Medication Administration Ear (Otic) Skill (See Skill 21.5 on p546 as well)

Why must drops and solutions instilled into the ear be sterile? To prevent loss of hearing Because a patient has an inflamed ear canal In case the eardrum is ruptured Because the ear is sterile

In case the eardrum is ruptured Although structures of the outer ear are not sterile, sterile drops and solutions must be used in case the eardrum is ruptured. Nonsterile solutions introduced into the middle ear may cause serious infection. Sterile solutions should always be used, even if there is no ear canal inflammation. Temporary hearing loss occurs until the medication is absorbed and is not related to the sterility of the medication.

After the nurse administers a prescribed otic medication into a patient, the patient reports feeling dizzy. What is the cause of the dizziness? Cerumen occluding the ear canal Repeated application of pressure to the tragus Keeping the patient in the recumbent position Administration of an otic medication that is cold

Administration of an otic medication that is cold Internal ear structures are very sensitive to temperature extremes; administer eardrops at room temperature. Instilling cold drops can cause vertigo (severe dizziness) or nausea and debilitate a patient for several minutes

The nurse planning to instill ear medication notices that the medication is cold. What is the most appropriate nursing action? Allow the ear drops to warm to room temperature. Instill the medication as it is. Heat the bottle of ear medication in the microwave. Omit the dose.

Allow the ear drops to warm to room temperature Medication may be warmed to room temperature per the organization's practice. Warming the medication prevents nausea and vertigo that may occur if the instilled medication is too cold. Cold medication may cause unnecessary discomfort for the patient. Using the microwave may overheat the medication and inactivate or destroy proteins. Overheated medication places the patient at risk for a burn. Omitting the dose is not an appropriate action.

Which action should the nurse take when instilling ear drops or solution into an adult's ear? Have the treated ear facing down Gently pull the pinna upward and outward Gently pull the pinna downward and backward Leave the ear in a neutral position

Gently pull the pinna upward and outward When administering ear medication for adults and children more than 3 years old, the nurse should have the treated ear facing up and gently pull the pinna upward and outward to straighten the ear canal. If the treated ear faces down, the medication will leak out and not be absorbed. The nurse should have the ear facing up and pull the pinna downward and backward for a child 3 years old or younger. Leaving the ear in a neutral position inhibits access to deeper external ear structures, whereas straightening the ear canal provides direct access.

Before instilling ear drops into an older adult's ear, the nurse notices excessive accumulation of cerumen in the outermost portion of the ear. What is the nurse's next action? Gently wipe out any cerumen with a cotton-tipped applicator. Use a cotton-tipped applicator to clean the inner ear canal. Instill the ear drops without manipulating the cerumen. Flush the ear with 0.9% sodium chloride solution to remove the cerumen.

Gently wipe out any cerumen with a cotton-tipped applicator. Gently wipe out any cerumen or drainage that occludes the outermost portion of the ear canal with a cotton-tipped applicator (Figure 3). Rationale: Cerumen and drainage harbor microorganisms and may block medication distribution. Do not use the cotton-tipped applicator to clean the ear canal because it may force wax inward, occluding the canal.

Which action should the nurse take when instilling ear drops? Insert the dropper far enough into the ear to occlude the ear canal. Hold the dropper above the ear canal. Use gentle force, if needed, to ensure that the entire dose has been delivered. Use a cotton-tipped applicator to hold the solution in the ear.

Hold the dropper above the ear canal. The nurse should instill prescribed drops while holding the dropper above the ear canal to prevent ear canal trauma from the dropper and allow for visualization of ear drop administration. Occluding the ear canal with the dropper during instillation may cause pressure in the canal and subsequent injury to the eardrum. The nurse should not use any force to instill ear drops. Forcefully instilling drops into an occluded canal can cause injury to the eardrum. Cotton-tipped applicators should not be used to keep medication in the ear canal.

In which position should the patient be placed for instillation of ear drops into the left ear? Dorsal recumbent position Semi-Fowler position Lying on the left side Lying on the right side

Lying on the right side Instruct the patient to assume a side-lying position (if not contraindicated by the patient's condition) with the ear to be treated facing up or have the patient sit in a chair or at the bedside with his or her head tilted. Stabilize the patient's head. Rationale: Appropriate positioning facilitates instillation. Stabilizing the head promotes safety while instilling medication with a dropper.

The nurse is teaching a parent how to instill ear drops into a 2-year-old child. Which method of straightening the child's ear canal is the correct one to teach this parent? Pull the pinna up and back. Pull the pinna up and forward. Pull the pinna down and back. Pull the pinna down and forward.

Pull the pinna down and back. Ensure that the parents, family members, or caregivers are competent in the proper method of administering ear drops (e.g., for children younger than 3 years old, gently pull the pinna of the ear downward and straight back)

After the nurse instills medication into the patient's ear, what should the patient do? Block the ear with his or her finger and apply moderate pressure. Turn his or her head to the other side immediately for more medication. Use a cotton-tipped applicator to keep the medication in the ear. Remain in a side-lying position.

Remain in a side-lying position Rationale: After the nurse administers ear drops or solution, the patient should remain in a side-lying position to allow the medication to be completely absorbed. Immediately turning the head may cause the instilled medication to drain out. Cotton-tipped applicators may cause damage to the eardrum. Attempting to block the ear with a finger to prevent medication from escaping is ineffective and may lead to increased pressure in the ear canal. The nurse should gently massage and apply light, not moderate, pressure to the tragus.

While administering a second dose of an otic medication, the nurse observes that the patient's tragus is red and swollen. Which action should the nurse take? Gently straighten the patient's ear canal. Continue to administer the medication as ordered. Withhold the medication and immediately notify the practitioner. Avoid pressing on the tragus after the medication is administered.

Withhold the medication and immediately notify the practitioner.