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Vaginal instillation

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a procedure to instill the drug into vagina.
will be helpful for neophyte nurses and student nurses.

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Vaginal instillation

  1. 1. Prepared by- Aashish Parihar m.sc. nursing
  2. 2. Introduction Advantages Disadvantages Forms of medication General instructions Articles required Procedure
  3. 3. Introduction Vagina is route for administration for contraceptives, antifungal and anti microbial. It is used for the achievement of local and systemic absorption. Vaginal medications include suppositories, creams, gels, and ointments. Suppositories melt when they contact the vaginal mucosa, and their medication diffuses topically (as effectively as creams, gels, and ointments). Vaginal medications usually come with a disposable applicator that enables placement of medication in the anterior and posterior fornices.
  4. 4. Advantages Prolonged release. Minimal systemic side effects. An increase in bioavailability. Use of less total drug than an oral dose. First-pass metabolism can be avoided. Self medication is possible.
  5. 5. Disadvantages Patient incompliance. Only a few drugs are administered by this route. Variability in drug absorption related with menstrual cycle, menopause and pregnancy, can also limit vaginal drug delivery route usage. Influence with sexual intercourse. Gender specificity.
  6. 6. Forms of vaginal medication Many different types of formulations have been applied vaginally as-  Tablets  Vaginal suppositories or pessaries (globular, oviform or cone-shaped, and weighing about 5 g each. )  Douches (aqueous solutions that are administered into the vagina for cleansing purpose. )  Foams  Sprays  Gels  Creams  Vaginal rings (Creams, gels, sprays and foams are used as vehicles for drugs such as anti-infective or contraceptive agents.)
  7. 7. General instructions To prevent damage, suppositories must be stored in refrigerator. Foams, jellies, and cream are administered with an inserter or applicator. Perineal pads may be used to collect excess drainage after inserting a suppository. Good aseptic technique must be followed. Good perineal hygiene must be maintained. The patient should be encouraged to empty her bladder as she has to lie down for 20 minutes The patient can either lie supine with knees up or lateral with knees up Always lubricate the pessary or applicator before inserting
  8. 8. Articles required A clean tray containing-  Medication administration record (MAR)  Nonsterile gloves  Mackintosh  Prescribed vaginal suppository or any other form of vaginal medication  Perineal pads  Water-soluble lubricant  Disposable applicator  Tissue paper/ cotton balls  Paper bag  Kidney tray And  Side screen
  9. 9. Procedure Preliminary assessment-  Review the physician’s order, patient’s name, name and form of vaginal medication, dosage and time.  Explain procedure to patient. If client plans to self-administer, be very specific with instructions.  Gather necessary equipment.  Follow the rights of medication administration.  Ask the client to void.  Provide for privacy.  Wash hands  Don Nonsterile gloves.  Position the client in a dorsal recumbent position with knees flexed and hips rotated laterally or in a Sims’ position.  Assess perineal area, inspect vaginal orifice, note any odor or discharge from the vagina, and inquire about any problems such as itching or discomfort.
  10. 10. Procedure  If secretion or discharge is present, cleanse the perineal area with soap and water.  Remove suppository from the foil wrapper and, if applicable, insert into applicator tip.  Apply a small amount of lubricant to rounded tip of suppository.  If not using an applicator, apply a small amount of lubricant to gloved index finger.  With non dominant hand, spread labial folds. Insert the suppository into the vaginal canal at least 2 inches (5 cm) along the posterior wall of the vagina or as far as it will go  If using an applicator, insert as described above and depress plunger to release suppository.
  11. 11. Procedure After care-  Wipe the perineum with clean, dry tissue.  Instruct the client to remain in bed for 15 minutes.  Wash applicator under cool running water to clean and return to appropriate storage in the client’s room.  Remove gloves, turning them inside out, dispose them.  Wash hands.  Record on the MAR the drug’s name dosage, route, and date and time of administration; document any evidence of discharge or odor from the vagina.  Check with the client in 15 minutes to ensure that the suppository did not slip out and to allow the client to verbalize any problems or concerns.  Observe for effectiveness of the medication; inspect the condition of the vaginal canal and external genitalia between applications.

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