1. The client/caregiver can list measures used when administering medication to the eye (ophthalmic).
   1. Wash your hands. Read label.
   2. Hold the bottle upside down.
   3. Tilt your head back and look upward.
   4. Hold the bottle in one hand, and place it as close as possible to the inner aspect of the eye.
   5. With the other hand, pull down the lower eyelid to form a pocket.
   6. Place the correct number of drops into the pocket.
   7. Avoid touching the eye with the tip of the applicator.
   8. If using more than one eyedrop medication, be sure to wait at least 5 minutes before the second medication.
   9. Close your eyes, or press the lower lid lightly.
   10. If applying ophthalmic ointment, apply a thin line of ointment evenly along the inner edge of the lower lid (from inner to outer edge).
2. The client/caregiver can list steps when administering ear drops.
   1. Wash hands. Read label.
   2. Have the client positioned with the ear facing up. Stabilize the head by placing a hand on the head.
   3. Check for occlusion of the outer ear canal with cerumen or drainage. Wipe the outer canal with a cotton-tipped applicator.
   4. Check the positioning of pinna before medication.
      1. For adults and children older than 3 years old, gently pull the pinna up and back.
      2. For children younger than 3 years old, gently pull down and back.
   5. Hold the dropper 0.5 inches above the ear canal, and instill the ordered amount of drops.
   6. Suggest that the client remains in the same position for 5 to 10 minutes.
   7. If ordered, a cotton ball may be placed in the outer part of the ear canal. Do not press into the canal.
3. The client/caregiver can explain the steps to administer nasal drops or sprays.
   1. Wash hands. Read label.
   2. Ask the client to blow the nose to clear nasal passages.
   3. The client should open and breathe through their mouth.
   4. Hold tip above nostril (without touching), and direct medication toward the top of the nasal cavity.
   5. Suggest client stay in position for 5 minutes.
4. The client/caregiver can list steps to apply transdermal medication.
   1. Read the manufacturer’s instructions regarding the application site and frequency of change.
   2. Apply gloves before handling medication to avoid absorption of medication.
   3. Remove the previous medication patches and cleanse the area.
   4. Press the patch to clean, dry, and hairless skin.
   5. Rotate sites to prevent skin irritation.
   6. Label the patch with the date, time, and initials.
   7. Discard old patches and gloves safely, keeping them away from children.
5. The client/caregiver can list the steps to administer vaginal medication.
   1. Apply gloves, open suppository, or measure cream in the provided syringe.
   2. Lubricate the rounded end of the suppository.
   3. Expose vaginal opening by separating the labia.
   4. Insert the rounded end of the suppository along the posterior wall of the vagina as far as it will pass.
   5. If using a cream, jelly, or foam, insert the applicator along the posterior wall and push the plunger until empty.
6. The client/caregiver can list steps to administer rectal suppositories.
   1. Lie on the left side with knees pulled toward the chest.
   2. Apply gloves and open suppository. Lubricate the round end.
   3. Gently insert the lubricated suppository into the rectum.
   4. Remain in the same position to prevent expulsion of the suppository.
7. The client/caregiver can explain the method of Metered-Dose inhaler administration.
   1. Inhalers are hand-held pressurized devices that deliver a premeasured amount of medication to the respiratory system. It is delivered in a fine mist or spray.
   2. Wash hands. Read medication labels to check accurate medication and dose. Read any manufacturer’s instructions.
   3. Remove cover, and shake if indicated.
   4. Hold the inhaler in the dominant hand and use an inhaler in one of two ways:
      1. Place the inhaler in the mouth with the opening toward the back of the throat, closing lips tightly around it or
      2. Position the device 1 to 2 inches in front of the widely opened mouth. Lips should not touch the inhaler.
   5. Take a deep breath and exhale. Depress medication canister with an inhaler in place. Breathe in slowly, and hold your breath for 10 seconds.
   6. Remove the inhaler, and exhale through the nose or using pursed lips.
   7. If using a spacer device with an inhaler
      1. Remove the mouthpiece cover from the inhaler and spacer.
      2. Insert the inhaler into the end of the spacer device.
      3. Continue as described previously.
   8. Precautions when using an inhaler are
      1. Use an inhaler only as ordered by a physician.
      2. If using a bronchodilator with other medication, always use the bron- bronchodilator first.
      3. Wait about 5 to 10 minutes between the two medications.
8. The client/caregiver can list important points to remember when giving oral medications.
   1. Medications are most commonly given in tablet or capsule form.
   2. Some medications are enteric-coated and designed to dissolve in the small intestines. This is to avoid exposure to acids in the stomach. These medications should not be crushed.
   3. Other medications have been designed to dissolve very slowly by creating a sustained-release tablet or capsule. They can be extended-release, long-acting, or slow-release tablets. They too should not be crushed or opened.
   4. The client should be seated or in a side-lying position to avoid aspiration.
   5. Sublingual administered medications are placed under the tongue and allowed to dissolve.
   6. Buccal-administered medications should be placed in the mouth against the mucous membrane until dissolved.
   7. Lozenges should not be chewed or swallowed.
   8. Powdered medications mixed in liquid should be taken immediately after mixing.
   9. Ensure that the client has safely swallowed the medication.
9. The client/caregiver can list measures to administer oral medications in tablet form.
   1. Wash hands. Read label.
   2. Offer sips of liquid prior to medications for those people with a dry mouth.
   3. If the client has difficulty swallowing, (and there are no contraindications), pills may be crushed. Mix crushed medication in a small amount of soft food (pudding, applesauce, etc.).
   4. Rinse oral cavity, and offer or provide mouth care as needed.
10. The client/caregiver can list measures to administer liquid medication.
    1. Wash hands. Read label.
    2. If medication is a suspension, shake well before using.
    3. Do not use silverware spoons to measure or give medications.
    4. Measuring spoons are accurate but can spill easily.
    5. Oral syringes or dosing cups can be used. Caution: The Food and Drug Administration has reports of young children choking on syringe caps. Caution: Do not use a hypodermic syringe or syringe with a needle.
    6. Measure into the dosing cup at eye level to be accurate.
    7. Hold the bottle with the label against the palm of your hand while pouring. This prevents future difficulty in reading labels caused by spillage.
    8. Flavorings can be added to liquid medications to improve taste.

Resources

Health care provider Pharmacist

Prepared information provided with medication by pharmacist and manufacturer

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Elsevier.
Adams, M. P., Josephson, D. L., & Holland, L. N. Jr. (2005). Pharmacology for nurses: A pathophysiologic approach. Upper Saddle River, NJ: Pearson Education, Inc.
Deglin, J. F., & Vallerand, A. H. (2001). Davis’s drug guide for nurses. Philadelphia: F. A. Davis Company.
Hunt, R. (2005). Introduction to community based nursing. Philadelphia: Lippincott Williams & Wilkins.
Nursing 2006 drug handbook. (2006). Philadelphia: Lippincott Williams and Wilkins.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Rice, J. (1998). Medications mathematics for the nurse. Albany, NY: Delmar.