DRUG

ADMINISTRATION
S.SERONEI
objectives
• Definition of terms
• Outline the various drug preparations
• State the factors affecting drug action
• State the 10 rights of drug administration
• Describe the various routes of drug administration
• Define a drug order
• Outline the abbreviations used in a drug order
• Calculate drug dosages
• Describe dangerous drugs
Introduction
A drug is a chemical substance that brings about
physical, emotional or behavioral change in a person
after taking it.
A drug is also any substance or product that is used or
intended to be used to modify the physiological system
or pathologic state in the benefit of the recipient.
•Prescription: A physician's order for the preparation and
administration of a drug or device for a patient
•Therapeutic effect: Is a desirable effect following drug
administration.
•Side effect: Is undesirable effect that occurs following drug
administration. The medical team foresees the effect and the
patient is told to be aware of the effects that could happen
following drug administration. Side effects resolve on their
own with time.
• Adverse effects: Is undesirable or unintended
pharmacological effect that occurs after drug
administration. The effect is not expected by the
doctor or the patient. The effects can be reduced
by either lowering the dose or stopping the
medication.
• Drug allergy: An allergic reaction to a medication
where by the immune system, which fights
infection and disease, reacts to the drug. This
reaction can cause symptoms such as rash, fever,
and trouble breathing. Severe drug allergies can
cause anaphylaxis.Anaphylaxis is a sudden, life-
threatening, whole-body reaction to a drug or
other allergen causing irregular heartbeat, trouble
breathing, swelling and unconsciousness.
•Prescription: A physician's order for the preparation
and administration of a drug or device for a patient
•Therapeutic effect: Is a desirable effect following drug
administration.
• Side effect: Is undesirable effect that occurs following
drug administration. The medical team foresees the
effect and the patient is told to be aware of the effects
that could happen following drug administration. Side
effects resolve on their own with time.
•Adverse effects: Is undesirable or unintended
pharmacological effect that occurs after drug
administration. The effect is not expected by the doctor
or the patient. The effects can be reduced by either
lowering the dose or stopping the medication.
• Drug allergy: An allergic reaction to a medication
where by the immune system, which fights
infection and disease, reacts to the drug. This
reaction can cause symptoms such as rash, fever,
and trouble breathing. Severe drug allergies can
cause anaphylaxis. Anaphylaxis is a sudden, life-
threatening, whole-body reaction to a drug or
other allergen causing irregular heartbeat, trouble
breathing, swelling and unconsciousness.
• Trade name: This is a drug name given by
the producing company .
• Generic name: This is the active
ingredient of a drug.
Example:Panadol is the trade name while
paracetamol is the generic name
Generic drugs will have different brand
names but contain the same active
ingredient.
Drug Preparations
Medicines are often in the following preparations:
•Liquid
The active part of the medicine is combined with a liquid to
make it easier to take or better absorbed. A liquid may also be
called a solution or syrup.
•Tablet
The active ingredient is combined with another substance and
pressed into a round or oval solid shape. Tablets can be
dissolved in water.
•Capsule
The active part of the medicine is contained inside a
plastic shell that dissolves slowly in the stomach. It
can be separated and mixed in the contents like a
child’s favourite food. Others need to be swallowed
whole, so the medicine isn’t absorbed until the
stomach acid breaks down the capsule shell
•Topical medicines

These are creams, lotions or ointments applied

directly onto the skin. They come in bottles or
tubes depending on the type of medicine. The
active part of the medicine is mixed with another
substance, making it easy to apply to the skin.
•Suppositories

The active part of the medicine is combined with another

substance and pressed into a ‘bullet shape’ so it can be inserted
into the rectal canal. Suppositories must not be swallowed.

