presentation eent review

7/29/2019 Presentation EENT Review

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Internal

Structures

Outer Layer

Sclera

Cornea

Middle Layer

Choroid

Ciliary Body

Iris

Pupil


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Inner Layer

Retina

Lens

Vitreous

humor

Optic disk

Macula Lutea Aqueous

humor

Canal of

Schlemm


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MEASUREMENT OF VISION

Visual Acuity

Snellens Chart

Confrontational test

Extraocular Muscle Function

Six cardinal position of gaze

Color Vision

Ishihara Chart/Plates


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DIAGNOSTIC TESTS

Slit lamp

Tonometry Opthalmoscopic Examination


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CATARACTS

Causes:

Aging Process

Inherited

Injury

Endocrine disorders

Signs & Symptoms

Gradual or abrupt?

Painful or painless? opaque or cloudy white pupil

decreasing visual acuity

progressive nearsightedness


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Diagnostic Study

Slit lamp examination

Opthalmoscopic examination

Surgical Management

Intracapsular Cataract Extraction

(ICCE)

Extracapsular Cataract

Extraction (ECCE)


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Pharmacologic Management

Mydriatrics

Epinephrine, adrenaline,phenylephrine HCl (Neo-

Synephrine, Ocu-phrin)

Cycloplegics

Atropine SO4 (Atropisol),

scopolamine hydrobromide

(Isopto-Hyoscine),

cyclopentolate (Cyclogyl) Acetazolamide, Mannitol

Antibiotics

Mild Analgesics


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RETINAL DETACHEMENT

Causes

Trauma

Retinal degeneration

Tumor in the eye

Hemorrhage

Cataract surgery Myopia


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Signs & Symptoms

Painful or Painless?

Diagnostic study

Opthalmoscopic examination


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Implementation

Provide bed rest

Cover eyes

Speak before approaching

Position head as prescribed Protect from injury


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Surgical Procedures

Scleral Buckling


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Post-op nursing management

eyepatch

Monitor for complication

Wear dark glasses during the day


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GLAUCOMA


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Types:

Chronic Open-Angle Glaucoma

Primary / simple / chronic

^ 3050 mmHg

Signs & symptoms:

No early s/s

Insidious visual impairment

Diminished accommodation &

loss of peripheral visionHalos around lights


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Acute Closed-Angle / Narrow

Angle Glaucoma

50-70 mmHg Signs & symptoms:

Transitory attacks of diminished

visual acuity Halos around lights

Excruciating pain

________, ________, _________ Blurred, cloudy vision


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Management:

Topical Miotics pilocarpine (Pilocar), Carbachol

Topical Beta-blockers betaxolol (Betoptic), metipranol

(Optipranolol), timolol (Timoptic)


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Oral Carbonic Anhydrase Inhibitors

reduces production of AH

acetazolamide (Diamox), may cause malaise, anorexia &

fatigue but do not d/c drug.

Osmotic diuretic / Hyperosmotic

agents

mannitol (Glycerol), Glycerine

(Glyrol, Osmoglyn)


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Diagnostic Studies:

Otoscopic Examination

Weber test

Rinne test


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Rombergs test

Caloric test


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MENIERES DISEASE

(Endolymphatic Hydrops)

Causes:

Unknown

May be related to the degenerationof cochlear hair cells.

Hypernatremia

Emotional disorders


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Signs & Symptoms

3 Cardinal signs: ____________,____________, __________

nausea/vomiting, nystagmus, severe

headache Warning sign of an attack:

_____________________________


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Management:

Furstenburg Diet

Vasodilators, Antihistamines, Mild

sedatives Diuretics

During attack: assume comfortable

position


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OTOTOXIC SUBSTANCES

Diuretics: ____________

Chemotherapeutic agents:

Cisplatin(Platinol), nitrogenmustard

Anti-inflammatory agents: __________

Antibiotics: _________Chemicals: alcohol, arsenic,

nicotine


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Anatomy & Physiology

External Structures:

Auricle / Pinna

External Auditory Canal

Tympanic membrane (Eardrum)

Middle Ear

Ossicles

Mallus (Hammer) Incus (Anvil)

Stapes (Stirrups)


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Eustachian Tube

Inner Ear Vestibule

Semicircular canals

Utricle & Saccule

Cochlea

Organ of Corti

Fluids

Perilymph

Endolymph


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OTOSCLEROSIS

Risk Factors:

Familial tendency Women

Caucasian

Signs & Symptoms:

gradual, progressive hearing loss

constant tinnitus

Rinne test / Weber test


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Management:

Stapedectomy

watch for signs of infxn

Antibiotics for prophylaxis

Bed rest

Do not blow nose for at least 2

weeks


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The nurse is evaluating a child for haring

loss. In reviewing the childs history,which finding would not be associated

with a hearing loss?

a. Prenatal problem of rubella

b. Repeated, chronic ear infection

c. Taking penicillin and cephalosporin

medicationd. Exposure to high-intensity sound

waves.


