The document discusses the anatomy and causes of a deviated nasal septum. It describes how the nasal septum can develop bends or become damaged by injury, causing it to deviate to one side and block airflow through the nose. Common causes of a deviated septum include birth trauma, injury from sports or accidents, and abnormal growth. Symptoms include nasal congestion, difficulty breathing, and recurrent sinus infections. Diagnosis involves physical examination and CT scan of the paranasal sinuses.

1. UNIT NO: 06
EYE AND ENT NURSING

2. BASIC ANATOMY OF THE EYE:
Eye. The organ of sight.
Parts of the eye;
1. Cornea: The clear front window of the eye. The
cornea transmits and focuses light into the eye.
2. Iris: The colored part of the eye. The iris helps
regulate the amount of light that enters the eye.
3. Lens: The transparent structure inside the eye that
focuses light rays onto the retina.
4. Macula: A small area in the retina that contains
special light-sensitive cells. The macula allows us to
see fine details clearly.

3. 5. Optic Nerve: The nerve that connects the eye to the
brain. The optic nerve carries the impulses formed by
the retina to the brain, which interprets them as
images.
6. Pupil: The dark center in the middle of the iris. The
pupil determines how much light is let into the eye. It
changes sizes to accommodate for the amount of light
that is available.
7. Retina: The nerve layer that lines the back of the eye.
The retina senses light and creates impulses that are
sent through the optic nerve to the brain.
8. Vitreous: The clear, jelly-like substance that fills the
middle of the eye.
cataracts 3

4. BASIC ANATOMY OF EYE:

5. cataracts 5

6. CATARACT

7. CATARACT:
• Cataract is a lens opacity or
cloudiness or blurred vision.
• Cataracts rank behind only
arthritis and heart disease as
a leading cause of disability in
older adults
• According to WHO, cataracts
is the leading cause of
blindness in world
cataracts 7

8. PATHOPHYSIOLOGY:
• Cataract can be develop in
one or both eyes at any age
• Three most common type of
senile (aged-related)
cataracts are defined by the
location in the lens
Nuclear:
• Central opacity in lens
• Associated with myopia
• Worsen on progression
cataracts 8

9. Cont…
• Cortical:
• Involve the interior and posterior
equatorial cortex of the lens
• Worst in very bright light
• Posterior sub capsular :
• occurs in front of posterior capsule
• Mostly occurs in youngers
• Associated with prolonged use of
corticosteroids, diabetes, ocular
trauma
• Near vision is diminished
cataracts 9

10. CAUSES AND RISK FACTORS:
• Cigarette smoking
• Long term use of corticosteroids, especially
high doses
• Sun light and ionizing radiation
• Diabetes
• Obesity
• Eye injuries
cataracts 10

11. CLINICAL MANIFESTATIONS:
• Painless, blurred vision
• The person perceived that surroundings
are dimmer
• Light scattering is common
• Monocular diplopia
• Reduce visual acuity
cataracts 11

12. ASSESSMENT AND DIAGNOSTIC
FINDINGS:
• Decrease visual
acuity is directly
proportionality to
cataract density
• Snellen visual acuity
test
• Ophthalmoscopy
• Slit-lamp bio
microscopic
examination
cataracts 12

13. MANAGEMENT:
MEDICAL MANAGEMENT
• No nonsurgical (medication, eye drops, eye glasses)
treatment cures cataract or prevent age related
cataracts
• Anti-oxidant supplement, vit:C and E, β-Carotene are
not too much beneficial
• Glasses or contacts, bifocal or magnifying lens may
improve vision
• Mydratics can be used short term (eye dilating
agents)
cataracts 13

14. SURGICAL MANAGEMENT:
• If reduced vision from cataract doesn’t interfere
with normal activities, surgery is not needed
• Surgical options include
1. Extra capsular cataract surgery
2. Lens replacement
• Cataracts are removed under local anesthesia
• When both eyes have cataracts, one eye is
treated first with at least several weeks or
months then other
cataracts 14

