Enteral Administration
Enteral Administration
- A method of medication administration
within, or by way of, the intestine or
gastrointestinal tract,
- A term used to describe tube feedings
Enteral Administration
Dosage Forms
1. Capsules – small, cylindrical gelatin
containers that hold dry powder or liquid
medicinal agents.
Enteral Administration
2. Pills – are an obsolete dose form
because of the development of capsules
and compressed tablets. However, the
term is still used to refer to tablets and
capsules.
Enteral Administration
3. Tablets
• are dried, powdered drugs that have been
compresses into small disk.
• Tablets also contain one or more of the ff:
– Binders
– Disintegrators
– Lubricants
– Fillers
• Tablets can be layered, scored and enteric
coated.
Enteral Administration
• An enteric coated tablet has a special
coating that resists dissolution in the acidic
pH of the stomach but is dissolved in the
alkaline ph of the intestines.
Enteral Administration
4. Syringe
• syringe nowadays nearly always means a
medical syringe, but it can mean any of these:
– A simple hand-powered piston pump consisting of a
plunger that can be pulled and pushed along inside a
cylindrical tube (the barrel), which has a small hole on
one end, so it can suck liquid in and then squirt it out
by the same hole
– Nowadays the word "syringe" is restricted to smaller
devices, used to transfer small amounts of liquids or
gases to or from otherwise inaccessible areas,
including particularly hypodermic syringes used with a
needle for injection.
Enteral Administration
– Disposable medical syringes are sometimes used
without a needle for orally administering liquid
medicines to young children or animals because the
dose can be measured accurately, and it is easier to
squirt the medicine into the subject's mouth instead of
coaxing the subject to drink out of a measuring
spoon.
Enteral Administration
5. Elixir
 once called the “elixir of life”
 a pharmaceutical preparation containing an
active ingredient that is dissolved in a solution
that contains some percentage of ethyl alcohol
 designed to be taken orally
 contain flavoring substances and are used either
as vehicles or for the therapeutic effect of the
active medicinal agents
Enteral Administration
5. Elixir
Ex. Morphine, allergy elixir, Dimetapp elixir,
scopolamine elixir
Enteral Administration
6. Emulsion
 A system containing two immiscible liquids in
which one is dispersed, in the form of very small
globules throughout the other.
 emulsifying is done by slowly (sometimes dropby-drop) adding one ingredient to another while
at the same time mixing rapidly. This disperses
and suspends minute droplets of one liquid
throughout the other.
 usually thick and satiny in texture.
Enteral Administration
6. Emulsion
Examples: Household
• Mayonnaise
• Hollandaise
Examples: Pharmaceutical
• Estradiol – Topical Emulsion
• Diprivan (propofol) Injectable Emulsion
• Diazepam emulsion injection
• Restasis ophthalmic emulsion
Enteral Administration
7. Suspension
 is the dispersion through a liquid of a solid in
finely divided particles of a size large enough to
be detected by purely optical means;
 May be a colloidal suspension;
 a class of pharmacopeial preparations of finely
divided, undissolved drugs (e.g., powders for
suspension) dispersed in liquid vehicles for oral
or parenteral use.
Enteral Administration
7. Suspension
Examples: Household
• Mayonnaise, as a colloidal suspension of mostly water and
few vinegar droplets in edible oil
• Gelatin, as a suspension of water in a matrix of protein
• Butter is a suspension of water in butterfat globules
• Ice cream is a suspension of microscopic ice crystals in
cream.
• Mud, as soil, clay, or silt particles are suspended in water.
• Paint: pigments in paint are mixed as the sediments in mud.
Ex. Pharmaceutical
• Mepron (atovaquone) – oral suspension
• Rifampicin
• streptomycin
Enteral Administration
8. Syrup
 Any sweet fluid;
 Termed medicated syrup if it contains medical
substance
 a solution of sugar in water in any proportion; a
liquid preparation of medicinal or flavoring
substances in a concentrated aqueous solution
of a sugar, usually sucrose;
 made by adding flavouring matter to simple
syrup, or, by adding medicaments to, or
dissolving them in, the simple syrup.
