Page 1986 - Saunders Comprehensive Review For NCLEX-RN

A. Instillation of ear drops

1. In an adult, pull the pinna up and back to straighten
the external canal to instill ear drops.
2. Tilt the client’s head in the opposite direction of the
affected ear and apply the drops into the ear.
3. With the head tilted, gently move the head back and
forth 5 times.
4. Pull the pinna down and back for infants and children
younger than 3 years, up and back for older children.

B. Irrigation of the ear (Fig. 57-2)

1. Irrigation of the ear needs to be prescribed by the
PHCP.
2. Ensure direct visualization of the tympanic membrane.
3. Warm the irrigating solution to 98.6° F (37.0° C),
because a solution temperature that is not close to the
client’s body temperature will cause ear injury,
nausea, vertigo, and nystagmus.
4. Irrigation must be done gently to avoid damage to the
eardrum.
5. When irrigating, to prevent injury, do not direct
irrigation solution directly toward the eardrum but
rather toward the wall of the ear canal. In addition, to
remove cerumen, the solution is directed above or
below the impaction toward the wall of the canal to
allow back pressure to push the impaction out.
6. During irrigation, the client should be positioned with
the ear to be irrigated facing up. Fall precautions
should be instituted, because the client may get dizzy,
and an emesis basin should be available, because
vomiting can occur.
C. Systemic medications that affect hearing (Box 57-6)

If a perforation of the eardrum is suspected, do not perform ear irrigation.
XIV. Anti-infective Ear Medications (Box 57-7)
A. Description
1. Anti-infective medications kill or inhibit the growth of
bacteria and are used for otitis media or otitis externa.
2. These medications are contraindicated if a prior
hypersensitivity exists.
B. Side and adverse effect: Overgrowth of nonsusceptible organisms

C. Interventions

1. Monitor vital signs.

1986