Notes for B.Sc. Nsg. Students

1. Administration of
Medication
By-
Jayesh Soni
Asst. processor
SCON, Udaipur

2. Administration of Medication
The administration of medication to a patient is often a
chief responsibility of the nurse. The practice of
administering medication involves providing the
patient with a substance prescribed and intended for
the diagnosis, treatment, or prevention of a medical
illness or condition.
Nurses must have the knowledge (indications,
contraindications, dose, interactions, adverse effects,
route and knowledge of how to administer drug safely)
skill, & judgement to assess the appropriateness of the
medication for a particular patient.

3. Routes of Drug Administration
Route Explanation
Buccal /Oral Held inside the cheek
Sublingual Drug placing under the tongue
Inhalation Inhales fumes into lungs for local & systemic effects
Inunction/topical
application
Applied topically usually by friction
Instillation Putting drug in liquid form into body cavity/orifice
Insertion Insert solid form drug into body orifices
Insufflation Blowing powder form drug into wound/body cavity
Implantation Planting/putting solid form drug into body tissues

4. Parenteral route of drug
administration
Route Explanation
Intramuscular IM injected into muscle with a syringe
Intravenous IV injected into a vein or into an IV line
Subcutaneous/Hypodermic injected into subcutaneous tissues
Intrathecal/Intraspinal injected into spine (Subdural, Arachnoid, &
lumber area )
Intra arterial injected into artery
Intra cardiac injected into cardiac muscles
Intradermal Injected under epidermis or into dermis
Intraosseous injected into bone marrow
Intra peritoneal injected into peritoneal cavity

5. INJECTION
 Injection is a method of putting liquid into the body
with a hollow needle and a syringe which is pierced
through the skin to a sufficient depth for the material
to be forced into the body.
 An injection follows a parenteral route of
administration, that is, its effect is not necessarily
local to the area in which the injection is
administered; it is systemic

7. Parts of a Syringe

9. Parts of the Needle

10. Types of Needles

12. Intramuscular Administration
 Administered into a muscle or muscle group
 Volume: up to 4ml
 Equipment: gloves, 1-5 ml syringe, needle
(18-23 g, ⅝ to 3 inch needle), alcohol swab
 RN is responsible to chose needle size and
gauge.
 Administration angle: 90°

13. Intramuscular Administration
Deltoid
Injection site is the
center of the
triangle,
3 finger widths (1-2
inches) below the
acromion process.

14. Deltoid Injection Site

15. Intramuscular Administration
Vastus Lateralis
 Injection site is
the lateral area
of the thigh

16. Intramuscular Administration
Ventral Gluteal
 Injection site lies
within the
triangle formed
by the index and
middle fingers

17. Intramuscular Administration
Dorsal Gluteal
 Injection site is
above and
lateral to the
line.
 Most
dangerous site
because of
sciatic nerve
location

18. Intramuscular Administration
 Prepare medication
 Gather supplies
 Identify site
 Don gloves
 Cleanse site with alcohol
 Pull skin taut
 Hold needle like “dart”
 Insert quickly at a 90°
angle
 Stabilize needle
 Aspirate for blood
 If no blood, instill
medication slow and steady
 Quickly remove needle.
 DO NOT RECAP. Activate
safety feature. Place needle
in sharps container
uncapped.
 Massage site with alcohol
swab
 Remove gloves

19. Z-track IM Administration
 The Z-track method is a type of IM injection
technique used to prevent tracking (leakage)
of the medication into the subcutaneous tissue
(underneath the skin).

20. Z-track IM Administration
 Prepare medication
 Change needle after drawing
up med
 Gather supplies
 Identify site
 Don gloves
 Cleanse site with alcohol
 Displace skin laterally 1-1 ½
inches from injection site
 While holding skin, insert
needle with a darting motion,
at a 90° angle.
 Stabilize needle with thumb
and forefinger.
 Aspirate.
 If no blood, then inject
medication slowly and steady
 Wait 10 seconds
 Quickly withdrawal needle
 Then release skin
 Cover site with swab and DO
NOT MASSAGE
 DO NOT RECAP. Activate
safety feature. Place needle in
sharps container uncapped
 Remove gloves

21. IV Medication
Ampule
s
•Administered into a Vein or infusions
•Volume: as per prescribed
•Equipment: gloves, syringe, needle (18-23 g, ⅝
to 3 inch needle), alcohol swab, kidney tray,
medican card
•RN is responsible to chose needle size and
gauge.
•Administration angle: 25°
Vials

22. Drawing Up Medication
From an Ampules
 Wash hands and gather
equipment.
 Grasp the stem with an
alcohol swab
 Snap off the ampoule’s
neck away from the hands
 Uncap the needle and inse
the needle into the ampule
 Avoid touching the rim
with the needle.

