Patient Rights

1. Right Drug.

● Check and verify if it’s the right name and form.

● Beware of look-alike and sound-alike medication names: is a common
mistake, sound-alike medication can lead to errors associated with verbal
prescriptions.

2. Right Patient.

Ask the name of the client and check his/her ID band before giving the medication. Even
if you know that patient’s name, you still need to ask just to verify.

3. Right Dose.

Check the medication sheet and the doctor’s order before medicating. Be aware of the
difference between an adult and a pediatric dose.

4. Right Route.

Check the order if it’s oral, IV, SQ, IM.

5. Right Time and Frequency.

Check the order for when it would be given and when was the last time it was given.

6. Right Documentation.

Make sure to right the time and any remarks on the chart correctly.

7. Right History and Assessment.

Secure a copy of the client’s history to ​drug interactions and allergies​.

8. Drug approach and Right to Refuse

 9. Right Drug-Drug Interaction and Evaluation.

Review any medications previously given or the diet of the patient that can yield a bad
interaction to the drug to be given. Check also the expiry date of the medication being
given.

10. Right Education and Information.

Provide enough knowledge to the patient of what drug he/she would be taking and
what are the expected therapeutic and side effects.

Drug Administration

Drug- and patient-related factors determine the selection of routes for drug
administration:
1. Characteristics of the drug.
2. Emergency/routine use.
3. Site of action of the drug—local or systemic.
4. Condition of the patient (unconscious, vomiting, diarrhoea).
5. Age of the patient.
6. Effect of gastric pH, digestive enzymes and first-pass metabolism.
7. Patient’s/doctor’s choice (sometimes).

Routes of Medication Administration

● Oral Route:​ such as tablet, capsule, and syrup.
● Make sure that the individual is in an upright and sitting
position.
● Make sure that the individual is completely alert when giving
medications.
● Stay with the individual to make sure that all medication has
been taken and swallowed.
 ● Some individuals need to have their medication put into food
or liquid to help them to swallow it. Always check with the pharmacist
before crushing or mixing.
● Never leave medications lying around.

Liquid medications:
● Shake the bottle well before giving liquid medications.
● Measure carefully using an approved measuring device to
prevent the label from becoming soiled.
Advantages Disadvantages
● Safer. ● Not suitable for emergency as onset of
● Cheaper. action of orally administered drugs is slow t is not
● Painless. suitable for/in: highly irritant drugs, drugs
● Convenient for destroyed by digestive juices (e.g. insulin).
repeated and prolonged ● Unconscious patients.
use. ● Uncooperative and unreliable patients.
● Can be ● Patients with severe vomiting and diarrhea.
self-administered.

● Sublingual medications​ are placed under the tongue and buccal mucous
where they are left until they dissolve.
Advantages Disadvantages
● Quick onset of action. ● It is not suitable for:
● Bypasses rst-pass
Irritant and lipid-insoluble drugs.
metabolism.
Drugs with bad smell and taste.
● Self-administration is
possible.
 ● Intraocular: ​such as eye drops or eye ointment.
● Check the label
● Wear gloves.
● Clean inside part of the eye to the outer part of the eye.
● Ask the individual to sit with their head tilted back, looking
“up” or lying down on their back. Use your finger to gently pull the lower lid
down to form a “pocket”.
● Hold the drops or the ointment container between your
thumb and index finger and rest your hand against the individual’s forehead
to steady your hand.
● Do not touch the dropper to the eyeball gently squeeze the
drop(s) into the “pocket” that you have made with the lower lid.
● For eye ointment, gently squeeze the ointment from the inner
part of the “pocket” toward the outer part of the “pocket”.
● Otic medication: ​labeled as "otic" solutions or "otic" drops.
● Wear gloves.
● Ask the individual to tilt their head to the side or to lie down
on their side with the ear that you will be putting the ear drops into facing
up.
● Gently grasp the ear lobe and lift it slightly up and outward.
This helps to straighten the ear canal so that the drops can get in to do their
work.
● Do not touch the ear with the dropper. Gently squeeze the
dropper and allow the medication to flow into the ear canal.
● Ask the individual to keep their head tilted or to remain lying
on their side for 1-2 minutes to keep the medication from draining back out
of the ear.
● Inhalation
 ● Ask the individual to exhale deeply just before placing the
device into the mouth.
● Place the inhaler in the individual’s mouth and ask the
individual to breath in slowly and deeply as you push down on the top of the
inhaler canister to deliver a "puff" of medication.
● Ask the individual to hold the medication in for 5-10 seconds
with each puff.
● Assist the person to rinse out their mouth with water after
giving medications by inhaler.
Advantages Disadvantages
● Quick onset of action. ● Local irritation may cause
● Dose required is very less, so increased respiratory secretions
systemic toxicity is minimized. and bronchospasm
● Amount of drug administered
can be regulated.

