UNIT 11 Administration of Nonparenteral Medications Copyright 2011

Key Terms • • Angina pectoris Canthus Enema Hypoxemia Inhalation Inhaler Insertion Instillation •

Nonparenteral Medications • • Oral Ophthalmic/otic Nasal Rectal • • Special delivery Inhalation Oxygen

Oral Medications • Advantages – Economical – Safest – Most convenient (continues) Copyright ©

Oral Medications • Disadvantages – – – – Bad taste or smell Discoloration of

Equipment and Supplies • • • Medicine cup Tablet crusher Medicine dropper Drinking straws

Multiple-Dose Solid Medication Administration • • • Remove cap, touching only outside Dispense into

Multiple-Dose Liquid Medication Administration • • Shake if necessary Remove cap; place face up

Unit-Dose Medication Administration • Open at the patient’s side – If refused, medication is

Crushing Medications • Ensure medication may be safely crushed – Time-released, buccal, sublingual, enteric-coated

Oral Medication Safety Precautions • • • Observe for reactions Check medication label (third

Oral Medication Safety Precautions Discussion Questions: Under what circumstances might you have to crush

Ophthalmic Medication Administration • Instillation – Eye drops or solutions • Application – Ointments

Eye Instillations • • Wash hands and put on gloves Assemble supplies and prepare

Eye Instillations • Have patient close eye and roll eyeball to distribute medication •

Eye Applications • • Wash hands and put on gloves Assemble supplies and prepare

Eye Applications • Have patient close eye and roll eyeball to distribute medication •

Otic Medication Administration • Usually administered by instillation • Uses – – – Treat

Otic Medication Administration • Contraindications – – Perforated eardrum Hypersensitivity Herpes or other viral

Otic Medication Administration Discussion Questions: Why would you not instill otic medications for a

Ear Instillation • • • Wash hands and put on gloves Assemble supplies and

Ear Instillation • Have patient remain in position for approximately 5 minutes • If

Nasal Medication Administration • • Instillation Spray Nasal inhaler Uses – Relief of nasal

Nasal Medication Administration • Contraindicated if hypersensitive • Long-term use of nasal decongestants may

Nasal Medication Administration Discussion Question: What is meant by “rebound effect”? Copyright © 2011

Rectal Medication Administration • Suppositories • Ointments • Enemas Discussion Question: Why should laxatives

Rectal Medication Uses • Suppositories – – – Laxatives Anti-inflammatory Anesthetic Antipyretic Analgesics Antiemetics

Rectal Medication Uses • Enemas – Laxatives – Bowel prep for surgery or diagnostic

Transdermal Medications • Patches consisting of four layers • Medical assistant must always wear

Inhaled Medication Administration • Local treatment for respiratory tract infections • Systemic treatment for

Inhalers • • Handheld Metered-dose inhaler (MDI) Nebulizer IPPB machines (continues) Copyright © 2011

Inhalers • Considerations – – – Follow physician’s orders Avoid overuse Use only for

Inhalers • Contraindications – – Delicate fluid balance Cardiac arrhythmias Status asthmaticus Hypersensitivity (continues)

Inhalers Discussion Questions: What would happen if a patient used an inhaler for more

Oxygen Administration • • Colorless Odorless Tasteless Essential for life (continues) Copyright © 2011

Oxygen Administration • Facts – – Normal adult range, arterial blood: 80– 100 mm

Hypoxemia • Deficient amount of oxygen in blood • Symptoms – – Anxiety, restlessness,

Oxygen Toxicity • May develop when 100% oxygen is breathed for prolonged period •

Oxygen Toxicity • Symptoms – – – Substernal pain Nausea/vomiting Malaise/fatigue Numbness Tingling of

Oxygen Delivery Methods • Nasal cannulas – Simplest and most convenient – Lower concentrations

Oxygen Delivery Methods Warning! Extreme caution should be used when administering oxygen to patients

Oxygen Considerations • Oxygen must be humidified prior to administration • Avoid direct flow

Oxygen Safety • NO SMOKING: oxygen supports combustion • Avoid use of small electrical

Oxygen Safety Discussion Questions: Is smoking acceptable if the oxygen tank is turned off?

Locally Applied Drugs • • • Ointments Lotions Liniments Wet dressings Poultices Plasters Copyright

Applications to Body Cavities • Irrigation – Flushing mucous lining with solution • Instillation

