INTRODUCTION TO CLINICAL PHARMACHOLOGY.PPTX

INTRODUCTION TO CLINICAL
PHARMACHOLOGY
CHARAN VIKRAM ZAGADE
CLINICAL INSTRUCTOR
DR. D. Y PATIL INSTITUTE OF NURSING
EDUCATION PIMPRI, PUNE-18

 A medication is a substance administered for the
diagnosis, cure, treatment, or relief of a symptom or for
prevention of disease.
 Pharmacology is the study of the effect of drugs on
living organisms.

 The written direction for the preparation and
administration of a drug is called a prescription.

PURPOSE OF MEDICATION
 Drugs can be administered for these
purposes:
 Diagnostic purpose: to identify any disease
 Prophylaxis: to prevent the occurrence of
disease.
e.g.: heparin to prevent thrombosis or
antibiotics to prevent infection.
 Therapeutic purpose: to cure the disease.

USES OF DRUGS
1. Prevention- used as prophylaxis to prevent
diseases e.g. vaccines; fluoride-prevents tooth
decay.
2. Diagnosis- establishing the patient's disease or
problem e.g. tuberculosis (Mantoux) testing.
3. Suppression- suppresses the signs and
symptoms and prevents the disease process
from progressing e.g. anticancer, antiviral
drugs.

4. Treatment- alleviate the symptoms for patients with
chronic disease e.g. Anti asthmatic drugs.
5. Cure- complete eradication of diseases e.g. anti-biotics,
anti-helmintics.
6. Enhancement aspects of health- achieve the best state
of health e.g. vitamins, minerals

PRINCIPLES OF MEDICATION
ADMINISTRATION
1. Almost all the drugs are potential harm producers.
2. The tongue present an irregular surface, for the tablets, and
capsules ensure that patient has taken the medication.
3. Unpleasant taste may cause nausea and vomiting.
4. Good blood supply, well diluted drugs and empty stomach
favours absorption.
5. Medical record has legal value and is helpful for future study
and research.
6. Volatile (evaporates) liquid when kept open diffuse into air.

7. Use of common ounce glass for medication administration
promotes cross infection.
8. Error is a possibility in all human activity. Omission(LEFT OUT)
in administration of medication may seriously endanger the life of
patient.
9. Knowledge regarding the effect of drug helps the patient to take
drug regularly.
10. Administration of medication is a therapeutic procedure. It will be
therapeutic only if the client gets the desired effect.

RIGHTS OF MEDICATION
ADMINISTRATION

 Medication errors can be detrimental to patients. To prevent
these errors, these guidelines are - the rights are used in drug
administration.
1. Right Patient: correct identification of the client cannot be
over emphasized. This can be done by asking the client to
mention his / her full name which should be compared with
that on the identification bracelet or the patient's folder and
medication / treatment chart for confirmation.
 Beware of same and similar first and surnames to prevent the
error of administering one person's medication to another and
vice versa.

2.RIGHT MEDICATION:
 Right Medication: before administering any medicine,
compare name on medication chart / medication order
with that on the medication at least 3 times-checking
medication label when removing it from storage unit,
compare medication label with that on treatment chart and
medication label and name on treatment chart with
patient's name tag.

3. RIGHT TIME
 Right Time: drug timing is very especially with some drugs like
antibiotics, antimalaria drugs etc. to achieve cure and prevents
resistance. Some drugs must be given on empty stomach e.g.
antituberculosis drugs; and some after meals.

4. RIGHT DOSE
 This becomes very important when medications at hand
are in a larger volume or strength than the prescribed
order given or when the unit of measurement in the order
is different from that supplied from the pharmacy. Careful
and correct calculation is important to prevent over or
under dosage of the medication.

5. RIGHT ROUTE
 Right Route an acceptable medication order must specify
the route of medication. If this is unclear, the prescriber
should be contacted to clarify or specify it. The nurse
should never decide on a route without consulting the
prescriber.

6. RIGHT TO INFORMATION ON DRUG /
CLIENT EDUCATION
 Right to information on drug / client education
The patient has the right to know the drug he / she is taking,
desired and adverse effects and all there is to know about the
medication. The charter on patient's right made this clear.

7. RIGHT TO REFUSE(REJECT)
MEDICATION
 Right to Refuse Medication: The patient has the right to
refuse any medication. However, the nurse is
obliged(must) to explain to patients why the drug is
prescribed and the consequences refusing medication.

8. RIGHT ASSESSMENT
 Right Assessment: Some medications require specific
assessment before their administration e.g. checking of
vital signs. Before a medication like Digoxin(Used to
treat heart failures) is administered the pulse must be
checked. Some medication orders may contain specific
assessments to be done prior to medication.

9. RIGHT DOCUMENTATION
 Right Documentation- documentation should be done
after medication and not before.

10. RIGHT EVALUATION
 Right Evaluation: Conduct assessment to ascertain drug
action, both desired an side effect.

MEDICATION ORDER
 The drug order, written by the physician, should has 7 essential
parts for administration of drugs safely.
1. Patients full name.
2. Date and time.
3. Drug name.
4. Dosage.
5. Route of administration.
6. Time and frequency of administration.
7. Signature of physician.

TYPES OF MEDICATION ORDERS
 Four types of medication orders are commonly used:
1. Stat order: A stat order indicates that the medication is to
be given immediately and only once. e. g: morphine sulfate
10 milligrams IV stat. (Narcotic Analgesics) pain medicine.
2. Single order: The single order or one-time order indicates
that the medication is to be given once at a specified time.
e.g: Seconal 100 milligrams at bedtime. (used to treat
insomnia in people who have trouble falling or staying
asleep)

3. Standing order: Standing order is written in advance carried out
under specific circumstances. (e. g: amox twice daily x 2 days)
4. PRN order: "PRN" is a Latin term that stands for “pro re nata,"
which means "as the thing is needed." A PRN order or as-needed
order, permits the nurse to give a medication when the client
requires it. (e.g., Amphojel 15 mL prn use:
stomach upset, heartburn, and acid indigestion.)

SAFETY IN ADMINISTERINGMEDICATIONS
There are five stages of the medication administration process.
1. Ordering / prescribing
2. Transcribing(printed form) and verifying.
3. Dispensing(distribute) and delivering.
4. Administering.
5. Monitoring and reporting.

 The main components of each step are:
1. Prescribing
 Choosing an appropriate medication for a given clinical situation,
taking individual patient factors into account such as allergies.
 Selecting the most appropriate administration route, dose, time and
regimen.
 Communicating the plan with the one who administer the
medication. This communication may be written, verbal or both.
 Documentation.

2. Administration
 Obtaining the medication and having it in a ready-to-use form. This
may involve counting, calculating, mixing, labeling or preparing in
correct way.
 Checking for allergies.
 Giving the right medication to the right patient, in the right dose,
via the right route, at the right time.
 Documentation.

3. Monitoring
 Observing the patient to determine whether the medication is acting
promptly, being used correctly and not harming the patient.
 Documentation.

MEDICATION ERRORS
 Medication errors, broadly defined as any error in the prescribing,
dispensing, or administration of a drug. A medication error is any
preventable event that may cause or lead to inappropriate
medication use or client harm while the medication is in control of
health care professional.
 Sources of Medication Errors:
1. Inaccurate recording and transcribing orders.
2. Unclear labeling of drugs.

3. Misidentification of client, wrong dose, wrong time, wrong route
and method.
4. Incomplete delivery of drugs
5. Verification errors
6. Use of inadequate knowledge or inaccurate knowledge base.

 Classification of Medication Errors:
Medication errors may be classified according to the stage at which they occur in the
medication use cycle, i.e. at the stage of prescribing, dispensing, or administration of a
drug.
 Factors Contributing to Medication Errors
1. Prescribing Error:
 Lack of knowledge of the prescribed drug, its recommended dose, and of the patient
details.
 Illegible handwriting.

 Inaccurate medication history taking. Confusion with the drug
name.
 Inappropriate use of decimal points.
 Use of abbreviations.
 Use of verbal orders.

2. Dispensing (distribute) Error
 From the receipt of the prescription in the pharmacy to the supply of
a dispensed medicine to the patient.
 This occurs primarily with drugs that have a similar name or
appearance. Example: Lasix (frusemide) and Losec (omeprazole).
 Other potential dispensing errors include wrong dose, wrong drug, or
wrong patient

3. Administration Errors:
 Discrepancy (difference) occurs between the drug received by the
patient and the drug therapy intended by the prescriber.
 Errors of omission - the drug is not administered.
 Incorrect administration technique and the administration of
incorrect or expired preparations.
 Deliberate(done consciously and intentionally) violation of
guidelines - Wrong time, wrong dose and wrong route.

Action to be taken when error occurs:
 The client safety becomes the top priority
 Stop the drug if it is still on flow
 The nurse assesses and examines the client's condition and notifies the
physician of the incident as soon as possible.
 Once the client is stable the nurse reports the incident to the appropriate person
in the institution like nursing supervisor or nursing manager.
 The nurse is also responsible for reporting the incident. An incident report must
be filed within 24 hours of an incident.
 Educate other staff to avoid similar incident in the future.

PREVENTIVE MEASURES OF MEDICATION ERROR:
Follow the 10 rights of medication administration.
1. Right patient
2. Right drug
3. Right dose
4. Right time
5. Right route
6. Right recording
7. Right assessment
8. Right education
9. Right evaluation
10. Right to refuse medication

 Be sure to read labels at least 3 times, before during and after administration of the drug.
 Prepare the medicine in a well lighted room.
 Check the expiry date of the drug before administration.
 Be aware about ambiguous orders or drug names and consult doctor if any doubt.
 Be alert to unusually large dosage or excessive increase in dose ordered.
 When in doubt, check order with prescriber, pharmacist and literature.
 Be aware about the method of administration of each drug eg: dilution, mixing, drug
interactions.
 Double check all calculations, even simple calculations.
 Do not allow any other activity to interrupt your administration of medication to a client.

