I.Drugs are applied to the skin in the form of ointments, emulsions, solutions, powders, tinctures, mash, etc. The application is designed mainly for local action, for a pronounced largely reflex and to a small extent resorptive effect. The suction capacity of intact skin is extremely small, only fat-soluble substances are absorbed mainly through the excretory ducts of the sebaceous glands and hair follicles.
Ways of application:lubrications, compresses, lotions, powders, various dressings for wounds and rubbing. Application of drugs should always be done on clean skin, with clean tools and thoroughly washed hands. Often the skin is lubricated with tincture of iodine for the purpose of disinfection or reflex exposure. To do this, take a sterile stick with a cotton swab, moisten cotton with iodine and lubricate the skin, and throw the stick out.
After wetting the cotton wool, you can’t immerse the stick in a bottle of iodine, a small amount of iodine tincture should be poured into a flat vessel so as not to contaminate the entire contents of the bottle with cotton wool flakes. During prolonged storage of tincture of iodine in a vessel with a loose fitting stopper, its concentration may increase due to the evaporation of alcohol. Lubricating the skin with concentrated iodine tincture can cause burns.
II.In the treatment of eye diseases, solutions of various medicinal substances and ointments are used.
Purpose of application - local effects, but you should remember about the good absorption capacity of the conjunctiva and dose the medicine with this possibility in mind. A drug is instilled into the eye with a pipette. For this, the lower eyelid is pulled and a drop is applied, on the mucous membrane closer to the outer corner of the eye, so that the solution is evenly distributed over the conjunctiva. An ointment with a special glass spatula is introduced into the gap between the conjunctival mucosa and the eyeball at the outer corner of the eye.
III. Drugs are applied to the nose in the form of powders, vapors (amyl nitrite, ammonia vapor), solutions and ointments for the purpose of local, resorptive and reflex effects. Absorption through the nasal mucosa is very vigorous.
Powders are drawn into the nose with a stream of inhaled air: closing the right nostril, the powder is inhaled through the left and vice versa. Drops are injected with a pipette, while the patient throws his head back. The ointment is made with a glass spatula. You can rinse your nose from a teaspoon. Lubrication is performed by a doctor with a cotton swab wound on the probe.
IV.Drugs are also instilled into the ears with a pipette. Oily solutions of medicinal substances should be heated. When instilled into the right external auditory meatus, the patient lies on his left side or tilts his head to the left and vice versa. After drug administration, the external auditory canal is closed with a cotton swab.
V.To affect the female genital organs, drugs are injected into the vagina in the form of balls made on cocoa butter, cotton-gauze swabs, soaked in various fluids and oils, powders (powders), lubrication and douching solutions. The effect of drugs is mainly local, since absorption through the intact mucous membrane of the vagina is negligible. Douching is performed in the same way as the previously described washing, only warm solutions of drugs and a special vaginal tip are used.
"General care for patients", E.Ya. Gagunova
See also on the topic:LOCAL USE OF MEDICINES IN TREATMENT OF SKIN DISEASES
When choosing forms medicines it is necessary to take into account the degree of spread of the disease process, its localization, the stage of the disease, the nature and depth of the inflammatory process, anamnestic data regarding the tolerance of various types and means of local therapy.
In acute and subacute stages of skin inflammation, lotions are used, shaken by mixtures, pastes, when the medicines contained in them act superficially. In chronic and deep processes, ointments and compresses that affect the deeper layers of the skin should be preferred. The concentration of the drug included in the dosage form also matters. You should also strictly adhere to the rule: do not use powders and ointments on wet lesions. Powder along with the serous fluid of the lesion creates a dough-like layer, which, when dried, forms dense crusts under which pyogenic microbes multiply, which leads to an exacerbation of the course of the disease. Under a layer of ointment on a weeping area, similar conditions are created that lead to an increase in the inflammatory process.
Before applying this or that external medicine, the lesion should be cleaned of pus, crusts, scales, etc. However, these elements cannot be removed by force. Such areas are abundantly moistened with sterile vaseline, sunflower or other oil, after which after 15-20 minutes the focus is re-treated or the dressing is left for a longer time. Contaminated erosion or ulcers are treated with a 3% hydrogen peroxide solution. The skin around the lesions with pyoderma and other infectious dermatoses is wiped with 2% salicylic or boric alcohol.
Powder - powdered substances that are used in the form of powders. Mineral powdery substances (zinc oxide, talc) and organic (starch) are mixed together in various proportions. They are designated as indifferent powders.