23. CONT…
 Remove the needle
cap and draw an
amount of air into the
syringe that is equal to
the amount of
medication that will
 Invert the ampule,
insert the needle into
the solution and
aspirate.

24. Drawing Up Medication From
a Vial
 Insert the needle
keeping it above the
solution
 Invert the vial
at eye level
 Hold the needle
upright and re-check
the syringe’s contents
for presence of air

25. Subcutaneous Injection
 Administered into subcutaneous tissue that lies
between the skin and the muscle.
 Common subcutaneous injections are heparin and
insulin
 Onset: within a half hour
 Volume: up to 1ml
 Equipment: TB or Insulin syringe (25-27g, ½ to⅝
inch needle), gloves, alcohol swab.
 Administration Angle: 45° or 90 °

26. Subcutaneous Injection Sites

27. Subcutaneous Injection
 Assist client to
comfortable position
 Apply alcohol swap
and rotate outward
in circular direction

28. Cont…

29. Subcutaneous Injection
procedure
 Prepare medication
 Gather supplies
 Identify site
 Don gloves
 Cleanse site with
alcohol
 Bunch the skin
 Hold needle like “dart”
 Pierce skin with quick
motion at 45-90 degree
angle.
 Do not aspirate.
 Inject medication slowly
 Quickly remove needle
 Do not recap. Activate
safety feature. Place
needle in sharps
container uncapped

30. Intradermal Administration
 Used for allergy and tuberculin skin testing
 Site: inner forearm (may use back and upper chest)
 Volume: 0.01-0.05 ml
 Equipment: gloves, TB syringe (1ml, 25-27g, ⅝
or ½ inch needle), alcohol swab.
 Administration angle: 10-15°

31. Procedure……
 Prepare medication
 Gather supplies
 Identify site
 Don gloves
 Cleanse site with alcohol
 Pull skin taut
 Insert needle with bevel
up at 10-15 degree angle
⅛ inch.
 Needle should be visible
under skin
 Push plunger to instill
medication creating a
wheal under skin
 Withdraw needle at same
angle inserted.
 Cover site with gauze for
bleeding. Do not massage.
 Do not recap. Activate
safety feature. Place needle
in sharps container
uncapped.

32. Intrathecal or Intraspinal
Injection
 Inseration needle into spine (Subdural, Arachnoid,
& lumber area )
 Syringe ( 16-25g, 3½ inch long spinal needle)

33. Intracardiac Injection

34. Intraosseous Injection

35. Oral Route of Drug
Administration
Definition:
Drugs given by the oral or gastric route are
absorbed into the bloodstream through the gastric
or intestinal mucosa. Usually the patient swallows
the drug.
Forms of oral medications:
 Tablets.
 Capsules.
 Liquid drugs like syrup
 Also available as powder,
granules or oil.

36. Cont..
Purpose:
 Uses basic safety factors of drug administration
in preparing and administering medications.
 Avoids client injury due to drug errors.
 Delivers medication for absorption through
alimentary tract for oral medication.

37. Preparation of Oral Medication
 Wash hands
 Gather equipment:
a. Medication Card
b. Medication tray
c. Glass of water or preferred liquid
d. Drinking straw
e. Pill Crusher device
 Unlock the medication cart or drawer.
 Prepare one client’s medication at a time.
 Calculate correct drug dose. Take time,Double
check calculation.

38.  If the client has difficulty in
swallowing, grind tablets in a pill
crusher until smooth. Mix it with
drinks or soft food.
 Measure liquid medication by holding
the medication cup at eye level. Pour
away from the label and wipe the
neck.
 Re-check each medication with
physician order.
 Don’t use liquid medication that are
cloudy or have changed in color.
Cont..

39.  Ask the patient his or her
name with a staff
witness.
 Assist the patient to a
comfortable position.
 Administer the
medication
 Remain with the client
until he or she has taken
all medication
Cont..

