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EENTEENT

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EYESEYES

Anatomy:

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External PartExternal Part

1. Eyelids/Palpebrae

*palpebral fissure

-space between two

lids

*canthi

-corners of the

fissure*meibomian gland

-oil secreting glands

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2. Orbit/eye socket

- surrounds and

protect the most of

the eye3. Conjunctiva

-thin transparent

layer of mucous

tissue that covers

the eyes

- lubricates the eye

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4. Lacrimal system

*lacrimal gland

-found at the upperlid over the outercanthus

-produces tear

*lacrimal ducts- directs flow oftears to thenose

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Internal StructureInternal Structure

1. Outer Layer

*Sclera- white of theeye

- a tough, opaquetissue

-serves as aprotective coat

*cornea

- transparent domed

shape found in frontof the eye

- focus light to theretina

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2. Middle Layer

*Choroid-

-lies between

retina and sclera-supplies blood tothe retina

*Ciliary Body

-lies behind the iris-produces aqueoushumor

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*Iris

- the colored portion

of the eye

-controls level oflight entering the eye

*Pupil

- the opening at thecenter of the iris

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3. Inner Layer

*lens

- located just

behind the iris

-focus light to the

retina

*Canal of schlemm-outflow of

aqueous humor

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*Aqueous humor

- watery fluid that

fills the space

between the corneaand the iris

- nourishes the lens

and cornea

- produced by the

ciliary body

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*Retina

-consistency of a wettissue paper

- contains photo

receptors*rods

*cones

*Macula Lutea

-found at the center ofthe retina

-central vision

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*Optic disc

-also called the

blind spot

*Vitreous Humor

-thick, transparent

substance that

fills the center of

the eye

-comprises 2/3 of

the eye volume

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Extraocular muscles

* Rectus

-horizontal and

vertical movementof the eyes

*Oblique-circular

movement of the

eye

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II. EYE FUNCTION

- light enrgy from an

objectcornea

aqueous h pupilslens vitreous h

retina photoreceptors

converts image to nerve

impulse transmitted tooptic nerve via optic

discoptic chiasm

cerebral cortex

interpretaion as sight

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DIAGNOSTICDIAGNOSTIC

PROCEDURESPROCEDURES

1. Snellens chart

- Test for visual

acuity

- normal readingis 20/20

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2. Ishihara Chart

- test for color vision

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3. Fluorescein Angiography

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DEFINITION

-is an eye test that uses an special

dye and camera to evaluate the

blood circulation in the retina and

choroid.

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HOW TEST IS PERFORMED

- Drugs that dilate the pupil is given

- the patient chin is placed at the

chin rest- 1st photograph is taken

- patient is injected with a dye

Fluorescein- more pictures is taken after20mins

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Preparation of the test:

1. Have someone to accompany the

patient

2. Check for allergies

3. have an informed consent

4. Ask the patient if pregnant

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What to expect during the procedure

- Stinging sensation-nausea and vomiting

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Result shows

macular edema

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4. Fundoscopy

-is an examination of

the back part of

the eyeball(fundus), which

includes the

retina, optic disc,

choroid, and bloodvessels.

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How Test is Performed:

- the patient is asked to sit in a darkened

room

- visualization of the eye using afunduscope

Preparation:

- Midriatic drugs may or may not be given

- Significant other

- Sunglasses

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5. Corneal Staining

- to check for

corneal surface

and corneal injuryusing a dye

Fluorescein

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6. Tonometry

- To check the

intraoccular

pressure.

- Topical anesthetic

is used to numb

the surface

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7. Gonioscopy

-is an eye examination

to look at the front

part of your eye

(anterior chamber)between the cornea

and the iris.

