ppt chapter 03

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 3

Drug Administration


Question

• Which of the following routes has the fastest rate of absorption?

– A. Oral

– B. Sublingual

– C. Intramuscular

– D. Intravenous


Answer

• D. Intravenous

• Rationale: The intravenous route has the fastest rate of absorption because it goes directly into the bloodstream.


Drug Administration Routes: General Considerations • Enteral route

– Gastrointestinal (GI) tract is used for the ingestion and absorption of drugs.

– The most common method of administering drugs

• Parenteral route

– Avoids the GI tract

– Associated with all forms of injections: intramuscular (IM), subcutaneous (SC or SQ), and intravenous (IV)

• Topical route

– Drugs administered topically are applied to the skin or mucous membranes


Local and Systemic Effects• Local effects: exert their effect at the site of

administration

• Systemic effects: Certain drugs given topically are absorbed by the skin and distributed throughout the body systems.

• Drugs administered by a route other than the enteral route have the advantage of avoiding the first-pass metabolism.

• Drugs administered enterally are absorbed from the stomach and small intestine.

• Drugs administered parenterally and even some topical drugs are transported directly into the blood.


Enteral Route and Forms

• The enteral route involves using the GI tract for the administration and absorption of drugs.

• Variety of forms

• The oral route of administration is the most common enteral route.

• Some oral drugs are given for their local effect in the GI tract.

• Most drugs are given to achieve a systemic effect.


Enteral Dosage Forms

• Tablets (the active ingredient is mixed with lactose or other sugars.)

– A tablet is a solid dosage form.

– An enteric coated tablet has a wax-like layer; allows the drug to dissolve in the intestines instead of the stomach.

– Sustained-release tablets are formulated to release a drug slowly over an extended period.


Enteral Dosage Forms (cont.)

• Sublingual and buccal tablets

– Designed to dissolve rapidly in the vascular mucous membranes of the mouth.

– Buccal tablets are placed in the buccal pouch.

– Sublingual tablets are placed under the tongue.

– Avoid the first-pass phenomenon

• Troches

– Used to achieve a local effect in the mouth or pharynx



• Capsules

– Medication is encased in solid dosage forms, paste, powders, and liquids in a shell of hard or soft gelatin.

– Disadvantage: The dosage cannot be divided.

• Syrups

– A concentrated solution of sugar that contains the medication.



• Elixirs

– A clear hydroalcoholic mixture

– Cloudiness indicates contamination

• Emulsions and suspensions

– An emulsion is created when two liquids that do not mix well are combined.

– A suspension is a drug preparation consisting of two agents.



• Nasogastric (NG) or gastrostomy (G) tube forms

– Drugs administered through a tube should be either liquid or crushed and in a liquid vehicle.

– A liquid drug form is preferred because research has shown that this form causes less clotting of tubes than crushed and dissolved drugs.

– Enteric-coated or sustained-release preparations cannot be crushed.


Question

• It is acceptable for a nurse to crush sustained-release medication to be administered via a PEG tube.

– A. True

– B. False


Answer

• B. False

• Rationale: The purpose of a sustained-release medication is to work over an extended period of time. If the medication is crushed when administered, it will not be absorbed slowly in the body.


Nursing Management in Enteral Drug Administration

• Core drug knowledge

– Gastric acids and enzymes destroy many drugs.

– Food may interfere with the dissolution and absorption of certain drugs.

• Assessment of relevant core patient variables

– Important aspect of drug administration


Core Patient Variables• Health status

– A primary consideration for administering an oral drug is the patient’s condition.

– Assess for ability to tolerate the drug

• Life span and gender

– The high sugar content of syrups can mask unpleasant drug flavors.

– Elixirs are usually not used in children or in adults who should avoid ethanol.

• Environment

– Oral drug forms are easily self-administered.


Therapeutic Effect

• Maximizing therapeutic effects

– Medications may be mixed with food or fluids.

– Shake liquid medication immediately before administration of the medication.

– Drugs administered through an NG or a G tube are instilled slowly.

– NG and G tubes need to be flushed after administration of medications.


Adverse Effects

• Minimizing adverse effects

– Drugs that have enteric coatings and drugs in sustained-release form should never be chewed, crushed, or broken.

– Repeated doses of sucrose-containing syrups may increase the risk of gingivitis or dental caries.

– Before administering drugs through an NG or G tube, the tube is assessed for proper placement.