DRUGS FORMS
 Medications are available in a variety of forms or
preparations. The form of medication determines the
route of administration. Medications are of several
forms such as tablets, capsules elixir, injections and
suppositories. Various drug forms are
1. Tablets: - Drug form which contains dried powdered
active drug. It contains binders and fillers to provide
bulk and proper size. Many different types of tablets
like scored tablets (a line running across the top for
easy breakage) enteric tablets and slow release
tablets.

2. Caplets: - Coated tablets in the
shape of a capsule and easy to
swallow.
3. Capsule:-Solid form for oral use.
Medication in powder, liquid, or
oil form covered with a gelatin
shell. Capsules are available in
different colors to help for
product identification.

4. Elixir: - Clear fluid containing water
or alcohol designed for oral use.
5. Emulsion: A fine dispersion of
minute droplets of one liquid in
another in which it is not soluble.
6. Lozenges:- Formed with a harden
base of sugar, water and flavorings.
Never swallow. Dissolve slowly in
mouth.

7. Powder :- Finely ground form of an
active drug. It can be contained in capsule
or vials.
8. Creams:- A semisolid emulsion in oil and
water. Main ingredient is water.
Emulsifying agent added to keep mixed.
9. Ointments:- Semisolid emulsion of oil
and water. Main ingredient is oil.
Normally applied to skin without precise
measurement.

10. Lotion:- Suspension of an active drug in a water
base applied externally to protect skin.
11. Solutions:- Liquid preparation that may be used
orally, Parenterally or externally. It contains water
with one or more dissolved compounds. For
parenteral use it should be sterile.
12. Suppository :- A solid base mixed with gelatin
and shaped in the form of pellet for easy insertion
to body cavity. It melts at body temperature. E.g.
Rectal or Vaginal Suppositories.

13. Suspensions: - It contains fine, un
dissolved particles of a drug
suspended in a liquid base. It is
important to shake always before use.
14. Liquid Sprays: - It has water and
alcohol base. Some dispensed as
foams or aerosol spray.

15. Trans dermal disk or Patch:- Consist of a
multi-layered disk of a drug reservoir d porous
membrane and a adhesive layer to it, which
allows medication to be absorbed through the
skin tincture.
16. Tincture: Alcoholic solution prepared from
drugs derived from plants.
17. Pellet / Bead:- Drug can be implanted in to
the body in the form of a pellet or bead that
slowly releases medicine into tissues.

ROUTES OF ADMINISTERING MEDICATION
 The route of administration of medication depends on the medication's
properties and the desired therapeutic effect on the client's physical and
mental condition. There are various routes for administering medications:
 Oral Route - It is the easiest and most commonly used method of
administering medication. Medication are given by mouth and swallowed
with any fluid. The oral medication has a slower onset of action and more
prolonged effect than parentral medications. It further includes sublingual
and buccal routes.

 Sublingual Administration - Some medications are placed under
the tongue to dissolve for the easy and early absorption. The
medication given by sublingual route should not be swallowed
because the therapeutic effect will not be achieved. e.g.
Nitroglycerine given through the sublingual route, when patient
complaints of chest pain. Do not give any fluid to drink until the
medication is dissolved completely.

 Buccal administration - It involves placing the solid
medication in the mouth against the mucous membranes
of the cheek until the medication dissolves. Patients are
instructed not to chew or swallow the medications or not
to drink any liquid with it. It acts locally on the mucosa or
systemically when swallowed in the person's saliva.

 Parentral Route- Injecting a medication into body
tissues and blood vessels.
 Some medications are administered into body
cavities. The following are the advanced techniques
of medication administration for which the nurses
are responsible :
 Epidural - Medications in the epidural space via a
catheter which is placed by a anesthesiologist used
for administration of analgesia postoperatively.

Parentral route
Subcutaneous
Inj. into tissue just
below dermis of
skin
Intramuscular
Intravenous Intradermal

 Intrathecal - Admistered through a catheter that is placed into the
subarachnoid space or into one of the ventricles of the brain.
 Intra osseous - Involves infusion of medication directly into the bone
marrow. It is used in infants and toddlers who have poor access to
intravascular space(The space contained within blood vessels.)
 Intra peritoneal - Involves administration of medication into the
peritoneal cavity, where it will be absorbed into the circulation.
Antibiotics and chemotherapeutics are commonly administered through
this route.

 Intra pleural - Involves administration of medication through the
chest wall and directly into the pleural space. Chemotherapeutics,
antibiotics are given through his route as well as to resolve the
persistent pleural effusion.
 Intra arterial - Administration of medications directly into the
arteries. Commonly used for the clients who have arterial clots.
 Intra cardiac - Injection of a medication directly into cardiac tissues.
 Intra articular - Injection of a medication into a joint.

 Topical Administration -The medications when applied on the skin and mucous
membranes generally have local effects. Systemic effect occurs only when the
client's skin is thin and the medication concentration is high as well as if contact
with the skin is prolonged. Medication can be applied to the mucous membranes in
a different ways.
 Directly applying a liquid or ointment e.g. gargles and swabbing the throat.
 Insertion of medication into a body cavity. e.g. suppository in rectum or vagina.
 Instilling fluid into body cavity. e.g. ear drops, nasal drops, bladder or rectal
instillation.
 Irrigating a body cavity. e.g. irrigating eye, nose, ear, vagina, bladder or rectum.

 Inhalation route - Medications can be administered through nasal
passages, oral passages or tubes that are placed into the mouth of
the patient to the trachea. These medications may have local or
systemic effects.
 Intra ocular route - Administering of medication to the contact
lens into the patient's eyes. Pilocarpine, medication used for
glaucoma, is a medication.

NURSING RESPONSIBILITY IN STORAGE AND
MAINTENANCE OF DRUGS
 Nurses are the persons who are delivering services
round the clock and they have the main responsibility
for the storage and maintenance of the drugs.

 Drugs are stored in drug cupboards
A. According to pharmacological action or
B. Alphabetically
 Drug Storage: Storage of the drug must be done in such a way that the drug should be
accessible and should not cause any alteration in its chemical composition.
1) Proper drug storage.
2) Storage Environment.
3) Arrangement of drugs on shelves.
4) The store room.
5) The dispensary.

1) Proper Drug Storage
Drugs are stored in a specially designed secure area or space of a building in
order to:
 Avoid contamination or deterioration Avoid disfiguration of labels
Maintain integrity of packaging and so guarantee quality and potency of
drugs during shelf life.
 Prevent or reduce pilferage, theft or losses.
 Prevent infestation of pests and vermin.
 The storage should not hinder the cleaning and should have sufficient
space for movement of stocks and handling.

 Products are to be stored in a manner that prevents damage due to
excessive vertical stacking heights and not to exceed eight stacks.
 Store the products as per product storage conditions.
 Monitor and record the temperature of storage area on daily basis.
 Routinely refer to drug interaction charts or drug reference source
and commit common interactive drugs to memory.
 Do not use any substandard abbreviations and symbols.
 Read the leaflet of the drug carefully when giving new drug first
time.

 Do not make assumptions of illegible orders.
 Clarify it before administering the drug.
 Do not accept incomplete orders and telephonic or verbal orders.
 Double check with a client who has allergies about all new drugs as they
are added in treatment plan.
 Document all medication as soon as they are given.

2) Storage environment
 Cold storage facilities.
 Humidity control.
 Clean conditions.
 Sufficient lighting.
 Adequate temperature.
 Adequate shelving to ensure integrity of the stored drugs.

 Drugs to be stored under conditions that prevent contamination and
"Well closed container" precautions to be taken in relation to the
effects of the atmosphere, moisture, heat and light. "Protected from
moisture" means that the product is to be stored in air tight
container.
 "Protected from light".

 Room temperature 15°C to 25°C
 Cold or cool - 80𝐶 to −150𝑐
 In a refrigerator - 2°C to -80
𝐶
 In a deep freeze -15°C
 The area must be kept clean.

 The floors are kept clean and free of trash, dirt, slippage water, drain water etc.
 The floor of the warehouse should be made of hard floor and must be in a good
state of repair and appearance at all times.
 The Storage area must be free from unsanitary conditions (E.g. Rodents, insects,
Birds, etc.)
 The Pest control shall cover treatment for rodents and ensure adequate pest
control measures.
 Secured area availability for damaged, rejected and expired goods.
 The area used for storage of IV fluids should have adequate space and to prevent
exposure to direct sunlight.

 Each dosage form of drug is arranged in separate and distinct areas.
 Drugs are arranged in alphabetical order or generic names.
 Cupboard should be strong and should be made of steel or treated wood.
 Put lids properly on tins always and at the end of the day.
 Most recently received drugs are placed behind old stock on the shelf
except where new drugs have shorter expiry dates.
 The store must be cleaned daily and mopped at least once a week.

 A well arranged store enables easy identification of drugs and saves time when
picking a drug from the shelf.
 Those with longer expiration dates should be placed behind those with shorter
dates.
 To have access to drugs with shorter expiration dates first, put these in front of
the shelves.
 In this regard, the principle of FIRST TO EXPIRE FIRST OUT (FEFO)
should apply. So, drugs that were received first should be used first, except
where the new stock has shorter expiration dates than the old stock.
 The rule of FIRST IN FIRST OUT (FIFO) should be applied always.

 Essential drugs should be available at all times in adequate amounts and
in appropriate dosage forms.
 Medications must not be administered, and products and equipment must
not be used beyond their expiry dates.
 All medical equipment, dressings and solutions used for invasive
procedures must be sterile.
 Store medications that are "for external use only" separate from
medications intended for internal use.
 Single use devices are meant for single use only and must not be reused.

