Oral, Enteral, Topical, Eye, Ear and Inhaled Medications

Oral, Sublingual, and Buccal Medication Administration

Administering oral medications safely requires continuous attention to client safety, correct positioning, and physical data collection. Before offering any oral medication, the practical nurse checks the client's ability to swallow. To prevent aspiration while taking medications, the practical nurse positions the client upright at a 60-to-90-degree angle. If the client experiences severe swallowing difficulty, or if the client vomits after taking an oral medication, the practical nurse does not guess or re-administer independently; instead, the practical nurse promptly reports this finding to the registered nurse.

Formulation integrity is critical to client safety. Enteric-coated and extended-release tablets must not be crushed or chewed because doing so can defeat an enteric coating or disrupt the product's extended-release mechanism. The nurse splits an enteric-coated or extended-release tablet only if the specific product is officially approved for splitting. Similarly, a scored tablet may be split only when that specific medication is approved for splitting and facility policy permits it. For liquid oral medications, accuracy depends on viewing angle; the nurse places the medication cup on a flat surface at eye level and reads the volume at the bottom of the meniscus.

Alternative oral routes deliver medications directly through the mucous membranes. For sublingual administration, the medication is placed directly under the tongue and allowed to dissolve completely without chewing or swallowing. For buccal administration, the medication is placed between the cheek and the gum until it is completely dissolved. To ensure effective absorption, the practical nurse avoids offering food or fluids until a sublingual or buccal medication has completely dissolved, and then reinforces and follows any medication-specific restrictions afterward.