ADVANTAGE: It is both the least expensive and generally the least offensive form of medication. They can come in a variety of forms – fast/slow release, capsules or coated. Oral medication is convenient, painless & easy to take. DISADVANTAGE: Oral medication can have a slower rate of absorption due to the time required to digest and absorb them. Some patients may have difficulty swallowing or unconscious. Oral medication can be affected by food in the gastrointestinal tract or by the motility of the gastrointestinal tract (Tollefson, J, Bishop, T, Jelly, E, Watson, G & Tambree, K, 2012, page 105).
MEDICATION EXAMPLE: Amoxycillin sodium NURSING ACTION REQIRED: * Perform hand hygiene. * Communicate and explain to client. * Verify client identification. * Check and report any changes in the clients condition. * Check medication sheet for route & timed medication is given, medical officers signature, start/finish dates and when medication was last administered. * Read the label 3 times and check it against the medical officers written order (when taken from storage, prior to dispensing and on return to storage). * Check label for expiry date and any cautionary attachments.
* Using a non touch technique, prepare the dose. * Assist client into a sitting position. * Administer medication and offer a glass of water. Encourage client to sip. * Remain with client until medication is swallowed. * Communicate any special instructions. * Record drug administered onto the medication record. * Report immediately if client refused medication or unable to swallow whole tablet/capsule. (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page446-447). (2) SUBLINGUAL ADVANTAGE: No interference from gastric juices and not detoxified by the liver.
They are absorbed rapidly due to the good blood supply under the tongue. DISADVANTAGE: Holding the medication in the mouth may be inconvenient and the taste may not be favourable. Difficult if the dose is large, so best suited for smaller doses. Client may accidently swallow a portion of the medication. MEDICATION EXAMPLE: Nitroglycerin – Nitrostat NURSING ACTION REQIRED: Follow same procedure as for oral medication, but also: * Ensure client has nil by mouth status * Place (or ask client to) medication under the tongue. * Advise client not to chew or swallow.
(Koutoukidis, G, Stainton, K & Hughson, J, 2013, page446). (3) TOPICAL ADVANTAGE: Has a local effect – skin, or mucous membranes such as the ear, eye, vagina, rectum or nose. Drug is made available directly to the intended site of action. Because the systemic circulation is not reached in great concentration, the risk of systemic side-effects is lower and there is a lower risk of an allergic reaction. DISADVANTAGE: Topical medications may be less accurate in dosages when applying. It can be messy and more difficult to apply. Clients may find some topical medications uncomfortable, such as eye drops.
May not be able to use when there is damage to the skin. Absorption of the medication is affected by many factors such as skin thickness and amount of water in the tissues (Nursing Times, 2012). MEDICATION EXAMPLE: Nitroglycerin – Nitro-Bid NURSING ACTION REQIRED: * Provide client privacy. * Wear gloves. * Position client to expose the application site. * Any residual medication on the clients should be removed before reapplication. * Clean and dry the application site. * Observe the application site. * Remove and discard gloves, practice hand hygiene and put on new gloves.
* Discard supplies and remove glove and perform hand hygiene. * Report immediately if client refused medication or unable to apply (Sorrentino, S & Remmert, L, 2009, page 145). (4) TRANSDERMAL ADVANTAGE: Supplies drugs directly into the bloodstream for prolonged systemic effect. The medication does not get broken down by the liver before having the chance to take effect. The medication effects can last up to 24-72 hours. DISADVANTAGE: There may be some skin irritation. Absorption can vary due to skin condition, age and gender.
Works better with low dose (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page453-455). MEDICATION EXAMPLE: Scopolamine – Transdermal-Scop. NURSING ACTION REQIRED: Follow procedures for medications as set out in oral medications, but also: * Provide client privacy. * Wear gloves. * Position client to expose the application site. * Any residual medication on the clients should be removed before reapplication. * Clean and dry the application site. * Observe the application site. * Remove and discard gloves, practice hand hygiene and put on new gloves. * Discard supplies and remove glove and perform hand hygiene.
* Report immediately if client refused medication or unable to apply (Sorrentino, S & Remmert, L, 2009 page 147). (5) MUCOUS MEMBRANES: ADVANTAGE: The mucosal surface is absent of the corneum epidermidis (the major barrier to absorption across the skin). Mucosal surfaces are also very rich in blood supply making for rapid transport of the medication. The medication goes straight to the systemic circulation and thereby is not affected or degraded by the liver or gastrointestinal tract (American Academy of Pediatrics, 2013). DISADVANTAGE: Some mucous membranes can be sensitive to medication concentrations.
