Eye, ear & nasal instillation nursing foundations.pptx

Eye ear and nasal installation

1. EYE,EAR,NASAL INSTILLATION KEERTHANA.B ASST PROFESSOR PSG COLLEGE OF NURSING

2. INSTILLATION An instillation is defined as a process by which a liquid (medication) is introduced into a cavity drop by drop.

3. INSTILLATION OF MEDICATION INTO THE EYE Medication may be instilled in the form of eye drops or ointments. PRINCIPLES IN THE ADMINISTRATION OF EYE MEDICATIONS: 1. The cornea of the eye is very sensitive so avoid instilling eye medications directly on to the cornea. 2. Prevent transmission of infection from one eye to the other. For this avoid touching the eyelid or other eye structures  with eye droppers or ointment tubes. 3. Use eye medication only for the affected eye. 4. Never allow a person to use another person’s eye medication.

4. Commonly Used Eye Drops and Ointment: 1. Atrophine 1 Percent – dilate the pupil. 2. Eserine ½ Percent – to contract the pupil. 3. Adrenaline 1/1000 – to check bleeding. 4. Silver nitrate 1 to 2 percent – as an antiseptic and astringent especially used in gonococcal infection. 5. Mercurochrome 1 to 2 Percent – as an antiseptic.

5. PROCEDURE 1. Place the patient in a back lying position with the head slightly hyperextended with a pillow under the shoulders. 2. Ask the patient to look upward while the nurse separates the lower lid by pressing it against the cheek bone. 3. The drops are taken in a dropper and holding the dropper from 1 to 2 cm above the eye, instill the ordered number of drops in the centre of the lower lid. 4. If ointment is to be applied apply the ointment from the inner aspect to the lateral aspect. 5. Ask the patient to close the eyelids and move the eyeballs from side to spread the medications all over the conjunctival sac. 6. Wipe off the excess medications that remains on the eye with a clean cotton swab. The nurse discards a small amount of ointment on a sterile cotton ball and wipes the top of the tube before she replaces the cap.

6. GENERAL INSTRUCTIONS 1. Be certain that you have the right patient, right medications and the right eye. Check the doctor’s orders to see which medication is to be instilled in which eye. 2. Know the diagnosis of the patient and the therapeutic effect of the medication. Certain medications are contraindicated for certain eye disorders. 3. Never instill any medication into the eye, unless it is ordered by the physician. 4. Check the expiry date of the medication. Never apply any medication with the date of expiry already over. 5. Never use any eye drops which are discoloured, cloudy and precipitated. 6. Ophthalmic solutions should be sterile and are prevented from contamination during its preparation or administration.

7. 7. Use separate eye droppers for separate medications. 8. Do not allow medication in an eye dropper to flow back into the bulb of the dropper. Do not return the remaining medication of the eye dropper back into the bottle after instillation. To prevent wastage, take only the required amount of solution in the dropper. 9. Neither substitute a solution or medication of one strength with that of another strength nor substitute one medication for another, without permission of the doctor. 10. Read specific instructions given on the leaflets supplied with the medications. 11. Never use any solution or ointment which are unlabelled to instill in the eye. 12. Always wash hands before and after instilling the medications into the eyes. 13. While attending both the eyes, apply the medication to the least infected eye to minimize the chances of infecting it with infection from the badly infected eye.

8. 14. Have separate tubes of ointments, drops and droppers for each patient. 15. Do not massage the eyeball after the instillation of medications. Ask the patient to close the eyes and move the eye balls from side to side, to help spreading the medication. 16. Injuries which may occur by the tip of the dropper or tube of ointment, should be prevented. Steady the head by having the patient rest his head on the back of the chair, if he is sitting. 17. Keep all strong solutions which should not be used on the eye away from the bedside of a patient and away from the area where ocular medicines are stored, to prevent accidental application of these medications into the eye. 18. Do all the procedures in an adequate light.

9. 19. Always see that the eyes are absolutely clean before the application of medications into the eye. 20. Instruct the patient not to touch the eyes, eye dressings etc. if the patient is uncomfortable with the dressings, instruct him to call for a nurse to attend to it. 21. If the patient is on self medication, give him clear instructions and make sure that the instructions are clear to him. 22. Ask the patient to consult the doctor regularly.

10. INSTILLATION OF EAR DROPS Ear drops are instilled into the auditory canal to produce the following local effects: 1. To combat infection. 2. To soften the ear wax. 3. To produce local anaesthesia and to reduce pain in the ear. 4. To kill an insect lodged in the auditory canal.

11. PROCEDURE Explain the procedure to the patient to win his confidence and co-operation. If the patient is a child or an uncooperative adult, restrain his hands. Place the patient in position (side-lying position). Draw the medication in a dropper (take only minimum amount). Straighten the auditory canal by pulling the ear pinna upward and backward in case of adults, downward and backward in case of children and instill the medication drop by drop. Instill the drops on the side wall of the auditory canal to allow the air to escape from the auditory canal. Instruct the patient to remain in the same position for few minutes. Plug the ear with a cotton or gauze piece, if indicated.

