Optic, Otic, and Nasal administration

    • Optic, Otic, and Nasal administration
      • The major difficulty is in gaining children’s cooperation. Older children need only an explanation and direction. 
      • Although the administration of optic, otic, and nasal medication is not painful, these drugs can cause unpleasant sensations, which can be eliminated with various techniques.
      • Eyedrops and ointments
        • Techniques
          • One technique involves
            • Place the child supine or sitting with the head extended and ask the child to look up. 
            • Use one hand to pull the lower eyelid downward; the hand that holds the dropper rests on the head so that it may move synchronously with the child’s head, thus reducing the possibility of trauma to a struggling child or dropping medication on the face
            • When the lower eyelid is pulled down, a small conjunctival sac is formed; apply the solution or ointment to this area rather than directly on the eyeball
          • Another effective technique
            • To pull the lower eyelid down and out to form a cup effect, into which the medication is dropped. 
            • Gently close the eyelids to prevent expression of the medication. 
            • Wipe excess medication from the inner canthus outward to prevent contamination to the contralateral eye.
          • May be difficult to obtain cooperation from the child
            • To reduce unpleasant sensations when administering medication
              • Eye: Apply finger pressure to the lacrimal punctum at the inner aspect of the eyelid for 1 minute to prevent drainage of medication to the nasopharynx and the unpleasant “tasting” of the drug.
              • Ear: Allow medications stored in the refrigerator to warm to room temperature before instillation.
              • Nose: Position the child with the head hyperextended to prevent strangling sensations caused by medication trickling into the throat rather than up into the nasal passages
        • If both eye ointment and drops are ordered, give drops first, wait 3 minutes, and then apply the ointment to allow each drug to work.
        • When possible, administer eye ointments before bedtime or naptime because the child’s vision will be blurred temporarily.
      • Ears in children
        • Technique
          • Ear drops are instilled when the child is in the prone or supine position and the head turned to the appropriate side. 
          • For children younger than 3 years of age, the external auditory canal is straightened by gently pulling the pinna downward and straight back. 
          • The pinna is pulled upward and back in children older than 3 years age.
      • Nasal
        • Technique
          • Remove mucus prior to administration
          • Position the child with the head hyperextended.
          • Use a football hold for infants
            • Insert the tip into the naris vertically, then angle it prior to administration
            • Play games with younger children
      • Infection control concerns

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