instillation and irrigation of eye,ear.nose

detail study of procedures

1. WELCOME

2. SEMINAR ON EYE, EAR, NOSE, INSTILLATIONS AND IRRIGATION

3. INTRODUCTION

4. EYE : The eye is the organ of sight. It is situated in the orbital cavity and supplied by the optic nerve. It is almost spherical in shape and about 2.5cm in diameter. The space between the eye and the orbital cavity is occupied by adipose tissue. The bony walls of the orbit and the fat helps to protect the eye from injury.

5. The human eye is an organ that reacts to light and has several purposes. As a sense organ, the mammalian eye allow vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth. The human eye can distinguish about 10million colors.

6. ANATOMY AND PHYSIOLOGY OF EYE

7. STRUCTURE There are three layers of tissue in the walls of the eye. The outer fibrous layer : sclera and cornea . The middle vascular layer or uveal tract consisting of the choroid ciliary body iris . The inner nervous tissue layer : retina.

8. The sclera, or white of the eye, forms the outermost layer of the posterior and lateral aspects of the eye ball and is continous anteriorly with transparent cornea. It consists of a firm fibrous membrane that maintains the shape of the eye and gives attachment to the extrinsic muscles of the eye. Anteriorly this sclera continous as a clear transparent epithelial membrane ,the cornea sclera and cornea

9. The ciliary body is the anterior continution of the choroid consisting of the ciliary muscles (smooth muscles fibres ) and secretory epithelial cells. As many of the smooth muscle fibres are circular the ciliary muscle acts like a sphincter. The lens is attached to the ciliary body by radiating suspensory ligaments likes this spokes of a wheel. ciliary body

10. CHOROID The choroid lines the posterior five-sixth’s of the inner surface of the sclera. It is very rich in blood vessels and it is deep choclate brown in colour . Light enters through pupil , stimulates the sensory receptors in the retina and is then absorbed by the choroid.

11. IRIS The iris is the visible colour part of the eye and extents anteriorly from the ciliary body line behind the cornea and infront of the lens. It divides the anterior segment of the eye into anterior and posterior chamber which contain aqueous fluid secreted by the ciliary body . It is the circular body composed of pigment cells and 2 layers of smooth muscle fibers ,one circular and other radiating in the center is an aperture called the pupil.

12. LENS The lens is highly elastic circular biconvex body lying immediately behind the pupil . It consists of fibres enclosed with in a capsule it is suspended from the ciliary body by the suspensory ligament . Its thickness is controlled by the ciliary muscle .

13. Retina is the inner most layer of the wall of the eye It is an extremely delicate structure and is well adopted for stimulation by light rays. It is composed of several layers of nerve cell bodies and their axons, lying on a pigmented layer of a epithelial cells which attached it to the choroid . retina

14. Th e eye is supplied with arterial blood by the ciliary arteries and the central retinal artery. These are branches of the opthalmic artery one of the branch of internal carotid artery venous drainage is by a number of veins, including the central retinal vein, which eventually empty into a deep venous sinus. blood supply to the eye

15. Dark Adaptation:- When expose to bright light, the rhodopsin with in the sensitive rods is completely degraded. This doesn’t effect vision in good light ,when there is an enough to activate the cones However if the individual moves into a darkened area where the light intensity is insufficient to stimulate the cones, temporary visual impairment results whilst the rhodopisn is being regenerated with in the rods “dark adaptation”. when regeneration of the rhodopsin has occurred normal sight returns. accommodation

16. Anatomy of Eye

17. PROCEDURE FOR EYE IRRIGATION

18. EYE IRRIGATION INTRODUCTION: An irrigation is the washing or flushing of an area , using a large volume of fluid in order to cleanse, to apply heat or to apply medications. Irrigations requried either a clean techinque or a sterile techinque . Sterile techinque when ever there is a break in the continity of the skin.

19. DEFINITION : An eye irrigation is the washing of the conjuctival sac by a liquid . PURPOSE: To treat inflammatory process of conjuctivitis . To apply medications for an antiseptic effect. To Remove foreign objects or irritating chemicals falling in the eyes. To apply heat or cold to the eyes.

