Medication: Oral Drug Administration

ORAL DRUG ADMINISTRATION

INTRODUCTION:

There are various routes of administration available, each of which has associated advantages and disadvantages.

Routes of administration of drugs are:

·         Oral

·         Sublingual, buccal

·         Rectal

·         Topical

·         Parenteral — Intravenous, intramuscular, subcutaneous etc..

Oral route- Introduction:

Oral route is the most common route by which medications are given, As long as a client can swallow and retain the drug in the stomach; This is the best route of choice.

Oral route is contraindicated when client vomiting, has gastric or intestinal suction or is unconscious and unable to swallow, Such clients are usually on orders nothing by mouth,

Oral route advantages:

·         Most convenient & easy to administer

·         Usually least expensive

·         Safe, does not break skin barrier

·         Administration usually does not cause stress

·         Produces Local or systemic erects

·         Can be self-administered

·         Painless

Oral route disadvantages:

·         Inappropriate for clients with nausea or vomiting

·         Drug may have unpleasant taste or odor

·         Inappropriate when gastrointestinal tract has reduced motility

·         Inappropriate if client cannot swallow or is unconscious

·         Cannot be used before certain diagnostic tests or surgical procedures

·         Drug may discolor teeth, harm tooth enamel

·         Drug may irritate gastric mucosa 

·         First-pass effect (The first-pass effect is the term used for the hepatic metabolism of a pharmacological agent when it is absorbed from the gut and delivered to the liver via the portal circulation. The greater the first-pass effect, the less the agent will reach the systemic circulation when the agent is administered orally)

·         Risk of aspiration

Routes of Drug Administration:

Oral Route:

Forms: a) solid: tablet, capsule, pill, powder.

            b) liquid: syrup, suspension, emulsion.

Enteric coated tablets should not be crushed before administration.

Suspensions are never administered intravenously,

If the patient vomits within 20-30mins of taking the drugs, notify the physician. Do not re-administer the drug without a physician's order.

Sublingual:

In sublingual a drug is placed under the tongue, where it dissolves.

In a relatively short time, the drug is largely absorbed into the blood vessels on the underside of the tongue.

The medication should not be swallowed. E.g. Nitroglycerin

Advantages of sublingual route:

·         Drug can be administered for local effect

·         More potent than oral route because drug directly the blood and bypasses the liver.

·         Others same as for oral.

Disadvantages of sublingual route:

·         If swallowed, drug may be inactivated by gastric Juice

·         Drug must remain under tongue until dissolved and absorbed. May cause stinging or irritation of the mucous membranes

·         Drug is rapidly absorbed into the bloodstream,

Example

Systemic use

·         Nitroglycerine

·         Nifedipine

Local  

·         Antispetic lozenge

Buccal route:

Buccal means a medication (e.g., a tablet) is held in the membranes of the cheek until the drug dissolves.

The drug may act locally on the mucous membranes of the mouth or systemically when it is swallowed in the saliva.

Advantages of buccal route:

·         Same as for sublingual

·         Can be used when drug has objectionable taste or odor

·         DNB released at slow, steady rate       

·         Provides a local therapeutic Effect

Disadvantage:

·         Same as for sublingual

·         Dose absorbed is unpredictable

·         May be perceived as unpleasant by the client

·         Limited use

PURPOSE of oral routes:

To provide a medication that has systemic effects or local effects on the gastrointestinal tract or both.

Assessment:

·         Allergies to medication

·         Ability to swallow medication

·         Presence of vomiting or diarrhea

·         Specific drug action, side effects, interactions, and adverse reactions.

·         Perform appropriate assessments (e.g., vital signs, laboratory results)

Equipments:

·         Medication cart

·         Disposable medication cups(small, plastic cups for tablets and capsules; calibrated cups for liquid)

·         MAR or computer printout

·         Pill crusher

·         Straws to administer medication that may cause discoloration of the teeth

·         Drinking glass with water or juice

IMPLEMENTATION:

Preparations:

1.       Know the reason why the client receive the medication, the drug  contraindications, side effects and outcome of the medications.

2.       Check the MAR:

For drug name, dosage, frequency, route

If the MMR is not clear compare it with the most recent physician's order.

Report any Discrepancies to the charge nurse or physician

3.       Verify the client's ability to take medication orally

Ability to swallow.

Status of NPO.

4.       Organize the supplies

Place the medication cart outside the client's room.

Assemble the MAR for each client together, so that medication can be prepared for one client at a time.

Performance:

1.       Wash hands and observe for infection control procedures,

2.       Unlock the medication cart,

3.       Obtain appropriate medication,

Read the MAR and take the appropriate medication from the shelf or refrigerator.

Compare the on the medication container or unit dog package against the MAR, to the accuracy of prescription.

