{"id":786,"date":"2015-05-22T21:42:27","date_gmt":"2015-05-23T01:42:27","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/6-5-installing-eye-ear-and-nose-medications\/"},"modified":"2022-06-08T11:28:32","modified_gmt":"2022-06-08T15:28:32","slug":"6-5-installing-eye-ear-and-nose-medications","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/6-5-installing-eye-ear-and-nose-medications\/","title":{"raw":"6.5 Instilling Eye, Ear, and Nose Medications","rendered":"6.5 Instilling Eye, Ear, and Nose Medications"},"content":{"raw":"

Instilling Eye Medications<\/h2>\r\n \r\n\r\n[caption id=\"attachment_2997\" align=\"alignleft\" width=\"320\"]\"\"<\/a> Figure 6.13 Eye anatomy[\/caption]\r\n\r\nThe eye is the most sensitive organ to which medication may be applied (Perry et al., 2018). The cornea is especially sensitive, making the conjunctival sac the\u00a0appropriate site for instilling eye (ophthalmic) medications. Eye medications might be necessary for conditions such as glaucoma, infection, and following eye surgery. Of note is that eye medication are for the most part administered into the conjunctival sac, which is much less sensitive than the cornea.\r\n\r\n \r\n\r\nChecklist 49 outlines the steps for instilling eye medications.\r\n\r\n \r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 49:\u00a0Instilling Eye (Ophthalmic) Medications<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:<\/h5>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Perform hand hygiene prior to medication preparation.\r\n\r\nCheck MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\r\n\r\n\r\n[caption id=\"attachment_509725\" align=\"aligncenter\" width=\"150\"]\"Comparing<\/a> Comparing physician orders and MAR[\/caption]\r\n\r\nA MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification processes.<\/td>\r\n<\/tr>\r\n
\r\n

2 a. As you are removing medication from the dispensing system, perform the SEVEN right three times with each individual medication:<\/p>\r\n\r\n

    \r\n \t
  • The right patient<\/li>\r\n \t
  • The right medication (drug)<\/li>\r\n \t
  • The right dose<\/li>\r\n \t
  • The right route<\/li>\r\n \t
  • The right time<\/li>\r\n \t
  • The right reason<\/li>\r\n \t
  • The right documentation<\/li>\r\n<\/ul>\r\n

    <\/p>\r\n<\/td>\r\n

\r\n

The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\r\n

The right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\r\n

The right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\r\n

The right route<\/strong>: Check that the route is appropriate for the patient's current condition.<\/p>\r\n

The right time<\/strong>: Adhere to the prescribed dose and schedule.<\/p>\r\n

The right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.<\/p>\r\n

The right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\r\n<\/td>\r\n<\/tr>\r\n

