PROCEDURES and RATIONALIZATIONT FOR ADMINISTERING TOPICAL MEDICATIONS

Steps Rationale

1. Silently recite the prayer for the success of the procedure.

ASSESSMENT
2. Review physician’s order for client’s name, name of drug, strength, time
of administration, site of application.
3. Review pertinent information related to the administration of the
medication such as action, purpose, side effects and nursing implications.
4. Assess condition of client’s skin. Cleanse skin if necessary to visualize
adequately.
5. Determine whether client has known allergy to latex or topical agent.
6. Determine whether client is physically able to apply medication
PLANNING
7. Identify client and introduce yourself to the client.
8. Explain procedure and rationale to the client and significant others.
9. Gather appropriate equipment.
10. Perform hand washing.
IMPLEMENTATION
11. Apply topical creams, ointments, and oil- based lotions.
11.1 Wear gloves. Exposed affected area while keeping unaffected areas
covered.
11.2 Wash affected area, removing all debris, and previous medications.
11.3 Soak area with plain warm water to removed crusted tissues.
11.4 Pat skin or allow to air dry.
11.5 If skin is excessively dry and flaking, apply topical agent while skin is
still damp.
11.6 Remove gloves and apply new clean gloves.
11.7 Place medication in the palm of gloved hand and soften by rubbing
briskly between hands.
11.8 Once medication is thin and smooth smear it evenly over skin
surface, using long and even strokes that follow direction of the hair
growth.
11.9 Explain to client that skin may feel greasy.
12. Ensure client’s comfort and safety.
 13. Perform hand washing.
14. Report and record nursing intervention.
EVALUATION
15. Evaluate learning needs of client and family.
16. Observe client’s ability to apply medication.
17. Evaluate learning needs of client and family.
18. Identify unexpected outcomes and intervene as necessary.
PROCEDURES and RATIONALIZATIONT FOR INSTILLING EYE AND EAR MEDICATIONS

Steps Rationale

1. Silently recite the prayer for the success of

the procedure.
ASSESSMENT
2. Review physician’s order for client’s name,
name of drug, concentration, number of
drops (if liquid) time and eye or ear.
3. Review pertinent information related to the
administration of the medication such as
action, purpose, side effects and nursing
implications.
4. Assess condition of external eye or ear
structures.
5. Determine whether client has symptoms of
discomfort or hearing or visual imapairment.
6. Determine whether client has any known
allergies to medications.
7. Assess client’s ability to manipulate or hold
dropper.
PLANNING
8. Identify client and introduce yourself to the
client.
9. Explain procedure and rationale to the client
and significant others.
10. Gather appropriate equipment.
11. Perform hand washing.
IMPLEMENTATION
12. Compare the medication card with the label
of medication.
13. Review the six rights of medication.
14. Verify client’s identification.
15. Apply gloves.
16. Ask client to lie supine or sit back in chair
with neck slightly hyperextended for eye
drops. For ear drops, position client on the
side or sitting in chair with affected ear
 facing up. Gently wash away drainage from
inner and outer canthus.
17. Instill eyedrops.
17.1 Apply gloves. Hold cotton balls or
cleanse tissue in nondominant hand on
client’s cheekbone just below lower lid.
17.2 With tissue or cotton resting below
lower lid, gently press downward with
thumb or forefinger against bony orbit,
exposing conjunctival sac.
17.3 Ask client to look at ceiling.
17.4 Rest dominant hand gently on client’s
forehead, and hold filled medication
eyedropper approximately ½ to ¾ inch into
conjunctival sac.
17.5 Drop prescribed number of medication
drops into conjunctival sac.
17.6 If client blinks or close eyes or if drops
land on outer lid margins, repeat procedure.
17.7 After instilling drops, ask client to close
eye gently.
18. To instill eye ointment.
18.1 apply gloves. Ask client to look up.
18.2 Apply thin stream of ointment along
upper lid margin on inner conjunctiva.
18.3 Have client close eyes and rub lid
lightly in circular motion with cotton ball, if
rubbing is not contraindicated.
18.4 If excess medication is on eyelid,
gently wipe it from inner to outer canthus.
19. If client needs an eye patch, apply clean
one by placing it over affected eye so entire
eye is covered. Tape securely without
applying pressure to the eye.

20. Instill eardrops.

20.1 Apply gloves if drainage is present.
20.2 Hold bottle in hand. Position client with
affected ear facing up.
20.3 Straighten ear canal by pulling auricle
 upward and outward (adult) or down and
back (child).
20.4 If cerumen or drainage occludes
outermost portion of ear canal, wipe out
gently with cotton- tipped applicator, or
taking not to force wax inward.
20.5 Instill prescribed drops holding dropper
½ inch above ear canal.
20.6 ask client to remain in side- lying
position 5- 10 minutes, and apply gently
massage or pressure to ear with finger.
EVALUATION
21. Evaluate effects of the medication
22. Note client’s response to instillation and
observe for side effects.
23. Evaluate client’s ability to self- evaluate.
24. Identify unexpected outcomes and
intervene as necessary.
PROCEDURES and RATIONALIZATIONT FOR INSERTING RECTAL AND VAGINAL
MEDICATIONS

Steps Rationale

1. Silently recite the prayer for the success of the procedure.

ASSESSMENT
2. Review physician’s order, including client’s name, drug name, form
(cream or suppository), route, dosage, and time of administration.
3. Review pertinent information related to medication, including action,
purpose, side effects and nursing implications.
4. Inspect condition of external genitalia and vaginal canal or rectum
( maybe done just before insertion).
5. Encourage client to ask clarification during communication.
PLANNING
6. Verify nursing interventions using physician’s order or nursing care plan.
7. Identify client and introduce yourself to the client.
8. Explain procedure and rationale to the client and significant others.
9. Gather appropriate equipment.
10. Perform hand washing.
IMPLEMENTATION
11. Create a climate of warmth and acceptance.
12. Address the client by name.
13. Use questions appropriately
a. Ask one at a time
b. Allow time to answer
c. Use open- ended questions
14. Use clear and concise statements.
15. Focus on understanding the client, providing feedback, assisting problem
solving.
16. Fold bath blanket back over client’s perinem, assist client to a side- lying
position, and inspect the area for any presence of cuts, bleeding or any
discharges..
17. If no signs of contraindications, apply thin layer of water soluble gel to the
suppository and gently insert it to the rectum of the patient.
 18. Remove gloves and dispose of them in proper receptacle.
19. Assist client in assuming a comfortable position.
EVALUATION
20. Note client’s response and observe for side effects.
21. Evaluate client’s ability to self- evaluate.
22. Identify unexpected outcomes and intervene as necessary.