UPDATED 2024

Definition

A drug or medicine is a substance used for diagnosis, treatment, cure, relief or prevention of disease

Medicine is defined as a substance used to promote health, to prevent and cure disease

Purpose of Medicine

• It is used for diagnosis
• It treats the disease condition
• To prevent health alterations
• To promote health condition
• To treat infections, allergic and inflammation
• To relieve pain

Forms of Medications

• Capsule: solid dosage form for oral care. Medicine is powder, liquid or oil of and encased by gelatin shell
• Lotion: medicine in liquid suspension applied externally to protect skin
• Solution: liquid preparation that may used orally, parentally or externally, can also be instilled into body organ or cavity (e.g. bladder irrigation) contains water with one or more dissolved compounds, most be sterile for parentaral use
• Suppository: solid dosage form mixed with gelatin and shaped inform of pellet for insertion into body cavity (rectum or vagina)
• Suspension: finely divided drug particles dispersed in liquid medium
• Syrup: medication dissolved in concentrated sugar solution, may contain flavoring to make medication more palatable
• Tablet: powdered dosage form compressed into hard disks or cylinders in addition to primary medication contains binders integrators, lubricates and filler

Types of Medication Action

• Therapeutic effect: it is the expected or predictable physiological response a medication causes
• Site: effect is the unintended secondary effects a medication predictably will cause. Side effects may be harmless or injurious
• Adverse effect: there are generally considered serve responses to medication. For example, a client maybe becomes comatose when a drug is ingested
• Toxic effect: may develop after prolonged intake of a medication or when a medication accumulation in the blood because of impaired. Metabolism or excretion
• Idiosyncratic reaction: medicine may cause an idiosyncratic effect. This occurs when a patient over react or under reacts to a drug or has a reaction different form the normal
• Allergic reaction: it is an unpredictable reaction to a drug. In this, the drug acts as an antigen and antibodies are produced. Allergy causes antigen-antibody reaction

Factors Influence the Medication Dosage

• Age: infants, children and the old requires smaller dosage of a drug than that of an adult
• Weight: a person of overweight requires a large dose the usual one
• Male requires: large dose then females
• Cumulative action of the drug: the frequency and dose of a drug administered depends upon the rate of excretion from the body
• Tolerance: it is capacity of taking excessive does without producing toxic effect
• Habituation: when a particular drug used continuously for a long period. The drug is withdrawn they may stop physical craving for it and show definite organic symptoms
• Addition: prolonged use of alcohol and narcotics may produce an extreme form of habituation and result in a condition known addiction
• Route of administration: drugs given by IV route have a very quick and immediate action

Route of Administration

The route of a drug depends on its properties, desired effect, and patient’s physical and mental condition

• Oral administration: it is the most common route and the most convenient route for most patients
• Sublingual: the drug is placed under the tongue and letting it slowly dissolve, e.g. nitroglycerine
• Inhalations: the patient inhales the fumes in the lung to have a local and systemic effect, e.g. nitrous oxide (anesthetic effect)
• Inunctions (topical application): it is the application of the drug to the skin, usually by a friction, e.g. ointment
• Instillation: it is putting a drug in liquid form into the body cavity, such as urinary bladder or into body orifices such as ears, eyes and nose
• Insertions: means introducing solid forms of drugs into the body orifices, e.g. suppositories are introduced into the rectum or vagina
• Implantation: means planting or putting in of solid drugs into the body tissues
• Parenteral administration: parenteral means giving of therapeutic agents outside the alimentary tract. It is the type if administration accomplished by a needle

Intramuscular: into the muscle

Subcutaneous: into the subcutaneous tissue

Intradermal: into the dermis

Intravenous: into the vein

Intraarterial: into the artery

Intracardiac: into the cardiac muscles

Intrathecal: into the spinal cavity

Intraosseous: into the bone marrow

Intraperitoneal: into the peritoneal cavity

Eight Rights of Giving Medication

Right Patient

• Check the name on the order and the patient
• Use 2 identifiers
• Ask patient to identify himself/herself
• When available, use technology (for example, bar-code system)

Right Medication

• Check the medication label
• Check the order

Right Dose

• Check the order
• Confirm appropriateness of the dose using a current drug reference
• If necessary, calculate the dose and have another nurse to calculate the dose as well

Right Route

• Again, check the order and appropriateness of the route ordered
• Confirm that the patient can take or receive the medication by the ordered route

Right Time

• Check the frequency of the ordered medication
• Double-check that you are giving an ordered dose at the correct time
• Confirm when the last dose was given

Right Documentation

• Document administration after giving the ordered medication
• Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug

Right Reason

• Confirm the rationale for the ordered medication. What is the patient’s history? Why is he/she taking this medication?
• Revisit the reasons the long-term medication use

Right Response

• Make sure that the drug led to the desired effect. If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?
• Be sure to document your monitoring of the patient and any other nursing interventions that are applicable

