The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [548]
7 Clean the area with warm water if necessary. To remove any previously applied creams (Downie et al. 2003, E).
8 Remove the pessary from wrapper and apply lubricating jelly to a topical swab and from the swab on to the pessary. Lubricate gloved index finger of dominant hand. To facilitate insertion of the pessary and ensure the patient’s comfort (manufacturer’s instruction, C).
9 With non-dominant gloved hand gently retract labial folds to expose vaginal orifice. To enable insertion of pessary into correct orifice (Snyder 2007, E).
10 Insert the rounded end of the pessary along the posterior vaginal wall and into the top of the vagina (entire length of finger). To ensure the pessary is inserted into the correct position to ensure equal distribution of medication (Snyder 2007, E).
To ensure that the pessary is retained and that the medication can reach its maximum efficiency (manufacturer’s instruction, C; Chernecky et al. 2002, E).
11 Wipe away any excess lubricating jelly from the patient’s vulval and/or perineal area with a topical swab. To promote patient comfort (Snyder 2007, E).
12 Make the patient comfortable and explain to her that there may be a small amount of discharge and apply a clean sanitary pad. To absorb any excess discharge (Snyder 2007, E).
Postprocedure
13 Remove and dispose of gloves safely and in accordance with locally approved procedures. To ensure safe disposal (DH 2005, C; MHRA, 2004 C).
14 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
The patient needs to retain the medication so it is recommended that the medication is administered prior to going to bed or the patient should remain supine for 5–10 minutes after instilling the pessary (Chernecky et al. 2002, Snyder 2007). It should be explained to the patient that she may also notice a discharge following administration and that it is nothing to be concerned about.
Pulmonary administration
Definition
‘Dosage forms introduced into the body via the lungs in an aerosol form to achieve local effects such as to improve bronchodilation or to improve clearance of pulmonary secretions’ (Chernecky et al. 2002, Snyder 2007). Systemic effects can also be achieved through the pulmonary route, for example volatile anaesthetics (Hillery et al. 2001). Some are inhaled via the mouth, some via the nose and some via nose and mouth (Downie et al. 2003).
Related theory
In order for drugs to reach the lungs, they must be delivered in an aerosol form. The aerosol penetrates the lung airways and the deeper passages of the respiratory tract provide a large surface area for drug absorption and the alveolar-capillary network absorbs medication rapidly (Snyder 2007). There are three ways in which this aerosol can be produced: by nebulizer, by pressurized metered dose inhalers and by drug powder inhalers.
Nebulization involves the passage of air or oxygen driven through a solution of a drug. The resulting fine mist is then inhaled via a facemask (Trounce and Gould 2000). Some antibiotics and bronchodilators may be given in this way (Figure 13.9).
Metered dose inhalers (MDI) involve a drug being suspended in a propellant in a small hand-held aerosol can in the form of a spray, mist or fine powder. Metered doses can then be delivered from the aerosol by the use of a metering valve within the device which is designed to release a fixed volume, for example ventolin. Steroid medications are often administered by MDI to treat long-term reactive airway disease (Chernecky et al. 2002, Snyder 2007) (Figure 13.10).
Dry powder inhalers (DPI) involve a powder being delivered to the lung via a breath-actuated device. Examples of inhalers in this group are the Accuhaler® (Figure 13.11) and the Turbohaler® (Figure 13.12).
Figure 13.9 Nebulizer.
Figure 13.10 Metered dose inhaler (MDI).
Figure 13.11 Accuhaler®.
Figure 13.12 Turbohaler®.
Preprocedural considerations