A patient is prescribed both an antibiotic eye drop and an eye ointment for bacterial conjunctivitis. What is the correct sequence of administration the nurse should follow?

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

The fundamental rule for ophthalmic administration is to apply liquid formulations (drops) before semi-solid ones (ointments).
Eye drops are aqueous and absorb quickly, while ointments are oil-based and create a barrier on the eye's surface.
Applying the ointment first would prevent the drop from being absorbed, making the medication ineffective.
A waiting period of at least 5-10 minutes between the drop and the ointment is necessary to allow the drop to be absorbed before the ointment is applied.

Option A: Applying the ointment first creates an oily barrier that physically blocks the eye drop from reaching the conjunctiva for absorption.
Option C: Administering both simultaneously would cause the thicker ointment to immediately displace the liquid drop, washing it out of the eye before it has a chance to work. It does not enhance absorption.
Option D: The order of administration is critical for therapeutic effectiveness. The different physical properties (liquid vs. oil-based) of the medications dictate the sequence to ensure proper drug delivery.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Medication Administration: Ophthalmic Route in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Correct administration technique is crucial for treating eye infections like conjunctivitis effectively and preventing treatment failure or prolonged infection.
Patient education is a key nursing responsibility. The nurse must teach the patient or caregiver the correct sequence and waiting time to ensure adherence and efficacy at home.
What if? If two different types of eye drops are prescribed, the nurse should still wait at least 5 minutes between instilling each drop to prevent the first drop from being diluted or washed out by the second.

How to Approach the Question

Identify the core of the question: it asks for the correct order of administering two different forms of eye medication (a liquid drop vs. a semi-solid ointment).
Recall the physical properties of the medications. Eye drops are liquid (aqueous), and ointments are semi-solid and greasy (oil-based).
Apply the basic principle of absorption for topical medications: liquids must be applied before thicker, oil-based substances. An oily layer will block a liquid from being absorbed.
Evaluate the options based on this principle. The only logical sequence is the drop first, followed by the ointment.
Consider the need for a time interval. A waiting period is necessary to allow the first medication (the drop) to be absorbed before applying the second (the ointment). This confirms that the drop should be given first, followed by a wait, and then the ointment.

Concept Tested & Keywords

Concept Tested: Medication Administration: Ophthalmic Route
Stem keywords: antibiotic eye drop, eye ointment, bacterial conjunctivitis, sequence of administration
Lead-in keywords: correct sequence
Clinical cues: Prescribed both an eye drop and an eye ointment

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

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 187-189

E6 Pharmacology Nursing Lilley 11e Part 1 p. 146-148

Practise the full SCTIMST Staff Nurse - 2015 (Set-A)

Attempt every question from this paper in a timed mock, then review the full solution for each one.