L
EARNING
O
UTCOME
1
Define selected terms related to the administration of medications.
Concepts for Lecture
1. There are many important definitions related to the administration of
medications. These are defined throughout the chapter (see Key
2. A medication is a substance administered for the diagnosis, treat-
ment, or relief of a symptom or for the prevention of diseases. This
term is used interchangeably with the word drug; however, the word
3. The chemical name of a drug is the name by which a chemist knows
the drug.
The trade or brand name is the name given by the drug manufac-
turer and is usually short and easy to remember.
L
EARNING
O
UTCOME
2
Describe legal aspects of administering medications.
Concepts for Lecture
1. The administration of medications in both the United States and
2. Nurses need to know how nursing practice acts in their areas define
and limit nursing functions. Also, nurses must be able to recognize
3.
Another aspect of nursing practice governed by law is the use of con-
trolled substances. Controlled substances are kept under lock. Special
inventory forms are used for recording the use of these substances. The
information usually required on these forms includes the name of the
C
HAPTER
35
MEDICATIONS
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Provide examples of the generic, official,
chemical, and trade (brand) names of common
medications.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Discuss nursing actions the nurse should take
when a medication ordered by a primary care
provider is inappropriate. Have the students role-
play contacting a primary care provider and dis-
cussing the medication order.
• Have the students review the state nurse prac-
students identify what statements are made
about administration of medication by
CHAPTER 35 / Medications 245
also be listed. A verifying signature of another RN may be required by
L
EARNING
O
UTCOME
3
Describe actions of medications on the body.
Concepts for Lecture
1. The action of a drug in the body can be described in terms of its half–
2. Because the purpose of most drug therapy is to maintain a constant
drug level in the body, repeated doses are required to maintain that
level. When an orally administered drug is absorbed from the gastro-
3. Key terms related to drug actions are as follows:
• Onset of action: The time after administration when the body
initially responds to the drug
4. Pharmacodynamics is the mechanism of drug action and relation-
ships between drug concentration and the body’s responses. A recep-
tor is the drug’s specific target
,
usually a protein located on the
surface of a cell membrane or within the cell. As the drug binds to
5. Pharmacokinetics is the study of the absorption, distribution,
biotransformation, and excretion of drugs.
• Absorption is the process by which a drug passes into the blood-
stream. For absorption of a drug to occur, the correct form of the
drug must be administered through the correct route. The rate of
pass through the liver and are partially metabolized prior to reach-
ing the target organ. This requires higher oral doses in order to
achieve the appropriate effect. A drug administered directly into
the bloodstream, that is, intravenously, is immediately in the vas-
cular system without having to be absorbed. This, then, is the route
medium, such as oil. The absorption of drugs from the rectum into
the bloodstream tends to be unpredictable. Therefore, the rectal
route of administration is normally used when other routes are
unavailable or when the intended action is localized to the rectum
or sigmoid colon.
metabolizing enzymes in the cells detoxify the drugs. The products
of this process are called
metabolites.
There are two types of
metabolites: active and inactive. An active metabolite has a phar-
• Excretion is the process by which metabolites and drugs are elimi-
nated from the body. Most drug metabolites are eliminated by the
kidneys in the urine; however, some are excreted in the feces, the
CHAPTER 35 / Medications 247
L
EARNING
O
UTCOME
4
Identify factors affecting medication action.
Concepts for Lecture
1. Medication action may be affected by developmental factors, gender,
culture, ethnicity, genetics, diet, environment, psychological factors,
illness and disease, and time of administration.
and because they may be prescribed multiple drugs and incompati-
bilities may occur.
certain medications (see Culturally Responsive Care).
The diet may contain nutrients that can interact with medications
and increase or decrease action.
It is important to consider the effects of a medication in the
context of the client’s personality, milieu, and environmental condi-
meal.
L
EARNING
O
UTCOME
5
Describe various routes of medication administration.
Concepts for Lecture
1. Routes of medication administration include oral, sublingual, buccal,
parenteral, and topical.
