ADMINISTRATION OF MEDICATION

FUNCTIONS OF THE NURSE

8 Dependent – Nursing Action carried out at the instruction or order of
the Physician.
9 Independent – Nursing Action carried out within the legal scope of
Nursing’s independent domain.
10 Interdependent – Nursing action performed by the Nurse in
collaboration with other members of the Health Care Team.

PHARMACOLOGY
11 Study of actions of chemicals on Living Organisms.
12 Study of drugs & the effects to the Person.

IMPORTANT THINGS TO NOTE BEFORE ADMINISTERING DRUGS

 Name of the Patient
 Name of the Drug
ο Generic Name – the name assigned by the manufacturer that 1st
developed the drug.
ο Trade/Brand Name – selected by the drug company that sells
the drug & is copyrighted.
 Dose
 Route (Drug Preparation)
 Timing & Frequency
 Doctor’s Orders/Signature
 Date

FIVE RIGHTS
The Right Drug with
The Right Dose through
The Right Route at
The Right Time to
The Right Patient

1. The Right Drug

 Name
ο Generic Name
ο Trade Name
 Preparation
ο Solid
 Capsule – powder or gel form of an active drug
enclosed in a gelatinous container, may also be
called liquigel.
 Pill – Mixture of a powdered drug with a cohesive
 material; may be round or oval.
 Tablet – small, solid dose of medication, compressed
or molded; may be any color, size or shape.
 Lozenge/Troche – small oval, round or oblong
preparation containing a drug in a flavored or
sweetened base, which dissolves in the mouth &
releases the medication.
 Trans-Dermal Patch – unit dose of medication applied
directly to the skin for diffusion through skin &
absorption into the bloodstream.
ο Liquid
 Elixir – medication in a clear liquid containing water,
alcohol, sweeteners & flavor.
 Syrup – medication combined in a water & sugar
solution.
 Suspension – finely divided, undissolved particles in a
liquid medium that needs to be shaken before use.
 Solution – a drug dissolved in another substance.
ο Semi-Solid
 Ointment – semi-solid preparation containing a drug
to be applied externally.
 Liniment – medication mixed with alcohol, oil or soap,
which is rubbed on skin.
 Lotion – drug particles in a solution for topical use.
 Suppository – easily melted medication preparation
in a firm base such as gelatin that is inserted in the
body.
 Effects
ο Primary (Therapeutic)
 Intended Effect of the drug.
ο Secondary (Side-Effect)
 Not intended effect of the drug
 Allergy
→ rapidly-developing reaction.
→ Signs & Symptoms may appear on the skin,
respiratory system or the GIT.
→ Anaphylactic Reaction – life-threatening reaction
that may result in respiratory distress, severe
bronchospasm, tachycardia, hypotension &
cardiovascular collapse. May be treated by
epinephrine, bronchodilators & antihistamines.
 Toxicity
→ Overdose – taking in a lethal dose of medication.
→ Cumulative Effect
♦ The body cannot metabolize one dose of the
 drug before another dose is administered.
♦ The drug is taken in more frequently than it
is excreted & each new dose increases the
total quantity in the body.
♦ May cause permanent damage to the
kidneys or liver.
 Ingestion of Drugs for External Use

DRUG NOMENCLATURE
1. Chemical Name
 Precise description of the drug’s chemical composition.
2. Generic Name
 The name assigned by the manufacturer that first develops the
drug.
 Often derived from the Chemical Name.
3. Official Name
 The name by which the drug is identified in the official
publication.
4. Trade Name
 Also referred to as the Brand Name or Proprietary Name.
 Selected by the drug company that sells the drug & is
copyrighted.
 A drug can have several Trade Names but the same Generic
Name.

DRUG PREPARATIONS
1. Oral
 Capsule, Pills, Tablets, Extended Release, Elixir, Suspension,
Syrup.
2. Topical
 Drug is applied directly to the body site, usually, the skin or
 mucous membranes.
 Liniment, Lotions, Ointment, Suppository, Transdermal Patch.

