Dermal administration refers to the direct treatment of body surface or some mucosal diseases by sticking, painting, rubbing, applying, smoking, washing and bathing. The following are the skin medication skills for nurses that I brought to you. Welcome to reading.

1. Formulation and selection skills of skin external drugs

(1) dosage form for external use on skin:

1) powder: suitable for acute dermatitis and eczema without erosion. Commonly used are talcum powder, zinc oxide powder and calamine powder.

2) Solution: Suitable for acute eczema and dermatitis with erosion and exudation. Commonly used are 3% boric acid, 3% aluminum acetate, 0. 1% yinshaacridine solution and physiological saline.

3) Lotion: used for acute dermatitis without exudation. Commonly used are calamine lotion and compound sulfur lotion.

4) Tincture, tincture: It is suitable for lichen-like transformation of chronic dermatitis, fungal and pruritic skin diseases. Commonly used are tincture of iodine, camphor and salicylic acid, antipruritic drugs, tinea drugs and so on.

5) Oil agent: suitable for subacute dermatitis and eczema with a small amount of exudation. Commonly used 40% zinc oxide oil.

6) Emulsion: suitable for subacute, chronic dermatitis and eczema.

7) Ointment: Suitable for chronic dermatosis and neurodermatitis. Commonly used ointments such as compound benzoic acid ointment, sulfur ointment, urea ointment, etc.

8) Cold cream preparation: it is the most commonly used preparation in dermatology. Commonly used cold cream preparations, in addition to antipruritic cream containing antipruritic drugs (such as Bishu ointment) and urea cream to prevent skin moisture evaporation (such as antidiarrheal ointment), the most common ones are various corticosteroid creams (such as fluoxetine, dexamethasone, triamcinolone acetonide, etc. ).

9) Cream: Suitable for subacute dermatitis and eczema with slight exudation. Zinc oxide paste is commonly used.

10) Plaster: It is suitable for chronic infiltrating hypertrophic skin lesions, such as neurodermatitis and chronic eczema.

1 1) coating agent: it is often used to treat chronic dermatitis and corneal proliferative injury, and can also be used to prevent occupational dermatoses.

12) gel: used to treat acute and chronic dermatitis.

13) aerosol: used to treat allergic or infectious skin diseases.

(2) Selection skills of drugs for external use on skin:

1) dosage form selection: Choose different dosage forms according to different skin lesions. If there are only erythema, papules and blisters in acute inflammatory lesions, powder or lotion can be used; If there is erosion or exudation, wet compress with solution should be used for a long time. When subacute inflammatory skin lesions are accompanied by a small amount of exudation, choose emulsion, ointment or oil. Patients with chronic inflammatory skin lesions can choose ointment, emulsion, plaster, film coating and tincture. If there is no skin lesion but itching, choose emulsion or tincture. Skin injury, exudation or complicated infection can be treated by solution preparation, moist therapy and semi-exposure method.

2) Selection of drugs: Choose appropriate drugs according to the etiology, pathological changes and conscious symptoms. Antibiotics can be used for suppurative dermatosis; Fungal dermatoses are treated with antifungal drugs; Keratinocyte promoter is selected for patients with dyskeratosis: antipruritic agent is the first choice for pruritic skin diseases.

3) The drug concentration should be appropriate. Stimulating drugs should be used in low concentration first, and then gradually increase the drug concentration according to the patient's acceptance and skin lesions.

2. Skin preparation before skin external use of drugs

(1) It is not allowed to apply medicine to the scab skin when the scab skin of the affected area or the scab skin is stuck with hair. You can apply non-irritating ointment to the scab first, and then wrap it up. After 24 hours, the scab softens and falls off, the hair is cut off, and then the medicine is applied appropriately according to the condition.

(2) If there is hair in the affected area, the hair should be cut off first, and then cleaned or medicated.

(3) When the affected area has formed pustules, the skin around the pustules should be scrubbed with 75% ethanol and disinfected, and then the pustule wall should be removed. If it is a blister, it is enough to cut the blister wall after disinfection to release the liquid, and it is not necessary to cut the blister wall completely. If the blister has burst, the blister membrane can be cut off, and then the medicine can be used.

(4) When there is a large amount of purulent secretion on the surface of the affected area, first soak a cotton ball with hydrogen peroxide, rinse it with 1:5000 potassium permanganate solution, then apply appropriate drugs and wrap it with gauze; If the secretion on the surface of the affected area is serous, wet compress or direct medication can be used first.

(5) Wash the skin with warm water and neutral soap before medication. If you have dermatitis, you can only wash it with water.

