NCM 100-SKILLS

LABORATORY
MEDICATIONS
 Medication
• A substance administered for the
diagnosis, cure, treatment, or relief
of a symptom or for prevention of
disease.
 MEDICATION
• Therapeutic Agents: Are drugs or
medications, which when introduced
into a living organism, modify the
physiologic functions of that
organisms.
• Usually refers to a chemical
compound (vitamin, mineral, herb or
even natural food)
• Therapeutic Agents – refers to drugs and
their action
• Prescription- the written direction for
the preparation and administration of a
drug.
• Pharmacopoeia- is a book containing a list
of products used in medicine, with
descriptions of the product, chemical
tests for determining identity & purity,
formulas& prescription
 Pharmacokinetics
• Study of the movements of drug
molecules in the body in relation to
drug’s absorption, distribution,
metabolism & excretion.
 Pharmacodynamics
• A process by which a drug changes
the body. Such changes require that
the drug interact with specific
molecules & chemicals normally found
in the body.
Pharmacokinetics
1. Absorption- process by which drug
is transferred from its site of
entry into the body to the
bloodstream.
• Factors influencing absorption:
1. Route of administration
2. Drug solubility
3. Ph –the form in which the drug is
found on the ph of the environment
• Acidic drugs are well absorbed in
the stomach.
4. Local condition at the site of
administration. The more extensive
the absorbing surface the greater
the absorption of the drug & the
more rapid the effect. ( eg; burn pt,
food in the stomach)
5. Drug dosages- a loading dose or a
larger than normal dose, is usually
given when a pt. is in acute distress
& the maximum effect is desired as
quickly as possible. (eg;
phenobarbital, digoxin )
6. Serum drug levels- after the drug
has been absorbed, its serum level
can be monitored by blood specimen
& measuring drug’s peak & trough
levels.
• Therapeutic range-is that
concentration of drug in the blood
serum that produces the desired
effect.
• Peak level- or the highest plasma
concentration of the drug & should
be measured when absorption is
complete.
• Trough level- is the point when the
drug is at its lowest concentration, &
this specimen is usually drawn in the
30 minutes interval before the next
dose.
• Half life- is the amount of time it
takes for half a dose of drug to be
eliminated from the body.
 Rationale of monitoring
the levels
• Ensures the therapeutic range is
obtained without reaching the toxic
levels.
 Pharmacokinetics
2. Distribution- after the drug has
been absorbed into the
bloodstream, it is distributed
throughout the body. The drug is
accumulated in specific tissues for
its action. (aka transportation)
• Drugs are absorbed by the mucous
membrane, the gastro intestinal tract,
the respiratory tract and the skin.
Transportation- refers to the way in
which a drug is transported from the
site of introduction to the site of action.
When a drug enters or is absorbed by the
body, it binds to plasma protein in the
blood and is transported through
circulation to all parts of the body.
3. Metabolism or Biotransformation
is converted by enzymes into a less
active and harmless agent that can
be easily excreted. Most of this
conversions occurs in the liver,
although some conversion does take
place in the kidney, plasma and
intestinal mucosa.
• Breakdown of drug into inactive
form.
4. Excretion- after the drug is broken
down to an inactive form, excretion
of the drug from the body occurs.
• The kidneys are the most important
part of excretion because they
eliminate both the pure drug and
the metabolites of the parent drug.
They are filtered through the
glomeruli, secreted by the tubules
and either reabsorbed through the
tubules or directly excreted.
• Other routes of excretion include
the lungs, feces, saliva, tears, and
mother’s milk.
Factors affecting
Medication Action
1. Developmental factors
2. Gender- differences in a way men &
women respond to drugs are chiefly
related to the distribution of body
fat & fluid hormonal differences.
3. Cultural, ethnic, and genetic factors
4. Diet
5. Environment
6. Psychological factors- a client
expectations about what a drug can
do can affect the response to the
medication. For example, a client
who believes that codeine s
ineffective as analgesic may
experience no relief from pain after
it is given.
7. Illness and Disease –drug action is
altered in clients with circulatory,
liver, or kidney dysfunction.
8. Time of administration- orally
administered meds are absorbed
more quickly if the stomach is
empty.
 Names of Drugs
• Chemical name – refers to the
chemical derivation of the drug; it
describes the constituents of the
drug; for example ethyl, 1-methyl-
4phenylisonipecotate hydrochloride
• Generic name-shorter and simpler
and reflects the chemical family to
which the drug belongs; ex.