3. Injectable
 Introduction of medication into the body by a syringe.
 Vials, Ampules, Pre-Filled Syringes.

DRUG CLASSIFICATIONS
1. Body Systems
 Drugs that affect the bodily systems, such as the Digestive
System, Cardiovascular System, etc.
2. Symptoms Relieved
 Ex: Fever, Colds, Cough, etc.
3. Clinical Indication of the Drug
 Ex: Analgesic, Anti-Pyretic, Anti-Hypertensive.

PHARMACOKINETICS
13 Study of the movement of drug molecules in the body.
1. Absorption
 The process by which a drug is transferred from its site of entry
into the body to the bloodstream.
2. Distribution
 After a drug has been absorbed into the bloodstream, it is
distributed throughout the body.
 Drug accumulates in specific tissues for its action to take place.
 Distribution depends on the rate of perfusion and capillary
permeability to the drug.
3. Metabolism
 Also called Biotransformation.
 The breakdown of the drug to an inactive form.
 The liver is the primary site for drug metabolism.
 Physiologic changes or presence of a Liver disease may
complicate the process.
4. Excretion
 After the drug is broken down to an inactive form, excretion of
the drug from the body occurs.
 The Kidneys excrete most of the drugs.
 The Lungs excrete gaseous substances such as inhaled
anesthesia.
 Many drugs are also excreted through the intestines.

FACTORS AFFECTING DRUG ABSORPTION

1. Route of Administration
 Injected medications are usually absorbed more rapidly than
 oral medications.
2. Drug Solubility
 Liquid medications are absorbed more rapidly than solid
preparations, as liquid medications do not have to be dissolved
by the gastric juices.
3. pH
 Acidic drugs are well absorbed in the stomach.
 Basic drugs remain ionized or insoluble in an acid environment.
They can only be dissolved in the Small Intestines.

4. Local Conditions at the Site of Administration

 The more extensive the absorbing surface, the greater the
absorption of the drug, thus, a more rapid effect will occur.
 Food in the stomach can delay the absorption of some
medications or enhance the rate of absorption of other drugs.
5. Drug Dosage
 A higher dose than the normal is usually given when a patient is
in acute distress and the maximum therapeutic effect is desired
as quickly as possible.
 A maintenance dose is a lower dosage that becomes the usual
or daily dosage.
6. Serum Drug Levels
 After a drug has been absorbed, its serum level can be
monitored by drawing blood and measuring the drug’s peak &
trough levels.

ADVERSE EFFECTS OF MEDICATION

1. Allergic Effect
 A drug allergy occurs when a person who has been previously
exposed to the drug develops antibodies.
 Can be manifested in a variety of symptoms which can range
from minor to serious.
 Reaction may occur immediately after the patient receives the
medication or be delayed for hours or days.
 Life-threatening immediate reaction is called Anaphylactic
Reaction and results in respiratory distress, sudden severe
bronchospasm, and cardiovascular collapse. Can be treated
with epinephrine, bronchodilators and antihistamines.
 Symptoms & signs of allergy to drugs:
ο Fever
ο Diarrhea – GIT
ο Urticaria – Local Effect
ο Rash– Local Effect
ο Nausea – GIT
 ο Vomiting – GIT
2. Cumulative Effect
 Also called Drug Tolerance
 Occurs when the body becomes accustomed to a particular
drug over a period of time.
 Larger doses are given to produce the same effects as the
initial dose.
 Occurs when the body cannot metabolize one dose of the drug
before another dose is administered.
 The drug is taken in more frequently than it is excreted.
 If allowed to reach toxic levels, it may cause permanent
damage to the body organs.
3. Idiosyncratic Effect
 Any abnormal or peculiar response to a drug that may manifest
itself by over-response, under-response, or response different
from the expected outcome.

4. Drug Interaction
 The combined effect of 2 or more drugs acting simultaneously
produces an effect either less than that of each drug alone
(Antagonist Effect), or greater than that of each drug alone
(Synergistic Effect).
 Drug A can inhibit the effect of Drug B.
 Ingestion of a drug with alcohol may create a synergistic effect.

