, or other substance is taken into the body . The various routes of drug administration are : Oral- most common ,convenient, less expensive, and safe for most of patient. Sublingual or buccal - drug is placed under the tongue for slow absorption Advantage- Drug can be administered for local effect & rapidly absorbed in blood steam Disadvantage- Drug may remain under the tongue until dissolve or absorbed

51. Topical application: application of drug on the skin usually by friction rubbing(topical) Advantages:- It can show local effect. That is the drug acts only at the site of application and not on whole body like in oral route. Rapidly absorbed. Ex : Powders , ointments , lotions etc.

52. Implantation- it is planting or putting in of solid drugs into the body tissue. Insertion- introducing a solid form of drug into the body orifices . Advantage- Provide local and therapeutic effect Disadvantage- Drugs have to be preserved at low temperature.

53. Inhalation & nebulization- this method have local and systemic effect by nebulizer or ventilator to carry the drug into the lungs by breath. Advantage- Rapid localized relief Can be administered to an unconscious client Disadvantage- Used only for respiratory system

54. Instillation - it is putting of drug in liquid form in a body cavity or body orifices e.g.- Eye, rectum Advantage- Provide local and therapeutic effect Drug released at slow rate Disadvantage- Limited use Dose absorbed is unpredictable

55. Parentral route- Parental administration involves giving drug by a route through injection in body tissue. It is giving of the medication outside the elementary tract. It is a method of delivering the drug directly into the blood stream without having to pass the oral or alimentary mucous layer. These are

56. Types of parentral routes Intra-venous injection : This route delivers drug directly into the blood veins. The formulation is given as a single lump or slowly by drip over a period of hours. It is route which shows fastest action compared to all others. This route is regularly used in times of emergency and critical care.

57. Intramuscular: Here the drug is given directly into the large skeletal muscles. The drug is released slowly from the sites of injection as the blood flows through. Since the muscle has less sensory nerves, irritant drugs can be given without pain.

58. Intra-peritoneal: Administration of drugs into the peritoneal cavity is called intra- periotneal injection. This method is less used in humans but widely used in research animals used for drug testing . The injection is done at the abdominal region below the skin into peritoneal cavity.

59. Subcutaneous: Here drug is injected just below the skin. This route is used for vaccines, disease diagnosis etc. The drug is deposited into the loose subcutaneous tissue which has many nerves. So irritant drug must be avoided as it can be painful. The rate of drug absorption is slower than that from intramuscular injection. It is of different types like

60. Intrathecal : Here drug is administered into the spinal cord. Epidural: The drug is injected near the spinal cord such that it affects the local nerves. Mostly used in anesthesia during surgery, delivery etc Intra-dermal injection: Here drug is given into the skin so it form a small bulge. Used for vaccination and drug allergy testing. Intracardiac : The injection is directly given into the heart.

61. Intra-osseous:- The injection is done directly into the bone marrow. The needle has to pass through the solid bone and reach the marrow. This is route is possible in children as the large bones are not completely hardened and are a bit soft to allow the penetration of the needle.

62. Stat Orders: A stat order is an order for a single dose of medication to be given immediately. Stat drugs are often prescribed in emergency situations to modify a serious physiological response; a stat dose of nitroglycerin may be ordered for a client experiencing chest pain. Single-Dose Orders: Single-dose orders are one-time medications or may require the administration of drops or tablets over a short period of time. The nurse should administer single-dose orders only once, either at a time specified by the prescribing practitioner or at the earliest convenient time

63. Standing Orders: Standing orders are also referred to as scheduled orders because they are administered routinely as specified until the order is canceled by another order. prn Orders: A drug may be ordered on a prn (given as needed) basis as circumstances indicate. The drug is administered when, in the nurse’s judgment, the client’s condition requires it. Routine order: - Given within 2 hours of being written and carried out on schedule.

64. Verbal and telephone orders:-

65. All orders should be written clearly and legibly, and the drug order should contain seven parts: The name of the client The date and time when the order is written The name of the drug to be administered The dosage The route by which it is to be administered and special directives about its administration The time of administration and frequency The signature of the prescribing practitioner writing the order Drug prescriptions written in settings other than acute care facilities may also specify whether the generic or trade name of the drug is to be dispensed, the quantity to be dispensed, and how many times the prescription can be refilled.

