Application of ointment powder plaster on the skin algorithm. Application of medicines to the skin. Certificate of honor for scientific, educational and educational activities within the framework of the "Infourok" project
SAINT - PETERSBURG
STATE BUDGET PROFESSIONAL
EDUCATIONAL INSTITUTION "MEDICAL TECHNICUM No. 2"
practical lesson
Professional module 04
Performing work by profession
"Junior nursing nurse"
in the specialty 34.02.01 "Nursing" (basic training)
Lesson topic
"External use of drugs"
Qualification: Nurse / Medical Brother
Full-time form of education; part-time
Profile of received professional education: natural science
Compiled by:Bannova O.V
Chairman of the CMC
Bannova O.V
"_____" ___________ 2016
Lesson objectives:
Methodical:
Application of a complex of teaching methods:
reproducing, training exercises;
problem-search methods (problem solving);
partial search methods - independent work;
method of problem presentation - a combination of verbal information with elements of problematicity;
individual simulation methods (simulation exercises, analysis of specific situations).
Didactic:
To expand knowledge about the external use of drugs, to know safety precautions when using ointments and when using an inhaler.
Explain the effect of the drug on the skin and mucous membranes.
Working with algorithms (- instilling drops in the eyes, nose, ears; - putting the ointment in the eyes, nose and ear; - applying ointments on the skin in various ways, powders, patches, solutions, tinctures; inhalation drug administration; direct drug administration intestine - suppositories).
To give practice (performance of skills) on teaching the patient about the external use of drugs - on the skin and mucous membranes.
Formation of skills - the implementation of training the patient in the technique of using a metered aerosol in an inhaler.
Educational:
Education of professional accuracy, diligence, responsibility for the assigned work.
Education in students of the most important personal and professional qualities of a medical worker:
the ability to be aware of the responsibility for the patient's life;
the ability to analyze your behavior;
education of the ability to work according to standards, algorithms.
Developing:
Formation among students:
the skill of analyzing and synthesizing the material being studied;
the ability to carry out intra-subject communications;
the ability to apply interdisciplinary connections.
Ability to solve problem and situational tasks.
Developing the ability to analyze errors.
Place of occupation: Medical College number 2
Duration of the lesson: 4 hours
Speciality: 02.34.01 "Nursing"
Occupation professiogram:
The student should know:
External use of drugs: on the skin, on mucous membranes. (PC 4.4. Provide medical services within the limits of their authority);
Safety precautions when using ointments and an inhaler (PC 4.4. Provide medical services within the limits of their authority);
Definitions of terms used during procedures; (PC 4.8. Participate in health education among the population; PC 4.4. Advise patients and his environment on the issues of care and self-care).
The student should be able to:
Bury drops in eyes, nose, ears.(PC 4.4. Provide medical services within the limits of their authority);
Apply ointments to the skin in various ways, powders, patches, solutions, tinctures. (PC 4.4. Provide medical services within the limits of their authority; PC 4.5. Provide a safe hospital environment for patient and staff);
Instill drops in the eyes, nose, ears (PC 4.4. Provide medical services within the limits of their authority; PC 4.1. Communicate effectively with the patient and his environment);
Putting ointment in the eyes, nose and ears (PC 4.4. Provide medical services within the limits of their authority; PC 4.1. Communicate effectively with the patient and his environment);
teach the patient the technique of using metered aerosol in the inhaler (PC 4.4. Provide medical services within the limits of his authority; PC 4.1. Communicate effectively with the patient and his environment);
to inject the drug into the rectum - suppositories (PC 4.4. Provide medical services within the limits of their authority; PC 4.1. Communicate effectively with the patient and his environment).
Methodological instructions for the teacher by the stages of the lesson
Course of the lesson
Methodological substantiation
Organizing time:
greetings;
marking of absent students, finding out the reason;
checking the appearance of students (adherence to uniforms);
checking the readiness of students for the lesson (the presence of diaries and notebooks of manipulations).
organizes and disciplines students;
fosters relevance, responsibility;
fosters self-exactingness;
self-control.
Lesson motivation:
familiarization with the topic, plan, purpose of the lesson;
substantiation of the significance of this topic of the lesson in future practical activities
creates a working environment;
activates the attention of students;
forms a cognitive interest in the lesson.
III
Updating basic knowledge .
Control of the initial level of knowledge :
Frontal survey on the topic: "External use of drugs." (Appendix # 1).
reproduction of previously studied material;
identifying the level of independent thinking.
Formation of new knowledge and skills :
Plan
Step-by-step presentation of new material
1. External use of drugs: on the skin, on mucous membranes.(Appendix # 2)
2. (Appendix # 3).
3. The use of medicines on the skin (ointments, powders, plasters, solutions and tinctures) (Appendix No. 4);
4. Methods for applying drugs to the skin (Appendix No. 5);
5. Instillation of drops in the eyes, nose and ears (Appendix No. 6).
6. Putting the ointment in the eyes, nose and ears (Appendix # 7).
7. Inhalation method of introducing drugs through the mouth and nose (Appendix No. 8).
Students are encouraged to step-by-step writing the plan in diaries.
Teacher using tables, diagrams
introduces new material step by step
informs students about new elements of knowledge, skills
explains the most important points
organizes the current control of knowledge for the assimilation of the material.
2) Demonstration by the teacher of the manipulation "instilling drops in the eyes, nose and ears"; "Putting the ointment in the eyes, nose and ears"; "The use of drugs by inhalation through the mouth and nose."
3) Independent work of students:
Practicing manipulations (according to algorithms)
Skin lubrication procedure;
rubbing the ointment on a limited area of the skin;
the use of a softening patch on the keratinized area of the skin (dry corn);
the use of powder for an adult patient;
instillation of drops in the eyes;
instillation of drops in the nose;
laying the ointment behind the eyelid from a tube;
the introduction of the ointment into the nose;
the introduction of drops into the external auditory canal;
inhalation administration of drugs using a nebulizer;
the use of a pocket inhaler with a space.
4) Pinning the topic:
Answer questions (Appendix 9, 9a)
5) Working with guidelines:
compilation of a glossary of terms (Appendix No. 10)
external route of administration;
spray can;
talkers;
liniment;
lotion;
ointment;
tinctures;
paste;
plasters;
powder;
solution;
emulsion.
allows you to present new material in a logical sequence with an explanation of concepts and essence;
allows you to establish a connection between new material and previously studied;
consolidates knowledge on the topic;
develops visual memory;
develops cognitive interest in students;
leads trainees to understand the problem;
deepens knowledge of the topic;
forms the ability to work according to a set of rules;
fosters a sense of responsibility and self-orientation regarding the priority of one's health;
reinforces the use of health-saving technologies in the work process.
Work of students in small groups (2-3 people):
Strengthens the skills of independent work with algorithms;
Activates interest in the lesson;
Encourages active educational and cognitive activity;
Improves the ability to work in a team.
Current control of knowledge to assess the assimilation of the material :
test solution;
(Appendix No. 11, 11a)
knowledge check
the whole brigade;
reveals the ability to apply the knowledge gained in practice;
determines the level of professional thinking.
Summing up the results of the lesson:
the achievement of the goals of the lesson is determined;
mistakes, positive and negative points in the work are commented;
the questions that have arisen are resolved;
a lesson point is set. (An example of a table in Appendix # 7, tables are attached separately).
Directs students to use the knowledge, skills and experience acquired in class in further work.
YII
Assignment for the next lesson :
Fundamentals of Nursing: Workshop. / T.P. Obukhovets, O.V. Chernov - Rostov n / a: Phoenix, 2013 .-- 766 p. - pp 394-398
Consolidation of the passed material
3. Complete tasks in the portfolio on the topic of introduction лв.
to expand self-education;
activates self-training;
forms the principle of consciousness and activity.
Appendix # 1
Frontal poll
List the methods of external administration of medicinal substances.
Appendix # 2
External use of medicines
External route of administration - the effect of drugs mainly locally on the skin and mucous membranes, in the eyes, nose, ears, through the respiratory tract.
The purpose of topical application of drugs:
improved absorption of drugs through the skin or mucous membranes;
providing a local anesthetic effect;
providing a bactericidal and bacteriostatic effect.
Application methods : compresses, lotions, dusting, application, rubbing, bandages, instillation of drops, inhalation.
Dosage forms: ointments, emulsions, liniments, lotions, jellies, gels, foams, pastes, solutions, talkers, powders, tinctures, aerosols.