● Topical medications
● Wear gloves.
● Gently clean the skin and dry before applying a topical
medication unless you have been specifically instructed not to.
● Gently apply the topical medication.
● Do not touch the medication container to the individual’s skin.
● Apply topical medications in a thin layer (unless otherwise
ordered) and only to the area(s) of the body indicated in the medication
order. Oral Route
● Rectal Route
Drugs can be given in the form of solid or liquid: Suppository, enema
The drug is absorbed through rectal mucous membrane and produces systemic effect,
e.g. diazepam for status epilepticus in children.
 ● Intravenous (I V) route​: Drugs are injected directly into the blood stream
through a vein. administered as:
1. Bolus: Single, relatively large dose of a drug injected rapidly or slowly as a single unit
into a vein. For example, iv ranitidine in bleeding peptic ulcer.
2. Slow intravenous injection: For example, iv morphine in myocardial infarction.
3. Intravenous infusion: For example, dopamine infusion in cardiogenic shock; mannitol
infusion in cerebral edema.

● Don gloves.
● Apply a tourniquet, locate the vein, prep the skin and insert the needle at a 30
degree angle with the bevel up.
● Lower the angle when you are in the vein.
● Check for blood backflow.
● Remove the tourniquet and slowly inject the medication at the ordered or
recommended rate.
● Withdraw the needle, cover the site with a gauze pad and pressure for 3
minutes.
● Place a bandage over the site.

Advantages ● Disadvantages

● Quick onset of action; ● Once the drug is injected,

therefore, it is the route of choice in its action cannot be halted.
emergency ● Local irritation may cause
● Large volume of uid can be phlebitis.
administered, e.g. intravenous uids ● Self-medication is not
in patients with severe dehydration. possible.
● Highly irritant drugs, e.g. ● Strict aseptic conditions
anticancer drugs can be given because are needed.
they get diluted in blood.
 ● Useful in: ● Extravasation of some
- Unconscious patient. drugs can cause injury, necrosis
- Uncooperative and unreliable and sloughing of tissues.
patients.
- Patients with vomiting and
diarrhea.

● Intradermal route​: The drug is injected into the layers of the skin. It is painful
and only a small amount (1ml) of the drug can be administered.
- Subcutaneous (SC) route​: The drug is injected into the subcutaneous tissues
of the thigh, abdomen and arm, e.g. adrenaline, insulin.
● Clean: There is debate around the use of alcohol-impregnated
swabs to clean injection sites. The World Health Organization suggested that
if a patient is physically clean and generally in good health, swabbing of the
skin before injection is not required. In older patients and those who are
immunocompromised, skin preparation using an alcohol-impregnated swab
(70% isopropyl alcohol) may be recommended.
● Free of infection, skin lesions, scars, birthmarks.
● A lifted skinfold technique (pinching or bunching the skin) can
be used to lift the subcutaneous layer away from the underlying muscle into
the muscle can lead to accelerated insulin absorption and lead to
hypoglycemia.
● Needle size
● Aspiration This is not recommended for subcutaneous
injections, as there are no major blood vessels in the subcutaneous tissue
and the risk of inadvertent intravenous administration is minimal.
Advantages Disadvantages
 ● Self-administration is ● It is suitable only for
possible (e.g. insulin). nonirritant drugs.
● Drug absorption is slow.