Meperidine Hydrochloride
• Official name- is the name by which
the drug is identified in the official
publications (USP & NF)

• Trademark name- or the brand name,

the most common way in which a drug
is known. For example: Demerol
 Medication orders
• Standing orders- set of orders that
they use for all of their hospitalized
patients, adding individualized order
as necessary. It may be carried out
indefinitely.
• Routine orders-medications that are
ordered to be given on a regular
order, until the order is cancelled.
• As needed or prn order- medication
that are given when needed or
requested.
• One-time only medications- are to
be given on one occasion only at a
specified time. (single order)
• “Stat” order –means to give it
immediately.
Components of a drug order
• The name of the patient
• The date the drug was ordered
• The name of the drug
• The dosage
• The route of administration and any
special rules of administration
• The time and frequency the drug
should be given
• The signature of the individual who
ordered the drug.
 Parts of Prescription
• Descriptive information about the
client: name, address, age.
• Date
• The Rx symbol, meaning “take thou”
• Medication name, dosage, & strength
• Route
• Dispensing instructions for the
pharmacist.
• Directions to be given to the patient
• Refill & or special labeling, for
example, “refill x 1”
• Prescriber’s signature
 Medication
Administration
• A basic nursing function that involves
skillful tecnique & consideration of
the patients development and safety.
• The nurse administering drugs
medications need a knowledge base
about the drugs, names, preparations
classifications, adverse effects, &
physiologic factors that affect drug
action.
 Principles of drug
administration
1. Observe the basic rights of drug
administration. (Observe the 3
checks)
2. Practice asepsis in handling
medications.
3. Nurse who administer medications
are responsible for their actions.
Question any order that you
consider incorrect.
 Principles of drug
administration
4. Be knowledgeable about medication
administration.
5. Keep narcotic in a locked cabinet.
6. Use meds that are in a clearly
labeled container.
7. Return liquid/IVF that are cloudy
or have changed color to the
pharmacy.
 Principles of drug
administration
8. Before administering, identify the
patient correctly.
9. Do not leave any meds at the
bedside. Check agency policy.
10. If patient vomits report it to the
nurse in charge/doctor.
 Principles of drug
administration
11. Pre-operative meds are usually
discontinued during the post-
operative period unless ordered to
be continued.
12. When medication error is made,
report it immediately to the nurse
in charge/ physician.
 Safety and Accuracy
• The three checks
Three times on checking the
medication label during preparation
1. The first check-read the MAR &
drug label & compare. Check the
expiration date.
2. Second check
While preparing the medication ( while
opening, pouring )
3. Third check
Before returning to the drawer or
before opening at the bedside
The ten rights of Medication
Administration
1. Right medication
2. Right dose
3. Right time
4. Right route
5. Right client
6. Right client education
7. Right documentation
8. Right to refuse
9. Right Assessment
10. Right evaluation
 Legal aspects of Drug
Administration
• Administration of drug is controlled
by (BFAD)
• Dangerous Drug Act 9165
• Generic Drug Act. 6675
• Nursing Law
 Common abbreviations
• PO---by mouth • Stat---immediately
• ac---before meals • C---with
• pc---after meals • S---without
• q.d.---every day • ss---one half
• q.o.d---every other • hs---at bed time
day • prn---as needed
• b.i.d.---twice a day • qh---every hour
• t.i.d.---three times • q2h---every two
a day hours
• q.i.d.---four times a
day
 Types of drug
preparation
• Capsule- powder or gel form of an
active drug, enclosed in a gelatinous
container, may also be called liquigel.
• Elixir- medication in a clear liquid
containing water, alcohol, sweeteners
and flavor.
• Enteric coated- a tablet or pill
coated to prevent stomach irritation.
• Extended release- preparation of a
medication that allows for slow &
continuous release over a pre-
determined period may also be
referred as controlled release
(CR,CRT), sustained or slow release
(SR), sustained action (SA), long
acting (LA), or timed release (TR).
• Liniment-medication mixed with
alcohol, oil or soap which is rub on
the skin.
• Lotion- drug particles in a solution
for topical use.
• Lozenge- small oval, round or oblong
preparation containing drug in a
flavored or sweetened base which
dissolves in the mouth and releases
the medication; also called troche.
• Ointment- semisolid preparation
containing a drug to be applied
externally; also called an unction.
• Pill- mixture of a powdered drug with
a cohesive material; maybe round or
oval.
• Paste- a preparation like an ointment
but thicker & stiff, that penetrates
the skin less than an ointment.
• Powder- singly or mixture of finely
ground drugs.
