This document discusses various methods of medication administration. It begins by covering oral medications as the most common route, and notes when it may be contraindicated. It then discusses administering medications through nasogastric or gastrostomy tubes for patients who cannot take oral medications. The document provides guidelines for administering medications via these enteral tubes. It also discusses parenteral medication administration through various routes like subcutaneous, intramuscular, and intravenous injections. It covers equipment used like syringes, needles, ampules and vials. It provides details on properly administering different types of injections and rotating injection sites.

1. PHARMACOLOGY (NCM 106)
BASICS IN MEDICATION
PART 2
JHONEE F. BALMEO.R.N.

2. MEDICATION ADMINISTRATION
• ORAL MEDICATIONS
THE ORAL ROUTE IS THE MOST COMMON ROUTE BY WHICH
MEDICATIONS ARE GIVEN.
AS LONG AS A CLIENT CAN SWALLOW AND RETAIN THE DRUG IN THE
STOMACH, THIS IS THE ROUTE OF CHOICE. ORAL MEDICATIONS ARE
CONTRAINDICATED WHEN A CLIENT IS VOMITING, HAS GASTRIC OR
INTESTINAL SUCTION, OR IS UNCONSCIOUS AND UNABLE TO
SWALLOW. SUCH CLIENTS IN A HOSPITAL ARE USUALLY ON ORDERS
FOR “NOTHING BY MOUTH”

3. MEDICATION ADMINISTRATION
• NASOGASTRIC AND GASTROSTOMY
• MEDICATIONS FOR CLIENTS WHO CANNOT TAKE ANYTHING BY
MOUTH (NPO) AND HAVE A NASOGASTRIC TUBE OR A
GASTROSTOMY TUBE IN PLACE, AN ALTERNATIVE ROUTE FOR
ADMINISTERING MEDICATIONS IS THROUGH THE NASOGASTRIC OR
GASTROSTOMY TUBE.
• A NASOGASTRIC (NG) TUBE IS INSERTED BY WAY OF THE
NASOPHARYNX AND IS PLACED INTO THE CLIENT’S STOMACH FOR
THE PURPOSE OF FEEDING THE CLIENT OR TO REMOVE GASTRIC

4. MEDICATION ADMINISTRATION
• A GASTROSTOMY TUBE IS SURGICALLY PLACED DIRECTLY INTO
THE CLIENT’S STOMACH AND PROVIDES ANOTHER ROUTE FOR
ADMINISTERING MEDICATIONS AND NUTRITION. GUIDELINES FOR
ADMINISTERING MEDICATIONS BY NASOGASTRIC TUBES AND
GASTROSTOMY TUBES ARE THE FOLLOWING.

5. ADMINISTERING MEDICATIONS BY
NASOGASTRIC OR GASTROSTOMY TUBE
• ALWAYS 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
THEY MAY BE CRUSHED.
• CRUSH A TABLET INTO A FINE POWDER AND DISSOLVE IN AT LEAST 30
ML OF WARM WATER. NOT COLD AS MUCH AS POSSIBLE.

6. ADMINISTERING MEDICATIONS BY
NASOGASTRIC OR GASTROSTOMY TUBE
• READ MEDICATION LABELS CAREFULLY BEFORE OPENING A
CAPSULE.
• DO NOT ADMINISTER WHOLE OR UNDISSOLVED MEDICATIONS
BECAUSE THEY WILL CLOG THE TUBE.
• ASSESS TUBE PLACEMENT.
• BEFORE GIVING THE MEDICATION, ASPIRATE ALL THE STOMACH
CONTENTS AND MEASURE THE RESIDUAL VOLUME.

7. ADMINISTERING MEDICATIONS BY
NASOGASTRIC OR GASTROSTOMY TUBE
• REMOVE THE PLUNGER FROM THE SYRINGE AND CONNECT THE SYRINGE TO
A PINCHED OR KINKED TUBE. RATIONALE (RATIONALE?)
• PUT 15 TO 30 ML (5 TO 10 ML FOR CHILDREN) OF WATER INTO THE
SYRINGE BARREL TO FLUSH THE TUBE BEFORE ADMINISTERING THE FIRST
MEDICATION.

