Fundamental Concepts II: Medication Administration Unit Specific Objectives

GENERAL CONTENT:
1. Define the terms
Nomenclaturethe devising or choosing names for things.
generic nameidentifies a drugs main ingredient; name assigned by manufacturer when
first developed.
official nameusually generic name; name given used in official publications
trade nameAKA brand name; specific drug name given by a certain manufacturer.
pharmacokineticsliterally means drug motion answers the question: How does the
drug concentration changes as it moves through the different part of the body? and
indicates the movement of drugs throughout the body via:
1. Absorptionroute administration determines the rate of absorption.
2. DistributionThe movement of drugs throughout the body.
3. MetabolismThe chemical changes the occur; drug moves from one form to a
new form. LIVER is the chief metabolizer.
4. ExcretionThe process of removing the drug from the body. KIDNEYS excrete
most drugs.
Book DefWhat your body does to the drug
pharmacodynamicsliterally means, drug power answers the question: How does the
drug exert its effect(s) on your body? Deals with drug potency; drug receptor
interactions. Indicative of a drugs impact, effect (efficacy) on the body.
Book DefWhat the drug does to your body.
adverse effectsUnwanted harmful effects of a drug on the body.
allergic effectImmune system response when body interprets drug as foreign and
antibodies formed to fight.
drug toleranceOccurs as body becomes accustomed to a drug.
toxic effectDrug effects that cause risk for permanent damage and/or death.
idiosyncratic effectUnusual/peculiar effect of a drug on the body.
therapeutic rangethe concentration of drug in the blood serum that produces the desired
effect without causing harm.
peak levelHighest concentration of drug when absorption complete.
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trough levellowest concentration level of drug.

half-lifeThe amount of time it takes for half (50%) of a drug to leave the body.
parenteraloutside the intestines or alimentary canal.
Ampulea glass flask that contains a single
dose of medication for parenteral admin.
Vialplastic or glass bottle with a self-sealing
stopper through which meds can be removed.
prefilled syringeSyringe that has drug in it;
no need to draw up; provide SINGLE dose of medication.
sublingualDrugs administered through this route are placed under the tongue for
absorption.
BuccalDrugs administered via this route are placed in the cheek.
injector devicedevice used to inject.
topical applicationdrug application on skin
medication reconciliationthe process of specifying medications and maintaining a
current, accurate list of medications the patient is receiving.
2. Explain how to perform a health assessment for medication administration. (p769-770)
a. Take medication history
b. Drug allergies
c. Health History
d. Physical exam/Focused Assessment
3. Explain how to perform a focus physical assessment for medication administration (p.
769). Focused assessmentNOTE: This is all the book lists
a. Previous and current drug use
b. Medication schedule
c. Response to meds
d. Attitude toward drugs & drug use
e. Storage
4. Apply legal and ethical principles when providing nursing care for patients receiving
medications.
Education patient about the drug, use, effects.
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 Implement Medication Rights (p. 771)

o 5 Main
1. Right Patient
2. Right Drug
3. Right Dosage
4. Right Time
5. Right Route
o Others:
Right reason
Documentation
Assessment
Education
Response
Refuse
5. Use tips and concepts related to culture, ethnicity, and race when planning and delivering
nursing care for patients receiving medications.
ADMINISTERING ORAL MEDICATIONS:
1. Explain the difference between solid and liquid oral medications (p 772).
a. Liquid Meds:
i. Elixirs
ii. Spirits
iii. Suspensions
iv. Syrups
b. Solid Meds:
i. Tablets
ii. Capsules
iii. Pills

2. Define and explain the significance of EC, LA (long lasting), CR/CRT (controlled
release), SA (sustained action), SR (sustained-release), and XL (extended release) oral
medications.
Oral meds that are indicated as extended-release. They should not be crushed or chewed
unless specifically indicated. Doing so destroys extended-release effect and may result in
toxic peaks or low troughs.
3. List the 2 main types of oral medication preparations.
a. Liquid
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b. Solid
4. List the 4 main types of liquid medication preparations (SEE Number 1).
5. Discuss the difference between multidose bottles and single dose containers of liquid
medications.
a. MultidoseMay be used for multiple doses
b. Single doseSingle use only.
6. List common techniques that can be used to help disguise or mast oral medications with
bad taste.
a. Crush and add to small bit of food; be sure all eaten before leaving.
b. Suck on ice
c. Use syringe to give meds at back of tongue.
d. Oral hygiene ASAP post admin.
e. Allow with copious amount of water.
7. Discuss the main difference between sublingual and buccal
medications.
a. Sublingualunder tongue
b. Buccalcheek
8. Review the skill actions with rationales on administering oral medications.

