Review on the EENT and the Integumentary system.

1. Bienes lyco nino

2. Impaired Vision
 A. Assessment
 1. Redness
 2. Edema
 3. Increased
 4. Headache, squinting
 5. Nausea and vomiting
 6. Altered growth and development
 7. Visual disturbances
 8. Altered visual function test

3. Visual tests
 TEST  Procedure & Pt Prep
 Tonometry  Cornea is anesthetized
 -measures intraocular  Tonometer registers degree
pressure of indentation on cornea
when pressure is applied
 N – 8-21 mm Hg
 Pressure increased in
glaucoma
 Client will be recumbent
 Remove contact lens
 Advise not to
squint, cough, or hold
breath during procedure

4.  Snellen’s test- test of  Pt stands 20 feet from
visual acuity chart of letters
 One eye is covered at a
time
 Patient reads chart to
smallest letter visible
 Test results indicate
comparisons of distance
at which this patient
reads to what normal eye
sees at 20 feet

5. B. Diagnose
 1. Disorders of accomodation
 2. Burns of the eye
 3. Eye trauma
 4. Eye infections/ inflammation

6. Disorders of Accomodation
Nsg Considerations
Types
 Myopia (nearsightedness)  Corrective lenses (concave)
light rays refract at a point in
front of the retina  Corrective lenses ( convex)
 Hyperopia (farsightedness)
light rays refract behing the
retina
 Commonly occurs after age
 Presbyopia with aging –
35
hardening of the lens
 Corrective lenses
decreased accomodation
 Corrective lenses
 Astigmatism – uneven
curvature of cornea causing
blurring of vision

7. Burns of the eye
Types Nsg Consideration
 Chemical –  Eye irrigation with copious
acids, cleansers, insectides amount of water for 15- 20
 Radiation –  Prevention – use of eye
sun, lightning, eclipses shields
 Thermal – hot  Use of goggles to protect the
meals, liquids, other cornea; patching; analgesics
occupational hazards

8. Eye trauma
Types Nsg Considerations
 Nonpenetrating – abrasions  Eye patch for 24
hrs, analgesics
 Cold compress, analgesics
 Nonpenetrating – contusions
 Cover both eyes with patch;
 Penetrating – pointed or
refer to surgeon
sharp objects

9. Eye infection/inflammation
Nsg Consideration
Type and cause
 Warm, moist compress,
 Conjunctivitis –

bacteria, virus , allergies Topical antibiotics
 Hydrocortisone eye ointment
 Warm compress
 Stye – staphylococcal
 Antibiotics
organism
 Incision and drainage
 Incision and drainage
 Chalazion (inflammatory
cyst) – duct obstruction
 Antibiotics, hot compress,
 Keratitis (inflammation of
 Steroids, except with Herpes
cornea) – virus, spread of
simplex
systemic disease
 Warm compressses, dark
 Uveitis (inflammation of
glasses, antibiotics, analgesics
iris, ciliary body, choroid) – , sedatives
local or systemic infection

10. C. Plan/ Implementation
 1. prevent eye injuries
 A. Provide safe toys
 B. Use eye protectors when working with
chemicals, tools
 C. Use eye protectors during sports
 D. Protect eyes from UV light

11. 2. Care of the blind client
 A. Enhance communication
 1. address client by name
 2. always introduce self
 3. state reason for being there
 4. Inform client when leaving the room

12.  B. Provide sense of safety and security
 1. explain all procedures in detail
 2. keep furniture arrangement consistent
 3. provide hand rail
 4. doors should never be half open
 5. have client follow attendant when walking by lightly
touching attendant’s elbow (1/2 step ahead)
 6. instruct client in use of lightweight walking stick
when walking alone

13.  C. Foster sense of independence
 1. provide assistance only when needed
 2. identify food and location on plate or tray
 3. encourage recreational and leisure time activities

14. 3. Care of artificial eye
 A. Remove daily for cleansing
 B. Cleanse with mild detergent and water
 C. Dry and store in water or contact-lens soaking sol.
 D. Remove before general surgery
 E. Insertion and removal method
 1. raise upper lid and slip eye beneath it
 2. release lid
 3. support lid and draw it over the lower edge of eye
 1. draw lower lid downward
 2. slip eye forward over lower lid and remove

15. Strabismus
 A. Assessment  C. Plan/Implementation
 1. visible deviation of eye  1. nonsurgical intervention
begins no later than age 6
 2. diplopia
 2. occlusion of unaffected
 3. child tilts head or
eye to strengthen weaker
squints to focus
eye
 3. corrective lenses
 B. Diagnose
combined with other
 1. eyes dont function as a
therapy to improve acuity
unit
 4. orthoptic exercises
 2. imbalance of the
designed to strenghthen
extraocular muscles eye muscles
 5. surgery

16. Retinal Detachment
 A. Assessment
 1. Flashes of light
 2. Blurred or sooty vision
 3. sensation of particles moving in line of vision
 4. delineated areas of vision blank
 5. a feeling of a curtain coming up and down
 6. loss of vision
 7. confusion & apprehension

