Overview

1. Purpose
   1. Medications administered in the eye, ear, or nose are given to affect specific conditions in those organs
   2. Proper administration ensures the med can actually work like it should
   3. Some of these medications may have systemic effects if given inappropriately

Nursing Points

General

1. Supplies needed
   1. Prescribed eye drop, eye ointment, ear drop, or nasal spray
   2. Tissues
   3. Washcloth or cotton-tipped applicator to clean eyes/ears

Assessment

1. Ensure eyes are clean before administering eye drops or ointment
   1. Wash with a warm washcloth
2. Remove external ear wax with a cotton-tipped applicator if needed
3. Before administering nose spray, have the patient gently blow their nose to clear any large obstructions

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what meds they will be receiving
   8. Eye Drops
      1. Have the client lie supine or sit back in a chair with their head slightly hyperextended
      2. Use thumb of non-dominant hand to gently pull downward on lower eyelid
         1. Check WHICH eye the drops are prescribed for
      3. Hold eye drop bottle in dominant hand
      4. Rest dominant hand on patient’s forehead
      5. Hold the bottle 1-2 cm above the patient’s eye
      6. Drop prescribed number of drops into conjunctival sac
         1. If the patient blinks or the drop misses, repeat
      7. Afterwards, have the patient gently close their eyes
      8. IF the drug can cause systemic effects, hold pressure with a tissue on the lacrimal duct for 30-60 seconds
         1. i.e. Timolol
      9. Repeat on other side if prescribed
   9. Eye Ointment
      1. Have the client lie supine or sit back in a chair with their head slightly hyperextended
      2. Use thumb of non-dominant hand to gently pull downward on lower eyelid
         1. Check WHICH eye the ointment is prescribed for
      3. Hold eye ointment tube in dominant hand
      4. Rest dominant hand on patient’s forehead
      5. Gently squeeze ointment in a single line along the lower conjunctival sac
      6. Have the patient close their eyes gently
      7. Offer a tissue for any watering
      8. Repeat on other side if prescribed
   10. Ear Drops
       1. Have the patient lie on their side OR in semi-fowler’s with their head turned
       2. For an adult, pull the pinna up and back
       3. For a child under 3, pull the pinna back and down
       4. Hold the open dropper 1 cm above the ear canal
          1. Check WHICH ear the drops are prescribed for
       5. Instill the prescribed number of drops
       6. The patient should remain in that position for 5-10 minutes
       7. Gently massage the tragus to help medicine go down
       8. Offer a tissue for any drainage
       9. Repeat on other side if prescribed
   11. Nose Spray
       1. Remove the cap from the nose spray bottle
       2. Clean the top of the nose spray bottle with an alcohol pad
       3. Insert into prescribed nostril
       4. Squeeze/spray as the patient sniffs
          1. Cover opposite nostril
       5. Instill prescribed number of sprays
       6. Repeat on other side if prescribed
       7. Offer a tissue for leakage
       8. Instruct patient not to blow nose for at least 5 minutes
   12. AFTER administration
       1. Document administration and patient’s response
       2. If using barcode medication administration
          1. Scan all meds before preparing
          2. Confirm administration AFTER giving to patient
   13. Discard all used supplies
   14. Remove gloves
   15. Perform hand hygiene
   16. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

1. Indication and possible side effect(s) of medication(s)
2. Signs to report to nurse or provider