ADMINISTRATION OF THERAPEUTIC AGENTS

Introduction:

The administration of medicine is a grave responsibility entrusted to the nurse. The doctor by
written order will indicate the drug name, amount of the drug per dose, the drug form (tablets,
capsules, etc.), the route by which to administer the drug and the frequency or number of times a
day the drug is to be taken. However, the nurse is expected to carry out these orders intelligently,
promptly and with extreme accuracy.

Definition: Medication is the administration of a substance for the diagnosis, cure,

treatment, relief or prevention of diseases.

The nurse is expected to take into consideration the following:

1. The general principles related to drug administration.

2. The various types of drugs and their uses.
3. The minimum and maximum dosage of drugs.
4. The most effective means of administration and its expected effect.
5. Signs and symptoms which would indicate patient’s idiosyncrasy or allergy.
6. Various factors such as weight, health status, age, surgery, diagnostic procedure,
chemotherapy which must be considered in determining the method and time of
administration of drugs.
7. Those factors such as genetics, environmental, drug interaction, weight, etc. which may
modify the drug action.
8. The nurse should also know the new drugs which are continually appearing in the
market.

GENERAL INFORMATION ABOUT DRUG ADMINISTRATION:

1. Doctors should order in writing the name of the drug, amount, time and frequency of giving
as well as the method of administration.
2. Verbal orders should be accepted only in extreme emergencies. A written order must be
obtained as soon as the emergency has been controlled.
3. If a physician orders a drug over the telephone, a registered nurse must take down the
information. On the next visit, the physician signs the written record of the verbal order.
4. The nurse should inform the doctor of any known patient’s allergies.
5. The nurse should recognize commonly used abbreviations and symbols utilized in medication
administration.
6. The nurse should bear in mind that accuracy in the measurement of drugs is vital especially
in pediatric doses where a relatively small error become magnified.
7. The nurse should know the usual therapeutic as well as side effects of each drug.
8. The physician must be notified immediately in case of error.
9. The nurse should question an order which in her judgment is erroneous. She
should tactfully clarify the order with the physician who made it.
10. The nurse should be knowledgeable of the patient’s diagnosis or tentative
diagnosis.
11. Each type of drug preparation usually requires a specific method of administration.
 12. The route of administration of the drug affects the optimal dosage of the drug. (Optimal
(Optimal dosage of drugs administered by injection may be different from those
administered orally.)
13. The safe administration of medication requires a knowledge of anatomy and physiology as
well as knowledge of the drug and the reason it has been prescribed.
14. The method of administration of drug is partially determined by the age of the patient, level
of consciousness and the disease process. Any difficulties encountered when administering
medicines should be reported.
15. Appropriate precautionary measures should be considered to avoid errors and accidents in
the preparation and the administration of therapeutic agents.
16. Physiologic activities of the body can be maintained, improved or in some instances restored
by the administration of therapeutic agents.
17. Persons vary in the way they metabolize injected or ingested agents or the way they react to
agents applied externally.
18. Each patient has his own needs for explanations and support with respect to the
administration of medicines. Some people want to know about their medicines, others prefer
not to. The amount of knowledge that a person requires is dependent upon individual
circumstances.

ROUTES OF ADMINISTRATION OF THERAPEUTIC AGENTS:

How therapeutic agent is administered Term Used to Describe the Route

(Route)
1. Having patient swallow Oral Administration
2. Placing therapeutic agent under the tongue. Sublingual administration
3. Having patient inhale the therapeutic agent. Inhalation
4. Inserting therapeutic agent into:
1. Vaginal administration
1. vagina
2. Rectal administration
2. rectum
5. Placing the therapeutic agent on the skin. Topical Application
6. Dropping therapeutic agent into the mucous Instillation
membrane.
7. Flushing mucous membrane with large Irrigation
amounts of the therapeutic agent.
8. Injecting therapeutic agent into the: Parenteral Administration

a. Corium a. Intracutaneous or intradermal injection

b. Subcutaneous tissue b. Hypodermic/subcutaneous injection
c. Muscle tissue c. Intramuscular injection
d. Vein d. Intravenous injection
e. Subarachnoid space of spinal canal e. Intrathecal or Intraspinal
f. Peritoneal cavity f. Intraperitoneal
g. Heart g. Intracardiac
h. Cavity of a joint h. Intra–articular
 GENERAL RULES IN THE ADMINISTRATION OF MEDICINES

