Pharmacology Eye & Ear Meds #4

Question

A 10 year old child has otitis media and ofloxacin otic solution, 0.3% is prescribed to be administered by placing 5 drops in each affected ear once a day for 7 days. Which instruction by the nurse is appropriate regarding otic drop placement? Select all that apply.

Answers

  1. Pull ear down and back for proper placement
    • Rationale:

      This answer is not correct because the proper instruction is for the ear to be pulled up and back, not down and back. Children under 3 years old should have the ear pulled down and back. Remember “grown UP” helps to remember the ear goes up and back for grown ups (or 3 and above).

  2. Cool drops in refrigerator before placement
    • Rationale:

      This answer is not correct because ear drops should be warmed by placing the drops in the hand for at least 1 minute to warm. Cool or cold drops can be very painful to the client.

  3. Do not double dose, unless instructed by prescriber
    • Rationale:

      This answer is correct because doubling doses is not appropriate, unless the prescriber has instructed to do so. Following prescriber directions is extremely important for effective treatment of otitis media.

  4. Tilt head or lie down with affected ear upward
    • Rationale:

      This answer is correct because tilting the head to the side or lying down with the affected ear upward is important for effective placement of otic drops. This allows gravity to help the drop go to the eardrum so to be most effective in combating infection.

  5. Wash hands before and after placement
    • Rationale:

      This answer is correct because washing hands before and after helps reduce spread of infection. Drainage on or near the ear can carry infection that can be spread easily.

Overview

Nursing education about proper methods of placement of otic drops is extremely important for adequate treatment of otitis media.

Explanation

Learning Outcomes

Complete and accurate instruction about how to place prescribed otic drops is essential to effective treatment of otitis media. Various instructions should be included: 

  • Wash hands before and after (to reduce spread of infection)
  • Warm drops by placing in hand for at least 1 minute (cool drops can cause pain)
  • Tilt head to the side or lie down with affected ear upward (to assure drop gets in ear)
  • Pull ear down and back for children under 3 or pull ear up and back for anyone 3 and over (to make sure drop gets to eardrum)
  • Take medications as directed, do not double the dose, unless instructed by the prescriber (for more effective treatment with less side effects)

Test Taking Tip

A way to remember which way to pull the ear is to remember that the age of 3 and above is when ear position changes. Remember “grown UP” helps to remember the ear goes up and back for grown ups (or 3 and above).

Video Rationale