Chapter-9 Medications Administration

Fundamental of Nursing Practice

Medication Administration

• Medication:

  • A substance administered for diagnosis, cure, treatment, relief of a symptom, or prevention of disease.

Therapeutic Actions of Drugs

• Palliative: Relieves symptoms (e.g., Morphine sulfate).

• Curative: Cures a disease (e.g., Penicillin).

• Supportive: Supports body function (e.g., Panadol for high temperature):

• Substitutive: Replaces body fluids/substances (e.g., Insulin for diabetes).

• Chemotherapeutic: Destroys malignant cells.

• Restorative: Returns the body to health (e.g., Vitamins & minerals).

Routes of Administration

• Enteral: Inside the intestine

  • Oral: Solid (pills, capsules, tablets) & liquid (syrups & suspensions).

  • Sublingual.

  • Buccal.

• Parenteral: Outside the intestine

  • Subcutaneous: Below the skin.

  • Intramuscular: Into the muscle.

  • Intradermal: Under the epidermis (into the dermis).

  • Intravenous: Into a vein.

  • Intrathecally: Into spinal canal.

  • Epidural: Into epidural space.

  • Intra-articular: Into a joint.

• Topical.

• Inhalation.

Angles for Inserting Injections

• Intramuscular: $90^{\circ}$

• Subcutaneous: $45^{\circ}$

• Intravenous: $25^{\circ}$

• Intradermal: $10-15^{\circ}$

Factors Affecting Drug Action

• Developmental considerations.

• Weight.

• Gender.

• Cultural and genetic factors.

• Psychological factors.

• Pathology.

• Environment.

• Timing of administration.

Common Types of Drug Preparations

• Capsule: Powder or gel in a gelatinous container.

• Elixir: Liquid with water, alcohol, sweeteners, and flavor.

• Extended Release: Slow and continuous release (CR, CRT, SR, SA, LA, TR).

• Liniment: Medication mixed with alcohol, oil, or soap for skin rubbing.

• Lotion: Drug particles in a solution for topical use.

• Lozenge: Flavored/sweetened base that dissolves in the mouth (troche).

• Ointment: Semisolid for external application (unction).

• Patch: Unit dose for skin diffusion and absorption.

• Pill: Powdered drug with cohesive material.

• Powder: Single or mixture of finely ground drugs.

• Solution: Drug dissolved in another substance (e.g., water).

• Suppository: Easily melted medication in a firm base inserted into the body.

• Suspension: Undissolved particles in liquid; shake before use.

• Syrup: Medication in water and sugar solution.

• Tablet: Solid dose, compressed or molded; enteric-coated tablets reduce gastric irritation.

Principles of Medication Administration

• Medication Orders:

  • No medication without a physician's order.

  • Each agency has policies for physician orders.

  • Orders are written on a specific form, becoming part of the client's permanent record.

  • Nurses should know when clients can take their own medications, understanding their purpose and adverse effects.

Types of Orders

• Standing Order: Carried out until canceled by another order.

• PRN (As Needed): Given when requested or needed (e.g., post-operative pain medication).

• Single Order: Carried out once at a specified time.

• Stat Order: Single order carried out immediately..

Parts of the Medication Order

• Client's name.

• Date and time the order is written.

• Name of the drug.

• Dosage of the drug.

• Route of administration.

• Frequency of administration.

• Signature of the person writing the order.

The Rights of Medication Administration

1. Right medication.

2. Right dose.

3. Right time.

4. Right route.

5. Right client.

6. Right client education.

7. Right documentation.

8. Right to refuse.

9. Right assessment.

10. Right evaluation.

Right Time Abbreviations

• BID: Twice daily.

• TID: Three times a day.

• QID: Four times a day.

• E.O.D: Every other day.

• OD: Once daily.

• Stat: Once and stop.

• PRN: When necessary.

• ABT: At bedtime.

• AM: At morning.

• PM: At night.

Checking the Medication Order

• Use a card system or medication administration record (MAR).

• Computerized patient records are increasingly common.

• Nurses are responsible for verifying the transcribed order against the original.

Questioning the Medication Order

• Nurses are legally responsible for the drugs they administer.

• Question any suspected error in the order.

• If unsure about the order's relevance to the client's care plan, ask for clarification.

• Nurses have the right to refuse to administer potentially harmful medications.

