Nursing Skills

Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 1

Foundations of Nursing Abejo
Medication


NURSING SKILLS

Medication

Lecturer: Mark Fredderick R. Abejo R.N, M.A.N



MEDICATION


FUNCTIONS OF THE NURSE

Dependent Nursing Action carried out at the
instruction or order of the Physician.
Independent Nursing Action carried out within the
legal scope of Nursings independent domain.
Interdependent Nursing action performed by the
Nurse in collaboration with other members of the
Health Care Team.

PHARMACOLOGY
Study of actions of chemicals on Living Organisms.
Study of drugs & the effects to the Person.

IMPORTANT THINGS TO NOTE BEFORE
ADMINISTERING DRUGS

Name of the Patient
Name of the Drug
Generic Name the name assigned by the
manufacturer that 1
st
developed the drug.
Trade/Brand Name selected by the drug
company that sells the drug & is copyrighted.
Dose
Route (Drug Preparation)
Timing & Frequency
Doctors Orders/Signature
Date

FIVE RIGHTS
The Right Drug with
The Right Dose through
The Right Route at
The Right Time to
The Right Patient

Right Recording & Documentation
Right Approach
Right Frequency
Right to Refuse
Right Education
Right Assessment
Right Evaluation

The Right Drug
Name
Generic Name
Trade Name

Preparation
Solid
Capsule powder or gel form of an active drug
enclosed in a gelatinous container, may also be
called liquigel.
Pill Mixture of a powdered drug with a
cohesive material; may be round or oval.
Tablet small, solid dose of medication,
compressed or molded; may be any color, size or
shape.
Lozenge/Troche small oval, round or oblong
preparation containing a drug in a flavored or
sweetened base, which dissolves in the mouth &
releases the medication.
Trans-Dermal Patch unit dose of medication
applied directly to the skin for diffusion through
skin & absorption into the bloodstream.

Liquid
Elixir medication in a clear liquid containing
water, alcohol, sweeteners & flavor.
Syrup medication combined in a water & sugar
solution.
Suspension finely divided, undissolved
particles in liquid medium that needs to be
shaken before use.
Solution a drug dissolved in another substance.

Semi-Solid
Ointment semi-solid preparation containing a
drug to be applied externally.
Liniment medication mixed with alcohol, oil
or soap, which is rubbed on skin.
Lotion drug particles in a solution for topical
use.
Suppository easily melted medication
preparation in a firm base such as gelatin that is
inserted in the body.

Drug Effects

Primary (Therapeutic)
Intended Effect of the drug.

Therapeutic Actions of Drugs
1. Palliative : relieves the symptoms of a disease but does
not affect the disease itself.
2. Curative : treats a disease or condition.
3. Supportive : sustain body function until other treatment
of the bodys response can take over.
4. Substitutive : replaces body fluids or substances.
5. Chemotherapeutic : destroys malignant cells.
6. Restorative : returns the body to health.

Secondary (Side-Effect)
Not intended effect of the drug
Allergy
Rapidly-developing reaction.
Signs & Symptoms may appear on the skin,
respiratory system or the GIT.
Anaphylactic Reaction life-threatening
reaction that may result in respiratory distress,
severe bronchospasm, tachycardia, hypotension
& cardiovascular collapse. May be treated by
epinephrine, bronchodilators & antihistamines.
Symptoms & signs of allergy to drugs:
Fever
Diarrhea GIT
Urticaria Local Effect
Rash Local Effect
Nausea GIT
Vomiting GIT
Toxicity
Overdose taking in a lethal dose of medication.
Cumulative Effect
The body cannot metabolize one dose of the
drug before another dose is administered.
The drug is taken in more frequently than it
is excreted & each new dose increases the
total quantity in the body.
May cause permanent damage to the
kidneys or liver.



Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 2

Foundations of Nursing Abejo
Medication
Iatrogenic Effect
The drug produces a disease condition.
Examples: Chloramphenicol, which is taken for
Typhoid Fever, may cause Depression of the Bone
Marrow functions, such as Anemia,
Thrombocytopenia, Neutropenia,
Idiosyncratic Effect
It is the unexpected peculiar response to drug,
either over response, under response, different
response than expected.
Unexplained response
Drug Interaction
Effects of one drug are modified by the prior on
concurrent administration of another drug. Thereby
increasing or decreasing the pharmacological effect.
Drug Antagonism
Conjoint effect of two drug is less than the effect of
drug acting separately
Drug Summation
The combined effect of two drugs produces a result
equals the sum of the individual effects of each agent.
Drug Synergism
The combined effects of drugs is greater than the sum
of each individual agent acting independently
Drug Potentiation
The concurrent administration of two drugs in which
one drug increases the effect of the other drug.

