topical medication

1. Presented By
Mrs.Usha Rani Kandula, MSc(N),
Assistant professor in Adult health nursing, Department of Clinical nursing, Arsi
University, College of health sciences, Asella, Ethiopia, Institutional email:
usharani2020@arsiun.edu.et.

2. Administration of Topical Medications
-Topical medications may be administered to the skin, eyes, ears,
nose, throat, rectum, and vagina.
-The medication generally provides a local effect but can also cause
systemic effects.
-Drugs directly applied to the skin to produce a local effect include
lotions, pastes, ointments, creams, powders, and aerosol sprays.
-The rate and degree of the drug’s absorption are determined by
the vascularity of the area.

3. -Topical drugs are usually given to provide continuous absorption to
produce different effects: to relieve pruritus (itching), to protect the skin,
to prevent or treat an infection, to provide local anesthesia, or to create
a systemic effect.
-Topical medications are usually ordered two or three times a day to
achieve their therapeutic effect.

4. -Before applying a topical preparation, the nurse should assess the
condition of the skin for any open lesions, rashes, or areas of erythema
and skin breakdown.
-Because secretions are produced by the skin and mucous
membranes, the nurse should always implement Standard Precautions
when applying a topical
drug.

5. -The medication can be transferred to the nurse if gloves are not worn
or an applicator, such as a sterile tongue depressor, is not used.
-The nurse should check with the client and the medical record for any
known allergies.

6. -Body oils may interfere with the adhesive properties of the patch, disk,
or tape.
-The skin harbors microorganisms, and lesions can cause
encrustation.
-The nurse should cleanse the area by washing with soap and warm
water, unless contraindicated by a specific order.

7. -The skin should be thoroughly dry before a topical medication is
applied.
-Open wounds require the nurse to use surgical asepsis.
-When the skin is dry, the nurse can apply the medication.
-When applying a paste, cream, or an ointment, the nurse should use a
sterile tongue depressor to remove the medication from the container;
this method
prevents cross-contamination.

8. -The medication is transferred from the tongue blade to a gloved hand
for application.
-The medication should be applied in long, smooth strokes in the
direction of the hair follicles to prevent the medication from entering the
hair follicles.
-A new sterile tongue depressor should be used whenever more
medication is removed from the container.
-Two to 4 hours after the application, the nurse should assess the area
for signs of an allergic reaction.

9. EYE MEDICATIONS
-Eye medications, often referred to as ophthalmic medications, refer to
drops, ointments, and disks.
-These drugs are used for diagnostic and therapeutic purposes—to
lubricate the eye or socket for a prosthetic eye and to prevent or treat
eye conditions such as glaucoma (elevated pressure within the eye)
and infection.

10. -Diagnostically, eye drops can be used to anesthetize the eye, dilate
the pupil, and stain the cornea to identify abrasions and scars.
-The nurse should review the abbreviations used in medication orders
to ensure that the medication is instilled in the correct eye.
-Cross-contamination is a potential problem with eye drops.

11. -The nurse should adhere to the following safety measures to
prevent cross contamination:
-Each client should have his or her own bottle of eye drops.
-Clients should never share eye medications.
-Discard any solution remaining in the dropper after instillation.
-Discard the dropper if the tip is accidentally contaminated, as by
touching the bottle or any part of the client’s eye.
-The risk of transferring infection from one eye to the other is increased
if the tip touches any part of the client’s eye.

12. -The nurse should insert medication disks at bedtime because they
usually cause blurring of the eyes on insertion.
-Standard Precautions are used when eye care and medications are
being administered because of the potential contact with bodily
secretions.

13. EAR MEDICATIONS
-Solutions ordered to treat the ear are often referred to as otic
(pertaining to the ear) drops or irrigations.
-Eardrops may be instilled to soften ear wax, to produce anesthesia, to
treat infection or inflammation, or to facilitate removal of a forgien body,
such as an insect.
-External auditory canal irrigations are usually performed for cleaning
purposes and less frequently for applying heat and antiseptic solutions.

