Upgrade to remove ads
Only $35.99/year

NUR 342 Exam 1 Study Guide

Terms in this set (59)

chain of infection
1. Infectious agent → bacteria, virus, fungi, parasites

2. Reservoir → natural habitat of the organism (humans, animals, soil, food, water)

3. Portal of exit → point of escape for the organism (respiratory or gastrointestinal tract, blood)

4. Means of transmission → how an organism is transmitted from its reservoir (direct contact, indirect contact, respiratory droplets, airborne)

5. Portal of entry → point at which organisms enter a new host (skin, urinary tract, respiratory tract, gastrointestinal tract)

6. Susceptible host → infectious agent must overcome resistance mounted by host's defense
how as a nurse you can break chain of infection
HAND HYGIENE
· Infectious agent to Reservoir
o Hand hygiene, sterilization, antibiotics/antimicrobials

· Reservoir to Portal of Exit
o Transmission-based precautions, sterilization or use of disposable supplies

· Portal of Exit to Mode of Transmission
o Dry intact dressing, hand hygiene, wear gloves if contact with body fluids, cover nose and mouth when sneezing

· Mode of Transmission to Portals of Entry
o Hand hygiene, use of pesticides to eliminate vectors, adequate refrigeration

· Portals of Entry to Susceptible Host
o Hand hygiene, wear gloves, use masks and appropriate protective gear, proper disposal of needles/sharps

· Susceptible Host to Infectious Agent
o Immunizations, screen health care staff
risk factors for infection:
· Integrity of skin and mucous membranes
· pH levels of GI and GU tracts
· Integrity and number of body's WBC
· Age (infants and elderly)
· Immunizations
· Level of fatigue, nutrition and general health status (including pre-existing conditions)
· Stress level
·Use of invasive or indwelling medical devices
· Lack of immunizations, natural or acquired
methods of infection transmission
· Direct Contact
Infections spread by contact, such as touching, kissing, or sexual intercourse
MRSA

· Indirect Contact
Infections spread by no direct human-to-human contact
Contaminated surfaces or objects (fomite)
Tick, rodent (vector)

· Respiratory droplets
Infections spread by large-particle droplets
Influenzas, mumps, diphtheria, and rubella

· Airborne
Infections spread through the air
Tuberculosis, varicella, rubeola, COVID
Differences between medical and surgical asepsis
Medical asepsis → a.k.a "clean technique," practices that assist in reducing the risk of infection
· Goal → PREVENT SPREAD of microorganisms
VS.


Surgical asepsis → a.k.a "sterile technique," practices to render and keep objects free from microorganisms; more stringent
· Goal → DESTROYS ALL microorganisms, including spores
principals surgical asepsis (objects touching each other, when is it consider contaminated, what do you do, what's no sterile in a field.
9 Principals of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object
2. Only sterile objects may be placed on a sterile field. All items on a sterile field must be sterile
3. A sterile object or field out of the range of vision is considered contaminated
4. A sterile object or field becomes contaminated by prolonged exposure to air
5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action
6. The outer 1 inch edge of a sterile field is considered contaminated
7. Hold sterile objects and position tables with sterile drapes above the level of the waist. Anything below the waste is considered contaminated
8. Movement in and around the sterile field must not compromise or contaminate the field
9. If sterility is questioned, the item(s) are considered contaminated


o Sterile solutions are only considered sterile 24 hours after they are opened
Purpose of precautions
· Used in the care of ALL hospitalized patients regardless of diagnosis or possible infection status to protect both the patient and health care worker

· Infection Control
Standard precautions: how and why
Standard Precaution:, did not exist pre HIV, are used in the care of ALL hospitalized patients regardless of diagnosis or possible infection status to protect both the patient and health care worker

· Wear clean nonsterile gloves when touching blood, body fluids, excretions or secretions, contaminated items, mucous membranes and non-intact skin

· Wear PPE during procedures or care activities likely to generate splashes or sprays of blood or body fluids

· Follow respiratory hygiene and cough etiquette

· Safe injection practices (avoid recapping needles, dispose in sharps, etc.)