Appendix No. 3
Advantages and disadvantages of external drug use
Advantages :
disadvantages :
Appendix No. 4
The use of medicines on the skin (ointments, powders, plasters, solutions and tinctures)
When using the drug on the skin, it is necessary:
inspect the place where the medicine is applied, make sure there is no redness, rash, swelling, wetness;
treat with warm water or skin antiseptic;
dry with a towel or gauze napkins.
Before exposure to the skin, dosage forms:
liquid (lotion, talker) - pour on a gauze napkin;
soft (ointment, paste, cream, jelly, gel) - apply to the skin area with an applicator, napkins, spatula, hands;
solid (dusting) - apply to the skin with shaking movements from the package.
Powder application
Sequencing:
2. Wash and dry the skin with a tissue or towel.
3. Apply evenly with shaking movements to the skin ("powder"),
4. Remove gloves, discard in a disinfectant.
5. Treat your hands.
Applying the patch to intact skin
Sequencing:
1. Treat your hands, put on gloves.
2. Open the package of the plaster with scissors.
3. Remove the protective layer without touching the inner surface with your hands.
4. Fix the patch to the skin.
5. Provide the patient with a comfortable environment.
7. Treat your hands.
Methods for applying ointments, gels, jellies, pastes to the skin:
1. Application.
2. Rubbing.
3.Compressors.
4. Dressings.
Applying ointments to the skin
Sequencing:
1. Examine the skin area to apply the ointment.
2. Handle your hands, put on gloves.
3. Squeeze the required amount of ointment from the tube onto the applicator.
4. When applying the ointment to the skin - apply the ointment in a thin layer;
when rubbing in the ointment - rub the ointment with rotational movements until completely absorbed (until the skin becomes dry).
5. When applying the ointment to the skin - leave the skin open for 10-15 minutes until completely absorbed;
when rubbing in the ointment - cover the patient for warming or warmth, wrap the place where the ointment is rubbed.
6. Create a comfortable position for the patient.
7. Remove gloves, discard in disinfectant, wash and dry hands.
Notes (edit) :
An irritating ointment is applied to the applicator, and an indifferent ointment is applied to the hands.
It is necessary to carefully study the annotations of the use of ointments.
Appendix No. 5
Methods for applying drugs to the skin
Rubbing – the introduction of medicinal substances through the skin in the form of liquids or ointments. Rubbing is performed in areas where the skin is thinner and not covered with hair (flexor surface of the forearms, back of the thighs, lateral surfaces of the chest, abdomen). The skin at the site of rubbing must be clean. If the ointment is not very irritating, you can rub it in with gloved fingertips. The required amount of ointment or liquid is applied in a thin layer to the skin and rubbed in a circular motion in one direction. For rubbing, you can also use the special devices that come with the ointments. A contraindication to this procedure is the presence of inflammatory changes in the skin.
In some cases, the ointment is applied to the skin, without rubbing, with a thin layer of a glass spatula or spatula, and the area is kept open for 10-15 minutes. It is not recommended to do this by hand, as some ointments are absorbed through intact skin or are irritating.
Lubrication is widely used mainly for skin diseases. A cotton or gauze swab is moistened in the required medicinal substance and applied to the patient's skin with light longitudinal movements (in the direction of hair growth).
Appendix No. 6
Instillation of drops in the eyes, nose and ears
Before injecting drugs into the eyes, nose, ears, it is necessary:
1) carry out personal hygiene measures;
2) observe the temperature regime of the drops:
in the eyes, nose - at room temperature
in the ears - body temperature.
In the nose, drugs are used to:
ensuring nasal breathing (vasoconstrictor agents);
anti-inflammatory therapy;
immunostimulation.
Instillation of drops in the nose
Sequencing:
1. Treat your hands, put on gloves.
3. Lift the tip of the nose.
4. Instill 3-4 drops of the drug in one nasal passage, press the wing of the nose against the septum and tilt the head in the same direction.
5. After 2 minutes, add drops in the same sequence to the other nasal passage.
6. Remove gloves, discard in a disinfectant.
7. Treat your hands.
Notes (edit) : When using oil preparations, tilt the patient's head back and inject 5-6 drops into both nasal passages. In the mouth, the patient will feel the taste of drops, the drug flows down the back of the pharynx.
Before and after manipulation, you should ask to free the nasal cavity from mucus using napkins. Blow your nose without tension, alternately from each nostril.
Instilling drops in the ear
Sequencing :
1. Treat your hands, put on gloves.
2. Sit down (or lay down) the patient, tilt his head to the healthy side.
3. Heat the preparation to body temperature.
5. Inject 5-6 drops into the external auditory canal.
6. Press lightly on the ear trag to direct the drops inward.
7. Put on a cotton ball, do not change the position of the head for 5-10 minutes.
8. Drop the ball into a special tray.
10. Treat your hands.
Goals the introduction of ophthalmic drugs:
local action of the drug;
measurement of intraocular pressure;
dilated pupil for examination.
All drugs and dressings must be sterile and intended for ocular practice, the drugs are injected into the lower conjunctival sac so as not to damage the sensitive cornea; do not recommend using dry balls. When applying the drug, do not touch the eyelashes, eyelids, conjunctiva.
The eye is a sensitive organ to infection and injury.
Instillation of drops in the eyes
Sequencing:
1. Treat your hands, put on gloves.
2. Sit down (or lay down) the patient with his head thrown back. Hand in a sterile bead / napkin. to ensure personal hygiene.
3. Ask the patient to look up.
4. Pull the lower eyelid down with the thumb of the left hand.
5. Inject 1 drop into the lower fornix of the eyeball, without touching the eyelashes and holding the pipette perpendicular to the lower eyelid.
6. Ask the patient to close their eyes.
7. Attach a sterile cotton ball moistened with 0.9% sodium chloride solution to the inner corner to remove some of the medication.
8. Dump the balls into a special tray.
9. Remove gloves, discard in a disinfectant.
10. Treat your hands.
Appendix No. 7
Putting the ointment in the eyes, nose and ears
Putting ointment in the nose
Sequencing:
1. Treat your hands, put on gloves.
2. Sit down (or lay down) the patient, tilt his head back slightly.
3. Apply a small amount of ointment to the cotton wool.
4. Lift the tip of the nose.
5. Introduce turunda with ointment into the nasal passage with rotational movements to a depth of no more than 1.5 cm.
6. Leave the turunda in the nose for 10-15 MINUTES, then remove.
7. Introduce, if necessary, turunda with ointment into the other nasal passage.
8. Dump the turunda into a special tray.
9. Remove gloves, discard in a disinfectant.
10. Treat your hands.
11. Create a comfortable position for the patient.
In the ear, drugs are used to:
· Relief of pain;
· The introduction of antibiotics;
· Softening of sulfur.
Putting the ointment in the ear
Sequencing:
1. Treat your hands, put on gloves.
2. Sit down (or lay down) the patient, tilt my head to the opposite shoulder.
3. Apply the required amount of ointment to sterile cotton wool.
4. Pull the auricle up and back to straighten the external auditory canal.
5. Introduce a cotton swab into the external auditory canal with rotational movements.
6. Leave the turunda in the ear for the duration of the treatment, then drop it into a disinfectant.
7. Remove gloves, discard in a disinfectant.
8. Treat your hands.
Applying eye ointment from a tube
Sequencing:
1. Treat your hands, put on gloves.
2. Sit down (or lay down) the patient with his head thrown back and ask to look up.
3. Pull the lower eyelid down with your thumb.
4. Apply the ointment to the lower conjunctival fornix from the inner corner of the eye to the outer one.
5. Ask the patient to close their eyelids.
6. Remove excess ointment with a sterile cotton ball and perform a light circular massage through closed eyelids,
7. To discard the balls, treat the "nose" of the tube with a ball moistened with alcohol.
8. Remove gloves, discard in a disinfectant.
9. Treat your hands.
10. Create a comfortable position for the patient.
Appendix No. 8
Inhalation method of administering drugs through the mouth and nose
Inhalation route of administration
Inhalation route of administration is the administration of drugs through the respiratory tract. Aerosols, gaseous substances (nitrous oxide, oxygen), vapors of volatile liquids (ether, fluorothane) are introduced.
The drug in the inhaler vial is in the form of an aerosol. Used as a vasoconstrictor and anti-inflammatory agent in the nose and mouth.
Advantages :
local action (mouth, nose);
impact in unchanged form on the pathological focus.
Disadvantages:
irritation of the mucous membrane of the respiratory tract;
poor penetration of drugs directly into the focus in violation of bronchial patency.
