Skills DEMO Administering Topical Meds Eval Tool e Learning PDF

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NCM 104: COMMUNITY HEALTH NURSING 1 (Individual and Family) PERFORMANCE EVALUATION TOOL SKILLS: ADMINISTERING TOPICAL MEDICATIONSOVERVIEW:The administration of topical medications may appear to be simple and harmless, it is associated with many side effects if not performed properly. Topical medicat...

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COLLEGE OF NURSING NCM 104: COMMUNITY HEALTH NURSING 1 (Individual and Family) PERFORMANCE EVALUATION TOOL SKILLS: ADMINISTERING TOPICAL MEDICATIONS OVERVIEW: The administration of topical medications may appear to be simple and harmless, it is associated with many side effects if not performed properly. Topical medications are an important and common mode of drug delivery, often offering continuous absorption of the medication over several hours. There are many classes of topical medications, such as creams, ointments, lotions, patches, and aerosol sprays. Topical administration directly to skin, mucous, or tissue membranes by of medications involves applying drugs directly to skin, mucous, or tissue membranes by spraying, painting, or spreading medication over a localized area

Learning Outcomes: At the end of this activity, the learner will be able to: 1. Identify different types of topical applications. 2. Ensure proper use of application in administering topical medications. 3. Prompts to learn and practice ways to improve the safety of medication use. 4. Maintain the standard of aseptic technique in providing safety and efficacy. Purpose: 1. Topical medications introduce medication through the skin, by absorption.

RATIONALE A. 1.

2.

3.

PREPARATION ASSESSMENT: ● Allergies to medication ● Specific drug action, side effects, and adverse reactions ● Client’s knowledge and learning needs about the medication ● Status and appearance of skin lesions, erythema, swelling, ecchymosis, inflammation, and tissue damage in applying topical medications ● Ability of client to cooperate during skin applications PLANNING: Assemble equipment and supplies: ● Clean gloves (for intact skin) or sterile gloves (for non-intact skin) ● Cotton-tipped applicators or tongue blades (optional) ● Ordered medication (powder, cream, lotion, ointment, spray, patch) ● Basin of warm water, washcloth, towel, and nondrying soap ● Sterile dressing, tape (if needed) ● Medication administration record (MAR) {electronic or printed} Check the MAR. Check the label on the medication carefully against the MAR to make sure that the correct medication is being prepared.

To guide you to which medication you are preparing.

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Compare physician orders and MAR Follow the three checks for administering medications. Read the label on the medication: ● When it is taken from the medication cart ● Before withdrawing the medication ● After withdrawing the medication

Check the right patient, medication, dose, route, time, reason, documentation Organize the equipment 4.

PROCEDURE: Wash hands and observe other appropriate infection control procedures.

Use gloves when applying ointment, cream, and lotion to avoid absorption of the medication into your skin. Prepare prescribed medications. Check that the client is not allergic to the drug or any of its derivatives prior to administration

5.

IMPLEMENTATION Introduce self Verify the client’s identity ; using 2 identifiers

To reduce the risk of cross infection

To fulfil legal requirements related to drug administration To protect the client from harm. If the client is allergic inform medical staff without delay to review prescription

This ensures that the right client receives the medication

Compare MAR with patient wristband Prepare the client ▪ Assist the client to a position in which the arm, leg, or abdomen can be relaxed, depending on the area to be used.

● A relaxed position of the site minimizes discomfort ● This prevents injury due to sudden

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▪ Obtain assistance in holding an uncooperative client. Explain the purpose of the medication and how it will help, using language that the client can understand. Include relevant information about effects of the medication. Provide for client privacy. Draw privacy curtain or close door. Administer the medication in the appropriate form, by the prescribed route, at the correct dosage to the correct client. A.

movement after needle insertion Information can facilitate acceptance of and compliance with the therapy

To fulfil your responsibilities and prevent any untoward occurrences

APPLYING A TRANSDERMAL PATCHES Before applying a transdermal patch, remove the old patch if it is still in place. Clean area thoroughly.

Not removing previous patch may result in overdose of the medication. Check between skin folds for old patch.

medication Transdermal patch Observe for signs of skin irritation at old patch and document as per agency policy. Dispose of old patch as per agency policy (usually in a biohazard trash bag) by folding in half with sticky sides together and wrapping it in a glove, or cutting it before disposal. Use a felt tip or soft tip pen to write the date, time, and your initials on the outside of the new patch. DO NOT use a ballpoint pen.

Do not apply new patch to previously used sites for at least one week to reduce the risk of skin irritation.

