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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 - PowerPoint PPT Presentation
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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• 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 anti-inflammatory drugs. Primary effect will be local in the lungs
Describe the procedure for:
• 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 pullingthe 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 & IMAll well covered in Perry & Potter pp.889-900Administering sc Administering IM For Labs, Know your
Land markingAdministration
Intradermal
Figure 33.28a
Figure 33.28b
Subcutaneous • Only small doses of meds via sc
• 0.5 to 1ml• Use syringe appropriate to med
• 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 sites1. Ventrogluteal (von Hochsterer’s site) is in
gluteus medius muscle is preferred site2. Vastus lateralis – esp for children3. Dorsogluteal – not used in children < 3yrs4. Deltoid – no more than 1ml tolerated5. 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