A nurse is preparing to administer eardrops to a 2-year-old. Which technique is appropriate?

Inhaled corticosteroids are essential in managing chronic respiratory conditions such as asthma and COPD due to their anti-inflammatory effects. However, because corticosteroids suppress local immune responses in the mouth and throat, they can increase the risk of oropharyngeal candidiasis (thrush). To minimize this risk, it is critical for the nurse to instruct patients to rinse the mouth thoroughly with water and spit it out after each use.

Rationale for correct answer:

2. Rinse the mouth thoroughly:
Rinsing after inhalation removes leftover steroid particles from the oral mucosa, helping prevent oral thrush and irritation. This is a key component of inhaler education and safe medication use.

1. Blow the nose:
This is more relevant for nasal sprays than for inhaled corticosteroids. It does not aid in removing medication from the mouth or throat, where the risk of fungal infection exists.

3. Take another puff within 30 seconds:
When a second puff is prescribed, waiting 1–2 minutes between doses is ideal for bronchodilators, not corticosteroids. Corticosteroids are usually not taken in rapid succession.

4. Drink water before each dose:
Drinking water before administration does not prevent side effects and does not replace the need for rinsing the mouth afterward. The priority is removing residual corticosteroid from the oropharynx post-use.

Take-home points:

• Always instruct patients to rinse their mouth and spit after using an inhaled corticosteroid.
• This practice significantly reduces the risk of oropharyngeal candidiasis.
• It should become a routine part of inhaler technique education.

Transdermal patches are designed to deliver medication slowly and consistently through the skin into the bloodstream, making them ideal for chronic conditions requiring steady plasma drug levels. To ensure both efficacy and safety, nurses must follow precise application guidelines that include choosing appropriate skin sites, monitoring for adverse effects, and maintaining accurate documentation. Recording the date, time, and location of the patch helps prevent errors such as overlapping applications, missed doses, or skin irritation from repeated site use.

Rationale for correct answer:

3. Document the date, time, and site of application:
Proper documentation helps ensure that the patch is changed at the correct time and applied to a new site, reducing the risk of medication buildup and skin breakdown. It also promotes accountability and continuity of care.

1. Cut the patch in half for dosage adjustment:
Cutting a transdermal patch compromises its integrity and may lead to uncontrolled medication release, increasing the risk of overdose or therapeutic failure. Most patches are not designed to be divided.

2. Apply over the same site as the previous patch:
Reusing the same site repeatedly can cause skin irritation, decreased absorption, and local tissue reactions. Rotating sites allows the skin to recover and ensures proper absorption.

4. Apply to broken or irritated skin for faster absorption:
Broken or inflamed skin can absorb medications unpredictably, potentially resulting in toxicity or adverse reactions. Patches should only be applied to intact, clean, and dry skin.

Take-home points:

• Always document date, time, and site when applying a transdermal patch to ensure consistent care.
• Never cut or divide transdermal patches unless specified by the manufacturer.
• Apply patches to intact, hairless skin and rotate sites to prevent irritation and maintain drug effectiveness.