A methodological guide for students, drug treatment in nursing practice: the discharge, storage and use of drugs. Algorithm of the procedure for lubricating the skin
Rational use of ointments
L. V. Derimedved, I. M. Pertsev, G. V. Zagoriy, S. A. Gutorov
National Pharmaceutical Academy of Ukraine
The external method of using drugs with a plastic-elastic-viscous dispersion medium (gels, creams, ointments, liniment, etc.) allows you to maximize the concentration of drugs directly in the lesion, for example, at the site of a violation of the integrity of the skin, diaper rash, bedsores, burns, damaged mucous membrane, etc. The percutaneous route of administration of medicinal substances is considered the safest, since most of the dose is on the surface and can be easily changed by partially removing the ointment.
Methods of applying ointments to the skin and mucous membranes are very diverse, which is used to optimize local or general effects on the body or individual organs and systems, and are also characterized in some cases by a long duration of use (sometimes lasts 2-3 months or more).
In some cases, for example, in the treatment of mycoses, the use of the drug is continued for another one (mycogel-KMP) or 2 weeks (clotrimazole) beyond the period specified by the instructions.
Gels, creams and ointments proper, which are often combined under the general term "ointments", are applied to the problem area in the same way, but depending on their composition (the nature of the active substance), the properties of the drug system, purpose, as well as the place and state of the problem area, methods applications may vary, which affects their clinical effectiveness.
There are the following methods of applying ointments:
- usual application in the form of a thin or thicker layer;
- application in the form of several layers (in the presence of several dosage forms). For example, a layer of gel is applied first, followed by a layer of ointment;
- application of ointment after preliminary treatment of the problem area (simple hydration; treatment with surfactants, volatile solvents, hydrogen peroxide, antiseptic solutions, removal of necrotic areas, etc.);
- active rubbing of the ointment into the skin, joints, muscles or other problem areas;
- application in the form of wipes or tampons pre-soaked with ointment;
- in the form of an occlusive dressing;
- application followed by the use of various devices (electrophoresis) that enhance the conductivity of medicinal substances;
- application with a syringe (catheter), etc.
Regardless of the method used, the ointment should be applied as much as possible to clean (not contaminated) areas, which significantly increases its effectiveness and shortens the treatment time in general.
Dermatological ointments most often used by applying a thin layer to the affected skin surface, usually using a sterile swab or plastic spatula (hydrocortisone ointment, depperzolone, karboderm-Darnitsa, clobederm, kremgen, zinkundan, ultralan, etc.). The method of application in a thin layer is typical for ointments containing glucocorticosteroids, and along with other factors (solubility of the substance, the degree of its release from the carrier, the state of the problem area), it mainly determines its local effect.
In order to exclude the general effect of ointments with hormonal agents, they are not used under an occlusive dressing, since their activity can increase by an order of magnitude or higher, and the drug can cause systemic side effects or cause local skin disorders (atrophy, striae, telangiectasia, etc.), which highly undesirable.
The thickness of the applied layer of the ointment depends on the physicochemical properties and concentration of the medicinal substance, as well as the properties of the carrier (ointment base).
Herbal ointments containing extracts or components from medicinal plants with a lower activity, as a rule, are applied in a thicker layer, for example, calendula ointment by Dr. Theiss, ointments containing vitamins A, D, etc., which accumulate mainly in the upper layers of the epidermis , hair follicles and penetrate transfollicularly.
Penetrating ointments apply by rubbing. For phlebitis, ointments are rubbed in with light massaging movements (venoruton, heparin ointment, ginkor gel, cremegen, etc.). For thrombophlebitis, the ointment is applied carefully without rubbing. Ointments apizartron, ben-gay, viprosal B, cream for rheumatism, etc. Theiss and others are thoroughly rubbed into the painful area (for neuralgia, myalgia, arthritis) or in the upper and middle part of the chest and interscapular region of the back (for respiratory diseases ).