BROAD CLASSIFICATION OF DRUGS
 Drugs are classified in different ways, according to their
mechanism of action, composition, their therapeutic uses etc. The
following are the classification of drugs according to their action :
 Analgesics :- Drugs used to relieve pain.
 Anesthetics:- Drugs which cause loss of sensation.
 Antihelmintics & Vermifuges :- Drugs that destroy & expel
worms.
 Anti pyretics :- Drugs that reduce fever
 Anti dotes :- Substances used to counteract the effects of poison.

 Anti-infectives:- Act either to inhibit, kill or retard the growth of micro
organisms.
 Anti-coagulants:- Substances which decrease the blood clotting process, either
by inhibiting the formation of the clotting substances in the liver or by
interfering with the peripheral action of the drugs.
 Anti-histamines :- Agents that block the effect of histamines therefore used to
prevent or relieve allergies.
 Antacids : Substances that react with hydrochloric acid and reduce the activity
of gastric secretions.
 Anti-convulsants :- Drugs used to prevent or treat convulsions, e.g. used in
epilepsy.

 Anti biotics :- Products of living micro-organisms that have the ability to
destroy or inhibit the growth of micro organisms. Broad spectrum
antibiotics are effective against many strains of micro-organisms.
 Anti- diarrhetic :- Agents that are used to treat diarrhea either by
detoxicating the noxious substances or by killing the gastro intestinal micro
organisms or merely sooth the irritated bowel mucosa & reduce the spasm.
 Anti tussive :- Drugs that inhibit the cough reflex, act primarily upon the
cough centre in the C.N.S.
 Anti- asthmatics :- Drugs that provide symptomatic relief of asthmatic
attacks by relaxing the smooth muscle of the bronchioles.

 Androgens :- Hormones secreted by the testis & the adrenal cortex.
They are steroids which can be synthesized to produce the
secondary male characteristics & building up of protein tissue.
 Anti pruritics :- A drug that relieves itching.
 Anti-inflammatory :- An agent used to prevent the progress of
inflammation.
 Antiseptic :- A substance that inhibits the growth of bacteria.

 Anti-fungal (Antimycotic) :- Drug which prevent the growth of
fungi or causes the destruction of the fungi.
 Antispasmodics :- An agent that relieves the spasmodic pains or
spasm of the muscles.
 Antiemetics :- Drugs relieving or preventing nausea & vomiting.
 Anti-tubercular:- The specific drugs used in the treatment of
tuberculosis.
 Broncho dilators:- Drugs that relax muscles of the bronchioles by
reducing the smooth muscle spam.

 Coagulants -:The drugs that helps in the clotting of blood either by
the increasing the formation of liver precursors or by the clotting
factors present in the drug administered.
 Cortico-steroids :- Hormonal drugs extracted from the adrenal
cortex. The are grouped as :
(a) Gluco-corticoid:- that stimulate the conversion of proteins to
carbohydrates.
(b) Mineralo-Corticoid - that regulate the sodium & potassium
metabolism.
(c)Androgens:- male sex hormone activity.

 Diuretics:- Increase the flow of urine.
 Oxytocic's :- Drugs that stimulate uterine contractions.
 Digestants: An agent that promotes digestion.
 Emetics : Drugs that produce vomiting.
 Hypnotics :- That Induce sleep.
 Hemostatic: An agent to control hemorrhage.
 Hypotensive :-An substance capable of lowering blood pressure.
 Hypoglycemics :- Drugs that lower the blood sugar level.

 Sedatives :- Decreases the body activity.
 Gastric tonics :- Drugs which promote appetite.
 vasodilator :- Drugs which dilate the blood vessels & lower the blood
pressure, but do not affect the action of the autonomic nervous system.
 Vasoconstrictors:- Drugs that constrict the blood vessels with effect of
raising the blood pressure.
 Urinary Antiseptics :- Any organic or inorganic compounds when
administered, is secreted by the kidneys & either stops or inhibits the
growth of bacteria in the urinary tract.

TYPE OF DRUG ACTION
 It is essential for the nurse to understand all the effects the
medication can have when taken by or given to clients.
1. THERAPEUTIC EFFECTS: is the expected physiological
response a medication causes. Each medication has a desired
therapeutic effect for which it is prescribed. It is important for
the nurse to know for which therapeutic effect, a medication is
prescribed. E.g. Theophylline as bronchodilator.

2. SIDE-EFFECTS: are unintended, secondary effect a
medication will cause. Side effects may be harmless. If
the side effects are severe, the medication may be
discontinued. E.g. Theophylline may cause headache and
dizziness.

3. TOXIC EFFECTS: The harm resulting from the adverse
effects of drugs. Toxic effects develop after prolonged
intake of high doses of a medication or when a
medication accumulates in the blood because of impaired
metabolism or excretion. E.g. Morphine relieves pain but
high doses causes severe respiratory depression.

4. IDIOSYNCRATIC REACTIONS: Medications may cause
unpredictable effects in which a client over acts or under
reacts to a medication or has a reaction which is not
normal.

5. ALLERGIC REACTIONS: An abnormal reaction of the immune
system to a medication. It is an unpredictable response to
medication. A client may become sensitized immunologically to the
initial dose of medication. The drug acts as an antigen and
stimulates antibody release. Anaphylactic reactions are
characterized by sudden constriction of bronchiolar muscles, edema
of pharynx and larynx, severe wheezing and shortness of breath.

6. DRUG TOLERANCE: A person's diminished response to a drug. An
increase in dosage may be needed to cause a therapeutic effect. E.
g: clients in pain medications may develop a tolerance over time
and requires increasing dosage overtime as in the case of morphine.

7. DRUG INTERACTIONS: When two drugs are given simultaneously,
they can have a additive(mix) effect. Drug interactions are
common in individual taking many medications.

8. DRUG ANTAGONISM: an interaction between two or more drugs
that have opposite effect on the body.

FACTORS INFLUENCING DRUG
ACTION
Developmental
factors
Environment
Psychologic factors
Cultural, Ethnic and
Genetic Factors
Gender
Diet
FACTORS INFLUENCING DRUG ACTION
Illness and disease

FACTORS INFLUENCING DRUG ACTION
1. Developmental factors :- During pregnancy, women must be very cautious
about taking medication. Some drugs which are taken during pregnancy cause
risk throughout the pregnancy but cause the highest risk during first trimester,
due to the formation of vital organs and function of the fetus during this time.
Most drugs are contra-indicated during pregnancy because of many adverse
affects on fetus.
 In adolescence or adult hood, allergic reactions may occur to drugs formerly
tolerated.
 Infants usually requires small dosages because of their body size and
immaturity of their organs, especially the liver and kidneys.

2. Gender :-There are two main reasons that men and women respond
to medications differently:
Difference in fat and water distribution and differences in hormones.
Although women have weight less than men, they have proportionally
more adipose tissue, men have more body fluid than women. Some
medications are more soluble in fat, whereas others are more soluble
in water. So, the men absorb some medication more rapidly than
women and due to hormonal changes, have more effects of drugs
actions in women.

3. Cultural, Ethnic and Genetic Factors: A client's response to a
drug is influenced by age, gender, size and body composition. This
variation in response is called drug polymorphism, Genetically,
the genes that controls liver metabolism vary and some clients may
have slow metabolism, whereas others have rapid metabolism, so
the metabolism effects the absorption of drug. So, the race may
affect a drug response. This is called genetic polymorphism.

4. Diet - Nutrients can affect the action of medications. e.g. :- vitamin
K found in green leafy vegetables can decrease the effectiveness of
warfarin (coumadin) and milk interferes with absorption of
tetracycline antibiotics.

5. Environment - The client's environment can affect the action of drugs,
particularly those used to alter behaviour and mood. Environmental
temperature may also affect drug activity. When environmental temperature
is high, the peripheral blood vessels dilate, thus intensifying the action of
vasodilators. In contrast, cold environment causes vasoconstriction which
inhibit the action of vasodilators but enhance the action of vasoconstrictors.
A client who takes a sedative or analgesic in a busy, noisy environment may
not benefit as fully as if the environment were quiet and peaceful.

6. Psychologic factors :- A client's expectations about what a drug
can do can affect the response to medication. e.g. A client who
believes that codeine(pain reliver) is ineffective as an analgesic
may experience no relief from pain after it is given.

7. Illness and disease:- Illness and disease can also affects the action
of drugs. e.g. aspirin can reduce the body temperature of a client
with fever but has no effect on the body temperature of a client
without fever. Drug action is altered in clients with circulatory, liver
or kidney dysfunction.

8. Time of administration - The time of administration of oral medication
affects the relative speed with which they act. Orally administered
medications are absorbed more quickly if the stomach is empty. Thus oral
medications taken two hours before meals act faster than those taken after
meals. However, some medications, e.g. iron preparations, irritate the
gastrointestinal tract and need to be given after a meal, when they will be
better tolerated. A client's sleep - wake rhythm may affect the action of a
drug.

SYSTEM OF DRUG MEASURMENT
 The correct administration of medication depends on the nurses' ability to
compute drug dosages accurately and measure medications correctly. A
careless mistake in placing a decimal point or adding a zero to a dosage
can lead to a fatal error.
 Three systems of measurement
1. Metric system
2. Household system

 Metric system
 It is the most logically organized of the measurement system. Each
basic units of measurement is organized into units of 10. The basic
units of measurement in the metric systems are the meter (length),
liter(volume) and gram (weight). Fractions are always in decimal
form E g: 500mg or 0.5g.

 Household system
 Household measures may be used when more accurate system of
measure are not required. Household measures include drops,
teaspoons, table spoons and cups for volume and ounces and
pounds for weight. The advantage of household measurements is
their convenience and familiarity.

