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School
Diablo Valley College *
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Course
135
Subject
Medicine
Date
Jun 12, 2024
Type
Pages
13
Uploaded by MegaFrog2141
ENTERAL
ADMINISTRATION
➔
Routes of drug administration:
◆
Enteral
◆
Parental
◆
Percutaneous
➔
Enteral route: drugs administered directly to GI tract by oral, rectal, or GI tube methods
➔
Oral route:
◆
Advantages:
●
Safe, convenient, and economical.
●
Dose forms readily available.
●
Drug retrieval possible in case of error or overdose.
○
At a certain time after administration
◆
Disadvantages:
●
Slowest and least dependable absorption.
●
Absorption affected by food, emotions, and physical activity.
●
Some drugs (e.g., insulin, gentamicin) destroyed by digestive fluids.
○
Given parenterally
●
Not suitable if:
○
Drug harms or discolors teeth.
○
Patient is vomiting, has gastric/intestinal suction, risk of aspiration, or is unconscious and unable to swallow.
➔
GI Tube Method:
◆
Purpose: Bypass mouth and pharynx.
●
For pt who cannot swallow or had oral surgery
◆
Advantages and Disadvantages:
●
Similar to oral route.
●
Consider irritation of nasal passage/throat vs.:
○
Immobility from continuous IV infusions.
○
Expense and pain from multiple injections.
●
Used for long-term drug and feeding administration.
➔
Rectal Route:
◆
Advantages:
●
Bypasses digestive enzymes.
●
Avoids irritation of mouth, esophagus, and stomach.
●
Suitable when nausea or vomiting present.
◆
Absorption Variability:
●
Depends on drug product.
●
Patient's ability to retain the suppository/enema.
●
Presence of fecal material.
ADMINISTRATION OF ORAL MEDICATIONS
Dose Forms
1.
Capsules
◆
Small, cylindrical, gelatin containers that hold dry powder or liquid medicinal agents; Available in a variety of sizes.
◆
Advantages:
●
Convenient for drugs with unpleasant odor or taste.
●
No need for coatings or additives to improve taste.
●
Identifiable by color, shape, and manufacturer's symbol.
◆
Timed-Release Capsules and Tablets:
●
Function: Provide gradual, continuous drug release.
●
Mechanism: Granules in capsules or tablet ingredients dissolve at different rates.
●
Advantages:
○
Reduces the number of doses needed per day.
○
Typically administered every 12 or 24 hours.
Medication Safety Alert
Timed-release capsules and tablets should not be crushed or chewed or have their contents emptied into food or liquids because this may alter
the absorption rate and could result in a drug overdose or subtherapeutic activity.
➔
Lozenges
◆
Description: Flat disks containing medicinal agents.
◆
Base: Hard sugar candy or sugar with gelatinous substances.
◆
Usage: Held in the mouth to dissolve slowly.
◆
Function: Releases therapeutic ingredients
gradually.
➔
Pills
◆
Description: Obsolete dose form.
◆
Current Use: Term often used to refer to
tablets and capsules.
◆
Reason for Obsolescence: Replaced by
capsules and compressed tablets.
➔
Tablets
◆
Description: Dried powdered drugs
compressed into small disks.
◆
Ingredients:
●
Binders: Adhesive substances for
cohesion.
●
Disintegrators: Encourage dissolution in body fluids.
●
Lubricants: Aid in manufacturing.
●
Fillers: Inert ingredients to make tablet size convenient.
◆
Features:
●
Scored/Grooved: Allows dose division (though exact dose preferred).
●
Crushing: Can be crushed for solution administration or mixed with food.
◆
Caplets:
●
Description: Tablets shaped like capsules.
●
Purpose: Prevents opening and contamination of contents.
●
Example: Reformulated from capsules for safety (e.g., in response to the Chicago Tylenol murders).
◆
Layered Tablets:
●
Description: Tablets formed in layers.
●
Purpose: Allows administration of incompatible medications simultaneously.
◆
Enteric-Coated Tablets:
●
Description: Special coating resists stomach acid, dissolves in intestines.
●
Purpose: Protects medications destroyed by stomach acid.
◆
Orally Disintegrating Tablets (ODTs):
●
Description: Rapidly dissolve (within seconds) on the tongue.