Drug Tolerance
A decreased physiologic response to the repeated
administration of a drug or chemically related
substance.
Excessive increase in the dosage is required in order
to maintain the desired therapeutic effect.

Drug Abuse
Inappropriate intake of a substance, either continually
or periodically.

Drug Dependence
It is persons reliance or a need to take a drug or
substance.
Intense physical or emotional disturbance is produced
if drug is withdrawn.

Drug Addiction
It is due to biochemical changes in the body tissues,
especially the nervous system. These tissues come to
require the substance from normal functioning.

Drug Habituation
It is the emotional reliance on a drug to maintain a
sense of well being, accompanied by feelings of need
or cravings for drug.




DRUG NOMENCLATURE

Chemical Name : Precise description of the drugs
chemical composition.
Generic Name : The name assigned by the
manufacturer that first develops the drug. Often
derived from the Chemical Name.
Official Name : The name by which the drug is
identified in the official publication.
Trade Name :Also referred to as the Brand Name or
Proprietary Name. Selected by the drug company that
sells the drug & is copyrighted. A drug can have
several Trade Names but the same Generic Name.







DRUG PREPARATIONS

1. Oral (Capsule, Pills, Tablets, Extended Release, Elixir,
Suspension, Syrup. )
2. Topical. Drug is applied directly to the body site, usually, the
skin or mucous membranes. ( Liniment, Lotions, Ointment,
Suppository, Transdermal Patch.)
3. Injectable. Introduction of medication into the body by a
syringe. ( Vials, Ampules, Pre-Filled Syringes. )


DRUG CLASSIFICATIONS

1. Body Systems
- Drugs that affect the bodily systems, such as the
Digestive System, Cardiovascular System, etc.
2. Symptoms Relieved
- Ex: Fever, Colds, Cough, etc.
3. Clinical Indication of the Drug
- Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive.




PHARMACOKINETICS

- Study of the movement of drug molecules in the body.

Absorption.
The process by which a drug is transferred from its
site of entry into the body to the bloodstream.
Factors That Affect Drug Absorption

Route of Administration.
Injected medications are usually absorbed more
rapidly than oral medications

Drug Solubility.
Liquid medications are absorbed more rapidly than
solid preparations, as liquid medications do not have
to be dissolved by the gastric juices.

pH.
Acidic drugs are well absorbed in the stomach.
Basic drugs remain ionized or insoluble in an acid
environment.
They can only be dissolved in the Small Intestines.

Local Conditions at the Site of Administration.
The more extensive the absorbing surface, the greater
the absorption of the drug, thus, a more rapid effect
will occur.
Food in the stomach can delay the absorption of some
medications or enhance the rate of absorption of
other drugs.

Drug Dosage.
A higher dose than the normal is usually given when a
patient is in acute distress and the maximum
therapeutic effect is desired as quickly as possible.
A maintenance dose is a lower dosage that becomes
the usual or daily dosage

Serum Drug Levels.
After a drug has been absorbed, its serum level can be
monitored by drawing blood and measuring the
drugs peak & trough levels.

Blood Flow.
Rich blood supply enhances absorption.

Pain
Stress

Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 3

Foundations of Nursing Abejo
Medication

Distribution
After a drug has been absorbed into the bloodstream, it
is distributed throughout the body.
Drug accumulates in specific tissues for its action to
take place.
Distribution depends on the rate of perfusion and
capillary permeability to the drug.


Factors That Affect Drug Distribution

Plasma-Protein Binding
Medications connect with plasma protein in the
vascular system.
Clients with reduced plasma protein such as kidney or
liver disease could receive a heightened drug effect.
Volume Distribution
Client with edema has an enlarged area in which a
drug can be distributed and may need an increased
dose.
Barriers to Drug Distribution
Blood Brain Barrier
Placental Barrier
Obesity
Receptor Combination
A receptor is an area on the cell wall ( protein or
nucleic acid ) where drug attaches and response takes
place.
Agonist, drug will connect itself to the receptor site
and cause pharmacological response.
Antagonist, drug will attempt to attach but because
attachment is uneven, there is no drug response.





Metabolism
Also called Biotransformation.
The breakdown of the drug to an inactive form.
The liver is the primary site for drug metabolism.
Physiologic changes or presence of a Liver disease
may complicate the process.

