Medication

Administration
Presentation by: Flores, Francezca S.
Gaffud, Erika Marie R.
Introduction
The administration of medicine is a common
but important clinical procedure. It is the
manner in which a medicine is administered
that will determine to some extent whether
or not the patient gains any clinical benefit,
and whether they suffer any adverse effect
from their medicines.
 Introduction
Therefore, it is very crucial that nurses develop
adequate knowledge, skills, and positive values to
ensure safe drug administration and safe patient
care, patient teaching on medications, encouraging
patients on adherence to the medication regimen,
and evaluating the patient’s and family caregiver’s
ability to administer medications.
Types of Doctor’s Order
Standing Order. It is carried out

01 until the specified period of time or

until it is discontinued by another
order.

02
Single Order. It is carried out for
one time only.

03
STAT Order. It is carried out at
once or immediately.

04
PRN Order. It is carried out as the
patient requires.
Components of medication Orders
A medication order needs to have all of the following parts:

Patient’s full name

Date and time that the order is written
Medication name
Dosage
Route of administration
Time and frequency of administration
Signature of health care provider
 Effects of the Drug
Therapeutic Effect. The primary effect intended, that Cumulative Effect. It is the increasing response to the
is the reason the drug is prescribed. Also called repeated dose of a drug that occurs when the rate of
desired effect. administration exceeds the rate of metabolism or
Side Effect. The effect of the drug that is unintended. excretion.
Also called secondary effect. Idiosyncratic Effect. It is the unexpected, peculiar
Drug Allergy. The immunological reaction to the drug. response to the drug; either overresponse,
Anaphylactic Reaction. A severe allergic reaction underresponse, different response than expected,
which usually occurs immediately following unpredictable or unexplained responses.
administration of the drug. Drug dependence. It is a person’s reliance to take a
Drug Tolerance. A deceased physiologic response to drug or substance. Intense physical or emotional
the repeated administration of a drug or chemical disturbance is produced if the drug is withdrawn.
related substance. Excessive increase in the dosage is Addiction. It is due to biochemical changes in body
required in order to maintain the desired therapeutic tissues, especially the nervous system. These tissues
effect. come to require the substance for normal functioning.
Also called physical dependence.
Drug Abuse. Inappropriate intake of a substance,
either continually or periodically.
 Effects of the Drug
Habituation. It is the emotional reliance Summation. The combined effect of two
on a drug to maintain a sense of well- drugs produces a result that equals the
being accompanied by feelings of need sum of the individual effects of each
or cravings for the drug. Also called agent.
psychological dependence. Synergism. The combined effects of
Drug Interaction. Effects of one drug drugs is greater than the sum of each
are modified by the prior or concurrent individual agent acting independently.
administration of another drug, thereby
Potentiation. The concurrent
increasing or decreasing the
administration of two drugs in which one
pharmacological action.
drug increases the effect of the other
Drug Antagonism. Conjoint effect of
drug.
two drugs is less than the drugs acting
separately.
 Therapeutic Actions of Drugs
1 Palliative 2 Curative 3 Supportive
Relieves the symptoms of Treats the disease Sustains body functions until
a disease but not affect condition. E.g. antibiotic other treatment of the body’s
response can take over. E.g.,
the disease itself. E.g. for infection.
Mannitol to reduce/ICP
antineoplastic agents for (intracranial pressure) in a
cancer. client for surgery due to brain
tumor.