The absorption of medicinal substances from ointments, as a rule, significantly increases in the presence in their composition of "activators" of absorption, for example, dimethyl sulfoxide, hyaluronidase, etc. (acyc, drapolen, irikar, calendoderm, kanesten, lamisil, etc.).
Sometimes, to increase the therapeutic effect, especially with hyperkeratosis, an occlusive dressing is used (Karboderm-Darnitsa, Klion, Dermovate, Clobederm, Latikort, Locoid, Lorinden A, fluoro-cort, etc.).
To soften dense tissues (dense scabs), a wet bandage (iruksol) is preliminarily used or soda-soap baths are used to steam keratinized masses (clotrisal-KMP, mycospore set for nail treatment). However, it should be remembered that before applying ointments containing antiseptics, which are destroyed in the presence of soap (drapolen, betadine, plivasept), wash the skin, remove traces of soap and dry thoroughly.
After applying preparations with local irritants (ungapiven, finalgon, eucalyptus balm for colds, etc. Theiss, efkamon, etc.), it is recommended to cover the area with the ointment with a woolen cloth (warming bandage).
Ointments-balms in the treatment of infectious and inflammatory diseases of the respiratory tract, in addition to being applied to the skin (in the upper and middle chest and interscapular region), are used for inhalation. For example, a strip (3-5 cm) of emulsion (eucabal balm C is stirred in 1-2 liters of hot water). For infants, prepare baths for 10 minutes by adding 8-10 cm of this drug to 20 liters of water at a temperature of 36-37 ° C.
Preparations such as micanol and tsignoderm are applied for a certain time (5-30 minutes), and then the remnants of the ointments are removed with cotton wool and the skin is washed with warm water and plenty of soap. Before each repeated application of the drug "Dermazin", remove the remnants of the cream with water or an antiseptic solution.
Depending on the etiology of the disease, the frequency of application of the same ointment may differ significantly. For example, streptonitol-Darnitsa ointment for the treatment of skin infections (pyoderma, acne) is applied 2 times a day, and for the treatment of burns - 1 time in 1-2 days.
For some drugs, the instructions provide the recommended amount of ointment for application. For example, when using the “Finalgon” ointment, “a column of ointment no more than 0.5 cm for a palm-sized area of skin” is indicated. In the sets of preparations "Finalgon", "Mikospor set for nails" there is a distribution device. To remove an excess amount of Finalgon ointment, use a cotton swab dipped in oil. After applying this ointment, you should thoroughly wash your hands with soap and water. When the drug gets into the eyes, nose and mouth, an unpleasant burning sensation occurs. In this case, the ointment must be washed off immediately with water. People with sensitive skin should not take hot showers or baths before and after using the drug.
For the treatment of scabies, the ointment is applied once a day (at night after washing) on the entire skin, excluding the face and scalp. Rub the ointment with your hands, and don't wash your hands until morning. On the 4th day, the ointment is reapplied. After rubbing in the ointment, use disinfected linen. On the 5th day, wash the patient, change underwear and bed linen. One rubbing consumes 30-40 g of ointment, for a course of treatment, on average, about 60-80 g of ointment is consumed.
Resorptive ointments(divigel, isoket, nitro ointment) are applied in specific doses. A special paper dosing scale is attached to the nitro ointment, on which a certain amount of ointment is applied in a thin layer (from 2 to 8 cm), then placed on the skin of the upper left side of the chest or forearm (where there is no hair). To improve the absorption of the ointment, a plastic wrap is applied on top and secured with a bandage. The effect occurs in 30-40 minutes and usually lasts more than 7 hours.
Ointment "Isoket" (the initial dose is 1 g - 2 single doses) is applied to the chest area, the inner surface of the forearms or to the abdomen in the evening before bedtime and rubbed in. The minimum surface area for applying the ointment should be 20x20 cm. If the effect is insufficient, the drug can be used in the morning (clothes are put on a few minutes after application). A daily dose (0.5–1.5 mg) of Divigel gel is rubbed into the skin of the lower part of the anterior abdominal wall or applied to the inner thighs, alternating between the right and left sides on an area of 1–2 palms in size. After rubbing in, the skin should dry out within a few minutes. The course of treatment can be cyclical (28 days) or continuous (up to 3 months).
