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Routes of Administration
Skin application = inunction Eye instillation Ear instillation Nasal instillation Rectal administration Vaginal administration
3 Checks and 5 Rights
ALWAYS perform the 3 checks and 6 rights prior to administering any medication
3 Checks
1. When taking container or dose out
2. Immediately before pouring med
3. When replacing container
6 Rights
1. Right medication
2. Right patient
3. Right dosage
4. Right route
5. Right time (and date)
6. Right documentation
In general……..
wash hands check the orders and never be afraid to
question or refuse to give a medication if you feel it has been ordered incorrectly
check for allergies - WHERE? know the drugs action, side effects,
nursing interventions, health teaching. never return unused medication to
container
check the drugs expiry date identify the patient -HOW? explain the procedure cleanse the area affected PRN maintain client position and comfort drape for privacy provide post administration instruction
and comfort document
Skin Application
absorption is enhanced by cleaning the skin with soap and water prior to application
make sure you dry it well
ointments (ungs.) provide prolonged skin contact - massage in well
creams and oils lubricate and soften the skin
lotions protect and soothe the skin -shake well prior to use and apply with cotton ball
Transdermal application
generally in patch form may contain nitroglycerine, estrogen,
nicotine or analgesic has slow onset of action but maintains
constant serum drug levels must be disposed of safely away from
children or pets
Procedure – Transdermal Nitro Patch
wash hands ALWAYS WEAR GLOVES - WHY?? remove old patch and clean area well -WHY?? rotate application sites/assess for skin irritation don’t use sites that are hairy, scarred or non
intact write date and time on patch
Eye Instillations
usually used for pupil dilatation/constriction, treatment of infection or controlling intraocular pressure for glaucoma
never touch cornea with dropper/applicator eyes are highly susceptible to injury and
infection DO NOT APPLY DIRECTLY TO THE EYE always place in lower conjunctival sac
Procedure - Eye Instillation
wash hands clean eye (inner to outer) PRN don’t touch lid or lashes with applicator -
will cause blinking don’t use cotton balls - risk of lint tilt head back have patient look up and back
exert pressure downward under lower eye lid to create conjunctival pouch
instill drops apply light pressure to inner canthus to
prevent drug from entering systemic circulation through tear ducts
instruct pt not to rub eye
if applying ointment, use about 1/2 inch have patient close eye after application
then roll eyeball around to disperse drug eye irrigations are used to remove
chemicals or a foreign body and involve flushing with large amounts of tap water or other solutions
Multiple Eye Instillations
Always read the literature accompanying drug carefully or check with the pharmacy department
Administer the drops in the appropriate sequence with 15 minute delays between each application
Ear Instillations
generally used to soften wax, relieve pain, apply local anesthesia or destroy an insect lodged in ear
N/S is usually used for irrigations always warm the solution apply drops to side of ear canal - do not
allow drops to fall on tympanic membrane
Procedure - Ear Instillations
position patient with head tilted or lying on unaffected side
clean external ear canal if necessary pull pinna up and back for adult, down
and back in infant and child under 3 and straight back for school aged child
instill drops
place gentle pressure on tragus a few times to move the medication along the canal
have patient maintain position for 5 mins may insert cotton ball if indicated repeat in second ear if ordered ( after
waiting 5 minutes)
Nasal Instillations
usually used to treat sinus infections or relieve nasal congestion
Procedure: have patient blow nose tilt head back and hold up tip of nose do not touch dropper to nares - insert
about 1/3 of an inch instill medication
keep head tilted back for a few minutes and avoid blowing nose
if using nasal spray use only sufficient force to bring med into contact with mucous membranes
too much force may drive med and contaminants into sinuses and eustachian tubes
Rectal Administration
usually used for laxatives, stool softeners, antiemetic or antipyretic effects or analgesia
remember to remove covering on suppository prior to administration
lubricate well be gentle with hemorrhoids If suppository expelled within ½ hour of
administration it will need to be repeated
Vaginal Administration
normal secretions in vagina are acidic which provides protection from some pathogens
usually in form of creams or suppositories
used to treat infections (fungal most common)
Procedure - Vaginal Administration have patient void prior to administering med position on back with knees flexed Remember to drape for privacy provide peri care PRN prepare medication Put suppository on applicator and then add a
small amount of water soluble gel prn.
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