DRUGS ADMINISTRATION by Nurse Abdullahi Musa
TABLE OF CONTENTS
•OBJECTIVES OF THE PRESENTATION•GLOSSARY
•INTRODUCTION
•PHARMACODYNAMICS
•PHARMACOKINETICS
•PRINCIPLES OF DRUG ADMINISTRATION
•FACTORS AFFECTING DRUG METABOLISM
•FACTORS AFFECTING DRUG ACTION
•DEFINITION
•ROUTES OF DRUG ADMINISTRATION
•DIFFERENT EQUIPMENTS & PROCEDURES OF DRUG ADMINISTRATION
•INTRAVENEOUS THERAPY
•SUMMARY AND CONCLUSION
•REFERENCES
OBJECTIVES:
At end of the presentation the audiences should be able:
• To describe various routes of drug administration
• To outline the necessary pieces of equipment required for drug administration
• To locate the different sites of parenteral drug administration.
GLOSSARY
• Drug: is a chemical substance taken into the body or applied to the body surface for the
purpose of prevention, control, and treatment of disease symptoms or for diagnostic purposes.
• Pharmacy: is the scientific study of how drugs are presented in a form suitable for administration
to the patients.
• Pharmacist: is a person who is trained in and has a legal duty to enforce the various laws governing
the production, distribution, storage, and dispensing of medicines.
• Route: simply means way by which something pass-through
• Drug misuse: occur when the drugs are taken in a manner contrary to legal and medical orders.
• Drug addiction: is defined as a chronic, relapsing disorder characterized by compulsive drug
seeking and use despite adverse consequences.
• Drug abuse: involve the use of psychoactive drugs in an amount or by methods that are
harmful to individual and others.
reward systems
• Drug dependencies: an adaptive state associated with a withdrawal syndrome upon cessation of
repeated exposure to drugs.
• Placebo: is any treatment medication, surgical or diagnostic procedure or nursing action that
elicits a client's response simply because of its intent rather than its known active properties. E.g
distilled water, normal saline, and vitamin. (Mckenry and Salerna, 1955).
INTRODUCTION
The study of human anatomy and physiology help us in understanding the structures of human
body and their functions, which in turn help us in locating each and every organ in the body and sites
where drugs can be administered safely depending upon the nature of drugs, prescription, how the
drugs need to produce desired effects either slowly or rapidly and where the drugs can be absorbed
and takedown to the area(s) of action safely.
The route of drug administration influences the action of that drug on the body. To obtain a
systemic effect, a drug must be absorbed and transported to the cells or tissues that respond to
them. How a drug is administered depends on the chemical nature and quantity of the drug, as
well as on the desired speed of effect and the overall condition of the client. Individual drugs are
designed to be administered by a specific route be sure to check drug labels for the appropriate route
of administration. Common routes of administration to obtain systemic effects include the
following: oral, sublingual, rectal, transdermal, and parenteral. Parenteral injections are commonly
administered in these sites: intradermal, subcutaneous, IM, and IV.
PHARMACODYNAMICS
This is the study of the mechanism of drugs' acting on the living tissue, often called what the drug does to the body. It is concerned with the responses of the tissues to specific chemical agents at various
sites in the body. The mode of action of a drug is the character of an effect produced by a drug.
However, the mechanism of action explains how the drug acts at the biochemical or cellular level to
produce it's therapeutic effects.
PHARMACODYNAMICS
Drug metabolism in the human body is accomplished in four basic stages: absorption,
transportation, biotransformation, and excretion. For a drug to be completely metabolized, it must
first be given in sufficient concentration to produce the desired effect on body tissues. When this
“Critical drug concentration” level is achieved, body tissue change.
ABSORPTION
Drugs are absorbed by the mucus membranes, the gastrointestinal tract, the respiratory tract, and
the skin. The mucus membranes are one of the most rapid and effective routes of absorption
because they are highly vascular. Oral drugs (drugs that are given by mouth) are absorbed in the
gastrointestinal tract. The rate of absorption depends on the pH of the stomach’s contents, the
food contents in the stomach at the time of ingestion, and the presence of disease conditions. Most
of the drug concentrate dissolves in the small intestine where the large vascular surface and
moderate pH level enhance the process of breaking down the drug. Parental methods are the most
direct, reliable, and rapid route of absorption.
