Oral & Topical medications

Nasogastric (NG) tube or enteral tube medication administration

1. place patient in a fowlers position (at least 30 degrees)

2. verify tube placement

3. aspirate a little bit of gastric fluid to check pH, color, and appearance and ensure proper positioning in the stomach.

4. check gastric residual with a 60 mL syringe, if contents are over 250 mL, follow agency policy regarding the return of contents back to stomach & administering meds

5. flush with 15 - 30 mL of water

6. ensure no contraindications with solutions for continuous feeding

7. be informed of how long you are supposed to stop feeding before administering meds

8. keep clients head elevated after for at least 1 hour following medication administration

what to do if liquid medication isn’t available for an enteral/ng tube?

dissolve with warm water crashable tablets, empty the contents of a capsule, or pierce gel tablets with a sterile needle

double check solvent with facility protocol as this can be sterile water or other

how to prevent NG tube from becoming occluded (clogged)

• flush 15-30 mL of water before and after each medication (5-10 for pediatrics patients)

• 30 - 60 mL after you have given ALL medications

might need sterile water to prevent chemical reactions- depending on facility protocol

if NG or enteral tube becomes occluted(clogged)

1. try flushing gently. if unsuccessful,

2. obtain prescription for pancrelipase and refer to those guidelines, if not

3. tube may need to be replaced
   
   always follow facility guidelines

metered dose inhaler procedure

1. have patient do a practice deep inhale and exhale

2. have patient inhale deeply and you deploy the meds during it

3. have pateint hold breath at the top of 10 secs

4. have patietn exhale thorugh nose or pursed lip

using inhaler with spacer device

1. insert inhaler to the end of the spacer to the device

2. shake the inhaler several times to mix medicaiton

3. have patient inhale deeply though inhaler device as you depress inhaler

4. instruct patient to hold breath at the top after inalation

5. have patient breath slowly though pursed lips or nose
   
   - wait 20-30 secs before additional puff of same medication
   - wait 2 mins before giving a puff of new medication

two most common types to administer inhaled medications and common conditions for their use

used to treat asthma and COPD

metered-dose inhalers: aerosolized medication
small volume nebulizers: mist, fine powder, or aerosol medication

metered dose inhalers (MDIs) ways to use it

patients can use them with tight lips around the mouthpiece or

1-2 inches in front of mouth

always depress medication during inhalation

Space device

A device that enhances the delivery of inhaled medications by holding the aerosolized medication in a chamber, allowing for better synchronization of inhalation and medication release.

patients use this when they cannot syncronize breathing rythm with the actuation of a metered-dose inhaler depression

small volume nebulizer

A device that converts liquid medication into a fine mist or aerosol. clients who cannot use this device should use a aerosol mask instead

risks of using corticosteroids with Meterted dose inhalers or small volume nebulizer

oral thrush or oral yeast infections also known as oral candidiasis

patients should be instructed to rinse their mouth with warm water after each use to minimize these risks.