Using Safety Measures While Preparing Drugs

• Minimize medication errors through three checks and five rights.

Three Checks:

1. When reaching for the container.

2. Immediately before pouring the medication.

3. When replacing the container.

The 5 Rights of Medication Administration

1. Right medication

2. Right client

3. Right dosage

4. Right route

5. Right time

The 8 Rights of Medication Administration

• Name on order and patient.

• Use 2 identifiers.

• Ask patient to identify themselves.

• Use technology (e.g., bar-code system).

• Medication label.

• Check the order.

• Allergies.

• Check the order.

• Confirm dose with drug reference.

• Calculate dose and have another nurse confirm.

• Route appropriateness.

• Confirm patient can take/receive medication by ordered route.

• Document administration AFTER giving medication.

• Chart time, route, and specific information.

• Confirm rationale for the ordered medication.

• Patient's history.

• Right to refuse.

• Desired effect.

• Document monitoring and nursing interventions.

Maintaining a Safe Environment

• Good lighting.

• Minimize noise and distractions.

• Nurse should work alone during preparation.

• The nurse who prepares the medication also administers and records it.

• Locking medication carts is a requirement.

Handling Controlled Substances Safely

• Medication dispensing rooms must be locked.

• Controlled substances are kept in a double-locked system.

• Narcotics can only be ordered by physicians.

• Nurses must observe federal law when administering narcotics.

Identifying the Client

• Verify the right drug is given to the right patient.

Dosage Calculations

• Proficiency in weights and measures is needed.

Metric System:

• Most widely accepted.

• Basic units: meter, liter, gram.

• Decimal system: $1 L = 1000 \, ml$, $1 Kg = 1000 \, gr$, $1 gr = 1000 \, mg$, $1 mg = 1000 \, micrograms$

Apothecary System:

• Less convenient than metric.

• Basic unit: grain.

• Minim, dram, ounce, pint, quart for volume.

• Roman numerals express numbers.

• Quantities less than 1 are written as fractions (e.g., grain ¼).

Household System:

• Least accurate.

• Used in home settings.

• Teaspoon, tablespoon, teacup, and glass.

Dosage & Calculations Metric Table

• $1,000 \, micrograms \, (mcg) = 1 \, milligram \, (mg)$

• $1 \, milliliter \, (mL) = 1 \, cubic \, centimeter \, (cc)$

• $1,000 \, grams \, (G) = 1 \, kilogram \, (kg)$

• $1 \, teaspoon \, (tsp) = 5 \, milliliters \, (mL)$

• $1,000 \, milligrams \, (mg) = 1 \, gram \, (G)$

• $1,000 \, milliliters \, (mL) = 1 \, liter \, (L)$

• $2.2 \, pounds \, (lbs) = 1 \, Kilogram \, (kg)$

• $3 \, teaspoons \, (tsp) = 1 \, tablespoon \, (Tbsp)$

• $30 \, milliliters \, (mL) = 1 \, ounce \, (oz)$

• $1 \, tablespoon \, (Tbsp) = 15 \, milliliters \, (mL)$

• $2 \, tablespoons \, (Tbsp) = 1 \, ounce \, (oz)$

Approximate Metric System Equivalents

Liquid Measure (Volume):

Conversions:

• $1 \, liter \, (L) = 1000 \, ml \, (milliters)$

• $1 \, gram \, (g) = 1000 \, mgs \, (milligrams)$

• $1 \, mg \, (milligrams) = 1000 \, mcgs \, (micrograms)$

• $1 \, ounce \, (oz) = 30 \, ml \, (milliters)$

• $1 \, tsp \, (teaspoon) = 5 \, ml \, (milliters)$

• $1 \, tbs \, (tablespoon) = 15 \, ml \, (milliters)$

• $1 \, inch = 2.5 \, cm \, (centimeters)$

• $1 \, cup = 8 \, ounces \, (ozs)$

• $1 \, drop \, (gtt) = 15 \, minims$

• $1 \, mg \, (miligram) = 1000 \, Microgram$

• $1 \, (microgram) = 1000 \, Nanogram \, (ng)$

• $0.01 \, c.c = 1 \, unit$

Methods for Computing Drug Dosages

• Sometimes drugs are prepared in the exact amount, calculation is unnecessary.

• When drugs are not in the exact quantities, dosage calculation is needed.

