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NCM 216 • Ratio of 1 absence:4 extensions

Operating Room/ Perception & Coordination
Concept
Perception and Coordination Concepts-
Orthopedic Nursing, Neurology Nursing, and
Eye, Ear, Nose, & Throat
Personal Grooming
• Violation= 1 day extension for every day of
sporting long hair, skin head, hair color,
tattoo

Clinical Instructors:
Jo Ann B. Dela Cerna, RN, MN
Nympha D. Fernando, RN, MN
Josephine B. Magno, RN, MN
SANCTIONS
✓ Tardiness of 15 mins or less= reading
✓ Tardiness of >15 minutes but <30 minutes=
1 day extension
✓ Tardiness of >30 minutes= present-absent;
2 days extension
* Tardiness does not require an absence slip
* New guideline= 15 minutes before 7:00 am
(6:45 am)
➢ 3 tardiness within a rotation= 1 day absence
✓ > 3 tardiness= Attention will be called by
the clinical instructor for a frequent
tardiness
Excused Absence
• DEATH
- single: immediate members of the family
- married: immediate members +
husband/wife and children as the case may
be
• School Representation
• Victims of fires, earthquakes, and other
calamities
• Illness
- valid medical certificate must presented to
the Level coordinator attached to the excuse
letter= if excused, an absence slip will be
provided and will be presented to the CI
• General transport strike with announcement
coming from SPC
• Problems with connectivity and/or power
interruptions
- send proof to CI (screenshots) attached to
an excuse letter with a photocopy/picture of
guardian’s valid ID with signature
Unexcused Absences
• All other absences not covered in the above-
mentioned instances
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I. INTRODUCTION (1 and ½ page) IV. RELATED NURSING THEORY

• Introduction of Case - minimum of 2
- short description of rotation - use other theories aside from nightingale
- short definition of the case, (overused)
- statistics (global, nat’l, local) - give only a BRIEF description of the theory
- implications to Nursing education, practice, - other paragraphs must explain how the theory
research) is applicable to the case (this will consist most of
• Objectives (General & Specific) the contents in related nursing theory)
• Etiology (tabular form)
• Symptomatology (may also include V. REVIEW OF RELATED STUDIES/
management for a specific symptom) LITERATURE
- not later than 5 years (2015 is still allowed)
II. PATHOPHYSIOLOGY AND - minimum of 3 related literatures
MANAGEMENT - somewhat like the summary of the case study
➢ Anatomy of the affected part - choose literature that fits the case
➢ Schematic Diagram - 1st and 2nd paragraphs: literature that talks
➢ Narrative Discussion about the definition of the case, factors, signs
➢ Diagnostic and Laboratory Tests- and symptoms
- Physical assessment - 3rd paragraph: literature about general
• observed in the case; affected system or management for patient, common treatments
other body parts; - 4th paragraph: literature about the role of
• DO NOT INCLUDE NORMAL nurse in the care of the patient having the
ASSESSMENT) disease
- Medical Diagnostic Tests - 5th paragraph: conclusion of learnings about
• ideal and possible tests; the case (wrap up the learnings)
• categorize if it is blood tests, imaging
studies; VI. REFERENCES
• include nursing responsibilities in each - APA format
test (either pre, intra, or post if
applicable)
- Nursing Diagnoses
• at least 3
• with rationale; 1 risk, 2 actual/problem-
focused diagnoses)
➢ Management
• Medical Management
- Drug study (complete presentation;
follow format except ordered dose)
• Surgical Management
• Nursing Management
- nursing interventions based on given
diagnosis
➢ Prognosis

III. DISCHARGE PLANNING

- METHOD (specific instructions)
- medication: include health teachings about
their medications (e.g., instruct the patient to
drink the medication before or after meals)

