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Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 36
Administration of Oral, Topical, and
Mucosal Medications
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Routes of Medication
Administration
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Oral
Enteral tube
Topical
Transdermal
Mucosal
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Oral Drugs
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Tablets
Caplets
Capsules
Liquid
 Syrups, elixirs, solutions, suspensions
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Medications That
Should Not Be Crushed
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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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Medications Causing
Clumping in Feeding Tubes
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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)
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Considerations When
Administering Medications to
Adults
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Difficulty swallowing
Metabolism of medications
Multiple medications
Adverse drug reactions
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Considerations When
Administering Medications
to Children
 Administration devices
 Small doses
 Objectionable taste
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Topical Medications
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Creams
Gels
Lotions
Ointments
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Administering Medications
via the Mucosal Route
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Eye
Ear
Nose
Rectum
Vagina
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Vaginal Medications
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Suppositories
Creams
Aerosol
Foams
Tablets
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Responsibilities for
Dispensing Medications
 Assessing the patient
 Monitoring laboratory results
 Evaluating the information before
administering any medications
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Documentation of
Medication Administration
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Identifying information
Date and time of administration
Who administered the medication
Omission of a medication administration
Discontinuation of a medication
prn medication
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Documentation
of Special Conditions
 Electronic medication administration record
 MARs in long-term care
 Withheld or refused medications
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Preventing Administration
and Documentation Errors
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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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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
Fundamentals of Nursing Care: Concepts, Connections, & Skills
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