• Solution- a drug dissolved in another
substance (eg. In an aqeous solution)
• Suppository- an easily melted
preparation in a firm base such as
gelatin that is inserted in the body.
• Tincture- an alcoholic or water &
alcohol solution prepared from drugs
derived from plants.
• Suspension- finely divided, undissolved
particles in a liquid medium; should be
shaken before use.
• Syrup- medication combined in a water
and sugar solution.
• Tablet- small, solid dose of medication,
compressed or molded; maybe in any color,
size shape.
• Transdermal patch- unit dose of
medication applied directly to skin for
diffusion through skin and absorption into
the bloodstream.
• Caplet- a solid form, shaped like a
capsule, coated & easily swallowed.
• Extract- a concentrated form of a
drug made from vegetables or
animals.
• Gel or jelly- a clear translucent
semisolid that liquifies when applies
to the skin.
 Drug effects
• Therapeutic effect- the desired
outcome in medication administration.
• Adverse drug effects- a harmful,
unintended reaction to a drug at a
normal dosage.
• Side effects –are effects that
drugs have on to your body that don’t
help your symptoms. Also called
secondary effect.
• Side effects are most often not
pleasant, they include nausea, feeling
dizzy, bleeding in your GI tract.

• Cumulative effect- it occurs when

the body cannot metabolize one dose
of a drug before another dose is
administered.
• Idiosyncratic effect- is any
abnormal or peculiar response to a
drug that may manifest itself by over
response, under response, or
response different from expected
outcome.
• - older patients often have erratic
responses to medication.
• - it could be the result f genetic
enzymes deficiencies.
• Drug interactions- the combined
effect of two or more drugs acting
simultaneously produces a effect
either less than that of drug alone
(antagonist effect) or greater that
of each drug (synergistic effect)
• Synergistic effect- when two
different drugs increase the action
of one or another drug.
• Eg; Alcohol & Barbiturates when
taken together create a synergistic
effect.
• Antagonist-drug that inhibits cell
function by occupying the receptor
sites.
• Drug toxicity- results from over
dosage, ingestion of a drug intended
for external use, & buildup of the
drug in the blood because of impaired
metabolism & excretion.
• Drug allergy- immunologic reaction to
a drug. When a client is first exposed
to a foreign substance (antigen), the
body may react by producing
antibodies.
• A client may react to a drug as to an
antigen & thus develop symptoms of
an allergic reactions.
• Anaphylactic reaction- a severe
allergic reaction usually occurs
immediately & response could be
fatal.
• Drug tolerance- exists in a person
who has unusually low physiologic
response to a drug.
• Drug tolerance- a condition in which
successive increases in the dosage of
a drug is required to maintain a given
therapeutic effect.
• Iatrogenic disease-disease caused
unintentionally by medical therapy.
Medication Supply System
(Dispensing system)
• Medication cart. Medication usually in
unit dose packaging.
• Medication cabinet
• Medication room
• Automated dispensing cabinet (ADC).
computerized access system
automates the distribution,
management & control of medication.
Systems of Measurement
• Metric system- a system prescribed
by law in most European Countries &
in Canada. It is a decimal system.
• Basic units of measurement are the
meter, the liter, & the gram. The
kilogram (kg) is the only multiple of
the gram used, & the milligram (mg) &
microgram (mcg) are subdivisions.
• Fractional parts of the liter are
usually expressed in milliliters (ml)
• Apothecaries’ System- older than
metric, was brought to the USA from
England during the colonial period.
The basic unit of weight is the grain
(gr), basic unit of volume is the minim
means the “least”. The other units of
weight are the scruple, the dram, the
ounce, & the pound.
• Household System- these are used
when more accurate system of
measure are not required. Included
are drops, teaspoons, cups, & glasses.
Although pint & quart are often find
in the home, they are defined as
apothecaries’ measure.
 Basic metric measurements
of volume &weight
volume weight
thousands kilogram
hundreds hectogram
tens decagram
liter 1 unit gram
deciliter tenths decigram
hundredths centigram
• Milliter-----thousands-------milligram
 Approximate Volume
Equivalents
metric apothecaries household
1ml 15 minims 15 drops
(min or m)
4-5 ml 1 fluid dram 1 teaspoon
15 ml 4 fluid drams 1 tablespoon
30 ml 1 fluid ounce same
500 ml 1 pint (pt) same
1000 ml 1 quart (qt) same
4000 ml 1 gallon (gal) same
 Approximate Weight
Equivalents
metric apothecaries
1mg 1/60 grain
60 mg 1 grain
1g 15 grains
4g 1 dram
30 g 1 ounce
500 g 1.1 pound (lb)
1000 g (1kg) 2.2 pounds
 Converting Units of
Weights & Measure
• For example: Converting grain to mg
The order is morphine gr ¼, the
available medicine is labeled only in
milligram.
