installation nasal drop

1. Instilling Nose Drops
Presented By
Mrs.Usha Rani Kandula, MSc(N),
Assistant professor in Adult health nursing, Department of Clinical nursing,
Arsi University, College of health sciences, Asella, Ethiopia, Institutional email:
usharani2020@arsiun.edu.et.

2. NASAL INSTILLATIONS
-Nasal instillations can be performed with different preparations: drops
or nebulizers (atomizer or aerosol).
-Nasal drugs are administered to produce one or more of the following
effects: to shrink swollen mucous membranes, to loosen secretions
and facilitate drainage, to treat infections of the nasal cavity or sinuses.
-Because many of these products are non-prescription drugs, clients
should be taught their correct usage.

3. -For example, nasal decongestants are common over-the-counter
drugs used to shrink swollen mucous membranes; however, when
these drugs mare used in excess, they may have a reverse or rebound
effect by increasing nasal congestion.
-The nasal sinuses (frontal, ethmoid, maxillary, and sphenoid sinuses)
communicate with the nasal fossae and are lined with mucous
membranes similar to those that line the nose.
-Nose drops can be instilled to remain in the nasal passage, to reach
the ethmoid and sphenoid sinuses, or to reach the frontal or maxillary
sinuses.

4. - Location is determined by the degree of hyperextension and position
of the head during instillation.
-Although the nose is considered a clean (not sterile) cavity, because
of its connection with the sinuses, the nurse uses medical asepsis
when performing nasal instillations.
-Nebulizers (inhalers) are used to deliver a fine mist containing
medication droplets.

5. The nurse should administer or assist clients with the usage of
atomizers and aerosols:
• Instruct the client to clear the nostrils by blowing the nose.
• Client should be in an upright position with head tilted back slightly.

6. Atomizer
• Occlude one nostril to prevent air from entering the nasal cavity and
to allow the medication to flow freely in the open nostril.
• Insert the atomizer tip into the open nostril and instruct the client to
inhale, then squeeze the atomizer once, and instruct the client to
exhale.

7. Aerosol
• Shake the aerosol well before each use.
• Grasp between thumb and index finger and insert the adapter tip into
one nostril while occluding the other nostril with a finger, then press the
adapter cartridge firmly to release one measured dose of medication.
• Repeat the above steps as ordered for the other nostril.
• Instruct the client to keep head tilted backward for 2 to 3 minutes and
to breathe through the nose while the medication is being absorbed.
-When the client is discharged with a nasal inhaler, the nurse should
teach the client how to store and use the device.

8. TEACH USE OF RESPIRATORY INHALANTS
-Respiratory inhalants are delivered by devices that produce fine
droplets that are inhaled deep into the respiratory tract.
-These medication droplets are absorbed almost immediately through
the alveolar epithelium into the bloodstream.
-Oropharyngeal hand-held inhalers deliver medications that produce
both local and systemic effects, such as bronchodilators and
mucolytics.
-Bronchodilators improve airway patency and are used to prevent or
treat bronchospasms, asthma, and allergic reactions.

9. -Mucolytics are used to liquify tenacious (thick) bronchial secretions.
-There are three types of oropharyngeal hand-held inhalers: metered-
dose inhaler, turbo-inhaler, and the nasal inhaler (previously
discussed).
-Clients must be able to form an airtight seal around the inhaling
devices and be able to assemble the turbo inhaler.
-This requirement prevents some clients, such as clients with visual or
coordination impairments, from using these devices.

10. -Bronchodilators are contraindicated in clients who have a history of
tachycardia.
-The nurse should ensure that the client knows how to use the inhaler
correctly so that the prescribed medication dose is delivered.
-A metered-dose inhaler delivers a measured dose of the medication
with each push of the canister.
-The nurse needs to evaluate the client’s ability to adequately
compress the inhaler to deliver a full dose and to inhale at the same
time as the dose is expressed.

11. - Failure to do either could prevent the client from receiving the full
benefit of the inhaler.
-The ability to compress the inhaler for dose delivery can be affected
by hand strength (which diminishes with age), flexibility (as in arthritic
changes), and disease related to weakness (such as chronic
respiratory disease).
-Careful discharge instructions and observation of the client performing
the task are important to continued therapeutic effect at home (see the
accompanying display for home care application).

12. Equipment
 Medication administration record (MAR)
 Medication with dropper
 Emesis basin (optional)
 Non sterile gloves
 Tissue

13. Sl.No Action Rationale
1 Check with the client and chart for any
known allergies.
Prevents the occurrence of
hypersensitivity
reactions.
2 Check the MAR against health care
practitioner’s written order.
Ensures accuracy in identification of
medication.
3 Wash hands. Reduces transfer of microorganisms.
4 Check client’s identification armband. Accurately identifies client.
5 Explain the procedure to the client and
provide privacy.
Reduces anxiety and enhances
collaboration.
6 Instruct client to blow nose unless
contraindicated by client condition
(such as recent nosebleed).
Removes mucus and secretions that
might block medication absorption.

14. Sl.No Action Rationale
7 Explain that the client may feel a
burning sensation to the mucosa or a
choking sensation, or both, as the drop
trickles back into the throat.
Understanding what to expect reduces
anxiety
and enhances cooperation.
8 Place the client in a supine position
and hyperextend the neck.
-Position the head to the site that
facilitates the drops’ reaching the
expected site,
-as shown in Figure 29-36.
Proper position provides access to
passages and helps medication reach the
appropriate site.
9 Instruct the client to breathe through
his or her mouth.
Helps prevent aspiration of drops into the
lungs.
10 Squeeze some medication into the
dropper.

15. Sl.No Action Rationale
11 -Insert the nasal drops about 3/8 inch
into nostril, keeping the tip of the
dropper away from the sides of the
nares.
-Instill the prescribed dosage of
medication and observe the client for
signs of discomfort.
Prevents contamination of the dropper.
12 -Instruct the client to remain supine for
5 minutes.
Prevents medication from leaking out of
the
nose prematurely.
13 -Discard any unused medication
remaining in the bottle.
Prevents contamination of inmedication in
the
the dropper.
14 -Return the client to a comfortable
position and provide the client with the
emesis basin and tissue to expectorate
Restores client comfort.

17. Sl.No Action Rationale
15 Remove gloves and wash hands. Reduces spread of microorganisms.
16 Record on the MAR the drug given,
number of drops instilled, and nostril
medicated.
Provides documentation that the
medication
was given.
17 Observe the patient for side effects for
30 minutes after administration.
Drugs given onto the mucosa can be
systemically absorbed, causing an
adverse reaction.
Thanking you