The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [556]
Evidence-based approaches
Internal ear structures are very sensitive to temperature extremes and so solutions should be administered at room temperature. When drops are instilled cold, patients may experience vertigo, ataxia or nausea (Chernecky et al. 2002, Snyder 2007). Solutions should never be forced into the ear canal as medication administered under pressure can injure the eardrum. The ear drop solution should be labelled for the ear it is intended to treat. The dropper should be held as close to the ear as possile without touching to reduce the risk of cross-infection.
Preprocedural considerations
Specific patient preparations
The nurse should examine the ear, taking note of any discharge, redness, swelling and the amount and texture of any ear wax present as these will give an indication of the general health of the ear (Harkin 2008). The nurse should also discuss with the patient their current level of hearing. It should be explained to the patient that they must lie still as sudden movements could cause injury from the ear dropper.
Procedure guideline 13.11 Medication: ear drop administration
Essential equipment
Clean non-sterile gloves
Tissues
Medicinal products
Ear 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 chart 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 using the appropriate diluent and by the correct route (NMC 2008a, C).
Procedure
3 Ask the patient to lie on their side with the ear to be treated uppermost. To ensure the best position for insertion of the drops. E
4 Warm the drops to body temperature if allowed. To prevent trauma to the patient (Harkin 2008, E; Snyder 2007, E).
5 Wash hands and apply gloves. To reduce the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
6 Pull the cartilaginous part of the pinna backwards and upwards (see Action Figure 6). To prepare the auditory meatus for instillation of the drops (Harkin 2008, E).
7 If cerumen (ear wax) or drainage occludes outermost portion of the ear canal, wipe out gently with cotton-tipped applicator. To enable the medication to enter the ear. E
8 Allow the drop(s) to fall in direction of the external canal. The dropper should not touch the ear. To ensure that the medication reaches the area requiring therapy. E
9 Gently massage over tragus to help work in the drops. To aid the passge of medication into the ear and prevent escape of medication. E
10 It may be necessary to temporarily place a gauze swab over the ear canal. To prevent escape of the medication (Chernecky et al. 2002, E).
11 Request the patient to remain in this position for 2–3 minutes. To allow the medication to reach the eardrum and be absorbed. To prevent escape of the medication (Aldridge, 2010, E; Snyder 2007, E).
Postprocedure
12 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).
Action Figure 6 Holding ear for ear drops.
Postprocedural considerations
The nurse should ask the patient if there are any changes in order to monitor effectiveness of the intervention. Consideration should also be given to the patient’s hearing aids and assistance given to help clean these.
Injections and infusions
Definitions
Injections are sterile solutions, emulsions or suspensions. They are prepared by dissolving, emulsifying or suspending the active ingredient and any added substances in either water for injections