• Formula:
  $\frac{Dose \, on \, hand}{Quantity \, on \, hand} = \frac{Dose \, desired}{x \, (quantity \, desired)}$

• Pediatric Calculations: Based on child's weight or body surface area (BSA).

Examples:

• Ex-1: Amoxicillin 625mg P.O. is ordered. Supplied as 250mg in 5ml. How much to administer?
  $\frac{250 \, mg}{5 \, ml} = \frac{625 \, mg}{x \, ml}$

  Cross-multiply: $3125 = 250x$

  $x = 12.5 \, ml$

Implementing: Administering a Medication

• Nurse should remain with the client until medication is taken.

Administering Oral Medications P.O or Per Os

• Drugs are absorbed in the stomach and small intestine.

• Most commonly used route.

• Available in solid (pills, capsules, and tablets) and liquid (syrups, suspensions, spirits, and elixirs) forms.

• Contraindications:

  • Difficulty swallowing

  • Unconsciousness

  • NPO or vomiting

• Certain drugs can discolor teeth.

Equipment

• Medication sheet

• Tray

• Kidney basin

• Medication cup (disposable)

• Label

• Water

Tablets or Capsules Medication Preparation

1. Check each medication order.

2. Hand washing.

3. Select proper medication and compare with sheet/order and expiration dates (5 rights).

4. Pour required number into bottle cap. Usually, all tablets/capsules are placed in the same cup.

5. Put label on the cup.

6. Assist client to an upright or lateral position to avoid aspiration.

7. Remain with the client until each medication is swallowed.

8. Inform patient about side effects

9. Record each medication given on the medication sheet.

10. Check on the patient within 30 min to verify response to medication.

Sublingual Medications

• Tablet placed under the tongue.

• Area rich in blood vessels, allowing rapid absorption.

• Medication should not be swallowed but held under the tongue for complete absorption.

Liquid Medication

1. Select the proper medication.

2. Calculate the dose

3. Hold the bottle with the label next to your palm and pour away from the label.

4. Hold the medication cup at eye level and fill to the desired level.

5. Repeat (5-6-7-8-9-10).

Administering Medications through Nasogastric Tube

• Administer liquid medications or crushed medications combined with liquid

• Bring liquid medications to room temperature to avoid cold discomfort.

• Remove the clamp from the tubing before administering medication

• Flush the tube with 30 ml of warm water before giving medication to check for tube blockage

• Pour medication into Asepto syringe

• After medication, flush the tubing again with 30ml of warmed water.

• Position the client upright on the right side after removing Asepto syringe to prevent regurgitation.

Administering Parental Medications

• Parenteral: Outside the intestines.

• Injection routes.

• Absorption occurs more rapidly.

• Desirable for irrational, unconscious clients, or those with GI disturbances.

• Used in emergencies.

Needles and Syringes

• Needles vary in length and gauge.

• Parts of a needle and syringe: Plunger, barrel, needle hilt, shaft.

• Barrel:

  • Plunger

  • Tip

• Needle:

  • Bevel

  • Shaft

  • Hub

Equipment Selection Criteria

• Route of administration: Longer needle for IM than ID or SC.

• Viscosity of solution: Large-lumen needle for viscous medications.

• Quantity to be administered: Larger syringe for larger amounts.

• Body size: Longer needle for obese individuals.

• Type of medication: Special syringes like insulin syringes exist.

Preparing Medications for Administration by Injection

• Drugs are packaged as solutions or powders.

Removing Medication from An Ampoule

• Ampoule: A glass flask containing a single dose of medication.

• Equipment: Sterile syringe and needle, ampoule, medication card or Kardex, dry gauze, tray, kidney basin, label, needle box.

1. Hand washing.

2. Check the medication order.

3. Assess patient

4. HW

5. Prepare equipment

6. Write label

7. Wrap gauze around the neck of the ampoule and break off the top.

8. Remove the cap from the needle, insert the needle into the ampoule.

9. Withdraw medication in the amount ordered. Do not inject air.

10. Cap the needle and syringe.

11. Put the label

12. H.W

Removing Medications From A vial

• Vial: A glass container with a self-sealing stopper.

• Equipment: Sterile syringe and needle, vial of medication, normal saline or distilled water, medication card or Kardex, betadine, dry gauze, tray, kidney basin, label, needle box.