2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:\r\n
    \r\n \t
  1. When the medication is taken out of the dispensing system or drawer.<\/li>\r\n \t
  2. Prior to opening the eye drop container.<\/li>\r\n \t
  3. After opening the eye drop container but PRIOR to administering the eye medication.<\/li>\r\n<\/ol>\r\n<\/td>\r\n
These checks are done before administering the medication to your patient. If taking a drug to the bedside (e.g., eye drops),\u00a0do the third\u00a0check at bedside.\r\n\r\n[caption id=\"attachment_3308\" align=\"aligncenter\" width=\"218\"]\"\" Figure 6.14 Check medication with MAR[\/caption]<\/td>\r\n<\/tr>\r\n
3. Take medications and MARs to the bedside.\r\n
    \r\n \t
  • Identify the patient using two identifiers.<\/li>\r\n \t
  • Confirm allergies.<\/li>\r\n \t
  • Inform the patient of the medication and its intended action.<\/li>\r\n \t
  • Complete any necessary assessment.<\/li>\r\n \t
  • Offer a tissue to the patient.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\"\"<\/a>MARs cannot be taken into rooms where additional precautions are necessary.\r\n\r\nThe patient has the right to be informed.\r\n\r\nDrops may spill from the eye during administration.<\/td>\r\n<\/tr>\r\n
4.\u00a0Wear clean, non-sterile gloves.<\/td>\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_62791524\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
5.\u00a0Cleanse the eyelashes and eyelids of any drainage or crusting with a warm washcloth or gauze. Use each area of cleaning surface only once, and move from inner to outer eye area.<\/td>\r\nCleansing removes debris from eye area.<\/td>\r\n<\/tr>\r\n
6.\u00a0Tilt patient's head back slightly if patient is sitting up, or place patient's head over a pillow (under the neck) if they are lying down.<\/td>\r\nTilting the head back makes it easier to reach the conjunctival sac for instilling drops.\r\n\r\nDo not tilt head back if patient has a cervical spine injury.<\/td>\r\n<\/tr>\r\n
7.\u00a0Invert the eye-drop container, and have patient look up and focus on something on the ceiling.<\/td>\r\nKeeping the eye focused will help keep it still.<\/td>\r\n<\/tr>\r\n
8. Gently pull patient's lower lid down using thumb or two fingers to expose conjunctival sac.<\/td>\r\nPlace eye drop in conjunctival sac, not directly on eyeball (cornea).<\/td>\r\n<\/tr>\r\n
9. Eye drops<\/strong>: Hold eye-drop container above eye taking care not to touch the eye, eyelids, or eyelashes. Instill one drop, or more if prescribed, into conjunctival sac.\r\n\r\nEye ointment<\/strong>: Apply about 1.5 cm of ointment along lower conjunctival sac moving from inner to outer canthus. Twist tube to break off ribbon of ointment.<\/td>\r\n\"DSC_0825\"<\/a>Touching the tip of the container to anything can contaminate the medication.<\/td>\r\n<\/tr>\r\n
10. Release lower lid after instillation and ask patient to close eyes gently. Ask patient to move the eyeball while eyes are closed.<\/td>\r\nThis step allows the medication to be distributed across the eye.\r\n\r\n[caption id=\"attachment_5063\" align=\"aligncenter\" width=\"150\"]\"DSC_0826\"<\/a> Have patient close eyes after drop is instilled[\/caption]<\/td>\r\n<\/tr>\r\n
11.\u00a0Eye drops only<\/strong>: Apply gentle pressure over inner canthus for 30 to 60 seconds to prevent medication from entering the lacrimal duct.<\/td>\r\nThis minimizes systemic absorption and thus systemic effects of the medication.<\/td>\r\n<\/tr>\r\n
12.\u00a0Instruct patient not to rub eye.<\/td>\r\nThis is to prevent irritation and injury to the eye and to allow the medication to be fully absorbed.<\/td>\r\n<\/tr>\r\n
13. Remove gloves and assist patient to a comfortable and safe position.\r\n\r\nPerform hand hygiene.<\/td>\r\nThis ensures patient safety and comfort.\r\n\r\nHand hygiene prevents the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
14. Document as per agency policy. Include date, time, dose, route; which eye the medication was instilled into; and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/td>\r\n<\/tr>\r\n
Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Instilling Ear Medications<\/h2>\r\n[caption id=\"attachment_3004\" align=\"alignleft\" width=\"298\"]\"\"<\/a> Figure 6.15 Anatomy of the ear[\/caption]\r\n\r\nCommon medications to be instilled into the ear include antibiotics, anti inflammatory agents, local analgesics, and wax emulsifiers (Lilley et al., 2016). In general, ear drops should be instilled after the ear has been thoroughly cleansed and the dropper cleaned with alcohol. Internal ear structures are particularly sensitive to temperature extremes. Therefore, ear (otic) medications should always be administered at least at room temperature but preferably at body temperature to promote comfort and to reduce risk of vertigo associated with cold ear drops (Lilley et al., 2016). Care must be taken to avoid contaminating the dropper and ear medication, as doing so could introduce microorganisms into the ear which could be very serious in the event the ear drum (tympanic membrane) is ruptured. After administration, the patient should be advised to lie on the unaffected side for 5 minutes to maximize medication absorption.\r\n\r\nChecklist 50 outlines the steps for instilling ear\u00a0medications.\r\n\r\n \r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 50:\u00a0Instilling Ear (Otic) Medications<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:<\/h5>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
    \r\n \t
  1. Perform hand hygiene prior to medication preparation.<\/li>\r\n<\/ol>\r\nCheck MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\r\n
\r\n\r\n[caption id=\"attachment_6278\" align=\"aligncenter\" width=\"150\"]\"Comparing<\/a> Comparing physician orders and MAR[\/caption]\r\n\r\nA MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification processes.<\/td>\r\n<\/tr>\r\n
2 a. As you are removing medications from the dispensing system, perform the SEVEN rights three times with each individual medication:\r\n
    \r\n \t
  • The right patient<\/span><\/li>\r\n \t
  • The right medication (drug)<\/li>\r\n \t
  • The right dose<\/li>\r\n \t
  • The right route<\/li>\r\n \t
  • The right time<\/li>\r\n \t
  • The right reason<\/li>\r\n \t
  • The right documentation<\/li>\r\n<\/ul>\r\n <\/td>\r\n
\r\n

The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\r\n

The right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\r\n

The right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\r\n

The right route<\/strong>: Check that the route is appropriate for the patient's current condition.<\/p>\r\n

The right time<\/strong>: Adhere to the prescribed dose and schedule.<\/p>\r\n

The right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.<\/p>\r\n

The right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\r\n<\/td>\r\n<\/tr>\r\n