Act: drying, degreasing, cooling, vasoconstrictor.
Application: acute and subacute dermatitis without weeping, with increased sweating and increased sebum secretion. To treat erosion and ulcers, sulfonamides, xeroform, dermatol are introduced into the composition of powders. If there are signs of pyoderma, antimicrobial substances (bismuth, dermatol, sulfonamides) are added to them, and menthol and anestezin are added to enhance the antipruritic effect. To obtain greasy powders, naphthalan oil is added. Starch should be excluded from powders with excessive sweating, especially in skin folds (causes fermentation).
Solutions - liquid dosage formobtained by dissolving in distilled water (less often in ethanol) a solid or liquid drug substance.
Lotions. For lotions, anti-inflammatory, astringent, disinfecting substances are prescribed in the form of solutions.
Act: cooling, anti-inflammatory, disinfectant, astringent.
Application: acute inflammation of the skin with or without weeping exudation (limited eczema, acute dermatitis, etc.) to reduce weeping, swelling, burning, itching in the affected areas. Usually lotions are used on limited areas of the lesion several times a day (1-3 days) until the weakening is reduced (island-inflammatory phenomena). With a longer exposure, the skin in the foci becomes dry, cracks may appear. With protracted processes, it is recommended to change the composition of lotions. In infants, it is advisable not to use lotions.
Mode of application: cooled medicinal solutions, poured into a kidney-shaped basin or a clean plate, moisten gauze (4-6 layers) or soft tissue, squeeze them and apply to the affected wet area. Lotions are changed after 5-15 minutes (as they warm and dry) for 1-1.5 hours; the entire procedure is repeated several times a day.
Wet-drying dressings. This dressing is prepared according to the same principle as the lotion, but there are more gauze layers (8-12) and the dressing is changed much less frequently (after 1 hour or more), as it dries. From above, the wet-drying dressing is covered with a thin layer of absorbent cotton and bandaged. These dressings help to ease the symptoms of acute inflammation, as slowly evaporating fluid causes the skin to cool (however, less actively than lotion).
Agitated suspensions - the smallest powdered substances suspended in water; water and glycerin; water, glycerin and ethyl alcohol. Before use, the suspension is thoroughly shaken (“talker”) and poured into a kidney-shaped basin or a clean plate, and then a cotton-gauze swab is applied to the affected areas.
The agitated suspension consists of 30-40% of powder substances (zinc, talc, starch) and 60-70% of a liquid (water; water and glycerin; glycerin and alcohol). After water evaporation, the powders applied to the skin remain on it with a thin layer. Glycerin keeps them on the skin for many hours. Alcohol helps to accelerate the evaporation of water from the surface of lesions. Others can be added to this dosage form. medications: ichthyol, anestezin, sulfur, etc. As a local anti-inflammatory agent, oil shake suspensions (liniments) are used, which consist of zinc oxide (30%) and vegetable oils (70%).
The action of aqueous agitated suspensions: anti-inflammatory, drying, antipruritic; oil suspensions: anti-inflammatory, emollient, exfoliating.
Application: with acute and subacute skin lesions without moknutia (dermatitis, allergic rashes, etc.). Shaken suspensions can be applied without bandages.
Aerosols - a dispersed system consisting of a gaseous medium in which solid and liquid drugs are weighed. They usually contain corticosteroids, antibiotics, antimycotics and are available in special sealed containers with a valve device.
Act: by the mechanism of action are close to agitated suspensions.
Application: various degrees of inflammation of the skin, including those accompanied by weeping, pyoderma, complicated by inflammation of mycoses.
Ointment - a dosage form based on fat or a fat-like substance. The use of the ointment stops the respiration of the skin, causes a slight increase in its temperature, loosening of the surface layers and vasodilation in the lesion areas, due to which the active substances contained in this dosage form are absorbed.
As a base, yellow petrolatum and lanolin (equally) are used, peeled lard, vegetable fats, oils, naphthalan, silicone compounds. Sulfur, tar, salicylic acid, naphthalan, ichthyol, resorcinol are introduced into ointment bases, antibiotics are taken into account in case of piodermic layering, given the possibility of sensitization.
Act: in small concentrations (up to 3%), for example, salicylic acid, resorcinol, introduced into the ointment base, cause a keratoplastic effect (exfoliating, epithelizing, anti-inflammatory, easy resolving); in high concentrations (3-5% or more) - keratolytic (exfoliating, exfoliating, exfoliating, pronounced resolving).
