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06.03 Topical Medications

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Overview

  1. Purpose
    1. Topical medications are absorbed through the skin
    2. They may have local benefits like decreasing itching or inflammation
    3. OR they may have systemic effects (like medicated patches)

Nursing Points

General

  1. Supplies needed
    1. The topical medication
      1. Cream
      2. Ointment
      3. Lotion
      4. Paste
      5. Patch
    2. Washcloth or bath wipe
    3. Permanent marker/pen
  2. ALWAYS
    1. Remove old patch or cream before applying new
      1. Exception – barrier cream shouldn’t be removed – can cause skin breakdown – just apply over it
    2. Rotate sites, especially with patches
    3. Wear gloves when administering!
      1. Otherwise YOU could get a dose!

Assessment

  1. Skin
    1. Only apply over broken skin if that is the purpose of the medication (i.e. bacitracin for a skin tear)
    2. Medicated patches should be applied over clean, dry, hairless, intact skin
      1. May need to use a razor to remove hair before applying

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Verify provider order
    2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
    3. ALWAYS prepare medications at the patient’s bedside
    4. Gather supplies
    5. Perform hand hygiene
    6. Don clean gloves
    7. Let the patient know what meds they will be receiving
    8. Creams, ointments, and lotions
      1. Place prescribed amount in palm of gloved hand
      2. Rub hands together to warm/soften if needed
      3. Spread evenly over skin in intended location
        1. Use even strokes
        2. Follow the direction of hair growth
      4. Apply to desired thickness based on manufacturer instructions or provider orders
    9. Medicated patches
      1. Remove old patch
      2. Dispose of old patch by folding medicated sides together and disposing in an appropriate waste container (per facility policy)
      3. Choose new site
      4. Clean the skin at the new site
      5. Time/date/initial the outside of the patch
      6. Remove backing/covering
      7. Hold only by the very edge of the patch
      8. Apply patch to desired area, press firmly for 10 seconds
    10. Nitro Paste/Ointment
      1. Remove previous dosing paper
      2. Dispose of appropriately
      3. Choose new site
        1. Typically chest,  upper arm or upper back
      4. Clean the skin at the new site
      5. Apply the desired inches of paste/ointment to the back of the dosing paper using the measuring guide
        1. Open the packet on the dotted line
        2. Squeeze the tube or packet gently
        3. Don’t glob
      6. Place the paper with ointment directly on the skin
        1. Don’t rub it in
      7. Time/Date/Initial the paper
      8. Secure the dosing paper with tape on at least 2 sides or with a Tegaderm
    11. AFTER administration
      1. Document administration and patient’s response
      2. If using barcode medication administration
        1. Scan all meds before preparing
        2. Confirm administration AFTER giving to patient
    12. Discard all used supplies
    13. Remove gloves
    14. Perform hand hygiene
    15. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

  1. Indication and possible side effect(s) of medication(s)
  2. Signs to report to nurse or provider

Reference Links

Study Tools

Video Transcript

In this video, we’re talking about topical medications. But, specifically, we want to look at administering topical nitro paste. Big thing to know about any topical medication whether it’s a cream or ointment or a patch or something like nitro paste is that you MUST wear gloves. The medication is DESIGNED to absorb through the skin and it WILL absorb through yours, too, if you don’t wear gloves!

So the first thing for any topical medication, especially patches, is to remove the old patch or dosing paper and clean the area.
We always rotate sites, so while you’re at it, choose a new site and clean that site as well.
Now, your nitro paste will be ordered in inches. So let’s say our provider has ordered 1 inch of nitro paste. You’re going to get a sheet of this dosing paper.
As you can see, when you turn it over, you can read the little ruler on the back. So you’ll apply the desired inches of paste/ointment to the back of the dosing paper using that measuring guide.
When you do that if you’re using a packet, open it directly on the dotted line, and just squeeze the packet or the tube gently along the line – you don’t want to glob it on or it’ll be too much.
Now, take the paper, turn it over, and apply it directly to the patient’s skin. Do NOT rub it!
Time/date/initial the paper and secure the paper with tape on at least 2 sides. OR you can use a big Tegaderm or transparent dressing over it. Just make sure you can see the labelling on the paper.

And that’s it – easy as that. Very similar with regular patches – remove the old one, clean your new site, label the patch, and secure it in place.

Be smart, if you’re ever not sure how to apply, check with your pharmacist. Now, go out and be your best self today. And, as always, happy nursing!

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