CONVERTING MEASUREMENTS-
CONVERSION WITHIN AND BETWEEN
SYSTEMS
 EQUIVALENT OF MEASUREMENT
METRIC HOUSEHOLD
1ml 15 drops
4-5 ml 1 teaspoon
15 ml 1 table spoon
30 ml 2 table spoon
240 ml 1 cup
480 ml (approximately 500 ml) 1 pint
960 ml (approximately 1 ltr) 1 quart
3840 ml (approximately 5 ltr) 1 gallon

DOSAGE CALCULATIONS
 Nurses need to be proficient in the
calculation of drug dosages and prepare
medications for administration. Several
formulas are used to calculate drug
dosages. The nurse is generally seeking
the quantity of on hand medication that is
equal to the ordered dose.

CALCULATING DOSAGES
 Several formulas are available to calculate drug dosages. Uses ratio as one of
several formulas.
Formula:
Dose on hand Desired dose
Quantity on hand Quantity desired (X)

 E g. Kanamycin 500 mg is ordered for a client . It is supplied in a liquid form containing
250mg in 5ml. Calculate dose?
Dose on hand (250mg) Desired dose (500mg)
Quantity on hand (5ml) Quantity desired (X)
Cross multiply
250X = 5ml x500mg
X = 5ml x 500mg
250mg
X = 5ml x 2
= 10 ml

 Another formula for calculating dosage is :
Desired dose
Amount to administrator (X) = x Quantity on hand
Dose on hand

 E .g : 2500 units of heparin is ordered for a client, heparin is available in vials in
prepared dilution of 1000 units per millilitre. The amount to administer is
Desired dose
Amount to administrator (X) = x Quantity on hand
Dose on hand
2500
X = x 1
1000
X = 2.5ml

DOSAGES FOR CHILDREN
 Children, body size significantly affects dosage. Dosage based on weight, use
kilograms of body weight and per kilogram medication recommendations to
arrive at appropriate and safe doses. Recommendations for surface area dosing
are also standardized. Body surface area estimation is considered to be the
most accurate method of calculating a child's dose.
surface area of child (𝒎𝟐)
 Childs dose = x normal adult dose
1.7 (𝒎𝟐
)
1.7(𝒎𝟐) is the surface area of an average adult

 E. g A child who weight 10 kg and is 75 cm tall has a body surface area of
0.4(𝑚2
) calculate the child dose of Ampicillin corresponding to an adult dose of
500mg.
0.4(𝑚2
)
Child dose = x 500mg
1.7(𝑚2
)
0.23 x 500mg
= 115mg

INTRAVENOUS FLUID CALCULATION
 Formula :
total volume to be infused in ml x drops per min.
rate of flow =
total time of infusion in min.
Example : Intravenous Dextrose Saline ordered for a client is 1500 ml in 24 hrs.
calculate rate of flow?
1500 x 15
= 16 drops / min
24 x 60

TERMINOLOGIES AND ABBREVIATIONS USED IN
PRESCRIPTIONS OF MEDICATIONS
ABBREVIATION DEPRIVATION MEANING
a.c. Antecibum Before meals
p.c. post cibum After meals
A.m Ante Meridien Before noon
p.m Post Meridien After noon
o.m Omni mane Each morning
Alt,die Alternis diebus Alternative days
o.n Omni, nock Each night

ABBREVIATION DEPRIVATION MEANING
h.s Hora somni At bed time
sos Si opus sit If necessary in emergency
b.d (b.i.d) Bis in die Twice a day
Tid (tds) Ter in die Three times a day
qid Quarter in die Four times a day
Stat Statim At once
H Hora Hour

ORAL DRUG ADMINISTRATION
(ORAL, SUBLINGUAL, BUCCAL)
 Equipment’s:
 Medication cart, or tray
 A glass of clean water
 Ounce glass, teaspoon, dropper etc.
 Towel and guaze pieces.
 Kidney tray / paper bag.

PROCEDURE
Steps Rationale
1. Check the patients biodata. Helps the confirm patient.
2. Assess for contraindication to the patient
receiving oral medication e.g. patient with
nausea and vomiting having bowel disorders,
reduced peristalsis, recent gastrointestinal
surgery etc. Assess the client's swallow, cough
and gag reflexes.
Alteration in gastro intestinal functions interferes
with medication, absorption, distribution and
excretion.
3. Assess patient's medical history, history of
allergies, medication history and diet history.
These factors can influence the actions of
medicines.
4. Gather physical examination and laboratory data. These may contraindicate medications
administrations.

STEP RATIONALE
5. Check the consciousness of the patient and
ability to follow instructions also assess the
patients knowledge regarding health and
medication use.
This helps to get co-operation of the patient
and to reduce medication related problems i.e.
non-compliance, abuse, addiction or
dependence.
6.Assess patients preferences for fluids. 6. The fluids ease swallowing and facilitate
absorption of the drug.
7. Check client's name, medication name, dose,
route of administration, time for administration
and indications for medication.
7. Order sheet is the most reliable source.
8.Explain the procedure to the patient. 8. Helps to get co-operation of the patient.

STEP RATIONALE
9.Assist the client in sitting position, if possible.
Lateral position can be given unless contra
indicated.
9. Inlying position the patient may aspirate the
drug and fluids when swallowed.
10.Spread the towel under the chin across the
chest.
10. Prevents spoiling patient's cloths.
11. Wash hands. 11. Reduce cross infection.
12. Take the medicine card, read it and compare
is with the physicians orders.
12. Ensures safety of the patient.
13. Take appropriate medicine from the shelf
compare with chart and read the entire label
including the expiry date.
13. First safety check to prevent the possibility of
wrong medication.

STEP RATIONALE
14. Calculate medication dose as necessary.
Double check calculation.
14. Double checking reduces the risk of error.
15. Prepare medication
16. Administering medications(a) Identify the
right patient. (i) Comparing name on the
medicine card. (ii) Calling patient by name.
(a) Administer right medicine to the right person.
iii) Asking patient to repeat his name.
(b) Explain purpose of each drug and its action
to the patient.(c) Offer some water or juice to the
patient.
(b) Patient has a right to be informed.
(c)Moistens the mouth prevents sticking of
medicines to the mucus membranes of mouth.

STEP RATIONALE
Sublingual Administration
(d) The patient place medication under the
tongue and allow the drug to dissolve
completely.
(d) Drugs absorbed through the blood vessels
on the under surface of the tongue.
Buccal Administration
(e) The patient place the medications in the
mouth against mucous membrane of the cheek
until dissolves.* Do not administer fluids until
medication dissolves.
(f) The powdered medicines are mixed at
bedside and give client to drink.
(g) Stay with the patient until swallow and
check the mouth of the patient for ensuring
swallowing.
(e) the medications act locally on mucous
membrane or systemically when they are
swallowed by saliva.
(f) Prevents thickening and hardening of the
drug and helps swallowed easily.
(g) Nurse is responsible for administration of
the ordered dosage

STEP RATIONALE
17. Wipe the mouth and remove the towel. 17. Maintains good feeling in patient.
18. Assist the patient for returning comfortable
position.
18. Maintains patient's safety.
19. Return with in 30 minutes to evaluate
response of the patient to the drug.
19. Helps to detect onset of side effects and the
therapeutic effect of drug.
20. Take the articles to the utility room, wash dry
and replace the articles.
20. Maintains clean environment of the patient.
21. Wash hands. 21. Safeguard yourself and prevents cross
infection.
Recording and Reporting
22.Record the drug name, dose and route. 22. It is a legal document and prevents chances
of doubling.

PARENTERALADMINISTRATION OF
MEDICATIONS
 Parenteral administration of medications is the administration of
medications by Injection or infusion. It is an invasive procedure that
must be performed using aseptic techniques. The effect of a parenterally
administered medication can develop rapidly depending on the rate of
medication absorption.
 PURPOSES
1. Ensure more rapid absorption and action of a drug than that can be
achieved orally.
2. Administer drugs to clients who are unable to take oral medications e.g.
Unconscious, uncooperative clients, clients with nausea and vomiting.

3. Administer medications that are not active by the oral route or are
inactivated by the digestive enzymes e.g. heparin, insulin etc.
4. To obtain a local effect e.g. local anesthetics –Xylocaine.
5. To replace fluid in order to restore blood volume e.g. shock
6. To give nourishment, if client is unable to take orally e.g. .Total
Parenteral Nutrition (TPN)

TYPES OF PARENTERAL THERAPIES
/INJECTIONS
1. Intra-dermal (ID) injection:- Injection in to the dermis just under the epidermis
e.g. Test dose
2. Subcutaneous injection (SC): Injection into the tissues just below the dermis of
the skin. It is also called hypodermal injection e.g. Insulin injection.
3. Intramuscular (IM) injection: Medicines injected into the muscle tissue.
4. Intravenous (IV) injection: Injection into the vein. Medicines or fluids are
introduced into the vein. When introduced into the arteries, it is called intra
arterial injection.
5. Intra osseous injection : Drug or fluids are introduced into the bone marrow.

6. Intra spinal or intra thecal injection: Medicines are introduced into the spinal
cavity.
7. Intra peritoneal injection: Injection of medications or fluids into the peritoneal
cavity.
8. Intra pleural injection: Injection of medications into the pleural cavity.
9. Transfusions: It is the introduction of whole blood or plasma into a vein. This is
to replace fluid or blood loss or introduce clotting factors or antibodies if needed.
10. Venous cut down or venesection: Medicines or fluids are introduced into a vein
by opening a vein and introducing a tube or wide bore needle. It is done in
emergencies.
Each type of injection requires a certain set of skills to make certain the medication
reaches the proper location.

TYPES OF SYRINGES AND NEEDLES
 Syringes have three parts
1. Tip which connects with the needle.
2. Barrel or outside part on which the
scales are marked.
3. plunger or piston which fits inside the
barrel.

