The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [544]
Lotions
These are emollient liquid solutions, emuslions or suspensions which may be water or oil based (Snyder 2007).
Pastes
These are semi-solid preparations with adhesive properties and they tend to be thicker than ointment or creams (Snyder 2007).
Wound products
See Chapter 15.
Evidence-based approaches
The risk of serious effects is generally low but systemic effects can occur if the skin is thin, if drug concentration is high or contact is prolonged (Snyder 2007).
Preprocedural considerations
Specific patient preparations
The condition of the affected site should be assessed for altered skin integrity as applying medicines to broken skin could cause them to be absorbed too rapidly, resulting in systemic effects (Chernecky et al. 2002, Snyder 2007). The affected area must be washed and dried before applying the topical medicines where appropriate, unless the prescription directs otherwise.
Procedure guideline 13.4 Medication: topical applications
Essential equipment
Clean non-sterile gloves
Sterile topical swabs
Applicators
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).
2 Check the patient’s prescription chart and the patient’s identity. To ensure that the patient is given the correct drug and dose (NMC 2008a, C).
Procedure
3 Assist the patient into the required position. To allow access to the affected area of skin. E
4 Close room door or curtains if appropriate. To ensure patient privacy and dignity. E
5 Assess the condition of the skin and use aseptic technique if the skin is broken. To prevent local or systemic infection (DH 2007, C; Fraise and Bradley 2009, E).
6 If the medication is to be rubbed into the skin, the preparation should be placed on a sterile topical swab. To minimize the risk of cross-infection. To protect the nurse (DH 2007, C; Fraise and Bradley 2009, E).
7 If the preparation causes staining, advise the patient of this. To ensure that adequate precautions are taken beforehand such as removal of clothing and to prevent stains (NMC 2008b, C).
8 Use a sterile dressing if required. To ensure the ointment remains in place (Chernecky et al. 2002, E).
Postprocedure
9 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2008a, C; NMC 2009, C)
Postprocedural considerations
Educate the patient to inform the nurse if there is any itching, skin colour change or signs of a rash following application.
Complications
Local skin reaction
The skin site may appear inflamed and oedema with blistering indicates subacute inflammation or eczema has developed from worsening of skin lesions. Patients may also complain of pruritus and tenderness which could indicate slow or impaired healing and should be referred to the prescriber; alternative therapies may be required (Snyder 2007).
Transdermal administration
Definition
Medication applied to the outermost layer of the skin, the stratum corneum, usually as an adhesive medicated disc that allows the medication to be absorbed at a slow and constant rate in order to produce a systemic effect (Chernecky et al. 2002).
Related theory
Conventional transdermal systems
These systems consist of a gel or ointment which is measured and placed directly onto the skin. Drugs that are used in this way include glyceryl trinitrate and oestradiol. Delivering drugs in this way can be messy for patients and can also result in variations of the dose delivered due to the amount applied, the amount of rubbing in of the product, the amount of product transferred onto clothing and so on.
Transdermal