15. NURSING MANAGEMENT:
• Pre and post-operative care
• Promoting home and community based care
• Anticoagulants therapy may continue
• Administer dilating drops every 10 min for 04 doses at
least 1 hour before surgery
• Administer antibiotics, corticosteroids and anti-
inflammatory drops prophylactically
• Educate patients to protect eye, administer medication,
recognize signs and complications and obtain emergency
care
• Continue the care up to recovery
cataracts 15

17. GLAUCOMA:
Definition:
• Glaucoma is characterized by abnormally
elevated intraocular pressure (IOP), which can
damage the optic nerve. This nerve carries
visual information from the eye to the brain.
TYPES:
• Chronic open-angle glaucoma
• Acute closed-angle (or narrow-angle) glaucoma

19. 19
OPEN-ANGLE GLAUCOMA:
• Also called wide-angle glaucoma, this is the
most common type of glaucoma. The
structures of the eye appear normal, but fluid
in the eye does not flow properly through the
drain of the eye, called the trabecular
meshwork.

20. 20
ANGLE-CLOSURE GLAUCOMA:
• Also called acute or chronic angle-closure or
narrow-angle glaucoma, this type of glaucoma
is less common but can cause a sudden
buildup of pressure in the eye. Drainage may
be poor because the angle between the iris
and the cornea (where a drainage channel for
the eye is located) is too narrow.

21. 21

22. 22
PATHOPHYSIOLOGY:
• Axons of retinal ganglion cells travel through
the optic nerve carrying images from the eye
to the brain.
• Damage to these axons causes ganglion cell
death with resultant optic nerve atrophy and
patchy vision loss.
• Elevated IOP (in unaffected eyes, the average
range is 11 to 21 mm Hg) plays a role in axonal
damage, either by direct nerve compression
or diminution of blood flow.

23. 23
CAUSES:
• Idiopathic
• Tumor
• Diabetes
• An advanced cataract
• Inflammation

24. 24
CLINICAL MENIFESTATION:
Primary open-angle glaucoma signs and
symptoms include:
• Gradual loss of peripheral vision, usually in both
eyes
• Tunnel vision in the advanced stages
Acute angle-closure glaucoma signs and
symptoms include:
• Eye pain
• Nausea and vomiting (accompanying the severe
eye pain)

25. 25
• Sudden onset of visual disturbance, often in
low light
• Blurred vision
• Halos around lights
• Reddening of the eye

26. 26
RISK FACTORS:
• Are over age 40.
• Have a family history of glaucoma.
• Black racial ancestry
• Have poor vision.
• Have diabetes.
• Trauma
• Take certain steroid medications, such as
prednisone.

27. 27
COMPLICATIONS:
• If left untreated, glaucoma will cause
progressive vision loss, normally in these
stages:
1.Blind spots in your peripheral vision
2.Tunnel vision
3.Total blindness

28. 28
DIAGNOSIS:
1.Eye-pressure test-
The doctor uses a tonometer, a device which
measures intraocular pressure (pressure inside
the eye). Some anesthetic and a dye is placed
in the cornea, and a blue light is held against
the eye to measure pressure. This test can
diagnose ocular hypertension; a risk factor for
open-angle glaucoma.

29. 29
2.Pachymetry-The doctor also measures corneal
thickness, because it affects how the pressure
inside the eye is interpreted.
3.Gonioscopy-This examines the area where the
fluid drains out of the eye. It helps determine
whether the angle between the cornea and the
iris is open or blocked (closed).

30. 30
4.Perimetry test-
• Also known as a visual field test. It determines
which area of the patient's vision is missing.
• The patient is shown a sequence of light spots
and asked to identify them.
• Some of the dots are located where the person's
peripheral vision is; the part of vision that is
initially affected by glaucoma.
• If the patient cannot see those peripheral dots,
it means that some vision damage has already
occurred.

31. 5.Optic nerve damage-
The ophthalmologist (eye doctor) uses
instruments to look at the back of the eye,
which can reveal any slight changes which
may also point towards glaucoma onset.