●
Usage:
○
Rapid onset of action (e.g., migraines).
○
For patients with difficulty swallowing (e.g., parkinsonism, Alzheimer's, post-stroke).
○
Ensures administration for patients prone to avoiding medication (e.g., schizophrenia).
●
Example: Sublingual film for rapid disintegration (e.g., Suboxone for opiate addiction).
Medication Safety Alert
Enteric-coated tablets must not be crushed or chewed because their active ingredients will be released prematurely and destroyed in the
stomach.
➔
Elixirs:
◆
Description: Clear liquids with drugs dissolved in alcohol and water.
◆
Usage: Used when drugs cannot dissolve in water alone.
◆
Components:
●
Alcohol content varies based on drug solubility.
●
Water and flavoring agents often added for taste.
◆
Examples: Many cough medicines and mouthwashes.
➔
Emulsions:
◆
Description: Dispersions of small droplets of water in oil or oil in water.
◆
Emulsifying Agents: Sodium lauryl sulfate, gelatin, acacia.
◆
Purpose:
●
Mask bitter tastes.
●
Improve mouth and throat feel (palatability).
●
Enhance drug solubility.
➔
Suspensions:
◆
Description: Liquid dose forms with solid, insoluble drug particles in a liquid base.
◆
Usage: Must be shaken well before administration for thorough mixing.
◆
Examples:
●
Oral liquid antacids (e.g., Maalox, Mylanta Classic).
●
Liquid antibiotics (e.g., Augmentin, EryPed).
➔
Syrups:
◆
Description: Medicinal agents dissolved in a concentrated solution of sugar (usually sucrose) and water.
◆
Purpose: Effectively mask the bitter taste of drugs.
◆
Usage: Common in pediatric preparations due to sweeter flavor.
Equipment
➔
Unit Dose or Single Dose:
◆
Description: Single dose of medication in one package.
◆
Labeling: Includes generic and brand names, manufacturer, lot number, expiration date.
◆
Additional Information: Patient's name and bar code for administration and inventory control.
➔
Soufflé Cup:
◆
Description: Small paper cup.
◆
Usage: Transports solid medication forms (capsules, tablets) to prevent contamination.
➔
Medicine Cup:
◆
◆
Description: Plastic container with scales (metric, household).
◆
Usage:
●
Measure liquid medications.
●
Ensure proper scale is used.
●
Place on a hard surface and read at eye level.
◆
Accuracy: Inaccurate for doses less than 1 teaspoon.
●
Use a syringe for smaller volumes.
●
Use a tuberculin syringe for volumes less than 1 mL.
➔
Medicine Dropper:
◆
Usage: Administer eye drops, ear drops, and occasionally pediatric medications.
◆
Considerations:
●
Use the dropper supplied by the manufacturer.
●
Familiarize with barrel calibrations.
●
Avoid tipping upside down to prevent
medication loss.
●
Do not transfer medication to another
container.
➔
Teaspoon:
◆
Usage: Measure doses of most liquid medications.
◆
Hospital Conversion: 1 teaspoon = 5 mL (read on
the metric scale of the medicine cup).
◆
Home Use:
●
Recommend oral syringe.
●
Baking teaspoon as an accurate
measuring device if syringe unavailable.
➔
Oral Syringe:
◆
Description: Plastic syringe for measuring liquid
medications.
◆
Sizes: Measures volumes from 0.1 to 15 mL.
◆
Design: Needle does not fit on the tip.
➔
Nipple:
◆
Usage: Administer oral medications to infants using an infant feeding nipple.
ADMINISTRATION OF SOLID-FORM ORAL MEDICATIONS
Procedure Protocol
●
Definition: Set of nursing interventions for medication administration.
●
Steps:
1.
Assemble Equipment:
●
Gather necessary tools and perform hand hygiene.
2.
Seven Rights:
●
Ensure adherence to the seven rights of medication preparation and administration:
○
Right Patient
○
Right Drug
○
Right Indication
○
Right Route
○
Right Dose
○
Right Time
Commonly Used Measurements
Equivalents
Household
Metric
2 Tbsp
30 mL
1 Tbsp
15 mL
2 tsp
10 mL
1 tsp
5 mL
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○
Right Documentation
3.
