PART C:
ADMINISTRATION
OF TOPICAL AND
INHALANT
MEDICATION
Topical Medications
•
Topical agents commonly used for a
local effect
•
•
Dermal medications (lotions, creams)
are applied to rashes, lesions or burns
for their local anti-inflammatory,
antiinfective or anesthetic effect
Inflamed, abraded or denuded skin will
absorb drugs readily as will hydrated
skin
•
•
Most topical drugs act on the
skin but are not absorbed
through the skin
Some medications are specially
formulated to be applied (via
adhesive patch or disc) for slow
absorption thru the skin
(transdermally) >>>>>>>>>
Topical/Transdermal
•
•
•
Transdermal preparations allow drugs to be
delivered at constant rates over several days
(nicotine, nitrodur, duragesic, estrogen)
Advantage of this system is much less of the
drug is lost to metabolism in the GI tract or
liver before it reaches the blood stream
Another benefit is to Home Clients on
medication as allows for fewer
administration times allowing clt more
mobility
Topical/ophthalmic medications
•
Most often administered for
•
•
•
•
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Infections or inflammations of eye
Glaucoma
Diagnostic purposes
Topically applied eye meds used mostly for their
local effects
Unwanted systemic effects are possible if the
drops drain thru the tear duct & enter the
systemic circulation via the nasal mucousa
absorption
Topical/Nasal Drops
•
•
Most administered for local effect
(as in antihistamines), some can be given
for a systemic effect
Since nasal mucous membranes absorb
drugs readily, an intended local may
sometimes result in systemic toxicity
•
it is essential you understand purpose for
drug being administered as well as
rationale for particular drug route of
administration
Topical/otic meds
•
Usually come in liquid form & administered to
treat conditions of external ear. If not
effective, systemic drugs used
• eg. Chloromycetin otic gtts are antibiotic for
external ear canal infections
• Can also have systemic effects
(chloromycetin gtts can cause bone marrow
depression)
Inhalant medications
•
Drug droplets, vapor or gas are administered
through mucous membranes of respiratory tract
via use of
•
•
•
•
•
Face mask
Nebulizer
Positive pressure machine
Metered dose inhalers
Some drugs administered by inhalation will be
bronchodilator, mucolytic & some antiinflammatory drugs. Primary effect will be local
in the lungs
Describe the procedure for:
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•
•
•
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Instilling eye drops
Applying ointment to the
eye
Instilling nose drops
Administering ear drops
and ear irrigation
Administering rectal and
vaginal suppositories
Skin applications
Metered dose inhalants
Instilling eye drops
Applying ointment to the eye
Instilling nose drops
Administering ear drops
Straightening the ear canal of a child by pulling
the pinna down and back.
rectal suppositories
vaginal suppositories
Skin applications
Transdermal patch = prepared medicated
PART D: PREPARATION OF
MEDICATION FROM
AMPULES AND VIALS
•
Identify parts of a needle and syringe
Syringe – has three parts:
•
•
•
tip, which connects with
the needle;
barrel or outside part, on
which the scales are
printed;
plunger, which fits inside
the barrel.
• Most
commonly used
types of syringes:
hypodermic,
the
insulin,
the tuberculin syringe
Size of needle, type and size of syringe
Syringe
•
Hypodermic syringes come
in
• 2,
• 2.5,
• and 3ml or 5ml sizes.
Hypodermic syringe marked
in tenths of a ml & in minims
•They usually have two scales marked on them:
•the minim = used for very small dosages
•the milliliter = the one normally used
Size of needle, type and size of syringe …
•
Insulin syringes are similar to
hypodermic syringes (not
interchangeable!), but they have a scale
specially designed for insulin:
• 100-unit calibrated scale intended for
use with U-100 insulin.
• Several low-dose insulin syringes are
also available and frequently have a
nonremovable needle.
Insulin syringe marked
in 100 units
Size of needle, type and size of syringe …
•
Tuberculin syringes (originally designed
to administer tuberculin) are narrow,
calibrated in tenths and hundredths of a
milliliter (up to 1ml) on one scale and in
sixteenths of a minim (up to 1 minim) on
the other scale.
•
also useful in administering other drugs,
particularly when small or precise
measurement is indicated (peds).