32. 32
TREATMENT:
• Eye drops (Prostaglandin analogues)
• Beta blockers
• Carbonic anhydrase inhibitors
• Cholinergic agents
• Sympathomimetic drugs
• Surgery- if drugs don't work

33. 33
NURSING MANAGEMENT:
• Monitor for any pain or visual changes.
• Monitor the patient’s compliance with medications
and follow-up care.
• Administer antiemetics as directed to prevent
vomiting, which will increase IOP.
• Administer medications I.V., orally or topically, as
directed, and explain the importance of
medications, the proper procedure for
administration of drops, and possible adverse
reactions.
• After surgery, elevate head of the bed 30 degrees to
promote drainage of aqueous humor after a
trabeculectomy.

34. 34
• Administer medications (steroids and
cycloplegics) as directed after peripheral
iridectomy to decrease inflammation and to
dilate the pupil.
• Alert the patient to avoid prolonged coughing
or vomiting, emotional upsets such as worry,
fear, anger; exertion such as pushing and
heavy lifting.
• Instruct the patient’s family how to modify the
patient’s environment for safety.

36. EPISTAXIS

37. 37
EPISTAXIS:
Definition:
• Epistaxis (from Greek: (epistazo) to bleed from the
nose: (epi) - "above", "over" + (stazo) - "to drip [from
the nostrils]")
OR
Epistaxis is defined as acute hemorrhage from the
nostril, nasal cavity, or nasopharynx.
. There are two types: anterior (the most common),
and posterior (less common, more likely to require
medical attention).

38. 38
ANATOMY OF NOSE:
• The nose is the part of the respiratory tract that sits front
and center on your face. You use it to breathe air in and to
stop and smell the roses. The nose’s exterior anatomy
includes the nasal cavity, paranasal sinuses, nerves, blood
supply, and lymphatics.
• The external part of the nose includes the root (between
the eyes), the dorsum that runs down the middle, and the
apex at the tip of the nose. Two openings called nostrils
(nares) allow air in. They’re divided by the nasal septum
(dividing wall of cartilage and bone), and the parts that
surround the nostrils are called the alae (ala singular).
• Nose is supplied by oflactory nerve.

39. 39

40. 40
PATHOPHYSIOLOGY:
• The physiological demands of the nose require
a healthy blood supply. Loss of mucosal
integrity, for any reason, exposes underlying
vessels, which may be break and bleed.
• Vasoconstriction and activation of the clotting
mechanism normally regains haemostasis.
Impairment of these processes may prolong
bleeding.

41. 41

42. 42
CAUSES:
• The most common cause is due to rupture of blood
vessels in the nose as a result of minor trauma
during nose blowing, rubbing, pricking and
sneezing.
• Other more definite trauma to the nose such as a
blow or a fall with nose hitting against object can
obviously results in epistaxis.
• Tumour of the nose or nasopharynx is also a
common cause.
• Epistaxis is also commonly seen in patient with
bleeding tendency e.g. platelet insufficiency.

43. 43
SING AND SYMPTOMS
• Dark or bright red bleeding from one or both
nostrils is the most common sign of epistaxis.
• You may also have trouble breathing,
• smelling, or
• talking if blood clots block your nostrils.

44. 44
RISK FACTORS FOR EPISTASIX :
• Risk factors for nosebleeds include:
• Colds
• Sinusitis
• Dry climate
• High blood pressure
• Allergic rhinitis
• Nose injury

45. 45
COMPLICATIONS:
• Acute bacterial rhinosinusitis(inflammation or
infection of the mucosa of the nasal passages
and at least one of the paranasal sinuses.)
• Cardiovascular compromise associated with
extensive bleeding
• Toxic shock syndrome
• Hypoxia
• Recurrent epistaxis

46. 46
DIAGNOSTIC TESTS:
• Blood tests- Complete blood count and
analysis of blood coagulation factors
• Measurement of the blood pressure.
• Nasal endoscopy
• X-rays of the skull and sinuses.
• CT scan of the nose and sinuses.