(6) Cleaning the original drug on the skin surface of the affected area: pasty or other fatty drugs can be gently cleaned and wiped with vegetable oil or liquid paraffin; If the powder has dried and hardened, it should be soaked in warm water and then wiped off.

3. Administration skills of drugs for external use on skin

(1) Before taking the medicine, remove the scabs and scales at the skin lesions. If conditions permit, take it off by shower or soaking, and cut the patient's hair if necessary.

(2) Suspension such as aerosol and lotion for external use should be fully shaken before use; Emulsion and paste are not suitable for hair; Ointment and hard ointment are prohibited for acute dermatitis with excessive exudation; Do not use tincture when there is erosion or exudation; Patients with chapped skin, acute inflammation or exudative erosion should not use tincture.

(3) Pay attention to adverse drug reactions at any time. If there is irritation, allergy or poisoning, stop taking the medicine immediately and report the treatment.

(4) For skin lesions with chronic hyperkeratosis, apply drugs with appropriate strength to facilitate drug penetration.

(5) External solution management skills:

1) External aqueous solution is mainly used for wet compress, and is often used for open cold wet compress. Wash the affected area with wet compress or vegetable oil first, and put 4? Immerse 6 layers of sterile gauze into the liquid medicine, take out the extra liquid medicine, apply it to the affected area (be sure to stick it on the skin lesion) without dripping water, and often add water solution to maintain a certain humidity. Change the bottom gauze twice a day for a long time? Three times. When there is little exudation, bandage can be used to extend the humidification time.

2) When a large area is wet-applied, the solution concentration should be low, and the wet-applied area should not exceed 1/3 of the body surface area, so as to avoid absorption and poisoning of some drugs.

3) Keep warm when doing wet compress in cold season to avoid catching a cold.

4) Topical solutions include lotion, liniment, emulsion, tincture and elixir. When it is used with ointment and cream, the principle of water first and cream later should be followed. Topical solution tablets or granules should be used after dissolution. For example, for potassium permanganate tablets, take 1 tablet and add water 1500mL for accurate preparation.

(6) Highly irritating drugs (such as tincture, tincture) are not suitable for thin and tender skin parts, such as the lower part of the breast, face, infants, skin around cavities, mucous membranes, external genitalia, etc.

(7) Cut the film according to the size of the lesion, stick it on the skin and fix it with adhesive tape. The film coating agent is used to clean and dry the affected part. It is applied to the affected part in the same direction until it dries to form a film. Avoid contact with water. Once in contact with water, don't rub it with your hands. It will not affect the curative effect after drying.

(8) Ointment and cream administration skills:

1) soak the affected area in warm water before use 10? For 30 minutes, make the keratinized thick skin soft, peel off the floating skin, and then apply ointment to make the medicine penetrate into the skin better.

2) Don't cover the affected area after applying the ointment, because the ointment contains more oil, and the unexposed part can be covered with oil paper to prevent the clothes from rubbing off the ointment and affecting the curative effect. Expose the affected area after using the cream, and don't bandage it.

3) The ointment is slow to absorb, and is generally taken 1 ~ 2 times a day. The cream is usually used 2 ~ 3 times a day.

4) Ointment and cream should not be used for skin diseases with erosion, exudation or blisters, otherwise it will aggravate the inflammation of skin lesions.

5) After the skin is clean and dry, apply the medicine to the affected part, gently massage and apply it to the administration part until the ointment or cream is evenly applied.

6) Because of the wide application of hormone cold cream preparation, it can cause some adverse reactions to patients: excessive use of hormone external preparation can often cause local skin atrophy, hirsutism, telangiectasia and pigmentation; If long-term and large-scale use of hormone external preparations, Cushing's syndrome (such as obesity, full moon, centripetal obesity, hypertension, etc. ) Because of the absorption of corticosteroids, it is best to use it under the guidance of a doctor, usually twice a day.

(9) Use skills of ointment and patch:

1) ointment: first wipe the affected area or acupoint skin with warm water, and then paste the rubber ointment. If you use black plaster, you should first heat it with low fire or float it on boiling water to soften it, and then apply it to the affected area when the plaster does not burn the skin. The time to change the plaster depends on the' duration of efficacy' in the instructions, and it is usually changed 1 time a day. The interval between dressing changes should be shortened to 5? Six hours is appropriate.

