Vaginal Medicine Administration
Vaginal medicines are topical agents prepared specifically for insertion into a woman's vagina. They are compounded in the form of a cream, foam, gel, tablet, or suppository, and are absorbed through the vaginal mucousa. Vaginal medicine in the form of a cream, foam, gel, or tablet is administered using a specific applicator that is provided by the manufacturer. Suppositories have the medicine suspended in wax and are shaped like a small bullet. They are inserted into the vagina with the index finger. Vaginal medicines are most often administered at bedtime, as the reclined position enhances medication absorption.
Vaginal medicines are most commonly used to combat infection, inflammation, or dryness of the vaginal mucousa. Other types of vaginal medicines include spermicides (i.e., to prevent conception), chemotherapy (i.e., for cancer treatment), and aborticides (i.e., for inducing labor).
Vaginal tissue can be traumatized by the forceful use of applicators or fingernails during medicine administration, so medications should be introduced into the vagina gently. Patients should be encouraged to relax, as this will decrease resistance to the mode of insertion. One should not attempt to insert vaginal medication when a patient is confused and combative.
Medicine should not be delivered via the vagina if it is not labeled for vaginal use. Vaginal medicine should not be taken orally.
A female staff member must be present in the room when a male nurse administers a vaginal medication. The patient should be positioned on her back, with knees bent. Her legs should be drawn up toward the hips, and the heels should be flat on the bed. A sheet across the abdomen and upper legs, falling just over the knees, will decrease the patient's feeling of exposure. Directions for filling the applicator should followed. At this point, the patient should be advised to drop her knees apart. The nurse should wash his or her hands and put on disposable gloves. Using one hand, the nurse should spread the labia and expose the vaginal opening. If there is drainage or exudate, the nurse should cleanse the area with warm, soapy water, using cotton balls or a clean washcloth. The vaginal opening should be rinsed and allowed to air dry. A small amount of water-soluble lubricant should then be placed on the tip of the applicator or suppository, the labia spread, and the suppository or applicator tipped into the vaginal opening. The suppository or applicator should be moved gently down, toward the posterior (i.e., back) wall of the vagina, toward the spine 2–4 inches (5-10 cm), or until resistance is felt. The suppository or applicator should then be angled upward. When using an applicator to deliver cream or gel, the plunger should be gently pushed to deliver the medicine. The nurse should then remove his or her finger and/or the applicator from the vagina. The disposable latex gloves should be disposed of properly.
Before beginning to administer vaginal medicines, the door to the room should be closed to ensure privacy. (A female staff member must already be present if the nurse is a male.) The patient should empty her bladder just before administration. The nurse should check the medication label each time medicine is given; this will avoid medication errors. The medication must be checked to confirm that it is the right medicine, the right dose (i.e., strength), the right time, the right patient, and the right method of administration. The expiration date on the label should be checked; outdated medication should never be used. If the nurse has not yet put on disposable gloves, it should be done at this time. His or her hands should be washed, and gloves should be put on.
The used applicator should be placed on a clean paper towel to prevent the spread of microorganisma. The patient should be covered and encouraged to maintain a reclined position, with knees up, for at least 10 minutes (30 minutes after a suppository). This will allow time for medicine absorption. If the applicator is reusable, it should be washed in warm soapy water, thoroughly rinsed, air dried, and placed back in the medicine box or a plastic bag until the next use. The used gloves and disposable applicator should be put into a trash bag, which can be sealed and discarded. The nurse should wash his or her hands. The patient should be given a mini-pad (or small sanitary napkins) to protect her underwear from medicine that may leak out.
The patient should not instructed not to use tampons after vaginal medicine administration; they will absorb the medicine more rapidly than the vaginal mucousa, and the full effect of the drug will not be achieved.
Tissue irritation or allergic reactions can result from vaginal medications. If irritation, swelling, or redness of the tissue is apparent, or if the patient complains of pain or burning, the next dose of medicine should not be given until the physician has been consulted.
Most vaginal medicines will produce the desired effects within several days to one week. Spermicides and aborticide vaginal medicines act more rapidly when used as directed. If the client experiences vaginal pain at the time of medicine instillation, or the condition does not improve, the physician should be contacted.
Health care team roles
Vaginal medicines are administered by a licensed nurse (i.e., R.N. or L.P.N.) in the health care setting. An alert and cooperative patient may be allowed to administer the medicine under the direction of the nurse. The nurse should, however, assess the site and the effectiveness of the medicine. The patient, or members of the patient's family, can be taught to administer vaginal medicines in the home setting.
Medication Administration, Nurse's Clinical Guide, Pennsylvania: Springhouse Corporation, 2000.
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Mary Elizabeth Martelli, R.N.,B.S.