What should the nurse instruct the patient to do after using an inhaled corticosteroid?

To ensure safe and effective medication delivery, nurses must adhere to evidence-based practices when applying topical ointments. These practices are essential for promoting optimal drug absorption, minimizing adverse effects, and ensuring therapeutic outcomes. One of the most critical steps in this process is proper skin preparation before application.

Rationales:

4. Cleaning and drying the skin before application:
Cleaning removes debris, oil, or contaminants, and drying prevents dilution or interference with absorption. This step ensures that the ointment contacts the skin effectively for localized or systemic effect.

1. Applying a large amount over a wide area:
Using excessive medication may not improve absorption and could increase the risk of systemic side effects. The goal is to apply only the prescribed amount to the affected area.

2. Massaging the medication vigorously into the skin:
Vigorous massage may irritate the skin or cause unintended systemic absorption. Gentle application is preferred unless otherwise specified by the medication guidelines.

3. Applying to moist, inflamed skin:
While inflamed skin may absorb more medication, it can also increase the risk of irritation or toxicity. Medication should generally be applied to intact, clean, and dry skin unless directed otherwise.

Take-home points:

• Clean, dry skin enhances absorption and reduces the risk of contamination or irritation.
• Avoid overuse or excessive application of ointments to prevent side effects.
• Follow product-specific instructions for massage or application pressure.

Nitroglycerin ointment is a transdermal nitrate medication used for the prevention of chronic angina by promoting vasodilation and improved myocardial oxygenation. Because the drug is absorbed through the skin, it is essential for nurses to apply it using safe, standardized techniques to ensure accurate dosing and avoid unintended exposure. Wearing gloves is a critical step, as nitroglycerin can be absorbed through the caregiver’s skin and may lead to hypotension, dizziness, or headaches.

Rationale for correct answer:

2. Use a gloved hand to apply the medication:
Gloves are essential when applying nitroglycerin ointment to prevent accidental absorption through the nurse’s skin, which could cause hypotension, headache, or dizziness.

Rationale for incorrect answers:

1. Rub the ointment into the skin for absorption:
Vigorous rubbing is discouraged as it can increase systemic absorption unpredictably and cause skin irritation. Nitroglycerin should be spread in a thin layer using the applicator paper and left to absorb passively.

3. Apply to the same site daily for consistency:
Using the same site repeatedly may lead to skin irritation and altered absorption. It is best practice to rotate application sites to maintain skin integrity and consistent drug levels.

4. Avoid rotating sites to maintain drug levels:
Rotating sites does not negatively impact drug levels. On the contrary, it helps prevent localized skin irritation and supports optimal absorption.

Take-home points:

• Always wear gloves when applying nitroglycerin ointment to prevent nurse exposure.
• Do not rub the ointment into the skin; allow it to absorb as prescribed.
• Rotate application sites to prevent skin breakdown and maintain drug effectiveness.
• Document the site and dose to ensure safe, consistent administration.