OPERATING ROOM ROTATION
(knee-controlled sink)
(brush for scrubbing & nail pick)
(Operating Theatre)
BASIC SURGICAL PROCEDURES:
(Sequence)
1. Medical handwashing- alcohol can
also be used in instances where time is
limited.
2. Opening of the pack
- must be in the presence of a CI;
- in SPMC, opening of pack is
simultaneous with induction of
anesthesia;
- wait for go signal;
- first cases of the day are already set
up in the room responsibility: check the
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pack and any permeation in the
packaging;
- can also be obtained from ante-room
- circulating nurse can help the scrub
nurse in opening the pack
3. Surgical handwashing
- if no permission is given yet for
surgical handwashing, both the
circulating and scrub nurse stays in the
room and guards the pack and check if
the anesthesiologist has arrived and
inform the CI for a go signal
4. Gowning & closed gloving
5. Setting up of the mayo table &
back-up table
- mayo table= basic instruments
- back-up table= additional instruments
specific to the procedure
- initial counting; INS
- study set up of mayo table in SPC and
SPMC
6. Serving of the gown and gloves to
the surgeon
7. Serving of instruments
8. Counting during the closure of the
surgical site
9. After care
- disposing of gowns, gloves, etc.
CONTENTS OF THE BIG PACK
- arranged according to use;
- first opened, opened on the back-up table;
- gowns and drapes are separated;
- opening of big pack must face the scrubbing
area
✓ OR gowns (5)
✓ Mayo cover (1)- cover the mayo table
✓ OR towels (5)- 4 towels=drape the
patient; 1 towel= used on top of the mayo
cover
✓ Foot drape (1)- cover from the lower
abdomen to the foot
✓ Head drape (1)- half of the body will be
covered from abdomen to the head
✓ Lap sheet (1)- last drape; cover head to
toe; has a hole in the middle
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TYPES OF SPONGE 6. Cottonoids

- contains 10 when opened per pack; initial
1. Abdominal Pack (AP) counting is 10
- with string at the end; string will be outside
while sponge is inserted

NOTE:

2. Medium Sponge (MS)
3. Operating Sponge (OS)
- with x-ray indicator
4. Cherry Ball (CB)
- do not drop at kick bucket because they are
very small and are hard to find
- used for blunt dissection
5. Peanut Ball (PB)
- sponge for delicate tissues or blunt dissection
- do not drop at kick bucket because they are
very small and are hard to find
✓ If AP, MS, and OS are soiled (i.e., with
blood), they are dropped in the kick
bucket/basin
✓ If CB, PB, and Cottonoids are soiled, do not
drop in kick bucket because they are very
small and are hard to find; only place them
on a container on the back-up table
✓ Anything added during surgery must be
added to the initial counting and
documented on the white board and the
sheet (e.g., if the initial counting is 10 and
cottonoid is cut into two, it will be counted
as 11)
✓ all soiled sponges dropped in the kick bucket
must not be discarded unless surgery is
done; more so with the specimen (e.g.,
scrapings from prostate during TURP); these
are still needed for the counting
✓ Initial counting- INS;
✓ Closure- SNI; sponges are very hard to
retrieve esp. if without indicator, next is
needles because they have different sizes
and are also hard to find
CONTENTS OF THE ABDOMINAL SET:
➢ Fine curve (12)
➢ Straight clamp (6)
➢ Big curve/Kelly (6)
- Mosquito (type of Kelly used for superficial
layers such as in thyroidectomy)
➢ Allis Forceps (3)
➢ Babcock (3)
➢ Needle holder (2)
- after suturing, make sure that the needle
is still attached in the needle holder (do not
accept needle holder without the needle)
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➢ Army navy (2)

- used in abdominal surgeries
➢ Towel clip (7)
➢ Ovum forceps (1)
➢ Blade handle (2)
odd numbers will fit with odd numbers; even
numbers fit into even numbers Needle holder
➢ Long tissue forceps w/o teeth (1)
➢ Tissue forceps w/o teeth (2)
- a.k.a. thumb forceps
➢ Tissue forceps w/ teeth (2)
- sometimes referred to as plainly “tissue
forceps”; medium-sized not the long tissue
forceps
➢ Adson w/teeth (1)
➢ Adson w/o teeth (1)
Army navy
Straight clamp

Big curve/Kelly

Towel clip

Allis Forceps
Ovum forceps

Blade handle
Babcock Forceps
Long tissue forceps w/o teeth
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- Instruments with teeth are usually used for

Tissue forceps w/o teeth
HARD tissues (e.g., Allis is used to grasp fascia)
- Instruments without teeth are usually used for
SOFT tissues or delicate structures (e.g.,
intestines)
- For appendectomy, Babcock is used

OPENING OF THE PACK (surgical supplies)

- Scrub Nurse: first person to perform gloving
and gowning, alcoholize hands before opening
- Opening (from you): away, lateral, towards
- In opening the big pack, you can hold the
sterile pickup forceps at the ring/holder to get
sterile items
Space for other sterile items (big
items before small items)

