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Difficulty: EasyPharmacological Therapies

A practical nurse is preparing to administer prescribed ophthalmic timolol drops to a client who has open-angle glaucoma and a baseline heart rate of 72 beats/minute72\text{ beats/minute}. Arrange the following steps for safely administering this medication in the correct chronological sequence.

  1. 1Cleanse the eyelid and eyelashes wiping from the inner to the outer canthus.
  2. 2Instruct the client to tilt the head backward and look upward.
  3. 3Gently pull the lower eyelid downward to create a small pocket.
  4. 4Instill the prescribed medication drop directly into the lower conjunctival sac.
  5. 5Apply gentle pressure to the nasolacrimal duct at the inner canthus.

Answer

The correct sequence begins with cleaning the eye to prevent contamination, positioning the client's head to reduce the blink reflex, retracting the lower eyelid to expose the conjunctival sac, instilling the drop safely into the sac, and finally applying pressure to the nasolacrimal duct to prevent systemic absorption.
The correct sequence ensures the eye is clean, properly positioned to receive the medication without inducing a blink reflex, opened to expose the conjunctival sac where the drop is placed to avoid corneal injury, and finally occluded to prevent systemic absorption of the drug.

Step-by-Step Solution

1
Cleanse the eyelid and eyelashes from inner to outer canthus.
The eye area is free of debris and drainage.
Maintaining a clean field prevents the introduction of bacteria into the eye during administration.
2
Instruct the client to tilt the head back and look up.
The eye is optimally positioned.
Looking upward redirects the cornea away from the dropper, which reduces the natural blink reflex.
3
Retract the lower eyelid downward.
The lower conjunctival sac is exposed.
Creating a pocket ensures the medication is delivered safely without falling directly onto the sensitive cornea.
4
Instill the drop into the conjunctival sac.
Medication is delivered to the proper anatomical site.
The conjunctival sac distributes the medication evenly across the eye without causing trauma.
5
Apply pressure to the nasolacrimal duct.
The tear duct is temporarily blocked.
Occluding the duct prevents the beta-blocker from entering systemic circulation, which could inappropriately lower the client's heart rate.

Key Concept

Ophthalmic Medication Administration Sequence
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Topics

Pharmacological Therapies

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