 While handling a syringe the nurse may touch the outer side of the barrel, the
handle of the plunger. Unsterile object should not touch the tip of the barrel, the
shaft of the plunger and the tip of the needle.
 Types of syringes
There are several kinds of syringes, differing in size, shape and material.
Commonly used ones are
1. Hypodermic syringe: It is available in 2, 2.5, 3 and 5ml sizes. The syringe is
marked as minim and the milliliter. Commonly used as milliliter and the minim
scale are used for very small dosages.

2. Insulin syringes: It is similar to hypodermic
syringe but the scale is specifically designed for
insulin. A 100 unit calibrated scale intended to use
with U 100 insulin. This syringe should be used
for administering insulin. The syringes frequently
have a non removable needle.

3. Tuberculin syringe: It is a narrow syringe
calibrated in tenths and hundreds of a milliliter
(up to 1ml) in one scale. This type of syringe
can also be used in administering other drugs
particularly when small precise measurement
is required. E.g. pediatric doses, penicillin
test dose etc.

4. Ordinary syringe: It can be reusable
or disposable. The usual sizes are 2,
2.5, 5, 10, 20, 30 and 50ml.

NEEDLES
 It is made up of stainless steel and available in two varieties
1. disposable
2. Reusable.
Reusable needles (e.g. spinal needle) need to be sharpened periodically before
resteralization because the tip become dull with use and sometime damaged. A
dull or damaged needle should never be used.

 PARTS OF NEEDLE
1. Hub - which fit on the syringe
2. Cannula or shaft - which is attached to the
hub
3. Bevel - This is the slanted part at the tip of
the needle. A disposable needle has a plastic
hub.

 CHARACTERISTICS OF NEEDLE
1. Length of the bevel - Bevel of the needle may be long or short. Longer
bevel causes less discomfort. They are commonly used for SC or IM
injections. Short bevels are used for intravenous or intra-dermal injections.
2. Length of the shaft- Shaft length varies from 1/2 to 2 inches. Appropriate
needle length should be selected for IM injection according to clients
muscle development, adipose tissue and weight.

3. Gauge or diameter of the shaft -
Gauge varies from 18 to 28. Larger the
gauge number, small the diameter of
the shaft. Smaller gauge produces less
tissue trauma but viscous medications
like penicillin requires large gauge size.
The nurse must assess client to
determine appropriate needle length.

SIZE OF SYRINGE AND NEEDLE FOR
GIVING INJECTIONS
SR.NO ROUTE NEEDLE SIZE SIZE OF SYRINGE
1. Intradermal
26,27 gauge diameter
3/8 to 5/3 of inch
1ml calibrated in 0.01 ml units.
Tuberculin
2. Subcutaneous 25 gauge and half to 5/8 inch 1ml calibrated in 40 to 80 units.
3. Intramuscular
21,22,23 gauge 1 to 2 inch
length
2-5ml calibrated in 0.2ml
4. Intravenous 18 to 21 gauge 1 to 2 inch
Size depends on the amount of
fluids to be injected.

PROTECTION FROM NEEDLE STICK
INJURIES
 Using and disposing of needles and sharps are the
most potentially dangerous procedures faced by
health care personnel. Needle stick injuries present
a major risk for infection with hepatitis B virus,
human immunodeficiency virus (HIV) etc.
 Giving medications with a safety syringe:
Safety syringes have been designed now a days to
protect health care workers. Safety devices are
categorized as passive or active
 e.g. In passive safety device the needle retracts
immediately into the barrel after injection.

 Measures to avoid puncture injuries
1. Use puncture proof disposal container for disposing uncapped
needles and sharps
2. Never throw sharps like needle, blades, and broken glasses in waste
baskets.
3. Never break or bend needles before disposal
4. Never recap used needles (i.e. after injecting client) except in
special circumstances e.g. transporting syringe to laboratory for
blood gas analysis or blood culture.

 Needle stick injury may cause transmission of
Blood borne infections like hepatitis B, C and
HIV. After any needle stick injury an affected
health care worker should wash the area with
soap and water immediately.
 Take anti HIV medications as post exposure
prophylaxis (PEP) if exposed to HIV infection
as per medical advice.

INTRADERMAL INJECTIONS
 An intradermal injection is the administration of
medicines into the dermis just beneath the epidermis.
A small amount of liquid is introduced, for example
0.1ml. This method is commonly used for allergy testing
and tuberculosis (TB) screening. Left arm is commonly
used for TB screening.
 Sites for Intradermal injections:
1. inner lower arm
2. the upper chest
3. the back beneath the scapula
Why the intradermal injections are only given to above sites
of the body ?

 Skin in these areas is usually lightly pigmented, thinly
keratinized, and relatively hairless, facilitating detection
of adverse reactions.

 PURPOSE : To introduce a medication for allergic testing and TB screening
PROCEDURE
STEPS RATIONALE
ASSESSMENT
Review medication order.
Assess the injection site for tissue integrity.
Ensures safe administration of medication.
Assess the specific action of drug and the client's
knowledge of drug.
Reveals need for client instruction.
Assess medical history and history of allergies. Nurse should not administer any drug to which the
client is known to be allergic.

PLANNING
Assemble the equipment needed for intra dermal
injection.
A tray containing Tuberculin syringe and needle 26
to 27gauge needle.
Ampoule or vial of the correct medication, Water for
injection, Antiseptic swab Medication card,
Disposable gloves
Kidney tray or Paper bag.
Arrangement of needed equipment saves time and
energy.
Prepare correct dose from vial or ampoule and
check the dose carefully.
Ensures accurate medication and dose.

Identify client correctly and compare with
medication order. Follow the three checks
of administering medication.
Ensures right client receives ordered drug.
Explain the steps of procedure. Minimize client's anxiety.
IMPLEMENTATION
Wash hands. Reduces transmission of microorganisms.
Close door or place room curtain if needed. To provide privacy.

Select appropriate injection site (forearm) free
from inflammation and lesions.
An intradermal site should be clear so that skin
test results can be seen and interpreted correctly.
Assist client to a comfortable position with elbow
and forearm extended and supported in flat
surface.
For easy accessibility.
Stabilizes injection site.
Put on gloves. Ensures safety.
Cleanse site with antiseptic swab using a firm
circular motion starting at the center and
widening the circle outward for about 2 inches.
Mechanical action of antiseptic swab removes
microorganisms.
Hold swab between 3rd and 4th fingers of non
dominant hand.
Swab remains readily accessible when needle is
withdrawn.

Remove needle cap from needle and hold syringe
between thumb and forefinger of dominant hand with
bevel pointing up.
With bevel up medication is likely to be deposited to
dermis.
With non dominant hand stretch skin over the site. Needle pierces tight skin more easily and cause less
discomfort.
With needle almost against client's skin, insert it
slowly at 5 - 15 degree angle until resistance is felt
and then advance the needle 3mm and needle tip can
be seen through skin.
Ensures needle tip is in dermis.
Inject medication slowly. Resistance occurs while
injecting medications.
Slow injection minimizes discomfort at site. Dermal
layer is tight when solutions are injected it does not
expand easily.

Notice a small bleb or wheal resembling
mosquito bite appears on skin surface while
injecting medications.
Bleb or wheal indicates medication is deposited
in dermis.
Withdraw the needle quickly at the same angle at
which it was inserted by placing a antiseptic
swab.
Support of tissue around injection site minimizes
discomfort during needle withdrawal.
Do not massage site. Massage may disperse medication into
underlying tissue layers and alter test results.
Assist client to a comfortable position. Gives client a sense of wellbeing.
Dispose the syringe and needle into sharp
container and remove gloves.
Do not recap the needle in order to prevent
needle stick injuries.

EVALUATION
Circle the injection site with ink to observe
for redness or indurations (hardness).
Evaluate the condition of the site depending
on the test and measure the area of induration
in millimeters.
RECORDING AND REPORTING
Record the testing material given, dosage
time, site and appearance of skin on nurse's
notes and report any undesirable effect
immediately to nurse in charge or physician.
Timely documentation and reporting ensure
client's safety.

SUBCUTANEOUS INJECTIONS
 Subcutaneous injection is the administration of mediation into the loose
connective tissue underlying the dermis. Subcutaneous tissue is not richly
supplied with blood vessels as in the case of muscles hence drugs are not
absorbed quickly, as in case of IM injections.
 Drugs commonly administered are vaccines, insulin and heparin. Only small
doses (0.5 to 1ml) of medication are usually injected via subcutaneous route. As
subcutaneous tissue is sensitive to irritating solutions and large volume of
medications, medications collecting within the tissue may cause sterile abscess
appeared as painful lumps.

 SITES FOR SUBCUTANEOUS INJECTIONS
1. Outer aspect of the upper arm.
2. Anterior aspect of the thigh.
3. Abdomen. It is the best site for clients with little peripheral
subcutaneous tissue.
4. Scapular areas of the upper back.
5. Upper ventrogluteal and dorsogluteal areas.
Why the subcutaneous injections are only given to above sites of body?

 Subcutaneous injection can be used to give many types of
medications for various medical conditions. There are fewer blood
vessels in the fatty layer of connective tissue just beneath the skin
than the muscle tissue. Having fewer blood vessels means that
medication injected subcutaneously is absorbed more slowly.

 CHARACTERISTICS OF INJECTION SITES
1. Site should be free from infection, skin lesions, scars, bony
prominences and large underlying muscles or nerves.
2. Size of the needle. Body weight influence the depth of the
subcutaneous layer, therefore use body weight as the criteria for
selecting the needle length and angle of insertion.25 gauge 5/8 inch
needle.