Enteral Administration
8. Syrup
Example:
Cough syrup
Equipment for Enteral
Administration
Enteral Administration
Unit Dose or Single Dose
packaging
• Provides a single dose of medication in
one package, ready for dispensing.
Enteral Administration
ORAL
SOLID
ORAL
LIQUID
Enteral Administration
Soufflé cup
• Used to transport solid medication forms such as
a capsule or tablet to the patient to prevent
contamination by handling.
Enteral Administration
Medicine cup
• Has three scales (apothecary, metric, and
household) for the measurement of liquid
medications.
Enteral Administration
Medicine dropper
• May be used to administer eye drops, ear drops,
and, occasionally, pediatric medications.
Enteral Administration
Measuring teaspoon
• Doses of most liquid medications are prescribed
in terms of using the teaspoon as the unit of
measure.
Enteral Administration
Oral syringe
• Used to measure liquid medications accurately.
Enteral Administration
Infant feeding nipple
• An infant feeding nipple with additional holes
may be used for administering oral medications
to infants.
Enteral Administration
Medication
card/profile/administration record
PRN
TID
QID
Q4
Q6
BID
OD, HS, Q8, Q12
• MAR includes date of
the medication order,
expiration date,
medication name and
dose, frequency of
administration and
route, and nurse’s
signature.
Patient Medication Card
Prescription Medications
Start
Date
Name of
Medicine
Prescribe
d By
Brand name
Generic name too
if available
1/1/0
5
Feel Better
Dr. Help
Dose
(mg,
units,
puffs,
drops)
5 mg
When Do
You Take It?
Purpos
e
Important
Comments
How many
times per day?
Morning and
night? After
meals?
Why do
you take
it?
(e.g. danger signs,
side effects, drugdrug, drug-food
interactions,
stopped taking*)
2 times –
morning,
night
ulcer
Makes me
dizzy
Stop
Date
Monitorin
g
Required
Notes
Date reviewed; Date
Updated
(e.g. lab
test every
_____
weeks)
Blood
test
every 4
weeks
5/18/05 Reviewed by Dr.
Help and
Changed Dose to
10 mg.
Enteral Administration
Medication dispensing system
• Medication cart
– is on
wheels allowing the
nurse to move the
cart to outside the
client’s room.
Enteral Administration
• Medication cabinet
– Some facilities have a
locked cabinet in the client’s
room or in the nurse’s station.
- This holds the client’s
unit-dose medications and
Medication administration
record (MAR)
Enteral Administration
• Medication room
- (depending on the facility)
- the medication cart may be placed
inside the medication room.
- may also be the central location for
stock medications, controlled medications,
and/or drugs used for emergencies.
- is often kept locked.
Enteral Administration
• Computerized medication access
system
- this system automates the
distribution, management, and control of
medications.
- similar to automated teller
machines, the nurse uses a password to
access the system and select the
medication.
Enteral Administration
Methods of Drug
Administration (Enteral)
Enteral Administration
Oral medications :
this includes tablets, pills, capsules, and liquids.
Most of medications are made in this form ; they
are preferred because they are the easiest and
most convenient method. These medications
may be short- or long-acting (timed release),
mostly are meant to be swallowed and they
enter the gastrointestinal tract immediately.
Enteral Administration
Oral Transmucosal
These medication are administered in the mouth
but are meant to be absorbed through the oral
mucosa in the mouth--not swallowed. These
delivery routes include the following:
• Transmucosal - medications in lozenge form
are taken this way.
Ex. Actiq®, which is a lozenge on stick that the
patient moves around inside his mouth. Saliva
dissolves the medication and it very quickly
enters the bloodstream.
Enteral Administration
• sublingual - medications are placed
under the tongue and absorbed. The
medication most commonly administered
this way is nitroglycerin, in tablet form, but
sometimes certain medications in liquid
form are administered sublingually in
people who are unable to swallow
medication or who have poor venous
access.
