Pharma module 2_final

A Legacy of Excellent Education in Virtus et Scientia
Email: vpaaoffice@usa.edu.ph | Tel. No.: (033) 337-4841 | Fax No.: (033) 337-7716
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LEARNING MODULE IN NCM 106
PHARMACOLOGY
PREPARED BY:
SHARON D. MAQUIRAN, RN

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NCM 106: PHARMACOLOGY
Module 2:
Nursing Process in Pharmacology
Module Overview:
This module is designed to explore the use of nursing process as it relates to drug therapy.
Module Outcomes:
At the end of the module the learner should be able to:
a. Assess with the client one’s health status/competence in relation to drug
administration.
b. Formulate with the client with reference to prescribed medications a plan of care to
address the health needs/problems based on priorities.
c. Determine the specific nursing considerations/precautions in safe drug administration:
o Interpret a medication order accurately
o Relate the rights in drug administration to patient safety.
o Compute accurately the drug dosage for a given medication orders.
o Practice correct decision making skills in safe drug administration.
Module Content:
Nursing Process in Pharmacology
A. Assessment
1. Drug History
B. Planning
C. Intervention
1. Drug Administration
2. Medication Orders
3. Medication Safety
4. Seven Rights
5. Dosage Calculation
D. Client Education
E. Evaluation
F. Recording and Reporting

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Activity Description Time
Overview
1 Interactive Discussion through GOOGLE MEET – Discussion Board
PowerPoint Presentation (per group)
40 minutes
2 Patient teaching card making (asynchronous)
3 Discuss and Share 20-30
minutes
4 Case Study 40 mins
5 Case Study 40 mins
6 Case Study 40 mns
7 Case study 40 mins
8 Conversion table making and Short quiz 2 hours
9 Case study 40 mins
10 Practice problem 1 hour
11 Comprehensive quiz 1 hour
Course Content:
The Nursing Process is crucial for safe medication administration.
 A research-based framework for professional practice
 Central to all nursing care
 Ongoing and constantly evolving process that involves critical thinking.
The Nursing Process involves 5 steps:
1. Assessment
 Data collection (subjective and objective)
o Subjective data include information provided verbally by the patient, family
members, friends, and other sources.
 Verbalized by the patient
 Use open-ended question (“Please tell me about your current
medications”)
 Examples of pertinent information that the nurse can use to help elicit
subjective data from the patient concerning medication administration
includes the following:
 Current health history, including family history
 Swallowing problems (dysphagia)
 Signs and symptoms of the patient’s illness verbalized by the
patient
 Current concerns about the patient:
o Knowledge abot the medications and side-effects
o Over-the-counter (OTC) remedies
 Allergies

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 Financial barriers
 Use of tobacco, alcohol and caffeine
 Cultural delivery barriers
 The patient’s home safety needs
 Caregiver needs and support system
o Objective data are what the nurse directly observes about the patient’s health
status.
 Physical health assessment
 Laboratory and diagnostic test results
 Data from the physician notes
 Measurement of vital signs
 The patient’s body language
2. Nursing Diagnosis
 Is made based on analysis of the assessment data, and it determines the type of care the
patient will receive.
 Decision about the need/problem (Actual or at-risk for)
 3 parts:
o Problem
o Etiology
o Signs and symptoms
 Common Nursing Diagnoses related to drug therapy:
o Pain, Acute or Chronic, related to surgery
o Knowledge deficit related to effects of anticoagulant medication
o Noncompliance related to forgetfulness
3. Planning
 During the planning phase, the nurse uses the data collected to set goals or expected
outcomes and interventions.
 Goals or expected outcomes should address the problems in the nursing diagnosis.
 Planning involves identification of goals.
o Must be patient-centered
 Outcome criteria must be SMART
o Specific, Measurable, Attainable, Realistic and Time-bound
4. Implementation
 Is a part of the nursing process in which the nurse provides education, drug
administration, patient care and other interventions necessary to assist the patient in
accomplishing the established goals.
5. Evaluation
 The nurse determines whether the goals and teaching objectives are being met.
Patient Teaching:
 It is important to keep in mind factors that help promote patient learning.
 Patient teaching is essential to the patient’s recovery.

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 It allows the patient to be informed about his or her health problems and to participate
in creating interventions that can lead to good health outcomes.
 The following are important principles to remember when teaching patients about their
medications:
o General: Instruct the patient to take the drug as prescribed.
 Provide simple, written instructions to the patient with the doctor and
pharmacy names and telephone numbers.
o Side effects – give patient instructions that would minimize side effects
o Self-administration – Perform an ongoing assessment on the patient’s motor
skills and abilities.
o Diet – what foods to include or to avoid
o Cultural considerations

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ACTIVITY 1. PATIENT TEACHING CARD.
 Basing from the principles given above, make a patient teaching card. You can also use
any Drug Handbook or search in the internet as your sources.
 Follow the format given below.
 Using the Microsoft Word, upload your output in our Google classroom.
 For taking modular mode, kindly detach this page and send back for checking.
 Deadline f submission will be on:_________________________________
PATIENT TEACHING CARD
Name of Drug Acetaminophen 325 mg
Reason for taking this drug
Dosage
Possible side effects
Notify healthcare provider
if:……
Warning/special
precautions

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ACTIVITY 2. CASE STUDY
 Read the case given below and answer the questions given.
 Using the Microsoft Word, upload your output in our Google classroom
Case Scenario:
Mr. John, is a 66-year-old man who just arrived in the Surgical ward following removal of
the appendix. He is complaining of pain on the operative site. You are the nurse assigned to care
for Mr. John. Basing from the Nursing Process, answer the following questions:
1. What critical assessment data do you need to identify and collect?
2. Formulate a Nursing Diagnosis based on your assessment data.
3. Describe two nursing interventions to assist the patient.
4. What criteria would you use to evaluate the effectiveness of the nursing interventions?

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Nursing Care Plan Rubric
CRITERIA 4 3 2 1 WEIGHT
Nursing
Diagnosis
Identifies
CORRECT nursing
problems basing
on NANDA;
Follows the PES
format for the
diagnostic label;
list appropriate
cues to support
the problem; uses
nursing
terminology; both
elements does not
say the same
thing; cause and
effect correctly
stated.
Identifies
CORRECT nursing
problems basing
on NANDA;
follows the PES
format for the
diagnostic label;
some cues are
not significant
uses medical
terminology for
the etiology;
both elements
does not say the
same thing;
cause and effect
clearly stated
Identifies
CORRECT
nursing
problems
basing on
NANDA;
Follows the
PES format for
the diagnostic
label; some
cues are not
significant or
did not supply
significant
supporting
details at all;
uses medical
terminology in
any elements
does not sat
OR say the
same thing.
Problems
identified is
not found in
the NANDA
or no
problems
identified at
all;
___x1=_
Objectives
Student
demonstrates full
knowledge;
Objective is
specific,
measurable (uses
verbs found in the
taxonomy of
objectives),
attainable,
realistic, and time-
bound; all are
related to the
concept.
Some objective is
not specific,
measurable (uses
verb found in the
taxonomy of
objectives),
attainable
realistic, and
time-bound;
some not related
to the concept.
Most objective
is not specific,
measurable
(uses verbs
found in the
taxonomy of
objectives),
attainable,
realistic, time-
bound; most
related to the
concept.
All objective
is NOT
specific,
measurable
(uses verbs
found in the
taxonomy of
objectives),
attainable,
realistic, and
time-bound;
all not
related to
the concept.
_x .5=_
Interventio
ns
All interventions
are addressed to
eliminate or
alleviate the
etiology of the
nursing problem
and is in
Most
interventions are
addressed to
eliminate or
alleviate the
etiology of the
nursing problem
Some
Interventions
are addressed
to eliminate or
alleviate the
etiology of the
nursing
No
interventions
are
addressed to
eliminate or
alleviate the
etiology of
_x2=_

