Medication Administration Oral Skill (See Skill 21.1 on p523 as well)

Provide examples of patients who should not take oral medications

-Patients with neuromuscular disorders, esophageal strictures, or lesions of the mouth -Patients who are unresponsive or comatose and cannot swallow -Patients with a high risk for aspiration

Before the nurse administers medication, which of these is the most critical assessment? Diet history Drug tolerance Surgical history Allergy history

Allergy history Drug allergies should be listed on each page of the MAR, prominently displayed on the patient's medical record, and the patient should be wearing the facility's allergy bracelet. Assessment for drug allergies is necessary before medication is administered. A client's diet, surgical, and drug histories are important areas to assess, but they are not as critical as his or her allergy history, which can be life-threatening.

The easiest, safest, and most desirable way to administer medications is by______

Mouth

What is the correct way to assist a patient who is having difficulty swallowing tablets and capsules? Administer the tablets one at a time with plenty of liquid. Insert a nasogastric tube and instill the medication. Crush the medication, if allowed, and administer it with a small amount of food. Administer the medication with less fluid.

Crush the medication, if allowed, and administer it with a small amount of food Crushing the medication is the best option for a patient having difficulty swallowing. Not every medication can or should be crushed. Providing less fluid with the medication makes it more difficult for the patient to swallow. Not every medication can or should be given by the nasogastric route. Additionally, a nasogastric tube insertion requires an order from the practitioner. It may not be safe for a patient who is having difficulty swallowing to swallow large capsules or tablets, even one at a time.

As the nurse is about to give a medication, the patient says, "This pill that you are giving me for my heart looks different than the one I was taking at home." What should the nurse do next? Administer the medication. Explore the patient's concerns, notify the practitioner, and verify the practitioner's order. Document that the medication was withheld. Notify the practitioner.

Explore the patient's concerns, notify the practitioner, and verify the practitioner's order. It is important for the nurse to allow the patient to verbalize concerns about the medication, and the nurse must also notify the practitioner and verify the practitioner's order. Administering the medication without taking the correct actions may result in a medication error. The medication should not be withheld once the order has been verified, so this would not be documented.

Which patient instructions are correct when administering a buccal medication? Chew the medication before swallowing. Hold the medication against the cheek and gum membranes. Swallow the medication after 30 seconds. Hold the medication under the tongue.

Hold the medication against the cheek and gum membranes. A buccal medication must be dissolved against the cheek and gum membranes. The sublingual route is used to administer medication under the tongue. Medication is dissolved, not swallowed or chewed, when using the buccal route.

Before administering oral medications, the nurse must determine the patient's ability to swallow. What is the most appropriate way to do that? Ask the patient or family how well the patient swallows. Place the thumb and index finger on the sides of the Adam's apple and feel for an elevation. Observe the intake of solid foods. Ask the patient to swallow a small amount of water and observe the action.

Place the thumb and index finger on the sides of the Adam's apple and feel for an elevation. Feeling the patient's Adam's apple for movement and symmetry is the best bedside technique for the assessment of dysphagia. Observing the intake of solid foods or fluids reveals some information about the patient's ability to swallow but is not the best bedside assessment technique. The patient or family member may be unable to determine if the patient is able to swallow medications safely.

Which consideration is important for a patient taking oral medications? The patient's ability to swallow The patient's admission weight in kilograms as stated by the patient Administering powdered medications 1 hour after mixing them at the bedside The use of an injectable medication syringe to administer oral medication

The patient's ability to swallow The physical ability to swallow is necessary for the consumption of oral medications. The patient's admission weight in kilograms provides accuracy for weight-based doses. Actual weight should be verified or measured. Stated, estimated, or historic weight should not be used. Powdered medications mixed at the bedside and given immediately reduce the risk to the patient. Waiting to administer a prepared powdered medication increases the risk that the medication may thicken or even harden, making swallowing difficult. Oral medication syringes are preferred. Using a parenteral or injectable syringe for the administration of an oral medication may cause serious consequences.

Administering through Sublingual route is...

Under the tongue

Administering through Buccal route is...

through the inner cheek

Which action should the nurse take to reduce the risk of aspiration for patients taking oral medications? Have the patient use a straw. Administer several pills at once to reduce the number of times the patient needs to swallow. Allow the patient to self-administer the medication. Give all medications before or after meals.

Allow the patient to self-administer the medication. Allowing the patient to self-administer oral medications gives him or her more control. The nurse should avoid straws because they decrease the patient's control over volume intake, increasing the risk of aspiration. The nurse should administer pills one at a time, ensuring that each is properly swallowed before the next one is introduced. Oral medications should be timed to coincide with mealtimes or given when the patient is well rested and awake if possible.

What are the only exceptions to medication labeling? Liquid medications that are administered in an oral syringe Liquid medications that are administered in a cup Any medication that is administered immediately by the person who prepared it Any medication that is administered during the nurse's shift

Any medication that is administered immediately by the person who prepared it According to The Joint Commission's National Patient Safety Goals, the only exceptions to medication labeling are medications still in the original container that are administered immediately by the person who prepared them.

What is the primary reason liquid medications are administered to children? Liquid medications are easier to swallow and safer for children. Children do not want to chew medications. All medications are available in liquid form. Because children refuse bitter or distasteful oral preparations, a liquid mixture with honey is recommended for pediatric medications.

Liquid medications are easier to swallow and safer for children. Compared with small pills, liquid medications reduce the risk of aspiration. A child would chew a medication if it was crushed and mixed with a small amount (about 1 teaspoon) of a sweet-tasting substance, such as jam, applesauce, sherbet, ice cream, or fruit puree. Not all medications come in liquid form, but liquid forms of medications should be provided to children whenever possible. Honey should not be used with infant medications because of the risk of botulism.

Which step should the nurse take when pouring liquid medications from multidose bottles? Remove the medication bottle cap and place it on the work surface upside up. Draw doses of liquid medications greater than 10 ml into an oral medication syringe. Hold the bottle with the label facing outward while pouring. Hold the medication cup at eye level and fill it to the desired level.

Hold the medication cup at eye level and fill it to the desired level. Holding the medication cup at eye level ensures correct dosing; the fluid level should be even with the scale marks at the center of the cup or base of meniscus, not the edges. The bottle cap should be placed upside down on the work surface to avoid possible contamination of the rim. An oral medication syringe should be used for doses of liquid medications that are less than 10 ml. When the nurse pours liquid medications, the label should be against the palm of the hand. This allows more accurate observation of the liquid in the medication bottle.

Ways to protect patient from aspiration

• Assess patient's ability to swallow and cough and check for presence of gag reflex. • Prepare oral medication in form that is easiest to swallow. • Allow patient to self-administer medications if possible. • If patient has unilateral (one-sided) weakness, place medication in stronger side of mouth. • Administer pills one at a time, ensuring that each medication is properly swallowed before next one is introduced. • Thicken regular liquids or offer fruit nectars if patient cannot tolerate thin liquids. • Avoid straws because they decrease control patient has over volume intake, which increases risk of aspiration. • Have patient hold and drink from a cup if possible. • Time medications to coincide with meals or when patient is well rested and awake if possible. • Administer medications using another route if risk of aspiration is severe.