Tissue forceps w/ teeth drapes gowns

- Open away from sterile field not over the

sterile field; distance of at least 1 foot from the
sterile field; ancillary items are also opened
- Surgical blade is dropped in the round basin
- The lower part of the backup table may have
items; these are not to be opened (these are
anticipated instruments only)
- After everything is opened, stay in the room
- If the patient is received in OR:
➢ provide headcap and attach to
Adson w/ teeth monitors/straps
➢ Monitor initial VS and write it in the white
board→ Name of patient, Date of Surgery,
Name of Procedure, Surgeon’s name
(consultants, assistants), Name of
Anesthesiologist, Accountables (SNI)
➢ Record the time of induction of anesthesia
➢ You can already write on the whiteboard
even if pt hasn’t arrived
- Go signal for surgical handwashing: when the
surgeon is around; “mag-induct na ko’g anes”

Adson w/o teeth

NOTE
- Any long instrument is usually used for deep
cavity; short usually for superficial
- Big retracting instrument is usually used for
deep cavity

Opening of Sterile Gloves
- Open first wrapper → hold the second wrapper
→ slide open the lower fold using the thumb
- And then flip/close using non-dominant hand
- Use sterile pickup forceps to take gloves from
the 2nd wrapper (L glove then R glove)
- When placing the gloves on the sterile field,
right glove is placed over the left glove (if you
are right-handed and vice versa)
- surgeon’s gloves are placed nearest to the
gown
- Arrangement of gloves from the gown-
surgeon’s, assistant’s, staff nurses’, student
nurses’
SURGICAL HANDSCRUBBING
Before wetting your hands
- check both the cap and mask (positioning, hair
underneath the cap)
- fold the sleeves to prevent them from being
wet
- attend to personal necessities (urinate,
defecate)
2 types:
Anatomical time scrub
Counted brush stroke
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1. Turn on faucet, wet hands from finger tips to
the elbow and out
2. Apply soap and make a lather
3. Start brushing (always use bristle part and in
a circular motion)
4. Brush first the fingers (20 strokes)
5. Start from the thumb (10 turns);
6. and then slide to the interdigital space to the
index, until pinky with the same (10 turns);
7. Brush the palm (10 strokes)
8. Dorsum/back of the hand (10 strokes)
9. Divide arm into two:
- 1st half: wrist until middle forearm (10
in each side 4; front, back, 2 sides)
- 2nd half: Just above the elbow x 10
strokes each side; last to be scrubbed is
the elbow x10 strokes
10. Rinse the brush and transfer it to the other
hand
11. Follow the same steps with your other hand
12. After hand scrubbing, drop the brush onto
the sink
13. Rinse starting from the fingertips, in one
direction only (never go back)
14. Enter the Operating Theatre and dry hands
using either sterile towel located on the back-up
table
- you can use OR towel or the foot part
of the gown;
- upon entering, use your butt and back;
- you can pick up the sterile towel if
your arm is not dripping wet or a CI can
pick it up using sterile pickup forceps
GOWNING AND GLOVING
In SPH; use of reusable (cloth) gown
Closed gloving
- surgically clean hands are not exposed; they
are kept inside the sleeve of the gown; Make
sure that hands won’t come out of the sleeves of
gown
- don your gloves OVER the sterile field (back-up
table)
- While gowning, it is the initiative of the
circulating nurse to go at the back of scrub
nurse and start tying
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3 principles of closed gloving technique

- thumb to thumb
- edge to edge
- palm to palm

1. Hand is anatomically positioned in relation to

gloves (fingers are in the same orientation with
the gloves)
- Palm and palm of gloves are parallel (but not
facing each other) 4. And then stretch and place the hand inside
- Thumb and thumb of gloves are aligned ➢ Be careful that glove won’t touch
unsterile areas such as your mask

‘ 5. Don’t pull the sleeve yet; unfold first the cuff

2. Flip the gloves; observing the 3 principles and slowly pull the sleeve towards you; (you can
- thumb to thumb hold the gloves to adjust as long as your hands
- edge to edge are kept inside the sleeve)
- palm to palm (facing each other)
- Edge of gloves must be in line with edge of
sleeve

3. The dominant hand will hold the upper lip of 6. Adjust the placement of fingers in the gloves
gloves; non dominant hold to the lower lip