Fentanyl Patch Apply the new patch to a new site that is clear, dry, hairless, and free of skin irritations.

Carefully remove the backing from the patch, taking care to hold it at the edges and not touch the medication with your fingers. Apply patch by holding one hand firmly over the patch for 10 seconds, then press around the edges to make sure that the patch is securely attached to the skin.

Remove previous patch This prevents accidental exposure to the medication. Initialling patch communicates application date and time to other health care providers.

Write the date, time, and your initials on the transdermal patch NOTE: Ballpoint pen can damage patch and thus affect medication delivery. If it is necessary to remove hair, clip the hair instead of shaving to avoid skin irritation. ● A consistent surface ensures even medication distribution. This prevents interference with medication and maintains stickiness of patch This prevents loss of patch and ensures effectiveness of medication delivery.

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Never cut patch in half; a change in dose requires a new transdermal patch.

Nicotine patch

B.

Apply new transdermal patch

APPLYING CREAMS, OINTMENTS, PASTES, AND OILBASED LOTIONS Apply non-sterile gloves unless skin is broken; then apply sterile gloves.

Wash, rinse, and dry the affected area with water and a clean cloth. If skin is very dry and flaking, apply topical medication while skin is still damp. Change gloves, performing hand hygiene in between.

Place required amount of medication in palm of hands and soften by rubbing palms together.

Let patient know that initial application may feel cold. Apply medication using long even strokes that follow the direction of the hair. Do not rub vigorously.

Using gloves protects health care provider from contact with medication.

If skin is broken, sterile gloves will prevent the spread of microorganisms. This removes previous topical medications. Applying while skin is damp helps to retain moisture within skin layers. Use sterile gloves for open skin lesions to prevent spread of microorganisms.

Apply sterile gloves if patient has open lesions Softening makes topical medication easier to spread.

Rub medication in hands to soften and warm This prevents irritation of hair follicles.

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Explain that the skin may feel somewhat greasy after application. Apply a sterile dressing if ordered by the primary care provider.

C.

APPLYING AN AEROSOL SPRAY Shake container vigorously to mix the contents. Hold the spray container at the recommended distance from the area (usually about 15 to 30 cm [6 to 12 in.] or check the label). Ask patient to turn face away from spray or cover the client’s face with a towel if the upper chest or neck is to be sprayed. Spray the medication over the specified area.

D.

Mixing ensures delivery of fine, even spray. Proper distance ensures that fine spray hits skin surface. Holding container too close results in thin, watery distribution. Prevents inhalation of spray.

APPLYING A SUSPENSION-BASED LOTION Shake container vigorously before use to distribute suspended particles. Put a little lotion on a small gauze dressing or pad, and Apply the lotion to the skin by stroking it evenly in the direction of the hair growth

Explain to patient that area will feel cool and dry E.

Some topical medications contain oils. Covering site prevents soiling of patient’s clothes and linens.

Mixes powder throughout liquid to form well-mixed suspension. Method of application leaves protective film of powder on skin after water base of suspension dries. Technique prevents irritation to hair follicles.

Water evaporates to leave thin layer of powder.

APPLYING POWDER Ensure that skin is completely dry and clean before application. With your nondominant hand, fully spread apart any skinfolds such as between toes or under axilla and dry with towel. If application is near patient’s face, ask patient to turn away from powder or briefly cover face with a clean towel. Dust skin site lightly with dispenser so area is covered with fine, thin layer of powder. Option: Cover skin area with dressing if ordered by health care provider. Cover the site with a dressing if ordered.

This minimizes potential for powder to cake and crust. Minimizes caking and crusting of powder. Fully exposes skin surface for application. This prevents patient from inhaling powder. Thin layer of powder has slight lubricating properties to reduce friction and promote drying Covering site prevents soiling of patient’s clothes and linens.

Disposed of soiled supplies in the appropriate trash receptacle, removed and disposed of gloves, and performed hand hygiene.

This prevents the transfer of microorganisms.

Document all relevant information. Document the medication given, dosage, time, route, and any assessments.

Accurate and timely documentation improves patient safety.

EVALUATION ■ Conduct any follow-up indicated during your care of the client ■ Evaluate patient's response to procedure, side effects and management ■ Report other information in accordance with facility policy and professional standards of practice. ■ Relate to previous findings if available.