Provide Privacy and Explanation:
●
Ensure patient privacy.
●
Explain the procedure and what the patient can expect.
4.
Premedication Assessment:
●
Conduct an assessment before administering any enteral medication.
●
Refer to individual drug monographs for specific information.
UNIT-DOSE SYSTEM
➔
Premedication Assessment: Refer to individual drug monographs for details.
Equipment:
◆
Medication cart
◆
Medication profile
Technique
1.
Procedure Protocol: Follow the previously described procedure protocol.
2.
Read Medication Profile:
●
Check prescribed drugs and administration times.
3.
Obtain Medication:
●
Retrieve medication from the patient’s assigned drawer in the medication cart.
4.
Compare Labels:
●
Verify the label on the unit-dose package against the medication profile.
●
Check expiration date on all medication labels.
5.
Check Doses:
●
Verify the number of doses remaining in the drawer.
●
Investigate if the number of doses is inconsistent.
6.
Recheck Seven Rights:
●
Verify the seven rights of medication administration against the medication profile and unit-dose package.
7.
Patient Interaction:
●
Proceed to the patient's bedside.
●
Check the patient’s identification bracelet against the medication profile.
●
Verify patient’s identity by asking for their name and birth date or two other identifiers.
●
Explain the drugs being given, stating their names and providing education.
●
Check pertinent patient monitoring parameters (e.g., apical pulse, respiratory rate).
8.
Hand Medication:
●
Allow the patient to read the package label.
9.
Facilitate Swallowing:
●
Offer a sip of water.
●
Retrieve the unit-dose package, open it, and place contents in the patient’s hand or a medication cup.
10.
Hand Hygiene:
●
Perform hand hygiene after administering medication.
COMPUTER-CONTROLLED DISPENSING SYSTEM
➔
Premedication Assessment: Refer to individual drug monographs for details.
Equipment:
◆
Computer-controlled dispensing system
◆
Medication profile
Technique
1.
Procedure Protocol:
●
Follow the previously described procedure protocol.
2.
Read Medication Profile:
●
Check prescribed drugs and administration times.
3.
Access Dispensing System:
●
Use security access code and password to access the system.
4.
Select Patient:
●
Choose the patient's name from the list of patients on the unit.
5.
Review On-Screen Profile:
●
Select the medications to be administered.
6.
Check Orders:
●
Verify all aspects of the on-screen order against the medication profile.
7.
Verify Labels:
●
Check the label on the unit-dose package against the medication profile.
●
Confirm expiration dates on all medication labels.
8.
Recheck Seven Rights:
●
Verify the seven rights of medication administration against the medication profile and unit-dose package.
9.
Patient Interaction:
●
Proceed to the patient's bedside.
●
Check the patient’s identification bracelet against the medication profile.
●
Verify patient’s identity by asking for their name and birth date or two other identifiers.
●
Use computerized scanner system to scan patient identification, the bar code on the unit-dose medication package, and the
nurse's badge (or follow institutional protocol).
●
Explain the drugs being given, stating their names and providing education.
●
Check pertinent patient monitoring parameters (e.g., apical pulse, respiratory rate).
10.
Hand Medication:
●
Allow the patient to read the package label.
11.
Facilitate Swallowing:
●
Offer a sip of water.
●
Retrieve the unit-dose package, open it, and place contents in the patient’s hand or a medication cup.
12.
Hand Hygiene:
●
Perform hand hygiene after administering medication.
GENERAL PRINCIPLES OF SOLID-FORM MEDICATION ADMINISTRATION
1.
Moisten Mouth:
●
Allow the patient to drink a small amount of water to ease swallowing.
2.
Place Medication:
●
Have the patient place the medication towards the back of their tongue.
●
Offer assistance as needed.
3.
Swallowing Aid:
●
Give the patient liquid to help swallow the medication.
●
Encourage the patient to keep their head forward while swallowing.
4.
Encourage Full Glass:
●
Promote drinking a full glass of fluid to ensure medication reaches the stomach and to dilute it, reducing irritation potential.
5.
Remain with Patient:
●
Stay with the patient while they take the medication.
●
Do not leave the medication at the bedside unless specifically ordered (e.g., nitroglycerin).
