Instillation of Nose

Medication
Prepared by: Jastin Joy C. Mandao
 Learning Objectives
1.Define what is Instillation of Nasal Medication

2.Enumerate the purposes of Nasal medication

Instillation

3.Learn how to Instill Nose medication

4.Demonstrate how to perform correctly the

Instillation of nose medication
What is Nose Instillation?
•  Nasal medications are used to
treat allergies, sinus infections
and nasal congestion.
Purposes:
• To shrink swollen mucus membrane of
nasal cavity (astringent effect)
• To loosen secretion and facilitate
drainage.
• To treat infections of the nasal cavity or
sinuses.
Anatomy of the Nose
External Nose
Sinuses:
•Sphenoid Sinus
•Frontal Sinus
•Ethmoid Sinuses
•Maxillary
Sinuses
Skeleton of the External Nose
composed of:
Bones
Cartilages
Nose and Sinus Common
Disorders
Sinusitis – an infection caused
by nasal inflammation and
swelling that prevents mucus
draining from the sinuses.
Symptoms:
•Nasal congestion
•Discolored nasal drainage
• Sinus pressure
•Headache
•Fever
Allergic rhinitis, also called “hay
fever”, is an allergic reaction that causes
sneezing, congestion, itchy nose and sore
throat.
Symptoms:
• Runny nose
• Nasal congestion
• Sneezing, postnasal drip
• Cough
Equipment
• Medication
• Droppers
• Gloves
• Tissue
• Computer generated Medication Administration
Record ( CMAR) or Medication Administration
Record (MAR)
Consideration in Instilling Nasal
medication
• Before instilling nasal
medication, don clean non-sterile
gloves.
• Provide patient with tissues and
ask that they blow their nose.
Assessment
Assess the nares for redness,
erythema, edema, drainage, or
tenderness
Assess the patient for
allergies
Assessment
Verify patient , dose, route, and
time of administration
Assess the patient’s knowledge of
medication and procedure
Assess the patient’s ability to
cooperate with the procedure
Procedure
Preparation
1. Complete the necessary focused
assessments and/or vital signs, and
document on MAR.
a. Review the physician’s order.
b. Review pertinent information
related to medication.
Procedure
c. Assess the patient for allergies.
d. Assess the patient’s knowledge of
medication to give.
e. Assess the nares for drainage or broken
skin.
f. Assess client’s history of hypertension,
heart disease, diabetes, and
hyperthyroidism.
Procedure:
2. Plan medication administration to avoid
disruption:
• Dispense medication in a quiet area.
• Avoid conversation with others.
• Follow agency’s no-interruption-zone policy.
• Prepare medications for ONE patient at a time.
• Follow the seven rights of medication
administration.
Procedure:
3. Check room for additional precautions.
Steps:
1. Perform hand hygiene.
2. Arrange supplies and medication at
bedside.
3. Check MAR and compare to doctor's
orders.
Procedure
4. Confirm patient ID using two
Identifiers.
5. Introduce yourself to the patient and
provide patient education as necessary.
6. Perform the seven rights of medication
three times (must be done with each
individual medication).
Procedure:
7. Check the label on the medication for name,
dose, and route, and compare with the MAR at
three different times:
• When the medication is taken out of the
drawer
• When the medication is being poured
• When the medication is being put away/or at
bedside
Procedure:
8. Don clean non-sterile gloves.
9. Provide patient with tissues and ask that
he clears or blows his nose gently (unless
contraindicated).
10. Assist the patient to supine position or
sitting back with head tilted back over a
pillow (underneath neck).
Procedure
11. Nose drops: Draw fluid into medication
dropper with enough amount for both
nares. Do not return excess fluid into the
stock bottle.

12. Support the client's head with non-

dominant hand.
Procedure
13. Ask the patient to breathe through the mouth.
• Nose drops: Hold dropper about 1 cm (1/2 inch)
above nares and instill prescribed number of
drops into one nares toward midline of ethmoid
bone. Do the same to the other nares.
• Nasal spray: Have patient hold one nostril closed
and breathe gently through the other as the spray
is being administered.
Procedure:
13. Instruct the patient to remain in
position with head tilted back for 3 to 5
minutes.
15. Offer facial tissue but instruct the
patient not to blow his nose.
16. Assist the patient to a position of
comfort after medication is absorbed.
Procedure
17. Dispose of soiled supplies in
proper container.