· Wear a face mask in high risk procedures (i.e. epidural)

· Handle equipment soiled with bodily fluids with care
PPE, steps
DONNING:
hand hygiene --> gown --> mask--> eyewear or goggles --> gloves

DOFFING:
gloves --> gown --> hand hygiene--> goggles --> mask --> hand hygiene
Principles of sterile glove donning
· After the gloves are on, only sterile items may be handled with the sterile-gloved hands.

· Careful removal of the gloves reduces any hand contact with contaminated materials.

· Good hand hygiene technique before and after putting on sterile gloves is

· Sterile gloves are donned in a way that allows only the inside of the gloves to come in contact with the hands.

· glove package must be above waist


DONNING:
· Carefully open the inner package. Fold open the top fap, then the bottom and sides. Do not touch the inner surface of the package or the gloves.

· With the thumb and forefnger of the nondominant hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove.

· Keeping the hands above the waistline, lift and hold the glove up and off the inner package with fngers down. Do not let it touch any unsterile object.

· Carefully insert dominant hand palm up into glove and pull glove on. Leave the cuff folded until the opposite hand is gloved.

· Hold the thumb of the gloved hand outward. Place the fngers of the gloved hand inside the cuff of the remaining glove. Lift it from the wrapper, taking care not to touch anything with the gloves or hands.

· Carefully insert nondominant hand into glove. Pull the glove on, taking care that the skin does not touch any of the outer surfaces of the gloves.
Transmission based precautions: what are they
used IN ADDITION to standard precautions for patients in the hospital with suspected or confirmed infections that may be transmitted by airborne, droplet or contact routes

Types:
· CONTACT
· AIRBORNE
· DROPLET
· NEUTROPENIC
contact precautions
Methods of infection control that must be used for patients known or suspected to be infected with epidemiological microorganisms that can be transmitted by either direct or indirect contact.


· Place the patient in a private room

· Wear a contact gown and gloves when entering the room

· Change gloves after coming in contact with infected material

· Avoid sharing patient equipment

· Limit movement of the patient out of the room
Airborne precautions
· Private room with monitored negative air pressure

· 6-12 air changes per hour, appropriate discharge of air outside

· Door closed

· Respirator (n95)
- Filters particles as small as 1 mcm

· Transport patient out of room only when necessary
Droplet precautions
· Use of a private room or cohort if available

· Door may remain open

· Wear a droplet mask

· Eye protection
Keep visitors 3 feet from infected patient

· Transport patient out of the room only when necessary
neutrophenic precautions
Patient has a compromised immune system with a notable LOW neutrophil count (i.e. patients recovering from transplantation surgery or receiving chemotherapy)

Precautions
·Ensure health care provider is healthy

· Restrict visits from friends and family who are ill

· Avoid collection of standing water in room
· Avoid plants and flowers

· Follow hospital protocol for PPE (i.e. contact gown, gloves and mask)
Patient teaching
...
Factors that affect hygiene
Factors that affect hygiene

· Social patterns - ethnic, social, and family influences on hygiene patterns

· Body image - a person's subjective concept of his or her body appearance

· Health beliefs & motivation - motivation is the key factor in hygiene

· Developmental stage - affects the patient's ability to perform hygiene care

· Personal preferences - dictate hygiene practices

· Socioeconomic status - influences the type and extent of hygiene practices used

· Cultural variables - people from diverse cultures practice different hygiene rituals

· Physical conditions - may lack physical energy and dexterity to perform self care
How to accommodate to factors that effect hygiene?
· Respect differences in patient hygiene practices and provide care and information in a nonjudgmental way

· Use communication skills to promote the therapeutic relationship

During hygiene assessment:
· Emotional status
· Health promotion practices
· Health care education needs
Nursing measures to implement hygiene, guidelines
· Use a caring attitude to reduce patient anxiety and promote comfort

· Administer medications for symptoms such as pain before hygiene activities

· Be alert for patient's anxiety or fear

· Assist and prepare patients to perform hygiene as independently as possible

· Teach hygiene techniques and signs of problems

· Inform patients about community resources

· These guidelines will lead to patient outcome achievements

· Increase level of patient participation in hygiene program

· Elimination of, reduction in, or compensation for factors interfering with independent execution of hygiene measures