ADMINISTERING PARENTERAL MEDICATIONS:

1. Identify the parts of a needle and syringe (p. 775).

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2. List the criterias

(pgs. 774-775).
a. Route of administration
b. Viscosity of solution
c. Quantity to be administered
d. Body size
e. Type of Medication

for selecting injection equipment

3. Explain the significance of the needle guard/safety (p. 775).

They help prevent accident or injury.
4. Explain the importance of do not recap needles. (p. 775)
Reduces the chance of sticking yourself; preventative measure to avoid
accident/injury.
5. Discuss how surgical asepsis applies to parenteral medications (p. 775).
Surgical asepsis shoud be maintained to avoid the entrance of microoganims into the
body.
Parts of the needle to be kept sterile:

Inside barrel
Plunger that enters barrel
Tip of barrel
Needle; save the exterior of needle hub

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6. Compare and contrast an ampule and a vial medication method (p. 775-776).
Ampulecontains a single dose of medication. Must be broken open; filter needle used.
Excess must be wasted.
Vialscontain a rubber/self-sealing stopper. Multi doses may be taken from one vial. Air
should be injected into vial before drawing, as helps with medication retrieval.
7. Explain the difference between prefilled cartridge and prefilled syringe (p. 776).
a. Prefilled cartridgeis inserted into a reusable holder or injection device; most
are overfilled. Excess must be wasted prior to administration. Come with excess
air.
b. Prefilled syringeusually have their needle attached; Also comes with excess air;
in some cases should not be expelled (e.g. Enoxaparin [Lovenox]).
8. Using a table, list the sites, landmarks, and need gauges/lengths/angles for ID, SQ,
and IM. SEE LAB NOTES!
9. Explain how the nurse can reduce discomfort during administration of SQ and IM
injections (p. 779).
a. Select needle with smallest gauge that right for the site/solution/length.
b. Be sure needle free of solution that could irritate when inserting.
c. Use Z-track method.
d. Inject into relaxed muscles.
e. DO NOT inject into hard muscles or tender areas.
f. Dart-like motion
g. DO NOT exceed recommended solution amounts for injection site.
h. Apply gentle pressure afterward.
i. Allow patients to talk about fears.
j. Rotate sites for patients who require frequent injections.
10. Using a chart, list, compare, and contrast the types of intravenous methods, IVF, IV
bolus/push, IV intermittent/IVPB (p. 785).
a. IVFinfusion solution; drug added to liquid infusion. Administered over set
amount of time.
b. IVP/Bolusmedication administration in single injection of concentrated
solution direct into IV line. Administer slowly over 1 minute.
c. Intermittent IVPMedication added to small amount of solution (gen 50-100
mL) and set with infusion pump.
11. Discuss the advantages and disadvantages of using the parenteral routes of medication
administration.
Parenteral admin is most invasive increasing the likelihood of infection or accident; once
a solution injected cannot be withdrawn. Conversely it has the fastest absorption rate.
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12. Discuss the criteria used in the selection of a site for parenteral administration (p. 774775).
a. Pt body size
b. Pt body build/size
c. Medication type
d. Route of administration
e. Viscosity of solution
f. Quantity to be administered
g. Age (Amarachis Addition)
13. Describe the Z track method of injection and discuss the rationale for its use (p. 784).
Recommended for all IM injections because it ensures the medication does not leak back
along the needle track and into the subcutaneous tissue. Also suggested for older pts who
have a decreased muscle mass.
14. Discuss factors that influence and alter the rate of an intravenous infusion.
Continuous Infusion
Intermittent Infusion
Bolus Push
15. Review the skill actions with rationales removing medication from an ampule.
16. Review the skill actions with rationales removing medication from a vial.
17. Review the skill actions with rationales on administering intradermal injection.
18. Review the skill actions with rationales on administering subcutaneous injection.
19. Review the skill actions with rationales on administering intramuscular injection.
20. Review the skill actions with rationales on administering medication by IV Bolus/Push.
21. Review the skill actions with rationales on administering IVPB medication.
22. Review the skill actions with rationales on administering medication by saline loc.

ADMINISTERING TOPICAL MEDICATIONS:

1. Using a table, differentiate between the various forms of eye medications; drops and
ointments (p. 787).
Dropsliquid; used for local effects (e.g. dilation, infection control).
Ointmentthick, jelly-like substance; used for local infection or irritation. Must be
dropped in the inner canthus (apply from inner canthus to outer canthus). May cause
temporary blurred vision.
2. Explain the importance of instilling eye medications in the conjunctive sac.