5. Iatrogenic Effect
 The drug produces a disease condition.
 Examples:
ο Chloramphenicol, which is taken for Typhoid Fever, may
cause Depression of the Bone Marrow functions, such as
Anemia, Thrombocytopenia, Neutropenia, Pancytopenia.
ο Augmentin, causes Diarrhea.
6. Drug Resistance
 When microorganisms would no longer respond to the drug.
7. Drug Dependence
 Abuse of regulated drugs.
 Physical Effects: Change in Biochemical make-up of the body &
experiences withdrawal symptoms.
 Psychological Effects: Feeling of Well-Being when taking the
drugs.
VARIABLES INFLUENCING THE EFFECT OF A MEDICATION
1. Developmental Considerations
 During pregnancy, most medications are contraindicated due to
its possible adverse effects on the fetus.
 Certain drugs have a Teratogenic Effect, which are known to
have a potential to cause developmental defects in the embryo
or fetus.
 Breastfed infants are also at a risk for adverse effects from the
drugs in the mother’s body.
 Children are given smaller doses of medication because the
immaturity of their organs are responsive to the medication.
 Older Adults are also responsive to medication because their
bodies have experienced physiologic changes associated with
the aging process.
 Small body size, reduced weight & reduced body water also
alter distribution.
 Drugs are excreted more slowly from the body as a result of
changes in kidney functions of Older people.
2. Weight
 Expected responses to drugs are based largely on those
reactions that occur when the drugs are given to healthy adults
(18-65 years old, 150 lb.)
 Drug doses for children are calculated by weight or Body
Surface Area.
3. Sex
 The difference in the distribution of body fat & fluids in men &
women is a minor factor affecting the action of some drugs.
4. Genetic & Cultural Factors
 Asian patients may require smaller doses of a drug because
they metabolize it at a slower rate.
 African Americans appear to require larger doses of some
medications that are used to lower blood pressure.
 Herbal treatments that are popular in some cultures may
interfere with or counteract the action of prescribed medication.
5. Psychological Factors
 The patient’s expectations of the medication affects the
response to the medication.
 Placebo is a pharmacologically inactive substance.
 Some patients appear to have the same response with the
placebo as with an active drug.
6. Pathology
 The presence of a disease may affect the drug action.
 Pathologic conditions that involve the Liver may slow the
metabolism & alter the dosage of the drug needed to reach a
 therapeutic level.

7. Environment
 Sensory deprivation and overload may affect drug responses.
 Nutritional state may also affect the body’s reaction to certain
drugs.
8. Timing of Administration
 The presence of food in the stomach delays the absorption of
orally administered medications.

TYPES OF MEDICATION ORDERS

1. Standard Order
 Carried out until cancelled by another order.
 The Physician specifies that a certain order is to be carried out
for a stated number of days or times. Once the stated period
has passed, the order is cancelled automatically.
2. PRN Order
 As needed, or only when necessary.
 Commonly written for post-operative pain medication.
3. Stat Order
 Carried out immediately and for one time only.
4. Single Order
 The medication is only ordered once, at a time specified by the
Physician.
5. Self-Terminating

PARTS OF A MEDICATION ORDER

1. Patient’s Name
2. Date & Time when the Order was written.
3. Name of the Drug to be administered.
4. Dosage of the Drug
5. Route by which the Drug is to be administered.
6. Frequency of administration of the Drug.
7. Signature of the Person/Physician writing the Order.

TRANSCRIPTION OF MEDICATION ORDERS

14 Kardex
15 Medication Sheet or Medication Administration Record
16 Medication Card

ROUTES FOR ADMINISTERING DRUGS

1. Oral Route – Having the Patient Swallow the medication
 Enteral Route – Administering the drug through an Enteral Tube.
  Sublingual Administration – Placing the drug under the tongue.
 Buccal Administration – Placing the drug between the cheek &
gum.
2. Parenteral Route – Injecting the Drug
 Subcutaneous Injection – Injecting the drug into the
Subcutaneous Tissue.
 Intramuscular Injection – Injecting the drug into the Muscle
tissue.
 Intradermal Injection – Injecting the drug into the Corium, under
the Epidermis.
 Intravenous Injection – Injecting the drug into the Vein.
 Intraarterial Injection – Injecting the drug into the Artery.
 Intracardial Injection – Injecting the drug into the Heart Tissue.
 Intraperitoneal Injection – Injecting the drug into the Peritoneal
(Abdominal) Cavity.
 Intraspinal Injection – Injecting the drug into the Spinal Canal.
 Intraosseous Injection – Injecting the drug into the Bone.

