1. DRUG ADMINISTRATION

2. Objectives :
At the end of this lecture the student will able to know all the following :
Definition of drug & drug administration .
Policy of drug administration .
Oral route & injections .
Needle gauge & length .
Types of injections .
Intramuscular , Intradermal & subcutaneous injection

3. All abbreviations related to drug administration .
Methods to decrease the pain during administration .
General assessment .
Nursing diagnosis .

4. Definition of drug :
Is a substance used for diagnosis , treatment ,relieve or prevention of disease .

5. Definition:
A route of administration is the path by which a drug, fluid, or other substance is brought into contact with the body.

6. Polices of drug administration (nurses responsibility)
Check physician order .
Check the timing of drug ordered by physician such as before or after food because medication action can interact with food .
Check 10 rights of medication administration .

7. Don’t administered drug that is ordered by unofficial abbreviations .
Don’t administered drug that is not labeled .
Check the expire date of drug .
Check drug with the physician order & medication charts .
Check patient allergy .
Don’t administered drug that is prepared by another person .

8. Patient’s Rights
Because of the risks involved in drug administration patients have the right to:
- be informed of the name, purpose, action & potential side effects of drugs
- refuse a medication regardless of the consequences

9. Patient’s Rights (con’t)
- receive labelled medications safely in accordance with the ten (10) rights
- be adequately informed of the experimental nature of any drug and sign a written consent .
- not receive unnecessary medications

10. The nurse is also responsible for ensuring that they have the knowledge to ensure the correct administration of drugs. This includes pharmacology, anatomy and physiology, and legal issues.

11. WHAT CONSTITUTES A LEGAL MEDICATION ORDER
Medication Charts should be written legibly in the prescriber’s own handwriting and include:
Patient’s name , medical record number (MRN), ward/clinic

12. Drug name (generic), dosage form, strength and dose required
Complete, clear and unambiguous directions for each item .
directions should be written in simple English (only approved abbreviations may be used)

13. Prescriber’s printed name, signature and date of order - the prescriber’s full signature and date of order must be written for EACH DRUG ordered .
Accept verbal orders only in emergency to save the life of patient .
Weight should be provided for any drug dosed by weight.

14. Each medication order must be legible, complete and unambiguous so that the correct patient is administered the correct drug at the appropriate dose. A nurse cannot administer the drug and a pharmacist cannot dispense a drug to a patient unless all details are correct and complete.

15. Every registered nurse is legally responsible for the correct administration of drugs. This includes the 10 “rights” of administration:
Right patient
Right drug
Right dose
Right route
Right time

16. Right education .
Right refuse .
Right assessment
Right evaluation
Right documentation

17. Right Patient :
check the patient name & hospital number against the chart & I.D. band.
ask the patient to state his/her name, & their date of birth (D.O.B)

18. Right Drug : - before removing it from the trolley
Check the drug three times:
- before removing it from the trolley
- when the drug is removed from the container
- before the container is returned to storage
- check the expiry date of the drug
Check the drug with another register nurse .

19. Routes of Administration

20. Route for administration
(Time until effect)
Intravenous : seconds
Endotracheal : 2-3 minutes
Inhalation : 2-3 minutes
Sublingual : minutes

21. Intramuscular : 10-20 minutes
Subcutaneous : minutes
Rectal : minutes
Ingestion : minutes
Transdermal : (topical) variable (minutes to hours)

22. Oral medication
Administration of medication by mouth & ensuring that patient swallow the medicine .
Forms ( tables ,capsule , syrup )

23. Contraindications to oral administration
Unconscious patient .
Patient on nil / oral ( NPO ) .
Gastric or intestinal suction .
Patient who are unable to swallow .
Continuous vomiting .

24. Instruction related to oral administration
Never giving water after cough syrup it leaves soothing effects to prevent cough .
Drug which stimulate appetite must be given before foods .
Give medicine at correct time & see patient takes it .

25. Injections
Are parenteral therapy , it means giving of therapeutic agents including food outside the alimentary tract .
Injections is forcing of a fluids into cavity ,blood vessels or body tissue through a hollow tubes or needle.

26. Advantages Get rapid & systemic effects of drugs .
To provide needed effects even the patient is unconscious .
It useful for medication that can not be given orally .
To restore blood volume by replacing the fluids & give nourishment to patient .

