Medication Administration Fundamentals - Fall 2025

Medication Administration and Fundamentals Notes

Medication Overview

  • Names of Medication

    • Chemical Name: Describes the molecular makeup

    • Example: N-acetyl-para-aminophenol

    • Generic Name: The official name of the medication

    • Example: Acetaminophen

    • Trade Name: The brand name under which the medication is marketed

    • Example: Tylenol

    • Tall-man lettering: Used for FDA-approved names to reduce medication errors

    • Example: aMILoride vs amLODIPine

Classifications of Medications

  • Classifications indicate one of the three aspects:

    • The effect of the medication on a body system

    • The symptoms a medication relieves

    • The desired effects of the medication

  • Each class includes multiple medications for similar health problems

    • Example: Anti-psychotics

  • Some medications may belong to multiple classes

    • Example: Aspirin is classified as both analgesic and anti-inflammatory.

Pharmacokinetics of Medications

  • Refer to NUR 1111 notes regarding pharmacokinetics

  • Key Points (refer to Table 20.2 on page 589 in Skills Book):

    • Medication absorption review

Medication Preparation

  • Ensure to review:

    • How to read medication labels

    • Measurements and conversions

    • Drug calculations

Actions of Medications

  • Therapeutic Effects: Desired beneficial effects of medications

  • Adverse Effects: Undesired effects including:

    • Side effects: Common, predictable effects

    • Toxic effects: Dangerous, potentially lethal effects

    • Idiosyncratic reactions: Unusual response to medication

    • Allergic Reactions: Immune response to medication

    • Mild reactions (refer to Table 31.2 on page 628)

Actions of Medications (continued)

  • Medication Interactions:

    • Synergistic Effect: Two drugs working together to enhance effects

  • Medication Tolerance: Reduced response to the same dose after repeated use

  • Medication Dependence (Addiction):

    • Physical: Body's adaptation to the drug

    • Psychological: Emotional or mental reliance on the drug

Medication Dose Responses

  • Key concepts include:

    • Minimum Effective Concentration (MEC)

    • Therapeutic Range: The range within which a drug is effective without being toxic

    • Peak: Highest concentration of drug in the bloodstream

    • Trough: Lowest concentration of drug in the bloodstream

    • Half-life: Time taken for the plasma concentration of a drug to reduce by half

    • Onset: Time taken for drug to start effect

    • Duration: Time drug remains effective.

Medication Dose Schedules

  • Understanding abbreviations and their meanings:

    • AC, ac: Before meals

    • ad lib: As desired

    • BID, bid: Twice each day

    • PC, pc: After meals

    • prn: Whenever there is a need

    • q am: Every morning

    • Qh: Every hour

    • q4h: Every day

    • TID, tid: 3 times per day

    • STAT, stat: Give immediately

    • q4h: Every 4 hours

  • Refer to Table 31.3 on page 629 for further details.

Forms of Medications

  • Form determines route and affects absorption, distribution, metabolism, and excretion (pages 626-627)

  • Oral Route:

    • Solids: Caplet, capsule, tablet, enteric-coated tablet

    • Liquids: Elixir, extract, aqueous solution/suspension, syrup, tincture

    • Others: Lozenge, aerosol, sustained-release

  • Parenteral Route:

    • Solution, Powder (dissolved)

  • Topical Route:

    • Ointment, salve, cream, liniment, lotion, paste, transdermal patch/disk

  • Instillation into Body Cavities:

    • Suppository, intraocular disk.

Routes of Administration

  • Oral Route:

    • By mouth, sublingual (under tongue), buccal (inside cheek)

  • Topical Route:

    • Skin and mucous membranes including

    • Direct application

    • Insertion into body cavity

    • Instillation of fluid or irrigation into a body cavity

  • Inhalation Route:

    • Respiratory tract (nasal/oral passages; endotracheal/tracheostomy tubes)

  • Intraocular Route:

    • Eyes (similar to contact lenses, lasts up to 1 week)

  • Parenteral Route:

    • Injection into body tissues (IM, SubQ, IV, ID).

Systems of Medication Measurement

  • Metric System:

    • Primary system used including units like liter (L, mL) and gram (g or GM, mg)

  • Household Measurements: Typically not reliable

  • Solutions: Solid dissolved in liquid, expressed in mass per volume (e.g., mg/mL), or as percentages (e.g., 0.9% NaCl).

Medication Dispensing

  • Unit Dose System:

    • Standardized, individually wrapped doses

    • Floor stock drugs

  • Automated Medication Dispensing System:

    • Requires password or biometrics (e.g., fingerprint) login

    • Synced with facility’s Electronic Medical Record (EMR)

Medication Distribution

  • Involves three key players:

    • Healthcare Provider: Writes the order (1st check)

    • Pharmacist: Prepares and dispenses medication (2nd check)

    • Nurse: Verifies and delivers medication (3rd and final check)

6 Rights of Medication Administration

  1. Right Medication

  2. Right Dose

  3. Right Patient

  4. Right Route

  5. Right Time

  6. Right Documentation

Right Medication

  • A medication order is necessary

  • The nurse must compare the medication order with the medication administration record (MAR/eMAR)

  • Use the verified MAR to prepare and administer the medication

  • The nurse who prepares the medication must administer it to ensure responsibility

  • Prohibited and Error-Prone Abbreviations: Refer to Table 31.7 on pages 637-638 in Fundamentals book.

