Pharmacology

Chapter 8

Administration

by

Gastrointestinal Route

Gastrointestinal Route

• Includes:

• Oral

• NGT – nasogastric tube

• GT – gastric tube or G-tube

• Rectal

• Meds are administered by gastrointestinal route more often than any other way

Advantages of oral route

• Convenience and patient comfort

• Safety r/t O.D. and the retrieval of the med if taken in error

• Economy r/t few equipment costs, no IV pumps etc.

Disadvantages of oral route

• Slower onset of absorption and action• Rate and degree of absorption can vary with GI

contents and motility• Some meds are not available in oral route and

therefore have to be given non-orally like SQ• Cannot be given orally if N/V• Dangerous if patient is dysphagic (difficulty

swallowing)• Cannot be used in the unconscious pt• Cannot be used if pt is NPO

Advantages of delivering meds via a NGT

• Ability to bypass the mouth and pharynx when necessary

• Eliminates the need for numerous injections

Disadvantages of an NGT

• Causes discomfort to the pt, feels like they have a sore throat

Advantages of a gastric tube or G-tube

• Meds can be administered comfortably to the pt and easily for the nurse

• Feedings can be administered also

Disadvantages of a G-Tube

• Irritation of skin around the site can be harmful to pt

• G-tube can become clogged if not properly flushed

• This is not a normal way to get meds or nutrients into the body

Advantages of the rectal route

• Bypassing the action of digestive enzymes, med won’t be destroyed in any way

• Avoids irritation of the upper airway

• Is useful in pts with dysphagia

Disadvantages of rectal route

• Many meds are unavailable in rectal form

• Some older adults and children have difficulty retaining the suppository and it just slides out

• Prolonged use of rectal meds can loosen the anal sphincter can cause incontinence

• Absorption of the med may be irregular or incomplete if feces is present

Administration of oral meds

• 1. Wash hands (always)• 2. Look at the MAR and read the med• 3. You may view the original order if unsure,

noting date written, pt’s name, med name, dosage, route and time

• 4. Be sure to have knowledge of the med. Be aware of its purpose, side effects, cautions, normal dosage range. You may need a drug reference book

Administration of oral meds

• 5. Choose paper cup, plastic cup, syringe etc.

• 6. Locate the med either in the med pyxis machine or locked pt med drawer

• 7. Hold the med label against the med sheet and look for the 5 rights: right med, right amount, right time, right route and right pt

Administration of oral meds

• 8. Check the dosage ordered and compare it to what is available. Unit doses are now very popular

• 9. Prepare the package as ordered, DO NOT OPEN THE MED PACKAGE until you are with the pt

• 10. Take the med into the pt’s room

Administration of oral meds

• 11. Check the pt’s ID band, ask pt to tell you his name and DOB, compare the verbal info. To what is on the band

• 12. Call pt by name and explain what you are doing. Answer any questions, if pt is not willing to take med d/t being unsure, take med out of room and re-check order. Educate pt upon returning about med dose, name of med and what it is for then offer it again

Administration of oral meds

• 13. Monitor Pts VS if required for specific meds such as for Digoxin. Record the BP 1st, then administer the med

• 14. Open the unit dose package and either place med in pt’s hand if he prefers pills one at a time, or place pills in container and hand container to pt. DO NOT TOUCH THE MED WITH YOUR HANDS

Administration of oral meds

• 15. Provide a full glass of water and assist the pt in any way

• Offer a straw • Raise HOB as to not cause choking• 16. Stay with the pt until ALL of the meds

have been taken. Never set meds on table and walk away, pt will forget to take his meds

Administration of oral

• 17. Discard used med cup and wrappers• 18. Record the med time, dosage, route, time and

initials in the MAR or as your facility allows• 19. If pt refuses med or it is held, follow facility

protocol and then write note in Nursing Notes as to why med was not given, be specific

• 20. Notify the Dr. immediately if pt refuses or cannot take the med

Special considerations for oral administration

• 1. Check pt’s status for NPO status, if pt is NPO, have meds ordered IV or get approval for meds with sips of water

