ADMINISTERING ORAL MEDICATION

Oral drug therapy for a woman or baby is commonly recorded on a drug prescription
chart. Medication is prescribed in this format to provide a specific treatment that is absorbed by
the gastrointestinal tract.

Treatment specific
Oral medication can be prescribed for an infection, to reduce an inflammatory response, as a
prophylaxis and for its analgesic effect. Administering it to a woman or baby will have a known
safety rating (British National Formulary (BNF), 2009a).

When to administer?
To ensure full absorption, the drug may be prescribed on an empty stomach or before, with or
after food. Ferrous sulphate is more effectively absorbed on an empty stomach, for example, but
due to its corrosive qualities, it is best taken with food (BNF, 2009a).

Oral Presentations

Preparation
Crushing tablets or opening capsules may affect the concentration of the drug rendering the
medication inert (Taylor and Johnson, 2010). This could affect the recovery of the woman or
baby.
What dosage?
The following formula can be used to calculate the dosage: what you want divided by
what you have multiplied by what it is in. The calculation needs to be completed and then
checked with a calculator.
Local policy will also advise and support your practice. Calculations for controlled drugs
require two people to complete the procedure (NMC, 2007). For a baby, the drug calculation
will also need to be calculated in relation to the baby’s weight
(BNF, 2009b).

Administering the drug

Before administering oral medication, an assessment needs to be completed to address if
the woman or baby are able to receive it. Midwives also need to obtain consent and ensure the
prescription is understood. All prescribed medication needs to be documented and signed for by
the registrant (NMC, 2007).
If administering drugs from a bottle or blister pack to a woman, they will need to be
dispensed into a medicine pot. Medication for a baby should be administered using a syringe
inserted into the mouth towards the cheek (Johnson and Taylor, 2010) 0.1ml at a time to enable
the baby to suck, swallow the medication and breathe.
The baby and mother will need to be observed for drug interactions and compatibility.
These may not occur initially, but can manifest orally as xerostomia (dry mouth) or candidiasis
(BNF, 2009a). If there is any incompatibility or reaction, it should be reported to the prescriber
immediately and the medication should be stopped.

Conclusion
The National Patient Safety Agency continues to report on medication errors. But
integrating Essential Skills Clusters (NMC, 2009) for medicine management into midwifery
education may reduce this type of error in future and improve the treatment of women and babies
in our care.
 REFERENCES

British National Formulary (BNF). (2009a) BNF.

BNF. (2009b) BNF for children.
Johnson R; Taylor W. (2010) Skills for Midwifery Practice (3rd edition).
National Patient Safety Agency (NPSA). (2009) Safety in Doses: Medication Safety Incidents in
the NHS.
Nursing and Midwifery Council (NMC). (2007) Standards for medicines management.
NMC. (2009) Standards for Pre-registration Midwifery Education.
 ADMINISTERING ORAL MEDICATION

Definition
Oral medication administration is the process by which drugs are delivered by mouth
through the alimentary tract.

Purpose
Drugs are taken by this route because of convenience, absorption of the drug, ease of use,
and cost containment. It is, therefore, the most common method used.

Precautions
Other routes are used when a person cannot take anything by mouth, or the drug is poorly
absorbed by the gastrointestinal tract. The nurse should check whether the patient has any known
allergies. It is useful to remember the following checks when administering any medication: the
right patient, the right medicine, the right route, the right dose, the right site, and the right time.

Description
Oral drugs are can be prescribed to be taken at different intervals, either before or after
food. They can be in either liquid or solid form. Questions about the frequency with which drugs
should be taken should be addressed to the primary health care provider.

Preparation
Wash the hands. The patient's order sheet should be checked to ensure that the dose has not
already been given. Once that is confirmed, the correct drug and dose should be selected. The
appropriate number of pills should be shaken onto the lid of their container and dropped into a
small measuring cup to hand to the patient. This should be done immediately prior to giving the
drug and not done in advance.
If the medication is liquid, the bottle should be shaken, the cap removed, and the bottle
held at eye level with the label turned upwards, to prevent staining. The correct dose should be
poured into a measuring cup.
 The patient should be informed that his or her doctor has prescribed some medicine for him
or her. The nurse should check the drug and dose against the patient's prescription chart again,
then confirm the patient's name on his or her wristband. The drug can then be handed to the
patient, who should also be offered a drink of water to aid in swallowing pills.
Liquid medicines containing iron should be taken through a straw to minimize staining of
the teeth.After ensuring that the drug has been taken, the nurse should record the time and the
dose that has been given.