•Drops

These are often used where the active part of the medicine
works best if it reaches the affected area directly. They are
mostly used for eye, ear and nose.
•Inhalers
•The active part of the medicine is released under
pressure directly into the lungs. The drug is
delivered through a handheld device that delivers
a puff or spray of these medicines straight into the
lungs through a mouthpiece.
• Injection
An injection is a way of administering a sterile
liquid form of medication into the body or
parenteral using a sharp, hollow needle or tube.
Injectable drugs are either in the ampule or vial.
Ampule are glass containers in 1 ml to 10 ml sizes
that hold a single dose of medication in liquid
form. They are made of glass and have a scored
neck to indicate where to break the ampule.
• Vial is a single- or multi-dose glass container
with a rubber seal top, covered by a metal or
plastic cap. A single-use vial must be discarded
after one use; a multi-dose vial must be labelled
with the date it was opened.
•Implants or patches
These medicines are absorbed through the skin,
such as nicotine patches for help in giving up
smoking, or contraceptive implants.
Factors Affecting Drug Action
Drug action differs in different individuals due to the
following factors:
 Body size/weight. This influences the concentration of
drug attained at the site of action. For the obese the
drug action will be low due to the fats as compared to
the lean individuals. Dose of drugs must be calculated
on the basis of body weight in cases of children, lean
and obese individuals.
• Age. Children may not react the same as adults
thus drug dosages must be adjusted since their
kidneys and liver are still immature to metabolize
and excrete drugs. The elderly drug action is
affected because they have a slower metabolism,
slower excretion, use of multiple medications
and chronic disease states.
• Sex. Females have smaller body size and require
lower drug dosages. Some drugs cannot be
administered such as quinine during pregnancy
because it is teratogenic.
 Diet. Medicine is usually taken after a meal to reduce
the risk of gastric irritation, nausea and vomiting.
Food depresses the rate and extent of drug absorption.
Drugs may be given in an empty stomach to get
immediate action or to prevent it from mixing with
food.
 Cigarette and alcohol induce liver enzymes causing
rapid metabolism of some drugs reducing drug action.
 Route of administration. Parenteral route has high
drug action especially intravenous route increasing its
drug action as compared to other routes.
 Pathologic states. Some diseases such as
gastrointestinal and hepatic disease affect the
absorption and metabolism of some drugs affecting its
action.
 RIGHTS OF DRUG
ADMINISTRATION
The rights of drug administration help to reduce medical errors such as
giving the wrong medication, wrong dose or wrong patient.
Right patient

Check the name on the patients file and ask

the patient to identify himself /herself.
Right medication

Triple check the medication label when retrieving,

preparing and before administering the
medication. Check the medication label with the
physician’s orders.
Never administer medication prepared by another
person and a medication that is not labeled.
Right dose

Check the label for medication concentration,

triple all medication calculation and check it with
another nurse. Verify that dosage is within
appropriate dose range for the patient.
Right route

Check the treatment sheet and appropriateness of

the route. Confirm the patient can receive the drug
by the prescribed route.
Right time

Verify schedule of medication that is the

date, time and the specified period of
time. Check the dosage of medication
given to the patient. Administer
medication within 30 minutes of
schedule
Right education

Inform the patient of the medication being

administered, the desired effects and the
side effects of the medication. Ask the
patient if they have any known allergies to
the medication.
Right to refuse

Inform the patient, parent or next of kin on the

right to refuse medication, the consequences
of refusing medications and notify the
physician on the refusal of medication by the
patient. Document refusal of medication and
that the patient and next of kin understands the
consequences.
Right Assessment

Properly asses patient and test to determine if

medication is safe and appropriate. If unsafe or
inappropriate notify the ordering physician and
document notification.
Document that the drug was not administered and
the reason that dose was skipped.
Right Evaluation

Asses the patient for any adverse side effects and

effectiveness of the medication.
Compare the patient prior status and post
medication status. Document patient’s response to
medication.
Right documentation

Document the medication, dosage, route, date

and time and signature and credentials.
Never document before medication is
administered.
ROUTES OF DRUG ADNMINISRATION

Drugs are administered in the following routes:

 Oral route/orally
 Parenteral route
 Inhalation
 Topical route
 Eye and ear route
 Rectal canal
Oral route