12. GENERAL INSTRUCTIONS: 1. The auditory canal should be thoroughly cleaned before instilling the ear drops. 2. Drops must be warm when they are instilled into the ear, otherwise it may cause vertigo. In order to warm the ear drops place the container in a bowel of warm water or rinse the dropper 3 or 4 times in hot water and then take the medications. 3. Place the patient in a side-lying position or in the dorsal recumbent position with the head turned to one side with the affected ear uppermost. 4. Allow 3 or 4 drops trickle down on one side of the canal so that the air may reach up to the ear drum. 5. Ask the patient to remain in the same position for few minutes following instillation. 6. Plug the ear with a small cotton ball or a small gauze piece. 7. Always secure a written prescription from a doctor to instill any medication into the ear. 8. Any complain made by the patient should not be ignored.

13. NASAL INSTILLATIONS An nasal instillation is defined as a process by which a liquid (medication) is introduced into a nasal cavity drop by drop. Purpose: 1. To combat infection. 2. To provide astringent effect. 3. To relieve inflammation and congestion in case of rhinitis. 4. To give local anaesthesia.

14. GENERAL INSTRUCTIONS Medications are instilled only on written order from the doctor. Avoid oil base solutions as nasal drops, since it interfere with the normal ciliary action and may cause aspiration pneumonia is aspirated into the lungs. (oily solutions if aspirated into the lungs, will not be absorbed and will act as a foreign body). Avoid the use of decongestant drops for a long period or their frequent use or excessive use, because they become ineffective and may actually worsen a patient’s nasal congestion. The patient should be instructed well regarding the use of nasal drops to avoid distressing and tension. E.g., vasoconstrictors are absorbed and cause systemic effects; these are harmful for a patient with hypertension. Therefore, these medications are avoided as far as possible. In case these have to be used, use minimum quantity (2 to 3 drops in each nostril).

15. Be careful to use drugs with correct concentration . Identify the drug correctly. Follow the rules for administration of medication – “right patient..” etc. Place a patient in a correct position for the instillation of medication into the nasal cavity. The head should be held in such a way that the medication should reach the desired area, otherwise, the procedure becomes ineffective, since the drops will simply run down into the throat and are swallowed. A – place the patient in a dorsal recumbent position with the head titled slightly to the affected side, if the drops reach the opening of the Eustachian tubes. B – place the head of the patient turned towards the affected side beyond the edge of the bed if the drops are to be reached to the maxillary sinuses. C – place the patient beyond the edge of the bed with the head hanging straight at the back. It will help the drops to reach ethmoid and sphenoid sinuses. If the patient is not able to assume a position with the head hanging beyond the bed, place him in the dorsal position, with a pillow under the shoulders.

16. Ask the patient to remain in the same position for sometime after the instillation of the drug. This allows the solution to flow into the posterior nares. It gives time for the medication to act on the mucus membranes of the anterior portion and then it can drain into the posterior nares. Be careful not to infect the dropper by touching it on the tip of the nose. Contamination of the dropper will cause contamination of the medicine in the container. See that the anterior nares are clean and free from discharges .

17. PROCEDURE OF NASAL INSTILLATION Explain the procedure to the patient. Place the patient in the desired position. Take the medication in the dropper and instill not more than 3 drops into the each nostril. Ask the patient to remain for few more minutes in the same position. Provide a handkerchief or a piece of rag piece to wipe off any medication that has escaped from the anterior nares. Provide a sputum mug to spit any medications that have reached the mouth and throat.

18. MEDICATION APPLICATION OF THROAT Medication is applied to the throat by way of spraying and painting. The medicines are applied for the following reasons: To relieve pain, inflammation and congestion. To treat infection. To anaesthetize the part.

19. Articles Required: 1 . Head mirror and spot light to visualize the throat. 2. Sterile cotton applicators in a container to apply the medication. 3. Tongue depressor to visualize the throat by depressing the tongue. 4. Kidney tray and paper bag to receive the wastes and the used articles. 5. Towel to protect the garments. 6. Medications (e.g. Mandle’s paint) as ordered .

20. Procedure: Explain the procedure to the patient. Make the patient sit on a chair with a back support so that he can lean backward with the head titled backward. Place a towel around the neck to protect the garments. Adjust the spot light behind the patient, so that reflection from the head mirror can be directed to the throat. Take the medication on the cotton applicators and squeeze off the excess medication from the applicator.

21. Instruct the patient to open the mouth and say ‘Aha’. Place the tongue depressor over the tongue and apply a slight pressure. The throat is painted gently and quickly using half circle movement and reaching all parts of the throat. Paint on one side first and repeat on the other side using separate swab sticks. Record the procedure in the nurse’s record with date and time. Record the type of medication applied and the condition of the throat.

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