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Zorluk: Çok zorPharmacological Therapies

A practical nurse is assigned to care for a client who has bacterial conjunctivitis and a history of open-angle glaucoma. The provider has prescribed timolol maleate ophthalmic solution (drops) and erythromycin ophthalmic ointment for the right eye. In which order should the nurse perform the following actions to safely administer these medications? Arrange the steps in the correct chronological sequence.

  1. 1Cleanse the client's right eyelid and lashes from the inner to the outer canthus.
  2. 2Instill the prescribed number of timolol maleate drops into the lower conjunctival sac.
  3. 3Apply gentle pressure over the nasolacrimal duct with a clean tissue for one to two minutes.
  4. 4Wait for approximately five minutes before proceeding with the next medication.
  5. 5Extrude a thin ribbon of erythromycin ointment along the inside of the lower eyelid.
  6. 6Instruct the client to gently close their eyes and move them around.

Cevap

The correct sequence is to first cleanse the eye, then instill the drops, apply nasolacrimal pressure, wait five minutes, apply the ointment, and finally instruct the client to gently close and roll their eyes.
The correct sequence ensures that the eye is properly prepared, the aqueous medication (timolol) is absorbed without causing dangerous systemic side effects, and the lipid-based medication (erythromycin) does not block the absorption of the drops.

Adım Adım Çözüm

1
Cleanse the eye from the inner to the outer canthus.
Debris and infectious crusts are safely removed.
Prevents the introduction of bacteria into the eye and tear duct, and avoids cross-contamination to the opposite eye.
2
Administer the timolol drops.
The aqueous medication is delivered to the conjunctival sac.
Aqueous drops cannot penetrate the lipid barrier created by ointments, so they must be administered first.
3
Perform nasolacrimal occlusion.
The tear duct is temporarily blocked.
Prevents systemic absorption of the beta-blocker, reducing the risk of severe side effects like bradycardia and hypotension.
4
Wait 3 to 5 minutes.
The timolol drops are fully absorbed.
Ensures the subsequent ointment does not physically wash the drops out of the conjunctival sac before they take effect.
5
Administer the erythromycin ointment.
Antibiotic ointment is applied.
Ointments are applied last because their thick, lipid-based structure blocks other topical medications from reaching the eye tissue.
6
Instruct the client to gently close their eyes.
Medication is dispersed.
Distributes the ointment evenly without expelling it from the eye via forceful blinking or squeezing.

Anahtar Kavram

Administration Sequence for Multiple Ophthalmic Medications
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