Administration of Oral

Medications
 Oral Medication
The oral route is the most commonly used route. Drugs given
orally are intended for absorption in the stomach and small
intestine.

Advantages
a. The easiest and most desirable way to
administer medication
b. Most convenient
c. Safe, does not break skin barrier
d. Usually less expensive
.
• Disadvantages
a. Inappropriate if client cannot swallow and if
GIT has reduced motility
b. Inappropriate for client with nausea and
vomiting
c. Drug may have unpleasant taste
d. Drug may discolor the teeth
e. Drug may irritate the gastric mucosa
f. Drug may be aspirated by seriously ill patient
 Sublingual Medications
a. A drug
that is placed under the tongue,
where it dissolves.

b. When the medication is in capsule and

ordered sublingually, the fluid must be
aspirated from the capsule and placed under
the tongue.

c. A medication given by the sublingual route

should not be swallowed, or desire effects
will not be achieved.
Advantages:
a. Same as oral
b. Drug is rapidly absorbed in the
bloodstream
Disadvantages
a. If swallowed, drug may be inactivated
by gastric juices.
b. Drug must remain under the tongue
until dissolved and absorbed.
 Buccal Administration
a. A medication is held in the mouth against the mucous membranes of the
cheek until the drug dissolves.

b. The medication should not be chewed, swallowed, or placed under the

tongue (e.g. sustained release nitroglycerine, opiates, antiemetics,
tranquilizer, sedatives)

c. Client should be taught to alternate the cheeks with each subsequent

dose to avoid mucosal irritation

Advantages:
a. Same as oral
b. Drug can be administered for local effect
c. Ensures greater potency because drug directly enters the blood and
bypass the liver

Disadvantages:
If swallowed, drug may be inactivated by gastric juice.
 Drug Forms for Oral Administration

a. Solid: tablet, capsule, pill, powder

b. Liquid: syrup, suspension, emulsion, elixir, milk, or other
alkaline substances.

Syrup: sugar-based liquid medication

Suspension: water-based liquid medication. Shake bottle
before use of medication to properly mix it.
Emulsion: oil-based liquid medication
Elixir: alcohol-based liquid medication. After administration
of elixir, allow 30 minutes to elapse before giving water.
This allows maximum absorption of the medication.
“NEVER CRUSH ENTERIC-COATED OR
SUSTAINED RELEASE TABLET”

> Crushing enteric-coated tablets – allows the

irritating medication to come in contact with
the oral or gastric mucosa, resulting in
mucositis or gastric irritation.

> Crushing sustained-released medication –

allows all the medication to be absorbed at the
same time, resulting in a higher than expected
initial level of medication and a shorter than
expected duration of action.
 Equipment

• Medication in disposable cup or

oral syringe
• Liquid with straw if not
contraindicated
• Medication cart or tray
 Assessment
• Assess the patient’s ability to swallow medications.
❖ If the patient cannot swallow, is NPO, or is
experiencing nausea and vomiting, the medication
should be withheld, the physician notified, and proper
documentation completed.

• Assess the patient’s knowledge of the medication.

❖ If the patient has a knowledge deficit about the
medication, this may be the appropriate time to begin
education about the medication.
❖ If the medication may affect the patient’s vital signs,
assess them before administration.
❖ If the medication is for pain relief, assess the patient’s
pain level before and after administration.
 Nursing Diagnosis

Determine related factors for the nursing

diagnoses based on the patient’s current
status. Appropriate nursing diagnoses may
include:

❖Impaired swallowing
❖Risk for aspiration
❖Anxiety
❖Deficient Knowledge
❖Noncompliance
Outcome identification and planning

The expected outcome to achieve when

administering an oral medication is that the patient
will swallow the medication. Other outcomes that
may be appropriate include the following:
• The patient will not aspirate
• The patient has decreased anxiety
• The patient understands and complies with the
medication regimen
 Implementation

1. Gather equipment.
▪ Check each medication order against the original
physician’s order according to agency policy.
▪ Clarify any inconsistencies. Check the patient’s
chart for allergies.

R: This comparison helps to identify errors that may

have occurred when orders were transcribed. The
physician’s order is a legal record of medication
orders for each agency.
 Implementation

2. Know the actions, special nursing

considerations, safe dose ranges, purpose of
administration, and adverse effects of the
medications to be administered.