2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:\r\n
    \r\n \t
  1. When the medication is taken out of the drawer.<\/li>\r\n \t
  2. When the medication is being poured.<\/li>\r\n \t
  3. When the medication is being put away or at bedside.<\/li>\r\n<\/ol>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_3308\" align=\"aligncenter\" width=\"168\"]\"\" Figure 6.14 Check medication with MAR[\/caption]<\/td>\r\n<\/tr>\r\n
3. Before instilling ear drops, donne clean, non-sterile gloves.<\/td>\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
4. Cleanse external ear of any drainage using a warm wet washcloth.<\/td>\r\nDrainage or debris may prevent some medication\u00a0from entering ear canal.<\/td>\r\n<\/tr>\r\n
5. If lying down, position patient on unaffected side with affected ear uppermost. Tilt head to side if sitting up.<\/td>\r\nProper positioning helps to stop medication from escaping.\r\n\r\nDo not tilt head if patient has a cervical spine injury.<\/td>\r\n<\/tr>\r\n
6. Draw up medication into ear dropper, ensuring correct dosage.\r\n\r\nDo not return excess medication to stock bottle.<\/td>\r\nRisk for contamination is increased if medication is returned to bottle.<\/td>\r\n<\/tr>\r\n
7. Adult administration<\/strong>: Gently pull ear pinna back and up.\r\n\r\nChild (up to 3 years) administration<\/strong>: Gently pull ear pinna down and back.<\/td>\r\nPulling the pinna (the external part of the ear) straightens ear canal.\r\n\r\n\"Pulling<\/a><\/td>\r\n<\/tr>\r\n
8. Hold dropper tip just above ear canal. Do not touch dropper tip to ear.<\/td>\r\nTouching the ear with the dropper tip will contaminate the dropper and the medication.<\/td>\r\n<\/tr>\r\n
9. Allow drops to fall on the side of the ear canal.<\/td>\r\nDropping the drops directly into the canal and onto the tympanic membrane will cause the patient discomfort.<\/td>\r\n<\/tr>\r\n
10. Release ear pinna and have patient remain in the position for at least 5 minutes.<\/td>\r\nThis position prevents medication from escaping from ear.<\/td>\r\n<\/tr>\r\n
11. Apply gentle pressure to tragus (the inner side of the external ear) several times.<\/td>\r\n\r\n\r\n[caption id=\"attachment_3584\" align=\"aligncenter\" width=\"207\"]\"\" Figure 6.16 massage the tragus after instilling ear drops[\/caption]\r\n\r\nPressure helps move medication toward tympanic membrane.<\/td>\r\n<\/tr>\r\n
12. If ordered, a cotton ball may be placed loosely in the ear canal.<\/td>\r\nCotton ball helps prevent medication from escaping from ear.<\/td>\r\n<\/tr>\r\n
13. Remove gloves and assist patient to a comfortable and safe position.<\/td>\r\nThis ensures patient safety and comfort.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n
14. Perform hand hygiene.<\/td>\r\nHand hygiene prevents the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
15. Document as per agency policy. Include date, time, dose, route; which ear the medication was instilled into; and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/td>\r\n<\/tr>\r\n
Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Instilling Nasal Medications<\/h2>\r\n\r\n\r\n\r\n
\r\n\r\n[caption id=\"attachment_3010\" align=\"alignleft\" width=\"320\"]\"\"<\/a> Figure 6.17\u00a0 Facial sinuses[\/caption]<\/td>\r\n\r\n\r\n[caption id=\"attachment_3009\" align=\"aligncenter\" width=\"262\"]\"\"<\/a> Figure 6.18 Nasal spray[\/caption]<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nNasal medications are instilled for the treatment of allergies, nasal congestion, and sinus infections. The nose is not a sterile cavity, but medical asepsis must be observed because of its connection to the sinuses. Prior to administering nasal medications ask the patient to gently blow their nose.\r\n\r\nFollowing administration, burning may be felt. At this point blowing the nose is discouraged, as the medication has not had time to absorb. Depending on the purpose of the nasal medication, different positioning may help facilitate delivery of the medication to the correct sinus area.\r\n\r\nChecklist 51 outlines the steps for instilling nasal\u00a0medications.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 51: Instilling Nasal Medications<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:<\/h5>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Perform hand hygiene prior to medication preparation. Check MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6278\" align=\"aligncenter\" width=\"150\"]\"Comparing<\/a> Comparing physician orders and MAR[\/caption]\r\n\r\nA MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification<\/td>\r\n<\/tr>\r\n
2 a. As you are removing medications from the dispensing system, perform the SEVEN rights three times with each individual medication:\r\n
    \r\n \t
  • The right patient<\/span><\/li>\r\n \t
  • The right medication (drug)<\/li>\r\n \t
  • The right dose<\/li>\r\n \t
  • The right route<\/li>\r\n \t
  • The right time<\/li>\r\n \t
  • The right reason<\/li>\r\n \t
  • The right documentation<\/li>\r\n<\/ul>\r\n<\/td>\r\n
The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).\r\n\r\nThe right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.\r\n\r\nThe right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.\r\n\r\nThe right route<\/strong>: Check that the route is appropriate for the patient's current condition.\r\n\r\nThe right time<\/strong>: Adhere to the prescribed dose and schedule.\r\n\r\nThe right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.\r\n\r\nThe right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/td>\r\n<\/tr>\r\n
2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:\r\n
    \r\n \t
  1. When the medication is taken out of the drawer.<\/li>\r\n \t
  2. When the medication is being poured.<\/li>\r\n \t
  3. When the medication is being put away or at bedside.<\/li>\r\n<\/ol>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_3585\" align=\"aligncenter\" width=\"208\"]\"\"<\/a> Figure 6.19 compare medication label with MAR[\/caption]\r\n\r\nThese checks are done before administering the medication to your patient. If taking drug to bedside (e.g., nose drops),\u00a0do a third\u00a0check at the bedside.<\/td>\r\n<\/tr>\r\n
3. Before instilling nasal medication, ask the patient to gently blow their nose.\r\n\r\nDonne clean, non-sterile gloves.<\/td>\r\nNose blowing clears the nose prior to medication instillation.\r\n\r\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.\r\n\r\n[caption id=\"attachment_5559\" align=\"aligncenter\" width=\"150\"]\"Apply<\/a> Apply non-sterile gloves[\/caption]<\/td>\r\n<\/tr>\r\n
4. Position patient.\r\n\r\nNose spray<\/strong>: Sitting upright with one nostril occluded, insert tip into open nostril.\r\n\r\nNose drops<\/strong>: Position patient sitting back or lying down with head tilted back over a pillow (underneath neck). Draw fluid into medication dropper with enough for both nares. Do not return excess fluid into stock bottle.<\/td>\r\nThis position allows medication to flow back into nasal cavity.\r\n\r\nDo not tilt head back if patient has a cervical spine injury.\r\n\r\nReturning fluid to stock bottle increases risk for contamination of medication.<\/td>\r\n<\/tr>\r\n
5. Instill medication:\r\n\r\nNasal spray<\/strong>: Have patient hold one nostril\u00a0closed and breathe gently through the other as the spray is being administered. Spray should be directed away from the nasal septum. Repeat as directed.\r\n\r\nNose drops<\/strong>: Hold dropper about 1 cm above naris and drop medication into one naris and then the other. Position patient with head back for 2 to 3 minutes.<\/td>\r\n\r\n\r\n[caption id=\"attachment_509821\" align=\"aligncenter\" width=\"150\"]\"Hold<\/a> Hold dropper about 1 cm above naris[\/caption]\r\n\r\nMaintaining position will help medications remain in place and maximize absorption.\r\n\r\nAdvise the patient they may feel like something is in the back of the throat. This is medication dripping into the pharynx.<\/td>\r\n<\/tr>\r\n
6.\u00a0Remove gloves and assist patient to a comfortable and safe position.<\/td>\r\nThis ensures patient safety and comfort.<\/td>\r\n<\/tr>\r\n
7.\u00a0Perform hand hygiene.<\/td>\r\nHand hygiene prevents the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
8.\u00a0Document as per agency policy. Include date, time, dose, route; which naris\u00a0the medication was instilled into (or whether it was both nares); and patient's response to procedure.<\/td>\r\nTimely and accurate documentation helps to ensure patient safety.<\/td>\r\n<\/tr>\r\n
Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
<\/div>\r\n
\r\n