17.  B. Diagnose
 1. separation of the retina from the choroid
 2. cause
 a. Trauma
 b. Aging process
 c. Diabetes
 d. Tumors
C. Plan/Implementation
1. Bed rest
2. affected eye or both eye may be patched to decrease
movement of eye (as ordered by the physician)

18.  3. specific positioning – are of detachment should be
in the dependent position (sleep on unaffected side)
 4. take precautions to avoid bumping head, moving
eyes rapidly, or rapidly jerking the head
 5. surgery to reattach retina to choroid; gas or air
bubble used to apply pressure to retina
 6. no hair washing for 1 week
 7. administer sedatives and tranquilizers
 8. avoid strenuous activity for 3 months
 9. care of patient undergoing eye surgery
 A. Preoperative care
 1. assess visual acuity
 2. prepare periorbital area

19.  3. orient to surroundings
 4. preoperative teaching – postoperative course
 5. teach postop need to avoid strainig at stool, stooping
 B. Postoperative care
 1. observe for complications – hemorrhage, sharp pain and
infection
 2. avoid sneezing, coughing, straining at stool, bending
down
 3. protect from injury; restrict activity
 4. keep signal bell within reach
 5. administer medications as ordered: antiemetics for
nausea, vomiting, sedatives for restlessness
 6. eye shield worn for protective purposes

20. Cataracts
Assessment
A.
Objects appear distorted and blurred
1.
Annoying glare
2.
Pupil changes from black to gray to milky white
3.
B. Diagnose
1. Partial or total opacity of the normally transparent
crystalline lens
2. Cause
a. Congenital
b. Trauma
c. Aging process
d. Associated with DM, intraocular surgery
e. Drugs- steroid therapy

21.  C. Plan/implementation
 1. Surgical management – Laser therapy
a. Extracapsular extraction – cut through the anterior
capsule to expose the opaque lens material, most
common procedure
b. Intracapsular extraction – removal of entire lens and
capsule; easier for physician to do; places client at
greater risk for retinal detachment and loss of
structure for intraocular lens implant
c. Lens implantation
d. Observe fro postoperative complications
1. hemorrhage indicated by sudden sharp pain

22.  2. Increased IOP
 3. slipped sutures
 4. If lens implant- pupil should remain constricted; if
aphakic (without lens) pupil remain dilated
e. Avoid straining; no heavy lifting
f. Bend from knees to pick things up
g. Instruct in instillation of eye drops to affected eye, use
of night shields
h. Usually suggest to sleep on unaffected side (decreases
pain ang swelling when elevated)
i. Protect eye from bright lights
j. Adjustments needed in perception if aphakic
k. Diversional activities

23. Glaucoma
 A. Assessment
 1. cloudy, blurry vision or loss of vision
 2. artificial lights appear to have rainbows or halos
around them
 3. decreased peripheral vision (tunnel vision)
 4. pain and headache
 5. nausea and vomiting
 B. Diagnose
 1. Abnormal increase in intraocular pressure leading to
visual disability and blindness; obstruction of outflow
of aqueos humor

24.  2. Types
 a. Acute or closed (narrow) angle glaucoma
-obstruction to outflow of aqueous humor
b. Chronic or open (wide) angle glaucoma
- overproduction of aqueous humor
3. Causes
a. CAN – associated with emotional
disturbances, allergy and vasomotor disturbance
b. COW – associated with trauma, tumor, hemorrhage
and iritis

25.  C. Plan/implementation
Medications: miotics (eg Isopto-carpine), carbonic
1.
anhydrase inhibitors ( eg Diamox)
Surgery – laser trabeculoplasty
2.
Avoid tight clothing (eg collars)
3.
Reduce external stimuli
4.
Avoid heavy lifting, straining at stool
5.
Avoid use of mydriatics (eg atropine) – it dilates
6.
pupil and obstructs the aqueous flow
Educate public to danger signs of glaucoma
7.

26. Hearing loss
 A. Conductive loss
 1. Assessment
 a. Pain, fever, headache
 b. Discharge
 c. Altered growth and devt
 d. Personality changes eg
irritability, depression, suspiciousness, withdrawal
 2. analysis
 A. Disorder in auditory canal, eardrum or ossicles

27.  B. Causes
 1. infection
 2. inflammation
 3. foreign body
 4. trauma
 5. ear wax
 C. Complications- meningitis resulting from initial
infection
 D. Diagnostics
 1. audiogram – quantitative ( degree of loss)
 2. tuning fork – qualitative (type of loss)

28.  3. plan/implementation
a. Heat – hair dryer and lamp
b. Antibiotics
c. Hearing loss
d. Ear irrigation
1. tilt head toward side of affected ear, gently direct
stream of fluid against sides canal
2. after procedure, instruct patient to lie on affected
side to facilitate drainage
3. contraindicated if there is evidence of swelling or
tenderness

