How to Administration Drug and safe medication administration and How to calculate Dose of client.

 Drug administration refer to the process of delivering a pharmaceutical compound into the body to achieve a therapeutic effect. In this content we are going to focus on form of drug and way will be administered and even right of drug administration and right of patient. An understanding of the landmarks and measurements of the fetal skull enables to recognize normal presentation and positions and to facilitate delivery with the least possible trauma to mother and child. 
we are going to define necessary terms that are needed in this content:  
Pharmacology can be defined as the study of substances that interact with living systems through chemical processes, especially by binding to regulatory molecules and activating or inhibiting normal body processes. Or Pharmacology can be defined as the study of substances that interact with living systems through chemical processes.
Toxicology is the branch of pharmacology that deals with the undesirable effects of chemicals on living systems, from individual cells to humans to complex ecosystems.
 Adverse drug event when an individual is harmed by a drug. 
 Adverse effect an effect of a drug that is undesired.
Side effect an effect of a drug that is undesired.

Drugs are substances or compounds that prevent, treat, diagnose, or cure various conditions or diseases.
Over-the-counter (OTC) drugs are available without a prescription to the public. They usually are safer than prescription products and are available for self-medication for various ailments. 
Principles of Safe Drug Administration
Safety is fundamental element in the process of medication administration. It is important to demonstrate good clinical decision making skills throughout the procedure.
In the process of Administering the drugs Nurse is  using the seven “rights,” which are as follows:
1. Right client.
2. Right medication.
3. Right indication.
4. Right dosage range and rate of administration (if appropriate).
5. Right route.
6.Right time.
7.Right documentation.
8. Monitoring for potential drug interactions.
• Assessment of the therapeutic and adverse effects of the drug
• Education of the client and family (or caregivers) about the disease process, drugs prescribed, and therapeutic and adverse effects
Form of drugs and their route that are used to administer drugs.

          If nurse is giving patient intravenous  injection needle should be in 250
          Enteral Route: drugs is placed into directly the gastro-intestinal tract, it is classified into different part which are: 
          1. Oral Route (PO)
          2. Sublingual Route.
          3. Rectal Route (Intra-rectally-IR) , suppositories.



            Parenteral Route: this route is classified into different form which are 
            1. Intramuscular.
             2. Intravenous.
            3. subcutaneous (SC).
            4. Intradermal.
            5. Inhalation. 
            3. Topical Route
            1. Local applications.
            2. Vaginal route: suppositories.
            3. Intranasal route.
            4. Transdermal route.
            5. Otis route. 
            1. Oral -per os(PO) 
             S            ite used for oral route: Mouth 
            Indications and contraindications for oral route 
                                                Indication
            Medication is an a form that is safe for oral administration( for example a pill or capsule or table). The patient is able to Swallow the medication safely( for example, the patient doesn't have condition that prevent them from swallowing safely). The medication is absorbed well through the gastrointestinal tract( for example, the medication is not destroyed by stomach acid).   
            Contraindication
            1. Nausea and vomiting.   
            2. In children who can be suffocated while swallowing a solid form of medicine.  
            3. Unconscious and mindless.
            4. Inability to swallow following surgical intervention or paralysis.
            5. Gastric aspiration.  
            Form of drug that are be used in Oral route
            The form of drugs that are typically used for oral administration are tablets, capsules, liquids, and powders.
             Tablets and capsules are solid forms of medication that are swallowed whole.
             Liquids are medications that are taken by mouth in liquid form, such as a syrup or elixir.
            Powders are medications that are mixed with water or other liquid and then swallowed. 
            There are also some medication that are available in other forms such as orally disintegrating tablets or films, which dissolve in the mouth.
            Advantages.
            1. Safe
            2. Cheaper
            3. Painless
            4. Convenient
            5. Sterilization is not essential.
             6. Self- administered
            Disadvantages
             Not suitable for emergency as  action of orally administered drugs is slow. its not suitable for unconscious or uncooperative or vomiting patient, un absorbable drug like aminoglycosides. Drugs that are destroyed by digestive juices drugs with extensive first-pass metabolism like lignocaine.
            Complication for oral Routes. 
            1. Gastrointestinal upset, such as nausea, vomiting, or diarrhea.
            2. Ingestion of the wrong medication (for example, if the medication is accidentally mixed up with another medication). 
            3. Esophageal irritation or injury from the medication.
            4.Medication being absorbed too slowly or too quickly from the gastrointestinal tract.
            5. Delayed or decreased absorption of the medication due to food or other substances in the stomach. 
            6.             Inability to swallow the medication.
            Safety measures for oral route.
            1. Checking the patient's ID bracelet to make sure the correct patient is being given the medication.
            2. Checking the dosage of the medication to make sure it is the correct amount.
            3. Checking the expiration date of the medication to make sure it is not expired.
            4. Checking for any allergies or contraindications that the patient may have to the medication.
            5. Making sure the patient is able to swallow the medication safely. 

            6. making sure the patient is aware of the risks and benefits of medication. 



            B. Sublingual Route.

            site used for sublingual route, some drugs are taken as smaller tablets which are held in the mouth under tongue. The absorption of medication occurs when the tablet is placed under the tongue that mode of administration is called sublingual.

             Indications and contra Indication 

              Indications.

            The medication is absorbed quickly through the mucous membranes under the tongue.
            The medication is not likely to be destroyed by stomach acid.
            The medication is not likely to cause gastrointestinal upset.  