R: This knowledge aids the nurse in

evaluating the therapeutic effect of the
medication in relation to the patient’s disorder
and can also be used in educating the patient
about the medication.
 Implementation

3. Perform hand hygiene.

R: Hand hygiene prevents the spread of
microorganisms.

4. Prepare for administration in the medication area.

R: Organization facilitates error-free administration
and saves time.

5. Prepare medications for one patient at a time.

R: This prevents errors in medication administration.
 Implementation
6. . Select the proper medication
from the drawer or stock and
compare with the Kardex or
order. Check the expiration
dates and perform calculations
if necessary.

R: Comparison of medication to
physician’s order reduces errors
in medication administration.
This is the first safety check.
Verify calculations with another
nurse if necessary.
 Implementation
a. Place unit dose-packaged medications in a disposable
cup. Do not open wrapper until at the bedside. Keep
narcotics and medications that require special nursing
assessments in a separate container.
R: The label is needed for an additional safety check.
Prerequisites to giving certain medications may include
assessing vital signs and checking laboratory test results.

b. When removing tablets or capsules from a bottle, pour the

necessary number into the bottle cap and then place the
tablets in a medication cup. Break only scored tablets, if
necessary to obtain the proper dosage. Do not touch
tablets with hands.
R: Pouring medication into the cap allows for easy return
of excess medication to bottle. Pouring tablets or capsules
into the nurse’s hand is unsanitary.
 Implementation
▪ Hold liquid medication
bottles with the label
against the palm.
▪ Use the appropriate
measuring device when
pouring liquids, and read
the amount of medication
at the bottom of the
meniscus at eye level
▪ Wipe the lip of the bottle
with a paper towel.
R: Liquid that may drip
onto the label makes the
label difficult to read.
Accuracy is possible when
the appropriate measuring
device is used and then
read accurately.
 Implementation
7. Recheck each medication package or preparation with the order as it is
poured./ recheck each prepared drug and container with the MAR again.
R: This is the second check to guard against medication errors.

8. When all medications for one patient have been prepared, recheck once
again with the medication order before taking them to the patient./
recheck the label on the container before returning the bottle, box,
envelope to its storage place.
R: This is the third check to ensure accuracy and to prevent errors.

9. Transport medications to the patient’s bedside carefully, and keep the

medications in sight at all times.
R: Careful handling and close observation prevent accidental or deliberate
disarrangement of medications.

10. See that the patient receives the medications at the correct time.
R: Check agency policy, which may allow for administration within a period
of 30 minutes before or 30 minutes after designated time.
 Implementation
11. Identify the patient carefully.
R: Identifying the patient is the nurse’s
responsibility to guard against errors.

There are 3 correct ways to do

this:
a. Check the name on the patient’s
identification band.
R: This is the most reliable method.
Replace the identification band if it is
missing or inaccurate in any way.

b. Ask the patient to state his or her

name.
R: This requires a response from the
patient, but illness and strange
surroundings often cause patients to
be confused.

c. Verify the patient’s identification with

a staff member who knows the patient.
R: This is another way to double-check
identity. Do not use the name on the
door or over the bed, because these
may be inaccurate.
 Implementation
12. Complete necessary
assessments before
administering medications.
Check allergy bracelet or ask
patient about allergies.
Explain the purpose and
action of each medication to
the patient.
R: Assessment is a
prerequisite to administration
of medications.

13. Assist the patient to an

upright or lateral position.
R: Swallowing is facilitated by
proper positioning. An upright
or side-lying position protects
the patient from aspiration.
 Implementation
14. Administer medications:
a. Offer water or other permitted fluids with pills, capsules, tablets, and
some liquid medications.
R: Liquids facilitate swallowing of solid drugs. Some liquid drugs are
intended to adhere to the pharyngeal area, in which case liquid is not
offered with the medication.

b. Ask whether the patient prefers to take the medications by hand or in

a cup and one at a time or all at once.
R: This encourages the patient’s participation in taking the medications.

c. If the capsule or tablet falls to the floor, it must be discarded and a

new one administered.
R: This prevents contamination.

d. Record any fluid intake if intake and output measurement is ordered.

R: This provides for accurate documentation.
 Implementation
15. Remain with the patient until each medication is
swallowed. Never leave medication at the patient’s
bedside.
R: Unless the nurse has seen the patient swallow the drug,
the drug cannot be recorded as administered. The patient’s
chart is a legal record. Only with a physician’s order can
medications be left at the bedside.

