N170 Eye, Ear + Nose Instillations

Question 1

Eye, ear + nose instillations are considered forms of _____ medications.

Answer 1

Topical

Question 2

When are topical meds more likely to have systemic effect?

Answer 2

• Skin is thin
• Drug [ ] is high
• Contact with skin is prolonged
• Drug is applied to skin that is not intact

Question 3

Topical administration is admin to? (3)

Answer 3

• Skin
• Mucous membranes
• Tissues

Question 4

Apply topical meds with ___ to avoid accidental exposure to the drug?

Answer 4

Gloves

Question 5

Should you apply a med to an area that already has a topical med applied?

Answer 5

No, will block therapeutic effect

** Always skin thoroughly of encrustations or other meds prior to new application

Question 6

Should sterile or clean gloves be used for applying topical meds?

Answer 6

Sterile if skin is broken

Question 7

How to apply topical meds:

Answer 7

• Rub med between hands to soften

- Spread evenly over skin surface using long, even strokes that follow direction of hair growth

Question 8

Steps for applying nitroglycerine ointment:

Answer 8

• Remove previous dose paper, fold sides with residual med together + dispose of in biohazard bag
• Wide off residual med with tissue
• Write date, time, and initials on new application paper
• Apply desired number of inches of ointment to paper-measuring guide (or use unit-dose)
• Choose site (rotate) - clean, dry, free of hair
• Apply + secure ointment + paper with transparent dressing or tape (or patch)

Question 9

Possible application site for nitro patch?

Answer 9

Chest, back, abdomen, or anterior thigh

**Not on hairy surfaces or over scar tissue

Question 10

Do nitro sites needs to be rotated?

How long should there be between application of nitro patch to same site?

Should you rub or massage nitro ointment into the skin?

Answer 10

Yes

At least a week

No

Question 11

Intraocular disk =

• What is it?
• How long can it be in place for?

Answer 11

Way of med delivery that resembles cataract lens

• Disc placed in conjunctival sac (not over cornea)
• Remains in place for up to 1 week

Question 12

Why is conjunctival sac more appropriate for med admin than the cornea?

Answer 12

Cornea is extremely sensitive (lots of nerve fibers)

- Care must be taken not to administer meds to the cornea

Question 13

What temp should ear drops be?

Answer 13

Room temp - inner ear structures VERY sensitive and cold will cause vertigo, nausea, etc.

Question 14

Procedure for eye drops

Answer 14

1) Pt supine or sitting with neck hyperextended
2) Apply gloves to clean crusties away with warm water + cloth (if any), then remove gloves + hand hygiene
3) Apply clean gloves, hold clean tissue on pt cheekbone below eye
4) Press down on bony orbit to expose conjunctival sac
5) have pt look up, place dominant hand on forehead with dropper 1-2cm above conjunctival sac
6) Drop into conjunctival sac
7) Ask pt to close eyes

Question 15

3 safety precautions for ear drops:

Answer 15

1) Room temp drops
2) Do not administer with force or occlude canal b/c risk of damage to ear drum
3) Use sterile solution in case ear drum is ruptured

Question 16

In which direction it important to clean eyes?

Answer 16

From inner to outer eye

Question 17

When giving eye drops with system effect, remember to:

Answer 17

apply pressure to patient’s nasolacrimal duct with tissue for 30-60sec over each eye after drops administered (to prevent systemic absorption)

Question 18

Procedure for instilling eye ointment:

Answer 18

• Hold applicator above lower lid margin, apply thin ribbon of ointment along inner edge of lower eyelid on conjunctiva
• Have close eye + rub lid gently in circular motion
• Apply eye patch if necessary

Question 19

Where to put extraocular disk?

Answer 19

• Place disk in conjuctival sac so it floats on sclera between iris and lower eyelid
• Pull lower lid over disk so cannot see it

Question 20

How to pull pinna of ear when instilling eardrops in those younger and older than 3

Answer 20

> 3: pull up and back

Question 21

What to do after administering ear drops?

Answer 21

• Have pt remain on side lying for a few minutes
• Can apply pressure to tragus (or insert portion of cottonball into outmost area of canal if ordered…and remove 15 minutes later)

Question 22

If both eye drops and ointment are ordered, which to administer first?

Answer 22

Drops, wait 3 minutes, than ointment

Question 23

Nasal Most commonly administered nasal instillation?

Answer 23

Decongestant spray or drops to relieve sinus congestion + cold symptoms

Question 24

What to watch out for prolonged use of nasal decongestant spray?

Answer 24

Can cause rebound effect (will worsen congestion)

Question 25

Procedure for nasal drops:

Answer 25

1) Have pt supine and position according to what sinus you wish to access:
- For posterior pharynx, tilt head backward
- For ethmoid or sphenoid sinus, tilt head back over edge of bed or with pillow behind shoulders
- For frontal & maxillary, tilt head back over bed with head tilted to side
2) Support head
3) Instruct to breath through mouth
4) Dropper 1cm above nares, drop in prescribed # of drops
5) Have pt remain supine for 5 mins
6) Offer tissue to blot runny nose (but don’t blow for several minutes)

Question 26

Procedure for nasal spray:

Answer 26

• Have seated, head tilted slightly forward
• Point spray tip toward side + away from center of nose
• Have pt administer while inhaling
• Remove and exhale through mouth

Question 27

Why should you discard the first bead in an eye ointment tube?

Answer 27

Is considered contaminated

Question 28

Eye drops should go where?

Answer 28

Into outer third of lower conjunctival sac (avoid cornea!)

Question 29

Eye ointment should be applied in what direction?

Answer 29

From inner canthus to outer canthus