Oral Drug Administration

Digracia L. Manatiga RN MAN

Chief, Affiliation, NETB
At the end of the discussion, students shall be able to:
1. Explain the concepts of oral drug administration as
a dependent nursing function.
2. Apply nursing process in the performance of oral
drug administration.
3. Improve ease and confidence in administering oral
medications.
1. Definition
2. Forms of Oral Medications
3. Common Abbreviations Used in
Medication Orders
4. Advantages and Disadvantages
5. Indications and Contraindications
6. General Instructions
7. Common Errors
• MEDICATION-a substance
administered for the diagnosis, cure,
treatment, or relief of a symptom or
for prevention of disease.
 ORAL DRUG ADMINISTRATION
• is the most common, least
expensive, and most convenient
route for most clients. Because
the skin is not broken as it is for
an injection, oral administration
is also a safe method.
ORAL DRUG ADMINISTRATION

• the administration of drugs by

mouth for systemic effect. It may
be in the form of pill, tablets,
capsules and liquid.
 INDICATIONS

• Patient is conscious and coherent

• Patient has no oropharyngeal

problems

• Patient has no gastric problems

CONTRAINDICATIONS
• Nausea and Vomiting
• Mental clouding, stuporous, unconscious,
irrational patient.
• Obstructive disease conditions affecting
the mouth and esophagus.
• Bleeding from the G.I. tract, hematemesis
(vomiting of fresh blood), hemoptysis
(coughing out of blood).
ADVANTAGES
• Most convenient
• Usually least expensive
• Safe, does not break the skin barrier
• Some oral medications dissolve
rapidly on the tongue, allowing faster
absorption and action.
DISADVANTAGES
• Inappropriate for client with nausea or
vomiting
• Drug may have unpleasant taste or odor
• Inappropriate when GIT has reduced motility
• Inappropriate when client cannot swallow or
is unconscious
DISADVANTAGES
• Cannot be used before certain diagnostic
test or surgical procedures.
• Drug may discolour teeth, harm tooth
enamel
• Drug may irritate gastric mucosa.
• Drug can be aspirated by seriously ill
clients.
FORMS OF ORAL
MEDICATIONS
 Caplet

• A solid form, shaped like a capsule,

coated and easily swallowed.
 Tablet

• A powdered drug compressed into a hard small disc

• Some are enteric-coated to prevent them from
dissolving in the stomach.
 Capsule

• A gelatinous container to hold a drug in

powder, liquid, or in oil form.
 Tablets/Capsules

• 1. Unless a tablet is scored, it should never be

broken to adjust dosage.
 Tablets/Capsules

• 2. Time-release capsules and enteric-coated

tablets should not be tampered with in any way.
 Tablets/Capsules
• 3. Sublingual tablets are to be placed under
the tongue and retained until dissolved or
absorbed.
 Lozenge (Troche)

• Flat, round, or oval preparation that dissolves

and releases a drug when held in the mouth.
 Lozenge (Troche)
• 1. Allow the lozenge to slowly dissolve in the
mouth.

• 2. Do not drink liquids for at least 15 min after

administration to prevent washing of contents
from the intended area.
 SUSPENSION
One or more drugs finely divided in a
liquid such as a water.

• Shake well until

there is no
apparent solid
material.
 EMULSION

A suspension where an unmixable

liquid is held in another liquid.

Can be diluted
with water.
 ELIXIR
A sweetened and aromatic solution of alcohol
used as a vehicle for medicinal agents.

Do not dilute; they contain

an alcohol base. Diluent
can cause precipitation of
drug.
 SYRUP
An aqueous solution of sugar often used to
disguise unpleasant tasting drugs

• Sweetened flavored
liquid form can be
diluted.
 POWDER
Finely ground drug or drugs; some are used
internally or externally.

• Can be taken orally by some

patients who are unable to
swallow other solid dosage
forms and can be blended with
other powdered materials prior
to fabrication into other solid
dosage forms.
COMMON ABBREVIATIONS
USED IN
MEDICATION ORDERS
ORAL DRUG ADMINISTRATION
• ADVANTAGES:
• Most convenient
• Usually least expensive
• Safe, does not break skin barrier
• Administration usually does not
cause stress
ORAL DRUG ADMINISTRATION
• DISADVANTAGES:
• In appropriate for clients with nausea or
vomiting.
• Drug may have an unpleasant taste or
odor.
• Inappropriate when gastrointestinal tract
has reduced motility.
• Inappropriate if client cannot swallow or
is unconscious.
ORAL DRUG ADMINISTRATION

• DISADVANTAGES:
• Cannot be used before certain
diagnostic tests or surgical procedures.
• Drug may discolor teeth, harm tooth
enamel.
• Drug may irritate gastric mucosa.
Administering Oral
Medications
PREPARATION
•Assess:
• Allergies

• Ability to swallow the medication

• Presence of vomiting or diarrhea

• Specific drug action, side effects,

interactions and adverse reactions

• Clients knowledge of the medication

• Note the following:
• Verify the patient’s ability to take medication
orally.
 NPO?

 Nauseated or vomiting?

 Has gastric secretions?

 Has diminished or absent gastric sound?

• Assemble equipments and supplies:
PROCEDURE
3. Wash your hands.
4. Do the 3 Checks:

 When taking the container from the

shelf or drawer.

 Before pouring the medication

into the medication cup.

 Before returning the container

to the shelf or drawer.
5. Observe the twelve (12) rights in administering medications.

