Nasal Spray

ACTION RATIONALE
1. Assist the patient to an upright position with the head
tilted back.
2. Instruct the patient to hold one nostril closed inhale
gently through the nose as the spray is being
administered
3. Agitate the medication container, if required, to mix the
contents thoroughly.
4. Insert the nozzle of the medication container just into
the nostril.

5. Compress the container, spraying the medication into

the nostril, while the patient gently inhales through the
nostril.
6. Keep the medication container compressed and remove
from the nostril. Release the container from the
compressed state.
7. Do not allow the container to return to its original
position until it is removed from the patient’s nose to
prevent contamination of the contents of the container.
8. Repeat in the other nostril, if prescribed

9. Instruct the patient to maintain head position for 1 to 2

minutes
10. Remove gloves. Assist patient to a comfortable position. This ensures patient comfort

11. Remove additional PPE, if used. Perform hand hygiene Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand
hygiene prevents the spread of microorganisms.
12. Document the administration of the medication Timely documentation helps to ensure patient safety.
immediately after administration
13. Evaluate the patient’s response to medication within The patient needs to be evaluated for therapeutic and
appropriate time frame. adverse effects from the medication

Unexpected Situations and Associated Interventions cannot determine how much medication was actually
absorbed.
Patient sneezes immediately after receiving nose drops:
Do not repeat the dosage, because you
 Equipment
Instilling Eye Drops
 Medication (warmed to 37 C [98.6F]
 Dropper
Eye drops
 Tissue
 Eye drops are instilled for their local effects,
such as for pupil dilation or constriction when  Cotton ball (optional)
examining the eye, for infection treatment, or  Gloves
for controlling intraocular pressure (for patients  Additional PPE, as indicated
with glaucoma).  Washcloth (optional)
 The type and amount of solution depend on the  Normal saline solution
purpose of the instillation  Chart
 The eye is a delicate organ highly susceptible to
infection and injury.
 Although the eye is never free or
microorganisms, the secretions of the
conjunctiva protect against many pathogens

Equipment

 Gloves
 Additional PPE, as indicated
 Medication
 Tissues
 Normal saline solution
 Washcloth, cotton balls, or gauze squares
 Patient’s Chart

Instilling Ear drops

Ear drops
 Drugs are instilled into the auditory canal for
their local effect. They are used to soften wax,
relieve pain, apply local anesthesia, and treat
infections. The tympanic membrane separates
the external ear from the middle ear. Normally,
it is intact and closes the entrance to the middle
ear completely. If it is ruptured or has been
opened by surgical intervention, the middle ear
and the inner ear have a direct passage to the
external ear. When this occurs, perform
instillations with the greatest of care to prevent
forcing materials from the outer ear into the
middle ear and the inner ear. Use sterile
technique to prevent infection
Eye Drops Procedure

ACTION RATIONALE
1. Gather equipment. Check medication order against the This comparison helps to identify errors that may have
original order in the medical record, according to occurred when orders were transcribed. The primary care
facility policy. Clarify any inconsistencies. Check the provider’s order is the legal record of medication orders for
patient’s Chart for allergies
each facility
2. Know the actions, special nursing considerations, safe This knowledge aids the nurse in evaluating the therapeutic
dose ranges, purpose of administration, and adverse effect of the medication in relation to the patient’s disorder
effects of the medications to be administered. and can also be used to educate the patient about the
Consider the appropriateness of the medication for medication
this patient.
3. Perform hand hygiene Hand hygiene prevents the spread of microorganisms.

4. Move the medication cart to the outside of the Organization facilities error free administration and saves
patient’s room or prepare for administration in the time
medication area.
5. Prepare medications for one patient at a time. This prevents errors in medication administration.