Enteral Administration
Administration of Solid-form
Oral Medication:
TECHNIQUE
1) Wash hands
2) Gather medication cards & verify against Kardex
3)
4)
5)
6)
& physician's order for accuracy.
Gather remainder of equipment.
Read the entire medication card.
Obtain the medication prescribed from the
cabinet.
COMPARE the label on the container against
the medication card: (Use 5R).
Enteral Administration
7) Open lid of the bottle; pour correct number of
capsules or tablet into the lid; return any extras
to the container using the lid. (DO NOT touch
the medication w/ the hands)
8) Transfer correct numbers of tab. or cap. from
the lid to the medicinal cup
9) COMPARE the information on the medication
card against the label on the stock bottle & the
qty. of drug placed in the cup.
10) Replace lid of container
11) RECHECK 5 Rights of medication order.
Enteral Administration
12. Return the medication container to the shelf in
the cabinet.
13. Place medication cup on the med tray with the
medication card.
14. Proceed to the pt bedside when all medications
are assembled for administration.
 Check pt ID bracelet & verify against medication card.
 Explain what you are doing.
 Check pertinent pt monitoring parameters (e.g., apical
pulse , respiratory rate)
 Hand medication to pt for placement in the mouth.
Enteral Administration
General principles:
• Give the most important medication first.
• Allow pt to drink small amt of water to
moisten the mouth to make swallowing the
medication easier.
• Have pt place the meds well back on the
tongue, offer appropriate assistance
Enteral Administration
• Give pt liquid to swallow meds. Encourage
keeping the head forward while
swallowing.
• Encourage pt to drink full glass of fluid, to
ensure that medication reaches the
stomach & to dilute the drug to decrease
the potential for irritation.
• DO NOT leave meds at the bedside
unless orders exist to do so.
(NITROGLYCERIN may be ordered for bedside)
Enteral Administration
• Discard medication container (such as
souffle cup or unit dose package).
• DOCUMENTATION
Enteral Administration
Administration Liquidform Oral Medication:
Enteral Administration
TECHNIQUE
Step 1 – 6, (same w/ solid form)
7) Shake medication if required
8) Remove lid & place upside down on
a flat surface to prevent
contamination.
9) Proceed with one of the following
measuring techniques
Enteral Administration
Measuring w/ a medicine cup:
• Hold bottle of liquid so that the label is in the
palm of the hand (to prevent contents from smearing
the label)
• Check med cup & locate exact place where
measured vol should be measured, place your
fingernail at this level.
• Hold cup straight in the eye, pour prescribed
vol., read vol accurately at the level of meniscus.
• Replace lid on the container & return meds to
the shelf.
Enteral Administration
Measuring w/ an oral syringe:
• Select syringe in a size comparable to the vol to
be measured.
Method 1: With large bore needle attach to the
syringe, draw up the prescribed vol of
medication. Needle is not necessary if bottle
opening is large enough to receive the syringe.
Method 2: Using a cup & method 1, pour amt of
meds needed into a med cup, then use a
syringe to measure the prescribed vol.
Enteral Administration
10)If medication is ready to administer,
proceed to the bedside.
 Check pt ID bracelet & verify against
medication card.
 Explain what you are doing.
 Check pertinent pt monitoring parameters
(e.g. apical pulse, respiratory rate)
 Hand medication to pt for placement of
the content in the mouth or administer
via the oral syringe.
Enteral Administration
General principles:
For Adult or Child
• Give the most important medication first.
• Never dilute a liquid medication unless
specifically ordered to do so.
• Always remain w/ the pt while the
medication is taken. DO NOT leave meds
at the bedside unless orders exist to do so.
Enteral Administration
For Infants
• Check infant's ID bracelet & verify against the
medication card or profile.
• Be certain that infant is alert.
• Position infant so that the head is slightly
elevated.
Enteral Administration
Administration:
• Oral syringe or dropper:
Place the syringe or dropper between the cheek & gums,
halfway back into the mouth. (This placement will reduce
the chance that the infant will spit out the meds w/
tongue mov't.). Slowly inject, allowing the infant to
swallow medications. ( rapid admin. may cause choking
& aspiration)
• Nipple:
When infant is awake (preferable hungry), place the
nipple in the infant's mouth. When baby starts to suck,
place medication in the back of the nipple with a syringe
or dropper & allow the baby to suck it in. Follow w/ milk
or formula if necessary. (size of nipple holes may need to
be enlarged for suspension & syrups).