· Changes related to specific skin problems and independent patient management of prescribed treatment program
shaving
· Shave after bath

· Skin must be softened first

· Short strokes, going down, not side to side. Shave in direction of hair growth

· Comb beards gently

· If on bleeding precautions or prone to bleed (anticoagulants) ---> electric razor ONLY

· Must obtain permission first, especially before trimming mustache or beard

· Important part of a patient's self-esteem and well-being
oral care
· Poor oral hygiene leads to colonization of oropharyngeal secretions by respiratory pathogens

· Poor oral hygiene can lead to aspiration pneumonia

Care of dentures
· Daily cleaning by soaking in and brushing with an abrasive denture cleaner

· Store in cold water when not in patients mouth

· Leaving dentures dry can cause warping

· Label denture holder with patient name
complete bed bath
· wash entire body
· Move from cleanest (face) to less clean areas
· Complete care
- Require nursing assistance with all aspects of personal hygiene

** Complete bed bath is done or the patient is taken to the shower

· Be sensitive to invasion of privacy
partial
· eyes, face, neck, ears, armpits, hands, back, genital/peri-care

**Used if a patient can't tolerate a complete bed bath due to weakness or activity intolerance

· Nurse will only wash areas where skin problems can develop or are causing discomfort

Partial care:
· Often receives morning hygiene care at the bedside or seated near the sink in the bathroom

· Usually only require assistance with body areas that are difficult to reach
when would you use complete vs partial bath
...
when do use water and soap vs just hand sanitizer
1. Soap and water - when hands are visibly soiled or contaminated, before eating, and after using the restroom
· Requires AT LEAST a 20 seconds scrub


2. Hand sanitizer - if hands are not visibly soiled

· Not recommended when C.diff organisms have been identified

*Does not kill spores*
*Does not kill norovirus *
Planning exercise programs for patients based on condition
...
Performing range of motion exercises
1. Active ROM (AROM): patient independently moves through their full ROM

2. Active-Assistance ROM (AAROM): nurse may provide minimal support while patient completes their full ROM

3. Passive ROM (PROM): patient is unable to move independently, and nurse moves each joint through its range of motion
Guidelines for ROM Exercises
o Communicate procedure and purpose of each exercise to patient.
o Avoid overexertion
o Avoid neck hyperextension
o Start gradually and work slowly
o Move each joint until there is resistance, but not pain
o Support the joint during the exercise
o Return the joint to the neutral position
o Use passive exercises as necessary, but encourage active participation
oIf HR and RR do not return to resting values within 3 minutes then the exercise was too strenuous for the patient.
Body mechanics
· Body mechanics is the safe use of the body using the correct posture, bodily alignment, balance and bodily movements to safely bend, carry, lift and move objects and people.

Coordinated use of body parts to produce and maintain equilibrium.
· Good body mechanics prevent fatigue, reduce risk for injury and improve appearance.

·Essential for the nurse to implement good body mechanics to reduce the risk of muscle strain while assisting clients with activities.

o Body Alignment/Posture: alignment of body parts that allows for optimal musculoskeletal balance, operation and promotes healthy physiologic functioning

· Posture: head erect, spine is straight
Knees pointed forward, arms at sides with elbows flexed

· Gait:
One leg in stance phase, other is in swing phase
Arms swing freely alternating with leg swings
Different types of exercises (types, purpose of each)
1. Isotonic: muscle shortening and active movement
Ex: carrying out ADLs, independent ROM activities, swimming , walking, jogging, and biking
- Benefits: increased muscle mass, tone, strength, improved joint mobility, cardiac and respiratory function, improved circulation, increased osteoblastic (bone-building) activity

2. Isometric: muscle contracts WITHOUT shortening
Ex: holding a yoga pose
- Benefits: increased muscle mass, tone, strength; circulation, osteoblastic activity


3. Isokinetic: involves muscle contracts WITH resistance
Resistance provided at a constant rate, usually by a device
· Muscles and joints are taken through a complete ROM without stopping; resistance at every point
Ex: lifting weights
· CPM (continuous passive device) can also be used; good for postoperative exercise plan after joint surgery
· Same type of exercises, but passive ROM
Positioning patients safely in bed
Purpose - helps maintain correct body alignment and facilitates physiologic functioning contributing to the patients psychological and physical well-being