There are inhalers - stationary, portable, pocket.
Pocket inhalers are used for an attack of bronchial asthma. The nurse teaches the patient how to use the individual inhaler.
Using a pocket inhaler
Sequencing:
1. Wash and dry your hands.
2. Remove the protective cap from the can and turn it upside down.
3. Shake the preparation.
4. Cover the mouthpiece with your lips.
5. Take a deep breath, press the bottom of the can and hold your breath for 5-10 seconds.
6. Breathe out slowly through the nose.
7. Put on the protective cap.
8. Wash and dry your hands.
The drug can be injected into the nose using a special nozzle.
Appendix No. 9
Questions to fix the topic
List the routes of external administration of medicinal substances.
Talk about the advantages and disadvantages of using medicinal substances externally.
Receiving, storing and discharging medicinal substances for external use.
Appendix No. 10
Glossary
External route of administration – the effect of drugs mainly locally on the skin and mucous membranes, in the eyes, nose, ears, through the respiratory tract. ointments, emulsions, liniments, lotions, jellies, gels, foams, pastes, solutions, talkers, powders, tinctures, aerosols.
Spray can - representing medicinal substances under pressure together with propellants in a sealed package equipped with a valve-spray system (dosing or non-dosing). An aerosol that releases the contents of the package with air is called a "spray".
Chatterbox is called a homogeneous mixture of certain substances, which is made for the treatment of skin diseases. The specific name of the drug is based on the fact that it must be shaken before use. This is to prevent the components from settling.
Liniments ( Linimentum ) – These are liquid ointments, which are thick liquids or gelatinous masses, applied externally.
Lotion ( , Tinctura ) – liquid alcohol extraction of biologically active substances from plant materials. Tinctures are dark-colored, but clear and storage-stable liquids.
Paste ( Pasta ) – This is a type of ointment containing from 25 to 50% of powdered substances. A dosage form containing less than 25% of powdered medicinal substances is called an ointment, but when starch, white clay, talc, zinc oxide is added to the latter in excess of the specified concentration, it acquires the properties and qualities of a paste.
Plasters ( Emplastrum ) – a dosage form for external use, having the ability, after softening at body temperature, to be retained on the skin, i.e. stick.
Powder ( Pulvis ) – it is a solid dosage form obtained by grinding medicinal substances and dried raw materials of any origin.
Solution ( Solutio ) – a liquid dosage form obtained by truly dissolving one or several medicinal substances in a solvent.
Emulsion ( Emulsum )– a liquid dosage form in which water-insoluble liquids (oils, balms) in the form of tiny droplets are suspended in an aqueous medium.
Appendix 11
Test
A dosage form made in a pharmacy for external use must have a label with a strip of the appropriate color:
a) white; b) yellow; c) blue; d) pink.
External method of using medicinal substances:
a) through the mouth; b) through the rectum; c) intradermally; d) on the skin, mucous membranes.
Inhalation can be administered:
a) liquid medicinal substances;
b) gaseous medicinal substances;
c) powdered medicinal substances;
d) suspensions.
Medicinal substances used externally have an effect on the body:
a) local; b) fortifying;
c) anticonvulsant; d) tonic.
Medicinal aerosols include:
a) suspensions of medicinal substances; b) aqueous solutions;
c) alcohol solutions; d) oil solutions
Appendix 9a
Sample answers to questions to consolidate the topic
The effect of drugs is mainly local on the skin and mucous membranes, in the eyes, nose, ears, through the respiratory tract.
Advantages : availability, variety of dosage forms and methods of their use.
disadvantages : the method is designed primarily for local effects, since only fat-soluble substances are absorbed through intact skin.
3. Discharge and receipt of medicines in a healthcare facility.
The nurse makes a selection of prescriptions every day and writes them down in a notebook or prescription sheet for each patient. Information about the prescribed injections is transferred to the treatment room to the nurse performing the injections. The list of all prescribed funds, written in Russian, is given by the ward and procedural nurses to the head nurse of the department, who summarizes this information and writes out a specific request form or a bill of lading for receiving medicines from the pharmacy. These requirements are signed by the head of the department.
Requirements are written out in 2 copies, one of which remains in the department. After receiving drugs from the pharmacy, the head nurse carefully checks the compliance of the drugs with the prescribed requirements, the presence of a label with the name of the drug and its dose, and the date of manufacture.
Requirements for poisonous, narcotic drugs, ethyl alcohol are prescribed in Latin inseparate forms (requirements) with a stamp, seal and signature of the head of the medical institution. At the same time, the routes of administration of these drugs and the concentration of ethyl alcohol are indicated. The requirements indicate the number of the medical card, the name of the patient and the diagnosis. List A - narcotic and poisonous drugs and list B - potent. Narcotic drugs include morphine, omnopon, promedol, codeine, and others. Poisonous substances include arsenic, strophanthin, atropine, proserin, strychnine. For potent - chlorpromazine, adrenaline, prednisone and others
The following storage conditions must be observed.
1. Medicines that decompose in the light (they are produced in dark bottles) are stored in a place protected from light.
2. Store strong-smelling medicines separately.
3. Perishable drugs (infusions, decoctions, potions, ointments, suppositories, serums, vaccines, blood preparations) are stored in the refrigerator. The shelf life of infusions, decoctions and mixtures in the refrigerator is no more than 3 days. Signs of unsuitability of dosage forms are turbidity, unpleasant odor, discoloration. If the ointments have stratified, changed color, or acquired a rancid odor, they are not used.
Vaccines, serums, blood products are stored in a separate refrigerator. The refrigerator must have a thermometer.
Posted on ref.rf
The nurse controls the temperature twice a day and records it on a special temperature control sheet, which is attached to the refrigerator. The freezer must store cold elements that are used in case of an emergency power outage. In this case, the cold elements are placed on the shelf of the refrigerating chamber.
4. Do not use drugs (tablets, powders, etc.) if their expiration date has expired or they have changed color, consistency.
5. All cabinets where medicines are stored must be locked with a key, a paramedic working in a post or in a treatment booth ete is responsible for their safety.
Nurse is not allowed˸
1) change the form of medicinal products and their packaging;
2) combine the same medicinal products from different packages into one;
3) replace and correct labels on medicinal products;
4) store medicines without a label
Appendix 11a Frontal
survey
Independent work
Solving situational tasks + Manipulation technique
Overall score
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Prepare: gloves, powder, napkin, disinfectant container.
3. Inspect the place of application of the medicinal product.
4. Carry out hygienic treatment of hands, wear gloves.
5. Wash and dry the skin with a napkin (towel).
6. Apply powder (powder) to the skin with shaking movements.
7. Remove gloves, discard in a disinfectant.
8. Provide the patient with a comfortable environment.
9. Wash and dry your hands.
Apply the patch to intact skin.
Prepare: plaster, scissors, gloves, disinfectant container.
2. Greet, introduce yourself, obtain informed consent from the patient for the procedure.
3. Inspect the place where the patch was applied.
5. Open the package of the plaster with scissors.
6. Remove the protective layer without touching the inner surface with your hands.
7. Fix the plaster on the patient's skin.
8. Provide the patient with a comfortable position.
9. Remove gloves, discard in a container with a disinfectant.
10. Wash and dry your hands.
Application of medications to the eyes, nose and ears.
Before the introduction of drugs, you must:
1. Observe the temperature regime of the drops:
In the eyes, nose - at room temperature
In the ears - body temperature!
2. Carry out measures for hygienic treatment of eyes, nose, ears.
Instillation of drops in the nose.
actions.
4. Carry out hygienic treatment of hands, wear gloves.
5. Ask the patient to cleanse the nose on their own with a napkin.
6. Sit down or lay down the patient, tilt the head back slightly.
7. Dispense the required amount of the drug into a sterile pipette.
8. Lift the tip of the patient's nose with the left hand.
9. Instill 3-4 drops in one nasal passage.
10. Press the wing of the nose against the septum and tilt the head in the same direction.
11. After 2 minutes, add drops in the same sequence to the other nasal passage.
12. Make sure that the patient is not uncomfortable after the manipulation.
13. Remove gloves, discard them in a disinfectant.
14. Wash and dry your hands.
15. Make a note of the procedure carried out in the documentation.
Putting the ointment in the nose.
Say hello, introduce yourself, get informed consent from the patient.
3. Tell the patient all the necessary information about the drug and its side effects.
actions.
4. Carry out hygienic treatment of hands, wear gloves.
5. Ask the patient to cleanse his nose (blow his nose) on his own with a napkin.
If this is a small child, then a special electric pump is used.