Intramuscular (i.m.) route​: Drugs are injected into large muscles such as deltoid, gluteus
Maximus and vastus lateralis, 5mL can be given at a time.
● Don gloves.
● Select the appropriate intramuscular injection site using bony landmarks.
● Position the client as indicated
● Clean the injection site with an alcohol swab in an outward circular pattern
of about 2inches around the selected site
● Position the needle with the bevel up and insert at a 90-degree angle.
● Pull the plunger back to check for blood. If blood appears withdraw the
needle and start again.
● Slowly inject the medication.
● Withdraw the needle and cover the site with an alcohol swab.
● Gently massage the site.
● Discard the needle and syringe in the proper container
Z Track Intramuscular Injections: ​special type of an intramuscular injection that is
used for example​ ​iron administration.
● Don gloves.
● Select the appropriate intramuscular injection site using bony landmarks.
● Position the client as indicated.
● Pull the skin over the selected site to the side.
● Inject the medication into the selected muscle.
● Release the skin.
● Do NOT massage the site if a dark solution like iron was administered.
Advantages Disadvantages
 ● Absorption is more rapid as
compared to oral route.
● Mild irritants, depot injections,
soluble substances and suspensions
can be given by this route.
● Aseptic conditions are needed.
● Intramuscular injections are
painful and may cause abscess.
● Self-administration is not
possible.
● There may be injury to the
nerves

Drug Dosage & IV Rates Calculations

Measurements

Kg– kilogram 1 Kg = 1000 g

gm– gram 1 Kg = 2.2 lbs
mg– milligram 1 L = 1000 mL
mcg– microgram 1 g = 1000 mg
mEq- milliequivalent 1 mg = 1000 mcg
L– liter 1 tsp = 5 mL
mL– milliliter 1 lb = 454 g
µg– microgram 1 tbsp = 15 mL
gtt – drop
µgtt – micro drop
tbsp – tablespoon
tsp – teaspoon

Drug dosage calculations are required when the amount of medication ordered (or
desired) is different from what is available on hand for the nurse to administer.

Amount DESIRED (D) /Amount on HAND (H) X QUANTITY (Q) = Y (Tablets Required
Note:​ When medication is given in tablets, the QUANTITY = 1 since the amount of
medication available is specified per (one) tablet.
Example 1:​ Toprol XL, 50 mg PO is ordered. Toprol XL is available as 100 mg per tablets.
How many tablets would the nurse administer?
Example 2: ​Doctor's order: Heparin 2,000 units subcutaneously Q 2hr, medication label:
5,000 units/mL How many milliliters will be administered for this patient?
Example 3​: The physician orders 375 mg of cefuroxime for the patient. The drug is
available in 750 mg vial. You plan to dilute it in 10 mL of sterile water. How much should
you give to your patient?

Example 4: ​A pediatric patient recovering from accidental fall is about to be given with
130 mg paracetamol syrup. The drug is available in 250 mg per 5 mL preparation. How
much should you give to your patient?

Calculation of Intravenous Drip Rates

Give medication
● Check doctor order.
● Review the patient's medical history and previous administration times,
medication allergies
● Wash hands with soap and warm water
● In the medication preparation area (may be in a secured room or in a
secured portion of the nurses' station), acquire the medication from a
medication dispensing device and complete the first safety check.
● Prepare the IV push medication according to best practices and
procedures.
● Open the medication box and pull out the medication vial. "Pop off" the
plastic cap on the top of the vial.
● Remove an alcohol wipe from the package and scrub the top of the
medication vial, with friction and intent.
● Open the syringe package using aseptic technique.
● Move the syringe between your dominant ring finger and middle finger
taking special care not to contaminate the syringe tip or the area of the plunger
that extends into the barrel by touching them to any surface or fingers.
 ● Withdraw the appropriate amount of fluid from the vial by drawing back
slowly on the syringe plunger until the "right" medication volume is obtained,
making sure that the needle tip is below the solution level at all times.
● If air bubbles are present, gently tap the syringe with your finger or a pen
to release the air bubbles and then eject the air.
● Set the vial down on the counter while holding the needle and syringe
upright in the air.
● Using tape or a pre-printed medication label (if available), write the
medication name and dosage amount on the label and place it on the syringe.
● Dispose of the empty medication vial in the sharps container, according
to institutional policies.
● Gather the necessary supplies, including an alcohol prep wipe,
non-sterile gloves, and two packages of 0.9% saline 5 or 10-mL syringe flushes.
● Enter patient's room.
● Before administrating the push, assess the peripheral IV insertion site for
redness, swelling, increased or decreased temperature, or bleeding.
● Leave the patient's room and wash hands.
● Document medication.