Aftercare
The nurse should monitor the patient's reaction and provide reassurance, if required.

Complications
Possible complications include:
The drug may interact with other drugs the patient is taking and alter the desired effect.
The patient may refuse the drug.
There may be difficulty in swallowing.
The drug may irritate the gastrointestinal tract.
The drug may pass quickly through the body, and the benefits of the drug may be lost.

Results
Administration of oral medication should result in the patient receiving the proper dose of drug
safely, and with no complications. Oral drugs can also interact with other medications that the
patient is taking, such as injections. The nurse should check for any adverse reactions if the drug
is being administered for the first time.

Health care team roles

The staff should establish whether a patient is taking any drugs prior to being given any
additional medication. It is important that a nurse understand the actions, side effects, and
incompatibility of drugs, recognize normal doses, and be knowledgeable about any reactions that
a patient may experience. The nurse should report any unusual effects to the medical staff and
record any side effects or negative reactions to the drug that has been given.
If the medication is to be prescribed regularly for a specific disease, the patient can be directed to
a self-help group in which members have the same medical condition. The patient should be
helped to feel confident that his or her privacy is ensured. If the labels on liquid medicine bottles
are stained and illegible, the medicine should not be used.

KEY TERMS
Alimentary— Relating to the system of nutrition.
Alimentary tract— The alimentary tract and the other organs involved in digestion and
absorption.
Gastro— Referring to the stomach.
Gastrointestinal tract— The stomach and intestinal tracts involved in digestion and the
elimination of waste products.
Intestinal— Referring to the intestine.
 REFERENCES

BOOKS
Denville, N.J. The Self Help Source Book. American Self Help Clearinghouse, 1998.

ORGANIZATIONS
American Academy of Nurse Practitioners. AANP, PO Box 12846, Austin, Texas, 78711. (512)
442-4262. admin@aanp.org.

American Nurses Association, 600 Maryland Avenue, SW, Suite 100 West, Washington, DC
20024. (202) 651-7000.

National Association of Clinical Nurse Specialists, 3969 Green Street, Harrisburg, PA, 17110.
(717) 234-6799. info@nacns.org.

National League for Nursing, 61 Broadway, 33rd Floor, New York, NY 10006. (212) 363-5555
or (800) 669-1656.

OTHER
"How to Administer Medications." 〈http://nursing.about.com〉.
 ADMINISTERING ORAL MEDICATION

The oral route is probably the easiest and most often used route for administering
medications. These medications have the potential to exert both local and systemic effects, and
patients are usually able to take oral medications independently with very few problems.
However, situations may arise that keep a patient from taking medications by this route. If a
patient is nauseated, is vomiting, has decreased intestinal motility, is NPO (receiving nothing by
mouth), cannot swallow, or has a nasogastric tube in place, another route must be used.

Before administering oral medications, assess your patient for any swallowing problems.
Make sure he is in a sitting position or in a side-lying position if unable to sit, to reduce his risk
of aspirating or choking.

Cutting and crushing tablets

When administering oral medications, it is sometimes necessary to give only a portion of

a tablet. To break a scored tablet in half, use a cutting device to improve accuracy. If the tablet
does not break evenly, discard it if your facility’s policy allows it and cut another tablet. If it is a
controlled substance, follow your facility’s policy for discarding these drugs. Keep in mind that
it is difficult to confirm that you are giving the correct dose after you divide a tablet, so this is a
practice best avoided if at all possible. Policies about this practice vary widely, so be sure you
understand what your facility requires should this situation arise. Some might allow this practice
only in the pharmacy, for example, or might prohibit nurses from dividing unscored tablets.

If a patient is unable to swallow pills, you may have to crush the medication and mix it
with food or a beverage before administering it. When mixing the medication, use the smallest
amount of food or fluid possible. Because medications can alter the taste of food, avoid mixing it
with the patient’s favorite foods and beverages as this might diminish the patient’s desire to eat
or drink them.

