PART C: ADMINISTRATION OF TOPICAL AND INHALANT MEDICATION

Topical Medications Topical agents commonly used for a local effect Dermal medications (lotions, creams) are applied to rashes, lesions or burns for their local anti-inflammatory, antiinfective or anesthetic effect Inflamed, abraded or denuded skin will absorb drugs readily as will hydrated skin

Most topical drugs act on the skin but are not absorbed through the skin Some medications are specially formulated to be applied (via adhesive patch or disc) for slow absorption thru the skin (transdermally) >>>>>>>>>

Topical/Transdermal Transdermal preparations allow drugs to be delivered at constant rates over several days (nicotine, nitrodur, duragesic, estrogen) Advantage of this system is much less of the drug is lost to metabolism in the GI tract or liver before it reaches the blood stream Another benefit is to Home Clients on medication as allows for fewer administration times allowing clt more mobility

Topical/ophthalmic medications Most often administered for Infections or inflammations of eye Glaucoma Diagnostic purposes Topically applied eye meds used mostly for their local effects Unwanted systemic effects are possible if the drops drain thru the tear duct & enter the systemic circulation via the nasal mucousa absorption

Topical/Nasal Drops Most administered for local effect (as in antihistamines), some can be given for a systemic effect Since nasal mucous membranes absorb drugs readily, an intended local may sometimes result in systemic toxicity it is essential you understand purpose for drug being administered as well as rationale for particular drug route of administration

Topical/otic meds Usually come in liquid form & administered to treat conditions of external ear. If not effective, systemic drugs used eg. Chloromycetin otic gtts are antibiotic for external ear canal infections Can also have systemic effects (chloromycetin gtts can cause bone marrow depression)

Inhalant medications Drug droplets, vapor or gas are administered through mucous membranes of respiratory tract via use of Face mask Nebulizer Positive pressure machine Metered dose inhalers Some drugs administered by inhalation will be bronchodilator, mucolytic & some anti- inflammatory drugs. Primary effect will be local in the lungs

Describe the procedure for: Instilling eye drops Applying ointment to the eye Instilling nose drops Administering ear drops and ear irrigation Administering rectal and vaginal suppositories Skin applications Metered dose inhalants

Instilling eye drops

Applying ointment to the eye

Instilling nose drops

Administering ear drops

child Straightening the ear canal of a child by pulling the pinna down and back.

rectal suppositories

vaginal suppositories

Skin applications

Transdermal patch = prepared medicated

PART D: PREPARATION OF MEDICATION FROM AMPULES AND VIALS

Identify parts of a needle and syringe Syringe – has three parts: tip tip, which connects with the needle; barrel barrel or outside part, on which the scales are printed; plunger plunger, which fits inside the barrel.

Most commonly used types of syringes:  hypodermic,  the insulin,  the tuberculin syringe

Size of needle, type and size of syringe Syringe Hypodermic syringes come in 2, 2.5, and 3ml or 5ml sizes.

Hypodermic syringe marked in tenths of a ml & in minims They usually have two scales marked on them: the minim = used for very small dosages the milliliter = the one normally used

Size of needle, type and size of syringe … Insulin syringes are similar to hypodermic syringes (not interchangeable!), but they have a scale specially designed for insulin: 100-unit calibrated scale intended for use with U-100 insulin. Several low-dose insulin syringes are also available and frequently have a nonremovable needle.

Insulin syringe marked in 100 units

Size of needle, type and size of syringe … Tuberculin syringes (originally designed to administer tuberculin) are narrow, calibrated in tenths and hundredths of a milliliter (up to 1ml) on one scale and in sixteenths of a minim (up to 1 minim) on the other scale. also useful in administering other drugs, particularly when small or precise measurement is indicated (peds).

Tuberculin syringe marked in tenths & hundreds of cubic ml & in minims

When handling a syringe the tip and inside of the barrel, the shaft of the plunger, and the shaft and tip of the needle must remain sterile.

hypodermic insulin tuberculin

Needle – has three parts: hub the hub, which fits onto the syringe; cannula the cannula, or shaft, which is attached to the hub; bevel the bevel, which is the slanted part at the tip of the needle.

Size of needle, type and size of syringe … Needle The bevel of the needle may be short or long. Longer bevels provide sharpest needles and cause less discomfort and are commonly used for subcutaneous and intramuscular injections. Short bevels are used for intradermal and intravenous injections.

Size of needle, type and size of syringe … The shaft length of commonly used needles varies from ½ to 2 inches. The appropriate needle length is chosen according to the client’s muscle development, client’s weight, type of injection.

Size of needle, type and size of syringe … The gauge (or diameter) of the shaft varies from #18 to #28. The larger the gauge number, the smaller the diameter of the shaft. Smaller gauges produce less tissue trauma, but larger gauges are necessary for viscous medications, such as penicillin.

Demonstrate the ability to assemble a needle and syringe, withdraw solutions from ampules and vials, mix medications from an ampule and vial, and prepare an injection from an ampule and a vial.

Ampules versus Vial

Drawing medication from an ampule. Break neck of amp Away from hands

Draw up medication with ampule upright

Medication can also be drawn upwards from ampule

Drawing from a vial

Mixing meds in 1 syringe P. 33-4

Administering SC, ID & IM All well covered in Perry & Potter pp  Administering sc  Administering IM  For Labs, Know your  Land marking  Administration

Intradermal

Subcutaneous Only small doses of meds via sc 0.5 to 1ml Use syringe appropriate to med E.g. hypodermic, tuberculin or insulin Usually a #25, 5/8 inch needle used for normal sized adult pt Insert at 90 or 45 degree angle dependent upon size Sites need to be rotated systematically

Sites for subcutaneous injections

Insertion for sc at 45 or 90 degree angle

Intramuscular injections Absorbed quicker than by sc (as more blood flow) Can also tolerate more volume by IM than sc Well developed muscles can tolerate up to 4ml (in gluteus medius & gluteus maximus). If they have less developed muscles can tolerate 1 – 2 ml Deltoid tolerates 0.5 to 1ml Usually a 2 to 5 ml syringe used Standard needle size is #21 or #22, 1½ inch

 To form the Z track at the injection site, use the ulnar side of your nondominant hand to pull the skin and subcutaneous tissue about 1 inch (2.5 cm) to the side.  Hold the skin in this position until you've administered the injection.  Quickly withdraw the needle and release the displaced tissue. Apply gentle pressure to the site with a dry sponge.

Factors to determine needle size & length Muscle to be used (if deltoid, often #23 to #25, 1 inch) Type of solution (if very thick, may need #20) Amount of adipose tissue (very obese may require 2 inch needle, very thin may require 1 inch) Age of client (infants & children will usually require smaller, shorter needles (#22 to #25, 5/8 to 1 inch)

Intramuscular sites 1. Ventrogluteal (von Hochsterer’s site) is in gluteus medius muscle is preferred site 2. Vastus lateralis – esp for children 3. Dorsogluteal – not used in children < 3yrs 4. Deltoid – no more than 1ml tolerated 5. Rectus femoris – rarely used as causes discomfort

Shows gluteal muscles used for IM

Marking ventrogluteal site

Vastus lateralis site

Dorsogluteal site

Deltoid muscle

Deltoid landmarking