3. Topical Route – Inserting or rubbing drug onto the Skin or Mucous

Membrane.
 Vaginal Administration – Inserting drug into the Vagina.
 Rectal Administration – Inserting drug into the Rectum.
 Inunction – Rubbing drug into the Skin.
 Instillation – Placing drug into direct contact with the Mucous
Membrane.
 Irrigation – Flushing the Mucous Membrane with drug in a
Solution.
 Skin Application – Applying Transdermal Patch.
4. Pulmonary Route – Having the Patient inhale the drug.

ADMINISTRATION OF ORAL MEDICATION

17 Intended for absorption in the Stomach & Small Intestines.
18 Most commonly used route of administration, most comfortable &
convenient for the Patient, also the safest.
19 Oral medications should not be administered to Patients who have
difficulty swallowing, unconscious, under NPO order, or is vomiting.
20 Available in solid & liquid forms.
21 Some tablets are scored for easy breaking for partial quantity
dosage.
22 Enteric-coated tablets are covered with a hard surface to impede its
 absorption until it has left the Stomach. It should not be chewed or
crushed.
23 Other forms of oral medication that should not be chewed or
crushed:
o SR – Sustained Release
o XL – Extended Release
o CR/CRT – Controlled Release
o SA – Sustained Action
o LA – Long Acting
24 Liquid preparations are administered using calibrated cups or using
a plastic syringe without a needle (placed between the gum &
cheek).

ADMINISTRATION OF PARENTERAL MEDICATION

25 Injecting the medication into those body tissues outside of the
intestines or alimentary canal.
26 Absorption occurs more rapidly with an injection than when other
routes are used.
27 Intravenous injections are absorbed more rapidly than
intramuscular ones, but the effects of intramuscular injections
usually last longer due to the increased absorption time.
28 Results are more predictable, and the desired dosage can be
determined with greater accuracy.
29 Used for patients who are unconscious, who have gastrointestinal
disturbances, or who are uncooperative.
30 Also used in emergencies because absorption and desired results
occur rapidly.

TYPES OF SYRINGES
1. Hypodermic Syringe
  Comes in 2-, 2.5-, and 3 mL sizes.
 Usually has 2 scales marked with minim & milliliter.
 Milliliter scale is normally used.
 Minim scale is used for very small dosages.
2. Insulin Syringe
 Similar to a Hypodermic Syringe but the scale is especially
designed for Insulin.
 Several low-dose Insulin Syringes are also available, frequently
with non-removable needles.
 All Insulin Syringes are calibrated on the 100-unit scale.
3. Tuberculin Syringe
 Originally designed to administer Tuberculin.
 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 another.
 Can also be useful in administering other drugs, particularly
when small or precise measurement is indicated.
4. Pre-Filled Syringes
 Syringes that are already filled with a medication and usually
have their own needle attached.
 Available as pre-filled syringes ready for use or pre-filled sterile
cartridges and needles that require attachment of a reusable
holder (injection system) before use.
 Provides a single dose of medication.

TYPES OF SYRINGE TIPS

1. Luer-Lok Syringe
 Has a tip that requires the needle to be twisted onto it to avoid
accidental removal of the needle.
2. Non-Luer-Lok Syringe
 Has a smooth graduated tip onto which needles are slipped.
 Often used for irrigation purposes.

PARTS OF THE SYRINGE

1. Plunger – Used to push the medication out of the Syringe.
2. Barrel

PARTS OF THE NEEDLE

1. Needle Hit or Hub – Where the needle is connected to the Syringe.
2. Shaft
3. Bevel – Sloped edge of the needle, designed to make a narrow, slit-
like opening that closes quickly.

PREPARING MEDICATION FOR INJECTION

1. Ampule
 An ampule is a glass flask that contains a single dose of
medication for parenteral administration.
 Before breaking the neck of the ampule, flick the tip or the stem
of the ampule to make sure that all the medication is returned
to the body of the ampule. DO NOT SHAKE.

