给 药给 药(( 四四 ))中国医科大学护理学院

王健

Medications(four)

Topical Medications Topical medications are those

that are applied locally to the skin or to mucous membranes in areas such as the eye, external ear canal, nose, vagina, and rectum.

Skin ApplicationsSkin Applications Topical skin or dermatologic Topical skin or dermatologic preparations include ointments, preparations include ointments, pastes, creams, lotions, powders, pastes, creams, lotions, powders, sprays, and patches. Before applying sprays, and patches. Before applying a dermatologic preparation, a dermatologic preparation, thoroughly clean the area with soap thoroughly clean the area with soap and water and dry it with a patting and water and dry it with a patting motion. General guidelines for motion. General guidelines for applying topical medications are applying topical medications are shown in the following:shown in the following:

Powder Powder Make sure the skin surface is Make sure the skin surface is dry. Spread apart any skin folds, dry. Spread apart any skin folds, and sprinkle the site until the area and sprinkle the site until the area is covered with a fine is covered with a fine thinthin layer. layer. Cover the site with a dressing if Cover the site with a dressing if ordered.ordered.

Suspension-Based LotionSuspension-Based Lotion Shake the container before Shake the container before use to distribute suspended use to distribute suspended particles. Put a little lotion on a particles. Put a little lotion on a small gauze dressing or pad, and small gauze dressing or pad, and apply the lotion to the skin by apply the lotion to the skin by stroking it evenly in the direction stroking it evenly in the direction of the hair growth.of the hair growth.

Creams, ointments, Pastes, andCreams, ointments, Pastes, and Oil-Based Lotions Oil-Based Lotions Warm and soften the preparation in Warm and soften the preparation in the gloved hands to make it easier to the gloved hands to make it easier to apply and to prevent chilling. Smear it apply and to prevent chilling. Smear it evenly over the skin using long strokes evenly over the skin using long strokes that follow the direction of the hair that follow the direction of the hair growth. Explain that the skin may feel growth. Explain that the skin may feel somewhat greasy after application. somewhat greasy after application. Apply a sterile dressing if ordered by Apply a sterile dressing if ordered by the physician.the physician.

Aerosol SprayAerosol Spray Shake the container well to mix the Shake the container well to mix the contents. Hold the spray container at contents. Hold the spray container at the recommended distance from the the recommended distance from the area. Cover the client’s face with a area. Cover the client’s face with a towel if the upper chest or neck is to towel if the upper chest or neck is to be sprayed. Spray the medication be sprayed. Spray the medication over the specified area.over the specified area.

Transdermal PatchesTransdermal Patches Select a clean, dry area that is free of hair Select a clean, dry area that is free of hair and matches the manufacturer’s and matches the manufacturer’s recommendations. Remove the patch from its recommendations. Remove the patch from its protective covering, holding it without touching protective covering, holding it without touching the adhesive edges, and apply it by pressing the adhesive edges, and apply it by pressing firmly with the palm of the hand for about 10 firmly with the palm of the hand for about 10 seconds. Advise the client to avoid using a seconds. Advise the client to avoid using a heating pad over the area to prevent an heating pad over the area to prevent an increase in circulation and the rate of increase in circulation and the rate of absorption. Remove the patch at the absorption. Remove the patch at the appropriate time, folding it so that the appropriate time, folding it so that the medicated side is covered.medicated side is covered.

Ophthalmic InstillationsOphthalmic Instillations Medications for the eyes, called Medications for the eyes, called ophthalmic medications, are instilled ophthalmic medications, are instilled in the form of liquids or ointments. in the form of liquids or ointments. The purposes are to provide an eye The purposes are to provide an eye medication the client requires to treat medication the client requires to treat an infection or for other reasons.an infection or for other reasons. How How to administer ophthalmic instillations to administer ophthalmic instillations are in the following:are in the following:

1.1.Check the medication order and the Check the medication order and the medication.medication.2.Prepare the client.2.Prepare the client.3.Clean the eyelid and the eyelashes.3.Clean the eyelid and the eyelashes.4.Administer the eye medication.4.Administer the eye medication. (see Figure 33-52, 33-53, 33-54) (see Figure 33-52, 33-53, 33-54)

5.5.Clean the eyelids as needed.Clean the eyelids as needed.6.Apply an eye pad if needed, and 6.Apply an eye pad if needed, and secure it with paper eye tape.secure it with paper eye tape.7.Assess the client’s response.7.Assess the client’s response.8.Document all relevant 8.Document all relevant information.information.

Otic InstillationsOtic Instillations Medical aseptic technique is Medical aseptic technique is used to instill medications to the used to instill medications to the ear, called otic medications, unless ear, called otic medications, unless the tympanic membrane is the tympanic membrane is damaged, in which case sterile damaged, in which case sterile technique is used. How to technique is used. How to administer otic instillations are in administer otic instillations are in the following:the following:

1.1.Check the medication order.Check the medication order.2.Prepare the client.2.Prepare the client.3.Clean the pinna of the ear and the 3.Clean the pinna of the ear and the meatus of the ear canal.meatus of the ear canal.4.Administer the ear medication.4.Administer the ear medication.(see Figure 33-55, 33-56)(see Figure 33-55, 33-56)5.Assess the client’s response.5.Assess the client’s response.6.Document all relevant information. 6.Document all relevant information.