7. Pull sleeve slowly and keep adjusting until
fingers are placed properly
- Be mindful while pulling; make sure skin
will not be exposed
8. Don the other glove
After donning of sterile gloves
- release shorter tie by pulling it out of the paper
while holding the tie with left hand,
- hold the paper with your other hand and let
the circulating nurse hold the TIP of the paper
that connects to the longer tie,
- and then the scrub nurse turns and;
- scrub nurse holds the longer tie while the
circulating nurse holds and pulls the paper
- while the scrub nurse holds longer the tie now,
he ties the gown himself
DRAPING AND ORGANIZING A MAYO
TABLE
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➢ arranged according to use
➢ after donning gown and gloves, start setting
up the mayo table; place all basic
instruments and arrange
➢ after arranging the mayo table, start with
initial counting of instruments; circulating
nurse also counts with the scrub nurse
➢ CIRCULATING NURSE’s Responsibility:
- list down all the instruments on jot
down notebook
- be familiar already with the instruments
even upon opening before patient is on
OR, so that in counting it will not take
time for you to write
➢ Rolled sheet (maroon)- where grasping
instruments are propped; OR towel is used,
you can ask extra towel for rolled towel
➢ Right side – pick up instruments
➢ 7 towel clips- Placed before the fine curve
on the rolled sheet, after counting the
instruments, 4 clips are placed near the
scrub nurse; 3 are placed on back-up table
➢ Serve the 5th towel clip to secure the tubings
(axillary instruments)
➢ after using the 1st knife cover it under the
mayo Towel, it can still be used if surgeon
extends incision on skin
INITIAL COUNTING
- count in 1 direction so that you will not
miss or double your counting;
- start counting with cutting instruments,
then grasping, to retracting, to tissue
forceps
- mention instrument first and point at it
- do not proceed unless acknowledged by
the circulating nurse “e.g., 2 knives noted”
- e.g., Scrub Nurse: Knife, 1,2, 2 Knives
Circulating nurse: 2 knives noted
- close items on the rolled towel: use tissue
forceps and slightly separate tip portion
while counting
- tissue forceps: start counting from outer to
inner
- towel clips: 1234 → go to backup table
567, 7 towel clips → circulating nurse says
“7 towel clips noted”
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- Needles: start with ATR before Non-ATR resident and the rest of the surgical team, the
➢ Arrange the sponges and needles on the first counting of SIN is complete.
backup table Second- “the second counting of SIN is
➢ We are already safe after counting complete
➢ Check the whiteboard for elective surgeries Third- “the third and final counting of SIN is
that are schedule for the next day and read complete
about them to have more knowledge - wait for an acknowledgement (e.g., thank you)
or else repeat until you can hear it and reply
COUNTING IN CLOSING welcome in response
Before the closure of the incision site, circulating - After 3rd counting, do after care
nurse initiates the counting: SNI • start taking care of your sharps
- Count sponges in the sterile field (abdomen, • Remove the blade from holder and
mayo, back-up) in one direction, discard it to waste receptacle for
- then in backup table by the SN, and lastly in sharps (surgical blade; ATR-cut the
the kick bucket by the CN using forceps from suture; don’t discard Non-ATR
abdominal set that is not used (e.g., ovum because they are reusable rather
forceps) secure it back in suture book)
- Order is Sponges, needles, instruments • Secure all instruments, take
everything from the mayo table and
Sample counting: place in basin; rinse and soak it in a
SN: AP, 1,2,3,4,5,6; disinfectant solution for 15 minutes
CN: APs down 1,2,3,4; 6 APs up + 4 APs down and rinse it again
is 10 APs check (CN then compares it to initial • Go to preparation area/working area
counting and then tick the instrument if it and dry them ready until ready for
matches) sterilization
SN: MS, 1,2,3,4,5; 5 MS up; • Check the room if it is clean
CN: MS down 1,2,3,4,5; 5 OS up + 5 OS down is CN’s Responsibility:
10 OS check - prepare post-op bed and new gowns,
SN: OS,1,2,3,4,5; 5 OS up; - ready the stretcher outside OR theatre,
CN: OS down, 1,2,3,4,5; 5 OS up + 5 OS down - assist care of patient, until transferring the
is 10 OS check patient to the recovery room
SN: Needles ATR 1,2,3 SERVING OF GOWN AND GLOVES
CN: 3 ATRS check - Do not wait for surgeon to dry his hands after
SN: Knife 1,2 offering the OR towel; get and serve the gown
CN: 2 Knives check and gloves
- If ever there is no towel, offer the foot part of
SN CN Total the gown to dry hands, hold at the middle part
6 AP 4 AP 10 while offering
5 OS 5 OS 10
3 ATR - 3
2 Knives - 2