4 Substitutive 5 CHEMOTHERAPEUTIC 6 RESTORATIVE

Replaces body fluids or Destroys malignant cells. Returns the body to
substances. E.g., Insulin E.g., Cyclophosphamide health. E.g., multivitamins
injection for diabetes for cancer of the prostate for elderly clients.
mellitus. gland.
Pharmacokinetic Factors in Drug
Therapy
1. Absorption. Is the process by which a
drug passes from its site of administration
into the bloodstream.
Factors That Affect Drug Absorptions
a. Blood Flow g. Solubility of the drug
b. Pain h. pH
c. Stress i. Drug Concentration
d. Food j. Dosage form
e. Exercise
f. Nature of the absorbing surface
Pharmacokinetic Factors in Drug
Therapy
2. Distribution, is the transport of a drug
from its site of absorption to its site of
action
Factors That Affect Drug Distribution
a. Plasma-Protein Binding
b. Volume distribution
c. Barriers to Drug Distribution
1. Blood Brain Barrier
2. Placental Barrier
d. Obesity
e. Receptor Combination
Pharmacokinetic Factors in Drug
Therapy
3. Metabolism or Biotransmission. A sequence
of chemical events that change a drug to a less
active form after it enters the body. Also called
detoxification.
Factors That Affect Drug Metabolism
1. Age 4. Excretion
2. Nutrition
3. Insufficient amounts of major body
hormones
Pharmacokinetic Factors in Drug
Therapy
Factors That Affect Drug Excretion
1. Renal Excretion. Carried out by glomerular filtration and tubular
secretion, which increase quantity of drug excreted.
2. Drugs can affect elimination of other drugs. Examples:
Probenecid prevents excretion of penicillin.
Antacid increases elimination of ASA.
3. Blood concentration levels. When peak level of the drug is reached,
excretion levels become greater than absorption and blood levels of
drugs begin to drop.
4. Half life. It is the time required for the total amount of drug to decrease
by 50%.
Physiological Changes Associated with Aging
that Influence Medication Administration and
Effectiveness
1. Altered memory.
2. Less acute vision.
3. Decrease in renal function resulting in slower elimination of drugs.
4. Less complete and slower absorption from gastrointestinal tract.
5. Increased proportion of fat to lean body mass which facilitates
retention of fat soluble drugs and increases potential for toxicity.
6. Decreased liver function, which hinders biotransformation of drug.
7. Decreased organ sensitivity. These may lead to underresponse to
drugs.
8. Altered quality of organ responsiveness, resulting in adverse effects
becoming pronounce before therapeutic effects are achieved.
Principles in Administering
Medication
1. Observe the “Rights” of drug administration.
Right drug. Read the label three times. Right recording. Sign medication sheet
Right dose. Know the usual dose of the drug. immediately after administration of the drug.
Calculate the correct amount. Right approach and right to refuse.
Right time. Standard time may be followed in
Right history and assessment
the institution.
Right route. Check the route of administration. Right drug-drug integration on evaluation
Right patient. Identify patient by: Checking the Right education and information
ID band, asking him to state his name.