– To ensure safety, the nurse must closely follow the cardinal rules of drug administration.


Parenteral Route

• Intramuscular administration

– Involves injecting drugs into certain muscles

– The onset of action with intramuscular injections is faster than with oral administration.

– The most common sites for IM injection are the ventrogluteal, deltoid rectus femoris, and vastus lateralis muscles.

– Many experts and nursing fundamental texts no longer recommend using the dorsogluteal site due to possible sciatic nerve damage.


Intramuscular Administration Sites


Parenteral Route (cont.)

• Subcutaneous administration

– Drugs are administered under the skin into fat and connective tissue.

– These drugs must be highly soluble, low volume, and nonirritating.


Subcutaneous Administration Sites


Parenteral Route (cont.)

• Intravenous administration

– The drug is administered directly into the bloodstream.

– IV administration ensures prompt, sometimes immediate, onset of action.

– Eliminates the uncertainty associated with varied absorption rates from other routes

– The IV route is also, however, one of the most dangerous routes.


Question

• Which of the following is not an advantage of giving a medication by the IV route?

– A. Immediate effect of the medication

– B. Allows administration of a large volume of drug

– C. Can cause local tissue irritation

– D. Circumvents impaired circulation


Answer

• C. Can cause local tissue irritation

• Rationale: IV administration avoids tissue irritation or injury resulting from IM or SC administration.


Other Parenteral Delivery Routes • Intradermal

– Injections are made into the dermis just below the epidermis.

– This technique is used primarily for local anesthesia and for sensitivity tests, such as allergy and tuberculin tests.

• Intra-articular

– Injecting a drug into a joint

• Intra-arterial

– A catheter inserted into an artery leading directly to the targeted treatment area

• Intrathecal

– A drug is delivered into the cerebrospinal fluid.


Nursing Management in Parenteral Drug Administration

• This route allows drugs to be distributed directly to the vascular system.

• The parenteral route avoids erratic absorption.

• Parenteral routes may also be necessary because of the GI irritant nature of the drug.

• Drugs administered by the parenteral route have a faster onset of action than those administered orally or topically.


Assessment of Relevant Core Patient Variables • Health status

– A parenteral route may be chosen because the patient cannot tolerate oral drugs.

• Life span and gender

– Infants have small muscle mass.

– Elderly people have decreased muscle mass overall and decreased tissue elasticity.

• Lifestyle, diet, and habits

– Parenteral forms of drugs are more expensive than oral forms.

• Environment

– The parenteral route requires increased patient teaching.


Maximizing Therapeutic Effects

• Selecting the appropriate-sized syringe and needle is key to administering an IM or SC injection.

• A continuous IV drug infusion should be monitored.

• After administration of an intermittent IV drug, the lock must be flushed to maintain patency.


Minimizing Adverse Effects

• To minimize adverse effects and drug errors, the nurse follows the five rights of drug administration.

• All parts of the syringe that enter the patient’s body must be sterile.

• Site selection is important because incorrect placement of the needle may damage blood vessels or nerves.

• When administering drugs that are irritating, the nurse may use an injection technique known as the Z-track.

• Patients receiving drugs by continuous IV infusion must be closely monitored.


Topical Route

• Apply the drug preparations to the skin or mucous membranes, including the eyes, ears, nose, rectum, vagina, and lungs.

• The primary advantage is that the drugs usually act locally.

• A disadvantage of topical drugs is that most are intended for only one specific site.

• Many different drugs can be given topically.


Topical Drug Forms

• The most common and widely used topical agents applied to the skin include lotions, creams, liquids, ointments, and emollients.

• Transcutaneous or transdermal drug delivery systems deliver a specific amount of a drug.

• Drugs administered to the eye take the form of drops or ointments.


Topical Drug Forms (cont.)

• Drugs administered through the rectum are either in suppositories or in ointments.

• Drugs administered into the vagina are in the form of suppositories, creams, foams, liquids, or tablets.

• Drugs given into the nose are in liquid sprays, drops, or aerosol preparations.

• Inhalers are used for respiratory conditions.


Nursing Management in Topical Drug Administration • Assessment of relevant core patient variables

– Assessment involves inspecting the skin for integrity.

• Planning and intervention

– To maximize therapeutic effects and minimize adverse effects:

• The nurse should wear gloves.

• Sterile technique is used when the skin is broken.

• In the event of an adverse effect, remove the medication.

– The nurse must again observe the five rights of drug administration.

ppt chapter 03

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