Medication Administration via the Gastrointestinal (GI)

RouteInformation in this presentation refers to Knowledge Objective II in your module syllabus:

At the completion of this module, nursing students will be able to differentiate between the routes and methods of medication administration using the six rights and three checks during case scenarios and simulation in the lab setting with 100% accuracy using a predetermined rubric.

See next slide for presentation specific objectives

Presentation Objectives

Upon completion of this presentation, the learner should be able to:• List essential guidelines for administering

medications via gastrointestinal (GI) route.• Identify essential information to be given to

the client about her/his medication.• Outline the general procedure for

administering medications via GI route.

A medication is generally prepared for one or more routes of administration. This unit will focus on the GI routes:• Oral• Sublingual• Buccal• Rectal

Comment on routes of administration

Oral Route

• Most common form of drug administration

• Always keep in mind the six rights and three checks

• Practice infection control: wash hands before setting up and between clients

General procedures for oral administration:• Identify the medication order, use hospital policy when

checking medication orders• Wash your hands and prepare the medication• Identify your client and explain the medications to be given• Take the required assessment measures (B/P, apical pulse, etc)• Assist the client to take the medications• Stay with the client until all medications have been taken• Document the medication administration• Evaluate the effects of the medication• Report any undesired responses or side effects

Oral Route

Check the orderson MAR

Wash your hands

Identify your client:Ask them their name and DOB

Verify id on client arm band

Perform required assessments:B/P, apical pulse, etc

Document results

Assist client to take meds

Document meds given

Important: let your client know as much as possible about the medications they are taking• Give the name of the medication• Explain what is being given for (in common language)• What effects are expected; explain possible adverse effects • Discuss reasons for why medications are scheduled the way

they are, for example:– With meals or on an empty stomach– Whether or not certain foods will affect the medication– The reason the medication is scheduled at regular intervals

• Explain medications that cannot be chewed or crushed (i.e., coated tablets) and to drink plenty of water with enteric coated pills and capsules to help dissolve

Oral Route, con’t

When the client is planning to go home:• Be specific with instructions on how to take and work out a

schedule that fits around the client’s home routine• Instruct the client on what to do if a dose is missed• Emphasize the importance of not discontinuing the

medication without consulting his/her doctor• Emphasize the importance of not sharing medications with

others who may have similar symptoms• Write the instructions out for the client – in clear language• Have the client repeat the instructions back to you

Oral Route, con’t

Oral Medication Considerations

Tablets and Capsules• Pouring from multiple dose bottle

– Pour correct amount into bottle cap– This method prevents contamination if you have to pour some back

• Pour into medicine cup and recapNote: Always alert the pharmacy when disposing of a contaminated drug• Never divide a tablet that isn’t scored, it will result in incorrect dosage• Opening a capsule or crushing a tablet when client has

trouble swallowing: – General rule: crush only uncoated tablets/capsules– Check “do not crush” list

Tablet

Capsule

Scored tablet

Liquids• Obtain a disposable measuring cup with amount markings• Open medication bottle and place cap on table top up to avoid contamination• Place the cup at eye level and pour the medication• When reading the correct dosage, read at the base of the meniscus at eye level on a flat surface. • If you pour too much, pour into the sink - NOT back into bottle• When administering, place client in a semi-Fowler’s position • Keep in mind: liquid meds are absorbed more quickly than

solids, such as pills

Oral Medication Considerations

Liquids with a syringe• Used when clients are unable to drink from a cup• Pour med into cup, then withdraw correct amount, dispose of

excess• Check dosage at eye level by reading measurement from top

edge of stopper• To administer:

– Position client in semi-fowler, upright position– Gently place syringe tip between cheek and 2nd molar– Instill slowly; ensure medication is being swallowed

Oral Medication Considerations

Check dosage at eye level by reading measurement from top edge of stopper

Sublingual• Medication is placed under the tongue until absorbed• Drug is mainly absorbed into the blood vessels under tongue• Caution client not to swallow

Buccal• Medication is placed between the cheek and the teeth and

held there until absorbed• Medication is in tablet form• Caution client not to swallow

Other Oral Medication Considerations

Buccal administration of anti-seizure medication

Sublingual nitroglycerin pills

Used when client is:• Vomiting• Unconscious• Unable to swallow

Procedure:• Lubricate tip with water soluble lubricant after removing foil• Provide privacy• Place in side-lying or Sim’s position• Ask client to take a deep breath and inset the pointed tip past

the internal sphincter (aprox 3 inches)• Instruct client to attempt to retain suppository at least 20 min

Rectal Medication Considerations

Suppository: push through outer and inner sphincters to insert into rectal cavity