- test if the drainage

angle is open orclosed

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How it is Performed:

- topical anesthetic is given

- a special lens is placed in front of

the eye

- the doctor will view the angle

using a slit-lamp

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WHAT TO EXPECT

- Painless

- Eye drops used to numbed will

burn a little

- procedure last 5 to 10 mins

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Nursing Considerations:

- tell the client not to rub the eye for

20 mins after the procedure or until

the medication wears off

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8. Opthalmoscopy

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9. Slit-lamp

-The test is used to

examine

the eyelids, thesclera,

conjunctiva, iris,

lens, and the

cornea.

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HOW THE TEST IS PERFORMED

- A small strip of paper stained with

dye

- first examination starts

- pupil dilator is placed in the eye

- then repeat examination takes

place after 15-20 mins

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SPECIAL PREPARATION

*No special preparation

Nursing Consideration

* Sensitivity to light after the

procedure

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EYE DISORDERSEYE DISORDERS

1. Glaucoma

Causes:

- Family

history - Blackrace

- trauma

- myopia

Types:A. open- angle

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B. angle-closure

C. Congenital

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D. Secondary

SIGNS AND SYMPTOMS

A. Open-angle

- Asymptomatic

- insidious visual impairment- loss of peripheral vision

- HALOS around lights

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B. Angle-closure

- Acute ocular pain

- diminished visual acuity

- colored HALOS around lights

- Blurry vision

- Nausea and vomiting

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DIAGNOSTIC EXAMS

- Tonometry

- Gonioscopy

- Opthalmoscopy

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TREATMENT

Medications

Topical Miotics

Topical Epinephrine

Topical Beta-blockers

* contraindicated in pts. w/ asthma.

Oral Carbonic Anhydrase InhibitorsGlycerin

Mannitol

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Surgical procedures

1. Laser

trabeculoplasty

- A laseris beingusedtoimprove

thedrainageat the

tubercular

meshwork- Treatment foropen

angleglaucoma

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2. Trabeculectomy

- The drainage

angle of the eye is

removed creating anew drainage

- the new opening

is being covered by

a part of the sclera

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3. Iridectomy

-Removal of a

portion of the iris

to enhance the outflow of aqeous

humor

- Close angle

glaucoma

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NURSING MGT Pre-op:

Admin. prescribed meds.

Routinepre-opprocedure Post-op:

Position accdg. tophysicians orders

Admin. eyedrops/meds as ordered

Orient pt. toenvironment Avoid activities that may raiseIOP

Observe forcomplications

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2. CATARACT

- Progressive and

gradual

development ofopacity in the

lens/lens capsule

that results in loss

of vision.

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CAUSES

- Aging Process

- Inherited

- Injury

- Endocrine Disorders

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SIGNS AND SYMPTOMS

- Gradual loss of vision

- Photophobia

- Opaque or cloudy white pupil

- Decrease visual acuity

DIAGNOSTIC TEST

- Slit lamp

- Opthalmoscopic examination

SLITSLIT LAMPLAMP

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SLITSLIT--LAMPLAMP

EXAMINATIONEXAMINATION

Cataract Lens Normal Lens

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TREATMENT

Surgery treatment ofchoice

1. ICCE (intracapsular cataract

extraction)

2. ECCE (extracapsular cataract

extraction)

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3. Phacoemulsification

- a small incision in

the cornea is done

- Special instrumentis inserted to break

the cataract into

fragments and

suction the smallfragments

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Pre-oppreparation:

- Assess visionfortheaffectedeye

- Administerpre-opmeds

- Instruct post-opmeasure to

prevent increaseinIOP

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Visualrestorationpost-op

Aphakic Eyeglasses

Contact Lens

IOL Implant

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Post-op complications:

Infection

Hemorrhage pt may verbalize

sudden pain in the eye.

Retinal detachment

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NURSING MGT

1. Orient pt to environment.

2. Prevent activities that increase

IOP.3. Instruct not to touch/rub the eye.

4. Use stool softener.

5. Side-rails up.6. Use sunglasses when patch isremoved.

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3. MACULAR DEGENERATION

Degeneration of the macular area of

the retina in the eye. The most

common type is age-related maculadegeneration (ARMD).

