Definition
Nasal drops instillation is the process by which a liquid is introduced into the nasal cavity drop-by-drop.
Purposes
- To treat allergies.
- To treat sinus infections.
- To treat nasal congestions.
- To give local anaesthesia.
Articles
- Prepared medication with clean dropper.
- Penlight.
- Clean gloves.
- Facial tissues.
- Small pillow.
- kidney tray.
- Tissue paper.
- Medication card.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Identify patient. | Ensures that correct patient receives medication. |
| 2. | Review physician’s order. | Ensures safe and correct administration. |
| 3. | Determine which sinus is affected by referring to medical record. | Determines patient’s position during drug instillation. |
| 4. | Assess patient’s history of hypertension, heart disease, diabetes mellitus, and hyperthyroidism. | These conditions can contraindicate use of decongestants that stimulate CNS side effects of transient hypertension, tachycardia palpitations, and headache. |
| 5. | Determine whether patient has any known allergies to nasal instillations. | Prevent complications. |
| 6. | During procedure. Perform hand hygiene. | Prevents infections. |
| 7. | Inspect condition of nose and sinuses using penlight. Palpate sinuses for tenderness. | Provides baseline data to monitor effects of medication. Presence of discharge interferes with medication absorption. |
| 8. | Explain to patient the procedure including positioning and sensations to expect, such as burning or stinging of mucosa or choking sensation as medication trickles into throat. | Helps patient anticipate experience of procedure to reduce anxiety. |
| 9. | Apply gloves if patient has nasal drainage. | Reduces transmission of microorganisms. |
| 10. | Instruct patient to clear or blow nose gently unless contraindicated (increased intracranial pressure or nose bleeds). | Removes mucus and secretions that can block distribution of medication. |
| 11. | Administer nasal a drop: Assist patient to supine position. | Position provides access to nasal passages. |
| Position head property. For access to posterior pharynx, tilt patient’s head backward. For access to ethmoid or sphenoid sinuses, tilt head back over edge of bed or place small pillow under patient’s shoulder and tilt head back. Support patient’s head with non-dominant hand. Instruct patient to breathe through mouth. | Position allows medication to drain into affected sinus. | |
| Hold dropper 1 cm (1/2 inch) above nares and instill prescribed number of drops toward midline of ethmoid bone. | Mouth breathing reduces chance of aspirating nasal drops. Avoids contamination of dropper. Instilling toward ethmoid bone facilitates distribution of medication over nasal mucosa. | |
| Have patient remain in supine position for 5 minutes. | Prevents premature loss of medication through nares. Allows maximal amount of medication to the absorbed. | |
| Offer facial tissue to blot running nose, but caution patient against blowing nose for several minutes. | ||
| 12. | After procedure Assist patient to a comfortable position after medication is absorbed. | Restores comfort. |
| 13. | Dispose of soiled supplies in proper container and perform hand hygiene. | Maintains neat orderly environment and reduces spread of microorganisms. |
| 14. | Observe patient for onset of side effects 15 to 30 minutes after administration. | Drugs absorbed through mucosa can cause systemic reactions. |
| 15. | Ask if patient is able to breathe through nose after decongestant administration. It may be necessary to have patient occlude one nostril at a time and breathe deeply. | Determines effectiveness of decongestant medication. |
| 16. | Record medication name, concentration, number of drops, nostril into which medication was instilled, time of administration, and patient’s response in nurses’ note. | Serves as a communication between the staff members. |
| 17. | Report any unusual systemic effects to the nurse-in-charge or physician. |
Unexpected Outcome
- Patient begins wheezing or displays other signs of allergic reactions to drug.
- Mucosa appears swollen and congestion is unrelieved.
- Nasal mucosa remains inflamed and tender with discharge from nares.
- Sinus headache.
Paediatric Variation
- Infants can be positioned in football hold for instillation of nasal drops.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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