Factors That Affect Drug Metabolism

Age
Nutrition
Liver enzymes involved in metabolism rely on
adequate amount of amino acids, lipids, vitamins and
carbohydrates.
Insufficient amount of major body hormones



Excretion

After the drug is broken down to an inactive form,
excretion of the drug from the body occurs.
The Kidneys excrete most of the drugs. ( most
important route of excretion )
The Lungs excrete gaseous substances such as inhaled
anesthesia.
Many drugs are also excreted through the intestines.

Factors That Affect Drug Excretion

Renal Excretion
Carried out by glomerular filtration and tubular
secretion, which increases quantity of drug excreted.
Drugs
Probenecid, prevent the excretion of penicillin.
Antacid, prevent elimination of ASA
Blood Concentration Level
Half-Life



VARIABLES INFLUENCING THE EFFECT OF A
MEDICATION

1. Developmental Considerations
During pregnancy, most medications are
contraindicated due to its possible adverse effects on
the fetus.
Certain drugs have a Teratogenic Effect, which are
known to have a potential to cause developmental
defects in the embryo or fetus.
Breastfed infants are also at a risk for adverse effects
from the drugs in the mothers body.
Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 4

Foundations of Nursing Abejo
Medication
Children are given smaller doses of medication
because the immaturity of their organs are responsive
to the medication.
Older Adults are also responsive to medication
because their bodies have experienced physiologic
changes associated with the aging process.
Small body size, reduced weight & reduced body
water also alter distribution.
Drugs are excreted more slowly from the body as a
result of changes in kidney functions of Older people.

2. Weight
Expected responses to drugs are based largely on those
reactions that occur when the drugs are given thealthy
adults (18-65 years old, 150 lb.)
Drug doses for children are calculated by weight or
Body Surface Area.

3. Sex
The difference in the distribution of body fat & fluids
in men & women is a minor factor affecting the action
of some drugs.

4. Genetic & Cultural Factors
Asian patients may require smaller doses of a drug
because they metabolize it at a slower rate.
African Americans appear to require larger doses of
some medications that are used to lower blood
pressure.
Herbal treatments that are popular in some cultures
may interfere with or counteract the action of
prescribed medication.

5. Psychological Factors
The patients expectations of the medication affects
the response to the medication.
Placebo is a pharmacologically inactive substance.
Some patients appear to have the same response with
the placebo as with an active drug.

6. Pathology
The presence of a disease may affect the drug action.
Pathologic conditions that involve the Liver may slow
themetabolism & alter the dosage of the drug needed
to reach a therapeutic level.

7. Environment
Sensory deprivation and overload may affect drug
responses.
Nutritional state may also affect the bodys reaction to
certain drugs.

8. Timing of Administration
The presence of food in the stomach delays the
absorption of orally administered medications.


MEDICATION ORDERS

No medication may be given to a patient without a
medication order from a physician or, in some states, a
nurse practitioner
Orders are written on a form designed specifically for a
physicians order, which becomes a permanent part of the
patients record
Many facilities use a computer-generated pharmacy order
system and can receive a medication order by fax from the
physician
Physician enters drug order into computer, computer sends
order directly to pharmacy and enters order into patients
permanent record
Prevent any guessing when handwriting is illegible or drug
names are similar
Provides physicians with recommended doses of
medication, indicates laboratory tests that monitor action of
drug, and lists potential interactions that may occur.
In certain circumstances (emergencies), a verbal order from
physician may be given to RN or pharmacist
Unless specific orders to the contrary are written, all drugs
that may have been ordered while at home are discontinued
Explain to patient and family how the patients drug plan is
to be implemented
In some inpatient facilities, patients keep medications at
bedside and learn or continue to administer as they would
at home
Promotes patients independence
Nurse should be aware when patients are allowed to do this
Notation should be made on patients care plan
When patient has had surgery or is transferred to another
clinical service or another health agency, it is general
practice that all orders related to drugs are discontinued and
new ones written
Check that all medications are appropriately reordered


TYPES OF MEDICATION ORDERS

1. Standard Order
Carried out until cancelled by another order.
The Physician specifies that a certain order is to be
carried out for a stated number of days or times. Once
the stated period has passed, the order is cancelled
automatically.

2. PRN Order
As needed, or only when necessary.
Commonly written for post-operative pain medication.

3. Stat Order
Carried out immediately and for one time only.

4. Single Order
The medication is only ordered once, at a time
specified by the Physician.

5. Self-Terminating

PARTS OF A MEDICATION ORDER

1. Patients Name
2. Date & Time when the Order was written.
3. Name of the Drug to be administered.
4. Dosage of the Drug
5. Route by which the Drug is to be administered.
6. Frequency of administration of the Drug.
7. Signature of the Person/Physician writing the Order.