1. Observe the “ten rights” (Joyce Kee) in giving each medication:

1.1 the right patient 1.6 the right dose
1.2 the right drug 1.7 the right time
1.3 the right route 1.8 the patient’s right to education
1.4 the right assessment 1.9 the right evaluation
1.5 the right documentation 1.10 the patient’s right to refuse

2. Consult the clinical instructor or the head nurse if a written order is not clear as to
meaning, not legible or not signed by the doctor.
3. Wash hands thoroughly before measuring and preparing medication.
4. Make certain that all equipment are clean.
5. When giving pills or tablets, place in proper container directly from the bottle. Do not touch
them with your hands.
6. Determine if medication is to be delayed or omitted for a specific length of time, as for x – ray
examination or basal metabolic test, blood chem, and/or in cases where the drug/s can
adversely affect the patient’s vital signs or condition.
7. Never leave the medicine cabinet unlocked. Never leave your cart or medicine tray out of your
sight.
8. Do not return to stock any excess medicine or medicine refused by a patient.
9. Do not use a drug which is discolored, has precipitated, is contaminated or outdated.
10. Provide drinking straws for irritating drugs and for those likely to stain the teeth e.g. iodine
and iron preparation.
11. Do not pour a drug from one bottle to another.
12. Never give two or more drugs at one time, unless ordered.
13. Do not permit a patient to carry medicine to another patient.
14. Know the minimum and maximum doses for the medication being given.
15. Report immediately to the CI or nurse- in- charge any error in medication.
16. Always provide a glass of fresh water to the patient immediately after giving an oral
medication, unless water is contraindicated.
17. The nurse who prepares a medicine should also give it and do the necessary recording.
18. Recap needles using the fish-hook technique, (Infection Control) if necessary.
19. Enteric coated drugs should never be powdered or crushed before administration.
20. Buccal and sublingual medication should be allowed to dissolved completely before the patient
drinks or eats.
21. Suspension and emulsion should be immediately administered after shaking and pouring in the
bottle.
22. Cough syrups are never diluted and followed up with water.
23. Sedatives are given with warm milk to increase or hasten desired effect of drug when not
contraindicated.
24. Never use milk or any juice to mark the taste of the medicine to a child for she/he may develop
unpleasant association and refuse them in the future.

Rules in Measuring Medication

1. Measure the exact amount of drug ordered with a calibrated equipment.

2. Do not converse with anyone while preparing a medication.
3. Ensure adequate lighting.
4. Make sure that the medicine glass is dry before pouring or measuring a medication.
5. Cleanse the mouth of every bottle after use and before replacing the cap..
6. Hold the medicine glass at eye level and place thumb nail of the hand holding the glass at the
level of the scale of the desired fluid volume
7. Measure accurately liquid medication. Check that the scale is even with the fluid level at its
surface or base of meniscus
8. Use of dropper: The size of the drops varies according to the size of the dose in the medicine
dropper , the angle at which the dropper is held and the viscosity of the liquid.
Use of syringe: Draw up small volumes (less than 10 ml) with syringe without needle, unless
drug has its own specific measuring device.

Rules Regarding Labels

1. Give medication only from clearly labeled containers.

2. For each dose of medicine prepared, read the label three times: before/after locating the bottle
from the medicine box, before preparing the desired amount of drug and before returning the
bottle to the medicine box.

A. Oral
1. Liquids – after locating the bottles from the medicine box, before preparing the
desired amount of drug and before returning the bottle to the medicine
box.
2. Tablet, Pills and Capsules – after locating the tablet/pills/capsules from the medicine
box; before placing in the medicine glass and before opening the unit pack.

