给 药 ( 四 ) 中国医科大学护理学院 王健

Medications (four)

Topical Medications Topical medications are those that are applied locally to the skin or to mucous membranes in areas such as the eye, external ear canal, nose, vagina, and rectum.

Skin Applications Topical skin or dermatologic preparations include ointments, pastes, creams, lotions, powders, sprays, and patches. Before applying a dermatologic preparation, thoroughly clean the area with soap and water and dry it with a patting motion. General guidelines for applying topical medications are shown in the following:

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 lotion 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 Lotions Warm and soften the preparation in the gloved hands to make it easier to apply and to prevent chilling. Smear it evenly over the skin using long strokes that follow the direction of the hair growth. Explain that the skin may feel somewhat greasy after application. Apply a sterile dressing if ordered by the physician. Creams, ointments, Pastes, and Oil-Based Lotions Warm and soften the preparation in the gloved hands to make it easier to apply and to prevent chilling. Smear it evenly over the skin using long strokes that follow the direction of the hair growth. Explain that the skin may feel somewhat greasy after application. Apply a sterile dressing if ordered by the physician.

Aerosol Spray Shake the container well to mix the contents. Hold the spray container at the recommended distance from the area. Cover the client ’ s face with a towel if the upper chest or neck is to be sprayed. Spray the medication over the specified area. Aerosol Spray Shake the container well to mix the contents. Hold the spray container at the recommended distance from the area. Cover the client ’ s face with a towel if the upper chest or neck is to be sprayed. Spray the medication over the specified area.

Transdermal Patches Select a clean, dry area that is free of hair and matches the manufacturer ’ s recommendations. Remove the patch from its protective covering, holding it without touching the adhesive edges, and apply it by pressing firmly with the palm of the hand for about 10 seconds. Advise 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 it so that the medicated side is covered. Transdermal Patches Select a clean, dry area that is free of hair and matches the manufacturer ’ s recommendations. Remove the patch from its protective covering, holding it without touching the adhesive edges, and apply it by pressing firmly with the palm of the hand for about 10 seconds. Advise 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 it so that the medicated side is covered.

Ophthalmic Instillations Medications for the eyes, called ophthalmic medications, are instilled in the form of liquids or ointments. The purposes are to provide an eye medication the client requires to treat an infection or for other reasons. How to administer ophthalmic instillations are in the following:

1.Check the medication order and the medication. 2.Prepare the client. 3.Clean the eyelid and the eyelashes. 4.Administer the eye medication. (see Figure 33-52, 33-53, 33-54) 1.Check the medication order and the medication. 2.Prepare the client. 3.Clean the eyelid and the eyelashes. 4.Administer the eye medication. (see Figure 33-52, 33-53, 33-54)

5.Clean the eyelids as needed. 6.Apply an eye pad if needed, and secure it with paper eye tape. 7.Assess the client ’ s response. 8.Document all relevant information.

Otic Instillations Medical aseptic technique is used to instill medications to the ear, called otic medications, unless the tympanic membrane is damaged, in which case sterile technique is used. How to administer otic instillations are in the following:

1.Check the medication order. 2.Prepare the client. 3.Clean the pinna of the ear and the meatus of the ear canal. 4.Administer the ear medication. (see Figure 33-55, 33-56) 5.Assess the client’s response. 6.Document all relevant information.

Nasal Instillations Nasal instillations (nose drops and sprays) usually are instilled for their astringent effect (to shrink swollen mucous membranes), to loosen secretions and facilitate drainage, or to treat infections of the nasal cavity or sinuses.

To treat the ethmoid and sphenoid sinuses, instruct the client to lie back with the head over the edge of the bed or a pillow under the shoulders so that the head is tipped backward.(Figure 33-57) To treat the ethmoid and sphenoid sinuses, instruct the client to lie back with the head over the edge of the bed or a pillow under the shoulders so that the head is tipped backward.(Figure 33-57)

To treat the maxillary and frontal sinuses, instruct the client to assume the same back-lying position, with the head turned toward the side to be treated (Figure 33-58). To treat the maxillary and frontal sinuses, instruct the client to assume the same back-lying position, with the head turned toward the side to be treated (Figure 33-58).

The client should also be instructed to (a) breathe through the mouth to prevent aspiration of medication into the trachea and bronchi. (b) remain in a back-lying position for at least 1 minute so that the solution will come into contact with all of the nasal surface. (c) avoid blowing the nose for several minutes.

Vaginal Instillations Vaginal medications, or instillations, are inserted as creams, jellies, foams, or suppositories to treat infection or to relieve vaginal discomfort, for example, itching or pain. Administering vaginal instillations are in the following:

1.Check the medication order and identify the client. 2.Prepare the client. 3.Position and drape the client appropriately. 4.Prepare the equipment. 5.Assess and clean the perineal area.

6.Administer the vaginal suppository, cream, foam, or jelly. (Figure 33-59,33-60) 7.Ensure client comfort. 8.Document all relevant information. 9.Assess the client ’ s response.

Rectal Instillation Insertion of medications into the rectum in the form of suppositories is a frequent practice.

To insert a rectal suppository: 1.Assist the client to a left lateral position, with the upper leg flexed. 2.Fold back the top bedclothes to expose the buttocks. 3.Don a glove on the hand used to insert the suppository. 4.Unwrap the suppository and lubricate the smooth rounded end.

5.Lubricate the gloved index finger. 6.Encourage the client to relax by breathing through the mouth. 7.Insert the suppository gently into the anal canal (Figure 33-61).

8.Avoid embedding the suppository in feces. 9.Press the client ’ s buttocks together for a few minutes. 10.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.

Respiratory Inhalation Medications administered by inhalation, such as bronchodilators, are frequently given to clients who have chronic respiratory disease such as asthma, emphysema, or bronchitis.

A metered-dose inhaler (MDI) is a handheld nebulizer (HHN) that can be used by clients to self-administer measured doses of an aerosol medication.(Figure 33-63, 33-64) A metered-dose inhaler (MDI) is a handheld nebulizer (HHN) that can be used by clients to self-administer measured doses of an aerosol medication.(Figure 33-63, 33-64)

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