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A 3-year old child had a myringotomy about a

week ago. The mother call the nurse and

report that one of the tubes fell out. After thenurse makes an appointment for the child to

be seen by the physician, what would be

important for her to tell her mother?

Observe for any purulent drainage from theear.

Rinse the tube in soapy H2O and keep it.

Do not allow any H2O to get into the childsear.

Do not allow the child to play outside.


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INTEGUMENTARY

SYSTEM


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DECUBITUS ULCER

RISK FACTORS:1. Immobility

2. Aging

3. Moisture

4. Inadequate hydration5. Pyrexia

6. Dryness

7. Incontinence

8. Cognitive impairments9. Equipment

10. Shearing force or friction


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S T A G E S

STAGE I

STAGE II

STAGE III

STAGE IV


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MANAGEMENT

1. Positioning & Supportive device

2. Diet

3. Adequate hydration4. Massage bony prominences

5. Apply Dressings

6. Antibiotic therapy7. Debridement


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S T A G E S

STAGE I

STAGE II

STAGE III

STAGE IV


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ETIOLOGY

Thermal

Chemical

Electrical

Radiation


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PATHOPHYSIOLOGY

TYPES:

Superficial Burn (1st degree)

Layer:

Pain: Characteristics:

Healing:


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Partial-thickness Burns (2nd degree)

Layers:

Pain: red to pale ivory moist skin w/ blisters

Healing:

Full Thickness Burns (3rd degree)

Layers:

Pain:

Skin: white, cherry red, black; - blisters;dry, hard, leathery appearance.


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Cardiovascular Response

Renal & GIT

Respiratory

Immune System


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Nursing Management:

Provide Emergency Care Eliminate source of burn

Cool the burn for several mins.

remove restrictive objects.

cover wound


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apply ABC of trauma

Assess for & treat smoke inhalation

injury Assess for & treat carbon monoxide

poisoning

prevent shock

monitor acid-base balance &

electrolyte

NPO


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Wound Care

Wound Cleansing&HydrotherapyBurn Wound Coverings

Biologic Dressings:

Amnion Allograft

Xenograft

Biosynthetic Dressing Biobrane

Autograft


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Care of Graft Site:

immobilize graft site

keep site free from pressure remove exudates

monitor foul-smelling drainage

use support garments & splints Topical Antimicrobials

silver sulfadiazine (Silvadene)

mafenide acetate 10% cream

silver nitrate

Metabolic Support


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Estimate Burn Size:

Rule of Nines

Lund & Browder

Promote optimum recovery

Wound management Physical Therapy

Pain Management

Morphine SO4 Meperidine (Demerol)


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Which intervention is inappropriate for a

client with severe burns?

a. Administration of IM pain medications

b. Oxygen therapy

c. Aggressive fluid resuscitation

d. Remove restrictive clothing


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A client arrives at the burn center after

sustaining a serious burn injury. The

burned area is white and leathery with no

blisters. What is the best classification?

a. First degree burn injury

b. Superficial partial thickness burn injury

c. Deep partial thickness burn injury

d. Third degree burn injury


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A client has just arrived at the emergency

department after sustaining a major burn

injury. Which of the following metabolicalterations is expected during the first 8

hours post-burn.

a. Hyponatremia and hypokalemia

b. Hyponatremia and hyperkalemia

c. Hypernatremia and hypokalemia

d. Hypernatremia and hyperkalemia


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Providing adequate nutrition is essential for

a burn client. Which of the following

statements best describes the nutritionalneeds of a burn client?

a. A child needs 100 cal/kg during

hospitalization

b. The hypermetabolic stage after a burn

injury leads to poor healing

c. Caloric needs can be lowered by

controlling environmental temperatured. Maintaining a hypermetabolic rate will

lower the childs risk for infection


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A client suffered a thermal burn injury causedby inhalation of steam. The clients mouthis edematous, and the nurse notes blistersin the clients mouth. Based on this data,

the nurse monitors the client most closelyfor:

a. Difficulty swallowing

b. pain

c. Fluid loss

d. Wheezing

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