Which instruction is essential when applying a new transdermal patch?

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.

Administering eardrops safely and effectively in pediatric patients requires knowledge of anatomical differences and age-appropriate techniques. In children under 3 years old, the ear canal is shorter and more horizontal than in adults, which affects how the medication is delivered. To ensure the drops reach the inner ear canal properly in a 2-year-old, the nurse should gently pull the earlobe down and back.

Rationale for correct answer:

3. Pull the earlobe down and back:
This is the appropriate technique for children under 3 years old. It straightens the horizontal ear canal, ensuring the drops flow inward effectively without causing pain or resistance.

Rationale for incorrect answers:

1. Pull the auricle up and back:
This method is used for older children and adults (typically over age 3) to straighten the more vertical ear canal. For toddlers, this direction may misalign the canal and reduce the effectiveness of the drops.

2. Warm the drops in a microwave before use:
Microwaving eardrops is unsafe and may cause the solution to overheat, risking burns to the delicate ear tissues. Drops should be warmed in the hands or placed in warm water to reach body temperature before administration.

4. Instill the drops with the patient seated upright:
The child should ideally be lying on their side with the affected ear facing up to allow the drops to remain in place and prevent spillage. Afterward, keeping the position for a few minutes enhances absorption.

Take-home points:

• For children under 3, gently pull the earlobe down and back when administering eardrops.
• Avoid microwaving eardrops; instead, warm them safely by hand.
• Positioning the child on their side helps retain the drops and ensures full therapeutic effect.