A healthcare prescriber orders medications.
Medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, or family member who is knowledgeable about the medication and techniques of administering enteral medications to a child.
Principles of pharmacologic management (see Chapter 6) are followed.
Medications are given by nasogastric (NG), gastrostomy, nasoduodenal, nasojejunal, or jejunostomy tube when the gastrointestinal (GI) tract is functional but the oral route is unavailable. The GI tract provides a vast absorptive area for medications. Absorption, distribution, metabolism, and elimination from the GI tract differ with maturation and some disease states. Factors such as gastric pH, gastric emptying time, motility, absorptive area, enzyme activity, and dietary factors affect GI absorption.
For enteral administration, the medication must be in liquid form when passed through the enteral tube so as not to obstruct the tube.
For patient safety, administer enteral medications through oral or catheter-tipped syringes only because needles cannot be attached to oral or catheter-tipped syringes, preventing inadvertent administration of enteral medications intravenously or intramuscularly. Use the largest syringe size that is practical—larger syringes generate less psi (pounds per square inch) than smaller syringes, thus reducing the potential of tube rupture.
Medications are administered within 1 hour of prescribed time.
Prescribed medication
Individual pill crusher or mortar and pestle, if needed for crushing pills
Pill cutter, if needed to cut pills
Medication cup
Water or other appropriate diluents
Syringes, oral, or catheter-tipped (appropriately sized for drawing up prescribed medication and flushes, 10 to 50 mL unless small volume of medication to be administered)
Catheter-tip adapter (if catheter-tipped syringes are unavailable)
Nonsterile gloves and goggles
Disposable waterproof pad
Refer to Chapters 38 and 39 for assessment and preparation for enteral tube use.
Determine the child’s height and weight. Accurate determination of weight ensures correct dosage of medications.
Assess the child’s and the family’s previous experience with enteral medications.
Prepare the child, as appropriate to cognitive level, and family before administration.
Provide therapeutic play as indicated, or involve a child-life specialist, to allow the child to work through his or her fears and master control of the situation.
Explain the medication’s actions and side effects and administration procedure.
Teach the family how to administer medications to the child, if necessary, in preparation for discharge from the hospital.
Assess for drug allergies; if present, notify healthcare prescriber of drug allergy. Label the child’s record and apply identification band indicating allergies.
Administering Enteral Medications
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