EYE IRRIGATION

1. define eye irrigation.

2. review the anatomy and physiology of the

eye.

3. discuss eye irrigation as to its:

1. purpose

2. indications

3. contraindications

4. complications

5. principles involved

6. guidelines

4. explain the nursing responsibilities

before, during and after the procedure.

5. demonstrate beginning skills in eye irrigation.

Is a medical procedure of washing out of the conjunctival sac with a stream of liquid.

This is use to clean out foreign objects that gets into the eye causing irritation.

ANATOMY & PHYSIOLOGY OF THE

EYE:

Optic tract

Thalamic Nucleus

Optic Radiation

Visual Cortex/ Occipital Lobe

I

R

I

S

PURPOSE OF EYE

IRRIGATION:

To clear the eye of noxious or other foreign

material or excessive secretions or in preparation

for surgery.

To prevent corneal burning.

To flush out irrigating or chemical solutions to the

eye.

To relieve itching.

To treat infections.

INDICATIONS OF EYE

IRRIGATION:

Chemical contact, irrigating after contact

Eye irritants

Excessive secretion

Preparations for surgery

Unconscious patients

Eye inflammation or crusting

CONTRAINDICATIONS OF EYE

IRRIGATION:

Eye surgery

Allergy to medication

COMPLICATIONS OF EYE

IRRIGATION:

Incomplete foreign body removal or Rust

ring

Conjunctivitis

Perforation of the cornea

Epithelial injury

Rust ring

Conjunctivitis

Perforation of the cornea

PRINCIPLES INVOLVED IN EYE

IRRIGATION:

1. Anatomy and Physiology

2. Microbiology

3. Pharmacology

4. Chemistry

5. Physics

6. Psychology

GUIDELINES FOR EYE

IRRIGATION:

1. Position patient in a SUPINE POSITION with head turned slightly toward the affected side.

2. Direct the irrigating solution along the conjunctiva from INNER to OUTER CANTHUS.

3. AVOID touching the eye structure with the irrigation equipment.

4. Place the kidney basin at the SIDE OF THE EYE.

NURSING

RESPONSIBILITIES:

BEFORE

1. Confirm the PATIENT’S IDENTITY by

checking the name band or asking for the

patient’s name and birth date.

2. Gather the NECESSARY MATERIALS.

3. Do MEDICAL HAND WASHING and wear

gloves (as necessary).

4. Position patient in a SUPINE POSITION with

HEAD SLIGHTLY TURNED TO THE

AFFECTED SIDE.

DURING

1. EXPOSE the conjunctival sac and HOLD

UPPER LID OPEN with non-dominant hand.

2. Instruct patient to LOOK UP.

3. Allow solution to flow from the INNER

CANTHUS to OUTER along the conjunctival

sac.

AFTER

1. PAT DRY patient’s face and eyes with a

cotton ball.

2. Document the following:

Duration of irrigation

Type and amount of solution

Characteristics of drainage

Patient’s reactions to the procedure

EYE INSTILLATION

1. define eye instillation.

2. discuss eye instillation as to its:1. purpose

2. indications

3. contraindications

4. complications

5. guidelines

3. explain the nursing responsibilities before, during and after the procedure.

4. enumerate common ophthalmic medications with its classification, mechanism of action, and side effects.

5. demonstrate beginning skills in eye instillation.

Administration of therapeutic agents such as ointments and creams into the eye.

PURPOSE OF EYE

INSTILLATION:

To dilate or constrict the pupil when

examing the eye.

To relieve pain, discomfort, itching and

conjunctivitis.

To act as an antiseptic in cleansing the

eye.

To combat infection.

To lubricate the eye.

INDICATIONS OF EYE

INSTILLATION:

Glaucoma

Papillary dilation for surgery and

examination

Opthalmic infections

Patients requiring local anesthesia for

tests

Eye discomforts

CONTRAINDICATIONS OF EYE

INSTILLATION:

Hypersensitivity to drug use in

instillation.

COMPLICATIONS OF EYE

INSTILLATION:

Allergic reaction

GUIDELINES FOR EYE

INSTILLATION:

Wash hands before putting on gloves

Offer the patient paper tissues to

remove solution and tears that may spill

from eye during the procedure

Clean the eyelids and eyelashes of any

drainage with cotton ball or gauze

Tilt the patient’s head slightly if sitting or

place the patient’s head over a pillow if

lying down

Place the thumb or two fingers near the

margin of the lower eyelid immediately

below the eyelashes, exertpressure

downward over the bony prominence of the

cheek

Hold the dropper close to the eye, but avoid

touching the eyelids or lashes

Squeeze the container and allow the

prescribed number of drops to fall in the

lower conjunctival sac

Release the lower lid after the eyedrops

are instilled, ask patient to close his eyes

gently

Apply gentle pressure over the inner

canthus

Do not apply medications to the cornea

since it can cause injury since it richly

supplies with sensitive nerve endings

Moving the eyes after instillation distributes

the solution over the conjunctival surface

and anterior eyeball

NURSING

RESPONSIBILITIES:

Before

1. Check doctor’s order for amount, no. of drops of solution and eye to be treated.

2. Explain procedure to the patient.

3. Prepare drug to be administered according to the 5R’s of administration.

4. Warm hands.

5. Do gloving.

6. Let patient sit with head tilted backward or to lie in supine position.

During

1. Pull lower lid down gently.

2. Instruct patient to look up.

3. Drop medication amount into center of lower lid and never in the cornea.

4. If using an ointment, apply from inner to outer canthus.

5. Instruct patient to close eyes and not to squeeze or rub the eyes.

After

1. Wipe off excess solution with sterile gauze or

cotton balls.

2. While closing his eyes, let patient roll his

eyes.

3. Record time, type, strength and amount of

medication and the eye into which medication

was instilled

COMMON OPTHALMIC

MEDICATIONS:DRUG CLASSIFICATION/

MECHANISM OF ACTION

SIDE EFFECTS RESPONSIBILITIE

S

Tetrahydrozolin

e hydrochloride

(Geneye)

Opthalmic decongestant

Opthalmic vasoconstrictor

and mydriatric

Dilates pupils; Increases

flow of aqueous humor,

vasoconstricts in eyes.

CNS: fear, anxiety,

tenseness,

restlessness,

headache,

lightheadedness,

dizziness,

drowsiness.

CV: Palpitations,

Tachycardia

GI: Nausea,

vomiting, anorexia

GU: Dysuria

Local: burning,

sneezing, dryness

Other: Pallor,

sweating

Do not administer

ophthalmic solution

if it is cloudy or

changes in color.

Do not exceed

recommended dose.

Demonstrate

proper

administration

technique for eye

drops.

Avoid prolong use

because of

underlying medical

problems can be

disguised.

DRUG CLASSIFICATION/ MECHANISM OF ACTION

SIDE EFFECTS RESPONSIBILITIE

S

Lotemax

(loteprednol

etabonate)

Dexamethason

e

Dexamethason

e phosphate

Fluorometholo

ne acetate

Hydrocortisone

Hydrocortisone

acetate

Loteprednol

etabonate

DRUG CLASSIFICATION/ MECHANISM OF ACTION

SIDE EFFECTS RESPONSIBILITIE

S

Bacitracin (AK-

Tracin)

Ciproflaxin

(Cipro)

Erythromycin

(Ilotycin)

Gentamicin

(Garamycin)

Norfloxacin

(Noroxin)

Oxytetracycline

Polymycin B

Sulfisoxazole

diethanolamine

DRUG CLASSIFICATION/ MECHANISM OF ACTION

SIDE EFFECTS RESPONSIBILITIE

S

Ganciclovir

(Vitrasert)

Idoxuridine

(Herplex)

EAR IRRIGATION

1. define ear irrigation.

2. review the anatomy and physiology of the ear.

3. discuss ear irrigation as to its:1. purpose

2. indications

3. contraindications

4. complications

5. principles involved

6. guidelines

4. explain the nursing responsibilities before, during and after the procedure.

5. demonstrate beginning skills in ear irrigation.

Washing by a stream of water or other fluid, if a wax plug is present in the auditory canal, irrigation is ordinarily done for cleansingpurposes.

ANATOMY AND PHYSIOLOGY OF

THE EAR

PURPOSE OF EAR

IRRIGATION

To clean the auditory canal.

To remove discharges from the ear canal.

To facilitate removal of foreign bodies such as

organic substances.

To soften wax.

To destroy organisms or insects lodging the

canal can cause almost intolerable discomfort.

For hygiene purposes.

INDICATIONS OF EAR

IRRIGATION:

For patients with cerumen impaction

For patients with ear infections

Patients with ear obstructions

Patients with hearing difficulties

CONTRAINDICATIONS OF EAR

IRRIGATION:

Patients with Tympanic membrane

perforation

Patients with Tympanostomy with

tubes

Tympanic membrane perforation

COMPLICATIONS OF EAR

IRRIGATION:

Dizziness

Perforation or damage of the Eardrum

PRINCIPLES INVOLVED:

1. Anatomy and Physiology

2. Physics

3. Microbiology

4. Psychology

5. Chemistry

GUIDELINES FOR EAR

IRRIGATION:

1. Warm the solution 35-40 degree

Celsius.

2. Wear gloves.

3. Straighten the auditory canal

-be sure not to occlude the meatus.

NURSING

RESPONSIBILITIES:

Before

1. Read/check physicians order

2. Explain procedure

3. Do medical hand washing

4. Assist patient in sitting position/Head

tilt.

During

1. Place a towel under the

shoulder

2. Support a basin under the

patient ear.

After

1. Document:

- Time of irrigation

- Effect of treatment.

- Kind and amount of solution used.

- Nature of the returned flow.

2. Do after care.