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
aected 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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