            Contra Indication 

            1. The medication is not absorbed well through the mucous membranes under the tongue.

            2. The medication is likely to be destroyed by stomach acid.

            3. The medication is likely to cause gastrointestinal upset.

            Complication.
            1. Respiratory complications.
            2. Patient complication 
            3. Availability in absorption.
            4. Drug collection.
            5. First -pass metabolism.   
            Incidence.
            1. Chocking, respiration, drug interventions and non compliance with the medication 
            2. Aspiration, when drug is swelling in respiratory tack. 
            Precautions to be taken. 
            A nurse should place the patient in a good position
            Instead of using tablets, ones should use syrup and suspension.
             the nurse should advise the patient on how he/she should take one drug instead of using two drugs also know as “drug interaction is the intake of two drugs at the same time that are inhabit each other”.



            2.Parenteral Routes

            There are sub types of it: 
            1. Intradermal (ID): Injection into the dermis just under the dermis of the skin.
            3. Intramuscular (IM): injection into a muscle
            4. Intravenous (IV): Injection into a vein Intravenous(iv).
            Site: lumen of vein, antecubital vein
            Merits(Advantage)
            Drug reaches directly into the bloodstream, and effects are produced immediately.
            A. Highly irritant drugs can be injected IV.  
            B.             Employed even in unconscious or uncooperative or vomiting patient.
            Demerits(Dis advantage)
            1. Strict aseptic condition is needed.
            2. Expertise's are needed.
            3. Painful
            4. Risky
            Thrombophlebitis of the injected vein and necrosis of Adjoining tissues if extravasation occurs.
            Intramuscular (IM).
            Site: large skeletal muscles such as deltoid, triceps, gluteus Maximus, vestas femoralis.
            Merits(Advantage)
            1. Depot preparations (oily solutions, aqueous suspensions)
            2. can be injected by this route.
            Demerits.(Disadvantage)
            1. Perfect aseptic condition required 
            2. Nerves Damage
            Subcutaneous (sc)

                Site:

            subcutaneous tissue
            Merits
            Deport preparation is given
            Demerits
            Irritant drug cannot administrate, example vaccine
            Intradermal al injection . 
            The drug is injected into the skin. example BCG vaccine, sensitivity testing
            The complications.

            The complications associated with the parenteral administration of drugs include intramuscular administration, anatomical and procedural considerations, Local muscle reaction, from mild inflammation to abscess formation, clostridia my necrosis, intra-synovial administration, post injection synivitis and lameness, and medication errors. 
            The rectal route. 
            The rectal route is a way of administering a drug through the rectum, which is the final part of the large intestine. The route can be used for both local and systemic effects, depending on the drug and the formulation.
            Site: rectum,
            Indications:
            1. When the oral route is not possible or desirable, such as in case of nausea, vomiting, unconsciousness, or diseases of the upper gastrointestinal tract.
            2. When the drug has an unpleasant tastes or smell, which can make it difficult to swallow or tolerate.
            3. When the drug needs to act quickly and avoid the first-pass metabolism in the liver, which can reduce its bioavailability.
            Contraindications
            1. When the patient have diarrhea.
            2. We don’t use the rectal route when patient have inflammation on rectum.
            3. We don’t use the rectal route when the patient refuse to use it.
            4. We don’t use the rectal route when the patient have allergic to it.
            Forms of Drugs that are use 
            1. Suppository.
            Advantages

            Useful for nausea and vomiting. useful for gastric irritant drugs.
            Disadvantages
            1. Rectal inflammation
            2. Inconvenient & embarrassing to patient. 
             Inhalation is the way of delivering a drugs or other substance to the lungs and the bloodstream through the respiratory system. sites: the nose, pharynx, larynx
            Indications:
            Treating or preventing respiratory diseases, such as asthma, COPD, cystic fibrosis, bronchitis, or sinusitis.
            Relieving pain, nausea, vomiting, or seizures, when oral or intravenous routes are not possible or effective.
            Enhancing athletic performance, by increasing oxygen delivery and reducing fatigue.
            Advantages
            Quick onset of action.
            Disadvantages
             Local irritation may cause increased respiratory secretions and bronchospasm. example: general anesthetics. 
            Local Routes.

            These routes can only be used for localized lesions at accessible sites and for drugs whose systematic absorption from these sites are minimal absent

            The local routes are:
            Topical 
            This refers to external application of the drug to the surface for localized action.
            It is often more convenient as well as encouraging to the  patient.
            Drugs can be efficiently delivered to the localized lesions  on skin, or pharyngeal or nasal mucosa, eyes, ear canal, anal  canal or vagina in the form of lotion, ointment, cream,  powder, rinse, paints, drops, spray. 
            Thing to remember. You ha to remember and respect right of drug administration.
            1. Right patient.
            2. Right dose.
            3. Right drugs.
            4. Right time.
            5. Right route.
            6. Right documentation.
            7. Right assessment.
            8. Right indication.  
            Nurse should remember the injection angle, If nurse is giving patient intramuscular injection needle should be in 900            , If nurse is giving patient subcutaneous injection needle should be in 450. If nurse is giving patient intradermal injection needle should be in 150.


            4 ethical principles: 

            1. Autonomy
            2. justice
            3. beneficence
            4. Non maleficence
            4 ethical Rules 
            1. veracity
            2. privacy
            3. confidentiality
            4. fidelity

            Before administer drug nurse should check the drug names, name of patient , name of drug and patient written in file if march with what patient say. 

            Nurse should always remember to protect him self and respect all infection control precaution as stetted by center for disease prevention and control and always Nurse Remember.

            Fundamental of nursing
            NursesCatalysts