1. Percutaneous Administration
Chapter 8
Percutaneous Administration
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Chapter 8
Lesson 8.1
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3. Objectives Describe the topical forms of medications used on the skin
Cite the equipment needed and techniques used to apply each of the topical forms of medications to the skin surface
Describe the procedure used and purpose of performing patch testing
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Objectives (cont’d)
Describe specific charting methods used with allergy testing
Identify the equipment needed, sites and techniques used, and patient education required when nitroglycerin ointment is prescribed
Describe specific documentation methods used to record the therapeutic effectiveness of nitroglycerin ointment therapy
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Objectives (cont’d)
Identify the equipment needed, sites and techniques used, and patient education required when transdermal medication systems are prescribed
Describe specific documentation methods used to record the therapeutic effectiveness of medications administered using a transdermal delivery system
Describe the dose form, sites used, and techniques used to administer medications in topical powder form
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Percutaneous Administration
Application of medications to the skin or mucous membranes for absorption
Includes:
Topical application of ointments, creams, dressings, lotions, or powders to the skin
Inhalation of aerosolized liquids or gases
Instillation of solutions into the mucous membranes of the mouth, eye, ear, nose, or vagina
Always follow the six rights of drug administration
Percutaneous medications are affected by the amount of drug used, how long the medication is in contact with the skin or mucous membranes, the size of the area in contact, thickness of the skin, hydration status, and any areas of disruption, such as broken skin.
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7. Percutaneous Administration (cont’d)
Premedication assessment and explanation
Patient teaching
Wash hands
Proper application techniques
How often to apply treatment
Cautions particular to drug
Adverse effects
When to contact health care provider
Document
Date, time, drug, dosage, route
Patient symptoms – rash, vesicle, etc.
Percutaneous medications are used to cleanse wounds, rehydrate the skin, reduce inflammation, relieve localized symptoms, provide a protective barrier, and reduce thickening of the skin.
Educate patients on procedure protocol (as detailed in next slides).
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8. Creams, Lotions, Ointments, and Dressings
Creams – nongreasy, removed with water
Lotions – soothing agents
Ointments – oil-based, keeps medications in contact with the skin longer
Dressings – dry gauze, transparent, hydrocolloid
Use dressings according to orders
What are the differences between creams, lotions, and ointments? Why is each used?
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9. Procedure Protocol Wash hands, put on gloves Position the patient
Clean the area
Shake lotion bottle; use tongue blade to remove desired amount of ointment or cream from container
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10. Patch Testing
Method used to identify sensitivity to contact materials such as soaps, pollen, and dyes
Allergens on patch placed in contact with back, arms, or thighs
Patch left in place for 48 hours
Site aired for 15 minutes, then read
Wheal is the definitive reaction measured from 1+ to 4+
Emergency equipment must be available in case of anaphylactic response
The signs and symptoms of an anaphylactic reaction include tightness and/or itching in the throat, difficulty breathing, drop in blood pressure, hoarseness, and unconsciousness.
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11. Patch Testing (cont’d)
Wash hands, put on gloves
Position the patient
Clean the area
Apply dose-measuring applicator paper
Do not rub in ointment
Cover area with plastic wrap
Hair is shaved from the test site to keep the antigen in close contact with the skin surface.
The patient should be positioned so that the surface where the test will be applied is horizontal.
Patch testing also may be read in 3 days and 7 days to detect delayed reactions.
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12. Transdermal Drug Delivery
Disk or patch providing controlled release of medication
Wash hands, put on gloves
Position the patient
Apply topical disk or patch
Application frequency depends on drug
Wash hands after application
Label disk with time, date, and nurse initials
Always remove the old patch before applying the new one.
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13. Topical Powders
Particles of medication in a talc base generally used to produce a cooling, drying, or protective effect
Wash hands, put on gloves
Position the patient
Wash and thoroughly dry area
Apply powder; smooth over area for even coverage
Avoid inhaling the powder during application.
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14. Chapter 8
Lesson 8.2
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15. Objectives
Describe the dose forms, sites and equipment used, and techniques for administration of medications to the mucous membranes
Identify the dose forms safe for administration to the eye
Describe patient education necessary for patients requiring ophthalmic medications
Compare the techniques used to administer ear drops in patients younger than 3 years with those older than 3 years
Describe the purpose, necessary precautions, and patient education required for those requiring medications by inhalation
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16. Objectives (cont’d)
Describe the dose forms available for vaginal administration of medications
Identify the equipment needed, site, and specific techniques required to administer vaginal medications or douches
State the rationale and procedure used for cleansing vaginal applicators or douche tips following use
Develop a plan for patient education of people taking medications via percutaneous routes
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17. Sublingual and Buccal Tablets
Sublingual tablets placed under the tongue
Buccal tablets held in the buccal cavity
Advantage: rapid absorption and onset of action
Action is usually systemic rather than localized to the mouth
Do not use water with these types of medications.
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18. Eye Drops, Ointments, and Disks
All medication used for the eye must be labeled ophthalmic
Inspect affected eye
Clean any exudate from eye
Expose lower conjunctival sac
Approach eye from below
Never touch eye with dropper or tube
Apply gentle pressure on inner corner of eyelid for 1 to 2 minutes after application
Wash hands and position patient so the back of the head is supported and the face is directed toward the ceiling.
Never share ophthalmic drops or ointments between patients.
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19. Ear Drops All medications used for the ear must be labeled otic
Ensure ear is clear of wax
Warm medication to room temperature
Younger than 3 years: pull earlobe downward and back
Older than 3 years: pull earlobe upward and back
Patient should remain in position for a few minutes after application
Ear drops are used for treatment of localized infection or inflammation of the ear.
Instilling cold ear drops can be painful to the patient.
The ear can also be gently massaged after the medication is applied to increase absorption.
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20. Nose Drops, Nasal Spray Patient should blow nose gently Nose drops
Position patient lying down with head hanging back
Nose spray
Patient is upright
Block one nostril
Shake bottle and insert tip into nostril
Spray while patient inhales
Nasal solutions are used to treat temporary disorders of the nasal membranes.
Advantage of nasal spray over drops is less waste of medication.
Patient should remain in position for 2 to 3 minutes after administration.
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21. Nebulizers and Inhalers
Prepare medication and fill nebulizer
Patient exhales through pursed lips
Put nebulizer in mouth; do not seal completely
Patient inhales
Metered-dose inhalers
Follow instructions on inhaler
Dry powder inhalers
As the patient inhales, activate the nebulizer or inhaler; have the patient hold the breath for 10 seconds before exhaling.
The use of a spacer is recommended to ensure that the medication inhaled gets to the lungs and not just the back of the throat.
Never share inhalers or nebulizers between patients.
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22. Vaginal Medications
Have patient empty the bladder before administration
Wash hands, put on gloves
Fill applicator
Place patient in lithotomy position, elevate hips with pillow
Spread labia and gently insert applicator or suppository
Remain in position for 5 to 10 minutes after application
Wash applicator with warm soapy water after each use
Applicators are used to administer creams, foams, tablets, and jellies. Suppositories are inserted with a gloved finger.
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.