8. ADMINISTERING MEDICATIONS BY
NASOGASTRIC OR GASTROSTOMY TUBE
• POUR LIQUID OR DISSOLVED MEDICATION INTO THE SYRINGE BARREL AND
ALLOW TO FLOW BY GRAVITY INTO THE ENTERAL TUBE.
• IF YOU ARE GIVING SEVERAL MEDICATIONS, ADMINISTER EACH ONE
SEPARATELY AND FLUSH WITH AT LEAST 15 TO 30 ML
• WHEN YOU HAVE FINISHED ADMINISTERING ALL MEDICATIONS, FLUSH WITH
ANOTHER 15 TO 30 ML (5 TO 10 ML FOR CHILDREN) OF WARM WATER TO
CLEAR THE TUBE.

9. PARENTERAL MEDICATION
• PARENTERAL ADMINISTRATION OF MEDICATIONS IS A COMMON
NURSING PROCEDURE. NURSES GIVE PARENTERAL MEDICATIONS
INTRADERMALLY (ID), SUBCUTANEOUSLY, INTRAMUSCULARLY
(IM), OR INTRAVENOUSLY (IV).
• BECAUSE THESE MEDICATIONS ARE ABSORBED MORE QUICKLY
THAN ORAL MEDICATIONS AND ARE IRRETRIEVABLE ONCE
INJECTED, THE NURSE MUST PREPARE AND ADMINISTER THEM

10. PARENTERAL MEDICATION
• ADMINISTERING PARENTERAL DRUGS REQUIRES THE
SAME NURSING KNOWLEDGE AS FOR ORAL AND TOPICAL
DRUGS;
HOWEVER, BECAUSE INJECTIONS ARE INVASIVE
PROCEDURES, ASEPTIC TECHNIQUE MUST BE USED TO
MINIMIZE THE RISK OF INFECTION.

11. PARENTERAL MEDICATION
• SYRINGES
SYRINGES HAVE THREE PARTS:
THE TIP, WHICH CONNECTS WITH
THE NEEDLE; THE BARREL, OR
OUTSIDE PART, ON WHICH THE
SCALES ARE PRINTED; AND THE
PLUNGER, WHICH FITS INSIDE THE
BARREL

12. PARENTERAL MEDICATION
• THERE ARE SEVERAL KINDS OF
SYRINGES DIFFERING IN SIZE,
SHAPE, AND MATERIAL.
SYRINGES RANGE IN SIZES
FROM 1 TO 60 ML. A NURSE
TYPICALLY USES A SYRINGE
RANGING FROM 1 TO 3 ML IN
SIZE FOR INJECTIONS

13. PARENTERAL MEDICATION
• A HYPODERMIC SYRINGE COMES IN
3- AND 5-ML SIZES. THE CHOICE OF
SYRINGE DEPENDS ON MANY
FACTORS, SUCH AS MEDICATION,
LOCATION OF INJECTION, AND TYPE
OF TISSUE.

14. PARENTERAL MEDICATION
• AN INSULIN SYRINGE IS SIMILAR TO A
HYPODERMIC SYRINGE, BUT THE SCALE
IS SPECIALLY DESIGNED FOR INSULIN: A
100-UNIT CALIBRATED SCALE
INTENDED FOR USE WITH U-100
INSULIN. THIS IS THE ONLY SYRINGE
THAT SHOULD BE USED TO ADMINISTER
INSULIN.

15. PARENTERAL MEDICATION
• THE TUBERCULIN SYRINGE WAS ORIGINALLY DESIGNED TO
ADMINISTER TUBERCULIN SOLUTION. IT IS A NARROW SYRINGE,
CALIBRATED IN TENTHS AND HUNDREDTHS OF A MILLILITER (UP
TO 1 ML) ON ONE SCALE AND IN SIXTEENTHS OF A MINIM (UP TO 1
MINIM) ON THE OTHER SCALE.

