INSTILLATION OF

EAR & NASAL

DROP
 INSTILLATION OF EAR DROP

Ear instillation is defined as the process by which a liquid is administered into the ear cavity drop
by drop.

Purposes
 To soften ear wax before removing it.
 To reduce inflammation and destroy infective organism in the external ear canal.
 To relieve pain.
 To facilitate removal of foreign body.
 ARTICLE RATIONALE
A Clean tray contains
Clean gloves. To prevent infection
Cotton tip applicator To instillation of drop to the affected
ear
Medication card To prevent medication error
Prescribed medication with To treat the patient from the existing
dropper disease condition.
Cotton balls To prevent reflux after giving the
drop.
Kidney tray To collect waste product
Hand sanitizer To prevent cross infection
Paper Bag To collect waste product
Bowl with normal saline (optional)
 Steps of Procedure
STEPS RATIONALE
Pre-Procedure Preparation
Check physician’s order for the name,
dose time amount and ear to be treated.
Assess for Explanation encourages cooperation
Allergy to medication and reduces apprehension
Redness/abrasion in the pinna/meatus
Type and amount of discharge.
Complaints of discomfort.
Ability to cooperate during procedure.
Specific drug action and side effects.
Firstly identify patient and explain To reduce anxiety and promote
procedure, the purpose of the medication cooperation of patient.
and position to be assumed during and
after instillation.
Intraprocedural steps
Provide side lying position to the patient
with ear being treated uppermost.
Clean meatus of ear canal by using cotton To move any discharge before
tipped applicators. Use normal saline if instillation.
necessary.
Warm medicine container in hand or by To promotes patient’s comfort and
placing it for a short time in warm water. prevents vertigo and nausea.
Fill ear dropper partially with medication or
as prescribed by the doctor.
To straighten auditory canal. For an infant Straightening the canal can ensure
or child under 3 years, pull pinna down and solution to flow the entire length of the
back ,for an adults or child older than 3year canal.
pull pinna upward and backward.
Instill correct number of drops alongside of To reduce trauma to tympanic
ear canal by holding the dropper one membrane.
centimeter (1/2 Inch) above ear canal.
Press gently and firmly a few times on the Pressing on the tragus assists flow of
tragus of the ear. medication into ear canal.
Instruct the patient to remain in side lying To prevent drops from escaping and
position for about five minutes. enable medication to reach all sides of
canal.
Insert a small piece of cotton fluff loosely at The cotton helps to retain medication
the meatus of auditory canal for 15-20 when patient is upright. If pressed too
minutes. tightly the cotton will interfere with the
action of drug and movement of
secretion.
Assess for patients comfort, response and
check for drainage/discharge from the ear.
Post procedural steps
Termination
Make the patient comfortable
Assess patient response
Take all the articles to the utility room &
clean them.
Replace medication
Wash hand thoroughly
Documentation the following
Ear that was treated
Medication administration
Number of drops and patient response.
 ADMINISTERING NASAL DROPS

• Introduction
• It is the introduction of nasal drop into the nostrils.
• OR
• Nasal instillation is the process by which a medicated liquid is introduced into the nasal cavity drop by drop.

• Purposes
• To treat allergies.
• To treat sinusitis.
• To treat nasal congestions.
• To give local anesthesia.
•
 Points to be remembered.

 Medication are instilled only on written order of the doctor.

 Administer drugs in correct concentration
 Identify the drug correctly and follow the rules for administration of medication.
 Medical asepsis should be observed carefully throughout the procedure.
 Do not insert the dropper more than 1-1.5 cm into the nostrils as it may stimulate sneezing.
 ARTICLE RATIONALE
A Clean tray contains
Prescribed medication with To treat the patient from the
dropper existing disease condition
Clean gloves To prevent cross infection
Kidney tray To collect waste product
Paper bag To collect waste product
Wet nasal sticks/Nasal wipes To clean the nostril
Medication card To avoid medication error
Cotton swabs in bowl To clean the excess medication
Hand sanitizer To prevent cross infection
STEPS RATIONALE
Pre-Procedure Preparation
Identify Patient Ensure that correct patient receives
medication
Review Physician order Ensure safe and correct
administration.
Determine which sinus is affected by Determine patient position during
referring the medical record. drug instillation.
Assess patient’s history of hypertension, These condition can contraindicate
heart disease, diabetes mellitus and use of use of decongestants that
hyperthyroidism. stimulate CNS side effects of
transient hypertension, tachycardia,
palpitation and headache.

Determine whether patient has known Prevent complications.

allergies to nasal instillations.
Perform hand hygiene Prevent infections
Intraprocedural steps
Inspect condition of nose and sinuses using Provide baseline data to monitor effect of
penlight. Palpate sinuses for tenderness. medication. Presence of discharge
interferes with medication absorption.

Explain the procedure to the patient including Helps patient anticipate experience of
positioning and sensation to expect such as procedure to reduce anxiety.
burning or stinging of mucosa or choking
sensation as medication trickles into throat.

Arrange articles and medication at bedside. Ensures smooth orderly procedure.

Apply gloves if patient has nasal drainage. Reduces transmission of microorganism

Instruct patient to clear or blow nose gently Remove mucus secretions that can block
unless contraindicated (increased intracranial distribution of medication.
pressure or nosebleed)
 Administer nasal drops
 Assist patient in supine position  Position provides access to nasal passage.
 For access to posterior pharynx tilt
patient head backward. Position allows
 Position the patient head properly medication to drain into affected sinus.

 To access the ethmoid or sphenoid sinuses, tilt

head back over edge of the bed or place small
pillow under the patient’s shoulder and tilt head
back.
Support patient’s head with nondominant hand
Instruct patient to breath through mouth. Mouth breathing reduces chance of
aspirating nasal drops.
Discard the first drop to prevent contamination.
Hold dropper 1cm above nares and instill Avoid contamination of dropper. Instilling
prescribed number of drops towards midline of toward ethmoid bone facilitates
ethmoid bone nasal mucosa distribution of medication over.
The patient remain in supine position for 5 Prevents premature loss of medication
minutes. through nares.

Offer cotton swabs to blot running nose, but Allows maximal amount of medication to
caution patient against blowing nose for several be absorbed.
minutes.

Assist patient, to a comfortable position after Restores comfort.

medication is absorbed.

Dispose off soiled supplies in proper container Maintains neat orderly environment and
and perform hand hygiene. reduces spread of microorganism.

Observe patient for onset of side effects 15-30 Drugs absorbed through mucosa can
minutes after administration. cause systemic reactions.
Postprocedural steps
Termination
Make the patient comfortable
Take all the articles to the utility
room, clean them.
Wash hands thoroughly.
Documentation
Record and report observations and
the care given to the patients with
date, time and signature.
Report any unusual systemic effects
to the nurse-in-charge or physician.