Definition
Administering oral medication is one of the most common and convenient routes for delivering drugs. It’s non-invasive, cost-effective, and generally well tolerated.
Purpose
To provide a medication that has systemic effect in the body or local effect on gastrointestinal tract.
Contraindications
- Alteration in normal functions of gastrointestinal tract, such as vomiting.
- Reduced gastrointestinal motility (after general anesthesia, bowel inflammation, etc.).
- Surgical resection of a portion of gastrointestinal tract.
- Inability to swallow (e.g. patients with neuromuscular disorders, esophageal strictures, mouth lesions).
- Patients with gastric suction/aspiration.
- Prior to certain tests/surgery.
- Unconscious/confused patients.
- Patients with poor gag reflex.
Articles required
- Medication card/patient files.
- Medication tray.
- Small plastic cups/paper cups/bottle caps.
- Glass of water.
- Calibrated disposable cups/ounce glass for liquid medications.
- Mortar and pestle(optional).
- Scissors.
- Kidney tray.
- Paper towel/tissue paper (for liquid medication).
Procedure
| NURSING ACTION | RATIONALE | |
| 1. | BEFORE PROCEDURE Assess for any contraindication. | Proper assessment will help in determining route of administration. |
| 2. | Determine patient’s preferences and physician’s order for fluid restriction, if any. | Patients on restricted fluids, such as those with renal, heart, lung and liver diseases need to be given measured quantity within the prescribed total amount. |
| 3. | Prepare needed supplies and articles. | |
| 4. | DURING PROCEDURE Check medication card/form with physician’s written order for accuracy, completeness, etc. Check patient’s name, name of drug, dose, route and time of administration. Clarify any doubt. Report any discrepancy to charge nurse and physician. | Physian’s order is the most legal and reliable source of information. |
| 5. | Prepare drug. Wash hands. Arrange medication tray in nurse’s station (optional). Prepare medicine of one patient at a time, keeping medication card and forms together. Select correct drug-container from stock while checking label with name of drug in medication card and expiry date (first check). Calculate correct drug dose. Take time and double check calculation. For tablets/capsules, pour required number from bottle into bottle cap and transfer to medication cup. Do not touch with fingers. Extra tablets/capsules may be returned to bottle. For packaged tablet/ capsule, place packaged tablet/capsule directly over cup and remove without touching it (retain strip) check medication before removing from bottle or strip (second check). Place all tablets to be given at the same time in one cup (except those requiring pre-administration assessment, e.g., vital signs). If patient has difficulty in swallowing, grind tablets in a mortar with pestle. Crush it to a fine powder and mix it with small amount of g water (DO NOT CRUSH ENTERIC COATED TABLET/SUSTAINED ACTION TABLET). Prepare liquids. Shake bottle. Hold bottle with label against palm of hand when pouring. Hold medication cup to eye level and fill it to desired level. Discard if there is excess liquid in cup into sink, wipe mouth of bottle with paper towel. Excess medication should not be returned to medication container. For volume less than 5 mL/10 mL, a syringe without needle can also be used to measure the quantity of medication. Do not leave drug unattended. Return drug container back to cupboard after checking label (Third check). | Reduces transfer of microorganisms to medication and equipment. Saves time and reduces error. Reduces chance of error. Hastiness will increase error. Provides accuracy and maintains cleanliness. Retaining strips will help in identifying medication till the last tablet and thus reducing error. Keeping such drug separately will help in withholding drug, if necessary. Large tablets are difficult to swallow. When mixed with water, ground tablets are easy to swallow. Enteric coated medication will not be absorbed in stomach. Label will not be soiled with spilled liquid. Ensures accuracy. Prevents contamination of bottle contents and prevents cap from sticking. Third check of label reduces errors. |
| 6. | Administer drug: Take medication to patient at correct time. | |
| Identify patient by comparing name on card with the name patient gives when asked. | ||
| Perform necessary pre-administration assessment for specific medication (e.g., blood pressure, pulse, etc.) | This gives information as to whether medications should be given at that time. | |
| Explain to patient the medications to be given and allow patient to clarify doubts. | Patient has the right to be informed, and understanding of medications increases compliance to therapy. | |
| Assist patient in sitting or side-lying position. | Prevents aspiration. | |
| Administer drug properly. Ask if patient wishes to hold medication in cup/hand before placing in mouth. Administer only one drug at a time. Offer a glass of water with the drug to be administered. Place medication under tongue and allow it to dissolve completely in case of sublingually administered medication. Caution patient against swallowing. Instruct patient to place the medication in mouth against cheeks until it dissolves completely in case of buccal administration. Prepare powdered medication at bed side and give to client. Caution patient against chewing or swallowing lozenges. Give effervescent tablets immediately after dissolving. If patient is unable to hold medication in hand, place cup to the lip and transfer each drug into mouth one at a time using a spoon. Do not rush. | Certain drugs when swallowed are destroyed by the gastric juices or rapidly detoxified by liver and thus therapeutic levels are not attained. Promotes local activity on mucus membrane. When prepared in advance, powdered medication becomes more solid and difficult to swallow. Such drugs act through slow absorption through oral mucosa and not gastric mucosa. Effervescence helps to improve taste of drug and is good for gastrointestinal tract problems. Prevents contamination of medication. Administering single tablet or capsule avoids difficulty in swallowing and aspiration. | |
| If tablet/capsule falls on the floor, discard it and repeat tablet preparation. | Drug is contaminated, if it falls to the floor. | |
| Stay with patient until each tablet is swallowed Ascertain that all tablets are swallowed. | Nurses assume responsibility for ensuring that patient receives ordered medication. If left unattended, patient may not take medication or may hoard medication. Maintains comfort | |
| After procedure Assist patient to comfortable position. | ||
| Dispose of soiled supplies and wash hands. | Reduce transmission of microorganisms. | |
| Return medication cards, forms/printouts to appropriate files for next administration. | Loss of record can lead to errors in administration. This leads to greater efficiency. | |
| Replenish items in medicine tray and return for next use. | ||
| Clean work area. | ||
| Record the medication administration with date, time, and signature. | Prompt documentation prevents errors, such as repeated doses. Signature establishes accountability for administration. | |
| Return within 3 minutes to evaluate the effectiveness of medication. | Useful in detecting therapeutic effects and also detecting side effect or adverse effects. |
Special Considerations
- Administer medications which can irritate the stomach mucosa with a light snack or following a meal, e.g., aspirin, brufen.
- Administer medication with water and avoid fruit juice, milk, etc.
- Do not administer water after giving cough syrup.
Paediatric Variations
Preparation of Child
- Give child a flavored ice pop or small ice cube to suck to numb the tongue before giving the drug.
- For medications with unpleasant taste or smell, have the child pinch the nose and drink the medicine through a straw.
- Give water, juice or ice pop after the drug.
- Infants may be given the medication in a needle-less syringe or dropper about 0.25-0.50 ml at a time.
Preparation of Medication and Articles
- Measure the medication preferably with calibrated disposable cups for accuracy.
- Medication in powder form (powered tablets) can be mixed with palatable substances, such as honey or flavored syrups.
- Medications that come in adult dose can be dissolved in premeasured amount of liquid and appropriate portion given to child.
Administration
- For giving medication, hold the child in a semi-reclining position to prevent aspiration.
- Small amounts of medication taken in disposable syringe or dropper can be placed directly into the mouth.
- May be allowed to suck medication placed in an empty nipple.
- Once the medication is emptied into the mouth, blow a small puff of air on to the face to elicit swallowing reflex.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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