Care of Medicine and Medicine

• All the medicines and drugs must be checked as they are received from the dispensary
• Dangerous drugs are given by special order and every dose should be accurate
• Medicine cupboard should be kept in room, near to the ward
• All poisonous drugs must be kept separately in a separate cupboard and it must be kept locked and the keys should be with ward sister
• Medicine for external use should be kept in a separate part of the cupboard
• The cupboard should be kept in well lighted and poison bottles should be clearly labeled
• There should be separate compartment for mixture, tablets, powders, etc
• The container should be arranged alphabetically so that it is easy to find them
• A register should be maintained to keep the account of the dangerous drugs
• Check the expiry date of every drug and make sure of it before its expiry date
• Emergency drugs should be kept in a place where they are readily obtained for emergency use

Rule of Administration of Medicines

Rule Regarding Labels

• Administer medications only form the properly labeler container
• Poisonous drugs should be labeled in red ink
• Read labels of medicine 3 times and check with doctor’s order
• Pour the medicine form the bottle only after shaking the bottle
• Do not use the medicine that is different in color, test, odor and consistency

Rules Regarding Measuring Medicine

• Always use a calibrated ounce glasses or medicine glass to measure the medicine
• Always give exactly what is ordered
• Make sure that the medicine glasses are clean and dry before pouring medicine
• Hold the ounce glass at eye level and place thumbnail of the hand at the required level and then pour the medicine
• Pour the medicine just before the time of administration into the medicine glasses

Rules Regarding Administration

• Observe the five rights in giving each medication; right patient, right time, right medicine, right dosage and right method of administration
• Give medicines only after checking a signed medication order by the doctor
• Accept verbal orders, only in emergency to save the life of a patient
• Always identify the patient before giving medication
• Stay with the patient until he has taken medicine completely
• An error in medication should be immediately reported to the ward sister
• Use proper light while giving medicines because aim light can cause errors
• Never give water after giving cough syrups. It leaves a soothing effect to prevent cough
• Drugs which stimulate appetite should be given before food

Rules Regarding Recording of Drugs

• Record each does if medicine soon after it is administered
• Follow standard observations in recording medicine
• Record time, dose and route of the medicine given
• Record only those medicines, which have been administered
• Record unusual effects such as allergic reactions

Precautions to be taken

• Check the doctor’s order, no medicine should be given without doctor’s written order
• Give the medications only form a clearly labeled container
• Be sure that the medicine glasses are clean and dry before use
• Shake the liquid medicine before pouring into the ounce glass
• Wipe the mouth of the bottle, close it tightly and replace the bottle in the proper place after use
• Pour the medicine from the bottle on the side opposite to the label
• Once poured out, the medicine should not be returned to the bottle to prevent contamination of the whole medicine
• Give medicine at the correct time and see that patient takes it
• Always give the medicine that you have prepared yourself
• Do not leave the medicine with the patient
• Record after drug is given

Nurses Responsibility in Drug Administration

The nurse should know the following

• The nature of the drug: that is the name classification, types of preparation, effects, dosage absorption and excretion, routes and time of administration
• Essential parts of a medication order
• Abbreviations and symbols used in writing a medication order
• Weights and measures used
• Preparation of solutions and calculation of fractional dose
• Storing of medicines in proper containers
• Factors of safety in the administration of medicines
• Ethical and legal aspects

Legal Aspects of Drug Administration

• Under the law the nurses are responsible for their work, though there is a written order
• The nurses must know the minimum and maximum dose of every medicine which she gives to the patient and its effect
• The nurse must know the law about the use of narcotics. These drugs must be kept in a separate cupboard the cupboard is kept locked and key is kept with the ward sister or senior nurse on duty
• The special register should be maintained for narcotics drugs, which includes clear detail about the patient nurse and the doctor who ordered the narcotic drug
• The nurse must observe five rights of giving medications to avoid errors
• The narcotic drugs should be stocked only persons. Institutions who have licensed to do so

Scientific Principles

• Almost all drugs are harm producer and are foreign materials that the body producing reactions
• Additional force of water towards the glass produces a downward curve called meniscus
• The human tongue presents an irregular surface and so tablets, powders and capsules produce friction and prevent easy swallowing
• The sense of taste is acute and unpleasant taste may produce nausea and vomiting, the taste buds of the tongue can be partially desensitized by cold drinks
• Well diluted drugs and empty stomach favor absorption of drugs. But certain drugs are irritating to mucous membrane of the stomach
• Medical record is a legal one and reference for future study and research
• Using common medicine glasses promote cross infection
• Volatile liquids when kept open or not tightly corked diffuse through air and get decomposed
• An element of error is a possibility of all human activity and commit or omit a dose of medicine means the existence of the end of life of the person
• Understanding of how the drug benefits how it is to be given and side effects of the drug will help the patient to take drug regularly and a report to the physician concerned
• Administration of the medicine is a therapeutic measure it will be therapeutic only, if the patient ge the desired effect of the drug

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