Pharmacology: Different Routes of Nursing Medication Administration

Class Administration Formulation Advantages Disadvantages

Route
Enteral Oral Tablet, Pill, • Easy and convenient • Lag-time required to
Capsule, for self-administration achieve effective blood
Syrup, • Non-invasive concentration, due to
Tincture absorption process
• First-pass effect may
reduce drug
bioavailability
• Various factors may
affect drug absorption,
such as food, other drugs,
gastric emptying, etc
Sublingual Tablet, Film • Rapid absorption and • Not all drugs are suitable
(under the onset of action to be delivered in this way
tongue) because of the blood
supply under the
tongue
• Avoids first pass
effect since you don’t
have to swallow
Oral • Enteric coated – absorbed in the alkaline
environment (small intestine). E.g., Ecotrin
• Pills, tablets, capsules, caplets, and liquids
(aspirin) – prevents stomach upset since it is
are administered through the oral route.
aspirin’s side effect.
• These agents are also called p.o or PO (per
orem or by mouth) medication
• Sublingual and buccal medication are also
considered to be PO
• When drugs are given into the GI tract but
bypass the mouth the oral drug preparation
are used. E.g., NGT or GT indicated for
patients who are having trouble of
swallowing
• Be sure the patient has an adequate level of
consciousness to prevent aspiration.
• The presence of pathology in the GI tract • Sustained release (for longer effect) –
may hinder the client’s ability to absorb releases medication at a controlled rate until
medication. E.g., problem in small intestine it is either all absorbed or passes in the feces.
(which is the center for absorption). E.g., Niacin
• Consider the presence or absence of food in o Do not break
the stomach and how this affects the o Beads or Granules
medications. Either take the drug with empty
(E.g., ferrous sulfate) or full stomach (E.g.,
antibiotic, NSAIDs [hydrochloric acid]).
o Empty stomach – before meals and 2
hours after meals (but it has
something to do with gastric
emptying time [gaano katagal
naeempty ang gastro] Average gastro
time is about 2 hours)
• Have patient sit upright when not
contraindicated to prevent aspiration and
cough reflex (samid) – protective mechanism
when a substance enters the airway
• When giving oral medications, follow these
guidelines.
o Wash hands
o Do not touch the medications
o Crush only medication that can be
crushed and split only scored tablets.
Example of drugs that can’t be
crushed is enteric coated.
o Make sure the client is awake, is
upright and can swallow.
Oral Step 4: Gently inject the saline to make sure that
the medication will reach the stomach.
• When giving medications through a
gastronomy tube (or NGT), wear gloves,
make sure the medication is appropriately
diluted, and check that the tube is in place.
Flush tube with water before and after
administration of medications.

Step 1: Withdraw the plunger while observing for

the presence of gastric fluid or contents.

Step 5: Clamp off the distal tube to prevent the

entrance of air or microorganisms

Step 2: Flush tube with water

Step 3: Instill the medication into the gastric tube
Class Administration Formulation Advantages Disadvantages
Route
Parenteral Intravenous Injections, • Not subject • Rapid action • Not suitable
injection Infusion to first-pass • Directly for self-
(nakaswero) metabolism delivered into administration
• Used in systemic • Invasive
unconscious circulation • Risk of
cases or (bioavailability infection
patients who is 100%)
are nil by • Easy dose
mouth control
Intramuscular Injections • Used for • Absorption is • Not often
injection drugs that are relatively fast suitable for
poorly and complete self-
absorbed or administration
unstable in • Invasive and
the GI tract often painful
Subcutaneous Injections, • Absorption is • Invasive
Infusion relatively • Risk of
slow. E.g., inflammation
insulin at the infusion
• Infusion site
avoids the
need for
repeated
injections
Parenteral Kinds of Parenteral Drug Containers
• Drug administration outside of the • Glass ampules
gastrointestinal tract • Vials
• Are administered by injection of any kind,
including SC, ID, IM, and IV
• Other parenteral routes of medication
administration not usually administered by a
nurse include intraventricular (ventricles),
intraarterial (arteries), intracardiac (heart),
intraperitoneal (peritoneum), intrathecal
(theca of spinal column) and intrapleural
(pleura of lungs).
• When giving parenteral medications, the
nurse must follow these guidelines:
o Wash hands
o Don gloves
o Assess and identify possible
detriments to absorption such as poor • Non-constituted vials actually consist of two
circulation. Since the medication will vials, one containing a powdered medication
not be absorb effectively. and one containing a liquid mixing solution.
o Select the appropriate site.
o Know your medications
o Note that parenteral medications are
limited in the volume that can be
delivered.

• Intravenous medication fluids

• Prefilled syringes
Injection Information

Type Angle Gauge Length Syringe Nursing Considerations

(diameter
of the bore)
ID 15° 26-27 3/8-5/8 in Tuberculin Area must be marked or
mapped if repeated tests done
SubQ 45° 23-25 5/8 – ½ in Tuberculin/Insulin (1-3 mL) Rotate sites
IM 90° 20-23 1 – 1½ in 2-3 mL (maximum) Rapid insertion and slow
injection help to decrease
pain.
Aspirate and massage
IV 25° 20-21 Bag with tubing Monitor site and needle
placement
Blood 16-18 Bag with tubing Check equipment, needle
placement and injection site
regularly

Note:
• There are situations that angle depends on the
size of the patient (fat or thin)
• Gauge – the smaller the number, the larger
the bore of the needle.
• Biggest gauge is for blood transfusion

Parenteral
• Know which type of delivery system to use
and how to prepare the medication in the
correct delivery system
• Use aseptic procedures at all time
• Subcutaneous medications should never be
greater than 1 mL; IM medications must
never be delivered into a muscle in volume
greater than 3 mL.
• IV medications can be given using direct
bolus method or drip method – Main line
• IVPB (piggyback) or side drip (soluset) and
IV continuous drip method must be
administered via an infusion pump to ensure
adequate dose
Parenteral Intradermal:
• Never mix IV medications without being
absolutely sure that the medication can safely
be mixed together.
• The gauge of a needle is the diameter of the
needle. Gauges can vary from very small
diameter (25 to 29 gauge) to large diameter
(18 to 22 gauge).