6.
Dispose of Container:
●
Discard the medication container (e.g., soufflé cup, unit-dose package) properly.
7.
Crushing Medication:
●
For patients with difficulty swallowing and when liquid medications are not available:
○
Use a tablet-crushing device.
○
Ensure the medication is not a capsule, timed-release, or enteric-coated product.
○
Follow guidelines for using the crushing device.
○
Mix the crushed medication with a small amount of soft food (e.g., applesauce, ice cream, custard, jelly) to mask bitter
taste and improve consistency.
Documentation
➔
Ensure accurate documentation of medication administration and patient responses to drug therapy.
➔
If using a computer-controlled dispensing system:
●
Date, time, drug name, dose, and route are automatically charted in the electronic medication administration record when the
nurse signs in and scans the patient's identification bracelet and the bar-coded unit-dose medication package.
➔
Charting:
1.
Chart the date, time, drug name, dosage, and route of administration.
2.
Perform and record regular patient assessments to evaluate therapeutic effectiveness:
●
Blood pressure, pulse, intake and output, improvement or quality of cough and productivity, degree and duration of pain relief.
3.
Document and report any signs or symptoms of adverse drug effects.
4.
Perform and validate essential patient education about drug therapy.
ADMINISTRATION OF LIQUID-FORM ORAL MEDICATIONS
UNIT-DOSE SYSTEM
➔
Premedication Assessment: Refer to individual drug monographs for details.
Equipment:
◆
Medication cart
◆
Medication profile
Technique
1.
Procedure Protocol:
●
Follow the previously described procedure protocol.
2.
Read Medication Profile:
●
Review prescribed drugs and administration times.
3.
Obtain Medication:
●
Retrieve prescribed medication from the patient’s assigned drawer in the medication cart.
4.
Verify Labels:
●
Check label on the unit-dose package against the medication profile.
●
Confirm expiration dates on all medication labels.
5.
Check Doses:
●
Verify the number of doses remaining in the drawer.
●
Investigate if the number of doses is inconsistent.
6.
Recheck Seven Rights:
●
Verify the seven rights of medication administration against the medication profile and unit-dose package.
7.
Patient Interaction:
●
Proceed to the patient's bedside.
●
Check the patient’s identification bracelet against the medication profile.
●
Verify patient’s identity by asking for their name and birth date or two other identifiers.
●
Explain the drugs being given, stating their names and providing education.
●
Check pertinent patient monitoring parameters (e.g., apical pulse, respiratory rate).
8.
Hand Medication:
●
Allow the patient to read the package label.
9.
Deliver Medication:
●
Retrieve the unit-dose package, open it, and place the container in the patient’s hand for placement of the contents into the
patient’s mouth.
10.
Hand Hygiene:
●
Perform hand hygiene after administering medication.
Liquid-Form Oral Medications In Multidose Containers
➔
Some liquid dosage forms, especially pediatric dosages, may not be available in unit-dose packaging due to small volumes.
➔
A small multidose container may be included in the unit-dose drawer with instructions for measuring the dose in a medicine cup or an
oral syringe.
➔
Technique:
1.
Procedure Protocol:
●
Follow the previously described procedure protocol.
2.
Read Medication Profile:
●
Review prescribed drugs and administration times.
3.
Obtain Medication:
●
Retrieve prescribed medication from the patient’s assigned drawer in the medication
cart.
4.
Verify Labels:
●
Check label on the multidose container against the medication profile.
●
Confirm expiration dates on all medication labels.
5.
Check Doses:
●
Verify the number of doses remaining in the container.
●
Investigate if the number of doses is inconsistent.
●
Remove the lid from the container.
○
Measuring with a medicine cup
➢
Hold Bottle Correctly:
■
Hold the bottle of liquid with the label in the palm of the
hand to prevent smearing.
➢
Examine Medicine Cup:
■
Locate the exact measurement line on the medicine cup.
➢
Prepare Surface:
■
Place the medicine cup on a hard surface.
➢
Pour Liquid:
■
Pour the prescribed volume of liquid into the cup at eye
level.
➢
Read Meniscus:
■
Read the volume accurately at the level of the meniscus.
