Monday, 28 March 2011

ORAL DRUGS

Because oral administration is usually the safest, most convenient, and least expensive method, most drugs are administered by this route. Drugs for oral administration are available in many forms: tablets, enteric-coated tablets, capsules, syrups, elixirs, oils, liquids, suspensions, powders, and granules. Some require special preparation before administration, such as mixing with juice to make them more palatable; oils, powders, and granules most often require such preparation.
Sometimes oral drugs are prescribed in higher dosages than their parenteral equivalents because after absorption through the GI system, they are immediately broken down by the liver before they reach the systemic circulation.
  • ELDER ALERT Oral dosages normally prescribed for adults may be dangerous for elderly patients.
Oral administration is contraindicated for unconscious patients; it may also be contraindicated in patients with nausea and vomiting and in those unable to swallow.
Equipment
Patient's medication record and chart • prescribed medication • medication cup • optional: appropriate vehicle, such as jelly or applesauce, for crushed pills commonly used with children or elderly patients, and juice, water, or milk for liquid medications; drinking straw; mortar and pestle for crushing pills.
Implementation
  • Verify the order on the patient's medication record by checking it against the physician's order.
  • Wash your hands.
  • Check the label on the medication three times before administering it to make sure you'll be giving the prescribed medication. Check when you take the container from the shelf or drawer, again before you pour the medication into the medication cup, and again before returning the container to the shelf or drawer. If you're administering a unit-dose medication, check the label for the final time at the patient's bedside immediately after pouring the medication and before discarding the wrapper.
  • Confirm the patient's identity by asking his name and checking the name, room number, and bed number on his wristband.
  • If your facility utilizes a bar code scanning system, be sure to scan your ID badge, the patient's ID bracelet, and the medication's bar code.
  • Assess the patient's condition, including level of consciousness and vital signs, as needed. Changes in the patient's condition may warrant withholding medication. For example, you may need to withhold a medication that will slow the patient's heart rate if his apical pulse rate is less than 60 beats/minute.
  • Give the patient his medication and an appropriate vehicle or liquid, as needed, to aid swallowing, minimize adverse effects, or promote absorption. For example, cyclophosphamide is given with fluids to minimize adverse effects; antitussive cough syrup is given without a fluid to avoid diluting its soothing effect on the throat. If appropriate, crush the medication to facilitate swallowing.
  • Stay with the patient until he has swallowed the drug. If he seems confused or disoriented, check his mouth to make sure he has swallowed it. Return and reassess the patient's response within 1 hour after giving the medication.
Special considerations
  • Make sure you have a written order for every medication given. Verbal orders should be signed by the physician within the specified time period. (Hospitals usually require a signature within 24 hours; long-term-care facilities, within 48 hours.)
  • Notify the physician about any medication withheld, unless instructions to withhold are already written.
  • Use care in measuring out the prescribed dose of liquid oral medication. (See Measuring liquid medications, page 230.)
  • Don't give medication from a poorly labeled or unlabeled container. Don't attempt to label or reinforce drug labels yourself. This must be done by a pharmacist.
  • Never give a medication poured by someone else. Never allow your medication cart or tray out of your sight. This prevents anyone from rearranging the medications or taking one without your knowledge. Never return unwrapped or prepared medications to stock containers. Instead, dispose of them and notify the pharmacy. Keep in mind that the disposal of any opioid drug must be cosigned by another nurse, as mandated by law.
  • If the patient questions you about his medication or the dosage, check his medication record again. If the medication is correct, reassure him. Make sure you tell him about any changes in his medication or dosage. Instruct him, as appropriate, about possible adverse effects. Ask him to report anything he thinks may be an adverse effect.
  • To avoid damaging or staining the patient's teeth, administer acid or iron preparations through a straw. An unpleasant-tasting liquid can usually be made more palatable if taken through a straw because the liquid contacts fewer taste buds.
  • If the patient can't swallow a whole tablet or capsule, ask the pharmacist if the drug is available in liquid form or if it can be administered by another route. If not, ask him if you can crush the tablet or open the capsule and mix it with food. Keep in mind that many enteric-coated or time-release medications and gelatin capsules shouldn't be crushed. Remember to contact the physician for an order to change the administration route when necessary.
  • PEDIATRIC ALERT Oral medications are relatively easy to give to infants because of their natural sucking instinct and, in infants under 4 months old, their undeveloped sense of taste.

Documentation
Note the drug administered, dose, date and time, and patient's reaction, if any. If the patient refuses a drug, document the refusal and notify the charge nurse and the patient's physician, as needed. Also note if a drug was omitted or withheld for other reasons, such as radiology or laboratory tests, or if, in your judgment, the drug was contraindicated at the ordered time. Sign out all opioids given on the appropriate opioids central record.