Right Dose

  • Calculate the correct dosage; verify high-risk medications with another RN

  • Utilize standard measuring devices

  • Use oral syringes when necessary, including:

    • Only oral solutions are available in bulk

    • Prescribed dose is less than the dispensed unit dose

    • Prescribed dose is less than 10 mL of solution

  • Regarding pill splitting or crushing medications, consult specific guidelines.

Right Patient

  • Verify the patient’s name and medical record number (or DOB) on the MAR with the patient's armband

  • In acute care settings, ask the patient to state their name and DOB as a 3rd check

  • Implement Bar-coding Medication Administration (BCMA) for accuracy.

Right Route

  • Always consult with the provider if the route is not specified or is not recommended

  • Use appropriate syringes for enteral and parenteral medications to prevent fatal errors

  • If a medication needs to be crushed and mixed with food/liquid, it does not change the route.

Right Time

  • Distinguish between time-critical and non-time-critical medications

    • Example: Every 8 hours vs. TID meds

    • STAT (immediate) vs. NOW (within 90 minutes)

  • Utilize military time notation and apply clinical judgment for PRN medications.

Right Documentation

  • Documentation serves as communication and must occur immediately after administration

  • Record the drug, dose, route, time, and site of administration

  • Document the patient's response to medications.

Right Indication

  • A proposed 7th Right of Administration focusing on indication-based prescribing

  • Proposed benefits include narrower choices of medications, dosage forms, and dosing regimens

  • Aim to reduce the risk of errors in administration.

Nursing Process: Assessment

  • Components of Assessment include:

    • Medical history

    • Allergies

    • Medication history

    • Diet history

    • Physiological assessment:

    • Coordination

    • Swallowing

    • Orientation status

    • Vital signs and lab results

    • Attitude towards medications and barriers to medication therapy

    • Learning needs assessment.

Nursing Process: Diagnosis & Planning

  • Nursing Diagnoses/Patient Problems:

    • Lack of knowledge

    • Nonadherence

    • Polypharmacy

  • Planning/Outcomes:

    • Set priorities for effective medication therapy

    • Collaborate with patient and family to achieve goals.

Nursing Process: Implementation

Pre-Administration:

  • Know the medications:

    • Check contraindications and allergies

    • Make pre-administration assessments when necessary

  • Administer the medication with the 6 rights confirmed

  • Post-Administration: Ensure proper documentation.

Drug Resources

  • Evolve eBook library: A comprehensive tool for reviewing medications

  • Mosby’s Drug Guide: Use the Index to find necessary medications

  • ClinicalKey for Nursing: Access drug monographs at the end of the webpage.

Nursing Process: Evaluation

  • Evaluate Patient Response to medications, focusing on:

    • Vital signs

    • Intake and output

    • Pain scale

    • Labs

    • Behavioral responses

    • Observation of injection sites

    • Patient’s understanding of medications and ability for self-administration.

Components of a Drug Order

  • Key features include:

    • Date and time of order

    • Patient’s full name

    • Medication name

    • Medication dose

    • Medication route

    • Medication schedule (time and frequency)

    • Signature of healthcare provider

Types of Orders

  • Standing/Routine Orders: Continue until discontinued or for a specific number of doses

  • PRN Orders: Given only when needed

  • Single/One-Time Orders: Given once at a specified time, often pre-operatively

  • STAT Orders: Single dose administered immediately, only once in emergencies

  • Now Orders: More specific than one-time, usually needs administering within 90 minutes

  • Prescriptions: For medications taken outpatient

  • Other Orders: Can be handwritten, via Computer Provider Order Entry (CPOE), telephone or verbal orders (must read back).

Prevention of Medication Errors

  • Medication error: Any preventable event that may cause inappropriate medication use or jeopardize patient safety

  • Ensure clarity and completeness of orders

    • Always follow agency policy and national patient safety standards

    • Rely on the MAR/eMAR for accuracy and ensure dose calculations are correct.

Steps to Take If You Make a Medication Error

  • Immediate Actions: Assess your patient as a priority

  • Contact the healthcare provider for further instructions

  • Carry out any new orders and continue monitoring the patient

  • Report the error, including near misses, to the proper channels

  • Complete an incident report covering the circumstances of the error.

National Patient Safety Goals

  • Medication Administration remains a core safety goal

  • Key points include:

    • Use of 2 patient identifiers

    • Proper labeling of medications

    • Management of high-risk medications (e.g., anticoagulants)

    • Regular medication reconciliation.

Demonstration Videos

  • Watch clinical skills videos for administering various medications:

    • Administering Topical Medications

    • Administering Eye Medications

    • Administering Ear Medications

    • Inserting a Rectal Suppository

    • Using a Metered-Dose Inhaler

Skills Practice

  • Ten practice boxes available in each lab; maintain supplies

  • Use SimChart for practice (videos available)

  • Always look up medications to enhance familiarity with drug resources

  • Practice! Check-offs are scheduled for next Friday!