Whenever you cut or crush a medication, clean the pill cutter or mortar and pestle before
and after use. It is a good practice to check with a pharmacist or a drug guide before cutting or
crushing a medication. Some medications, such as sublingual, enteric-coated, and timed-release
preparations, must not be cut or crushed.

Pediatric and older adult considerations

When administering oral medications to pediatric patients, liquids are often easier and
safer to administer.
 If the drug has a bitter or bad taste, it may be helpful to mix the drug with a small amount
of food, such as applesauce, pudding, or ice cream. Avoid mixing the drug with milk or formula
as this may make the child refuse it later. If you’re administering a small amount of a
medication, usually less than 1 teaspoon, use an oral dosing syringe or medicine spoon to
measure the medication accurately. If the child’s parents are available and willing, ask them to
give it to the child. Pediatric patients often take medications more willingly from a parent than
from a nurse.

Most older adult patients can take oral medications without any problems. However, age-related
physiological changes can influence how oral medications are distributed, absorbed, and
excreted. Because of these changes, geriatric patients can be at higher risk for drug toxicity.
 REFERENCES

Bentz, P. M. & Ellis, J. R. (2007). Modules for basic nursing skills (7th ed.). Philadelphia:
Lippincott Williams & Wilkins. pp. 829-833.

Duell, D. J., Martin, B. C., & Smith, S. F. (2004). Clinical nursing skills: Basic to advanced
skills (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc. pp. 529-531.

Perry, A. G., & Potter, P. A. (2006). Clinical nursing skills and techniques (6th ed.). St. Louis,
MO: Elsevier Mosby. pp. 633-641.

http://www.atitesting.com/ati_next_gen/skillsmodules/content/Medication-Administration-
2/equipment/oral.html
 ADMINISTERING ORAL MEDICATIONS

 Oral Liquid Medicines

 Guide to Measuring Liquid Medicines
 Liquid Medicine Tips
 Chewable tablets
 Capsules and Tablets
 Tips for swallowing pills
 Tips for Pills
 Medication Sprinkles
Taking medicine by mouth is one of the rituals of childhood. It seems so simple that we
can easily forget important parts of the process. There are also a few things to avoid. Here are
some General Quick Tips – detailed information follows:

General Oral Medicine Tips

 Keep all medicines locked away and in child-resistant containers

 Keep a good count of tablets and pills to be sure none disappear

 Try to give every dose on a regular schedule

 When you get the prescription, ask your doctor what to do if you forget a dose, and write
the answer here: _________________________

 If child spits or vomits within 15 minutes, repeat dose.

 Continue to give the medicine until it is all gone, or until your doctor asks you to stop.

 Only give a prescription medicine to the person it is for. NEVER share prescriptions

 Parents should keep the container for teens on antidepressants. Give out one pill each time.
This can prevent intentional overdose.

Oral medications come in a wide variety of forms. There are liquid solutions, suspensions,
and syrups, chewable tablets, as well as standard tablets and capsules. Some oral medications
come in the form of “sprinkles” that you can mix with foods. The form of the medication is often
almost as important as the medicine itself.

Oral Liquid Medicines

Oral liquid medicines can make it easy to give medication to young children who can’t
swallow pills or capsules. They can also make it easy to over- or under-dose the medicine,
however, since usually you must measure each dose yourself. Many liquid medicines, especially
antibiotics and many seizure medications, come prepared as “suspensions.” This means that the
medicine is actually in tiny particles floating in the liquid syrup. The particles can settle to the
bottom of the bottle, so it is important to

Many liquid medicines expire very rapidly. In fact, the pharmacist usually prepares the medicine
right before you get the prescription. These medicines often require refrigeration to keep them
fresh through the whole treatment course. Refrigeration does not usually harm other liquid
medications, so when in doubt, refrigerate!shake the bottle well before each and every dose. If
you don’t shake the bottle before the dose, you will give nothing but syrup for the first half of the
bottle, and then far too much medicine when you get closer to the bottom. You don’t have to
shake medicines that are called “solutions,” but shaking won’t hurt them. When in doubt, shake!

Dosing in liquid medicines is by volume. That is, you will give your child a specific
measured number of cc’s, ml’s, or teaspoons or tablespoons.