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Must be placed into the conjunctive sac because most applications cannot be placed into
the eyeball directly. Sac helps distribute safely.
3. Using a table, differentiate between the various forms skin-transdermal medications.
Transdermallayered patch placed on skin to ensure timed drug releaase.

NOTE: Estrogen patches should not be placed on the breast.

Forms of transdermal patches:
Reservoirs Micro-reservoirs Adhesives
Matrices4. List the guidelines for applying transdermal patches (p. 788).
a. Wash hands
b. Apply gloves
c. Remove any old patches
d. Assess skin
e. Wash/cleans skin with soap
5. List the guidelines for instilling eye drops.
See page 789
6. List the guidelines for instilling ear drops.
See page 790

7. List the guidelines for nasal instillation medications.

See page 791
8. List the guidelines for vagal instillation medications.
See page 792
9. List the guidelines for rectal instillation medications.
See page 793
APPLICATION IN LAB & CLINICAL:
1. Check off on medications administration in the lab setting.
2. Demonstrate how to administer medications to various patients.
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3. Utilize critical thinking skills to plan and evaluate nursing care for patients receiving
medications.

MEDICATION DOCUMENTATION-ERRORS-EDUCATION:

1. Explain the significance of documenting all medication administration.

a. Its the law!the medication record is a legal document.
b. Documentation important to reference in the incidence of complications, med
record may be easily referenced.
2. Discuss how the nurse will address and document intentionally or inadvertently omitted
medication administration.
The omission and reason for the omission must be documented on pt record.
Reasons for intentional omissions:
Pt diagnostic test/procedure requires fast (pt cannot eat)
Drug no longer necessary
Suspected allergy
3. Discuss how the nurse will address and document medication refused by the patient.
If pt refuses a helpful drug, report promptly. Do best to persuadeif pt still refuses
reasonable efforts of persuasion, respect pt right to refuse.
Documentation: Describe refusal and methods of persuasion. Report according to facility
policy.
4. List the common types of medication errors.
a. In appropriate prescribing of the drug (i.e. wrong dose, quantity, route) (p. 796).
b. Extra, omitted, or wrong doses.
c. Admin of meds to pt that wasnt ordered for that pt (wrong person).
d. Failure to administer med in proper time frame.
e. Incorrect preparation of drug prior to administration.
f. Improper technique when administering drug.
g. Giving drug that has deteriorated.
5. List the most common points at which medication errors usually occurs (p.796).
Errors commonly occur at transition in care, primarily due to incorrect/imcomplete
transfer of medication info.
6. Listed the suggested steps when a medication error occurs.
a. Check pt condition STAT. Observe for adverse effects.
b. Document description of error in pt medication record.
c. Complete facility error reporting: DO NOT REPORT FILED INCIDENT
REPORT IN PT MEDICAL RECORD.
7. List some steps that can be helpful in reducing medication errors.
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a.
b.
c.
d.

Be vigilant
Communicate if something unclear
Perform 3 medication checks
Observe/Practice patient 5 medication rights

8. Explain the significance of the medication reconciliation process (p. 761).

Medication reconciliationthe process of specifying and documenting medications pt is
taking.
This should occur when the patient enters the facility and across the continuum of care
through discharge when PCP tells pt drugs to continue taking and drugs to discontinue.
9. Discuss the significance to MEDWATCH and MEDMARX.
Governmental agencies used to prevent and report medication errors. MEDMARX tracks
adverse drug reaction in addition to medication errors.
10. List some teaching tips when it comes to medication administration (p. 799).
Teach to pt level of understanding; consider culture
Explain to pt & familyallow opportunities for practice and return
demonstration
Explain the importance of continuity/Advise not to alter dosage
Advise not to share prescribed drugs
Teach pt about drug abuse
PATIENT SAFETY CONCEPTS:
1. Explain how QSEN, NPSGs, Core Measures, NICHE, and SCIP concepts impact patient
care during medication administration.

PRINCIPLES OF MEDICATION ADMINISTRATION:

1. Explain the importance of CPOE in health care today (p. 761).

CPOEComputer prescribed order-entry systems
CPOEs help reduce the incidence of med errors because PCP can enter orders in
standard format and are guided to make correct orders sent electronically to pharmacy
avoiding handwritten order errors (e.g. illegible handwriting). Some CPOE systems
provided pertinent drug information (e.g. recommended dosage, drug specific
information).

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2. Explain the importance of medication reconciliation.