· Foam wedges and pillows - to provide support or elevate a body part
Ideal for support or elevation of the extremities, shoulders, or incisional wounds

· Mattresses - special mattresses and pads to prevent pressure injuries for a patient who must remain in bed

· Adjustable beds - elevating the head and/or foot of the bed, can also be raised so that the mattress is flexed at the level of the knee (rarely recommended)

· Positioning the height of the bed
Trapeze bar - a handgrip to help patients raise their trunk from the bed
Positions
1. Fowler's Position
o Semi sitting (head is elevated 45 to 60 degrees)

2. High Fowler's
o Head of bed is elevated to 90 degrees

2. Supine or Dorsal Recumbent Position
o Lying flat on the back

3. Side-lying or Lateral Position
o Comfortable Alternate to the supine position

4. Prone Position
o Laying on abdomen
o Helps to prevent flexion contractures of the hips and knees

*Need to change the patient's position at least every 2 hours.*
risks of immobility
Potential for complications in every body system, may be temporary or chronic.

· Cardiovascular:
Increased workload of the heart
Increased risk of blood clots
Increased risk for orthostatic hypotension and venous stasis

· Respiratory:
Poor oxygenation (atelectasis)
Decreases depth and rate of respirations

· Musculoskeletal:
Muscle atrophy, decreased tone, and decreased strength
Decrease joint mobility and flexibility
Bone demineralization
Limited endurance

· Metabolic Processes
Decreased metabolic rate resulting in muscle wasting and negative nitrogen balance

· GI System
Disturbances in appetite, decreased food intake, altered protein metabolism, poor digestion and utilization of food

· Urinary system
Urinary tract infections
Kidney stones

· Skin
Skin breakdowns leading to pressure injuries

· Psychosocial Outlook
Coping difficulties
Feelings of worthlessness and diminished self-esteem
Exaggerated emotional responses
Inferring with sleep patterns
assessments to be made on immobility
Assessment to be made - used to help obtain data about the patient's mobility and activity status

1. Nursing History (interview)
Daily activity level
Endurance
Exercise and fitness goals
Mobility problems
Physical or mental health alterations that affect mobility


2. Physical Assessment
General ease of movement and gait
Alignment
Joint structure and function
Muscles mass, tone, and strength
Endurance
What type of assistive devices do you use for patients that are immobile
1. Gait belts - used for transferring patients and assisting with ambulation
2. Stand-assist and repositioning aids
- Help a patient stand from sitting position

3. Lateral-assist devices
- Reduce patient-surface friction during side-to-side transfers
- Roll boards, slide boards, transfer boards, inflatable mattresses

4. Friction-reducing sheets
- Reduces friction with transfer, however, requires excessive force by the caregiver

5. Mechanical lateral-assist devices
- Motorized, moves patients from bed to stretcher

6. Transfer chairs
- Chairs that can convert into stretchers

7. Power stand-assist and repositioning device
- Mechanical, helps patient to a standing position from sitting

8. Powered full-body lifts
- Mechanical lift for patients who are completely dependent
Behaviors which may indicate need for use of restraint
· Patients who are fall-risk, confused, a danger to themselves, or others.
· May only be used if necessary to protect safety of patient, staff, or others
· May only be used as a last resort when all other alternative measures have failed