Guide to Measuring Liquid Medicines

1cc = 1 ml (a cc and an ml are the same thing)

1 teaspoon = 5 cc = 5 ml
1 TABLESPOON = 3 teaspoons = 15 ml

Very few medicines require using one or more tablespoons – Please double check very
carefully if someone tells you to give a tablespoon or more of a liquid medicine.
Pharmacists usually dispense liquid medicines with a proper measuring device. This may be a
special syringe (no needle!) or a specially shaped spoon that is marked into cc/ml and teaspoon
markings. Because liquid medicines usually have sugar in them, it’s important to wash the device
after each use to prevent germs from growing on it. If you use a syringe for medicine, please be
sure to remove any cap or cover before you give the medicine. Children have choked to death
on these covers when they got into their air passages.Most manufacturers make liquid medicines
in such a way that some easily measured amount of liquid is the “right dose” for children at
different ages. For example, children’s antibiotic liquids come in different concentrations so that
your doctor can usually prescribe an easy amount such as one teaspoonful, or one and a half
teaspoonfuls of medication. If your medication label says to use some unusual amount, such as,
for example, “1.37 teaspoonfuls,” please carefully double-check with your doctor or pharmacist.
Anyone who has ever watched a child take liquid medicine knows that such accurate measures
don’t make sense!

It is always a good idea to remind your child that the medicine will help him or her to get
better, but also that it is medicine, not candy or a treat. Manufacturers always have to struggle to
make a medicine taste just good enough that a child will take it, but not so good that s/he is
tempted to take too much. If your child does not like the taste of the medicine, you may want to
have a glass of water or juice ready to help wash it down. Please also be sure the cap is securely
fastened back on the bottle after each use.

Please: never hold a child’s nose closed in order to get him or her to swallow medicine.This
will terrify the child because s/he feels s/he cannot breathe. It may actually work the first time
you try it, but it will make the next dose nearly impossible to give.

Liquid Medicine Tips

 Keep bottle tightly closed

 Shake before using

 Keep refrigerated unless otherwise instructed

 Use medicine measuring device or measuring spoon, not household teaspoons.

 Wash measuring device after use and dry thoroughly

 Use measuring syringe if possible and give small squirts at a time.

 Let baby swallow each squirt before giving next squirt

Chewable tablets

Chewable tablets are a wonderful option for a growing number of medications. They help
a great deal in giving medication to toddlers and pre-school children. Please be sure to give them
exactly as directed. Just like with the liquid medicines, there is the danger that a child may like
the taste too much, and try to eat the tablets like candy. Most manufacturers package chewable
tablets in “blister packs” that make it hard to get at more than one tablet at a time, but children
are ingenious and industrious. Please keep these medications safely locked away when you are
not using them. Always dispense chewable medicines yourself on schedule – NEVER ask a child
to get his or her own chewable medicines.

Capsules and Tablets

Most children can start swallowing capsules and tablets by late school-age. Some
children can start earlier, but please be careful that your child doesn’t chew the pill. Capsules and
tablets dissolve in the stomach at a carefully designed rate. Chewing can release too much
medicine all at once, or can destroy some of the medicine. Some pills are fine if chewed or
broken, so please check with your doctor if it seems this might help your child. Also, please
remember that some people reach adulthood without being able to swallow pills.

Tips for swallowing pills

 Have some water or juice handy

 Tablets (solid pieces of medicine) sink in water, so have your child take a sip of water and
hold it in the mouth. Then drop the tablet into the throat and swallow with the head held
slightly up. The tablet will sink to the bottom of the water and will be the first thing to be
swallowed.

 Capsules (bits of medicine inside a shell) float in water, so use the opposite technique: Sip
water and hold it in the mouth, put the capsule in the mouth, and tip the head slightly
forward. Then swallow – the capsule will float right down!
  If a person gags or chokes on a pill they almost always spit it out. Wait at least half an hour
before trying again. If it doesn’t work the second time, your child probably isn’t ready for
pills yet.

