Administering Vaginal Medication

Nursing Procedure 5.20

Administering Vaginal Medication

Delivers medication for absorption through vaginal membranes for such therapeutic effects as resolving infections and treating inflammation.

Doctor's order
Computerized medication administration record (or manual record if computerized record not available)
Barcode or electronic client and medication identification scanner, if available
Vaginal suppository or cream to be administered
Vaginal applicator
Basin of warm water
Nonsterile gloves
Washcloth
Soap
Towel
Sanitary pad
Pen

Assessment should focus on the following:

Complete medication order
Condition of vaginal area (presence of lesions, tears, bleeding, tenderness, discharge, or odor)
Client's or caregiver's understanding of medication and procedure for administration
Medication allergies or sensitivity to latex (if latex gloves used)

Nursing diagnoses may include the following:

Ineffective therapeutic regimen management related to deficient knowledge of follow-up care
Pain related to vaginal irritation

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include the following:

Client has no redness, heat, swelling, abnormal drainage, or pain in vaginal area.
Client verbalizes understanding of purpose of medication and procedure for administration.

Special Considerations in Planning and Implementation

Pediatric

Vaginal medications should not be given to female children, particularly in consideration of the hymen remaining in contact. Consult closely with doctor and parents on this issue prior to administration, even if hymen is not intact.

Geriatric

Mucous membranes are thin in older clients; therefore, insert suppositories carefully to avoid injury to tissue.

Delegation

As a basic standard, medication preparation, teaching, and administration are done by a licensed registered or vocational nurse. Some drugs may be given by registered nurses only. Policies vary by agency and state. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. BE SURE TO NOTE SPECIFIC AGENCY POLICIES FOR A GIVEN ROUTE AND DRUG BEFORE DELEGATING ADMINISTRATION!

[Outline]

Desired Outcomes
Special Considerations in Planning and Implementation

Action		Rationale
1	Perform hand hygiene and organize equipment.	Reduces microorganism transfer; promotes efficiency
2	Prepare drug to be administered, adhering to the five rights of drug administration (see Nursing Procedure 5.1). Use barcode scanning, if available.	Promotes safe drug administration
3	Identify client by scanning or visually checking (if scanning unavailable) identification bracelet and by addressing client by name.	Verifies identity of client
4	Explain procedure and purpose of medication to client.	Reduces anxiety; promotes cooperation
5	Verify any client allergies.	Prevents allergic reactions and injury
6	Provide privacy.	Decreases embarrassment
7	Don gloves.	Prevents contamination of hands; reduces risk of infection transmission
8	Lower side rails, and assist client into dorsal recumbent or Sims’ position.	Places client in appropriate position for drug placement
9	Wash and dry perineum if discharge or odor noted.	Promotes cleanliness; facilitates drug absorption; removes excess secretions
10	Insert medication into vaginal applicator:
	For a vaginal cream, place applicator over top of open medication tube, invert applicator/tube combination, and squeeze tube.	Forces medication into applicator
	For a vaginal suppository, remove from package and insert suppository into applicator (suppository can be inserted without applicator, if desired).	Assists with insertion of drug into vagina at depth necessary to facilitate absorption
11	Spread labia if vagina is not easily visible.	Exposes vaginal opening
12	Insert applicator into vagina about 2.5–3.0 in. and press applicator top down (Fig. 5.29); if using finger to insert suppository, also insert 2.5–3.0 in.	Inserts medication
13	Remove applicator or finger.	Completes process
14	Instruct client to remain in bed in a flat position for 15–20 min.	Allows time for medication to be absorbed
15	Apply sanitary pad.	Contains discharge
16	Remove gloves and discard with soiled materials.	Decreases microorganism transfer
17	Perform hand hygiene.	Reduces microorganism transfer
18	Raise side rails and place call light within reach.	Promotes safety; facilitates communication
19	Restore or discard all equipment properly (applicators may be washed with soap and water and stored in plastic wrapping, box, or washcloth).	Reduces transfer of microorganisms among clients; prepares equipment for future use
20	Document administration on medication record.	Provides legal record of medication administration; prevents accidental remedication

Were desired outcomes achieved? Examples of evaluation include:

Desired outcome met: Client has no redness, heat, swelling, abnormal drainage, or pain in vaginal area.
Desired outcome met: Client verbalized understanding of medication and procedure for administration.

The following should be noted on the client's record:

Name of drug, amount, route, and date and time administered
Assessment data relevant to purpose of medication
Client's response to medication
Teaching of information about medication and techniques of self-administration

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