Transcript eyeearmeds

OPHTHALMIC AND
OTIC MEDICATIONS
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness.
Philadelphia: W.B. Saunders.
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.
PYRAMID POINTS
• Actions, side effects, contraindications, and
nursing considerations when administering eye
and ear medications
• Procedure for administering eye and ear drops
• Procedure for irrigation of an ear
• Client education regarding prescribed
medications
ADMINISTERING OPHTHALMIC MEDICATIONS
• Place prescribed dose of eye medication in the
lower conjunctival sac, never directly onto the
cornea
• Avoid touching any part of the eye with the dropper
or applicator
• Administer drops or liquid preparations before
ointments
• Administer glucocorticoid preparations before
other medications
• When two or more eye medications are to be
administered, wait at least 3 minutes between
medications
ADMINISTERING OPHTHALMIC MEDICATIONS
• To prevent overflow of medication into the nasal
and pharyngeal passages, thus reducing systemic
absorption, occlude the nasolacrimal duct with one
finger for 1 to 2 minutes after instilling the
medication
• Monitor the pulse of the client receiving an
ophthalmic beta-blocker and instruct the client to
do the same; if the pulse is below 50 to 60 beats
per minute (adult), withhold the next dose of eye
medication and notify the physician
ADMINISTERING OPHTHALMIC MEDICATIONS
• CLIENT INSTRUCTIONS
– How to instill medication correctly; supervise
instillation until the client can do it safely
– Avoid driving or operating hazardous equipment
if vision is blurred
– Wear sunglasses and avoid bright lights if
photophobia occurs
– Administer a missed dose of the eye medication
as soon as remembered, unless the next dose is
scheduled to be administered in 1 to 2 hours
ADMINISTERING OPHTHALMIC MEDICATIONS
• CLIENT INSTRUCTIONS
– Report the development of any eye irritation
– Inform the client using eye gel to store the gel at
room temperature or in the refrigerator but not
to freeze it; discard unused eye gel kept at room
temperature after 8 weeks
ADMINISTERING OPHTHALMIC MEDICATIONS
• CLIENT INSTRUCTIONS
– Soft contact lenses may absorb certain eye
medications and that preservatives in eye
medications may discolor the contact lenses
– In infants, inform the parents that atropine
sulfate eye drops may contribute to abdominal
distention; the parents should keep a record of
the bowel movements of the infant
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• DESCRIPTION
– Mydriatics and cycloplegics dilate the pupils
(mydriasis) and relax the ciliary muscles
(cycloplegia)
– Anticholinergics block responses of the
sphincter muscle in the ciliary body, producing
mydriasis and cycloplegia
– Used preoperatively or for eye examinations to
produce mydriasis
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• DESCRIPTION
– Contraindicated in clients with glaucoma
because of the risk of increased intraocular
pressure
– Mydriatics are contraindicated in cardiac
dysrhythmias and cerebral atherosclerosis and
should be used with caution in the elderly and
in clients with prostatic hypertrophy, diabetes
mellitus, or parkinsonism
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• SIDE EFFECTS
– Tachycardia
– Photophobia
– Conjunctivitis
– Dermatitis
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• ATROPINE TOXICITY
– Dry mouth
– Blurred vision
– Photophobia
– Tachycardia
– Fever
– Urinary retention
– Constipation
– Headache, brow pain
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• SYSTEMIC REACTIONS OF ANTICHOLINERGICS
– Dry mouth and skin
– Fever
– Thirst
– Confusion
– Hyperactivity
MYDRIATIC, CYCLOPLEGIC AND
ANTICHOLINERGIC MEDICATIONS
• IMPLEMENTATION
– Monitor for allergic response
– Assess for risk of injury
– Assess for constipation and urinary retention
– Instruct the client that a burning sensation
may occur on instillation
MYDRIATIC, CYCLOPLEGIC, AND
ANTICHOLINERGIC MEDICATIONS
• IMPLEMENTATION
– Instruct the client not to drive or operate
machinery for 24 hours after instillation of the
medication unless otherwise directed by the
physician
– Instruct the client to wear sunglasses until the
effects of the medication wear off
– Instruct the client to notify the physician if
