Medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, child, or family member who is knowledgeable about the medication and techniques of administering topical medication to a child.
Principles of pharmacologic management (see Chapter 6) are followed.
Medications are given topically through the skin (transdermally) and absorbed because of the skin’s relatively rich blood supply. Because skin thickness and blood flow to the skin vary with age, the potential for toxic effects of the drug must be considered. Children have a larger body surface area and a thinner layer of cutaneous and subcutaneous tissue than adults, so there is an increased risk for systemic absorption and effects through topical application.
Do not apply topical medication to skin with open lesions unless ordered.
Medications are administered within 1 hour of prescribed time.
EQUIPMENT
Prescribed medication
Nonsterile gloves
Washcloth
Basin of warm water
Gauze (if needed)
Appropriate applicator (cotton swab, tongue depressor, or other)
Sterile dressing (if needed)
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess the child’s skin integrity before administration of topical medication. Observe for cleanliness and clean off dirt and excess lotions as needed.
Assess the condition of the child’s skin, noting areas of healing, excoriation, edema, rashes, or increased redness.
Assess the child’s previous experience with topical medications.
Prepare the child, as appropriate to cognitive level, and the family before administration.
Provide therapeutic play as indicated, or involve a child life specialist, to allow the child to work through his or her fears and master control of the situation.
Teach the child and the family about the medication’s actions and side effects, how the medication is to be applied, and the reason for its use.
KidKare Remind the child not to rub or scratch where the medication is to be applied. Scratching or rubbing the area may remove some of the medication, interfere with absorption, and damage the skin or underlying tissue.
Assess for drug allergies; if present, notify healthcare prescriber. Label child’s record and apply identification band indicating allergies.
PROCEDURE Administering Topical Medication
Steps
Rationale/Points of Emphasis
1 Verify the order with the child’s medical record, including calculation of appropriate dose, and check for allergy to drug; if present, do not administer drug and notify prescriber.
Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.
2 Obtain the ordered topical medication and read the label to verify with the order. Check for expiration date; if expired, do not administer. Use topical medication at room temperature unless otherwise specified.
Room temperature medication may be more comfortable and easier to apply.
3 Perform hand hygiene and don gloves.
Reduces transmission of microorganisms.
4 Verify the medication with the electronic medication record, or take the medication record and medication to the child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with child’s identification band and any other patient identifier required by the institution.
Ensures proper identification of child.
5 Cleanse the skin, as ordered or per reference manual recommendations, before application of the medication. Use a basin of warm water and a washcloth only. If an open wound is present, use gauze instead of a washcloth. Dry skin well after washing.
Some medications require cleansing all old medication off the skin before the application of new medication. Other medications require applying new sterile medication over the old medication without cleansing the area.
6a Apply topical medication to the site. Use the correct amount as ordered and administration technique for the type of topical medication.
An excessive amount of medication may result in irritation of the skin and adverse systemic effects. Unintentional absorption through mucous membranes can result in systemic toxicity.
6b Administer gels, ointments, and pastes using cotton swabs or tongue blades.
6c Administer lotions and creams using cotton swabs, tongue blades, or the nurse’s gloved hands.
Gloves help to reduce transmission of microorganisms and protect the caregiver from absorbing the medication through his or her hands.
caREminder
Do not apply moisturizers or lubricants to an infant or toddler’s diaper area. These products may enhance the incidence of skin breakdown by causing the skin to become overhydrated and act as a friction between the diaper and the child’s skin.
6d If a powder is ordered, sprinkle it over the site. Ensure that the child’s head is turned away to avoid inhalation of the powder (see Chapter 34 ). If a spray is ordered, check with reference source or manufacturer’s recommendations; most sprays must be shaken before administration. Spray over the site and ensure that the child’s head is turned away to reduce potential of inhalation.
Powders and sprays are easily inhaled, which may cause lung tissue damage or increase absorption through the respiratory system.
6e Emulsions are often mixed with water (water temperature should be between 98.6°F and 113°F [37°C and 45°C]) and the area submerged in the liquid for a specific period of time, usually 15-20 minutes. Follow time recommendations closely.
Avoid using products with alcohol, perfumes, or dyes in neonates. The newborn’s skin is drier than that of an adult but becomes gradually more hydrated as the eccrine glands mature during the first year of life. Routine use of emollients, such as Aquaphor ointment, can prevent excessive dryness, skin cracking, and fissures in premature and full-term infants. However, perfumes and dyes in these substances can be absorbed and are potential contact irritants.
Water temperature that is too hot can cause vasodilation and heat injury. Water that is too cold can cause discomfort and chilling. Prolonged exposure can cause vasodilation of the skin or increased absorption of the medication.
6f Apply transdermal and topical systemic medication patches to a flat area of the skin; they are self-adhesive. Rotate application sites.
Flat areas help the medication remain in contact with the skin, promoting even absorption. Rotation reduces skin irritation.
Do not cut medication patches to fit area because this alters the dose administered. Also, do not cut to reduce dose because the medication may not be distributed evenly on the patch, and there is no way to know the amount of medication left on the patch.
7 Apply a dressing over the site if indicated.
A covering prevents the medication from being rubbed off, protecting clothing and site.
Occlusive dressings may increase absorption of the medication and should not be used with topical steroids.
KidKare Fluffy toys or other objects may stick to the medication site. Toys should either be kept away or the site covered, whichever is appropriate.
8 Remove gloves and perform hand hygiene.
Reduces transmission of microorganisms.
9 Return medication to appropriate storage area.
Provides safe storage of medication.
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KidKare Remind the child not to rub or scratch where the medication is to be applied. Scratching or rubbing the area may remove some of the medication, interfere with absorption, and damage the skin or underlying tissue.
PROCEDURE
Avoid using products with alcohol, perfumes, or dyes in neonates. The newborn’s skin is drier than that of an adult but becomes gradually more hydrated as the eccrine glands mature during the first year of life. Routine use of emollients, such as Aquaphor ointment, can prevent excessive dryness, skin cracking, and fissures in premature and full-term infants. However, perfumes and dyes in these substances can be absorbed and are potential contact irritants.
Do not cut medication patches to fit area because this alters the dose administered. Also, do not cut to reduce dose because the medication may not be distributed evenly on the patch, and there is no way to know the amount of medication left on the patch.
Occlusive dressings may increase absorption of the medication and should not be used with topical steroids.
KidKare Fluffy toys or other objects may stick to the medication site. Toys should either be kept away or the site covered, whichever is appropriate.
