Purpose Diagnosis Cure Treatment of symptoms Relief of symptoms Prevention of disease

Generic name – given before a drug becomes official

Official name – name under which it is listed in one of the official publications

Chemical name – name by which a chemist knows it; name describes the constituents of the drug precisely

Trademark or brand name – name given by the drug manufacturer

Absorption - way medication enters the blood stream

Distribution – transportation of a drug from its site of absorption to its site of action

Metabolism – liver break down to less active form; drug is converted to a less active form

Excretion – elimination from body

Therapeutic Effect or desired effect• The reason the drug is prescribed

Side Effect or secondary effect – unintended; usually predictable may be harmless or potentially harmful

Adverse Effect – side effects that are not tolerated

Idiosyncratic – unexpected & individual

Patient name Time/Date order written Name of medication Dosage of medication Frequency of dose Route Signature

Stat – immediately• Demerol 50mg IV now

Single order/one time only – given once at a specific time• Demerol 50mg IV at 0800

Standing – carried out indefinitely • Demerol 50mg IV q8h• Demerol 50mg IV q8h x 4days

PRN – as needed order • Demerol 50mg IV q4h prn

ac – before meals bid – twice a day h – hour hs – at bedtime pc – after meals q – every qid – four times a

day tid – three times

a day

IM intramuscular

IV intravenous sq subcutaneous q2h every 2

hours NPO nothing by

mouth OD right eye OS left eye OU both eyes

“U” – (unit) – Mistaken for zero: write out unit

“IU” – International Unit – Mistaken for “IV”

“Q.D” “QD” “q.d.” “qd” – Daily “Q.O.D.” “QOD” “q.o.d.” “qod” – every

other day Relating to ears – AU, AS, AD D/C – discharge or discontinue Qhs – at bedtime, hours of sleep Ss – sliding scale vs one half

Trailing zero – X.0mg – write X mg Lack of leading zero - .X mg write

0.X mg Decimal points are missed “cc” – use “ml” or “milliliters” Abbreviations for drugs due to

similar abbreviations for multiple drugs

The use of “/” write per

Right patient Right medication Right dose Right route Right time Right documentation

Clarify any inappropriate/unclear orders

Follow patient rights

Do not administer medication from an unlabeled container

Do not prepare medications and not give them

Do not leave medications at the bedside – exceptions, nitro tabs, inhalers

Verify for accuracy – insulin and anticoagulants

Do not administer medication prepared by another nurse

Check or scan patient wrist band with MAR before administration

If patient questions medication – verify order

Identify the patient – watch for similar names

Inform the patient – explain purpose of medications, potential side effects

Administer the medication – Use appropriate interventions Document medication Evaluate patient response

Decreased vision/manual dexterity Decreased renal function Slower absorption in GI tract Decreased liver function Increased proportion of fat to lean

body mass Increases the chances of

cumulative effects and toxicity

Oral Sublingual Buccal Parenteral

•Subcutaneous•Intramuscular•Intradermal•Intravenous

Topical•Transdermal•Inhalation•Ophthalmic•Otic•Nasal

Rectal Vaginal

Most common route Assess patient’s ability to swallow Tablets or capsules – do not crush

enteric coated, cut only scored tablets

Liquid medications – pour medications away from the label

Sublingual/Buccal – directly enters bloodstream, bypass liver

Assess patency of NG tube, Dob-Hoff tubes are not used for medication administration.