6. Put on a mask.
7. Perform hand hygiene and wear gloves.
8. Sit down or lay down the patient. Throwing his head back slightly.
9. Apply 0.5 cm of ointment to the turundas and put them in the tray.
10. Raise the tip of the patient's nose with your left hand.
11. Insert the turunda into the nasal cavity by a rotational movement by 1.5 cm by 2-3
12. Remove the turunda, throw it into a disinfectant.
13. Introduce another turunda into another nasal passage, observing the same sequence.
14. Make sure the patient is not uncomfortable.
15. Remove gloves and discard them in a container with a disinfectant.
16. Wash and dry your hands.
17. Make a note of completion in the documentation.
Instillation of eye drops.
All medications and dressings must be sterile!
When applying the drug, do not touch the eyelashes, eyelids, conjunctiva.
Prepare: sterile gloves, eye drops, sterile tray, sterile pipette and sterile beads, sterile furacillin solution.
Say hello, introduce yourself, get informed consent from the patient.
3. Tell the patient all the necessary information about the drug and its side effects.
actions.
4. Carry out hygienic treatment of hands, wear gloves.
6. Dispense the required amount of the drug into the pipette.
7. Ask the patient to look up.
8. Pull the lower eyelid down with a sterile swab to form
conjunctival sac.
9. Instill 2-3 drops of the drug in the conjunctival sac, holding
pipette perpendicular to the lower eyelid.
10. Ask the patient to close their eyes.
11. Dispose of the sterile ball into the disinfectant.
12. With another sterile ball, blot the remaining liquid that has come out at
inner corner of the eye.
13. Make a light circular massage of the eye through closed eyelids.
14. Dump the balls into a container with a disinfectant.
15. Repeat the procedure with the other eye. If required.
16. create a comfortable position for the patient.
17. Remove gloves and discard them in disinfectant.
18. Wash and dry your hands.
19. Put a mark on the procedure in the documentation.
Putting the ointment in the eyes.
Prepare: eye ointment, eye bath, sterile gloves, sterile beads and two sterile glass rods, sterile kidney-shaped tray, sterile furacillin solution.
suitability.
Say hello, introduce yourself, get informed consent from the patient.
3. Tell the patient all the necessary information about the drug and its side effects.
actions.
4. Carry out hygienic treatment of hands, wear gloves.
5. It is convenient to sit or lay down the patient, tilt the head back slightly.
Perform hygienic eye care.
6. Squeeze the required amount of ophthalmic ointment into the ophthalmic bath.
7. Pull the lower eyelid down with a sterile ball.
8. Introduce the ointment into the lower conjunctival sac from the inner corner to the outer with
using a sterile glass rod.
9. Ask the patient to close their eyelids.
10. Dispose of the used ball into disinfectant.
11. Remove excess ointment with a new sterile ball and lightly massage the eye
round.
12. Dispose of the ball into the disinfectant.
13. Create a comfortable environment for the patient.
14. Remove gloves and discard them in disinfectant.
15. Wash and dry your hands.
16. Enter a note on the completion of the procedure in the documentation.
Instillation of drops in the ear.
Prepare: ear drops, gloves, a container with a disinfectant, ear turundas,
cotton balls.
suitability.
Say hello, introduce yourself, get informed consent from the patient.
3. Tell the patient all the necessary information about the drug and its side effects.
actions.
4. Carry out hygienic treatment of hands, wear gloves.
5. It is convenient to lay the patient on his side, or sit down and tilt his head slightly to the healthy side.
6. Carry out hygienic ear care without petroleum jelly.
7. Heat the drug to the patient's body temperature.
8. Draw up the medicinal product into the pipette.
9. Pull the auricle back and up.
10. Inject 5-6 drops into the external auditory canal.
11. Press on the ear tragus to direct the drug inward.
12. Put a cotton ball into the external auditory canal and do not change the position of the head
5-10 minutes.
13. make sure the patient is not uncomfortable.
14. Throw the ball into the disinfectant and gloves.
15. Wash and dry your hands.
16. Put a mark on the procedure in the documentation.
Putting the ointment in the ear.
Prepare: ear ointment, gloves, a container with a disinfectant, ear turundas,
cotton balls.
| Stages | Justification | |
| Preparing for the procedure | ||
| 1. Inform the mother (child) about the rules of the procedure | Ensuring the right to information | |
| 3. Help your child get into a comfortable position | Ensuring a comfortable state. | |
| 4. Read the name of the medicinal substance, see the expiration date, ( if the medicinal product was stored in the refrigerator, warm up to room temperature) | Ensuring the clarity of the procedure, preventing unwanted effects. | |
| 5. Wash and dry hands, wear gloves | Infection safety control. | |
| Procedure execution | ||
| 1. Squeeze ointment or paste onto a spatula or glass stick, a bolt on a cotton swab and apply a thin layer on the skin; P control that the child is 10-15 min. held the surface of the skin open; Ask older children about discomfort, if any; Examine the skin after 10-15 minutes | Relieves inflammatory changes For a better effect of the drug Prevention of side effects, identification of individual intolerance Make sure that the drug is completely absorbed | |
| Completion of the procedure | ||
| 1. Treat a used glass rod or spatula in a disinfectant solution. | ||
| 2. Take off the gloves, disinfect them, wash and dry your hands | Ensuring infectious safety |
Medical masks and lotions
Target: curative
Indications:
ü inflammatory skin diseases, skin diseases accompanied by weeping.
Contraindications:
P individual hypersensitivity to the drugs used.
Equipment:
P tray for equipment;
P medicinal solutions: (as prescribed by a doctor)
* potassium permanganate 1: 5000
* rivanola 1000
* 2-5% resorcinol
* 10% ichthyol ointment
* 4% tannin solution
ü gauze napkin;
ü scissors;
ü gloves;
ü tray for used equipment;
ü container with a disinfectant solution;
Mandatory conditions
ü the temperature of the solution for young children is 36-37 0 С, and for older children 22-24 0 С
Table 28
Technique for conducting a medical mask and lotions
| Stages | Justification | ||
| Preparing for the procedure | |||
| 1. Explain to the mother (child) the purpose and course of the procedure, to obtain consent. | Ensuring the right to information. Formation of motivation for cooperation | ||
| 2. Prepare the necessary equipment. | Ensuring the clarity of the procedure | ||
| 3. Prepare the medicinal solution, if necessary, warm it up. | Ensuring a comfortable state | ||
| 4. Wash and dry your hands. Wear gloves. | Ensuring infectious safety | ||
| 5. Fold the gauze in 10-12 layers, cut out a hole for the mouth, nose, eyes (when applied to the face). | Do not violate the basic needs of the child | ||
End of table 28
| 6. Pour the prepared solution into a tray and moisten a gauze cloth, then squeeze out slightly. | Ensuring hygienic comfort |
| Procedure execution | |
| 1. Apply a napkin to the affected area. | Providing local action of the solution |
| 2. If necessary, fix with 1-2 rounds of bandage. | Ensuring fixation |
| 3. If necessary, moisten the napkin every 20-30 minutes. Using a cotton swab. | |
| Completion of the procedure | |
| 1. The napkin can be left on for 2-5 hours. | |
| 2. After using the lotions, apply ointment to the skin | Providing a therapeutic effect |
| 3. Dispose of the used napkin in the tray and disinfect. | Ensuring infectious safety |
| 4. Remove gloves, disinfect them, wash and dry hands | Ensuring infectious safety |
Healing baths
Indications:
ü suppression of inflammation on the skin with atopic dermatitis;
ü elimination of dry skin and skin itching;
P prevention and elimination of secondary infection;
P restoration of the epithelium;
P improvement of skin barrier functions.
Equipment:
P bath tub
P dechlorinated water
P bath diaper or stand
P water thermometer
P bottle with 5% aqueous solution of potassium permanganate
P decoctions and infusions of herbs: string, birch leaf, St. John's wort, bay leaf, burdock root, yarrow, oak bark, horse sorrel, motherwort, flax seed infusion, bran
P starch, vegetable oil
P cotton towel
P clean set of cotton, flannel
P laundry bag
P container with disinfectant solution
Mandatory conditions:
P during the period of exacerbation, conduct baths 1 time in 2 -7 days
P baths with decoctions and herbal infusions should be used 1-3 times a week
P in the presence of secondary infection, add a 5% aqueous solution of potassium permanganate to the water (until slightly pink)
P for severe dry skin, add flax seed (decoction), bran, starch, vegetable oil to the bath
P infusions and decoctions are prepared in advance: infusion: 1 tablespoon of herbs in 1 glass of boiling water - leave for 10 minutes; decoction: 1 tablespoon of herbs in 1 cup of boiling water, cook in a water bath for 20 minutes, then strain.