16. PARENTERAL MEDICATION
• MOST SYRINGES USED TODAY ARE
MADE OF PLASTIC, ARE INDIVIDUALLY
PACKAGED FOR STERILITY IN A PAPER
WRAPPER OR A RIGID PLASTIC
CONTAINER, AND ARE DISPOSABLE
• THE TIP OF A SYRINGE VARIES AND IS
CLASSIFIED AS EITHER A LUER-LOK
OR NON–LUER-LOK

17. PARENTERAL
MEDICATION
• INJECTABLE MEDICATIONS ARE
FREQUENTLY SUPPLIED IN
DISPOSABLE PREFILLED UNIT-
DOSE SYSTEMS.

18. PARENTERAL MEDICATION
• NEEDLES
NEEDLES ARE MADE OF STAINLESS STEEL, AND MOST ARE
DISPOSABLE.
REUSABLE NEEDLES(E.G., FOR SPECIAL PROCEDURES) NEED TO BE
SHARPENED PERIODICALLY BEFORE RESTERILIZATION BECAUSE THE
POINTS BECOME DULL WITH USE AND ARE OCCASIONALLY
DAMAGED OR ACQUIRE BURRS ON THE TIPS

19. PARENTERAL MEDICATION
• A NEEDLE HAS THREE DISCERNIBLE PARTS: THE HUB, WHICH FITS
ONTO THE SYRINGE; THE CANNULA, OR SHAFT, WHICH IS
ATTACHED TO THE HUB; AND THE BEVEL, WHICH IS THE SLANTED
PART AT THE TIP OF THE NEEDLE

20. PARENTERAL MEDICATION
• NEEDLES USED FOR INJECTIONS HAVE THREE VARIABLE
CHARACTERISTICS:
1. SLANT OR LENGTH OF THE BEVEL. THE BEVEL OF THE NEEDLE MAY
BE SHORT OR LONG. LONGER BEVELS PROVIDE THE SHARPEST
NEEDLES AND CAUSE LESS DISCOMFORT. THEY ARE COMMONLY
USED FOR SUBCUTANEOUS AND INTRAMUSCULAR INJECTIONS.

21. PARENTERAL MEDICATION
• 2. LENGTH OF THE SHAFT. THE SHAFT LENGTH OF COMMONLY
USED NEEDLES VARIES FROM 1/2 TO 2 INCHES.
• 3. GAUGE (OR DIAMETER) OF THE SHAFT. THE GAUGE VARIES FROM
#18 TO #30. THE LARGER THE GAUGE NUMBER, THE SMALLER THE
DIAMETER OF THE SHAFT.

22. PARENTERAL MEDICATION
• PREVENTING NEEDLE STICK INJURIES
ONE OF THE MOST POTENTIALLY HAZARDOUS PROCEDURES THAT
HEALTH CARE PERSONNEL FACE IS USING AND DISPOSING OF
NEEDLES AND SHARPS. NEEDLESTICK INJURIES PRESENT A MAJOR
RISK FOR INFECTION WITH HEPATITIS B VIRUS, HUMAN
IMMUNODEFICIENCY VIRUS (HIV), AND MANY OTHER PATHOGENS.

23. PARENTERAL MEDICATION

24. PARENTERAL MEDICATION
• AMPULES AND VIALS
AMPULES AND VIALS ARE FREQUENTLY USED TO
PACKAGE STERILE PARENTERAL MEDICATIONS.
• AN AMPULE IS A GLASS CONTAINER USUALLY
DESIGNED TO HOLD A SINGLE DOSE OF A
DRUG.

25. PARENTERAL
MEDICATION
• IT IS MADE OF CLEAR GLASS AND
HAS A DISTINCTIVE SHAPE WITH A
CONSTRICTED NECK.

26. PARENTERAL MEDICATION
• AMPULES VARY IN SIZE FROM 1
TO 10 ML OR MORE. MOST
AMPULE NECKS HAVE COLORED
MARKS AROUND THEM,
INDICATING WHERE THEY ARE
PRESCORED FOR EASY OPENING.

