The document discusses several common HEENT disorders, including cataracts, color blindness, crossed eyes (strabismus), glaucoma, and otitis media. It outlines symptoms, causes, treatments, and management strategies for these conditions, stressing the importance of medical intervention and regular eye exams. Emphasis is placed on age-related changes and genetic factors contributing to these disorders.

1. Identify and Manage HEENT
disorders
6/23/2024 Ibrahim A(BsN) 1

2. Identify and Manage HEENT
disorders
• Cataracts
• The eye's natural crystalline lens helps us focus
on people and things at varying distances.
• Unfortunately, as we grow older this lens often
stiffens and hardens, and without its youthful
suppleness it loses its ability to focus, creating
vision problems.
6/23/2024 Ibrahim A(BsN) 2

3. • This condition — for most, a natural
consequence of aging — is called presbyopia.
• As we age, these changes occurring to the natural
crystalline lens can lead to the development of
cataracts, or a loss in clarity of the lens.
• Since the lens is no longer as flexible or as clear
as it used to be, the eye can't focus light properly.
6/23/2024 Ibrahim A(BsN) 3

4. Causes
• While cataracts can occur as a result of other eye
diseases, they mostly develop naturally with age.
• In fact, by age 65, many of us will develop a
cataract.
• There is other, less common causes of cataracts
as well, including heredity, birth defects, chronic
diseases such as diabetes, excessive use of
steroid medications, and certain eye injuries.
6/23/2024 Ibrahim A(BsN) 4

5. Symptoms of Cataracts
• At first, symptoms may be undetectable or very
slight.
• However, any noticeable change in vision may be
cause for concern, and should be brought to the
attention of an eye care professional.
6/23/2024 Ibrahim A(BsN) 5

6. Common symptoms of cataracts
include:
• Cloudy or blurred vision
• Sensitivity to light and glare
• Frequent prescription changes for glasses or
contact lenses
• Poor night vision
• Color vision changes and dimming
• Double vision in a single eye
6/23/2024 Ibrahim A(BsN) 6

7. Treatment for Cataracts
• While there is no way to prevent cataracts, there
are things you can do to slow their formation.
• Modifiable factors that increase the risk of
cataract include smoking, high blood pressure,
obesity, and excessive alcohol intake.
• You may also slow the formation of cataracts by
protecting your eyes from direct sunlight.
6/23/2024 Ibrahim A(BsN) 7

8. • In the beginning stages of cataracts, vision may
be slightly improved using forms of visual
correction.
• However, in the later stages, surgery may be
required.
• Fortunately, surgery has proven to be extremely
successful in the removal of cataracts.
• During cataract surgery, your physician will
replace your natural lens with an IOL.
6/23/2024 Ibrahim A(BsN) 8

9. Color Blindness
• Nearly all people who are “color blind” can see colors
but have difficulty distinguishing between certain
colors.
• Not all people who are color blind have trouble with
the same colors –
• most cannot distinguish between reds and greens;
some cannot separate blues from yellows; and a very
small group have a condition called
monochromatism which only allows them to see
black and white.
• Color blindness of various kinds affects roughly 8%
of men – and less than 1% of women.
6/23/2024 Ibrahim A(BsN) 9

10. What Causes Color Blindness?
• Color blindness is a genetic condition caused by a
difference in how one or more of the light-
sensitive cells found in the retina of the eye
respond to certain colors.
• These cells, called cones, sense wavelengths of
light, and enable the retina to distinguish
between colors.
• This difference in sensitivity in one or more
cones can make a person color blind.
6/23/2024 Ibrahim A(BsN) 10

11. Symptoms of Color Blindness
• The symptoms of color blindness are often
observed by parents when children are young.
• In other cases, symptoms are so slight; they may
not even be noticed.
• Common symptoms of color blindness include:
• Difficulty distinguishing between colors
• Inability to see shades or tones of the same color
6/23/2024 Ibrahim A(BsN) 11

12. Treatment for Color Blindness
• There is no known cure for color blindness.
• Contact lenses and glasses are available with
filters to help color deficiencies, if needed.
• Fortunately, the vision of most color-blind people
is normal in all other respects and certain
adaptation methods are all that is required.
6/23/2024 Ibrahim A(BsN) 12