1. Hande washing

2. Check the medication order.

3. Assess patient

4. HW

5. Prepare equipments

6. Write the label

7. Remove plastic cap from vial.

8. Remove needle cap.

9. Invert the vial and withdraw the needle tip slightly so that it is below the fluid level

10. Draw up the prescribed amount of medication while holding the syringe at eye level and vertically

11. Tap the syringe to remove air bubbles, then re-inject air into the vial.

12. Remove the needle and cap it

13. Put the label

14. H.W

Administering Medications Intradermally

• ID injections are administered into the dermis just below the epidermis.

• Longest absorption time of all parenteral routes.

• Used for sensitivity tests (e.g., tuberculin, allergy tests) and local anesthesia.

• Advantage of ID route is that the body's reaction to the substance is easily visible.

• Sites: Inner forearm, dorsal upper arm, upper back.

• Equipment: Sterile syringe and needle

  • Needle gauge $26- 27gauge$

• Ampoule of medication

• Medication card or kardex

• 2 dry gauze

• Tray

• Kidney Basin

• Label

• Needle box

• 2 Alcohol swab

• Gloves

1. Hand washing

2. Check the medication order.

3. Assess patient and explain procedure.

4. HW

5. Prepare the medications ( the dosage given ID is small)

6. Cleanse the area with an alcohol swab by circular motion and moving outward from injection site

7. Use the non dominant hand to spread the skin taut over the injection site

8. Insert the needle into the skin at $5-15^{\circ}$ angle so the point of the needle can be seen through the skin

9. Slowly inject the medication while watching for a small wheal or blister to appear

10. Do not massage

11. Do not recap needle

12. Observe the area for signs of a reaction at 24-27 hour periods.

Administering Medications Subcutaneously

• S/C injections are administered into the adipose tissue layer just below the epidermis and dermis.

• Few blood vessels.

• This route is used to administer drugs such as insulin and heparin.

• Sites: Outer upper arm, anterior thigh, abdomen, upper back.

• Equipment: Sterile syringe and needle (25 gauge), medication ampoule, card or kardex, dry gauze, tray, kidney basin, label, needle box, alcohol swab, gloves.

1. Hande washing

2. Check the medication order.

3. Assess patient and explain procedure.

4. HW

5. Prepare the medications ( the dosage given SC is no more than 1ml ).

6. Hold the skin

7. Hold the syringe in the non dominant hand between the thumb and Fore finger. inject the needle quickly at an angle at $45-90^{\circ}$.

8. Do not massage the area after removing the needle.

Administering Medications Intramuscularly

• IM injections deliver medication through the skin and S/C tissues into certain muscles.

• Muscles have larger number of blood vessels than subcutaneous tissues, allowing faster onset of action.

• Can take larger volumes of fluid without discomfort.

• Used to administer drugs such as antibiotics , hormones , and vaccines.

  • Sites:

    • Dorsogluteal Site

    • Ventrogluteal Site

    • Vastus Lateralis Site

    • Rectus Femoris Site

    • Deltoid muscle

Dorsogluteal Site

• Located in the buttock, using anatomic landmarks, palpate the posterior superior iliac spine and the greater trochanter. Draw an imagined line between them. Injection site is lateral and slightly superior to the midpoint of the line.

Ventrogluteal site

• Involves the gluteus medius and minimus muscles in the hip area.

• Recommended for adults and Children.

• No large nerves or blood vessels.

• Client can be on the back, abdomen, or side.

• To relax muscles, the client flexes the knees while lying on the back, points toes inward when prone, and flexes the top leg when side-lying.

• To locate the site, place the palm over the greater trochanter with fingers to the head. Place the index finger on the anterior superior iliac spine, with the middle finger extending dorsally, palpating the crest of the ileum. A triangle forms. Inject in the center.

Vastus Lateralis Site

• Being recommended more frequently for injections.

• Thick muscle, little danger of injury.

• No large nerves or vessel proximity, does not cover a joint.

• Covers the anterolateral aspect of the thigh.

• Divide the thigh into thirds horizontally and vertically. Give injection in outer middle third.

• Desirable for infants and children.

Rectus Femoris Site

• On the anterior thigh.

• Used only when others are contraindicated.

• Some clients inject themselves at home at this location, as it's a more convenient injection site.

Deltoid Muscle site

• Located on the lateral upper arm. Not often used because it is a small muscle, not capable of absorbing large amounts of solution.

• Damage to the radial nerve and artery are risks.