· Physical reasons - ie. falls
· Medical reasons - ie. pulling out IV's
· Violent behavior - ie. patient is attempting to hurt self or others
Use of restraint alternatives (what they are and when to use them)
Alternatives to restraints:
· Involve family members in patient care or use a 1:1 sitter
· Verbal redirection and patient education
· Bed alarm
· Allow a restless patient to walk
· Assist with toileting at frequent intervals
· Play music or videos or implement other diversionary activities
· Consider relocation of patients room closer to the nurse's station
· Conceal tubing necessary for care (anchor tubing securely, conceal with gauze)
· Investigate possibility of discontinuing bothersome treatment devices
How to manage a patient who is a fall risk (interventions)
Complete a risk assessment
· Indicate risk for falling on patient's door and chart
· Keep bed in a low position
· Keep wheels on bed/wheelchair locked
· Leave call bell in patient's reach
· Instruct patient on use of call bell
· Answer call bell promptly
· Leave a night light on
· Eliminate all physical hazards in room
· Provide non skid footwear
· Leave water, tissues, bedpan/urinal within patient's reach
· Move bedside commode out of sight to discourage attempts at independent transfer
· Document and report any changes in patients cognitive status
· Use alternative strategies when necessary instead of restraints
· As a last resort, use least restrictive restraint according to facility policy
· If restraint is applied, assess patient at the required intervals
· Use bed and chair alarms
How to manage a patient who is a fall risk: identification
Factors that Contribute to Falls
1. Age greater than 65
2. History of Falls
3. Lower body weakness
4. Poor vision
5. Gait and/or balance issues
6. Postural Dizziness
7. Problems with feet and/or shoes
8. Use of psychoactive medications
9. Hazards in home or community
Assessments required when patient is in restraints (freq, when do you have to renew order)
**Ensure orders are current
Requires an order By MD, PA, APRN**

· Orders are time limited:
- Adults - 4 hours
- Children 9-17 - 2 hours
- Children under 9 - 1 hour

*MD/LIP must evaluate within 1 hour(physical) or 24 hours(medical)*

Assessment of patient in restraints:
· Assess movement of patients extremity, sensation, capillary refill, warmth, pulses etc.
· Assess the patient every 15 minutes with restraints placed for a physical reason (i.e. fall risk)
· Assess the patient every 2 hours with restraints placed for a medical reasons (i.e. pulling IV tubbing)
· Continuous supervision (1:1) if restraints are placed due to violent behavior

What do I assess? CMS (circulation, motor, sensory)
· If safe, ensure a temporary release from restraints is provided
· At least every 2 hours
· Ensure toileting, hygiene and oral intake is offered regularly

**Can you fit two fingers underneath the restraint?
Assessments and planning before moving patients
1. Assessing:
See what can a patient handle, daily exercise levels
Nursing history:
Daily activity level
Endurance
Exercise and fitness goals
Mobility problems
Physical or mental health alterations that affect mobility


2. Physical Assessment:
General ease of movement and gait
Alignment
Joint structure and function
Muscle mass, tone, and strength
Endurance

Planning:
Patient will:
· Identify personal benefits of regular exercise
· Demonstrate full range of joint motion (joint mobility)
· Demonstrate adequate muscle mass, tone and strength to perform functional ADLs
· Be free from alterations in skin integrity
Show signs of adequate venous return
· Be free from contractures
Names used to describe medications -recognize the differences
1. Chemical Name: identifies drug's atomic and molecular structure

2. Generic Name: identifies the drug's active ingredient
Usually derived from the chemical name which described the drug's chemical composition
There is only ONE generic name universally used

3. Trade name: "brand name"
A drug can have several trade names based on different manufacturers
Ex:
Generic Name: Ibuprofen
Trade/Brand Name: Advil, Motrin
adverse drug effects
1. Allergic Effect: immune system response that occurs when the body misinterprets the drug as a foreign substance and forms antibodies against the drug
- Can happen immediately after administration or be delayed for hours, days, weeks, etc.
- Symptoms can increase in severity each time the drug is administered
- Common symptoms → rash, urticaria, diarrhea, fever, nausea, vomiting

2. Anaphylactic reaction/Anaphylaxis: more serious, life threatening allergic reaction characterized by respiratory distress, sudden bronchospasm, and cardiovascular collapse
- Treated with vasopressors, bronchodilators, corticosteroids, O2 therapy, IV fluids, antihistamines

3. Drug Tolerance: when the body becomes accustomed to the effects of a drug over a period of time; larger doses needed to produce the same effects
Ex: morphine → when used consistently for a long period of time, the body will become tolerant to the therapeutic effects therefore person would need a higher dose of the drug to control their pain


4. Toxic Effect: specific groups of symptoms related to drug therapy that carry risk for permanent damage or death
Can be caused by:
Cumulative effect → body cannot metabolize one dose of a drug fully before another dose is given
- Drug is taken in more frequently than it is excreted leading to an increase in concentration in the body
- Older adults at risk for this due to altered hepatic metabolism and decreased renal clearance/excretion