40. Sublingual medications are orally
disintegrating or dissolving
medications that are administered by
being placed under the tongue.
These medications are transferred to
the bloodstream from the mucous
membranes in the mouth after
dissolving.
Doctors may recommend sublingual
medications if a patient has trouble
swallowing or digesting the
medication.
Sublingually drug
administration

41. Common sublingual medications
include:
 Heart medication (Such as nitroglycerin &
Verapamil)
 Certain steroids
 Certain opioids
 Certain barbiturates
 Enzymes
 Certain vitamins and minerals
 Certain mental health medications

42.  Wash your hands
 Gather equipment:
 Medication Card
 Medication tray
 Clean disposable gloves
 Pill cutter (if necessary)
 Unlock the medication cart or drawer.
 Prepare one client’s medication at a time.
 Calculate correct drug dose
 Double-check that the medication is prescribed to
be taken sublingually
Preparation of Sublingual
Medication

43. Cont…
 Correct the position, sit upright position
 Place the medication under the tongue
 Hold the sublingual medication under the tongue for
the prescribed length of time
 Instruct to not swallow the medication, Swallowing
sublingual medication may cause erratic or
incomplete absorption
 Wait before drinking or rinsing the mouth

44. Inhalation
or
or

45. Types of inhalation-
DRY INHALATIONS
It is the inhalation of
gases, fumes from volatile
drugs or burning drugs
e.g ether, chloroform,
nitrous oxide
MOIST INHALATIONS
Breathing down and moist
air produced by a
vaporizer is called
stream/moist inhalation.

46. Inhalation….
Advantages
 Less systemic toxicity
 More rapid onset of
medication
 Delivery to target of
action
 Higher concentrations
available in the lung
Disadvantages
 Time and effort
consuming
 Limitation of delivery
device

47. Devices for Inhalations
 Nebulizer: small volume, large volume, ultrasonic
 Metered dose inhaler, (MDI)
 Dry powder inhaler, (DPI)
 Spacer
 Rotahaler
 Spinhaler

48. Nebulizer: small volume, large
volume, ultrasonic

49. Metered dose inhaler

50. Dry powder inhaler, (DPI)

51. Spinhaler

52. Rotahaler

53. “Steam inhalation supplying warm, moist (vapor) into lungs for
local and systemic effects..”
Purposes:
 To relieve inflammation and congestion of upper respiratory
mucous membrane
 To relieve irritated throat by moistening the air
 To relieve spasmodic breathing
 To loosen secretions and stimulate discharge of mucous from
the throat and lungs
 To relax muscles and relieve coughing
 To keep mucous membranes from excessive drying
Steam Inhalation

54. Articles required…
 Towel & face towel
 Nelson’s inhaler in a bowl
 Sputum cup with antiseptic solution
 Inhaler mouthpiece
 Gauze piece/cotton ball
 Kidney tray
 Cardiac table
 Medication:
- Tincture Benzoin 5 ml per 500 ml of boiling water
- Camphor/Menthol few crystals per 500 ml of boiling water
 Boil water (160 ̊ F)
Nelson’s inhaler

55.  Measure the capacity of the inhaler with cold water. Measure
the capacity when it is filled half to two thirds full.
 Warm the inhaler by pouring a little hot water into the jug and
emptying it to maintain the temperature for longer period.
 Pour the required amount of inhalant into the inhaler and fill
the jug 2/3 with hot water. The water should remain just below
the spout.
 Place the mouth piece with a gauze piece to prevent burns and
plug the spout with a cotton ball to prevent escape of steam.
 Place the inhaler in the basin and take it to the bedside without
losing time.
Procedure …

56. Cont…
 Place the apparatus conveniently in front of the
patient with the spout opposite to the patient.
Remove the cotton plug and discard it into the
paper bag.
 Instruct the patient to place the lips on the
mouth piece and breath in the vapor. After
removing the lips from the mouth piece, breath
out the air. Alternately, he should breath in the
steam through the nostrils.
 Cover the patient’s head and jug with a bath
blanket or a bath towel to collect the steam
around the face of the patient, also the
concentration of the steam will be increased.
Mouth piece
Nelson’s inhaler

57. Instillation – Ophthalmic
medication
Definition:
Medications are instilled in mucous membranes of
eye for various therapeutic effects.
Purpose:
 To treat infection.
 To relieve inflammation.
 To treat eye disorders such as glaucoma.
 To diagnose such as foreign bodies and corneal
abrasions.