In oral administration, the medication is swallowed. It is the most
common, least expensive, and most convenient route for most clients.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• Divide the students into groups. Assign a
medication to each group. Have the students
use the medication book required by the
curriculum to illustrate how individual factors
could affect the action of the assigned medica-
tion and nursing interventions to counter
these, if possible.
action of each medication. Discuss how the
nurse might facilitate the desired action of the
medication and reduce adverse reactions, if
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Assign the students to look up specific
medications to determine the various routes
available for administration. Ask the students
to suggest when the various routes would be
appropriate.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
• Have the students review the medications
prescribed for their clients, indicating the var-
2. Topical applications are those applied to a circumscribed surface
area of the body. Routes for topical applications include dermatolog-
ic, applied to the skin; instillations and irrigations, applied into body
L
EARNING
O
UTCOME
6
Identify essential parts of a medication order.
Concepts for Lecture
1. Essential parts of a medication order include the full name of the
client, date and time the order is written, name of the drug to be
L
EARNING
O
UTCOME
7
List examples of various types of medication orders.
Concepts for Lecture
1. There are four common medication orders: stat order, single order,
standing order, and prn order.
A stat order indicates that the medication is to be given immedi-
order is written to cancel it, or may be carried out for a specified
number of days (e.g., Demerol 100 mg IM q4h
5 days).
A prn order or as-needed order permits the nurse to give a medi-
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Provide the students with several medication
orders. Ask them to identify the essential parts
of the medication order in each.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Provide the students with a list of various
types of medication orders. Have the students
identify the type of order for each.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
er facility.
CHAPTER 35 / Medications 249
L
EARNING
O
UTCOME
8
State systems of measurement that are used in the administration of medica-
tions.
Concepts for Lecture
1. Systems of measurement used in the administration of medications
include metric, apothecary, and household.
L
EARNING
O
UTCOME
9
Describe four formulas for calculating drug dosages.
Concepts for Lecture
1. Four common formulas are used to calculate drug dosages. Any of
2. Basic Formula
The basic formula for calculating drug dosages is commonly used
and easy to remember:
H
3. Ratio and Proportion Method
The ratio and proportion method is considered the oldest method
4. Fractional Equation Method
The fractional equation method is similar to ratio and proportion,
except it is written as a fraction:
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Provide the students with medication calcula-
tion problems requiring conversion from one
system to another. Review the calculations.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Supply the class with a common drug calculation
problem to solve and have students quietly put
down their pencils when they find the answer.
When all students are done, have everyone shout
out their answer. Choose someone who got the
lem on the board; students should explain how
they reached the answer when they are done.
Multiple students can be solving problems in
the quantities of medication they would ad-
minister if they were preparing medications
for their clients.
5. Dimensional Analysis
The dimensional analysis method is often used in the physical
sciences where a quantity in one unit of measurement is converted to
an equivalent quantity in a different unit of measurement by cancel-
ing matching units of measurement (Olsen et al., 2012). In some
instances, the nurse needs to convert from one or two systems to one
L
EARNING
O
UTCOME
10
List six essential steps to follow when administering medication.
Concepts for Lecture
1. When administering any medication, regardless of the route of
administration, the nurse must identify the client, inform the client,
or another personal identifier.
If the client is unfamiliar with the medication, the nurse should
medication administration must be observed (see Box 35–6).
The nurse should provide adjunctive interventions as indicated.
Clients may require physical assistance in assuming positions for
parenteral medications or may need guidance about measures to
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Invite a quality assurance representative to
discuss common medication errors and how they
can be prevented.
• Provide the students with various scenarios
that may occur when administering medica-
tions (e.g., another nurse asks the student to
administer medications that the student has
not prepared). Have the students provide
cy, including acceptable patient identifiers, how
to perform the three checks, use of the medica-
tion administration record (MAR), and documen-
due, what to do if a client refuses a medication).
ordered for their elderly clients in terms of the
L
EARNING
O
UTCOME
11
State the “rights” to accurate medication administration.