Ear ointments for otitis externa (lokakorten, sofradex, etc.) are applied in a thin layer, and the Tolmizen cream is lightly rubbed into the affected surface. Before using pimafucin (with otomycosis), the external auditory canal is pre-cleaned, and after applying the cream, a cotton swab is placed in the ear canal.
Ointments and nasal gels applied to the mucous membrane (after clearing the nasal cavity) using a small cotton swab, and then moderately squeezing the wings of the nose (for even distribution over the entire mucous membrane). The Vibrocil gel has a special tip for injecting the drug as deep as possible into the nasal cavity. And drugs "Xylometazoline" and "Galazolin" are instilled directly from the tube.
Dental ointments with local anesthetic substances (dentol 7.5% benzocaine, dentol 10% benzocaine, kamistad gel international) is applied to the gums and rubbed lightly. Ointments with antiseptic agents (cliostoma, metrogil denta) are applied after brushing the teeth with a swab or soft toothbrush on the gums and between the teeth. After applying the ointment to the surface for 15 minutes, do not rinse your mouth and eat. Solcoseryl dental adhesive paste is applied in a thin uniform layer to the affected area, dried with a cotton or gauze swab, and then slightly moisten the site of application of the drug.
Eye ointments and gels gently lay a pea-sized volume with a special glass spatula (pre-boiled), pulling the lower eyelid, at the inner corner of the eye. The eye is closed, a cotton swab is applied, the closed eyelids are lightly massaged so that the ointment is evenly distributed over the eyeball. If the drug is placed in a tube with a special tip (Actovegin eye gel, Solcoseryl eye gel, etc.), then it is used by squeezing it out of the tube, evenly distributing it over the lower eyelid, and then the closed eyelids are easily massaged.
Ointments containing non-steroidal anti-inflammatory substances- diclak gel, dolgit, dolobene, mobilizik, etc., can be applied by electrophoresis, applying under the cathode.
Protective pastes (furacilin, etc.) are used to prevent occupational skin diseases when working in aggressive environments. Before starting work, the preparations are applied to cleanly washed hands in the amount necessary for the formation of a thin film, and evenly distributed over the surface of the hands. After the applied layer has dried, they begin to work. At the end of the work, the preparation is washed off with cold water.
Cosmetic ointments used mainly by applying a thin layer of the drug to the skin. So, for example, the therapeutic and cosmetic cream "Talita" is applied, removing the remnants of the cream with a napkin after 20 minutes. To achieve the effect, the cream should be applied once every 7-10 days to cleansed and steamed skin.
When treating acne vulgaris, the drug (Ayrol, Retin-A) is applied to a washed dry skin surface with a very thin layer 1 time per day, after 6 hours it is washed off with running water. For persons with light and dry skin, the exposure time at the beginning of treatment is 30 minutes, then it is gradually increased. Fully softened comedones and pustules can be carefully removed. For prophylactic purposes, it is used once a week (after a warm bath).
Ointments for the treatment of wounds have their own peculiarities of application, which consist in the need to take into account the phases of the course of the wound process, since it takes place in several clearly alternating stages (phases), each of which has its own clinical picture and requires a different approach to treatment.
Ointments for the treatment of complicated infected wounds are, as a rule, multicomponent formulations created on hydrophilic polymer bases, each of which contains properties that best correspond to a certain phase of the wound process.
Because of this, ointments for the treatment of the first phase have a different effect on the wound process, antimicrobial, anti-inflammatory, analgesic, dehydrating and necrotic, absorb exudate, thereby facilitating the early cleansing of the wound.
In the 2nd phase of the wound process, ointment compositions have a weaker property to suppress microflora, but they contribute to the formation and growth of granulations. At this stage, ointments with strong osmotic properties are not used: levosin, levomekol, iodopyrone ointment, oflokain-Darnitsa, nitatsid-Darnitsa, etc.
