Transdermal Disc Application

Assistance with Transdermal Discs

• A transdermal patch is a medicated patch to deliver a specific medication dose through the skin into the bloodstream.
• Medication absorption happens over hours or days with transdermal patches.
• Medications can be administered through transdermal patches.
• Identifying the client according to employer policy reduces the risk of mistaking the client.
• Perform hand hygiene for yourself and the client.
• Gather medication (transdermal disc), disposable gloves, a small garbage bag, and a pen with non-smear ink to label the patch.
• Client privacy is important
• Check the label on the disc and compare it to the MAR and follow the 10 rights of medication assistance to reduce client injury or error.
• Put on gloves and get the client to put on a glove as well, because the medication is absorbed through the skin.
• Clients should remove, fold, and discard the old disc in the waste container.
• Wash the skin covered by the old disc with warm water and mild soap eliminating remaining medication and adhesive; do not use lotions.
• Clients should select a new site for the new disc, usually the chest or upper arm.
• Avoid bony prominences and hairy areas of the body because they do not allow for good seal of the disc or absorption of the correct medication dosage.
• Help the client apply the new disc.
• The patch goes on a clean area, sticky side down, pressing firmly with the palm to attach it securely.
• Ensure the medication doesn't touch an ungloved hand.
• Write the date and time on the disc so the other health care team members know when it was applied.
• Discard the wrapper and used materials in a garbage bag, tie it, and dispose of it in a lidded garbage bag to ensure the patch is not chewed by pets or touched by others, it still contains medication.
• Remove gloves, wash hands, and help the client wash their hands.
• Have the client record the medication, or record it for them.
• Store the medications properly.
• Remove privacy measures.
• Always record and report actions and observations per employer policy for legal reasons and to keep the team informed.

Metered Dose Inhalers

• Inhaled medications are delivered via a metered dose inhaler (MDI).
• MDIs give consistent medication doses through a pressurized medicine canister in a plastic holder with a mouthpiece.
• Patients with respiratory conditions like asthma often use MDIs.
• Identifying the client according to employer policy reduces the risk of mistaking the client.
• Explain the procedure to the client.
• Perform hand hygiene for yourself and the client.
• Gather medication (MDI container), a holding chamber if needed, and disposable gloves if needed.
• Client privacy is important
• Read labels and compare to the MAR and follow the 10 rights of medication assistance to reduce risk of client injury or error.
• If the client is taking two inhaled medications, double-check with the client or supervisor, which one should be taken first.
• The order of medication is important because the first medication usually opens clients' airways to help the second one.
• Vigorously shake the MDI container to activate the medication inside.
• Help the client remove the cap from the inhaler and insert it into the holding chamber if one is needed.
• A holding chamber, aka a spacer or aerochamber, helps medication reach the client's lungs instead of landing on their tongue.
• Hand the MDI and chamber to the client to inhale the medication.
• Once the plunger is pushed and the medication is inside the aerochamber, the client should breathe normally for at least six breaths.
• Wait at least one minute between puffs of the same medication.
• If two different medications (puffers) are needed, wait at least five minutes before switching to the second medication.
• Repeat the steps with the second medication.
• Have the client rinse their mouth with water and spit it out, but don't swallow, as it may contain traces of medications that damage the mouth's mucosa, causing thrush, or affect the digestive tract.
• Have client record the medication, or record it for them if they are unable to do so
• Clean the MDI device
• Store the medications properly.
• Remove privacy measures.
• Wash your hands.
• Do not forget to record and report your actions and observations per employer policy for legal reasons and to keep the team informed.

Assisting with Glucometers

• Many clients have diabetes, a chronic condition where the body can't manage blood sugar levels well, but clients with diabetes are taught how to test their blood sugar with a glucometer, test results help to decide the correct dose of medication.
• Check your organization policy and ensure you are trained to assist with this task if needing to assist with this activity.
• Many types of glucometers and test strips exist so familiarize yourself with the client's equipment.
• Review the client's care plan to determine the goals of care.
• Identifying the client according to employer policy reduces the risk of mistaking the client.
• Explain and assess the level of assistance your client needs.
• Perform hand hygiene for yourself and the client.
• Gather an alcohol swab, lancet, glucose meter, testing strip, gloves, cotton ball, and paper towel.
• Client privacy is important
• Follow the 10 rights of medication assistance to reduce the risk of client injury or error
• Work with the client to select the finger and site for testing.
• The sides of the finger between the fleshy pad and nail are ideal as there are less nerve endings than at the tips or pads.
• Put on gloves.
• Observe the client insert the test strip into the glucose meter.
• Observe the client clean off the area with an alcohol swab and wait until it dries before the test.
• Observe the client use the lancet ensuring is kept upright; in one motion, squeeze the plunger to get a blood sample.
• Keep the finger squeezed yet avoid touching the puncture site.
• Observe the client discard the first blood drop.
• Squeeze the finger to get enough blood to fill the test strip.
• Observe the client apply the blood drop to the test strip and allow its absorption; the test strip should be completely filled to ensure that the proper reading is done.
• Take note of the reading on the glucometer
• Discard the test strip.
• Check the puncture site for bleeding.
• Make sure the client is comfortable.
• Discard the gloves and wash your hands.
• Store the glucometer and equipment properly.
• Remove privacy measures.
• Don't forget to record and report actions and observations per employer policy for legal reasons and to keep the team informed.

Assisting with an Insulin Pen

• As a PSW, you can only assist a client, you cannot administer an insulin pen.
• You can help the client read their dose and compare it to the MAR but not change the dose on the dosing indicator.
• You're also allowed to steady their hand while they self-administer.
• Help the client gather necessities like the insulin pen, pen needle, alcohol swabs, and a sharps container.
• Assist the client in performing hand hygiene and opening alcohol swabs as needed.
• Make sure that the client uses a new needle.
• If the insulin is cloudy, make sure that clients gently roll the pen ten times before gently flipping it up and down ten times to ensure proper mixing.
• Gentle mixing prevents air bubbles.
• Observe the client priming the needle by setting the dose indicator to 2 Units, then squeezing the plunger to release one drop to remove air bubbles.
• Ensure the client uses a new injection site and cleans it outwards in a circular motion.
• Fleshy areas, including the abdomen, back of the arms, upper buttocks, and outer thighs, are good injection sites.
• Each time, rotate the site by moving one finger width away from the previous site for healing and use a completely different area weekly.
• Clients may or may not need to pinch the skin, depending on the type of needle.
• Ensure client inserts the needle at a 90-degree angle.
• Help the client remove the needle and put it in the sharps container.
• Document any observations like skin integrity and client independence, with your assistance.
• Notify your supervisor if the client is unable to self-administer the insulin pen.
• Ensure the client always eats as ordered.
• Be aware of what to do in case of low blood sugar symptoms and if the client has glucose tablets prescribed for hypoglycemia, know where the tablets are stored.
• Knowing where clients' items are stored is important if they become hypoglycemic.