1. PHARMACOLOGICAL PERSPECTIVES
IN NURSE’S CONTEXTUALITIES

2. FIVE RIGHTS IN DRUG
ADMINISTRATION
 RIGHT DOSE
 The nurse
 Minimizes any forms of errors
 Checks the supply – UNIT DOSE or STOCK SUPPLY
 Requires two nurses to verify the medicine being administered
 RIGHT DRUG
 The nurse
 Compares the medicine card or unit dose recording form with
the physician’s order
 Compares the label three times
 Administers one has prepared

3. FIVE RIGHTS IN DRUG ADMINISTRATION
 RIGHT CLIENT
 The nurse
 Identifies the patient correctly
 RIGHT ROUTE
 Oral (Buccal or Sublingual)
 Parenteral

4. FIVE RIGHTS IN DRUG ADMINISTRATION
 RIGHT TIME
 The nurse must know why a medicine is ordered
for certain times of the day & whether the time can
be altered
 EXAMPLE: q8h and TID
 The q8h (every 8 hour) is intended for around the clock
 TID (three times a day) is given during waking hours (8 – 1 – 6)
 QID (8 – 12 – 4 – 6)
 Physician orders (stat, prn, single dose, standing)

5. FIVE RIGHTS IN DRUG ADMINISTRATION
 RIGHT ASSESSMENT
 RIGHT APPROACH
 RIGHT DOCUMENTATION
 RIGHT EVALUATION
 RIGHT TO CONSIDER THE CLIENT’S
REFUSAL TO TREATMENT OR
MEDICATION

6. ORAL MEDICATION
• Assessment – client’s knowledge, diet status, oral
cavity, ability to swallow
• Enteric coated not be crushed only the scored tablet
• Time release capsule contents may be mixed with
food
• SOLID MEDICATIONS
– All solid medications can be placed in one container unless
if one needs further assessment before administering
– Unit dose in original individual package
– Reduce chance of contamination – medicines into cap of
container, top side down, transfer to medicine cap and
replace lid and container

7. ORAL MEDICATION
• LIQUID MEDICATION
– Shake liquid medication
if necessary
– Pour away from liquid
bottle
– Do not administer alcohol
based products to
alcohol dependents
– Iron preparation with
straw

8. ORAL MEDICATIONS

9. ORAL MEDICATIONS
• Absorption is reduced by the presence of
food
• Dilute or dissolve irritating drugs to reduce
gastric irritation

10. ORAL MEDICATIONS
• INFANTS
– Use calibrated dropper, nipple or syringe
– Keep infant 45 degrees
– Not to use medicine as child’s favorite food or
punishment
– If using NGT, check for patency

11. VAGINAL INSTILLATIONS
Available as suppo, enema, foam,
jellies, creams
Individually packaged in foil wrappers
Foam, jellies, creams with inserter or
applicator; suppo with a gloved hand
Patient prefers to insert their own,
privacy needed SIMS POSITION
Perineal pads provided
Aseptic technique & perineal hygiene
RETRACT LABIA WITH
NON DOMINANT HAND
INSERT 2 – 3INCHES

12. RECTAL MEDICATION
 Differ in shape from V, thinner,
bullet shaped, rounded
SPECIAL ASSESSMENT
 Bowel function, ability to retain supp
or enem
 Supp from refrigerator
 Provide privacy
 Left lateral position
 Gloves or finger cot
 Lubricant
 Insert approx 2 inches, retain 10 –
20 minutes
 If enem retain 20 – 30 min

13. OTIC INSTILLATIONS
Internal ear structures
High sensitivity with extreme temperatures
Causes vertigo (severe dizziness)

14. OTIC MEDICATION
SPECIAL ASSESSMENT
 Warm meds in hands
 Don gloves
 Turn to unaffected side
 Clean outer ear
 Straighten ear canal by
pulling pinna UP & BACK
(ADULTS), DOWN & BACK
(CHILDREN > 3)
 Instill gtts along side w/o
touching ear
 Remain on side 5 – 10 min

15. OPTHALMIC APPLICATION
Eye drops, ointment, OTC artificial tears, vasoconstrictors
PRINCIPLES
Cornea is supplied with pain fibers
Risk of transmitting infection
Used only for affected eye
Never allows a person to use another’s eye medication

16. OPTHALMIC MEDICATION
 Check solution & warm in hands
 Lie on back or sit with head turned
to affected side
 Cleanse eyelid & eyelashes
 Have patient look up
 Assist patient in keeping eye open
by pulling down on cheekbone with
thumb or forefinger
 Lower conjunctiva near outer
canthus
 OINTMENT – Squeeze into lower
conjunctiva moving from inner to
outer canthus, do not touch eye with
applicator, have client blink 2-3
times
 Wipe any excess from inner to outer
canthus