CUASE:

- Aging

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TYPES

Atrophic (dry)

Exudative (wet)

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SIGNS AND

SYMPTOMS

Loss of central

vision scotoma

Pale yellow spots

drusen appear

on the macula

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Visual distortion

Difficulty with activities requiring

close central vision

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TREATMENT

1. Laser

photocoagulation

- Uses laser to sealof damage blood

vessel in the retina

- destroys

abnormal bloodvessels

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2. Photodynamic

therapy

- light-activated

drug known asVerteporfin is

injected into the

patient's

bloodstream- Produces clot on

the abnormal

blood vessels

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NURSING MGT

Early referral for ophthalmologist.

Reassure that loss of central does

not progress to loss of peripheral

vision.

Institute safety measures to prevent

injury.

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4. RETINAL

DETACHMENT

-Separation of the

sensory layer ofthe retina from the

choroid.

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CAUSES:

- aging

- cataract surgery

- myopia

- trauma

- tumor

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SIGNS AND SYMPTOMS

- blurred vision

- floaters

- flashes of light

- curtain vision

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Floaters are blood cells released

into the vitreous humor by the

detachment

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TREATMENT

Bed rest

Tranquilizers

Scleral buckling Pneumatic

retinopexy

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Laser

photocoagulation/

cryosurgery

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NURSING MGT

1. Provide bed rest.

2. Maintain eye patch.

3. Speak to a client before

approaching.

4. Avoid jerky movements.

5. Protect client from injury.

EYEEYE

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INFECTION/INFLAMMATIONINFECTION/INFLAMMATION

Blepharitis -inflammation of

the eyelid margin

glands and lash

follicles.

Hordoleum (sty) -

infection of Zeis or

Moll gland.

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Chalazion-cyst of one oremore meibomianglands

Conjuctivitis (Pinkeye, red eye, soreeyes) - infectionand inflammation

of conjuctiva byallergen orbacteria.

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Keratitis -inflammation of

cornea.

Uveitis -

inflammation of

uveal tract.

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MANAGEMENT

Medication therapy with

topical/systemic antibiotics,

antivirals, antihistamine,corticosteroid.

Promote infection control.

Reduce pain or discomfort.

REFRACTIVE ERRORSREFRACTIVE ERRORS

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REFRACTIVE ERRORSREFRACTIVE ERRORS

MYOPIA

Management:

BICONCAVE LENS

HYPEROPIA /

HYPERMETROPIA

Management:

BICONVEX LENS

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PRESBYOPIA

Management:

Biconvex lens

ASTIGMATISM

Management:

Astigmatic lens

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EARSEARS

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EARSEARS

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I. Anatomy

1.External

Auricle/Pinna

- Collects soundwaves from the

environment

Auditory canal

- Relays sound

waves to the ear

drum

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2. MiddleEustachian tube

-connected to the

nasopharynx

-Maintains pressure

in the inner ear

Tympanic Membrane

-conducts vibrationfrom external

canal to middle

ear

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Ossicles

a. Malleus

b. Incus

c. Stapes

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Mastoid bone

- Part of the temporal

lobe bone, found at

the back of the ear

Window membranes

Oval- where the sound

vibration enters

Round- sound

vibration exits

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3. Inner (Labyrinth)Bony Labyrinth-

proctects themembranous

labyrinthSemicircular Canals-

resposible forbalance

Cochlea Organ ofCorti(organ ofhearing)

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Fluids

Perilymph- fluid at the bony

labyrinth

Endolymph- fluid that fills themembranous labyrinth,

- responsible for balance

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EAR FUNCTION

Hearing

Sense of Balance

DAIGNOSTICDAIGNOSTIC

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PROCEDURESPROCEDURES

a. Otoscopic

examination

Child

Adult

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NORMAL TYMPANIC

MEMBRANE

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b. Tuning Fork tests

Rinne test

Weber test

Criteria

Sensorineural hearing loss Conductive hearing loss

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Anatomical

Site

Innerear, cranial nerve VIII, or

central processing centers;

irreversible

Middle ear(ossicular chain),

tympanic membrane, orexternal

ear; reversible

Weber Test Sound is heard in normal ear Sound is heard in the affected ear(ear with conductive loss)

