The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [555]
The advantages of the delivery of drugs using the nasal route include the large vascular surface of the nasal cavity which allows rapid absorption, the avoidance of first-pass metabolism, the accessibility of the nose, the ease of administration and the fact that this route can be used when patients are unable to swallow. There are some disadvantages to the nasal route, including the presence of mucus which acts as a barrier to absorption, the mucociliary clearance which reduces the time that drugs are held in the nasal cavity, disorders such as colds that can affect absorption from the nasal cavity, and drugs can have an irritating effect on the nasal cavity.
Preprocedural considerations
Specific patient preparations
The patient should be encouraged to clear their nostrils by blowing or manually cleaning with a tissue or damp cotton bud to ensure that the drug has access to the nasal mucosa (Aldridge 2010).
Procedure guideline 13.10 Medication: nasal drop administration
Essential equipment
Tissues
Clean non-sterile gloves
Optional equipment
Cotton bud
Medicinal products
Nasal spray or drops
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).
2 Consult the patient’s prescription sheet and ascertain the following:
Drug
Dose
Date and time of administration
Route and method of administration
Validity of prescription
Signature of doctor.
To ensure that the patient is given the correct drug in the prescribed dose and by the correct route (NMC 2006b, C).
3 Have paper tissues available. To wipe away secretions and/or medication. E
Procedure
4 Ask the patient to blow their nose to clear the nasal passages, if appropriate. To ensure maximum penetration for the medication (Chernecky et al. 2002, E).
5 Place the patient in a supine position and hyperextend the patient’s neck (unless clinically contraindicated, for example cervical spondylosis). To obtain a safe optimum position for insertion of the medication. E
6 Wash hands and put on gloves. To reduce the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
7 With the non-dominant hand, gently push upward on the end of the patient’s nose. To aid in opening the nostrils. E
8 Avoid touching the external nares with the dropper and instil the drops just inside the nostril of affected side. To prevent the patient from sneezing. E
9 Ask the patient to sniff back any liquid into the back of the nose or to maintain their position for 2 or 3 minutes. To ensure full absorption of the medication. E
10 Discard any remaining medication in the dropper into the sink before returning it to the container. To minimize the risk of cross-infection (Chernecky et al. 2002, E; DH 2007, C; Fraise and Bradley 2009, E).
11 Instruct patient not to blow their nose. To maintain the medication in contact with nasal passages. E.
12 Each patient should have their own medication and dropper. To minimize the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
Postprocedure
13 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, C; NMC 2009, C).
Postprocedural considerations
The patient should be discouraged from sniffing too vigorously post administraton as this can cause ‘run-off’ of the medication down the nasopharynx. This can cause an unpleasant taste in the throat and affect absorption of the medication (Aldridge 2010).
Otic administration
Definition
Medication introduced into the ear for local effects such as treatment of ear infections and softening of ear wax (cerumen) (Aldridge 2010, Chernecky et al. 2002).
Related theory
Drugs administered via this route are intended to have a localized effect and act within the anatomy of the ear and auditory canal (Aldridge 2010). Ear preparations can be presented in the form of drops, sprays,