A child admitted with an eye infection. The ophthalmologist prescribed antibiotic eye drops. Where should the… - SGPGI Nursing Officer-2023

SGPGI Nursing Officer-2023

Child Health Nursing (Pediatrics)

Easy

Appeared in: SGPGI Nursing Officer-2023

Explanation

The correct site for instilling eye drops is the lower conjunctival sac.
This site is accessed by gently pulling the lower eyelid downward to create a small pocket.
This method ensures the medication pools and spreads evenly across the eye surface, maximizing contact time and therapeutic effect.
It also minimizes the blink reflex, which could expel the medication.
The image provided visually confirms this technique, showing the lower lid being pulled down to form a sac for the drop.

Option A: Instilling drops on the upper eyelid is ineffective as the medication would run down the patient's cheek rather than entering the eye.
Option C: The inner canthus contains the nasolacrimal duct. Placing drops here leads to rapid drainage into the nasal cavity, reducing the drug's local effect on the eye and increasing the risk of systemic absorption and side effects.
Option D: Instilling drops at the outer canthus is inefficient. The medication may not distribute evenly across the cornea and could easily spill out of the eye.

Clinical Relevance

Nursing practice connection: Use the key finding related to The concept tested is the correct anatomical location and procedure for administering ophthalmic (eye) medications to ensure maximum therapeutic effect and minimize side effects to guide bedside assessment, documentation, and the next nursing action.
Proper technique is crucial to ensure the medication treats the infection effectively and to prevent contamination of the dropper bottle, which could introduce new bacteria.
Applying pressure to the nasolacrimal duct (nasolacrimal occlusion) after instillation is a critical nursing action. It prevents the medication from entering the systemic circulation, which is especially important in children and with certain drugs like beta-blockers or potent antibiotics.
What if? If the medication were an eye ointment instead of drops, the site would still be the lower conjunctival sac. However, the application method would change: a thin ribbon of ointment is applied along the inside of the lower eyelid, typically from the inner to the outer canthus.

How to Approach the Question

First, identify the core task in the question: administering eye drops to a child.
Recall the standard nursing procedure for ophthalmic medication. The goal is to get the medication onto the surface of the eye in a way that it will be retained.
Visualize the anatomy of the eye. The space between the eyeball and the eyelid is the conjunctival sac. Creating a 'pocket' here is the most effective way to hold the liquid.
Evaluate the options based on this principle. Pulling the lower eyelid down creates this pocket (the lower conjunctival sac).
Eliminate the other options: the upper eyelid would cause runoff, and the inner/outer canthi are inefficient delivery points, with the inner canthus leading to rapid drainage.

Concept Tested & Keywords

Concept Tested: The concept tested is the correct anatomical location and procedure for administering ophthalmic (eye) medications to ensure maximum therapeutic effect and minimize side effects.
Stem keywords: child, eye infection, antibiotic eye drops, administered
Lead-in keywords: Where should
Clinical cues: The patient is a child, which requires special consideration for cooperation and minimizing systemic absorption.

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