Rinne Test Positive Rinne; Air conduction >

Bone conduction

Negative Rinne; Bone Conduction >

Air Conduction (Bone/Air Gap)

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c. Whisper Voice Test

d. Audiometry

f. Tympanogram-measures middle ear

muscles reflex tosound stimulationand compliance oftympanic membrane

Severity of Hearing loss

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Severity of Hearing loss

Loss in DecibelsInterpretation

>15 Normal hearing

>15-25 Slight hearing loss

>25-40 Mild

>40-50 Moderate

>55-70 Moderate-severe

>70-90 Severe

>90 Profound

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g. Rombergs Test-test for balance

EAR DISORDERSEAR DISORDERS

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EAR DISORDERSEAR DISORDERS

CONDUCTIVE HEARING LOSS

SENSORINEURAL HEARING LOSS

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OTOSCLEROSIS

Hardening of the inner

ear in which repeated

resorption and

redeposition of abnormal

bone growth gradually

leads to fixation of the

footplate of the stapes.

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RISK FACTORS

- Familial Tendency

- Women

- Caucasian

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SIGNS AND SYMPTOMS

- Gradual, progressive hearing loss

- Constant tinnitus

- Schwartzes sign- reddish or pinkish

tympanic membrane

- (-) Rinne test

TREATMENT

Hearing aids

Stapedectomy

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NURSING MGT (Stapedectomy)

- watch for signs of infx

- Antibiotics for prophylaxis

- Bed rest

- Do not blow nose for at least 2

weeks

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OTITIS MEDIA

Usually begins in childhood that

results from the spread of

microorganisms from theEustachian tube to the middle ear

during upper respiratory infections.

May be acute or chronic.

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SIGNS AND SYMPTOMS

Hearing loss

Feeling of fullness within the ear

Pain

Drainage from the ear that may

be foul-smelling

Bulging or perforation of the

eardrum

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TREATMENT

Systemic antibiotics

Antibiotic eardrops

Symptomatic relief withanalgesics

Gentle irrigations to cleanse

the ear

Myringotomy

Tympanoplasty

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TYMPANOPLASTY

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MASTOIDITIS Infection of the

mastoid process

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SIGNS AND SYMPTOMS

Tenderness over the mastoid

process

Headache and ear pain

Vertigo

Swelling over the mastoidprocess

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TREATMENTMedication

Antibiotics

SurgicalIntervention

Mastoidectomy

Tympanoplasty

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MENIERES DISEASE

Disorder of the inner ear in which

there is excessive accumulation of

endolypathic fluid in themembranous labyrinth.

Also known as Endolymphatic

hydrops. Incidence is higher between 35-

60 y.o.

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CAUSES:

- Unknown

- maybe related to:

- Hypernatremia

- Allergic reactions

- Emotional disturbaces

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SIGNS AND SYMPTOMS

Triadofsymptoms:

-Tinnitus

- Vertigo

- Hearingloss

Warning SignofImpending Attack:

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TREATMENT

Medications

Diuretics

Antihistamines

Atropine SO4

Antivertigo- meclizine

Antiemetics- phenergan

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Surgicalprocedures-Endolymphatic

decompression

-Vestibular

neurectomy

-Labyrinthectomy

-Cochlearimplant

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NURSING MGT Instruct pt to avoid moving abruptly.

Protect pt from injury.

Keep the pt on bed rest is has severevertigo.

Explain that Bells palsy may occur

post-op but will subside within few

months. Teach pt to avoid foods high in salt.

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PRESBYCUSSIS

Hearing loss among elderly.

IMPACTED CERUMEN

Having excessive thick or dry

cerumen.