16. Perform hand hygiene.

R: Hand hygiene prevents the spread of microorganisms.
 Implementation
17. Record each medication given on the medication chart or record using
the required format.
R: Prompt recording avoids the possibility of accidentally repeating the
administration of the drug.

a. If the drug was refused or omitted, record this in the appropriate area
on the medication record and notify the physician.
R: This verifies the reason medication was omitted and ensures that the
physician is aware of the patient’s condition.

b. Recording of administration of a narcotic may require additional

documentation on a narcotic record, stating drug count and other
specific information.
R: Controlled substance laws necessitate careful recording of narcotic
use. If a computerized medication station is being used, the machine
may document needed information upon withdrawal of the medication.
 Implementation

18. Check on the patient within 30 minutes to

verify response to medication.

R: This provides the opportunity for further

documentation and additional assessment
of effectiveness of pain relief and adverse
effects of medications.
Teaching Clients about Oral Medications
Read all directions, warnings, and interactions
1.
about the drug.
2. Most medications should be taken with a full
glass of water to enable the drug to be dissolved
and begin working more quickly.
3. Medications should never be combined with
alcohol.
4. Do not mix medications in hot drinks. The hot
temperature can destroy some drugs, and the
tannic acid in hot tea can reduce the absorption
of certain medications.
5. Do not mix medications in food unless
specifically ordered.
6. Vitamin and mineral supplements can
interfere with drug absorption.
7. Store medications in their original containers
in a dry location.
8. Store all medications out of reach of children.
9. Do not keep drugs for long periods.
10. Do not start or stop drugs without consulting
the physician.
11. Develop a routine time and place for taking
medications
 -
Topical Medications

Application of medication to a circumscribed

area of the body
 Dermatologic
– includes lotions, liniment and ointments, powder.
a. Before application, clean the skin thoroughly
by washing the area gently with soap and water,
soaking an involved site, or locally debriding
tissue.
b. Use surgical asepsis when open wound is
present
c. Remove previous application before the next
application
d. Use gloves when applying the medication
over a large surface. (e.g large area of burns)
e. Apply only thin layer of medication to
prevent systemic absorption.
 Opthalmic
▪ includes instillation and irrigation
a. Instillation – to provide an eye medication
that the client requires.
▪ b. irrigation
▪
 Eye instillation
Purposes:
✓ To dilate or contract the pupil
✓ To relieve pain, discomfort, itching and
inflammation
✓ To act as an antiseptic in cleansing the
eye
✓ To combat infection
Nursing action Rationale

Preparatory phase

1. Inform the patient of the need and reason for

instilling drops or ointment

2. Allow the patient to sit with head tilted Provides a position of comfort and safety for
backward or to lie in a supine position. the patient and accessibility for the nurse.

Performance phase

1. Check the patient’s name For proper patient identification

2. Check written prescription and bottle,, vial or To avoid medication error.

tube for correct medication.

3. Check prescription designating eye requiring

drops and confirm with patient
OD ( oculus dexter) right eye
OS ( oculus sinister) left eye
OU ( oculus uterque) both eye
Nursing action rationale

4. Wash hands before instilling medication To prevent transfer of microorganisms to

patient.

5. Remove cap from container and place on To prevent contamination of lid.

clean surface.

6. If eyedropper is used, fill eyedropper with Loose particles of rubber from bulb end may
medication by squeezing bulb. Do not tip slip into medication.
eyedropper upside down so medication can flow
back into bulb end.

7. Using forefinger, pull lower lid down gently. To expose the inner surface of lid and cul-de-sac

8. Instruct patient to look upward Prevents medication from hitting sensitive

cornea.

9. Drop medication amount prescribed into Prevents medication from hitting sensitive
center of lower lid ( cul-de-sac) cornea.
Nursing action Rationale

10. If ointment is to be instilled, squeeze out a To prevent contamination of the tube.

ribbon of medication from the tube into the
lower lid without touching the eye

11. Instruct the patient to close eyes slowly but Squeezing or rubbing would express medication
not to squeeze or rub them. Open eye. from eye; closing medication to be distributed
evenly over eye.

