Ppt chapter 03

Chapter 3
Drug Administration
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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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