 If the neck of the ampule has perforations to make breaking it

easier, no need to file the neck.
 The ampule can be inverted or placed on a flat surface to draw
solution into the syringe.
 Make sure that the needle does not touch the rim of the ampule
as it may contaminate the needle.
2. Vial
 A vial is a glass bottle with a self-sealing stopper through which
the medication is removed.
 A vial usually contains several doses of medication.
 Before drawing the medication from the vial, wipe the rubber
stopper with alcohol.
 To facilitate the removal of medication, inject air into the vial in
the same amount as the quantity of medication to be
administered, while it is standing on a flat surface.
 Invert the vial and withdraw the needle tip slightly so that is
below the fluid level. This is to prevent air from being aspirated
into the syringe.
 Draw the prescribed amount of the medication while holding
the syringe at eye level, vertically, for accurate reading.
 After withdrawing the medication from the vial, carefully
replace the cap of the needle using the Scooping Method.

ADMINISTERING MEDICATIONS INTRADERMALLY

31 Intradermal Injections have the longest absorption time of all
parenteral routes.
32 Only used for diagnostic purposes.
33 Intradermal injections are placed just below the epidermis.
34 Usually only a small amount of the medication is administered.
35 Usual Sites for Intradermal Injections:
o Inner surface of the Forearm
o Dorsal Aspect of the Upper Arm
 o Upper Chest
o Upper Back
36 Cleanse the area of the injection site by using an alcohol swab or
cotton ball going on circular motions moving outward from the site.
37 Allow skin to dry.
38 Use your non-dominant hand to tauten the skin over the injection
site. This will facilitate an easier entrance into the intradermal
tissue.
39 Place the needle almost flat against the Patient’s skin with the Bevel
Side up, and insert the needle into the skin so that the point of the
needle can be seen through the skin.
40 Once the needle is inserted at about 1/8 of an inch, slowly inject the
medication while watching for a small wheal or bleb to appear. If
none appears, withdraw the needle slightly.
41 Withdraw the needle quickly at the same angle it was inserted to
minimize tissue damage & discomfort for the patient.
42 Do not massage the area of the injection so that it will not interfere
with the test results.

ADMINISTERING MEDICATIONS INTRAMUSCULARLY

43 Often used to administer drugs that are irritating, because there are
a few nerve endings in deep muscle tissues.
44 Absorption occurs more rapidly because of the greater vascularity
of muscle tissues.
45 Intramuscular Injection Sites:
o Deltoid – 3 finger-breadths below the Acromion Process.
o Ventrogluteal – Hips, right below the Iliac Crest
o Vastus Lateralis
 Found on the Antero-Lateral middle third of the Thigh.
 Usually used for Patients below 1 year old.
o Dorsogluteal – Upper Outer Quadrant of the Buttocks (to avoid
piercing the Sciatic Nerve)
46 Z-Track Technique
o This method prevents seepage of the medication into the
needle track and reduces pain and discomfort.
o Suggested for elderly patients with decreased muscle mass.
o The skin is pulled down or to one side about 1 in and held in
this position with the non-dominant hand, while the needle &
medication is injected.
o Steadily withdraw the needle and release the displaced tissue
to return to its normal position.
o Do not massage the site as it may cause the seepage of the
medication back to the needle track.
47 Clean the injection site with an alcohol swab using friction & allow to
dry.
48 Hold the syringe with your dominant hand between the thumb &
forefinger.
49 Quickly dart the needle into the tissue at a 90-degree angle to
facilitate the entry into the muscle tissue.
50 As soon as the needle is in place, use your non-dominant hand to
hold the lower end of the syringe, to steady the syringe as you
aspirate.
51 Aspirate by slowly pulling back on the plunger to determine whether
the needle is in a blood vessel. If blood is aspirated, discard the
needle, syringe & medication, and start over on another site.
52 If no blood is aspirated, inject the solution slowly (10 seconds per
mL of medication). This will reduce discomfort of the patient as it
allows the medication to disperse in the tissues.
53 Remover the needle slowly and steadily.
54 Apply gentle pressure at the site as this will cause less trauma and
irritation to the tissues.

ADMINISTERING TOPICAL MEDICATIONS

55 Drug is applied directly to the body site.
56 Usually intended for direct action at a particular site.

IRRIGATION
57 Washing and allowing the solution to come out
58 Used for the eyes, ears, nose, rectum & vagina.

