Medication Administration in nursing.pdf

explains how medication is administered

1. Medication
Administration
By Jester Jere
Nursing and Midwifery Department
Feb, 2024

2. Learning Outcomes
1.Definition of terms in medication/Drug administration.
2.Overview of Medication legislation
3.Explain the measures for safe medication administration
4.Discuss steps in medication administration
5.State factors that affect medication action
6.Competently calculate medication dosages
7.Explain developmental considerations in DA

3. Definitions
A Drugany substance that alters physiologic function with
the potential for affecting health positively or negatively
Medicationis a drug/chemical substance intended to elicit
a therapeutic effect.
It is administered for diagnosis, cure, treatment, or relief of
a symptom or prevention of disease

4. Drugs have natural sources (animal, plant, mineral)
e.g. vaccines, digoxin, and iron respectively.
They may also be synthesized in the laboratory e.g.
Bactrim

5. Concepts in Medication
Administration
•Pharmacokinetics–istheprocessbywhicha
Medicationmovesthroughthebodyandiseventually
eliminated.
•Pharmacodynamics–referstothephysiologicaland
biochemicaleffectsofaMedicationonthebody
•Therapeuticeffect–referstothemedication’s
desiredandintentionaleffect–analgesic,anti-
inflammatory
•Cumulativeeffect-Buildupofthemedicationsin
thebloodbecauseofimpairedmetabolismor
excretionleadingtotoxics

6. Side effects –refers to minor adverse effects, or
unintended secondary effects.
Adverse effect –is any effect other than a therapeutic
effect. Can be minor (e.g. constipation) or severe (e.g.
respiratory depression). Severe side effects.
Tolerance–occurs when a client develops a decreased
response to medication e.g. alcohol, nicotine, methadone

7. Allergic reaction-results from an immunologic response
to a medication to which the client has been sensitized.
The antigen-antibody reaction occurs immediately -fatal
Interactions–occurs when a medication’s effects are
altered by the concurrent presence of other medications
or food
A prescription is a written direction for the preparation
and administration of a Medication.

8. Types of Medication preparations
Aerosol spray or foam
Aqueous solution
Aqueous suspension
Caplet
Capsule
Cream
Pill
Powder
Suppository
Tablet
Gel/jelly
Liniment
Lotion
Lozenge
Ointment
Paste
Tincture
Transdermal patch
Syrup

9. Medication Standards and
Legislation
Standards are set to ensure Medication
uniformity in:
▪Strength
▪Purity
▪Efficacy
▪Safety
▪Bioavailability (readiness to produce a
Medication effect)

10. Legal aspects of Medication
administration
In Malawi the Pharmacy, medicine and Poisons Act No. 15
of 1988 controls the development and administration of
drugs
Nurses need to know their limitations in Medication
administration based on their scope of practice.
Nurses must also recognize the limits of their knowledge
and skills

11. Functioning beyond one’s limits is malpracticeand may put
a client’s life in danger.
A nurse must therefore clarify any incorrect order before
administering any Medication
Nurses should also follow institutional policy on the use of
controlled substances/drugs e.g. pethidine –verification
by two registered nurses

12. Ethical and Legal Issues in
Medication Administration
Nurses have a duty and responsibility to
ensure the safety of patients when
administering medications e.g. by using
the Five Rights Principle (5Rs)
Clients have a right to refuse to take
medication
Medication administration errors (MAEs)
due to malpractice or negligence are
acts of crime.
“Failure to disclose MAEs compromise patients and
societal trust”

13. Common Abbreviations used in
Medication Orders
P.O, per os= Orally, by
mouth
I.V = Intravenous
I.M = Intramuscular
PR = Per rectal
PV = Per Vaginal
PRN = Whenever necessary,
as needed
Stat = immediately, at once
OD = Once a day
BD/BID = Twice a day/12
hourly
TDS/ TID = Three times a
day/8 hourly
QID = 4 times a
day/6hourly
AM = In the morning/
before noon
PM = In the
afternoon/evening
Rx = Prescription
N/S= Normal saline
R/L= Ringers lactate
D5= 5% dextrose

14. Routes of Medication
administration

15. 1. Oral Medication Administration
The most frequently used method of medication
administration.
Oral -Taken by mouth through either swallowing
with water/chewed
Position the client in an upright position.
Have a glass of water available and encourage
a drink before and after giving the medication.

16. Oral Medication Administration
Other routes for oral medication
Sublingual –medication is placed under the tongue
Sublingual and dissolved
Buccal –the medication is held in the mouth against
the mucous membrane of the cheek until it dissolves.