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congruence with
the
Goal/objective; all
are
appropriate to the
client’s
understanding
and resources;
specific and laid
out in detail;
realistic
and is in
congruent with
the Goal/
objective; most
are appropriate
to the client’s
understanding
and resources;
specific and laid
out in detail;
realistic
problem and is
in congruent
with the
Goal/objective
; some are
appropriate to
the client’s
understanding
, and
resources; not
specific and
not laid out in
detail; some
are realistic
the nursing
problem; OR
student has
no nursing
interventions
/ strategies
planned at
all.
Evaluation
Able to evaluate
correctly in
accordance with
the outcome
criteria/objectiv
e and able to
give correct
justification to
the evaluation
by listing,
appropriate
significant cues.
Able to evaluate
correctly in
accordance with
the outcome
criteria/
objective and but
is unable to give
correct
justification to
evaluation by
listing
appropriate
significant cues.
Able to
evaluate in
accordance
with only
some of the
outcome
criteria/
objective and
is unable to
give
justification.
Failed to
evaluate.
_x .5= _
(20 points) Total --
Rubrics Case Analysis
CRITERIA POINTS SCORE
4 3 2 1
Clear
explanation of
key
issue/case
Shows superior
knowledge of
the issues, key
problems
Shows
adequate
knowledge of
the issues, key
problems,
Shows some
understanding
of the issues,
key problems,
Shows little
understanding
of the issues,
key problems,
Appropriate
analysis,
evaluation,
synthesis of
the issue/case
Issue were
clearly
identified
Issue were
partially
identified
Issue were not
identified
Inadequate
analysis of the
issue
Interpretation
and
application
Demonstrate
critical thinking
skills about the
Demonstrate
less critical
thinking skills
Lacks critical
thinking skills
about the topic
No critical
thinking skills
about the topic

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topic and the
student’s own
impressions
and
interpretations
of the case
about the topic
and the
student’s own
impressions
and
interpretations
of the case
Summary
paragraph
Well organized,
demonstrates
logical
sequencing and
sentence
structure
Well organized,
but
demonstrates
illogical
sequencing or
sentence
structure
Well organized,
but
demonstrates
illogical
sequencing
and sentence
structure
Weakly
organized
Grammar and
spelling
Punctuations
and
capitalizations
are correct
There is 1 error
in Punctuations
and/or
capitalizations
There are 2 or
3 errors in
Punctuations
and/or
capitalizations
There are 4 or
more errors in
Punctuations
and/or
capitalizations
TOTAL /20
pts
https://www.slideshare.net/ludymae/pharmathe-nursing-process

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DRUG ADMINISTRATION
General Principles of Drug Administration:
1. Confirm client diagnosis and appropriateness of medicines.
2. Identify all concurrent medicines and any potential contraindications and side effects.
3. Research drug compatibilities, action, purpose, route, contraindication and side effects.
4. Calculate dosage accurately especially for pediatric clients.
5. Check for expiration date of medicines
6. Compare drug label 5 times (when removing and returning medicines from cabinet,
before and after giving medication, before documentation)
7. Confirm patient’s identity
8. Provide client teachings
9. Stay with client until medicines is gone, do not leave at bedside.
10. After giving medicines, leave client in a position of comfort.
11. Give medicines within 30 minutes of prescribed time.
12. To ensure safety, do not give a medication that someone has prepared.
FORMS AND ROUTES OF DRUG ADMINISTRATION:
Routes of Drug administration:
Oral sublingual transdermal
Buccal topical instillation

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Inhalation nasogastric tube gastrostomy tube
Suppository parenteral
Forms of Drug administration:
Tablets and Capsules
 Most common, convenient and less expensive.
 Oral drugs not given to patients who are vomiting, lack a gag reflex, or who are
comatose.
 Do not mix a drug with large amounts of foods or beverages; patient may not consume
food. Do not mix drugs in infant formula.
 Enteric-coated and time-release capsules must be swallowed whole to maintain a
therapeutic drug level.

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o Enteric-coated - is a polymer barrier applied on oral medication that prevents its
dissolution or disintegration in the gastric environment.
o Time-release - Time-release drugs use a special technology to release small
amounts of the medication into a person's system over a long period of time.
This is also referred to as sustained release, extended release, or
controlled release. These tend to come in pill form and are simply made to be
more potent but dissolve slowly
 Administer irritating drugs with food to decrease gastrointestinal irritation.
 Administer drugs on an empty stomach if food interferes with medication absorption.
 Drugs given via sublingual or buccal routes remain in place until fully absorbed,
therefore no food or fluid should be taken while the medication is in place.
Liquids
 Elixirs, emulsions, suspensions and syrup.
o Elixirs – sweetened, hydroalcoholic liquids.
o Emulsions – mixture of two liquids that are not mutually soluble
o Suspensions – liquids in which particles are mixed but not dissolve.
o Syrups - viscous concentrated solution of a sugar, such as sucrose, in water or
other aqueous liquid; combined with other ingredients, such a solution is used
as a flavored vehicle for medications.
 Read the labels to determine whether diluting or shaking is required.
 Secure a plastic dosing cups that measures in millilitres in giving liquid drugs.
https://www.youtube.com/watch?v=FjrsXfysGek

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Transdermal
 Transdermal medication is stored in a patch placed on the skin and absorbed through
the skin to prpoduce a systemic effect.
 May be left in place for 12 hours or as long as 7 days depending on the drug.
https://www.youtube.com/watch?v=x8sOrXljT9I
Topicals
 Most frequently applied to the skin by painting or spreading the medication over an area
and applying a moist dressing or leaving the area exposed to air.
Instillations
 Instillations are liquid medication usually administered as drops, ointments or sprays in
the following forms:
o Eyedrops
o Eye ointment
o Eardrops
o Nose drops and sprays

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https://www.youtube.com/watch?v=TLhnsABDtco
https://www.youtube.com/watch?v=4lLG7GnTmBU
https://www.youtube.com/watch?v=65uAZr7TsAE
https://www.youtube.com/watch?v=r4rWN8T89yU
https://www.youtube.com/watch?v=THNYITLcfD4
Inhalations
 Metered-dose inhalers (MDI’s) are handheld device used to deliver a number of
commonly prescribed asthma and bronchitis drugs to the lower respiratory tract via
inhalation.
 Take special measures when handling the capsules used in some MDI’s to prevent the
transfer of medication.
 Spacers are devices used to enhanced the delivery of medications from the MDI.
 Nebulizer is a device that changes a liquid medication into a fine mist or aerosol that has
the ability to reach the lower, smaller airways.
Spacer nebulizer
 When administering drugs via an MDI or nebulizer, the preferred patient position is the
semi-fowler or high fowler position.