On the pharmaceutical market there is a wide range of surgical ointments that can be successfully used in a complete logical sequence in the treatment of wounds, taking into account the clinical characteristics of the development of the wound process (table).
Topical treatment of infected wounds
| The phase of the wound process and its characteristics | Medicinal product | Main pharmacological action |
| 1st phase a) stage of alteration b) stage of exudation The wound is characterized by the presence of necrotic tissue and purulent discharge. The edges of the wound are swollen and infiltrated. Characterized by a high level of bacterial contamination, increased osmotic pressure in the tissues surrounding the wound. |
levosin; metrocaine | antimicrobial, anti-inflammatory, analgesic, dehydrating, osmotic |
| oflokain-Darnitsa | antimicrobial, analgesic, osmotic, anti-inflammatory | |
| levomekol | antimicrobial, dehydrating, osmotic | |
| nitatsid-Darnitsa | antimicrobial, anti-inflammatory, osmotic | |
| miramistin-Darnitsa | antimicrobial, osmotic | |
| iodopyrone ointment; argosulfan; dermazin | antimicrobial, osmotic | |
| iruksol | lyses necrotic tissue | |
| Phase 2 - the phase of regeneration, formation and maturation of granulation tissue. The wound is mostly clear of purulent-necrotic contents, and purulent exudation can remain only in places. | betadine; miramistin-Darnitsa | antimicrobial, osmotic |
| methyluracil-Darnitsa | reparative, antimicrobial | |
| methyluracil ointment | reparative | |
| oxycort | antimicrobial, anti-inflammatory, antipruritic, anti-allergic | |
| hyoxysone | antimicrobial, anti-inflammatory, antipruritic, anti-exudative, anti-allergic | |
| streptonitol-Darnitsa | antimicrobial, moderate osmotic, anti-inflammatory | |
| Pantestin-Darnitsa | antimicrobial, promotes wound epithelialization | |
| Kalanchoe ointment | reparative, antimicrobial, analgesic | |
| calendula | reparative, antimicrobial | |
| armon | reparative, analgesic, anti-inflammatory | |
| wundahil; balsam "Rescuer" | reparative, anti-inflammatory | |
| exalbus | anti-inflammatory, reparative | |
| Phase 3 - epithelialization phase | Pantestin-Darnitsa; bepanten plus | promotes wound epithelialization, antimicrobial |
| actovegin, bepanten, solcoseryl | promotes wound epithelialization |
Before applying the ointment in the 1st phase of the wound process, pus and necrotic masses are removed from the damaged surface using tweezers or a tampon and the wound is washed with an antiseptic solution (furacilin 1: 5000, chlorhexidine bigluconate 0.05%, etc.). Then apply a thin layer of ointment with a prolonged action (in order to reduce the number of dressings), and apply a sterile gauze bandage. More often, a gauze swab is impregnated with ointment, which is applied to the wound. This is how ointments are used: miramistin-Darnitsa, nitatsid, oflokain-Darnitsa, streptonitol-Darnitsa, etc. If the dressing with ointment dries to the wound surface, before removing it, it is recommended to soak it with an antiseptic solution (furacilin, hydrogen peroxide) in order to avoid trauma to the superficial epithelium and bleeding of the wound ...
Ointments "Levosin", "Levomekol" are applied to the wound surface in the form of napkin applications, on which a 2-3 mm layer of the preparation is applied, or the wound cavity is filled with tampons soaked in ointment. It is possible to inject the drug (heated to 35–36 ° C) into the wound course or fistula using a syringe or catheter. These drugs are effective for radiation damage to the skin.