60mg= 1gr
then Xmg =1/4gr (0.25gr)
X=60x0.25
1
X=15mg
 Converting weights within
the metric system
• Equivalents are computed by by
dividing or multiplying. For example
to change milligrams to grams; divide
the number of mg by 1000 or just
move the decimal point three places
to the left:
500 mg= ? G
Answer= 0.5 g
 To convert grams to
milligrams
• Multiply the number by of grams by
1000 or move the decimal points
three places to the right:
0.006 g = ? mg
Answer =6 mg
 Converting weights &
measure between systems
• Converting units of volume
refer to slide # 58
Converting units of weights
• The nurse should keep in mind that a
milligram is smaller than
grain(1mg=1/60gr & 1 gr=60mg)
• The nurse must divide by 60 if
converting from mgs to gr.
• Multiply by 60 if converting from
grains to milligrams
 Examples
mg to gr
3000mg
60
= 50 grains
gr to mg
50 gr X 60= 3000MG
 Calculating Dosages
• Formula by using ratios:
Dose on hand = desired dose
Quantity on hand Q desired (x)
Eg; Erythromycin 500mg is ordered. It
is supplied in a liquid form 250mg in 5
ml.
Dose on hand = desired dose
Quantity on hand Q desired (x)
250mg = 500mg
5ml (x)
250x = 5ml X 500mg
x = 5ml X 500mg
250mg
x = 10ml
• Formula :
Desired dose x quantity on hand
dose on hand
500mg x 5ml
250mg
= 2x5
= 10ml
Available heparin is 10000units/ml. The
order is 5000units.
Desired dose x quantity on hand
dose on hand
5000units x 1
10000units
= 0.5 x 1
= 0.5 or ½ ml
 Routes of drug
administration
• Oral- is the most common, least
expensive & most convenient route
for most patient, & also a safe
method.
• Sublingual- a drug is placed under
the tongue, where it dissolves. eg;
Nitroglycerine
• Buccal- “pertaining to the cheek”. A
medication is held in the mouth
against the mucous membrane of the
cheek until the drug is dissolves.
• Parenteral route –other than the
alimentary or the respiratory tract;
that is by needle. Sterile equipments
& drug solutions are essential.
 Parenteral routes
• Subcutaneous (hypodermic)- into the
subcutaneous tissue, just below your
skin
• Intramuscular- into a muscle
• Intradermal- under the epidermis
(into the dermis)
• Intravenous- into a vein
• Intra-arterial- into the artery
• Intracardiac- into the heart muscles
• Intrathecal or intraspinal- into the
spinal canal
• Intrapleural- into the pleural space
• Epidural- into the epidural space
• Intra-articular-into a joint
• Topical applications- are those
applied to a circumscribed surface
area of the body. They affect only
the area to which they are applied.
• Include the following:
• Dermatologic preparations- applied
to the skin
• Installations & irrigations- applied
into the body cavities or orifices,
• Such as the urinary bladder, eyes,
ears, nose, rectum, or vagina.
• Inhalations- administered into the
respiratory tract by a nebulizer or
positive pressure breathing
apparatus. Air, oxygen, & vapor are
generally used to carry the drug into
the lungs.
Nasogastric & Gastrostomy
Medications
• Are alternative routes for administering
medication, for clients who cannot take
anything by mouth.
• NGT- is inserted by way of the
nasopharynx & into the stomach.
• Gastrostomy tube- is surgically placed
directly into the clients stomach
• Transdermal patch- sustained-action
medication (e.g., nitroglycerin,
estrogen, & nicotine)
• Applied to a hairless, clean area of
the skin that is not subject to
excessive movement or wrinkling.
• Not applied to areas with cuts, burns,
or abrasions or on distal part of the
extremities.
 Ophthalmic Medications
• Use of irrigations or Instillations
• Irrigation is administered to wash
out the conjunctival sac to remove
secretions or foreign bodies or
chemicals that may injure the eye.
 Procedures
• Oral medications
• Purpose: To provide a medication that has
systemic effects on the gastrointestinal
tract or both.
• Assessment
– Allergies to medication
– Client’s ability to swallow
– Presence of vomiting or diarrhea that would
interfere with absorption
– Specific drug action, side effects,
interactions & adverse reactions.
– Client’s knowledge of learning of &
learning needs abut medication.