Concepts for Lecture
1. The 10 “rights” of medication are the right medication, right dose,
L
EARNING
O
UTCOME
12
Concepts for Lecture
1. Physiological changes in older adults that alter medication admin-
istration and effectiveness include altered memory; decreased visual
acuity; decreased renal function, resulting in slower elimination of
drugs and higher drug concentration in the bloodstream for longer
periods; less complete and slower absorption from the gastrointesti-
L
EARNING
O
UTCOME
13
Verbalize the steps required to administer oral medications safely.
Concepts for Lecture
1. Refer to Skill 35–1 in the text and the Skill Checklist
included on the Student DVD–ROM.
Prior to administering oral medications, the nurse should assess
In preparation for administering the medication, the nurse should
know the reason why the client is receiving the medication, the med-
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• Discuss the nursing responsibility when a
client refuses to take a prescribed medication.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
“rights” as they administer medications to
assigned clients.
group to develop guidelines for safely admin-
istering medications to elders based upon the
physiological changes of aging.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
• Ask the students to review medications
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• Obtain practice medications, MARs, and
administration equipment. Develop client
scenarios, and have the students practice
safely administering oral medications for the
clients in these scenarios.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
reason the client is receiving the medication,
actions of the medication, possible side effects
and adverse reactions, and related nursing in-
252 CHAPTER 35 / Medications
L
EARNING
O
UTCOME
14
Outline the steps required for nasogastric and gastrostomy tube medication
administration.
Concepts for Lecture
1. Check with the pharmacist to see if the client’s medications come in
a liquid form because these are less likely to cause tube obstruction.
If medications do not come in liquid form, check to see if the
medications may be crushed. (Note that enteric–coated, sustained–
2. When administering the medication(s):
• Remove the plunger from the syringe and connect the syringe to a
pinched or kinked tube.
• Put 15 to 30 mL (5 to 10 mL for children) of water into the syringe
3.
If the tube is connected to suction, disconnect the suction and keep the
L
EARNING
O
UTCOME
15
Identify equipment required for parenteral medications.
Concepts for Lecture
1. To administer parenteral medications, nurses use syringes and nee-
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• Set up the manikins with nasogastric or
gastrostomy tubes. Prepare scenarios for the
students to practice administering medications
through these tubes.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
•
Review the agency’s policies and procedures for
•
Obtain various types of syringes and needles.
Make a poster illustrating the components of the
syringes and needles.
• Provide the students with various medication
orders and indicate how the medications are
supplied (e.g., the number of mg/mL). Have
the students identify the appropriate syringe to
use to draw up the medication.
• Have the students identify the length and
3. The three most commonly used types are the standard hypodermic
syringe, the insulin syringe, and the tuberculin syringe. Injectable
L
EARNING
O
UTCOME
16
Verbalize the steps used in:
Concepts for Lecture
1. An ampule is a glass container usually designed to hold a single dose
of a drug. It has a distinctive shape with a constricted neck. Ampules
vary in size and most have colored marks around the necks indicat-
2. A vial is a small glass bottle with a sealed rubber cap that comes in
different sizes, from single to multidose vials. To access the medica-
tion, the vial must be pierced with a needle. In addition, air must be
injected into a vial before the medication can be withdrawn in order
3.
Sometimes it is desirable to mix medications in one syringe after check-
ing for compatibility. Mixing insulin is a variation of this skill.
Skill 35–4 presents the steps for this procedure. (See the textbook and
the Skill Checklist on the Student DVD-ROM.)
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Using practice vials and ampules, have the stu-
dents practice withdrawing medications safely.
withdraw insulin doses requiring the use of
either the 100-U or 50-U syringe.
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
S
UGGESTIONS FOR
C
LINICAL
A
CTIVITIES
254 CHAPTER 35 / Medications
L
EARNING
O
UTCOME
17
Identify the sites used for intradermal, subcutaneous, and intramuscular
injections.
Concepts for Lecture
1. Intradermal injection sites include the inner lower arm, the upper
2. Subcutaneous injection sites include the outer aspect of the upper
3.
Sites used for intramuscular injections include the ventrogluteal, vastus
lateralis, dorsogluteal, deltoid, and rectus femoris.