17. NASAL INSTILLATION
Altered nasal sinuses
Spray, drops, tampons
(Decongestant spray)
Overuse Swallowed
REBOUND EFFECT SYSTEMIC EFFECTS

18. NOSE DROP MEDICATION
 Have patient blow nose
 Position patient – head is tilted
back or specific position to
expose sinuses
 Push up on tip of nostril
 Place dropper slightly upward
just inside the nostril not
touching nose with applicator
 Head tilted 5 minutes
 Instruct not to blow, drops may
produced unpleasant taste
SPECIAL CONCERNS
 (+) if patient begins to aspirates
& coughs?
 (+) if patient is infant?

19. INHALANTS
Deeper passages of respiratory tract
Vascular alveolar – capillary network
EASY ABSORPTION
Designed to produce LOCAL EFFECTS but have dangerous
SYSTEMIC EFFECTS
(Oxygen and general anesthetics)

20. METERD DOSE NEBULIZER

21. ORAL INHALER
METERED DOSE
INHALER

22. IRRIGATION
• Medications may be used to irrigate or wash
out body cavity & delivered thru a stream of
solution (sterile water, NSS, antiseptic)
• Eye, ear, throat, vagina & urinary tract
• Avoid further injury to the tissue
• Prevent transmission of infection
• Maintain patient’s comfort

23. PARENTERAL DRUG ADMINISTRATION
ADVANTAGES DISADVANTAGES
• More rapid absorption • Penetrates the first line of
and effect defense, the skin
• Effects are more • Danger of damaging
predictable nerves and blood vessels
• Desirable for patients • Pain might be present
who are irrational, • Possibility of abscess
unconscious on having GI formation
disturbances

24. PARENTERAL DR ADMINISTRATION
UG
SPECIAL CONSIDERATION
The size and type are determined by Know the volume of the drug
the type of medication and amount
to be injected Characteristics
The size of the needle is determined Viscosity
by the route of administration, size, Anatomical structures or
age landmarks
Surgical asepsis
Position of comfort
No way of protecting unused
medication
Ice application prior
Rotate sites Divert client attention
Do not mixed
Assess if you need assistance –
restraining or turning
Countercheck

25. VIAL – single or multiple dose glass container with a rubber seal at the top
NSS or sterile water used as diluents
AMPULES – contain single doses of meds in a liquid form from 1 – 10 ml or
more, made of glass with a constricted neck, colored ring around the neck

26. PARTS OF SYRINGE

27. 3 cc SYRINGE
STANDARD U 100 INSULIN
1 ml Tuberculin with Leur Lock

28. 25 gauge 1 inch needle
With safety cap
21 gauge 1 inch needle
With safety cap
18 gauge 1 inch needle

29. INTRADERMAL INJECTION
Upper chest Upper back
Inner aspect of the forearm
Sample: Tuberculin testing and allergy tests
DRUGS ARE POTENT
DERMIS
Reduced blood supply and absorption slowed

31. SUBCUTANEOUS INJECTION
Free of infection,
skin lesions, scars,
bony prominences SCAPULARIS AREA ON BACK
& large
underlying muscle
or blood vessels
ABDOMEN
LATERAL & ANTERIOR ASPECTS UPPER VENTRODORSAL
OF UPPER ARM & THIGH GLUTEAL AREA
Insulin self administration
Loose connective tissues under dermis Heparin injection
Slowed absorption
Pain receptors
ROTATE SITES

33. SITES FOR INTRAMUSCULAR INJECTION
DORSOGLUTEAL
Place hand on iliac crest and locate the posterosuperior iliac spine. Draw
an imaginary line between the trochanter and the iliac spine.
Risk of striking sciatic nerve & greater trochanter or major blood vessels
Not used with infants or children under 3 y/o
Avoid contamination

34. INCLUDES GLUTEUS MUSCLE & MINIMUS
VENTROGLUTEAL SITE
A deep site
Situated away from
major nerves & blood
vessels
Less chance of
contamination
Place of left hand on right greater Easily identified by a
trochanter – index finger is pointing prominent bony landmark
at the anterosuperior iliac spine.
Spread first and middle finger to
form V

35. VASTUS LATERALIS

36. DELTOID MUSCLE
Easy accessible Use for small drug Not for infants
Potential injury or damage to
ulnar radial or brachial artery

38. Z TRACK METHOD
Grasp and pull the muscle before injecting the drug
Leaves a zigzag path
Prevents spillage of the medicine
Minimizes tissue irritation

42. MAJOR LONG EXAMINATION
APRIL 14, 2008
MONDAY