• Right documentation
• Right evaluation
• Right assessment
• Right reason
• Right patient
• Right time
• Right route
• Right to refuse
• Right expiration date
• Right education
• Right drug
• Right dose

6. Check and calculate dosage accurately.

 Formula for Drug Calculation

DESIRED DOSE
AVAILABLE DOSE × QUANTITY Right
dose
 Examples

Give: Digoxin 0.375 mg p.o. daily

Available: Digoxin in scored tablets of 0.25 mg

(D) 0.375 mg
 (Q) 1 tab = x tab
(H) 0.25 mg
0.375
x=
0.25
1
x  1 tabs
2
 Tablets or Capsules
 Place tablets directly into the medicine cup.
 If using with the stock container, pour the
required number into the bottle cap, and
transfer the medication to the disposable cup
without touching the tablets.
 Break scored tablets only.
 If the patient has difficulty swallowing, crush
the tablets to a fine powder. Mix it with a small
amount of soft food, such as applesauce.
 Liquid Medication
 Thoroughly mix the medication before
pouring.
 Remove the cap and place it upside down on
the countertop.
 Hold the bottle so the label is next to your
palm, and pour the medication away from the
label.
 Hold the medication cup at the eye level and
fill it to the desired level, using the bottom of
the meniscus to align with the container scale.
Cont.
Liquid Medication
 Before capping the bottle, wipe the lip with the
paper towel.
 When giving the small amounts of liquids
(<5ml), prepare the medication in a sterile
syringe without the needle.
9. Carry medication tray to patient’s bedside.
Provide for patient privacy.

10. Prepare the patient.

 Ascertain patient’s identity. Check room or bed or card, call out
patient’s name, check ID or wrist tag.

 Assist the patient to a sitting position or, if not possible, to a side-

lying position.

11. Explain the purpose of the medication and how it will help.

12. Administer the medication at the correct time.

 Take the medication within 30 min
or after the scheduled time.

 Stay with the client until all medications

had been swallowed.
13. Wash your hands.
Documentation
Record the following:
 Prescribed medication
 Dosage
 Time given
 Any complaints or assessments of the patient.

If medication is refused or omitted, document the

reason and the nurse’s action.
After care
 Special Consideration
 Make sure you have a written order for every medication given. Verbal orders
should be signed by the prescriber within the specified time period (within 24hrs).

 Notify the prescriber about any medication withheld, unless instructions to withhold
are already written.

 Don’t give medication from poor labeled or unlabeled container.

 Don’t attempt to label or reinforce drug labels yourself.

 Never give a medication prepared by someone else.

Cont.

Special Consideration
 Never allow your medication cart or tray out of your
sight.
 If the patient questions you about
his medication..
• Check the medication chart again.

• If the medication is correct, reassure him.

• Inform the patient about any changes in his medication

or dosage.

• Inform the patient of possible adverse effects.

• Ask the patient to report anything he thinks may be an

adverse effect.
Cont.

Special Consideration
 Administer acid or iron preparation through a
drinking straw to avoid staining the patient’s
teeth.

 If the patient can’t swallow tablet or capsule,

verify if the drug can be crushed
or open the capsule and mix
it with food.

 Take note of the drugs not intended

to be crushed
ex. enteric-coated drugs
Patient teachings
 Instruct the patient, as appropriate, about
possible adverse effects.

 Advise the patient that the medication must

be taken as prescribed.

 For home administration, teach the patient

any necessary preparation.
GENERAL INSTRUCTIONS
Be sure physician’s order is
complete and well understand before
carrying it out.

Know the patient’s condition and all

other factors related to the proper
use of the drug.
Be alert for signs of allergy and
idiosyncracy manifested by the
patient.

Observe the 12 Rights in Drug

Administration.
Be familiar with standard abbreviations
and symbols commonly used.

Verbal orders are accepted in extreme

emergencies and only the graduate nurse
should assume the responsibility of
carrying out the order.
Know the purpose and therapeutic
effect of each drug ordered.

Verify if drugs to be delayed or

omitted for a specific period of
time, if diagnostic procedure or
operation is to be done.
Always clarify any order that is not
clear and doubtful before executing
it.

Do not leave medicine with the

patient to take by himself unless
specifically ordered by the
physician.
Do no give the drug that shows
physical changes or deterioration.

Report an error in medication

immediately.
The nurse who prepares the
medication must be responsible for
administering and recording it.
Never endorse it to another nurse.

Always observe asepsis in preparing

and administering drugs.
Full concentration is necessary while
preparing and administering drugs.
Never allow interruptions.

Be able to use with accuracy either the

metric or apothecary unit of
measurement.
Always use the corresponding
medication card for each drug
prepared and administered.

Be sure all written computation for

dosage is checked.
COMMON ERROR IN
ORAL DRUG
ADMINISTRATION
• Took medication twice
• Wrong medication
• Incorrect dose
• Missed dose
CAUSES:
•not understanding medication label
•not understanding how to give
medication
•poor communication between
parents/guardians and health care
professional
PROMOTE SAFE
MEDICATION
•Reading back and verifying
medication orders given verbally or
over the phone.

•Double-check your medications

when giving high-alert drugs.
•Become familiar with your facility’s
“do not use” list of abbreviations.

•Assessing patients for drug allergies

before giving new medications.
 -Thank you-
“Don’t study to earn
Study to learn
What you will learn today
Is what you will
Become tomorrow”
“If you talk to a man in a language he understands,

that goes to his head.

If you talk to him in his language, that goes

to his heart.”

– Nelson Mandela