20. Although eye is not a sterile organ it is better to use a sterile technique when treating the eye for the fear of introducing infection into the eye and for the value of sight. All the articles and the solutions that come in contact with the eye should be sterile. Wash hands thoroughly before and after the procedure. general instructions

21. It is best to treat each eye separately using separate equipments and solutions to prevent infections from one eye entering into the other. Place the head tilted to the effected side so that it allows drainage away from the unaffected eye. thus potential contamination of the healthy eye is prevented. Before irrigation starts, carefully clean the eye lips to remove any secretions or particles of dust adhering to the lashes, which would otherwise be carried into the conjuctival sac.

22. When both eyes or to be treated, treat the least infected eye first to minimize changes of accidentally infecting it by the infection carried from the badly contaminated eye. Never direct forceful streams of solutions into the eye. If the solutions are held very high, it will flow in great force that might injure the eyes. The solutions are held to the height which allow a steady flow of the solutions. Restrict the movements of the patients when he is lightly to be un-co-operative .

23. NURSING RESPONSIBILITIES IN EYE IRRIGATION

24. Check the name ,bed number and identification of the patient. Check the diagnosis and the purpose for the eye irrigation. Check the doctor’s order for specific instructions regarding type of solution , and the temperature at which it is to be used. preliminary assessment

25. Assess the patients abilities and limitations. Assess the patients mental state to follow instructions. Assess the need for any restraints. Check the articles available in the patient’s unit.

26. PREPARATI0N OF THE ARTICLES ARTICLES PURPOSE 1.A sterile irrigator appropriate for irrigation with sterile solution for irrigation .Any one of the following may be used as an irrigator. - An undine -A rubber bulb syringe The size of the irrigator depends upon the amount of fluid to be used.

27. ARTICLES PURPOSE - Iv bottle with Iv set -An irrigating can with tubing -A medicine dropper 2.Sterile jug with extra fluid 3.Kidney tray and paper bag 4.Sterile wet swabs in a bowl 5.Sterile cotton balls in a container. 3.To receive waste 4.To clean the eyes before the procedure . 5.To dry the eyes after the procedure.

28. ARTICLES PURPOSE 6.Mackintosh and towel. 7.Transfer forceps in a sterile container. 8.Eye dressings and eye medications ,if ordered 9.Iv stand , if needed 6.To protect the bedding 7.To handle the sterile articles 9.To adjust the height of an irrigator .

29. PREPARATION OF THE PATIENT AND THE UNIT Explain the procedure to the patient to win his confidence and co-operation. Explain the sequence of the procedure and tell him how he can co-operate in the procedure. Have the patient lying on his back with the head turned slightly to the side to be irrigated. If the patient is a child or un-co-operative restrain the movement to prevent any interference with the procedure.

30. Protect the patient garments and the bedding with a mackintosh and a towel. Arrange the light in a way to provide adequate light. Ask the patient if appropriate , to hold the kidney tray to receive the return flow. Arrange the articles conveniently in the patient’s unit.

31. PROCEDURE STEPS RATIONALE 1. Wash hands 2. Clean the eyelids and eye lashes using the wet swabs . Wipe the lids from the inner corner of the eye to the outer corner using one swab for one stroke. 1. To prevent cross infection 2. Cleaning the eyelids during irrigation helps to prevent infection and dust particles carried to the conjuctiva of the eye cleaning from the inner corner to the outer corner.

32. STEPS RATIONALE 3.Irrigate the eye using an appropriate irrigator Adjust the flow of liquid by adjusting the height of an irrigator and using clamps for the tubing. ii. Test the temperature of the irrigation solution on the inner aspect of the wrist. If the fluid is directed forwarded into the eyes, it can injury the soft tissues of the eyes. ii. The fluid should be at high temperature

33. STEPS RATIONALE iii. Ask the patient to close the eyes and allow a small amount of fluid to run over the lid. iv. Hold the eyelids open by separating the eyelids gently with the thumb and forefinger of the left hand when opening iii . To reassure the patient that the solution is not very hot. iv. If force is exerted on the eyelids , it can cause spastic classic of the eye lids and will make irrigation difficult.

34. STEPS RATIONALE the eyelids, don’t supply pressure on the eyeball but press against the cheek and eyebrow. v. Hold the nozzle of the irrigator about 2cm above the eyes and allow the fluid to run into the conjuctival sac. v. Precaution is taken not to touch the eye with an irrigator .