TRANSCRIPTION OF MEDICATION ORDERS
Kardex
Medication Sheet or Medication Administration
Record
Medication Card

Questioning Medication Order

Any drug order suspected to be in error should be
questioned
Suspected error should be noted and reported
On occasion, nurse may not think there is an error but may
not understand why medication has been prescribed
Ask how order relates to patients care plan
May prevent medication error if wrong med has been
ordered
Confusion over placement of decimal point can be
prevented by always having a zero precede the decimal for
clarity (no need for zero after decimal can cause
confusion if decimal is unclear or missed completely)
Drug to which patient is allergic may inadvertently be
prescribed
Notation should be made in patients record of past adverse
reactions
Do not administer and question when, in nurses judgment,
patient is allergic
Patient may wear wristband indicating specific allergies
Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 5

Foundations of Nursing Abejo
Medication
Drug may be ordered that would potentially interact with
another med patient is taking
All unfamiliar meds should be verified before
administering
Guessing is a gross carelessness action checking with
person that wrote the order is the only safe procedure
Nurses have the right to refuse to administer any
medication that, based on their knowledge and experience,
may be harmful to patient
Must notify physician of refusal


Caring for Controlled Substances Safely
Controlled substances are kept in a locked drawer or
container as a safety measure
Narcotics or controlled substances may be ordered
only by physician (sometimes, nurse practitioners
registered with Dept. of Justice)
Record must be kept for each narcotic administered
Forms are kept with narcotics
Information required:
receiving patients name
hour narcotic was given
name of physician prescribing narcotic
name of nurse administering narcotic
Narcotics are checked daily
Amount on hand is counted and each dose used
must be accounted for on the narcotic record
Nurse has a secure i.d. code that provides access
into the system, Identifies patient by name or i.d.
number, and verifies count for each drug as it is
removed
Count that does not check properly must be
reported immediately
If for any reason a narcotic prepared for
administration has to be discarded, a 2
nd
nurse should
act as witness, and that person should also sign the
narcotic sheet
also document with a witness any time a full dosage is
not given and some of the narcotic needs to be
disposed of



PREPARATION AND ADMINISTRATION
OF DRUGS

Definition :

Drug or medicine is a chemical agent which acts to maintain,
improve and restore physiologic processes of the body.

Purposes in general:
- To maintain and promote health
- To restore physiologic processes
- To aid in diagnosis
- To provide palliative effect
- To supply substances which is deficient. (Ex. Insulin)
- To help prevent disease

Assessment for all medications administration:
- Clients diagnosis
- Clients medication
- Clients allergies to medication
- Specific drug action
- S/S of side effects or adverse reaction
- Clients age & developmental stage
- Problems in self-administering a medication (e.g. poor
eyesight, unsteady hands)
- Clients ability to cooperate during administration
- Clients knowledge of & learning needs about medication



GENERAL INSTRUCTIONS:

Be sure doctors order is complete & well understood before
carrying it out.
Know the clients condition & all other factors related to the
proper use of the drug.
Be alert for signs of allergy & idiosyncrasy manifested by the
client.
Know the purpose & therapeutic effect of each drug ordered.
Be familiar with standard abbreviations & symbols
commonly used.
Verbal orders are accepted in extreme emergencies.
Observe the RIGHTS in giving medications.
Always clarify doubtful /unclear order before executing it
Verify if drug is to be delayed or omitted for specific period
of time
Do not leave medicine with the client to take by himself
Do not give drug that shows physical changes or
deterioration
Report an error in medication immediately to the nurse in
charge.
The nurse who prepares the medication must be responsible
for administering and recording it. Never endorse it to
another nurse.
Always observe asepsis in preparing and administering
drugs.
Always use the corresponding medication card for each drug
prepared and administered.




Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 6

Foundations of Nursing Abejo
Medication
ROUTES FOR ADMINISTERING DRUGS

A. ORAL ROUTE having the Patient Swallow the
medication

Advantages Disadvantages
Most convenient
Usually less expensive
Safe, does not break skin
barrier
Administration usually
does not cause stress
Inappropriate for client
with N & V
Drugs may have
unpleasant taste and odor
Inappropriate when GIT
has reduced motility.
Inappropriate if client
cannot swallow.
Cannot used before
certain diagnostic test or
surgical procedure
May discolor teeth, harm
tooth enamel.
May irritate gastric
mucosa.
Can possible aspirated.