27. PARENTERAL MEDICATION
• A VIAL IS A SMALL GLASS BOTTLE
WITH A SEALED RUBBER CAP. VIALS
COME IN DIFFERENT SIZES, FROM
SINGLE-USE VIALS TO MULTIPLE-
DOSE VIALS. THEY USUALLY HAVE A
METAL OR PLASTIC CAP THAT
PROTECTS THE RUBBER SEAL AND
MUST BE REMOVED TO ACCESS THE
MEDICATION. TO ACCESS THE
MEDICATION IN A VIAL, THE VIAL

28. PARENTERAL MEDICATION
• IN ADDITION, AIR MUST BE INJECTED
INTO A VIAL BEFORE THE MEDICATION
CAN BE WITHDRAWN. FAILURE TO INJECT
AIR BEFORE WITHDRAWING THE
MEDICATION LEAVES A VACUUM WITHIN
THE VIAL THAT MAKES WITHDRAWAL
DIFFICULT.
• A SINGLE-USE VIAL CONTAINS ONLY ONE
DOSE OF MEDICATION AND SHOULD
ONLY BE USED ONCE

29. PARENTERAL MEDICATION
• SOME DRUGS (E.G., PENICILLIN) MAY BE
DISPENSED AS POWDERS IN VIALS. A
LIQUID (DILUENT) MUST BE ADDED TO A
POWDERED MEDICATION BEFORE IT CAN
BE INJECTED. THE TECHNIQUE OF
ADDING A DILUENT TO A POWDERED
DRUG TO PREPARE IT FOR
ADMINISTRATION IS CALLED
RECONSTITUTION.

30. PARENTERAL MEDICATION
• MIXING MEDICATIONS IN ONE SYRINGE FREQUENTLY, CLIENTS
NEED MORE THAN ONE DRUG INJECTED AT THE SAME TIME. TO
SPARE THE CLIENT THE EXPERIENCE OF BEING INJECTED TWICE,
TWO DRUGS (IF COMPATIBLE) ARE OFTEN MIXED IN ONE SYRINGE
AND GIVEN AS ONE INJECTION.

31. PARENTERAL MEDICATION
• IT IS COMMON, FOR INSTANCE, TO
COMBINE TWO TYPES OF INSULIN IN
THIS MANNER OR TO COMBINE
INJECTABLE PREOPERATIVE
MEDICATIONS SUCH AS MORPHINE
WITH ATROPINE OR SCOPOLAMINE.

32. END OF MONDAY SESSION

33. INTRADERMAL INJECTIONS
• AN INTRADERMAL (ID) INJECTION IS THE
ADMINISTRATION OF A DRUG INTO THE DERMAL LAYER
OF THE SKIN JUST BENEATH THE EPIDERMIS. USUALLY
ONLY A SMALL AMOUNT OF LIQUID IS USED, FOR
EXAMPLE, 0.1 ML.

34. • COMMON SITES FOR
INTRADERMAL
INJECTIONS ARE THE
INNER LOWER ARM, THE
UPPER CHEST, AND THE
BACK BENEATH THE
SCAPULAE

35. SUBCUTANEOUS INJECTIONS
• AMONG THE MANY KINDS OF
DRUGS ADMINISTERED
SUBCUTANEOUSLY (JUST BENEATH
THE SKIN) ARE VACCINES, INSULIN,
AND HEPARIN. COMMON SITES
FOR SUBCUTANEOUS INJECTIONS
ARE THE OUTER ASPECT OF THE
UPPER ARMS AND THE ANTERIOR
ASPECT OF THE THIGHS.

36. SUBCUTANEOUS INJECTIONS
• FOR SUBCUTANEOUS INJECTIONS ARE THE OUTER ASPECT
OF THE UPPER ARMS AND THE ANTERIOR ASPECT OF THE
THIGHS ARE THE ABDOMEN, THE SCAPULAR AREAS OF
THE UPPER BACK, AND THE UPPER VENTROGLUTEAL AND
DORSOGLUTEAL AREAS

37. SUBCUTANEOUS INJECTIONS
• GENERALLY A #25-GAUGE, 5/8-INCH NEEDLE IS USED
FOR ADULTS OF NORMAL WEIGHT AND THE NEEDLE IS
INSERTED AT A 45-DEGREE ANGLE; A 3/8-INCH NEEDLE
IS USED AT A 90-DEGREE ANGLE. A CHILD MAY NEED A
1/2-INCH NEEDLE INSERTED AT A 45-DEGREE ANGLE.