6. Read the Chart and select the proper medication from This is the first check of the label
the patient’s medication drawer.
7. Compare the label with the chart. Check expiration This is the second check of the label. Verify calculations with
dates and perform calculations, if necessary. another nurse to ensure safety, if necessary.
8. When all medications for one patient have been This is a third check to ensure accuracy and to prevent
prepared, recheck the label with the chart before errors.
taking them to the patient.
9. Transport medications to the patient’s bedside Careful handling and close observation prevent accidental
carefully, and keep the medications in sight at all or deliberate disarrangement of medications.
times.
10. Ensure that the patient receives the medication at the Check agency policy, which may allow for administration
correct time. within a period of 30 minutes before or 30 minutes after
designated time.
11. Perform hand hygiene and put on PPE, if indicated Hand hygiene and PPE prevent the spread of
microorganisms.
12. Identify the patient Ensures the right patient receives the medications and
helps prevent errors.
13. Check the name and identification number on the This is the most reliable method
patient’s identification band.
14. Ask the patient to state his or her name and birth date This requires a response from the patient, but illness and
based on facility policy strange surroundings often cause patient’s to be confused.
15. Verify the Patient’s identification with a staff member Do not use the name on the door or over the bed, because
who knows the patient for the second source. these signs may be inaccurate.
16. Complete necessary assessments before administering Assessment is a prerequisite to administration of
medications. Check patients allergy medications
 ACTION RATIONALE
17. Explain the purpose and action of each medication to Explanation promotes cooperation
the patient.
18. Put on gloves Gloves protect the nurse from potential contact with
mucous membranes and bodily fluids.
19. Offer tissue to patient Solution and tears may spill from the eye during the
procedure
20. Cleanse the eyelids and eyelashes of any drainage with a Debris can be carried into the eye when the conjunctival sac
wash cloth, cotton balls, or gauze moistened with is exposed.
normal saline solution.
21. Use each area of the cleaning surface once, moving Prevents debris to the lacrimal ducts
from the inner toward the outer canthus
22. Tilt the Patient’s head back slightly if sitting, or place the Tilting patient’s head back slightly makes it easier to reach
patient’s head over a pillow if lying down. The head may the conjunctival sac. This should be avoided if the patient
be turned slightly to the affected side to prevent has a cervical spine injury. Turning the head to the affected
solution or tears from flowing toward the opposite eye. side helps to prevent solution or tears from flowing toward
the opposite eye.
23. Remove the cap from the medication bottle, being Touching the inner side of the cap may contaminate the
careful not to touch the inner side of the cap. bottle of medication
24. Invert the monodrip plastic container that is commonly By having the patient look up and focus on something else,
used to instill eye drops, Have patient look up and focus the procedure is less traumatic and keeps the eye still
on something on the ceiling
25. Place thumb or two fingers near margin of lower eyelid The eye drop should be placed in the conjunctival sac, not
immediately below lashes, and exert pressure directly on the eyeball.
downward over bony prominence of cheek. Lower
conjunctival sac is exposed as lower lid is pulled down
26. Hold dropper close to the eye, but avoid touching Touching the eye, eyelids, or lashes can contaminate the
eyelids or lashes. Squeeze container and allow medication in the bottle; startle the patient, causing blinking;
prescribed number of drops to fall in lower conjunctival or injure the eye. Do not allow medication to fall onto
sac cornea. This may inure the cornea or cause the patient to
have an unpleasant sensation.
27. Release lower lid after eye drops are instilled. Ask This allows the medication to be distributed over the entire
patient to close eyes gently. eye.
28. Apply gentle pressure over inner canthus to prevent eye Minimize the risk of systemic effects from the medication
drops from flowing into tear duct
29. Instruct the patient not to rub affected eye. This prevents injury and irritation to the eye.

30. Remove gloves. Assist patient to a comfortable position This ensures patient comfort
 ACTION RATIONALE
31. Remove additional PPE, if used. Perform hand hygiene Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand
hygiene prevents the spread of microorganisms
32. Document the administration of the medication Timely documentation helps to ensure patient safety
immediately after administration.
33. Evaluate the patient’s response to medication within The patient needs to be evaluated for therapeutic and
appropriate time frame adverse effects from the medication

UNEXPECTED SITUATIONS AND ASSOCIATED

INTERVENTIONS

 Drop is placed on eyelid or outer margin of

eyelid due to patient blinking or moving: Do
not count this drop in total number of drops
administered. Allow the patient to regain
composure and proceed with application of
medication. Consider approaching the
patient from below the line of sight.
 You cannot open eyelids due to direct crust
and matting of eyelids; place a warm, wet
washcloth over the eye and allow it to remain
there for approx. 3 minutes. Cleanse eye as
described previously. You may need to repeat
this procedure if there is a large amount of
matting
 Bottle or tube of medication comes in contact
with eyeball when applying medication:
Bottle is contaminated; discard appropriately.
Notify pharmacy or retrieve a new bottle for the
oncoming shift
Instilling Ear Drops Procedure

ACTION RATIONALE
1. Gather equipment. Check medication order against the This comparison helps to identify errors that may have
original order in the medical record, according to facility occurred when orders were transcribed. The primary care
policy. Clarify any inconsistencies. Check the patient’s provider’s order is the legal record of medication orders for
Chart for allergies
each facility
2. Know the actions, special nursing considerations, safe This knowledge aids the nurse in evaluating the therapeutic
dose ranges, purpose of administration, and adverse effect of the medication in relation to the patient’s disorder
effects of the medications to be administered. Consider and can also be used to educate the patient about the
the appropriateness of the medication for this patient. medication
3. Perform hand hygiene Hand hygiene prevents the spread of microorganisms.

