1. PYRAMID POINTS CHAPTER 64: OPHTHALMIC AND OTIC MEDICATIONS

2. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-2 PYRAMID POINTS I. Ophthalmic Medication Administration  Guidelines administering eye medications Wash hands and don gloves Wash hands and don gloves If both eye drops and eye ointment are scheduled, administer the drops first If both eye drops and eye ointment are scheduled, administer the drops first Separate instillation by 3 to 5 minutes if two medications are scheduled Separate instillation by 3 to 5 minutes if two medications are scheduled Place medication in lower conjunctival sac Place 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 drops If possible, administer ointment at bedtime If possible, administer ointment at bedtime

3. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-3 PYRAMID POINTS II. Mydriatic, Cycloplegic, and Anticholinergic Medications  Description Dilate pupils and relax muscles; contraindicated in glaucoma Dilate pupils and relax muscles; contraindicated in glaucoma  Side effects and toxicities Tachycardia Tachycardia Photophobia Photophobia Conjunctivitis Conjunctivitis Elevated blood pressure Elevated blood pressure Atropine toxicity: dry mouth, blurred vision, tachycardia, urinary retention Atropine toxicity: dry mouth, blurred vision, tachycardia, urinary retention  Interventions Monitor for side effects and toxic effects Monitor for side effects and toxic effects Instruct client that a burning sensation may occur on instillation Instruct client that a burning sensation may occur on instillation

4. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-4 PYRAMID POINTS III. Anti-infective Eye Medications  Description Kill or inhibit growth of bacteria, fungi, or viruses Kill or inhibit growth of bacteria, fungi, or viruses  Side effects Superinfection Superinfection Global irritation Global irritation  Interventions Advise client to contact the physician if improvement does not occur Advise client to contact the physician if improvement does not occur

5. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-5 PYRAMID POINTS IV. Anti-inflammatory Eye Medications  Description Control inflammation of conjunctiva, cornea, and lids Control inflammation of conjunctiva, cornea, and lids  Side effects Cataracts Cataracts Increased intraocular pressure Increased intraocular pressure Impaired healing Impaired healing  Interventions Advise client to contact the physician if improvement does not occur Advise client to contact the physician if improvement does not occur

6. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-6 PYRAMID POINTS V. Topical Anesthetics for the Eye  Description Produce corneal anesthesia Produce corneal anesthesia  Side effects Stinging and burning of the eye Stinging and burning of the eye Temporary loss of corneal reflex Temporary loss of corneal reflex  Interventions Corneal epithelium needs to be protected Corneal epithelium needs to be protected Provide eye patch until corneal reflex returns Provide eye patch until corneal reflex returns

7. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-7 PYRAMID POINTS VI. Eye Lubricants  Description Used for keratitis, during anesthesia, with disorder that results in unconsciousness or decreased blinking Used for keratitis, during anesthesia, with disorder that results in unconsciousness or decreased blinking  Side effects Burning on instillation Burning on instillation  Interventions Inform conscious client that burning may occur on instillation Inform conscious client that burning may occur on instillation

8. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-8 PYRAMID POINTS VII. Miotics  Description Constrict the pupil Constrict the pupil Reduce intraocular pressure Reduce intraocular pressure  Side effects Headache Headache Eye pain Eye pain Decreased vision in poor light Decreased vision in poor light  Toxicity Syncopy Syncopy Bradycardia Bradycardia Hypotension Hypotension

9. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-9 PYRAMID POINTS continued …  Interventions Assess risk for injury Assess risk for injury Monitor for side effects and toxic effects Monitor for side effects and toxic effects Instruct client to take medication exactly as prescribed and not to stop medication because intraocular pressure will increase Instruct client to take medication exactly as prescribed and not to stop medication because intraocular pressure will increase

10. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-10 PYRAMID POINTS VIII. Ocusert System  Description Eye disk with a time-release dose of pilocarpine Eye disk with a time-release dose of pilocarpine Disk is replaced every 7 days Disk is replaced every 7 days Drawbacks include sudden leakage of pilocarpine, migration of the disk over the cornea, and unnoticed loss of system Drawbacks include sudden leakage of pilocarpine, migration of the disk over the cornea, and unnoticed loss of system  Interventions Assess client’s ability to insert disk Assess client’s ability to insert disk Inform client that temporary stinging is expected but to notify the physician if blurred vision or brow pain occurs Inform client that temporary stinging is expected but to notify the physician if blurred vision or brow pain occurs Instruct client to check for the presence of the disk in the morning and at bedtime Instruct client to check for the presence of the disk in the morning and at bedtime

11. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-11 PYRAMID POINTS IX.  -Adrenergic Blocking Eye Medications  Description Reduce intraocular pressure and decrease aqueous humor production Reduce intraocular pressure and decrease aqueous humor production Contraindicated in client with asthma or chronic obstructive pulmonary disease Contraindicated in client with asthma or chronic obstructive pulmonary disease  Side effects Ocular irritation Ocular irritation Bradycardia Bradycardia Hypotension Hypotension Bronchospasm Bronchospasm

12. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-12 PYRAMID POINTS continued …  Interventions Monitor apical pulse rate and blood pressure Monitor apical pulse rate and blood pressure Monitor for shortness of breath; contact physician if shortness of breath occurs Monitor for shortness of breath; contact physician if shortness of breath occurs Instruct client to change positions slowly because of the risk of orthostatic hypotension Instruct client to change positions slowly because of the risk of orthostatic hypotension

13. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-13 PYRAMID POINTS X. Carbonic Anhydrase Inhibitors  Description Decrease aqueous humor formation and intraocular pressure Decrease aqueous humor formation and intraocular pressure Contraindicated in client allergic to sulfonamides and used with caution in the client with severe renal or liver disease Contraindicated in client allergic to sulfonamides and used with caution in the client with severe renal or liver disease  Side effects Paresthesias Paresthesias Polyuria Polyuria Hypokalemia Hypokalemia Photosensitivity Photosensitivity Drowsiness Drowsiness

14. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-14 PYRAMID POINTS continued …  Interventions Assess risk for injury Assess risk for injury Monitor intake and output Monitor intake and output Assess visual acuity Assess visual acuity Monitor for paresthesias and signs of hypokalemia Monitor for paresthesias and signs of hypokalemia

15. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-15 PYRAMID POINTS XI. Osmotic Medications  Description Lower intraocular pressure and are used in emergency treatment of acute closed-angle glaucoma Lower intraocular pressure and are used in emergency treatment of acute closed-angle glaucoma  Side effects Headache Headache Gastrointestinal disturbances Gastrointestinal disturbances Disorientation Disorientation  Interventions Monitor for side effects Monitor for side effects Assess for risk of injury Assess for risk of injury Assist with monitoring effectiveness of medication Assist with monitoring effectiveness of medication

16. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-16 PYRAMID POINTS XII. Otic Medication Administration  Instillation 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 lobe down and back For infants and children younger than 3 years of age, pull lobe down and back Tilt head in the opposite direction of affected ear and apply drops Tilt head in the opposite direction of affected ear and apply drops  Irrigation of ear Warm irrigating solution to 98  F Warm irrigating solution to 98  F Avoid irrigation if perforation of eardrum is suspected Avoid irrigation if perforation of eardrum is suspected Irrigate gently and direct solution toward wall of ear canal, not toward eardrum Irrigate gently and direct solution toward wall of ear canal, not toward eardrum

17. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-17 PYRAMID POINTS XIII. Anti-infective Ear Medications  Description Kill or inhibit growth of bacteria Kill or inhibit growth of bacteria  Side effects Overgrowth of nonsusceptible organisms Overgrowth of nonsusceptible organisms  Interventions Monitor for signs of superimposed infection Monitor for signs of superimposed infection Instruct client to keep ear canals dry Instruct client to keep ear canals dry

18. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-18 PYRAMID POINTS XIV. Antihistamines and Decongestants  Description Used for acute otitis media Used for acute otitis media Reduce tissue hyperemia and edema to open obstructed eustachian tubes Reduce tissue hyperemia and edema to open obstructed eustachian tubes  Side effects Drowsiness Drowsiness Dry mucous membrane Dry mucous membrane  Interventions 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 alleviate dry mouth Instruct client to increase fluid intake or suck on hard candy to alleviate dry mouth

19. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-19 PYRAMID POINTS XV. Local Anesthetics  Description Used for pain associated with ear infections Used for pain associated with ear infections  Side effects Irritation Irritation Allergic reaction Allergic reaction  Interventions Monitor for irritation or allergic reaction Monitor for irritation or allergic reaction Monitor for pain relief Monitor for pain relief

20. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-20 PYRAMID POINTS XVI. Ceruminolytic Medications  Description Emulsify and loosen cerumen deposits Emulsify and loosen cerumen deposits  Side effects Irritation Irritation Redness or swelling of ear canal Redness or swelling of ear canal  Interventions Perform ear irrigation 30 minutes after instillation to remove cerumen Perform ear irrigation 30 minutes after instillation to remove cerumen Inform client to notify physician if redness or swelling of ear canal occurs Inform client to notify physician if redness or swelling of ear canal occurs

21. ADULT HEALTH: Ophthalmic and Otic Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.64-21 A  -adrenergic blocking agent has been prescribed for the client with glaucoma. The nurse monitoring this client for side effects of the medication would place highest priority on noting which of the following parameters? 1. Respiratory rate 2. Oxygen saturation 3. Pulse rate 4. Blood glucose level