• Limited to 1ml of solution, used only for adults.

• Not developed enough in infants and children.

• Locate deltoid muscle by palpating the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm.

Equipments for IM injection

• Tray

• Kidney basin

• Medication

• Medication sheet

• Sterile syringe and needle

• 21, 22 gauge / 23 to 25 gauge for deltoid muscle

• Label

• Alcohol swabs

• Dry gauze

• Needle box

Injection Procedure

• No more than 3ml should be injected into a single injection site.

• Avoid air bubble in the syringe.

• Select the site and clean the site by alcohol swab.

• Injection should be $90^{\circ}$.

• The nurse should aspirates the plunger.

• Massage the area gently after injection.

• Chart the administration of the medication.

• Evaluate the response of the patient to the medication within 15-30 min.

Positions during IM injections:

1. Provide for privacy. Have the client assume a position appropriate for the site selected:

   • Dorsogluteal: The client may lie prone with toes pointing inward or on the side with the upper leg flexed and placed in front of the lower leg.

   • Ventrogluteal: The client may lie on the back side with the hip and knee flexed.

   • Vastus lateralis: The client may lie on the back or may assume a sitting position.

   • Deltoid: The client may sit or lie with arm relaxed.

2. Locate the site of choice according to directions given in this chapter and ensure that the area is non tender and free of lumps or nodules. Don, disposable gloves (optional).

Zig-Zag or Z-track technique

• Used to administer medications that highly irritating to subcutaneous tissues.

• Reduces pain and discomfort.

• Skin is pulled to one side, blood is aspirated, and solution is injected.

• When the needle is withdrawn and the displaced tissue is allowed to return to its normal position, the solution is prevented from escaping from the muscle tissue.

Administering Medications Intravenously

• Immediate effect.

• Most dangerous administration route, drug is placed directly into the bloodstream.

• Several ways:

  • Medications via intravenous solution.

  • Intravenous push IVP (or intravenous Bolus).

  • Volume-controlled infusion (intravenous drip IVD) (Microdrip).

  • Intermittent infusion ports (device).

  • Intermittent intravenous infusion (piggyback or tandem setups).

  • Intravenous infusion pump( or syringe pump or mini-infuser).

IVD

• Equipments:

  • Tray

  • Kidney basin

  • Medication sheet

  • Medication prepared in a syringe

  • Betadine swab

  • Label

  • Alcohol swab

  • Needle box

  • Watch with second hand

• Procedure:

  • Prepare equipment.

  • Check the physician's order.

  • Explain the procedure to the client.

  • Hand washing.

  • Add the medication to the IV solution that is infusing:

    • Check that the volume in the bag or bottle is adequate.

    • Close the IV clamp.

    • Clean the medication port with betadine.

    • Inject the medication in container.

    • Open the serum ,readjust the flow rate, attach the label to the container.

  • Dispose of equipments.

  • H.W

  • chart the medication.

  • Evaluate the response of the patient.

IVP

• Equipments:

  • Tray

  • Kidney basin

  • Gloves (disposable)

  • Medication sheet

  • Label

  • Medication prepared into a syringe (23-25 gauge).

  • Betadine swabs

  • Watch with second hand.

  • Needle box.

• Procedure (IVP):

  • Prepare equipment.

  • Check the physician 's order.

  • Explain the procedure to the client.

  • Hand washing.

  • Clean the port with betadine.

  • Steady the port with your non dominant hand while inserting the needle into the center of the port.

  • Move your non dominant hand to the section of IV tubing just beyond the injection port. fold the tubing between your fingers to temporarily stop the flow of the IV solution.

  • inject the medication slowly while interrupting IV flow..

  • Remove the needle

  • -H.W.

  • Chart the medication.

  • -Evaluate the response of the patient.

Administering Topical Medications

• Applied to the skin or mucous membranes, eyes, ears, nose, rectum, vagina, and lungs.

Skin application

• The skin is a mechanical and chemical barrier.

• Typical preparations: powders, ointments, creams, oils, lotions, and transdermal delivery systems.

• Method:

  • Ensure skin is dry and clean before applying anything.

  • Prior preparations are typically removed before additional medications except in the case of lotions.

  • Clean the skin with detergent or soap and water before administering a preparation to the skin.

  • Apply local heat to the area, when indicated .This measure promotes absorption by improving blood circulation to the area.