P do not apply immediately after feeding
P when swimming, the air temperature is 22-24 C 0.
P do not rinse the baby after taking a bath
P bath duration 10-15 minutes
rubbing ointments).
Indications for the use of plasters: treatment of wounds, mucous membranes, skin diseases, pain in joints, muscles.
Contraindications to the use of patches: eczema or allergic dermatitis. Dermatitis
can occur after applying the patch as a complication.
Technique for applying the patch:
1. Before applying the patch to the patient, the nurse must thoroughly degrease the patient's skin, and shave the hair at the site of the patch.
2. The plaster is cut to the required size.
3. Remove the protective film from the patch and stick with the drug base on the prepared skin area.
How to remove the patch? Remove the patch gradually, from one edge. Before removing the patch, moisten the edges with alcohol.
APPLICATION OF OINTMENTS, SOLUTIONS, POWDERS AND PLASTERS
Lubrication (widely used for skin conditions). A cotton swab is moistened in the required amount of the drug and applied to the patient's skin with longitudinal movements in the direction of hair growth. With pustular diseases, the skin is lubricated around the lesions in the direction from the periphery to the center.
Rubbing (injecting fluids and ointments through the skin). It is carried out on areas of the skin that have a small thickness and poorly expressed hair (flexor surface of the forearms, back of the thighs, lateral surfaces of the chest). If necessary, the hair is shaved off. It is necessary that the skin is clean at the place of rubbing. In case of contamination, the patient's skin should be washed with soap. The required amount of the drug is applied to the skin and rubbed in with light circular motions until the skin becomes dry. Contraindication this procedure is the presence of inflammatory changes in the skin (eczema, dermatitis, etc.). In some cases, the ointment is applied to the skin without rubbing (for example: 2% nitro ointment), smeared with a thin layer and covered with plastic wrap for better absorption and protection of clothing. Sometimes the ointment is applied to a sterile napkin and applied to the affected area.
Medicines should always be applied to clean skin, with clean tools and thoroughly washed hands. For disinfection or providing a reflex effect (for example, when applying the so-called iodine mesh), the skin is lubricated with tincture of iodine. To do this, take a sterile stick with a cotton swab, moisten it with iodine and lubricate the skin. When the cotton wool is moistened, the stick should not be immersed in the iodine bottle; a small amount of iodine tincture should be poured into a flat vessel to avoid contamination of the entire contents of the bottle with cotton flakes. It is impossible to store the iodine tincture for a long time in a container with a loosely closed stopper, since during such storage the concentration of iodine can increase due to the evaporation of alcohol, and lubrication with a concentrated tincture of iodine on delicate areas of the skin can cause burns.
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Application of powder, ointment, patch on the skin.
Examine the place of application of the medication, make sure there is no hyperemia, rash, swelling;
Treat with warm water or skin antiseptic;
Dry the skin with a towel or gauze pads.
Target: treatment process.
Indications: doctor's appointment.
Contraindications: individual intolerance to the powder, skin irritation, damage to the skin.
Equipment: gloves, dusting powder, sterile napkins, water (37-38 o C), tray, screen, container with disinfectant solution.
Treat and dry the skin with blotting movements with napkins.
Apply the powder to the skin with even shaking movements (“powder”).
Target: treatment process.
Indications: doctor's appointment.
Contraindications: individual intolerance to the drug, skin irritation, damage to the skin.
Equipment: gloves, plaster, napkins, water (37-38 o C), tray, screen, container with disinfectant solution.
Prepare everything you need to perform the manipulation.
Inform the patient about the course of manipulation and about the drug. Obtain patient consent.
Separate the patient with a screen. Help the patient get into a comfortable position.
Treat hands, wear gloves.
Treat and dry the skin with a napkin or towel (gently shave, if necessary, the area where the patch will be applied).
Open the package of the plaster.
Remove the protective layer without touching the inner surface with your hands.
Apply the patch to the prepared skin and press lightly without leaving air bubbles (the size of the patch containing the medicinal substance should correspond to the area of the lesion).
Remove gloves and discard into waste tray.
Provide the patient with a comfortable environment.
Put on gloves, disinfect the waste material. After removing gloves, treat hands.
Make a mark on the completion of the appointment.
Target: treatment process.
Indications: doctor's appointment.
Contraindications: individual intolerance to the drug.
Equipment: gloves, ointment, sterile applicator, scissors, bandage or adhesive plaster, water (37-38 o C), antiseptic solution for skin treatment (if necessary), tray, screen, container with disinfectant. solution, sterile: napkins, spatula, dressings, gloves.
Inform the patient about the course of manipulation and about the drug. Obtain patient consent.
Separate the patient with a screen. Help the patient get into a comfortable position.
Treat hands, wear gloves.
Treat and dry the skin with a napkin or towel.
Apply ointment from a tube to the applicator; in its absence, rub in the ointment only with gloves.
Do not rub the ointment onto the patient with unprotected hands - it is unsafe for your health!
Rub the ointment with light rotational movements for 3-4 minutes until complete absorption, in some cases there are exact instructions on when to stop rubbing (provide warmth if indicated in the instructions for using the ointment).
Applicator in waste tray.
Remove gloves and discard into waste tray.
Provide the patient with a comfortable environment.
Put on gloves, disinfect the waste material. After removing gloves, treat hands.
Make a mark on the completion of the appointment.
Applying the ointment to the skin
Carefully study the instructions for using the ointment. Prepare everything you need to perform the manipulation.
Inform the patient about the course of manipulation and about the drug. Obtain patient consent.
If necessary, shield the patient with a screen. Help the patient get into a comfortable position.
Treat hands, wear gloves.
Examine the skin area to apply the ointment.
Squeeze the required amount of ointment from the tube onto the applicator.
Apply a thin layer of ointment to the skin and leave the skin open for minutes until completely absorbed.
Remove gloves, discard in a container for waste material.
Throughmin. examine the skin to make sure the ointment is absorbed.
Make a note in the documentation that the assignment has been completed.
Algorithm for the introduction of the ointment
A) Algorithm for introducing ointment into the nose
Establish a trusting relationship with the patient, explain the mechanism of the procedure and obtain consent to carry it out; seals; ointment; sterile glass rods; sterile tray; sterile wipes; cotton towels, a screen and a garbage container.
Put up the screen; wash (hygienic level), dry hands and wear gloves; read the name of the drug and inform the patient about it; prepare sterile glass rods; help the patient to lie down or sit comfortably, while his head should be slightly thrown back; squeeze out on
cotton turunda 0.5 - 0.7 cm of ointment; lift the tip of the nose with your thumb and introduce the turunda with a rotational movement into the lower nasal passage; remove the turunda and put it in a container; help the patient to take a comfortable position and make sure that he does not experience discomfort in connection with the procedure; take off gloves and put them in a container; wash (hygienic level) and dry hands; fill out medical records and remove the screen.
Algorithm for the application of powders
Establish a trusting relationship with the patient, explain the mechanism of the procedure and obtain consent to carry it out; seals; powder; napkins; screen and waste container:
Put up the screen; wash (hygienic level), dry hands and wear gloves; read the name of the drug and inform the patient about it; dry the area to which the powder will be applied with a gauze cloth; turn the container with the powder upside down and, with shaking movements, evenly apply the powder to the desired surface of the skin; take off gloves and put them in a container; remove the screen; wash (hygienic level) and dry hands; fill out medical records.
External use of medicines
External use of drugs is designed mainly for their local action. Only fat-soluble substances are absorbed through intact skin, mainly through the excretory ducts of the sebaceous glands and hair follicles.
Cutaneous administration of drugs
Medicines are applied to the skin in the form of ointments, emulsions, solutions, tinctures, talkers, powders, pastes. There are several ways to apply the drug to the skin.
Lubrication (widely used for skin conditions). A cotton swab is moistened in the required amount of the drug and applied to the patient's skin with longitudinal movements in the direction of hair growth.
Rubbing (injecting fluids and ointments through the skin). It is carried out on areas of the skin that have a small thickness and poorly expressed hair (flexor surface of the forearms, back of the thighs, lateral surfaces of the chest). The required amount of the drug is applied to the skin and rubbed in with light circular motions until the skin becomes dry.