■
The meniscus is caused by the surface tension of the
solution against the walls of the container, forming a
concave or hollowed curvature on the surface.
■
Read the level at the lowest point of the concave curve.
○
Measuring with an oral syringe
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➢
Select Syringe Size:
■
Choose a syringe size comparable to the volume needed.
➢
Method 1:
■
Attach a large-bore needle to the syringe (if necessary).
■
Draw up the prescribed volume of medication.
■
Needle may not be necessary if bottle opening is large enough.
➢
Method 2:
■
Pour the required medication amount into a medicine cup.
■
Use a syringe to draw up the prescribed volume.
6.
Replace Lid:
●
Securely replace the lid on the container.
7.
Recheck Seven Rights:
●
Verify the seven rights of medication administration against the patient medication profile and the multidose container.
8.
Return Medication:
●
Return the medication container to the unit-dose cart.
9.
Patient Interaction:
●
Proceed to the patient's bedside once all medications are assembled.
●
Check patient's identification bracelet and verify against medication profile.
●
Confirm patient’s identity using required identifiers.
●
Explain administered drugs, stating names and providing education.
●
Assess pertinent patient monitoring parameters (e.g., apical pulse, respiratory rate).
10.
Medication Administration:
●
Hand the medication cup to the patient for self-administration or administer medication via the oral syringe.
11.
Hand Hygiene:
●
Perform hand hygiene after medication administration.
GENERAL PRINCIPLES OF LIQUID-FORM ORAL MEDICATION ADMINISTRATION
For an adult or child
1.
Medication Dilution:
●
Never dilute a liquid medication unless specifically ordered.
2.
Patient Supervision:
●
Always remain with the patient during medication administration.
●
Do not leave medication at the bedside unless ordered.
For an infant
1.
Patient Identification:
●
Check infant's identification bracelet and verify against medication card or profile.
2.
Alertness:
●
Ensure the infant is alert.
3.
Positioning:
●
Position the infant with head slightly elevated.
4.
Administration:
●
Oral Syringe or Dropper:
○
Place syringe or dropper between cheek and gums, halfway back into mouth.
○
Administer medication slowly to reduce chances of spitting out.
●
Nipple:
○
When awake and preferably hungry, place nipple in mouth.
○
Administer medication into back of nipple with syringe or dropper while infant sucks.
○
Follow with milk or formula if necessary.
5.
Hand Hygiene:
●
Perform hand hygiene after medication administration.
Documentation
1.
Charting:
●
Date, time, drug name, dosage, and route of administration.
2.
Patient Assessments:
●
Perform and record regular patient assessments to evaluate therapeutic effectiveness:
○
Blood pressure, pulse, output, improvement or quality of cough and productivity, degree and duration of pain relief.
3.
Adverse Drug Effects:
●
Chart and report any signs and symptoms of adverse drug effects.
4.
Patient Education:
●
Perform and validate essential patient education about drug therapy and other essential aspects of intervention for the disease
process affecting the individual.
●
For medications administered to children, provide and validate essential patient education to the caregiver and child,
considering the child's developmental level.
●
Address drug therapy and other essential aspects of intervention for the disease process affecting the individual.
ADMINISTRATION OF MEDICATIONS BY GASTROINTESTINAL TUBES
➔
Uses of GI Tubes:
◆
Administer medications to patients with impaired swallowing, those who are comatose, or those with esophageal disorders.
➔
Types of GI Tubes:
◆
Nasogastric (NG), nasoduodenal (ND), or nasojejunal (NJ) tubes inserted through the nose.
◆
Gastrostomy tubes (G-tubes) surgically inserted through the abdomen into the stomach.
◆
Percutaneous endoscopic gastrostomy (PEG) procedure for inserting gastrostomy tubes; should not refer to the tube itself.
◆
Jejunostomy tubes (J-tubes) inserted into the small intestine during PEG procedure.
➔
Administration Guidelines:
◆
Whenever possible, use liquid form of drug for GI tube administration.
◆
For tablets or capsules:
●
Crush tablets or pull apart capsules, then sprinkle powder in 10 to 15 mL of water.
●
Do not crush enteric-coated tablets or open timed-release capsules.