Tips for Pills

Sip water or juice before putting pill in mouth

Keep liquid in mouth, then put pill in mouth
Tablets: tip head backward and swallow
Capsules: tip head forward and swallow

Medication Sprinkles

A small number of medications as well as some vitamin formulations are available as

“sprinkles.” The sprinkles typically contain the medication or vitamin inside a protective coating.
Each sprinkle particle is tiny – about the size of a sugar grain. Sprinkles are designed so that you
can sprinkle them over your child’s favorite food – in theory making it easy for your child to
swallow the medicine. There are a few tricks to know about, however! First, please avoid just
sprinkling the medicine on top of a spoonful of food – your child will see and taste the
medication right away. Instead, pour the correct amount of sprinkles into a small dish or cup, and
add the spoonful of food you will use. Mix it up well with a baby spoon. Then scoop up the
entire amount with the spoon and feed it to your child. If you use a sticky, thick material such as
chocolate syrup or peanut butter, your child will be less likely to spit out the medicine. Please
never use honey for this purpose in a child under 2 years of age, because of the risk of
infant botulism.
 REFERENCES

1. Institute for Quality and Efficiency in Health Care. "Oral medications". Informed Health
Online. Institute for Quality and Efficiency in Health Care. Retrieved 22 June 2013.
2. TheFreeDictionary > oral administration of medication Citing: Mosby's Medical
Dictionary, 8th edition. 2009
3. http://kidemergencies.com/administering-oral-medications.html
4. http://familydoctor.org/online/famdocen/home/children/parents/safety/097.printerview.h
tml
 Oral Horse Medications, How to Administer TOP VIEWED ARTICL

Oral Horse Medications,

Drs. Foster & Smith Educational Staff
How to Administer

Calming Supplements for

Horses: Compare

Vitamin & Mineral

Supplements for Horses:
Comparison

PRODUCTS RELATED
Health Supplements

Giving oral medication to a horse is no easy task. Frustration mounts as he eats around
the pill you artfully hid within the feed, or sniffs suspiciously at the powder you mixed
with "irresistible" applesauce. Yet, you can't stop trying. Your horse must get the total
dose of medicine at the correct time for the prescribed number of days. As you
experiment with different oral feeding techniques, keep in mind that there are
established methods of administering oral medications. Combining these methods with
your horse's personal preferences will help you find a successful system. Cosequin Equine Join
Supplements
How to administer pastes As low as $115.99

1. Place the tip of the paste syringe in the corner of your horse's mouth.
2. Raise your horse's head.
3. Move the syringe tip around to stimulate movement of the tongue.
4. Inject medication.

Tips for pastes

 For horses who spit out the medication, make sure you get the tongue moving. This movement
causes the paste to stick to the tongue and gums, so the medication will be swallowed eventually.
 For thick pastes, use a syringe with a wider tip. Regular sized syringes may have too narrow of a
tip and can become blocked. Equi-Shine Horse Supplem
 Make paste more palatable by mixing in a few teaspoons of a sticky, sweet treat such as
molasses, applesauce, or corn syrup. As low as $45.99
 Use a dosing syringe to help administer medications to even the finickiest of horses.
How to administer powders and granules

 Mix powders or granules directly with feed.

 Check bottom of feed bucket after feeding to make sure entire mixture has been eaten.

Tips for powders and granules

 Not all medications can be given with food; check labeling if unsure.
 Try adding molasses to the feed. The molasses will help prevent the powders or granules from
separating from the feed.
Hyalun Joint Supplement
Hyalogics
How to administer tablets
With a balling gun, which is a special, syringe-like device to administer tablets and capsules: As low as $29.99

1. Place the balling gun in the corner of your horse's mouth.

2. Gently push balling gun tip to the back of your horse's tongue.
3. Raise your horse's head.
4. Push the balling gun plunger to dispense the tablet.
5. Watch to make sure your horse swallows the medication.

By crushing:

1. Crush tablet(s) with a mortar and pestle.

2. Administer the crushed tablet;
a. Mix crushed tablet(s) with feed.
b. Dissolve the crushed tablet(s) in a small amount of water to form a paste.

Tips for tablets

 Consult with your veterinarian before crushing tablets. Some tablets with special coatings must be
given whole.
 Use caution when crushing tablets, make sure you do not inhale any of the substance.
 Small tablets can be mixed with feed without crushing.

As your horse becomes accustomed to receiving oral medications, your job of administering will become
easier. Enlist a friend to help you in your task, as extra hands are always good. Also, always come
prepared. Don't wait until you are standing by the horse to grind the pill and load the syringe.