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https://www.youtube.com/watch?v=fHYTz-ZoRLw
https://www.youtube.com/watch?v=0bU6fCN44FA
https://www.youtube.com/watch?v=pEKFKZiLNaA
Nasogastric tube
 Before administering the medication, always check for the proper placement of the tube
and assess the gastric residual.
 High fowlers position or elevate head of bed at least 30 degrees to avoid aspiration.
 Make sure the drug is crushable. If it is a capsule, assess whether it can be opened to be
administered through the tube.
 Remove the plunger from the syringe and attach it to the feeding tube, release the
clamp, and allow the medication to flow properly by gravity.
 Ensure proper identification of each drug until the time of administration. Do this by
administering one drug at a time. Flush with 10 to 15 ml of water in between each
administration to maintain patency of the tubing.
 When finished, flush tubing with 30 ml of water or whichever amountis recommended
by the agency’s policy.
 Clamp the tube and remove the syringe.
https://www.youtube.com/watch?v=PhTsuBtITLM
https://www.youtube.com/watch?v=dj45W_LZbyE
https://www.youtube.com/watch?v=z5PZXA1zqA4

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Suppositories
 A suppository is a solid medical preparation that is cone or spindle shaped for insertion
into the rectum; globular or egg-shaped for used in the vagina; pencil-shaped for
insertion into the urethra.
https://www.youtube.com/watch?v=PggDPsQ2KsQ
Parenteral Administration of Medication:
 Safety is a special concern with parenteral drugs, which are administered via injections.
 Methods of parenteral administration include:
o Intradermal
o Subcutaneous
o Intramuscular
o Z-track technique
o Intravenous
o Intraosseous

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Intradermal (ID)
 Action:
o Local effect
o Administered for skin testing
 Sites:
o Location are chosen so an inflammatory reaction can be observed.
o Lightly pigmented, free of lesions and hairless.
o Ventral mid-forearm, clavicular area of the chest or scapular area of the back.
 Equiptment:

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 Technique (Watch the video)
https://www.youtube.com/watch?v=dKo6L9Q7x-E
Subcutabeous (Subcut)
 Action:
o Systemic effect
o Sustained effect: absorbed mainly through capillary usually slower in onset than
with the intramuscular route.
 Sites:
o Adequate fat-pad size.
o Upper outer aspect of the arms; abdomen; anterior thigh
o 0.5 to 1 ml solution is given subcutaneously.
 Equipment:
 Technique (Watch the video)
https://www.youtube.com/watch?v=LNXOFKjTPJc
https://www.youtube.com/watch?v=8MPdw-0HbTg
Intramuscular (IM)
 Action:
o Systemic effect
o Usually a more rapid effect of drug than with the SC route
o For solutions that are more viscous and irritating for adults, children and infants.

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 Sites:
o Locations are chose for adequate muscle size and minimal major nerves and
blood vessels in the area.
o Ventrogluteal, Dorsogluteal, Deltooid, vastus lateralis
 Equipment:
 Technique: (Watch the videos)
https://www.youtube.com/watch?v=wKCPiSnYqwA
https://www.youtube.com/watch?v=nbLc2Q1rxwU
https://www.youtube.com/watch?v=k2gNv8yIzlY
https://www.youtube.com/watch?v=fgpwIfj1A5w
https://www.youtube.com/watch?v=Dzdf2YfOuQw
https://www.youtube.com/watch?v=AxKEJQg6lB8

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https://www.youtube.com/watch?v=4DSfCiL0F6A
https://www.youtube.com/watch?v=QrSJTjNJR6s
Z-Track Technique
 Recommended when administering IM injections to help minimize local skin irritations
by sealing the medication in the muscle tissue.
https://www.youtube.com/watch?v=DBHnd3N-5Ns
Intravenous (IV)
 Action:
o Systemic effect
o More rapid than IM and SC
 Sites:
o Accessible peripheral veins are preferred
o Cephalic or cubital vein of the arm, dorsal vein of the hand.
o When possible, ask the patient about his or her preference, and avoid needless
body restriction.
o In newborns, the veins of the feet, lower legs and head may be used after sites
have been exhausted.

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 Equipment:
Gauge 20 for adult Infusion pump
Gauge 24 for infants
Gauge 22 for children
 Technique: (Watch the videos)
https://www.youtube.com/watch?v=HxT7E14euZ8
https://www.youtube.com/watch?v=pln-x9YKnK0
https://www.youtube.com/watch?v=vE99rZ7JT3Q
https://www.youtube.com/watch?v=4ntqS_R1r70
Intraosseous (IO)
 Involves the infusion of medication directly into the bone marrow.
 Contraindications include: fracture in the insertion limb, infection at the insertion site,
severe osteoporosis, and other bone abnormalities.
 Sites:
o Ventrogluteal (preferred)
o Vastus lateralis(for infants less than 12 months and toddlers not walking alone)

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 Equipment:
 Technique: (watch the videos)
https://www.youtube.com/watch?v=KHXSfh2ZRDM
https://www.youtube.com/watch?v=Rer4pH3HgOc
https://www.youtube.com/watch?v=UXVDx26N9Zk

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ACTIVITY 3. SHORT QUIZ
For modular program, kindly remove this page and send back for checking.
1. The nurse is administering an IM injection to a 5-year-old . Choose the correct site the nurse
will use:
A. Intravenous C. Dorsogluteal
B. Deltoid D. Ventrogluteal
2. The nurse is teaching a patient to use an inhaler. What common teaching point is essential for
the nurse to include?
A. Cleansing the metered-dose inhaler or nebulizer is not recommended.
B. The semi-fowler or high fowler position is recommended
C. spacers decrease delivery of medication
D, Nebulizers change medications to a large particle powder mist
3. What needle gauge is use for intradermal injection?________________________________
4. What are other sites for IV infusion in newborn if other sites are not accessible?
_______________________ ________________________ ________________________
 Use Calibri font, size 11
 For modular program, kindly remove this page and send back for checking.
 Deadline of submission will be on:_________________________________
Case scenario:
Jane, a diabetic, on oral hypoglycaemic medication, is being discharged from 24-hour
observation care. The doctor orders regular, subcutaneous insulin and syringes. Home health is
ordered with instructions for the nurse to provide detailed teaching concerning insulin
administration. As the nurse assigned to discharge Jane, explain the following information
included in the discharge teaching about subcutaneous injections.
1. Common subcutaneous injection sites
2. The angle of the needle’s insertion
3. How the skin is held prior to inserting the needle
4. Choosing the correct needle gauge for the subcutaneous injection
5. Maximum amount of solution administered in a subcutaneous site
6. An explanation of what occurs after the needle is inserted
7. The final step after the drug is injected