blurring of vision, loss of sight, difficulty
breathing, sweating, or flushing occurs
– Instruct the client to report eye pain to the
physician
ANTIINFECTIVE EYE MEDICATIONS
• DESCRIPTION
– Kill or inhibit the growth of bacteria, fungi, and
viruses
• SIDE EFFECTS
– Superinfection
– Global irritation
ANTIINFLAMMATORY EYE MEDICATIONS
• DESCRIPTION
– Control inflammation, thereby reducing vision
loss and scarring
– Used for uveitis, allergic conditions, and
inflammation of the conjunctiva, cornea, and
lids
• SIDE EFFECTS
– Cataracts
– Increased intraocular pressure
– Impaired healing
– Mask the signs and symptoms of infection
ANTIINFECTIVE AND ANTIINFLAMMATORY EYE
MEDICATIONS
• IMPLEMENTATION
– Assess for risk of injury
– Instruct the client how to apply the eye
medication
– Instruct the client to continue treatment as
prescribed
– Instruct the client to wash hands thoroughly
and frequently
– Advise the client to notify the physician if
improvement does not occur
TOPICAL ANESTHETICS
• DESCRIPTION
– Produce corneal anesthesia
– Used for anesthesia for eye examinations,
surgery, or to remove foreign bodies from the
eye
• SIDE EFFECTS
– Temporary stinging or burning of the eye
– Temporary loss of corneal reflex
TOPICAL ANESTHETICS
• IMPLEMENTATION
– Assess for risk of injury
– Note that the medications should not be given
to the client for home use and are not to be
self-administered by the client
– Note that the blink reflex is temporarily lost
and that the corneal epithelium needs to be
protected
– Provide an eye patch to protect the eye from
injury until the corneal reflex returns
EYE LUBRICANTS
• DESCRIPTION
– Replace tears or add moisture to the eyes
– Moisten contact lenses or an artificial eye
– Protect the eyes during surgery or diagnostic
procedures
– Used for keratitis, during anesthesia, or in a
disorder that results in unconsciousness or
decreased blinking
EYE LUBRICANTS
• SIDE EFFECTS
– Burning on instillation
– Discomfort or pain on instillation
• IMPLEMENTATION
– Inform the client that burning may occur on
instillation
– Be alert to allergic responses to the
preservatives in the lubricants
MIOTICS
• DESCRIPTION
– Reduce intraocular pressure
– Used for chronic open-angle glaucoma or
acute and chronic closed-angle glaucoma
– Used to achieve miosis during eye surgery
– Contraindicated in clients with retinal
detachment, adhesions between the iris and
lens, or in inflammatory diseases
MIOTICS
• SIDE EFFECTS
– Myopia
– Headache
– Eye pain
– Decreased vision in poor light
– Local irritation
MIOTICS
• SYSTEMIC EFFECTS
– Flushing
– Diaphoresis
– GI upset and diarrhea
– Frequent urination
– Increased salivation
– Muscle weakness
– Respiratory difficulty
MIOTICS
• TOXICITY
– Vertigo and syncope
– Bradycardia
– Hypotension
– Cardiac dysrhythmias
– Tremors
– Seizures
MIOTICS
• IMPLEMENTATION
– Assess vital signs
– Assess for risk of injury
– Assess the client for the degree of diminished
vision
– Monitor for side effects and toxic effects
– Monitor for postural hypotension and instruct
the client to change positions slowly
MIOTICS
• IMPLEMENTATION
– Assess breath sounds for rales and rhonchi
because miotic cholinergic medications can
cause bronchospasms and increased
bronchial secretions
– Maintain oral hygiene because of the increase
in salivation
– Have atropine sulfate available as an antidote
for pilocarpine
– Instruct the client or family regarding the
correct administration of eye medications
MIOTICS
• IMPLEMENTATION
– Instruct the client not to stop the medication
suddenly
– Instruct the client to avoid activities such as
driving while vision is impaired
– Instruct clients with glaucoma to read labels
on over-the-counter medications and to avoid
atropine-like medications because atropine will
increase intraocular pressure
OCUSERT SYSTEM
• DESCRIPTION
– Ocusert is a thin eye wafer (disk) impregnated
with time-release pilocarpine
– It is placed in the upper or lower cul-de-sac of
the eye
– The pilocarpine is released over 1 week
– The disk is replaced every 7 days
– Drawbacks of its use include sudden leakage
of pilocarpine, migration of the system over
the cornea, and unnoticed loss of the system
OCUSERT SYSTEM
From Jeglleon El. Ocular Therapeutics. Nursing Clinic of North America 16 (3): 456, 1981.