5. Idiosyncratic Effect: "paradoxical effect"; an unusual response to a drug; either an over-response, under-response, or the opposite of the expected response
Drug Interactions
1. Antagonistic: combined effect of two or more drugs that produces LESS than the effect of each drug alone

2. Synergistic: combined effect of two or more drugs is GREATER than the effect of each drug alone
Ex: alcohol and barbiturates → taken together can increase/amplify CNS depression

3. Additive: drugs with similar actions result in an increase in overall effect

4. Interference: one drug interferes with the metabolism of another; leads to medication buildup in body and can cause toxicity

5. Displacement: one drug binds to a protein-binding site and displaces another drug, causing it to be released and become active; can lead to increased effect of the unbound drug
Safe practices around administering meds PRIOR
Nurse only follows a written or typed order
Only under certain circumstances, such as emergencies or during a code, should a nurse follow a verbal order
Three Checks PRIOR to administering a medication
1. At the drawer when taking out the medication container or bottle
Check the label against the MAR to make sure you have the right medication

2. At the pour → when putting the medication in the cup

3. Right before administration → check right before giving it to patient


Sometimes you can scan the patient's bracelet, then scan the medication to double check that you have the right medication, dose, etc.
RIGHTS OF ADMINISTRATION
1. Right medication
2. Right dose
3. Right route
4. Right patient
5. Right time
6. Right documentation
Systems of measuring
1. Metric System
- Meters, liters, grams
Most logical, most organized

2. Household System
- Most familiar to individuals
Ex: teaspoon, tbsp, cups
Disadvantage: can be inaccurate
Nursing responsibility around administering meds: controlled vs noncontrolled
· Medication dispensing systems should be locked
· Controlled substances should be kept in a locked drawer or container
· Opioids and other controlled substances may only be prescribed by physicians (some states, NPs and PAs can too)
· Check controlled substances daily, usually at each shift change
· Amount of controlled substances should be counted and recorded
· If a controlled substance needs to be discarded, always have a second nurse with you to be a witness, and remember BOTH nurses need to document!!!
· Also document whenever a full dosage is not given and some of the substance was discarded
what to document after giving meds
Documentation:
· Name of patient receiving controlled substance
· Amount of substance used
hour/time the controlled substance was given
· Name of the prescribing provider
· Name of the nurse who administered substance
How to determine therapeutic use
Serum drug (blood) levels are used to initiate and monitor drug therapy, assess peak and trough levels
effect of meds
1. Therapeutic range: concentration of drug in the blood that produces the desired effect, without causing toxicity

2. Trough level: when drug is at its lowest concentration; determines rate of drug excretion; usually 30 min before next scheduled dose

3. Peak level: highest concentration of the drug; should be measured when absorption is complete

4. Half-Life: amount of time it takes for 50% of the concentration to be eliminated
What to do with Med errors
*Check the patient's condition first*
*Observe for any adverse effects*
· Notify nurse manager and physician
· Write/document description of error and remedial steps taken
· Complete form used for reporting errors
Why and how med errors happen
Why they happen:
· Usually happens at point of transition of care
· Admission to a hospital
· Transfer from one department to another
· Discharged home or to another facility

How they happen:
· Inappropriate prescribing (ex: dose, quantity, route, instruction)
· Extra, omitted, or wrong doses
· Giving a drug to the wrong patient
· Administering a drug by wrong route or wrong time
· Incorrect preparation of drug
· Failure to give within the prescribed time

Time period: 1 hour before or after prescribed time is fine
· Improper technique when administering drug
· Giving drug that has deteriorated or expired
· Important to always double-check, especially high-risk medications
ORAL MEDS: BUCCAL, SUBLINGUAL
What and how they are administered and safety:
- Oral medications are intended for absorption in the stomach and small intestine

- Oral meds should not be administered if the patient is unconscious, vomiting, has difficulty swallowing, or is not allowed to receive anything by mouth

· Sublingual Medication: medication placed underneath the patient's tongue

· Buccal Medications: Placing the medicine between the cheek and the gum


*Offer patient water before administering these meds to help dissolve appropriately. Patients SHOULD NOT swallow these meds*
TOPICAL: APPLICATION, WHY ARE THEY GIVEN, WHAT IS THE ABSORPTION
· Applied to skin or mucous membranes → including the eyes, ears, nose, rectum, vagina, and lungs,

· Usually intended for direct action at a particular site, although some can have systemic effects and are given for that (depending on type of tissue/nature or agent).