Drug Forms for Oral Administration:

Solid: tablet, capsule, caplet, lozenges, pill, powder
Liquid : syrup, suspension, emulsion, elixir, milk or
other alkaline substances.

Enteric coated tablets should not be crush before
administration.
Other forms of oral medication that should not be chewed
or crushed:
SR Sustained Release
XL Extended Release
CR/CRT Controlled Release
SA Sustained Action
o LA Long Acting
Do not administer enteric coated with antacids, milk or
another alkaline substance
Suspension are never administered through IV
If patient vomits within 20 30 minutes of taking the drug,
notify the physician. Do not re-administer the drug
without doctors orders.


Administration of Oral Medication

Definition:
Oral Medication is the administration of drugs by
mouth for systemic effect. It may be in the form of pills, tablets,
capsules and liquid.

Objectives
To prepare & administer the most common, least
expensive route of administering medication safely
To provide a sustained drug action and increased
absorption without feelings of nausea and vomiting.

Equipments:
Medication tray with medication
Medicine card
Mortar and pestle for crushing pill
Water, juice or milk (if not contraindicated by drug
absorption)

PROCEDURE RATIONALE
1. Check medicine cards with
physicians order sheet or clients
chart for written orders or any
changes in the order.

Counter checking
prevents error in
medication
2. Arrange the medicine cards in the
medication tray according to the
following:
o Location of the client
o Time of administration
o Condition of client (more


Systemic way will
facilitate lesser error
and minimize time
involved in
serious clients are scheduled
last)
medications.
3. Wash your hands Handwashing
removes
microorganisms that
can cause infection.
4. Gather necessary equipment. Make
sure medicine glasses are clean and
dry.

5. Check medication 3 times before
taking to the client:
o When taking the medication
from the storage area
o Before placing medication
into the medicine rack/glass
o Before placing medicine to the
storage area



Rechecking can lead
to accuracy in
medication
6. Place medication in each separate
container with the corresponding
card behind each medicine glass.
Mixing liquid
medicine can reduce
concentration and
strength of the drug.
7. Observe the 5 Rights in
administering medications:
o Right client
o Right drug
o Right dose
o Right time
o Right route

8. Correctly calculate dose if
necessary

9. Set the medicine glass at eye level
when pouring

10. Ascertain clients identity before
administering medications. Check
room or bed or card, call out
clients name, check I.D., wrist
band

11. Give medications one at time. Give
liquid medications and cough syrup
last
Liquid and cough
syrup does not need
water follow up

12. Elevate clients head to prevent
aspiration.
The client might
forget or might
ignore taking the
medicines

13. Remain with the client until all
medications have been swallowed.
Never leave any medications at
clients side, for client to take as he
pleases
The client might
forget or might
ignore taking the
medicines

14. File medicine card on the card rack.
15. Wash hands Prevents spread of
infection
16. Record all medications given right
after administration.

17. Check client 30 min to 1 hour later
for effects of medication.



B. SUBLINGUAL ROUTE drugs that is placed under the
tongue, where it dissolves.

C. BUCCAL ROUTE a medication is held in the mouth
against the mucous membranes of the cheek until the drugs
dissolves

Advantages
Sublingual / Buccal
Disadvantages
Sublingual / Buccal
Most convenient
Usually less expensive
Safe, does not break skin
barrier
Administration usually
does not cause stress
Can be administered for
local effect
Inappropriate for client
with N & V
Drugs may have
unpleasant taste and odor
If swallowed, drug may
be inactivated by gastric
juice.
Drug must remain under
Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 7

Foundations of Nursing Abejo
Medication
Drugs is rapidly absorbed
into the bloodstream.
Ensures greater potency
because drug directly
enters the blood and
bypass the liver
the tongue until dissolved
and absorbed.



D. TOPICAL ROUTE Inserting or rubbing drug onto the
Skin or Mucous Membrane.

a) Dermatologic ( includes lotions, liniments,
ointments, pastes and powders )
Wash and pat dry area well before application to
facilitate absorption of drugs.
Use surgical asepsis when open wound is present.
If the skin has lesions, wear gloves or use tongue
depressor to apply medications.
Apply only a thin layer of medication

b) Ophthalmic / Eye Medication

Administration of Eye Medication

Objectives
To provide an eye medication the client requires to
treat an infection or other reason.

