6.11. Steps and procedures for the different routes of Medication Administration (Applications)
Application: ointments, lotions, liniments, and aerosols: Topical Medications
- Wash hands thoroughly.
- Wear gloves and use tongue blade, gauze or cotton tipped applicator to apply medication. Gloves should be worn whenever coming into direct contact with medication or a client’s skin. Never use your bare fingers to apply ointments, lotions or liniments. Do not discard gloves and supplies in areas accessible to clients.
- Directions for application of the medication should be a part of the physician’s order or included with the instructions accompanying the medication. Apply the cream or ointment as directed by the label or the doctor’s order.
- Cleanse the skin with warm water and soap.
- Place the lid or cap of the container to prevent contamination of the inside surface.
- Ointments are applied directly to the skin or placed on a dressing that is then applied to the skin. A tongue blade may be used to remove ointments from a jar or container. You may also use the tongue blade as an applicator. Use a new applicator each time medication is removed from container to prevent contamination.
- Lotions are applied / swabbed on the skin for their antiseptic and/or astringent effects.
- Liniments are vigorously rubbed into the skin to relieve soreness of the muscles and joints.
- Aerosols are sprayed onto the skin. Spraying is less painful if skin is irritated or burned. Have client turn head away from aerosol spray.
NOTE: When transcribing orders for applying ointments, be sure to indicate where the ointment should be applied.
- Notify the nurse if you notice: a change in the amount, color, consistency, or odor of the drainage or if there is any swelling or redness.
Application: Transdermal patches:
A transdermal skin patch is impregnated with medication which, when applied to the skin, releases a continuous and controlled dosage over a specified time period.
- Gloves should be worn to apply/remove transdermal patches to avoid contact with the patch.
- Remove the old patch, if present.
- Wash client’s skin with soap and water (both new site and removal site).
- Rotate application sites to avoid skin irritation. If previous sites are blistered, notify your supervisor.
- Peel backing off the patch, press on skin and apply pressure to assure skin adherence.
- Include the site of application with documentation on the MAR.
- Write your initials, date and time on the patch after applied.
Application: eye drops/eye ointments:
- Wash hands prior to and after administration of eye drops and ointments;
- Instruct client about procedure. Assist the client to sit or lie down with head tilted back.
- Cleanse the eye(s) with a clean tissue, clean, wet washcloth or cotton ball. Always cleanse from the inside of the eye, near the nose, to the outside. Use a clean tissue or cotton ball for each wipe.
- Follow standard precautions.
- Wear gloves as indicated. Always wear gloves when there is redness, drainage or possibility of infection.
- Remove cover of container, place lid with the open side up. (or in a clean medicine cup).
- Do not touch eyes with a dropper or medication container.
- Remove the cover of container, place lid with the open side up. (or in a clean medicine cup).
- Retract lower lid (make a pocket). Holding the bottle, no more than one inch from the lower lid, instill one drop in the center of the lower lid. Repeat procedure for the second drop, if ordered. Wait 3-5minutes if multiple eye drops are ordered, to allow time for absorption.
- After application, instruct the client to look downward, then close eye(s) for a short time.
- Give the client a clean tissue or cotton ball to wipe the excess.
- Procedure for ointment: instruct client to lookup. Retract the lower lid (make a pocket). With care to avoid touching the eye with the tip of the tube, lay a thin strip along the lower lid.
Application: ear drops:
- Wash hands before and after administration of medication.
- Gloves are to be worn as indicated.
- Gently shake the bottle Hold the dropper tip down at all times.
- Clean external ear canal with a clean tissue or cotton ball.
- Hold ear lobe in such a manner (n adults, hold the earlobe up and back, in children, hold the earlobe down and back) to allow visualization of the ear canal by gently pulling on the ear, straighten the ear canal (If lying in bed, have bed flat and turn head to the opposite side, if sitting up, tilt head sideways until the ear is as horizontal as possible).
- Instill an ordered number of drops without touching dropper to the client’s external ear.
DO NOT SQUEEZE THE DROPPER TOO HARD
- Place a small wad of cotton in the external portion of the first ear. If it is necessary to instill drops in both ears, you should wait at least five minutes before instilling drops in the other ear and place wad of cotton.
- Request the client to remain in the same position for 5 minutes to allow the medication to penetrate.
- Gently plug the ear with cotton to prevent excessive leakage if necessary.
- Return to the client in 10 minutes to remove cotton wads; forgotten cotton wads can become difficult to remove.
Application: nose drops/nasal sprays:
- Wash hands before and after.
- Gloves are to be worn as indicated.
- For drops, client should lie down on his/her back with head tilted or the client may sit up for nasal sprays.
- Place the nose dropper just inside the nostril. Instruct the client to “sniff” on the count of three and instill the correct number of drops. Instruct the client to remain with head back for a short time.
- Request the client to remain in the position for about 2 minutes to allow sufficient contact of medication with nasal tissue.
- Avoid touching the dropper or spray nozzle to the client’s nose. If it happens wipe tip of the applicator with an alcohol swab.
- For Sprays before using a nasal spray, the client should blow the nose.
- Hold head erect and spray quickly and forcefully while the client “sniffs” quickly or instructs the client to sniff on the count of three as you squeeze the nasal spray. This will help to coordinate the client’s sniffing with the application of the medication.
Optional: Close one nostril while spray is applied to the other nostril.
- Have the client tilt head back to aid penetration of the medication into the nasal cavity, if necessary.
- Wipe dropper or sprayer with a tissue before replacing the cap.