L
EARNING
O
UTCOME
18
Verbalize the steps used in administering parenteral medications by
intradermal, subcutaneous, and intramuscular routes.
Concepts for Lecture
1. Refer to Skill 35–5 for the technique of administering an intradermal
2. Subcutaneous: Refer to Skill 35–6 (See the Skill Checklist provided
on the Student DVD–ROM.)
3. Intramuscular: Refer to Skill 35–7 (See the Skill Checklist provided
on the Student DVD–ROM.)
Perform hand hygiene and observe other appropriate infection
control procedures (e.g., clean gloves). Prepare the medication, and
es, such as for an emaciated client or an infant, the muscle may be
pinched.
• Holding the syringe between the thumb and forefinger (as if hold-
ing a pencil), pierce the skin quickly and smoothly at a 90–degree
angle, and insert the needle into the muscle.
perse into the muscle tissue, thus decreasing the client’s discomfort.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Have the students identify the bony landmarks
for intramuscular injections on a skeleton.
• Have the students identify sites for intrader-
mal, subcutaneous, and intramuscular injec-
tions on at least two other students.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Using manikins, injection simulators, or oranges,
have the students practice administering
intradermal, subcutaneous, and intramuscular
injections.
• Set up the manikins or simulator arms for
practice administering intravenous medica-
tions. Develop various medication orders
• Show videotaped demonstrations of adminis-
tering parenteral medications. Compare and
contrast with the skills in the textbook.
CHAPTER 35 / Medications 255
until it stops.
4. Adding medications to intravenous fluid containers: Refer to Skill
35–8. (See the Skill Checklist provided on the Student DVD–ROM.)
L
EARNING
O
UTCOME
19
Verbalize the steps used in adding medications to intravenous fluid contain-
ers and administering intravenous medications using IV push.
Concepts for Lecture
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 35–8: ADDING MEDICATIONS TO INTRAVENOUS
FLUID CONTAINERS
COMPETENCY
DEMONSTRATED?
Yes
No
1. Gathered appropriate equipment.
2. Performed hand hygiene and observed other appropriate infection
3. Prepared the medication from the ampule or vial for drug with-
drawal.
4. Added the medication.
To New IV Container:
a. Located the injection port. Cleaned port with antiseptic or
alcohol swab.
Activated the needle-safety device.
d. Completed IV additive label with name and dose of medication,
date, time, and nurse’s initials. Attached it on bag or bottle.
b. Removed needle cap from syringe, inserted needle through
center of injection port, and injected medication into bag.
To an Existing Infusion:
a. Determined that the IV solution in the container was sufficient
for adding the medication.
b. Confirmed desired dilution of the medication.
c. Closed the infusion clamp.
injected medication.
5. Disposed of equipment and supplies.
256 CHAPTER 35 / Medications
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 35–9: ADMINISTERING INTRAVENOUS
MEDICATIONS USING IV PUSH
COMPETENCY
DEMONSTRATED?
Yes
No
2. Gathered appropriate equipment.
3. Prepared medication.
Existing Line:
a. Prepared the medication according to the manufacturer’s
directions.
IV Lock:
of sterile normal saline.
1 mL each of sterile, normal saline.
a. Flushing with saline: prepared two syringes, each with 1 mL
c. Drew up medication into a syringe.
4. Applied a small-gauge needle on syringe if used a needle system.
5. Performed hand hygiene and applied clean gloves.
6. Provided client privacy.
7. Prepared the client:
a. Introduced self and verified the client’s identity.
9. Administered the medication by IV push:
IV Lock with Needle:
a. Cleaned the injection port with an antiseptic swab.
blood.
c. Flushed the lock by slowly injecting 1 mL of saline.
d. Removed the needle and syringe. Activated needle-safety
device.
e. Cleaned the lock’s injection port with an antiseptic swab.
f. Inserted the needle of the syringe containing the prepared
medication through the center of the injection port.
infusion. Used a watch to time the injection. Removed the
needle and syringe when all medication administered.
b. Inserted the needle of the syringe containing normal saline
through the center of the injection port and aspirated for
h. Activated needle-safety device.
i. Cleaned injection port of the lock.
j. Attached the second saline syringe and injected 1 mL of
saline.
k. If heparin was used, inserted the heparin syringe and injected
the heparin slowly into the lock.
