1. Enteral Administration Jeanelle F. Jimenez RN, BSN, CCRN Chapter 9 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Objectives Correctly define and identify oral dose forms of medications Identify common delivery systems used to administer oral medications Describe general principles of administering solid forms of medications and the different techniques used with a medication card, computer-controlled, and unit dose distribution systems Compare techniques used to administer liquid forms of oral medication using the medication card and unit dose systems of distribution Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Cite the equipment needed, techniques used, and precautions necessary when administering medications via a nasogastric tube Meet the person’s basic metabolic requirements and provide adequate nutritional intake through the use of enteral nutrition support Cite the equipment needed and technique required to administer rectal suppositories Cite the equipment needed and technique used to administer a disposable enema Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. 3 Routes of Drug Administration Enteral Parenteral Percutaneous Slide 4 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Administration of Oral Medications Capsules – small, cylindrical gelatin containers used to administer unpleasant-tasting medications  Timed-release capsules – provide gradual and continuous release of a drug Lozenges, troches – flat disks in a flavored base Tablets – powdered drugs that have been compressed Orally-disintegrating tablets – rapidly dissolve on tongue within seconds Elixirs – drugs dissolved in water and alcohol Liquid suspensions, syrups Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Administration of Oral Medications (cont’d) Common methods used to administer oral medications  Unit dose packaging – provides a single dose  Soufflé cups  Medicine cups  Medicine droppers  Teaspoons  Oral syringes – plastic syringes calibrated and used to measure liquid medications  Nipples with additional holes – used for infants Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Administration of Solid-Form Oral Medications Two techniques for administering medications  Medication card  Unit dose distribution Perform premedication assessment in all cases All techniques follow the six rights  RIGHT patient  RIGHT drug  RIGHT route  RIGHT dose  RIGHT time  RIGHT documentation Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Administration of Solid-Form Oral Medications (cont’d) General principles apply to all distribution systems  Give the most important medications first  Do not touch the medication with your hands  Encourage liquid intake to ensure swallowing  Remain with patient while medication is taken; DO NOT leave the medication at bedside unless an order to do so exists  Discard the medication container Provide complete documentation of administration and responses to therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Slide 9 Administration of Solid-Form Oral Medications (cont’d) Chart date, time, drug name, dosage, and route of administration Regularly record patient assessments to evaluate therapeutic effectiveness Chart and report any sign of adverse effects Perform and validate essential education about drug therapy and other aspects of intervention for the individual Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Slide 10 Administration of Liquid-Form Oral Medications General procedures are the same as with solid-form oral medications Perform premedication assessment in all cases Liquid medications are most commonly given to infants using a syringe or dropper Place the syringe between the cheek and gums, halfway back into the mouth, and slowly inject medication to allow the infant to swallow Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 Administration of Liquid-Form Oral Medications (cont’d) General principles for infants, children, and adults  Give adults and children the most important medications first  NEVER dilute medications without specific orders. DO NOT leave a medication at the bedside without an order to do so  Check an infant’s ID and be certain the infant is alert Provide complete documentation of administration and responses to therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Slide 12 Administration of Liquid-Form Oral Medications (cont’d) Measuring techniques vary according to receptacle used Measuring cup  Cover label to prevent smearing; place fingernail at exact level on measuring cup; read the volume at the level of meniscus Oral syringe  Select syringe of appropriate size. Draw up prescribed volume of medication from bottle or medicine cup Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Slide 13 Administration of Medications by Nasogastric Tube Drugs are administered via nasogastric tube for specific patients, using a liquid form whenever possible. Remember:  Always flush the tube before and after administration with 30 mL of water  Perform premedication assessment  Assemble equipment before administration  Flush between each medication with 5 to 10 mL of water Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Slide 14 Administration of Medications by Nasogastric Tube (cont’d) Prepare doses as for administration of solid- or liquid-form oral medications Check nasogastric tube placement Follow procedure for administering medication DO NOT attach suction for 30+ minutes Provide complete documentation of administration and responses to therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Slide 15 Administration of Enteral Feedings via Gastrostomy of Jejunostomy Tube Enteral formulas are designed to provide basic metabolic requirements and adequate nutritional intake Prescribed enteral formula should be checked Formula should be fully labeled Discard unused formula every 24 hours Follow the guidelines specific for patients receiving general nutrition via intermittent or continuous feedings Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Slide 16 Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube (cont’d) Verify tube placement and initiate feeding Flush with 30 mL water, then clamp tube Proceed with tube feeding technique  Intermittent: use Toomey syringe  Continuous: use disposable feeding container and enough formula for a 4-hour period Check gastric residual volume before next feeding; listen for bowel sounds Provide complete documentation of administration and responses to therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

17. Slide 17 Administration of Rectal Suppositories Suppositories are solid medication designed to dissolve inside a body orifice Equipment is simple  Finger cot or disposable glove  Water-soluble lubricant  Prescribed suppository Perform standard premedication assessment Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Slide 18 Administration of a Disposable Enema The dose form will be a prepackaged, disposable-type enema solution Technique begins with the six rights  Explain procedure and check pertinent parameters Time of last defecation  Position patient on left side  Apply lubricant to rectal tube  Insert lubricated tube and insert solution. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.