29.  e. Ear drops
 1. position the affected ear uppermost
 2. pull outer ear upward and backward for adult
 3. pull outer ear Downward and backward for chilD
 4. place drops so they run down the wall of ear canal
 5. have patient lie on unaffected ear to encourage
absorption
 F. Surgery
 1) Preoperative care
 a. Baseline hearing assessment
 B. Assessment of preoperative symptoms

30.  c. Encourage patient to wash hair prior to surgery
 d. Teaching – expect postoperative hearing loss;
discuss need for special position of operative ear as
ordered
 2. postoperative care
 a. Reinforce dressing, dont change
 b. Avoid noseblowing, sneezing and coughing
 c. Observe for possible complications
 i. Facial nerve damage – may be transient
 ii. Infection
 iii. Vertigo and tinnitus

31.  d. Do not apply any pressure if bleeding is noted –
notify physician immediately
 e. Administer medications
 f. Provide for patient safety
 g. Position on unaffected side (decreases swelling and
pain of surgical site)
3. Discharge teaching – avoid getting water in
ear, flying, drafts, crowds, people with respiratory
infections

32.  B. Perceptive (sensorineural) loss
 1. Assessment
 a. Pain, fever, headache
 b. Discharge
 c. Altered growth and devt
 d. Personality changes eg
irritability, depression, suspiciousness , withdrawal
2. Analysis
a. Due to disorder of the organ of Corti or the Auditory
nerve

33.  b. Causes
 1. congenital – maternal exposure to communicable
disease
 2. infection, drug toxicity
 3. trauma
 4. labyrinth dysfunction – Meniere’s disease
 C. Complications
 1. vertigo
 2. tinnitus
 3. vomiting

34.  3. Plan/Implementation
 a. Care of the deaf/hard of hearing client
 1. Enhance communication
 a. Position self directly in front of client
 b. Well-lit, quiet room
 c. Get client’s attention
 d. Move close to better ear, if appropriate
 e. Speak clearly and slowly; do not shout
 f. Keep hands and other objects away from mouth when
speaking
 g. Have client repeat statements
 h. Use appropriate hand motions
 i. Write messages down if client able to read

35.  2. health teaching
 a. Provide health care resources
 b. Encourages use of visual cues
 c. Advise that auditory cues (such as smoke alarms)
may not be feasible

36. Acute Otitis Media
 A. Assessment
 1. fever, chills
 2. headache
 3. ear noises
 4. deafness
 5. sharp pain
 6. head rolling, crying, ear-tugging (child)
 7. nausea, vomiting

37.  B. Diagnose
 1. Definition – infection of middle ear
 2. cause – pathogenic organisms (bacteria and viruses)
 3. Complications
 a. Chronic otitis media –children more susceptible
because of short eustachian tube
 b. Residual deafness
 c. Perforation of tympanic membranes
 d. Cholesteatoma growth – a cystic mass composed of
epithelial cells and cholesterol that is found in the
middle ear
 e. Mastoid or brain involvement

38.  C. Plan/implementation
 1. administer medication as ordered
 a. Antibiotics –organism-specific
 b. Antihistamine for allergies
 c. Nasal decongestants
 2. Report persistent symptoms to physician
 3. Ventilatory tubes – inserted in eustachian tube for
continuous ventilation
 4. Myringotomy – tympanic membrane incision to
relieve pressure and release purulent fluid; no water
can be allowed to enter the scar
 5. bedrest if temp is elevate
 6. position on side of involved ear to promote drainage

39. Meniere’s Syndrome
(endolymphatic hydrops)
 A. Assessment
 1. nausea and vomiting
 2. incapacitating vertigo, tinnitus
 3. feeling of pressure/ fullness in the ear
 4. fluctuating, progressive decreased hearing on
involved side( unilateral sensorineural hearing loss)
 5. nystagmus, headache

40.  B. Diagnose
 1. Dilation of the membrane of the labyrinth
 2. recurrent attacks of vertigo with sensorineural
hearing loss
 3. follows middle ear infection or head trauma
 4. a chronic disease of the inner ear
 5. attacks recur several times a week; periods of
remission may last several years

41.  C. Plan / Implementation
 1. Drug therapy
 a. Antihistamine in acute phase (epinephrine, Benadryl)
 b. Antiemetics
 c. Antivertigo medications
 d. Diuretics
2. Bed rest during acute phase
3. Provide protection when ambulatory
4. Low sodium diet (2g/day); avoid caffeine, nicotine and
alcohol
5. Decompression of endolymphatic sac with Teflon shunt(
method of choice)
6. Total labyrinthectomy – last resort due to possible
complication of Bell’s Palsy

42.  7. Patient education
 a. Need to slow down body movements – jerking or
sudden movements may precipitate attacks
 B. Need to lie down when an attack occurs
 c. If driving, pull over and stop car
8. Occupational counseling – if occupation involves
operating machinery