B. Parenteral – after locating in the vial/ampule; before withdrawing the medicine

from vial/ampule and after withdrawing the medicine from vial/ampule.
3. Never give a drug with an effaced label and from an unmarked bottle or box.
4. Pour medicine from the bottle on the side opposite the label.
5. Labels on medicine containers should be changed only by the pharmacist.
6. If a drug has two commonly used names, both names should appear in the label.
7. Take note of the expiry date marked on the label.
Rules for Giving Medications

1. Give the medication within 30 minutes before or after the schedule for which it is ordered.
2. Always identify the patient before giving the medication.
3. If the medication is refused or cannot be administered, notify the CI /head nurse, and record
accordingly on the patient’s chart.
4. Remain at the bedside until the patient has taken the medicine.
5. Administer only those medicines which you have prepared.
6. Never give two drugs together, unless specifically ordered to do so. Different drugs taken at
the same time may form a chemical compound that can be injurious to the patient or will render
the drug inactive or less effective.
7. When a patient goes to the Operating Room, all orders for medication are automatically
 discontinued. New orders for post – operative medications will be written by the doctor.
8. When special tests are being done, medications due at the particular time are omitted. They are
resumed when next dose is due. (This is true of BID, TID, QID orders, etc.). Medications given
once a day are also administered.
9. Nurses should listen carefully to the patient who questions the addition or deletion of a
medication. If a patient questions the drug or dose you prepared to administer, recheck the
order.
10. Medicine ticket for Stat order should be torn halfway after the drug is administered. Inform
NOD.

Rules for Recording Drugs Administered

1. Record if an ordered medication is refused and if it cannot be administered for whatever reason.
2. Record each dose of medicine soon after it is administered.
3. Use standard abbreviations in recording medications.
4. Never record medication before it has been administered.
5. Record only those medicines which you have administered.
6. Record time, kind, dose and route of drug given.
7. Record effect (beneficial or untoward) of medication.
8. Affix your initials on the appropriate space of the medication sheet for those medications you
actually have administered. If delayed or first dose of drug is to be given, indicate the time
above your initial

TEN COMMANDMENTS:
1. Thou shalt know thy drug.
2. Thou shalt read the label three times.
3. Thou shalt clarify thy doubts.
4. Thou shalt measure the drug accurately.
5. Thou shalt only think of what thou art doing.
6. Thou shalt use the medication ticket always.
7. Thou shalt give the drug promptly.
8. Thou shalt give the drug to the right patient.
9. Thou shalt report errors promptly.
10. Thou shalt chart only what thou hath given.

ORAL MEDICATION

Oral administration of drugs is generally the safest, most convenient, and the least
expensive. Drugs for oral administration are available in many different forms: tablets, enteric
coated tablets, capsules, syrups, emulsion, elixirs, oils, suspensions, powders, and granules.

Oral drugs are sometimes prescribed in higher dosage than their parenteral equivalents
because after absorption through the gastrointestinal system, they are immediately broken down
by the liver before they reach the systemic circulation. Nausea, vomiting, inability to swallow and
unconsciousness may contraindicate oral administration.
Purpose: To prepare and administer oral medication safely and accurately so that
patient may receive maximum therapeutic effectiveness from them.

Equipment: OPTIONAL:
1. Medicine/s 10. Spoons as required
2. Medicine ticket/s 11. Mortar and pestle
3. Medicine tray 12. Stirring rod if powder is used
4. Medicine glasses 13. Tongue depressor
5. Medicine dropper/s 14. Drinking straws
6. Syringe/s
7. Glass of water
8. Paper wipes
9. Waste receptacle

Procedure
Action Principles
1. Locate the corresponding medication The source of the order is more reliable than
ticket due for the shift and compare it the medication tickets which are only a devices
with the doctor’s order. for convenience.
2. Check for history of allergies. Fill up This ensures that no patient is given a
the medication booklet. medication containing an ingredient to which
the patient is allergic.
3. Arrange the ticket/s automatically Organization and planning result in economy
either by the location of the patients of time and effort and minimize confusion.
or by some other factors.
4. Wash your hands. Prevent spread of microorganisms.
5. Bring requisites to preparation area. Broken rim of the medicine glass can injure or
Check the medicine glass to ensure damage the mucous membrane of the patient’s
that the rim is not broken. mouth or lips.

