Lecture 7: (Theory)
Administering medications
Assist.lect.ALi.M.Salman
Administering medications
The scope of practice regarding a nurse’s ability to legally
dispense and administer medication is based on each state’s
Nurse Practice Act. Registered Nurses (RNs) and Licensed
Practical Nurses (LPNs) may legally administer medications
that are prescribed by a health care provider, such as a
physician, nurse practitioner, or physician’s assistant.
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Medication orders
A medication order may be written, typed, or it may be given
verbally or by telephone to a nurse or pharmacist.
Types of Orders
Prescriptions are often referred to as orders in clinical
practice. There are several types of orders, such as routine
orders, PRN orders, standing orders, one-time orders, STAT
orders, and titration orders. Dr/Ali. M. Salman
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1-A routine order is a prescription that is followed until
another order cancels it. An example of a routine order is
“Lisinopril 10 mg PO daily.”
2-A PRN (or as-needed) order is a prescription for
medication to be administered when it is requested by, or
as needed by, the patient. PRN orders are typically
administered based on patient symptoms, such as pain,
nausea, or itching. An example of a PRN order for pain
medication is “Acetaminophen 500 mg PO every 4-6 hours
as needed for pain.”
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3-A standing order is also referred to in practice as an “order
set” or a “protocol.” Standing orders are standardized
prescriptions for nurses to implement to any patient in
clearly defined circumstances without the need to initially
notify a provider. An example of a standing order set/
protocol for patients visiting an urgent care clinic reporting
chest pain is to immediately administer four chewable
aspirin, establish intravenous (IV) access, and obtain an
electrocardiogram (ECG).
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4-A one-time order is a prescription for a medication to be
administered only once. An example of a one-time order is
a prescription for an IV dose of antibiotics to be
administered immediately prior to surgery.
5-A STAT order is a one-time order that is administered
without delay due to the urgency of the circumstances. An
example of a STAT order is “Benadryl 50 mg PO stat” for a
patient having an allergic reaction.
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6-A titration order is an order in which the medication dose is either
progressively increased or decreased by the nurse in response to the
patient’s status. Titration orders are typically used for patients in critical
care as defined by agency policy. An example of a titration order is
“Norepinephrine 2-12 micrograms/min, start at 2 mcg/min and titrate
upward by 1 mcg/min every 5 minutes with continual blood pressure
monitoring until systolic blood pressure >90 mm Hg.”
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Components of a Medication Order
• According to the Centers for Medicare & Medicaid Services,
all orders for the administration of drugs and biologicals must
contain the following information:
Name of the patient
Age or date of birth
Date and time of the order
Drug name
Dose, frequency, and route
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Name/Signature of the prescriber
Weight of the patient to facilitate dose calculation when
applicable.
Dose calculation requirements, when applicable
Exact strength or concentration, when applicable
Quantity and/or duration of the prescription, when
applicable
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Route of Administration
• Common routes of administration and standard abbreviations
include the following:
Oral (PO) – the patient swallows a tablet or capsule
Sublingual (SL) – applied under the tongue
Enteral (NG or PEG) – administered via a tube directly into the GI
tract
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Rectal (PR) – administered via rectal suppository . S al
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Inhalation (INH) – the patient breathes in medication from an inhaler
Intramuscular (IM) – administered via an injection into a muscle
Subcutaneous – administered via injection into the fat tissue beneath the skin
Transdermal (TD) – administered by applying a patch on the skin
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Rights of Medication Administration
• The Centers for Medicare & Medicaid Services requires
nurses to verify specific information prior to the
administration of medication to avoid errors, referred to as
verifying the rights of medication administration. These
rights of medication administration are the vital last safety
check by nurses to prevent errors in the chain of medication
administration that includes the prescribing provider, the
pharmacist, the nurse, and the patient.
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The six rights of medication administration must be verified by the nurse at least
three times before administering a medication to a patient. These six rights
include the following:
1. Right Patient
2. Right Drug
3. Right Dose
4. Right Time
5. Right Route
6. Right Documentation
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Effect of drugs
Dosing considerations play an important role in
understanding the effect that a medication may have on a
patient. During administration, the nurse must pay close
attention to the desired effect and therapeutic patient
response, as well as the safe dose range for any
medication. The nurse should have an understanding of
medication efficacy in order to ensure its appropriateness.
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Three additional principles related to the effect of a
medication on a patient are onset, peak, and duration.
1.Onset: the onset of medication refers to when the
medication first begins to take effect.
2.Peak: the peak of medication refers to the maximum
concentration of medication in the body, and the patient
shows evidence of greatest therapeutic effect
3.Duration: the duration of medication refers to the length of
time the medication produces its desired therapeutic effect
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