Counselling (Admin Techniques)

Question 1

Eyedrops administration techniques (7)

Answer 1

1. Shake the bottle & remove cap
2. Seat and tilt chin upwards (surface of eye is parallel to ground)
3. Look upwards & pull down lower eyelid (non-dominant hand)
4. Use dominant hand and instill a drop into eye (ensure tip dont touch)
5. Close your eyelids & press the corner of eye nearest to nose, blocking drainage canals
6. Wipe away excess drops with clean tissue
7. Instill another drop 5 min apart

Question 2

Eye ointment administration (8)

Answer 2

1. Be seated and tilt chin upwards (surface of eye parallel to ground)
2. Pull down eyelid using non-dominant hand
3. Use dominant hand, squeeze to apply 1 FTU of ointment along the inner margin of lower eyelid (ensure no contact with eye)
4. Close your eyes for 1-2 min, roll eyeballs around to spread medication
5. Close the eyelids and press onto corner of eye to block drainage canal
6. Wipe away excess medication
7. Administer eyedrop first before eye ointment (10 min later)
8. Remain seated for a few minutes due to blurred vision

Question 3

Rectal Suppository administration (6)

Answer 3

1. Lie on the left side with right knee raised towards chest
2. Put absorbent pad under hip/buttocks
3. Moisturise the rectal area with water
4. Part the buttocks and insert pointed end of suppository using gloved index finger, insert around 2-4 cm
5. If faeces present, insert between rectal wall & faeces
6. Remain in position for 15 min for drug to be absorbed

Question 4

Ear drop administration (6)

Answer 4

1. Wash and dry outside of ear with damp cloth (no water in canal)
2. Use palm to warm the eardrops
3. Tilt head to side opposite affected ear, pull the ear backwards and upwards (child = backwards and downwards)
4. Position dropper tip near canal, drop correct dose in ear (do not touch)
5. Keep the head in the position for a few min after
6. Regain normal position & wipe away excess

Question 5

Nasal spray administration (5)

Answer 5

1. Shake the bottle, prime the nasal spray until fine mist appears
2. Tilt head forward, depress one nostril, insert tip into the other nostril
3. Aim away from the nasal septum & squeeze nozzle, inhale & breath out through mouth after each spray
4. Alternate sprays between nostrils
5. Try not to blow your nose for several min after

Question 6

MDI administration (9)

Answer 6

1. Remove cap, hold the inhaler upright & shake well
2. Prime by pressing top of inhaler til fine mist appears
3. Take a deep breath and breath out away from device
4. Seal lips around mouthpiece
5. Breath in slowly and press down canister together
6. Remove inhaler & hold your breath for 10 seconds
7. Breath out away from inhaler, wait for 1 min before next puff
8. For steroids: gargle & rinse mouth then spit out water
9. Use relieer first & wait for 5 min before using controller

Question 7

MDI + spacer administration + cleaning (9)

Answer 7

1. Insert the inhaler upright into the spacer
2. Prime the space (1st time) by pressing inhaler 10 times
3. Take a deep breath & breath out as much
4. Seal lips around mouthpiece / attach mask securely ensure no gap
5. Breathe in slowly & press down canister at the same time
6. Continue to breath in and out for 5-10 breaths
7. Remove inhaler & hold your breath for 10 sec
8. Breath out, wait for 1 min before another puff
9. Clean with water + a little bit of detergent + dont wipe dry

Question 8

Soft Mist inhaler (Respimat) set up (4)

Answer 8

1. Remove clear base by pressing safety catch & pull off base
2. Insert medication cartridge into inhaler, push down firmly until it clicks
3. Turn the clear base in the direction of arrow until it clicks
4. Open the cap & Point inhaler towards the ground and press release to see a mist

Question 9

Soft mist (respimat) administration (7)

