Eye, Ear, Nose and Throat Assessment and Disorders Final PPT, Nursing
Eye, Ear, Nose and Throat Assessment and Disorders Final PPT, Nursing
Eye, Ear, Nose and Throat Assessment and Disorders Final PPT, Nursing
NURSING DEPARTMENT
Muller’s muscle
Parts Conjunctiva
I. Tarsal/pulpural Conjunctiva
- The part lining in the inner aspect of the eye lid.
- Firmly attached to the underlying tarsal plate.
- Which is highly pink- easily anemic identified
II. Bulbar Conjunctiva
- The part lining the eye ball.
- Loosely attached to the underlying sclera.
III. Fornix
-Part in which the tarsal and bulbar
conjunctivas are continuous.
C. Glands
Glands of zeis and glands of Moll
– Testing vision
Current History
Duration of illness
Family history
Medical history
Ophthalmoscope
External examination
conjunctiva
– multiple sclerosis,
– brain lesions, or
– narcotics use.
Ocular motility test…
Perform cover test
• As you cover the eye, observe the
uncovered eye for movement.
– Hand movement
– Light perception
Accommodation.
eyes.
Visual Fields by Confrontation…
• While you return the patient‘s gaze, place your
hands about 2 feet apart, lateral to the patient‘s
ears.
– Use your right hand and right eye for pt's right
eye, left hand and left eye for the pt‘s left eye
– Disturbance of vision
– Eye discharge
Eye disorders
– Refractive errors
– Myopia
– Astigmatism
– Presbyopia
Hyperopia (far sightedness)
• Mechanism
• Etiology
– * Genetic link
• Diagnosis
– * Ophthalmoscope
Hyperopia (far sightedness)…
•Treatment
–* Convex lens
Myopia (near sightedness)
• Mechanism
• Etiology
– * Genetic link
– Squinting
– Eye rubbing
– Headaches
• Treatment
– *Concave lens
Astigmatism
• Mechanism
– * Genetic link
Astigmatism…
• Symptoms and signs
– * Squinting
– * Eye rubbing
– Headache
Astigmatism…
• Diagnosis
• Treatment
– * Genetic link
• Treatment
– * Convex lens
– Lens transplant
Disorders of the eye lid and eye lashes
• Hordeolum • Ectropion
• Chalazion • Trichiasis
• Blepharitis • Edema
• Entropion
Disorders of the eye lid
• Hordeolum (stye)
– *Inflammation of the hair follicle of the eye lid
• Etiology
– * Staphylococcal infection
* Usually associated with blepharitis
Internal Hordeolum
• It is secondary infection of meibomian glands
caused by staphylococcus
• Non-pharmacological treatment
• Mechanism
• Etiology
• Treatment
• Topical treatment
– Dexamethasone eye drop, 1 drop QID, for 3
to 6 weeks, then taper every 5 to 7 days OR
– Oxytetracycline+ Polymyxin B+Hydrocortisone
suspension TID/4 weeks OR
Ulcerative Blepharitis…
• Topical treatment…
– Generally asymptomatic
• Pharmacological treatment
• Etiology
– Itching, redness
– Visual examination
• Treatment
• Etiology
to cornea
Ectropion…
• Cause: _ Blepheritis
_ Trauma
• Rx: - Epilation
Inflammatory edema
Non-inflammatory edema
Eye lid edema…
Eye lid edema…
Diseases of the conjunctiva
• Conjunctivitis
– Bacterial conjunctivitis
– Viral conjunctivitis
– Allergic conjunctivitis
• Trachoma
Conjunctivitis (pink eye)
• * Is the inflammation of the conjunctiva
Etiology
– * Viral / bacterial
* Irritants (allergies, chemicals, UV light)
Conjunctivitis (pink eye)…
Common symptoms and signs
• Photophobia
• Eye discharge
Conjunctivitis…
• Types
– Bacterial conjunctivitis
– Viral conjunctivitis
– Allergic conjunctivitis
Bacterial conjunctivitis
• Is a bacterial infection of the conjunctiva usually
caused by Staph.auerus, streptococcus,…
Non-pharmacological treatment
Topical antibiotics
– Red eye
– Itching, Photophobia
Treatment
• Steroids if needed
Allergic conjunctivitis
• Inflammation of the conjunctiva caused by
air born allergy contacting the eye.