Considerations
The eye is the most sensitive organ to which the nurse
applies medications. Care must be taken to prevent
instilling medication directly into cornea.
Instilling wrong concentration may cause local
irritation of the eyes as well as systemic effects

Equipment
Medication bottle with eye dropper or ointment tube
Cotton ball or tissue
Eye patch or tape (optional)

PROCEDURE RATIONALE
1. Check medicine cards with
physicians order sheet or clients
chart for written orders or any
changes in the order.

Counter checking
prevents error in
medication
2. Arrange the medicine cards in the
medication tray according to the
following:
a. Location of the client
b. Time of administration
c. Condition of client (more
serious clients are scheduled
last)


Systemic way will
facilitate lesser error
and minimize time
involved in
medications.
3. Wash your hands Handwashing
removes
microorganisms that
can cause infection.
4. Gather necessary equipment.
5. Check medication 3 times before
taking to the client:
o When taking the medication
from the storage area
o Before placing medication
into the medicine rack/glass
o Before placing medicine to the
storage area


Rechecking can lead
to accuracy in
medication
6. Place medication in each separate
container with the corresponding
card behind each medicine glass.

7. Observe the 5 Rights in
administering medications:
o Right client
o Right drug
o Right dose
o Right time
o Right route

8. Correctly calculate dose if
necessary

9. Place client in supine position or sit
back in chair with head slightly
hyperextended
Provide easy access
to eye and
minimizes drainage
of medication
through the tear
duct.
10. Clean the eyelid /lashes if
necessary using a cotton soak in
sterile saline. Wiping from inner to
outer canthus, one cotton for each
eyes.


Eye Drops


11. Squeeze prescribed dose in the
eyedropper
Ensure correct
dosage
12. Place a tissue below the lower lid Cotton or tissue
absorbs medication
that escapes eye
13. Hold eyedropper one-half to three-
fourth inch above eyeball with
dominant hand
Helps prevent
accidental contact of
dropper with eye,
thus reducing risk of
injury and transfer
of infection.
14. Gently press downward with thumb
or forefinger against bony orbit.
Exposes lower conjunctival sac by
pulling down on cheek.
Prevents pressure
and trauma to
eyeball and prevents
fingers from
touching eye.

15. While client looks up, drop
prescribed dose into center of the
conjunctival sac.
Prevent damage
directly to the
cornea. Reduces
stimulation of blink
reflex
16. While client closes and move eyes,
place finger on either side of the
nasolacrimal duct for 1 minute.
Prevents overflow of
medication into
nasal passage and
possible systemic
effect.




Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 8

Foundations of Nursing Abejo
Medication

Eye Ointment


17. Separate clients eyelids and grasp
lower lid, exert downward pressure
over the cheek.

18. Instruct patient to look up
19. Apply ointment along insidebedge
of the lower eyelid from inner to
outer canthus.
Distributes
medication without
traumatizing eye
20. Wipe excess medication Promtes comfort and
facilitate cleanliness



21. Place client in comfortable position
22. Wash hands
23. Assess for possible drug reaction
24. Documentation


Eye Irrigation

Have patient sit or lie with head tilted toward side of
affected eye
Clean from inner toward outer canthus to prevent debris
entering lacrimal ducts
Expose lower conjunctival sac, hold irrigator about 2.5 cm
(1) from eye, direct flow from inner to outer canthus
Irrigate until solution is clear or all of the solution has been
used
Use only enough force to remove secretions gently
Avoid touching any part of eye
Dry area with cotton balls or gauze sponge
Chart irrigation, appearance of eye, drainage, and patients
response



c) Otic ( Ear ) Medication
Includes instillations and irrigations
Instillations:
To soften earwax
To reduce inflammation
To treat infection
To relive pain
Irrigations:
To remove cerumen or pus
To apply heat
To remove a foreign body or object

Administration of Ear Medication

Objectives
To soften earwax so that it can be readily removed at
a later time
To provide local therapy to reduce inflammation,
destroy infective organism.
To relieve pain

Equipment
Medication bottle with dropper
Cotton tipped applicator
Cotton ball



PROCEDURE RATIONALE
1. Check medicine cards with
physicians order sheet or clients
chart for written orders or any
changes in the order.

