Transcript PN1lab notes\Topical Medications

Topical Medications
PN 1 Nursing Skill Labs
Routes of Administration






Skin application = inunction
Eye instillation
Ear instillation
Nasal instillation
Rectal administration
Vaginal administration
3 Checks and 5 Rights

ALWAYS perform the 3 checks and 6
rights prior to administering any
medication

3 Checks
1. When taking container or dose out
2. Immediately before pouring med
3. When replacing container
6 Rights
1.
2.
3.
4.
5.
6.
Right medication
Right patient
Right dosage
Right route
Right time (and date)
Right documentation
In general……..





wash hands
check the orders and never be afraid to
question or refuse to give a medication if
you feel it has been ordered incorrectly
check for allergies - WHERE?
know the drugs action, side effects,
nursing interventions, health teaching.
never return unused medication to
container








check the drugs expiry date
identify the patient -HOW?
explain the procedure
cleanse the area affected PRN
maintain client position and comfort
drape for privacy
provide post administration instruction
and comfort
document
Skin Application


absorption is enhanced by cleaning the
skin with soap and water prior to
application
make sure you dry it well



ointments (ungs.) provide prolonged skin
contact - massage in well
creams and oils lubricate and soften the
skin
lotions protect and soothe the skin shake well prior to use and apply with
cotton ball
Transdermal application




generally in patch form
may contain nitroglycerine, estrogen,
nicotine or analgesic
has slow onset of action but maintains
constant serum drug levels
must be disposed of safely away from
children or pets
Procedure – Transdermal Nitro
Patch






wash hands
ALWAYS WEAR GLOVES - WHY??
remove old patch and clean area well WHY??
rotate application sites/assess for skin
irritation
don’t use sites that are hairy, scarred or non
intact
write date and time on patch
Eye Instillations





usually used for pupil dilatation/constriction,
treatment of infection or controlling
intraocular pressure for glaucoma
never touch cornea with
dropper/applicator
eyes are highly susceptible to injury and
infection
DO NOT APPLY DIRECTLY TO THE EYE
always place in lower conjunctival sac
Procedure - Eye Instillation






wash hands
clean eye (inner to outer) PRN
don’t touch lid or lashes with applicator will cause blinking
don’t use cotton balls - risk of lint
tilt head back
have patient look up and back




exert pressure downward under lower
eye lid to create conjunctival pouch
instill drops
apply light pressure to inner canthus to
prevent drug from entering systemic
circulation through tear ducts
instruct pt not to rub eye



if applying ointment, use about 1/2 inch
have patient close eye after application
then roll eyeball around to disperse drug
eye irrigations are used to remove
chemicals or a foreign body and involve
flushing with large amounts of tap water
or other solutions
Multiple Eye Instillations


Always read the literature accompanying
drug carefully or check with the
pharmacy department
Administer the drops in the appropriate
sequence with 15 minute delays
between each application
Ear Instillations




generally used to soften wax, relieve
pain, apply local anesthesia or destroy
an insect lodged in ear
N/S is usually used for irrigations
always warm the solution
apply drops to side of ear canal - do not
allow drops to fall on tympanic
membrane
Procedure - Ear Instillations




position patient with head tilted or lying
on unaffected side
clean external ear canal if necessary
pull pinna up and back for adult, down
and back in infant and child under 3 and
straight back for school aged child
instill drops




place gentle pressure on tragus a few
times to move the medication along the
canal
have patient maintain position for 5 mins
may insert cotton ball if indicated
repeat in second ear if ordered ( after
waiting 5 minutes)
Nasal Instillations
usually used to treat sinus infections or
relieve nasal congestion
Procedure:
 have patient blow nose
 tilt head back and hold up tip of nose
 do not touch dropper to nares - insert
about 1/3 of an inch
 instill medication




keep head tilted back for a few minutes
and avoid blowing nose
if using nasal spray use only sufficient
force to bring med into contact with
mucous membranes
too much force may drive med and
contaminants into sinuses and
eustachian tubes
Rectal Administration





usually used for laxatives, stool
softeners, antiemetic or antipyretic
effects or analgesia
remember to remove covering on
suppository prior to administration
lubricate well
be gentle with hemorrhoids
If suppository expelled within ½ hour of
administration it will need to be repeated
Vaginal Administration



normal secretions in vagina are acidic
which provides protection from some
pathogens
usually in form of creams or
suppositories
used to treat infections (fungal most
common)
Procedure - Vaginal Administration






have patient void prior to administering
med
position on back with knees flexed
Remember to drape for privacy
provide peri care PRN
prepare medication
Put suppository on applicator and then
add a small amount of water soluble gel
prn.





insert down and back following normal
contours of vagina
depress plunger gently ensuring that all
medication is expelled
have patient maintain position for at least
10 mins
usually given at night to maximize
contact
provide peri pad/ peri care post PRN