Share This Link

Chewable tablets:These are specifically designed to be chewed before swallowing. Crushing is not harmful and may even be appropriate if the patient has difficulty chewing or swallowing, depending on the situation.

Regular coated tablets:Although coated to improve taste or ease swallowing, regular coated tablets typically do not have a time-release mechanism. While not ideal, they may be crushed if the patient cannot swallow them, and the drug itself is safe to crush.

Sublingual tablets:Sublingual tablets are designed to dissolve under the tongue for rapid absorption into the bloodstream. Crushing would alter the route of absorption and reduce the drug's intended rapid effect, but they are not typically classified as sustained-release formulations.

Administering medication while the patient is supine:The supine position increases the risk of aspiration because gravity does not aid in swallowing. Instead, patients should be upright or in a high Fowler's position during oral medication administration.

Mixing with a full glass of water:Although water may aid in swallowing, a full glass may overwhelm patients with impaired swallowing. This method does not directly control the flow of liquid or prevent aspiration in those at risk.

Placing the liquid toward the back of the throat:Placing medication at the back of the throat can trigger the gag reflex or cause choking, especially in patients with difficulty swallowing, making this approach unsafe.

Warm the medication:Warming medications is not a priority and may alter the drug’s stability. Medications should be given at room temperature unless otherwise directed, but this does not take precedence over verifying safe placement of the PEG tube.

Flush with 5 mL of air:Flushing with air does not reliably confirm placement and may lead to inaccurate assessments. Tube placement must be verified using institutional protocols such as checking for residuals or aspirating stomach contents.

Check respiratory rate:Although respiratory rate monitoring is important in general care, it does not help determine if a PEG tube is properly positioned for medication administration and is therefore not the most immediate priority.

Crushed tablets in sterile water:Tablets that are safe to crush can be mixed with sterile water and administered through the gastrostomy tube. This method is commonly used for drugs that do not have extended-release or special coatings.

Liquid acetaminophen:Liquid forms are preferred for tube administration because they are already in a form that allows for quick absorption and are unlikely to clog the tube. Acetaminophen in liquid form is well tolerated and easy to deliver.

Reconstituted antibiotic suspensions:These are commonly used for patients with feeding tubes. When properly mixed, they are easy to administer and generally well absorbed through the gastrointestinal tract via a gastrostomy tube.

Clamp the tube for 1 hour:Clamping may be necessary in some cases, such as to enhance drug absorption, but it is not the universal or most essential follow-up step. The priority after giving medications is to ensure the tube remains clear and functional, which is achieved by flushing.

Administer all medications together in one mixture:Combining all medications in one container is not recommended. Each medication should be administered separately with water flushes in between to avoid drug incompatibility, tube blockage, or altered therapeutic effects.

Keep patient supine for comfort:The patient should be kept in a semi-Fowler’s or upright position (30–45°) during and for at least 30–60 minutes after administration to reduce the risk of aspiration. Supine positioning can increase this risk and is not advised.

1 inch:Inserting a suppository only 1 inch is insufficient for adults, as it may not pass the internal anal sphincter. This could result in the suppository being expelled before absorption occurs.

2 inches:Although better than 1 inch, 2 inches might still place the suppository too close to the sphincter, risking expulsion. It's important to ensure it reaches the rectal vault.

4–5 inches:Inserting a suppository this far could cause discomfort or trauma to the rectal mucosa. It exceeds the recommended insertion depth for adults and is unnecessary for effective absorption.

Constipation with abdominal cramping:Although rectal medications such as suppositories or enemas may relieve constipation, abdominal cramping might signal a potential bowel obstruction, in which case rectal administration could be contraindicated or harmful.

Dysphagia after stroke:While swallowing difficulties limit oral medication use, rectal administration isn’t typically the first alternative. Safer and more common alternatives include enteral (e.g., PEG tube) or parenteral routes for long-term use.

Frequent urination due to UTI:Rectal administration is not appropriate for managing urinary tract infections. Oral or IV antibiotics are the standard routes for treating UTIs, as rectal administration doesn’t effectively target the urinary tract.

Giving the drug on time but without documenting:Timely administration is part of the “right time,” but omitting documentation violates the “right documentation.” This can lead to duplication, missed doses, or legal liability.

Administering the correct dose to the wrong patient:Even if the medication and dose are correct, giving it to the wrong person breaches the “right patient” principle. This error can cause harm and is a major safety violation.

Adjusting the dose based on nurse judgment:Altering the medication dose without a provider’s order violates scope of practice and the “right dose.” Nurses must administer only what is prescribed unless authorized changes are made by the provider.