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TREATMENTIrrigation

Instilling otic solution

a. Warm the solution beforeinstilling to the affected

ear.

b. Let the solution flow towards

the side of the ear and NOTdirectly in the tympanicmembrane

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OTOTOXICITYDetrimental effect of certain medicationson the cranial nerve VIII or hearingstructures.

Examples of ototoxic drugs:

Salicylates

Loop diuretics

Quinidine

Antibiotics

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BURNBURN

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A traumatic injury to the skin andunderlying tissues caused by heat,

electricity, radiation, chemical, or

inhalation

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CAUSESa. Thermal flame, hot fluids, hotobjects

b. Chemical strong acids, alkali ororganic compounds

c. Electrical faulty electrical wiringor high voltage power lines,lightning

d. Radiation sunburn, prolonged

exposure to UV rayse. Inhalation smoke or gases, direct

injury to the lungs

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CLASSIFICATIONa. 1st degree-

epidermis, reddish,

painful

b. 2nd degree-

dermis, moist

surface withvesicles, painful

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c. 3rd degree- subcutaneous layer,connective tissues, pearly whitewith no pain

d. 4th degree- muscles, bones,blackish or charred, no pain

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STAGES OF BURNSSTAGES OF BURNS

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11stst stagestageShock/ Fluid Accumulation Phase

(Emergent stage)

First 24-48 h

Intervascular space (IVS) -interstitial space (ISS)

Generalized dehydration

HypovolemiaHemoconcentration, oliguria

HyperK, Hypo Na

22ndnd stagestage

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Diuretic/Fluid Remobilization Phase(Acute stage)

After48 h

ISS-IVS

Hypervolemia

Hemodilution

Diuresis

Hypo K, Hypo Na

33rdrd stagestage

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Recovery (Rehabilitationstage)

5th day onwards

HypoCa, HypoNa

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TREATMENTMedical Mgt

a. Initial First AidIntervention

STOP THE BURNING PROCESS!

Remember: R.A.C.E

R- escue the patient

A- larmC- onfine

E- xtinguish

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b. Promote respiratory Functionc. Assess burn severity

Rule of nines quickest way to

assess TBSA

d. Promoting fluid-electrolyte, acid-

base balanceParkland/Baxter formula

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FORMULAFORMULA

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Parkland GIVE Lactated Ringerssolution

4ml x kg x % of burn =

Example: What volume of fluids isrequired for a client who weighs

100lbs and has acquired 36% TBSA.

ANSWER: 6480 mL

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Brooke lactated ringers2ml x kg x % burn = ___ ml

Example: A man sustained 27% burnand currently weighs 145 lbs. Using

Brookes formula, how much LR

should be given?ANSWER: 3564 ml

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e. Promoting comfort; relief of painMorphine So4

Meperidine (Demerol)

f. Prevent Infection

Topical IV antibiotics

Reverse or protective isolation

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g. Maintaining adequate nutritionHigh-CHON diet, CHO, fats and

minerals

- TPN

WoundManagementWoundManagement

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Openmethod- wound is uncovered

andexposed toair

Closed-method- wound is covered

with thick layerof sterilegauze

or with occlusivedressings.

Antimicrobial Therapy

Silver NO3

Silver sulfadiazine

Mafenideacetate- drugof choice

SurgicalManagementSurgicalManagement

8/9/2019 EENT JEPTA

155/160

Debridement-removalof

necrotic tissue.

Escharotomy- An

incisioninto the

escharto relieve

pressureon the

affected area.

SKIN GRAFTINGSKIN GRAFTING

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156/160

Purpose: Lessen the potential for infection.

Minimize fluid loss by evaporation.

Promotes growth of epithelial tissue

Reduce scarring

Prevent loss of function.

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157/160

8/9/2019 EENT JEPTA

158/160

TYPESTYPES

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159/160

Isograft donor from identical twinAutograft- from self

Homograft from another humanbeing

Heterograft/xenograft- from theanimal, e.g. pigskin

8/9/2019 EENT JEPTA

160/160