- After counting: in SPMC- the SN reports; SPH-

CN reports

Sample reporting:
Initial WHEN SERVING THE GOWN
Excuse me name of the surgeon, all senior and • posterior side of the gown must face the
junior residents, anesthesiologist and his surgeon, while the anterior must face you
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• be sure that the armhole is facing toward
the surgeon, spread the distance between
your arms to expose the armhole
• only at shoulder level, do not raise
• once arms are already inserted, release and
drop the gown; then circulating nurse will
automatically tie at the back
- arranging the gloves is always right over left
WHEN SERVING THE GLOVES:
• make a cuff using forefingers with thumbs
out (easier to stretch) and thumb of the
glove faces the surgeon;
• palm of gloves must face the surgeon kay;
• expand your base for stability of stance
while serving;
• say “right glove doc” when serving but do
not say left glove doc anymore;
• when stretching the glove, move your arms
apart but maintain at waist level of the
surgeon
- after surgeon donned his/her gloves, create
now the sterile field
- double draping of mayo towel, 4 remaining
- offer OR towel to surgeon not higher than
shoulder level
- next to be draped is the foot part
- next is head drape and then lap sheet
- secure the or towels with towel clip
- after, accessory instruments are next served
- Surgical Pause: checklist to check for the
Correct patient, correct surgery, correct site
- Circulating nurse:
Take note of the time of
- cutting
- specimen out
- when surgery is done
- after surgical pause, serve the sponge to the
surgeon to remove the antiseptic used in skin
preparation
- Thyroidectomy= peanut balls sponge tick
- Asepto syringe= for washing an area
- when opening suture, portion of a needle is
exposed
- more 0s =the finer and thinner the suture
- 10-0 and 11-0 for ophtha surgeries
PASSING OF BASIC SURGICAL
INSTRUMENTS
EXHIBIT FORM BOOKLET
- Erasures are not allowed
- Copy the post-op procedure;
- Copy data from accounting clearance (AC); at
the front part= proposed surgery, back of the
slip = procedure; date of surgery, time of
surgery, name of patient (initials start with first
name) is written
- Copy on jot down NB everything that is from
exhibit form + post-op diagnosis
- Compile your cases on your jot down NB
according to: Major SN, major CN, Minor SN,
Minor CN, etc.
- 1 institution/hospital per 1 page
- in SPH, the student SN will let staff SN affix
their signature except if surgical technician; in
such cases, the student SN as well as student
CN will let the staff CN sign

LOADING A SCALPEL, NEEDLE HOLDER,

AND SPONGE STICK

- Hold package of suture while holding the 1/3

of the needle with needle holder and remove
- Right handed surgeon=pointed end facing left
and vice versa
- Sponge stick= cherry balls + ovum forceps
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EENT
➢ Otorhinolaryngology
- Ears, nose, throat
- It is a surgical subspecialty of medicine that
deals with the surgical and medical management
of conditions of the head and neck
➢ Ophthalmologist- Eyes

EYES
- a multichambered, almost spherical structure ASSESSMENT OF VISION
located in the anterior portion of the orbit. I. Visual Acuity Test
- consists of 3 layers: - measures the client’s distance and near vision
- Snellen Chart/ Illiterate E chart
1. External Layer- - Normal vision 20/20
a. Sclera
- white part of the eye
- previously the tunica albuginea oculi,
b. Cornea
- transparent part of the eye
- covers a portion of the eye; iris and pupil
c. Corneoscleral junction
- junction of the cornea and the sclera (the
white of the eye)

2. Middle layer
a. Choroid
- supplies the outer retina with
nutrients, and
- maintains the temperature and volume TEST FOR COLOR VISION
of the eye. I. Ishihara Chart
b. Ciliary body - measures ability to tell the difference between
- the structure supporting the lens colors
c. Iris - screening test for red, green, and blue color
- colored part, deficiency
- regulates the amount of light that - use of polychromatic plates
enters the eye by opening and closing - each eye is tested separately
the pupil - sensitive for the diagnosis of red/green
- When there is bright light, the iris blindness
closes the pupil to let in less light. And
when there is low light, the iris opens up
the pupil to let in more light.
3. Inner layer
a. Retina
- has 2 photoreceptors; rods and cones
also called the neurons of the eyes,
- rods: night vision, vision at low light
levels,
- cones: day vision, higher light levels
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DIAGNOSTIC TEST FOR THE EYE EARS

-Hearing and balance
1. TONOMETRY
- measures Intraocular Pressure by determining
the amount of force needed to indent a portion
of the anterior lobe
- Principle: a soft eye is easier to indent than a
hard eye
- Normal IOP: 11-21 mmHg