47. 47
MEDICAL MANAGEMENT:
• Medical approaches to the treatment of
epistaxis may include the following:
• Oral and topical antibiotics to prevent
rhinosinusitis and possibly toxic shock
syndrome
• Avoidance of aspirin and other nonsteroidal
anti-inflammatory drugs (NSAIDs)
• Medications to control underlying medical
problems (e.g, hypertension, vitamin K
deficiency).

48. 48
NURSING MANAGEMENT:
• Place patient in an upright position, leaning
forward to reduce venous pressure
• Avoiding the patient to talk and let to breathe
through his mouth
• Tell the Patient to firmly grasp and pinch his entire
nose between the thumb and fingers for at least
10 minutes
• Compress the soft outer portion of the nose
against the midline septum for about 5-10
minutes continuously

49. 49
Cont…
• Keep the head of the bed elevated 30 to 45
degrees for the next 4 hours.
• Tell to the patient not to blow his/her nose for
several hours and to avoid lifting objects or
bending at the waist for the next 24 hours.
• Psychological support to the patient specially if
he feels uncomfortable.

50. DAVIATED NASAL
SEPTUM:

51. 51
ANATOMY OF NASAL SEPTUM:
• The nasal septum is the wall dividing the nasal
cavity into halves.
• The septum is composed of cartilage and bone
covered on each side by mucous membrane

52. 52

53. 53
DEFINATION OF DAVIATED NASAL
SEPTUM:
• The nasal septum
may develop bends
as it grows or be
damaged by injury to
the nose – called
nasal septum
deviation – causing a
blocked nose.

54. 54

55. 55
PATHOPHYSIOLOGY:
Deformity of nasal septum may be classified
into:
1. Spurs
2. Deviations
3. Dislocations

56. 56
• Spurs - They are seen at the cartilago-bony
junction of the septum.Thickened septum post
trauma

57. 57
• Deviations - May be C shaped or S shaped.
These can occur in either vertical or horizontal
plane. It may also involve both cartilage and
bone.
• Dislocations - In this the lower border of the
septal cartilages displaced from its medial
position and projects into one of the nostrils.

58. 58
C - shaped nasal septal deviated causing
contour changes in the nose.

59. 59
S- shaped nasal septal deviation causing
external deviation of nose.

60. 60
CAUSES:
• Birth Moulding theory: Abnormal intrauterine
posture and second stage of labour lasting more
than 15 minutes in primipara.However these are
postulated theories.
• Trauma: Commonest cause of deviation.
• Secondary to a tumour, mass or polyps in the nose
to compression.
• Developmental Buckling: If the septum starts
growing rapidly it gets buckled to one side to
accommodate itself.

61. 61
CLINICAL MENIFESTATIONS:
• Nasal congestion
• Difficulty breathing.
• Recurrent or repeated sinus infections
• Nosebleeds
• Facial pain
• Headache
• Postnasal drip
• Loud breathing and snoring during sleep
• Sleep apnea

62. 62
RISK FACTORS:
• Playing contact sports
• Not wearing your seat belt while riding in a
motorized vehicle.

63. 63
COMPLICATIONS:
1. Nasal septum perforation : Due to bilateral
trauma of the mucoperichondrial flaps
opposite each other.
2. Septal haematoma and septal abscess.
3. Adhesions and synachiae: between septal
mucosa and lateral nasal wall.
4. Saddle nose: Due to over resection of the
dorsal wall of the septal cartilage.
5. Dropped nasal tip: Due to resection of the
caudal margin

64. 64
DIAGNOSIS:
• Physical exam
• Ct scan paranasal sinuses
• X-ray paranasal sinuses

65. 65
TREATMENT/ MANAGEMENT:
• Managing symptoms-such as nasal congestion
and postnasal drip. Your doctor may prescribe:
• Decongestants
• Antihistamines
• Antibiotics
• Nasal steroid sprays.
• Surgical repair (septoplasty)
• Rhinoplasty

66. 66
NURSING MANAGEMENT:
• To treat epistaxis, elevate the head of bed,
compress the outer portion of nose against the
septum for 10-15 min. & apply ice packs. if
bleeding persist, notify the doctor
• Warn the patient with perforation or severe
deviation against blowing his nose.
• To relieve nasal congestion, instill saline nasal
drops.
• Teach the patient about rebound effects of
continual use of decongestant nasal sprays.