35. STEPS RATIONALE vi. Direct the flow of fluid from the inner canthus to the outer canthus .Ask the patient to look while irrigating the inner part of the upper lid is irrigated. vi. Directing the flow of fluid from inner canthus to the outer canthus will prevent forcing the infection to the naso-lacrimal duct. Directing the stream of fluid to different parts of the eyeball ensure through cleaning of the eye.

36. STEPS RATIONALE vii. Irrigate the eye until the desired effect is achieved. viii. Repeat the procedure on the other side , if necessary using separate articles and solutions.

37. AFTER CARE OF THE PATIENT AND THE ARTICLES Wipe the discharge if any, from the eyelids and clean thoroughly . Inspect the eyes for the effect of the irrigation. If the irrigation was carried out to treat inflammatory conditions , no pus should be clean and separate when the procedure is completed. Instill the eye drops or ointments , if ordered . Apply dressings if ordered .

38. Take all articles to the utility room , clean and replace them to their proper places Wash hands. Record the procedure on the nurses record with date and time. Record the solutions used , medications instilled , the condition of the eye before and after the procedure. Repeat the procedure at the specified interval.

39. EYE INSTILLATION

40. DEFINITION: An instillation is defined as process by which a liquid medication is introduced into a cavity drop by drop. INSTILLATION OF MEDICATIONS INTO THE EYE: Medications may be instilled in the form of eye drops or ointment . The commonly used eye drops and ointments are:

41. Atropine 1% - to dilate the pupil. Eserine ½% - to contract the pupil. Adrenaline 1/1000% - To check bleeding. Silver nitrate 1 to 2% - as an antiseptic and especially used in gonococcal infection. Mercurochrome 1 to 2% - as an antiseptic Boric acid 2 to 4% - as an antiseptic. Novocaine and cocaine – as local anaesthetic . Teramycin and soframycin – as antibiotic. Betnovate eye ointment – anti infective and anti inflammatory.

42. PROCEDURE: place the patient in a back lying position with the head hyper extended with a pillow under the shoulders. Ask the patient to look upwards while the nurse separates the lower lid by pressing it against the cheek bone. The drops are taken in a dropper holding the dropper from 1 to 2cm above the eye . Instill the number of drops in the centre of the lower lid. If ointment is to be applied , apply it from the inner aspect to the outer aspect.

43. Ask the patient to close the eyelids and move the eyeballs from side to spread the medications all over the conjuctiva . Wipe of 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 wipe the top of the tube before she replaces the cap .

44. GENERAL INSTRUCTIONS: Be certain that you have the right patient , right medication and the right eye .Check the doctor’s orders to see what medication is to be instilled in which eye. Never instill any medication into the eye , unless it is ordered by the physician. Check the expiry date of the medications. Never apply any medication with the date of expiry already over. Never use any eye drops which are discolored , cloudy and precipitated.

45. Ophthalmic solutions should be sterile and are prevented from contamination during the preparation or administration. Use separate eye droppers for separate medications. Neither substitute a solution or medication of one strength with that of another strength nor substitute one medication for another , without permission from the doctor. Never use any solution or ointment which are unlabelled to instill in the eye.

46. ear

47. INTRODUCTION The ear is the organ of hearing and is also involved in balance. It is supplied by the 8 th cranial nerve i.e the cochlear part of the vestibulo - cochlear nerve , which is stimulated by vibrations caused by sound waves.

48. ANATOMY AND PHYSIOLOGY OF THE EAR: STRUCTURE:- The ear is divided into three distinct parts -outer ear -middle ear -inner ear *The outer ear collects the sound waves and directs them to the middle ear , which in turn transfers them to the inner ear ,where they are converted to nerve impulses and transmitted to the hearing area in the cerebral cortex.

49. OUTER EAR: The outer ear consists of the auricle ( pinna ) and the external acoustic meatus (auditory canal). AURICLE (PINNA): The auricle is visible part of the ear that projects from the side of the head. It is composed of fibro elastic cartilage covered with skin .It is deeply grooved and ridged the most prominent outer ridge is helix .

50. EXTERNAL ACOUSTIC MEATUS (AUDITORY CANAL) This is a slightly ‘s’ shaped tube about 2.5cm long extending from the auricle to the tympanic membrane (ear drum). The lateral 3 rd is cartilaginous and the remainder is a canal in the temporal bone. The meatus is lined with skin continous with that of the auricle.

