4 Nonparenteral Medication Administration
Learn how to administer medications by noninjection routes, select safe techniques for each route, and monitor and document the patient’s response.
Start with safe administration
Nonparenteral medications are given without injection. The route affects where a medication acts, how it is absorbed, and how quickly it takes effect. Safe administration starts by checking the prescription, patient identity, allergies, medication, dose, time, and route. Also assess whether the patient can safely use the prescribed route, and follow product instructions and facility policy.
Explain the medication and respect the patient’s right to refuse. Observe the patient’s response, then document administration—or an omission and its reason. Report unexpected effects or problems.
Takeaway: Match the prescribed route and dosage form to the patient’s needs, and confirm that administration is safe before proceeding.
Oral and enteral routes
For an medication, assess alertness, swallowing ability, nausea or vomiting, and any required food or fluid restrictions. Position the patient upright when possible, offer the prescribed form with an appropriate amount of fluid, and confirm that it was swallowed. Do not leave medication unattended unless self-administration is part of the care plan.
Measure oral liquids with a calibrated oral syringe or medicine cup, not a household spoon. Read the measurement at eye level, and check whether a suspension needs shaking. Do not split, crush, chew, or open a dosage form unless product instructions or a pharmacist confirms that it is appropriate. Altering some delayed- or extended-release forms can change drug release and safety.
Sublingual medications dissolve under the tongue; buccal medications dissolve between the cheek and gum. Place each dose in the specified location and allow it to dissolve as directed. Do not chew or swallow it unless instructed, and avoid food or drink until dissolution is complete if directed.
delivers medication into the stomach or intestine through a feeding tube. Verify that the medication and dosage form are appropriate for the specific tube and location; consult a pharmacist if uncertain. Do not assume a tablet can be crushed or a capsule opened. Give each medication separately, and flush before, between, and after medications according to the care plan and facility guidance. Mixing medications together or directly into formula can cause incompatibility, blockage, or incomplete dosing.
Takeaway: Use the prescribed dosage form, verify that it is safe to alter before doing so, and follow the patient-specific instructions for oral and tube administration.
Topical and routes
Topical creams, ointments, lotions, and gels are applied to skin or mucous membranes, commonly for a local effect. Check the correct site and amount, wear gloves when indicated, and apply to clean, dry skin as directed. Avoid contaminating the container or applicator, and wash hands afterward.
patches deliver medication through the skin, often over an extended period. Check for and remove an old patch before applying a new one. Inspect and clean the skin, then dry it fully. Apply the new patch to an appropriate site, rotate sites as directed, and document its location and application time. Wear gloves when handling medicated patches. Do not cut a patch or apply heat over it unless its instructions specifically permit this; heat can increase absorption from some patches. Dispose of used patches safely because medication may remain in them.
Takeaway: Keep application sites and tools clean, follow product instructions, and take care to prevent unintended medication exposure or absorption.
Inhaled and intranasal routes
Inhaled medications act in the airways or lungs. Technique depends on the device, so follow its instructions and check that the patient can use it correctly. With a typical , the patient exhales, seals their lips around the mouthpiece or spacer, coordinates one actuation with a slow, deep inhalation, and holds their breath briefly if able. A spacer can help with many metered-dose inhalers, but device directions take precedence. After an inhaled corticosteroid, rinse the mouth and spit to reduce local side effects. Do not assume that dry-powder inhalers use the same technique as metered-dose inhalers.
Intranasal sprays or drops are delivered into the nose. Have the patient clear the nose if appropriate, position the head as directed for the product, and aim the spray away from the nasal septum when instructed. Avoid touching the applicator tip to the nose, and do not share devices.
Takeaway: Device-specific technique matters for inhaled medication, while intranasal administration requires attention to positioning and applicator hygiene.
Eye, ear, rectal, and vaginal routes
(eye) medications require care to keep the dropper tip sterile: do not let it touch the eye, lashes, or other surfaces. Place drops in the lower-lid pocket rather than directly on the cornea. Close the eye gently, and apply light pressure near the tear duct when directed. Allow the prescribed interval between different eye medications.
Otic (ear) medications must be intended for the ear. Warm the container in the hands if appropriate, position the affected ear upward, and avoid touching the dropper tip to the ear. Keep the patient in position for the time directed.
For rectal and vaginal medications, provide privacy, explain the procedure, use gloves and appropriate lubricant, and follow product-specific instructions for positioning and insertion. Assess for relevant contraindications or discomfort and report concerns.
After administration, reassess the patient and document the medication and response. Document any omitted dose and the reason, and report unexpected effects or administration problems.
Takeaway: Use the route-specific technique, protect applicator hygiene, respect privacy, and follow up on the patient’s response.