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Creams and ointments

Watch this video to understand how cream and ointments doses should be measured.
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Creams and ointments are another example where the dose the patient receives is dependent on how much is applied. This video is going to look at measuring doses for creams. There are two main types of creams or ointments that will be prescribed; emollients and steroids. Emollients are sometimes referred to as moisturisers, they soothe, smooth and hydrate the skin. Creams and ointments are either supplied in tubs, tubes or pumps. The quantity required will depend on where the cream or ointment is to be applied, this table gives a guide to the volume that is required for each application on different parts of the body.
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Let’s give you an example, our patient ‘Poppy Pills’ has been prescribed an emollient to alleviate dry skin on her face and her arms. For her face she would need 1 to 2 grams, this is what 1 to 2 grams looks like if measuring cream from a tube. When we remove creams or ointments from a tub, it is best practice to use a spoon to remove the quantity you require from the tab, 1 to 2 grams looks like this. The volume of emollient that is dispensed when you pump from a pump will vary on the size of the pump. One pump of a 500 ml bottle will provide more than one Pump of a 300ml bottle.
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In this example, 1 to 2 grams would be obtained by using 2 pumps. When we apply creams and ointments it is important that we apply in the direction of hair growth, although there is a guide to the volume of emollient that should be used on different parts of the body, emollients are very safe and you can’t overuse them. This isn’t true for the other type of creams, steroids. Steroid creams are used to treat inflammation of the skin. They are usually prescribed when an emollient alone has been ineffective. Steroid creams and ointments will only come in tubes, but the size of these tubes may vary.
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The amount to be applied is much smaller, the unit of measurement for steroid creams is fingertip units (also known as FTU). One fingertip unit weighs approximately half a gram, this table shows the number of fingertip units required for different parts of the body. A fingertip is from the very end of the finger to the first crease in the finger. Sometimes the instructions say to apply to the affected area, here you would need to use some number sense to work out how much is needed.
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So, if the affected area is the flexure on the arm, if the inflamed area looks about the size of a hand, you would need half a fingertip unit because one fingertip unit is enough to do the front and back of one hand. The key thing to remember when applying steroid creams is that you only apply enough to give a soft sheen on the surface of the skin. You do not keep rubbing until all the cream or ointment that you’ve squeezed out has been absorbed. If you accidentally squeeze up too much cream, remove the surplus with a tissue and discard.
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So that brings this section to a close, hopefully you feel a lot more confident about administering creams and liquids in your care settings.
OK, so now we know how to measure liquid dosage forms, but what about medicines that need to be applied onto the resident’s skin?
It’s often difficult to know how much of a cream or ointment is a ‘dose’. Watch this video for guidelines on how to measure these formulations.
This information will come in useful for the final steps of this week. You can come back to, pause or replay the video as you need.
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Medicine Administration for Carers

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