6. Take one medicine ticket at a time, For organization of work, avoidance of

locate medicine in the box, read and confusion, and ensures safety of patient.
compare label against the medicine
ticket. Note also the expiration date.
Remove the medicine from the box.
7. Before pouring or getting the
Proper checking ensures correct drug is
prescribed dose; compare name of
prepared.
drug on the label with name of drug
on medicine ticket.
8. Pour or prepare prescribed dosage of
medicine in glass as follows:
LIQUIDS
a. Shake bottle if necessary
To mix the drug well and obtain the right dose.
(suspensions, granules).
Avoid contamination.
b. Remove cap and place it upside
down on the counter.
For accurate measurement.
c. Hold medicine glass with the
non-dominant, with the
thumbnail, marking the level of
the prescribed amount. Read at
eye level using the lower
meniscus.
To ensure that label is intact and could be read.
d. Hold bottle with the dominant
hand with label facing up. Pour
the exact prescribed amount. Ants and other insects may feast on the liquid
that is left.
e. Wipe rim of bottle with paper
towel. Replace the cap.
TABLETS, PILLS, CAPSULES
a. Using the index finger of the
dominant hand, gently tap the
bottle to allow the prescribed
number of medicine into the
bottle cover.
If in a box, tap the prescribed
number into a dry medicine glass.
The wrapper keeps the medication clean and
b. Place packaged dose or unit-dose facilitates identification. When not used, it
capsules or tablets directly into could be returned to the medication box.
the medicine cup. Do not remove
the medication from the wrapper
until at the bedside.

POWDERS
a. Shake powder from its base.

b. Add required amount of water to

powder in its container and
shake until thoroughly
dissolved.

DROPS
a. Before inserting the medicine
 dropper into the bottle, press the
rubber and draw up the prescribed
amount at eye level.
b. Place the dropper (with medicine)
inside the medicine glass.

EFFERVESCENT TABLET
a. Read the instructions for
preparation on the label.
b. Pour in a glass the amount of
water required and drop the
effervescent tablet
c. Allow tablet to dissolve completely.
9. When through with medicine Frequent checking ensures the proper
preparation, place ticket and observance of the safeguards in drug
medicine on the tray according to the administration.
hospital protocol.

10. Read again the label on medicine and If drugs are spilled or refused, positive
check against medicine ticket before identification as to name and amount can be
returning the drug/ container to the made.
medicine box.
11. Complete the preparation until all Keeping drugs identified ensures proper
medicines and tickets are on the tray. administration of the correct drug to the correct
See to it that each medication is in a patient.
separate container.
12. Keep medication ticket and drug Ensures accuracy of the prepared medication.
together at all times.

13. Have the CI or nurse check the

prepared medicines. Also, present the
filled up medication booklet for her
signature.
14. While transporting medication to the Careful handling and close observation prevent
patient’s bedside, carefully hold the accidental or deliberate disarrangement of
tray in front and at waist level. medications.
15. At each patient’s bedside:
a. Identify patient before giving Ensures proper identification of patient
medicine. Check the medication consider that illness and strange surroundings
ticket, ask the patient to state his often cause patient to be confused.
name. If the patient is a child, ask
 the parents to tell you the name of
the child.
b. Perform any assessment Provides data if the medication should be
necessary prior to giving certain given.
medication (e.g get BP before
giving Nifedipine, Methergin or
get heart rate (HR) before giving
Digoxin . Record result in the
jotdown notebook.
c. Assist patient to sitting or high Prevents aspiration and promotes swallowing
Fowler’s position if necessary. of medication.
d. Give the prepared medicine. If Consider patient’s right to be beard and thus,
the patient expresses doubt about prevent error medication.
the medication, always recheck
the order, drug label, and dosage
stated in the container.
e. Pour drinking water and hand to Cough syrup is intended to have a soothing
the patient (if not effect in the mucous membrane of the throat.
contraindicated. Cough syrup is
not followed by water).
f. Stay at bedside until patient has The presence of the nurse will encourage the
taken the medicine. patient to swallow the medicine. Unless the
nurse has seen that the medicine has been
taken, it cannot be recorded that the drug was
administered .
g. Offer additional fluids as Fluids facilitate swallowing it helps dissolve
necessary. and dilute solid drugs.
h. Turn medicine ticket after each Ensures that medicine has been given
medication .