Answer 9

1. With the cap closed, turn clear base towards the arrows until it clicks
2. Breath out slowly & fully
3. Open cap and close your lips around mouthpiece
4. Point inhaler to the back of your throat, breath in & press the release button at the same time
5. Hold your breath for 10 seconds
6. Release one puff to ground if not used > 7d
7. Repeat loading steps before use if not used > 24d

Question 10

Turbuhaler administration (5)

Answer 10

1. Hold turbuhaler upright, load with a dose by twisting the base as far as it will go in one direction & back to orignial position (CLICK sound)
2. Breath out
3. Seal your lips around the mothpiece and inhale forcefully & deeply
4. Remove turbuhaler & hold your breath for 10 sec
5. Rinse mouth with water & spit out

Question 11

Accuhaler administration (6)
(Similar for Ellipta)

Answer 11

1. Open accuhaler, hold accuhalere towards you
2. Push lever away from you until you hear a click sound
3. Breath out
4. Put the mouthpiece to your lips, breath in deeply and quickly
5. Remove accuhaler + hold your breath for 10 sec
6. Breath out and close accuhaler

Question 12

Nicotine patch administration (3)

Answer 12

1. Apply patch on waking up daily and remove next morning
2. Always paste the new patch on a different site to reduce skin irritation
3. Remove patch before sleeping if there are sleep disturbances

Question 13

NRT gum / lozenges administration (4)

Answer 13

1. Suck / chew until tingling sensation / peppery taste appear
2. Park between cheek & gum
3. Resume chewing / sucking when taste fades for 30 min before discard
4. No food / drink for 15 min before and during

Question 14

Insulin injection preparation (8)

Answer 14

1. Take out from fridge and leave in room temperature for 5-10 min
2. Check label for insulin type and expiration date
3. Visually inspect vial for contamination / degredation
4. Cloudy insulin, roll the vial between hands
5. Wipe vial and injection site with alcohol swabs
6. Draw up air equal to insulin dose & inject air into vial
7. Invert the vial & withdraw insulin dose
8. If bubbles present, tap syringe to release bubble

Question 15

Insulin injection administration

Answer 15

1. Pinch the area to be injected (abdomen > upper arm > outer thigh > buttocks) —> rotate injection sites
2. INsert the needle at 90 degree angle (45 for small children / skinny)
3. Release the pinch and press the plunger to inject insulin
4. Hold the syringe in the area for 5-10 sec (ensure full delivery)
5. Remove syringe & leave the cap on the table to slot needle into cap
6. Discard into sharp bin

Question 16

Mixing insulin preparations (4)

Answer 16

1. Withdraw air equal to dose of cloudy insulin, inject air into cloudy
2. Withdraw air equal to dose of clear insulin, inject air into clear
3. Invert the clear vial and withdraw clear insulin dose
4. Invert the cloudy vial & withdraw cloudy insulin dose

Question 17

Fleet Enema administration (6)

Answer 17

1. Kneel and lower head with chest forward until left side of face is resting on folded left arm
   (Elderly patients can lie on their left side with right knee bent)
2. Remove the cap from the nozzle.
3. Gently insert the nozzle into the anus and squeeze the bottle. It is not necessary to fully empty the bottle.
   Bottle contains more liquid than required
4. Keep the bottle squeezed and withdraw the nozzle from the anus
5. Try to retain the solution for 2-5 minutes until you feel a strong urge to evacuate. Do not repeat the enema within 24 hours.
6. Lie down for a short while. A bowel movement should be produced in 15-60 minutes

Do not use more than 1 every 24 hours. Do not use for >3d unless physician directs.
Drink extra water unless contraindicated.

Question 18

GTN Administration (4)

Answer 18

1. Place the tablet under your tongue and allow it to dissolve completely.
2. You may chew the tablet into smaller pieces to facilitate abs
3. If you are using GTN to prevent anticipated anginal attack, dissolve tablet under your tounge before engaging in the activity
   *GTN is short-acting –> ineffective if administered way in advance
4. This med shld give relief within 5 mins, if still have chest pain after 5 mins –> Continue to use the GTN every 5 mins –> Call 995 if no relief of Sx