Xavier University

COLLGE OF NURSING
Ateneo de Cagayan

NCM 101 RLE - HEALTH ASSESSMENT

PERFORMANCE RATING SCALE

Administering Otic Instillations

NAME: Ira Velle J. Vios Date: April 07, 2022

BLOCK: NJ CI: Sir Alan Elmer Celesios SCORE: ______________________

PERFORMANCE EVALUATION CRITERIA

SCALE DESCRIPTION INDICATORS

4 Very Good
3 Good
2 Fair
1 Need Improvement
Student performs behaviors/tasks affecting the highest level of
performance: consistent, independent, effective
Student performs behaviors/tasks reflecting mastery of performance
with minimal supervision
Student performs behaviors/tasks reflecting development and
movement toward mastery of performance: with help or direct
supervision in some aspects
Student performs behaviors/tasks reflecting beginning level of
performance; tasks not done properly majority of the time but
demonstrate understanding of concepts involved with tasks

PROCEDURE RATIONALE 4 3 2 1 REMARKS

ASSESSMENT: The medical
1. Check accuracy and completeness of administration record is
each MAR with health care provider’s one of the medical
medication order. Check patient’s name, documents that a patient
medication name, dosage & route & time must get to be both
of administration. reliable and legal. The
MAR's precision and
thoroughness aid the
nurse in administering the
proper medicine to the
patient.
2.Assess patient’s medication history (e.g. This provides a baseline
dizziness, hearing loss) medication history, to later determine if the
history of medication allergies. local response to
medication occurs. Also,
this indicates the need to
clean the ear before
medication application.
Factors in history
influence how certain
drugs act, this protects
the patient from risk of
allergic medication
response.
3. Review pertinent information related to Certain ear medications
medication: action, purposes, normal dose, act to either lessen or
and route, side effects, time of onset and increase these symptoms.
peak action and nursing implication. This provides baseline
assessment for
recognizing change in the
patient’s condition.
PLANNING: This enhances time
1.Prepare the necessary equipment & MAR management and
efficiency. Moreover, it
 avoids the nurse from
leaving the client alone
while getting missing
supplies.
2. Plan preparation to avoid interruptions. Following the agency
Follow agency policy. policy prevents any
inconsistencies from
occurring. As a result of
fewer interruptions,
medical mistakes will be
avoided during the
treatment.
IMPLEMENTATION: Hand hygiene reduces
1.Perform hand hygiene and observe transmission of
appropriate infection control. microorganisms.
2. Introduce yourself & explain the This helps build rapport
procedure to the patients to its purpose & with the patient and
implication. relieves anxiety about
medication being
installed into the ear.
3. Provide privacy. This prevents the patient
from feeling self-
conscious from others
during the procedure.
4. Assist the client to side lying position if This position provides
not contraindicated by his or her condition easy access to the ear for
with ear treated facing up or have him or medication installation
her sit in a chair or at the bedside. and minimizes drainage of
medication.
5. Clean the pinna of the ear and the a. To prevent having
meatus of the ear canal: direct contact of
a. Apply gloves if infection is suspected. any infections or
b. Use cotton-tipped applicators & solution bodily fluid.
to wipe the pinna and auditory meatus. b. To prevent
c. Ensure that applicator does not go into irritation in the
the ear canal. client’s ear as well
d. Remove & discard gloves if it is soiled. as to moisten any
crust and remove
any secretions in
the ears.
c. This is to avoid
pushing the ear
wax into the canal
that may cause a
blockage.
To maintain cleanliness
and reduce transmission
of microorganisms
6. Take the medication ticket & This ensures that the
medication, check & compare the correct patient receives the
label of the medication, expiration, dose, correct medications. The
route. third check for accuracy
ensures that the right
medication is
administered.
7.Identify patient and compare on the MAR This ensures the correct
identification. patient in compliance
with the recommended
national patient’s safety
goal.
8. Apply clean gloves. This reduces transmission
of microorganisms and
follow standards to
 prevent accidental
exposure to body fluids.
9. Warm the medication container in your To ensure the stability
hand or place it in warm water for a short and efficacy of the
time. If eardrops are a cloudy suspension medication as too low or
shake them for about 10 seconds high temperature of
medication may impact
the medication’s potency.
10. Straighten the auditory canal. Pull the This allows the ear canal
pinna downward and backward (for to be straightened.
children younger than 3 years) or upward
and outward (for children 3 years of age
and older and adults).
11. Instill prescribed drops by holding To keep the dropper from
dropper 1cm (1/2 inch) above ear canal. being contaminated
(touching the ear). Allow
the drops to fall on the
side of the canal rather
than directly into the ear
canal, since this might
create discomfort for the
patient.
12. Ask patient to remain in side-lying This keeps medicine from
position 2-3 minutes. Apply gentle massage escaping through the
or pressure to tragus of ear with finger ears. Pressure aids the
unless contraindicated because of pain. movement of medicines
toward the tympanic
membrane.
13. If cotton ball is needed, place it into A cotton ball can also be
outermost part of canal. Do not press used to keep medication
cotton deep into canal. Remove after 15 from escaping your ear.
minutes.
13. Remove and discard gloves. Perform To prevent the gloves
hand hygiene. from being reused. Hand
hygiene helps to keep
bacteria from spreading.
EVALUATION: 1. To ensure that
1.Note patient immediate response to the procedure
instillation ask if patient felt any was performed
discomfort. correctly and
2. Assess the client’s response & the 2. To evaluate the
character & amount of discharge, effects of the
appearance of the canal, discomfort, and medication and to
so on, immediately after the instillation address the
and again when the medication is expected patient’s
to act. Inspect the cotton ball for any concerns
drainage. immediately.
3. Record medication on patient MAR after
administering the medication. 3. To avoid any
4. Report & document on the nurse’s notes discrepancies
for any untoward reaction. from the agency.

4. To provide an
insight for other
health workers
that will assist the
same patient
during any further
concerns.
Range of score:
A (92-100) Excellent
A- (84-91.99) Very Good
B (76-83.99) Good
B- (68-75.99) Very Satisfactory
C (60-67.99) Satisfactory
F (below 60) Failed

Reference: Potter, P. & Perry, A. (2017). Fundamentals of Nursing. Singapore: Elsevier Pte. Ltd. page 640.