Tuberculin syringe
marked in tenths & hundreds of
cubic ml & in minims
• When
handling a syringe
the tip and inside of the
barrel, the shaft of the
plunger, and the shaft and
tip of the needle must
remain sterile.
hypodermic
insulin
tuberculin
•
Needle – has three parts:
the hub, which fits onto the syringe;
• the cannula, or shaft, which is
attached to the hub;
• the bevel, which is the slanted part
at the tip of the needle.
•
Size of needle, type and size of syringe …
Needle
• The bevel of the needle may be short or
long.
•
•
Longer bevels provide sharpest
needles and cause less discomfort
and are commonly used for
subcutaneous and intramuscular
injections.
Short bevels are used for intradermal
and intravenous injections.
Size of needle, type and size of syringe …
•
•
The shaft length of commonly used
needles varies from ½ to 2 inches.
The appropriate needle length is
chosen according to the
•
•
•
client’s muscle development,
client’s weight,
type of injection.
Size of needle, type and size of syringe …
•
The gauge (or diameter) of the shaft varies
from #18 to #28.
•
•
The larger the gauge number, the
smaller the diameter of the shaft.
Smaller gauges produce less tissue
trauma, but larger gauges are
necessary for viscous medications,
such as penicillin.
•
Demonstrate the ability to assemble a
needle and syringe, withdraw
solutions from ampules and vials, mix
medications from an ampule and vial,
and prepare an injection from an
ampule and a vial.
Ampules
versus
Vial
Drawing medication from an ampule.
Break neck of amp Away from hands
Draw up medication with ampule upright
Medication can also be drawn upwards from ampule
Drawing from a vial
Mixing meds in 1 syringe P. 33-4
Figure 33.26
Administering SC, ID & IM
All well covered in Perry & Potter
pp.889-900
Administering sc
Administering IM
For Labs, Know your
Land marking
Administration
Intradermal
Figure 33.28a
Figure 33.28b
Subcutaneous
•
Only small doses of meds via sc
•
•
Use syringe appropriate to med
•
•
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•
0.5 to 1ml
E.g. hypodermic, tuberculin or insulin
Usually a #25, 5/8 inch needle used for
normal sized adult pt
Insert at 90 or 45 degree angle dependent
upon size
Sites need to be rotated systematically
Sites for subcutaneous injections
Figure 33.29
Insertion for sc at 45 or 90 degree angle
Figure 33.30
Intramuscular injections
•
•
•
•
Absorbed quicker than by sc (as more blood flow)
Can also tolerate more volume by IM than sc
• Well developed muscles can tolerate up to 4ml
(in gluteus medius & gluteus maximus).
• If they have less developed muscles can
tolerate 1 – 2 ml
• Deltoid tolerates 0.5 to 1ml
Usually a 2 to 5 ml syringe used
Standard needle size is #21 or #22, 1½ inch
To
form the Z track at the injection site, use the ulnar
side of your nondominant hand to pull the skin and
subcutaneous tissue about 1 inch (2.5 cm) to the side.
Hold the skin in this position until you've administered
the injection.
Quickly
withdraw the needle and release the displaced
tissue. Apply gentle pressure to the site with a dry sponge.
Factors to determine needle size & length
•
•
•
•
Muscle to be used (if deltoid, often #23 to
#25, 1 inch)
Type of solution (if very thick, may need
#20)
Amount of adipose tissue (very obese
may require 2 inch needle, very thin may
require 1 inch)
Age of client (infants & children will
usually require smaller, shorter needles
(#22 to #25, 5/8 to 1 inch)
Intramuscular sites
1.
2.
3.
4.
5.
Ventrogluteal (von Hochsterer’s site) is in
gluteus medius muscle is preferred site
Vastus lateralis – esp for children
Dorsogluteal – not used in children < 3yrs
Deltoid – no more than 1ml tolerated
Rectus femoris – rarely used as causes
discomfort
Shows gluteal muscles used for IM
Figure 33.32
Marking ventrogluteal site
Figure 33.33
Vastus lateralis site
Figure 33.35
Dorsogluteal site
Figure 33.36
Deltoid muscle
Figure 33.37
Deltoid landmarking
Figure 33.38