Applying a patch (in which a thick consistency ointment base containing medicinal substances is covered with waterproof gauze). Before applying the patch, the hair is shaved off on the corresponding part of the body, and the skin is degreased with a 70% alcohol solution.
Dusting and dusting is used to dry the skin with diaper rash, sweating.
Medicines should always be applied to clean skin, with clean tools and thoroughly washed hands. For disinfection or reflex action (for example, when applying the so-called iodine mesh), the skin is lubricated with tincture of iodine or 70% alcohol solution. To do this, take a sterile stick with a cotton swab, moisten it with iodine and lubricate the skin. When the cotton wool is moistened, the stick should not be immersed in the iodine bottle; a small amount of iodine tincture should be poured into a flat vessel to avoid contamination of the entire contents of the bottle with cotton flakes. It is impossible to store the iodine tincture for a long time in a container with a loosely closed stopper, since during such storage the concentration of iodine can increase due to the evaporation of alcohol, and lubrication with a concentrated tincture of iodine on delicate areas of the skin can cause burns.
Topical application of drugs to the conjunctiva of the eyes
In the treatment of eye lesions, solutions of various medicinal substances and ointments are used. The purpose of application is local exposure. It is necessary to carefully select the dose of the drug, since the conjunctiva absorbs the drug very well. The medicine is instilled into the eye with a pipette. To do this, the lower eyelid is pulled back and a drop is applied to the mucous membrane closer to the outer corner of the eye so that the solution is evenly distributed over the conjunctiva. Eye ointment with a special glass spatula is introduced into the gap between the conjunctiva and the eyeball at the outer corner of the eye.
In the nose (intranasally), drugs are used in the form of powders, vapors (amyl nitrite, ammonia vapors), solutions and ointments. They have a local, resorptive and reflex effect. Absorption through the nasal mucosa is very rapid. Powders are drawn into the nose by a stream of inhaled air: by closing one nostril, the powder is inhaled through the other. Drops are injected with a pipette, while the patient's head should be thrown back. The ointment is applied with a glass spatula. Lubrication is carried out by the doctor with a cotton swab wrapped around the probe. After lubrication, the swab is discarded and the probe is sterilized in a disinfectant solution. Recently, for intranasal administration, special nebulizers-dispensers have been used, in which medicinal substances are in the form of solutions or suspensions with the addition of substances that increase viscosity, to slow down the evacuation of the drug from the nasal cavity.
Medications are instilled into the ears with a pipette. Oil solutions of medicinal substances should be warmed up to body temperature. When instilled into the right external auditory canal, the patient lies on his left side or tilts his head to the left, if it is buried in the left external auditory canal - on the contrary. After the injection of the drug, the external auditory canal is closed with a cotton swab.
Introducing drugs into the vagina
In the treatment of female genital organs, drugs are injected into the vagina in the form of balls based on cocoa butter, cotton wool tampons soaked in various liquids and oils, powders (dusting), solutions for lubrication and douching. The action of medications is mainly local, since absorption through the intact mucous membrane of the vagina is negligible. Douching is carried out using an Esmarch mug (with a special vaginal tip) or a rubber bulb; at the same time, a vessel is placed under the patient's pelvis. For douching, warm solutions of drugs are used as directed by a doctor.
Recently, special dosage forms have been developed that are fixed with a sticky substance on the skin and provide slow and prolonged absorption of the drug, thereby increasing the duration of its action. In this way, for example, nitroglycerin is introduced.
Topic 2.5. Provision of medical services in solving patient problems.
Lecture 2.5.1. Types and mechanism of action of various enemas
SKIN APPLICATION
Equipment: gloves, powder, a container of water, sterile wipes.
I. Preparation for the procedure
Rice. 9-12. Powder application
II. Procedure execution
5. Gently wash and dry with a gauze cloth the area to be applied with the medicinal product.
6. Turn the container with the powder upside down and apply the powder evenly to the desired surface with shaking movements (“powder” the skin).
III. End of procedure
7. Take off gloves, wash your hands.
9. Make a record of the procedure and the patient's response to it in the medical record.
Equipment: gloves, ointment, a device for rubbing in ointment.
I. Preparation for the procedure
1. Clarify the patient's knowledge of the drug, the course of the procedure, obtain his consent.
2. Ask the patient if he needs to be fenced off during the procedure (if he is not alone in the ward).
3. Help the patient to take a comfortable (desired) position.
5. Examine the skin area to rub in the ointment.
II. Procedure execution
7. Apply the required amount of ointment to a special device; in its absence, rub in the ointment only with gloves.
Attention! Do not rub the ointment onto the patient with unprotected hands - it is unsafe for your health.
8. Rub the ointment with light circular motions on the area of the body determined by the doctor until the ointment disappears (in some cases there are exact instructions on when to stop rubbing).
9. Cover the patient warmly if instructed to do so.
III. End of procedure
10. Make sure that the patient does not feel discomfort after the procedure.
Rice. 9-13. Unction:
a - applying ointment to a special device for rubbing it; b - rubbing in the ointment; c - position of the patient after the procedure; d - self-rubbing the ointment with light circular movements
11. Take off gloves, wash your hands.
12. Remove the screen.
13. Make a record of the procedure and the patient's response to it in the medical record.
If the ointment does not have a strong irritating effect on the skin, the patient can rub it on his own with his fingertips. In this case, the movements of the fingers should be light rotational. When teaching the patient the technique of performing this procedure, he should be warned about the need to wash his hands before and after rubbing the ointment.
Applying the ointment to the skin (Fig. 9-14)
I. Preparation for the procedure
1. Clarify the patient's knowledge of the drug, the course of the procedure, obtain his consent.
II. Procedure execution
Rice. 9-14. Applying the ointment to the skin:
a - squeezing the ointment out of the tube onto a glass spatula; b - applying ointment to the skin; c - view after applying the ointment
5. Squeeze the required amount of ointment out of the tube onto a glass spatula (or take from a large container with a sterile spatula). Close the tube (bottle).
6. Apply the ointment in a thin layer to the skin using a glass spatula (do not do it with your hands).
7. Warn the patient not to put clothes on the part of the body with the ointment applied earlier than after a minute.
III. End of procedure
8. Ask the patient if he is experiencing any discomfort in connection with the procedure.
10. Examine the skin to make sure that the ointment is absorbed.
11. Help the patient to get dressed (if necessary).
12. Make a record of the procedure and the patient's response to it in the medical record.
Applying an ointment bandage to damaged skin (Fig. 9-15)
Equipment: gloves, sterile spatula, dressing material, tray, scissors. I. Preparation for the procedure
1. Clarify the patient's knowledge of the drug, the course of the procedure, obtain his consent.
Rice. 9-15. Dressing with ointment:
a - equipment for the procedure; b - applying ointment to a napkin; c - the imposition of a napkin with ointment on the patient's skin; d - fixing the napkin with a bandage
3. Wash your hands and put on gloves.
II. Procedure execution
5. Apply the required amount of ointment to the napkin using a sterile spatula.
6. Put a napkin with ointment on the patient's skin (you can put a small layer of cotton wool on top of a napkin with a strong smelling or staining ointment).
7. Fix a napkin with ointment (and cotton wool) with a bandage (gauze or tubular).
III. End of procedure
8. Ask the patient if he is experiencing any discomfort due to the applied bandage.
9. Take off gloves, wash your hands.
10. Warn the patient about how long he should wear the bandage.
11. Make a record of the procedure and the patient's response to it in the medical record.
The introduction of drugs into the body by inhalation is called inhalation. The medicinal product is in the form of an aerosol. By inhalation, drugs are administered through the mouth or nose.
The nurse must teach the patient this procedure, as he usually does it himself.
Application of medicines to the skin
Equipment: gloves, powder, water container, sterile napkins.
I. Preparation for the procedure
- Ask the patient if they need to be fenced off during the procedure.
- Wash your hands, put on gloves.
- Read the name of the medicinal product (as a rule, powder for dusting is packaged in containers with pin holes).
II. Procedure execution
- Gently wash and blot dry the area to be applied with a gauze pad.
- Turn the container with the powder upside down and apply the powder evenly to the desired surface with shaking movements (“powder” the skin).
III. End of procedure
- Remove gloves, wash hands.
- Remove the screen.
Equipment: gloves, ointment, ointment wiper.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Ask the patient if he needs to be fenced off during the procedure (if he is not alone in the ward).
- Help the patient to take a comfortable (desired) position.
- Wash the hands.
- Examine the skin area to rub in the ointment.
II. Procedure execution
- Apply the required amount of ointment to a special device; in its absence, rub in the ointment only with gloves.