•This is the administration of medication for the patient to

swallow, to place it under the tongue (sublingual)or between
the cheeks (buccal cavity).
•Oral medications can either be in solid form (tablets or
capsule) of in liquid form. Infants and young children
receive the liquid preparation while the adult receive the
tablets and capsules.
• Tablets are powdered drug preparation that are
compressed in to pills of various courtside and
shape. Tablets are coated to decrease unpleasant
taste, to ease swallowing and to protect the
stomach lining.
•Capsules are hard or soft gelatin coverings that encase an
oil, powder or granular form of a specific medication.
Capsules should be taken as a whole, they should not be
crushed or opened.
•Liquid medication is medicine in liquid form.it is usually
prescribed for children and the Capsules should drug include
cough syrups, antiacids and analgesics for children.
Oral medications are considered to be the
safest, convenient and most economical to the
patient.
Oral medications are contraindicated if
patient has gastric or intestinal suctioning or
if the patient is vomiting.
•Sublingual route. the medications are placed under
the tongue and allowed to dissolve completely.
•Buccal cavity the medication is placed in lower or
upper buccal pouch against the cheek and allowed
to dissolve.
CAPSULES
Parenteral route

This is the administration of medication by injection.it

can administered via the following routes:
 Subcutaneously
 Intramuscularly
 Intravenously
 Intradermally
Subcutaneously

Subcutaneous (SC) injections are administered

into the adipose tissue layer just below the
epidermis and dermis. This tissue has few blood
vessels, so drugs administered by this route have a
slow, sustained rate of absorption.
Sites for SC injections include the upper outer
quadrant of the upper arm, the abdomen within
one inch of the belly button and anterior aspects of
the thighs.
Examples of subcutaneous medications include
insulin, heparin, epinephrine, and allergy
medication
Before administering the injection, identify the
site of injection, disinfect using an alcohol swab,
hold the skin between the fore fingers, insert the
needle at 450 and inject the medicine. Remove the
needle and do not massage the injection site.
Discard the syringe and the needle in a sharp box.
Cover the patient and thank them. Document on
the patient’s treatment sheet and Kardex.
Intramuscularly
This is the delivery of medication into the deep
muscle.
Intramuscular injections are administered in the
deltoid muscle, muscle of the thigh and muscle of
the buttocks in the upper outer quadrant. Caution
must be taken in giving injections in the gluteal
muscle to prevent injecting the sciatic nerve.
Most vaccines are administered via this route.
Intramuscular injections may be used instead of
intravenous injections because some drugs are
irritating to veins, or because a suitable vein
can’t be located. It may be used instead of oral
delivery because some drugs are destroyed by
the digestive system when a drug is swallowed
• .
Intramuscular injections are absorbed faster
than subcutaneous injections because muscle tissue
has a greater blood supply than the tissue just under
the skin.
Before administering the injection, identify the site of
injection, disinfect using an alcohol swab, hold the
skin between the fore fingers, insert the needle at 90 0
•.
• .Push back the plunger and if blood gets into the
syringe, it means the needle is in a blood vessel,
remove the remove the needle. If blood does not
get into the syringe, the needle is in the right
place and you can inject the medicine. Remove
the needle, apply pressure on the injection site
and discard the syringe and the needle in a sharp
box. Cover the patient and thank them.
Document on the patient’s treatment sheet and
Kardex
Intramuscular injection has side effect like severe
pain at the injection site, tingling or numbness,
redness, swelling or warmth at the injection site
and signs of any allergic reaction, such as
difficulty breathing. The nurse should watch out
of the following side effects and if it occurs, he or
she should report immediately
Intravenously
This is the administration of medication direct in to the blood
stream.
The purpose of this route is to achieve high levels, immediate and
maximum the effects of medication within a short period of time.
Intravenous drugs are indicated I cases of emergency or if the
medication cannot be taken and absorbed by other routes.
Intravenous drugs are administered through, a thin plastic tube
called a cannula is inserted into your vein.
Before administering the drug, swab the cannula
site with cotton wool swab. Connect a syringe
with sterile water for injection to intravenous port
and withdraw the piston. Check for back flow of
blood and air. If air is present in the syringe
remove the syringe from the port and push the air
out , connect the syringe again and push water for
injection.
Carefully and slowly inject the medication as you
observe patient’s reaction. Clear the cannula by
infusing 1-2mls of water for injection. Remove
syringe, cap the cannula and discard the syringe in
the sharp box. Thank the patient and document on
the patient’s treatment sheet and kardex.
Intradermally