51. There are numerous ceruminous glands and hair follicles , associated with sebaceous glands , in the skin of the lateral third. Ceruminous glands are modified sweat glands that secrete cerumen (ear wax) , a sticky material containing protective substances including the enzyme lysozyme and imunoglobulins .

52. MIDDLE EAR This is an irregular shaped air filled cavity with in the petrous portion of the temporal bone. The cavity , its contents and the air sacs which open out of it are lined with either squamous or cuboidal epithelium. The lateral wall of the middle ear is formed by the tympanic membrane. The roof and floor are formed by the temporal bone. The posterior wall is formed by the temporal bone with openings leading to the mastoid antrum .

53. The medial wall is a thin layer of temporal bone in which there are two openings: -oval window -round window The oval window is occluded by part of a small bone called the stapes and the round window, by a fine sheet of fibrous tissue . AUDITORY OSSICLES: These are three very small bones only a few millimeters in size that extend across the middle ear from the tympanic membrane to the oval window.

54. The malleus , this is the lateral hammer shaped bone. The incus this is the middle anvil shaped bone. The bony articulates with the malleus , the long process with the stapes. The Stapes this is the medial stirrup shaped bone.

55. Anatomy of the Ear

56. Ear irrigation

57. DEFINITION: An ear irrigation is the washing of the external auditory canal with a stream of liquid. PURPOSE: To remove the ear wax . To remove the foreign bodies. To cleanse the ear in case of purulent discharges caused in the middle infection. For antiseptic affect. To apply heat. To evaluate vestibular functions eg : by thermal caloric test.

58. SOLUTIONS USED: Boric acid 2 to 4% Sodium bicarbonate solution 1% Normal saline Hydrogen peroxide -2% Plain water

59. GENERAL INSTRUCTIONS: Explain the procedure to the patient to win his confidence and co-operation. Straighten the external auditory canal by holding the patient ear upward and backward in case of adults and pull it downward and backward. When irrigating the ear direct the stream of solution and the wall of external auditory canal and never approach tympanic membrane to prevent damage to it which it cause deafness.

60. Irrigation should be given with only a minimum amount of pressure an irrigating can with tubing is preferred to a syringe because it provides a continous flow of fluid and the pressure of the fluid also can be controlled by adjusting the height of the can and by the application of clamps the reservoir should not be 6inches or 15cms above from the level of the ear. Watch the patient for the symptoms of vertigo if this occurs the irrigation should be discontinued. Use sterile equipment. Always do the procedure in an adequate light.

61. NURSING RESPONSIBILITY IN EAR IRRIGATION PRELIMINARY ASSESSMENT: Check the name, bed number and other identification of the patient. Check the diagnosis and purpose of the ear irrigation. Check the doctor’s orders and the specific instructions regarding the type of solutions to be used and the movement of the patient. Assess the patients abilities and limitations .

62. Assess the patient mental state to follow the instructions. Ascertain whether the impaction is due to a hygroscopic substance which attracts and observes moisture in such case the ear irrigation should not be carried out because the substance will observe , water and swell and produce intense pain. Examine the ear for any perforation of the tympanic membrane by using an otoscope . Check whether one or both ears are to be irrigated. Check the articles available in the patient’s unit .

63. PREPARATION OF THE ARTICLES ARTICLES PURPOSE 1.A sterile container appropriate for the irrigation with the sterile solution use one of the following as an irrigator. i . An irrigating can with tubing. ii. A rubber bulb syringe 1.Even though the auditory canal is not sterile cavity , techniques are used to prevent introducing infections into the middle ear in case of the perforation of the tympanic membrane .

64. ARTICLES PURPOSE iii. A metal syringe iv. Sterile jug with fluid if necessary . v. Kidney tray and paper bag. vi. Sterile gauze piece or Cotton balls in a container. vii. Cotton applicator in a container. v .To receive the wastes vi. To plug the ear at the end of the procedure to absorb the infection left in the auditory canal. vii. To clean the external auditory canal and to remove any discharge

65. ARTICLES PURPOSE viii. Mackintosh and towel . ix. Transfer forceps in a sterile container. x. Ear medications. Present these will prevent the infection forced into the middle ear. viii. To protect the bedding and the garments. ix.To handle the sterile supplies. x. To instill into the ear after the irrigation.

66. ARTICLES PURPOSE xi. Iv stand xii. Spot light and head mirrors. xi. To adjust the height of the irrigator. xii. To visualize the ear cavity.

