Administering Medication by Nasogastric Tube

Nursing Procedure 5.18

Administering Medication by Nasogastric Tube

Delivers medication for absorption through the gastrointestinal tract when client cannot take medication orally.

Doctor's order
Computerized medication administration record (or manual record if computerized record not available)
Barcode or electronic client and medication identification scanner, if available
Medication to be administered (liquid, capsule, powder, tablet)
Note: No enteric-coated or time-release tablets or capsules or any medications designated as "Do not crush"
Nonsterile gloves
Plastic medicine cup
Water (4 oz at room temperature)
30-mL syringe (cone-tipped)
Disposable protective pad or small towel
Tube clamp (on client's tubing)
Pen

Assessment should focus on the following:

Condition of nasal mucosa
Placement of nasogastric tube
Patency of nasogastric tube
Form of drug (tablet, capsule, liquid suspension) and appropriateness to be crushed or diluted (and proper solution)
Medication allergies or sensitivity to latex (if latex gloves used)

Nursing diagnoses may include the following:

Anxiety related to dysphagia and change in health status
Risk for injury related to aspiration of oral medication secondary to dysphagia

Outcome Identification and Planning

Desired Outcome

Sample desired outcomes include the following:

Client demonstrates no signs of anxiety within 1 hr of administration of sedative by nasogastric tube.
Client tolerates medications administered by nasogastric tube without complications.

Special Considerations in Planning and Implementation

General

Many oral medications should NOT be crushed or altered to give in tube form. BE SURE TO VERIFY THAT THE DRUG CAN BE crushed or altered in form, including mixing with liquids. For example, drugs such as time release medications can have an immediate cumulative effect and cause serious or lethal consequences to the safety of the client.

Delegation

As a basic standard, medication preparation, teaching, and administration are done by a licensed registered or vocational nurse. Some drugs may be given by registered nurses only. Policies vary by agency and state. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. BE SURE TO NOTE SPECIFIC AGENCY POLICIES FOR A GIVEN ROUTE AND DRUG BEFORE DELEGATING ADMINISTRATION!

[Outline]

Desired Outcome
Special Considerations in Planning and Implementation
- General
- Delegation

Action		Rationale
1	Perform hand hygiene and organize equipment.	Reduces microorganism transfer; promotes efficiency
2	Prepare medication to be administered, adhering to the five rights of drug administration (see Nursing Procedure 5.1). Use barcode scanning, if available.	Promotes safe drug administration
3	Identify client by scanning or visually checking (if scanning unavailable) identification bracelet and by addressing client by name.	Verifies identity of client
4	Explain procedure and purpose of medication to client.	Reduces anxiety; promotes cooperation
5	Verify any client allergies.	Prevents allergic reactions and injury
6	Prepare medication:	Allows medication to go down nasogastric tube; prevents clogging the tube
	For a tablet: Crush tablet with a pill crusher or mortar and pestle, or between two spoons (Fig. 5.26). Mix with 10–20 mL lukewarm tap water.
	For a capsule: Empty contents of capsule in medicine cup. Mix with 10–20 mL lukewarm tap water. Check medication resource or procedure manual to make sure guidelines for drug administration are being followed.
7	Assist client into proper position: semi-Fowler’s in bed or sitting up in wheelchair.	Promotes flow of fluid and medication into nasogastric tube and stomach
8	Don gloves.	Prevents contamination of hands; reduces risk of infection transmission
9	Place towel or disposable pad over client’s chest.	Promotes cleanliness
10	Release clamp on client’s tube or disconnect from tube feeding.	Provides access to open tubing system to give medication
11	Check tube placement medications.	Prevents aspirations of secretions into tracheobronchial tree; identifies air moving into stomach
	Attach syringe to free end of tube.
	Place stethoscope on left upper quadrant below sternum (Fig. 5.27).
	Instill 20 mL of air into tube while listening for a “swishing” sound.
	Aspirate small amount of gastric fluid and check acidity with pH indicator strip.
12	Flush tube with 30–60 mL water.	Lubricates inner tube to facilitate movement of medication
13	Pull medication into syringe, attach syringe to nasogastric tube, and then gently push through tube.	Delivers medication to stomach with minimal trauma to tissues
14	Follow medication with instillation of 30–60 mL water.	Prevents obstruction of tubing
15	Clamp nasogastric tube for 30 min or more.	Closes system and promotes medication passage into stomach
16	Keep client in upright position for 30–45 min.	Decreases risk of aspiration; facilitates movement of medication in gastrointestinal system
17	Remove gloves and discard with soiled materials.	Reduces microorganism transfer
18	Perform hand hygiene.	Reduces microorganism transfer
19	Restore or discard all equipment appropriately.	Reduces transfer of microorganisms among clients; prepares equipment for future use
20	Document administration on medication record.	Provides legal record of medication administration; prevents accidental remedication

Were desired outcomes achieved? Examples of evaluation include:

Desired outcome met: Client verbalizes decreased anxiety 30 min after medication administered.
Desired outcome met: Client tolerated diazepam (Valium) administered in 30 mL water by nasogastric tube without complications.

The following should be noted on the client's record:

Name of drug, amount, route, and date and time administered
Assessment data relevant to verification of tube placement and patency
Assessment data relevant to purpose of medication
Client's response to medication and procedure

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