2. Practice asepsis. Wash hands before and after preparing

medications.
3. Nurses who administer medications are responsible for their
own actions. Verify any order that you consider incorrect (may
be unclear or inappropriate).
4. Be knowledgeable about the medication that you administer.
5. Keep narcotics in locked place.
Principles in Administering
Medication
6. Use only medications that are in clearly labeled containers. Relabeling of drugs is the
responsibility of the pharmacist.
7. Return liquid that are cloudy in color to the pharmacy.
8. Before administering the medication, identify the client correctly.
9. Do not leave the medication at the bedside. Stay with the client until he actually takes the
medications.
10. The nurse who prepares the drug administers it. Only the nurse who prepared the drug knows
what that drug is. Do not accept endorsement of medications.
11. If the client vomits after taking the medication, report this to the nurse in charge or physician. Do
not repeat the dose without consulting the physician.
12. Preoperative medications are usually discontinued during the postoperative period unless
ordered to be continued.
13. When a medication is omitted for any reason, record the fact together with the reason.
14. When a medication error is made, assess the patient, then report it immediately to the nurse in
charge or physician. To implement necessary measures immediately. This may prevent any adverse
effects of the drug.
 Routes of Drug Administration
Oral Drug Forms for Oral Administration
· Advantages
a. Most convenient - Solid: tablet, capsule, pill, powder
b. Usually less expensive - Liquid: syrup, suspension, emulsion, elixir, milk, or other
c. Safe, does not break skin barrier
· Disadvantages
alkaline substances.
a. Inappropriate for client with Syrup: sugar – based liquid medication.
nausea and vomiting Suspension: water – based liquid medication. Shake
b. Drugs may have unpleasant
taste or odor
the bottle before use of medication to properly mix it.
c. Inappropriate if client cannot Emulsion: oil – based liquid medication.
swallow and if GIT has reduced Elixir: alcohol – based liquid medication. After
motility.
administration of elixir, allow 30 minutes to elapse
d. Drug may discolor the teeth.
e. Drug may irritate gastric mucosa. before giving water. This allows maximum absorption
f. Drug may be aspirated by of the medication.
seriously ill patient.
 Routes of Drug Administration
Sublingual Buccal
A drug that is placed under the tongue, where it A medication is held in the mouth against the
dissolves. When a medication is in capsule and mucous membranes of the cheek until the drug
ordered sublingually, the fluid must be aspirated dissolves. The medication should not be
from the capsule and placed under the tongue. chewed, swallowed, or placed under the
· Advantages tongue. E.g. sustained release nitroglycerine,
a. Same as oral, plus- opiates, antiemetics, tranquilizers, sedatives.
b. Drug can be administered for local effect. · Advantages
c. Drug is rapidly absorbed in the bloodstream. a. Same as oral plus-
· Disadvantages b. Drug can be administered for local effect
a. If swallowed, drug may be inactivated by c. Ensures greater potency because drug
gastric juices. directly enters the blood and bypass the liver.
b. Drug must remain under the tongue until · Disadvantages
dissolved and absorbed. If swallowed, drug may be inactivated by
gastric juice.
 Routes of Drug Administration
Topical b. Ophthalmic (Eye). Includes instillations and irrigations.
a.Dermatologic (Skin). 1. Instillations. To provide an eye medication that the client requires.
2. Irrigations. To clear the eye of noxious or other foreign materials.
Includes lotions, liniments and
· Position client either sitting or lying.
ointments.
· Use sterile technique
·Wash and pat dry area well · Clean the eyelid and eyelashes with sterile cotton balls moistened
before application to facilitate with sterile normal saline from the inner to the outer canthus.
absorption. · Instill eye drops into lower conjunctival sac.
· Use surgical asepsis when · Instill a maximum of two drops at a time. Wait for 5 minutes if
open wound is present. additional drops need to be administered. This is for proper
· Remove previous application absorption of the medication.
before the next application. · Avoid dropping a solution onto the cornea directly, because it
· Apply only thin layer of causes discomfort.
medication to prevent systemic · Instruct the patient to close the eyes gently. Shutting the eyes
absorption. tightly causes spillage of the medication.
· Use gloves when applying the · For liquid eye medications, press firmly on the nasolacrimal duct
medication over a large surface. (inner canthus) for at least 30 seconds to prevent systemic
absorption of the medication.
E.g. large area of burns.
c. Otic (Ear). Includes instillations and irrigations. d. Nasal (Nose). Nasal instillations usually are
· Instillations instilled for their astringent effect (to shrink
1.To soften earwax.
swollen mucous membrane), to loosen secretions
2.To reduce inflammation and treat infection.
3.To relieve pain. and facilitate drainage or treat infections of the
· Irrigation nasal cavity or sinuses. E.g. decongestants,
1.To remove cerumen or pus steroids, calcitonin.
2.To apply heat Have the client blow the nose prior to nasal