EYE INSTILLATIONS & IRRIGATIONS

1. Eyedrops
 Eyedrops are instilled for their local effects, such as pupil
dilation or constriction, for treating an infection, etc.
 Tilt the Patient’s head back, if sitting, the head may be turned
to the affected side to prevent the solution from flowing to the
other eye.
 Have the Patient look up.
 Place 2 fingers of your non-dominant on the lower eyelid, just
below the eyelashes and slightly pull down to expose the lower
conjuctival sac.

 Holding the dropper, place your dominant hand on the Patient’s

forehead.
 Hold the dropper close to the eye, while avoiding to touch the
 eyelashes, eyelid & eyeball, slowly squeeze the container to
allow the prescribed number of drops to fall onto the lower
conjuctival sac.
 Release the lower lid once the medication is instilled & ask the
Patient to slowly close the eyes.
 Apply gentle pressure on the inner canthus to prevent the
medication from flowing into the tear duct.
2. Ointments
 Used for local infection or irritation.
 A small amount of ointment is distributed along the exposed
lower conjustival sac from the inner cathus to the outer
canthus.
3. Eye Irrigation
 Performed to remove secretions or foreign bodies or to cleanse
and soothe the eyes.
 Irrigation should continue for 15 minutes, and then professional
help should be sought.
 Usually, tap water is used to irrigate and remove chemicals
from the eyes.

EAR INSTILLATIONS & IRRIGATIONS

• Drugs or irrigations are instilled in the auditory canal for local effect.
• If the tympanic membrane is ruptured or opened through surgical
means, instillation & irrigations have to be performed with the
greatest of care to prevent forcing materials from the outer ear into
the middle & inner ear.

1. Ear Drops
 Ear drops should be warmed to body temperature to minimize
the discomfort of the Patient.
 Tilt the Patient’s head towards the unaffected area, so that the
affected ear is exposed. This will prevent the medication from
spilling outside of the ear.
 Children below 3 years old: Straighten the auditory canal by
pulling the Pinna down and back.
 3 years old & Above: Straighten the auditory canal by pulling
the Pinna up & back.
 Allow the Eardrops to fall on the side of the auditory canal as it
may be uncomfortable for the Patient if the medication drops
directly on the Tympanic Membrane.
 Release the Pinna after instilling the medication.
 Gently press on the Tragus to help move the medication from
the canal towards the Tympanic Membrane.
2. Ear Irrigations
  Irrigations of the external auditory canal are ordinarily done for
cleaning purposes, or applying heat.
 Typically, Normal Saline Solution is used.
 To prevent pain, the solution should be warmed to Room
Temperature.
 An Irrigation Syringe is typically used in most cases.

NASAL INSTILLATIONS
59 Used to treat allergies, sinus infections and nasal congestion.
60 Nasal Sprays may also be used to apply medication to the nasal
mucous membrane.
61 Instilling Medication to the Ethmoidal or Sphenoidal Sinuses:
o Place the Patient on a Proetz Position, by letting the head hang
straight back on the edge of the bed.
o The patient may also slightly tilt head to the affected side.
o Instill prescribed medication on the nares.
o Let Patient remain in the same position for a few minutes to
prevent the solution from escaping.
62 Instilling Medication to the Maxillary & Frontal Sinuses:
o Place the Patient on a Parkinson’s Position, by placing the head
slightly over the edge of the bed & turn to the affected side.
o Instill prescribed medication on the nares.
o Let Patient remain in the same position for a few minutes to
prevent the solution from escaping.

SUPPOSITORIES
63 Medication that is inserted into a body cavity & that melts at body
temperature.
64 Has to be frozen or refrigerated before use.
65 Rectal Insertion:
o Place the Patient on Sims Position.
o Push the suppository into the Rectal Mucosa up to 2 inches.

66 Vaginal Insertion:
o Have the Patient lie on a Dorsal Recumbent Position.
o Push the suppository approximately 1-2 inches into the Vaginal
 Canal.