2) Transdermal patch: Choose hairless or shaved skin, remove the protective layer of the transdermal patch before use, and gently press it with your hands or fingers to ensure that the patch is closely attached to the skin. The drug delivery site should be a site where strenuous exercise is not performed, such as the chest or upper arm. Replace the new membrane in time according to the requirements of the drug instructions to ensure the continuity of administration.

3) During dressing change, the affected area should be properly cleaned, and the skin should be properly ventilated after removing the drug scale adhered to the skin surface. Two hours.

4) The preparation of plaster may cause some patients to be allergic to adhesive tape. If severe itching, blisters or even blisters appear after applying the medicine, the medicine applied to the affected area must be taken out immediately and treated according to the doctor's advice.

5) Some plasters must be attached to specific parts, such as umbilical plaster and acupoint plaster. Shangshi Zhitong ointment should be applied 24 hours after sprain.

6) Not suitable for sticking on erosive skin and infected parts.

(10) Post management skills:

1) Wipe off the original cream with oil before skin administration, and don't rinse with water.

2) the part of the hair that is too long should be cut off and then coated with medicine.

3) Apply it to the lesion and wrap it with gauze.

4. 10% is the first choice of commonly used topical drugs for scabies? 20% sulfur ointment (5% for infants) or 10%? 25% benzyl benzoate cream, followed by 1% propylene hexachlorocyclohexane (? 1666) cream (such as mirabilite cream, mirabilite grease), 30% sodium thiosulfate solution, metronidazole, etc. The scabies nodule can be externally applied with cortical solid.

Alcohol or local injection of prednisolone suspension.

5. Use skills of sulfur ointment

(1) course of treatment: 10%? 20% sulfur ointment is applied to the whole body except the head and face, and the daily dosage is 1? Twice every three days, and then take a shower and change clothes and bedding on the fourth day. 1 course. Generally, two courses of treatment are continuous, and the condition is observed for 2 weeks after treatment to see if it recurs. If it recurs, repeat 1 course of treatment.

(2) Location: When applying sulfur ointment, it should be applied from the neck down to the whole body skin, especially the skin lesions and skin wrinkles such as finger joints, which need to be applied repeatedly.

(3) Wipe method:

1) Bathing: 1 Before application, you must take a bath with hot water and soap, or take a bath with traditional Chinese medicine decoction (such as Stemona, Sophora Flavescentis, Betel nut, Walnut Kernel, Fructus Cnidii, etc.). ) has insecticidal effect. Do not take a bath or change clothes during the medication until the end of the treatment.

2) Application: Apply the drug 1 time to the prone parts and skin lesions, and then apply it to the whole body skin below the neck. For younger patients, a small amount of medicine should be applied to the head and face, 1 time in the morning and evening, 3 times in a row. Four days. If there is a nodular rash in scrotum, the application time can be appropriately extended.

3) Dressing and disinfection: 1 course, take a bath by the above method, put on sterilized underwear after bathing, and boil the changed clothes and bedding or fully expose them to the sun for disinfection.

6. Other administration techniques

(1) 1% propyl-1666 cream: such as mirabilite cream and mirabilite grease. Usage: dry for half an hour after bathing, apply medicine 1 time, and take a bath after 24 hours. The medicine is odorless, tasteless and non-irritating, and has a good curative effect, but it is potentially harmful after being absorbed by the skin. Therefore, it is not suitable for women and babies, and it is best not to use it if there is skin damage. It is not advisable to take a bath with hot water before taking the medicine to avoid excessive absorption of the medicine.

(2) 10%-25% benzyl benzoate emulsion: Rub the medicine 1~2 times a day for 2 ~ 3 days, with strong insecticidal effect.

(3)30% sodium thiosulfate solution: Rub the medicine all over the body twice a day, 1 week to recover.

(4) Metronidazole: also known as Metronidazole, used according to the doctor's advice. Generally, oral administration of 0.2g each time, three times a day for 7 days is 1 course of treatment. The medicine has the effect of killing sarcoptes, and can also be used externally with 2%~3% metronidazole ointment.

(5) Youlifu Ointment: Apply the medicine to the whole body every night 1 time, 3 times in total. Five days.

7. Prevention skills of scabies

(1) Pay attention to personal hygiene, take a bath frequently and change the bedding frequently. If clothes and bedding are suspected of being contaminated, they should be boiled and disinfected or fully exposed to the sun.

(2) Family members living in the same room as collective residents should be treated positively.

(3) put an end to unclean sexual intercourse.

(4) Take a bath frequently when traveling and staying in hotels, and pay attention to changing beds. When you get home, you should take a shower and change clothes in time. The clothes should be washed separately and exposed to the sun.

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