Steps

Rationale/Points of Emphasis

1 Verify the order with the child’s medical record and check for allergy to drug; if present, do not administer drug and notify prescriber.

Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.

2 Perform hand hygiene and don gloves.

Reduces transmission of microorganisms.

3a Obtain medication and read the label to verify with the order. Check for expiration date; if expired, do not administer. Identify the correct nostril in which to administer the medication.

To decrease chance of medication error, patient, route, dose, frequency, and time to be administered must be verified each time a medication is administered.

3b Bring medication to room temperature before administration. Warm the solution by gently rotating the bottle in your hands before administration.

Cold medication increases discomfort when medication is administered nasally.

caREminder

Nasal medication must be water based and not oil based. This prevents the possibility of aspiration pneumonia and facilitates absorption through nasal mucosa.

4 Verify medication with the electronic record or take medication record and medication to the child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with the child’s identification bracelet band and any other patient identifier required by the institution.

Ensures proper identification of the child.

5 Have the child blow his or her nose before administration. If the child is not old enough to cooperate, use a bulb syringe.

Clears the nose to allow for proper absorption of the medication.

6 Nose drops:

6a Position the child in the supine position with the head tilted back or place a rolled towel or pillow under the child’s neck and shoulder. An older child can extend the head over the side of the bed so that it is lower than the trunk.

Allows medication to coat nasal mucosa.

6b Aim the tip of the dropper toward the nasal passage and instill the ordered number of drops into each nostril, being careful not to touch the sides of the nostril (Figure 66-1).

Deposits the drug within the nose rather than in the throat and ensures administering the correct dose. Prevents contamination of the dropper or bottle.

Figure 66-1 Position the child in the supine position with the head tilted back. Instill the ordered number of drops into each nostril, being careful not to touch the sides of the nostrils.

6c Have the child remain in that position for several minutes, if possible.

Gives time for absorption of the medication.

7 Nasal spray:

7a Position the child in a semi-Fowler position with the head tilted slightly back.

Allows medication to coat nasal mucosa.

7b Instill the spray by holding (or having the child hold) one nostril closed while the medication is sprayed into the other nostril. Direct the spray to the side away from the septum and toward the top of the ear on that side.

Allows for full administration of the spray into the nostril.

7c Have the child take a deep breath through the nostril while the medication is being administered.

Facilitates absorption of the medication.

7d If indicated, repeat the procedure on the other nostril.

8 Remove gloves and perform hand hygiene.

Reduces transmission of microorganisms.

9 Recap the medication. Return medication to appropriate storage area.

Provides safe storage of medication.