3.To remove foreign body. instillation.
Warm solution at room or body temperature. Using hot or cold Assume back lying position, or sit up and lean
solution into the ear can cause nausea, vertigo, and pain.
Side lying position with the ear being treated uppermost.
head back.
Clean the pinna and the meatus of the ear canal with cotton – Elevate the nares slightly by pressing the
tipped applicator. thumb against the client’s tip of the nose.
Straighten the ear canal.
- 0 – 3 years old: pull pinna downward and backward.
While the client inhales, squeeze the bottle.
- Older than 3 years old: pull the pinna upward and backward. Keep head tilted backward for 5 minutes after
Instill eardrops on the side of the auditory canal to allow the instillation of nasal drops.
drops to flow in and to continue to adjust to body
temperature.
When the medication is used on a daily basis,
Press gently but firmly a few times on the tragus of the ear to alternate nares to prevent irritation.
assist the flow of medication into the ear canal. For sinus instillation:
Ask the client to remain in side-lying position for about 5
- Parkinson’s position for frontal and maxillary
minutes.
Insert a small piece of cotton fluff loosely at the meatus of the sinuses.
auditory canal for 15 to 20 minutes. To prevent spillage of - Proetz position for ethmoid and sphenoid
medication out of the ear. sinuses.
 Routes of Drug Administration
e. Inhalation. Use of nebulizers, metered-dose inhalers (MDI).
Semi- or high- Fowler’s position or standing position. To enhance full chest expansion allowing
deeper inhalation of the medication.
Shake the canister several times. To mix the medication and ensure uniform dosage delivery.
Position the mouthpiece 1 to 2 inches from the client’s open mouth or instruct patient to seal
mouthpiece with lips. As the client starts inhaling, press the canister down to release one dose of the
medication. This allows delivery of the medication more accurately into the bronchial tree rather than
being trapped in the oropharynx then swallowed.
Instruct client to hold breath for 10 seconds. To enhance complete absorption of the medication.
If bronchodilator, administer a maximum of 2 puffs, for at least 30 seconds interval. Administer
bronchodilator before other inhaled medication. This opens airway and promotes greater absorption
of the medication.
Wait at least 1 minute before administration of the second dose or inhalation of a different medication
by MDI.
Instruct client to rinse mouth, if steroid had been administered. This is to prevent oral fungal
infection.
A canister of bronchodilators usually has a total of 200 puffs. To determine how long the MDI will last:
2 puffs x 4 times/day = 8 puffs/day
200 puffs ÷ 8 puffs/day = 25 days
 Routes of Drug Administration
Vaginal Irrigation. Is the washing of the
f. Vaginal vagina by a liquid at low pressure. It is also
· Advantage called douche.
1. Provides local therapeutic · Empty the bladder before the procedure.
effect. · Position and drape the client.
· Disadvantages 1. Instillation: back – lying position with
knees flexed and hips rotated laterally.
1. Has limited use.
2. Irrigation: back – lying position with the
· Drug Forms: Tablet, liquid hips higher than the shoulders (use
(douches), cream, jelly, foam and bedpan).
suppository. · Irrigating container should be 30 cm. (12
· Use applicator or sterile gloves inches) above.
for vaginal administration of · Ask the client to remain in bed for 5-10
minutes following administration of vaginal
medications. suppository, cream, foam, jelly or irrigation.
5. Rectal
· Advantage
1. Can be used when the drug has objectionable taste or odor.
· Disadvantages
1. Dose absorbed is unpredictable.
Need to be refrigerated so as not to soften.
Use glove for insertion of suppositories.
Have client lie on left side and breathe through the mouth to relax the anal sphincter.
Insert suppository until a sensation of “as if something has grabbed it away,” occurs. This indicates
that the suppository has been inserted past the internal anal sphincter.
§ Ensure that the suppository comes in contact with the rectal wall. This ensures accurate
absorption of the medication.
Client must remain on side for 20 minutes after insertion. To promote adequate absorption of the
medication.
6. Parenteral. The administration of medication by needle.
a. Intradermal. Under the epidermis. (ID)
b. Subcutaneous. Into the subcutaneous tissue. (SC)
c. Intramuscular. Into the muscle. (IM)
d. Intravenous. Into the vein. (IV)
e. Intraarterial. Into the artery.
f. Intraosseous. Into the bone.
A. Intradermal injection. the administration of a drug into the dermal layer of the skin
beneath the epidermis.
The sites are the inner lower arm, upper chest and back, and beneath the scapulae.
Indicated for allergy and tuberculin testing and for vaccinations.
Use left arm for tuberculin test; use right arm for all other tests.
Use the needle gauge 25, 26, 27; needle length 3/8”, 5/8” or ½”.
Needle at 10-15 degree angle; bevel up.
Inject a small amount of drug slowly over 3 to 5 seconds to form a wheal or bleb.
Do not massage the site of injection. To prevent irritation of the site, and to prevent
absorption of the drug into the subcutaneous.
B. Subcutaneous. Drugs administered subcutaneously are as follows: vaccines,