Critical Thinking Exercises<\/h3>\r\n
    \r\n \t
  1. Your patient is due to receive a dose of medication instilled into both ears. You find the ear medication stored in the refrigerator. How should you proceed?<\/li>\r\n \t
  2. Your patient is due to receive medication instilled into her right eye, but you notice that her left eye has crusting and discharge. Discuss how you would proceed in this situation.<\/li>\r\n \t
  3. You need to teach a patient how to self administer nasal spray for seasonal allergy symptoms. Describe the key points you will discuss with them.<\/li>\r\n<\/ol>\r\n<\/div>\r\n

    Attributions<\/h2>\r\n

    Figure 6.13. Anatomy of eye<\/a> from\u00a0OpenStax College, Anatomy & Physiology (2013)\u00a0 is used under a CC BY 3.0<\/a> license.<\/span><\/p>\r\nFigure 6.14. Drops with MAR by author\u00a0is licensed under a\u00a0Creative Commons Attribution 4.0 International License<\/a>.\r\n\r\nFigure 6.15. Anatomy of ear by\u00a0<\/span>Anatomy of the Ear <\/a>\u00a0by <\/span>Blausen.com staff<\/a> (2014) is used under a <\/span>CC BY 3.0<\/a> license.<\/span>\r\n\r\nFigure 6.16. Massage the tragus after instilling ear drops by author is\u00a0<\/span>licensed under a\u00a0<\/span>Creative Commons Attribution 4.0 International License<\/a>.<\/span>\r\n\r\nFigure 6.17. Nasal sinuses illustration from OpenStax College,\u00a0Anatomy & Physiology.\u00a0Used under a <\/span>CC BY 3.0<\/a> license.\u00a0Download for free at\u00a0<\/span>http:\/\/cnx.org\/contents\/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22@6.27<\/a>.<\/span>\r\n\r\nFigure 6.18.\u00a0<\/span>Diagram of nasal spray application<\/a> by BruceBlaus is used under a cc BY-SA 4.0 license.<\/span>\r\n\r\nFigure 6.19. Spray with MAR by author is\u00a0<\/span>licensed under a\u00a0<\/span>Creative Commons Attribution 4.0 International License<\/a>.<\/span>","rendered":"