Eye Instillations and Irrigations

• Eye drops: Pupil dilation or constriction for exams or infection treatment.

• Ointments: Local infection or irritation.

• Eye irrigation: Remove secretions or foreign bodies or cleanse the eye. Remove chemicals in an emergency.

• Eye medication disks: Flexible and resembles a contact lens.

Equipment

• Disposable gloves

• Medication

• N/S + sterile sponges

• Dry sterile absorbent sponges

• Sterile eye pad as needed.

• Abbreviations: OD (right eye), OS (left eye), OU (both eyes).

Procedure:

1. Check the medication order & the medication

2. Check the expiration date and ensure the 5 rights.

3. Check the client identification.

4. Explain the procedure, medication is not painful

5. Assist the client to a comfortable position, either sitting or lying. the parent may hold the infant or young child.

6. Clean the eyelid and the eyelashes: use gloves than use sterile cotton balls moistened with irrigating solution or N/S, and wipe from the inner canthus to the outer canthus.

7. Check the ophthalmic preparation for the name, number of drops.

8. If ointment is used discard the first bead.

9. Instruct patient to look up to the ceiling the cornea is partially protected by the top eyelid.

10. Give the client a dry sterile absorbent sponge to press on the nasolacrimal duct after a liquid instillation or to wipe excess ointment from eyelashes after an ointment is instilled.

11. Expose the lower conjunctival sac by placing the thumb or fingers of your non dominant hand on the client cheekbone just below the eye and gently drawing down the skin on the cheek

12. Approach the eye from the side and instill the correct number of drops onto the outer third of the lower conjunctival sac. Hold the dropper 1 to 2cm above the sac . Or holding the tube above the Lower conjunctival sac squeeze 2 cm of Ointment from the tube into the lower conjunctival sac from the inner canthus outward.

Ear Instillation and Irrigation

• Ear drops: Place drops in the external auditory canal.

• Ear irrigation: Cleaning the external auditory canal (N/S or antiseptic solution).

• Purposes:

  • Soften earwax

  • Provide local therapy

  • Relieve pain

Equipment:

• Disposable gloves( optional)

• Cotton-tipped applicator

• Medication bottle with a dropper.

• Cotton fluff

Procedure:

1. check the medication order (kind, time, amount, dosage and which ear is to be treated).

2. prepare patient (ID bracelet, name).

3. Assist the client to a side-lying position with the ear being treated uppermost.

4. Clean the pinna of the ear and the meatus of the ear canal( use gloves if infection , use cotton-tipped applicators and solution to wipe the pinna and auditory meatus .remove any discharge before the instillation).

5. Warm the medication container in hand

6. Partially fill dropper with medication.

7. Straighten the auditory canal: gently pull pinna down and back for infant; for adult/child over 3 years, pull pinna upward and backward.

8. instill the correct number of drops along the side of the ear canal.

9. Press gently a few times on the tragus of the ear to assists the flow of medication into the ear canal.

10. Ask the client to remain in the side-lying position for about 5 min

11. Insert a small piece of cotton fluff loosely at the meatus of the auditory canal for 15-20min. do not press it into the canal

12. Assess the client response, assess the character and amount of discharge, appearance of the canal, discomfort after instillation.

13. Document all nursing assessments and interventions.

Nasal instillation

• Nasal instillations (nose drops and sprays)

  • Shrink swollen mucous membranes

  • Loosen secretions and facilitate drainage

  • Treat infection of the nasal cavity or sinus. Nasal decongestants.

• Saline drops are safer for children

• Clients self-administer sprays in the supine position with the head tilted back, holds the tip of the container just inside the nares and inhales as the spray enters the nasal passages.

• For repeated nasal sprays, assess nares for irritation.

• In children, nasal sprays given with the head upright to prevent excess spray from being swallowed.

• Nasal drops are used to treat sinus infections

• Clients should: Breathe through the mouth to prevent aspiration and remain back-lying for at least 1 minute so solution is in contact with all of the nasal surface. Avoid blowing the nose for several minutes.

Rectal installations

• Rectal suppositories are used for local action , such as laxatives and fecal softeners.

• Advantages include the following:

  • Avoids irritation of the upper gastrointestinal tract in clients who encounter this problem.

  • The medication has an objectionable taste or odor.

  • The drug is released at a slow by steady rate.

  • Rectal suppositories are thought to provide higher blood