14. -The internal ear is very sensitive to changes in temperature.
-Sudden changes can cause nausea and dizziness.
- Eardrops and irrigation fluids should be at room temperature.
-Before instilling a solution into the ear, the nurse should inspect the
ear for signs of drainage, an indication of a perforated tympanic
membrane.

15. -The internal ear is very sensitive to changes in temperature.
-Sudden changes can cause nausea and dizziness.
- Eardrops and irrigation fluids should be at room temperature.
-Before instilling a solution into the ear, the nurse should inspect the
ear for signs of drainage, an indication of a perforated tympanic
membrane.

16. -Eardrops are usually contraindicated when the tympanic membrane is
perforated.
-If the tympanic membrane is damaged, all procedures must be
performed using sterile aseptic technique; otherwise, medical asepsis
is used when instilling medications into the ear.
-Medication should never be forced into the ear canal especially if it is
occluded (as by wax).

17. -Forcing medication into an occluded eardrum can injure the eardrum.
-Certain conditions have contraindications for specific drugs; for
example, hydrocortisone eardrops are contraindicated in clients with a
fungal infection or a viral infection such as herpes.

18. NASAL INSTILLATIONS
-Nasal instillations can be performed with different preparations: drops
or nebulizers (atomizer or aerosol).
-Nasal drugs are administered to produce one or more of the following
effects: to shrink swollen mucous membranes, to loosen secretions
and facilitate drainage, to treat infections of the nasal cavity or sinuses.
-Because many of these products are non-prescription drugs, clients
should be taught their correct usage.

19. -For example, nasal decongestants are common over-the-counter
drugs used to shrink swollen mucous membranes; however, when
these drugs mare used in excess, they may have a reverse or rebound
effect by increasing nasal congestion.
-The nasal sinuses (frontal, ethmoid, maxillary, and sphenoid sinuses)
communicate with the nasal fossae and are lined with mucous
membranes similar to those that line the nose.
-Nose drops can be instilled to remain in the nasal passage, to reach
the ethmoid and sphenoid sinuses, or to reach the frontal or maxillary
sinuses.

20. - Location is determined by the degree of hyperextension and position
of the head during instillation.
-Although the nose is considered a clean (not sterile) cavity, because
of its connection with the sinuses, the nurse uses medical asepsis
when performing nasal instillations.
-Nebulizers (inhalers) are used to deliver a fine mist containing
medication droplets.

21. The nurse should administer or assist clients with the usage of
atomizers and aerosols:
• Instruct the client to clear the nostrils by blowing the nose.
• Client should be in an upright position with head tilted back slightly.

22. Atomizer
• Occlude one nostril to prevent air from entering the nasal cavity and
to allow the medication to flow freely in the open nostril.
• Insert the atomizer tip into the open nostril and instruct the client to
inhale, then squeeze the atomizer once, and instruct the client to
exhale.

23. Aerosol
• Shake the aerosol well before each use.
• Grasp between thumb and index finger and insert the adapter tip into
one nostril while occluding the other nostril with a finger, then press the
adapter cartridge firmly to release one measured dose of medication.
• Repeat the above steps as ordered for the other nostril.
• Instruct the client to keep head tilted backward for 2 to 3 minutes and
to breathe through the nose while the medication is being absorbed.
-When the client is discharged with a nasal inhaler, the nurse should
teach the client how to store and use the device.

24. TEACH USE OF RESPIRATORY INHALANTS
-Respiratory inhalants are delivered by devices that produce fine
droplets that are inhaled deep into the respiratory tract.
-These medication droplets are absorbed almost immediately through
the alveolar epithelium into the bloodstream.
-Oropharyngeal hand-held inhalers deliver medications that produce
both local and systemic effects, such as bronchodilators and
mucolytics.
-Bronchodilators improve airway patency and are used to prevent or
treat bronchospasms, asthma, and allergic reactions.

25. -Mucolytics are used to liquify tenacious (thick) bronchial secretions.
There are three types of oropharyngeal hand-held inhalers: metered-
dose inhaler, turbo-inhaler, and the nasal inhaler (previously
discussed).
Clients must be able to form an airtight seal around the inhaling
devices and be able to assemble the turbo inhaler.
-This requirement prevents some clients, such as clients with visual or
coordination impairments, from using these devices.

