Enteral Administration of Medication

• Enteral administration involves administering medications through the gastrointestinal tract.

Oral Medications - Solid forms

• Capsules are small, cylindrical gelatin containers that administer unpleasant-tasting medications.
  • Timed-release capsules release drugs gradually and continuously.
• Lozenges are flat disks in a flavored base.
• Tablets are compressed powdered drugs.

Oral Medications - Liquid forms

• Orally disintegrating tablets dissolve quickly on the tongue.
• Elixirs consist of drugs dissolved in water and alcohol.
• Emulsions are dispersions of small water droplets in oil or small oil droplets in water.
• Suspensions are liquid dose forms with solid, insoluble drug particles in a liquid base.
• Liquid suspensions are syrups.

Methods to Administer Oral Medications

• Unit-dose packaging provides a single dose.
• Soufflé cups are used for dispensing solid medications.
• Medicine cups should be read at eye level to ensure correct dosage.
• Medicine droppers and teaspoons are used for liquid medications.
• Oral syringes are plastic and calibrated for measuring liquid medications.
• Nipples with additional holes are used for infants.

Solid-Form Oral Medications - Techniques

• Unit-dose systems and computer-controlled dispensing systems are two techniques for solid-form oral medication administration.
• Premedication assessment must be performed in all cases.
• All techniques must follow the seven rights of medication administration: right patient, drug, indication, route, dose, time, and documentation.
• Give the most important medications first.
• Do not touch medication with bare hands.
• Encourage liquid intake to facilitate swallowing.
• Remain with the patient until the medication is taken, and do not leave medication at the bedside unless ordered.
• Discard the medication container after administration.
• Documentation should include the date, time, drug name, dosage, route of administration, and patient responses to therapy.
• Therapeutic effectiveness should be regularly recorded along with any adverse effects.
• Education essential for the individual about drug therapy and other aspects of intervention must be performed and validated.

Liquid-Form Oral Medications

• General procedures for liquid medications are the same as for solid medications.
• Premedication assessment should be performed in all cases.
• Liquid medications are commonly given to infants via syringe or dropper.
• The syringe should be placed between the cheek and gums, halfway back in the mouth with slow injection to allow swallowing.
• Adults and children should be given the most important medications first.
• Medications should never be diluted without specific orders.
• Medication should never be left at the bedside without an order.
• Confirm the patient's ID and alertness are confirmed before administering medication.
• Complete documentation of administration and responses to therapy is required.
• Measuring techniques depend on the receptacle:
  • Measuring cup: Cover label to prevent smearing, place fingernail at the exact level on the measuring cup, and read at the level of the meniscus.
  • Oral syringe: Select the appropriate syringe size and draw up the prescribed volume from the bottle or medicine cup.

Medications via Gastrointestinal Tubes

• Medications are administered via nasogastric (NG), nasoduodenal (ND), or nasojejunal (NJ) tubes, using a liquid form if possible.
• Gastrostomy or G-tubes are surgically inserted into the stomach through the abdomen.
• Percutaneous endoscopic gastrostomy (PEG) is the procedure during which a gastrostomy tube is inserted.
• It's important to remember to verify the location of the GI tube before administering anything liquid.
• The tube must be flushed before and after administration with 30 mL of water and between each medication with 5 to 10 ml of water.
• A premedication assessment and assembly of equipment before administration must be carried out.
• Doses should be prepared as for administration of solid- or liquid-form oral medications, following the procedure for administering medication.
• Do not attach suction for 30+ minutes after administration.
• Provide complete documentation of administration and patient responses to therapy.

Enteral Feedings via Gastrostomy or Jejunostomy Tube

• Enteral formulas help achieve basic metabolic requirements and adequate nutritional intake.
• Prescribed enteral formulas should be checked and fully labeled.
• Unused formula should be discarded every 24 hours.
• Adhere to specific guidelines for patients getting nutrition through continuous or intermittent feedings.
• Verify tube placement, check for residual, and initiate feeding.
• Flush with 30 mL of water, then clamp the tube.
• Proceed with tube feeding technique:
  • Intermittent: Use a Toomey syringe.
  • Continuous: Use a disposable feeding container and enough formula for a 4-hour period.
• Check gastric residual volume before the next feeding and listen for bowel sounds.
• Document the administration and patient response to therapy.

Rectal Suppositories

• Suppositories are solid medications that dissolve inside a body orifice.
• Simple equipment: finger cot or disposable glove, water-soluble lubricant, and prescribed suppository.
• Perform a standard premedication assessment.
• Not indicated for patients who've had recent prostatic or rectal surgery, or rectal trauma.
• Follow procedure protocol and the seven rights.
• Wash hands and don gloves.
• If possible, ask the patient to defecate before inserting the suppository.
• Ensure privacy by providing a drape and positioning the patient on their left side.
• Apply water-soluble lubricant and insert about an inch beyond the internal sphincter.
• Dispose of gloves and wash hands and provide patient education, and documentation after the procedure.

Disposable Enemas

• The dose form is a prepackaged, disposable-type enema solution.
• Technique begins with the seven rights.
• Explain the procedure, check pertinent parameters, and determine the last time the patient defecated.
• Position the patient on their left side, apply lubricant to the rectal tube, and insert the lubricated tube and solution.
• Educate the patient, and document the procedure.