12. Wipe off excess solution with gauze or Prevents possible skin irritation.
cotton balls

13. Wash hands after instilling medication. Prevents transfer of microorganisms to self or
other patients.

14. If additional eye drops are ordered, wait 5 To allow time for absorption of medication.
minutes between each medication
Nursing action Rationale

Follow-up

Record time, type, strength and amount of

medication and the eye into which medication
was instilled.
 Eye irrigation
Purposes:
✓ To irrigate the chemicals or foreign
bodies from the eye.
✓ To remove secretions from the
conjunctival sac
✓ To treat infections
✓ To relieve itching
Nursing action rationale

Preparatory Phase
1. Verify the eye to be irrigated and the solution To prevent error.
and the amount of irrigant.

2. The patient may sit with head tilted back or To facilitate flow of solution over the eye.
lie in a supine position.

Instruct the patient to tilt his head toward the To prevent fluid from draining into unaffected
side of the affected eye eye.

Performance phase

1. Wash eyelashes and lids with prescribed Any materials on the lids and lashes should be
solution at room temperature; acurved basin washed off before exposing the conjunctiva.
should be placed on the effected side of the face
to catch the outflow.
Nursing action Rationale

2. Evert the lower conjunctival sac ( if feasible Exposes inner surfaces of lower lid and
have the patient pull down lower lid with index conjunctival sac (involves the patient and gives
finger) a sense of control).

3. Instruct the patient to look up; avoid touching Prevents injury to the sensitive cornea.
eye with equipment.

4. Allow irrigating fluid to flow from the inner Prevents solution from flowing toward the
canthus to the outer canthus along the lacrimal sax, duct, nose, possibly transmitting
conjunctival sac. infection.

5. Use only enough force to flush secretions Prevents eye injury ( involves the patient in the
from conjunctiva. (allow patient to hold curve treatment)
basin near the eye to catch the fluid)

6. occasionally, have patient close eyes Allows upper lid to meet lower lid with the
possibility of dislodging additional particles.
Nursing action Rationale

Follow-up

1. Pat eye dry and dry the patient’s face with a Provides comfort
soft cloth.

2. Record kind and amount of fluid used as Provides documentation of nursing actions.
well as its effectiveness.
 Otic Instillation
– to remove cerumen or pus or to remove foreign body
Purpose:
1. To soften earwax so that it can be easily removed at a later
time.
2. To provide local therapy to reduce inflammation, destroy
infective organisms in the external ear canal or both
3. To relieve pain
Assessment:
1. Appearance of the pinna of the ear and meatus for signs of
redness and abrasions.
2. Type and amount of discharge
 Procedure:

a. Warm the solution at room temperature

or body temperature, failure to do so may
cause vertigo, dizziness, nausea and pain.
b. Have the client assume a side-lying
position ( if not contraindicated) with ear to
be treated facing up.
c. Perform hand hygiene. Apply gloves if
drainage is present.
• D. Straighten the ear canal:
0-3 years old: pull the pinna
downward and backward
Older than 3 years old: pull the pinna
upward and backward
• e. Instill eardrops on the side of the
auditory canal to allow the drops to flow
in and continue to adjust to body
temperature
f. Press gently bur firmly a few times on
the tragus of the ear to assist the flow of
medication into the ear canal.
• G. Ask the client to remain in side lying
position for about 5 minutes
h. At times the MD will order insertion of
cotton puff into outermost part of the
canal.Do not press cotton into the canal.
Remove cotton after 15 minutes.
Irrigating the external auditory canal
• Purposes:
✓ To remove discharge from the canal
✓ To facilitate removal of cerumen or foreign
body
Equipment:
✓ Kinds and amount of solution desired ( usually warm
water)
✓ Ear syringe or irrigating container with tubing, clamp and
catheter
✓ Protective towels
✓ Cotton balls and cotton tipped applicators
✓ Solution bowl and emesis basin
✓ Bag for disposable items
Nursing action Rationale

Preparatory phase

1. After explaining procedure to the patient, Ear should be accessible and able to drain into
place in a position of sitting or lying with head basin.
tilted forward and toward affected ear.

2. Position protective towels. Water often runs down neck onto clothing.

Performance phase

1. Use a cotton applicator to remove any To prevent carrying discharge deeper into canal.
discharges on outer ear

2. Place basin close to the patient’s head and To provide a receptacle to receive irrigating
under the ear. solution.

3. Test temperature of solution . It should be Solutions that are hot or cold are most
comfortable to the inner aspect of wrist area. uncomfortable and may initiate a feeling of
dizziness.
Nursing action rationale

4. Ascertain whether impaction is due to a If water contacts a substance, it may cause it to

foreign hydroscopic (attracts or absorbs swell and produce intense pain.
moisture) body before proceeding.