58. Preparation of Ophthalmic
medication
 Gather Equipments
 Medication bottle with sterile dropper or
ointment tube.
 Small gauze squares or cotton balls.
 Eye patch and tape (optional).
 Disposable gloves.
 Explain the need and reason for instilling drops or
ointment.
 Allow the patient to sit with head tilted backward
or to lie in a supine position.
 Explain steps of procedure to patient.

59. Instillation of eye drops
 Identify patient, Compare name on medication card
& ask patient to state name.
 Check prescribed medication order for number of
drops (if a liquid) and eye-
 Wash Hands
 With dominant hand resting on client’s forehead,
hold filled medication eye dropper or ophthalmic
solution approximately 1-2 cm (1/2-3/4 in) above
conjunctival sac.
Rt. = O.D.
Lt. = O.S.
Both = O.U.

60. Cont…
 Pull the lower lid down to expose
the conjunctival sac. have the pt
look up and away, then squeeze
the prescribed numbers of drops
into the sac.
 Release the patient's eyelid, and
have him/ her to blink to distribute
the medication.
 If drops land on outer lid margins,
repeat procedure

61. Instillation of eye ointment
 Gently lay a thin strip of the
medication along the
conjunctival sac from the
inner canthus to the outer
canthus. avoid touching the
tip of the tube to the
patient's eye. then release
the eye lid and have the
patient roll his eye behind
closed lids to distribute the
medication.

62. Definition:
Instill liquid medication into external auditory
canal for such therapeutic effects.
Purpose:
 To treat infection and inflammation.
 To soften cerumen (ear wax) for removal.
 To produce local anesthesia or relieve pain
 To aid in removal of foreign body trapped in the
ear.
Instilling – Ear (Otic)
medication

63. Articles required…
 Disposable gloves
 2 or 3 cotton balls
 Medication card
 Medication with dropper, to be administered
 Kidney basin
 Bowl with normal saline (optional)

64.  Check Medication administration record (MAR) with
medication card for name, dose, time, amount or ear
(Rt/Lt/Both)
 Identify patient and explain procedure, purpose and position
 Before instilling ear drops, don clean disposable gloves.
 Cleanse external ear of any drainage using a warm wet
washcloth.
 Position patient with affected ear uppermost, on unaffected side
if lying down, or tilt head to side if sitting up.
Preparation of Ear (Otic)
medication

65. Cont…
 Before instilling eardrops, have the
client lie on his or her side. Then
straighten the ear canal to help the medication
reach the eardrum. For adult, gently pull
the auricle up and back. For young child
and infant, gently pull down and back
 Draw up medication into ear dropper,
ensuring correct amount of dosage
 Hold dropper tip just above ear canal.
Do not touch dropper tip to ear.
 Allow drops to fall on the side of the ear
canal.

66. Cont…
 Release ear pinna and have patient
remain in the position for at least 5
minutes.
 Apply gentle pressure to tragus several
times.
 If ordered, a cotton ball may be placed
loosely in the ear canal.
 Remove gloves and assist patient to a
comfortable and safe position.
 Perform hand hygiene
 Document as per hospital policy, and
patient’s response to procedure.

67. Nose is concerned with special sense of smell as
well as first organ of respiratory system, certain
disease or ailments that concern the nose will
require nasal drops.
“Nasal instillation is the process by which a
liquid is introduced into the nasal cavity drop
by drop”
Purposes:-
 To treat allergies
 To treat sinus infections
 To treat nasal congestion
 To give local anesthesia
Instilling – Nasal medication

68. Articles required…
 Disposable clean gloves
 2 or 3 tissue paper
 Medication card
 Medication with clean dropper
 Kidney basin
 Penlight
 Small pillow

69.  Check MAR with medication card for name, dose,
time, amount
 The label on the medication must be checked for
name, dose, and route, and compared with the MAR
 Before instilling nasal medication, don clean non-
sterile gloves.
 Provide patient with tissues and ask that they blow
their nose, to Clears the nose prior to medication
instillation.
 Position patient sitting back or lying down with head
tilted back over a pillow (underneath neck).
 Draw fluid into medication dropper with enough for
both nares, Do not return excess fluid into stock
bottle.
Preparation of instilling Nasal
medication

70. Cont…
 Ask patient to breathe through the mouth.
 Nose drops: hold dropper about 1 cm above naris
and drop medication into one naris and then the
other.
 Nasal spray: have patient hold one nostril closed
and breathe gently through the other as the spray
is being administered.
 Do not touch the naris with the dropper/spray
bottle.
 Position patient with head back for 2 to 3 minutes.
 Remove gloves and assist patient to a comfortable
and safe position.
 Perform hand hygiene
 Document as per hospital policy, and patient’s
response to procedure.