TRANSPORTATION
The second stage of metabolism refers to the way in which a drug is transported from the site of
introduction to the site of action. When the body absorbs a drug, a portion of the drug binds to
plasma protein and may compete with other drugs for this storage site. Another portion is
transported in “free” form through the circulation to all parts of the body. It is the “free” drug
that is pharmacologically active. As the free drug moves from the circulatory system, it crosses
cell membranes to reach its site of action. As the drug is metabolized and excreted, protein-bound drug is freed for action. Lipid-soluble drugs are distributed to and stored in fat and then
released slowly into the bloodstream when drug administration is discontinued.
BIOTRANSFORMATION:- The third stage of metabolism takes place as the drug, which is a
foreign substance in the body; is converted by enzymes into a less active and harmless agent that
can be easily excreted. Most of this conversion occurs in the liver, although some conversion does
take place in the lungs, kidney plasma, and intestinal mucosa.
EXCRETION:- The final stage in metabolism takes place when the drug is changed into an
inactive form or excreted from the body. The kidneys are the most important route of excretion
because they eliminate both the pure drug and the metabolism of the parent drug. During
excretion, these two substances are filtered through glomeruli, secreted by the tubules, and either
reabsorbed through the tables or directly excreted. Other routes of excretion include the lungs
(which exhale gaseous drugs). Feces, saliva, tears, and mother’s milk.
PRINCIPLES OF DRUG ADMINISTRATION
• Remember the 5 Rs
Right patient
Right medication
Right route
Right dose
Right time
• Always keep the bottle tightly closed.
• Clean and keep the label of the bottle clear.
• Keep the medication away from light.
• Cheek their expiration date. Keep the rim of the bottle clean.
• Give your undivided attention to your work while preparing and giving medications.
• Make sure that you check some potent drugs.
• Never give medications from an unlabeled container
• Never return a dose once poured from the bottle.
• Check your patient's vital signs may be necessary before and after administrating some drugs e.g.
digitals, ergometrine.
• Never give medicine that someone poured or drawn.
• Never leave medicine at bedside of a patient and within reach of the children
• Document after serving
FACTORS AFFECTING DRUG METABOLISM
Many factors affect drug metabolism, including personal attributes, such as body weight, age, and
sex, physiologic factors, such as state of health or disease processes, acid-base and fluid and
electrolyte balance; permeability; diurnal rhythm; and circulatory capability. Genetic and
immunologic factors play a role in drug metabolism, as do psychologic, emotional and
environmental influences, drug tolerance, and cumulation of drugs. Responses to drugs vary,
depending on the speed with which the drug is absorbed into the blood or tissues and the
effectiveness of the body’s circulatory system.
FACTORS THAT AFFECT DRUG ACTION
1 • Age: standard dosages are based on the amount of a drug that will cause the desired effect in an
average adult. The bodies of very young and very old patients don’t function exactly like the
average adult body. In infants, body systems are not fully developed, they may have trouble
breaking down or excreting drugs. The body systems of the elderly may not function as efficiently
as when they were younger. Therefore, age affects drug action.
2 • Body size: If an average dose of medication is given to a very tall or very obese or very small
and thin patient, the concentration of the drug in the bloodstream will not be the right amount to
produce the effect you want.
3 • Sex: Women may react more strongly to certain drugs than men. They are generally smaller
and have a higher proportion of fat than men.
4 • Diseases condition: can strongly affect how patients respond to drugs. The organs necessary
for biotransformation and excretion may be impaired such as liver and kidneys which in turn
affect the processing and elimination of drugs.
5 • Emotion: mental state can be an important factor in the success or failure of drug therapy.
Negative emotional states and strong feelings such as jealousy, anger, or fear may have a
noticeable effect on drug action.
6 • Route: drugs are absorbed, distributed, and excreted at different rates when given by different
means or routes (drugs are quickest when injected into the bloodstream, slowest when
administered by mouth).
7 • Environmental Factors: extremes of weather or temperature can affect the action of drugs
because heat and cold influence body functions. Heat relaxes the blood
vessels and speeds up circulation so drugs act faster. Cold slows their action by constricting the
blood vessels and slowing circulation.
8 • Time of Day: drugs that make a patient sleepy are ordered to be taken at bed-time; stomach-
irritating drugs may be taken with meals to avoid discomfort. Normal bodily functions also vary
with the time of day, thus affecting drug action.