PREPARING MEDICATION FOR INJECTION

1. Ampule
 An ampule is a glass flask that contains a single dose of
medication for parenteral administration.
 Before breaking the neck of the ampule, flick the tip or the stem
of the ampule to make sure that all the medication is returned
to the body of the ampule. DO NOT SHAKE.
 If the neck of the ampule has perforations to make breaking it
easier, no need to file the neck.
 The ampule can be inverted or placed on a flat surface to draw
solution into the syringe.
 Make sure that the needle does not touch the rim of the ampule
as it may contaminate the needle.
2. Vial
 A vial is a glass bottle with a self-sealing stopper through which
the medication is removed.
 A vial usually contains several doses of medication.
 Before drawing the medication from the vial, wipe the rubber
stopper with alcohol.
 To facilitate the removal of medication, inject air into the vial in
the same amount as the quantity of medication to be
administered, while it is standing on a flat surface.
 Invert the vial and withdraw the needle tip slightly so that is
below the fluid level. This is to prevent air from being aspirated
into the syringe.
 Draw the prescribed amount of the medication while holding
the syringe at eye level, vertically, for accurate reading.
 After withdrawing the medication from the vial, carefully
replace the cap of the needle using the Scooping Method.

ADMINISTERING MEDICATIONS INTRADERMALLY

67 Intradermal Injections have the longest absorption time of all
parenteral routes.
68 Only used for diagnostic purposes.
69 Intradermal injections are placed just below the epidermis.
70 Usually only a small amount of the medication is administered.
71 Usual Sites for Intradermal Injections:
o Inner surface of the Forearm
o Dorsal Aspect of the Upper Arm
o Upper Chest
o Upper Back
72 Cleanse the area of the injection site by using an alcohol swab or
 cotton ball going on circular motions moving outward from the site.
73 Allow skin to dry.
74 Use your non-dominant hand to tauten the skin over the injection
site. This will facilitate an easier entrance into the intradermal
tissue.
75 Place the needle almost flat against the Patient’s skin with the Bevel
Side up, and insert the needle into the skin so that the point of the
needle can be seen through the skin.
76 Once the needle is inserted at about 1/8 of an inch, slowly inject the
medication while watching for a small wheal or bleb to appear. If
none appears, withdraw the needle slightly.
77 Withdraw the needle quickly at the same angle it was inserted to
minimize tissue damage & discomfort for the patient.
78 Do not massage the area of the injection so that it will not interfere
with the test results.

ADMINISTERING MEDICATIONS INTRAMUSCULARLY

79 Often used to administer drugs that are irritating, because there are
a few nerve endings in deep muscle tissues.
80 Absorption occurs more rapidly because of the greater vascularity
of muscle tissues.
81 Intramuscular Injection Sites:
o Deltoid – 3 finger-breadths below the Acromion Process.
o Ventrogluteal – Hips, right below the Iliac Crest
o Vastus Lateralis
 Found on the Antero-Lateral middle third of the Thigh.
 Usually used for Patients below 1 year old.
o Dorsogluteal – Upper Outer Quadrant of the Buttocks (to avoid
piercing the Sciatic Nerve)
82 Z-Track Technique
o This method prevents seepage of the medication into the
needle track and reduces pain and discomfort.
o Suggested for elderly patients with decreased muscle mass.
o The skin is pulled down or to one side about 1 in and held in
this position with the non-dominant hand, while the needle &
medication is injected.
o Steadily withdraw the needle and release the displaced tissue
to return to its normal position.
o Do not massage the site as it may cause the seepage of the
medication back to the needle track.
83 Clean the injection site with an alcohol swab using friction & allow to
dry.
84 Hold the syringe with your dominant hand between the thumb &
forefinger.
85 Quickly dart the needle into the tissue at a 90-degree angle to
facilitate the entry into the muscle tissue.
86 As soon as the needle is in place, use your non-dominant hand to
hold the lower end of the syringe, to steady the syringe as you
aspirate.
87 Aspirate by slowly pulling back on the plunger to determine whether
the needle is in a blood vessel. If blood is aspirated, discard the
needle, syringe & medication, and start over on another site.
88 If no blood is aspirated, inject the solution slowly (10 seconds per
mL of medication). This will reduce discomfort of the patient as it
allows the medication to disperse in the tissues.
89 Remover the needle slowly and steadily.
90 Apply gentle pressure at the site as this will cause less trauma and
irritation to the tissues.