preoperative medications, narcotics, insulin, heparin.
The sites are the outer aspects of the upper arms, anterior aspect of the thighs,
abdomen, scapular areas of the upper back and ventrogluteal and dorsogluteal
areas.
Only small doses of medication should be injected via subcutaneous route. (0.5 to
1 ml.).
Rotate sites of injection to minimize tissue damage.
Needle length and gauge are the same as for intradermal injections
Use 5/8 needle for adults when the injection is administered at 45 degree
angle; ½ is used at a 90 degree angle.
For thin patients: 45 degree angle of needle.
For obese patients: 90 degree angle of needle.
For heparin injection. Do not aspirate. Do not massage the injection site to
prevent hematoma formation.
For insulin injection. Do not massage to prevent rapid absorption which may
result to hypoglycemic reaction. Always inject insulin at 90 degree angle to
administer the medication in the packet between the subcutaneous and
muscle layer. Adjust the length of the needle, depending on the size of the
client.
For other medications, aspirate before injection of medication to check if
blood vessel had been hit. If blood appears on pulling back of the plunger
of the syringe, remove the needle and discard the medication and
equipment.
C. Intramuscular injections.
Needle length is 1”, 1 ½”, 2”, To reach the muscle
layer.
Use needle gauge 20, 21, 22, 23, depending on
the viscosity of medication.
Clean the injection site with alcoholized cotton
ball. To reduce microorganisms in the area.
Inject the medication slowly to allow the tissues
to accommodate volume.
Sites
1. Ventrogiuteal site (von Hochteter’s site)
Uses gluteus medius which lies over the gluteus minimus
muscle.
The area contains no large nerves, or blood vessels and
less fat. It is farther from the rectal area, so it less
contaminated.
Position the client in prone or side-lying. When in prone
position, curl the toes inward. When in side-lying position,
flex the knee and hip. These ensure relaxation of gluteus
muscles and minimize discomfort during injection.
To locate the site, place the heel of the hand over the
greater trochanter, point the index finger towards anterior
superior iliac spine, then abduct the middle (third) finger.
The triangle formed by the index finger, the third finger
and the crest of the ilium is the site.
Sites
2. Dorsogluteal site
uses the gluteus medius muscle.
Position of the client is similar to ventrogluteal site.
The site should not be used for infants under 3 years,
because the gluteal muscles are not well-developed
yet.
To locate the site, the nurse draws an imaginary line
form the greater trochanter to the posterior superior
iliac spine. The injection site is lateral and superior to
this line.
Another method of locating this site is to imaginary
divide the buttock into four quadrants. The upper outer
quadrant is the site of injection. Palpate the crest of the
ilium to ensure that the site is high enough.
Sites
3. Vastus lateralis
Recommended site of injection for infants.
Located at the middle third of the anterior
lateral aspects of the thigh.
Assume back-lying or sitting position.
4. Rectus femoris site
Located at the middle third, anterior
aspect of the thigh.
Sites
5. Deltoid site
Not used often for IM injection because it is relatively small
muscle and is very close to the radial nerve and radial artery.
To locate the site, palpate the lower edge of the acromion
process and the midpoint on the lateral aspect of the arm that
is in line with the axilla. This is approximately 5cm. (2 inches) or
2 to 3 fingerbreadths below the acromion process.
Variation of the IM injection: Z-tract technique
Used for parenteral iron preparation. To seal the drug into the
muscles and prevent permanent staining of the skin.
Retract the skin laterally, inject the medication slowly. Keep the
needle in place for 10 seconds after injection of the medication,
to ensure adequate distribution of the medication into the
muscles. Hold retraction of skin until the needle is withdrawn.
Do no massage the site of injection. To prevent leakage into
subcutaneous.
 Forms of Medication
MEDICATION FORMS COMMONLY PREPARED FOR ADMINISTRATION BY
ORAL ROUTE SOLID FORMS
Caplet - Solid dosage form for oral use; shaped like capsule and coated for ease
of swallowing
Capsule - Medication encased in gelatin shell
Tablet - Powdered medication compressed into hard disk or cylinder, in addition
to primary medication, contains binders (adhesive to allow powder to stick
together), disintegrators (to promote tablet dissolution), lubricants (for ease of
manufacturing), and fillers (for convenient tablet size)
Enteric-coated tablet - Coated tablet that does not dissolve in stomach,
coatings dissolve in intestine, where medication is absorbed
 Forms of Medication
LIQUID FORMS
Elixir - Clear fluid containing water and/or alcohol; often sweetened
Extract - Concentrated medication form made by removing the
active part of medication from its other components
Aqueous solution - Substance dissolved in water and syrups
Aqueous suspension - Finely dissolved drug particles dispersed in
liquid medium; when suspension is left standing, particles settle to
bottom of container
Syrup - Medication dissolved in a concentrated sugar solution
 Forms of Medication
OTHER ORAL FORMS AND TERMS ASSOCIATED WITH ORAL PREPARATION

