TOPICAL ADMINISTRATION OF

MEDICATIONS
 Topical medications
A topical medication is a medication that is applied to a
particular place on or in the body.
Most often topical administration is a application to body
surfaces such as the skin or mucus membrane.
Many topical medications are percutaneous, which are
applied directly to the skin.
Topical medications also can be inhalational, such
as asthma medications, or applied to the surface of
tissues other than the skin.
Topical medications are administered directly to the skin
and mucous membranes.
Topical medications are applied to produce local effects.
 Different Methods of Application

1. Direct
2. Insertion
3. Instillation
4. Irrigation
5. Spraying
6. Inhalation
Special Considerations for Topical
Application

The area of the skin should be thoroughly

cleaned before the application of an ointment or
lotion.
The ointment or lotion should be ‘rubbed in ’
instead of ‘painted on ’ to achieve a therapeutic
effect.
A lotion should be shaken well, then applied on
the skin and allowed to dry.
The lotion tend to flake and fall off, they can be
reapplied as necessary.
The skin should be observed frequently after the
application of ointment or lotion for any local
skin irritation.
A thin coating of ointment is preferred to a thick
layer.
The nurse may use a sterile/clean gloves
depending upon the condition of the skin.
Take only sufficient medications for one
application to the patient unit.
When lotion and ointments are applied, avoid
introducing them into the eyes, mouth,
respiratory passages.
Look for the special instruction on the label.
No ointment or lotion should be applied on any
patient without the doctor’s orders.
Note: lotion should be ‘rubbed in ’ instead of
‘painted on ’
 Application to skin

A topical medicine is a form of medication meant to be

administered externally onto the body rather than ingested or
injected into the body.

Purpose
The purpose of using topical medicine is to deliver
medication directly onto areas of the skin that are irritated,
inflamed, itching, or infected.
Topical medicines are often applied directly onto a rash or an
irritated area on the skin for rapid relief of symptoms.
 Suitable for self-medication

Medications such as Nitro-glycerine, Oestrogen

applied topically by transdermal disk or patch.
Mucous membrane used by route of administration of
drugs for quickly absorbed.
Mucous membrane at different regions differs in their
sensitivity to drugs.
The cornea of the eye and nasal mucous membrane
are very sensitive.
Vaginal and rectal mucosa is not very sensitive and
medications are less irritating.
 Two basic types

External - that are spread or dispersed on the

cutaneous surface covering the affected area.
Internal - that are applied to the mucous
membrane of eye (conjunctiva), ear, or
pharyngeal cavity, nasal cavity, vagina or
anorectal region for local activity.
Classification Based on physical state

Solid: Powder, Aerosol, Plaster

Liquid: Lotion, Liniment, Solution, Emulsion,
Suspension, Aerosol
Semi-solid: Ointment, Cream, Paste, Gel, Jelly,
Suppository.
Advantages of topical drug delivery
system

Easy application
Avoidance of the risks and inconveniences of
administration and the varied conditions of
absorption, like pH changes, presence of
enzymes, gastric emptying time etc. in enteral or
parenteral routes
Easy termination of medications, when needed.
Relatively large area of application.
Drug can be delivered more selectively to a
specific site.
Avoidance of gastro-intestinal incompatibility.
Improved physiological and pharmacological
response .
 Articles

A tray containing:
Medicine ( Ointment, powder or lotion)
Gloves
Cotton swabs or gauze piece
Adhesive tape and dressing pad
Kidney tray with paper bag
 Steps of procedure

Nursing actions Rationales

1. Review the medication orders and check the To prevent error during
identification of the patient medication application.

