PYRAMID POINTS CHAPTER 64: OPHTHALMIC AND OTIC MEDICATIONS.

PYRAMID POINTSPYRAMID POINTS

CHAPTER 64:CHAPTER 64:

OPHTHALMIC AND OTIC OPHTHALMIC AND OTIC MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH:Ophthalmic and Otic Medications

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I. Ophthalmic Medication AdministrationI. Ophthalmic Medication Administration Guidelines administering eye medicationsGuidelines administering eye medications

• Wash hands and don glovesWash hands and don gloves

• If both eye drops and eye ointment are scheduled, If both eye drops and eye ointment are scheduled, administer the drops firstadminister the drops first

• Separate instillation by 3 to 5 minutes if two medications Separate instillation by 3 to 5 minutes if two medications are scheduledare scheduled

• Place medication in lower conjunctival sacPlace medication in lower conjunctival sac

• Apply gentle pressure to nasolacrimal duct for Apply gentle pressure to nasolacrimal duct for

30 seconds to 1 minute following administration of drops30 seconds to 1 minute following administration of drops

• If possible, administer ointment at bedtimeIf possible, administer ointment at bedtime



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II. Mydriatic, Cycloplegic, and Anticholinergic II. Mydriatic, Cycloplegic, and Anticholinergic MedicationsMedications DescriptionDescription

• Dilate pupils and relax muscles; contraindicated in glaucomaDilate pupils and relax muscles; contraindicated in glaucoma Side effects and toxicitiesSide effects and toxicities

• TachycardiaTachycardia• PhotophobiaPhotophobia• ConjunctivitisConjunctivitis• Elevated blood pressureElevated blood pressure• Atropine toxicity: dry mouth, blurred vision, tachycardia, urinary Atropine toxicity: dry mouth, blurred vision, tachycardia, urinary

retentionretention InterventionsInterventions

• Monitor for side effects and toxic effectsMonitor for side effects and toxic effects• Instruct client that a burning sensation may occur on instillationInstruct client that a burning sensation may occur on instillation



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III. Anti-infective Eye MedicationsIII. Anti-infective Eye Medications DescriptionDescription

• Kill or inhibit growth of bacteria, fungi, or virusesKill or inhibit growth of bacteria, fungi, or viruses

Side effectsSide effects• SuperinfectionSuperinfection

• Global irritationGlobal irritation

InterventionsInterventions• Advise client to contact the physician if improvement Advise client to contact the physician if improvement

does not occurdoes not occur



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IV. Anti-inflammatory Eye MedicationsIV. Anti-inflammatory Eye Medications DescriptionDescription

• Control inflammation of conjunctiva, cornea, and lidsControl inflammation of conjunctiva, cornea, and lids

Side effectsSide effects• CataractsCataracts

• Increased intraocular pressure Increased intraocular pressure

• Impaired healingImpaired healing

InterventionsInterventions• Advise client to contact the physician if improvement Advise client to contact the physician if improvement

does not occurdoes not occur



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V. Topical Anesthetics for the EyeV. Topical Anesthetics for the Eye DescriptionDescription

• Produce corneal anesthesiaProduce corneal anesthesia

Side effectsSide effects• Stinging and burning of the eyeStinging and burning of the eye

• Temporary loss of corneal reflexTemporary loss of corneal reflex

InterventionsInterventions• Corneal epithelium needs to be protectedCorneal epithelium needs to be protected

• Provide eye patch until corneal reflex returnsProvide eye patch until corneal reflex returns



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VI. Eye LubricantsVI. Eye Lubricants DescriptionDescription

• Used for keratitis, during anesthesia, with disorder that Used for keratitis, during anesthesia, with disorder that results in unconsciousness or decreased blinkingresults in unconsciousness or decreased blinking

Side effectsSide effects• Burning on instillationBurning on instillation

InterventionsInterventions• Inform conscious client that burning may occur on Inform conscious client that burning may occur on

instillationinstillation



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VII. MioticsVII. Miotics DescriptionDescription

