1. Chapter 8 Administration by Gastrointestinal Route
Pharmacology
Chapter 8
Administration by
Gastrointestinal Route

2. Gastrointestinal Route
Includes:
Oral
NGT – nasogastric tube
GT – gastric tube or G-tube
Rectal

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

4. 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.

5. 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

6. Advantages of delivering meds via a NGT
Ability to bypass the mouth and pharynx when necessary
Eliminates the need for numerous injections

7. Disadvantages of an NGT
Causes discomfort to the pt, feels like they have a sore throat

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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.

24. “NEW SLIDE” Unit dose Multi dose Single dose Floor stock Narcotic
Non-narcotic

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Position pt on the right side and elevate HOB to encourage the faster emptying of the stomach
Document that you gave med

32. 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

33. 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

34. 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.

35. 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

36. The End