Session 9Administration of Drugs by Topical Route

Session 9Administration of Drugs by Topical Route

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Learning Objectives

Learning Objectives

By the end of this session, students are expected to be able to:

Explain topical route of drug administration

Describe routes for administration of medicine topically

Describe techniques of administering drugs by topical route

Describe administration of rectal medications

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Administration of Drug Topically

Administration of Drug Topically

To administer a drug topically means to apply a drug locally at an intended site such as skin, eye, ear, nose, vaginal and rectum.

Topical application usually is intended for direct action on the particular site.

If the site of application is readily accessible such as the skin, an agent can be placed on it easily.

If it is a cavity such as a nose, or enclosed as the eye is, it is necessary to use a mechanical applicator for introducing the drug.

Rationale for applying topical medication is to treat localized skin condition, to provide relief and curative purpose.

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Routes of Administration of Medicine Topically

Routes of Administration of Medicine Topically

Medications are applied directly to the skin for the following intended effects

Provides a soothing and softening effect to dry and rough areas of the skin.

Provides an antiseptic or bacteriostatic effect in order to inhibit the growth and multiplication of micro-organisms.

Relieves itching and other discomforts associated with skin rashes.

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Applying skin preparations have different instructions depending on formulation of the drug as follows:

Applying skin preparations have different instructions depending on formulation of the drug as follows:

Powder

Make sure the skin surface is dry.

Spread apart any skin folds, and sprinkle the site until the area is covered with a fine thin layer.

Cover the site with a dressing if ordered.

Suspension-based lotion

Shake the container before use to distribute suspended particles.

Put a little on a small gauze dressing or pad, and apply the lotion to the skin by stroking it evenly in the direction of the hair growth.

Creams, ointments, pastes, and oil based lotion

Warm and soften the preparation in warm gloved hands to make it easier to apply and to prevent chilling (if a large area is to be treated).

Smear it evenly by over the skin using long strokes that follow the direction of hair growth.

Explain that the skin may feel somewhat grease after application.

Apply sterile gauze if indicated.

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Aerosol spray

Aerosol spray

Shake the container well to mix the contents.

Hold the spray container at the recommended distance from the area (usually about 15 to 30 cm- a [6-12 inches] but check the label).

Cover the client’s face with a towel if the upper chest or neck is to be sprayed.

Transdermal Patch

Select a clean dry area that is free of hair and match the manufacturer’s recommendations.

Remove the patch from its protective covering holding it without touching the adhesive edges, and apply it by pressing it firmly with the palm of the hand for about 10 sec.

Advice the client to avoid using a heating pad over the area to prevent an increase in circulation and the rate of absorption.

Remove the patch at the appropriate time, folding the medicated side to the inside so it is covered.

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Liniments

Liniments

These may be fluid, semi-fluid and occasionally semi-solid preparations intended for external use.

They may contain alcohol, oil or emulsions.

Liniments are massaged or rubbed into the skin.

Liniments are usually prescribed for temporary relief of pain and swelling by improving circulation of blood at the affected site.

Liniments should not be massaged on a broken skin.

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Instilling drops in the eye

Instilling drops in the eye

The purpose of instilling drugs into the eyes includes

To treat infections such as conjunctivitis.

Drugs such as tetracycline eye ointment may be used.

To anaesthetize the eye before operation or any examination.

To dilate the eye pupil, for example: before certain examinations of the eye, and after cataract extraction.

To obtain this effect drops like atropine may be employed.

To contract the pupil in order to reduce the tension of eye- ball in eye conditions such as glaucoma.

Example of such drugs includes- pilocarpine eye drops.

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Technique (Procedure) for Administering Ophthalmic Instillation

Technique (Procedure) for Administering Ophthalmic Instillation

Assess

Appearance of eye and surrounding structures for lesions, exudates, erythema, or swelling.

Location and nature of any discharge, lacrimation, and swelling of the eye lids or of the lachrymal gland.

Client complains (e.g. itching, burning pain, blurred vision, and photophobia).

Client behaviour (e.g. squinting, blinking excessively, frowning or rubbing the eyes).

Determine if assessment data influence the administration of the medication (i.e. is it appropriate to administer the medication or should the medication be withheld).

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Planning

Planning

Equipments

Clean gloves

Sterile absolvent sponge soaked in sterile normal saline

Sterile normal saline

Medicine

Sterile eye dressing pack and paper eye tape to secure it

For irrigation add the following; irrigation solution (e.g. normal saline) and irrigation syringe or tubing

Dry Sterile absolvent sponge

Moisture resistant towel

Basin- 2

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Performance

Performance

Inform the patient about the procedure.

Wash hands and prepare the equipment and the drug.

Provide for the client privacy.

Assist a patient to a comfortable position either sitting or lying.

Put on clean gloves.

Clean the eyelid and eyelashes using sterile cotton balls moistened with sterile irrigating solution or sterile normal saline.

Wipe from inner canthus to the outer canthus.