Creams differ from ointments in the fat content of water. If water particles are surrounded by oil (water in oil), then a oily ointment (cream) is formed, if vice versa (oil in water), then a non-greasy emulsion ointment (cream) is formed. Often apply a cream consisting of equal parts of lanolin (animal fat), petroleum jelly (or vegetable oil) and water. Often, synthetic fat-like substances are used as the basis for patented creams - derivatives of cellulose, ethylene oxides, etc. Antipruritic (diphenhydramine, menthol), exfoliating (salicylic acid) substances, urea, vitamins A, E, corticosteroids and other drugs are often introduced into creams.
Act: when applying creams, the skin softens and moisturizes, is cleaned of scales, crusts, while its breathing is preserved, a cooling, vasoconstrictive, anti-inflammatory effect is manifested.
Application: with dry flaky skin, cracks, subacute dermatitis (eczema), itching dermatoses, some infiltrative-desquamative (psoriasis, neurodermatitis, ichthyosis) and other dermatoses.
Lucky used in dermatology in the form of an elastic collodion with 10% castor oil or traumacitin (rubber in chloroform). Salicylic, carbolic, lactic acids, resorcinol, tar and other substances are introduced into the base. The varnish hardens on the skin in the form of a thin film; the substances contained in it penetrate deep into the skin, it is removed by gasoline.
Application: for the treatment of calluses, warts, nail plates with onychomycosis, with plaque psoriasis, for detachment of the stratum corneum.
Patches. The basis of the patch is wax or rosin, providing its thick and sticky consistency. Keratolytic concentrations of salicylic acid, urea, iodine, carbolic and acetic acids, lead oxide, etc. are introduced.
Act: active absorbable, exfoliating, loosening, disinfecting, fungicidal, depending on the substances introduced.
Application: for removal of callosities, loosening of nails, treatment of the nail bed with onychomycosis, with trichomycosis, vermicular form of lichen planus, limited neurodermatitis, purulent-inflammatory processes in the skin. Before use, the patch is heated, the focus is wiped with alcohol (gasoline). Change the patch 1 time in 2-3 days.
Through the excretory ducts of the sebaceous glands and hair follicles of the skin, only fat-soluble drugs are absorbed, therefore the external use of drugs is designed primarily for their local effects on the skin, mucous membrane or wound surface.
Rubbing - the introduction through the skin of medicinal substances in the form of liquids or ointments. Rubbing is carried out in the following areas of the skin: the flexion surface of the forearms, the back surface of the thighs, the lateral surfaces of the chest, abdomen, i.e., those areas where the skin is thinner and not covered with hair. If necessary, shave the hair. The skin must be clean at the point of rubbing. In case of contamination, the patient's skin should be washed with soap. The necessary amount of ointment or liquid is applied to the skin and rubbed in a circular motion until the skin becomes dry.
A contraindication to this procedure is the presence of inflammatory changes on the skin (eczema, dermatitis, etc.). In some cases, the ointment is applied to the skin without rubbing it (2% nitro ointment): it is smeared with a thin layer and covered with a plastic film for better absorption.
Lubrication as a method of applying various medicinal substances is widely used mainly for skin diseases.
A cotton or gauze swab is moistened in the required solution and applied to the patient's skin with light longitudinal movements. In the presence of hair, lubrication is carried out in the direction of their growth. With pustular diseases, the skin is smeared around the lesions. direction from the periphery to the center.
The patch is a thick consistency of a sticky ointment base covered with impermeable gauze. The ointment base contains active medicinal substances.
Contraindications to the use of the patch are: eczema, allergic dermatitis.
Before applying the patch, the skin is thoroughly degreased with medical alcohol, and the hair is shaved off. Then a patch is cut out with scissors of the required size and applied to the skin. Remove the patch gradually, starting from one edge. Before removing the patch, soak the edges with alcohol.
When using the patch, dermatitis may occur.
Dusting or powdering powders medicinal substances (talcum powder or rice powder) is used to dry the skin with diaper rash and sweating. A clean cotton swab is coated with powder and applied to the skin at the site of diaper rash.
Aerosol inhalation (inhalation of aerosols) is prescribed to patients to improve bronchial patency; liquefaction of sputum; infection control; protect the mucous membrane of the respiratory tract from the harmful effects of irritating agents.
