Nonparenteral Medication Administration
Administering Ear Medications
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Take the Review Test:
Safety
- Ensure that the Six Rights of Medication Administration are followed: right medication, right dose, right patient, right route, right time, and right documentation.
- Administer ear drops at room temperature. Instilling cold drops can cause vertigo (severe dizziness) or nausea and debilitate a patient for several minutes.
- Although structures of the outer ear are not sterile, use sterile drops and solutions in case the eardrum is ruptured.
- Avoid forcing solution into the ear.
- Do not occlude the ear canal with a medicine dropper; doing so can cause pressure within the canal during instillation and subsequent injury to the eardrum.
Equipment
(Roll cursor over items to see labels)
Prescribed medication
Clean gloves
Cotton-tipped applicator
Cotton balls
Bulb syringe (optional)
PrintableDelegation
The skill of administering ear medication cannot be delegated to NAP. Be sure to inform NAP of the following:
- Review the expected therapeutic effects as well as potential side effects of medications that should be reported to the nurse.
- Discuss the potential for temporary hearing changes after administration of ear medications.
Preparation
- Check the accuracy and completeness of each medication administration record (MAR) against the health care provider’s medication order. Confirm the patient’s name, the drug and dosage, number of drops to instill, ear to be treated (left, right or both), and the time of administration. Clarify incomplete or unclear orders with the health care provider
- Note patient allergies.
- Read manufacturer’s application/administration directions carefully.
- Observe the six rights of medication administration: right medication, right dose, right patient, right route, right time, and right documentation. (For details, see the video skill "Ensuring the Six Rights of Medication Administration.")
- Prepare medications for application. Check label of medication against MAR two times. Check expiration date on container.
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If ear medication has been refrigerated, hold container in hands for a few minutes to bring to body temperature.
Follow-up
- Ask the patient or a family member to name the ear medication and state its action, purpose, dosage, schedule, and side effects.
- Note the patient's response to the medication by assessing for hearing changes; ask if symptoms have been relieved, and note any side effects.
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Watch the patient or family member instill the next dose of ear medication, providing appropriate reinforcement of technique.
Documentation
- Record the time of administration, type and strength of medication applied, number of drops instilled, and application site (right, left, or both ears) in the MAR immediately after administration, not before. Include your initials or signature. Record patient teaching and validation of the patient's understanding.
- Document objective data related to the ear involved (e.g., redness, drainage, irritation, cerumen) as well as any subjective data (e.g., pain, itching, altered hearing) and the patient’s response to the medications, including any side effects.
- Record the reason any medication was withheld and follow facility policy for noting withheld doses.
Review Questions
1. What is the best way to minimize discomfort caused by the instillation of ear medication?
Warm the ear drops to room temperature before instillation
Wear treatment gloves during the application process- Ask the patient to sit while introducing the medication
- Use a cotton-tipped applicator to remove any visible cerumen
CORRECT. Warming the medication to room temperature minimizes the risk of vertigo and/or nausea from instillation of eardrops.
INCORRECT. Although it is appropriate to wear gloves if the patient has ear drainage, doing so does not minimize the patient’s discomfort.
INCORRECT. Instilling the medicine with the patient in a sitting position would have little or no effect on his or her postinstillation discomfort.
INCORRECT. Although it is appropriate to use a cotton-tipped applicator to remove any visible cerumen, doing so will not minimize the patient’s discomfort.
2. Which instruction would help ensure the maximum therapeutic response when a patient self-administers ear medication?
- Remain in the lateral position (unaffected side) for a few minutes after instillation
- Bring refrigerated ear medication to room temperature before instillation
- Place a cotton ball firmly into the ear canal for 30 minutes after instillation
- Apply a warm, damp washcloth to the external ear to remove any crusted discharge
CORRECT. Remaining in the lateral position for a few minutes after instillation allows the medication to remain in contact with the tissues of the ear canal.
INCORRECT. Although it is appropriate to bring refrigerated ear medication to room temperature before instillation, doing so has no effect on therapeutic response.
INCORRECT. A cotton ball is inserted gently into the ear canal for 15 minutes, and only when ordered by the provider.
INCORRECT. Although it is appropriate to remove any crusted discharge from the external ear, or pinna, with a warm, damp washcloth, doing so has no effect on therapeutic response.
3. Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the instillation of ear medications?
- "Did you let the ear medication warm to room temperature?"
- "Do you think the patient is capable of instilling her own ear drops?"
- "Please tell the patient that the medication may make him dizzy when he stands up."
- "Be sure to keep the patient on her side for a few minutes, because I just administered her ear drops."
INCORRECT. No aspect of the instillation of ear medication may be delegated to NAP.
INCORRECT. Responsibility for patient assessment may not be delegated to NAP.
INCORRECT. Responsibility for patient education may not be delegated to NAP.
CORRECT. NAP may provide supportive care to a patient receiving ear medication.
4. After instructing a patient in the self-administration of antibiotic ear drops, what must come first in the nurse’s assessment?
- Patient’s understanding of the medication's purpose
- Patient’s hand grasp, strength, coordination, and ability to manipulate the applicator
- Patient’s comprehension of the dosage instructions provided with the medication
- Patient’s ability to recognize the signs of an allergic reaction to the medication
INCORRECT. Although it is appropriate to assess the patient's understanding of the purpose of the medication, another item takes priority in self-administration.
CORRECT. After demonstrating the technique for instilling ear medication, the nurse must ensure that the patient is physically capable of using the applicator.
INCORRECT. Although it is appropriate to make sure the patient understands the dosage instructions, the nurse's highest priority at this point is to ensure that the patient is capable of administering the medication.
INCORRECT. Although it is important that the patient be alert for signs of an allergic reaction, the patient's ability to recognize such signs does not pertain to self-administration of the medication—the technique that the nurse has just demonstrated for the patient.
5. To ensure proper distribution of ear medication after instillation, what will the nurse instruct an adult patient to do?
- Have a family member instill the medication
- Avoid contaminating the medication's applicator tip
- Instill the medication at the time ordered by the provider
- Instill the medication after gently pulling the ear up and back
INCORRECT. Having a family member instill the medication does not ensure its proper distribution.
INCORRECT. Avoiding contamination of the applicator tip is appropriate but has no bearing on distribution of the medication.
INCORRECT. Instilling the medication at the time ordered by the provider is appropriate but has no bearing on distribution of the medication.
CORRECT. Pulling the pinna up and back straightens the ear canal in an adult patient.
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