Planning: Prepare all the needed

equipments to administer oral meds.
Implementation
Preparation
1. Know the reason why the client is
receiving is receiving the mediation,
the drug classification,
contraindications, usual dosage range,
side effects & nursing consideration
for administering & evaluating the
intended outcomes for the medication.
2. Check the MAR
– For the drug name, dosage, frequency,
route & expiration date.
 – If the MAR is unclear or pertinent
information is missing, compare Mar
with the most recent prescriber’s
written order.
– Report any discrepancies
3. Verify the client’s ability to take
medication orally.
– Determine whether the client can
swallow, is NPO, is nauseated or
vomiting, has gastric suction or has
diminished or absent bowel sounds.
4. Organize the supplies
• Performance
1. Perform hand washing & observe
other appropriate infection control
procedures.
2. Unlock the dispensing system.
3. Obtain the appropriate medication
4. Prepare the medication
– Calculate the medication dosage
correctly.
– Prepare the correct amount of
medication for the required dose
without contaminating the medication
– While preparing medication, apply the
second safety check.
Tablets or capsules
– Place packaged unit dose directly into
the medication cup.
– If using stock container, pour the
required number into the bottle cap, &
transfer it to the medication cap
without touching the tablet.
– Break only scored tablets if necessary
to obtain the correct dose. Use a
cutting & splitting device.
– If the client has difficulty swallowing,
crush the tablets to a fine powder.
Liquid preparation
– Thoroughly mix the medication before
pouring. Discard any medication that has
changed color or turned cloudy.
– Remove the cap & place it upside down
on the counter top.
– Hold the bottle so the label is next to
your palm & pour the medication awy
from the label.
– Place the medication cup on a flat
surface at eye level & fill it to the
desired level, using the bottom of the
meniscus (crescent shaped upper
surface of a column of liquid) to align
with the container scale.
– Before capping the bottle wipe the lip of
the bottle with paper towel.
– When giving small amount of liquid(<5ml),
prepare the medication in a sterile
syringe without a needle.
– label the syringe PO for safety.
– Keep unit dose liquids in their package &
open them at the bedside.
All medications:
– Place the prepared medication & MAR
together on the medication cart.
– Recheck the label on the container
before returning to its storage. This is
the third check.
– Avoid leaving prepared medication
unattended. This will prevent potential
mishandling errors.
– Lock the medication cart before
entering client’s room.
– Check the room number against the
MAR. To ensure that the nurse is
entering the correct room.
5. Provide privacy.
6. Prepare the client
• Check the client’s identification band
• Assist the client in a sitting position,
or if not possible in a side-lying
position.
• If not previously assessed take the
required assessment measures.
• Explain the purpose of the medication
& how it will help. Information can
facilitate acceptance & compliance.
8. Administer the medication
• Take the medication to the client
within the period of 30 minutes before
or after the scheduled time,
• Give the client sufficient water or
juice to swallow the medication.
• If the client is unable to hold the cup,
use the pill cup to introduce the
medication into client’s mouth & give
only one capsule or tablet at a time.
• If an older child or adult has difficulty
swallowing, ask the client to place the
Medication on the back of the tongue before
taking the water.
• If the medication has objectionable taste.
Ask the client to suck a few ice chips
beforehand or give the medication with
juice or applesauce, or bread if there are no
contraindications. ( ice chips will disensitize
the taste buds, juices or bread can ask the
taste of the medication.
• If the client says that the medication you
are about to give is different from what the
client is receiving, do not give the
medication without first checking the
original order.
 • Stay with the client until all medication
have been swallowed.
9. Document each medication given
10. Dispose all supplies appropriately
11. Evaluate the effects of the
medication.
• Return to the client usually after 30
minutes to evaluate the effects of the
medication on the client.
 Parenteral Medications
• Administering parenteral drugs
requires the same nursing knowledge
as for oral, however because
injections are invasive procedures,
aseptic technique must be used to
minimize the risk of infection.
 EQUIPMENT
• SYRINGES ( Hypodermic syringe)
Hypodermic Syringes
• Tuberculin syringe
Insulin syringes
• Needles
• Active safety device
• Ampules
• ampules
• Ampule opener
• vials
• Sharps containers
• deltoid
• Vastus lateralis
• Subcutaneous sites
• subcutaneous
• intradermal
• intradermal
• Sources (photos)
• Retrieved April 9, 2009
• http://www.ozoneservices.com/produ
cts/OLP/syringe/images/plastic-01-
b.jpg
• http://www.impact-
enterprises.com/photo/1304156a.jpg