!70- Topical, Eye/Ears/Nose,Inhaled medications

Question 1

What is an enema?

Answer 1

The instillation of a solution into the rectum and sigmoid colon to promote defecation by stimulating peristalsis through infusion of large volumes of solution

Question 2

Kinds of enemas?

P&P- pp. 852-856

Answer 2

• Oil retention enemeas = lubricating rectum and colon making It easier to pass
• Medicated enemas- contain pharmacologic therapeutic agents. Some are prescribed to reduce dangerously high serum potassium levels (sodium polystyrene sulfonate) or to reduce bacteria in the colon before bowel surgery (neomycin enema)
• Tap water enema (hypotonic)= not repeated after first installation because water toxicity or circulatory overload can develop
• Physiologic normal saline= safest to administer
• Hypertonic solution (fleet enema)= patients who cannot tolerate lrg volumes of fluid (120-180 ml)
• Harris flush enema= fluid flows into and out of large intestine
• Soapsuds enema (sse) = pure castile soap

Question 3

Considerations for Vaginal instillations?

Answer 3

• Available forms; Foam, Jelly, cream, or suppository. Medicated irrigations or douches may also be given→ however excessive use = vaginal irritation
• Vaginal Suppositories are larger and more oval than rectal
• Storage in fridge prevents melting
• Insert with applicator or gloved hand
• Patients prefer to do own often, if so allow privacy

Question 4

What should be written on a topical Patch?

Answer 4

Write date and time and nurses initials on new patch (Med name should already be there)

Question 5

Where can one place a nitro patch?

Answer 5

• Apply nitroglycerin to chest area, back, abdomen or anterior thigh→ do not apply to hairy surfaces or over scar tissue

(Remove old patch and wipe excess away, fold patch onto itself before disposable)

Question 6

Basics of aerosol spray administration?

Answer 6

• Administering aerosol sprays - shake container, holy spray away from area (15-30cm), ask patient to turn away from spray

Question 7

Basics of applying suspension based lotion?

Answer 7

• Apply suspension based lotion- Shake container, apply small amount of lotion to gauze or pad and apply to skin by stroking

Question 8

Basics of topical powder admin?

Answer 8

• Apply powder- make sure skin is dry, ask patient to turn away from powder, dust skin lightly with dispenser, thin layer of powder

Question 9

At what temp should ear drops be administered

Answer 9

• Internal ear structures are very sensitive to temp drops, administer drops at room temp. Instilling cold drops can cause vertigo, nausea and pain

Question 10

Basics of ear drop administration?

Considerations?

Answer 10

straighten ear canal by pulling pinna up and back to 10 o’clock position (adult or older than 3) or down and back to 6 to 9 o’clock position (under 3). Apply drops.

Considerations-
• Use sterile drops and solutions in case eardrum is ruptured
• Avoid forcing solution into ear
• Do not occlude ear canal with a medicine dropper because this can result in injury to the eardrum
• Desired outcomes; patient experiences effect of medication, patient experiences no side effects and symptoms are relieved, patient is able to discuss information of medication and can self administer drops

Question 11

Basics of eye ointment administration?

Answer 11

Apply thin ribbon of ointment evenly along inner edge of lower eyelid conjunctiva

Question 12

Basics of applying intraocular disk?

Answer 12

gently press fingertip on disk to pick it up, place disk in conjunctival sac so it floats on sclera between iris and lower eyelid, pull patients lower eyelid out and over disk

Question 13

What is a suppository?

Can they be self- administered?

Answer 13

Suppositories are a medication that melts in rectal mucosa causing localized effect in GI system, not as reliable as oral or parental route for absorption and distribution.

Can be self-administered with instruction

Question 14

Basics of suppository administration position?

Answer 14

Pt position- patient assume left side-lying Sims’ position with upper leg flexed upward. exposes anus and relaxes external anal sphincter. Left side-lying Sims’ position lessens likelihood of suppository or feces being expelled.

Question 15

Depth of suppository admin?

Answer 15

4 inch for adult, 2 in for children

Question 16

Pre and post Nursing considerations for suppository?

Answer 16

Pre- Review GI hx and bowel hx, lubricate generously

Post- Remain on side for 5 min afterward, preventing leakage and encouraging absorption

Question 17

Types of inhalers and most common action?

Answer 17

Pressurized metered-dose inhalers (pMDIs)
Breath- actuated metered-dose inhalers (BAIs)
Dry powder inhalers (DPIs)

Deliver medications that produce local effects such as bronchodilation

Question 18

Should all inhalers use a spacer?

What are the advantages of spacers?

Answer 18

Some use spacers, some do not.

Spacers reduce medication absorption in oral mucosa, allowing more medications to be inhaled. They avoid the need for synchronizing spray admin and inhalation.

Question 19

Basics of inhaler admin with and without spacer?

Answer 19

Inhalers should be shaken for 2-5 seconds, pt holds medication in lungs for 10s

With spacer lips directly on mouth piece. Without spacer-> inhaler mouthpiece 2 to 4 cm (1 to 2 inches) from widely open mouth.

Question 20

What is Nebulization?

Common drug classes for nebulization?

Answer 20

Nebulization is a process of adding medications or moisture to inspired air by mixing particles of various sizes with air. Adding moisture to the respiratory system through nebulization improves clearance of pulmonary secretions. Medications such as bronchodilators, mucolytic, and corticosteroids are often administered by nebulization.

Question 21

With multiple medications requiring inhalation or nebulization, what rule should be used in deciding order of admin?

Answer 21

Bronchodilators before corticosteroids (B before C)

Question 22

Considerations if steroidal med is nebulized?

Answer 22

Instruct patient to rinse mouth and 
gargle with warm water after nebulizer treatment to reduce steroid leftover in oral mucosa.

Question 23

Basic pt instruction for using Nebulizer?

Answer 23

Turn on small-volume nebulizer machine and ensure that a 
sufficient mist begins to flow 
Patient take deep breath, slowly, to a volume slightly greater than normal. Encourage brief end of inspiration pause for about 2 to 3 seconds, then have patient exhale passively.

 Repeat

Question 24

Common forms and use for nasal instillations?

Answer 24

Patients with nasal sinus problems may receive drugs by spray, drops, or tampons. The most commonly administered form of nasal instillation is a decongestant spray or drops used to relieve sinus congestion and cold symptoms. 


Question 25

Basic procedure for nasal instillations

Answer 25

Tell patients receiving nasal instillation that they may experience burning or stinging of mucosa or choking sensation as medication trickles into throat.

Gently roll or shake container. Instruct patient to clear or blow nose gently unless contraindicated (e.g., risk of increased intracranial pressure or nosebleed). 
Lightly blow nose unless contra indicated.

Head tilt back in supine position for drops
Sitting up patient spray medication into nose while inhaling

Question 26

Considerations if eye drops have unwanted systemic effects?

Answer 26

After drop administration apply gentle pressure to sinus for ~20s to prevent systemic absorption

Question 27

What to do if there is hair in the way of a transdermal patch?

Answer 27

Clip don’t shave