doses should be wiped completely from the skin between reapplication, as residual can lead to cumulative effects and overdose. Creams are water-based, which allow them to absorb directly into the skin. A common example is Kwell, a prescription cream applied to treat lice and scabies. Gels are suspension- based. A common example is Voltaren, also known as diclofenac , a non-steroidal anti-inflammatory applied to reduce osteoarthritic pain. Plasters are applied to the skin under a base material such as moleskin, paper, linen or plastic (Watkins, 2013, p. 162). Common examples include salicylic acid for treating fungal warts, and capsaicin plaster, a topical analgesic. Non- prescription semisolids include lotions and liniments. Lotions are water-based like creams, though they contain a higher percentage of water as opposed to medication. A common example is Calamine lotion, used to treat pruritus or itching irritation. Liniments, or salves, are lotions that include a skin irritant, such as alcohol or wintergreen, that draws blood flow to the application area for increased uptake. Common examples include Bengay and Icy Hot, which are often applied to aching muscles. Solid topical medications are often formed into a powder or patch. Powders commonly reduce moisture and are applied to localized fungal infections. A common example is Desenex, or miconazole, which is applied to treat tinea pedis, or athlete’s foot. Transdermal patches include specific solid medication doses and are applied directly over skin. The pharmaceutical is then absorbed into the skin at a consistent rate, i.e. time release. Transdermal patch medications are widely variable. Common examples include NicoDerm for smoking cessation, Dramamine or scopolamine for nausea and/or motion sickness, fentanyl for pain relief, and clonidine for hypertension. While transdermal patches are easy to apply, the risk of cumulative effects and overdose are present if the application area is not cleansed between doses. In addition, patch application can be affected by excessively dry or oily skin. In turn, skin can become irritated when patch locations are not changed. Clinicians applying patches should wear gloves in order to prevent the pharmaceutical from affecting his or her body. Ophthalmic medications are drops or ointments that are applied directly onto the eye to lubricate the surface, treat infections and glaucoma, and prime the eye for further examination and/ or treatment. Ophthalmic drop medications are widely variable. Common examples include Visine to constrict dilated blood vessels, anti-allergen drops, lubricant drops, and bacitracin to treat conjunctivitis, i.e. “pink eye.” Multiple ophthalmic drops can be used to manage glaucoma symptoms. The primary therapeutic effect for these drugs is to reduce ophthalmic pressure, thereby safeguarding the integrity of the optic nerve (Radhakrishnan, 2016). Mechanisms of action for glaucoma drops may include increased fluid production, reduced fluid production and/or enhanced fluid drainage. Otic medications are drops applied directly into the ear canal to treat irritation and/or infection of the inner and outer ear, as well as to decrease cerumen impaction, i.e. earwax (Watkins, 2013, p. 166). Common examples include ofloxacin to treat bacterial infections of the middle and outer ear and associated with treatment of otitis externa, or “swimmer’s ear,” as well as various antibiotic drops applied for otitis media, i.e. middle ear infections. Vaginal medications are composed of gels, foams, lotions and jellies. Common application includes treatment of local bacterial and fungal infections, as well as contraception. Nasal medications are applied treat various sinus conditions including congestion, asthma and seasonal allergies (Watkins, 2013, p. 168). Methods of use include inhalers, sprays, drops and installation. Administration by inhalation reaches systemic circulation quickly and efficiently, and may provide additional therapies by dilating and/or breaking up congestion in the lungs. Metered-dose inhalers provide a specified dosage of an aerosol pharmaceutical
through a hand-held inhalation device. Sterile water or sodium chloride is often added to facilitate inhalation of a powder form of medication (Watkins, 2013, p. 169). A spacer is a plastic chamber that may be attached to an inhaler in order to suspend a medication dosage until a patient is ready to inhale. Inhalers require sanitary measures to prevent infection. Nebulizers are relatively small machines that condense air or oxygen to aerosolize medication into minute particles within a light mist for inhalation. Nebulizers are used often to administer bronchodilators and hypertonic saline for patients with asthma and cystic fibrosis. Oxygen may also be inhaled by way of nasal cannulas, masks and positive airway pressure devices. Machine choice depends on the amount of oxygen required, as well as the patient’s ventilatory capacity. Prolonged oxygen delivery can dry out mucus membranes and must be supplemented with distilled water for humidification (Watkins, 2013, p. 172). Injectable medications are liquids, or powder compounds mixed with sterile water or bacteriostatic sodium chloride solution, administered by needle or syringe. Medication may be injected via intradermal, intramuscular, subcutaneous or intravenous routes (Watkins, 2013, p. 173). Intradermal administration reaches the dermis of the skin by way of a 10- to 15-degree angled injection and is a common method for tuberculosis and allergy testing. Intramuscular administration facilitates rapid systemic access via abundant capillary regions. Intramuscular injections are inserted at a 90-degree angle. Common administration areas include the deltoid, dorsogluteal, ventrogluteal and vastus lateralis. The general standard for deltoid injections limits needle length to 1 inch, and pharmaceutical dosage to 1 milliliter (mL) (Watkins, 2013, p. 175). Dorsogluteal injections present a risk of insulting the sciatic nerve, and should be administered in a superolateral quadrant. A topographic boundary line for the sciatic nerve may be drawn from the greater trochanter to the posterior superior iliac spine. Vastus lateralis is a common injection site for patients under the age of 2. Subcutaneous injections are indicated for medications that are best suited for decreased rate of absorption and prolonged systemic circulation. Subcutaneous injection sites are regions of increased adipocytes, decreased vascular potential and limited nerve supply, such as the abdomen and fleshy segments of the arm and thigh (Watkins, 2013, p. 180). Common medications administered subcutaneously include insulin and heparin. Consideration must include rotation of subcutaneous injection sites in order to prevent complications such as drug accumulation and/or abscess formation. Intravenous (IV) medication administration is the fastest way to administer drugs into the bloodstream, making it the method of choice in an emergency and/or critical situation. Intravenous administration also delivers the most rapid relief of acute symptoms. Intravenous medications and fluids are directly administered into the venous system to treat a disease, prevent illness and provide nutrition and/or hydration, and as part of a diagnostic procedure (Watkins, 2013, p. 183). Peripheral IV lines may be placed in veins of the arms, hands, feet or scalp. Central IV lines are placed in larger veins such as the subclavian or internal jugular veins, with the catheter tips terminating in the superior vena cava. This position allows for medications to mix with larger amounts of blood closer to the heart. A peripherally inserted central catheter (PICC) line is inserted from a peripheral site, often the arm, and extends to larger veins proximal to the heart (Watkins, 2013, p. 184). Although the majority of intravenous lines are administered during hospital admission, many patients are discharged with these lines still in place for continued treatment. Routine inpatient medical treatment may include intravenous administration of fluids, electrolytes, blood or total parenteral nutrition. Common fluids include dextrose, saline and lactated ringers. Dextrose is a variable solution of sugar and water. Saline is a solution of sodium chloride. Lactated ringers are solutions of dextrose, potassium chloride, sodium, lactate and calcium. Each one is an example of crystalloids.
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