67. RETINAL
DETACHMENT

68. A) DEFINITION:
• The separation of the retina
from the choroid (a dense
membrane that is located
between retina & sclera)
• or “Retinal detachment” is the
moving away of the retina from
the middle wall of the eyeball.
68
RETINAL DETACHMENT
The condition of being “separated or disconnected”

69. B) PATHOPHYSIOLOGY
• There are 3 layers of eye
outer fibrous, Middle
vascular, inner retina.
• Retina is a thin layer of light
sensitive tissue on the eye. It
sends image as neural
impulses to brain via Optic
nerve.
• Retinal Detachment is a
disorder of eye in which the
retina peels away from its
supportive layer choroid.
69

70. Cont…
• Initial detachment may be localized, but
without rapid treatment the entire retina may
detached, leading to vision loss or blindness.
• Retina may be due to trauma, increased age
or family history.
CONTNUOUS 70

71. C) ETIOLOGY OR CAUSES:
Several conditions may cause retinal
detachment:
• Shrinkage of the vitreous can pull
the retina inward.
• Small tears in the retina allow
liquid to leak behind the retina
and push it forward.
• Injury to the eye can lose retina.
71

72. Cont…
• Bleeding behind the retina.
• Injury can push it forward, this is occurs more
often in the elderly people.
• Tumors can cause the retina to detach.
• If most of the retina is detached, there may be
only a small part of vision remaining.

73. D ) CLINICAL MANIFESTATIONS :
 Symptoms may include:
• The sensation of a shade or curtain coming
across the vision of one eye.
• Bright flashing lights or Spots before the eyes.
• Shadows or black areas in the field of vision.
• The sensation of spots or moving particles in
the field of vision.
• Cloudy vision or loss of a portion of the visual
field. 73

74. E) DIAGNOSIS:
• May be made on
basis of clinical
signs and
symptoms
• Ophthalmoscopic
examination
• Scleral depressor
(for assessing
rotating eye ball )
74

75. F) COMPLICATIONS
• Vision problems
• Hemorrhage
• Glaucoma
• Loss of vision
75

76. G) SURGICAL MANAGEMENT:
 There are four known surgical treatment of retinal
detachment
1) Laser photo coagulation:
If detachment is small, By Laser surgery we can seal the retina
against the choroid.
76

77. 2) Cryopexy:
• It uses nitrous oxide to freeze the tissue behind the retinal
tear, stimulating scar tissue formation that will seal the edges
of the tear.
CONTNUOUS 77
Cont…

78. 3) Pneumatic Retinopexy:
A small gas bubble injected into vitreous body, the bubble
rises and pressure against retina ,pushing it against the
choroid. The gas bubble is slowly absorbed over the next 1 or
2 weeks.
CONTNUOUS 78
Cont…

79. 4) Scleral Buckling:
To place the retina back in contact with choroid this method is
used. The sclera is actually depressed from the outside by rubber
like “silicon” or “bands” that are sutured in place permanently,
intraocular injection of “air” or “sulfur hexafluoride gas” bubble
is used to apply pressure on retina from the inside of eye, this
holds retina by force during healing phase.
79
Cont…

80. H) NURSING MANAGEMNENT:
• Nursing care focuses on reducing the fears
related to loss of vision.
• Nurse should observe the eye for any drainage.
• Assess the level of pain.
• Teach the patient that avoid from any
movement if an air or gas bubble has been
injected.
• Provide suggestion for comfort and support
with the positioning (pillows under elbows or
ankles).
80