71. Inuction / Topical application
It is the application of medication locally to the skin or mucus
membrane in the form of lotion, ointment, or liniments
Purposes:-
 To protect, soften surface area
 To provide warmth, and muscles relaxation
 To relieve itching
Articles Required: Clean gloves, cotton balls/gauze pieces,
medicine (Ointment, lotion or liniment), Dressing pads,
Adhesive tape, Kidney tray…

72. Forms of topical medications:
 Powder
 Sprays
 Creams
 Ointments
 Lotions
 Pastes

73.  Check MAR with medication card for
name, dose, time, amount
 The label on the medication must be
checked for name, dose, and route and
compared with the MAR
 Apply non-sterile gloves unless skin is
broken; then apply sterile gloves.
 Wash, rinse, and dry the affected area
with water and a clean cloth.
 Place required amount of medication in
palm of hands and soften by rubbing
palms together.
Preparation of Topical
application

74. Cont…
 Let patient know that initial application may
feel cold. Apply medication using long even
strokes that follow the direction of the hair. Do
not rub vigorously.
 Let patient know that skin may feel greasy after
application.
 Perform hand hygiene
 Document as per hospital policy, and patient’s
response to procedure.

75. Insertion
Introduction of medication into the body
orifices (in rectum in form of suppository or in
vagina in form of creams/jellies/suppository)
Purposes:
 To promote peristalsis
 To promote defecation
 To act as analgesics or antipyretic
 To reduce inflammation
 To relieve vaginal discomfort
Articles required:
 Rectal suppository
 Lubricating jelly
 Clean gloves
 Tissue paper
 Kidney tray
 Bed pan

77. Medication Administered
Rectally
 Check MAR with medication card for name, dose, time,
amount
 The label on the medication must be checked for name, dose,
and route, and compared with the MAR
 If possible, have patient defecate prior to rectal medication
administration.
 Ensure that you have water-soluble lubricant available for
medication administration.
 Explain the procedure to the patient. If patient prefers to self-
administer the suppository, give specific instructions to patient
on correct procedure.

78. Cont…
 Position patient (Sims position).
 Provide privacy and drape the patient with only the
buttocks and anal area exposed.
 Place a drape underneath the patient’s buttocks.
 Apply clean non-sterile gloves.
 Assess patient for diarrhea or active rectal bleeding.
 Remove wrapper from suppository and lubricate
rounded tip of suppository and index finger of
dominant hand with lubricant.
 Separate buttocks with non-dominant hand and, using
gloved index finger of dominant hand, insert
suppository (rounded tip toward patient) into rectum
toward umbilicus while having patient take a deep
breath, exhale through the mouth, and relax anal
sphincter.

79. Cont…
 With your gloved finger, insert suppository along wall
of rectum about 5 cm beyond anal sphincter. Do not
insert the suppository into feces.
 Remove finger and wipe patient’s anal area.
 Ask patient to remain on side for 5 to 10 minutes.
 Discard gloves by turning them inside out and
disposing of them
 Perform hand hygiene
 Patient will require a bedpan/commode or close
proximity to toilet.
 Document as per hospital policy, and patient’s
response to procedure.

81. Medication Administer into
Vagina
 Check MAR with medication card for name, dose, time,
amount
 The label on the medication must be checked for name, dose,
and route, and compared with the MAR
 Before inserting the medication vaginally, explain the
procedure to the patient. If patient prefers to self-administer
the vaginal medication, give specific instructions to patient on
correct procedure.
 Ensure that you have water-soluble lubricant available for
medication administration.
 Ensure that patient void prior to procedure which prevents
passing of urine during procedure.

82. Cont…
 Position patient on back with legs slightly bent and feet flat
on the bed. (Sims position).
 Provide privacy, and drape patient so that vaginal area is
exposed.
 Apply clean non-sterile gloves.
 Remove suppository from wrapper and apply a liberal
amount of water-soluble lubricant to suppository and index
finger of dominant hand. Suppository should be at room
temperature.
 With non-dominant hand, gently separate labial folds. With
gloved index finger of dominant hand, insert lubricated
suppository about 8 to 10 cm along posterior vagina wall.
 Withdraw finger and wipe away excess lubricant.
 Discard gloves by turning them inside out and disposing of
them