Xavier University

COLLGE OF NURSING
Ateneo de Cagayan

NCM 101- HEALTH ASSESSMENT

Administering Ophthalmic Instillations

NAME: ________________________________________ Date: __________________________

BLCOK: _______________________ CI: _______________________ SCORE: ___________________

PERFORMANCE EVALUATION CRITERIA

SCALE DESCRIPTION INDICIATIONS

4 Very Good Student performs behaviors/tasks affecting the highest level of
performance, consistent, independent, effective
3 Good Student performs behaviors/tasks reflecting mastery of performance
with minimal supervision
2 Fair Student performs behavior/tasks reflecting development and
movement toward mastery of performance with help or direct
supervision in some parts
1 Needs Student performs behaviors/tasks reflecting beginning level of
Improvement performance, tasks not done properly majority of the time but
demonstrate understanding of concept involved with tasks

PROCEDURE RATIONALE 4 3 2 1 REMARKS

ASSESSMENT:
1.Check accuracy and completeness of
each MAR with health care provider’s
medication order. Review patient
information & information related to
medication to its action, purpose, dose,
route, side effects & nursing implication.
2. Assess condition of external eye
structures, medical history, history of
allergies.
3. Determine whether patient has any
symptoms of visual alteration.
4. Assess patient of level of consciousness
& ability to follow instructions.
PLANNING:
1.Prepare the necessary equipment &
MAR.
2. Plan preparation to avoid
interruptions. Follow agency policy.
IMPLEMENTATION:
1.Perform hand hygiene and observe
appropriate infection control.
2. Introduce yourself & explain the
procedure to the patients to its purpose
& implication.
3. Provide privacy.
4. Position patient in semi-fowler’s
position.
5. Clean the eyelid & eyelashes using a
sterile cotton balls moistened with sterile
irrigating solution or sterile normal saline
wipe from the inner to outer canthus.
7. Take the medication ticket &
medication, check & compare the correct
label of the medication, expiration, dose,
route.
8. Identify patient and compare on the
MAR identification.
9. Apply clean gloves.
10. Gently roll eyedrop container
between your hands.
11. Hold cotton ball or clean tissue in
non-dominant hand on patient’s
cheekbone just below the eyelid.
12. with tissue or cotton resting below
lower lid, gently press downward with
thumb or forefinger against the orbit.
13. Ask the patient to look upward or at
the ceiling.
14. INSTILLING OPHTHALMIC DROPS:
a. with dominant hand resting on
patient’s forehead, hold filled medication
eyedropper or ophthalmic solution
approximately 1-2cm ( ½ to ¾ inches)
above the conjunctival sac
b. Drop prescribed number of medication
drops on conjunctival sac
c. If patient blinks or closes eye or if
drops land on outer lid margins, repeat
instillation
d. after instilling drops, ask patient to
close eye gently
e. When administering medication that
cause systemic effects, apply gentle
pressure with finger and clean tissue on
patient’s nasolacrimal duct for 30-60
seconds
f. If patient receives more than one eye
medication to the same eye at the same
time, wait at least 5 minutes before
administering next medication & use
different cotton ball or tissue with each
medication
15. INSTILLING OPHTHALMIC OINTMENT:
a. Holding ointment applicator above the
lower lid margin, apply thin stream of
ointment evenly along inner edge of
lower eyelid on conjunctiva from inner to
outer canthus
b. Have patient close eye and rub lid
lightly in circular motion with cotton ball
if rubbing is not contraindicated
c. Clean & dry the eyelids as needed.
Wipe eyelid gently from inner to the
outer canthus to collect the excess
medication
16. Remove and discard gloves. Perform
hand hygiene.
17. Apply an eye pad if needed & secure
it with paper eye tape.
EVALUATION:
1.Note patient immediate response to
instillation ask if patient felt any
discomfort.
2. Observe response to medication by
assessing visual changes & noting any
side effects.
3. Record medication on patient MAR
 after administering the medication.
4. Report & document on the nurse’s
notes for any untoward reaction.

Range of score:

A (92-100) Excellent
A- (84-91.99) Very Good
B (76-83.99) Good
B- (68-75.99) Very Satisfactory
C (60-67.99) Satisfactory
F (below 60) Failed

Reference: Potter, P. & Perry, A. (2017). Fundamentals of Nursing. Singapore: Elsevier Pte. Ltd. pages 660
– 663.