◆
Flush tube with at least 30 mL of water before and after administering medication to clear the tube and facilitate drug transport
to the intestine.
◆
Flush 5 to 10 mL of water between each medication when administering multiple medications simultaneously.
◆
Include water used for flushing in total water requirements for patient over 24-hour period.
➔
Premedication Assessment: Refer to individual drug monographs for premedication assessment details.
Equipment
➔
Glass of water
➔
Two 60-mL catheter tip syringes
➔
Measuring container or graduated cylinder
➔
Pill crusher (as needed for non-liquid medications)
➔
Towel or small incontinence pad
➔
pH tape and color verification
➔
Gloves
Technique
1.
Refer to sections on administration of solid-form or liquid-form oral medications for dose preparation.
2.
Follow procedure protocol described earlier.
3.
Proceed to patient's bedside when all medications are assembled.
●
Check patient's identification bracelet and verify against medication profile.
●
Confirm patient’s identity using required identifiers.
●
Explain medication administration procedure to patient, stating drug names and providing education.
4.
Apply clean gloves.
5.
Position patient upright and check GI tube location before administering any liquid.
●
Note: Radiographic confirmation of GI tube placement is typically done initially. Subsequently, pH and color testing may confirm
placement.
ph and Color Testing of Gastrointestinal Contents to Check for Tube Placement
➔
Aspirate part of GI contents using 60-mL catheter tip syringe.
◆
If unable to aspirate, reposition patient on left side and retry.
➔
Check color of aspirated fluid:
◆
Gastric fluid: green with sediment or off-white
◆
Intestinal fluid: yellow (bile-colored)
◆
Pleural fluid: clear to straw-colored
◆
Tracheobronchial fluid: off-white or tan
➔
Check pH of GI contents:
◆
Stomach pH: < 3
◆
Intestinal fluid pH: 6 to 7
◆
Respiratory fluid pH: > 7
➔
Impact of H2(Histamine-2) antagonists on pH:
◆
No H2 blockers: gastric pH = 1 to 4; intestinal pH ≥ 6
◆
With H2 blockers: gastric pH = 1 to 6; intestinal pH ≥ 6; tracheobronchial or pleural aspirate pH ≥ 7
➔
Return GI contents after confirming correct tube placement.
➔
Administer medication after confirming proper tube placement.
Two-Syringe Technique for Medication Administration
➔
Draw 60 mL of tepid water in catheter tip syringe for flush.
➔
Place towel or small incontinence pad under GI tube.
➔
Disconnect GI tube from suction (if applicable) and pinch tube to prevent backflow. Attach flush syringe.
➔
Flush with 30 mL of water to clear tube. Place flush syringe on towel and obtain second syringe.
➔
With second 60-mL syringe, draw liquid medication or crush tablets, suspend in water (5 to 10 mL), and draw up into syringe.
➔
Administer medications one at a time. Do not mix in one syringe to prevent clogging.
➔
Lay out multiple medication syringes orderly for ease.
➔
Pinch GI tube, disconnect flush syringe, attach medication syringe, and administer medication vertically.
➔
Pinch tube to prevent backflow, switch to flush syringe, and flush tube with 10 mL of water after each medication.
➔
Continue medication administration and flushing until all medications are given.
➔
Flush GI tube with 30 mL of water when finished and clamp tube for 30 to 60 minutes for absorption.
➔
Provide oral hygiene if needed.
6. Remove gloves and perform hand hygiene.
Documentation:
1.
Chart verification of GI tube placement.
2.
Record date, time, drug name, dosage, route of administration, and all fluids given, including those used to flush the tube, on the intake
record.
3.
Perform and document regular assessments for therapeutic effectiveness, including blood pressure, pulse, output, improvement in cough
and productivity, and degree and duration of pain relief.
4.
Chart and report any signs and symptoms of adverse drug effects.
5.
Provide and validate essential patient education about drug therapy.
