I. DESCRIPTION:
Ear drops instillation: Medication can be introduced into the ear to soften wax, relieve pain, or treat disease. The instillation of medication to the ear is a clean procedure, except when the tympanic membrane is not intact, in which case sterile technique is needed. Ear irrigation: Before an ear can be irrigated, it must be examined with an otoscope to check the tympanic membrane. This may have been done by the physician, but if not, you should do it. If the tympanic membrane is not intact, do not irrigate the ear. The fluid could enter the middle ear and cause an infection. You should also inspect the pinna and the external ear canal for signs of infection, open areas, the presence of cerumen, or foreign objects. An ear irrigation is most often used to remove cerumen or a foreign object in the ear.
II. MATERIALS NEEDED:
III. PROCEDURE:
Preparation: 1. Review the medication record to identify whether any medications are to be given to your patient. 2. Examine the medication administration record (MAR) for accuracy and completeness as prescribed by your facility. 2.1. Check the MAR for the drug name, strength, number of drops, and prescribed frequency. 2.2. If the MAR is unclear, or pertinent information is missing, compare it with the most recent primary care provider’s written order. 2.3. Report any discrepancies as agency policy dictates.
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2.4. Know why the patient is receiving the medication, the drug classification, contraindications, usual dose range, side effects, and nursing considerations for administering and evaluating the intended outcomes of the medication. 3. Review information about the medication(s) to be administered. Assessment:
1. Assess whether the patient can take the medications as ordered (e.g., ability to swallow, level of consciousness).
2. Assess appearance of the pinna of the ear and meatus for signs of redness and abrasion. 3. Assess type and amount of any discharge.
Procedure: 1. Compare the label on the medication container with the medication record, and check the expiration date. 2. If necessary, calculate the medication dosage. 3. Explain to the client what you are going to do, why it is necessary, and how the client can cooperate. 4. Perform hand hygiene, and observe other appropriate infection control procedures. 5. Provide for client privacy.
6. Prepare the client: 6.1. Introduce yourself, and verify the client’s identity. 6.2. Assist the client to a comfortable position for eardrops, lying with the ear being treated uppermost. 7. Clean the pinna of the ear and the meatus of the ear canal. 7.1. Put on gloves, if infection is suspected.
7.2. Use cotton-tipped applicators and solution to wipe the pinna and auditory meatus. 8. Administer the ear medication: 8.1. Warm the medication container in your hand, or place it in warm water for a short time. 8.2. Partially fill the ear dropper with medication. 8.3. Straighten the auditory canal. Pull the pinna upward and backward.
8.4. Instill the correct number of drops along the side of the ear canal.
8.5. Press gently but firmly a few times on the tragus of the ear.
8.6. Ask the client to maintain in the side-lying position for about five minutes.
8.7. Insert a small piece of cotton fluff loosely at the meatus of the auditory canal for 15-20 minutes. Do not press it into the canal. 8.8. Explain that the client might experience a feeling of fullness, warmth, and, occasionally, discomfort when the fluid comes in contact with the tympanic membrane.
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8.9. Assist the client to a sitting or lying position with head turned toward the affected ear.
8.10. Place the moisture-resistant towel around the client’s shoulder under the ear to be irrigated, and place the basin under the ear to be irrigated.
8.11. Fill the syringe with solution; or 8.12. Hand up the irrigating container, and run solution through the tubing and nozzle.
8.13. Straighten the ear canal.
8.14. Insert the tip of the syringe into the auditory meatus, and direct the solution gently upward against the top of the canal.
8.15. Continue instilling the fluid until all the solution is used or until the canal is cleaned, depending on the purpose of the irrigation. Take care not to block the outward flow of the solution with the syringe.
8.16. Assist the client to a side-lying position on the affected side.
8.17. Place a cotton fluff in the auditory meatus to absorb the excess fluid.
9. Assess the client’s response.
9.1. Assess the character and amount of discharge, appearance of the canal, discomfort, and so on, immediately after the instillation, and again when the medication is expected to act. Inspect the cotton ball for any discharge. 10. Document all nursing assessments and interventions relative to the procedure. 10.1. Include the name of the drug or irrigating solution, the strength, the number of drops, if it was a liquid medication, the time, and the response of the client.
IV. DIAGRAM ILLUSTRATIONS:
V. NURSING INTERVENTIONS:
1. BEFORE PROCEDURE a. Review the medication record to identify whether any medications are to be given to your patient. b. Examine the medication administration record (MAR) for accuracy and completeness as prescribed by your facility. b.i. Check the MAR for the drug name, strength, number of drops, and prescribed frequency. b.ii. If the MAR is unclear, or pertinent information is missing, compare it with the most recent primary care provider’s written order. b.iii. Report any discrepancies as agency policy dictates.
b.iv. Know why the patient is receiving the medication, the drug classification, contraindications, usual dose range, side effects, and nursing considerations for administering and evaluating the intended outcomes of the medication. c. Review information about the medication(s) to be administered.
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2. DURING PROCEDURE
a. Explain to the client what you are going to do, why it is necessary, and how the client can cooperate. b. Ask the client to maintain in the side-lying position for about five minutes. c. Explain that the client might experience a feeling of fullness, warmth, and, occasionally, discomfort when the fluid comes in contact with the tympanic membrane.
3. AFTER PROCEDURE
a. Assess the character and amount of discharge, appearance of the canal, discomfort, and so on, immediately after the instillation, and again when the medication is expected to act. Inspect the cotton ball for any discharge. b. Documentation. Include the name of the drug or irrigating solution, the strength, the number of drops, if it was a liquid medication, the time, and the response of the client.