Remember! Do not rub the ointment on the patient with unprotected hands, it is unsafe for your health.
- Rub the ointment with light circular motions on the area of the body determined by the doctor until the ointment disappears (in some cases, there are exact instructions on when to stop rubbing).
- Cover the patient warmly if instructed to do so.
III. End of procedure
- Make sure that the patient does not feel discomfort after the procedure.
- Remove gloves, wash hands.
- Remove the screen.
- Make a record of the procedure and the patient's reaction to it in the "Medical record".
If the ointment does not have a strong irritant effect on the skin, the patient can independently rub the ointment with their fingertips. In this case, the movements of the fingers should be light, rotational. When teaching the patient the technique of performing this procedure, he should be warned about the need to wash his hands before and after rubbing the ointment.
Equipment: sterile spatula (spatula), medicine.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Help the patient get into a comfortable position for the procedure.
- Wash the hands.
- Read the name of the medicinal product.
II. Procedure execution
- Squeeze out of the tube onto a glass spatula (or take from a large container with a sterile spatula) the amount of ointment required for the patient. Close the tube (bottle).
- Apply the ointment in a thin layer to the skin using a glass spatula (do not do it with your hands).
- Warn the patient not to put on clothes on the part of the body with the ointment applied earlier than after 10-15 minutes.
III. End of procedure
- Ask the patient if they are uncomfortable with the procedure.
- Wash the hands.
- Examine the skin to make sure the ointment is absorbed.
- Help the patient to get dressed (if necessary).
- Make a record of the procedure and the patient's reaction to it in the "Medical record".
In surgical practice, dressings with various ointments are widely used.
Applying an ointment bandage to damaged skin
Equipment: gloves, sterile spatula, dressing material, tray, scissors.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Help the patient get into a comfortable position for the procedure.
- Wash your hands, put on gloves.
- Read the name of the ointment.
Rice. 9.15. Dressing with ointment
II. Procedure execution
- Apply the required amount of ointment to the napkin using a sterile spatula.
- Place a napkin with ointment on the patient's skin (a small layer of cotton wool can be put on top of a napkin with strong smelling or staining clothes).
- Fix a napkin with ointment (and cotton wool) with a bandage (gauze or tubular).
III. End of procedure
- Ask the patient if they are uncomfortable with the bandage.
- Remove gloves, wash hands.
- Warn the patient about how long he should wear the bandage.
- Make a record of the procedure and the patient's reaction to it in the "Medical record".
Methodical recommendations for the teacher PM 04 on the topic "External use of medicinal substances"
The purpose of topical application of drugs:
Improving the absorption of drugs through the skin or mucous membranes;
Providing a local anesthetic effect;
Providing bactericidal and bacteriostatic effect.
Application methods : compresses, lotions, dusting, application, rubbing, bandages, instillation of drops, inhalation.
Dosage forms: ointments, emulsions, liniments, lotions, jellies, gels, foams, pastes, solutions, talkers, powders, tinctures, aerosols.
Advantages and disadvantages of external drug use
Advantages: availability, variety of dosage forms and methods of their use.
disadvantages: the method is designed primarily for local effects, since only fat-soluble substances are absorbed through the intact skin.
The use of medicines on the skin (ointments, powders, plasters, solutions and tinctures)
When using the drug on the skin, it is necessary:
Examine the place where the medicine is applied, make sure there is no redness, rash, swelling, wetness;
Treat with warm water or skin antiseptic;
Dry with a towel or gauze pads.
Before exposure to the skin, dosage forms:
Liquid (lotion, talker) - pour onto a gauze napkin;
Soft (ointment, paste, cream, jelly, gel) - apply to the skin area with an applicator, napkins, spatula, hands;
Solid (powders) - apply to the skin with shaking movements from the package.
2. Wash and dry the skin with a tissue or towel.
3. Apply evenly with shaking movements to the skin ("powder"),
4. Remove gloves, discard in a disinfectant.
5. Treat your hands.
Applying the patch to intact skin
1. Treat your hands, put on gloves.
2. Open the package of the plaster with scissors.
3. Remove the protective layer without touching the inner surface with your hands.
4. Fix the patch to the skin.
5. Provide the patient with a comfortable environment.
6. Remove gloves, discard in a disinfectant.
7. Treat your hands.
Methods for applying ointments, gels, jellies, pastes to the skin:
Applying ointments to the skin
1. Examine the skin area to apply the ointment.
2. Handle your hands, put on gloves.
3. Squeeze the required amount of ointment from the tube onto the applicator.
4. When applying the ointment to the skin - apply the ointment in a thin layer;
when rubbing in the ointment - rub the ointment with rotational movements until completely absorbed (until the skin becomes dry).
5. When applying the ointment to the skin - leave the skin open for minutes until complete absorption;
when rubbing in the ointment - cover the patient for warming or warmth, wrap the place where the ointment is rubbed.
6. Create a comfortable position for the patient.
7. Remove gloves, discard in disinfectant, wash and dry hands.
An irritating ointment is applied to the applicator, and an indifferent ointment is applied to the hands.
It is necessary to carefully study the annotations of the use of ointments.
- Oksana Bannova
- 14.12.2017
Material number: DB
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External route of drug administration
The external route of administration is the use of medicinal substances on the skin and mucous membranes: in the eyes, nose, ears, the introduction of a suppository per vaginum (suppositories). This route of administration is designed primarily for the local action of drugs, since only fat-soluble substances are absorbed through intact skin (mainly through the excretory ducts of the sebaceous glands and hair follicles).
Compresses, lotions, dusting, lubrication, rubbing, dressings on the wound surface, instillation of drops in the eyes, ears, nose, putting ointments in the eyes, ears - all these are ways of the external route of administration of various dosage forms: ointments, emulsions, solutions, talkers, powders , tinctures, pastes, etc.
Rubbing - the introduction of medicinal substances through the skin in the form of liquids or ointments.
Rubbing is performed in those areas where the skin is thinner and not covered with hair (flexor surface of the forearms, back of the thighs, lateral surfaces of the chest, abdomen). The skin at the site of rubbing must be clean.
The required amount of ointment or liquid is applied to the skin and rubbed in circular motions until the skin becomes dry (30-40 min.)
A contraindication to this procedure is the presence of inflammatory changes in the skin (eczema, dermatitis, etc.).
In some cases, the ointment is applied to the skin without rubbing, for example, 2% nitromase: it is smeared with a thin layer and covered with plastic wrap for better absorption.
Lubrication is widely used, mainly for skin diseases. A cotton or gauze swab is moistened in the required medicinal substance and applied to the patient's skin with light longitudinal movements (in the direction of hair growth).
Plaster application. The patch is a thick sticky ointment base covered with impenetrable gauze. The ointment base contains medicinal substances. Before applying the patch, the skin is degreased with alcohol, and the hair is shaved off. Then the plaster is cut out with scissors of the required size and applied to the skin. Remove the patch gradually, starting from one edge, after wetting the edges with alcohol. The patch is also used to secure the dressings.
Dusts or dusting with powdered medicinal substances (talc) are used to dry the skin with diaper rash and sweating.
External use of medicinal substances
Purpose: application of medicines to the skin
Equipment: ointments, emulsions, talkers, napkins, bandage
PREPARATION FOR THE PROCEDURE
1.Wash your hands. Wear gloves.
1. Apply ointment - disinfect the skin with an aseptic solution, apply a thin layer of ointment to the napkin, apply the napkin with the ointment to the skin and secure with a bandage.
2. Rub the ointment into the skin - disinfect the skin with an aseptic solution, apply a thin layer of the ointment on the skin with a clean hand, rub the ointment with your hand until it is completely absorbed.
3. Rub the patient - disinfect the skin with an aseptic solution, apply a small amount of ointment, tincture on the skin, rub it in an even layer and rub the skin until slight hyperemia. Remove the remaining ointment with a gauze pad.
Note! Rubbing and rubbing is done without gloves.
Note! Gloves must be worn to perform this procedure.
Lay the patient on her back with legs bent and slightly apart, release the candle from the sheath, with your left hand, part the labia minora, and with your right hand insert the candle into the vagina. Help the patient to lower her legs and lie down comfortably. Recommend to lie down for a minute and not go to the toilet for 1 - 1.5 hours.