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Key Terms • • Angina pectoris Canthus Enema Hypoxemia Inhalation Inhaler Insertion Instillation • • Inunction Irrigation Nitroglycerin Ointment Oxygen Suppository Transdermal system Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oral Medications • Disadvantages – – – – Bad taste or smell Discoloration of teeth, gums, or tongue Irritation to stomach Altered by digestive enzymes Poor absorption/less predictable Difficult to take because of nausea/vomiting May be refused by patient Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Multiple-Dose Solid Medication Administration • • • Remove cap, touching only outside Dispense into cap Transfer to paper cup Recap container Dispense one medication at a time Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Multiple-Dose Liquid Medication Administration • • Shake if necessary Remove cap; place face up on flat surface Cover label with palm of hand Pour at eye level; measure lowest point of meniscus • Do not touch bottle to cup • Cleanse bottle; recap Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Unit-Dose Medication Administration • Open at the patient’s side – If refused, medication is not wasted • Without touching medication, place in patient’s hand or medicine cup • If necessary to bisect tablet, do so before entering patient room Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Crushing Medications • Ensure medication may be safely crushed – Time-released, buccal, sublingual, enteric-coated tablets cannot be crushed • Tablet crusher or mortar and pestle work best • May sometimes mix medication in food • Ensure all medication is taken Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oral Medication Safety Precautions • • • Observe for reactions Check medication label (third time) Discard disposable materials Return unused supplies to storage Clean and return reusable materials Wash hands (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oral Medication Safety Precautions Discussion Questions: Under what circumstances might you have to crush medications? What types of medications should not be crushed? What should you do if the label on a bottle of liquid medication becomes soiled? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Ophthalmic Medication Administration • Instillation – Eye drops or solutions • Application – Ointments Warning! Ophthalmic medications are meant to have a local effect, but if not administered properly, may be absorbed systemically. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Eye Instillations • • Wash hands and put on gloves Assemble supplies and prepare patient Have patient look up to ceiling Place drops in center of lower conjunctival sac • Do not touch eye with dropper (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Eye Instillations • Have patient close eye and roll eyeball to distribute medication • Blot excess from eyelids with cotton ball • Dispose of supplies • Wash hands • Document procedure Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Eye Applications • • Wash hands and put on gloves Assemble supplies and prepare patient Have patient look up to ceiling Place hand in which you are holding ointment against patient’s forehead • Place medication along conjunctival border, starting at inner canthus, moving toward outer canthus (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Eye Applications • Have patient close eye and roll eyeball to distribute medication • Blot excess from eyelids with sterile gauze pad • Instruct patient to not rub eyes and to remain supine for 5 minutes • Dispose of supplies and wash hands • Document Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Otic Medication Administration • Usually administered by instillation • Uses – – – Treat infection Reduce inflammation Soften cerumen Localize anesthetic effect Immobilize trapped insect (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Otic Medication Administration • Contraindications – – Perforated eardrum Hypersensitivity Herpes or other viral infections Systemic fungal infections (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Otic Medication Administration Discussion Questions: Why would you not instill otic medications for a patient with herpes? Why would you not instill otic medications for a patient with a perforated eardrum? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Ear Instillation • • • Wash hands and put on gloves Assemble supplies and prepare patient Adult: pull top of ear upward and back Child: pull earlobe downward and back Instill medication (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Ear Instillation • Have patient remain in position for approximately 5 minutes • If instructed by physician, insert moistened cotton ball for 15 minutes • Dispose of supplies • Wash hands • Document procedure Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Nasal Medication Administration • Contraindicated if hypersensitive • Long-term use of nasal decongestants may cause rebound effect • Best administered by patient • Instruct patient to clear nasal passages prior to use (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Rectal Medication Administration • Suppositories • Ointments • Enemas Discussion Question: Why should laxatives or enemas be avoided for anyone with undiagnosed abdominal pain? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Rectal Medication Uses • Suppositories – – – Laxatives Anti-inflammatory Anesthetic Antipyretic Analgesics Antiemetics • Ointments – Anti-inflammatory – Shrink hemorrhoidal tissues (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Rectal Medication Uses • Enemas – Laxatives – Bowel prep for surgery or diagnostic testing Warning! Enemas should never be given to children under the age of 2 or to patients with undiagnosed abdominal pain. Enema or suppository use may cause a vagal response, which may slow or stop the heart. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Transdermal Medications • Patches consisting of four layers • Medical assistant must always wear gloves when applying transdermal medications • Remember to remove previous patch before placing a new one on the patient’s skin Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Inhaled Medication Administration • Local treatment for respiratory tract infections • Systemic treatment for serious respiratory infections • Supply medication that can be absorbed into the bloodstream through the lungs Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Inhalers • Considerations – – – Follow physician’s orders Avoid overuse Use only for labeled number of uses Notify physician if prescribed dose is ineffective Perform good oral hygiene (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Inhalers Discussion Questions: What would happen if a patient used an inhaler for more than the labeled number of actuations? What could happen with overuse of an inhaler? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Administration • Facts – – Normal adult range, arterial blood: 80– 100 mm Hg Must be prescribed by physician Dosage based on individual needs Ordered as LPM or % Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Hypoxemia • Deficient amount of oxygen in blood • Symptoms – – Anxiety, restlessness, confusion Cyanosis; pale, cold extremities Dyspnea Increased BP and pulse Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Toxicity • May develop when 100% oxygen is breathed for prolonged period • Depends on dose, time, and patient response • May cause alveolar collapse, hemorrhage, CNS disturbance (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Delivery Methods • Nasal cannulas – Simplest and most convenient – Lower concentrations • Masks – Types: disposable, partial rebreather, nonrebreather, Venturi – Higher concentrations – More humidity (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Delivery Methods Warning! Extreme caution should be used when administering oxygen to patients with COPD, particularly emphysema. Flow rates greater than 2 LPM may result in apnea for patients with emphysema. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Considerations • Oxygen must be humidified prior to administration • Avoid direct flow of oxygen against nasal mucosa • Ensure proper fit of cannula or mask Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Safety • NO SMOKING: oxygen supports combustion • Avoid use of small electrical appliances • Electrical medical equipment should be used with extreme caution • Explain precautions to patient and family (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygen Safety Discussion Questions: Is smoking acceptable if the oxygen tank is turned off? What fabrics should patients be discouraged from wearing if using oxygen? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Applications to Body Cavities • Irrigation – Flushing mucous lining with solution • Instillation – Temporary retention of liquid drug • Insertion – Suppository or oral tablet Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.