78 Chapter 8 Ophthalmic Medication ‘The first oplathalmic medication is given as prophylaxis for sexually transmitted infee- tion in the newborn. The procedure is described in Skill 8-5. Older children receive “ophthalmic medication for treatment of infections and other eye conditions, and the technique for administration is described in Skill 8-6. Children usually fear having, anything placed in their eyes, and special care is often needed to reduce the child's anx- jety and promote cooperation during instillation of ophthalmic medications. An expla nation of the procedure may help gain the child’s cooperation. To prevent the transfer ‘of pathogens to the eye, the medication and its dispensing port must be kept sterile. SKILL 8-5 Administering Neonatal Ophthalmic Ointment Instill ing Eye Medications Ie can be challenging to safely instill eye medication into young dilldren. Give parents the following suggestions: ‘Wash your hands wel. Be sure the medicine is waemed to room ‘temperature. Remove any drainage from, ‘the eye with a clean oF sterile moist, warm cloth or gauze. ‘Wash your hands again Have the child lie on the back with eyes closed. Gently pull the lower fc down to form a small pocket Apply a thin string (for ‘intment) or dros of the medicine. Allow the eyelid to return t0 the normal position, Have the child keep the eye closed for several seconds. Help prevent spread of the infection by keeping the child's ands clean, Enhance comfort by keeping the head elovated ‘0 decrease swelling and avoiding exposure to bright light. Gonorthea, Chlamydia, and Staphylococcus aureus can colonize within the birth canal without symptoms inthe mother. The infective agents can be transferred to the newborn during birth and toad to eye infection, which i called ophthalmia neonatorum. Application of erythromycin ‘ophthalmic tment ean prevent this infection and protect eyesight. Its easy to administer and causes few side effects. For this reason its applied soon after birth folowing drying of the hhewbom, attending to temperature, atessing inital adaptation, and ensuring adequate ‘oxygenation. Eye prophylaxis is required by law inthe United States and Canada: it can be declined in writing by parents in Cand, PREPARATION 1. Gather necessary supplies. 2. Verity the kdentity of the newborn. 3, “Teach parents about the medication end the reason for administration, EQUIPMENT AND SUPPLIES 1 lean cotton pads = tythromyein ophthalmic ointment Sterile gloves (at least two sets) PROCEDURE 1. Perform hand hygiene, Swaddle the infant and place ina supine position, ‘swaddling the infant will help to Keep hands trom interfering with medication administration. Don sterile gloves i Using a cotton pad, wipe excess fluid andl vernix from one eye, working from the inner to outer canths. Repeat with the opposite eye using a clean cotton pad. Remove gloves and perform hand hygiene. Open the mesication, Bon a second set of sterile gloves. 1 Stand at the infants head, Using thumb and fingers ofthe nondominant hang, retract both the upper and lowrer eyelids so thatthe eye can be visualized, 9. Apply a 1-10 2-cm (half inh) line of ointment into the lower conjunctival sac, working from “the inner to outer canthus, Be careful sotto touch the tube to the eye oF mucous membrane. 10. Repeat on the opposite eye, maintaining stele application technique, 11, Refrain from wiping the eyes after administration, 42, Remove gloves and perform hand hygiene, Document administration in the medica recor.