– Cold compress
Allergic conjunctivitis…
• There are various forms of allergic conjunctivitis
– Conjunctival swelling
• Non-pharmacological treatment
– Cold compress
• Pharmacological treatment
– Eyelid edema
– Cold compresses
• Pharmacological treatment
– Allergen avoidance
– Cold compress
• Pharmacological treatment
is a disease of poverty
Poverty
Poor hygiene
on upper tarsus
• Represent prior/old
• Likely to develop
progressive corneal
scarring, needs surgical
treatment
Corneal opacity (CO)
• Corneal opacity
affecting central
cornea
• Goal of treatment
– Prevent complications
• Non-pharmacological treatment
• Systemic treatment
• Cataract
• Glaucoma
Keratitis
• It is inflammation and ulceration of the cornea
– * Trauma
– lid abnormalities
– Immunosuppression
• Sign and symptoms
Photophobia
Blurred vision
– * Medical history
• Treatment
• Maintenance therapy
– * Foreign bodies
* Trauma (fingernail, contact lenses)
– Lid abnormalities
– Immunosuppression
– Dry eye
Corneal abrasion or ulcer…
Symptoms and signs
– Pain
– Redness
– Tearing
– Something constantly in eye
– Whitish opaque cornea
– Vision impairment
Corneal abrasion or ulcer…
Corneal abrasion or ulcer…
• Diagnosis
– * Visual examination
– *Tonometry (IOP)
• Etiology
– Autoimmune disorders
– * Rheumatoid arthritis
- Watering, photophobia
– * Ophthalmic examination
* Blood work to uncover underlying cause
• Treatment
• Etiology
– Photophobia
– Reduction of vision
– Watery discharge
– * Familial or * congenital
– * Uveitis
• Clinical
• Visual examination
– Eyeglass
• Advanced age
• Refractive error
– Acute or Chronic
– Primary or Secondary
• Mechanism
– Hemi-cranial headache
• Goal of treatment
– Elevated IOP
Chronic open-angle glaucoma…
• Diagnosis
• Prostaglandin analogues
• Adrenergic Agonists
• Para sympathomimetic
Prostaglandin analogues
Adrenergic Agonists
Para sympathomimetic:
• Surgery
– Trabeculectomy
– Ridotomy or Iridectomy
– Tube-shunt implant
– * Ophthalmoscopy
* Fluorescein angiography
* Patient history
Macular degeneration…
• Treatment
– * No known cure
* Laser photocoagulation
• MECHANISM
• ETIOLOGY
- Trauma
Retinal detachment…
Retinal detachment…
– * Visual floaters
– * Light flashes
* Dark/opaque shadow
– * Ophthalmoscopy
• Treatment
– Pneumatic retiopexy
– Vitrectomy
Retinal detachment…
Disease of the lacrimal apparatus
Dacryocystitis
• It is an inflammation of the lacrimal sac
Tympanic membrane
Middle ear
Inner ear
equilibrium
• Inspection
• Palpitation
• Otoscopic examination
Palpitation
• Assess the auricle, tragus and mastiod process
for tenderness
– Whisper Test
– Weber Test
– Rinne Test
Physical examination of the Ear…
• Whisper Test
patient‘s head
is heard equally in
both ears
Weber Test…
Rinne Test
• Used to compare air conduction (AC) and bone
conduction (BC)
• Radiographic examinations
– Foreign bodies
– External otitis
Cerumen impaction
Decreased hearing
• Suctioning, or Instrumentation
• Management…
• N.B: Syringing and manual irrigation should be
done by;
• Diagnosis
Causes
≠ Common causative agents being Pseudomonas
A., Staphylococcus aureus and others
Topical antibiotics
Mastoiditis
Otosclerosis
Tympanic Membrane Perforation
– Decreased hearing.