ADMINISTRATION OF ENTERAL FEEDINGS VIA GASTROSTOMY OR JEJUNOSTOMY TUBE
Dose Form
➔
Available in various mixtures to meet patient needs
➔
Four general categories:
◆
Intact Nutrient (Polymeric)
◆
Elemental
◆
Disease or Condition Specific
◆
Modular Nutrient
➔
Selection of Formula:
◆
Healthcare provider selects formula based on:
◆
Patient's energy requirements for body functions, growth, and tissue repair
◆
Individual patient needs based on illness or injury
Equipment
➔
Prescribed enteral formula
➔
Disposable or ready-to-hang bag for continuous administration
➔
Infusion pump specific for enteral formulas
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➔
Blood glucose testing materials (if ordered)
➔
60-mL catheter tip syringe
➔
50 mL of water
➔
Measuring container or graduated cylinder
➔
pH indicator tape
➔
Clamp (C clamp or ostomy plug)
➔
Towel or small incontinence pad
Technique
1.
Position patient in semi-Fowler position with 30-degree head-of-bed elevation
2.
Follow procedure protocol
3.
Verify patient identification against formula profile
4.
Educate patient on enteral feeding procedure and formula being used
5.
Check patient positioning and drape for privacy
6.
Place towel or incontinence pad under feeding tube area
7.
Apply clean gloves
8.
Cleanse stoma site if necessary
9.
Verify tube placement:
●
Gastrostomy Tube:
○
Attach 60-mL catheter tip syringe, release clamp, aspirate residual material
○
Observe color and check pH of aspirated contents
○
Notify healthcare provider if residual is >100 mL since last bolus feeding
○
Reintroduce aspirated gastric contents if necessary
●
Jejunostomy Tube:
○
Aspirate intestinal secretions, observe color, and check pH
10.
Flush tube with 30 mL of water
11.
Clamp tube (gastrostomy or jejunostomy)
12.
Proceed with feeding technique
●
Intermittent Tube Feeding:
○
Fill disposable or ready-to-hang bag with prescribed formula amount
○
Allow infusion by gravity on IV pole, typically over 30 minutes
○
Check frequently to ensure formula is running
○
Flush tubing with 50-60 mL water after bag is empty
○
Prevents bacterial growth and maintains tube patency
○
Clamp or plug ostomy tube
○
Instruct patient to remain in semi-Fowler position or right side for 30-60 minutes
1.
Aids digestion, prevents gastric reflux, leakage, and possible aspiration
○
Wash and dry reusable equipment, store in clean area until next feeding
○
Change equipment (e.g., syringes) per institutional policy (usually every 24 hours)
●
Continuous Tube Feeding:
○
Fill disposable feeding container with prescribed formula for 8-hour period
1.
Store remaining formula in refrigerator, label container with date and time of initiation
2.
Formula must be at room temperature at initiation
○
Feeding tubes may have Luer-Lok ends for easier syringe attachment
○
Prefilled feeding formulas available with spiked tubing for bag connection
○
Hang container on IV pole, clear air from tubing, thread tubing through pump as per manufacturer's instructions
○
Connect enteral feeding tube to source, release tube clamp
○
Set flow rate at prescribed rate to deliver correct volume over specified time
1.
Initiate feedings at slow rate, gradually increase at specified intervals
○
Wash, dry reusable equipment, store in patient's environment until next feeding
1.
Change equipment every 24 hours
13.
Blood glucose determination every 6 hours during tube feeding initiation
●
Assess until glucose levels maintained within specified range for 24 hours after maximum flow reached
14.
GI tube care:
●
Regularly inspect nares for pressure injuries from feeding tube
●
Check tissue around gastrostomy or jejunostomy tube for breakdown or infection
15.
Gastric residual volume check before next feeding:
●
Aspirate with syringe to ensure formula passage into intestine
●
Residual <100 mL: readminister and resume feeding
●
Residual >100 mL: notify healthcare provider
●
"Coffee-ground" color: notify healthcare provider, may indicate bleeding
16.
Perform hand hygiene.
Documentation
➔
Chart the following:
◆
Date and time
◆
Amount, color, and pH of aspirated residual
◆
Amount, type, and strength of formula instilled
◆
Amount of water used for tubing flush
Medication Safety Alert
Enteral formulas should be properly labeled with the time, date, type of formula, and strength. Check the date and time of preparation on a
formula that is mixed in the hospital pharmacy, and discard any unused portion after 24 hours.
Commercially prepared vacuum-sealed formulas are generally stored at room temperature until used. Check the expiration date and return the
product if it is outdated. If the product has been opened, discard it in accordance with the manufacturer's recommendations or institutional
policy.
