Name: ________________________________________
Date: _________________________________________
Procedure 38-9:
Instilling Nasal Medications
Objective: Instill nasal medication as ordered by the physician.
Equipment and Supplies: Physician’s order; patient’s record; nasal medication; sterile medicine
dropper; tissues; gloves
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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POINT VALUE
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. Check physician’s orders.
2. Perform hand hygiene.
3. Assemble the equipment.
4. Identify the patient and explain
the procedure.
5. Position the patient with head
lower than the shoulders to instill
medication into the ethmoid
and sphenoid sinuses. To instill
medication into the maxillary and
frontal sinuses, have the patient
assume the same back-lying
position with the head turned
toward the side to be treated
(Figures A and B). Place patient
in a supine position with a pillow
under the neck to lower the
head below the shoulders. Make
the patient as comfortable as
possible.
6. Check the medication three
times for correct name, dosage,
and expiration date. Draw the
medication into a dropper, and
hold it over the center of the
aected nostril, taking care not to
touch the dropper to the inside of
the nostril.
7. Administer the medication.
Repeat in the other nostril if
ordered.
8. Tell the patient to stay in that
position for five minutes to
prevent medication from running
out of the nostril.
9. Provide tissues for the patient to
wipe excess from the skin.
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POINT VALUE
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
10. Discard the dropper in the
biohazard waste container, recap
the medication, and return it to
the storage place.
11. Clean the area and remove
gloves.
12. Provide home instruction
if needed. Verify patient
understanding.
13. Perform hand hygiene.
14. Document the procedure in the
patient’s medical record.
GRADING
Points Earned
Points Possible 99 99
Percent Grade (Points Earned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
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