DEFINITION
Drugs administration is often classified by the location at which the drug is administered, it
involves the procedure of administering drugs into various routes of administration.
ROUTES OF DRUG ADMINISTRATION
1. Oral route
3. Topical route
2. Parenteral route: this refers to the method of drug administration other than the oral route. It further
divided into:
• Intradermal
• Subcutaneous
• Intramuscularly
• Intravenous
4. Rectal
4. Vaginal
6. Inhalation
ORAL ADMINISTRATION
Definition: Oral medication is the drug administered by mouth
PURPOSE
• When local effects on the GI tract are desired
• When prolonged systemic action is desired
CONTRAINDICATIONS
• For a patient with nausea & vomiting, unconscious patients.
• When digestive juices inactivate the effect of the drug.
• When there is inadequate absorption of the drug, which leads to inaccurate determination of the
drug absorbed.
• When the drug is irritating to the mucus membrane of the alimentary canal.
TYPES OF ORAL MEDICATIONS
• Lozenges
• Tablets
• Capsules
• Syrup
• Pills
• Suspension
TYPES OF EQUIPMENT FOR ORAL ADMINISTRATION OF DRUG
• Tray
• Towel
• A bowl of water for used mediation cup
• Measuring spoon
• A Jug of water (boiled water)
• Chart and medication card
• Ordered medication
• Straw if necessary
PROCEDURE
• Prepare your tray and take it to the patient's room
• Begin by checking the order
• Read the label 3 times
• Place solution and tablets in a separate container.
• If suspension, shake the bottle well before pouring
• Take it to the pt's bedside
• Keep the medication on site at all times
• Identify the patient carefully using all identification variables. (Pt’s name, bed number…)
• Remain with the pt. until each medicine is swallowed
• Offer additional fluid as necessary unless contra-indicated
• Record the medication given, refused, or omitted immediately.
• Take care of the equipment & return them to their proper places.
• Wash your hands.
SUPPOSITORY: this method of drug administration via the rectum
Equipment
• Suppository (as ordered)
• Gauze square
• Rectal glove or finger cot
• Toilet paper
• Receiver for soiled swabs
• Screen
• Bedpan, if the treatment is in order to produce defection.
• Mackintosh and towel
PROCEDURE
• Check medication order.
• Review client’s medical record for rectal surgery/ bleeding.
• Wash hands.
• Prepare needed equipment and supplies.
• Apply disposable gloves.
• Identify client.
• Explain procedure to the client.
• Arrange supplies at the client’s bedside.
• Provide privacy.
• Position client in Sims’ position.
• Keep client draped, except for anal area.
• Examine the external condition of client’s anus.
• Palpate rectal walls.
• Dispose of gloves, if soiled, and reapply new gloves.
• Remove suppository from wrapper and lubricate rounded end.
• Lubricate gloved finger of the dominant hand.
• Ask the client to take slow, deep breaths through mouth and to relax the anal sphincter.
• Retract client’s buttocks with the nondominant hand.
• With the index finger of the dominant hand, gently insert suppository through the anus, past the internal
sphincter, and place against the rectal wall, 10 cm for adults or 5 cm for children and infants.
• Withdraw finger and wipe client’s anal area clean.
• Remove and dispose of gloves.
•nWash hands.
• If suppository contains a laxative or fecal softener, be sure that client will receive help to reach
bedpan or toilet.
• Keep client flat on the back or on the side for 5 minutes.
• Return in 5 minutes to determine if the suppository has been expelled.
• Observe client for effects of suppository 30 minutes after administration.
• Record medication administration.
EXAMPLES SUPPOSITORIES
• Bisacodyl (Dulcolax)
• Glycerin
• Bismuth - for checking diarrhea.
• Opium, sodium barbital, etc.
INTRADERMAL INJECTION
DEFINITION: It is an injection given into the dermal layer of the skin (corneum)
SITE OF INJECTION
• The inner part of the forearm (midway between the wrist and elbow.
• Upper arm, at the deltoid area for BCG vaccination
EQUIPMENT
• Tray
• Syringe & needle (sterile)
• Receiver
• Drug (to be injected)
• File
• Alcohol swab
• Marking pen
• Water in the bowel to rinse syringe and needle
PROCEDURE
• Take the equipment to the patient's side
• Explain procedure to the patient
• Get hold of the arm & locate the site of injection.