OCUSERT SYSTEM
• IMPLEMENTATION
– Assess the client’s ability to insert the
medication disk
– Store the medication in the refrigerator
– Instruct the client to discard damaged or
contaminated disks
OCUSERT SYSTEM
• IMPLEMENTATION
– Inform the client that temporary stinging is
expected but to notify the physician if blurred
vision or brow pain occurs
– Instruct the client to check for the presence of
the disk in the conjunctival sac daily at
bedtime and upon arising
– Since vision may change in the first few hours
after the eye system is inserted, instruct the
client to replace the disk at bedtime
BETA-ADRENERGIC BLOCKING EYE
MEDICATIONS
• DESCRIPTION
– Reduce intraocular pressure
– Used to treat chronic open-angle glaucoma
– Contraindicated in the client with asthma
because systemic absorption can cause
increased airway resistance
– Used with caution in the client receiving oral
beta-blockers
BETA-ADRENERGIC BLOCKING EYE
MEDICATIONS
• SIDE EFFECTS
– Ocular irritation
– Visual disturbances
– Bradycardia
– Hypotension
– Bronchospasm
BETA-ADRENERGIC BLOCKING EYE
MEDICATIONS
• IMPLEMENTATION
– Monitor vital signs, especially blood pressure
and pulse before administering medication
– If the pulse is 60 or below or if the systolic
blood pressure is below 90 mm Hg (adult),
withhold the medication and contact the
physician
– Monitor for shortness of breath
– Assess for risk of injury
BETA-ADRENERGIC BLOCKING EYE
MEDICATIONS
• IMPLEMENTATION
– Monitor I&O
– Instruct the client to notify the physician if
shortness of breath occurs
– Instruct the client not to discontinue the
medication abruptly
– Instruct the client to change positions slowly
to avoid orthostatic hypotension
– Instruct the client to avoid hazardous activities
– Instruct the client to avoid over-the-counter
medications without the physician’s approval
CARBONIC ANHYDRASE INHIBITORS
• DESCRIPTION
– Interfere with the production of carbonic acid,
which leads to decreased aqueous humor
formation and decreased intraocular pressure
– Used for long-term treatment of open-angle
glaucoma
– Contraindicated in the client allergic to
sulfonamides
CARBONIC ANHYDRASE INHIBITORS
• SIDE EFFECTS
– Appetite loss and gastrointestinal upset
– Paresthesias in the fingers, toes, and face
– Polyuria
– Hypokalemia
– Renal calculi
– Photosensitivity
– Lethargy and drowsiness
– Depression
CARBONIC ANHYDRASE INHIBITORS
• IMPLEMENTATION
– Monitor vital signs
– Assess visual acuity and the risk of injury
– Monitor I&O and weight
– Maintain oral hygiene and increase fluid intake
unless contraindicated
– Monitor electrolytes for hypokalemia
CARBONIC ANHYDRASE INHIBITORS
• IMPLEMENTATION
– Advise the client to avoid prolonged exposure to
sunlight
– Encourage the use of artificial tears for dry eyes
– Instruct the client not to discontinue the
medication abruptly
– Instruct the client to avoid hazardous activities
while vision is impaired
OSMOTIC MEDICATIONS
• DESCRIPTION
– Lower intraocular pressure
– Used in emergency treatment of acute closedangle glaucoma
– Used preoperatively and postoperatively to
decrease vitreous humor volume
OSMOTIC MEDICATIONS
• SIDE EFFECTS
– Headache
– Nausea, vomiting, diarrhea
– Disorientation
– Electrolyte imbalances
OSMOTIC MEDICATIONS
• IMPLEMENTATION
– Assess vital signs
– Assess visual acuity and the risk of injury
– Monitor I&O and weight
– Monitor for electrolyte imbalances
– Increase fluid intake unless contraindicated