Counter checking
prevents error in
medication
2. Arrange the medicine cards in the
medication tray according to the
following:
a. Location of the client
b. Time of administration
c. Condition of client (more
serious clients are scheduled
last)


Systemic way will
facilitate lesser error
and minimize time
involved in
medications.
3. Wash your hands Handwashing
removes
microorganisms that
can cause infection.
4. Gather necessary equipment.
5. Check medication 3 times before
taking to the client:
o When taking the medication
from the storage area
o Before placing medication
into the medicine rack/glass
o Before placing medicine to the
storage area



Rechecking can lead
to accuracy in
medication
6. Observe the 5 Rights in
administering medications:
o Right client
o Right drug
o Right dose
o Right time
o Right route

7. Warm medication by running warm
water over the bottle.
Prevents nausea and
vertigo that may
occur if the
medication is too
cold
8. Correctly calculate dose if
necessary

9. Place the client in side- lying
position with the affected ear
facing up. The nurse should
stabilize the clients head with his
or her hand.
Provide easy access
to ear for instillation
of medicine.
Stabilizing the head
promotes safety.
10. Fill medication dropper with
prescribed amount of medication.

11. Prepare client for instillation as
follows:
Infants: draw the auricle gently
downward and backward.
Adults / Children : lift pinna upward
and backward
Straightening of ear
canal provides direct
access to deeper
external ear
structures.
12. Instill the medicine into the ear
canal holding the dropper 1 cm
above ear canal
Forceful instillation
of medicine into
occluded canal can
cause injury to
eardrum.
13. Ask the client to maintain the
position for 2-5 minutes. Apply
gentle massage or pressure to
tragus of ear with finger.
Allows complete
distribution of
medication. Pressure
and massage moves
medication inward.
14. Place client in comfortable position
15. Wash hands
16. Assess for possible drug reaction
17. Documentation



Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 9

Foundations of Nursing Abejo
Medication


Tilt your head (or have the patient tilt his or her head) to
the side as shown in drawing A. Or lie down with the
affected ear up as shown in drawing B.

Guidelines for Removing Excessive/ Impacted Cerumen

Place 5 to 10 drops of the cerumen-softening solution into
the ear canal, and allow it to remain for at least 15 minutes.
Prepare a warm (not hot) solution of plain water or other
solution as directed by your doctor. Eight ounces of
solution should be sufficient to clean out the ear canal.
To catch the returning solution, hold a container under the
ear being cleaned. An emesis basin is ideal because it fits
the contour of the neck.
Tilt the head down slightly on the side where the ear is
being cleaned.
Gently pull the earlobe down and back to expose the ear
canal as shown in drawing A.
Place the open end of the syringe into the ear canal with the
tip pointed slightly upward toward the side of the ear canal,
as shown in the drawing. Do not aim the syringe into the
back of the ear canal. Make sure the syringe does not
obstruct the outflow of solution.
Squeeze the bulb gentlynot forcefullyto introduce the
solution into the ear canal and to avoid rupturing the
eardrum.
(Note: Only health professionals trained in aural
hygiene should use forced water sprays [e.g., Water Pik]
to remove cerumen.)
Do not let the returning solution come into contact with the
eyes.
If pain or dizziness occurs, remove the syringe and do not
resume irrigation until a doctor is consulted.
Make sure all water is drained from the ear to avoid
predisposing to infection from water-clogged ears.
Rinse the syringe thoroughly before and after each use,
and let it dry.
Store the syringe in a cool, dry place (preferably, in its
original container) away from hot surfaces and sharp
instruments.
Do this procedure twice daily for no longer than 4
consecutive days.











d) Nasal Medication
Nasal instillation ( nose drops ) usually are
instilled for their astringent effect .

Administration of Nasal Medication

Objectives
To shrink swollen mucous membrane
To loosen secretions and facilitate drainage.
To treat infections of the nasal cavity or sinuses.



Equipment
Medication bottle with dropper or spray container
Facial tissue
A. Nasal Sprays

Gently insert the bottle tip into one
nostril as shown in drawing A.

Keep head upright. Sniff deeply while
squeezing the bottle. Repeat with other
nostril.

B. Pump Nasal Sprays

Prime the pump before using the first
time. Hold the bottle with the nozzle
between the first two fingers and thumb
on the bottom of the bottle.

Tilt the head forward.

Gently insert the nozzle tip into one
nostril as shown in drawing B. Sniff
deeply while depressing the pump once.

Repeat with other nostril.

C. Nasal Inhalers

Warm the inhaler in hand just before use.

Gently insert the inhaler tip into one
nostril as shown in drawing C. Sniff
deeply while inhaling.

Repeat with other nostril.

Wipe the inhaler after each use. Make
sure the cap is tightly in place between
uses. Discard after 2-3 months even if the
inhaler still smells medicinal.


If broncholilator, administer a max. of 2 puffs for at least 30
second interval.

D. Nasal Drops

Squeeze the bulb to
withdraw medication
from the bottle.

Lie on bed with head
tilted back over the
side of the bed as
shown in drawing D.