81. Cont...
• Encourage the client to resume a regular diet and fluid
as tolerated.
• Administrate Acetazolamide (Diuretic) intravenous; it
may reduce increased intra ocular pressure
• Provide Pre and postoperative care.
• Postoperative eye medication generally includes an
antibiotic steroid combination eye drop to prevent
infection & reduce inflammation.
• Instruct the patient to clean eye with warm tap water.
• Home and Self care.
81

82. BURN

83. BURN:
Definition:
A burn is a type of injury to flesh or skin
caused by heat,
electricity, chemicals, friction, or radiation
83

84. CLASSIFICATION OF BURN:
• Superficial (first degree burn)
• Superficial partial thickness(second degree burn)
• Deep partial thickness(third degree burn)
• Full thickness (fourth degree burn)

85. SUPERFICIAL BURN (1ST DEGREE)
•Includes only the outer layer of skin, the epidermis
•Skin is usually red and very painful.
•Equivalent to superficial sunburn without blisters
•Dry in appearance
•Healing occurs in 3-5 days, injured epithelium peels
away from the healthy skin
85

86. 86

87. SUPERFICIAL PARTIAL-THICKNESS (FIRST DEGREE)
Can be classified as partial or full thickness.
• Partial thickness
– Blisters can be present
– Involve the entire epidermis and upper layers of the
dermis
– Wound will be pink, red in color, painful and wet
appearing
– Wound will blanch (turn white) when pressure is applied
– Should heal in several weeks (10-21 days) without
grafting, scarring is usually minimal.
87

88. Cont...
Full thickness
•Can be red or white in appearance, but will appear dry.
•Involves the destruction of the entire epidermis and most of the
dermis
•Sensation can be present, but diminished
•Blanching is sluggish or absent
•Full thickness will most likely need excision & skin grafting to heal
88

89. DEEP PARTIAL THICKNESS(THIRD DEGREE)
• All layers of the skin is destroyed
• Extend into the subcutaneous tissues
• Areas can appear, black or white and will be
dry
• Can appear leathery in texture
• Will not blanch when pressure is applied
• No pain
89

90. FULL THICKNESS (FOURTH DEGREE)
• Full thickness that extends into
muscle and bone.
90

91. CAUSES:
Burns are caused by a variety of external sources
classified into;
• Thermal
• Chemical
• Electrical
• Radiation
91

92. Thermal
• It is most commonly occurs from
exposure to hot drinks, high
temperature tap water in baths or
showers, hot cooking oil or steam.
92

93. Chemical
• it occur due to exposure of common
agents include: sulfuric acid as found in
toilet cleaners, sodium hypochlorite as
found in bleach, and halogenated
hydrocarbons as found in paint remover.
93

94. Electrical
• It occurs due to exposure of electrical
things, Electrical injuries primarily
result in burns they may also
cause fractures and trauma.
94

95. Radiation
Radiation burns may be caused by exposure
to ultraviolet light (such as from the
sun, tanning booths or arc welding) ionizing
radiation (such as from radiation therapy, X-
rays or radioactive fallout). Sun exposure is
the most common cause of radiation burns
and the most common cause of superficial
burns overall.
95

96. SIGN AND SYMPTOMS:
• Blister
• Redness
• Pain
• Dryness
• swelling
96

97. MEASUREMENT OF BURN ( RULE OF NINE)
97

98. MANAGEMENT OF BURN:
• Maintain I/v line
• Administer I/v Ringer lactate
• Wash the wounds with normal saline
solution and dressing the wound as order.
• Administer analgesics to reduce the pain
i.e. ibuprofen, morphine
98

99. Cont…
• Administer intravenous antibiotics i.e.
ceftriaxone.
• Prepare for surgery (skin grafting)
• Honey has been used since ancient times to aid
wound healing and may be beneficial in first
and second degree burns. There is little
evidence that vitamin E helps with keloids(
scars).