    Instilling Eye Medications<\/h2>\n

     <\/p>\n

    \"\"<\/a>
    Figure 6.13 Eye anatomy<\/figcaption><\/figure>\n

    The eye is the most sensitive organ to which medication may be applied (Perry et al., 2018). The cornea is especially sensitive, making the conjunctival sac the\u00a0appropriate site for instilling eye (ophthalmic) medications. Eye medications might be necessary for conditions such as glaucoma, infection, and following eye surgery. Of note is that eye medication are for the most part administered into the conjunctival sac, which is much less sensitive than the cornea.<\/p>\n

     <\/p>\n

    Checklist 49 outlines the steps for instilling eye medications.<\/p>\n

     <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 49:\u00a0Instilling Eye (Ophthalmic) Medications<\/h3>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:<\/h5>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Perform hand hygiene prior to medication preparation.<\/p>\n

    Check MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\n

    		\n
    \"Comparing<\/a>
    Comparing physician orders and MAR<\/figcaption><\/figure>\n

    A MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification processes.<\/td>\n<\/tr>\n

    \n

    2 a. As you are removing medication from the dispensing system, perform the SEVEN right three times with each individual medication:<\/p>\n

      \n
    • The right patient<\/li>\n
    • The right medication (drug)<\/li>\n
    • The right dose<\/li>\n
    • The right route<\/li>\n
    • The right time<\/li>\n
    • The right reason<\/li>\n
    • The right documentation<\/li>\n<\/ul>\n

      \n<\/td>\n

    		\n

    The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\n

    The right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\n

    The right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\n

    The right route<\/strong>: Check that the route is appropriate for the patient’s current condition.<\/p>\n

    The right time<\/strong>: Adhere to the prescribed dose and schedule.<\/p>\n

    The right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.<\/p>\n

    The right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\n<\/td>\n<\/tr>\n

    2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:<\/p>\n
      \n
    1. When the medication is taken out of the dispensing system or drawer.<\/li>\n
    2. Prior to opening the eye drop container.<\/li>\n
    3. After opening the eye drop container but PRIOR to administering the eye medication.<\/li>\n<\/ol>\n<\/td>\n
    		These checks are done before administering the medication to your patient. If taking a drug to the bedside (e.g., eye drops),\u00a0do the third\u00a0check at bedside.<\/p>\n
    \"\"
    Figure 6.14 Check medication with MAR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    3. Take medications and MARs to the bedside.<\/p>\n
      \n
    • Identify the patient using two identifiers.<\/li>\n
    • Confirm allergies.<\/li>\n
    • Inform the patient of the medication and its intended action.<\/li>\n
    • Complete any necessary assessment.<\/li>\n
    • Offer a tissue to the patient.<\/li>\n<\/ul>\n<\/td>\n
    		\"\"<\/a>MARs cannot be taken into rooms where additional precautions are necessary.<\/p>\n

    The patient has the right to be informed.<\/p>\n

    Drops may spill from the eye during administration.<\/td>\n<\/tr>\n

    4.\u00a0Wear clean, non-sterile gloves.<\/td>\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5.\u00a0Cleanse the eyelashes and eyelids of any drainage or crusting with a warm washcloth or gauze. Use each area of cleaning surface only once, and move from inner to outer eye area.<\/td>\nCleansing removes debris from eye area.<\/td>\n<\/tr>\n
    6.\u00a0Tilt patient’s head back slightly if patient is sitting up, or place patient’s head over a pillow (under the neck) if they are lying down.<\/td>\nTilting the head back makes it easier to reach the conjunctival sac for instilling drops.<\/p>\n

    Do not tilt head back if patient has a cervical spine injury.<\/td>\n<\/tr>\n

    7.\u00a0Invert the eye-drop container, and have patient look up and focus on something on the ceiling.<\/td>\nKeeping the eye focused will help keep it still.<\/td>\n<\/tr>\n
    8. Gently pull patient’s lower lid down using thumb or two fingers to expose conjunctival sac.<\/td>\nPlace eye drop in conjunctival sac, not directly on eyeball (cornea).<\/td>\n<\/tr>\n
    9. Eye drops<\/strong>: Hold eye-drop container above eye taking care not to touch the eye, eyelids, or eyelashes. Instill one drop, or more if prescribed, into conjunctival sac.<\/p>\n

    Eye ointment<\/strong>: Apply about 1.5 cm of ointment along lower conjunctival sac moving from inner to outer canthus. Twist tube to break off ribbon of ointment.<\/td>\n