If not removed, material on the eyelid and eyelashes can be washed into the eye.

Cleaning toward the outer canthus prevents contamination of the other eye and the lacrimal duct.

Administer the eye medication.

Check the ophthalmic preparation for the name, strength, and the number of drops if a liquid is used.

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Checking medication data is essential to prevent medication error.

Checking medication data is essential to prevent medication error.

Draw the correct number of drops into the shaft of the dropper if a dropper is used.

In case of an ointment is used, discard the first bead.

The first bead of ointment from the tube is considered to be contaminated.

Instruct the patient to look up and focus on something on the ceiling.

Give the client a dry sterile absorbent sponge.

The person is less likely to blink if looking up and the cornea is partially protected by the upper eyelid.

A sponge is needed to press on the nasolacrimal duct after the liquid instillation or to wipe excess ointment from the eyelashes after an ointment is instilled.

Wipe away any secretions from the inner toward the outer canthus of the eye and discard the soiled swabs in the receiver.

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Allow the prescribed drops to fall gently on the lower conjunctival sac.

Gently separate the eye-lids with your left hand and apply traction to the lower lid over the bony prominence of the cheek.

The lower conjunctival sac is exposed as the lower eye-lid is retracted down-wards. If the tissues are oedematous handle the tissues carefully to avoid damaging them.

Approach the eye from the side and instil the correct number of drops onto the outer third of the lower conjunctival sac.

Allow the prescribed drops to fall gently on the lower conjunctival sac.

The dropper should not be held more than two centimetres above the eye.

Care should be taken not to touch the eye-lid or eye-lashes.

Never allow drops to touch the sensitive cornea

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Instruct the patient to close his eye-lids but not to squeeze them shut.

Instruct the patient to close his eye-lids but not to squeeze them shut.

Closing the eye spreads the medication over the eyeball.

For liquid medication press firmly or have the client press firmly on the nasolacrimal duct for at least 30 seconds.

Pressing on the nasolacrimal duct prevents the medication from running out of eye and down the duct.

Wipe from the lids any excess solution.

Apply the sterile eye pad if needed and secure it with paper eye tape.

Record all the relevant information.

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Procedure for Instillation of Ear Drops

Procedure for Instillation of Ear Drops

Purpose

Ear drops are instilled in the auditory canal for their local effect.

The effects intended include to

Soften ear – wax

Relieve pain

Treat infections

To apply local anaesthetic

Assess

Appearance of the pinna of the ear and the meatus for signs of redness and abrasions.

Type and amount of discharge

Determine if assessment data influence the administration of the medication.

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Planning

Planning

Equipment: A tray containing

Prescribed eye drops.

Sterile ear dropper.

Galipot with sterile swabs.

Clean gloves.

Cotton- tipped applicator.

Kidney dish for used swab.

Sterile pipette if the medicine bottle has no dropper.

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Performance

Performance

Wash hands and assembles supplies.

Identify patient and explain the procedure.

Provide for patient privacy.

Correctly position the patient sitting or lying: If the patient is sitting, request him to tilt his head to the side so that the ear to be treated.

Clean the pinna of the ear and the meatus of the inner canal using cotton applicators and solution.

Check medication including expired date.

Draw the prescribed amount of medication.

Put on gloves.

Gently pull the top of the ear upward and downward.

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Install the correct amount of prescribed dose of medication into the ear.

Install the correct amount of prescribed dose of medication into the ear.

Instruct the patient to maintain his position for about 5 minutes to prevent the escape of the drops. A loose cotton mop may be inserted.

Wipe excessive drops thank the patient and leave him/her comfortable.

Dispose used supplies.

Remove gloves and wash hands.

Documents the medication.

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Lifespan Considerations

Lifespan Considerations

Infants/Children

Obtain assistants to immobilize an infant or young child in order to prevent accidental injury due to sudden movement during the procedure.

Infants and children under 3years of age direct the ear canal upward by gently pulling the pinna down and back and for older children more than 3 years pull the pinna upward and backwards.

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Administration of Nasal Drops

Administration of Nasal Drops

Nasal medications are usually administered by instillation, spray or nasal inhaler.

Many of the nasal drops act as vasoconstrictors and are used to relieve nasal congestion and stuff mess.

Great care should be taken when treating children as they may aspirate.

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Procedures

Procedures

Clean any secretion from the nose by telling the client to blow the nose.

Have the patient propped up with his head tilted well back.

This position will allow the drops to flow easily into the nares.

With the dropper, draw the prescribed amount of drops.

Hold the tip of the nose and instil the drops into the nose while avoiding touching the nares.

Have the patient remain in that position for 2-3 minutes.

Leave patient comfortable.

Document medication.

