Health Assmnt Unit 9

Systemic effects of topical meds

more likely to occur if

- thin skin

- high med conc.

- prolonged skin contact

- applied to non-intact skin

Topical medications

- lotions, transdermal patches, pastes, ointments

- applied to skin, mucous membranes or tissues

Med checks

1. when removing from drawer/cabinet

2. prior to preparing for administration

3. at pt bedside

Skin hydration

enhances absorption of topical meds

- if dry, apply when skin damp

NTG patches

- on in AM, off in PM

- apply to chest, back, abdomen, or anterior thigh

- apply on nonhairy, nonscarred, intact skin

- rotate sites (1 week)

- date, time, and initials on new patch

If transdermal patch falls off...

... apply new one immediately or at next scheduled dose, depending on med

Changes in skin of older persons

increased fragility, wrinkling, dryness, flaking, bruising

Documentation in MAR

circle time when bringing meds to bedside, initial after taken by pt

Ophthalmic medications

drops, ointments, or intraocular discs administered to conjunctival sac of eye (not directly in cornea)

- administer at room temp

- temporary blurred vision and light sensitivity may occur

Administering 2+ eye meds

wait 10 mins in between so first one is absorbed and is not washed out by other

- eye ointments last

Systemic effects from eye meds

to prevent, apply gentle pressure to nasolacrimal duct for 30-60s

- if occurs, notify HCP, assess V/S, withhold doses

Mydriatics

meds to dilate pupils; may temporarily blur vision and cause light sensitivity

Otic meds

ear meds, usually in a solution and instilled as dropped; administer at room temp

Cold ear drops

can cause vertigo, nausea, or debilitate a pt for several mins

Medications that require exact timing

STAT, first-time, loading, and 1-time doses

10 rights of medication administration

1. Medication

2. Dose

3. Time

4. Route

5. Client

6. Client Education

7. Documentation

8. to Refuse

9. Assessment

10. Evaluation

Nasal instillations

nose drops, sprays, or tampons for nasal sinus problems

Longterm use of decongestants

can worsen congestion because of rebound effect

Nasal instillations to ethmoid or sphenoid sinus

tilt head back over EOB or place small pillow under pt's shoulder and tilt head back

Nasal instillations to frontal and maxillary sinus

tilt head back over EOB or pillow with head turned toward side (nostril) to be treated

Metered-dose inhalers

disperses med thru an aerosol spray, mist, or powder that penetrates the airways

- shake for 2-5s, exhale completely before and hold breath for 10s after

Dry powder inhalers

deliver inhaled med in a fine powder formulation to respiratory tract

Spacer or BAI

assists with administration of inhaled med for pts with poor coordination of breathing cycle or poor hand coordination

Incorrect activation of inhalers

usually occurs when canister is depressed before taking a breath

Multiple doses of same inhaler med

wait 20-30s between inhalations

Multiple doses of different inhaler meds

wait 2-5 mins between inhalations

Corticosteroid inhalers

rinse mouth 2 mins after last dose to prevent development of fungal infection

Nebulization

the process of adding meds or moisture to inspired air by mixing particles of various sizes with air; improves clearance of pulmonary secretions

- ex. bronchodilators, mucolytics, corticosteroids

Small-volume nebulizers

convert a med solution into a mist that is inhaled by pt into tracheobronchial tree

- much finer droplets than in MDIs or DPIs

Assessment for small-volume nebulizers

HR, RR, breath sounds, SpO2

Dyspnea + small-volume nebulizers

encourage pt to hold every fourth or fifth breath for 5-10s to maximize effectiveness of med; repeat until med fully nebulized (10-15mins)

Vaginal instillations

vaginal meds available as foam, jelly, cream, suppository, or irrigations/douches; treat infections

- dorsal recumbent, remain for 10mins after

- room temp

Rectal suppository

med delivery system designed to be inserted into rectum, where it melts and releases the med and is absorbed into rectal mucosa and enters bloodstream

Body position for rectal suppository

left lateral recumbent with upper leg flexed up

Contraindications for rectal suppositories

recent surgery on rectum, bowel, prostate gland; rectal bleeding or prolapse; very low platelet counts

Vagal stimulation

bradycardia; can be caused by rectal suppositories