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Student Name: _________________________________ Skills Lab/Date: ________________________

Eye Drop – Skill Performance Evaluation

Module 5

VNSG 2413

|Performance Points |S |U |Comments |

|*Wash hands. | | | |

|*Check medication order. Note eye to be treated. Note | | | |

|patient allergies. | | | |

|Prepare patient for medication | | | |

|instillation: | | | |

|Check patient’s identity using an identification bracelet or | | | |

|other accepted means. | | | |

|Explain procedure to patient in a calm and confident manner. | | | |

|Assist patient to sit or lie down with head slightly hyper | | | |

|extended. | | | |

|Put on gloves. | | | |

|Assess condition of the eye and wash away exudates, wiping | | | |

|from inner to outer canthus. | | | |

|*Administer medication: | | | |

|Remove cap from bottle and place it on its side. Fill | | | |

|medicine dropper (if used) to prescribed amount. | | | |

|With the head tilted back slightly, gently pull the lower lid | | | |

|down to form a pouch, exposing the conjunctival sac. | | | |

|Instill the prescribed number of drops. | | | |

|Have the patient close their eyes for 30 seconds. | | | |

|*Remove gloves and perform hand hygiene. | | | |

|*Document on MAR. | | | |

*ALL CRITICAL

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