The success of topical treatment of burns also depends on the correct choice of medications. They must effectively influence the inflammatory response and respond to the stages of development of the wound process. Therapeutic efficacy and a noticeable reduction in the duration of treatment can be observed only with the correct treatment regimen using various formulations in the form of gels, creams or ointments containing the active substance in different concentrations. For example, in the case of application of the Actovegin gel in the first 4 days after the burn (exudation stage), a 20% gel is used, which reduces pain syndrome, helps to cleanse the wound surface. Then, in the phase of cleansing the wound from necrotic tissues and the growth of granulations (from 4 to 10-11 days), 5% Actovegin cream is used and at the final stage of treatment - the epithelialization phase - 5% Actovegin ointment, which contributes to the final recovery normal functions of the affected tissue. Gel "Actovegin" for burns, radiation injuries is applied in a thin layer, for ulcers - in a thicker layer, followed by a layer of ointment, which acts as a compress and prevents the dressing from sticking to the wound surface.
For resorption of keloid scars, the Kontrubex gel is lightly rubbed into the scar tissue until completely absorbed, several times a day. With hardened old scars, the drug is left under a bandage overnight. Taking into account the condition of the problematic area of the skin, various dosage forms of "Bepanten" are also used. The cream is used for wet burns, wounds, and the ointment is used for dry skin.
Depending on the place of application and the structural features of the skin, the same drug can also be used in different dosage forms. So, the drug "Bactroban" for application to the nasal mucosa is used in the form of an ointment, and in dermatology - ointment and cream. Dalacin for the treatment of acne vulgaris is produced in the form of a gel, and vaginal - in the form of a cream. For application to hair, Mikospor is used in the form of a gel, on the skin - in the form of a cream, on the nail plates - in the form of an ointment. Solcoseryl is produced in the form of an eye gel, dental adhesive paste, and for application to the skin - in the form of a gel, ointment and cream.
Rectal and vaginal ointments injected using a tampon pre-soaked with the drug (heparin ointment, Kalanchoe ointment, oxycort, etc.).
Many drugs, especially imported ones, have an applicator in their kit (antihemorrhoids, gyno-pevaril, proctosedil, etc.). The drugs "Dalatsin vaginal cream", "Norgalax", "Prepidil" and others are administered in dosage. For example, 3 g of Prepidil gel (the entire contents of the syringe), using the supplied catheter, is injected into the cervical canal below the level of the internal os. When treating external lesions, the areas are smeared with a thin layer. Sometimes, for example, heparin ointment (for hemorrhoids) is applied to a calico pad and applied to the restrained nodes.
During catheterization and drainage of the bladder, cystoscopy and other urological procedures, 7-10 ml of xylocaine jelly is preliminarily administered for anesthesia.
Thus, ointments, depending on the composition and purpose, are applied in different ways and their effectiveness depends on the correct use. The mode, duration and peculiarity of the application of the ointment depend on the physicochemical properties of the substance and the carrier, the state of the surface on which they are applied, as well as the nature of the disease and other factors. Before using the ointment, you should carefully read the recommendations in the instructions or other special information.
Literature
- Compendium 2000/2001 - Medicines / Ed. V.N.Kovalenko, A.P. Viktorova.- K: MORION, 2000.- 1456 p.
- Mashkovsky M. D. Medicines: A guide for doctors. In two volumes. Ed. 13th.- Kharkov: Torsing, 1997.- T. 1.- 560 p .; T. 2.- 592 p.
- Pertsev I. M., Zupanets I. A. Biological pharmacy - modern theory of optimal production and use of drugs // Klinichna Pharmacy.- 1999.- T. 3, No. 2.- P. 128-132.
- Radar - Encyclopedia of Medicines / Ch. editor Yu. F. Krylov. Publishing house 8.- M: RLS, 2001.- 1503 p.
- Theory and practice of local treatment of purulent wounds (problems of drug therapy) / Ed. prof. B. M. Datsenko.- K: Health, 1995.- 384 p.
- Pharmaceutical and biomedical aspects of drugs. In 2 volumes / Pertsev I.M., Zupanets I.A., Shevchenko L.D. and others - X: UkrFA Publishing House, 1999.- T. 1.- 464 p.
CAUTION, MEDICINE
A.M.Svyadoshch, professor
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!
The effectiveness of the therapeutic action of a medicinal substance largely depends on the dosage form in which it is used: in the form of a lotion or compress, paste or ointment, etc.
