Chapter Six Routes of Administration



Home Care Association of New Hampshire

Licensed Nursing Assistant Medication-Certified

Routes of Administration

One of the five rights of administration is the right or correct route. The route is determined by the best way to achieve the desired therapeutic effect. Any variation to the defined routine facilitation must be defined in the patient’s Plan of Care. Any medication given on an as-needed basis (PRN) MUST be directly delegated by the supervising nurse.

Oral route

Oral medications come in many forms: tablets, capsules, liquids. Most oral medications are absorbed in the small intestine and have a peak effect in 1-3 hours.

Some patients have their medications crushed. It is important to know which pills can be crushed and which can’t. Capsules may be timed- release, so they shouldn’t be opened.

The LNA Medication Certified may, using hand over hand technique, assist the patient to crush tablets, cut tablets in half, or open capsules in accordance with the patient’s POC.

If you are unsure about crushing tablets or opening capsules, consult the nurse or a nursing supervisor according to your agency’s policies.

No oral medication is given to a patient who is vomiting, who lacks a gag reflex or who is unresponsive.

Liquid medications come in three forms: elixirs, emulsions and suspensions. When administering liquid medications:

• Dilute, shake or stir the medication only as required.

• Read the dosage at eye level when pouring the medication.

• Refrigerate open or reconstituted liquid per the label directions or the patient’s care plan.

Sublingual and Buccal Medications: Sublingual medications are placed under the tongue. Buccal is placed between the cheek and the gum. Both routes deliver the drugs fairly quickly. When administering these drugs:

• Make sure the patient doesn’t eat or drink anything until the medication is dissolved.

Topical Route

Topical medications are applied to the skin. Medication can be delivered by glove, tongue blade or cotton tipped applicator. Always wear gloves when applying a topical medication. When facilitating application of a topical medication:

• Check the patient’s care plan and apply the medication as instructed.

• Stroke the medication firmly onto the skin.

• Don’t use a light feathery touch when administering medication to an area that is itchy or irritated as this can make the itch worse.

Installation Route

These are liquid medications that are administered to the eyes and ears as drops, ointment s or sprays. Good infection control practices must be used to prevent the spread of infection.

To facilitate administration of eye drops or ointments using hand over hand technique:

• Check the patient’s care plan.

• Wash hands and apply gloves.

• Give the patient a tissue.

• Position the patient so he/she is looking up at the ceiling.

• Utilize hand-over-hand technique.

• Gently pull down the skin below the appropriate eye to expose the conjunctiva sac.

• For eye drops, instruct the patient to instill the prescribed number of drops to the center of the conjunctiva sac. The dropper should not touch the mucus membrane. Release the skin and gently press the lacrimal (tear) duct with a clean cotton ball/tissue for 1-2 minutes. This prevents absorption through the lacrimal canal.

• For eye ointments, assist the patient to squeeze about ½ inch of ointment onto the mucus membrane of the lower lid. Remind the patient that he/she may have blurred vision for a short time. Instruct the patient to keep his/her eyes closed for a few minutes.

• Wash hands.

To facilitate administration of ear drops:

• Check the patient’s care plan.

• Wash hands and apply gloves.

• The medication should be at room temperature.

• Place the patient in a position of comfort with his/her head tilted toward the unaffected side.

• Straighten the ear canal by pulling the auricle up and back.

• Instruct/assist the patient to instill the prescribed number of drops into the ear, using hand over hand technique.

• The dropper should not touch the ear.

• Have the patient remain with his/her head tilted for 2-3 minutes.

• Wash hands.

To facilitate administration of nose drops and sprays:

• Ask the patient to blow his/her nose

• Instruct the patient to administer the prescribed number of drops into one or both nostrils according to the care plan and using hand over hand technique.

• Instruct the patient to keep his/her head tilted back for several minutes after administering, supporting the head well.

Inhalation Route

Inhalers are commonly used to dilate the bronchi and improve breathing. When the medication enters the lower respiratory tract, it is rapidly absorbed in the bronchioles providing relief from breathing disorders.

Common disorders needing this treatment:

• Asthma

• Pneumonia

• Chronic Obstructive Pulmonary Disease (COPD)

Medications delivered through inhalation devices may include antibiotics,

steroids, and mucolytic agents (thins mucous secretions)

Side effects may include tremors, nausea, rapid heart beat, palpitations, nervousness, and abnormal heart rhythms.

Two common types of inhalers:

• Hand held: changes liquid into a spray

• Hand held metered dose

This is not generally an efficient way to deliver medications as only about 9% reaches the lungs. The patient must inhale deeply and slowly.

To facilitate administration of medication via inhalers:

• Check the patient’s care plan for instructions

• Encourage the patient to use inhaler as instructed by the nurse and the care plan

Nebulizer Treatments

Using hand over hand technique, assist the patient to twist off the top of the medication container and place medication into the nebulizer cup. Instruct the patient to proceed with the treatment according to the POC.

Suppositories

Suppositories are used to deliver drugs through the rectum or vagina. Rectal is preferred when the GI tract is not functioning effectively or the medication has an offensive taste. They are also used when digestive enzymes may alter the drug. The rectum has a large blood supply that can easily absorb the medication.

The patient’s care plan must reflect that assistance with suppositories by the LNA Medication-Certified is done ONLY for patients who are cognitively intact.

When administering rectally:

• Check the patient’s care plan.

• Provide for privacy and position the patient according to care plan instructions.

• Wash hands and apply gloves.

• Lubricate the suppository if necessary.

• Have the patient breathe through his/her mouth to relax the anal sphincter.

• Insert the suppository through the two muscle groups and have the patient lie quietly for 20 minutes.

• Cover the patient, remove gloves and wash hands.

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