Troche (lozenge) - Flat, round tablets that dissolve in

mouth to release medication; not meant for ingestion
Aerosol - Aqueous medication sprayed and absorbed in
mouth and upper airway; not meant for ingestion
Sustained release - Tablet or capsule that contains small
practices of a medication coated with material that requires
a varying amount of time to dissolve
 Forms of Medication
MEDICATION FORMS COMMONLY PREPARED FOR ADMINISTRATION BY
TOPICAL ROUTE
Ointment (salve or cream) - Semisolid, externally applied preparation,
usually containing one or more medications
Liniment - Usually contains alcohol, oil, or soapy emollient applied to skin
Lotion - Semiliquid suspension that usually protect, cools, or cleanses skin
Paste - Thick ointment; absorbed through skin more slowly than ointment;
often used for skin protection
Transdermal disk or patch - Medicated disk or patch absorbed through
skin slowly over long period of time (e.g., 24 hours)
 Forms of Medication
MEDICATION FORMS COMMONLY PREPARED FOR ADMINISTRATION BY
PARENTERAL ROUTE
Solution - Sterile preparation that contains water with one or more dissolved compounds
Powder - Sterile particles of medication that are dissolved in a sterile liquid (e.g., water, normal
saline) before administration
MEDICATION FORMS COMMONLY PREPARED FOR INSTILLATION INTO BODY
CAVITIES
Intraocular disk - Small, flexible oval (similar to contact lens) consisting of two soft, outer layers
and a middle layer containing medication; slowly releases medication when moistened by ocular
fluid
Suppository - Solid dosage form mixed with gelatin and shaped in form of pellet for insertion
into body cavity (rectum or vagina); melts when it reaches body temperature, releasing
medication for absorption
General Principles in Parenteral
Administration of Medications
1. Check the doctor’s order.
2. Identify the client properly.
3. Practice ASEPSIS.
4.Use appropriate needle size.
5.Plot the site of injection properly.
6.Use separate needles for aspiration and
injection of medications.
7.Introduce air into the vial before aspiration.
8.Allow a small air bubble (0.2 ml.)
9. Introduce the needle in a quick thrust.
10. Either spread or pinch muscle when
introducing the medication.
General Principles in Parenteral
Administration of Medications
11. Minimize discomfort by applying cold compress
over the injection site before introduction of
medication to numb nerve endings; apply warm
compress to improve circulation in the area.
12. Aspirate before introduction of medication. To
check if blood vessel had been hit.
13. Support the tissues with cotton swabs before
withdrawal of needle. To prevent discomfort of
pulling tissues as needle is withdrawn.
14. Massage the site of injection to hasten
absorption.
15. Evaluate effectiveness of the procedure and
make relevant documentation.
d. Intravenous (IV)

Direct IV, IV push, IV infusion.

Most rapid route of absorption

of medications.
Predictable, therapeutic blood
levels of medications can be
obtained.
The route can be used for clients with
compromised gastrointestinal 5function or
peripheral circulation.

Larger doses of medications can

be administered by this route.
d. Intravenous (IV)

Direct IV, IV push, IV infusion.

Most rapid route of absorption

of medications.
Predictable, therapeutic blood
levels of medications can be
obtained.
The route can be used for clients with
compromised gastrointestinal 5function or
peripheral circulation.