18. Remove gloves and perform

hand hygiene.
Procedure
19. Document the medication
administration. Include the date, time,
dose, route; which nares the medication
was instilled into (or whether it was both
nares); any drainage noted; and the
patient's response to the procedure.
20. Observe patient for side effects 15 to
30 minutes after administration.
Ears
Instillation
Learning Objectives
1.Define what is Instillation of the Ear Medication

2.Enumerate the purposes of Ear medication

Instillation

3.Learn how to Instill Ear medication

4.Demonstrate how to perform correctly the

Instillation of Ear medication
What is Ear Instillation?
• The process of introducing otic
medication or other liquids into the
ear canal. Proper care is needed in
delivering such liquids.
Purposes:
• To soften earwax so that it can be readily
removed at a later time.
• To provide local therapy to reduce
inflammation, destroy infective
organisms in the external ear canal, or
both.
• To relieve pain
THREE REGIONS OF EARS
•Outer Ear( External )
Auricle (Pinna)
External auditory canal
Tympanic membrane (Ear drum)
Middle Ear
• Middle ear is small, air filled cavity in
temporal bone
• It is lined by epithelium
• It is separated from external ear by ear drum
• It separated from inner ear by oval window
Structures of Middle Ear
consist of:
• Auditory Ossicles
• Oval window
• Eustachian tube
1. Auditory Ossicles
A). Malleus
B). Incus ( Anvil)
C). Stapes
2. Oval Window
• It is a membrane-covered opening that leads from
the middle ear to the vestibule of the inner ear.
• By the time vibrations reach the oval window, they
have been amplified over to times from what they
were when they contacted the tympanic
membrane.
3. Eustachian Tube
• The middle ear is an air-filled space
• It consists of both bone and hyaline
cartilage
• It is normally closed at pharyngeal end
Inner Ear
• It is also called as labyrinth
• Two main divisions of labyrinth
• Outer Bony labyrinth
• Inner membranous labyrinth
Three regions consist of:
1. Semicircular canals- three tiny,
fluid-filled tubes in your inner ear
that help you keep your balance
2. Vestibule
• It is the central part. Lies between
cochlea in front and semicircular canal
behind.
• The walls of both Saccule and Utricle
contain small thickened region is called
macula.
3. Cochlea
• Snail shaped
• Bony spiral canal
• Divided into three channels:
Cochlear duct
Scala vestibuli
Scala tympani
 Common Disorder of
the Ear
Impacted Ear Wax
-Is a buildup of the natural wax in the ear (cerumen).
Symptoms
• Hearing loss
• Earache
• Sense of ear fullness
• Itching in the ear
• Ringing in the ears
Ear Infection (Otitis Media)
• Inflammation or infection located in the
middle ear. Otitis media can occur as a
result of a cold, sore throat, or respiratory
infection.
Symptoms
• Earache
• A high temperature (fever)
• Being sick
• A lack of energy
• Slight hearing loss - if the middle ear becomes
filled with fluid
• Odor or Discharge
Assessment
Appearance of the pinna of the ear and
meatus for signs of redness and
abrasions
Type and amount of any discharge
Determine if assessment data influence
administration of the medication
Equipment
• Clean gloves
• Cotton-tipped applicator
• Correct medication bottle with a dropper
• Cotton
• Basin
Consideration in Administration of
Otic Medications for Infants/Children
Obtain assistance to immobilize an infant or
young child.

In infants and children under 3 years of age.

Procedure:
Preparation:

1. Complete necessary focused

assessments and/or vital signs, and
document on MAR.
a. Review the physician's order.
b. Review pertinent information related to
medication.
Procedure:
c. Assess the affected ear for drainage
or tenderness.
d. Assess the patient for allergies.
e. Assess the patient's knowledge of
medication to give.
Procedure:
2. Plan medication administration to avoid
disruption:
• Dispense medication in a quiet area.
• Avoid conversation with others.
• Follow agency's no-interruption zone policy.
• Prepare medications for ONE patient at a
time.
• Follow the seven rights of medication
administration.
Procedure:
3. Check room for additional precautions.
Steps:
1. Check MAR and compare to the doctor's
orders.
2. Bring the equipment to the patient's bedside.
3. Confirm patient ID using two patient
identifiers.
Procedure:
4. Introduce yourself to the patient and
provide patient education as necessary.
5. Perform hand hygiene.
6. Perform the seven rights to medication
three times (must be done with each
individual medication).
Procedure:
7. Check the label on the medication for
name, dose, and route, and compare with
the MAR at three different times:
1. When the medication is taken out of
the drawer
2. When the medication is being poured
3. When the medication is being put
away/or at bedside
Procedure:
8. Don clean non-sterile gloves if
drainage is present.
9. Offer tissue to the patient to be used
when solution spills from the ear toward
the eye.
10. Have the patient sit or lie down with
head turned to the unaffected side.
Procedure:
11. Cleanse the external ear of any drainage
using a warm washcloth moistened with
normal saline solution.
12. Draw up exact amount of solution needed
using a dropper. Do not return back to stock
the excess solution.
Procedure
13. Straighten the auditory canal by gently
pulling the pinna UP AND BACK (children
and adults) and DOWN AND BACK (infants
and children younger than3 years old).
14. Hold the dropper in ear with its tip above
auditory canal. For an infant or an irrational
or confused patient, protect dropper with a
piece of soft tubing.
Procedure:
15. Instill ear drops on side of the auditory
canal.
16. Release the pinna, and gently massage
tragus of the ear. Have the patient maintain
the position for at least 3 minutes.
17. If permitted, place a cotton ball or wick
in the outer ear.
Procedure
18. If required in the opposite ear, wait for
a few minutes, and repeat the procedure in
that ear.
19. Remove gloves and perform hand
hygiene.
20. Document medication administration
and any drainage from ear noted.