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Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
Eent Review & Integ
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Eent Review & Integ

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Review on the EENT and the Integumentary system.

Review on the EENT and the Integumentary system.

Published in: Education, Health & Medicine
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  • 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

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