Eyes, Ears & Nasal

Medications
 Ophthalmic Instillation

Definition
• administration of the medication to the eye
Assessment
• assess patient’s ability to cooperate during
administration, since medications are instilled
into the lower conjunctival sac
• Check medication’s expiry date
• Assess condition of the eye and surrounding
areas
 Ophthalmic Instillation
Objectives
• To provide direct route for local effect
• To decrease intra-ocular pressure
• To provide means for eye evaluation
• To obtain desired therapeutic effect
Equipment
• Medication card
• Eye drops/eye ointment
• Cotton balls/tissue
• Applicator stick (prn)
• Clean gloves
 Ophthalmic Instillation
• Check the MAR for the drug name, dosage and strength. Also
confirm the prescribed frequency of the instillation and which eye
is to be treated
• Gather and assemble the equipment
• Compare the label on the medication tube or bottle with the
medication record, and check the expiration date
• Introduce yourself, and verify the patient's identity
• Explain the procedure and how he can cooperate
• Wash hands and observe appropriate infection control procedures
• Provide privacy & prepare the patient
• Assist the patient to a comfortable position, either sitting or lying
 Ophthalmic Instillation

• Put on gloves
• Use sterile cotton balls moistened with sterile irrigating solution or
sterile normal saline and wipe from the inner canthus to the outer
canthus
• Check ophthalmic preparation for the name, strength and the number
of drops, if a liquid is to be used
• If ointment is used, discard the first bead
• Instruct the patient to look up to the ceiling; give the patient a dry,
sterile, absorbent sponge/tissue paper
• Expose the lower conjunctival sac by placing the thumb or fingers of
your non-dominant hand on the patient's cheekbone, just below the
eye, and gently drawing down the skin
 Ophthalmic Instillation
• Hold the medication in the dominant hand, place yourhand on
patient's forehead to stabilize your hand
• Instill the correct number of drops onto the outer third of lower
conjunctival sac. Hold the dropper 1-2 cm above the sac*
• While holding the tube above the lower conjunctival sac, squeeze
2 cm of ointment from the tube into the lower conjunctival sac
from inner canthus outward*
• Instruct the patient to close eyelids
but not to squeeze them shut for 1-2
min (liq) or 2-3 min (ointment)
following application*
• For liquid medications, press firmly or
have the patient press firmly on the
nasolacrimal duct for at least 30
seconds*
 Ophthalmic Instillation
• Clean and dry the eyelids as needed; wipe
the eyelids gently from the inner to outer
canthus to collect excess medication
• Assess the patient's response
• Document all relevant assessments and
interventions
 Nasal Instillation