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Rubrics for Case Analysis
CRITERIA POINTS SCORE
4 3 2 1
Clear
explanation of
key
issue/case
Shows superior
knowledge of
the issues, key
problems
Shows
adequate
knowledge of
the issues, key
problems,
Shows some
understanding
of the issues,
key problems,
Shows little
understanding
of the issues,
key problems,
Appropriate
analysis,
evaluation,
synthesis of
the issue/case
Issue were
clearly
identified
Issue were
partially
identified
Issue were not
identified
Inadequate
analysis of the
issue
Interpretation
and
application
Demonstrate
critical thinking
skills about the
topic and the
student’s own
impressions
and
interpretations
of the case
Demonstrate
less critical
thinking skills
about the topic
and the
student’s own
impressions
and
interpretations
of the case
Lacks critical
thinking skills
about the topic
No critical
thinking skills
about the topic
Summary
paragraph
Well organized,
demonstrates
logical
sequencing and
sentence
structure
Well organized,
but
demonstrates
illogical
sequencing or
sentence
structure
Well organized,
but
demonstrates
illogical
sequencing
and sentence
structure
Weakly
organized
Grammar and
spelling
Punctuations
and
capitalizations
are correct
There is 1 error
in Punctuations
and/or
capitalizations
There are 2 or
3 errors in
Punctuations
and/or
capitalizations
There are 4 or
more errors in
Punctuations
and/or
capitalizations
TOTAL /20
pts

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MEDICATION ORDERS
The prescription or medication order conveys the therapeutic drug plan for the patient. It is the
responsibility of the burse to:
 Interpret the order
 Prepare the exact dosage of the prescribed drug
 Identify the patient
 Administer the proper dosage by the prescribed route at the prescribed time intervals
 Educate the patient regarding the medication
 Record the administration of the prescribed drug
 Monitor the patient’s response for desired (therapeutic) and adverse effect
Common Medical Abbreviations
Abbreviation Interpretation Abbreviation Interpretation
Route
 IM
 IV
 IV PB
 SUBCUT
 SL
 ID
 GT
 NG/NGT
 NJ
 p.o.
 p.r.
 o.s.
 o.d.
 o.u.
Intramuscular
Intravenous
Intravenous piggyback
Subcutaneous
Sublingual
Intradermal
Gastrostomy tube
Nasogastric tube
Nasojejunal tube
Per orem, by mouth, orally
Per rectum, rectally
Left eye
Right eye
Both eyes
General
 a
 p
 c
 S
 q
 qs
 aq
 NPO
 ss
 gtt
 Tab
 Cap
 et
 noct
Ante, before
Post, after
With
Without
Every
Quantity sufficient
Water
Nothing by mouth
One-half
Drop
Tablet
Capsule
And
night

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 a.d.
 a.s.
 a.u.
Right ear
Left ear
Both ears
Frequency
 a.c.
 p.c.
 h.s.
 ad. Lib
 p.r.n.
 stat
 b.i.d.
 t.i.d
 q.i.d.
 q.d.
 q.o.d.
 min
 h
 q.h.
 q.2h
 q.4h
 q.6h
 q.8h
 q.12h
Ante cebum, before meals
Post cebum, after meals
Hours of sleep, at bedtime
As desired, freely
When necessary
Immediately, at once
Twice a day
Three times a day
Four times a day
Once a day, every day
Every other day
Minute
Hour
Every hour
Every 2 hours
Every four hours
Every 6 hours
Every 8 hours
Every 12 hours
THE DRUG ORDER

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Sample Medication Order Sheet:
Note: Format of the medication order sheet varies depending on the agency policies. It is
important that you can be familiar of what a medication order form looks like.

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Sample Medication/Administration Sheet:
Note: Format of the medication sheet varies depending on the agency policies. It is important
that you can be familiar of what a medication order form looks like.
Caution: If any of the seven parts is missing or unclear, the order is considered
incomplete and is, therefore, not a legal drug order.

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DRUG LABELS:
The drug order prescribes how much of a drug the patient is to receive. The nurse must prepare
the order from the drugs on hand. The drug label tells how the available drug is supplied.
 Brand name – is the manufacturer’s name of the drug.
 Generic name – appears directly under the brand name or placed inside the parenthesis
 Dosage strength – dosage weight or amount of drug provided in a specific unit of
measurement.
 Form – identifies the structure and composition of the drug such as tablets and capsules.
 Administration route – refers to the site of the body or method of delivery into the
patient.
 Supply dosage – refers to both dosage strength and form.
 Total volume – refers to the full quantity contained in a package, bottle or vial.
 Direction for mixing or reconstituting
 Label alerts – printed warnings or special alerts added by the pharmacy before
dispensing.
 Name of manufacturer – is circled on the following labels
 Expiration date – a note the date of medication will expire.
 Lot or control numbers – required by the Federal law to quickly identify the particular
group of medication if damage or tamper.
 National drug code- a unique identification number required by the Federal law
 Bar code symbols – are commonly used in retail sales. Used for recording and stock
recorder, and can automate medication documentation right at the patient’s bedside.
 Unit - or single dose labels – are available in unit dosage such as tablet or capsule.
 Combination drugs – combination of two or more drugs or different substances in one
tablet.
 Supply dosage expressed as a ratio or percent – refers to solutions with a dosage
expressed as a ratio or percent such as 1:1000 (1mg/ml)

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ACTIVITY 5 : Answer what is ask. Using the Microsoft word, upload your answer in our google
classroom. For those who are on modular and non-connectivity, remove this page and send back
for not later than____________________________________________.
Interpret the following medication orders:
1. naproxen 250 mg p.o. b.i.d.______________________________________________________
2. cefaclor 500 mg p.o. stat, then 250 mg q.8h ________________________________________
3. Ativan 10 mg IM q.4h p.r.n., agitation ______________________________________________
4. Mylanta 10 ml p.o. p.c. at bedtime_________________________________________________
5. atropine sulphate ophthalmic 1% 2 gtt o.d. q.15 min x 4 _______________________________
6. Compare and contrast t.i.d. and q.8h administration times. Include sample administration
time for each in your explanation.
7. Describe your action if no method of administration is written?
8. Do q.i.d. and q4.h have the same meaning? Explain.
9. Name the seven parts of a written medication prescription.
10. Who determines the medication administration times?

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ACTIVITY 6. CASE ANALYSIS.
Read the case scenario and answer what is asked. Using the Microsoft word, upload your answer
in our google classroom. For those who are on modular and non-connectivity, remove this page
and send back not later than____________________________________________.
It is the responsibility of the nurse to clarify any drug order that is incomplete – that is, order
that does not contain the essential seven parts discussed in this module. Let us look at an
example in which this error occurred.
SCENARIO 1: Failing to clarify incomplete orders
Suppose a physician ordered omeprazole capsules p.o. at bedtime for a patient with an active
duodenal ulcer. You will note there is no dosage listed. The nurse thought the medication came
in only one dosage strength, added 20 mg to the order, and sent it to the pharmacy. The
pharmacist prepared the dosage written on the physician’s order sheet. Two days later, during
rounds, the physician noted that the patient had not responded well to the medication. When
asked about this, the nurse explained that the patient had received 20 mg at bedtime. The
physician informed the nurse that the patient should received the 40 mg dosage for high acid
suppression.
Potential Outcome:?
Prevention:?
SCENARIO 2. Omitting medication due to incorrect scheduling of dose.
An order was written for ampicillin 500 mg IV PB q4.h, which was handwritten on the medication
administration record (MAR). The registered nurse was distracted while verifying the order and
writing in the scheduled times of administration. The nurse saw the number 4 and instead of
scheduling the medication every 4 hours, scheduled the medication to be given 4 times a day at
6-12-6-12 timing. For 2 days, the shift nurses each checked to see what medication needed to be
given on their scheduled shifts but did not take time to compare the ordered frequency to the
scheduled times. Eventually a nurse did look over the entire medication record and noticed the
error. The medication times were corrected and the doctor was notified. A medication variance
form was completed, documenting the error, and it was submitted to the hospital risk
management department.
Potential Outcome:?
Prevention:?