38. ADMINISTERING INSULIN
• WHEN ADMINISTERING INSULIN TO ADULTS, THE
CURRENT STANDARD NEEDLE GAUGE IS #30 GAUGE WITH
A SHORT NEEDLE (4 TO 6 MM). MOST CLIENTS PREFER
THE SHORTER AND THINNER NEEDLES BECAUSE THEY ARE
LESS PAINFUL.
• THE RISK OF INJECTING INTO THE MUSCLE IS LESSENED
WITH THE SHORTER NEEDLE.

39. ADMINISTERING INSULIN
• SUBCUTANEOUS INJECTION
SITES NEED TO BE ROTATED
IN AN ORDERLY FASHION
TO MINIMIZE TISSUE
DAMAGE, AID ABSORPTION,
AND AVOID DISCOMFORT.

40. SUBCUTANEOUS INJECTIONS
• NURSES HAVE TRADITIONALLY BEEN TAUGHT TO ASPIRATE BY
PULLING BACK ON THE PLUNGER AFTER INSERTING THE NEEDLE
AND BEFORE INJECTING THE MEDICATION. THE NURSE COULD
THEN DETERMINE WHETHER THE NEEDLE HAD ENTERED A BLOOD
VESSEL.
• ABSENCE OF BLOOD WAS BELIEVED TO INDICATE THAT THE NEEDLE
WAS IN SUBCUTANEOUS TISSUE AND NOT IN THE MORE VASCULAR
MUSCULAR TISSUE

41. INTRAMUSCULAR (IM) INJECTIONS
• INJECTIONS INTO MUSCLE TISSUE, OR INTRAMUSCULAR
(IM) INJECTIONS, ARE ABSORBED MORE QUICKLY THAN
SUBCUTANEOUS INJECTIONS BECAUSE OF THE GREATER
BLOOD SUPPLY TO THE BODY MUSCLES.

42. INTRAMUSCULAR (IM) INJECTIONS
• USUALLY A 3- TO 5-MLSYRINGE IS NEEDED. THE SIZE OF SYRINGE
USED DEPENDS ON THE AMOUNT OF MEDICATION BEING
ADMINISTERED. THE STANDARD PREPACKAGED INTRAMUSCULAR
NEEDLE IS 1 1/2 INCHES AND #21 OR #22 GAUGE. SEVERAL
FACTORS INDICATE THE SIZE AND LENGTH OF THE NEEDLE TO BE
USED:
• ■ THE MUSCLE
• ■ THE TYPE OF SOLUTION
• ■ THE AMOUNT OF ADIPOSE TISSUE COVERING THE MUSCLE

43. INTRAMUSCULAR (IM) INJECTIONS
• THE VENTROGLUTEAL
SITE IS IN THE GLUTEUS
MEDIUS MUSCLE, WHICH
LIES OVER THE GLUTEUS
MINIMUS

44. INTRAMUSCULAR (IM) INJECTIONS
• THE VENTROGUTEAL SITE IS THE PREFERRED SITE FOR
INTRAMUSCULAR INJECTIONS BECAUSE THE AREA:
• ■ CONTAINS NO LARGE NERVES OR BLOOD VESSELS.
• ■ PROVIDES THE GREATEST THICKNESS OF GLUTEAL MUSCLE
CONSISTING OF BOTH THE GLUTEUS MEDIUS AND GLUTEUS
MINIMUS.
• ■ IS SEALED OFF BY BONE.
• ■ CONTAINS CONSISTENTLY LESS FAT THAN THE BUTTOCK AREA,
THUS ELIMINATING THE NEED TO DETERMINE THE DEPTH OF

45. • THE CLIENT POSITION
FOR THE INJECTION
CAN BE A BACK, PRONE,
OR SIDE-LYING
POSITION

47. VASTUS LATERALIS SITE
• THE VASTUS LATERALIS MUSCLE IS USUALLY THICK AND WELL
DEVELOPED IN BOTH ADULTS AND CHILDREN. IT IS
RECOMMENDED AS THE SITE OF CHOICE FOR
INTRAMUSCULAR INJECTIONS FOR INFANTS.