67. PREPARATION OF THE PATIENT AND THE ENVIRONMENT Explain the procedure to the patient to win his confidence and co-operation. Unless contra -indicated make the patient to sit on a chair with a back support. Leaning against the back of the chair. If the patient condition does not allow for a sitting position have the patient lying on his back with the head turned slightly to the sight to be irrigated’

68. Place the mackintosh and towel under the head to protect the bedding and the garments. Place the kidney tray under the ear to be irrigated. Ask the patient to adjust the position of the kidney tray against the neck to receive the return flow. Arrange to provide enough light for the procedure Arrange the articles conveniently in the patient’s unit. If the patient is a child or un-co-operative restrict the movements.

69. PROCEDURE FOR EAR IRRIGATION STEPS RATIONALE 1 . Wash hands. 2. Cleanse the pinna of the ear and the external auditory canal with the cotton applicator dipped in the cleaning solution . To prevent cross infection . Any discharge present in these areas will not be flushed into the middle ear .

70. STEPS RATIONALE 3. If an irrigating can is used, adjust the height of the can , not more than 6 inches above the level of the ear. Open the clamp and expel the air from the tubing (or) Draw the solution in 3. If air is introduced into the ear it will produce loud sounds and cause discomfort to the patient. -Adjust the height of the can helps to regulate the flow of fluid.

71. STEPS RATIONALE to the syringe and expel the air by holding it vertically. 3. Test the temperature of the solution on the inner aspect of the wrist. 4.Straighten the ear canal by pulling the pinna of the ear 3.The temperature variation between the fluid and the body temperature causes vertigo. 4. A straight auditory canal allow fluid to reach upto the

72. STEPS RATIONALE upward and down ward and backward in adults. 5.Place the tip of the syringe or tip of the nozzle at the opening of the canal , but do not block the canal. tympanic membrane and wash the area thoroughly it allows the visualization of the entire canal. 5. Allows for return flow to come back to the kidney tray.

73. STEPS RATIONALE 6 . Allow a small amount of fluid to run over the pinna of the ear. 7. Direct the fluid towards the lateral walls of the auditory canal. Allow a steady and continous flow of fluid into the auditory canal(exert gentle pressure in case of syringe). 6 . To reassure the patient that the solution is not very hot. 7. If the fluid is directed straight onto the tympanic membrane may cause perforation due to the undue force. The force of fluid should not damage the ear drum.

74. STEPS RATIONALE 8 . Irrigate the eye till the desired effect is achieved (see that the kidney tray does not over flow).

75. AFTER CARE OF THE PATIENT AND THE ARTICLES Turn the patient to the affected side , so that the drainage from the ear is facilitated. Plug the ear loosely with a gauze piece to collect the drainage. Dry the skin in and around the ear and instill medication if ordered. Remove the mackintosh and towel from under the head as to make the patient comfortable. Ask the patient in bed enquire for any signs of giddiness

76. Collect all the articles used and take them to the utility room. Clean them first in the cold water and then with warm soapy water. Rinse them thoroughly dry them and send for sterilization. Wash hands. Record the treatment ,the type of solutions used , the effect of treatment along with the date and time in nurses record .

77. EAR INSTILLATION

78. INTRODUCTION: Ear drops are instilled into the auditory canal to produce the following local effects : To combat infection. To soften the ear wax. To produce local anesthesia and to reduce pain in the ear. To kill an insect lodged in the auditory canal.

79. DEFINITION: Ear instillation is the process of introducing otic medication or other liquids into the ear canal. PROCEDURE: Explain the procedure to the patient to win his confidence and co-operation. If the patient is a child or an un co-operative adult restrain his hands. Place the patient in position (side lying position). Draw the medication in a dropper (take only minimum amount).

80. Straighten the auditory canal by pulling the ear pinna upward and backward in case of adults , downwards and backwards in case of children. Instill the medication drop by drop. I nstill the drops on the side wall of the auditory canal. Instruct the patient to remain in the same for few minutes . Plug the ear with a cotton or gauze piece as indicated.

81. GENERAL INSTRUCTIONS The auditory canal should be thoroughly clean before instilling the ear drops. 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. Place the patient in a side-lying position or in the dorsal recumbent position with the head

82. Turned to one side with the affected ear upper most. Allow 3 or 4 drops trickle down on one side of the canal (or) that the air may escape from the auditory canal and the medication may reach up to the ear drum. Ask the patient to remain in the same position for few minutes following instillation. Plug the ear with a small cotton ball or a small gauze piece. Any complaints made by the patient should not be ignored.