ADMINISTERING TOPICAL MEDICATIONS

91 Drug is applied directly to the body site.
92 Usually intended for direct action at a particular site.

IRRIGATION
93 Washing and allowing the solution to come out
94 Used for the eyes, ears, nose, rectum & vagina.

EYE INSTILLATIONS & IRRIGATIONS

1. Eyedrops
 Eyedrops are instilled for their local effects, such as pupil
dilation or constriction, for treating an infection, etc.
 Tilt the Patient’s head back, if sitting, the head may be turned
to the affected side to prevent the solution from flowing to the
other eye.
 Have the Patient look up.
 Place 2 fingers of your non-dominant on the lower eyelid, just
below the eyelashes and slightly pull down to expose the lower
conjuctival sac.

 Holding the dropper, place your dominant hand on the Patient’s

forehead.
 Hold the dropper close to the eye, while avoiding to touch the
eyelashes, eyelid & eyeball, slowly squeeze the container to
allow the prescribed number of drops to fall onto the lower
 conjuctival sac.
 Release the lower lid once the medication is instilled & ask the
Patient to slowly close the eyes.
 Apply gentle pressure on the inner canthus to prevent the
medication from flowing into the tear duct.
2. Ointments
 Used for local infection or irritation.
 A small amount of ointment is distributed along the exposed
lower conjustival sac from the inner cathus to the outer
canthus.
3. Eye Irrigation
 Performed to remove secretions or foreign bodies or to cleanse
and soothe the eyes.
 Irrigation should continue for 15 minutes, and then professional
help should be sought.
 Usually, tap water is used to irrigate and remove chemicals
from the eyes.

EAR INSTILLATIONS & IRRIGATIONS

• Drugs or irrigations are instilled in the auditory canal for local effect.
• If the tympanic membrane is ruptured or opened through surgical
means, instillation & irrigations have to be performed with the
greatest of care to prevent forcing materials from the outer ear into
the middle & inner ear.

1. Ear Drops
 Ear drops should be warmed to body temperature to minimize
the discomfort of the Patient.
 Tilt the Patient’s head towards the unaffected area, so that the
affected ear is exposed. This will prevent the medication from
spilling outside of the ear.
 Children below 3 years old: Straighten the auditory canal by
pulling the Pinna down and back.
 3 years old & Above: Straighten the auditory canal by pulling
the Pinna up & back.
 Allow the Eardrops to fall on the side of the auditory canal as it
may be uncomfortable for the Patient if the medication drops
directly on the Tympanic Membrane.
 Release the Pinna after instilling the medication.
 Gently press on the Tragus to help move the medication from
the canal towards the Tympanic Membrane.
2. Ear Irrigations
 Irrigations of the external auditory canal are ordinarily done for
cleaning purposes, or applying heat.
  Typically, Normal Saline Solution is used.
 To prevent pain, the solution should be warmed to Room
Temperature.
 An Irrigation Syringe is typically used in most cases.

NASAL INSTILLATIONS
95 Used to treat allergies, sinus infections and nasal congestion.
96 Nasal Sprays may also be used to apply medication to the nasal
mucous membrane.
97 Instilling Medication to the Ethmoidal or Sphenoidal Sinuses:
o Place the Patient on a Proetz Position, by letting the head hang
straight back on the edge of the bed.
o The patient may also slightly tilt head to the affected side.
o Instill prescribed medication on the nares.
o Let Patient remain in the same position for a few minutes to
prevent the solution from escaping.
98 Instilling Medication to the Maxillary & Frontal Sinuses:
o Place the Patient on a Parkinson’s Position, by placing the head
slightly over the edge of the bed & turn to the affected side.
o Instill prescribed medication on the nares.
o Let Patient remain in the same position for a few minutes to
prevent the solution from escaping.

SUPPOSITORIES
99 Medication that is inserted into a body cavity & that melts at body
temperature.
100Has to be frozen or refrigerated before use.
101Rectal Insertion:
o Place the Patient on Sims Position.
o Push the suppository into the Rectal Mucosa up to 2 inches.

102Vaginal Insertion:
o Have the Patient lie on a Dorsal Recumbent Position.
o Push the suppository approximately 1-2 inches into the Vaginal
Canal.