• 2. Check for allergies, and watch for combo. Products or mixing meds

• 3. Give the most important med 1st, give vitamins last

• 4. Elevate HOB as to not choke

• 5. Stay with pt until all meds are taken

• 6. Try and give meds with water only. Sometimes, juice inactivates the med due to citric acid or milk and alkylosis

• 7. Be careful with meds that must be taken on an empty stomach, follow ALL directions

• 8. DO NOT open or crush ER or SR meds, pts must take them whole

• 9. Do not divide pills in half with your hands, use a pill splitter

• 10. When removing pills from a bottle, place pills in the lid carefully and dump into the med cup. DO NOT touch the caps or tabs

• 11. DO NOT administer any meds that are discolored, has precipitate, is contaminated or is out-dated

• 12. If a pt vomits within 20 minutes after taking the med, is NPO or refuses the meds, always report this to the Dr. A written order is needed to change the route of the med. Be sure to document on the pt’s record the time of emesis, its appearance

• 13. If the pt refuses the med, determine the reason why, try to educate the pt, notify the Dr. and record all info. In the pt’s chart

• 14. If meds are to be opened or crushed and put into liquid or applesauce or ice cream, be certain that the med can be tampered with.

“NEW SLIDE”

• Unit dose

• Multi dose

• Single dose

• Floor stock

• Narcotic

• Non-narcotic

Prep of liquid meds

• Check MAR or actual Dr.s order• Hold bottle of medication up to the MAR and

compare the order• Wash hands• Shake the bottle• Remove cap and place upside down on the table• Hold bottle with the label side upward to prevent

from smearing of label while pouring

• In other hand, hold med cup at eye level and place thumb nail where level of liquid will be poured to and pour the prescribed amount

• Replace the med to the med supply drawer

• Recheck the 5 rights of med administration

• Deliver the med

When pt needs a different method to take in a liquid med

• If someone can’t drink the liquid from a cup, you must use a straw so they can sip it or a syringe

• Draw up the liquid into a syringe• Sit the HOB up completely• Be sure pt is alert to swallow• Place syringe tip in the pocket between cheek and

gums (buccal)• Instill the med slowly giving the pt time to swallow• Be sure all of the med is gone before leaving the

room

Document

• You must always document after the med is given

• DO NOT EVER SIGN OFF THE MED BEFORE YOU GIVE IT

• Be sure to initial the time you gave the med and many institutions cross through the med time delivered

Administration of meds via NGT

• Be sure to check the med order or MAR• Wash hands• Prepare the med by drawing up liquid into a

syringe or….• Crushing the pill and dissolving the crushed

powder in warm water• NEVER CRUSH EC or ER tabs and be

careful with capsules

NGT

• Check the pts ID band, elevate the HOB• Check for placement of NGT by???????

• attach syringe to end of NGT and slowly inject liquid med down the tube

• Flush the NGT with water slowly• If pt is on suction via NGT, leave suction off for at

least 30 minutes to allow for med to absorb

• Position pt on the right side and elevate HOB to encourage the faster emptying of the stomach

• Document that you gave med

Administration of meds via G-tube

• It is done the same way that meds are given via an NGT except there is no need to test residual

• Document accurately

Administration of rectal meds

• Administration is more effective with Pt’s cooperation obviously

• Remember to respect the pt’s privacy, close door, pull curtains, keep pt covered as much as possible

Administration of suppository

• Explain to pt what med will be given• Answer all of pt’s questions• Check MAR and med for correct administration,

prepare all supplies• Wash hands, close door or pull curtain• Don non-sterile gloves• Place pt on left side with knees sl. bent• Open lubricant• Apply lubricant to end of tapered suppository• Separate buttocks and gently insert supp.

PR

• Push gently until the suppository has passed the internal sphincter

• Hold buttocks closed and talk with pt to keep them calm and cooperative

• Wash hands when finished

• Enc the pt to hold the supp for 20 minutes

The End