1. Topical Medications PN 1 Nursing Skill Labs

2. Routes of Administration Skin application = inunction Eye instillation Ear instillation Nasal instillation Rectal administration Vaginal administration

3. 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

4. 6 Rights 1. Right medication 2. Right patient 3. Right dosage 4. Right route 5. Right time (and date) 6. Right documentation

5. 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

6. 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

7. Skin Application absorption is enhanced by cleaning the skin with soap and water prior to application make sure you dry it well

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

20. 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

21. 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

22. 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)

23. 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.

24. 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