Rationale: This is a safety check to ensure that the right medication is given

4.       Prepare the medication.

Calculate medication dosage accurately,

Prepare the correct amount of medication for the required dose, without contaminating the medication.

While preparing the medication, recheck each prepared drug and container with MAR again,

Rationale: This second safety check reduces the chance of error

MODES OF PREPARATIONS:

A.      For Tablets or capsules

Place the packaged medication dose capsules or tablets directly in to the medication cup. Do not remove the medication from the wrapper until at the bed side, 

Rationale: The wrapper keeps the medication clean, Not removing the medication facilitates identification of the medication in the event the client refuses the drug or assessment data indicate to hold the medication,

If the client difficulty in swallowing, crush the tablets in to a fine powder with a pill crusher. Then mix it with small amount of soft food.

ALERT:

Check with the pharmacy before crushing the tablets. Enteric coated tablets, buccal or sublingual tablets should not be crushed

If using a stock container, pour the required number into the bottle cap, and then transfer the medication to the disposable cup without touching the tablets,

Break only scored tablets, if necessary to obtain the correct dosage, Use a cutting device or a file, if needed

If the client has difficulty in swallowing, crush the tablets in to a fine powder with a pill crusher. Then mix it with small amount of soft food

B.      Liquid medication:

Thoroughly nix the medication before pouring.

Discard any medication that has change in color or turned cloudy.

Remove the cap and place it upside down.

Hold the bottle so that the label is next to your palm and pour the medication away from the label.

Rationale: This prevents the label from becoming soiled and illegible as a result of spilled liquid

Place the medication cup on a flat surface at eye level and fill it to the desired level, using the bottom of the meniscus to align with the container scale.

Rationale: This method ensures accuracy of measurement.

Before capping the bottle, wipe the lip with a paper towel to avoid the encrustation of the medicine at the cap.

C.     All medication

Place the prepared medication and MAR together on the medication cart.

Recheck the label on the bottle before returning it,

Rationale: This is third check further reduces the risk of error.

Avoid leaving prepared medications unattended.

Lock the-medication cart before entering the client's room.

         5.   Provide the client privacy       

         6.   Prepare the client.

Check the identification band. 

Assist the client to a sitting position or a side lying position.

Take the apical pulse rate before administering digitalis preparations.

Take blood pressure before giving antihypertensive drugs.

Take the respiratory rate prior to administering narcotics. Rationale: Narcotics depress the respiratory center.

If any of the findings are above or below the predetermined parameter, consult the primary care provider before administering the medication.

          7.   Explain the procedure and purpose to the patient.

Rationale: Information can facilitate acceptance of and compliance with the therapy.

          8.   Administer the medication at the correct time.

Take the medication to the client within the period of 30 minutes before or after the scheduled time.

Give the client sufficient water or preferred juice to swallow the medication.

Rationale: Fluids ease swallowing and facilitate absorption from the

Liquid medications other then antacids or cough preparations may be diluted with 15 mL of water to facilitate absorption.

If the client is unable to hold pill cup, use the pill cup to introduce the medication into the client's mouth, and give only one tablet or capsule at a time.

Rationale: Putting the cup to the client's mouth maintains the cleanliness of the nurse's hands. Giving one medication at a time eases swallowing

If an older child or adult has difficulty swallowing, ask the Client to place the medication on the back of the tongue before taking the water.

Rationale: Stimulation of the back of the tongue produces the swallowing reflex.

If the medication-has an objectionable taste, ask the client to suck a few ice chips or give the medication with juice, or bread if there are no contraindications.

Rationale: The cold of the ice chips will desensitize the taste buds, and juices or bread can mask the taste of the medication

Stay with the client until all medications have been swallowed.

Rationale: The nurse must see the client swallow the medication before the drug  can be recorded.

            9.    Document each medication given.

Record the medication given, dosage, time, any complaints of the client, and your signature.

If medication was refused or omitted, record this fact on the appropriate record.

            10.        Dispose of all supplies appropriately.

Replenish stock (e.g., medication cups) and return the cart to the appropriate place.

Discard used disposable supplies.

             11.   Evaluate the effects of the medication.

Return to the client when the medication is expected to take effect (usually 30 minutes) to evaluate the effects of the medication on the client.

INFANTS:

Oral medications can effectively administered in several ways:

A syringe or dropper

A medication nipple which allows the infant to suck the medication

Mixed in small amounts of food

A spoon or medication, cuy, for older children

Never mix medications into foods that are essential, since the infant may associate the food with an unpleasant taste and that food in the future, Never mix medications with formula.

Place a small amount of liquid medication along the inside of the baby's cheek and wait for the infant to swallow before giving more to prevent aspiration or spitting out.