19. Principles of drug administration
Role and responsibilities of the midwife145
Having read this chapter the reader should be able to:
• discuss the different preparations available for oral use, giving an example of each
• describe the procedure for administering a drug orally to a woman and a baby
• summarise the role and responsibilities of the midwife.
This chapter considers the different preparations suitable for oral use, the procedure for administering them to an adult and a baby, and the midwife’s role and responsibilities. It should be read in conjunction with Chapter 18.
The majority of medication taken via the mouth (orally) is absorbed by the gastrointestinal tract. The woman or baby needs to be compliant, alert and able to swallow. If this is not possible or if faster absorption is required then an alternative route should be prescribed. Many preparations can be found in alternative forms. Oral preparations may be affected by other constituents in the stomach, and so the manufacturer’s directions should be followed (e.g. before, during or after a meal) for maximum effectiveness. The medication is prescribed as for any other prescription (see Chapter 18); P.O. (through the mouth) is the agreed abbreviation.
Medicine cups with gradations on the side are used; these may be disposable or washed and reused. Elixirs may be poured into a medicine cup, or ‘drawn up’ using an oral medicine syringe. Oral medicine syringes were originally designed for children, they are often a different colour and have a non-Luer tip so that a needle cannot be connected. This prevents accidental administration of oral medicines via intramuscular or intravenous routes. They are supplied sterile, but for older children the syringe may be washed and reused. It is supplied with a bung that fits into the bottle neck, this allows the bottle to be inverted and the correct dose drawn into the syringe at eye level.
Some inhalational drugs (e.g. Entonox®, oxygen) may be taken via the mouth, but in this chapter only the following oral medications are considered:
• Tablets: these should generally be swallowed whole. If scored they may be divided in half using a tablet cutter, according to the required dosage. Some tablets are coated to protect the stomach lining; the coating may also affect the rate of absorption, it being designed to ensure optimum therapeutic levels at the correct time. Chewing such tablets would destroy this effect. Tablets should not be crushed unless approved by the pharmacist. Examples of tablets include analgesics, antibiotics, iron supplementation.
• Granules, powders and soluble tablets: these need to be thoroughly dissolved before administration. This is generally in water, but the manufacturer’s guidelines should be followed. Examples include analgesics, e.g. paracetamol.
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