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Chapter 8
Percutaneous Administration
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 8
Lesson 8.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
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.
Slide 3
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.
Slide 4
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.
Slide 5
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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Percutaneous
Administration (cont’d)
• Premedication assessment and explanation
• Patient teaching
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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.
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Procedure Protocol
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Patch Testing
• Method used to identify sensitivity to contact
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Patch Testing (cont’d)
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Transdermal Drug
Delivery
• Disk or patch providing controlled release of
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Topical Powders
• Particles of medication in a talc base
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Chapter 8
Lesson 8.2
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Objectives
• Describe the dose forms, sites and
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Eye Drops, Ointments, and Disks
• All medication used for the eye must be
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Ear Drops
• All medications used for the ear must be
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Nose Drops, Nasal Spray
• Patient should blow nose gently
• Nose drops
 Position patient lying down with head hanging
back
• Nose spray
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Patient is upright
Block one nostril
Shake bottle and insert tip into nostril
Spray while patient inhales
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20
Nebulizers and Inhalers
• Nebulizers
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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
 Follow instructions on inhaler
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Vaginal Medications
• Have patient empty the bladder before
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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
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 22