• Risk factors:
– Crowed conditions
– day care
– passive smoking
– bottle feeding
– low economy
Acute otitis media…
Causes
• Usually caused by Streptococcus pneumoniae
• Other bacterias :- Haemophilus influenzae,
Moraxella catarrhalis, influenzae A and B,…
• Viral causes :- RSV, Rhinovirus, Adenovirus,…
• Inflammation of surrounding structures and
allergic reactions ( E.g. sinusitis, rhinitis )
Pathophysiology
and bulging
auricle
Diagnosis
• Otoscopic examination
– Bulging TM
– Opacification of eardrum
– Squamous exudate
Medical management
• AOM spontaneously resolves (40 - 60%)
• Non pharmacologic
• Pharmacologic treatment
Pharmacologic treatment
• Tuberculosis
Clinical manifestation
• Fever, pain
– Surgery / Mastoidectomy/
Nursing interventions
Relive pain and reduce anxiety
Preventing infection
Improving hearing and communication
Assisted ambulation after surgery/balance
Instruct to avoid heavy lifting, straining, exertion,
and nose blowing for 2-3wks post-op
o Prevents dislodging of TM graft or prosthesis .
Otosclerosis
• Hearing aids
otosclerosis.
hearing loss)
Nursing management
• Operative ear up
• Ear plug for asepsis
• Treat N/V
• Safety measures
• Don‘t dislodge prosthesis
– No cough, sneeze, blowing of nose, vomiting,
flying, lifting, showering
–If gets a cold: consult physicians
Inner ear disorders
– Labyrinthitis
– Tinnitus
Labyrinthitis
• It is inflammation of the inner ear
– IV antibiotic therapy
– Fluid replacement
– Autoimmune disorders
– Hereditary
– Post-traumatic
– Allergy
Pathophysiology
• The membranous labyrinth is filled with a fluid
called endolymph
• Antiemetic-Promethazine
• Vasodilators
• Labyrinthectomy
Management…
Endolymphatic Sac Decompression
– Stay motionless
– Sleep
Nursing interventions
– Bed rest during acute phase
– Psychological evaluations
Tinnitus
• An auditory meaningless perception in the
absence of external source of sound, related to
loss of stimuli to the central auditory pathways
If meaning full perception in the absence of
external auditory sound is auditory hallucination
• It can occur on one or both sides of the head
• Mostly happens in the setting of Sensory Neural
Hearing Loss (SNHL)
Tinnitus…
• Could be intermittent or persistent (> 6 month)
– Neurological examination
examination;
• Inspection
• Palpation
• Epistaxis • Tonsillitis
septum • Pharyngitis
• Rhinitis • Laryngitis
Nasal obstruction
It is the blockage of passage of air through the
nostrils, frequently caused by:
• Nasal bleeding
Management
Decongestants / E.g. xylomethazole, antihistamines,
to open the nasal airway
– Recurrent sinusitis
• Pharmacologic management
– Anosmia, hyposmia
– Nasal obstruction
• Pharmacologic
• It is a common complaint
• Symptom
• Sign
– Resuscitation
– Anterior rhinoscopy
– Prevent complications
Removal techniques for NFBs
• Forced exhalation by occluding unaffected nose
• Mother‘s kissing; Provide a puff of forced exhalation
to the child mouth
• Direct instrumentation
• Hooked probs
• Ballon catheter (5-8 Fr)
• Suction
• Magnet, irrigation, posterior displacement
Sinusitis
It is Inflammation of mucosa of the sinuses
– Semi-Fowlers position
• 1+ = Visible
needed
– Tepid sponge
– Paraphayrengial abscess
– Retropharyngeal abscess
– Septicemia
– Chronic tonsillitis
Peritonsillar abscess
• Collection of pus outside the tonsillar capsule
abscess
• It is usually unilateral
Clinical features
• Severe pain such that the patient often refuses
to eat
• Systemic complication
– Septicemia
Clinical features
Differential diagnosis
Complications
Etiology:
Clinical manifestations
• Hoarseness or complete loss of voice
• Severe cough
Potential complications
• Sepsis
• Peritonsillar abscess
• Otitis Media
• Sinusitis
Laryngitis…
Medical management
–Resting the voice
–Avoid smoking
–Bed rest
• Give analgesics
• Promoting communication