Enteral Administration
Administration of
Medication by NGT:
Enteral Administration
Medications are administered via a
nasogastric (NG) tube to patient:
Who have impaired swallowing;
Who are comatose;
Who have disorder of esophagus
Whenever possible, liquid form of drug
should be use for NG administration
Enteral Administration
If tablet or capsule should be used,
tablet should be crushed or the capsule
pulled apart
the powder is sprinkled in approx 30ml of
water
DO NOT crush enteric coated tablets or
time-released capsule
If more than 1 medication is ordered for
administration at same time, FLUSH
between each medication with 5 to 10 ml
of water
Enteral Administration
EQUIPMENT
Glass of water
20 – 30 ml syringe (adult pt)
1 ml syringe (young child)
Stethoscope
Medications
Bulb syringe w/ catheter tip
pH tape & color verification
Gloves
Enteral Administration
TECHNIQUE
Preparation of doses is same with
administration of solid or liq form meds.
A. Proceed to the pt bedside when all
medications are assembled for administration.
 Check pt ID bracelet & verify against
medication card.
 Explain what you are doing.
Enteral Administration
B. Sit the pt upright & check location of NGT
before administering any liquid
Method 1: pH testing of gastric contents
 Put on gloves
 Flush the tube with 20 – 30 cc of AIR
using a 30cc syringe (or larger). Aspirate
some of the stomach content using the
bulb syringe. If unable to aspirate
contents, reposition pt on left side & try
aspirating again.
Enteral Administration
To check for tube placement:
1) Check aspirated fluid color.
Color Verification guidelines:
Gastric fluid (watery) = green w/ sediment or off-white
Intestinal fluid
= yellow (bile-colored)
Pleural fluid (watery) = clear to straw-colored
Tracheobronchial fluid
(more viscous)
= off-white or tan
Enteral Administration
2) Check pH of gastric contents.
• Stomach pH is less than 3
• Intestinal fluid pH is 6 to 7
• Respiratory fluid pH is greater than 7
 H2 antagonists (ranitidine, cimetidine,
famotidine, nizatidine) affect the aspirated
fluid pH in the ff way:
 Persons not receiving H2 blockers:
Gastric = 1.0 to 4.0
Intestinal = >6.0
Enteral Administration
 Persons receiving H2 blockers:
Gastric = 1.0 to 6.0
Intestinal = >6.0
Tracheobronchial
/ Pleural Aspirate = 7.0 or greater
3) X-ray for confirmation of placement.
Return stomach contents after confirmation of correct
tube placement.
If contents are not obtained, use methods 2 or 3 or
both, to assess the location of the tube tip.
Enteral Administration
Method 2: Auscultation
 Place a stethoscope ever the stomach area;
 Listen as 5 to 10 ml (adult) or 0.5 to 5 ml
(child) of AIR are injected;
 A gurgling sound should be heard if the NGT
is properly placed;
 Withdraw the amt of air inserted.
Method 3:
 Place unclamped NG tube next to your ear &
listen for any crackling noise;
 If crackling sounds are heard, the tube may
be in the lung. Remove & reinsert.
C. Once the placement of the NG tube in the
stomach is confirmed, do the ff:







Clamp the tubing & attach the bulb syringe;
Pour medication into the syringe (while tubing is still
clamped);
Unclamp the tubing & allow the medication to run in
by gravity;
Add at least 50 ml of water to flush the medication
through the tube & into the stomach;
Clamp the tubing as soon as the water has flowed
thru the bulb syringe;
DO NOT attach the suction source for at least 30
mins., or the meds will be suctioned out.
Provide oral care, if needed.