IV Lock with Needleless System:
a. Cleaned injection port of lock.
b. Inserted syringe containing normal saline into the injection
c. Flushed the lock with 1 mL sterile saline.
d. Removed the syringe.
e. Inserted the syringe containing the medication into the port.
f. Injected the medication at the recommended rate of infusion.
g. Withdrew the syringe.
h. Repeated injection of 1 mL of saline.
Existing Line:
a. Identified the injection port closest to the client.
b. Cleaned the port with an antiseptic swab.
c. Stopped the IV flow by closing the clamp or pinching the
tubing above the injection port.
d. Connected the syringe to the IV system.
i. Needle system: Held port steady. Inserted needle of syringe
10. Disposed of equipment according to agency practice.
11. Removed and disposed of gloves. Performed hand hygiene.
12. Observed client closely for adverse reactions.
13. Determined agency policy about recommended times for chang-
ing IV lock.
L
EARNING
O
UTCOME
20
Verbalize the steps used in administering the following topical medications:
a. Dermatologic
b. Ophthalmic
c. Otic
Concepts for Lecture
1. Topical skin or dermatologic preparations include ointments, pastes,
creams, lotions, powders, sprays, and patches. See Table 35–1. Also
see Practice Guidelines for applying skin preparations. Before apply-
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Show a videotape of administration of topical
medications. Compare and contrast with the
related skills in the text.
• Obtain samples of various types of topical
medications for the students to view.
administering various topical medications.
• Assign students to administer topical medica-
tions for assigned clients.
2. Refer to Skill 35–11: Administering Otic Instillations.
To treat the ethmoid and sphenoid sinuses, instruct the client to
lie back with the head over the edge of the bed or a pillow under the
3. Refer to Skill 35–12: Administering Vaginal Instillations.
4. Rectal preparations:
• Assist the client to a left lateral or left Sims’ position, with the
upper leg flexed.
• Fold back the top bedclothes to expose the buttocks.
• Put a glove on the hand used to insert the suppository.
5. Respiratory inhalation:
• Nebulizers deliver most medications administered through the
inhaled route. A nebulizer is used to deliver a fine spray (fog or
mist) of medication or moisture to a client. There are two kinds of
nebulization: atomization and aerosolization.
• Exhale comfortably (as in a normal full breath).
• Hold the canister in the dominant hand, with the thumb at the
bottom and the forefinger on top.
• Press down once on the MDI canister (which releases the dose)
and inhale slowly (for 3 to 5 seconds) and deeply through the
into the lungs.
• Following use of the inhaler, rinse the mouth with tap water to
L
EARNING
O
UTCOME
21
Recognize when it is appropriate to delegate medication administration to
unlicensed assistive personnel.
Concepts for Lecture
1. In acute care settings, administration of oral/enteral medications is
performed by the nurse and is not delegated to unlicensed assistive
personnel (UAP). The nurse can inform the UAP of the intended
2. Preparing medications from ampules and vials, mixing medications
3.
Administration of IV push medications varies by state nurse practice
acts. For example, some states may allow the RN to delegate certain
medications to be given by an LPN/LVN, whereas other states may
L
EARNING
O
UTCOME
22
Demonstrate appropriate documentation and reporting of medication admin-
istration skills.
Concepts for Lecture
1. When the nurse judges that a medication ordered by a primary care
provider is inappropriate, the nurse should document the following:
when the primary care provider was notified, what was conveyed to
2. Document all medications given, including the name of the medica-
tion given, dosage, time, any complaints or assessments of the client,
3. Following administration of intradermal medication, evaluate the
4. Many agencies prefer that medication administration be recorded on
the medication record. The nurse’s notes are used when PRN medi-
5.
Assess the effectiveness of the medication at the time it is expected to act
and document it.