 ARTICLES FOR SUBCUTANEOUS INJECTIONS
A tray containing
1. Syringe (1 to 3ml)
2. Needle 25 gauge 3/8 to 5/8 inch
3. Antiseptic swab
4. Medication vial or ampoule
5. Medication card or computer print out
6. Disposable gloves
7. Kidney tray or paper bag
8. Dry sterile gauze for opening the ampoule

PROCEDURE
STEPS RATIONALE
ASSESSMENT
Review medication order for clients name,
age, dose, time and route of administration.
Ensures correct and safe administration of
medications.
Gather information about the drug ordered
e.g. action, side effects if any, allergies and
the need for subcutaneous injection.
Parenteral administration of medication is
desirable when oral intake is contraindicated.
Assess client's knowledge regarding
medication to be received and the response
towards injection.
Information on medication helps to relieve
client's anxiety.

PLANNING
Assemble articles at the bed
side.
Saves time and energy.
Prepare correct dose of
medication from ampoule or
vial.
Ensures the dose is accurate..
Correctly identify the client Ensures that right client receive
the prescribed medications.
Explain procedure to client in a
calm and confident manner.
Calm approach minimizes
client's anxiety.

IMPLEMENTATION
Wash hands and put on disposable gloves. Reduces transmission of microorganisms.
Close door or put on room curtain. To provide privacy.
Select appropriate injection site, free from
inflammation and bruises.
Injection site should be free from lesions that
might interfere with drug absorption.
In case of repeated daily injections (insulin)
rotate injections site each time.
Rotation of site prevents subcutaneous scarring
and lipodystrophy which may interfere with drug
absorption.

Prepare the syringe for injection and
inject the medication by grasping the
syringe in your dominant hand by
holding it between thumb and fingers
and insert the needle quickly and firmly
into the subcutaneous tissue using
45degree and 90 degree angles.
A simple rule to ensure medication to
reach subcutaneous tissue. If two inches
of tissue can be grasped, the needle
should be inserted at 90 degree angle, if
one inch of tissue can be grasped, the
needle should be inserted at 45 degree
angle.
• A quick firm insertion minimizes
discomfort.
Pull back plunger slowly to aspirate, if
blood appears in the syringe, withdraw
needle, discard medication and syringe
and repeat the procedure.
Aspiration of blood into syringe indicates
intravenous placement placement of
needle. Subcutaneous medications are
not meant for intravenous absorption.

Inject the medication slowly and
steadily if no blood appears
Slow introduction of medication
reduces pain.
Withdraw needle quickly while
placing antiseptic swab over site.
Supporting tissues around injection
site minimizes discomfort during
needle withdrawal.
Do not massage the site after
injection especially when patient
receives insulin or heparin.
Massage stimulates circulation
results in rapid absorption.
Assist client into a comfortable
position.
Gives a sense of well being.

Discard used articles appropriately. Prevents injury to client and health care personnel.
Remove gloves and wash hands. Reduces transmission of microorganisms.
EVALUATION
Assess clients response to medication, 30 minutes
after injection
Determines efficacy of drug and allows evaluation
of undesirable side effects.
RECORDING AND REPORTING
Document all relevant information and report any
undesirable effects of medication.
Timely documentation prevents errors and prompt
reporting saves life.

INTRAMUSCULAR INJECTIONS
 Definition:- It is a form of parenteral administration of medication where a drug
is injected into deep muscle tissue. Muscle can hold a large volume of fluid
without discomfort. Adult can safely tolerate up to 3ml of medication in
developed muscles like gluteal muscle. The angle of insertion of needle for IM
injection is 90 degrees. Needle size 1 half inches and 21 or 22 gauge.
 The size and length of needle selection depends on:
1. The muscle size
2. The type of solution
3. The age of the client
4. The amount of adipose tissue covering the muscle

 An volume of 0.5 to 1ml and a smaller needle with gauge 23-25 and one inch
long is commonly used for injecting into deltoid muscle.
 The intramuscular injections are absorbed more quickly than the subcutaneous
injections because of the greater blood supply to the muscles.
 An adult with well developed muscles can safely tolerate up to 4 ml of
medications in the gluteus medius and gluteus maximus muscles.
 A major consideration in the administration of intra muscular injections is the
selection of a safe site located away from large blood vessels, nerves, and
bone.

SPECIAL TECHNIQUES IN IM INJECTIONS
1. Air lock technique
2. Z- track method

 PURPOSES:
1. To introduce drugs into the muscular tissue for quick absorption.
2. When oral medications are contraindicated.
 Articles
 Trolley or tray containing
1) Syringe and needles of appropriate size. Medication in ampoule or vial.
2) Distilled water.
3) antiseptic swab.
4) disposable gloves.
5) kidney tray

 ASSIGNMENT ON IM INJECTIONS
PROCEDURE

INTRAVENOUS MEDICATIONS
 Injecting medications into a vein is termed as intravenous
(IV) medications
 Purposes
1. To inject a drug directly into the blood stream to get
immediate effect.
2. To inject a drug for its specific action in the blood stream
or on the walls of the blood vessels e.g. anticoagulant.
3. To inject a drug when it cannot be given through other
routes.
4. To introduce a drug for diagnostic purposes.
5. To supply the body with food in the form of fluids.
6. For fluid and electrolyte replacement.

 Methods of intravenous administration of medications
1. As mixtures within large volume of intravenous fluids
2. Small volume of medication (i.e. injection of a bolus) through an
existing IV infusion line .
3. Intermittent intravenous infusion by 'piggy back' i.e. infusion of a
solution containing the prescribed medication and a small amount
of IV fluids through an existing line.

4. Volume controlled infusions. (Small amount 50 to 100ml)
5. Intermittent venous access.
 The above methods are used when client has an existing IV infusion line or IV
access site.
 In case of IV administration of medications, after a drug enters the blood stream,
it begins to act immediately and there is no way to stop its action. Hence the
nurse should take special care to avoid errors in dosage calculation and
preparation. The rights of safe drug administration should be double checked by
nurses and aware of actions and potential side effect of drugs. If the drug has an
antidote make sure that it is available in the unit.

 Isotonic solution: A solution that has the same salt concentration as cells and
blood. Isotonic solutions are commonly used as intravenously infused fluids in
hospitalized patients.
 Hypotonic solution: A solution that contains fewer dissolved particles (such as
salt and other electrolytes) than is found in normal cells and blood.
 Hypertonic solution: A solution that contains more dissolved particles (such as
salt and other electrolytes) than is found in normal cells and blood.

Common intravenous solutions
1) Isotonic solutions- having same concentration of solutes as plasma e.g.
Normal Saline 0.9% (Sodium chloride), Ringer lactate and 5% Dextrose.
2) Hypotonic solutions: less concentration of solutes than plasma e.g. 0.45%
sodium chloride 0.3% sodium chloride
3) Hypertonic solutions: concentration of solute is greater than plasma e.g.
Dextrose 10% solution 3% to 5% sodium chloride.

Guidelines for vein selection
a) Use most distal portion of the vein first.
b) Use client's non dominant hand whenever possible.
c) Use veins in the feet and legs only when arm veins are inaccessible, since they
are more prone to thrombus formation.
d) Select a vein that
I. Easily palpated and feels soft and full.
II. Is naturally splinted by bone.
III. Is large enough to allow adequate circulation around the catheter.

Commonly used Intravenous sites
1. Cephalic vein, (up side)
2. basilic vein, (down side)
3. meta carpel,
4. median cubital vein,
5. brachial vein,
6. radial vein,
7. ulnar vein,
8. femoral vein,
9. saphenous vein and veins in the scalp ( for infants).

Articles for intravenous injections
 A clean tray containing
1. Sterile disposable syringe, needle,
2. IV cannula,
3. Sterile cotton swabs, antiseptic solution,
4. Tourniquet,
5. IV fluid and tubing,
6. kidney tray,
7. adhesive tape,
8. scissors,
9. Disposable gloves, and towel.

 PROCEDURE FOR INTRAVENOUS ADMINISTRATION OF
MEDICATIONS.
1. Check that there is an order.
2. Inform and explain procedure to the client.
3. Check the record to see when the last dose was given.
4. Wash hands.
5. Assemble and arrange the articles and bring to the bedside.
6. Move the patient to the working area. Protect the bed and expose only the
needed part.

7. Wear gloves.
8. Load the syringe with medicine and expel the air.
9. Apply tourniquet.
10. Clean and dry the site.
11. Insert the needle into the vein with bevel up at 15-30 degree angle. When the needle is
in the vein lower the angle of the needle until it is nearly parallel with the skin and
insert the needle and pull the plunger back to see whether it is in the vein.
12. If it is in the vein release tourniquet.
13. Introduce medication slowly.
14. If it is a cannula. Insert cannula into the vein and forward the catheter 1 inch.
15. Remove the needle and release tourniquet.

16. Remove the protective cap from the IV tubing and attach IV tubing
to the cannula.
17. Open roller clamp to start infusion.
18. Secure IV cannula and IV tubings in place with adhesive tape and
remove gloves.
19. Adjust flow rate and record it.

ADVANCEDTECHNIQUES OF MEDICATIONADMINISTRATION
 Epidural route of medication administration-
 Epidural administration is a medical route of administration in
which a drug is injected into the epidural space of the spinal
cord.
 Techniques such as epidural analgesia and epidural anesthesia
are employed in this route of administration.
 Epidural techniques frequently involve injection of drugs
through a catheter placed into the epidural space.
 The injection can result in a loss of sensation including the
sensation of pain by blocking the transmission of signals
through nerve fibers in or near the spinal cord.

 Intrathecal route of medication administration –
 An intrathecal injection is a route of administration
of drugs via an injection into the spinal canal, more
specifically into the subarachnoid space so that it
reaches the cerebrospinal fluid (CSF) and is useful
in spinal anesthesia, chemotherapy, or pain
management.
 This route is also used to introduce drugs that fight
certain infections, particularly in post operative
patients after neurosurgery.