13. Crossed Eyes (Strabismus)
• Crossed eyes (or strabismus) occur when a
person’s eyes are not able to align on the same
point at the same time, and appear to be
misaligned or pointed in different directions.
• Usually this results from weakness of the
muscles in one or both eyes.
• The weak eye will turn away from the object that
it is supposed to be focused on.
6/23/2024 Ibrahim A(BsN) 13

14. • The eye that turns off-target may be the same in
every incidence, or it could be a different eye at
different times.
• A young child with strabismus will unconsciously
reject the image of the improperly aligned eye
and the related nerve connections between their
eye and brain may fail to develop.
• This can lead to reduction in vision in the eye -
known as amblyopia, or lazy eye.
6/23/2024 Ibrahim A(BsN) 14

15. • Crossed eyes develop most often in babies.
• It is easier to correct when caught early.
• This is often not a condition babies or children
simply outgrow so children with eyes that seem
to be misaligned should be examined and treated
if necessary.
6/23/2024 Ibrahim A(BsN) 15

16. Causes
• There are many different causes for crossed eyes
and it does seem to run in families.
• In some cases, it may be caused by severe
farsightedness that has been left untreated.
• Significant head trauma may also cause crossed
eyes, as it can affect the portion of the brain that
controls eye muscles.
6/23/2024 Ibrahim A(BsN) 16

17. Signs of Crossed Eyes
• The most obvious sign of crossed eyes is when the
eyes appear to be pointed in different directions.
• There are, however, more signs of crossed eyes that
can most often be observed in children, including:
• Eyes that do not move together
• Unsymmetrical points of reflection in each eye
• Tilting the head to one side
• Inability to gauge depth
• Squinting with only one eye
6/23/2024 Ibrahim A(BsN) 17

18. Treatments for Crossed Eyes
• In order to improve vision, the weakened
muscles in the affected eye or eyes must be put to
work.
• Several treatments may be used alone or in
combination, depending on the type, severity,
and cause of strabismus, including:
• Eyeglasses or contact lenses – this method may
help people who have crossed eyes due to an
uncorrected farsightedness
6/23/2024 Ibrahim A(BsN) 18

19. • Medication (eye drops) – In some cases, as an
alternative to patching, eye drops are used in the
stronger (good) eye to temporarily blur the vision in
the good eye.
• This forces use of the weaker eye.
• Surgery – straightens and realigns muscles in the
eyes; this method has a high success rate although it
is expensive and involves more risk than other
options.
• Patching or covering the better-seeing eye – similar
to eye drops, this method works to strengthen the
weakened eye.
6/23/2024 Ibrahim A(BsN) 19

20. Glaucoma
• The term glaucoma is used to refer to a group of
ocular conditions characterized by optic nerve
damage.
• In the past, glaucoma was seen more as a
condition of elevated intraocular pressure (IOP)
than of optic neuropathy.
• Increasingly, that is no longer the case.
• There is no doubt that increased
• IOP damages the optic nerve and nerve fiber
layer, but the degree of harm is highly variable.
6/23/2024 Ibrahim A(BsN) 20

21. • The optic nerve damage is related to the IOP
caused by congestion of aqueous humor in the
eye.
• Most cases are asymptomatic until extensive and
irreversible damage has occurred.
6/23/2024 Ibrahim A(BsN) 21

22. • Glaucoma affects people of all ages but is more
prevalent with increasing age (above 40 years).
• Others at risk are patients with diabetes, African
Americans, those individuals with a family
history of glaucoma, and people with previous
eye trauma or surgery or those who have had
long-term steroid treatment.
• There is no cure for glaucoma, but the disease
can be controlled.
6/23/2024 Ibrahim A(BsN) 22

23. Classification of Glaucoma
• There are several types of glaucoma.
• Current clinical forms of glaucoma are identified
as
• open-angle glaucoma,
• angle-closure glaucoma (also called pupillary
block),
• congenital glaucoma,
• and glaucoma associated with other conditions.
6/23/2024 Ibrahim A(BsN) 23

