ADMINISTERING EYEDROPS AND OINTMENTS
PRELIMINARIES
1. Wash your hands thoroughly, using the procedure. Then put on fresh gloves, if that is your office policy.
2. Instruct the patient to lie down or sit.
3. Inspect the patient's eyelids to determine if they require cleansing. Cleansing of eyelids is often needed in the morning or if the patient has had an eye pad or dressing. To cleanse the eyelids:
a. Tell the patient that you are going to clean the eyelids.
b. Remove and discard the eye pad or dressing, if any.
c. Moisten a sterile cotton ball with sterile ophthalmic saline solution and squeeze out any excess solution.
d. Instruct the patient to close both eyes completely without squeezing the lids.
e. Gently wipe the margins of the eyelids, moving from the inner to the outer canthus. Properly dispose of the used cotton ball.
f. Repeat if necessary, using a new sterile cotton ball each time.
4. Select the correct medication from the medications tray. It is best to set up the medications tray ahead of time to ensure that the correct medications will be available when needed.
a. Always read the label on the medication container to double-check that you have the right one.
b. Recheck the doctor's instructions to be sure you understand them and to make certain of the correct eye requiring medication.
c. If the medication to be instilled is a suspension, shake the container well to ensure that the drug is distributed consistently throughtout the liquid.
d. To maintain sterility when handling the medication, do not allow the inside edge of the bottle cap to contact any surface or objects other than the bottle.
5. Instruct the patient to open both eyes and look up. If the patient is seated, instrut him or her to tilt the head back.
6. Using the little finger of the hand that is holding the dropper or dispensing bottle, gently pull the lower lid down and out by exerting a downward pull over the skin of the cheekbone. This movement exposes the palpebral conjunctiva. Never apply direct pressure to the eyelids or eyeball.
INSTILLING EYEDROPS
1. Gently squeeze the bottle or dropper applicator between your thumb and forefinger to instill the correct amount of medication (usually a single drop) into the exposed conjunctival sac.
a. If necessary to control blinking, you may hold the patient's upper lid open by gently pulling upward, with the thumb or a finger of your other hand, the skin of the upper lid near the orbital rim.
b. If possible, avoid applying the medication directly to the cornea, because this is the most sensitive surface of the eye.
c. Be careful not to touch the dropper to the surface of the eye, the eyelashes, or any part of the patient's or your own skin. If this occurs, the applicator may become contaminated with potentially infectious matter, and the entire container of medication must be discarded to avoid the potential transfer of infection to others.
2. Instruct the patient to close both eyes gently while keeping the head in the same position.
3. Place your finger over the patient's lacrimal sac and apply light pressure for 15 seconds after instilling the medication. This action will prevent the drug from draining into the nose and throat. For hygienic reasons, some offices prefer that assistants place a tissue between their bare finger and the patient's lacrimal sac area.
4. Wipe any excess drops from the patient's skin with a fresh, dry cotton ball or tissue.
5. Dispose of contaminated gloves (if used) and eyedropper in the manner recommended in your office.
6. Record at the appropriate place in the patient's chart:
a. Medication and strength.
b. Number of drops instilled.
c. Time medication was administered.
d. Which eye received the medication.
APPLYING OINTMENTS:
Perform steps 1 through 6 of the section "Preliminaries" earlier in this box. Then continue with steps 1 through 4 below:
1. If the tube of ointment has been opened prior to this use, express 1 inch of ointment onto a fresh cotton ball, gauze, or tissue and discard it.
2. Squeezing the tube lightly and with even pressure, apply the ointment along the conjunctival surface of the lower lid, moving from the inner to the outer canthus. Usually 1/2 to 1 inch of ointment is enough. Avoid touching the tip of the tube to the eye, eyelashes, or skin to prevent contamination of the ointment tube.