Nasal InstillationsNasal Instillations Nasal instillations (nose drops Nasal instillations (nose drops and sprays) usually are instilled for and sprays) usually are instilled for their astringent effect (to shrink their astringent effect (to shrink swollen mucous membranes), to swollen mucous membranes), to loosen secretions and facilitate loosen secretions and facilitate drainage, or to treat infections of the drainage, or to treat infections of the nasal cavity or sinuses.nasal cavity or sinuses.

••To treat the ethmoid and sphenoid To treat the ethmoid and sphenoid sinuses, instruct the client to lie sinuses, instruct the client to lie back with the head over the edge of back with the head over the edge of the bed or a pillow under the the bed or a pillow under the shoulders so that the head is tipped shoulders so that the head is tipped backward.(Figure 33-57)backward.(Figure 33-57)

••To treat the maxillary and frontal To treat the maxillary and frontal sinuses, instruct the client to sinuses, instruct the client to assume the same back-lying assume the same back-lying position, with the head turned position, with the head turned toward the side to be treated toward the side to be treated (Figure 33-58).(Figure 33-58).

The client should also be instructed to The client should also be instructed to (a) breathe through the mouth to (a) breathe through the mouth to prevent aspiration of medication into prevent aspiration of medication into the trachea and bronchi. the trachea and bronchi. (b) remain in a back-lying position for (b) remain in a back-lying position for at least 1 minute so that the solution at least 1 minute so that the solution will come into contact with all of the will come into contact with all of the nasal surface.nasal surface.(c) avoid blowing the nose for several (c) avoid blowing the nose for several minutes. minutes.

Vaginal InstillationsVaginal Instillations Vaginal medications, or Vaginal medications, or instillations, are inserted as instillations, are inserted as creams, jellies, foams, or creams, jellies, foams, or suppositories to treat infection or suppositories to treat infection or to relieve vaginal discomfort, for to relieve vaginal discomfort, for example, itching or pain. example, itching or pain. Administering vaginal Administering vaginal instillations are in the following:instillations are in the following:

1.1.Check the medication order Check the medication order and identify the client.and identify the client.2.Prepare the client.2.Prepare the client.3.Position and drape the client 3.Position and drape the client appropriately.appropriately.4.Prepare the equipment.4.Prepare the equipment.5.Assess and clean the perineal 5.Assess and clean the perineal area.area.

6.6.Administer the vaginal Administer the vaginal suppository, cream, foam, or jelly. suppository, cream, foam, or jelly. (Figure 33-59,33-60)(Figure 33-59,33-60)7.Ensure client comfort.7.Ensure client comfort.8.Document all relevant 8.Document all relevant information.information.9.Assess the client’s response.9.Assess the client’s response.

Rectal InstillationRectal Instillation Insertion of medications into Insertion of medications into the rectum in the form of the rectum in the form of suppositories is a frequent suppositories is a frequent practice.practice.

To insert a rectal suppository:To insert a rectal suppository:1.Assist the client to a left lateral 1.Assist the client to a left lateral position, with the upper leg flexed.position, with the upper leg flexed.2.Fold back the top bedclothes to 2.Fold back the top bedclothes to expose the buttocks.expose the buttocks.3.Don a glove on the hand used to 3.Don a glove on the hand used to insert the suppository.insert the suppository.4.Unwrap the suppository and 4.Unwrap the suppository and lubricate the smooth rounded end.lubricate the smooth rounded end.

5.5.Lubricate the gloved index finger.Lubricate the gloved index finger.6.Encourage the client to relax by 6.Encourage the client to relax by breathing through the mouth.breathing through the mouth.7.Insert the suppository gently into 7.Insert the suppository gently into the anal canal (Figure 33-61).the anal canal (Figure 33-61).

8.8.Avoid embedding the suppository in Avoid embedding the suppository in feces.feces.9.Press the client’s buttocks together 9.Press the client’s buttocks together for a few minutes.for a few minutes.10.Ask the client to remain in the left 10.Ask the client to remain in the left lateral or supine position for at least 5 lateral or supine position for at least 5 minutes to help retain the suppository. minutes to help retain the suppository. The suppository should be retained for The suppository should be retained for at least 30 to 40 minutes.at least 30 to 40 minutes.

Respiratory InhalationRespiratory Inhalation Medications administered by Medications administered by inhalation, such as bronchodilators, inhalation, such as bronchodilators, are frequently given to clients who are frequently given to clients who have chronic respiratory disease have chronic respiratory disease such as asthma, emphysema, or such as asthma, emphysema, or bronchitis.bronchitis.

A A metered-dose inhalermetered-dose inhaler (MDI) is (MDI) is a handheld nebulizer (HHN) that can a handheld nebulizer (HHN) that can be used by clients to self-administer be used by clients to self-administer measured doses of an aerosol measured doses of an aerosol medication.(Figure 33-63, 33-64)medication.(Figure 33-63, 33-64)

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