24. • Glaucoma can be primary or secondary,
depending on whether associated factors
contribute to the rise in IOP.
• The two common clinical forms of glaucoma
encountered in adults are primary open angle
glaucoma (POAG) and angle-closure glaucoma,
which are differentiated by the mechanisms that
cause impaired aqueous outflow.
6/23/2024 Ibrahim A(BsN) 24

25. Clinical Manifestations
• Most patients are unaware that they have the
disease until they have experienced visual
changes and vision loss.
• Symptoms may include blurred vision or “halos”
around lights, difficulty focusing, difficulty
adjusting eyes in low lighting, loss of peripheral
vision, aching or discomfort around the eyes, and
headache.
• Pallor and cupping of the optic nerve disc; as the
optic nerve damage increases, visual perception
in the area is lost.
6/23/2024 Ibrahim A(BsN) 25

26. Assessment and Diagnostic
Methods
• Ocular and medical history (to investigate
predisposing factors)
• Diagnostic tests include tonometry (measures
IOP), ophthalmoscopy (to inspect the optic
nerve), gonioscopy (to examine the filtration
angle of the anterior chamber), and perimetry
(visual fields assessment) are major diagnostic
tests.
6/23/2024 Ibrahim A(BsN) 26

27. Medical Management
• The aim of all glaucoma treatment is prevention
of optic nerve damage.
• Lifelong therapy is almost always necessary
because glaucoma cannot be cured.
• Treatment focuses on pharmacologic therapy,
laser procedures, surgery, or a combination of
these approaches, all of which have potential
complications and side effects.
6/23/2024 Ibrahim A(BsN) 27

28. • The objective is to achieve the greatest benefit at
the least risk, cost, and inconvenience to the
patient.
• Although treatment cannot reverse optic nerve
damage, further damage can be controlled. The
goal is to maintain an IOP within a range unlikely
to cause further damage.
6/23/2024 Ibrahim A(BsN) 28

29. Pharmacologic Therapy
• Medical management of glaucoma relies on
systemic and topical ocular medications that
lower IOP.
• Periodic follow-up examinations are essential to
monitor IOP, the appearance of the optic nerve,
the visual fields, and side effects of medications.
6/23/2024 Ibrahim A(BsN) 29

30. • Therapy takes into account the patient’s health
and stage of glaucoma.
• Patient is usually started on the lowest dose of
topical medication and then advanced to
increased concentrations until the desired IOP
level is reached and maintained.
6/23/2024 Ibrahim A(BsN) 30

31. • One eye is treated first, with the other eye used
as a control in determining the efficacy of the
medication.
• Several types of ocular medications are used to
treat glaucoma,
• including miotic (medications that cause
papillary constriction), adrenergic agonists (i.e.,
sympathomimetic agents), beta-blockers, alpha2-
agonists (i.e., adrenergic agents), carbonic
anhydrase inhibitors, and prostaglandins.
6/23/2024 Ibrahim A(BsN) 31

32. Surgical Management
• Laser trabeculoplasty or iridotomy indicated when IOP is
inadequately controlled by medications.
• Filtering procedures: an opening or a fistula in the
trabecular meshwork; trabeculectomy is standard
technique.
• Drainage implant or shunt surgery may be performed.
• Trabectome surgery is reserved for patients in whom
pharmacologic treatment and/or laser trabeculoplasty do
not control the IOP sufficiently.
6/23/2024 Ibrahim A(BsN) 32

33. Nursing Management
• Create a teaching plan regarding the nature of
the disease and the importance of strict
adherence to the medication regimen to help
ensure compliance.
• Review the patient’s medication program,
particularly the interactions of glaucoma-control
medications with other medications.
6/23/2024 Ibrahim A(BsN) 33

34. • Explain effects of glaucoma-control medications
on vision (e.g., miotics and sympathomimetics
result in altered focus;
• Provide reassurance and emotional support.
• Integrate patient’s family into the plan of care,
and because the disease has a familial tendency,
encourage family members to undergo
examinations at least once every 2 years to
detect glaucoma early.
6/23/2024 Ibrahim A(BsN) 34