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Procedure for Instillation of Drugs by the Vaginal Route

Procedure for Instillation of Drugs by the Vaginal Route

Purpose

To treat or prevent infection

To reduce inflammation

To relieve vaginal discomfort

Assess

Vaginal orifice for inflammation

For complaints of vaginal discomfort (e.g. burning or itching)

Determine if assessment data influence the administration of the medication

Planning

Equipment

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Drape

Drape

Correct vaginal suppository or cream

Applicator for the vaginal cream

Clean gloves

Lubricant for the suppository

Disposable towel

Clean perineal pad

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Performance

Performance

Inform the patient about the procedure.

Wash hands and observe appropriate infection control procedures.

Provide privacy.

Ask patient to void in order to minimize discomfort during the procedure and prevent injuring the vaginal lining.

Position the patient supine with her knees flexed and spread apart to enable you to see the vagina orifice.

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Drape the patient to avoid exposing the patient.

Drape the patient to avoid exposing the patient.

Unwrap the suppository and put it on the opened wrapper or fill the applicator with prescribed cream, jelly or foam.

Assess and clean the perineal area after putting gloves.

Clean the vaginal orifice with warm water with antiseptic using cotton wool swabs.

Start from above the orifice moving downward towards the rectum in a single stroke.

Each swab is used once only.

Lubricate the suppository with warm water.

Using your left hand to open the vagina, insert the suppository gently into the vaginal canal.

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If the drug is in a form of a cream, fill the applicator with prescribed amount of cream.

If the drug is in a form of a cream, fill the applicator with prescribed amount of cream.

Insert the applicator gently into the vaginal canal following the normal contour of the vagina and press down the plunger to expel the prescribed amount of cream.

Remove the applicator gently.

Apply a sanitary pad to prevent medication soiling the patient's undergarments.

Ask the patient to remain in supine position for at least 5 to 10 minutes to allow the drug to be absorbed.

Clear and clean equipment.

Record the medication in the patient's chart.

If the prescribed vaginal medicine is to be given for some days, teach the patient self-administration (if appropriate).

Document everything done.

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Administration of Rectal Medications

Administration of Rectal Medications

Rectal medications are usually administered by instillation or insertion.

The medication may be in the form of a suppository, ointment, or enema.

Advantage

It avoids irritation of Upper Gastrointestinal Tract (GIT) in clients who encounter this problem.

It is advantageous when the medication has an objectionable taste or order.

The drug is released at a slower but steady rate.

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Performance

Performance

Assist patient to a left lateral position with the upper leg flexed.

Hold back the top bedclothes to expose the buttocks.

Put on gloves to the hand used to insert the suppository.

Unwrap the suppository and lubricate the smooth rounded end.

Lubricate the gloved index finger.

Encourage the client to relax by breathing through the mouth in order to relax the external anal sphincter.

Insert the suppository gently in the anal canal, rounded end first.

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Avoid embedding the suppository in the faeces in order for the suppository to be absorbed effectively.

Avoid embedding the suppository in the faeces in order for the suppository to be absorbed effectively.

Press the client’s buttocks for a few minutes.

Ask the client to remain in the left lateral or supine position for at least 5 minutes.

To help retain the suppository.

The suppository should be retained for at least 30 to 40 minutes.

Remove gloves, dispose accordingly and wash hands.

Document all that you have done.

An enema: The means of delivering a solution or medication into the rectum and colon.

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Indications of Enema

Indications of Enema

Used to cleanse the lower bowel in preparation for radiography, sigmoidoscopy, proctoscopy, endoscopy

Surgery

Other special procedures

The ready –to-use fleet enema may be utilized in a hospital, nursing home, extended care facility, home, or physician’s office.

It is not to be administered to children less than 2 years of age or to patients with undiagnosed abdominal pain.

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Safety Precaution Cardiac Patients

Safety Precaution Cardiac Patients

By introducing an enema or suppository into the rectum a vaginal response may occur.

This slows the heart rate, or could even cause it to stop.

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Key Points

Key Points

Topical route includes administration of medicine to the skin, eye, nose, ear, vagina and rectum.

Topical medications are applied to the skin and mucous membranes primarily for their local effects, although some systemic effects may occur.

Method of application differs from one site to another.

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Evaluation

Evaluation

What is topical route of drug administration?

What are the routes for administration of medicine topically?

What are the techniques of administering drug by any of the topical route that you choose.

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References

References

Adams, M. P. et al. (2008). Pharmacology for Nurses. A Pathophysiologic Approach. (2nd ed.). New Jersey: Pearson.

Kozier, B. et al. (2004). Fundamentals of Nursing. Concepts Process and Practice. (7th ed.). New Jersey: Pearson Education, Inc.

MOHSW (2008). Basic Nursing Procedures. A manual for Nursing Practice in Tanzania. (3rd ed.). Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.

Rice, J. (2006). Principles of Pharmacology for Medical Assisting (4th ed.). Delmar Cengage Learning.

Wong, D.L. et al. (2003). Nursing Care of Infants and Children (7thed.) Mosby

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you can either experience the pain of discipline or the pain of regret. The choice is yours

you can either experience the pain of discipline or the pain of regret. The choice is yours

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