66. Definition : Administration of medicine through mouth for prophylactic and therapeutic effects .

67. To promote health- e.g. iron supplement, vitamin, calcium etc To prevent illness e.g. vaccines To help in diagnosis e.g. barium used in x-ray, contrast medicine To alleviate illness e.g. analgesics Therapeutic purpose e.g. antibiotics for infection To prevent the disease and take supplement in order to maintain health To cure the disease To give as a symptomatic treatment

68. For unconscious patient. For uncooperative patient. After oral and gastric surgeries. Oral cancer. Before diagnostic tests and operation.

69. Explain the procedure. Check the identification of the patient of the patient. Check the diagnosis. Be sure for the purpose of giving medication. Confirm the previous dose given or not. Check for any contraindication before giving any medication. Check the method and nature of administration of the drug. Check the patient is able to swallow. Assist the patient is able to a sitting position, if possible. Protect the patient’s clothing with a towel.

70. Dr’s prescription with prescribed Medication A medicine glass (ounce glass), a teaspoon or a dropper. A glass or feeding cup with drinking water. A duster or a towel. Mortar and pestle. A kidney tray and a paper bag. Medication recording card Pill crusher/ tablet cutter if needed

71. Wash hands with water and soap Read the physician’ prescription and enter it in the medicine card. Make sure that all the medicines are entered correctly. Take out the medicine from the shelf after reading the medicine card. Check the medicine table thrice, check the expiry date of the medicine. Take out tablets or capsules from the bottle into the lid of the container first. Pour syrup from the side of the bottle away from the label. Do not pour an excess amount and wipe the mouth of the bottle with a clean duster and close it tightly. Do not touch with hands. Take the tray to the bed side .

72. Place the card with medicine on the tray. Explain the procedure to the patient/client and the family. Identify the patient: By calling out his name ob by asking the patient to repeat his name. Verify identification with the nurses’ record and medicine chart. Provide proper & comfortable position to the patient. Instruct the patient to take a deep breath and consume little water if necessary.

73. Administer the medicine by instructing the patient/client to consume the medication and water thereafter as much as possible. Stay with the patient until he has swallowed the medicine & observe for any side effects as desired duration. Replace all the articles at their appropriate place and wash Hands. Record the medications in the medication card .

74. Remove the towel and wipe the face with it. Position the patient for good body alignment .tidy up the bed. Repeat the articles to the utility room. Wash hands. Recording the medication. Observe any expected and unexpected reactions. Returns the medication card to the storage area.

75. Before administration of the drug: Identify the patient by checking the medication card. Check the physician prescription before preparing the drug. Check the label of containers thrice before preparing the drug. Check the expiry date. Always use a calibrated measure while prepare the drug. Shake the liquid medicine before pouring into ounce glass; pour it away from the label. Wipe the mouth of the bottle, close it tightly and replace it at the proper place.

76. Hold the ounce glass at eye level and place the thumb on the neck of the ounce glass to which medicine is to be poured. Read the lower level of the meniscus in the ounce glass. When taking the tablets or capsules do not touch them with the hands, drop them from the container to its lid and them to the medicine cup. Do not put back the medicine once it is taken out of the container. Do not use the medicine if there is change in color, odour or consistency. Prepare the drug just before the time of administration and do not leave the drug in the medicine tray

77. During administration of medication: Observe the right of medication: Right patient- Read the patient’s name on his medicine Chart. Read the physician’s prescription Call the patient by name and ask him to repeat the name.

78. Right Drug: Read the physician’s order. Make sure that the drug is written correctly in the medicine card. Take care of the drug whose names sound alike. Check the drug thrice as mentioned before. Avoid conservation or anything that distracts the mind while preparing or administering the drug. Be sure of the trade names of the medicine. If doubtful, confirm it. Avoid accepting verbal orders. In an emergency get written orders as soon as possible.

79. Right Time: Give the medicine near the prescribed time. Give the medicine before food if it is so prescribed, or at bed time or in the normal hours as ordered by the physician. Verify schedule of medication with order. Date Time Specified period of time Check last dose of medication given to patient. Administer medication within 30 minutes of schedule

80. Right Dose: Check the instruction to confirm the correct dose. Check the patient’s age and weight to get the correct. Dose measure accurately The medicine should be carried to the patient without Spilling it out of the container. Check the expiry date of the drug before administration. Right Method Check the physician‘s note to determine the route of administration. Be sure the medicine is given to the patient in preposition. Stay with the patient until he has swallowed the medicine. Never leave the medicine with the patient. Any mistake in giving the medicine must be reported immediately .

