Chapter 36

1. Chapter 36 Administration of Oral, Topical, and Mucosal Medications

2. Routes of Medication Administration • Oral • Enteral tube • Topical • Transdermal • Mucosal

3. Types of Oral Drugs • Tablets • Caplets • Capsules • Liquid • Syrups, elixirs, solutions, suspensions

4. Multiple Choice Question A nurse administering medications on a pediatric ward knows which of the following medications may be crushed to add to food? A. Enteric-coated ibuprofen B. Cough medicine in a gel cap C. Sustained-release pain medication D. None of the above

5. Answer D. None of the above Rationale: Some medications should not be crushed because crushing can cause them to be absorbed too quickly or because they are designed to dissolve in the intestines rather than in the stomach. In addition, some medications can irritate mucous membranes in the esophagus and stomach if they are crushed.

6. Medications That Should Not Be Crushed • Buccal or sublingual tablets • Effervescent tablets • Enteric-coated tablets • Liquid-filled gel caps • Medications that may taste too bitter to swallow • Mucous membrane irritants • Neoplastic agents (chemotherapy drugs) • Orally disintegrating medications • Sustained-release tablets

7. Forms of Liquid Medications • Elixir: contains sweeteners, water, alcohol • Solution: liquid containing dissolved substance • Suspension: contains fine particles of medication mixed in a liquid • Syrup: concentrated aqueous preparation of sugars and medicine

8. Administering Liquid Medications • Shake suspensions • Read measuring device at eye level • Read measuring cup at lowest level of meniscus • Hold label of multidose bottle in palm of hand when pouring • Administer medications that stain teeth through a straw

9. Narcotic Medications • Made with opium and opium derivatives • Control and relieve pain • Formulated for oral, topical, injectable, and IV administration • Make sure patient does not “cheek” the pill • Must be counted at specific times • Do not dispose of wasted narcotics by flushing

10. True/False Question The nurse administering a pain tablet to a patient with an enteral tube should crush the tablet to a fine powder and mix it with a small amount of water. A. True B. False

11. Answer A. True Rationale: The nurse administering a pain tablet to a patient with an enteral tube should crush the tablet to a fine powder and mix it with a small amount of water. When possible, the prescriber will order liquid medications, but if that is not possible, tablets will be crushed if they can be crushed safely.

12. Administering Medications via an Enteral Tube • Crush tablets to a fine powder and mix with a small amount of water • Mix the contents of certain capsules with juice rather than water and administer through a large-bore tube • Know that some medications should be taken on an empty stomach and some medications can interact with the ingredients in tube feeding formulas, decreasing effectiveness

13. Administering Medications via an Enteral Tube (cont.) • Know that certain medications cause clumping with tube feeding formula • Always flush the feeding tube with 30 to 60 mL of water before and after administration of medications • When administering multiple medications, flush the tube between medications with 5 to 15 mL of water before instilling the next medicine • Avoid mixing crushed pills or liquids together in the same cup

14. Medications Causing Clumping in Feeding Tubes • Brompheniramine (Dimetapp elixir) • Ferrous sulfate (Feosol elixir) • Guaifenesin (Robitussin) • Lithium citrate (Cibalith-S) • Monobasic sodium phosphate (Fleet Phospho-Soda) • Potassium chloride liquid • Pseudoephedrine hydrochloride (Sudafed syrup)

15. Considerations When Administering Medications to Adults • Difficulty swallowing • Metabolism of medications • Multiple medications • Adverse drug reactions

16. Considerations When Administering Medications to Children • Administration devices • Small doses • Objectionable taste

17. Types of Topical Medications • Creams • Gels • Lotions • Ointments

18. Administering Medications via the Mucosal Route • Eye • Ear • Nose • Rectum • Vagina

19. Vaginal Medications • Suppositories • Creams • Aerosol • Foams • Tablets

20. True/False Question The nurse caring for patients with COPD, knows that dry powder inhalers (DPIs) are pressurized medication dispensers that spray a premeasured amount of drug into the lungs. A. True B. False

21. Answer B. False Rationale: Metered-dose inhalers (MDIs) are pressurized medication dispensers that spray a premeasured amount of drug into the lungs. Dry powder inhalers (DPIs) do not contain a pressurized canister and do not spray medication out; they rely on the force of the patient’s own inhalation to dispense medication.

22. Inhalers • Dry power inhalers (DPIs) • Rely on force of patient’s own inhalation to dispense dose of dry powder medication • Metered-dose inhalers (MDIs) • Pressurized medication dispensers that spray a premeasured amount of drug into the lungs • The most efficient way to get medications into the airways.

23. Nursing Responsibilities for Dispensing Medications • Assessing the patient • Monitoring laboratory results • Evaluating the information before administering any medications

24. Documentation of Medication Administration • Identifying information • Date and time of administration • Who administered the medication • Omission of a medication administration • Discontinuation of a medication • prn medication

25. Documentation of Special Conditions • Electronic medication administration record • MARs in long-term care • Withheld or refused medications

26. Preventing Administration and Documentation Errors • Check original order against order of MAR • Check for new or changed medications • Read medication orders carefully • Look up any unfamiliar medications • Be certain it is appropriate to administer • Follow the 6 rights of medicine administration • Question any orders exceeding recommended dosage

27. Preventing Administration and Documentation Errors (cont.) • Document medications as soon as administered • Check carefully for discontinued orders • Carefully supervise UAPs administering medications in long-term care settings

28. What to Do If a Medication Error Occurs • Put the patient first; check for adverse effects • Notify prescriber and explain what happened • Carry out additional orders for assessing and monitoring patient • Complete an incident report • Avoid being too hard on yourself