Intradermal injections (ID) are injections

administered into the dermis, just below the
epidermis. The ID injection route has the longest
absorption time of all parenteral routes.
The most common sites used are the inner surface
of the forearm and the upper back, under the scapula
The dosage of an ID injection is usually under 0.5 ml.
The angle of administration for an ID injection is 5
to 15 degrees. Once the ID injection is completed, a
wheal forms under the skin.
Before administering the injection, identify the site of
injection, disinfect using an alcohol swab, hold the
skin between the fore fingers, insert the needle at 150
Inject the medicine while watching for a weal to
appear. Remove the needle and do not apply
pressure on the injection site. Discard the syringe
and the needle in a sharp box. Cover the patient
and thank them. Document on the patient’s
treatment sheet and Kardex.
AMPOULES
VIALS
Inhalation

Nebulization is a process by which medications are

added to inspired air and converted into a mist that is
then inhaled by the patient into their respiratory system
Medications administered through inhalation are
dispersed via an aerosol spray, mist, or powder that
patients inhale into their airways. Delivery of nebulized
medication is by face mask or a mouthpiece.
Patients taking medication by an inhaler have
asthma or chronic respiratory disease and should
learn how to administer these medications
themselves
Assemble nebulizer as per manufacturer’s
instructions. Add the prescribed medication into
the nebulizer cup. Position patient sitting up in a
chair or raise the head of the bed to 45 degrees.
Use a mask and turn on air to nebulizer and ensure
that a sufficient mist is visible exiting nebulizer
chamber. Have patient take slow, deep, inspiratory
breaths. Encourage a brief 2- to 3-second pause at
the end of inspiration, and continue with passive
exhalations, to maximize on the effectiveness of
medication. Have patient repeat this breathing
pattern until medication is complete and there is no
visible misting
• This process takes approximately 8 to 10
minutes. Once treatment is complete, turn
flowmeter off and disconnect nebulizer.
Document on the patient’s treatment sheet and
kardex.
Topical Route
This is the application of medication directly to
the skin on form of lotions, creams, aerosol sprays
and ointment.
The drug is absorbed through the skin.
Topical drugs are indicated in patients with nappy
rash, bacterial skin infections, burns and
inflammatory skin conditions.
Wear gloves and maintain standard precautions
when administering topical medications to the
skin, mucous membranes, and tissues. Do not
touch any preparations to your own skin, and turn
your face away from powdered applications.
In administration of topical drugs, wear a non-
sterile glove unless skin is broken; then wear
sterile gloves. Wash, rinse, and dry the affected
area with water and a clean gauze. Apply topical
medication. Thank the patient and document your
implementation in the treatment sheet and the
Kardex.
Eye and Ear Route
•This is the administration of medication via the
ear or eyes.
•Ear medication it is liquid form and it as
administered in drops.
•Eye medication is in liquid that is administered in
drops or as ointment.
Instilling eye drops
•Cleanse the eyelashes and eyelids of any drainage
or crusting with a warm washcloth or gauze. Use
each area of cleaning surface only once and move
from inner to outer eye area. Tilt patient’s head
back slightly if patient is sitting up, or place
patient’s head over a pillow (under the neck) if
they are lying down. Invert the eye-drop
container and have patient look up and focus on
the ceiling.
Gently pull patient’s lower lid down to
expose conjunctival sac. Hold eye-drop
container above eye, taking care not to touch
the eye, eyelids, or eyelashes. Instill the
prescribed number of drops into conjunctival
sac, to prevent contamination of the
medication. Release lower lid after
instillation and ask patient to close eyes
• Ask patient to move the eyeball while eyes are
closed, for distribution of the medication. Assist
patient to a comfortable position. Thank the
patient and document your implementation in the
treatment sheet and the Kardex.
Instilling ear drops
•Cleanse external ear of any drainage using a warm
wet washcloth. Position patient with affected ear
facing upwards.
•Draw up medication into ear dropper. Gently pull
ear pinna back and up for an adult or downward and
backward for children. Hold dropper tip just above
ear canal, do not touch the tip of the ear with the
dropper.
• Administer the ear drops. Release ear pinna and
have patient remain in the position for at least 5
minutes. Assist the patient to a comfortable
position. Thank the patient and document on the
patient’s treatment sheet and Kardex.
Rectal Route
Drugs administered per rectal (PR) have a faster
action than via the oral route.
Rectal absorption results in more of the drug
reaching the systemic circulation with less
alteration on route.
Rectal administration reduces side-effects of some
drugs, such as gastric irritation, nausea and
vomiting.
Rectal medications are given for their local effects
in the gastrointestinal system (e.g., laxatives) or
their systemic effects (e.g., analgesics when oral
route is contraindicated).
Rectal medications are contraindicated after rectal
or bowel surgery, with rectal bleeding, severe
diarrhea.
The nurse should maintain patient’s privacy when
giving rectal medications.
Before administration, position the patient on left
side with upper leg flexed over lower leg toward the
waist (Sim’s position). Ensure to lubricate the drug to
prevent friction as the drug enters the rectal canal.
The patient should remain on the side for 5 to 10
minutes. Document the procedure
DRUG ORDER
A drug order is a written directions provided by a
prescribing practitioner for a specific medication to be
administered to an individual.
Examples of different types of drug orders are:
• Copy of a written prescription
• Written order on consultation form
• Copy of a pharmacy call in order
Parts of a Drug Order
All drug orders and prescription must contain:
• Patient’s name
• Date
• Drug name
• Route of administration
• Dose
• Frequency
• Duration of order
• Doctor’s or presciber’s signature
Drug order sample
• Name: Hospital no.
• Age : Weight :
• Diagnosis:
•
Date DRUG DOSE FREQUEN DURATI DOCTOR/
CY ON PRESCIB
ER 3AM 3PM
9AM 9PM
C OM M ON AB B RE V I AT I O NS U SE D I N ME D I C AT I O N P RE SC R I P TI ON