• Constrict the pupilConstrict the pupil• Reduce intraocular pressureReduce intraocular pressure

Side effectsSide effects• HeadacheHeadache• Eye painEye pain• Decreased vision in poor lightDecreased vision in poor light

ToxicityToxicity• SyncopySyncopy• BradycardiaBradycardia• HypotensionHypotension



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continued …continued …

InterventionsInterventions• Assess risk for injuryAssess risk for injury

• Monitor for side effects and toxic effectsMonitor for side effects and toxic effects

• Instruct client to take medication exactly as prescribed Instruct client to take medication exactly as prescribed and not to stop medication because intraocular pressure and not to stop medication because intraocular pressure will increasewill increase



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VIII. Ocusert SystemVIII. Ocusert System DescriptionDescription

• Eye disk with a time-release dose of pilocarpineEye disk with a time-release dose of pilocarpine

• Disk is replaced every 7 daysDisk is replaced every 7 days

• Drawbacks include sudden leakage of pilocarpine, migration of Drawbacks include sudden leakage of pilocarpine, migration of the disk over the cornea, and unnoticed loss of systemthe disk over the cornea, and unnoticed loss of system

InterventionsInterventions• Assess client’s ability to insert diskAssess client’s ability to insert disk

• Inform client that temporary stinging is expected but to notify Inform client that temporary stinging is expected but to notify the physician if blurred vision or brow pain occursthe physician if blurred vision or brow pain occurs

• Instruct client to check for the presence of the disk in the Instruct client to check for the presence of the disk in the morning and at bedtimemorning and at bedtime



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IX. IX. -Adrenergic Blocking Eye Medications-Adrenergic Blocking Eye Medications DescriptionDescription

• Reduce intraocular pressure and decrease aqueous Reduce intraocular pressure and decrease aqueous humor productionhumor production

• Contraindicated in client with asthma or chronic Contraindicated in client with asthma or chronic obstructive pulmonary diseaseobstructive pulmonary disease

Side effectsSide effects• Ocular irritationOcular irritation

• BradycardiaBradycardia

• HypotensionHypotension

• BronchospasmBronchospasm



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InterventionsInterventions• Monitor apical pulse rate and blood pressureMonitor apical pulse rate and blood pressure

• Monitor for shortness of breath; contact physician if Monitor for shortness of breath; contact physician if shortness of breath occursshortness of breath occurs

• Instruct client to change positions slowly because of the Instruct client to change positions slowly because of the risk of orthostatic hypotensionrisk of orthostatic hypotension



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X. Carbonic Anhydrase InhibitorsX. Carbonic Anhydrase Inhibitors DescriptionDescription

• Decrease aqueous humor formation and intraocular Decrease aqueous humor formation and intraocular pressurepressure

• Contraindicated in client allergic to sulfonamides and Contraindicated in client allergic to sulfonamides and used with caution in the client with severe renal or liver used with caution in the client with severe renal or liver diseasedisease

Side effectsSide effects• ParesthesiasParesthesias• PolyuriaPolyuria• HypokalemiaHypokalemia• PhotosensitivityPhotosensitivity• DrowsinessDrowsiness



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InterventionsInterventions• Assess risk for injuryAssess risk for injury

• Monitor intake and outputMonitor intake and output

• Assess visual acuityAssess visual acuity

• Monitor for paresthesias and signs of hypokalemiaMonitor for paresthesias and signs of hypokalemia



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XI. Osmotic MedicationsXI. Osmotic Medications DescriptionDescription

• Lower intraocular pressure and are used in emergency Lower intraocular pressure and are used in emergency treatment of acute closed-angle glaucomatreatment of acute closed-angle glaucoma

