administering ophthalmic instillations

7/25/2019 Administering Ophthalmic Instillations

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ADMINISTERING OPHTHALMIC INSTILLATIONSPURPOSE

To provide an eye medication the client requires (e.g., an antibiotic) to treat an infection orfor other reasons (see specic drug action)

ASSESSMENT

In addition to the assessment performed by the nurse related to the administration of anymedication, prior to applying ophthalmic medications, assess:Appearance of eye and surrounding structures for lesions, eudate, erythema, or s!elling

The location and nature of any discharge, lacrimation, and s!elling of the eyelids or of thelacrimal gland

" #lient complaints (e.g., itching, burning pain, blurred vision, and photophobia)" #lient behavior (e.g., squinting, blin$ing ecessively, fro!ning, or rubbing the eyes).

%etermine if assessment data in&uence administration of the medication (i.e., is itappropriate to administer the medication or does the medication need to be held and theprimary care provider notied').

PLANNINGDelegation

%ue to the need for assessment, interpretation of client status, and use of sterile technique,ophthalmic medication administration is not delegated to A.

Equipment" #lient*s +A or computer printout" #lean gloves" -terile absorbent sponges soa$ed in sterile normal saline" +edication" -terile eye dressing (pad) as needed and paper tape to secure it

For irrigation a!!"" Irrigating solution (e.g., normal saline) and irrigating syringe or tubing" %ry sterile absorbent sponges

" +oistureresistant to!el" /asin (e.g., emesis basin)

Preparation

0. #hec$ the +A.

" #hec$ the +A for the drugname, dose, and strength. Alsoconrm the prescribed frequencyof the instillation and !hich eyeis to be treated.

" #hec$ client allergy status.

" If the +A is unclear or pertinentinformation is missing, compare

it !ith the most recent primarycare provider*s !ritten order.

" eport any discrepancies to thecharge nurse or primary careprovider, as agency policydictates.

1. 2no! the reason !hy the client isreceiving the medication, the drugclassication, contraindications, usualdose range, side e3ects, and nursingconsiderations for administering andevaluating the intended outcomes ofthe medication.

Per#orman$e4. #ompare the label on the medication

tube or bottle !ith the medicationrecord and chec$ the epiration date.

5. If necessary, calculate the medicationdosage.

6. Introduce self and eplain to the client!hat you are going to do, !hy it is


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necessary, and ho! he or she canparticipate. The administration of anophthalmic medication is not usuallypainful. 7intments are often soothing tothe eye, but some liquid preparationsmay sting initially. %iscuss ho! the

results !ill be used in planning furthercare or treatments.8. erform hand hygiene and observe

other appropriate infection preventionprocedures.

9. rovide for client privacy.

. repare the client.

rior to performing theprocedure, verify the client*sidentity using agency protocol.ationale: This ensures that theright client receives the rightmedication.

" Assist the client to a comfortableposition, usually lying.

;. #lean the eyelid and the eyelashes.

" Apply clean gloves.

" se sterile cotton ballsmoistened !ith sterile irrigatingsolution or sterile normal saline,and !ipe from the inner canthusto the outer canthus. ationale:If not removed,material on theeyelid and lashes can be washedinto theeye. Cleaning towardthe outer canthus prevents

contaminationof the other eyeand the lacrimal duct.

0pose the lo!er con?unctivalsac by placing the thumb orngers of your nondominant


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hand on the client*s chee$bone?ust belo! the eye and gentlydra!ing do!n the s$in on thechee$. If the tissues areedematous, handle the tissuescarefully to avoid damaging

them. ationale: #lacingthengers on the cheekboneminimi$es the possibility oftouchingthe cornea, avoids

putting any pressure on theeyeball, and prevents the personfrom blinking or s!uinting.

" @olding the medication in thedominant hand, place hand onclient*s forehead to stabiliehand. Approach the eye from theside and instill the correctnumber of drops onto the outer

third of the lo!er con?unctivalsac. @old the dropper 0 to 1 cm(pose the lo!er con?unctivalsac. 7r, to irrigate in stages, rst


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hold the lo!er lid do!n, thenhold the upper lid up. >ertpressure on the bonyprominences of the chee$boneand beneath the eyebro! !henholding the eyelids. ationale:

&eparating the lids preventsre'e" blinking.("erting pressureon the bony prominencesminimi$es thepossibility of

pressing the eyeball and causingdiscomfort.

" Bill and hold the eye irrigatorabout 1.6 cm (0 in.) above theeye. ationale:t this height the

pressure of the solutionwill notdamage the eye tissue, and theirrigator will nottouch the eye.

" Irrigate the eye, directing the

solution onto the lo!ercon?unctival sac and from theinner canthus to the outercanthus. ationale: )irecting thesolution in this wayprevents

possible in%ury to the cornea andprevents 'uid andIrrigate untilthe solution leaving the eye isclear (no discharge is present) oruntil all the solution has beenused.

" Instruct the client to close andmove the eye periodically.

ationale:(ye closure and

movement help to movesecretionsfrom the upper to thelower con%unctival sac.

00. #lean and dry the eyelids as needed.Cipe the eyelids gently from the innerto the outer canthus to collect ecessmedication.

01. emove and discard gloves.

" erform hand hygiene.04. Apply an eye pad if needed, and secure

it !ith paper eye tape.05. Assess the client*s response

immediately after the instillation orirrigation and again after the medicationshould have acted.

06. %ocument all relevant assessments andinterventions. Include the name of thedrug or irrigating solution, the strength,the number of drops if a liquidmedication, the time, and the responseof the client.

E%ALUATION

" erform follo!up based onndings of the e3ectiveness ofthe administration or outcomes

that deviated from epected ornormal for the client. elatendings to previous data ifavailable.

" eport signicant deviationsfrom normal to the primary careprovider.

INFANTS&CHILDREN


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" >plain the technique to theparents of an infant or child.

" Bor a young child or infant,obtain assistance to immobiliethe arms and head. The parentmay hold the infant or young

child. ationale: This preventsaccidental in%ury duringmedicationadministration.

" Bor a young child, use a doll todemonstrate the procedure.ationale: This facilitatescooperation and decreasesan"iety.

" %rops may be tolerated better bychildren than ointment sincethey are less li$ely to causeblurred vision.

" An ID bag and tubing may be

used to deliver irrigating &uid tothe eye

Ot'er $omment("EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Name o# Stu!ent Signature Date

#linical InstructorA((e((or)( Name Po(ition Signature Date

administering ophthalmic instillations

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