ASSESSMENT OF THE EAR

Abbreviations:
➢ As- left ear
➢ Ad- right ear
➢ Au- both ears

1. VOICE TEST (WHISPER TEST)

- Ask client to block one external canal
- Examiner stands 1-2 ft away and quickly
whispers a statement
- The client is asked to repeat the whispered
statement
Causes of increased IOP 2. WATCH TEST
- excessive exposure to gadgets - Ticking watch tests high-frequency sounds
- inadequate sleep - Ticking watch about 5 inches from each ear
Signs and symptoms and asks the client if the ticking is heard
- pooling of blood in the eye (hyphema) 3. TUNING FORK TESTS
- eye pain a. Weber test
- dizziness • tests sensorineural hearing loss
• normal: hearing the sounds equally in
2. SLIT LAMP both ears
- allows examination of the anterior ocular Findings:
structures under microscopic magnification • Affected ear- Conductive hearing loss
- help detect disorders of the anterior portion of • Unaffected ear- sensorineural hearing
the eye loss

3. FLUORESCENT EYE TEST VESTIBULAR ASSESSMENT OF THE EAR

- detect foreign bodies in the eye/ determining if TEST FOR FALLING
there is a scratch or other problem with the - client normally remains erect with slight
surface of the cornea swaying
- once you blink, the orange-colored dye will be - closed eyes during assessment
spread over the cornea, Abnormal result: (+) Romberg Sign- presence of
significant swaying
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DIAGNOSTIC TEST FOR THE EAR Paranasal sinuses (frontal, sphenoid,

OTOSCOPIC EXAM maxillary, ethmoid)- air-filled cavities lined with
Guidelines mucous membranes
• The speculum is never blindly Functions:
introduced into the external canal 1. Reduce the weight of the skull
• Tilt the head slightly away and hold the 2. To produce mucus
otoscope upside down as if it were a 3. To influence voice quality (resonating
large pen chambers)
• Visualize the external canal while slowly
inserting the speculum
Normal:
➢ External canal- colored, intact,
w/out lesions
➢ Eardrum- shiny, transparent,
opaque, or pearly gray; mobile

NOSE, SINUSES, PHARYNX, AND LARYNX

Pharynx
- commonly called throat;
- divided into 3 regions: nasopharynx,
oropharynx, laryngopharynx
Functions:
1. Respiratory Function- receives air from
the nasal cavity
2. Digestive Function- receives air, food,
and fluids from the oral cavity

Nose
- consists of bone and cartilage; air enters
through 2 openings/ nostrils (nares) Larynx
Functions: - Commonly called the voice
1. Olfaction- smelling (cranial nerve 1) box/ glottis; passageway of
2. Air-conditioning- controlling air air between the pharynx
temperature and humidity; removing above and the trachea below
particles before air enters into the
trachea, bronchi, and lungs Function: essential in human
Anosmia- loss of sense of smell (prone to speech
poisoning)
Hyposmia- decreased sense of smell
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ADMINISTERING OTIC MEDICATIONS After procedure

- Route is via ears - wash hands
- document (use universal abbreviations)
P- Position (side-lying)
A- Age (>3 yrs.= pinna up and back to allow
solution to enter the ears; <3 yrs.= pinna down
and back)
S- Solution (must be warm; if cold, hold in your
hand for 1-2 minutes, you can also immerse
bottle in warm water)
D- Direction (administer at side of the ear canal)
A- Absorption (press the ear for 20-30 seconds)
T- Timeline (administration of other ears, 5 mins
interval)
T- Technique (clean technique; handwashing
before and after administration; wipe excess
solution)

ADMINISTERING OPTIC MEDICATION

Types:
➢ Myotic- constrict the eyes
➢ Mydriatic- relax the eyes
➢ Lubricants- moistening the eyes (e.g.,
artificial tears, Eye Mo)

Types:
➢ Liquid- eye drops
➢ Solid- eye ointments (terramycin)

Best Position- sitting position with neck

extended and pt. instructed to look upward

In giving liquid form

- pinch the lower conjunctival sac to prevent
drug from entering internal canthus of the eyes
=prevent systemic effects,
- don’t apply directly to the cornea; press the
inner canthus for 20-30 secs and administer at
least 2-3 drop or depending on the doctor’s
order
- drop at 1/3 from the inner canthus

In giving solid form

- pull down the lower conjunctival sac
- from inner to outer canthus, approx. 2 cm of
ointment