– Monitor for changes in level of orientation
OTIC MEDICATION ADMINISTRATION
• ADMINISTERING DROPS
– In an adult, pull the pinna up and back to
straighten the external canal to instill ear
drops
– Pull the pinna down and back for infants and
children younger than 3 years of age; up and
back for older children
OTIC MEDICATION ADMINISTRATION
• IRRIGATION OF THE EAR
– Irrigation of the ear needs to be prescribed by the
physician
– Ensure that there is direct visualization of the
tympanic membrane
– Warm irrigating solution to 100° F because
solutions that are not close to the client’s body
temperature will cause ear injury, nausea, and
vertigo
OTIC MEDICATION ADMINISTRATION
• IRRIGATION OF THE EAR
– Irrigation must be done gently to avoid
damage to the eardrum
– When irrigating, do not direct irrigation
solution directly toward the eardrum
– If a perforation of the eardrum is suspected,
irrigation is not done
ANTIINFECTIVE EAR MEDICATIONS
• DESCRIPTION
– Kill or inhibit the growth of bacteria
– Used for otitis media or otitis externa
– Contraindicated if a prior hypersensitivity
exists
• SIDE EFFECT
– Overgrowth of nonsusceptible organisms
ANTIINFECTIVE EAR MEDICATIONS
• IMPLEMENTATION
– Monitor vital signs
– Assess for allergies
– Assess for ear pain
– Monitor for nephrotoxicity
– Instruct the client to report dizziness, fatigue,
fever, or sore throat, which may be indicative
of a superimposed infection
– Instruct the client to complete the entire
course of the medication
– Instruct the client to keep ear canals dry
ANTIHISTAMINES AND DECONGESTANTS
• DESCRIPTION
– Produce vasoconstriction
– Stimulate the receptors of the respiratory
mucosa
– Reduce respiratory tissue hyperemia and
edema to open obstructed eustachian tubes
– Used for acute otitis media
ANTIHISTAMINES AND DECONGESTANTS
• SIDE EFFECTS
– Drowsiness
– Blurred vision
– Dry mucous membranes
ANTIHISTAMINES AND DECONGESTANTS
• IMPLEMENTATION
– Inform the client that drowsiness, blurred
vision, and a dry mouth may occur
– Instruct the client to increase fluid intake
unless contraindicated and to suck on hard
candy to alleviate a dry mouth
– Instruct the client to avoid hazardous activities
if drowsiness occurs
LOCAL EAR ANESTHETICS
• DESCRIPTION
– Block nerve conduction at or near the
application site to control pain
– Used for pain associated with ear infections
• SIDE EFFECTS
– Allergic reaction
– Irritation
• IMPLEMENTATION
– Monitor for effectiveness if used for pain relief
– Assess for irritation or allergic reaction
CERUMINOLYTIC MEDICATIONS
• DESCRIPTION
– Emulsify and loosen cerumen deposits
– Used to loosen and remove impacted wax from
the ear canal
• SIDE EFFECTS
– Irritation
– Redness or swelling of the ear canal
CERUMINOLYTIC MEDICATIONS
• IMPLEMENTATION
– Instruct the client not to use drops more often
than prescribed
– Moisten a cotton plug with medication before
insertion
– Keep the container tightly closed and away
from moisture
– Avoid touching the ear with the dropper
CERUMINOLYTIC MEDICATIONS
• IMPLEMENTATION
– Thirty minutes after instillation, gently irrigate
the ear as prescribed with warm water using a
soft rubber bulb ear syringe
– Irrigation may be done with hydrogen peroxide
solution as prescribed, to flush cerumen
deposits out of the ear canal
– For a chronic cerumen impaction, 1 to 2 drops
of mineral oil will soften the wax
– Instruct the client to notify physician if
redness, pain, or swelling persists