16. Repeat all steps until all medicines in

tray are given.

17. Return medicine tickets to the place Careful management of medication tickets
provided for them. reduce the possibility of error and losses.
18. Wash all equipment used, dry and To deter the spread of microorganism
return to their proper place. Wash
hands.
19. Immediately record the medications Immediate recording prevents the possibility
given. of accidentally repeating administration of the
a. Affix initial on medication sheet drug.
the patient’s chart.
b. Document on the nurse’s notes.
Include also special factors related
to oral administration (eg. NGT
 clamped following administration)
in addition to the usual factors
charted.

SAN PEDRO COLLEGE

Davao City

PERFORMANCE CHECKLIST
ADMINISTRATION OF MEDICINE BY MOUTH

Name: ________________________________ Grade: ____________________

Year and Sec. _________________ Date : ____________________

Legend: 5 – Excellent; 4 – Very good 3 – Good; 2 – Fair; 1 – Poor

Rating

5 4 3 2 1
1. Checks physician’s orders and finds the corresponding
medication tickets.
2. Arranges the tickets in order in the medication tray.

3. Washes hands.

4. Brings requisites to preparation area.

5. Takes one medicine ticket at a time.

6. Reads first the ticket, locates medicine in the box, reads
label and notes also the expiration date. Removes
medicine from the box.
7. Compares name of drug on label with name of drug on
medicine ticket.
8. Pours or prepares prescribed dosage of medicine in glass
as follows:
 Liquids / Suspension:
a. Shakes bottle if necessary
b. Removes cap and places it upside down on the
counter.

c. Holds medicine glass at eye level.

d. Places thumb on prescribed level and reads it at the
lower meniscus.
e. Pours the exact amount of medicine prescribed into
the medicine glass.
f. Wipes rim of bottle with tissue paper and replaces
cap.
Tablets, Pills, Capsules:
a. If in a bottle, gently shakes the prescribed number
into the bottle cover.
b. If in a box, shakes prescribed number into the
medicine glass.
9. Rechecks label of medicine and dosage with the medicine
ticket before returning to its medicine box.
10. Places ticket with corresponding medicine on tray.
11. Takes each remaining ticket in turn until all medicines
and tickets are on the tray.
12. Places each medicine in a separate container.

13. Keeps medication ticket and drug together at all times.

14. Presents prepared medicines and medication booklet to
CI for checking.
15. Transports medications to the patient’s bedside carefully
and keeps the medication tray in sight at all times.
16. At each patient’s bedside:
a. Identifies patient by asking patient to state his
name or by checking the wrist band against the
medication ticket.

b. Assists patient to sit or be in comfortable

position.
c. Hands medicine to patient.
d. Hands drinking water to patient (if not
contraindicated).
e. Stays at bedside until patient takes the medicine.
 Makes patient comfortable.
f. Turns medicine ticket to show that medicine has
been given.
17. Returns medicine tickets to the place provided for them.
18. After care of equipment: Soaps, rinses, and dries
equipment used and returns to proper places.
19. A. Initials the medication sheet to the corresponding
drug, time, and date.
B. On the nurse’s notes, documents the:
b. 1 drug, dose, time, route given

b. 2 significant symptoms in relation to drug/s.

b. 3 drug/s that have not been given and reason for
omission.
b. 4 Signature
20. Maintains body mechanics throughout the performance
of the procedure.
21. Manifests neatness in the performed procedure.

22. Receptive to criticisms.

23. Observes courtesy.

24. Shows calmness while performing the procedure.
25. Uses correct English.

26. Shows mastery of the procedure.

Remarks:

Criteria : I Knowledge (quiz) 30%

II Performance 70%
100%
________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date