• Check the MAR; check the label on

the medication carefully against the
medication card or the MAR to
ensure accuracy
• Organize equipment
• Perform hand hygiene, and observe
other appropriate infection control
procedures
• Inteoduce yourself ; verify patient’s identity using 2 identifiers
and explain the procedure
• Prepare patient by positioning him or her on sitting position
with his /her head tilted back , if he/she is lying down, tilt
his/her head back with pillow
• Provide the patient with tissue paper for expectoration of
secretions
 Nasal Instillation
• Draw sufficient amount of solution into the dropper
• Hold up the tip of the nose and place the dropper just inside the
nares, about 1/3 of an inch
• Instill the prescribed number of drops in one naris and then into
the other
• Have the patient remain in position with his head tilted back for
a few (5) minutes to prevent escape of the solution
• Assess patient's response
• Document all nursing assessments and interventions
• Record the name of the drug, strength, the number of drops or
spray, the time and the response of patient
 Otic Instillation
Definition
• administration of the medication into the ear
Assessment
• Assess patient’s ability to cooperate with
instillation
• Assess patient’s ability to be positioned on side
 Otic Instillation
Objectives
• To soften the earwax
• To relieve pain and obtain desired therapeutic effect
• To apply anesthetic agent
• To provide route for antibacterial medications
Equipment
• Medication card
• Dropper for instilling medication
• Cotton wick
• Medication
• Clean gloves & flashlight (prn)
 Otic Instillation
• Check the MAR for the drug name, strength, number of drops and
prescribed frequency
• Compare the label on the medication container with the medication
record and check the expiration date
• Introduce yourself and verify patient’s identity
• Explain to the patient what you are going to do, why it is necessary,
and how the patient can cooperate
• Perform hand hygiene, and observe other appropriate infection control
procedures
• Provide privacy
• Prepare the patient
• Assist the patient to a comfortable position for eardrops, lying with
the ear being treated uppermost
 Otic Instillation
• Put on gloves, if infection is suspected
• Use cotton-tipped applicators and solution to wipe the pinna and
auditory meautus
• Warm the medication container in your hand, or place it in warm
water for a short time*
• Partially fill the ear dropper with medication
• Straighten the auditory canal. adUlt; chilD*
• Instill the correct number of drops along the side of the ear canal
• Press gently but firmly a few minutes on the tragus of the ear
• Ask the patient to remain in the side-lying position for about 5
minutes (15 mins)
 Otic Instillation
• Insert a small piece of cotton fluff loosely at the meatus of the
auditory canal for 15-20 minutes. Do not press it into the
canal
• Assess the patient's response
• Document all nursing assessments and interventions relative to
the procedure
• Record the name of the drug or irrigating solution, the
strength, the number of drops, if liquid medication, the time
and the response of the patient
Medication and Treatment Record

The Medication and

Treatment Record is a
record of all medications
and treatments legally
prescribed by the
physicians and checked/
implemented by the nurse
within his tour of duty.
11/20/16
7:00 am
#1 PNSS 1 L + 20 mEq KCL X 100 cc/hr

Tweety Bird, SN.

11/20/16
5:00 pm
#2 PNSS 1 L X 100 cc/hr

Tweety Bird, SN.

11/20/16
6:00 pm IVF decreased to 80 cc/hr

Tweety Bird, SN.

11/20/16 IVF removed with no ill effects

8:00 pm

Tweety Bird, SN.

 1/09/17 cefuroxime (Zegen) 500mg IV 0.1 cc
7:30 am
injected intradermally at Right inner
forearm as skin test

Speedy Gonzales, SN.

1/09/17 paracetamol (Biogesic) 500 mg/tab 1

9:30 am tab given per orem for temp. of 38.9 ‘
C

Speedy Gonzales, SN.

 Types of Drug Orders
Standing Order: it is carried out until the specified period of time (ex.
Kalium Durule 1 durule TID X 6 doses); or until discontinued by another
order (shift to oral after the 9th dose); or until the doctor orders it to
be discontinued, held or shifted to another medications, higher dose,
etc.
Single Order (Single Future Order): carried out for one time only
(secobarbital (Seconal) 100mg 30 minutes before surgery)
STAT Order: carried out once and immediately (meperidine (Demerol)
100 mg IM stat; diazepam 5 mg IV now)
PRN Order: carried out as the patient requires (paracetamol (Tempra)
500 mg/tab 1 tab PO Q4h for temp > 38 degrees Celsius)
 Parts of a Drug Order
Name of the patient
Date and Time the order was given/written/prescribed
Name of Drug (Generic and Brand)
Dose of Drug
Route of Administration
Time or Frequency
Special Instructions for withholding/adjusting the dosage
Signature of the Physician
Nurse’s signature taking the order/carrying-out the order

October Give ranitidine (Ramadine) 50 mg/tab 1 tab PO BID

21, 2016
9:00 am
Dr. J. Causapin
 Nurses Responsibilities Associated with Drug Order

1. Verification of the Drug Order

- The nurse interprets and makes a professional judgment on the
applicability of the drug order
a. Common pharmacological abbreviations
b. Drug and solution measurements (apothecaries/metric)
c. Drug dosage and forms
d. Frequency and timing of drug administration
2. Transcription
- Transferring of drug order into the KARDEX/MAR
 Nurses Responsibilities Associated with Drug Order