The advantages of administering drugs by inhalation are as follows: 1) action directly at the site of the pathological process in the lungs; 2) getting into the lesion, bypassing the liver, unchanged, which leads to a high concentration of the drug substance.
The disadvantages of the method include: 1) inaccuracy of dosage; 2) with sharply impaired bronchial patency, poor aerosol penetration directly into the pathological focus; 3) the possibility of irritation of the bronchial mucosa with an aerosol.
In medical practice, steam, heat, moisture and oil inhalations are most often used.
For carrying out steam inhalation, a simple steam inhaler is used. When water is heated, the resulting vapor sucks in drug solution and disperses it, forming an aerosol, which is fed through the glass tube-tip into the respiratory tract of the patient. For inhalation, solutions of menthol, eucalyptus, antibiotics are used. Aerosol temperature 57-60 ° С. When carrying out warm-humid inhalation, a compressor is used that atomizes with compressed air. The aerosol has a temperature of 38-40 ° C. For inhalation, a 2% solution of baking soda is used mixed with alkaline mineral waters and antibiotic solutions.
During oil inhalation, oil, covering a thin layer of the mucous membrane of the respiratory tract, protects them from mechanical and chemical agents and prevents the absorption of toxic substances.
Dripping drops in ears, nose, eyes. Before dropping into the ear, the drops are heated to body temperature, since cold drops, irritating the labyrinth, can cause discomfort in the patient (dizziness, vomiting).
Drops are infused into the ear with a pipette. If the patient has suppuration, then before instillation, it is necessary to clean the auditory meatus with the help of cotton turunda (: see the chapter "Personal hygiene of the patient and his position in bed"). Otherwise, the injection of drops into the ear in the presence of pus in it is completely ineffective. Adults bury on average
6-8 drops. Before the introduction of the drops, the patient’s head is tilted towards the healthy ear, and when the patient is lying, they are turned on their side so that the ear into which the drops should be instilled is on top. With the left hand, pull the auricle posteriorly and upward to straighten the external auditory meatus, and with the right hand, with the aid of a pipette, drop the required number of drops into the ear (Fig. 14, a). Drops let in ear
2-3 times a day, each time holding them for 10-15 minutes, then tilt the word towards the sick ear so that the drops will flow out of it. If necessary, the external auditory meatus is dried with a cotton turunda (see the chapter "Personal hygiene of the patient and his position in bed").
Remember! Before dropping drops into the ear, the patient's head is tilted towards the healthy ear and the auricle is pulled back and up with the hand. Drops in the ear are instilled only warmed up to body temperature.
The instillation of drops into the nose is carried out alternately first in one and then in the other half of the nose with a pipette. Before dropping drops, it is necessary to clear the nasal passages from the crusts with a cotton turudna (see the chapter "Personal hygiene of the patient and his position in bed"). Drops are admitted in a patient who is in a sitting position or lying on his back with his head thrown back and slightly turned in the direction opposite to that into which the medicine is injected. This is necessary so that the drops moisturize the largest possible surface of the nasal mucosa. In each half of the nose, adults are instilled with 6-7 drops of the drug, and oil drops of up to 15-20 drops.
Before dropping drops into the conjunctival sac, the nurse thoroughly washed her hands with soap and a brush and wiped them with alcohol, then buried eye drops using a sterile pipette.
There are 4 intake methods eye drops. Usually they are instilled into the lower arch of the conjunctiva with the lower eyelid pulled down with the finger of the left eyelid and the patient's gaze deviated upward (Fig. 14, b). In this case, the end of the pipette should not touch the patient's eyelashes. It is possible to let drops into the region of the upper zone of the edge of the cornea while pulling the upper eyelid * and moving the patient’s gaze down. In children and restless persons, it is necessary to instill the medicine from any convenient direction at the moment when it is possible to open the eye gap at least a little. Finally, in case of sharp b / epharospasm in the patient lying on the back of the skin after the toilet, several drops of the drug can be instilled into the skin fossa at the inner corner of the palpebral fissure, and then, slightly opening the eyelids with your fingers, let the fluid flow by gravity into the conjunctival sac (Fig. 14, c). Admitting more than 2 drops does not make sense, since one drop is placed in the conjunctival sac. For a while, the patient should close his eyes. The part of the medicine leaking from the eye is removed with a cotton ball. The use of a separate sterile pipette for each patient fully guarantees infection with the solution administered.
