Metered-Dose Inhaler

Chapter 13

Percutaneous Routes

1 Learning Objectives

Describing percutaneous routes of medication administration. Administering topical forms of medication. Administering nitroglycerin ointment. Describing patch testing for allergens. Explaining how to apply transdermal drugs. Discussing use of sublingual and buccal forms of medicine.

Learning Objectives (cont’d.)

 Administering ophthalmic liquids and ointments.  Administering otic medications.  Describing how to use nasal medications.  Administering inhalation medicines using a metered-dose inhaler.  Describing use of vaginal suppositories and douches.  Providing patient education for safety and compliance with the percutaneous routes.

Introduction

Absorbed through skin or mucous membranes Administration routes include:  buccal  sublingual  topical  transdermal Local or systemic effect

Topical Medications

Used for local effect or systemic action Important to apply as prescribed Wash skin only with water Keep skin hydrated for optimal absorption

Applying Topical Medications

Powders, Soaks, Compresses, and Wet Dressings Powder applied in fine, thin layer Extremities can be soaked in solution Warm soaks no warmer than 115°F Wet applications leave a mild astringent on the skin Plastic wrap keeps dressings moist

Applying Topical Medications

Creams, Ointments, Gels, and Lotions Creams—semisolid; water based Ointments—soft; oil, lanolin, or petroleum based Gels—soft, thick; water-based for lubrication, or oil-based for longer lasting treatment Lotions—soft; water-based

Applying Topical Medications

Equipment needed Physician’s order medication ordered gloves supplies to cleanse skin dressing and bandages as needed

Applying Topical Medications

Patches, Disks, and Transdermal Dots Extended effect up to several days. Medication passes through skin into circulatory system for continuous treatment. Change as indicated to maintain desired dosage. Handle carefully to prevent absorption through hands.

Applying Topical Medications

Common Uses for Patches, Disks, and Transdermal Dots  Nitroglycerin—to treat angina  Female hormones—to alleviate menopausal symptoms  Scopolamine—for motion sickness  Duragesic—to treat chronic pain  Nicotine—for smoking cessation  Allergy testing  Contraceptives  Methylphenidate – Ritalin  Testosterone – male hormone

Applying Topical Medications

Figure 13-1 Application of a transdermal medication patch. (From Young AP, Proctor DB: Kinn’s the medical assistant, ed 11, St Louis, 2011, WB Saunders.)

Applying Topical Medications

Applying nitroglycerin ointment Cleanse skin of any residual ointment. Ensure site is dry, free from hair and scar tissue. Apply prescribed amount in inches to applicator paper.

Applying Topical Medications

Applying nitroglycerin ointment (cont’d.) Check patient’s pulse. Apply to skin, hold in place 10 seconds. Add tape, plastic, or wax dressing if needed. Typical documentation:  7/13/XX 9:15 AM Pulse 72. Nitroglycerin ointment, 2 inches, applied to left upper chest after skin cleaned of residue. Tape applied to application paper. No apparent adverse reactions.-- G. Olive, CMA

Applying Topical Medications

Sprays and Aerosols Shake aerosols vigorously before applying. Spray fine, even coating of medication specified distance from skin (usually 6 to 12 inches). Have patient turn head if spraying medication near face.

Special Considerations for Topical Medications in Geriatric Patients

Apply with minimal friction. Observe for excoriated skin caused by irritation from medication.

Buccal and Sublingual Medications

Sublingual medications tiny, porous tablets, liquid from capsules, aerosol sprays placed under tongue for rapid absorption into

bloodstream Figure 13-2 A, Sublingual administration of medication. (From Leahy JM, Kizilay PE: Foundations of nursing practice: a nursing process approach, Philadelphia, 1998, WB Saunders.)

Buccal and Sublingual Medications

Buccal medications placed between teeth and gums for local absorption when saliva swallowed, systemic absorption occurs medication should be allowed to dissolve completely

Buccal and Sublingual Medications

Figure 13-2 B, Buccal administration of medication. (From Leahy JM, Kizilay PE: Foundations of nursing practice: a nursing process approach, Philadelphia, 1998, WB Saunders.)

Ophthalmic Medications

Ointments, drops, intraocular disks Most for topical administration but some absorbed systemically Must be sterile; label marked “ophthalmic”

Ophthalmic Medications

Instilling Eye Drops Cleanse any eye drainage, moving from inner to outer canthus. Warm drops, check for ophthalmic label. Hold dropper 1/4 to 1/2 inch above conjunctival sac. Do not touch eye with dropper tip.