48. VASTUS LATERALIS SITE
• BECAUSE THERE ARE NO MAJOR
BLOOD VESSELS OR NERVES IN
THE AREA, IT IS DESIRABLE FOR
INFANTS WHOSE GLUTEAL
MUSCLES ARE POORLY
DEVELOPED. IT IS SITUATED ON
THE ANTERIOR LATERAL
ASPECT OF THE INFANT’S

50. DORSOGLUTEAL SITE
• HISTORICALLY, THE DORSOGLUTEAL SITE WAS PRIMARILY
USED FOR INTRAMUSCULAR INJECTIONS.
• HOWEVER, THIS SITE IS CLOSE TO THE SCIATIC NERVE
AND THE SUPERIOR GLUTEAL NERVE AND ARTERY. AS A
RESULT, COMPLICATIONS (E.G., NUMBNESS, PAIN,
PARALYSIS) OCCURRED IF THE NURSE INJECTED A
MEDICATION NEAR OR INTO THE SCIATIC NERVE.

51. RECTUS FEMORIS SITE
• THE RECTUS FEMORIS MUSCLE,
WHICH BELONGS TO THE
QUADRICEPS MUSCLE GROUP, IS
USED ONLY OCCASIONALLY FOR
INTRAMUSCULAR INJECTIONS. IT IS
SITUATED ON THE ANTERIOR
ASPECT OF THE THIGH

52. DELTOID SITE
• THE DELTOID MUSCLE IS FOUND ON THE LATERAL ASPECT OF THE
UPPER ARM. IT IS NOT USED OFTEN FOR INTRAMUSCULAR
INJECTIONS BECAUSE IT IS A RELATIVELY SMALL MUSCLE AND IS
VERY CLOSE TO THE RADIAL NERVE AND RADIAL ARTERY.
• THIS SITE IS RECOMMENDED FOR THE ADMINISTRATION OF
HEPATITIS B VACCINE IN ADULTS.

55. INTRAMUSCULAR INJECTION TECHNIQUE

56. INTRAVENOUS MEDICATIONS
• BECAUSE IV MEDICATIONS ENTER THE CLIENT’S BLOODSTREAM
DIRECTLY BY WAY OF A VEIN, THEY ARE APPROPRIATE WHEN A
RAPID EFFECT IS REQUIRED. THIS ROUTE IS ALSO APPROPRIATE
WHEN MEDICATIONS ARE TOO IRRITATING TO TISSUES TO BE
GIVEN BY OTHER ROUTES.
• WHEN AN IV LINE IS ALREADY ESTABLISHED, THIS ROUTE IS
DESIRABLE BECAUSE IT AVOIDS THE DISCOMFORT OF OTHER
PARENTERAL ROUTES.

57. FOLLOWING ARE METHODS TO ADMINISTER
MEDICATIONS INTRAVENOUSLY:
• ■ LARGE-VOLUME INFUSION OF INTRAVENOUS FLUID
• ■ INTERMITTENT INTRAVENOUS INFUSION (PIGGYBACK
OR TANDEM SETUPS)
• ■ VOLUME-CONTROLLED INFUSION (OFTEN USED FOR
CHILDREN)
• ■ INTRAVENOUS PUSH (IVP) OR BOLUS
• ■ INTERMITTENT INJECTION PORTS (DEVICE)

58. LARGE-VOLUME INFUSIONS
• MIXING A MEDICATION INTO A LARGE-VOLUME IV CONTAINER IS
THE SAFEST AND EASIEST WAY TO ADMINISTER A DRUG
INTRAVENOUSLY. THE DRUGS ARE DILUTED IN VOLUMES OF 250,
500, OR 1,000 ML OF COMPATIBLE FLUIDS. IT MAY BE NECESSARY
TO CONSULT A PHARMACIST TO CONFIRM COMPATIBILITY.

59. LARGE-VOLUME
INFUSIONS
• FLUIDS SUCH AS IV NORMAL SALINE
OR RINGER’S LACTATE ARE
FREQUENTLY USED.

61. LARGE-VOLUME INFUSIONS
• MIXING A MEDICATION INTO A LARGE-VOLUME IV
CONTAINER IS THE SAFEST AND EASIEST WAY TO
ADMINISTER A DRUG INTRAVENOUSLY. THE DRUGS ARE
DILUTED IN VOLUMES OF 250, 500, OR 1,000 ML OF
COMPATIBLE FLUIDS.

