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. Right medication

2. Right patient

3. Right dosage

4. Right route

5. Right time (and date)

6. 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