For patients who are receiving enteral nutrition via intermittent tube feedings (using institutional guidelines), remember the following:
➔
Check the residual volume before each feeding.
➔
Check to ensure the presence of bowel sounds. The absence of bowel sounds indicates the need to contact the healthcare provider for
orders before proceeding.
➔
Check the position of the tube to ensure that it is still in the stomach or intestine.
➔
During the initiation of enteral feedings by intermittent or continuous methods, blood glucose testing may be ordered.
ADMINISTRATION OF RECTAL SUPPOSITORIES
Dose Form
➔
Suppository: Solid medication form for introduction into body orifice
➔
Dissolves and absorbed by mucous membranes at body temperature
➔
Store in cool place to prevent softening
➔
If soft, hold wrapped suppository under cold running water or place in ice water to harden
➔
Rectal suppositories not recommended for:
◆
Patients with recent prostate or rectal surgery
◆
Patients with recent rectal trauma
➔
Perform premedication assessment, refer to individual drug monographs for details
Equipment
➔
Gloves
➔
Water-soluble lubricant
➔
Prescribed suppository
Technique
1.
Follow procedure protocol.
2.
Patient bedside procedure:
●
Check patient's identification against medication profile.
●
Verify patient's identity.
●
Explain procedure and drug details to patient.
●
Check relevant monitoring parameters.
3.
Encourage patient to defecate before administration.
4.
Ensure patient privacy, position on left side (left lateral recumbent position).
5.
Apply clean gloves.
6.
Instruct patient to bend uppermost leg toward waist.
7.
Unwrap suppository, apply water-soluble lubricant to tip.
●
Avoid petroleum jelly or mineral oil.
8.
Insert suppository gently about an inch past rectal entrance and internal sphincter.
●
Use index finger for adults, fourth finger for infants.
9.
Instruct patient to lie on side for 15-20 minutes for melting and absorption.
●
For children, compress buttocks gently for prevention of expulsion.
10.
Dispose used materials, remove gloves.
11.
Perform hand hygiene.
Documentation
1.
Chart the following:
a.
Date, time
b.
Drug name, dosage, route of administration
2.
Perform and record regular patient assessments for therapeutic effectiveness:
a.
Example: For laxative, chart color, amount, consistency of stool
b.
For pain relief medication, chart degree and duration of pain relief
c.
For antiemetic suppository, chart degree and duration of relief of nausea and vomiting
3.
Chart and report any signs and symptoms of adverse drug effects.
4.
Perform and validate essential patient education about drug therapy.
ADMINISTRATION OF DISPOSABLE ENEMAN
Dose Form
➔
Prepackaged, disposable enema solution prescribed by healthcare provider
➔
Perform premedication assessment; refer to individual drug monographs for details
Equipment
➔
Toilet tissue
➔
Bedpan (if patient not ambulatory)
➔
Water-soluble lubricant
➔
Gloves
➔
Prescribed disposable enema kit
Technique
1.
Follow procedure protocol.
2.
Patient bedside procedure:
●
Check patient's identification against medication profile.
●
Verify patient's identity.
●
Explain procedure and solution details to patient.
●
Depending on enema purpose, encourage defecation if urge present.
●
Check pertinent monitoring parameters (e.g., time of last defecation).
3.
Position patient on left side, drape for privacy.
4.
Apply clean gloves, lubricate end of enema.
5.
Insert lubricated end into patient's rectum, dispense solution by compressing container.
6.
Dispose used container in original package.
7.
Encourage patient to hold solution for about 30 minutes before defecating.
8.
Assist patient to sitting position on bedpan or bathroom.
9.
Instruct patient not to flush toilet; enema results need documentation.
●
Inform patient about location of call light for assistance.
10.
Remove and discard gloves.
11.
Perform hand hygiene.
Documentation
1.
Chart the following:
●
Date, time
●
Drug name, dosage, route of administration
2.
Perform and record regular patient assessments for therapeutic effectiveness:
●
Example: Color, amount, consistency of stool
3.
Chart and report any signs and symptoms of adverse drug effects.
4.
Perform and validate essential patient education about drug therapy.
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