• Clean the skin with a swab and inject the drug about 0.1. 0.2 inch at an angle of 10_15 degrees into
the epidermis after the bevel of the needle is no longer visible. Don't massage the site.
• Check for the immediate reaction of the skin (10-15 minutes later for tetanus, 20-30 minutes
later for penicillin)
• If it is for tine test, mark the area
• Chart the data and time of the administration of the drug.
• Take care of the equipment & return to their places.
• Do not forget to do the reading after 72 hours if it is for the fine test (tuberculin test)
• Document about the procedure
SUB-CUTANEOUS INJECTION
DEFINITION: Injecting of the drug under the skin in the sub-cutaneous tissue, (under the dermis)
PURPOSE:
• To obtain quicker absorption than oral administration
• When it is impossible to give medication orally
EQUIPMENT
• Tray
• Sterile syringe & needle (disposable)
• Alcohol swabs
• Medication
• File
• Receiver
• Medication card and patient chart
• Water in a bowel
• Disposing box
SITES OF INJECTION
• Outer part of the upper arm
• The abdomen below the costal margin to the iliac crest.
• The anterior aspect of the thigh
PROCEDURE
• Take the equipment to the pt's bed sid or room
• Explain the procedure to the patient
• Draw your medication
• Expel the air from the syringe
• Clean the site (usually it is in upper arms, thighs, or abdomen)
• Grasp the area between your thumb & forefinger to tense it.
• Insert the needle elevate at an angle of 45 degrees.
• Pierce the skin quickly & advance the needle
• Aspirate to determine that the needle has not entered a blood vessel
• Inject the drug slowly.
• After injecting withdraw the needle and massage the area with an alcohol swab. Note.
• Chart the amount and time of administration immediately.
• Take care of the equipment- wash, sterilize and return to its place
• Watch for undesired reaction (side effect of the drug) etc
INTRAMUSCULAR INJECTION
DEFINITION: It is an introduction of a drug into a body's system via the muscles.
PURPOSE
• To obtain quick action next to the intra- venous route
• To avoid irritation from the drug if given through another route.
EQUIPMENT
• Tray
• Ordered drug (ampoule, vial)
• Sterile syringes and needle in a container
• Alcohol swab
• Receiver
• File
• Chart
• A bowl of water for used syringes and needle
• Sterile jar with sterile forceps
SITES FOR I.M. INJECTION
• Ventrogluteal muscle
• Dorsogluteal muscle
• Deltoid muscle
• Vastus Lateralis
PROCEDURE
• Prepare tray & take it to the patient's room
• Prepare the medication
• Draw the medicine
• Expel the air from the syringe
• Choose the site of injection (the site for intra- muscular)
• Using the iliac crest as the upper boundary divided the buttock into four.
• Clean the upper outer quadrant with alcohol swab at an angle of 90 degree
• Stretch the skin and inject the medicine
• Drawback the piston (plunger) to check whether or not you are in the blood vessel ( if blood
returns, withdraw and get a new needle & reinject in a different spot)
• Push the drug slowly into the muscle
• When completed, withdraw the needle and massage the area with a swab gently to and absorption.
• Place the patient comfortably
• Take care of the equipment you have used & return to their places
• Chart the amount, time route, and type of the medicine
• Check the patient's reaction
INTRAVENOUS INJECTIONS
DEFINITION: It is the introduction of a drug in solution form into a vein. Often the amount is not
more than 10. ml. at a time.
SITES FOR IV INJECTION
• Dorsal Venous network
• Dorsal metacarpal Veins
• Cephalic Veins
• Radial vein
• Ulnar vein
• Basilic vein
• Median cubital vein
• Greater saphenous vein
EQUIPMENT
• Tray
• Towel and rubber sheet
• Sterile needle and syringes in a sterile container
• Sterile forceps in a sterile container
• Alcohol swabs
• File
• Medication
• Tourniquet
• Receivers (2)
• Treatment Chart
• Glove
PROCEDURE
• Prepare your tray & the medication
• Explain the procedure to the patient
• Position the patient properly
• Place rubber and towel under his arm(to protect the bed linen)
• Expose the arm and apply a tourniquet
• Ask pt. To open and close his fist.