1.Take off your gloves (if worn), drop them into the KSBU,
Ointments, powders, pastes
Ointments, pastes, powders and other dosage forms that are applied to the skin and mucous membranes, in terms of frequency of use, occupy, perhaps, the second place after medicines in tablets. They seem harmless and are therefore very popular among self-mediciners. Highly effective agents such as corticosteroid ointments are especially often used at their own discretion. But here's the paradox: people, say, taking prednisolone in tablets, treat it quite carefully, strictly observing the doctor's instructions on single and daily doses, duration of use, and prevention of side effects. But they seem to be replaced if the same prednisolone is prescribed in the form of an ointment. As if in such cases, precaution is no longer needed and there is no need to adhere to the doctor's instructions about how much and how long to apply the ointment.
When asking patients about the reasons for such “complacency”, I often heard the answer: “Why is the ointment dangerous? No matter how much you smear, it does not go further than the skin! A pill is another matter, it penetrates into the bloodstream and spreads throughout the body. "
The fact that "the ointment does not go further than the skin" is a clear delusion. Almost all medicines intended for topical use are actively absorbed through the skin and even more so the mucous membranes, enter the bloodstream and can cause not only local, but also general reactions, often very severe, with illiterate use, in excessive doses.
Recently, a 43-year-old woman was brought to the therapeutic department of the hospital by ambulance. She complained of severe weakness, nausea, vomiting, fainting, and abdominal pain. Her blood pressure dropped critically. The doctors tried to determine why the patient developed cardiovascular insufficiency, why the treatment they were conducting did not give the expected results. It is difficult to say how it would have ended if, during a survey of the patient's husband, it turned out that she had been using some kind of ointment for a long time. It turned out that two years ago she had itchy skin, and the doctor prescribed her a course of treatment with prednisolone ointment. The itching disappeared, but for "prevention" the woman continued to use the ointment every day; 5 days before the incident, she stopped using it: the ointment supply ran out, and there was no recipe.
Then it became clear what had happened. Long-term use of prednisolone ointment led to the fact that, being absorbed through the skin and entering the bloodstream, prednisolone began to inhibit the production of corticosteroid hormones by the adrenal glands. When the patient suddenly stopped using the ointment, the adrenal glands were unable to provide the body with the necessary amount of hormones, and disorders developed, which I described.
Doctors usually recommend that the dose of corticosteroids be reduced after 20 foams. And in order to get this patient out of her serious condition, in the hospital she had to be given prednisolone (a synthetic corticosteroid hormone). And only after some time, as the dose of prednisolone decreased, the adrenal glands began to produce hormones themselves. After a certain period of time, the patient was completely canceled prednisone.
This is a relatively rare case. More often, prolonged and uncontrolled use of corticosteroid ointments promotes excessive accumulation of hormones in the blood, which is fraught with the development of so-called hypercortisolism, which is characterized by excessive fat deposition on the face ("moon face"), on the trunk, increased blood pressure and blood sugar levels.
People with drug allergies should be especially wary of ointments, pastes and other topical agents.
Let me give you two examples. A 20-year-old young man showed an increased sensitivity to levomycetin, which he took in connection with an exacerbation of chronic dysentery. After one day chloramphenicol provoked a severe bronchospasm in a patient, he was categorically forbidden to take this drug, and at the same time synthomycin, the active principle of which is chloramphenicol. Two years later, the young man fell off a motorcycle; injured his leg, and the family put a bandage on the wound with the synthomycin emulsion available in the house. Reckoning did not hesitate to wait, a critical condition developed - a severe drug anaphylactic shock: pallor, shortness of breath, a sharp drop in blood pressure. And only intensive emergency measures saved the life of the young man.
A young woman sunbathed in the south so hard that she developed a skin burn on her back. A neighbor on the beach offered her a dermosolone ointment containing prednisolone and enteroseptol. A few hours after the burn was treated with this ointment, the skin on the back became covered with blisters, pain and itching appeared, and the temperature rose to 39 degrees. The blisters had to be opened surgically, and long-term drug treatment was also required.
It turned out that this woman had been allergic to iodine and iodine-containing preparations since childhood, which had previously caused her rashes and “blisters like after a burn”. Since der-corn, or rather, its component enteroseptol contains iodine, the ointment caused a serious complication.
In both cases, drug allergy sufferers showed negligence in the use of medications, against the use of which they were warned by doctors. At the same time, they, like many others, mistakenly believed that if the medicine is used in the form of an ointment, there will be no allergic complications.
I must say that most often children suffer from "harmless" ointments and powders, because parents willingly use these funds at their own discretion.
More recently, I examined a two-month-old baby who had developed seizures three days earlier. It turned out that after being discharged from the hospital, noticing diaper rash in the child, the mother used powder for oily skin. The diaper rash zone after such treatment expanded, and then the mother applied amy-kazole powder. She was at hand, the child's father used it to treat fungal skin diseases. Three days later, the child developed convulsive seizures as a result of absorption of amikazole through the skin.
Uncontrolled self-medication with topical drugs provokes not only general toxic and allergic reactions. If used incorrectly, these agents cause side local reactions: exacerbation of skin disease, pustular skin lesions, rash.
In conclusion, I want to warn you again: no ointments, powders, pastes without a doctor's prescription!
Powder application
Equipment: gloves, powder, water container, sterile napkins.
I. Preparation for the procedure
- Ask the patient if they need to be fenced off during the procedure.
- Wash your hands, put on gloves.
- Read the name of the medicinal product (as a rule, powder for dusting is packaged in containers with pin holes).
Rice. 9.12.
II. Procedure execution
- Gently wash and blot dry the area to be applied with a gauze pad.
- Turn the container with the powder upside down and apply the powder evenly to the desired surface with shaking movements (“powder” the skin).
III. End of procedure
- Remove gloves, wash hands.
- Remove the screen.
Unction
Equipment: gloves, ointment, ointment wiper.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Ask the patient if he needs to be fenced off during the procedure (if he is not alone in the ward).
- Help the patient to take a comfortable (desired) position.
- Wash the hands.
- Examine the skin area to rub in the ointment.
Rice. 9.13.
II. Procedure execution
- Apply the required amount of ointment to a special device; in its absence, rub in the ointment only with gloves.
Remember! Do not rub the ointment on the patient with unprotected hands, it is unsafe for your health.
- Rub the ointment with light circular motions on the area of the body determined by the doctor until the ointment disappears (in some cases, there are exact instructions on when to stop rubbing).
- Cover the patient warmly if instructed to do so.
III. End of procedure
- Make sure that the patient does not feel discomfort after the procedure.
- Remove gloves, wash hands.
- Remove the screen.
- Make a record of the procedure and the patient's reaction to it in the "Medical record".
If the ointment does not have a strong irritant effect on the skin, the patient can independently rub the ointment with their fingertips. In this case, the movements of the fingers should be light, rotational. When teaching the patient the technique of performing this procedure, he should be warned about the need to wash his hands before and after rubbing the ointment.
Applying the ointment to the skin
Equipment: sterile spatula (spatula), medicine.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Wash the hands.
- Read the name of the medicinal product.
Rice. 9.14.
II. Procedure execution
- Squeeze out of the tube onto a glass spatula (or take from a large container with a sterile spatula) the amount of ointment required for the patient. Close the tube (bottle).
- Apply the ointment in a thin layer to the skin using a glass spatula (do not do it with your hands).
- Warn the patient not to put on clothes on the part of the body with the ointment applied earlier than after 10-15 minutes.
III. End of procedure
- Ask the patient if they are uncomfortable with the procedure.
- Wash the hands.
- Examine the skin to make sure the ointment is absorbed.
- Help the patient to get dressed (if necessary).
- Make a record of the procedure and the patient's reaction to it in the "Medical record".
In surgical practice, dressings with various ointments are widely used.
Applying an ointment bandage to damaged skin
Equipment: gloves, sterile spatula, dressing material, tray, scissors.
I. Preparation for the procedure
- Ask the patient about the medicinal product, the course of the procedure, and consent.
- Help the patient get into a comfortable position for the procedure.
- Wash your hands, put on gloves.
- Read the name of the ointment.
Rice. 9.15. Dressing with ointment
II. Procedure execution
- Apply the required amount of ointment to the napkin using a sterile spatula.
- Place a napkin with ointment on the patient's skin (a small layer of cotton wool can be put on top of a napkin with strong smelling or staining clothes).
- Fix a napkin with ointment (and cotton wool) with a bandage (gauze or tubular).
III. End of procedure
- Ask the patient if they are uncomfortable with the bandage.
- Remove gloves, wash hands.
- Warn the patient about how long he should wear the bandage.
- Make a record of the procedure and the patient's reaction to it in the "Medical record".