17. Advantages of Oral Route
Advantages
Oral -the safest, most convenient, and least
expensive
For sublingual & buccal -More potent since acts
quickly because of the oral mucosa’s thin epithelium
and large vascular system, which allows the
Medication to quickly be absorbed by the blood.
17

18. Disadvantages of Oral Routes
Oral-slower acting than the other routes,
unpleasant taste, irritation of the gastric mucosa
Sublingual & buccal-If swallowed may be
inactivated by gastric juice
18

19. 2. Parenteral (injectable) from
Ampoules/Vials
Parenteralrefers to
injecting medication into
body tissues and includes:-
Intradermal-Dermis
Subcutaneous–
Subcutaneous tissue
Intramuscular –Muscle.
Intravenous-Vein.
Intraarterial–An artery
Intraosseous–The bone
Intrathecal/intraspinal –
into the spinal canal
Epidural–Epidural space

20. Advantages
Onset of Medication action faster than oral; Rapid
effect
Larger volumes can be administered
Medication more rapidly absorbed
Disadvantages
Breaks skin barrier therefore risk foe infection if
aseptic technique is not maintained.
20

21. Other Routes
Vaginal–Inserted into the vagina
Rectally–Inserted into the rectum
Installations and irrigations-applied to body
cavities e.g. ear drops or eye drops
Inhalations: administered into the respiratory tract
e.g. nebulizers and inhalers

22. Topical route: Drugs are applied to a circumscribed
surface area of the body. They have a local effect.
These include:
Dermatologic preparations-appliedto the skin

23. Components of Medication Orders
INDICATION OR
PURPOSE
e.g., Paracetamol 500mg po
tds for moderate pain
al aPRESCRIBER’S
SIGNATURE
For accountability and legal
purposes
Note:
- All Medication orders must be written clearly and correctly
- Always clarify with the prescriber any medication order that is unclear or
seems inappropriate

24. Types of Medication Orders
Routine or Standing Order –an order for a specific
number of days to be administered routinely e.g.
antibiotic
PRN Orders –for medication to be administered as
needed-depending on one’s judgment.
Standing Protocols –orders for medications to be
administered in specific situations with criteria for
administration outlined clearly for clients on a specific
unit
One-time Order or single dose –one-time or single
order for medications that will be given only once

25. Stat Order –one time or single order for medications
to be administered immediately
Verbal Orders -a situation when the prescriber and
the nurse are physically present in the same room.
Telephone & Fax Orders
Electronic Orders

26. Types of Medication Orders and
Examples
Stat order
◼Pethidine 100 mg IM stat
Single order
◼Pethidine 100 mg before surgery
Standing order
◼Multivitamin 1 capsule po daily
◼Benzylpenicillin 3 MU IV q 6 h x 5 days
Prn order
◼Diclofenac 75 mgs IM prn

27. Actions of drugs in the body
The action of a Medication in the body is described in
terms of:
Medication half-life (elimination half-life)-this is the
time required for the elimination process to reduce the
concentration of the Medication to one-half in the body.
E.g. a Medication with half-life of 8 hours; initially 100%,
after 8 hours 50% after 16 hours 25%.
Repeated doses are required to maintain a constant

28. Cont..
Oral drugs are absorbed from the gastrointestinal tract
into blood plasma. The plasma concentration increases
until its elimination rate equals the absorption rate. This
is called peak plasma level.
For drugs administered intravenously, its plasma levels
are high immediately and decreases through time.

29. Medication Action -Concepts
Onset of action-the time after administration when
the body initially responds to the Medication
Peak plasma level-the highest plasma level
achieved by a single dose when the elimination rate
of a Medication equals the absorption rate
Plateau–a maintained concentration of a
Medication in the plasma during series of scheduled
doses

30. Cont..

31. Pharmacodynamics
Refers to the mechanism of Medication action and
relationships between Medication concentration and
the body's responses.
Such responses require that the Medication interact
with specific molecules and chemicals normally found
in the body.

