An order has been placed for a sublingual medication. The person you are caring for currently has a nasogastric tube in place. What is your MOST appropriate action?
Ask the pharmacy for a liquid form of the medication.
Crush the medication and administer it through the nasogastric tube.
Administer the medication as ordered.
Call the physician and ask if the medication can be ordered by another route.
The correct answer and explanation is :
The most appropriate action is:
Call the physician and ask if the medication can be ordered by another route.
Explanation:
Sublingual medications are specifically formulated to be absorbed directly into the bloodstream through the mucous membranes under the tongue. They bypass the digestive system and liver metabolism (first-pass effect), allowing for faster and more effective absorption. If a patient has a nasogastric (NG) tube in place, they are typically unable to take medications by mouth, making sublingual administration difficult or impossible.
Why Calling the Physician is the Best Option:
- Preserving Medication Efficacy:
- Sublingual medications are designed for rapid absorption in the oral mucosa. Administering them via the NG tube would send them into the stomach or intestines, where they may be broken down by gastric acids and enzymes, reducing their effectiveness.
- Ensuring Patient Safety:
- Not all medications can be safely crushed or converted to liquid. Some sublingual drugs have specific formulations that would lose their intended effect if altered.
- Avoiding Medication Errors:
- Altering the route of administration without medical approval could result in underdosing or overdosing. Some medications require specific absorption conditions, and bypassing these conditions could lead to subtherapeutic effects or adverse reactions.
- Following Proper Protocol:
- Changing the route of administration is a medical decision that requires a physician’s order. Nurses should not modify medication routes without proper authorization.
- Considering Alternative Forms:
- The physician may prescribe an alternative route, such as intravenous (IV), transdermal, or another formulation that is suitable for NG administration.
By calling the physician, the healthcare provider ensures that the patient receives the most appropriate and effective treatment while maintaining safety and adherence to medical guidelines.