    		\"DSC_0825\"<\/a>Touching the tip of the container to anything can contaminate the medication.<\/td>\n<\/tr>\n
    10. Release lower lid after instillation and ask patient to close eyes gently. Ask patient to move the eyeball while eyes are closed.<\/td>\nThis step allows the medication to be distributed across the eye.<\/p>\n
    \"DSC_0826\"<\/a>
    Have patient close eyes after drop is instilled<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    11.\u00a0Eye drops only<\/strong>: Apply gentle pressure over inner canthus for 30 to 60 seconds to prevent medication from entering the lacrimal duct.<\/td>\nThis minimizes systemic absorption and thus systemic effects of the medication.<\/td>\n<\/tr>\n
    12.\u00a0Instruct patient not to rub eye.<\/td>\nThis is to prevent irritation and injury to the eye and to allow the medication to be fully absorbed.<\/td>\n<\/tr>\n
    13. Remove gloves and assist patient to a comfortable and safe position.<\/p>\n

    Perform hand hygiene.<\/td>\n

    		This ensures patient safety and comfort.<\/p>\n

    Hand hygiene prevents the spread of microorganisms.<\/td>\n<\/tr>\n

    14. Document as per agency policy. Include date, time, dose, route; which eye the medication was instilled into; and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/td>\n<\/tr>\n
    Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Instilling Ear Medications<\/h2>\n
    \"\"<\/a>
    Figure 6.15 Anatomy of the ear<\/figcaption><\/figure>\n

    Common medications to be instilled into the ear include antibiotics, anti inflammatory agents, local analgesics, and wax emulsifiers (Lilley et al., 2016). In general, ear drops should be instilled after the ear has been thoroughly cleansed and the dropper cleaned with alcohol. Internal ear structures are particularly sensitive to temperature extremes. Therefore, ear (otic) medications should always be administered at least at room temperature but preferably at body temperature to promote comfort and to reduce risk of vertigo associated with cold ear drops (Lilley et al., 2016). Care must be taken to avoid contaminating the dropper and ear medication, as doing so could introduce microorganisms into the ear which could be very serious in the event the ear drum (tympanic membrane) is ruptured. After administration, the patient should be advised to lie on the unaffected side for 5 minutes to maximize medication absorption.<\/p>\n

    Checklist 50 outlines the steps for instilling ear\u00a0medications.<\/p>\n

     <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 50:\u00a0Instilling Ear (Otic) Medications<\/h3>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:<\/h5>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    \n
      \n
    1. Perform hand hygiene prior to medication preparation.<\/li>\n<\/ol>\n

      Check MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\n

    		\n
    \"Comparing<\/a>
    Comparing physician orders and MAR<\/figcaption><\/figure>\n

    A MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification processes.<\/td>\n<\/tr>\n

    2 a. As you are removing medications from the dispensing system, perform the SEVEN rights three times with each individual medication:<\/p>\n
      \n
    • The right patient<\/span><\/li>\n
    • The right medication (drug)<\/li>\n
    • The right dose<\/li>\n
    • The right route<\/li>\n
    • The right time<\/li>\n
    • The right reason<\/li>\n
    • The right documentation<\/li>\n<\/ul>\n

       <\/td>\n

    		\n

    The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\n

    The right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\n

    The right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\n

    The right route<\/strong>: Check that the route is appropriate for the patient’s current condition.<\/p>\n

    The right time<\/strong>: Adhere to the prescribed dose and schedule.<\/p>\n

    The right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.<\/p>\n

    The right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/p>\n<\/td>\n<\/tr>\n

    2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:<\/p>\n
      \n
    1. When the medication is taken out of the drawer.<\/li>\n
    2. When the medication is being poured.<\/li>\n
    3. When the medication is being put away or at bedside.<\/li>\n<\/ol>\n<\/td>\n
    		\n
    \"\"
    Figure 6.14 Check medication with MAR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    3. Before instilling ear drops, donne clean, non-sterile gloves.<\/td>\nUsing gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n
    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    4. Cleanse external ear of any drainage using a warm wet washcloth.<\/td>\nDrainage or debris may prevent some medication\u00a0from entering ear canal.<\/td>\n<\/tr>\n
    5. If lying down, position patient on unaffected side with affected ear uppermost. Tilt head to side if sitting up.<\/td>\nProper positioning helps to stop medication from escaping.<\/p>\n

    Do not tilt head if patient has a cervical spine injury.<\/td>\n<\/tr>\n

    6. Draw up medication into ear dropper, ensuring correct dosage.<\/p>\n

    Do not return excess medication to stock bottle.<\/td>\n

    		Risk for contamination is increased if medication is returned to bottle.<\/td>\n<\/tr>\n
    7. Adult administration<\/strong>: Gently pull ear pinna back and up.<\/p>\n