62. INTERMITTENT INTRAVENOUS INFUSIONS
• AN INTERMITTENT INFUSION IS A METHOD OF
ADMINISTERING A MEDICATION MIXED IN A SMALL
AMOUNT OF IV SOLUTION, SUCH AS 50 OR 100ML

63. INTERMITTENT INTRAVENOUS INFUSIONS
• THE DRUG IS ADMINISTERED AT REGULAR INTERVALS,
SUCH AS EVERY 4 HOURS, WITH THE DRUG BEING
INFUSED FOR A SHORT PERIOD OF TIME SUCH AS 30 TO
60 MINUTES.
• TWO COMMONLY USED ADDITIVE OR SECONDARY IV SET
UPS ARE THE TANDEM AND THE PIGGYBACK.

65. VOLUME-CONTROL
INFUSIONS

66. VOLUME-CONTROL
INFUSIONS
• INTERMITTENT
MEDICATIONS MAY ALSO BE
ADMINISTERED BY A
VOLUME-CONTROL
INFUSION SET

67. INTRAVENOUS PUSH
• INTRAVENOUS PUSH (IVP) OR
BOLUS IS THE INTRAVENOUS
ADMINISTRATION OF AN
UNDILUTED DRUG DIRECTLY
INTO THE SYSTEMIC
CIRCULATION. IT IS USED
WHEN A MEDICATION CANNOT
BE DILUTED OR IN AN

68. INTERMITTENT INFUSION DEVICES
• INTERMITTENT INFUSION DEVICES MAY BE ATTACHED TO AN
INTRAVENOUS CATHETER OR NEEDLE TO ALLOW MEDICATIONS TO
BE ADMINISTERED INTRAVENOUSLY WITHOUT REQUIRING A
CONTINUOUS INTRAVENOUS INFUSION.

69. INTERMITTENT INFUSION DEVICES

70. • THE DEVICE MAY ALSO HAVE A
PORT AT ONE END OF THE LOCK
AND A NEEDLELESS INJECTION
CAP AT THE OTHER END WITH
THE EXTENSION TUBING
BETWEEN THE TWO ENDS

71. TOPICAL MEDICATIONS
• A TOPICAL MEDICATION IS
APPLIED LOCALLY TO THE SKIN
OR TO MUCOUS MEMBRANES
IN AREAS SUCH AS THE EYE,
EXTERNAL EAR CANAL, NOSE,
VAGINA, AND RECTUM.

72. OPHTHALMIC MEDICATIONS
• MEDICATIONS MAY BE ADMINISTERED TO THE EYE USING
IRRIGATIONS OR INSTILLATIONS. AN EYE IRRIGATION IS
ADMINISTERED TO WASH OUT THE CONJUNCTIVAL SAC TO
REMOVE SECRETIONS OR FOREIGN BODIES OR TO REMOVE
CHEMICALS THAT MAY INJURE THE EYE. MEDICATIONS FOR THE
EYES, CALLED OPHTHALMIC MEDICATIONS, ARE INSTILLED IN THE
FORM OF LIQUIDS OR OINTMENTS.

74. OTIC MEDICATIONS
• OTIC MEDICATIONS
INSTILLATIONS OR
IRRIGATIONS OF THE
EXTERNAL AUDITORY CANAL
ARE REFERRED TO AS OTIC
AND ARE GENERALLY CARRIED
OUT FOR CLEANING PURPOSES.

75. NASAL MEDICATIONS
• NASAL INSTILLATIONS (NOSE DROPS AND SPRAYS) USUALLY ARE
INSTILLED FOR THEIR ASTRINGENT EFFECT (TO SHRINK SWOLLEN
MUCOUS MEMBRANES), TO LOOSEN SECRETIONS AND FACILITATE
DRAINAGE, OR TO TREAT INFECTIONS OF THE NASAL CAVITY OR
SINUSES.