35. Otitis
• Acute otitis media is an acute infection of the
middle ear, usually lasting less than 6 weeks.
• The pathogens that cause acute otitis media are
usually
• Streptococcus pneumoniae,
• Haemophilus influenzae,
• and Moraxella catarrhalis
6/23/2024 Ibrahim A(BsN) 35

36. • which enter the middle ear after eustachian tube
dysfunction caused by obstruction related to
upper respiratory infections,
• inflammation of surrounding structures (e.g.,
rhinosinusitis,
• adenoid hypertrophy), or
• allergic reactions (e.g., allergic rhinitis
6/23/2024 Ibrahim A(BsN) 36

37. Clinical Manifestations
• Symptoms vary with the severity of the infection;
usually unilateral in adults.
• Pain in and about the ear (otalgia) may be intense
and relieved only after spontaneous perforation of
the eardrum or after myringotomy.
• Fever; drainage from the ear, hearing loss.
• Tympanic membrane is erythematous and often
bulging.
• Conductive hearing loss due to exudate in the middle
ear.
• Even if the condition becomes subacute (3 weeks to
3 months) with purulent discharge, permanent
hearing loss is rare.
6/23/2024 Ibrahim A(BsN) 37

38. Complications
• Perforation of the tympanic membrane may
persist and develop into chronic otitis media.
• Secondary complications involve the mastoid
(mastoiditis),meningitis, or brain abscess (rare).
6/23/2024 Ibrahim A(BsN) 38

39. Management
• With early and appropriate broad-spectrum
antibiotic therapy, otitis media may clear with no
serious sequelae.
• If drainage occurs, an antibiotic otic preparation
may be prescribed.
• Outcome depends on efficacy of therapy (the
prescribed dose of an oral antibiotic and the
duration of therapy), the virulence of the
bacteria, and the physical status of the patient.
6/23/2024 Ibrahim A(BsN) 39

40. Otitis Media, Chronic
• Chronic otitis media results from repeated
episodes of acute otitis media, causing
irreversible tissue pathology and persistent
perforation of the tympanic membrane.
• Chronic infections of the middle ear cause
damage to the tympanic membrane, can destroy
the ossicles, and can involve the mastoid.
6/23/2024 Ibrahim A(BsN) 40

41. Clinical Manifestations
• Symptoms may be minimal, with varying degrees
of hearing loss and a persistent or intermittent
foul-smelling otorrhea (discharge).
• Pain may be present if acute mastoiditis occurs;
when mastoiditis is present, postauricular area is
tender; erythema and edema may be present.
6/23/2024 Ibrahim A(BsN) 41

42. • Cholesteatoma (sac filled with degenerated skin
and sebaceous material) may be present as a
white mass behind the tympanic membrane
visible through an otoscope.
• If untreated, the cholesteatoma continues to
grow and destroys structures of the temporal
bone, possibly causing damage to the facial nerve
and horizontal canal and destruction of other
surrounding structures.
• Auditory tests often show a conductive or mixed
hearing loss.
6/23/2024 Ibrahim A(BsN) 42

43. Medical Management
• Careful suctioning and cleansing of the ear are
done under microscopic guidance.
• Antibiotic drops are instilled or antibiotic
powder is applied to treat purulent discharge.
• Tympanoplasty procedures (myringoplasty and
more extensive types) may be performed to
prevent recurrent infection, reestablish middle
ear function, close the perforation, and improve
hearing.
6/23/2024 Ibrahim A(BsN) 43

44. • Oculoplastic may be done to reconstruct the
middle ear bones to restore hearing.
• Mastoidectomy may be done to remove
cholesteatoma, gain access to diseased
structures, and create a dry (noninfected) and
healthy ear.
6/23/2024 Ibrahim A(BsN) 44

45. Headache
• Headache (cephalgia) is one of the most common
of all human physical complaints.
• Headache is actually a symptoms rather than a
disease entity and may indicate organic disease
(neurologic), a stress response, vasodilation
(migraine), skeletal muscle tension (tension
headache), or a combination of these factors.
6/23/2024 Ibrahim A(BsN) 45