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MEDICATION SAFETY
“FIVE-PLUS-FIVE” RIGHTS OF MEDICATION ADMINISTRATION (10 R’s):
1. Right patient
 The Joint Commission requires two forms of identification before drug administration:
o Ask the patient to state her name and birth date
o Compare with the patient’s identification band and the medication
administration record
 If the patient is an adult with a cognitive disorder or a child, verify the patient’s name
with a family member. In the event a family member is unavailable and the patient is
unable to self-identify, follow the facility’s policy.
 Distinguish between two patients with the same first or last name by placing “name
alert” stickers as warning on the medical records.
2. Right drug
 Check the doctor’s order if complete making sure that all the components of the drug
order are present.
 To avoid drug errors, the drug should be read three times:
o When you pick up the medication and remove it from the drug cabinet
o As you prepare the drug for administration
o When you administer the drug
3. Right dose
 Refers to verification by the nurse that the dose administered is the amount ordered and
that it is safe for the patient for whom it is prescribed.
4. Right time
 Refers to the time the prescribed dose is ordered to be administered.
 Daily drug dosages are given at a specified intervals, such as bid,tid,qid, this is so the
plasma level of the drug is maintained at a therapeutic level.
5. Right route
 Right route is necessary for adequate or appropriate absorption.
PLUS FIVE
6. Right assessment
 Requires the collection of appropriate baseline date before administration.
 Vital signs, laboratory results, allergies, etc.
7. Right documentation
 Requires the nurse to record immediately the appropriate information about the drug
administered.
 Information needed to be documented in the medication administration record (MAR):
o Name of the drug
o Dose
o Route
o Date and time given
o Nurse’s initials or signature

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Sample Medication Administration Record:
Name of patient: Juan de la Cruz
Age: 42 Sex: F CS: M
Room no: 1
MEDICATION ADMINISTRATION RECORD
DATE NAME OF MEDICATION TIME GIVEN
8/17/2020 Paracetamol 500 mg p.o.q4h 10 am sdm 2pm sdm 6pm sdm
Nurse name Signature Initial
Sharon Maquiran Signed sdm
8. Right education
 Requires that the patients receive accurate and thorough information about the drugs
they are taking and how each drug relates to their particular condition.
9. Right evaluation
 Determines the effectiveness of the drug based on the patient’s response of the drug.
 Evaluation in this context asks whether the medication did for the patient what it was
supposed to do.
10. Right to refuse
 The patient has the right to refuse the medication and it is the nurse’s responsibility to
determine the reason for the refusal, explain to the patient the risks involved with
refusal, and reinforce the important benefits of and reasons for taking the medication.
Preventing Medication Errors:
Medication administration is one of the primary functions of the nurse and other health
care practitioners in most health care settings. Unfortunately, medication administration
errors are common. He medication delivery process is complex and involves many
individuals and departments. The critical role of the nurse in this process and the
importance of legible medication orders, accurate transcription and interpretation, and
safe medication administration.

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Steps in safe medication administration:
1. Prescription
 Only those licensed health care providers who has authority by their state to write
prescription are permitted to do so, such as medical doctor (MD) dentist, advanced
practice nurse (ARNP).
 Although nurses are not the originator of drug prescriptions, they play an important role
in preventing errors in the prescription step.
 It is important to always remember that the practitioner who administers a drug shares
the liability for patient injury, even if the medical order was incorrect.
Verbal Orders or Telephone orders:
1. Write it down in the patient’s chart or enter it in the computer record.
2. Read it back to the prescriber
3. Get confirmation from the prescriber that it is correct.
2. Transcription
Transcription is the action of copying details of prescribed medication on to a MAR or
MIS. discharged directly from. Nurse Prescribers' Formulary.
One of the most main causes of medication errors is incorrect transcription of the
original prescriber’s order. Many studies addressing the causes of medication errors identify
one of the main sources to be illegible physician’s handwriting (Stetina et al., 2005) During the
transcription process, the transcriber must ensure that the drug order includes all seven parts.
Safety Risk with Medication Administration:
The majority of medication errors occur in the transcription stage (56%), followed by nurse
administration stage (41%) and finally the doctor prescribing stage (39%).
Things to watch out:
 Counterfeit drugs
o Look like the desired drug but may have no active ingredient, the wrong active
ingredient, or the wrong amount of active ingredient.
The order must first be written and then it must be read back after it is written to
ensure that the order is clear to the recipient and in turn confirmed by the prescriber giving the
order. Verbal orders must then be written down and signed by the prescriber within 24 hours.

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 Dosage forms: To crush or not to crush
 High-alert medications
o Can cause significant harm to the patient .
o HAM if given in error, can have a major effect on the patient’s organs: this
includes cardiac, respiratory, vascular and neurologic system.
https://www.ismp.org/assessments/high-alert-medications
 Look-alike and Sound-alike Drug names

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ACTIVITY 7. CASE ANALYSIS
Instructions:
Read the case scenario and answer what is asked. Using the Microsoft word, upload your answer
in our google classroom. For those who are on modular and non-connectivity, remove this page
and send back not later than____________________________________________.
Case scenario:
Ms. Castro, a patient on the medical-surgical unit, was admitted 2 days before with a diagnosis
of exacerbation of heart failure. This morning her BP is 175/80 mm Hg. She denies chest pain,
but state that she has been experiencing shortness of breath. She tells the nurse she uses three
pillows to be able to breathe at night while sleeping. Her baseline weight at admission was 170
lb, but this morning’s scale indicates a 4-lb weight gain, and +3 pitting edema to the lower
extremities is evident. The nurse telephones the doctor and receives an order for furosemide 40
mg by mouth twice daily and metoprolol 25 mg PO daily to start immediately.
1. How will the nurse identify Ms. Castro prior to administering medications?
2. Which lab should the nurse review prior to administering furosemide and metoprolol?
3. The nurse scans the medication administration record (MAR), and administers the metoprolol.
When she attempts to administer the furosemide, the patient states. “I don’t want the water
pill”. What is the nurse’s next action?
4. What safety measures should the nurse use when administering the medication to MS.
Castro?
5. What important information should the nurse document into MS. Castro’s medical record 30
minutes after administering the medication?

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DRUG CALCULATIONS
Systems of Measurement:
 The Metric System
o Preferred for prescribing and administering medications
o Decimal system, based on power of 10.
o The base units are:
 Gram for weight (g)
 Liter for volume (L)
 Meter for length ( m)
Metric prefixes:
Micro = one millionth or 0.000001 or 1/1,000,000 of the base unit
Milli = one thousandth or 0.001 or 1/1,000 of the base unit
Centi = one hundredth or 0.01 or 1/100 of the base unit
Deci = ome tenth or 0.1 or 1/10 of the base unit
Kilo - one thousand or 1,000 time the base unit
The following 10 critical rules will help to ensure that you accurately write and interpret
metric notation:
1. The unit or abbreviation always follows the amount. Example : 5 g NOT g 5
2. Do not put a period after the unit abbreviation because it may be mistake for the number 1 if poorly
written. Example P mg NOT mg.
3. Do not add an s to make the unit plural because it may be misread for another unit. Example: ml
NOT mls
4. Separate the amount from the unit so the number and the unit of measure do not run together
because the unit can be mistake as zero or zeros, risking a 10-fold to 100-fold overdose. Example:
20 mg NOT 20mg.

