A 68-year-old patient is prescribed a corticosteroid eye drop and an antibiotic eye drop for postoperative care following cataract surgery. The nurse is providing instructions on administration. Which statement by the nurse is most appropriate?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

A 5-minute waiting period between different eye drops is the standard of care to ensure the first medication is properly absorbed and to prevent a 'washout effect'.
Instilling drops too close together causes the second drop to flush out the first, significantly reducing its therapeutic efficacy.
The recommended order is typically solutions before suspensions. Since many antibiotics are solutions and corticosteroids are suspensions, administering the antibiotic first is the correct procedure.
This method ensures that the patient receives the full therapeutic dose of both the anti-infective and anti-inflammatory medications crucial for postoperative healing.

Option A: Instilling two drops simultaneously will cause the conjunctival sac to overflow, and the second drop will immediately wash out the first, leading to under-dosing of both medications.
Option B: A one-minute interval is insufficient for the first drop to be absorbed by the ocular tissues. The washout effect will still occur, reducing the drug's effectiveness.
Option D: Mixing medications in the same container is a dangerous practice that can lead to chemical incompatibility, drug degradation, contamination, and unpredictable dosage.

Clinical Relevance

Nursing practice connection: Use the key finding related to Proper administration technique for multiple ophthalmic medications to guide bedside assessment, documentation, and the next nursing action.
Correct eye drop administration is crucial in post-cataract patients to prevent complications like endophthalmitis (infection inside the eye) and to control postoperative inflammation, both of which can threaten vision.
Patient education is a key nursing responsibility. Failure to provide clear, correct instructions can lead to treatment failure, disease progression, and adverse outcomes.
What if? If the patient was also prescribed an eye ointment, it should always be administered last, at least 5-10 minutes after the final eye drop. Ointments create a barrier that can block the absorption of any drops applied afterward.

How to Approach the Question

Identify the core of the question: it's about the correct procedure for administering two different eye drops.
Recall the key principles of ophthalmic medication administration: sufficient wait time between drops, the order of administration (solutions before suspensions, drops before ointments), and avoiding contamination.
Evaluate each option against these principles.
Option A (simultaneous) and D (mixing) are immediately identifiable as unsafe and incorrect practices that violate fundamental medication safety rules.
Compare Option B (1 minute) and C (5 minutes). Recall that the standard recommended wait time is 5 minutes to prevent the washout effect. Therefore, a 1-minute wait is insufficient.
Conclude that Option C provides the safest and most effective instruction by incorporating the correct wait time.

Concept Tested & Keywords

Concept Tested: Proper administration technique for multiple ophthalmic medications.
Stem keywords: corticosteroid eye drop, antibiotic eye drop, postoperative care, cataract surgery, administration instructions
Lead-in keywords: most appropriate
Clinical cues: Postoperative care following cataract surgery indicates a need for strict aseptic technique and correct medication delivery to prevent infection and control inflammation.

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E6 Pharmacology Nursing Lilley 11e Part 3 p. 269-271

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