Administering medication can be felt as intrusive or uncomfortable to the client (American Academy of Pediatrics, 2013). MEDICATION EXAMPLE: estropipate – Ogen Cream NURSING ACTION REQIRED: Same as Oral Medication, but specifically: * Ensure privacy * Explain procedure and purpose of medication. * Assist client into position. * Perform hand hygiene and use gloves. * Encourage client to remain in recumbent position for at least 10 minutes. * Wash the applicator, which may only be used by that client only. * Remove gloves and perform hand hygiene. (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page459).
(6) INHALATION ADVANTAGE: The very large surface area and the rich blood supply of the lungs make this a very rapid route of administration. DISADVANTAGE: Difficulty in controlling dosage levels and possible harmful effects upon the membranes. Because of these difficulties, this route is usually limited to drugs that are specifically for their local effects such as anti-asthmatic compounds and medically supervised anesthesia (Timmons & Hamilton, 2013). MEDICATION EXAMPLE: Albuterol – Ventolin NURSING ACTION REQIRED: * Perform hand hygiene. * Communicate and explain to client. * Verify client identification.
* Check and report any changes in the clients condition. * Check medication sheet for route & timed medication is given, medical officers signature, start/finish dates and when medication was last administered. * Read the label 3 times and check it against the medical officers written order (when taken from storage, prior to dispensing and on return to storage). * Check label for expiry date and any cautionary attachments. * Assist client to upright position * Load inhaler with medication canister * Shake inhaler * Instruct client to breathe out slowly and fully, insert mouthpiece and tilt head back slightly.
Inhale quickly and deeply while pressing canister down to administer a metered dose. * Client should hold breath for as long as possible and then breath out slowly through the mouth. * Clean mouthpiece after each use. * Perform hand hygiene. * Encourage client to eat or drink after use. * Record medication chart. (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page460). (7) PARENTERAL ADVANTAGE: A very fast response (especially by the IV route). Because the gastrointestinal tract is bypassed, the medication is not degraded and bioavailability is greatly improved.
Parental route offers a method for clients who are unconscious, uncooperative or for clients who are suffering nausea or vomiting. Dose is easily controlled. DISADVANTAGE: High skill levels are required by staff administering medication by parental routes. Must be performed using aseptic technique. Administration of medication can be either painful or uncomfortable. If client has an allergic reaction to the medication, then that reaction would usually be both rapid and intense. More expensive than other routes of medications (Pharmacy Centre – Concern For Your Health, 2010). MEDICATION EXAMPLE: Insulin NURSING ACTION REQIRED:
* Explain procedure to client * Ensure privacy * Gain assistance of another nurse if client is young or is restless/irrational * Check drug order sheet for client name, medication name, dose, route, time of last administration and frequency of administration * Perform hand hygiene/follow infection control procedures * Check medication expiry date * Calculate dose and prepare medication. Have checked by second nurse. * Check client identity * Select appropriate injection site and assist client into position. Select a site that has not been used often and look for any masses, lumps, infection, scars or skin lesions.
* Cleanse site with antiseptic swab and allow to dry * Once a needle is inserted, if blood appears when plunger is pulled back, then the needle needs to be withdrawn and another site chosen. Use a fresh dose, syringe and needle. * When using injections, inject the medication slowly. * Place antiseptic swab over the injection site and withdraw needle. * Syringe disposes into sharps container * Record on the medications chart including the site of injection * Perform hand hygiene. And follow infection control procedures (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page451-452).
(8) SUBCUTANEOUS ADVANTAGE: Allows for a deposit (depot) of a drug to become established that will be released gradually into the systemic circulation over a period of time. Used for many protein drugs that would otherwise be destroyed by the gastrointestinal tract if taken orally. There are less risks associated with subcutaneous injection that there is with intravascular injection. DISADVANTAGE: Only small volumes of medication and only medications that will not damage subcutaneous tissue can be administered by this route. This route requires absorption and is much slower than the IV route.
Clients may find it uncomfortable or painful. Irritant medications can cause local tissue damage. MEDICATION EXAMPLE: Etonogestrel Insulin NURSING ACTION REQIRED: * Explain procedure to client * Ensure privacy * Gain assistance of another nurse if client is young or is restless/irrational * Check drug order sheet for client name, medication name, dose, route, time of last administration and frequency of administration * Perform hand hygiene/follow infection control procedures * Check medication expiry date * Calculate dose and prepare medication. Have checked by second nurse. * Check client identity
* Select appropriate injection site and assist client into position. Select a site that has not been used often and look for any masses, lumps, infection, scars or skin lesions. * Cleanse site with antiseptic swab and allow to dry * Insert the needle quickly and firmly at 45 or 90 degree angle. * Once a needle is inserted, if blood appears when plunger is pulled back, then the needle needs to be withdrawn and another site chosen. Use a fresh dose, syringe and needle. * When using injections, inject the medication slowly. * Place antiseptic swab over the injection site and withdraw needle. * Syringe disposes into sharps containerю
* Record on the medications chart including the site of injection * Perform hand hygiene. And follow infection control procedures (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page451-452). (9) INTRAMUSCULAR ADVANTAGE: Provides a sustained dose over an extended period of time as the medication slowly diffuses from the muscle. Intramuscular injections enable larger volumes of the medication to be administered than by the subcutaneous route. A rapid systemic action (Kluwer, W, 2009, page 4). DISADVANTAGE: Poor injection technique may lead to some muscle damage. Client may experience fear, pain or discomfort.