 Administration of Intraosseous Infusion
 Intraosseous infusion is the process of injecting
medication directly into the marrow of a bone.
 This technique is used to provide fluids and
medication when intravenous access is not available
or not feasible.
INDICATIONS:
 Emergency intravascular access when other methods have failed
 Cardiac arrest in infants and young children
 Obtaining blood for laboratory evaluation

 Administration of intra peritoneal injection –
 Intraperitoneal injection or IP injection is the
injection of a substance into the peritoneum (body
cavity).
 IP injection is more often applied to animals than
to humans. In general, it is preferred when large
amounts of blood replacement fluids are needed.
 In humans, the method is widely used to
administer chemotherapy drugs to treat some
cancers, in particular ovarian cancer.

 Intra pleural route of medication
administration:
 Administration of a drug in to the
pleural cavity. The intra pleural drug
administration usually results in both
local and systemic drug actions.

 Intra arterial route of medication
administration:
 Intra arterial drug injection or infusion is a
method of delivering a drug directly into an
artery or arteries to localize its effect to a
particular organ or body region.
 The method is considered more dangerous
than intravenous administration and should
be reserved to experts.

ROUTE OF DRUG
ADMINISTRATION
TIME FOR INITIATION OF
ACTION OF DRUGS
Intravenous route 30-60 seconds
Intraosseous route 30-60 seconds
Endotracheal inhalation 2-3 minutes
Intramuscular route 10-20 minutes
Sublingual route 3-5 minutes
Rectal route 5-30 minutes
Ingestion 30-90 minutes

Conclusion:
 Parenteral administration of medications ensure more rapid
absorption and action of drugs when compared to oral medications.
Strict aseptic technique must be followed when the nurse
administers medication parenterally to prevent introduction of
microorganisms.

D) TOPICAL ADMINISTRATION OF MEDICATIONS
 Topical medication is applied to the skin or to
mucous membrane in various areas such as ear,
eye, nose, vagina and rectum. Most topical
application is not absorbed well because the skin's
thick outer layer acts as a barrier to drug diffusion.
Absorption through the skin is called percutaneous
absorption. If large amounts of topical medications
are applied to the skin repeatedly it may enter the
blood stream to cause systemic effects. Direct
application includes insertion of drug into body
cavities, irrigations and instillations.

 SITES
1. Skin
2. mucus membrane
3. Eye
4. Ear
5. Nose
6. vagina and rectum.

 TYPES OF TOPICAL MEDICATIONS
1. Skin applications
2. Ophthalmic medications
3. Otic (ear) medications
4. Nasal medications
5. Vaginal medications
6. Rectal medications
7. Irrigations
8. Respiratory inhalation

1. SKIN APPLICATIONS
Topical or dermatological preparations include creams, ointments, lotions, pastes,
powder, spray and patches.
Special considerations /guidelines for applying skin preparations:
1. Before applying a dermatologic preparation, thoroughly clean the area with soap
and water and dry it.
2. Nurses should wear gloves when applying skin preparations and use surgical
asepsis in case of an open wound.
3. If using suspension based lotion for application, shake the container before use to
disperse suspended particles.

4. For applying creams, ointments and pastes use gloved hands, soften the
preparation and smear it evenly over the skin using long strokes.
5. The skin should be observed after the ointment or lotion application for any
signs of skin irritation. If any, it should be reported immediately and the
application must be discontinued.
6. Take only the needed medication for one application to the client's unit, in order
to prevent wastage.

7. If the applicator has touched the client's skin, it should not be returned to the
container to avoid contamination of the entire bottle.
8. Be careful while applying lotions and ointments to client's body, Use protective
measures to prevent introducing them into eyes, mouth, ears and nostrils by
using protective measures.
9. Lotion or ointment or any skin applications should be applied to clients only
with doctors' prescription.
10. Record the name of medication, area applied and condition of the skin in the
nurses' notes.

2. OPHTHALMIC MEDICATIONS
 Medications for the eyes called ophthalmic medications
and are instilled in the form of ointments or liquids.
 Medication may be administered to the eye by
instillations or using irrigations. An eye irrigation is
done to wash out the conjunctival sac to remove
secretions or foreign bodies or to remove chemicals. Eye
drops are available in monodrip plastic containers and
ointments are usually available in small tubes. It is
written in the container that medication is for
ophthalmic use. Sterile technique should be followed for
application.

 ADMINISTERING OPHTHALMIC INSTILLATIONS
 PURPOSES
1. To treat an infection.
2. To get the local effect E.g. for pupil constriction or dilatation.
3. For controlling intraocular pressure E.g. Clients with
glaucoma.(Glaucoma is a group of eye conditions that damage the
optic nerve, the health of which is vital for good vision.)
 NOTE: Intraocular pressure (IOP) is the fluid pressure of the eye.

PROCEDURE
STEPS RATIONALE
Assessment
Review physician's medication order, client's name,
drug name, number of drops and the eye to receive
medication.
To ensure correct administration of medication.
Wash hands. To reduce transmission of microorganisms.
Prepare articles
A tray containing
Prescribed eye ointment or ophthalmic eye drops,
medication card, cotton ball or tissue. Wash basin
with water.
Disposable gloves.
Eye pad and tape (optional).
Assembling needed articles saves time and energy.

Assess condition of external eye structures. Provides base line data and also indicates the need to
clean eyes before drug application.
Explain procedure to client. To reduce anxiety.
Arrange supplies at bedside and apply gloves. Ensures carrying out procedure smoothly and gloves
reduces nurses exposure to infected drainage.
Instruct client to lie supine or sit back in chain with
head slightly hyper extended.
Provides easy installation of eye medication and
minimizes drainage of instilled medication through
tear duct.
If crusts or discharge are present along eye lid
margins or inner canthus wash away gently. Soak
crust by using, damp cotton ball. Always clean from
inner canthus to outer canthus.
Crust and drainage harbor microorganisms. Soaking
allows easy removal. Cleansing from inner canthus to
outer canthus avoids entrance of microorganisms in
to lacrimal duct.

Ask client to look at ceiling. It helps the sensitive cornea move up and away from
conjunctival sac and reduces stimulation of blink
reflex.
Instill eye drops
With dominant hand resting on clients' forehead hold
medication eye dropper 1to 2 cms above conjunctival
sac.
To prevent accidental eyedropper with eye structures.
Drop prescribed number of drops into the
conjunctival sac.
Applying drops in to sac provides even distribution
across eye.
If client blinks or closes eye or if drop fall on outer
lid margins, repeat the procedure.
After instilling eye drops, instruct client to close the
eye gently.
Therapeutic effect is obtained only when drops enter
conjunctival sac.
Promote distribution of medication.

Instill eye ointment
Apply thin stream of ointment evenly
along inside edge of lower eye lid on
conjunctiva.
Helps to distribute medication evenly.
Ask client to look down. Reduces blinking reflex during ointment
application.
Apply a thin stream of ointment along
upper lid margin on inner conjunctiva.
To distribute medication evenly across eye
and eyelid margin.
If client has an eye patch, apply a clean one
and secure it with tape measure.
Reduces chance of infection.

Dispose soiled supplies, gloves and wash
hands.
Reduces transmission of microorganisms.
Observe response to medication and the
condition of the eye.
To evaluate reaction to medication.
Record drug, number of drops, time of
administration and eye that received
medication.
Timely documentation prevents drug
errors.

3. EAR INSTILLATION
 Internal ear structures are very sensitive to temperature
extremes. Failure to instill ear drops or irrigating fluid at
room temperature may cause vertigo,(make you feel
dizzy and off-balance.) dizziness and nausea.
 The entry of non sterile solutions into middle ear
structures could result in infection.
 With ear drainage, the nurse should assess to make sure
that, the client does not have a ruptured ear drum.

PROCEDURE
 Have client assume side-lying position with ear to be treated facing up, or
client may sit in chair or at the bed side.
 Perform hand hygiene. Apply gloves if drainage is present.
 Straighten the ear canal by pulling auricle down and back (children) or
upward, and outward. (adult).
 Instill prescribed drops holding dropper 1 cm (1/2 inch) above ear canal.
 Ask client to remain in side-lying position 2 to 3 minutes. Apply gentle
massage or pressure to tragus of ear with finger unless contraindicated due to
pain.

 At times the physician orders insertion of portion of cotton ball into
outermost part of canal. Do not press cotton into the innermost part
of the canal. Remove cotton after 15 minutes.
 Dispose of soiled articles and wash hands.
 Assist client to a comfortable position after drops are absorbed.
 Evaluate the condition of external ear between drug instillations.
 Record drug, number of drops, time administered, and ear into
which drops are administered in client's chart.

4. NASAL INSTILLATION
 Nasal instillations are used to treat allergies, sinus
infections, and nasal congestion. Medications with a
systemic effect, such as vasopressin, may also be
prepared as a nasal instillation.
 Severe nose bleedings are treated with packing which
are treated with epinephrine,(adrenaline) to reduce
blood flow by vasoconstriction.
 Solutions instilled by drops may also be applied to
the nasal mucous membrane in the form of spray.
 The nose is normally not a sterile cavity, but because
of its connection with the sinuses, medical asepsis
should be observed carefully when using nasal
instillations.

Equipment:
 Prepared medication with clean dropper or spray container.
 Facial tissue
 Small pillow (optional)
 Wash cloth (optional)
 Disposable gloves
 Penlight (to inspect nares; if ointment is to be applied to a specific lesion
inside the nares)

 STEPS
1. For nasal drops, determine which sinus is affected by referring to medical
record.
2. Assess client's history of hypertension, heart disease, diabetes mellitus and
hyperthyroidism.
3. Review physician's order, including client's name, medication name, dosage,
route, time of administration and indication for instillation.
4. Determine whether client has any known allergies to nasal instillations.
5. Identify client; compare name on MAR with client's identification (ID)
bracelet. Ask client to state name.

