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06.02 EENT Medications

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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

Reference Links

Study Tools

Video Transcript

In this video, we’re going to talk about giving eye, ear, and nose medications. Sometimes we think, ‘Oh, eye drops, that’s so basic’, but actually there is a right and wrong way to do it, so we’re gonna show you the right steps. For all of these, you want to make sure the eyes, ears, or nose is clean before you instill the medication

First, let’s look at eye drops. You want the patient to lie supine or sit back in a chair with their head slightly hyperextended.
You’re going to use the thumb of your non-dominant hand to gently pull downward on lower eyelid on whichever eye is prescribed
Hold the eye drop bottle in your dominant hand and rest it on the patient’s forehead.
Hold the bottle 1-2 cm above the patient’s eye and drop the prescribed number of drops into conjunctival sac, If the patient blinks or the drop misses, repeat that again.
Afterwards, have the patient gently close their eyes, but don’t rub them. IF the drug can cause systemic effects, hold pressure with a tissue on the lacrimal duct for 30-60 seconds. A good example is beta blocker eye drops like Timolol.
And of course, repeat this on the other side if prescribed.
If you have to give eye ointment, you’re going to keep the patient in the same position and pull their eyelid down in the same fashion.
Hold the eye ointment tube in your dominant hand and rest it on the patient’s forehead.
Gently squeeze the ointment in a single line along the lower conjunctival sac and have the patient close their eyes gently.
For both eye drops and eye ointment you can offer a tissue if their eyes water at all.
Now, let’s look at ear drops. You want to have the patient lie on their side OR in semi-fowler’s with their head turned.
For an adult, you’re going to pull the pinna up and back, but for a child under 3, pull the pinna back and down.
Hold the open dropper about 1 cm above the ear canal of whichever ear is prescribed.
Drop the prescribed number of drops into the ear canal. Then have the patient stay in that position for at least 5 minutes.
You can gently massage the tragus to help the medicine go down. THEN after 5 minutes you can repeat on the other side. I usually give the one side, do other assessments or tasks, then do the other side.
Lastly, let’s look at nose sprays. A lot of times I’ll have the patient do this themselves, but it’s important that we know the RIGHT way to do it!
First, remove the cap from the nose spray bottle and clean the top of the bottle with an alcohol pad.
Then, insert it into the prescribed nostril. Have the patient cover the other nostril and sniff.
You’ll squeeze or spray the med as the patient sniffs. Make sure you do the prescribed number of sprays, and repeat on the other side if needed.

As always, offer a tissue for any leakage. Just make sure the patient doesn’t blow their nose for at least 5 minutes afterward.

So that’s it for EENT meds, make sure you don’t get complacent with these because proper administration is super important.

Okay guys, go out and be your best selves today. And, as always, happy nursing!

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