Nurse Care Plan

Administering medications through a feeding tube provides an alternative route for administration of medications to the patient who cannot take anything by mouth and has a nasogastric, nasoenteric, or gastrostomy tube in place.

Preparations:
● Check prescriber’s order to verify medication orders.
● Use the five “rights” of drug administration.
● Check with the pharmacist to see if the patient’s medication comes in a liquid form, because these are less likely to cause tube obstruction.
● Determine if the nasogastric tube or gastric tube is in place

Special Considerations
Elderly Patient
• Check level of consciousness.
• Check for aspiration.
• Place in Fowler’s position (30 to 45 degrees) before and after feeding to prevent aspiration.

Pediatric Patient
• Because of the small size of the feeding tube, use only medications that come in a liquid preparation to prevent occlusion.
• Be sure children are in a high Fowler’s or upright position to prevent aspiration during administration.
• Position an infant in a prone or side-lying position for 30 minutes to 1 hour following medication administration.

Relevant Nursing Diagnoses:
● Altered nutrition: less than body requirements related to anorexia and/or failure to thrive
● Self-care deficit related to impaired swallowing and physical mobility
● Ineffective infant feeding pattern related to premature birth and underdeveloped sucking reflex

Expected Outcomes:
● Medications will be administered safely and on time according to physician’s order
● Desired effects from the medication (e.g., relief or pain or decrease in body temperature) will occur
● The feeding tube will remain patent

Equipments and supplies:
● Medication prepared and ready for insertion through the feeding tube according to physician’s orders
● Water for diluting and flushing the feeding tube 60-mL catheter-tip syringe
● Clean gloves

Implementation and Rationale:
1. Review prescriber’s orders.
Determine medications and route to be administered to patient.
2. Gather all equipment before administering the medications.
Saves time and allows efficiency in the medication administration.
3. Stop the tube feeding if medication is to be given on an empty stomach.
Some medications are not absorbed if taken with food or other medications.
4. Prepare each medication separately.
Maintains discrete identity of each medication. If, for some reason, a medication must be withheld, it can be easily identified.
5. Check to determine if medications can be crushed.
Enteric-coated, sustained-action, buccal, and sublingual medications should never be crushed, as doing so alters the absorbability of the medication or yields a toxic dose of the medication.
6. Dilute crushed tablet or powder from a capsule in 30-mL warm water.
Facilitates easier flow of medications through the tube, and cold water may cause patient discomfort.
7. Don nonsterile gloves.
Reduces transmission of microorganisms.
8. Always check and confirm NG tube placement before administering the medications.
Tube must be placed in the correct position to avoid aspiration.
9. Check residual volume, return residual, and flush NG tube.
Validates gastric capacity for receiving medications and flush solution.
10. Flush the tube with 15 to 30 mL of water before administering medications.
Determines tube patency and reduces the risk for obstructing the feeding tube.
11. Disconnect NG tube from the feeding tube, maintaining asepsis of the connecting adapter.
Reduces transmission of infectious organisms.
12. If several medications are being given, administer each one separately using gravity.
Allows identification of each medication given.
13. Flush tube with 15 to 30 mL water after each medication.
Reduces risk for tube obstruction.
14. Restart tube feeding.
Continues nutrition feeding.

Evaluation and Follow-up Activities
● Note if patient gags or coughs
● Patient verbalizes no gastric discomfort
● Patient will exhibit desired effects from the medication
● The NG tube remains patent