Preparation and delivery of prescribed medications by nasogastric tube and evaluation of patient response.
Objectives:
– Administer prescribed medication to the patient by nasogastric tube under safe conditions. – Educate the patient and family on the therapeutic regimen.
Equipment:
– Tray. – Stethoscope.
Material:
– Prescribed medication. – Medical treatment sheet with prescribed medication. – Disposable clamp. – Disposable gloves. – 1 Syringe of 50 c.c. – Nasogastric tube – 1 Glass for liquids. – Water, juice, etc. – Single-dose cups. – Paper towelettes. – Nursing records.
Procedure:
– Wash hands. – Consult the pharmacy service for the preparation to be administered by nasogastric tube. – Follow general rules in the administration of medication.
Prepare the medication. The oral forms of the drugs can be:
1. normal tablets: they can be crushed to fine powder or dissolve in water. 2. Delayed-release tablets: they should not be crushed. 3. Enteric coated tablets: they should not be crushed. 4. Effervescent tablets: should be dissolved in water before administration. Administer at the end of effervescence. 5. Sublingual tablets: their administration by gavage is not recommended. 6. Gelatin capsules: in general, they can be opened, mixed in water and administered. 7. Syrups, solutions: this is the best form of administration by nasogastric tube. – Techniques for the preparation and administration by nasogastric tube: 1. Crush and dissolve: crush the tablet with a mortar and pestle until it is reduced to a homogeneous powder. Introduce the powder in a 50 ml syringe. Add 15-30 ml. of warm water and shake. 2. Dissolve and dissolve: Introduce the tablet without crushing in the 50 ml syringe. Add 15-30 ml of warm water and shake. – Place the patient in Fowler or semi-fowler position.
– Determine the patient’s medication knowledge and understanding of the method of administration. – Put on non-sterile gloves. – Check the placement and patency of the tube with the stethoscope. – Clamp the tube and place the syringe cone on the tube connection. – Unclamp the tube and allow the water to enter by gravity by removing the syringe plunger. – Wash the nasogastric tube with 10 cc of water. -Pour the contents of the medication into the syringe allowing it to fall by gravity. – Add 10-20 c.c. of water to wash the tube (5-10 c.c. in children) after the medication. – If the medication does not pass by gravity, the plunger of the syringe should be used. – Clamp the nasogastric tube and remove the syringe. – Keep the tube clamped for 1 hour for the medication to be absorbed. – Leave the patient in a comfortable position. – Collect the material. – Remove gloves. – Wash hands. – Record: medication administered, dose, route, date and time, incidents and patient response.
Observations:
– In patients with enteral nutrition do not add the medication to the formula to avoid interactions. – In case the prescribed medications cannot be crushed or diluted due to their own characteristics, the physician should be informed for a possible substitution of the medication or change of route. – Do not administer bolus syrups in the intestine because it can cause osmotic diarrhea. – The washing of the tube should be done with warm water to avoid the formation of lumps and possible obstruction. – Do not mix different medications simultaneously in the same syringe.
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