Pharm Basics, part 5: Routes of Administration: Oral, NG/G-tube, Sublingual, Transdermal, Inhalation, Optic, Otic

by Cathy Parkes August 13, 2021 Updated: August 21, 2021

Full Transcript

Hi, I'm Cathy with LevelUpRN. In this video, I am going to start talking about routes of medication administration and best practices for each route. The routes I'll be covering in this particular video include the oral route, NG and G tube, sublingual, transdermal, inhalation therapy, optic, and otic medication administration. So let's start with oral medication administration. There are some contraindications for a patient receiving their medications orally, for example, if they have a decreased level of consciousness, if they lack a gag reflex, if they have difficulty swallowing, so dysphagia, or if they're vomiting. Or if we have them connected to NG suctioning, then oral medications would be contraindicated for that patient. In terms of some key points, when we're administering an oral medication, we want to sit the patient up in an upright seated position, such as a high Fowler's position. We do not want to mix the medications with a large amount of food. So we can crush certain medications with a small amount of food, like a small amount of applesauce or pudding. You don't want to mix it with a lot of food because if the patient decides they don't want any more pudding and don't want any more applesauce, then they're not going to get all of their medication.

Also, it's important to note that you do not crush enteric-coated or extended-release medications. These may not be crushed. You can only crush regular tablets. For liquid medications, when you are measuring those out, when you're holding up the little cup, you want to make sure that the lowest point of the liquid, which is the meniscus, is at the ordered dose level. If we need to administer medications through the NG tube or G tube, we need to first confirm placement of the tube. So if you've just put in an NG tube for a patient, you need to have the location of that NG tube confirmed via x-ray first, before you administer any medications. Once we have that confirmed, then from there on out, you can confirm placement of that NG tube using gastric pH testing. This is where you would aspirate some gastric fluid, check the pH. Gastric pH should be under 5.5. So whenever possible, when you're giving medications via the NG tube route or G tube route, you want to use liquid forms of medications whenever you can. If that's not possible, you can crush tablets in 15 to 30 milliliters of sterile water, and that is not normal saline. You want to use sterile water.

However, just like I mentioned before, we never want to crush enteric-coated or extended-release capsules. You want to flush with 30 milliliters of sterile water before and after medication administration. And if you're administering more than one medication, you want to administer each medication separately and flush with sterile water before and after each medication. Next, we have sublingual or buccal medications. So you always want to administer these types of medications after you provide the patient with their oral medications. As far as placement, you're going to put sublingual medications under the tongue, so sub means under, and lingual means tongue. And you would place buccal medications between the gum and cheek. And it's important to teach your patient not to eat or drink anything until those medications have been completely dissolved. All right. Next, we have transdermal medications. You always want to wear gloves when you're applying transdermal medications. And you never want to cut those transdermal patches. You want to remove the prior dose. So you want to take the prior patch off, fold it in half, and dispose of it properly. And then you want to rotate sites for the patches and apply the patch in a clean, hairless, dry area of the body and label that patch with the date, time, and initials.

Next, let's talk about inhalation therapy, which includes a metered-dose inhaler as well as a dry powder inhaler. So if your patient has to use a metered-dose inhaler, you want to provide teaching for how to do this effectively. So first of all, they should shake their inhaler and attach a spacer, if applicable. They should take a deep breath and exhale. Then they can place the inhaler between their lips and press the inhaler as they take a slow deep breath over 3 to 5 seconds. Then they should hold their breath for 10 seconds, take the inhaler out of their mouth and slowly exhale. Now, if they are using a glucocorticoid inhaler, it's going to be important that the patient rinse their mouth after administration to prevent a fungal infection in the mouth. Now, in terms of a dry powder inhaler, there's a few key differences between this and an MDI. So with a dry powder inhaler, you do not shake the device. You do not attach a spacer. And instead of inhaling slowly and deeply over 3 to 5 seconds, you should advise the patient to breathe in rapidly and deeply over 1 to 2 seconds.

All right. Next, we have optic medication. So these are medications for the eye. With the non-dominant hand, you want to gently lower the patient's lid to expose the conjunctival sac. And you want to drop the medication into that conjunctival sac without touching the tip of the applicator to the eye. Then, after you put the drop in, you want to apply gentle pressure to the nasolacrimal duct here for about a minute. And that will help to prevent systemic absorption. If the patient has multiple eye drops that are ordered, you want to wait about five minutes between the application of those eye drops. All right. Lastly, we're going to talk about otic, or ear medication administration. So you always want to ensure ear drops are at room temperature before administration. You want to lay your patient on their unaffected side so that the affected side is up. You want to pull the pinna up and back for adults, and down and back for children under three years of age. The way I remember this is adults will be taller, so they're up higher, so up and back. And children are shorter, so they'll be down lower. So we want to pull down and back for children. You want to hold the dropper about one centimeter above the ear canal. After you instill the drops, you want to apply gentle pressure to the tragus. And then the patient should remain on their side for about one to two minutes.

Okay, quiz time. I have three questions for you. First question. Why do we apply pressure to the nasolacrimal duct after administration of eye drops? The answer is, to prevent systemic absorption of the medication. Question number two. You should provide sublingual medications before a patient's oral medications. True or false? The answer is false. We want to provide those sublingual tablets after oral medications because they need time to dissolve. And we don't want the patient to swallow them if we were to give them first, and then give them their oral medications that they swallow. Third question. Prior to administration, you need to shake a dry powder inhaler. True or false? The answer is false. So we would shake our metered-dose inhaler, our MDI, but we do not shake our dry powder inhaler. All right. I hope that was helpful. And I want to wish you good luck with studying. Thank you so much for listening.

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