On intact skin, drugs are absorbed into the lining of the sebaceous glands.

· Absorption is hindered because of the protective outer layer of the skin, which makes penetration difficult; fatty substances protect the lining of the glands.

· Cleaning the skin thoroughly with soap or detergent and water before administration and then rubbing the medicated preparation into the skin can enhance absorption.

· Absorption can also be improved by using a drug mixed in an ointment or added to a liniment that will mix with the fat in the gland lining.

· When indicated, local heat applied to the application area can improve blood circulation and promote absorption.

· To prevent any absorption by the nurse's skin, wear gloves during the application of topical medications.
INSTILLING: EYE AND EAR
Proper techniques

· Drugs or irrigations are instilled into the auditory canal for their local effect; used to soften wax, relieve pain, apply local anesthesia, destroy organisms, or destroy an insect lodged in the canal.

· Clean external ear of drainage with moistened cotton ball (water or saline solution)

· Place the patient on the unaffected side in bed or if ambulatory, have the patient sit with the head well tilted to the side so that the affected ear is uppermost.

· Remove cap, DO NOT touch the inner side of cap or tip of the container (contamination)

· Straighten the auditory canal by pulling the cartilaginous portion of the pinna up and back in an adult
- straight back for a child older than 3
- down and back in an infant or a child under age 3 years
- Pulling on the pinna as described helps to straighten the canal properly for ear instillation.

· Invert bottle and hold dropper tip above the auditory canal.

Squeeze the bottle and allow drops to fall on the side of the canal. Avoid instilling in the middle of the canal, to avoid instilling directly onto the tympanic membrane.

Release pinna and have the patient maintain position to prevent medication from escaping.

Gently press on tragus a few times to help move the medication from the canal to the tympanic membrane.


Instruct the patient to remain lying down with the affected ear upward for 5 minutes. Wait 5 minutes before instilling drops in the second ear, if prescribed.
INHALERS: MDI, DPI (Dry Powder inhaler)
Patient Knowledge , how they are administered

· Drugs that are inhaled are aerosolized, delivered in small particles, and breathed in by patient
· Easy absorption from the lower respiratory tract→ the smaller the particles of inhaled medication, the further it goes down the tract

1. Bronchodilators: Medications that are administered by inhalation. They relax the musculature in the tracheobronchial tree in order decrease the resistance to airflow and allow for room in the passageway

2. Metered-dose inhaler (MDI): A pressurized canister of medicine. Spacers are recommended for a better medication delivery (esp. with children).
Steps to properly use an MDI
1. Shake the inhaler well.
2. Remove the mouthpiece covers from the MDI and the spacer. Attach the MDI to the spacer by inserting it in the open end of the spacer, opposite the mouthpiece.

3. Have the patient place the spacer's mouthpiece into his or her mouth, grasping securely with the teeth and sealing the lips tightly around the mouthpiece lips. Have the patient breathe normally through the spacer.

4. If no spacer is used, the patient takes a deep breath, exhales, holds the inhaler 1 to 2 in away from the mouth, inhales slowly and deeply while depressing the medication canister and continues to inhale for a full breath.

5. Have the patient breathe normally through the spacer.

6. Instruct the patient to exhale completely, then depress the canister once, releasing one puff into the spacer, and inhale slowly and deeply through the mouth. Instruct the patient to hold his or her breath for 5 to 10 seconds, or as long as possible, then to exhale slowly through pursed lips.

7. Wait 1 to 5 minutes, as indicated by the medication, before administering the next puff, as prescribed.

8. After the prescribed number of puffs has been administered, have the patient remove the MDI from the spacer and replace the caps on both the MDI and spacer.

9. Have the patient gargle and rinse with tap water after using an MDI, as indicated. Clean the MDI according to the manufacturer's directions.
Other sets by this creator