7. Perform hand hygiene. Using a penlight, inspect condition of nose and sinuses,
palpate sinuses for tenderness.
8. Assess client's knowledge regarding use of nasal instillations and techniques for
instillation and willingness to learn self administration.
9. Explain procedure to client regarding positioning and sensations to expect such
as burning or choking sensation as medication trickles into throat.
10. Arrange supplies and medications at bedside. Apply gloves if client has nasal
drainage.
11. Instruct client to clear or blow nose gently unless contraindicated (E.g. risk of
increased intracranial pressure or bleeding from nose).

11. Administer Nasal Drops.
 Assist client to supine position.
 Position head by tilting client's head backward by placing a pillow under the
shoulder.
 Support client's head with dominant hand.
 Instruct client to breath through mouth
 Hold dropper 1cm(1/2 in) above nares and instill prescribed number of drops
towards midline of ethmoid bone.
 Have client remain in supine position for 5minutes.
 Offer facial tissue to blot runny nose, but be caution client against blowing nose for
several times.

12. Assist client to a comfortable position after medication is absorbed.
13. Dispose of soiled supplies in proper container and perform hand hygiene.
14. Observe client for onset of side effects, 15 to 30 minutes after administration.
15. Ask whether client is able to breathe through nose after decongestant
administration.
16. Reinspect condition of nasal passages between the instillations.
17. Teach the client to review risk of over use of decongestants and methods for
administration.
18. Have client demonstrate self administration.

NASAL PACKS
It is the application of medicated gauze in to the nostril to control bleeding.
Purpose
To stop bleeding in the case of epistaxis.
Procedure
 If first aid is not effective to stop bleeding, medical management is essential. Anterior packing of the
nostril is done by physician.
 Anterior packing may consist of ribbon gauze or nasal tampon impregnated with antibiotic ointment and
or vasoconstrictive agents that is placed firmly in the bleeding site. It is allowed to remain in place for
48 to 72 hours.
 Nasal packing may alter respiratory status. So the nurse should monitor respiratory rate, heart rate,
oxygen saturation and observe for signs of aspiration. After the removal of nasal pack the nares must be
cleaned gently and lubricated with jelly.

 Carefully examine the nasal cavity, looking for any bleeding points, which can
usually be seen on the anterior septum, either as an oozing point or a visible clot. Note
whether there is any pus, suggesting local bacterial infection.
 Blowing the nose decreases the effects of local fibrinolysis(Fibrinolysis is a normal
body process. It prevents blood clots that occur naturally) and removes clots,
permitting a clearer examination. Applying a vasoconstrictor before examination may
reduce hemorrhage and help locate the bleeding site.

 A topical local anesthetic reduces pain from examination and nasal packing.
Topical application with 0.5% neomycin cream or with Vaseline petroleum jelly
are alternative topical treatments.
 If bleeding continues, packing may be considered.
 Complications
 Infection
 Septal hematoma

THROAT IRRIGATIONS AND GARGLES
 Throat irrigation is the washing out of the oropharynx with a solution. Acute and chronic
inflammation of the throat is treated with irrigating the throat with warm normal saline or
by any antiseptic solution. Gargling is less effective when compared to throat irrigation.
 Purposes
 To remove secretions from the throat.
 To treat inflammation by the application of heat.
 To reduce pain.
 To relieve congestion and discomfort.

Procedure
Articles
1. Irrigating Can with tubing.
2. Nozzle.(A nozzle is a narrow pipe, used to control the flow of a fluid as it leaves another
pipe)
 Explain procedure to the client and place the client comfortably on a chair with head
turned forward over a wash basin.
 Hold or hang the Irrigating Can around 18 to 24 inches above the level of the client's head.
 Warm normal saline or antiseptic solution is used.
 Temperature should not be more than 49 degree C and it should be at the tolerance level of
the client.

 Encourage client to open the mouth and insert the nozzle without touching the
uvula and tongue.
 Open the clamp and allow the solution to flow and instruct the client to direct
solution to all parts of the throat.
 Instruct client to hold the breath while irrigating the throat to prevent aspiration of
fluid. At intervals stop the flow of fluid to enable the client to take breath.
 While gargling the solution may not reach all parts of the oropharynx hence it is
less effective than irrigation and is also uncomfortable to the client.

5. VAGINALINSTILLATION OF MEDICATIONS
 Vaginal medications or instillations are inserted as
jellies, creams, foams or suppositories to treat
infection or to relieve vaginal discomfort.
Ex. To relieve Pain. Vaginal creams or jellies are
applied by using an applicator with a plunger.
Suppositories are inserted with the index finger of a
gloved hand. Suppositories are designed to melt at
body temperature so they are kept in the refrigerator.

Vaginal Irrigation
It is the washing of the vagina by a liquid at a low pressure. Vaginal irrigation is done to
prevent infection by applying an antimicrobial solution. Vaginal irrigation is done under
sterile technique if there is an open wound.
 Purposes
1. To prevent the growth of microorganisms.
2. To remove offensive discharges.
3. To reduce inflammation.
4. To prevent hemorrhage by the application of cold.
5. To relieve vaginal discomfort.

6. RECTAL INSTILLATION
 Rectal suppositories are thinner and bullet shaped
and the rounded end prevents trauma to anus during
its insertion. Rectal suppositories contain
medications that have local effects like promoting
defecation or systemic effects like reducing fever. It
is stored in refrigerator. During insertion, the nurse
must place the suppository well inside the internal
anal sphincter and against the rectal mucosa, about
10cms (4 inches) in adults and 5cms (2inches) in
children. Sims' position of the client during
administration facilitates easy insertion of
suppository.

7. BLADDER IRRIGATION
It is the flushing or washing out of the urinary bladder
with a specified solution.
 Purposes
 To wash out the bladder in order to remove pus.
 To apply a medication to the bladder lining.
 To maintain or restore the patency of the catheter.
 To promote healing.
 To relieve congestion and pain in case of
inflammatory condition of the bladder.
 To prevent clot formation after bladder surgeries.

 Solutions used
 Normal saline
 Distilled water
 5% glucose
 Antiseptic solutions

 Methods used
1. Open method:
The closed bladder drainage system is opened to the environment to do the
bladder irrigation. Frequently the catheter is disconnected from the drainage
tubing to do the irrigation. The risk of introducing microorganisms into the
urinary tract is greater with open irrigation.
2. Closed method: it is the preferred technique for bladder or catheter irrigation
because it is associated with less risk of urinary tract infection.

8. RESPIRATORY INHALATION
 Inhalation is the act of drawing in air, gas or vapour into the lungs. Drugs are
inhaled for either local or general effect.
e.g. local effect - bracho dilatation, general effect - anesthesia.
 Two types of inhalation
1. Dry inhalation - Inhalation of fumes, gases from volatile drugs
e.g. Ether, Chloroform etc.
2. Moist inhalation - Inhalation of moist warm air produced by vaporizer.
E.g. Steam inhalation A nebulizer is used to deliver a fine spray or mist of medication
to a client.

 Two kind of inhalation
1. Atomization
2. Aerosolization
Atomization: A devise called atomizer produces large droplets for inhalation.
Aerosolization: The droplets are suspended in a gas. E.g.: Oxygen. If the
droplets are smaller, further they can be inhaled into the respiratory tract.

 The metered dose inhaler (MDI): It is a handheld
nebulizer used to release medication through a mouth
piece. The force of movement of air through the nebulizer
causes the large particles of medicated solution to break up
into finer particles forming a mist or spray.
 Advantages:
1. It deliver an accurate dose, focusing targeted action at the
specified sites.
2. It has less systemic effects.
3. It delivers medication deep into the lungs.

DOCUMENTATION OF MEDICATIONADMINISTRATION
 The medication record is a legal document.
 Record the medication and dose as soon as it is
administered to patients. Do not record medications
before they are given.
 Different forms are used for recording medications. The
name of the medication, dosage, route of administration,
time given and the nurse's initials are noted on the form.
 The site used for an injection should be recorded.
 The nurses' full signature and title must appear on the
form for initial identification.

 Computerized medication administration records (CMARS) are
also used by some agencies.
 The identity of the nurse completing the documentation is recorded
based on the unique user ID and password assigned to each nurse
when CMAR is used.
 Other specific patient's information may be documented. E.g.:-
Record pulse rate if patient receives cardiac drugs.

 Omitted Drugs
 Drugs may be omitted intentionally or accidentally. The omission and its reason should
be recorded. Drugs may be omitted intentionally for the following reasons.
1. If the patient is to have a diagnostic test or surgery. Nil per oral status.
2. The problem for which medication is prescribed no longer exists. E.g.: - Laxative has
been ordered for a patient, the patient has had the bowel movement and laxative is not
needed, hence omitted.
3. Occurrence of side effects.
4. The patient is suspected of having allergy to the prescribed medication. Any suspected
allergy should be reported to the physician.
5. Changes in vital signs, urine output etc.

Drug Refusal
 If the patient refuses to take a drug that is essential for his recovery, report immediately.
 The nurse can find out the reason for the refusal and help the patient to understand the
importance of taking the drug.
 If the patient adamantly refuses to take a medication, it is unwise to continue urging the
patient.
 Patients have the right to refuse therapy.
 Nurses should recognize and respect patient's right.
 The nurse must document in the patient's record the refusal to take prescribed drugs and the
manner in which the situation was managed and report according to the agency policy.

 CONCLUSION:
 Medications are chemicals administered to clients to
diagnose, treat and prevent the diseases. Medications
are administered orally, parenterally and topically.
Administering medication to clients is an important
nurse's responsibility. To ensure safe medication
administration the nurse should be aware of ten
rights of drug administration. Timely recording and
reporting protect nurses from legal liabilities and
saves the life of their patients.

INTRODUCTION TO CLINICAL PHARMACHOLOGY.PPTX

INTRODUCTION TO CLINICAL PHARMACHOLOGY.PPTX

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