Injections Sites:
• Intradermal: Ventral forearm, upper chest,
shoulder
• Subcutaneous: outer aspects of the arms and Subcutaneous:
thighs, hip and lower abdomen, above the
iliac crest
• IM: Ventrogluteal, deltoid, dorsogluteal,
vastus lateralis, rectus femoris
o Z-track is an IM technique used for
solutions that are especially staining
or irritating.
• IV: lower arm and hand, upper arm,
antecubital fossa (rarely because prone to
bending)
Intramuscular: Z-track method is a type of IM injection technique
used to prevent tracking (leakage) of the medication
into the subcutaneous tissue (underneath the skin).
During the procedure, skin and tissue are pulled and
held firmly while a long needle is inserted into the
muscle. E.g., Iron.

Z-track Method of IM Injection:

Other Routes

Others Inhalation Pressurized • Rapid absorption • Only appropriate for

metered-dose • Used for local and drugs that can be made
inhalers, Dry systemic actions into gas form or those
powder inhalers, that can be dispersed in
medical gases (e.g., an aerosol
anesthesia)
Topical Cream, spray, Gel, • Easy to self- • Not always convenient
(pinapahid) Paste, Powder administrator
• Used for local
actions (e.g., rashes)
Transdermal Spray, Patch, • Easy to self- • Not always convenient
(mga Cream, Ointment administer • Potential for irritation of
tinatapal) or Gel • Used for continued skin
slow drug delivery • Significant lag-time to
achieve effect
Rectal Suppository, • Avoids first-pass • Absorption is varied and
Enema effect and often incomplete
destruction by • Not convenient
intestinal enzymes or • Less acceptable to
by low pH in the patients
stomach
• Useful for drugs that
induce vomiting
• Used in unconscious
cases or patients who
are vomiting or nil by
mouth
• Used for local and
systemic actions
Respiratory Drug Administration
• Medications are administered into pulmonary
system
• Instillation
o Inhalation
o Instruct the client on how to use and
clean the equipment.
o Turboinhaler, metered-dose
nebulizer, vaporizer, intermittent
positive-pressure breathing (IPPB)
Small Volume Nebulizer
Nebulizer with attached face mask, bag valve
mask (ambubag) and endotracheal tube
Metered Dose Inhaler
Topical
• Absorbed through the skin at a slow, steady
rate (E.g., Nitroglycerin patch)
o Clean administration site
o Apply medication (If the client has
excessive hair where the patch is to be
applied, the area should be shaved
first)
o Leave medication in place for
required time.
o Monitor the patient for desirable or
adverse effects.
o Be sure to date a patch when applied
o Be sure to date and time a dressing
when applied
Nitroglycerin Patch (Vasodilation, Hypotensive
effect, Headache)
Eye Medication Administration
• When administering medication in the eye,
the client’s position is very important.
• Place the client in the supine position, and
have the client look upward.
• With the lower lid everted to exposed
conjunctival sac, hyperextended the client’s
neck.
• DO NOT TOUCH the dropper or applicator
for the ointment, or clean technique will be
interrupted
• Apply the medication as directed (irrigation,
drops, ointment)
Note:
• Normally we asked the patient to press the
area of nasolacrimal duct after the drop to
absorb the drops fully to avoid the drops
going to the nasolacrimal duct. (2 to 5
minutes)
Ear Medication Administration
• For adults, pull pinna up and backward; For
children (3 years and below), pull the pinna
back and down. Rationale: It is because of the
eustachian tube.
• DO NOT TOUCH THE DROPPER. (E.g.,
irrigation, drops)
• Instruct the client to lie with head turned to
unaffected side.
• Apply eardrops so that the medication slides
down the ear canal. (Wag mismo sa butas
ipatak)
• Have the client stay in position for 5 minutes.
Aural/Otic Medication Administration
Vaginal Medication Administration
• Often the client will administer this herself
• Offer or apply a sanitary pad for comfort
• Make sure the client knows how to use, clean,
and maintain the applicator
• Examples are irrigation, suppository, cream,
ointment, tablet, gel
Rectal Medication Administration
• The rectum’s extreme vascularity promotes
rapid drug absorption.
• Avoid first pass effect
• Example is suppository
• The client may wish to self-administer this
medication
o Instruct the client how to use KY
lubricating jelly
o Instruct client to resist the urge to bear
down and to retain the medication for
at least 30 minutes (Wag iire)
Note:
• Rectal suppository position is sims position

Nurse’s Role in Comfort Measures During Drug

Therapy
• Placebo Effect
o The anticipation that a drug will be
helpful (placebo effect) has proved to
have tremendous impact on the actual
success of drug therapy.
o For example, a back rub, a kind word,
and a positive approach may be as
beneficial as the drug itself
• Managing Adverse Effects
o Intervention can be directed at
promoting patient safety and
decreasing the impact of the
anticipated adverse effects of a drug.
o Such interventions include
environmental control (E.g.,
Temperature, light), safety measures
(E.g., avoiding driving, avoiding the
sun, using side rails), and physical
comfort measures (E.g., Skin care,
laxatives, frequent meals)
• Lifestyle Adjustment
o Some medications and their effects
require that a patient make changes in
his or her lifestyle
o For example, patients taking diuretics
may have to rearrange their day so as
to be near toilet facilities when the
drug action peaks.