4. Move the medication cart to the outside of the patient’s Organization facilities error free administration and saves
room or prepare for administration in the medication time
area.
5. Prepare medications for one patient at a time. This prevents errors in medication administration.

6. Read the Chart and select the proper medication from This is the first check of the label
the patient’s medication drawer.
7. Compare the label with the chart. Check expiration This is the second check of the label. Verify calculations with
dates and perform calculations, if necessary. another nurse to ensure safety, if necessary.
8. When all medications for one patient have been This is a third check to ensure accuracy and to prevent
prepared, recheck the label with the chart before taking errors.
them to the patient.

9. Transport medications to the patient’s bedside carefully, Careful handling and close observation prevent accidental
and keep the medications in sight at all times. or deliberate disarrangement of medications.

10. Ensure that the patient receives the medication at the Check agency policy, which may allow for administration
correct time. within a period of 30 minutes before or 30 minutes after
designated time.
11. Perform hand hygiene and put on PPE, if indicated Hand hygiene and PPE prevent the spread of
microorganisms.
12. Identify the patient Ensures the right patient receives the medications and
helps prevent errors.
13. Check the name and identification number on the This is the most reliable method
patient’s identification band.
14. Ask the patient to state his or her name and birth date This requires a response from the patient, but illness and
based on facility policy strange surroundings often cause patient’s to be confused.

15. Verify the Patient’s identification with a staff member Do not use the name on the door or over the bed, because
who knows the patient for the second source. these signs may be inaccurate.
 ACTION RATIONALE
16. Complete necessary assessments before administering Assessment is a prerequisite to administration of
medications. Check patients allergy medications.
17. Explain the purpose and action of each medication to Explanation promotes cooperation
the patient.
18. Put on gloves Gloves protect the nurse from potential contact with
mucous membranes and bodily fluids.
19. Offer tissue to patient Solution and tears may spill from the eye during the
procedure
20. Cleanse external ear of any drainage with cotton ball or Debris and drainage may prevent some of the medication
washcloth moistened with normal saline from entering the ear canal
21. Place patient on his or her unaffected side in bed, or, if This positioning prevents the drops from escaping from the
ambulatory, have patient sit with head well tilted to the ear.
side so the affected ear is uppermost
22. Draw up the amount of solution needed in the dropper. Risk for contamination is increased when medication is
Do not return excess medication to stock bottle. A returned to the stock bottle
prepackaged, mono drip plastic container may also be
used
23. Straighten auditory canal by: Pulling on the pinna as described helps to straighten the
 ADULT: pulling cartilaginous portion of pinna up canal properly for ear drop instillation
and back
24. Child older than 3 years: Pull pinna straight back an Pulling on the pinna as described helps to straighten the
infant or a canal properly for ear drop instillation
 Child younger than 3 years: down and back

25. Hold dropper in the ear with its tip above the auditory By holding the dropper in the ear, most of the medication
canal. Do not touch the dropper to the ear, will enter the ear canal. Touching the dropper to the ear
contaminates the dropper and medication. The hard tip of
the dropper can damage the tympanic membrane if it is
jabbed into the ear.
26. Allow drops to fall on the side of the canal It is uncomfortable for the patient if the drops fall directly
onto the tympanic membrane
27. Release pinna after instilling drops, and have patient Medication should remain in ear canal for at least 5 minutes
maintain the position to prevent escape of medication
28. Gently press on the tragus a few times Pressing on the tragus causes medication from the canal to
move toward the tympanic membrane
29. Remove gloves. Assist patient to a comfortable position This ensures patient comfort

30. Remove additional PPE is used. Perform hand hygiene Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand
hygiene prevents the spread of microorganisms
 ACTION RATIONALE
31. Document the administration of the medication Timely documentation helps to ensure patient safety
immediately after administration.
32. Evaluate the patient’s response to medication within The patient needs to be evaluated for therapeutic and
appropriate time frame adverse effects from the medication

UNEXPECTED SITUATIONS AND ASSOCIATED

INTERVENTIONS

 Medication runs from ear into ear: Notify

primary care provider and check with the
pharmacy. Eye irrigation may need to be
performed
 Patient complains of extreme pain when
you press on the tragus; Allow patient to
press on tragus. If pressure causes too
much pain, this part may be deffered.