Larger doses of medications can

be administered by this route.
Types of IV
fluids Nursing Interventions
1. Isotonic in IV Infusion
solution 1. Verify the doctor’s order.
2. Hypotonic 2. Know the type, mount, and indication of IV therapy.
3. Practice strict asepsis.
3. Hypertonic 4. Inform client and explain purpose of IV therapy.
5. PRIME IV tubing to expel air. This will prevent air
embolism.
6. Clean the insertion site of IV needle from center to
the periphery with alcoholized cotton swab.
7. Shave area of needle insertion if hairy.
8. Change IV tubing every 72 hours. To prevent
contamination.
9. Change/alter IV needle insertion site every 72
hours. To prevent thrombophlebitis.
10. Regulate IV every 15-20 minutes. To ensure
administration of proper volume of IV fluid as ordered.
11. Observe for potential complications.
Complications of IV Infusion
1. Infiltration. The needle is out of vein, and fluids accumulate in the
subcutaneous tissues.
Assessment
Pain.
Swelling.
Skin is cold at needle site.
Pallor of the site.
Flow of IV rate decreases or stops.
Absence of backflow of blood into the tubing as the IV fluid is put down, or
the IV tubing is kinked.
Nursing Interventions
Change the site of needle.
Apply cold compress. This will reabsorb edema fluids and reduce swelling,
“cold to cold” (cold skin, cold compress).
Complications of IV Infusion
2. Circulatory Overload. Results from administration of excessive volume of IV
fluids.
- Assessment
Headache Pulmonary edema
Flushed skin Increased venous pressure
Rapid Pulse Coughing
Increased BP SOB (shortness of breath)
Weight gain Tachypnea
Syncope or faintness Shock
- Nursing Interventions
Slow infusion to KVO (keep vein open – 10 gtts/min.)
Place patient in high fowler’s position. To ease breathing.
Administer diuretic, bronchodilator’s ordered.
Complications of IV Infusion
3. Drug overload. The patient receives an excessive amount of fluid containing drugs.
- Assessment - Nursing Intervention
Dizziness Slow infusion to KVO. Notify physician.
Shock
Fainting
4. Superficial Thrombophlebitis. It is due to overuse of a vein, irritating solutions or drugs, clot formation,
large bore catheters.
- Assessment
Pain along the course of vein.
Vein may feel hard and cordlike.
Edema and redness at needle insertion site.
Arm feels warmer than the other arm.
- Nursing Interventions
Change IV site every 72 hours.
Use large veins for irritating fluids.
Stabilize venipuncture at area of flexion.
Apply warm compress immediately to relieve pain and inflammation. “warm to warm” (warm skin, warm
compress).
Complications of IV Infusion
5. Air Embolism. Air manages to get into the circulatory system; 5 ml. of air or more causes air embolism.
- Assessment
Chest, shoulder, or backpain Tachycardia
Hypotension Increased venous pressure
Dyspnea Loss of consciousness
Cyanosis
- Nursing Interventions
Do not Allow IV bottle to “run dry”
“Prime” IV tubing before starting infusion. To expel air from the tubing.
Turn patient to left side in the Trendelenburg position. To allow air to rise in the right side of the heart.
This prevents pulmonary embolism.
6. Nerve Damage. May result from tying the arm too tightly to the splint.
- Assessment - Nursing Interventions
Numbness of fingers and hands Massage area and move shoulder through its ROM.
Physical therapy may be required.
7. Speed Shock. May result from administration of IV push medications rapidly.
To avoid speed shock, and possible cardiac arrest, give most IV push medication over 3 to 5 minutes.
Timing of Medication Dose Responses

Medications administered intravenously enter the

bloodstream and act immediately, whereas those
given in other routes take time to enter the
bloodstream and have an effect.

When a medication is administered repeatedly, its

serum level fluctuates between doses. The highest
level is called the peak concentration, and the
lowest level is called the through concentration.
Medication Errors
A medication error can cause or lead to inappropriate medication use or
patient harm. Medication errors include inaccurate prescribing,
administering the wrong medication, giving the medication using the wrong
route or time interval, administering extra dose, and/or failing to administer
a medication. Preventing medication errors is essential. The process of
administering medications has many steps and involves many members of
the health care team. Because nurses play an essential role in preparing and
administering medications, they need to be vigilant in preventing errors.
Advances in health care informatics have helped to decrease the
occurrence of medication errors.
NURSING PROCESS IN MEDICATION
ADMINISTRATION
Assessment
During the assessment process thoroughly assess each patient and critically
analyze findings to ensure that you make patient-centered clinical decisions
required for safe nursing care.
History. Before you administer medications, review a patient’s medical
history to help you understand the indications or contraindications for
medication therapy.
Allergies. Inform the other members of the health care team if a patient has
a history of allergies to medications and foods.
Medications. Ask your patients questions to find out about each medication
they take.
Diet History. A diet history reveals a patient’s normal eating patterns and
food preferences.
Patient’s perceptual or Coordination Problems. Patients with perceptual,
fine-motor, or coordination limitations often have difficulty self-
administering medications.
Patient’s Current Condition. The ongoing physical or mental status of a
patient affects whether a medication is given and how it is administered.
Patient’s Attitude About Medication Use. A patient’s attitudes toward
medications (e.g., benefit, risk, likelihood to cure) sometimes reveals a level
of medication dependence or drug avoidance.
Factors Affecting Adherence to Medication Therapy. Many complex
factors affect a patient’s ability to adhere to prescribed medication therapy.
Patient’s Learning Needs. Health-related information is difficult to
understand because of the use of technical terminology. Serious errors can
occur when patients do not understand information about their medications.
Assess patients’ health literacy regarding medication administration to
determine their need for instruction (Weekes, 2012; Zullig et al., 2014).
 Nursing Diagnosis
This list of nursing diagnoses may apply during medication
administration in a variety of settings:
Anxiety
Deficient Knowledge (Medication Self-administration)
Noncompliance (Medications)
Impaired Swallowing
Impaired Memory
Caregiver Role Strain (Caregiving Activities)
 Planning
Always organize your care activities to ensure
the safe administration of medications. Rushing to
give patients medications leads to errors. It is
important to minimize distractions or interruptions
when preparing and administering medications
(Ching et al., 2015). NIZs are created by placing signs,
red tape, or some type of borders on the floor around
medication carts or areas. Nurses standing in these
areas are not to be interrupted.
 Goals and Outcomes
Goal: The patient will safely self-administer all ordered
medications before discharge.