D. Documentation
Enteral Administration
Administration of Rectal
Suppositories:
Enteral Administration
DOSE FORM
Suppositories
• are solid form of medication designed for
introduction into a body orifice;
• at body temperature, the substance dissolved & is
absorbed by the mucus membranes;
• if it becomes soft in unopened package: hold the
foil wrapped suppository under cold running water,
or place in ice water until it hardens.
NOT be used for patient who had recent
prostatic or rectal surgery, or rectal trauma.
Enteral Administration
TECHNIQUE
1) Wash hands & assemble necessary equipment & prescribed suppository.
2) COMPARE the label on the container against the medication card or drug profile:
(follow the 5R)
3) Proceed to the pt. bedside.
 Check pt ID bracelet & verify against medication card.
 Explain what you are doing.
4) Check pertinent pt monitoring parameters
(e.g., time of last defecation, severity of
nausea or vomiting, respiratory rate) as
appropriate to the medication to be
administered.
5) Whenever possible, have the pt defecate.
6) Provide for pt. Privacy; position pt. on the left
side (Sim's position) & drape to avoid
unnecessary exposure.
Enteral Administration
7) Put on disposable gloves or finger cot
(index finger for ADULT; 4th finger for INFANT).
8) Ask pt to bend uppermost leg toward the
waist. Unwrap suppository & apply watersoluble lubricant to the tip of it. If lubricant is
not available, use plain water to moisten, DO
NOT use petroleum jelly or mineral oil.
9) Place tip of suppository at the rectal entrance
& ask the pt. To take a deep breath & exhale
thru the mouth (to minimize rectal involuntary
gripping). Gently insert the suppository about
an inch beyond the orifice past the internal
sphincter.
Enteral Administration
10)Ask pt. To remain lying on side for 15-20
min. to allow melting & absorption of
medication.
11)In children, it is necessary to gently but
firmly compress the buttocks & hold in place
for the same period to prevent expulsion.
12)Discard used materials & wash hands
thoroughly.
13)DOCUMENTATION ( the 6th Right)
Enteral Administration
Administration of
Disposable Enema:
Enteral Administration
DOSE FORM
Prepackaged, disposable-type enema sol'n of
the type prescribed by the physicians
EQUIPMENT
 Disposable gloves
 Toilet tissue
 Bedpan, if pt is not ambulatory
 Water soluble lubricants
 prescribed disposable enema kit
Enteral Administration
TECHNIQUE
1)
2)
3)
Wash hands & assemble necessary equipment & prescribed rectal enema.
COMPARE the label on the container against the medication card or drug
profile: (follow the 5R)
Proceed to the pt. bedside.
 Check pt ID bracelet & verify against medication card.
 Explain what you are doing
4) Check pertinent pt monitoring parameters
(time of last defecation).
5) Provide pt. Privacy; position pt. On left side;
drape to avoid unnecessary exposure.
6) Put on gloves, remove protective covering
from the rectal tube & lubricate.
7) Insert tube into rectum & dispense sol'n by
compressing plastic container.
Enteral Administration
8) Replace used container on its original wrapping
for disposal.
9) Encourage pt to hold the sol'n for a short period
of time (30 min) before defecating.
10)Assist pt to a sitting position on the bedpan or
to the bathroom as orders permit.
11)Tell pt. NOT to flush the toilet until you can see
the results of enema. Instruct pt regarding
location of call light incase assistance is
needed.
12)Wash hands thoroughly.
13)DOCUMENTATION ( the 6th Right)
Vaginal Suppository
• Is a suppository drug delivery system that is
inserted into the vagina where it dissolves. They
are used to deliver both systemically-acting and
locally-acting medications. The alternative term
for delivery of medicine via such routes, is as a
pharmaceutical pessary.
• Vaginal suppositories are commonly used to
treat gynaecological ailments, including vaginal
infections such as candidiasis.
• Other suppositories are made from a water
soluble base, such as polyethylene glycol.
Suppositories made from polyethylene glycol are
commonly used in vaginal and urethral
suppositories.
Enteral Administration
Eucalyptol and Glycerin Vaginal Suppository
• Glycerin suppositories are made of glycerol and
gelatin.