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 Household System
o Because of the lack of standardization of spoons, cups and glasses, household
measurement is not as accurate as the metric system, therefore ,easurements
are approximate.
5. Place commas for amounts at or above 1,000. Example: 10,000 mcg NOT 10000mcg
6. Decimals are used to designate fractional amounts. Example: 1.5 ml NOT 1 ½ ml
7. use a leading zero to emphasize the decimal point for fractional amounts less than 1. Without
the zero, the amount may be interpreted as a whole number, resulting in serious overdosing.
Example 0.5 mg NOT .5 mg
8. Omit unnecessary or trailing zeros that can be misread as part of the amount if the decimal
point is not seen. Example: 1.5 mg NOT 1.50 mg
9. Do not use the abbreviation ug for microgram because it might be mistake for mg, which is
1,000 times the indtended amount. Example: 150 mcg NOT 150 ug
10. Do not use the abbreviation cc for ml because the unit can be mistaken for zeros. Example:
500 ml NOT 500 cc
Note: Always ask the write to clarify if you are not sure of the abbreviation or notation
used. NEVER GUESS!!!

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 Apothecary System
o Utilizes Roman Numerals
o The style of apothecary notation includes:
 The unit or abbreviation typically precedes the amount. Example: gr v
 Lowercase Roman numerals are often used to express whole numbers. I,
v,x
 Fractions are used to designate amounts less than 1. Examples: gr ½ or
gr ¼
 You may see the symbol ss to designate the fraction ½ . Because this
symbol can be easily misinterpreted.
https://www.slideserve.com/holli/metric-conversions-roman-numerals-and-fractions

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Other common drug measurements:
 International unit represent a unit of potency used to measure such things as
vitamins and chemicals. The unit is a standardized amount need to produce a
desired effect.
 Milliequivalent (mEq) is one thousandth (1/1000) of an equivalent weight of a
chemical.
Error: Not placing a zero before a decimal point in medication orders.
Scenario: An emergency room physician wrote an order for the bronchodilator for a patient with
asthma. The order was written as follows:
Terbutaline .5 mg subcutaneously now, repeat dose in 30 minutes if no improvement.
Suppose the nurse, not noticing the faint decimal point, administered 5 mg of terbutaline
subcutaneously, instead of 0.5 mg. The patient would receive ten times the dose intended by the
physician.
Potential Outcome: ?
Prevention: ?
How should the order be correctly written?

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Converting from one unit to another using the conversion factor method:
After learning the systems of measurement common for dosage calculation and their
equivalents, the next step is to learn how to use them. First, you must be able to convert or
change from one unit to another within the same measurement system. To accomplish this
simple operation you need to:
 Recall the equivalents
 Multiply or divide
Rule:
To convert from a larger to a smaller unit of measurement, multiply by the conversion factor.
Think: “Larger is going down to smaller, so you will multiply”.
Example:
 How many cups are there in 3 quarts?
o 1 quart = 4 cups
o Cups are smaller than quarts
3 qt x 4 cups = 12 cups
1 qt
Rule:
To convert from a smaller to alarger unit of measurement, divide by the conversion factor.
Think: “Smaller is going up to larger, so you will divide”.

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800 mcg = 0.8 mg (moved the decimal to the left 3 places)
75 mg = 0.075 g (moved the decimal to the left 3 places)
0.03 g = 30 mg (moved the decimal to the right 3 places)
2.7 kg = 2,700 g (moved the decimal to the right 3 places)
 How many feet are there in 36 inches?
o 12 in = 1 ft
36 in / 12 in = 3 ft
1 ft
Remenber this diagram when converting dosages within the metric system:
Move decimal point three places to the left for each step
Kg g mg mcg
Move decimal point three places to the right for each step.

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9
 Make a conversion table on the different system of measurement (Metric, Household,
apothecaries and approximate equivalents)
 For taking modular mode, kindly place your output in a short size bond paper and send it
back together with your other activity sheets.
Short Quiz: Answer the following questions. Write you answer on the space provided.
1. The label for a granular medicine recommends mixing it with at least 120 ml of water or juice.
At the time of discharge, the nurse should advise the patient to mix the medicine
with ________ fluid ounce(s) or _________cup(s) of water or juice.
2. A patient who weighs 250 lb starts a weight loss program with a goal of losing 10 lb before the
next doctor’s appointment. At the next office visit the patient is weighed at 108 kg. Has the
patient met the weight loss goal?_____
3. A child who weighs 55 lb is to receive 0.05 mg of a drug per kg of body weight per dose. How
much of the drug should the child receive for each dose? _____
4. A child is taking 12 ml of a medication 4 times per day. If the full bottle contains 16 fluid
ounces of the medication, how many days will the bottle last?_____
5. The doctor prescribes 10 ml of Betadine concentrate in 500 ml of warm water as a soak for a
finger infection. Using measures commonly found in the home, how would you instruct the
patient to prepare the
solution?______________________________________________________________________

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METHODS OF DRUG CALCULATION
1
 Basic Formula
D
H X V = A
Where:
D = desired dose (as ordered)
H – drug on hand (available)
V = volume of a drug form
A = amount calculated to be given to the patient
Order: Cefaclor 0.5 g PO bid
Available: Cefaclor 500 mg capsule
1. How many capsules should the patient receive per dose?
Convert:
0.5 g x 1000 mg = 500 mg
1 g
500 mg
500 mg x 1 capsule = 1 capsule
Answer: 500 mg or I capsule

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2
 Ratio and Proportion/ Fractional Equation
o The Ratio and proportion method can be expressed linearly or as a fraction.
H : V = D : x
Means
Extremes
X =
Where:
D = desired dose (as ordered
H = drug on hand (available)
V = Volume of a drug form
X = unknown amount to give to the patient
: stands for “as” or “equal to”
Multiply the extremes and the means
( Hx : VD)
Solve for the x:
Hx : :VD
H H H is the divisor
X = VD
H
Order : Amoxicillin 100 mg po qid
Available : Amoxicillin 250 mg per 5 ml
How many ml should the patient receive per dose?

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Conversion is not needed because both are expressed in the same unit of
measure
H : V = D : x
250 mg 5 ml 100 mg x ml
Means
Extremes
250 mg (x) = 5 ml (100mg)
250x = 500
X = 500
250
X = 2 ml
Answer: 2 ml. The nurse will administer 2 ml per dose
3
 Dimensional Analysis (DA)
o Dimensional Analysis is a calculation method known as units and conversions.
o D, H, and V are still used in DA.
o The advantage of DA is that all the steps for calculating drug dosages are
conducted in one equation without having to remember various formulas.
However, conversion factors still need to be momorized.

