Administering Tubal Medication

Study Notes

Alternative route for medication administration through nasogastric or gastrostomy tubes
Purpose: Clients who cannot take anything orally (NPO) and have a NG or gastrostomy tube in place.
Nasogastric (NG) tube: Placed into the stomach via the nasopharynx for feeding or gastric secretion removal.
Assessment:
- Assess the tube type, size, and placement.
- Evaluate the nose and mouth.
- Assess the area around a gastrostomy.
- Determine the specific drug action and expected response.
Equipment:
- Medication administration record (MAR)
- Water, juice, or other liquid
- Pill crusher
- Syringe
- Tissue paper
- Plastic cups
Procedure (Wash Hands):
- Wash hands
- Gather equipment
- Review the MAR (medication administration record) for drug name, dosage, frequency, route, and expiration date.
- Check the medication administration

Ensure client safety. The pharmacist should be consulted before administering any medications that are in a liquid form.
Crush pills
- Use a pill crusher to crush each pill.
- Dissolve the powdered pill in water or other solution.
Administer liquids
- Handle the medication bottle with the label facing the palm. The appropriate measuring device must be used when pouring liquids.
- Check the liquid level at eye level.
- Wipe the bottle opening with a paper towel.
Mix capsules
- Mix capsules with warm water with pharmacist's advice.
- Avoid mixing capsules with other liquids; this may negatively affect medication dissolution.
Transport Medications: Administer medications to the bedside and keep medications in visible areas.
Identify the patient.
Medication administration using tubes

Place the patient in a Fowler's position, unless medically contraindicated, to prevent aspiration.
Assess the tube placement before administering medication.
Aspirate and measure the residual stomach volume before administering medications.
Procedure to prevent aspiration

Before administering medication, flush the tube with a prescribed amount of water.
Adjust the syringe flow as needed during flushing.
Flush the tube thoroughly after each medication administration.
Ensure the water is at the appropriate temperature.
Ensure that all air bubbles are removed from the medication before administering it.

Pour the prepared liquid or dissolved medication into the syringe barrel and carefully administer it using gravity flow to the tube.
When administering multiple medications, flush the tube thoroughly with 15 – 30 ml warm water after giving each medication to reduce medication interaction issues.
When finished, flush the tube with an additional 15-30ml of water.

Types of topical medications: Eye drops, eye ointments, ear drops, nose drops, and metered-dose inhalers.
Purpose: Slow and continuous absorption of medication.
Indications: Pupil dilation for eye exams; neutralizing chemical exposure; softening and removing earwax; promoting breathing and loosening secretions.
Assessment: Route of medication administration; condition of the eye or ear; purpose; client ability to cooperate with procedure; breathing difficulties; side effects (e.g., nausea, tremor, tachycardia); breath sounds before and after treatment.
Equipment: Eye-drop medications, ointment containers; gloves; tissue paper

Check for allergies and contraindications (before giving the topical medications).
Check the MAR to ensure the correct instructions.
Have necessary materials ready.
Follow the five rights of medication administration (medication, dose, client, route, time).
Explain the procedure to the patient; explain if they can assist in instilling the medication.
Wash hands and use non-sterile gloves.
Flush the eye or ear as per instructions.
Instill medications as per instructions by a medical professional.
Ensure that a piece of tissue or a sterile cotton ball is placed on the eye or ear canal.
Document the procedure, dosage, route, and time of the administration.

Equipment: Medication bottle, dropper, tissue paper.
Procedure: Compare the medication record to the doctor's order. Gather required materials. Gather the necessary equipment. Ensure the medication is correct and administered appropriately with client safety in mind. Determine the client's name and birthdate for identification. Perform hand hygiene. Place the client in a comfortable position. Place 1-2 drops of prescribed medication in the appropriate nasal passages. Check the client for any discomfort; if uncomfortable reposition as needed. Have the client remain in this position for a few minutes. Check the client for any side effects. Perform hand hygiene. Return the medication to its designated storage area. Document the administration of nasal drops.