See Previous Section
3. Using a chart, list and explain the seven parts of the medication order (p. 762).
a. Pt full name
b. Date/Time order written
c. Name of drug
d. Dosage
e. Route of administration
f. Frequency of administration
g. Signature of prescriber
4. List and explain the difference in the types of medication orders (p. 761, 762).
a. Standing/Routine Ordercarried out as specified until cancelled by another
order. May have a specified time limit.
b. PRN orderas needed
c. Single/One-time Orderdirective carried out once at time specified.
d. Stat orderImmediate one-time order
5. Discuss the importance of the use of CMAR in health care today (p. 764).
CMARComputerized medication administration record
It contains a complete list of all drugs prescribed to the pt.
The nurse is still responsible for checking CMAR against original order and verifying the
dosage.
6. Explain how the nurse can be a patient advocate for medication administration.
By questioning order that may not seem correct.
PRINCIPLES OF MEDICATION SUPPLY SYSTEMS:
1. Explain the significance of COWS, ADC, and BCMA in medication administration.
CowsComputer on Wheels: Cart with drawers for each pt.
ADCsComputerized Automated Dispensicg Cabinets: Stock suppyly unit dose meds.
Only unit dose meds for each pt dispensed at a time. Pharmacy packages meds for 24hour period, simplying med prep.
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BCMABar-code-enabled mediation admin: Helps prevent wrong pt and wrong

time errors.
2. Discuss the significance of accurate math calculations in medication administration.
3. Explain why the metric system is universal for drug dosage calculations (p.765).
It is the most widely accepted convenient system.
4. Identify the recommended abbreviations used in medication orders.
5. Safely calculate medication orders with 90% accuracy.
6. Explain the significant meaning of the 3 checks and the 5 plus rights of medication
administration.
7. Summarize how the 5 plus rights helps to ensure correct medication administration (p.
767).
o

5 Main
1.
2.
3.
4.
5.

Right Patient
Right Drug
Right Dosage
Right Time
Right Route

Others:
Right reason
Documentation
Assessment
Education
Response
Refuse

The rights of medicaton administration can

help ensure accuracey when administering
medications. The rights have no power
unless the nurse practices medication
administratin using the rights as standards
to applied.

8. Discuss how control substances are handled safely (767-768).

a. Controlled drugs must be locked some double-locked
b. Proper documentation is important
c. Use other nurse witness if controlled substance must be wasted
d. Document anytime full dosage not givendispose in presence of nurse witness.

9. Explain how the NPSGs patient identification method is essential to safe medication
administration.
10. List ways to maintain a safe medication administration environment (p.767).
a.
b.
c.
d.

Good lighting when preparing drugs

Quiet location
Work alone to prepare rugs
Dont leave drugs unattended
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e. Keep drug cart locked when unattended

PRINCIPLES OF PHARMACOLOGY:
1. Explain the role of pharmacodynamics (drug power) in medication administration.
Pharmacodynamicsthe cellular change drugs cause.
Drugs turn cells on or off or may block body processes. Drug-receptor interactions occur
when drugs interact with 1 or more cell structures to alter cell function.
2. List and explain the common types of drug preparations.
o
o
o
o
o
o
o
o
o
o
o
o
o

Capsule
Elixir
Enteric coated
Powder
Solution
Suspension
Tablet
Lotion
Lozenge
Transdermal patch
Ointment
Syrup
Suppository

3. List the methods of how drugs can be classified (p.753, 754).

NOTE: Drugs may be classified in a number of ways including:
a. By effect on body systems
b. By chemical composition
c. By clinical indication/therapeutic action
d. By class
4. Using a table, list and explain the pharmacokinetic mechanisms of drug actions.
Pharmakinetic drug action involves following how drug moves throughout body:
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
5. Using a chart, compare and contrast the adverse effect of drugs (p.756).
Adverse effect of a drug is unintended/undesirable effects othr than the therapeutic effect.
6. Explain the importance of knowing drug-drug, drug-food/beverage, and drug-herbal
interactions.
Its important to know to avoid harmful drug interactions.
7. Using a table, list and explain the common factors that can affect drug actions.

