Fundamental Nursing Skills and Concepts

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Fundamental Nursing Skills and Concepts

• Chapter 33

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TOPICAL ROUTE

• Administration of medications to the skin or
  mucous membranes can be applied externally or
  internally
• Topically applied drugs have a local or systemic
  effect
• Administered to achieve a direct effect on the
  tissue to which they are applied
• Cutaneous applications are drugs rubbed or placed
  in contact with the skin (inunctions and
  transdermal patches or pastes)

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INUNCTION, TRANSDERMAL APPLICATIONS

• Inunction-Medication incorporated into an agent
  that is administered by rubbing it into the skin
• TRANSDERMAL-Drug incorporated into patches or
  paste (method of applying a drug on the skin and
  allowing it to become passively absorbed)
• SKIN PATCHES-Drugs bond to an adhesive bandage
  and applied to the skin.
• DRUG PASTE-Paste that contains a drug within a
  thick base and is applied but not rubbed into the
  skin.

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OPTHALAMIC APPLICATION

• Method of applying drugs onto the mucous membrane
  of one or both eyes.

5
OTIC APPLICATIONS

• Drug instilled in the outer portion of the ear.
• Manipulate the ear to straighten the auditory
  canal
• Child-The nurse pulls the ear down and back
• Adult-The nurse pulls the ear up and back

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NASAL APPLICATIONS

• Topical medications are dropped or sprayed within
  the nose
• Proper instillation is important to avoid
  displacing the medication into nearby structures
  such as the back of the throat.
• Nurses should warn the client about the rebound
  effect

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SUBLINGUAL AND BUCCAL APPLICATIONS

• Sublingual application-drug placed under the
  tongue and is left to dissolve slowly and become
  absorbed by the rich blood supply in the area
• Buccal application-drug placed against the mucous
  membranes of the inner cheek

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VAGINAL APPLICATIONS

• Topical vaginal applications are used to treat
  local infections
• Early and appropriate self treatment restores
  normal tissue integrity

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RECTAL APPLICATIONS

• Drugs administered rectally usually in form of
  suppositories, creams, or ointments

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INHALANT ROUTE

• Administration of drugs in lower airways
• Distribution of medication to the distal areas of
  the airways, liquid medication is converted to an
  aerosol
• AEROSOL-MIST RESULTS AFTER A LIQUID DRUG IS
  FORCED
• THROUGH A NARROW CHANNEL USING PRESSURIZED AIR OR
  AN INERT GAS
• INHALERS-HAND-HELD DEVICES FOR DELIVERING
  MEDICATION INTO THE RESPIRATORY PASSAGES
• TURBO-INHALER-PROPELLER-DRIVEN DEVICE THAT SPINS
  AND SUSPENDS A FINELY POWDERED MEDICATION
• METERED-DOSE INHALER-CANISTER THAT CONTAINS
  MEDICATION UNDER PRESSURE

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NURSING IMPLICATIONS NURSING DIAGNOSES

• Deficient Knowledge
• Ineffective Therapeutic Regimen Management
• Impaired Gas Exchange
• Impaired Skin Integrity
• Impaired Tissue Integrity

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GERONTOLOGIC CONSIDERATIONS

• Provide devices for older adults to instill eye
  medications independently
• Be sure when instilling more than one eye
  medications that the client knows to wait 5
  minutes between administration
• Lack of subcutaneous tissue causes more rapid
  absorption of topical medications than in younger
  adults
• Arthritis may interfere with applying medication
  within the vagina or rectum or to the skin of the
  lower extremities
• Provide spacer devices to assist in
  administration of inhalers
• Monitor heart rate and blood pressure with
  bronchodilators