Administering ophthalmic medications is a common nursing task, but it requires meticulous attention to detail to prevent contamination, ensure proper absorption, and avoid patient discomfort. The nurse's actions throughout the process, from preparation to post-administration care, are vital for positive patient outcomes.
Preparing for Ophthalmic Medication Administration
Before approaching the patient, the nurse must complete a series of preparatory steps to ensure a sterile and safe procedure.
Verify the Prescription and Rights of Medication Administration
The nurse must confirm the prescription using the seven rights of medication administration. This includes ensuring the right patient, medication, dose, route, time, and documentation. For ophthalmic medications, paying attention to the right eye (OD for right eye, OS for left eye, OU for both eyes) is critical. Additionally, checking the medication for the label "for ophthalmic use" and verifying the expiration date is crucial.
Perform Hand Hygiene and Gather Equipment
Thorough hand hygiene is the first and most critical step in preventing infection. After washing hands, the nurse should don clean gloves. Gathering all necessary equipment beforehand streamlines the process and minimizes patient anxiety. Equipment typically includes the ophthalmic medication, sterile gauze or cotton balls, and a facial tissue.
Assess and Prepare the Patient
The nurse should explain the procedure to the patient and assess their eye for any signs of irritation, redness, or discharge. If discharge is present, the nurse should gently cleanse the eye, wiping from the inner canthus (nearest the nose) to the outer canthus, using a clean gauze or cotton ball for each stroke. This prevents microorganisms from entering the nasolacrimal duct and spreading to the inner eye. If the patient wears contact lenses, they should be removed unless specified otherwise by the provider.
Correct Techniques for Instillation
The technique for administering ophthalmic medications varies slightly depending on whether drops or ointments are used.
Administering Ophthalmic Eye Drops
- Position the patient: Instruct the patient to tilt their head back or lie in a supine position, looking upward toward the ceiling. This position helps the medication pool in the conjunctival sac.
- Expose the conjunctival sac: With a non-dominant hand, gently pull the lower eyelid down to create a small pocket or pouch.
- Instill the drops: Hold the dropper about ½ to ¾ inches above the conjunctival sac. Crucially, the nurse must never touch the dropper to the eye, eyelid, or lashes to prevent contamination of the bottle. The prescribed number of drops should be instilled into the center of the sac.
- Post-instillation care: After the drops are in, instruct the patient to gently close their eyes. Applying gentle pressure with a clean tissue to the nasolacrimal duct (inner corner of the eye) for 30–60 seconds prevents systemic absorption of the medication. This is especially important for medications that can cause systemic side effects, such as beta-blockers.
Administering Ophthalmic Ointments
- Position the patient: Similar to drops, the patient should be in a supine or seated position with their head tilted back and looking up.
- Expose the conjunctival sac: Pull the lower eyelid down to create a pocket.
- Apply the ointment: Squeeze a thin ribbon (about ½ inch) of ointment into the conjunctival sac, moving from the inner canthus to the outer canthus. Again, the nurse must ensure the ointment tube does not touch the eye or lashes.
- Post-application care: Instruct the patient to close their eye and move it around to help distribute the ointment. Patients should be warned that their vision will be blurred for a few minutes after application.
Comparison of Techniques: Ophthalmic Drops vs. Ointments
| Feature | Ophthalmic Eye Drops | Ophthalmic Ointments |
|---|---|---|
| Effect on Vision | Minimal or temporary blurring. | Significant temporary blurring due to thicker consistency. |
| Absorption | Absorbed relatively quickly. | Slower absorption, leading to a prolonged therapeutic effect. |
| Application | Requires precise aiming to instill into the conjunctival sac. | Applied as a continuous ribbon along the conjunctival sac. |
| Systemic Absorption | Controlled by applying pressure to the nasolacrimal duct. | Less systemic absorption due to thick vehicle, but still possible. |
| Timing | If multiple drops are needed, wait 5-10 minutes between instillations. | If both are prescribed, administer drops first, wait several minutes, then apply ointment. |
Essential Safety Considerations and Patient Education
Patient safety and education are ongoing responsibilities for the nurse.
- Preventing Contamination: Never allow the medication tip to touch any surface, including the eye, skin, or hands. Recap the bottle or tube immediately after use.
- Managing Multiple Medications: If the patient requires multiple eye drops in the same eye, the nurse should wait at least 5 to 10 minutes between different medications to ensure proper absorption and prevent the first dose from being washed out.
- Patient Education: Teach the patient about the purpose of the medication, the correct technique for self-administration, and the importance of not rubbing the eyes after instillation. Inform them about potential side effects, such as temporary blurry vision with ointments.
- Documentation: The nurse must document the medication, dose, time, route, and the specific eye(s) treated (OD, OS, or OU). Any patient tolerance issues or responses should also be recorded.
Conclusion: The Nurse's Pivotal Role in Ophthalmic Care
The answer to the question "Which action would the nurse perform when administering ophthalmic medications?" is not a single action but a comprehensive process that prioritizes patient safety, proper technique, and education. By adhering to strict infection control measures, positioning the patient correctly, using the appropriate instillation method for drops or ointments, and providing thorough patient education, the nurse ensures the medication is delivered effectively. These meticulous actions prevent contamination, maximize therapeutic outcomes, and minimize systemic side effects, underscoring the nurse's critical role in delivering quality ophthalmic care.
The Seven Rights of Medication Administration
- Right Patient: Verifying the patient's identity using two identifiers.
- Right Medication: Ensuring the correct drug is being administered.
- Right Dose: Confirming the amount of medication is correct.
- Right Route: Administering the medication via the prescribed path, e.g., ophthalmic.
- Right Time: Administering the medication at the scheduled time.
- Right Documentation: Recording the administration accurately and promptly.
- Right Indication: Understanding the reason for the medication.