81. Right Education Inform patient of medication being administered. Inform patient of desired effects of medication. Inform patient of side effects of medication. Ask patient if they have any known allergies to medication. Right Evaluation Assess patient for any adverse side effects. Assess patient for effectiveness of medication. Compare patient’s prior status with post medication status. Document patient’s response to medication

82. After administration of drug: Record only the medicine, which you have administrated. Record the date, time, name and dose of the drug. Never record the medication before it is given. Record the effect observed.

83. Ease of administration as even the patient can take medicine on his own without others help. The chances of taking improper dose are absent. This is non-painful, inexpensive & safe route. Also dosing by this route allows no wastage of drug.

84. In case of emergency this route is not preferred. Inappropriate for the patient with oral surgery, altered consciousness. Unpleasant taste, discoloration of tooth. Cannot be given before surgery Drug may be inactivated by gastric juices result in poor absorption.

85. Parentral administration involves giving drug by a route through injection by a body tissue. Parenteral refers to the path by which medication comes in contact with the body. Parenteral medications enter the body by injection through the tissue and circulatory system. Injection medications are absorbed more quickly. Parenteral medications can be effective and safe when prepared and administered correctly. However, because they are invasive and absorbed readily and quickly into the body, there are numerous risks associated with administering them.

86. Check doctor's order Check the expiration for medication - drug potency may increase or decrease if outdated Observe verbal and non-verbal responses toward receiving injection. It can be painful, client may have anxiety, which can increase the pain  Practice asepsis to prevent infection. Apply disposable gloves  Use appropriate needle size. To minimize tissue injury  Plot the site of injection properly. To prevent hitting nerves, blood vessels, bones  Use separate needles for aspiration and injection of medications to prevent tissue irritation  Introduce air into the vial before aspiration. To create a positive pressure within the vial and allow easy withdrawal of the medication 

87. Allow a small bubble (0.2 ml) in the syringe to push the medication that may remain Introduce the needle in quick thrust to lessen discomfort Either spread or pinch muscle when introducing the medication. Depending on the size of the client Minimized discomfort by applying cold compress over the injection site before introduction of medication to numb nerve endings  Aspirate before introduction of medication. To check if blood vessel had been not hit.   Support the tissue with cotton swabs before withdrawal of the needle. To prevent discomfort of pulling tissues as needle is withdrawn  Massage the site of injection to haste absorption  Apply pressure at the site for few minutes. To prevent bleeding Evaluate effectiveness of the procedure and make relevant documentation

88. Parental administration involves giving drug by a route through injection by a body tissue. It is giving of the medication outside the elementary tract. It is a method of delivering the drug directly into the blood stream without having to pass the oral or alimentary mucous layer. There are four routes for parenteral medications these are:- Intradermal (ID ), Subcutaneous (SC or SQ ), Intramuscular (IM ) & Intravenous ( IV)

89. In this route the drug is given directly into the large skeletal muscles. The drug is released slowly from the sites of injection as the blood flows through. Since the muscle has less sensory nerves, irritant drugs can be given without pain. Advantage – can administered large amount Disadvantage- can irritate tissue and cause pain, Effect is slow than I/V & Small amount to be administered .

90. The upper arm: The deltoid muscle is the most common site for vaccines. This muscle is in the upper arm near the shoulder. It can only receive small volumes of medication, usually 1 milliliter or less. Therefore, doctors do not use it for drugs that require larger quantities. People self-administering medication rarely use the deltoid, as an injection site, because it is difficult for them to reach. To find the deltoid muscle, a person feels for the bone at the top of the upper arm. Two finger-widths below this, there is a triangular muscle. The needle should enter the triangle's center.

91. The Hip:- Healthcare professionals often give intramuscular injections into the ventrogluteal muscle of the hip. This muscle is a very safe injection site for adults and infants more than 7 months old because it is thick and located away from major nerves and blood vessels. But it can be challenging to self-administer medication into the hip. To locate the ventrogluteal muscle on someone else, place the heel of the hand on the hip, with the fingers pointing toward the head. The thumb should point toward the groin. Position the index and middle fingers into a V then administer the shot in the middle of the V

92. The thigh: Typically, people who need to self-administer injections use the vastus lateralis muscle in the thigh. To locate the correct spot, imagine dividing the thigh vertically into three equal parts. Give the injection into the outer top part of the middle section.

93. The buttocks: Before doctors began using the hip as an injection site, they used the dorsogluteal muscles in the buttocks. They tend to avoid using these muscles now because of the potential risk of injury to the sciatic nerve. People should avoid self-administering medications into the dorso gluteal muscles

94. Intravenous injection: This route delivers drug directly into the blood veins. The drug is given slowly by drip over a period of hours. It is routing which shows fastest action compared to all others. This route is regularly used in times of emergency and critical care. Advantage – rapid effect Disadvantage- drug distribution is slow if there is poor circulation & direct infection can be introduced.