76. VAGINAL MEDICATIONS
• VAGINAL MEDICATIONS, OR
INSTILLATIONS, ARE INSERTED AS
CREAMS, JELLIES, FOAMS, OR
SUPPOSITORIES TO TREAT INFECTION
OR TO RELIEVE VAGINAL DISCOMFORT
(E.G., ITCHING OR PAIN). MEDICAL
ASEPTIC TECHNIQUE IS USUALLY USED

77. A VAGINAL IRRIGATION (DOUCHE)
• IS THE WASHING OF THE VAGINA
BY A LIQUID AT A LOW
PRESSURE. VAGINAL
IRRIGATIONS ARE NOT
NECESSARY FOR ORDINARY
FEMALE HYGIENE BUT ARE USED
TO PREVENT INFECTION

78. RECTAL MEDICATIONS
• INSERTION OF MEDICATIONS
INTO THE RECTUM IN THE FORM
OF SUPPOSITORIES IS A
FREQUENT PRACTICE. RECTAL
ADMINISTRATION IS A
CONVENIENT AND SAFE METHOD
OF GIVING CERTAIN
MEDICATIONS.

79. TO INSERT A RECTAL SUPPOSITORY:
• ■ 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.
• ■ UNWRAP THE SUPPOSITORY AND LUBRICATE THE SMOOTH
ROUNDED END, OR SEE THE MANUFACTURER’S INSTRUCTIONS.
THE ROUNDED END IS USUALLY INSERTED FIRST AND LUBRICANT
REDUCES IRRITATION OF THE MUCOSA.

80. TO INSERT A RECTAL SUPPOSITORY:
• ■ LUBRICATE THE GLOVED INDEX FINGER.
• ■ ENCOURAGE THE CLIENT TO RELAX BY BREATHING THROUGH
THE MOUTH. THIS USUALLY RELAXES THE EXTERNAL ANAL
SPHINCTER.
• ■ INSERT THE SUPPOSITORY GENTLY INTO THE ANAL CANAL,
ROUNDED END FIRST (OR ACCORDING TO MANUFACTURER’S
INSTRUCTIONS).
• FOR AN ADULT, INSERT THE SUPPOSITORY BEYOND THE INTERNAL
SPHINCTER (I.E., 10 CM [4 IN.])

81. TO INSERT A RECTAL SUPPOSITORY:
• ■ AVOID EMBEDDING THE SUPPOSITORY IN FECES IN ORDER FOR
THE SUPPOSITORY TO BE ABSORBED EFFECTIVELY.
• ■ PRESS THE CLIENT’S BUTTOCKS TOGETHER FOR A FEW MINUTES.
• ■ ASK THE CLIENT TO REMAIN IN THE LEFT LATERAL OR SUPINE
POSITION FOR AT LEAST 5 MINUTES TO HELP RETAIN THE
SUPPOSITORY.

82. INHALED MEDICATIONS
• NEBULIZERS DELIVER MOST MEDICATIONS ADMINISTERED
THROUGH THE INHALED ROUTE. ANEBULIZER 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.

83. • THE METERED-DOSE INHALER (MDI), A
HANDHELD NEBULIZER, IS A
PRESSURIZED CONTAINER OF
MEDICATION THAT CAN BE USED BY THE
CLIENT TO RELEASE THE MEDICATION
THROUGH A MOUTHPIECE.

84. IRRIGATIONS
• AN IRRIGATION (LAVAGE) IS THE WASHING OUT OF A BODY CAVITY
BY A STREAM OF WATER OR OTHER FLUID THAT MAY OR MAY NOT
BE MEDICATED.
• IRRIGATION IS PERFORMED FOR ONE OR MORE OF THE FOLLOWING
REASONS:
• ■ TO CLEAN THE AREA, THAT IS, TO REMOVE A FOREIGN OBJECT
OR EXCESSIVE SECRETIONS OR DISCHARGE
• ■ TO APPLY HEAT OR COLD
• ■ TO APPLY A MEDICATION, SUCH AS AN ANTISEPTIC
• ■ TO REDUCE INFLAMMATION

87. REFERENCES:
• Audrey Berman . . . [et al.]. –
9th ed. (2012) KOZIER & ERB’S
Fundamentals of NURSING
Concepts, Process, and
Practice.