26. -Bronchodilators are contraindicated in clients who have a history of
tachycardia.
-The nurse should ensure that the client knows how to use the inhaler
correctly so that the prescribed medication dose is delivered.
-A metered-dose inhaler delivers a measured dose of the medication
with each push of the canister.
-The nurse needs to evaluate the client’s ability to adequately
compress the inhaler to deliver a full dose and to inhale at the same
time as the dose is expressed.

27. - Failure to do either could prevent the client from receiving the full
benefit of the inhaler.
-The ability to compress the inhaler for dose delivery can be affected
by hand strength (which diminishes with age), flexibility (as in arthritic
changes), and disease related to weakness (such as chronic
respiratory disease).
-Careful discharge instructions and observation of the client performing
the task are important to continued therapeutic effect at home (see the
accompanying display for home care application).

28. RECTAL INSTILLATIONS
-Rectal instillations can be in the form of enemas, suppositories, and
ointments. See Chapter 39 for a complete discussion of enema
administration.
-Rectal ointments are used to treat local conditions and symptoms
such as pain, inflammation, and itching caused from hemorrhoids.
-Rectal suppositories are cone-shaped masses of substances
designed to melt at body temperature and to produce the intended
effect at a slow and steady rate of absorption.

29. -Suppositories provide a safe and convenient route for administering
drugs that interact poorly with digestive enzymes or have a bad taste
or odor.
-They are also used to provide temporary relief for clients who cannot
tolerate oral preparations: for example, to relieve nausea and vomiting.
-Suppositories are also used to induce relaxation, relieve pain and
local irritation, reduce fever, and stimulate peristalsis and defecation in
clients who are constipated.

30. -Rectal suppositories are contraindicated in cardiac clients because
insertion may stimulate the vagus nerve, causing cardiac dysrhythmias
(abnormal heart patterns).
-These drugs are also avoided in clients recovering from rectal or
prostate surgery because they may cause pain on insertion and
trauma to the tissues.
-The nurse should assess the rectum for irritation or bleeding and
check sphincter control. Some clients may experience problems in
retaining the suppository.

31. -The nurse should instruct such a client to remain in the Sims’ position
for at least 15 minutes or should place the client on the abdomen, if the
condition allows, and hold the buttocks closed.
-The health care practitioner should be notified when the client is
unable to retain a suppository so that another route can be ordered.
-Suppositories are often stored in the refrigerator to preserve the
integrity of the drug form.

32. -A softened suppository is difficult to insert; to harden a suppository,
place it under cold running water while it is still in its original wrapper.
-The nurse should follow the five rights of medication administration
and Standard Precautions when administering rectal instillations.

33. VAGINAL INSTILLATIONS
-Medications inserted into the vagina are in the form of suppositories,
creams, gels, ointments, foams, or douches.
-These medications may be used to treat inflammation, infections, and
discomfort, or as a contraceptive measure.
-Vaginal creams, gels, or ointments usually come with a disposable
tubular applicator with a plunger to insert the drug.
-Standard precautions are always used by the nurse when inserting
suppositories.

34. -Body temperature causes the suppository to melt and be absorbed.
-Suppositories are usually inserted with the index finger of a gloved
hand;
-however, small suppositories may come with an applicator and the
suppository is placed in the applicator’s tip.
-Many clients prefer to insert their own vaginal suppository.
-In this case, provide privacy for the client.

35. -After insertion of these preparations, the client may notice drainage
and should be informed that this is expected.
-If a suppository is given to treat infection, tell the client that the
drainage may be foul smelling.
-The nurse should advise the client to wear a perineal pad to prevent
soiling of the underpants.
-Sterile technique is usually required by agency policy, especially if
there is an open wound when administering a vaginal douche
(irrigation).

36. -Douches are ordered to apply antimicrobial solutions, to remove
offensive or irritating discharge, to reduce inflammation, and to prevent
hemorrhage with warm or cold irrigations.
-The nurse should ensure that the client does not have an allergy to
iodine because many vaginal preparations contain povidone-iodine.
Thanking you