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Steps in Dimensional analysis:
1. Identify the unit/form (tablet, capsule, ml) of a drug to be calculated. Place the unit/form to
one side of the equal sign (=). This is your Desired unit/form.
2. Determine the known dose and unit/form from the drug label that matches the unit/form of
the desired dosage. Place this on the other side of the equal sign.
3. Continue with additional fractions using a multiplication operation between each fraction until
all but one unit you want to eliminate.
4. Multiply the numerators and multiply the denominators.
5. Solve for x (the unknown)
Order: Amoxicillin 500 mg po q8h.
Available: 250 mg per capsule
How many capsules will the nurse administer per dose?
Cap = 1 cap (H = on hand)
250 mg
 We must determine how many capsules need to be administered for the dose to be
500 mg.
 The available capsule is 250 mg this is placed in the denominator.
 The available strength (250 mg) is the denominator, and the unit/form “mg” must match
the next numerator, which is ordered dose of 500 mg (desired dose). The next
denominator would be x (unknown) or it would be left blank.
Unit/form = H x desired
Unknown
Cap = 1 mg x 500 mg
250 mg x
Cap = 500
250x = 2 capsules

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When conversion is needed:
H x CF (conversion factor) x D (desired)
unknown
Order: Amoxicillin 0.5 g po q8h
Available 250 mg per capsule
How many capsules will the nurse administer?
Cap = 1 cap x 1000 mg x 0.5 g = 1000 x 0.5
250 mg 1 g x cap 250
= 500 = 2 capsule of amoxicillin
250
CALCULATING DOSAGES FOR DRUGS MEASURED IN UNITS OR MILIEQUIVALENTS
 Some medications, such as heparin and insulin, are measured in units. Typically, units are
not converted into any other measure.
Drug Measured in Units:
Order : Heparin 2500 units subcut daily
Available : Heparin 10,000 units per ml in a multiple- dose vial (10ml)
 Basic Formula
D 2500 units 25
H x V = 10000 units x 1 ml = 100 = 0.25 ml
 Ratio and proportion
H D 10000 units 2500 units
= = =
V x 1 ml x
10000 x = 2500
X = 2500
10000
X = 0.25 ml
Answer : Heparin 2500 units = 0.25 ml or 0.3 ml

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4
 Body Weight (BW)
o The BW method of calculation allows for individualization of the drug dose and
involves the following three steps:
 Convert pounds to kilograms (2.2 lb = 1 kg)
 Determine the drug dose for the body weight by multiplying as follows:
Drug dose x body weigh = patient’s dose
 Follow the basic formula, ratio and proportion or dimensional analysis
method to calculate the drug dose
Order : Fluorouracil 12 mg per kg per day intravenous (IV) for a patient
who weighs 176 lb.
Available : 2 vials of Fluorouracil 50 mg per ml
How many millilitres should the nurse administer per day?
Using the Basic Formula:
1. Convert lb to kg
176 lb / 2.2 = 80 kg
2. Multiply the ordered dose by the patient’s weight in kg
Mg x kg = patient dose
12 mg x 80 kg = 960 mg per day
3. Determine the volume in ml to administer 960 mg
D 960 mg
H x V = 50 mg x 1 ml = 19.2 ml
 Dimensional Analysis:
1 ml 2500 units
ml = x
10000 units x
= 2500
10000
= 0.25 ml or 0.3 ml ( per rounding rule)

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10
PRACTICE PROBLEM.
 From what was discussed in this module regarding drug calculations, solve the following
problems using the formula Basic formula, ratio and proportion and Dimensional
analysis.
 Write your answer on the space provided and upload on our google classroom.
 For those who are in modular program, answer on this sheet and send it back for
checking not later than:_______________________________________
1. Order: Ranitidine 150 mg PO q12h
Available : Ranitidine 75 mg per tablet
Administer how many tablets per dose?_______________________
2. Order: Furosemide 20 mg IM stat
Available : Furosemide 10 mg per ml
Administer how many ml per dose?___________________________
3. Order: Phenytoin oral solution 0.25 g PO bid
Available : Phenytoin oral solution 125 mg per 5 ml
Administer how many ml per dose?_________________________________

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4.
Order: Valproic acid oral solution PO 15 mg per kg per day in two divided doses for a
pediatric patient who weighs 66 lb.
Available: Valproic acid oral solution 250 mg per 5 ml
a. How many kilograms does the child weigh?______________________________
b. How many milligrams per day should the child receive?____________________
c. How many milligrams per dose should the child receive?___________________
d. How many millilliters per dose should the child receive?____________________
5.
Order: Gentamycin 2.5 mg per kg q8h IV for a pediatric patient who weighs 38 lb.
Available: Gentamycin 10 mg per ml
a. How many kilograms does the child weigh?______________________________
b. How many milligrams per dose will the child receive?___________________
c. How many millilliters per dose will the child receive?____________________

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Drug Reconstitution:
Both enteral and parenteral drugs may come in powder form due to the drug’s instability in
liquid. The liquid use to reconstitute a dry powder is called a diluent. Diluents can be sterile
water for injection, 0.9% saline solution, or a special liquid supplied by the manufacturer. The
nurse must follow directions for reconstitution on the label exactly.
1. Below is a label for reconstituting cefadroxil.
Read the left side of the label that says “to prepare suspension”
Note that 67 ml of water in 2 portions is needed to liquefy the powder. This is an oral
drug, so drinking water can be used. The nurse is instructed to shake the powder loose
to prevent clumping.
Add 34 ml of water and shake well. Add another 33 ml of water and shake well.
Now the powder has been reconstituted into a suspension, each 5 ml of liquid contains
250 mg of cefadroxil.
The entire bottle has 100 ml when mixed, a number that is relevant in calculating a dose
Order: Cefadroxil oral solution 1 g PO q12h
Available: Cefadroxil oral solution 250 mg per 5 ml
How many ml will the nurse administer per dose?
Dimensional analysis:
ml = 5 ml 1000 mg 1 g
x x
250mg 1 g x
= 5000
250
= 20 ml
https://www.youtube.com/watch?v=8ECYuiHFObU&has_verified=1
https://www.youtube.com/watch?v=vSg2wMv3sR8 ( windrawing meds in a vial)

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Drug Calculation in Units:
 Insulin are prescribed and measured in units. Most insulin are produced in
concentrations of 100 units per ml.
 Insulin should be administered with an insulin syringe, which is calibarated to
correspond with the concentration of 100 units of insulin per ml in a vial.
INTRAVENOUS THERAPY (IV)
 IV is used to administer fluids that contain water, dextrose, vitamins, electrolytes, and
drugs.
 Methods of IV administration includes:
o Intermittent bolus
o IV push (IVP)
o Intermittent infusions
o IV piggyback (IVPB)
o Continuous infusions
 Drugs given in IVPB are usually small in volume and administered over a few seconds to
a few minutes.
 Many IV drugs irritate the veins, therefore they are diluted prior to administration..
 The amount of diluent used depends on the drug: drugs given IVP can be diluted in
small amounts of diluent, whereas other drugs are diluted in a large volume of fluid
given over a specific period such as 4 to 8 hours.
 Continuous IV infusion replaces fluid loss, maintain fluid balance, and serves as a vehicle
for IV drugs.

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 Kinds of IV solutions:
o 0.9% Sodium chloride (normal saline; NSS)
o 0.45% Sodium Chloride (0.5 NSS)
o 5% Dextrose in water ( D5W)
o Lactated Ringer’s Solution (LR)
PNSS D5W
LR 0.5% Sodium Chloride

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 Role of the nurse in preparation and administration of IV solutions:
o Gather equipment
o Know IV sets including drop factor
o Calculate appropriate flow rate
o Mix and dilute drugs in IV fluids
o Know the pharmacokinetics and Pharmacodynamics of drugs and their adverse
effects.
Intravenous Administration Sets:
IV administration set include printed information on the packaging cover, such as drop factor or
the number of drops per millilliter. .
 Macrodrip set – delivers large drops ( 10 to 20 gtt/ml); commonly used for adult
 Microdrip set – delivers small drops (60 gtt/ml);
At times, primary IV fluids are given at a slow rate, ordered to keep vein open (KVO), or to keep
open (TKO). The reason for KVO include a suspected or potential emergency situation for rapid
administration of fluids and drugs and need for an open line to give IV drugs at specified hours.