Prevents spread of
2. Wash hands and don gloves
microorganisms

3. Explain procedure to the patient To reduce anxiety of the patient

4. Expose the area where lotion/ointment is to be

Prevent unnecessary exposure
applied

5. Wash affected area with soap and water. Allow Cleaning of area will reduce the
the area to dry. harbouring of micro organisms
  
6. Apply topical preparation
Smearing of medication ensure
a.Ointment or creams: place the medication on the
uniform distribution
palms and smear thin and smooth layer of medicine
 
over skin using long strokes following direction of hair
 
growth and apply dressing if required.
It reduces crusting of powder
b.Powder: dry the skin before applying powder then
and facilitates proper
spread the powder over skin by making a thin and
application
fine layer. Protect the skin by dressing if required.
  
c.Lotion: shake the container properly and put it on
Shaking of container helps in
small gauze and apply in the direction of hair growth.
proper mixing of medication
7. After application make patient
comfortable, replace articles and remove To prevent cross infection
gloves

8. Wash hands examine the patient and To check for any rash or
record the procedure observable sign
 After care

Document in patient's record

Patient's response to procedure
Communicate with the physician
 Spraying

Nasal spray
Nasal sprays are liquid medicines that spray into
nose. Most often, nasal sprays are nasal
decongestants. These decongestants relieve the
congestion (stuffiness) in nose.
 Advantages of nasal drug

 It is a non-invasive route.
 Rapid drug absorption.
 Quick onset of action.
 Better nasal bioavailability for smaller drug
molecules.
 Drugs which cannot be absorbed orally are
delivered to the systemic circulation through nasal
drug delivery system.
 Convenient route when compared with parenteral
route for long term therapy.
 Drugs

 Drugs commonly used are

 Β2-adrenergic agonist
 Corticosteroids
 Anti-cholinergic
 Mast cell stabilizer.
 Throat Gargle

Salt gargle is letting hot salt solution roll in the

throat for a few seconds.

Purpose
To relieve throat congestion
To relax the throat muscles
To relieve sore throat
To reduce inflammation
To relieve throat itching
 Equipment

Two glasses of hot water

One teaspoonful of salt
Kidney tray and clean gloves if required.
 Procedure

Explain the procedure to patient.

Add ½ teaspoon of salt into the glass of water.
Temperature should be as hot as can be tolerated for drinking.
Stir with teaspoon until salt is completely dissolved in the
water.
Make the patient to stand near the sink.
Ask the patient to sip enough water and gargle
Continue the procedure of throat gargle until all the two
glasses of salt solutions are consumed.
If sore throat is severe with harsh voice, salt gargle may be
repeated every two hours.
 Special Instructions

Throat gargle is best done after meals.

Do not take cold beverages until sore throat is
healed - For best results.
 Application to mucus membrane
(Instillations and irrigation)
Definition of Instillation: Instillation is pouring or
injecting a substance drop by drop.
Solution/ suspension
Relatively brief contact time with absorbing surface
It requires aseptic handling
Use droppers with attached or separate plastic
nozzle, avoid touching the application surface
Use to prevent or treat infections e.g. Ciprofloxacin
eye/ear drop, artificial tear .
 Eye drop instillation

Eye drop instillation is the dispensation of a sterile

ophthalmic medication into a patient’s eye.

Purpose
To dilate or constrict the pupil
To relieve pain and discomfort
To act an antiseptic
To relieve inflammation
To act as lubricant
 Equipment

A medication tray containing

Eye drops
Cotton swabs
Sterile water in bowl
Gloves
Kidney tray
 Procedure

Check the physician order

Identify the patient
Prepare the equipment
Wash hands to prevent cross infection
Explain procedure to the patient
Keep the patient in a comfortable position
Clean the eye
Ask the patient to look upward and gently pull down inner lid
to instil the drops
Hold the dropper about 2 cm above the eye and allow the
drop fall in to the lower conjunctiva sac, avoid the cornea.
Use only on the affected eye
Ask the patient to close the eyes for some time for proper
absorption
Replace or dispose all equipment safely
Document the nursing procedure appropriately
Report any abnormal findings immediately
 Irrigation

An irrigation is the washing or flushing of an

area.
Irrigations required either a clean technique or a
sterile technique.
Sterile technique whenever there is a break in the
continuity of the skin.
 Eye Irrigation

Eye irrigation is the washing of the conjunctival

sac by a liquid.