5. Gently pull the outer ear upward and To straighten the ear canal
backward ( adult) or downward and
outward(child)

6. Place tip of syringe or irrigating catheter at To decrease direct force of irrigation against
opening of ear; gently direct stream of fluid eardrum and possibility of rupturing it.
against sides of canal.

7. If an irrigating container is used, elevate To provide safe and effective pressure of fluid;
only high enough to remove secretions or no if height is more than 6 inches, pressure will
more than 6 inches (15 cm) above patient’s be too great and may damage tissue.
ear.
Nursing action rationale

8. Observe for signs of pain or dizziness Discontinue treatment if they occur.

9. If irrigating does not dislodge the wax, instill To soften and loosen impaction
several drops of prescribed glycerin, carbamide
peroxide ( Debrox) or other solutions as directed
two or three times daily for 2-3 days.

Follow-up

1. Dry external ear

2. Remove soiled equipment and make the Large amount of brown cerumen may be
patient comfortable. returned in irrigation solution

3. Patient should lie on irrigated (affected) side Narrow or tortuous ear canals may drain slowly,
for a few minutes after procedure to allow any retained solution any be uncomfortable and lead
remaining solution to drain out. to infection

4. Record time of irrigation, type and amount of For future reference about effectiveness of
solution, nature of return flow and effect of procedure.
treatment
 Nasal Instillations
– Nasal instillations usually are instilled for their
astringent effects (to shrink swollen mucous
membrane), to loosen secretions and facilitate
drainage or to treat infections of the nasal cavity or
sinuses. Decongestants, steroids, calcitonin.

a. Have the client blow the nose prior to nasal

instillation
b. Assume a back lying position, or sit up and lean
head back.
c. Elevate the nares slightly by pressing the thumb
against the client’s tip of the nose. While the client
inhales, squeeze the bottle.
• d. Keep head tilted backward for 5
minutes after instillation of nasal drops.
e. When the medication is used on a
daily basis, alternate nares to prevent
irritations
 Inhalation
– use of nebulizer, metered-dose inhaler

a. Semi or high-fowler’s position or standing position.

To enhance full chest expansion allowing deeper
inhalation of the medication
b. Shake the canister several times. To mix the
medication and ensure uniform dosage delivery
c. Position the mouthpiece 1 to 2 inches from the
client’s open mouth. As the client starts inhaling,
press the canister down to release one dose of the
medication. This allows delivery of the medication
more accurately into the bronchial tree rather than
being trapped in the oropharynx then swallowed
• d. Instruct the client to hold breath for 10
seconds. To enhance complete absorption of
the medication.
e. If bronchodilator, administer a maximum of
2 puffs, for at least 30 second interval.
Administer bronchodilator before other inhaled
medication. This opens airway and promotes
greater absorption of the medication.
f.
• Wait at least 1 minute before
administration of the second dose or
inhalation of a different medication by
MDI
g. Instruct client to rinse mouth, if steroid
had been administered. This is to
prevent fungal infection.
 Vaginal Instillations
– drug forms: tablet liquid (douches). Jelly, foam and
suppository.
a. Close room or curtain to provide privacy.
b. Assist client to lie in dorsal recumbent position to provide
easy access and good exposure of vaginal canal, also
allows suppository to dissolve without escaping through
orifice.
c. Use applicator or sterile gloves for vaginal administration
of medications.
 Vaginal Irrigation
• is the washing of the vagina by a liquid
at low pressure. It is also called douche.
a. Empty the bladder before the
procedure
b. Position the client on her back with
the hips higher than the shoulder (use
bedpan)
c.
• Irrigating container should be 30 cm (12
inches) above
d. Ask the client to remain in bed for
5-10 minute following administration of
vaginal suppository, cream, foam, jelly
 Rectal Administration
– can be use when the drug has objectionable taste or odor.

a. Need to be refrigerated so as not to soften.

b. Apply disposable gloves.
c. Have the client lie on left side and ask to take slow
deep breaths through mouth and relax anal sphincter.
d. Retract buttocks gently through the anus, past internal
sphincter and against rectal wall, 10 cm (4 inches) in
adults, 5 cm (2 in) in children and infants. May need to
apply gentle pressure to hold buttocks together
momentarily.
• Discard gloves to proper receptacle and
perform hand washing.
f. Client must remain on side for 20
minute after insertion to promote
adequate absorption of the medication