3. Instruct the patient to close the eyes gently.
4. Wipe any excess ointment from the skin with a fresh cotton ball, gauze, or tissue; then discard it properly.
5. Record the application of ointment in the patient's chart, as described in step 6 under "Instilling Eyedrops" above.
PRELIMINARIES
1. Wash your hands thoroughly, using the procedure. Then put on fresh gloves, if that is your office policy.
2. Instruct the patient to lie down or sit.
3. Inspect the patient's eyelids to determine if they require cleansing. Cleansing of eyelids is often needed in the morning or if the patient has had an eye pad or dressing. To cleanse the eyelids:
a. Tell the patient that you are going to clean the eyelids.
b. Remove and discard the eye pad or dressing, if any.
c. Moisten a sterile cotton ball with sterile ophthalmic saline solution and squeeze out any excess solution.
d. Instruct the patient to close both eyes completely without squeezing the lids.
e. Gently wipe the margins of the eyelids, moving from the inner to the outer canthus. Properly dispose of the used cotton ball.
f. Repeat if necessary, using a new sterile cotton ball each time.
4. Select the correct medication from the medications tray. It is best to set up the medications tray ahead of time to ensure that the correct medications will be available when needed.
a. Always read the label on the medication container to double-check that you have the right one.
b. Recheck the doctor's instructions to be sure you understand them and to make certain of the correct eye requiring medication.
c. If the medication to be instilled is a suspension, shake the container well to ensure that the drug is distributed consistently throughtout the liquid.
d. To maintain sterility when handling the medication, do not allow the inside edge of the bottle cap to contact any surface or objects other than the bottle.
5. Instruct the patient to open both eyes and look up. If the patient is seated, instrut him or her to tilt the head back.
6. Using the little finger of the hand that is holding the dropper or dispensing bottle, gently pull the lower lid down and out by exerting a downward pull over the skin of the cheekbone. This movement exposes the palpebral conjunctiva. Never apply direct pressure to the eyelids or eyeball.
INSTILLING EYEDROPS
1. Gently squeeze the bottle or dropper applicator between your thumb and forefinger to instill the correct amount of medication (usually a single drop) into the exposed conjunctival sac.
a. If necessary to control blinking, you may hold the patient's upper lid open by gently pulling upward, with the thumb or a finger of your other hand, the skin of the upper lid near the orbital rim.
b. If possible, avoid applying the medication directly to the cornea, because this is the most sensitive surface of the eye.
c. Be careful not to touch the dropper to the surface of the eye, the eyelashes, or any part of the patient's or your own skin. If this occurs, the applicator may become contaminated with potentially infectious matter, and the entire container of medication must be discarded to avoid the potential transfer of infection to others.
2. Instruct the patient to close both eyes gently while keeping the head in the same position.
3. Place your finger over the patient's lacrimal sac and apply light pressure for 15 seconds after instilling the medication. This action will prevent the drug from draining into the nose and throat. For hygienic reasons, some offices prefer that assistants place a tissue between their bare finger and the patient's lacrimal sac area.
4. Wipe any excess drops from the patient's skin with a fresh, dry cotton ball or tissue.
5. Dispose of contaminated gloves (if used) and eyedropper in the manner recommended in your office.
6. Record at the appropriate place in the patient's chart:
a. Medication and strength.
b. Number of drops instilled.
c. Time medication was administered.
d. Which eye received the medication.
APPLYING OINTMENTS:
Perform steps 1 through 6 of the section "Preliminaries" earlier in this box. Then continue with steps 1 through 4 below:
1. If the tube of ointment has been opened prior to this use, express 1 inch of ointment onto a fresh cotton ball, gauze, or tissue and discard it.
2. Squeezing the tube lightly and with even pressure, apply the ointment along the conjunctival surface of the lower lid, moving from the inner to the outer canthus. Usually 1/2 to 1 inch of ointment is enough. Avoid touching the tip of the tube to the eye, eyelashes, or skin to prevent contamination of the ointment tube.
3. Instruct the patient to close the eyes gently.
4. Wipe any excess ointment from the skin with a fresh cotton ball, gauze, or tissue; then discard it properly.
5. Record the application of ointment in the patient's chart, as described in step 6 under "Instilling Eyedrops" above.
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