External medicinal substances most often used in the following pharmacological forms: 1) lotions, 2) compresses, 3) powders, 4) liquid pastes (water and oil, 5) pastes, 6) ointments, 7) creams, 8) plasters, 9) glue and 10 ) soap.
When prescribing a medicinal substance in one form or another, one should take into account not only its pharmacological action, but also the physical properties of the basis on which it is prepared. So, for example, the same medicinal substance in paste and ointment has a different intensity of action. In an ointment, for example, tar during acute inflammation will irritate, and in a paste it can have a beneficial effect.
1. Lotions. The use of lotions is based on their cooling, vasoconstrictor, anti-inflammatory effect. In addition, lotions, depending on the nature of the medication used, have an astringent, disinfectant and deodorizing effect. Due to the cooling effect, the lotions have a pain and itching effect.
Indications: acute inflammatory processes, accompanied by oozing, a feeling of heat and tension in limited areas of the skin (eczema, dermatitis, neurodermatitis, etc.).
Method of application: several layers of gauze napkins are moistened in a cooled liquid intended as a lotion, slightly squeezed and applied to the affected skin area for 15-20 minutes, and this is repeated several times for 1.5-2 hours. Such sessions are repeated at least 3 times a day.
2. Compresses are used in cases where a warming, analgesic and resorbing effect is required.
Indications: non-acute inflammatory limited infiltrative processes (eczema, neurodermatitis, psoriasis and other diseases). The use of compresses for boils, hydradenitis, carbuncles is contraindicated.
Method of application: several layers of gauze are impregnated with a medicinal substance and applied to the affected area; an oilcloth or wax paper is placed on top of the gauze napkins, then cotton wool and secured with a bandage. The compress is applied for several hours, and sometimes for a day.
Wet-drying compresses are applied without compress paper and oilcloth. The technique for their use is as follows: the affected area of the skin is smeared with ointment (preferably cream), then covered with a gauze napkin moistened with one of the listed liquids, fixed with a bandage and left overnight. When the gauze napkin dries, it can be re-moistened with the same liquid without removing the bandage. Such wet-drying compresses have antipruritic, anti-inflammatory and resorption effects.
Medicinal substances used in compresses: 40 ° alcohol, ichthyol, etc.
3. Powders. Powdered substances with an adsorbing and drying effect are used as powders.
Indications: common acute inflammatory processes (allergic rashes) and limited acute inflammatory processes, especially in the face, with sweating in the folds and in the feet. The use of powders is especially indicated for diaper rash in young children.
4. Liquid pastes (talkers). The use of liquid pastes is based on their cooling, anti-inflammatory, absorbent, drying and antipruritic action. There are two types of liquid pastes: water-based and oil-based. Water pastes are prescribed for oily skin, oil - for dry skin. However, this indication can not always be guided - in practice, one has to reckon with the individual characteristics of patients: some do not tolerate water pastes, others - oil.
Indications: common acute inflammatory processes, in particular allergies, accompanied by itching and other unpleasant sensations.
Method of application: with a cotton swab or gauze, the liquid paste is evenly applied to the skin. Shake the bottle with liquid paste beforehand.
In these recipes for liquid pastes, you can enter any medicinal substances, depending on the indications. For example, to enhance the cooling and antipruritic effect, menthol is added in 1% concentration; you can also enter anesthesin (5-10%), tar (2%) and other medicines.
5. Pastes. The paste contains 50% powdery substances and 50% fat or fat-like substances (petrolatum, lanolin, lard). Pastes are prescribed in cases where an adsorbing and drying effect is required. Medicinal substances used in pastes are poorly absorbed by the skin, therefore their effect in pastes is weaker than in ointments.
Indications: for limited eczema, neurodermatitis, dermatitis and other diseases in cases where the appointment of fatty ointments is contraindicated.
Method of application: the paste is applied in a thin layer to the affected area of the skin: it is better to spread it on a soft canvas napkin, put the napkin on the skin and secure with a bandage.