Place the
recommended number of drops into one nostril. Gently tilt
head from side to side.

Repeat with other nostril. Lie on bed for a couple of minutes
after placing drops in the nose.

Do not rinse the dropper.

e) Vaginal Medication

Drug Forms: tablet, cream , jelly, foam, suppository

Vaginal Irrigation ( Douche ) : is the washing of vagina by a
liquid.

Empty the bladder before the procedure
Position and drape the client.
Instillation : back lying position with knees flexed
and hips rotated laterally.
Irrigation : back lying position with the hips higher
than the shoulder ( use bedpan )


Nursing Skills
Medication
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 10

Foundations of Nursing Abejo
Medication

Guidelines for Applying Vaginal Antifungal Products

Start treatment at night before going to bed. Lying down
will reduce leakage of the product from the vagina.
Wash the entire vaginal area with mild soap and water, and
dry completely before applying the product.
Vaginal cream: (If prefilled applicators are being used, skip
to step 4.) Unscrew the cap; place the cap upside down on
the end of the tube. Push down firmly until the seal is
broken. Attach the applicator to the tube by turning the
applicator clockwise. Squeeze the tube from the bottom to
force the cream into the applicator. Squeeze until the inside
piece of the applicator is pushed out as far as possible and
the applicator is completely filled with cream.
Remove the applicator from the tube.
Vaginal tablets/suppositories: Remove the wrapper and
place the product into the end of the applicator barrel.
While standing with your feet slightly apart and your knees
bent, as shown in drawing A, or while lying on your back
with your knees bent, as shown in drawing B, gently
insertthe applicator into the vagina as far as it will go
comfortably.




Push the inside piece of the applicator in and place the
cream as far back in the vagina as possible. To deposit
vaginal tablets/suppositories, insert the applicator into the
vagina and press the plunger until it stops.
Remove the applicator from the vagina.
After use, recap the tube (if using cream). Then clean the
applicator by pulling the two pieces apart and washing
them with soap and warm water.
If desired, wear a sanitary pad to absorb leakage of the
vaginal antifungal. Do not use a tampon to absorb leakage.
Continue using the product for the length of time specified
in the product instructions. Use the product every day
without skipping any days, even during menstrual flow.


f) Rectal Medication
Drugs administered rectally exert either a local or
systemic effect on the gastrointestinal mucosa.

Considerations
Rectal medication is a convenient and safe method of
giving certain medications but not as reliable as oral or
parenteral routes in terms of drug absorption and
distribution.
Improper placement can result in expulsion of the
suppository before medication dissolves and is
absorbed into the mucosa.
Never force a suppository into a mass of fecal
material. It may be necessary to administer a small
cleansing enema before a suppository can be inserted.
Do not cut the suppository into sections to divide the
dosage, the active drug may not be distribute evenly
within the suppository.











Administration of Rectal Suppository

Gently squeeze the suppository to determine if it is firm
enough to insert. Chill a soft suppository by placing it in
the refrigerator for a few minutes or by running it under
cool running water.
Remove the suppository from its wrapping.
Dip the suppository for a few seconds in lukewarm water to
soften the exterior.
Lie on your left side with knees bent or in the knee-to-chest
position (see drawings A and B). Position A is best for self-
administration of a suppository. Small children can be held
in a crawling position.





Relax the buttock just before inserting the suppository to
ease insertion. Gently insert the tapered end of the
suppository high into the rectum. If the suppository slips
out, it was not inserted past the anal sphincter (the muscle
that keeps the rectum closed). 4 adults, 2 children and
infants)
Continue to lie down for a few minutes and hold the
buttocks together to allow the suppository to dissolve in the
rectum. The parent/caregiver may have to gently hold a
childs buttocks closed.
Remember that the medication is most effective when the
bowel is empty. Try to avoid a bowel movement after
insertion of the suppository for 30 minutes up to 1 hour so
that the intended action can occur.


E. ENTERAL TUBE ROUTE administration of medicine
via nasogastric tube.


ADMINISTERING MEDICATIONS THROUGH ENTERAL FEEDING
TUBE

Use liquid meds or meds that can be crushed and combined
with liquid
Bring liquid med to room temp
Remove clamp from tube, checking for tube placement
before administering drug
Flush tube with 15 30 mL water (5 10 mL for children)
before giving meds and immediately after
Give meds separately and flush with water between each
drug
Disconnected from suction and clamped 20 30 minutes
after administration
Disconnect continuous tube feeding, leaving tube clamped
for short period of time
Document water intake and liquid med on I & O chart