Pharmacokinetics and Routes of Administration (Fundamentals Ch 46)

Question 1

Verifying NG tube placement

Answer 1

1) verify proper tube placement–after initial insertion, before beginning a feeding or instilling liquids, and at regular intervals during continuous feedings. Tip of tube should be in the stomach or intestine. Methods: x-ray, measure aspirate pH, visual assessment of aspirate, measurement of tube length and of tube marking, and monitoring CO2.
a) x-ray: verifies initial placement
b) visual assessment and pH measurement of aspirate: i) allow 1-hr interval after pt received med or intermittent feeding before testing, ii) insert 30 mL of air into tube before aspirating GI contents to flush out contents of tube, iii) withdraw small amount (5-10 mL) of gastric secretions, iiii) if unable to obtain, reposition patient and flush tube again with 30 mL of air (may be necessary to retry several times), iv) place drop of secretion onto pH paper or place small amount in plastic cup and dip pH paper into it. Within 30 sec, compare color on paper w/ chart supplied v) document results.

Question 2

Stomach: pH and color of contents

Answer 2

• < 5.5 (if taking acid-inhibiting agent, 4-6)

- grassy green, tan, off-white, bloody, or brown

Question 3

Intestines: pH and color of contents

Answer 3

• 7+

- medium to deep golden-yellow (may be greenish-brown if stained w/ bile)

Question 4

Respiratory tract: pH and color of contents

Answer 4

• 6+

- off-white and tinged w/ mucus

Question 5

Administering medication via NG tube

Answer 5

1) verify proper tube placement
2) use a syringe and allow medication to flow by gravity or push it with the plunger of the syringe
3) liquid forms must be used
4) bring liquid meds to room temperature
5) elevate HOB to prevent reflux
6) sublingual meds should not be administered
7) DO NOT crush specially prepared oral meds (ER tablets, fluid-filled, EC)
8) administer each med separately
9) DO NOT mix meds w/ enteral feedings
10) Completely dissolve crushed tablets and capsule contents in 15-30 mL of water prior to administration
11) to prevent clogging, flush tubing before and after each medication w/ 15-30 mL of water

Question 6

Appropriate administration of transdermal medication

Answer 6

1) hand hygiene
2) identify patient
3) explain procedure to patient
4) put on gloves
5) assess patient’s skin where patch is to be placed (is there irritation or breakdown?) Site should be clean, dry, and free of hair. Rotate application sites.
6) Remove old patch before applying new. Fold in half with adhesive sides together and discard according to facility policy.
7) gently wash area where old patch was w/ soap and water
8) remove patch from protective covering. Write your initials, date, and time of administration on label side of patch
9) remove covering w/o touching medication surface. apply patch to patient’s skin. Use palm of hand to press firmly for 10 sec. DO NOT massage.
10) Remove gloves and perform hand hygiene

Question 7

Ophthalmic instillation

Answer 7

1) use medical aseptic technique
2) have client sit upright or lie supine w/ head tilted slightly and looking up at ceiling
3) rest dominant hand on client’s forehead, hold dropper above conjunctival sac (1-2 cm), drop med into center of sac, and have client close eye gently
4) apply gentle pressure w/ finger and clean tissue on nasolacrimal duct (inner canthus) for 30-60 seconds to prevent systemic absorption of medication

Question 8

Administering 2 medications in one syringe

Answer 8

1) draw back an amount of air into the syringe equal to dose of modified insulin (cloudy) to be withdrawn
2) inject the measured air into space above the solution (DO NOT inject into the solution). Withdraw the needle.
3) draw back amount of air into syringe equal to dose of unmodified insulin (clear) to be withdrawn
4) inject the measured air into space above the solution. KEEP needle in vial.
5) invert vial of unmodified insulin (clear) and draw up prescribed amount of medication
6) calculate end point on syringe for combined insulin amount by adding the number of units for each dose together
7) insert needle into modified insulin (cloudy) vial and invert it, take care not to push plunger and inject medication into vial. Draw up prescribed amount of medication.

**Lantus and Levemir CANNOT be mixed with other insulins.