The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [554]
4 Consult the patient’s prescription chart and ascertain the following:
Drug
Dose
Date and time of administration
Route and method of administration, including which eye the drops are prescribed for
Expiry date on bottle
Validity of prescription
Signature of doctor.
To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NMC 2006b, C).
5 If there is any discharge, proceed as for eye swabbing (see Chapter 11). If any crusting or drainage is present around the eye, gently wash away with warm water or 0.9% sodium chloride. To prevent the introduction of micro-organisms into the lacrimal ducts (Snyder 2007, E).
6 Ask the patient to look at the ceiling and carefully pull the skin below the affected eye using a wet swab to expose the conjunctival sac. To move the sensitive cornea up and away from the conjunctival sac and reduce stimulation of blink reflex (Snyder 2007, E).
7 Either: Administer the prescribed number of drops holding the eye dropper 1–2 cm above the eye. If the patient blinks or closes their eye, repeat the procedure. To provide even distribution of medication across the eye (Snyder 2007, E).
Or: Apply a thin stream of ointment along the upper lid margin on the inner conjunctiva from the nasal corner outwards. If there is excess medication on the eyelid, gently wipe it from inner to outer canthus. To provide even distribution of medication across the eye and reduce the risk of cross-infection, contamination of the tube and trauma to the eye (Fraise and Bradley 2009, E; Snyder 2007, E; Stollery et al. 2005, E). To avoid excess ointment irritating the suroounding skin (Stollery et al. 2005, E).
8 Ask the patient to close their eyes and keep them closed for 1–2 minutes. To help distribute medication (Snyder 2007, E; Aldridge 2010, E).
9 Explain to the patient that they may have blurred vision for a few minutes after application. To ensure the patient understands why they have blurred vision and to refrain from driving or operating machinery until their vision returns to normal (Aldridge 2010, E).
Postprocedure
10 Clean any equipment used and discard all disposable equipment in appropriate containers. To minimize the risk of infection (DH 2007, C; Fraise and Bradley 2009, E).
11 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2008a; NMC 2009, C).
Postprocedural considerations
Immediate care
After using any eye medications, any excess medication should be wiped off from inner to outer canthus. If an eye patch is to be worn, it should be secured without putting any pressure on the eye. Patients should be warned not to drive for 1–2 hours after instillation of mydriatics (which dilate the pupil and paralyse the ciliary muscle) (BNF 2011). Patients should be taught how to instil eye medication. If it is difficult for them to do so then it may be necessary for a community nurse to attend and administer the eye medications (Chernecky et al. 2002).
Nasal administration
Definition
Medication introduced to the cavity of the nose for local or systemic effects (Aldridge 2010).
Related theory
The nasal passages are lined with highly vascular mucous membranes covered with ciliated epithelium which warms and moistens air and traps dust. Medication can be delivered directly to the nasal cavity to relieve local symptoms such as allergic rhinitis in the form of nasal drops or nasal sprays (Aldridge 2010).
The nasal cavity can also be used to allow the delivery of drugs systemically. Examples include sumatriptan for migraine, desmopressin for the treatment of diabetes insipidus and nocturia and fentanyl for the treatment of breakthrough pain.
Evidence-based approaches