27. Types Intradermal Intramuscular Intravenous . Subcutaneous .
Intraspinal .
Intraosseous (into peritoneal cavity) .
Venesection ( open vein insert tube to administer medicine or taking out blood )

29. Parts of needles

30. Needles Parts are the hub, shaft, and beveled tip.
Opening at the needle’s beveled tip is the lumen.
Size of the diameter of the inside of the needle’s shaft determines the gauge of the needle; the smaller the gauge, the larger is the diameter.
Needle gauge selection is based on the viscosity of the medication.

31. Needle Length
Selected based on the depth of the tissue into which the medication is to be injected
Intradermal: 3/8 to 5/8 inch
Subcutaneous: 5/8 to 1/2 inch
Intramuscular: 1 to 1 1/2 inch

32. Needle length & gauge

33. Insulin syringe

34. Intramuscular Injections
Involves inserting a needle into the muscle tissue to administer medication
Site Selection :
Gluteal sites
Vastus lateralis muscle
Rectus femurs muscle
Deltoid muscle
Z-track Method :
Used to inject medications that are irritating to the tissues

35. Locating IM injection for ventrogluteal site.

36. Dorsogluteal sites

37. Old Method

38. Current method

39. Giving IM injection in vastus lateralis site on adult.

40. Deltoid muscles

41. Equipment Syringe & needle Cotton swap Antiseptic solution ( spirit)
Medication
Medication administration cards / physician order
Tray

42. Important point in the procedure
Needle inserted at 90 angle
Aspirate to check for blood
Do massage after needle remove
Ask patient to take rest for 15 minute
Inspect the area for bleeding after removing of needle .
Check for limb movement to confirm there is no nerve injury .

43. Intradermal Injections
Gauge-25-29
Length-1/4 to ½ inch
Amount- 0.1 ml
Angle degrees
DO NOT ASPIRATE

44. Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agent
Not aspirated
Small volumes (0.1 ml) injected to form a small bubble like wheal just under the skin
Used for allergy sensitivity tests, TB screening, and local anesthetics
A tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle

45. Important point Insert needle at 10 – 15 angle .
Don’t aspirate & don’t massage ( to prevent absorption into subcutaneous tissue ) .
Inject medication slowly over (3 – 5) second while watching for small blister to appear .
Wait for 15 – 60 minute to read the allergy test & for 48 – 72 hours to read the test of tuberculin .

46. Subcutaneous injections
Gauge-25-29
Length-3/8, ½ and 5/8 inches
Angle degrees
DO NOT ASPIRATE

47. Injections made into the loose connective tissue between the dermis and the muscle layer
Drug absorption slower than with IM injections
Given at a 45-degree angle if the patient is thin or at a 90-degree angle if patient fat .
Usual needle length is 1/2 to 5/8 inch and 25 gauge
Used to administer insulin and heparin

48. Common site Outer aspect of upper arm .
Posterior chest wall below the scapula .
Anterior abdominal wall below breast to iliac crest .
Anterior & lateral aspect of the thigh .

50. Methods to Decrease the Pain of Injections
Encourage client relaxation-position client to have muscle relaxed .
Change needle after preparing medication in syringe .
Avoid injecting into sensitive or hardened skin .
Use needle long enough to reach muscle.
“Dart” needle quickly into muscle
Use smallest gauge possible .

51. Inject medication slowly
Do not move needle once inserted .
Withdraw needle quickly .
Apply pressure/ice to site before injection.

52. COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS frequency

53. COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS
Meaning
Abbreviations
morning
MANE
midday
MIDI
night
NOCTE
Twice a day BD
Three times a day
TDS
Four times a day
QID
Give immediately
STAT
COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS
Mosby items and derived items © 2005 by Mosby, Inc.

54. COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/frequencyac pc
q.h.or 1/24
q2h or 2/24
q4h or 4/24
before meals
after meals
every hour
every two hours
every four hours

55. COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route
BUC
O/P.O
S/L ID IM
IMI SC
inside cheek
oral/per oral
sublingual
(under the tongue)
Intradermal
intramuscular
intramuscular injection
subcutaneous

56. COMMOM ABBREVIATIONS USED IN MEDICATION ORDERS/route
SCI
IVI
IVT
NEB PR
TOP
VAG
subcutaneous injection
intravenous injection
intravenous therapy
nebuliser
per rectum
topical/skin
vaginal

57. Assessment Medical history History of allergies Medication data
Diet history
Assess the site of injection .
Perceptual or coordination problems
Current condition

58. Nursing Diagnoses
Deficient knowledge (medications)
pain
Disturbed sensory perception
Impaired swallowing
Ineffective therapeutic regimen management

59. Good Luck