Purposes
To treat inflammatory process of conjunctivitis.
To apply medications for an antiseptic effect.
To Remove foreign objects or irritating chemicals
falling in the eyes.
To apply heat or cold to the eyes.
To clear the eye of noxious or other foreign
material or excessive secretions or in
preparation for surgery.
To prevent corneal burning
To relieve itching.
To treat infections.
 Indications of eye irrigation

Chemical contact, irrigating after contact

Eye irritants
Excessive secretion
Preparations for surgery
Unconscious patients
Eye inflammation or crusting
 General instructions

Although eye is not a sterile organ it is better to

use a sterile technique
All the articles and the solutions that come in
contact with the eye should be sterile.
It is best to treat each eye separately using
separate equipment and solutions.
Place the head tilted to the effected side so that it
allows drainage away from the unaffected eye.
When both eyes to be treated, treat the least
infected eye first to minimize changes of
accidentally infecting it by the infection carried
from the badly contaminated eye.
Never direct forceful streams of solutions into
the eye. If the solutions are held very high, it will
flow in great force that might injure the eyes.
Restrict the movements of the patients when he
is lightly to be un-co-operative.
 Articles

A sterile irrigator - to irrigate with sterile solution.

Sterile jug with extra fluid
Kidney tray and paper bag: To receive waste
Sterile wet swabs in a bowl: To clean the eyes before the procedure.
Sterile cotton balls in a container: To dry the eyes after the
procedure.
Mackintosh and towel: To protect the bedding
Transfer forceps in a sterile container: To handle the sterile articles.
Eye dressings and eye medications, if ordered
IV stand, if needed: To adjust the height of an irrigator.
 Procedure
Nursing actions Rationale
1. Explain the procedure to the patient To win his confidence and co-
operation.
2. Have the patient lay on his back with If the patient is a child or un-co-
the head turned slightly to the side to operative restrain the movement to
be irrigated. prevent any interference with the
procedure.

3. Protect the patient garments and the From becoming soiled

bedding with a mackintosh and a towel.

4. Wash hands To prevent cross infection

5. Clean the eyelids and eye lashes Cleaning the eyelids during
using the wet swabs. Wipe the lids irrigation helps to prevent
from the inner corner of the eye to infection and dust particles
the outer corner using one swab for carried to the conjunctiva of the
one stroke eye cleaning from the inner
corner to the outer corner.

6. Irrigate the eye using an If the fluid is directly forwarded

appropriate irrigator: into the eyes, it can injure the
Adjust the flow of liquid by adjusting soft tissues of the eyes
the height of an irrigator and using
clamps for the tubing.
7. Test the temperature of the irrigation To avoid burns
solution on the inner aspect of the wrist

8. Ask the patient to close the eyes and To reassure the patient that the
allow a small amount of fluid to run over the solution is not very hot.
eye lid.
9. Hold the eyelids open by separating the If force is exerted on the eyelids, it
eyelids gently with the thumb and forefinger can cause spasm of the eye lids and
of the left hand when opening will make irrigation difficult.

10. Hold the nozzle of the irrigator about Precaution is taken not to touch the
2cm above the eyes and allow the fluid to eye with an irrigator.
run into the conjunctiva sac
11. Direct the flow of fluid from the Directing the flow of fluid from inner canthus to
inner canthus to the outer canthus. the outer canthus will prevent forcing the
Ask the patient to look while infection to the naso-lacrimal duct.
irrigating the inner part of the upper Directing the stream of fluid to different parts
lid is irrigated. of the eyeball ensure thorough cleaning of the
eye.

12. Irrigate the eye until the desired Repeat the procedure on the other side, if
effect is achieved necessary using separate articles and solutions.

13. Take all articles to the utility Timely and accurate documentation promotes
room, clean and replace them to patient safety.
their proper places, wash hands and
record the procedure.