32. A receptor is the Medication’s specific target usually a
protein located on the surface of the cell membrane or
within the cell.
Depending on the location of the cellular receptor, the
Medication can have a local effect, a systemic effect, or
both.
The binding is reversible and Medication action is
terminated once the Medication leaves the receptor
As the Medication binds to the receptor it enhances
(agonism) or inhibits (antagonism) the cellular function

33. An agonist Medication produces the same effect/response
as the physiological or endogenous substance e.g. an
epinephrine-like Medication may be used to increase
heart rate
Antagonist Medication prevents natural body substances
or other drugs from activating cell functions by occupying
receptor sites. E.g. naloxone is used to reverse respiratory
depression by preventing opioid (morphine) from binding

34. Pharmacokinetics
This is the study of the absorption, distribution,
biotransformation, and excretion of drugs.
Absorptionis the process by which a Medication passes
into the bloodstream unless it is administered directly into
the vein where absorption doesn’t occur
Correct formand routeof administration are
requirements for absorption

35. Distributionis the transportation of a Medication from
the site of absorption to its site of action.
The physical and chemical properties largely determine
the area of the body where the Medication will be
attracted.
E.g. fat-soluble drugs will accumulate in the fatty tissue
and others in the plasma proteins

36. Biotransformation/detoxification/metabolismis a
process by which a Medication is converted to a less active
form. This takes place in the liver. The products of this
process are either activeor inactive metabolites.
Accumulation of active metabolites due to altered
metabolism as a result of liver problems may lead to
toxicity.
Nurses must be very alert to the accumulation of active
drugs and consequent toxicity.

37. Excretionis the process by which metabolites and drugs
are eliminated from the body.
Most drugs are eliminated by the kidneys in urine but
may also be excreted in feces, breath, breastmilk, and
sweat.
Note that the kidney’s efficiency to excrete Medications
reduces with age hence smaller doses may be required
in older people

38. Effects of Medications
Therapeutic / desired effect is the primary effect intended
thus the reason for the medication prescription e.g.
therapeutic effect of paracetamol is analgesia
A side effect is the unintended effect of a Medication.
May be predictable and can either be harmless or
potentially harmful. E.g. nausea
A severe side effect is called an adverse effectand may
justify discontinuation of a Medication

39. Medication toxicity is the harmful effect of a Medication on
an organism or tissue resulting from an overdose, use of the
wrong route, or build-up of the medication due to impaired
metabolism or excretion.
Medication allergy is the immunologic reaction to a
Medication. Some mild signs of allergic reaction include skin
rash or diarrheal.
Anaphylactic reactions -Severe reactions that occur immediately after
Medication administration. They are potentially fatal and hence
require urgent attention. They may include acute shortness of breath,
swelling of lips and tongue, acute hypotension and tachycardia

40. Medication tolerance exists in a person with low
physiological response to a Medication and requires
higher doses to maintain therapeutic effect. Common with
opiates e.g. morphine
Medication interaction occurs when the administration of
one Medication before, at the same time or after another
Medication alters the effect of one or both Medication.
May be beneficial or harmful.

41. Medication misuse –improper use of common
medications in a way that leads to acute or chronic
toxicity.
Medication abuse is an inappropriate intake of a
substance continually or periodically. Usually defined by
society.
Medication abuse may lead to:
✓Medicationdependence–person’s reliance on or need to
take drugs or substances.
✓Habituation–mild form of psychological dependence where

42. Factors affecting Medication action
1. Developmental factors
Infants require small doses due to small body size and
immaturity of organs
Older adults also require smaller doses due to
physiological changes that accompany aging.

43. Developmental Considerations
Infants and children
Children tend to fear any procedure with needles
Mask the taste of medications-syrups
Older adults
Altered memory
Decreased visual acuity

44. Decrease in renal function
Less complete and slower absorption from the
gastrointestinal tract
Increased proportion of fat to lean body mass
Decreased liver function
Decreased organ sensitivity
Altered quality of organ responsiveness
In pregnancy most drugs are contraindicated to
avoid adverse effects on the foetus.

45. 2.Diet / Food
Food or some nutrients can affect Medication
absorption, distribution, metabolism or counteract
Medication action in the body.
Some may improve or reduce metabolism or
absorption. E.g. antibiotics like tetracycline and
ciprofloxacin should not be taken together with milk
because the calcium in milk binds the antibiotic and
prevents gut absorption

46. 3.Illness and diseases
Medication action may be altered in clients with liver or
kidney dysfunction since metabolism and detoxification
may be compromised
4.Psychological factors
A client’s expectation about medication action affects the
response to the medication. Stress reduces the absorption
of medication
5.Environment
❑E.g. the use of analgesics or sedatives in a noisy and busy
environment may have little effect
6. Time of administration
❑Some medications like ampicillin will absorb rapidly on an
empty stomach

47. What is a Medication Administration Error (MAE)?
Definition
“A commission or an
omission with potentially
negative consequences”
(Wu et al, 1997)

