Here’s something useful for new nurses — a guide to medications for nurses. A nurse’s shift never ends without preparing and giving medications to patients. For this reason, mastering every little detail about medication preparation and administration is essential in improving your skill competency as a nurse.
To help you with this endeavor, here’s your complete guide in giving medications.
Types of Drug Preparations
Medications come in different kinds and forms. Here are the most common types of drug preparations.
• Tablet – a powdered drug preparation compressed into a hard disc.
• Capsule – a powdered or gel-type drug enclosed in a gelatinous container.
• Sustained-release – a tablet formulated with special coating to allow controlled-release of the drug in the digestive tract.
• Suspension – one or a combination of two or more drugs dissolved in water.
• Syrup – a drug dissolved in thick and sweet solution to mask unpleasant taste.
• Liquid – liquid drugs for parenteral administration are stored in ampoules, vials, IV bags, prefilled syringes and cartridges. They need to be diluted or reconstituted before administration.
• Lyophilized – lyophilized drugs are stored in cartridges, vials, prefilled mixing systems and dual-chamber syringes. These drugs are freeze-dried and needed to be reconstituted before administration.
• Gel – a sticky substance that liquefies upon skin contact.
• Cream – combination of oil and water in equal proportions that penetrates the stratus corneum well.
• Ointment – combination of 80% oil and 20% water. Ointments are effective against moisture loss.
• Transdermal patch – a semi-permeable membrane that sticks on skin well for controlled release of enclosed drug into the skin.
Also Read: 12 Pharmacology Flashcards for Nurses
Routes of Administration
Drugs are given in varied ways to maximize effectiveness and efficiency. Here are the most commonly used routes of administration when giving medicines to patients:
• Per orem
This is the simplest and most common route of medication administration. The patient will just need to take the drug by mouth and ingest it.
A pill or a small tablet needs to be dissolved under the tongue or between the cheeks for immediate absorption and effect.
• IV push
A parenteral drug preparation needs to be reconstituted to be administered directly to the vein or to the IV line. Not all parenteral drugs can be given through IV push and some preparations need to be administered slowly. Read the drug’s literature well before giving it through IV push.
• IV infusion
A drug is reconstituted to a 100-1000 ml of saline or any other ordered parenteral fluid. The reconstituted drug is prepared to be infused at an ordered rate per hour through an IV pump. It is usually hooked as a side drip in a mainline.
• Subcutaneous injection
A small needle is used to administer the drug into the subcutaneous tissue. The syringe is tilted in a 45 degree angle to successfully inject the drug into the fatty layer of the skin.
• Intramuscular injection
The drug is given into the muscle. The syringe is tilted in a 90 degree angle to inject the medication directly to the muscle.
• Intradermal injection
The drug is given just underneath the skin layer. The syringe is tilted in a 15 degree angle to inject the drug directly under the skin. A small bleb should be formed as a sign of successful administration.
The transdermal route enables drug absorption in the skin. The medication, in liquid form, is encased in an adhesive patch with semi-permeable membrane. By sticking the adhesive patch into the skin, the medication is absorbed transdermally.
8 Rights of Medication Administration
In discussing medications for nurses, ensuring patient’s safety is always a priority. Here are the eight “rights” that you need to remember when giving medications to your patients:
1. Right Patient
Check the patient’s name in the doctor’s order. Use two identifiers in verifying the patient’s name – ask the patient to state his/her name and check the patient’s ID bracelet.
2. Right Medication
Check the medication in the doctor’s order and read the medication’s label.
3. Right Dose
Check the prescribed drug dose from the doctor’s order. Using a drug guide, check the ordered dose if within recommended standards. If you need to calculate the desired dosage, have another nurse double-check your calculated dosage.
4. Right Route
Check the ordered route of administration from the doctor’s order and evaluate if it’s appropriate with the drug’s preparation. Validate if the patient is capable of taking or receiving the medication by the physician’s ordered route.
5. Right Time
Confirm the frequency of the ordered medication from the doctor’s order. Check when the last dose was given from the patient’s medication sheet. Before giving the medication, double-check your watch as a precautionary measure.
6. Right Reason
Validate the rationale for the ordered medication. Evaluate the benefits of the drug versus its side-effects.
7. Right response
Evaluate if the given medication elicited its desired effects to the patient. Did the anti-hypertensive medication given lower the patient’s blood pressure? Did the patient have improved breathing patterns with the bronchodilator you gave?
If the desired effects of the drug given was not achieved, you need to report it to the patient’s doctor for proper management.
8. Right Documentation
Document the medication administration right after giving the ordered drug. Record the name of the drug given, route of administration and time it was given.
If there is any other important information related to the drug given like vital signs or laboratory result that needed to be checked prior to administration, record them as well.
A Few More Reminders
When giving an unfamiliar medication, it is best to read a drug handbook first before administration. Check for drug incompatibilities especially when giving it through the intravenous route.
This is important because some parenteral medications are not compatible to be administered in an IV line with ongoing drug incorporation. In cases such as these, you might need to start another IV line.
• Crushing medications
Pediatric and geriatric patients usually have difficulty swallowing medications. Before crushing drugs and mixing them in applesauce, make sure that this practice is not contraindicated to the drug’s efficacy.
Sustained-release tablets, chemo drugs and capsules should NOT be crushed as their efficacy can be altered.
With this guide to medications for nurses, are you now more confident and knowledgeable in giving medications to your patients? To enrich your knowledge every day, develop the habit of reading the drug handbook for every new medication you are about to give. Arming yourself with the right knowledge is your best protection against the possibility of committing medication errors in the future.