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PLEASE OPEN THE LINK AND WATCH for a demonstration on how to administer Topical Medications A 201Administering topical medications https://www.youtube.com/watch?v=PENoLw94q_8

COMPREHENSI ON EXERCI SES Please read all the information carefully. Failure to follow the instructions may result in failing the activity. TASK 01 INSTRUCTION: Do the following statements agree with the information given below based on Performance Evaluation Tool as your Reading Passage. TRUE FALSE NOT GIVEN

if the statement agrees with the information if the statement contradicts the information if there is no information on this

1. Observes the individual to assure all affected skin areas are covered with the topical medication. ANSWER: TRUE 2. Transdermal systems or "patches" can be placed on any area of skin except below elbows and knees. ANSWER: TRUE 3. When applying the next dose of transdermal patch, apply to different skin sites and rotate the area of application to avoid skin irritation. ANSWER: TRUE 4. Applying excessive amounts of topical medicine can cause adverse skin reactions such as redness, itching, and inflammation. ANSWER: FALSE 5. Apply cream medication using long even strokes that follow the direction of the hair and rub vigorously. ANSWER: FALSE 6. Warm the medication in gloved hands and apply gently to the skin in the direction of hair growth. ANSWER: TRUE 7. Remove wrapper from the patch. Do not touch the adhesive surface. d. Apply to the skin, pressing firmly for approximately ten seconds. ANSWER: TRUE 8. In applying powder, sprinkle the site with a fine, thin layer of powder, spreading any folds of skin. ANSWER: TRUE

TASK 02 INSTRUCTION: Fill in the correct word (s) in each blank to complete the sentence. Please watch the video link provided and listening comprehension is your passage to answer the information given below. 1. To use a topical cream, ointment or oil-based lotion expose the affected area, keep on affected area Covered and clean the area. 2. If your patient skin is successively flaky and dry, apply a topical agent while her skin is still damp. 3. After changing your gloves, place the required amount of medication at palm of your hand and warm it by briskly rubbing your glove hands together, spread the medication evenly over her skin using long strokes in the direction of hair growth, avoid rubbing the skin vigorously. 4. Fold the sticky sides together and dispose of a patch according to agency policy. 5. Apply the new patch to a clean dry area and avoid using the previous site for at least a week. 6 | Page

6. When you found a good site carefully pull the liner of the new patch, hold it around edges without touching the adhesive. 7. Apply the patch immediately to the selected site, pressing it firmly with your hand for 10 seconds, make sure it adheres well. 8. To apply an aerosol spray such as local anesthetic, have her turn face away or cover it with a towel. 9. Place a small amount of lotion on a gauze dressing or pad and apply it to her skin. 10. To apply a powder medication the skin surface must be thoroughly dry, with your non dominant hand spread any fold skin.

CRI TI CALTHI NKI NG EXERCI SES TASK 03 Answer the following questions below. 1. Why it is necessary to ensure that your patient’s skin is clean and dry prior to applying a prescribed topical powder? ANS: This minimize potential for powder to cake and crust 2. What is the rationale for not applying new patch to previously used sites? ANS: To prevent the risk of irritation.

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Comments/Recommendation: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

General Appraisal of Student Performance ( _________ x 2 ) = ___________ Performance of Skill: Independent (4)

Supervised (3)

Assisted (2)

Marginal (1)

The student performs the skill in a very consistent and independent manner with very minimal guidance and supervision.

The student performs the skill in a consistent and independent manner but requires moderate guidance and supervision.

The student performs the skill in a consistent and independent manner with frequent guidance and supervision.

The student performs the skill with errors even with frequent guidance and supervision.

Transmutation of Raw Score to Percent Grade using 60% as minimum Passing Grade: Descriptor Range 4

Independent

90 and above

3

Supervised

85 – 89

2

Assisted

80 – 84

1

Marginal

75 – 79

PERFORMANCE OF SKILL: TOTAL POINTS: ____________ POINTS EARNED: ____________ SKILLS DEMO RATING: ____________ DESCRIPTOR: ____________ REFERENCES: - Berrnan, A & Synder,S. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process and Practice.9 thed .Singapore: Pearson Education, Inc Copper Kim (2014) Computation of Grades: o Step 1: Get the sum of all the points for the entire procedure o Step 2: Use the formula below to get the final grade for particular competency checklist. o FORMULA: RAW SCORE/PERFECT SCORE X 60 + 40 = Final Score

Evaluated by: ________________________________ Signature over printed name CLINICAL INSTRUCTOR Date: _________________ Curriculum: Bachelor of Science in Nursing CHED MEMORANDUM ORDER NO. 15 Series of 2017

Conformed: _________________________________ Signature over printed name STUDENT Date: __________________

Effectivity

Course Name:

School Year 20202021

NCM 104: COMMUNITY HEALTH NURSING 1 (Individual and Family)

Date Prepared: July,2020

Prepared by: _______________________ Faculty

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