!70- Topical, Eye/Ears/Nose,Inhaled medications Flashcards
What is an enema?
The instillation of a solution into the rectum and sigmoid colon to promote defecation by stimulating peristalsis through infusion of large volumes of solution
Kinds of enemas?
P&P- pp. 852-856
- 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
Considerations for Vaginal instillations?
- 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
What should be written on a topical Patch?
Write date and time and nurses initials on new patch (Med name should already be there)
Where can one place a nitro patch?
• 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)
Basics of aerosol spray administration?
• Administering aerosol sprays - shake container, holy spray away from area (15-30cm), ask patient to turn away from spray
Basics of applying suspension based lotion?
• Apply suspension based lotion- Shake container, apply small amount of lotion to gauze or pad and apply to skin by stroking
Basics of topical powder admin?
• Apply powder- make sure skin is dry, ask patient to turn away from powder, dust skin lightly with dispenser, thin layer of powder
At what temp should ear drops be administered
• Internal ear structures are very sensitive to temp drops, administer drops at room temp. Instilling cold drops can cause vertigo, nausea and pain
Basics of ear drop administration?
Considerations?
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
Basics of eye ointment administration?
Apply thin ribbon of ointment evenly along inner edge of lower eyelid conjunctiva
Basics of applying intraocular disk?
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
What is a suppository?
Can they be self- administered?
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
Basics of suppository administration position?
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.
Depth of suppository admin?
4 inch for adult, 2 in for children
Pre and post Nursing considerations for suppository?
Pre- Review GI hx and bowel hx, lubricate generously
Post- Remain on side for 5 min afterward, preventing leakage and encouraging absorption
Types of inhalers and most common action?
Pressurized metered-dose inhalers (pMDIs)
Breath- actuated metered-dose inhalers (BAIs)
Dry powder inhalers (DPIs)
Deliver medications that produce local effects such as bronchodilation
Should all inhalers use a spacer?
What are the advantages of spacers?
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.
Basics of inhaler admin with and without spacer?
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.
What is Nebulization?
Common drug classes for nebulization?
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.
With multiple medications requiring inhalation or nebulization, what rule should be used in deciding order of admin?
Bronchodilators before corticosteroids (B before C)
Considerations if steroidal med is nebulized?
Instruct patient to rinse mouth and gargle with warm water after nebulizer treatment to reduce steroid leftover in oral mucosa.
Basic pt instruction for using Nebulizer?
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
Common forms and use for nasal instillations?
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.
Basic procedure for nasal instillations
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
Considerations if eye drops have unwanted systemic effects?
After drop administration apply gentle pressure to sinus for ~20s to prevent systemic absorption
What to do if there is hair in the way of a transdermal patch?
Clip don’t shave
