The last time that you had a headache and took an aspirin you were using the oral route to get rid of your headache. The oral route is just one of 11 different routes that are used to administer medication.
As the name implies, the oral route means that the patient ingests the medication. Sublingual and buccal are two other routes that also involve the patient’s mouth but instead of ingesting the medication, the medication is absorbed within the oral cavity from beneath the tongue (sublingual) or between the cheek and gum (buccal).
You probably rubbed hydrocortisone on an insect bite to relieve itching. Itching subsides as the skin absorbs the hydrocortisone. This is the topical route. Medication is also absorbed by the skin using the trans dermal route, which is commonly known as the “patch".
Medication that you place in your eyes, ears, or in your nose is administered using the instillation route in the form of drops, ointment, and sprays. Patients with lung problems sometimes receive medication using the inhalation route. Medication is delivered using an inhaler that changes liquid medication into a spray.
Patients who have upper gastrointestinal (GI) disturbances might have a tube inserted via the nasal passage into the stomach (nasogastric tube) or a tube inserted directly into the stomach through the skin and stomach wall (gastrostomy tube) that is used to bypass the upper GI tract and provides a direct path to the stomach. Both tubes can be used to introduce medication into the patient.
The suppository route is used to administer medication through the rectum and the vagina. A route that few patients look forward to is the parenteral route because medication is given using injections or directly into the vein, the intravenous (IV) routes.
Oral medications are in the form of tablets, capsules, and liquids and most are absorbed in the small intestine and have a peak time of between 1 and 3 hours .Tablets can be divided using a tablet cutter into half or quarters to reduce the dosage that is given to the patient. Some tablets can also be crushed so that the medication can be mixed with food such as applesauce. Capsules must be taken whole because they are enteric-coated so that the medication isn’t released until it reaches the intestines. Some capsules contain timed-release medication.
Here are the precautions that must be taken when the oral route is prescribed.
Liquid medication takes one of three forms: elixirs, emulsion, and suspensions. An elixir is a sweet, pleasant-smelling solution of alcohol and water used as a vehicle for medicine. Robitussin, a commonly used cough preparation, is an elixir. An emulsion is a suspension of small globules of one liquid in a second liquid with which the first will not mix, such as milk fats in milk. And a suspension is a preparation of finely divided, un dissolved particles dispersed in a liquid, such as bismuth subsalicylate (Pepto-Bismol).
When administering liquid medication:
SUBLINGUAL AND BUCCAL MEDICATION
These medications are quickly absorbed into the circulatory system because the tissues beneath the tongue and between the cheek and gum consist of a thin layer of epithelium cells and a vast network of capillaries. Nitroglycerin can be administered sublingually.
When administering sublingual or buccal medication:
The trans dermal route is commonly referred to as “the patch” because the medication is contained in a patch that is absorbed through the skin. There are an increasing number of drugs that are administered using this route. These include cardiovascular medication such as nitroglycerin, neo plastic drugs (cancer), and hormones (estrogen and birth control medications). In addition, analgesics (Fentanyl), medication used to treat allergic reactions, and smoking cessation drugs such as Nicotrol are also administered through the trans dermal route. Trans dermal patches provide a consistent blood level and less absorption problems in the gastrointestinal tract that are commonly experienced by patients who take oral medications.
When administering trans dermal medication:
The topical route refers to applying medication to the skin for a local effect. There are three ways to administer topical medication. These are with a glove, with a tongue blade, or with a cotton-tipped applicator. Never apply topical medication with an un gloved hand because medication may be absorbed into your body as well as into the patient’s body.
When administering a topical medication:
Instillation's are liquid medications that are administered to the eyes and ears as drops, ointment, or sprays. You’All need to take special precautions when administering an instillation to prevent spreading the disease.
Here’s what you need to do to administer installations in the eye:
Here’s what you need to do to administer eardrops:
When administering nose drops and sprays:
The inhalation route is used to have the patient inhale the medication using an inhaler. This is a common route used to administer bronchodilators to patients with breathing problems such as asthma, pneumonia, and chronic obstructive pulmonary disease.
The medication enters the lower respiratory tract where it is rapidly absorbed in the bronchioles providing the patient with relief from bronchospasms, wheezing, asthma, or allergic reactions.
Inhalation is used to deliver antibiotics, steroids and mucolytic agents (drugs that thin secretions making it easier to clear the bronchi). The patient can experience side effects such as tremors, nausea, tachycardia, palpitations, nervousness, and dysrhythmias (see Chapter (Respiratory Diseases) ).