Outcomes:
The patient verbalizes understanding of desired and adverse
effects of medications.
The patient states signs, symptoms, and treatment of
hypoglycemia.
The patient is able to monitor blood glucose levels to determine if
it is safe to take medication or if an alteration in dose is needed.
The patient prepares a dose of ordered medication.
The patient describes a daily routine that will integrate timing of
medication with daily activities.
Setting Priorities. Prioritize care when administering
medications. Use patient assessment data to determine which
medications to give first, whether it is time to evaluate a patient’s
response to a medication, or if it is appropriate to administer prn
medications. For example, if a patient is in pain, it is important to
provide pain medication before other medications.
Teamwork and Collaboration. Collaboration during medication
administration is essential. You need to collaborate with a
patient’s family caregivers whenever possible. Family caregivers
and significant others often reinforce the importance of
medication schedules when a patient is at home. Nurses often
collaborate with patients’ health care providers, pharmacists, and
case managers to ensure that patients are able to afford their
medications.
Implementation
Health Promotion. In promoting or maintaining a
patient’s health, nurses identify factors that improve
or diminish well-being. Health beliefs, personal
motivation, socioeconomic factors, and habits
influence a patient’s adherence with medications.

Patient and Family Teaching. Some patients take

medications incorrectly or not at all because they
do not understand their medications. When this
happens, you need to provide patient education
using language/dialect your patient understands.
Implementation
Acute Care. Patients are often hospitalized
to receive expert nursing observation and
documentation of responses to medications.
Receiving, Transcribing, and Communicating
Medication Orders. An order is required to
administer any medication.
Accurate Dose Calculation and Measurement.
When measuring liquid medications, use standard
measuring containers. Use a systematic procedure for
medication measurement to lessen the change of
error.
Implementation
Correct Administration. For safe administration follow the
six rights of medication administration (refer to previous
discussions on Principles in Administering Medications).
Recording Medication Administration. Follow all agency policies when
documenting medication administration. After administering a medication,
appropriately document the name of the medication, dose route, and exact
time of administration immediately. Include the site of any injections per
agency policy.

Restorative Care. Because of the numerous types of

restorative care settings, medication administration
activities vary. Patients with functional limitations
often require a nurse to fully administer all
medications.
Implementation
Special Considerations for Administering Medications
to Specific Age-Groups. A patent’s developmental level
is a factor to consider when administering medications.

Infants and Children. In many pediatric settings the

standard of practice is to have another nurse verify
all pediatric dose calculations before administration.

Older Adults. Older adults also require special

considerations during medication administration. In
addition to physiological changes of aging, behavioral
and economic factors influence an older person’s use
of medications.
 Polypharmacy. Polypharmacy happens when a
patient takes multiple medications or potentially
inappropriate or unnecessary medications or when a
medication does not match a diagnosis (Touhy and
Jett, 2014).

EVALUATION
Evaluation of medication administration is an essential
role of professional nursing that requires assessment
skills; critical thinking; analysis; and knowledge of
medications, physiology, and pathophysiology.
Patient Outcomes. A patient’s clinical condition can
change minute by minute. Use knowledge of the
desired effect and common side effects of each
medication to compare expected outcomes with actual
findings.