Enteral Medication Administration

Enteral Administration

• Enteral administration involves administering medication through the gastrointestinal tract.

Administration of Oral Medications

• Solid forms of oral medications include capsules and tablets.
• Capsules: Small, cylindrical gelatin containers administer unpleasant-tasting medications.
• Timed-release capsules provide gradual and continuous drug release.
• Lozenges: Flat disks in a flavored base.
• Tablets: Powdered drugs that have been compressed.
• Orally disintegrating tablets rapidly dissolve on the tongue within seconds.
• Elixirs: Drugs dissolved in water and alcohol
• Emulsions: Dispersions of small droplets of water in oil or small droplets of oil in water
• Suspensions are liquid dose forms that contain solid, insoluble drug particles dispersed in a liquid base.
• Liquid suspensions: Syrups
• Common methods to administer oral medications include unit-dose packaging, soufflé cups, medicine cups, medicine droppers, teaspoons, oral syringes, and nipples with additional holes.
• Unit-dose packaging provides a single dose of medication.
• Medicine cups should be read at eye level.
• Oral syringes are plastic syringes calibrated and used to measure liquid medications
• Nipples with additional holes are suitable for infants.

Administration of Solid-Form Oral Medications

• Techniques to administer medications include unit-dose systems and computer-controlled dispensing systems.
• All techniques should follow the seven rights: right patient, drug, indication, route, dose, time, and documentation.
• General principles when administering solid form oral medications include giving the most important medications first, not touching the medication with your hands, encouraging liquid intake, and remaining with the patient while medication is taken.
• Complete documentation of administration and responses to therapy and regularly record patient assessments to evaluate therapeutic effectiveness.
• Chart and report any sign of adverse effects, and perform and validate essential education about drug therapy and other aspects of intervention for the individual.

Administration of Liquid-Form Oral Medications

• General procedures are the same, but liquid medications are most commonly given to infants with a syringe or dropper.
• Place the syringe between the cheek and gums, halfway back into the mouth, and slowly inject medication to allow the infant to swallow.
• General principles for infants, children, and adults:
• Give adults and children the most important medications first.
• Never dilute medications without specific orders.
• Do not leave medication at the bedside without an order to do so.
• Check an infant's ID and be certain the infant is alert.
• Provide complete documentation of administration and responses to therapy
• Techniques vary based on receptacle used.
  • Measuring cup: Cover label to prevent smearing.
  • Place fingernail at exact level on measuring cup and read the volume at the level of the meniscus.
  • Oral syringe: Select syringe of appropriate size, draw up prescribed volume from bottle or medicine cup.

Administration of Medications via Gastrointestinal Tubes

• Medications are administered via nasogastric (NG), nasoduodenal (ND), or nasojejunal (NJ) tubes for specific patients, using a liquid form whenever possible.
• Gastrostomy or G-tubes: Surgically inserted through the abdomen into the stomach.
• Percutaneous endoscopic gastrostomy (PEG) is a procedure to insert a gastrostomy tube.
• Key reminders:
  • Check the location of the GI tube before administering any liquid.
  • Always flush the tube with 30 mL of water before and after administration.
  • Perform premedication assessment and assemble the equipment. Flush between each medication with 5 to 10 mL of water.
• Medications should be prepared as for solid- or liquid-form oral medications.
• Follow the procedure for administering medication.
• Do not attach suction for 30+ minutes following administration.
• Provide complete documentation of administration and responses to therapy

Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube

• Enteral formulas are designed to provide basic metabolic requirements and adequate nutritional intake.
• The prescribed enteral formula should be checked and fully labeled.
• Unused formula should be discarded every 24 hours.
• Follow the guidelines specific for patients for general nutrition via intermittent or continuous feedings.
• Verify tube placement, assess for residual, and initiate feeding.
• Flush with 30 mL water, then clamp tube.
• Proceed with tube feeding technique.
  • Intermittent feeding uses a Toomey syringe.
  • Continuous feeding uses a disposable feeding container and enough formula for a 4-hour period.
• Check gastric residual, listen for bowel sounds, and provide complete documentation.

Administration of Rectal Suppositories

• Suppositories are solid medications made to dissolve inside a body orifice.
• Equipment: Finger cot or disposable glove, water-soluble lubricant, and prescribed suppository,.
• Perform standard premedication assessment.
• Rectal suppositories should not used on patients who have had recent prostatic or rectal surgery, or rectal trauma.
• Technique: adhering to procedure protocols and the seven rights, wash hands, don gloves, and ask the patient to defecate before suppository use.
• Provide privacy, drape, position on left side, and insert the suppository about an inch beyond the internal sphincter.
• Dispose of gloves, wash hands, and education.
• Provide documentation.

Administration of a Disposable Enema

• The dose form will be a prepackaged, disposable-type enema solution.
• The technique begins with the seven rights.
• Explain the procedure and check parameters, including the time of the last defecation.
• Position the patient on the left side.
• Apply lubricant to the rectal tube, insert the lubricated tube, insert solution, educate, and document.