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.
COMMENTS