46. • A primary headache is one for which no organic
cause can be identified.
• These types of headache include migraine,
tension-type, and cluster headaches.
6/23/2024 Ibrahim A(BsN) 46

47. • A secondary headache is a symptoms associated
with organic causes, such as a brain tumor or
aneurysm, subarachnoid hemorrhage, stroke,
severe hypertension, meningitis, and head injury.
• Examples of secondary headaches include the
following:
• Miscellaneous headaches associated with
structural lesions
• Headache associated with head trauma
• Headache associated with vascular disorders
6/23/2024 Ibrahim A(BsN) 47

48. 1.7.1 Migraine Headache
• Migraine is a complex of symptoms characterized
by periodic and recurrent attacks of severe
headache.
• The cause of migraine has not been clearly
demonstrated, but it is primarily a vascular
disturbance that occurs more commonly in
women and has strong familial tendencies.
• Onset typically occurs in puberty, and the
incidence is 18% in women and 6% in men.
6/23/2024 Ibrahim A(BsN) 48

49. Clinical Manifestations
• Headache often begins in early morning
(headache on awakening).
• The classic migraine attack can be divided into
four phases: prodrome, aura, headache, and
recovery.
6/23/2024 Ibrahim A(BsN) 49

50. Prodrome Phase
• Present in 60% of patients with migraine
headache.
• Symptoms may occur consistently hours to days
before onset of migraine.
• Depression, irritability, feeling cold, food
cravings, anorexia, change in activity level,
increased urination, diarrhea, or constipation
may be noted with each migraine
6/23/2024 Ibrahim A(BsN) 50

51. Aura Phase
• Occurs in a minority of patients and lasts less
than 1 hour.
• Focal neurologic symptoms, predominantly
visual disturbances (light flashes), occur and may
be hemianoptic (occurring in half of the visual
field).
• Numbness and tingling of lips, face, or hands;
mild confusion; slight weakness of an extremity;
and drowsiness and dizziness may be present.
6/23/2024 Ibrahim A(BsN) 51

52. Headache Phase
• This phase, occurring in 60% of patients,
involves a unilateral, throbbing headache that
intensifies over several hours.
• Pain is severe and incapacitating, often
associated with photophobia, nausea, and
vomiting.
• Duration varies from about 4 to 72 hours..
6/23/2024 Ibrahim A(BsN) 52

53. Recovery Phase (Termination
and Postdrome)
• Pain gradually subsides.
• There is a period of muscle contraction in the
neck and scalp with associated muscle ache and
localized tenderness, exhaustion, and mood
changes.
• Any physical exertion exacerbates the headache
pain.
• Patient may sleep for an extended period
6/23/2024 Ibrahim A(BsN) 53

54. Assessment and Diagnostic
Methods
• Physical assessment of head and neck
• Neurologic examination
• Detailed health and headache assessment and
history; medication history
• Cerebral angiography, computed tomography
(CT), or magnetic resonance imaging (MRI) if
abnormalities on neurologic examination
6/23/2024 Ibrahim A(BsN) 54

55. • Electromyography (EMG) and laboratory tests
(complete blood cell [CBC] count, electrolytes,
glucose, creatinine, erythrocyte sedimentation
rate, electrolytes, glucose, creatinine, and thyroid
hormone levels)
6/23/2024 Ibrahim A(BsN) 55

56. Medical Management
• Therapy is divided into abortive (symptomsatic)
and preventive approaches.
• Abortive approach is used for frequent attacks
and is aimed at relieving or limiting a headache
at onset or while in progress.
• Preventive approach is used for those who have
frequent attacks at regular or predictable
intervals and may have medical conditions that
preclude abortive therapies.
6/23/2024 Ibrahim A(BsN) 56

57. Nursing Management
• Relieving Pain
• Attempting to abort headache early.
• Provide comfort measures (e.g., a quiet, dark
environment); elevate the head of bed 30
degrees.
• Administer medications
• If non pharmacologic measures are ineffective.
• Provide symptomsatic treatment, such as
antiemetics, as indicated.
6/23/2024 Ibrahim A(BsN) 57

58. END
•THANKS FOR
YOUR
ATTENTION
6/23/2024 Ibrahim A(BsN) 58