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Difficulty: MediumPharmacological Therapies

A client with a history of chronic stable angina is scheduled to receive a new transdermal nitroglycerin patch. What is the correct sequence of steps the practical nurse should follow to safely administer this medication? Arrange the actions in the correct chronological order.

  1. 1Perform hand hygiene and don clean gloves.
  2. 2Remove the previously applied medication patch and fold it in half with sticky sides together.
  3. 3Cleanse the skin of the previous application site and allow it to dry.
  4. 4Label the new patch with the current date, time, and nurse's initials.
  5. 5Apply the new patch to a different, hairless area of the skin.

Answer

The correct sequence ensures safety and proper absorption: perform hand hygiene and don gloves, remove the old patch, cleanse the old site, label the new patch, and apply the new patch to a rotated site.
The correct sequence minimizes the risk of medication errors and protects the nurse. Gloves must be worn first to prevent self-medication. The old patch must be removed and the site cleaned to prevent a dangerous overdose. The new patch must be labeled before application to prevent skin trauma or a sudden bolus dose, and then applied to a new, rotated site to prevent skin irritation.

Step-by-Step Solution

1
Perform hand hygiene and don clean gloves.
Nurse and client are protected from exposure.
Gloves prevent the nurse from accidentally absorbing nitroglycerin through the skin, which could cause a severe headache or dangerous hypotension.
2
Remove the old transdermal patch and fold it in half.
Old medication source is safely contained and removed.
Leaving an old patch on while applying a new one can lead to medication toxicity and adverse cardiovascular events.
3
Cleanse the skin of the old site.
Skin is completely free of residual medication.
Nitroglycerin residue left on the skin continues to absorb and may cause unintended dosing if not washed away.
4
Label the new patch.
Patch is identified with date, time, and initials prior to application.
Writing on the patch before applying it prevents pressing down on the client's tissue and inadvertently squeezing out a bolus of medication.
5
Apply the new patch to a new site.
Medication is administered correctly to a fresh area.
Rotating sites prevents contact dermatitis and ensures consistent, reliable systemic absorption of the drug.

Key Concept

Safe administration of transdermal medications
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Topics

Pharmacological Therapies

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