Download Unit 6 Systems of drug distribution Formulations Oral Medications

Unit 6
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Enteral Administration
Systems of drug distribution
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• Unit dose
• Automated systems
• Med Cart
Enteral Drugs
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• Enteral drugs are given orally (PO) or via nasogastric or gastrostomy tubes
• Tablets and capsules administered orally
– Assist the patient to a sitting position
– Check the manufacturer’s instructions to be sure crushing or opening capsule is allowed
Advantages of Enteral Drug Route of Administration
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Most convenient
Least costly
Safest route - skin barrier not broken
Overdose can be retrieved from stomach
Relatively easy to administer
Can be given rectally if stomach upset
Disadvantages of Enteral Drug Route of Administration
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Patient must be conscious and be able to swallow
Some drugs are inactivated by digestive enzymes
First pass effect
Differences in GI motility and absorption can create differences in bioavailability
Some people do not like to swallow large pills or take medication that is distasteful
Formulations
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• Tablet
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Short acting
Sustained release
Enteric coated
Scored
• Capsule
• Liquid
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Elixir
Emulsion
Syrup
Suspension
Powder
• Lozenge
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Oral Medications
• Oral Route
– Swallow, sublingual, buccal
– Client status
– Ability to swallow/eat /drink
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– Nausea/vomiting, NG suctioning
– Physical position
Oral Medications
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• Tablet/capsule
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Need any data before administering
Crushing/opening – is it safe?
Open package in room
Give enough fluid
• Liquid
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Unit dose cup
Using a medication cup or syringe
Powder/granules mixed
Fluid for dissolving
Oral Medications
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• Sublingual Route
– Tablet, liquid
– Under tongue, dissolves
– Give after swallowed medications
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• Buccal Route
– Tablet
– Place between cheek and gum
• Lozenges
– Hold in mouth
– Suck/dissolve
Sublingual and Buccal Drug Administration
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• Sublingual and Buccal Drug Administration
– Sublingual (SL) route drug is placed under the tongue
– For the buccal route the tablet, capsule, or lozenge, is placed between the gum and
cheek
– Patient does not swallow tablet but keeps in the mouth until it dissolves
– Do not move drug with the tongue
– Do not eat or drink anything until medication has completely dissolved
(a) Sublingual (under the tongue) drug administration;
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(b) buccal (between the gums and cheek) drug administration
Administering Medications via Gastric Tube
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• Tube
– Verify NG placement
– Ensure GT in place
– Residual?
• Client position
– Head of bed(HOB) 45-60 degrees
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• What is being administered?
– Tablet – Crushable?
– Dilute?
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• Flush before and after
Nasogastric or Gastrostomy Tubes
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Administering Medications Rectally
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• Uses
– Systemic or Local
• Formulations
– Suppository or Enema
• Absorption
– No first pass effect
– Slower that some routes
• Client Status
– GI function – N& V, diarrhea, bleeding, NPO
– Ability to hold medication at least 30 min
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• Client position
– Left side, Sim’s position – ensure privacy
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Inform client of everything you are doing
– Suppository
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Remove from package, lubricate round end
Gently insert past sphincter
– Enema
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Gently insert lubricated tip app. 2-3 inches
Slowly instill fluid
Rectal Drug Administration
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• A form (handwritten or computerized) that health care facilities use to document all of the
drugs administered to a patient.
– Routine, PRN, and STAT medications all may be written in separate locations on the MAR.
– PRN and STAT medications may also have a separate form.
– If the medication is to be given regularly, a complete schedule is written for all administration times.
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– The nurse or other healthcare provider transcribes the order to the MAR.
– The healthcare worker initials the time of administration each time a dose is administered
with a full name, title, and initials, recorded usually at the end of the MAR.
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Routine and Stat meds
• Document date and time med is given
• Administer within time frame allowed or it becomes a medication error
• All 6 rights must be checked 3 times
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Narcotics
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Documented on MAR and on Narcotic Control sheet
Can be identified by C and control number on label of medication
Kept in separate locked area
Counted at beginning and end of each shift or at time of staff change
No one leaves the floor until all are accounted for. If any missing must complete necessary
paperwork
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Meds that must be double signed
• Insulin and Heparin as well as any Narcotic waste
• Nurse administering as well as a second licensed nurse must check and verify
the medication is drawn up as ordered or wasted properly
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PRN medications
• Administer only within physician’s parameters
• Check all appropriate documentation to make sure medication can safely be administered
– (MAR and Narcotics sheet)
• Assess and verify patient needs or wants medications
• Document all appropriate places
• Go back and document effectiveness after appropriate time period
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Nurse’s Responsibilities in Drug Delivery
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Knowledge and understanding of drug ordered
Drug’s generic and trade names
Drug’s classification
Use of drug
Effects on body
Contraindications
Special considerations
Side effects
Nurse’s Responsibilities (cont’d)
• Why medication has been prescribed for
“this patient”
• How the pharmacy supplies the medication
• How the medication should be administered
• Dosage range
• Nursing process considerations related to the medication
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Nurse’s Responsibilities (cont’d)
• Assessment
– Reason client is receiving the drug
– Subjective and objective data
• Implementation
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Hand washing, gloves
Medication is NOT to be left at the bedside
Stay with Client until all taken to verify no choking
Check 6 rights
Nurse’s Responsibilities (cont’d)
• Evaluation
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Were therapeutic effects achieved?
Any side effects?
Any unforeseen effects?
Any action needed?
• Documentation
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When do you document?
What do you document?
Time
Route
Dose
Holding a med
Documentation
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• Documentation
– When do you document?
– What do you document?
• Time
• Route
• Dose
• Holding a med
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• Special Documentation
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Narcotics
Waste of narcotics
Double checks on certain meds
Results of prn meds
Results of psych meds
Common Protocols of Drug Administration
• If the drug is prepackaged remove it from the packaging at the bedside whenever possible
• Do not leave drugs at the patient’s bedside, unless specifically ordered to do so
• Document the medication administration and any patient responses on the MAR
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