Trained personnel required for administration. Absorption is sometimes erratic, especially for poorly soluble drugs. MEDICATION EXAMPLE: Morphine Sulfate injection NURSING ACTION REQIRED: * Explain procedure to client * Ensure privacy * Gain assistance of another nurse if client is young or is restless/irrational * Check drug order sheet for client name, medication name, dose, route, time of last administration and frequency of administration * Perform hand hygiene/follow infection control procedures * Check medication expiry date * Calculate dose and prepare medication. Have checked by second nurse.
* Check client identity * Select appropriate injection site and assist client into position. Select a site that has not been used often and look for any masses, lumps, infection, scars or skin lesions. * Cleanse site with antiseptic swab and allow to dry * Insert the needle quickly and firmly at 90 degree angle. * Once a needle is inserted, if blood appears when plunger is pulled back, then the needle needs to be withdrawn and another site chosen. Use a fresh dose, syringe and needle. * When using injections, inject the medication slowly. * Place antiseptic swab over the injection site and withdraw needle.
* Massage the area gently. * Syringe disposes into sharps container * Record on the medications chart including the site of injection * Perform hand hygiene. And follow infection control procedures (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page451-452). (10) INTRAVENOUS ADVANTAGE: The medication avoids the gastrointestinal tract and therefore avoids fist pass metabolism by the liver. The best way to administer a precise dose and quickly. Permits a maximal degree of control over the circulating levels of the drug. The whole dose is delivered to the blood stream. High level of bioavailability of the medication (100%).
Larger doses may be given by infusion over an extended time. DISADVANTAGE: It may be difficult to find a suitable vein. There may be some tissue damage at the site of the injection. The rapid response to the medication can be an issue if there is an allergic or adverse reaction to the medication. Administering requires trained staff and is more difficult to administer than subcutaneous or intramuscular injection as it may be difficult to locate vein in some clients (Merck Manual Home Health Hand Book for Patients and Caregivers, 2012).
MEDICATION EXAMPLE: Fosphenytoin – Cerebyx NURSING ACTION REQIRED:
* Calculate correct dose and prepare medication * Collect necessary information about the medication, including action, purpose, normal dose, side effects, any special administration information and compatibility of fluids and medication. * Ensure correct medication is given by checking the ‘seven rights’. Two nurses must complete the checking procedures.. * Explain the procedure and the medication purpose to the client. * Check injection site for any signs of warmth, redness, swelling, tenderness or pain. * Assess the patency of the IV infusion line. * Check vital signs before, during and after infusion if necessary.
* Perform hand hygiene and use gloves. * Safely dispose of needle and syringe after use. * Record medication administered on medication chart. * Report any adverse reactions to medical officer and nurse in charge and document in client’s notes. (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page453-454). (11)
INTRADERMAL ADVANTAGE: Good for allergy testing when you only want a very small amount of allergen/antigen under the skin. Easy to determine results. Reaction contained to superficial site. DISADVANTAGE: Can only be administered in very small amounts. Slow absorption.
MEDICATION EXAMPLE: Tuberculin – Tubersol NURSING ACTION REQIRED:
* Explain procedure to client * Ensure privacy * Check drug order sheet for client name, medication name, dose, route, time of last administration and frequency of administration * Perform hand hygiene/follow infection control procedures * Check medication expiry date * Calculate dose and prepare medication. Have checked by second nurse. * Check client identity * Select appropriate injection site and assist client into position. Select a site that is easily obtainable and fee from clothing. * Cleanse site with acetone or alcohol swab and allow to dry * Insert the needle quickly and firmly at 20 degree angle, then lower at once to 15 degrees..
* When using injections, inject the medication slowly. * Place antiseptic swab over the injection site and withdraw needle slowly at the same angle that it was inserted. * Without applying pressure, quickly cover the injection site with a dry and sterile small gauze. * Syringe disposes into sharps container * Record on the medications chart including the site of injection * Perform hand hygiene. And follow infection control procedures (Koutoukidis, G, Stainton, K & Hughson, J, 2013, page451-452) & (BD Medical – Pharmaceutical Systems, 2012).