 NOCTE – Night
 STAT - Immediately
 BD – Twice a day
 TDS/TID – Three times a day
 QID/QDS - Four times a day
 STAT-Give immediately
 PRN – When required
 O/P. O – oral / per oral
 SL - Sublingual
 ID – Intradermally
 IM – Intramuscularly
 IV – Intravenously
 SC- Subcutaneously
 NEB – Nebulizer
 PR – Per rectal
 DRUG
CALCULATIONS
Drugs must be calculated before being administered so
that the right dose can be administered.
The calculations will be based on the drug available and
the ordered drug.
Example:
Drug ordered- 500mg paracetamol PO QID
Drug available-250mg tablet
250mg+ 250mg= 500mg
Drug order-Gentamycin 24mg IV BD
Drug available –Gentamycin 80mg/2ml
24mg 2ml 0.6ml
80mg
DANGEROUS DRUGS

This are drugs with the ability to cause addiction if not

used correctly or if used for a long time.
These drugs are governed by the Control Drug Act
(CDA)
Dangerous drugs should be kept in a lockable cupboard
within another lockable cupboard together with the
CDA register.
•The nurse in charge of the ward keeps the keys of
the CDA cupboard.
•Example of drugs include: morphine, pethidine
Administration of Dangerous Drugs

Administration of CDA is done by two nurses,

either both are qualified or one is qualified.
Both nurses must read the prescription and
confirm the drug prescribed and the signature of
the clinician.
Indicate the time to be given and route of
administration.
The nurse will open the medicine cupboard and
then the CDA cupboard. The nurse removes the
CDA register and open the page with the record of
the drug to be given. This ensures that the nurse
confirms the accuracy of the balance before
administration is done.
CDA register is return back to the CDA cupboard.
Both nurses administer the drug to the patient and
document on the patient’s treatment sheet and the
Kardex
THE END