A variety of medicinal products can be added to pastes. substances depending on the indications.
6. Ointments. Basically, ointments contain fats (pork, bovine) or a fat-like substance (petroleum jelly). Ointments have a softening effect on the epidermis, loosen the stratum corneum, thereby facilitating a deeper penetration of medicinal substances into the skin. The negative properties of ointments include their ability to disrupt the perspiration of the skin. This adversely affects the course of acute inflammatory, especially common processes, causing their exacerbation. The appointment of ointments in the acute stage of eczema is contraindicated.
Indications: for eczema, neurodermatitis and other diseases, mainly in the non-acute stage; in some cases, it is possible to prescribe ointments in the subacute stage of inflammation.
Method of application: the ointment is smeared with a continuous thin layer or in the form of strips on the affected area of the skin; with limited non-acute inflammatory infiltrative processes, it is advisable to prescribe ointments under a compress in order to enhance their resorption effect. Sometimes, for example with scabies, rubbing in ointments is recommended.
In ointments and pastes, you can prescribe a variety of medicinal substances, depending on the indications.
7. Creams. Unlike an ointment, a cream contains more water and fat. Of the fats in creams, lanolin, spermaceti, etc. are used.
Due to the water content, the cream has a cooling and therefore anti-inflammatory and antipruritic effect. The cream has a soft, delicate texture, so it softens the skin well. Water mixed with fats in the cream forms a colloidal-dispersed system, so the cream does not disturb the perspiration of the skin and is better tolerated than ointments. Factory-made emulsion creams (cosmetic creams) have a particularly beneficial effect on the skin.
Indications: due to the content of lanolin in the cream, it is indicated for dry skin; the cream is preferred to ointments for a variety of chronic, infiltrative processes, when an emollient effect is required; creams are widely used in cosmetics.
The methods of application are the same as when using ointments.
The cream can be used instead of petroleum jelly as a base for various medicinal substances.
In case of allergic diseases (eczema, allergic dermatitis, neurodermatitis), patients do not tolerate petroleum jelly; in such cases, it is recommended to use a base in the form of a cream without petroleum jelly.
8. Plasters. This is a special form of a remedy, when a mass with a medicinal substance is applied to a special fabric (chiffon) and then applied to the skin. Plasters are also made without drugs, containing only a sticky substance (sticky patch). The adhesive patch is intended for fixing the dressings, and is also used in combination with ointments.
Indications: plasters are used in cases where deep penetration of the drug into the skin is necessary, for example, with limited chronic infiltrative processes (eczema, limited neurodermatitis, chronic forms of psoriasis, discoid lupus erythematosus, etc.). A sticky patch is often used to hermetically seal chronic non-healing leg ulcers, unopened boils, etc.
How to use: cut a piece of the patch of the required size; slightly warmed up and glued to the affected area of the skin.
9. In medical practice, glue is used to apply adhesive dressings.
Indications: chronic non-healing leg ulcers, difficult to treat microbial eczema localized in the leg.
Methods of application: the glue mass is heated in a water bath and applied to a previously applied bandage of gauze bandage. After the glue mass hardens, a soft elastic bandage is obtained, tightly adhering to the skin.
10. Medical soaps... Liquid soaps (potash) are used in combination with medicinal substances in ointments (green soap). Solid soaps (soda) are produced in the form of toilet soap containing various medicinal substances (tar, sulfur soap, etc.).
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.
Remember!
When using the drug on the skin, it is necessary:
inspect 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.
Powder application 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.
Sequencing:
Treat and dry the skin with blotting movements with napkins.
Apply the powder to the skin with even shaking movements (“powder”).
Application of the patch
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.
Sequencing:
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.
Application of the ointment
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.
Sequencing:
Rubbing the ointment into the skin
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 10-15 minutes until completely absorbed.
Remove gloves, discard in a container for waste material.
Treat your hands.
After 10-15 minutes. examine the skin to make sure the ointment is absorbed.
Make a note in the documentation that the assignment has been completed.