    Child (up to 3 years) administration<\/strong>: Gently pull ear pinna down and back.<\/td>\n

    		Pulling the pinna (the external part of the ear) straightens ear canal.<\/p>\n

    \"Pulling<\/a><\/td>\n<\/tr>\n

    8. Hold dropper tip just above ear canal. Do not touch dropper tip to ear.<\/td>\nTouching the ear with the dropper tip will contaminate the dropper and the medication.<\/td>\n<\/tr>\n
    9. Allow drops to fall on the side of the ear canal.<\/td>\nDropping the drops directly into the canal and onto the tympanic membrane will cause the patient discomfort.<\/td>\n<\/tr>\n
    10. Release ear pinna and have patient remain in the position for at least 5 minutes.<\/td>\nThis position prevents medication from escaping from ear.<\/td>\n<\/tr>\n
    11. Apply gentle pressure to tragus (the inner side of the external ear) several times.<\/td>\n\n
    \"\"
    Figure 6.16 massage the tragus after instilling ear drops<\/figcaption><\/figure>\n

    Pressure helps move medication toward tympanic membrane.<\/td>\n<\/tr>\n

    12. If ordered, a cotton ball may be placed loosely in the ear canal.<\/td>\nCotton ball helps prevent medication from escaping from ear.<\/td>\n<\/tr>\n
    13. Remove gloves and assist patient to a comfortable and safe position.<\/td>\nThis ensures patient safety and comfort.<\/td>\n<\/tr>\n<\/tbody>\n
    14. Perform hand hygiene.<\/td>\nHand hygiene prevents the spread of microorganisms.<\/td>\n<\/tr>\n
    15. Document as per agency policy. Include date, time, dose, route; which ear the medication was instilled into; and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/td>\n<\/tr>\n
    Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Instilling Nasal Medications<\/h2>\n\n\n\n
    \n
    \"\"<\/a>
    Figure 6.17\u00a0 Facial sinuses<\/figcaption><\/figure>\n<\/td>\n
    		\n
    \"\"<\/a>
    Figure 6.18 Nasal spray<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Nasal medications are instilled for the treatment of allergies, nasal congestion, and sinus infections. The nose is not a sterile cavity, but medical asepsis must be observed because of its connection to the sinuses. Prior to administering nasal medications ask the patient to gently blow their nose.<\/p>\n

    Following administration, burning may be felt. At this point blowing the nose is discouraged, as the medication has not had time to absorb. Depending on the purpose of the nasal medication, different positioning may help facilitate delivery of the medication to the correct sinus area.<\/p>\n

    Checklist 51 outlines the steps for instilling nasal\u00a0medications.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 51: Instilling Nasal Medications<\/h3>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:<\/h5>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Perform hand hygiene prior to medication preparation. Check MAR to guide you to which medications you are preparing. Follow agency policy to ensure MARs are accurate and verified appropriately.<\/td>\n\n
    \"Comparing<\/a>
    Comparing physician orders and MAR<\/figcaption><\/figure>\n

    A MAR that is checked by more than one healthcare professional provides a very reliable record for administering medications. Agencies may vary in relation to MAR verification<\/td>\n<\/tr>\n

    2 a. As you are removing medications from the dispensing system, perform the SEVEN rights three times with each individual medication:<\/p>\n
      \n
    • The right patient<\/span><\/li>\n
    • The right medication (drug)<\/li>\n
    • The right dose<\/li>\n
    • The right route<\/li>\n
    • The right time<\/li>\n
    • The right reason<\/li>\n
    • The right documentation<\/li>\n<\/ul>\n<\/td>\n
    		The right patient<\/strong>: Check that you have the correct patient using two patient identifiers\u00a0(e.g., name and date of birth).<\/p>\n

    The right medication (drug)<\/strong>: Check that you have the correct medication and that it is appropriate for the patient in the current context.<\/p>\n

    The right dose<\/strong>: Check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions.<\/p>\n

    The right route<\/strong>: Check that the route is appropriate for the patient’s current condition.<\/p>\n

    The right time<\/strong>: Adhere to the prescribed dose and schedule.<\/p>\n

    The right reason<\/strong>: Check that the patient is receiving the medication for the appropriate reason.<\/p>\n

    The right documentation<\/strong>: Always verify any unclear or inaccurate documentation prior to administering medications.<\/td>\n<\/tr>\n

    2 b. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times:<\/p>\n
      \n
    1. When the medication is taken out of the drawer.<\/li>\n
    2. When the medication is being poured.<\/li>\n
    3. When the medication is being put away or at bedside.<\/li>\n<\/ol>\n<\/td>\n
    		\n
    \"\"<\/a>
    Figure 6.19 compare medication label with MAR<\/figcaption><\/figure>\n

    These checks are done before administering the medication to your patient. If taking drug to bedside (e.g., nose drops),\u00a0do a third\u00a0check at the bedside.<\/td>\n<\/tr>\n