There are two commonly used inhalers. These are the hand-held nebulizer and the hand-held metered-dose device. The hand-held nebulizer changes liquid medication into a fine spray. The hand-held metered dose device is a small, metal container about 5 to 6 inches high, with a push button spray device on the top to release the medication.
Inhalers are not a very efficient way of delivering medications to the lungs because only 9% of the medication reaches the lungs. The efficiency increases by using a spacer, which delivers 21% of the medication to the lungs. The spacer is a funnel-like device that attaches to the mouthpiece of the metered dose inhaler (MDI). The medication is released into the spacer and then the patient inhales slowly and deeply to get the drug into the airway.
When administering medication using an inhaler:
NASOGASTRIC AND GASTROSTOMY TUBE ROUTE
Nasogastric and gastrostomy tubes are used for patients who are unable to swallow or ingest anything orally. The nasogastric tube is passed through the nose and into the stomach opening with direct access to the stomach through which medication can be administered to the patient. The nasogastric tube is also used as a temporary feeding tube and to remove stomach contents. The gastrostomy tube is inserted through the skin and directly into the stomach and is used primarily as a permanent feeding tube that can also be used to administer medication.
When administering medication through the nasogastric tube and the gastrostomy tube:
Suppositories are used to administer medication via the rectum or the vagina, depending on the nature of the patient’s condition or the type of medication. Rectal suppositories are the preferred route to administer medication when the patient’s upper GI tract is not functioning properly or when the medication has an offensive taste or foul odor. It is also used when digestive enzymes change the chemical integrity of the medication.
The rectum promotes absorption of the medication because it contains many capillaries and can produce a high blood concentration of the medication.
When administering a suppository rectally:
When administering a suppository vaginally:
The parenteral route is where medication is injected into the patient using a syringe. There are four commonly used parenteral routes: intradermal (ID), subcutaneous (SC), intra muscular (IM), and intravenous (IV).
The choice of which of the parenteral routes to use is determined by the prescriber based on the nature of the medication, the desired onset of the therapeutic effect, and the patient’s needs. For example, the test for TB is performed by injecting the purified protein derivative intradermally, which is under the skin. Insulin is injected subcutaneously, although regular insulin can also be administered intravenous. Medications administered intravenously have a faster onset of therapeutic effect than other parenteral routes. Vaccinations, some antibiotics, and other medications are injected intramuscularly.
Intradermal injections are given in hairless areas of the body that are lightly pigmented and thinly keratinized so that the nurse can observe any reaction to the medication. These are:
Medication injected intradermally has a localized effect because it does not enter the bloodstream. It usually causes a wheal (blister) to appear at the injection site. Injections are given using a 26–27 gauge needle and a 1 mL syringe calibrated in 0.01 mL increments. The typical injection is between 0.01 to 0.1 mL.
Here’s how to administer medication intradermally:
The subcutaneous injection is suited for medications that need to be absorbed slowly to produce a sustained effect, such as insulin and heparin. Subcutaneous medications are absorbed through capillaries and the onset of the medication is slower than intramuscular and intravenous routes.
Choose an injection site that has an adequate fatpad. To prevent lypodystrophy, sites must be rotated if injections are given frequently. Lypodystrophy is a loss of the fat area under the skin causing ineffective absorption of insulin. These sites are: abdomen, upper hips, upper back, lateral upper arms, and lateral thighs.
Subcutaneous injections are given using a 25–27-gauge needle that is 1/2 or 5/8 inches in length and with a 1 to 3 mL syringe calibrated 0.5 to 1.5 mL. However, syringes used for insulin are measured in units and not mL.
Here’s how to administer medication subcutaneously:
Intramuscular injections are used so that the medication is rapidly absorbed into the patient’s body. The absorption rate depends on the patient’s circulatory state. Usually no more than 5 mL of medication is injected for an adult and 3 mL for a child. If the prescriber orders a higher dose, divide the dose into two syringes. Choose an injection site based on the size of the muscle with a minimum number of nerves and blood vessels in the area. These sites are:
See Table (Injection sites) for more details.
Intramuscular injections use a 20 to 23-gauge needle that is 1 to 1.5 inches in length and a 1 to 3 mL syringe that is calibrated with 0.5 mL to 1.5 mL.
Here’s how to administer medication intramuscularly:
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An Inside Look At Pharmacology
Drug Action And Drug Interactions
Pharmacology And The Nursing Process
Principles Of Medication Administration
Route Of Administration
Vitamins And Minerals
Fluid And Electrolyte Therapy
Nutritional Support Therapies
Antimicrobials— Fighting Infection
Nervous System Drugs
Cardiac Circulatory Medications
Disorders Of The Eye And Ear
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