83. NOSE

84. INTRODUCTION: The sense of smell or olfaction , originates in the nasal cavity , which also acts as a passage way for respiration. ANATOMY AND PHYSIOLOGY: OLFACTORY NERVES (1 st cranial nerve): These are the sensory nerves of smell. They originate as specialized olfactory nerve endings (chemo receptors) in the mucous membrane of the roof of the nasal cavity above the superior nasal conches. On each side of the nasal septum nerve fiber

85. PHYSIOLOGY OF SMELL: The human sense of smell is less acute than in other animals. Many animals secrete odorous chemicals called pheromones, which play an important part in chemical communication, for eg -territorial behavior, making and bonding of mothers and their newborn. All odorous materials give off volatile molecules , which are carried into the nose with inhaled air and even very low concentrations, when divided in mucus , stimulate the olfactory chemoreceptors .

86. The air entering the nose is warmed , and convection currents carry eddies of inspired air to the roof of the nasal cavity Sniffing concentrates volatile molecules in the roof of the nose. this increases the number of olfactory receptors of simulated and thus perception of the smell increase. The sense of the smell may effect the appetite. It the odours are pleasant the appetite may improve and vice versa.

87. When accompanied by the sight of food an appetizing smell increases salivation and stimulates the digestive system

88. ADAPTION When an individual is continuously exposed to an odour, perception of the odour decreases and ceases with in a few minutes. This loss of perception effects the specific odour

89. Nasal irrigation INTRODUCTION Occasionally nasal irrigation are ordered to cleanse the nose, to apply heat to relieve congestion, swelling and pain To give relief to the patients with chronic atrophic rhinitis or prior to the local application of an oestrogenic compound. However, nasal irrigation are not commonly ordered because of the potential danger of forcing infected matter into the patient’s Eustachian tubes or sinuses or both

90. procedure Explain the procedure to the patients to win his confidence and cooperation. The patient must be asked to breath through the mouth and to cough, speak, or swallow. Place the patient in a sitting position on a chair or in bed with the head bending forward. Use an irrigation can with a tubing keeping it 12inches above the nose.

91. maintain a steady and continues stream of solution into one of the nostrils and allow the fluid to run out of the other nostril. When the desired effect is achieved , stop the procedure dry the nasal passages and make the patient comfortable .

92. General Instructions As far as possible nasal irrigations are avoided because of the potential hazards of forcing infected materials to the adjacent cavities. Nasal irrigations are given only on the return order of a doctor. The solutions used for the nasal irrigations are normal saline or any mild anti septic order by the doctor. It should not be harmful for the patient if it is swallowed accidentally

93. since the patient may feel hard to speak cough or swallow it is desirable to teach him how to old the tip of the nozzle, how to remove it and how to control the flow of fluid. if properly taught, the patient can take the irrigation by himself.

94. NASAL INSTILLATION DEFINITION: A nasal instillation a medicine solution prepared for administration into the nose. Nasal medicine is given in the form of nose drops (or) sprays. PURPOSE: To combat infection To provide astringent effect To relive inflammation and congestion in case of rhinitis To give local anesthesia.

95. General instructions Medications are instill only on written order from the doctor. Avoided oil base solutions as nasal drops, since it interfere with the normal ciliary action and may cause aspiration pneumonia . If aspirated into the lungs. Avoid the use of decongestant drops for a long period or there frequent use or excessive use, because there become ineffective and mat actually worsen the patient nasal congestion

96. Be careful to use to drugs with correct concentration. Indentify the drug correctly. Follow the rules for the administration of medication “RIGHT PATIENT” etc…

97. 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 each nostril. Ask the patient to remain few minutes in the same position for few minutes provide a hand kerchief or a piece of rag to wipe off any medication that have escaped from the anterior nares . Provide a sputum mug to spit any medication that have reached the mouth and throat . procedure

98. CONCLUSION At the end of the topic we could know clearly about the procedures of eye instillation, eye irrigation, ear instillation and ear irrigation and nasal instillation and nasal irrigation We also can know the drugs which are used in a certain dosage and their action and their particular usage This procedures can’t be known or used with out the doctor’s prescription or advice, so this should be consulted whit the doctor .

99. THANK YOU