3. Drug Administration
a. Legal and Ethical Considerations
*3 Common Offenses the Nurse can commit:
1. Misfeasance – negligence; giving of wrong drug /dose
to patient
2. Nonfeasance – omission of drug order
3. Malfeasance – giving the correct drug at a wrong
route of administration
b. Do’s and Don'ts of Drug Administration
c. Twelve Rights of Drug Administration
d. Calculation of Drug Dosages
e. Techniques of Drug Administration
 Nurses Responsibilities Associated with Drug Order

4. Documentation
- Requires appropriate or accurate recording of the information
regarding the drug administered (Medication Sheet)
a. name of drug
b. drug dose
c. route of administration
d. time and date the drug was given
e. Nurse’s initial/signature
 Nurses Responsibilities Associated with Drug Order

5. Monitoring
- patient’s response after the drug is given

6. Reporting unusual reactions of the drug to Attending Physician

(AP)
Life is Like a Cup of Coffee
Thank you guys!
Nursing Process
Overview of Medication
Administration
Assessment:
*obtain appropriate vital signs and relevant laboratory test results for future
comparisons and evaluation of therapeutic response
*obtain drug history, including drug allergies
*identify high-risk patients for reactions
*assess patient's capability to follow therapeutic regimen
Potential Nursing Diagnosis:
*risk for injury related to possible adverse reaction
*ineffective individual/family therapeutic regimen management related to
knowledge deficit, economic difficulties or complexities of the regimen
*knowledge, readiness for enhanced management of medication regimen
*effective therapeutic regimen management related to medication
administration
Planning:
*identify goals
*promote therapeutic response and prevent or minimize adverse reactions
*identify strategies to promote adherence
*identify interventions
Nursing Interventions:
*prepare equipment and environment;wash hands
*check for allergies and other assessment data
*check drug label three times; check expiration date
*be certain of drug calculation; verify dose with another nurse as necessary
*pour liquids at eye level on flat surface
*keep all drugs stored properly, especially related to temperature, light and
moisture
Nursing Interventions:
*avoid contact with topical and inhalation preparations
*verify patient identification
*administer only drugs that you have prepared
*assist patient to desired position
*discard needles and syringes in "sharps" container
*follow policy related to discarding drugs and controlled substances
*report drug errors immediately
*document all appropriate information in a timely manner
*record effectiveness of drugs administered and reason for any
drugs refused
General
*caution against the use of OTC preparations including herbal
remedies without first contacting the health care provider
*reinforce the importance of follow-up appointments with health
care providers
*encourage patient to wear Medic-Alert band with medications or
allergies indicated
*reinforce that community resources are available and need to be
mobilized according to the patient or family needs
Client Teaching:
General
*emphasize safety
*monitor patient's physical abilities regularly as needed
*keep or store medications in original labeled containers with child-resistant
caps as needed
*provide patient or family about the expected therapeutic effect and length of
time to achieve a therapeutic response from the medication and the
expected duration of treatment
*instruct patient or family about possible drug-laboratory test interaction
*advise patient of nonpharmacological measures to promote therapeutic
response
*encourage patient or family to have adequate supply of necessary medications
available
Diet
*advise patient or family about possible drug-food interactions
*advise patient or family what foods are contraindicated
*instruct regarding alcohol use
Self-administration
*instruct patient or family regarding drug dose and dosing schedule
*instruct patient or family on all psychomotor skills related to the drug
regimen
*provide patient or family with contact person and telephone number for
questions and concerns
Side Effects
*instruct patient or family about general side effects and adverse reactions of
the medications
*advise patient or family when and how to notify health care provider
Cultural Considerations
*assess personal beliefs of patient and family
*modify communications to meet cultural needs of patient and
family
*communicate respect for culture and cultural practices of patient
and family
Evaluation:
*evaluate effectiveness of medications administered
*identify expected time frame of desired drug response; consider
modification of therapy as needed
*determine patient satisfaction with regimen
Questions?

Clarifications?

Thank You!