95. In this the drug is injected just below the skin. This route is used for vaccines, disease diagnosis etc. The drug is deposited into the loose subcutaneous tissue which has many nerves. So irritant drug must be avoided as it may be painful. The rate of drug absorption is slower than that from intramuscular injection. Advantage – test dose for checking sensitivity of pt. Disadvantage- absorption is slow

96. In this the drug is given into the capillary-rich layer just below epidermis. In this the drug’s dosage contained in a small quantity of solution (0.01 to 0.1 ml ). Commonly used sites for ID injection are the Inner aspect of the forearm (upper chest and upper back beneath the scapula ). It is used for Vaccination/ immunizations Drug allergy testing Administer local anesthetics Diagnostic tests Advantage- Rapid action Disadvantage- requires sterile technique, required more experience personnel & Break skin barrier

97. Infection - due to improper sterilization Pyrogenic reaction- due to pyrogens presence in fluids. Allergic reaction Tissue trauma Pain & swelling Circulatory overload- due to large quantity of fluids

98. A needle syringe is a device used for injecting, removing or infusing fluids. They are most commonly known in health care settings for injecting medications and for use in removing blood from the body. Needles Available in different gauges – the smaller the number, the larger the gauge (inside diameter ) Length – long enough to penetrate the appropriate layers of tissue Most of the health organization used disposable syringe that are inexpensive and easy to use. Syringes coming in a no of sizes from 0.5 to 60 ml Syringes can differ in size and type, and they can be made of glass or plastic. The syringe chosen usually depends on its intended purpose.

99. Syringes are available in several different varieties. Most syringes are disposable. Syringes are available either with or without an attached needle. The volume of medication the syringe can hold determines the size of the syringe you should select. Standard- comes in 3ml,5 and 10ml Insulin syringe- 0.5 to 1 ml and are calibrated in unit insulin syringe that hold 0.5ml, designed especially for use with the ordered dose of insulin Tuberculin syringe- It has a long thin barrel with a pre attached thin needle. Syringe with capacity of 1ml. It is used for preparing a small precise dose for the infants and young children. Tuberculin syringe, use to administer small or precise doses such as pediatric dosages. It Should be used for doses of 0.5ml or less

100. The syringe consists of a plunger, barrel, hub, needle and the needle's protective cover. It is important that all parts of a syringe coming into contact with the body be kept free of contamination. Syringes consist the following parts: Plunger Barrel Hub Needle- protective cap The Plunger: - The plunger is located at the end of the syringe and can be made of clouded or colored glass or plastic. Its purpose is to fill or empty the barrel. The plunger is pulled back to fill the barrel and is pushed forward for emptying.

101. The Barrel: - The barrel is the part of the syringe that contains the fluid, whether it is a medication, blood or a solution drawn from the body. The barrel can range in size from 0.5 mL to 60 ml. The Hub/tip: - It is at one end of the needle and is the part that attaches to the syringe. The hub also functions to lock the needle in place while using the syringe for its desired function .

102. The Needle: - The needle consists of the shaft, lumen and bevel. Needles vary in length, size of the shaft and size of the lumen. A needle has three parts, the hub, the shaft, and the bevel . The shaft is the metal's length and is usually chosen depending upon the route and site of administration, physical mass of the client, and the thickness of the medication. The lumen, also known as the bore, is the hollow space within the needle. The diameter of the lumen is known by the needle's number gauge. The lumen is chosen with the same specifications as the shaft. The last part of the needle, the bevel , is the pointed end and determines the needle's sharpness .

103. Protective Cover/Cap: - The protective cover/cap is provided to maintain the needle's sterility. Needle sticks are a common way of transporting infections to health care providers and clients. The needle's bevel is covered to limit the amount of accidents that could happen involving needles and to ensure that only the intended client receives the needle stick. In an attempt to reduce contamination and increase safety, most needles are disposable and are thrown out after a single use.

104. The length of a needle is measured in inches from the juncture of the hub and the shaft to the tip of the point. Needle lengths range from 3/8 inch to 31/2 inches; some special use needles are even longer . The gauge of a needle, used to designate the size of the lumen, ranges from 27 (the finest) to 13 (the largest).

105. Ampule – glass or plastic container that is sealed and sterile (open with care). Vial – small bottle with rubber diaphragm that can be punctured by needle.