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8. Explain the importance of serum levels in drug dosing and administration (p.759-760).
o Developmental considerations
o Weight
o Gender
o Cultural/genetics
o Psychologic considers
o Pathology
o Environment
o Timing of administration
9. List and discuss the importance of the use of drug legislation in the United States (p.760).
They help regulate and control drug safety for the safety and security of the public.
o SPECIAL POPULATION: OLDER ADULTS:
1. List the recommend IM sites for the older adult.
o Ventralgluteal
o Deltoid
2. List the recommended needle length for the older adult (IM only listed).
o Vastus lateralis5/8-1
o Deltoid5/8-11/2
o Ventrogluetal-11/2
3. Recognize the special considerations of the older adult population during medication
administration (p. 758).
o Toxic effectdue to lower hepatic functioning
o Drug-to-drug interactions
o Idiosyncratic response to drugs.
4. Discuss how age can have an impact on the effects of medication pharmacodynamics.
Decreased nurmber of protein-binding sights.
5. Explain how the normal physiological aging changes can impact medication
administration (p. 758).
a. Difficulty swallowing
b. Decreased lipid content in skin
c. Decreased lean body mass
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d. Dry mouth
e. Decreased oral secretions
6. List helpful strategies for administering oral medication to the older adult population.
a. Allow extra admin time; reflexes slow
b. May have trouble swallowingcrush meds or use liquid form
c. Reevaluated dosage; wt and age criteria
d. Assist with making schedule for med reminders
e. Monitor pt for adverse reactions
f. Teach pt drug names rather than color identification
7. Discuss criteria considered when selecting IV sites in the older adult population.
Ultrasound of peripheral and IV placement may be needed as landmarks in aged may be
difficult to find.

o SPECIAL POPULATION: PEDIATRICS:

1. Explain why body weight is the most common method for calculating pediatric
medications.
2. Explain why BSA is the most accurate method for calculating pediatric medications
(p.766).
Due to the wide range of size differences between infants, toddlers and school-age
children.
3. Explain the difference between mg/kg/day and mg/kg/dose.
Always check order to
mg/kg/dayamount of drug given over 24-hr period
determine the dosage
mg/kg/doseamount of drug given a s a single dose
amount.

4. List the recommended IM sites for infants, toddlers, and children (IM Only Listed).
DeltoidChildren (3-18 yrs) Some toddlers may have sufficient muscle mass for
deltoid injection (Kyle 381).
Vastus LateralisInfants, toddlers and children
5. List the recommended needle length and gauge for the pediatric population.
o Vastus Lateralis5/8-1
o Deltoid5/8-11/2
o Ventrogluetal-11/2
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6. Recognize the special considerations for the pediatric population during medication
administration.
a. Development
b. Dose determination (BSA)
c. Administration types/guidelines for each
7. Discuss how age can have an impact on the effects of medication pharmacodynamics and
pharmacokinetics (Kyle p. 374).
A childs age/body may affect pharmocodymanicsdrug may not act as intended.
A childs wt and BSA/body composition affect a drugs pharmacokietics. Affects 4 parts of
drug movement (i.e. enzyme production, skin permeability, distribution)
8. Discuss how developmental age impacts medication administration and common nursing
interventions to address the issues and concerns.
Age Group
Infant
Toddler

Issue
Development of
Trust
Development of
Autonomy

Preschool

Development
Initiative

School-Age

Development
Industry

Teens

Development of
Identity

Nursing Intervention
Involve parents
therapeutic hugging
Follow routine rituals when giving
meds
Allow simple choice
Allow equipment handling
Offer choice
Involve parents
Allow equipment handling
Explain medications purpose
Allowing to help set-up
Give more choices
Reward System
Approach like and adult
Maintain privacy

9. Explain the importance of the use of praise when administering medications to the
pediatric population.
Fosters cooperation and courage?
10. List helpful strategies for administering oral medications to the pediatric population.
Use a dropper with infants & young kids for liquids
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Crush uncoated tabs/empty soft capsules; mix with foods

Warn child of objectionable taste
Offer flavored ice pop/frozen fruit bar STAT after med taken
Praise child for job well done

11. List helpful strategies for administering topical medications to the pediatric population.
Rectalnot the preferred med admin route because invasive, drugs absorption may be
erratic and unpredictable. Used if child is NPO.
12. List helpful strategies for administering ophthalmic medications to the pediatric
population (Kyle 379).

Provide age appropriate explanation

Keep eyes closed until admin
Warm med

13. List helpful strategies for administering optic medications to the pediatric population
(Kyle 380).
Explain in easily understandable terms
Room temp drops
Ages less than 3 years pull; pinna down and back
Ages older than 3 pull pinna up and back
14. List helpful strategies for administering parenteral medications to the pediatric
population.
Needle size
Site selection
Muscle mass
Medication viscosity
15. List safeguards to reduce medication errors in the pediatric population (Kyle 326).
Confirming childs weight accurate
Weigh kids in kg
Double check med calculation
If dose seems to large or small, verify
Confirming child identity
Double-checking dosage prior to administration
Always report med errors
Use med order/administration systems
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16. Explain how to provide atraumatic care to the pediatric population when it comes to
medication administration (Kyle 383).

Apply topical anesthetic to reduce pain prior to injection

Be sure child remains still during procedure.
o USING THE NURSING PROCESS:
1. Apply the nursing process to medication administration.

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