If to suction, turn suction off Verify tube placement, aspiration or

auscultation Flush tube with 15-30 ml of water Dissolve medications in warm water Slowly administer medications through

tube Flush tube –assuring administration Leave suction off for 30 minutes Record water used for flush/administration

on Intake report

Tube placed through abdominal wall If to feeding, place on hold Check residual by aspiration. Flush tube with 15-30 ml of water Dissolve medications in warm water Slowly administer medications

through tube Flush tube –assuring administration Resume feedings Record water used for

flush/administration on Intake report

Provides local effect Dermatological- applied to skin Installations/Irrigations – urinary

bladder, ears, eyes, nose, rectum, vagina

Inhalations – into the respiratory system

Prolonged systemic affect Patches- nitroglycerine, estrogen,

nicotine Apply to clean area of skin Each application to a different site May cause localized, redness, itching Wear gloves when applying to avoid

receiving the medication

Administered by irrigation or installation

Drops or ointment Clean eye from inner canthus

to outer Medication is placed in the

lower conjuctival sac

Installation or irrigation Softening of wax to ease with

removal Reduce inflammation/infection Aseptic technique Sterile technique if eardrum is

perforated

Drops or spray Shrink swollen membranes Loosen secretions to facilitate

drainage Treat infections Chronic use of decongestants-

rebound effect

Inhalation Nebulizers- delivered by a

fine spray MDI- metered dose inhaler Rapid localized relief

Provides local therapeutic effect Treat infections & vaginal discomfort Foams, creams, suppositories Medical aseptic technique is used Application:

• Tubular applicator with a plunger (2in)• Suppositories inserted with the index finger

of a gloved hand (3-4in) Patient to remain supine for approx

5-10minutes

Suppositories Insert approx 4 inches Left lateral/supine for 5-10

minutes Retain for 30-40minutes Medication released at a

slow steady rate

Intramuscular (IM)• Ventrogluteal, vastus lateralis,

dorsogluteal, deltoid • Gauge and needle size depend on

amount of solution, muscle to be used, condition of patient

Ampule – Glass, unit dose, draw up using filter needle then change to injection needle, do not inject air into ampule

Vial – Rubber seal, unit or multiple dose, clean top prior to withdrawing medication, inject air into vial equal to the amount to be withdrawn

Reconstitution – adding of sterile water or sterile normal saline

Mixing Medications – if compatible

Use if volume is 0.5 - 1 cc, but not more than 1 ml. Use a 23 -25 gauge, 1 inch needle.

Client may be positioned sitting, standing, supine, or prone.

Locate site by measuring 2–3 fingerbreadths below the acromion process on the lateral midline of the arm.

Use if volume is 1 - 3 cc, but less than 4 cc. Use a 20 - 23 gauge, 1-1/2 inch needle.

Position client in side-lying or supine position, with knee flexed on injection side,

Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter. Administer medication above imaginary line at midpoint.

Use if volume is 1 - 3 cc. Use a 20 - 23 gauge, 1-1/2 inch needle

This is the preferred site for adults

Position client in supine, prone, lateral position.

Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger (forming a "V"). Injection of medication is given within the "V" area.

Use 22–25 gauge, 5/8–1 inch needle.

Position client in supine or sitting position.

Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the middle third and anterior lateral aspect of the thigh.

Subcutaneous(SQ) – Ex. Insulin• #25 gauge, 3/8 or 5/8-inch needle, 2ml syring,

inserted at either a 45 degree or 90 degree angle.• Site: Abdomen, upper arm, thigh• Sites rotated to avoid tissue damage, aid

absorption Intradermal (ID) – Ex. TB

• #25-#27guage needle, ¼ to 5/8 inch needle; insert at a 5 to 15 degree angle, bevel up

• Medication forms a bleb under the epidermis (small wheal on the skin)

• Site: inner lower arm, the upper chest, & the back beneath the scapulae

Figure 33-35

Mixing two types of insulin

Enter directly into blood stream –rapid effect

Large Volume – 500-1,000 ml Intermittent – piggy back IV push (IVP) – verify rate of

infusion Assess IV site, redness, swelling, s/s

infection, Verify IV patency prior to

administering IV medications All IV fluids must be labeled

Infection – (catheter related) – sepsis Air embolism – introduction of air

during administration•S/S respiratory distress, chest pain, hypotension, weak rapid pulse

Infiltration – seepage of fluid into surrounding tissue•S/S swelling coolness, discomfort