Inhalers are not a very efficient way of delivering medications to the lungs
because only 9% of the medication reaches the lungs. The efficiency increases
by using a spacer, which delivers 21% of the medication to the lungs. The spacer
is a funnel-like device that attaches to the mouthpiece of the metered dose
inhaler (MDI). The medication is released into the spacer and then the patient
inhales slowly and deeply to get the drug into the airway.
When administering medication using an inhaler:
- Check the prescriber’s order.
- Position the patient in a semi- or high-Flower’s position (sitting up).
- Teach the patient to wait 2 minutes between puffs of an MDI if the pre-
scriber orders more than one puff. - The patient should rinse his or her mouth with water and expectorate (spit)
following inhalation of steroids because steroid inhalants promote oral
fungal infections.
NASOGASTRIC AND GASTROSTOMY TUBE ROUTE
Nasogastric and gastrostomy tubes are used for patients who are unable to swal-
low or ingest anything orally. The nasogastric tube is passed through the nose and
into the stomach opening with direct access to the stomach through which med-
ication can be administered to the patient. The nasogastric tube is also used as a
temporary feeding tube and to remove stomach contents. The gastrostomy tube is
inserted through the skin and directly into the stomach and is used primarily as a
permanent feeding tube that can also be used to administer medication.
When administering medication through the nasogastric tube and the gas-
trostomy tube:
- Check the prescriber’s order.
- Be sure that the tube is in the proper position by one of two methods:
1.Attach syringe to free end of NG tube; inject 1 or more 20 mL bursts of
air into the tube. Aspirate gastric contents and check pH with test paper.
If it is 0–4 the tube is in the stomach.
2.Inject 10 mL of air through NG tube and listen with the stethoscope over
the stomach for a rush of air. This is not done with a gastronomy tube. - Remove the plunger from a syringe and pour medication into the syringe.
- Close the clamp on the nasogastric or gastrostomy tube.
- Attach the syringe to the nasogastric or gastrostomy tube.
- Open the clamp, pour the medication into the syringe and hold the tube up,
allowing the medication to flow down the tube.
CHAPTER 6 Route of Administration^103