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Soluset

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CALCULATING INTRAVENOUS FLOW RATE:
Basic formula Method:
TV x DF
FR =
T in h x 60 mins
Where:
FR = flow rate (gtt/min)
TV = total volume
DF = drop factor (gtt/ml)
T = time required for TV (converted to minutes)
The physician orders D5W IV 1 L to run for 8 hours. The infusion set is calculated for a drop
factor of 10 gtt/ml. Calculate the IV flow rate in gtt/min.
Formula method (shortcut)
FR = 1000 ml x 10 gtt/ml
= 20.8 gtt/min = 21 gtt/min
8 h ( 60 mins/h)
Long method:
1. Calculate for ml per hour = TV
T (in hours)
= 1000 ml
8 h
= 125 ml/h
2. Calculate for ml per minute = ml/h
60 min/h
= 125 ml/h
60 min/h
= 2.08 ml/min

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3. Calculate for gtt per min (FR) = ml/min x DF
= 2.08 ml/min x 10 gtt/ml
= 20.8 gtt/min = 21 gtt/min
Calculating for Infusion time ( rate at which a drug should be administered)
Formula: TV
ml/h
The doctor orders 0.9% saline solution 1000 ml at 125 ml/h. The infusion set is calibrated for a
drop factor of 10 gtt/ml. How long will the infusion be comsumed?
= 1000 ml
125 ml/h
= 8 hours

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11. Comprehensive quiz
Read carefully each questions. Solve the following questions in a paper and fill-up the space
provided for your answer. Each item correspond to 1 point for every correct answer. For those
students taking modular program, you can write your answer on the space provided and kindly
detach this sheet and send back to for checking , not later than:___________________________
Test I. Calculate the amount you will prepare for 1 dose. Indicate the syringe you will sect to
measure the medication.
1. Order: Zosyn 2.5 g IV q8h
Supply: 3.375 g vial of powdered Zosyn
Directions: Reconstitute Zosyn with 5 ml of a diluent from the list for a total solution volume
of 5 ml.
 The concentration is _____g per _____ml.
 Give _____ml
 Select: _____ syringe
2. Order: Ampicillin 500 mg IM q4h.
Supply: Ampicillin 500 mg
Directions: Reconstitute with 1.8 ml diluent for a concentration of 250 mg/ml.
 Give _____ ml
3. Order: Ancef 500 mg IV q6h.
Supply: Ancef 1 g
Directions: Reconstitute with 2.5 ml diluent to yield 3 ml with concentration of 330 mg/ml
 Give _____ ml
 Select _____ syringe
4. Order: Cefepime 500 mg IM q12h
Supply: Maxipime (cefepime) 1 g
Directions: Reconstitute with 2.4 ml diluent for an approximate available volume of 3.6 ml and
a concentration of 280 mg/ml.
 Give _____ ml
 How many full doses are available in this vial? ____ dose(s)

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Prepare a reconstitution label for the remaining solution. The drug is stable for up to 7 days
refrigerated and 24 hours at controlled room temperature. Write on the space provided in the
box.
Reconstitution label
5. Order: Ceftriaxone sodium 750 mg IV q6h in 50 ml 5% Dextrose in Water IV solution.
Supply: See label and package insert for Rocephin IV vial.
 Add _____ ml diluent to the vial
 The concentration is _____ mg/ml
 Give _____ ml
 How many full doses are available in this vial?_____
Test II. Calculate the IV flow rate for these manually regulated IV administration. Write your
answer on the space provided. Each item correspond to 1 point.
1. Order: 0.45% NaCl 3,000 ml IV for 24 hours.
Drop factor: 15 gtt/ml
 Flow rate: __________ml/h
 Flow rate: __________gtt/min

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2. Order: D5W 200 ml IV to run at 100 ml/h
 Flow rate: __________ gtt/min
3. Order: NSS 1,000 ml IV at 50 ml/h
 Flow rate: __________ gtt/min
4. Order: Lactated ringer’s solution 1,500 ml IV for 12 hours at 125 ml/h.
 Original flow rate: __________ gtt/min
 After 6 hours, there is 850 ml remaining. Describe your action now:
______________________________________________________________________
 Time remaining: _____h
 Recalculated flow rate: __________ ml/h
 Recalculated flow rate: __________ gtt/min
 Action to be taken after recalculating: ______________________________________
5. Order: Lactated Ringer’s solution 1,000 ml for 6 h at 167 ml/h.
 Original flow rate: ___________ gtt/min
 After 4 hours, there is 360 ml remaining. Describe your action
now:___________________________________________________________________.
 Time remaining: ___________ h
 Recalculated flow rate: __________ ml/h
 Recalculated flow rate: __________ gtt/min
 Action to be taken after recalculating: ______________________________________
6. Order: D5W 1,000 ml to run for 8 h at 125 ml/h.
 Original flow rate: __________ gtt/min
 After 4 hours, there are 500 ml remaining. Describe your action now:
_____________________________________________________________________.
Remember:
 Drop factor = gtt/ml
 The drop factor is stated on the IV tubing package
 Macrodrip factors: 10, 15, or 20 gtt/ml
 Microdrip factor: 60 gtt/ml

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References
1. Kee, J & Hayes, E.Pharmacology: A Nursing Process Approach, 8th
Ed. 2016
2. Nursing Drug Handbook, 34th Edition 2014, Kluwer, Lippincott, Willliams& Wilkins
3. Clayton, Stock &Harroun: Basic Pharmacology for Nurses, 17th
Edition 2017
4. Edmunds, M. Introduction to Clinical Pharmacology, 8th
Ed 2015
5. Adams, M.P., Holland, L.N., Urban, C. (2013). Pharmacology for Nurses: A Pathophysiologic
Approach, 4th
Edition
6. Doenges, M. Nurse’s Pocket Guide: Diagnoses Prioritized Intervention and Rationales 14th
Edition, 2016
7. Straight A’s in Nursing Pharmacology Philadelphia: Lippincotts, Williams and Wilkins 20012
2nd
edition
8. Karch, Amy M. Focus on Nursing Pharmacology, 6th
Ed. 2012
9. Johnson, Joyce Y., Fluids and Electrolytes Demystified,copyright, McGraw Hill Company, 2018,
2nd
edition
10. Lippincott and Wilkins, Straight A’s in Fluids and Electrolytes, copyright 2012
11. Darius Candelario, Nursepro’s CGFNS and NCLEX Reviewer, July 2006
12. McCuistion, Vuljoin-DiMaggio, Winton, Yeager: Pharmacology:A Patient-Centered Nursing
Process Approach, 9th
edition, 2018
CONGRATULATIONS!!! You have finished Module 2.
For any concerns you can reach me on the following:
Email address : smaquiran@usa.edu.ph
Messenger : norashyamseledid
Mobile no. : 09952501611 – globe
09511762949 – smart

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