Oral, Topical, Ophthalmic, Otic, and Inhalation Administration

Oral, Topical, Ophthalmic, Otic, and Inhalation Administration

Administering medications by non-injectable routes is one of the most common tasks you will perform as an LPN. Each route has its own anatomy, technique, and safety considerations. Mastering these routes protects patients and demonstrates the competence tested on the NCLEX-PN.

The Ten Rights — Your Foundation for Every Route

Before you touch any medication, confirm the Ten Rights: right patient, right drug, right dose, right route, right time, right documentation, right reason, right response, right to refuse, and right education. Skipping any right is a safety failure regardless of which route you are using.

Oral Route (Swallowed Tablets, Capsules, and Liquids)

The oral (PO) route is the most common. Tablets and capsules are swallowed with enough water to move the medication safely into the stomach. Liquids are measured at eye level using a calibrated medication cup. Key safety points:

• Never crush enteric-coated or extended-release formulations unless the prescriber and pharmacist confirm it is safe; crushing alters drug delivery and can cause toxicity or subtherapeutic dosing.
• Keep the patient upright (head of bed at least 30 degrees) to prevent aspiration.
• For liquid medications, use the correct measuring device — a household teaspoon is not accurate enough for clinical use.

Sublingual and Buccal Routes

Sublingual (SL) medications (such as nitroglycerin tablets) dissolve under the tongue where the rich blood supply allows rapid absorption directly into the bloodstream, bypassing the gastrointestinal tract. Buccal medications are placed between the cheek and gum. For both routes:

• The patient must not swallow the medication or drink water until it is fully dissolved.
• Do not crush SL or buccal formulations.
• Wear gloves when placing buccal medications to avoid self-exposure.

Topical Route (Skin and Transdermal Patches)

Topical medications are applied to the skin surface (creams, ointments, lotions) or delivered continuously through transdermal patches. Steps for transdermal patches:

1. Remove the old patch, fold it sticky-side-in, and dispose of it according to facility policy to prevent accidental exposure.

2. Clean and dry the application site before applying the new patch.

3. Rotate sites with each application to prevent skin irritation and ensure consistent absorption.

4. Document the site of application.

Always wear gloves when handling patches or ointments — many drugs (including nitroglycerin and fentanyl patches) can be absorbed through your skin.

Ophthalmic Route (Eye Drops and Ointments)

Eye medications must be sterile. Improper technique causes eye infections or injury.

• Position the patient with head tilted back and eyes looking upward.
• With a clean, gloved finger, gently pull the lower eyelid down to create a conjunctival sac (pocket).
• Hold the dropper or tube tip 1–2 cm above the conjunctival sac without touching the eye or lashes — contact contaminates the bottle.
• Instill drops or a thin ribbon of ointment into the conjunctival sac, not directly onto the cornea.
• After instillation, have the patient gently close the eye. Apply gentle pressure to the inner corner of the eye (nasolacrimal duct occlusion) for about one minute to reduce systemic absorption and keep the medication local.
• If more than one eye drop is ordered, wait at least five minutes between drops to prevent the first from being washed out.

Otic Route (Ear Drops)

Ear drops treat conditions of the external ear canal. Temperature and technique matter:

• Warm the drops to body temperature by holding the bottle in your hands for a few minutes — cold drops cause dizziness by stimulating the vestibular system.
• For adults and children older than 3 years, gently pull the pinna (outer ear) up and back to straighten the ear canal.
• For children 3 years and younger, pull the pinna down and back.
• Instill the prescribed number of drops along the side of the canal, not directly onto the eardrum.
• Have the patient remain on their side for 2–5 minutes; a cotton ball may be placed loosely at the canal opening if ordered.
• Never use otic drops if the eardrum is perforated unless specifically ordered by the prescriber.

Inhalation Route — Metered-Dose Inhaler (MDI) with Spacer

Inhalers deliver medication directly to the airways, which produces rapid effects with lower systemic doses. A spacer (holding chamber) attached to the MDI improves drug delivery and reduces the need for perfect hand-breath coordination.

Steps for MDI with spacer:

1. Shake the MDI well for 5–10 seconds.

2. Attach the MDI to the spacer; remove the mouthpiece caps from both.

3. Have the patient exhale fully and away from the device.

4. The patient seals the lips around the spacer mouthpiece.

5. Press the canister down once to release one puff into the spacer.

6. The patient inhales slowly and deeply over 3–5 seconds.

7. The patient holds the breath for 10 seconds, then exhales slowly.

8. Wait at least one minute before a second puff if ordered.

9. If the medication is a corticosteroid inhaler, the patient must rinse the mouth with water after each use to prevent oral fungal infection (thrush).

Patient Teaching

Patient education is part of safe medication administration, not an afterthought. Use plain language, demonstrate the technique, and ask for a teach-back to confirm understanding. Adapt your teaching for health literacy level, language, and vision or dexterity limitations.

Documentation

Document every medication immediately after administration — never before. Record the route, site (for topical), and any patient response. If a patient refuses, document the refusal and notify the supervising nurse or provider per facility policy.