Ophthalmic Medications

Drop the prescribed medication amount into the conjunctival sac. If the patient blinks or closes the eye, repeat the procedure.

Ophthalmic Medications

Instilling Eye Drops (cont’d.) Drop prescribed amount into conjunctival sac. Repeat if patient blinks or closes eye. Apply gentle pressure to nasolacrimal duct for 30 to 60 seconds. Typical documentation 7/22/XX 3:15 PM Pilocarpine hydrochloride ophthalmic drops, gtt i OU, with no apparent adverse reaction. --G. Olive, CMA

Ophthalmic Medications

Instilling Eye Ointment Cleanse any eye drainage. Check for ophthalmic label. Ask patient to look up to ceiling. Hold applicator above lower lid; apply thin ointment stream along inner edge of lower lid from inner to outer canthus. Ask patient to close eye slowly, then blink several times.

Ophthalmic Medications

Hold the ointment applicator above the lower lid and apply a thin stream of ointment along the inner edge of the lower lid from the inner to outer canthus.

Ophthalmic Medications

Instilling Eye Ointment Repeat several times to further melt ointment, distribute medication. Wipe excess ointment away. Apply eye patch as needed. Document the procedure.

Otic Medications

Administer at room temperature to prevent vertigo and nausea. Use sterile medication if physician suspects ruptured eardrum, or if tubes are present. Can use sterile ophthalmologic drops in ears, but do not use otic medication in eyes.

Otic Medications

Never force solution into ear. Never fill ear canal with medication dropper. Wipe away excess cerumen from outer ear with cotton-tipped swab.

Otic Medications

Instilling Otic Medications Have patient lie on side, with affected ear up. Warm the medication. Administer medication slowly, holding dropper about 1/2 inch above ear. Aim toward canal wall, rather than eardrum.

Otic Medications

Slowly administer the prescribed medication amount, holding the dropper about ½ inch above the ear, and aiming the drops toward the wall of the canal.

Otic Medications

Instilling otic medications (cont’d.) Massage out ear. Ask patient to retain position for 5 minutes. Typical documentation 7/13/XX 2:45 PM Cortisporin Otic Solution, gtts iii in Lt ear, with no apparent adverse reaction. Patient instructed in proper method of instilling ear drops at home. --G. Olive, CMA

Nasal Medications

Anatomic structure of the nasal cavity. From Seidel HM et al (2003). Mosby’s guide to physical examination (5th ed.). St. Louis: Mosby.

Nasal Medications

Administer by dropper, atomizer, or aerosol Used for local or systemic effect Relatively safe if given in small doses Repeated use of decongestant sprays can worsen nasal congestion

Nasal Medications

Instructions for Administering Nasal Spray Clear nasal passages as much as possible. Sit upright. Tilt head back. Occlude one nostril, inhale through other. Ensure spray tip is centered in nostril. Squeeze to deliver medication.

Nasal Medications

Figure 13-3 Administration of nasal medication. (From Chester GA: Modern medical assisting, Philadelphia, 1998, WB Saunders.)

Nasal Medications

Administering Nasal Spray (cont’d.) Keep head tilted back for about 5 minutes. Do not blow nose. Expectorate any medication that spills into throat.

Vaginal Medications

Suppositories, tablets, creams, solutions Treat local infections; contraception Many over-the-counter medications available; typically self-administered Often used at bedtime

Inhaled Medications

Gases, sprays, powders, and liquids inhaled into respiratory tract via vapor or mist Absorbed rapidly Metered-dose inhaler (MDI): handheld device that disperses medication to lungs

Metered Dose Inhaler

Figure 13-4 A metered dose inhaler. (From Young AP, Proctor DB: Kinn’s the medical assistant, ed 11, St Louis, 2011, WB Saunders.)

Inhaled Medications

Administration of Medication Using Metered Dose Inhaler Remove cover from MDI, gently shake. Take deep breath, exhale. Position inhaler in mouth, 1 to 2 inches from mouth, or with spacer attached. Place middle finger at top of inhaler.

Inhaled Medications

Administration of Medication Using Metered Dose Inhaler Tilt head back slightly. Inhale slowly and deeply through mouth. Depress medication canister fully. Hold breath 10 seconds. Exhale through pursed lips.

Inhaled Medications

Administration of Medication Using Metered Dose Inhaler  If second dose indicated, wait 2 to 5 minutes between doses.  Cleanse MDI after each use.  Review instructions for home use.  Typical documentation 7/12/XX 9:15 AM Albuterol inhaler, 2 puffs as directed, with no apparent adverse reactions. Return demonstration by patient and instructions given for use at home.-- G. Olive, CMA