    3. Before instilling nasal medication, ask the patient to gently blow their nose.<\/p>\n

    Donne clean, non-sterile gloves.<\/td>\n

    		Nose blowing clears the nose prior to medication instillation.<\/p>\n

    Using gloves protects the nurse from potential contact with patient body fluids and medications.<\/p>\n

    \"Apply<\/a>
    Apply non-sterile gloves<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    4. Position patient.<\/p>\n

    Nose spray<\/strong>: Sitting upright with one nostril occluded, insert tip into open nostril.<\/p>\n

    Nose drops<\/strong>: Position patient sitting back or lying down with head tilted back over a pillow (underneath neck). Draw fluid into medication dropper with enough for both nares. Do not return excess fluid into stock bottle.<\/td>\n

    		This position allows medication to flow back into nasal cavity.<\/p>\n

    Do not tilt head back if patient has a cervical spine injury.<\/p>\n

    Returning fluid to stock bottle increases risk for contamination of medication.<\/td>\n<\/tr>\n

    5. Instill medication:<\/p>\n

    Nasal spray<\/strong>: Have patient hold one nostril\u00a0closed and breathe gently through the other as the spray is being administered. Spray should be directed away from the nasal septum. Repeat as directed.<\/p>\n

    Nose drops<\/strong>: Hold dropper about 1 cm above naris and drop medication into one naris and then the other. Position patient with head back for 2 to 3 minutes.<\/td>\n

    		\n
    \"Hold<\/a>
    Hold dropper about 1 cm above naris<\/figcaption><\/figure>\n

    Maintaining position will help medications remain in place and maximize absorption.<\/p>\n

    Advise the patient they may feel like something is in the back of the throat. This is medication dripping into the pharynx.<\/td>\n<\/tr>\n

    6.\u00a0Remove gloves and assist patient to a comfortable and safe position.<\/td>\nThis ensures patient safety and comfort.<\/td>\n<\/tr>\n
    7.\u00a0Perform hand hygiene.<\/td>\nHand hygiene prevents the spread of microorganisms.<\/td>\n<\/tr>\n
    8.\u00a0Document as per agency policy. Include date, time, dose, route; which naris\u00a0the medication was instilled into (or whether it was both nares); and patient’s response to procedure.<\/td>\nTimely and accurate documentation helps to ensure patient safety.<\/td>\n<\/tr>\n
    Data sources: BCIT, 2015; Lilley et al., 2016; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    <\/div>\n
    \n

    Critical Thinking Exercises<\/h3>\n
      \n
    1. Your patient is due to receive a dose of medication instilled into both ears. You find the ear medication stored in the refrigerator. How should you proceed?<\/li>\n
    2. Your patient is due to receive medication instilled into her right eye, but you notice that her left eye has crusting and discharge. Discuss how you would proceed in this situation.<\/li>\n
    3. You need to teach a patient how to self administer nasal spray for seasonal allergy symptoms. Describe the key points you will discuss with them.<\/li>\n<\/ol>\n<\/div>\n

      Attributions<\/h2>\n

      Figure 6.13. Anatomy of eye<\/a> from\u00a0OpenStax College, Anatomy & Physiology (2013)\u00a0 is used under a CC BY 3.0<\/a> license.<\/span><\/p>\n

      Figure 6.14. Drops with MAR by author\u00a0is licensed under a\u00a0Creative Commons Attribution 4.0 International License<\/a>.<\/p>\n

      Figure 6.15. Anatomy of ear by\u00a0<\/span>Anatomy of the Ear <\/a>\u00a0by <\/span>Blausen.com staff<\/a> (2014) is used under a <\/span>CC BY 3.0<\/a> license.<\/span><\/p>\n

      Figure 6.16. Massage the tragus after instilling ear drops by author is\u00a0<\/span>licensed under a\u00a0<\/span>Creative Commons Attribution 4.0 International License<\/a>.<\/span><\/p>\n

      Figure 6.17. Nasal sinuses illustration from OpenStax College,\u00a0Anatomy & Physiology.\u00a0Used under a <\/span>CC BY 3.0<\/a> license.\u00a0Download for free at\u00a0<\/span>http:\/\/cnx.org\/contents\/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22@6.27<\/a>.<\/span><\/p>\n

      Figure 6.18.\u00a0<\/span>Diagram of nasal spray application<\/a> by BruceBlaus is used under a cc BY-SA 4.0 license.<\/span><\/p>\n

      Figure 6.19. Spray with MAR by author is\u00a0<\/span>licensed under a\u00a0<\/span>Creative Commons Attribution 4.0 International License<\/a>.<\/span><\/p>\n","protected":false},"author":397,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[],"contributor":[],"license":[50],"class_list":["post-786","chapter","type-chapter","status-publish","hentry","license-cc-by"],"part":757,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/786","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":27,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/786\/revisions"}],"predecessor-version":[{"id":5208,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/786\/revisions\/5208"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/757"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/786\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=786"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=786"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=786"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=786"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}