Examples
•Wrong treatment
• Incorrect dosage
•Incorrect route
•Delay in treatment
•Mix-up in patient identities

48. What Causes MAEs?
Personal factors
Professional issues
Healthcare systems complexity issues
•High workload and busy schedules
(with many pressures and high
levels of stress)
•Illegible handwriting & inaccurate
prescription
•Lack of knowledge &
incompetency
•Failure to acknowledge and
understand how errors occur
and their consequences
•Poor organizational culture
•Inadequate technology
•Poor communication channels
•Poor leadership
•Lack of incident reporting systems
•Lack of skilled healthcare staff

“Beyond honest errors are mistakes caused by negligence - haste, carelessness.”

49. Effects of MAEs?
“Honest error is to be pitied, not ridiculed.” ~ Lord Chesterfield
“Admit your errors before someone else exaggerates them.”
~ Andrew Mason

50. How can we prevent
MAEs?

51. Safe Medication Administration
General principles
Medication Assessment
Explain to patient
Obtain consent
Five Rights principle
Documentation
Communication
Monitor response to medication
Follow up-care

52. Safe medication administration
All medication orders should contain:
1.Client’s full name
2.Date & Time
3.Name of medication to be administered
4.Dosage
5.Route of administration
6.Time & frequency & duration
7.Signature of person ordering

53. Steps in Medication administration
1.Identify the client
2.Inform the client about the procedure
3.Administer the medication
4.Provide adjunctive interventions as indicated
5.Record the medication administered
6.Evaluate the client’s response to the medication

54. Identify the client
Use at least two client identifiers whenever
administering medications.
Acceptable identifiers may be the person’s name
and an assigned identification number for
example admission number and age

55. Medication Assessment
Medication History
Allergies
Medical History
Pregnancy and Lactation status

56. Inform the client
The nurse should explain the intended action i.e. the
medication name, indication, route of administration,
his expectation, as well as any side effects or
adverse reactions that might occur.

57. Administering the Medication
The nurse MUST follow the following rights in
Medication administration

58. Five Rights (5Rs) Principle of Administering
Medications
•Identify the right client
•Select the right medication
•Give the right dose
•Give medication at the right time
•Give medication by the right route

59. 10 rights to follow in Medication
Administration
1.Right medication
2.Right dose
3.Right route
4.Right time
5.Right client
Right education
Right documentation
Right to refuse
Right assessment
Right evaluation

60. Administer the Medication
the nurse should read the medication
administration record carefully and
perform three checks with the labeled
medication

61. Provide adjunctive interventions as
indicated
Clients may require physical assistance in assuming
positions for parenteral medications or may need
guidance about measures to enhance Medication
effectiveness and prevent complications.

62. Record the medication administered
The nurse must record the medication administered,
following agency regulations.
Evaluate the client’s response to the
medication
The nurse should know the kinds of behavior that reflect
the action or lack of action of the medication and its
unpleasant effects (both minor and major) for each
medication the client is receiving.

63. General guidelines in Medication
administration
Nurses are responsible for their actions in Medication
administration
Question any illegible order or that you consider incorrect
Be knowledgeable about the medication you administer
Keep controlled medications locked up and follow the
policy
Use medications that are labelled on the container clearly

64. Do not use liquid medications that are cloudy or have
changed color
Calculate medication dosage accurately
Administer only medications personally prepared
Before administering medication, identify the patient
Do not leave medications at the bedside
Report and record if the patient vomits oral
medication
Take special precautions when administering certain
medications that require extra caution
Record any medication omission and its reason
Report medication error immediately
Always check the medication expiry date

65. Common medical errors -examples
Illegible Medication
order
Unlabeled Medication
bottle

66. Units of Medication measurements
Milligrams (mg)
Grams (g)
Micrograms (µgs)
Mega units (MU)
Pints
Drops

67. Calculating medication dosages
General formula
Desired dose/dose ordered ×Vehicle (i.e. form in which
the medication comes e.g. tablet/liquid ÷Dose on
hand/as labeled on bottle, vial, ampule.
Example :
Medication order = Paracetamol 1000mg
Dose at hand 250mg/kg
1000×1tab = 4 tablets
250mg
NB: Children’s dosages are often calculated using the child's body weight

68. Assignment
Studyonthefollowing
1.FactorsthatmayinhibittherateofMedication
absorptioninthestomach
2.Advantagesofintravascularandintramuscular
routesofMedicationadministration