Side effectsSide effects• HeadacheHeadache

• Gastrointestinal disturbancesGastrointestinal disturbances

• DisorientationDisorientation InterventionsInterventions

• Monitor for side effectsMonitor for side effects

• Assess for risk of injuryAssess for risk of injury

• Assist with monitoring effectiveness of medicationAssist with monitoring effectiveness of medication



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XII. Otic Medication AdministrationXII. Otic Medication Administration Instillation of ear dropsInstillation of ear drops

• In adult, pull pinna up and back In adult, pull pinna up and back • For infants and children younger than 3 years of age, pull For infants and children younger than 3 years of age, pull

lobe down and backlobe down and back• Tilt head in the opposite direction of affected ear and Tilt head in the opposite direction of affected ear and

apply dropsapply drops Irrigation of earIrrigation of ear

• Warm irrigating solution to 98Warm irrigating solution to 98 F F• Avoid irrigation if perforation of eardrum is suspectedAvoid irrigation if perforation of eardrum is suspected• Irrigate gently and direct solution toward wall of ear Irrigate gently and direct solution toward wall of ear

canal, not toward eardrumcanal, not toward eardrum



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XIII. Anti-infective Ear MedicationsXIII. Anti-infective Ear Medications DescriptionDescription

• Kill or inhibit growth of bacteria Kill or inhibit growth of bacteria

Side effectsSide effects• Overgrowth of nonsusceptible organismsOvergrowth of nonsusceptible organisms

InterventionsInterventions• Monitor for signs of superimposed infectionMonitor for signs of superimposed infection

• Instruct client to keep ear canals dryInstruct client to keep ear canals dry



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XIV. Antihistamines and DecongestantsXIV. Antihistamines and Decongestants DescriptionDescription

• Used for acute otitis mediaUsed for acute otitis media

• Reduce tissue hyperemia and edema to open obstructed Reduce tissue hyperemia and edema to open obstructed eustachian tubeseustachian tubes

Side effectsSide effects• DrowsinessDrowsiness

• Dry mucous membraneDry mucous membrane InterventionsInterventions

• Instruct client to avoid hazardous activities if drowsiness occurs Instruct client to avoid hazardous activities if drowsiness occurs

• Instruct client to increase fluid intake or suck on hard candy to Instruct client to increase fluid intake or suck on hard candy to alleviate dry mouthalleviate dry mouth



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XV. Local AnestheticsXV. Local Anesthetics DescriptionDescription

• Used for pain associated with ear infectionsUsed for pain associated with ear infections

Side effectsSide effects• IrritationIrritation

• Allergic reactionAllergic reaction

InterventionsInterventions• Monitor for irritation or allergic reactionMonitor for irritation or allergic reaction

• Monitor for pain reliefMonitor for pain relief



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XVI. Ceruminolytic MedicationsXVI. Ceruminolytic Medications DescriptionDescription

• Emulsify and loosen cerumen deposits Emulsify and loosen cerumen deposits

Side effectsSide effects• IrritationIrritation

• Redness or swelling of ear canalRedness or swelling of ear canal

InterventionsInterventions• Perform ear irrigation 30 minutes after instillation to Perform ear irrigation 30 minutes after instillation to

remove cerumenremove cerumen

• Inform client to notify physician if redness or swelling of Inform client to notify physician if redness or swelling of ear canal occursear canal occurs



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A A -adrenergic blocking agent has been prescribed for the client -adrenergic blocking agent has been prescribed for the client with glaucoma. The nurse monitoring this client for side effects with glaucoma. The nurse monitoring this client for side effects of the medication would place highest priority on noting which of of the medication would place highest priority on noting which of the following parameters?the following parameters?

1.1. Respiratory rate Respiratory rate

2.2. Oxygen saturation Oxygen saturation

3.3. Pulse rate Pulse rate

4.4. Blood glucose level Blood glucose level

PYRAMID POINTS CHAPTER 64: OPHTHALMIC AND OTIC MEDICATIONS.

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