Administering Other Medications

Core Concepts

Sublingual and buccal: melt-and-absorb routes

Sublingual medications are placed under the tongue; buccal medications go between the cheek and the gum. Both areas are lined with thin mucosa over a rich blood supply, so these routes absorb quickly into the systemic circulation — often faster than a swallowed tablet, because the drug bypasses the stomach and the liver's first-pass processing. The rules are strict: the medication must not be chewed, crushed, or swallowed; it should dissolve completely, with no eating or drinking until it has; and some tablets must be handled with dry hands per the product's instructions. These are often rescue or fast-acting medications — the nurse verifies the right medication and dose and keeps the dose within reach per policy.

Transdermal patches: steady absorption through the skin

A transdermal patch delivers medication through the skin into the bloodstream at a steady rate over its wear time (typically a day to a week — follow the order and label). Technique centers on the old patch: remove the old patch before applying the new one — leaving both on delivers a double dose. Apply the new patch to clean, dry, intact, relatively hairless skin, and rotate sites to avoid irritating one area. Write the date and time on the patch per policy. Never cut patches (cutting can dump the whole dose at once), and avoid placing heat sources over the patch (heat increases absorption). Dispose of used patches per policy — often by folding them sticky-side together — because they still contain active drug.

Topical skin products: creams, ointments, lotions, gels

Topical products act on the skin itself (moisturizing, or treating infection, inflammation, or itching). Apply to clean, dry skin in a thin, even layer over the ordered area, using gloves per policy; avoid broken skin unless the order says so; and don't double-dip into shared containers — label them with the person's name and use a clean applicator or gloved hand each time. Some products are hazardous to the person applying them (chemotherapy and hormonal creams, for example), so glove use and hand hygiene follow the product's safety data and facility policy — wash hands after application even when gloves were worn.

Vaginal and rectal: mucous-membrane routes with dignity and precision

Vaginal medications come as suppositories, creams, and tablets with applicators. The person is positioned supine with knees bent (per facility policy), the medication is inserted with the applicator, and the person usually remains lying down afterward. Privacy, draping, and gentle communication are core nursing behaviors — these routes can feel intimate and embarrassing for the person. Rectal medications (suppositories, enemas) are inserted into the rectum, where the mucosa absorbs the drug; the person lies on their side (often the left side, per facility policy) with the top knee bent, the suppository is lubricated and inserted gently per policy, and the person remains lying down for the ordered time. Never force insertion — if there is resistance, stop and reassess. Assess for lesions, bleeding, or discomfort before either route.

The thread that ties them together

Every route above still begins with the rights of medication administration: right person, medication, dose, route, time, and documentation — plus the person's right to ask questions and refuse. The order always specifies the exact route, and "route errors" (giving a medication by the wrong route) are among the most dangerous medication errors. Which of these routes a nurse may administer, and under what supervision, varies by state, facility, and role — always follow your institution's policy and scope-of-practice rules.

Common Confusions