• Palpate the vein and clean with alcohol swab the site of the injection (Which is mainly the mid
cubital vein of the arm)
• Clean with a circular motion; proceed from the center of the site outward.
• Hold the needle at an angle of 25 - 45 degrees in line with the veins.
• Puncture the vein and drawback to check whether you are in the vein or not. (Blood return
should be seen if you are in the vein)
• Once you know that you are in the vein, release the tourniquet and gently lower the angle of the
needle
• When it is nearly paralleled to the vein and instills the medications.
•Give very slowly unless there is an order to give it fast (Normally 40-60 drops is given in 1
minute).
• Check the pt's pulse in between.
•Any complaint from the patient should not be ignored.
• Apply pressure over the site after removing the needle to prevent bleeding.
•Tell the patient to flex his elbow.
• Watch the patient for a few minutes before leaving him.
• Remove your equipment
• Put the pt. In a comfortable position
• Wash, sterilize, and place the equipment in order.
• Chart the medication is given the amount, time & the reaction of the pt.
INTRAVENOUS THERAPY
DEFINITION: It is the administration of a large amount of fluid into the system through a vein.
PURPOSE
• To maintain fluid & electrolyte balance
• To introduce medication particularly antibiotics.
EQUIPMENT
• IV fluid as ordered
• Sterile syringe & needle
• Rubber & towel
• Receiver
• Alcohol swabs
• Arm board
• Bandage & scissors
• Tourniquet
• I. V pole
• Adhesive tape
• Medication chart
PREPARATION OF THE PATIENT
Since an infusion therapy takes several hours to complete, the patient should first be made
comfortable
PROCEDURE
• Take the equipment to the patient's bedside
• Explain the procedure to the patient. Be sure you have the right patient.
• Remove air from the tubing
• Place rubber & towel under the arm
• Apply tourniquet about 3 c.m. above the intended site of entry.
• Observe & palpate for a suitable vein
• Cleanse the skin with alcohol swabs thoroughly & place the swab used to thumb the retract down
the vein & soft tissue 4 c.m. below the intended site of injection.
• Hold the needle at an angle of 25- 45 degree line with the vein
• Pierce the skin and puncture the vein
• Check if you are in the vein by drawing back with the syringes. (blood returns if you are in the
vein)
• Release the tourniquet gently
• Start the flow of the solution by opening the clamp.
• Support needle with sterile gauze or sterile cotton balls If necessary to keep it in the proper position
in the vein
• Adjust the rate of flow
• Anchor the I.V. tubing with the adhesive tape to prevent pull on the needle.
• Place arm board or splint under the arm and bandage around.
SUMMARY AND CONCLUSION
A medication administration route is often classified by the location at which the drug is
administered, such as oral or parenteral. The choice of routes in which the medication is given
depends not only on the convenience and compliance but also on the drug’s pharmacokinetics and
pharmacodynamic profile. Therefore, it is crucial to understand the characteristics of the various
routes and techniques associated with them. Drugs administration involve the roles of
interprofessional healthcare team member improving care for patients who undergo medication
administration. However, drugs administration is mainly nurses' procedure responsible for
keeping the drugs, preparation of patients for the procedure, administering, observing the patients
for any side effects, and documentation after the procedure.
REFERENCES
Ali, Mohammed (2010). ''Pulmonary Drug Delivery.'' Handbook of Non-Invasive Drug Delivery Systems. Elsevier. pp. 209–246. doi :10.1016/b978-0-8155-2025-2.10009-5. ISBN 978-0-8155-2025-2.
''Routes for Drug Administration'' (PDF). Emergency Treatment Guidelines Appendix. Manitoba Health. 2003. Archived from the original (PDF) on October 1, 2013. Retrieved April 2, 2013.
Sandra F. S., Donna J. D., and Barbara C. M (2004). Clinical Nursing Skill. Basic to advanced skills, (6th ed.) PEARSON, Prentice-Hall, New Jersy.
Smith & Duel,( 1996). Clinical Nursing Skills, basic to advanced skills, (4th ed.), Appleton & Lange comp
Sorensen and Luck Mann's. (1994). Basic Nursing, A psychophysiological approach (3rd ed.) W.B. Saunders comp.
''The Administration of Medicines''. Nursing Practice Clinical Zones: Prescribing. NursingTimes.net. 2007. Archived from the original on January 2, 2020. Retrieved April 2, 2013.
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