DISEASES OF THE EENT

PREPARED BY: MA. CHRISTINE ANNE T. RAMOS CABAHUG RN, MD, MPH

CATARACT
A lens opacity or cloudiness that distorts image Can progress to blindness Risk factors Aging, DM, Inherited, trauma

ASSESSMENT 1. painless, blurry vision 2. surroundings are dimmer 3. reduced visual acuity

DIAGNOSTIC TEST 1. Snellen chart for visual acuity 2. ophthalmoscopy 3. slit-lamp to establish the degree of cataract formation

CATARACT
SURGICAL MANAGEMENT intracapsular /extracapsular extraction phaecoemulsification and lens replacement No useful drug to combat cataract

CATARACT
NURSING INTERVENTION 1. PRE-OPERATIVE CARE Withhold aspirin, NSAIDS & anticoagulant therapy Dilating drops are administered at least 1 hour before surgery

CATARACT
2. POST-OPERATIVE CARE POSITION: side lying on the UNAFFECTED side Wear glasses x 24 hours or metal shield nightly x 1-4 weeks Clean eyes with single stroke from inner to outer canthus

Avoid lifting, pushing or pulling >15 pounds Avoid prolonged stooping and bending

 A client reports gradual painless blurring of vision. On assessment, the nurse notes a cloudy, opaque lens. Based on this assessment, the nurse suspects the client has:

1. Glaucoma 2. Cataract 3. Retinal detachment 4. Diabetic retinopathy

GLAUCOMA
Increased intra-ocular pressure:  Inadequate drainage of aqueous humor from canal of schlemm  Overproduction of aqueous humor

TYPES OF GLAUCOMA
1. CHRONIC (open angle) Most common Obstruction in outflow at trabecular meshwork of canal of schlem 2. ACUTE (closed angle) Most dangerous type Forward displacement of iris to cornea 3. CHRONIC (closed angle) Precipitated by acute attack

ASSESSMENT 1. Blurred vision 2. halos around the lights 3. Loss of peripheral vision or tunnel vision 4. headache

GLAUCOMA
DIAGNOSTICS: 1. TONOMETRY Increase IOP (N 12-21 mmHg) 2. PERIMETRY Decrease peripheral vision 3. GONIOSCOPY Obstruction in anterior chamber

NURSING INTERVENTIONS:
Enfore CBR Maintain siderails Administer meds: 1. Miotics e.g. Pilocarpine Contracts ciliary muscles & constricts pupil 2. CAI ex. Acetazolamide (diamox) Promotes increase outflow of aqueous humor 3. Timoptics ex. Timolol maleate Increase outflow of aqueous humor

SURGICAL INTERVENTIONS
1. TRABECULECTOMY Removal of trabecular meshwork of canal of sclera to drain aqueous humor 2. PERIPHERAL IRIDECTOMY portion of iris is excised to drain aqueous humor

 To determine if a client has glaucoma or a detached retina, the nurse understands that a client with glaucoma will report:

1. Seeing floating spots 2. Eye pain 3. Seeing flashing lights 4. Sudden loss of vision

 A client has just been diagnosed with glaucoma. During a teaching session, the nurse should:

1. Provide instructions on eye patching 2. Assess the clients visual acuity 3. Demonstrate eyedrop instillation 4. Teach about intraocular lens cleaning

RETINAL DETACHMENT
layers of the retina separate due to accumulation of fluid between them or retinal layers elevate away from the choroid as a result of a tumor

TYPES OF RETINAL DETACHMENT

PARTIAL RETINAL DETACHMENT becomes complete if left untreated COMPLETE RETINAL DETACHMENT when detachment is complete, blindness may occur

RETINAL DETACHMENT
Flashes of light Floaters Sense of curtain being drawn Loss of a portion of the visual field

NURSING INTERVENTIONS
Provide bed rest Cover both eyes with patches to prevent further detachment Position the clients head as prescribed

SURGICAL INTERVENTIONS
1. SEALING RETINAL BREAKS BY CRYOSURGERY - a cold probe applied to the sclera to stimulate an inflammatory response leading to adhesions

SURGICAL INTERVENTIONS
2. LASER THERAPY - to stimulate an inflammatory response to seal small retinal tears before the detachment occurs

SURGICAL INTERVENTIONS
3. SCLERAL BUCKLING to hold the choroid & retina together with a splint until scar tissue forms closing the tear

POST OP NURSING INTERVENTIONS:

Provide bedrest for 1-2 days Maintain eye patches bilaterally as prescribed Monitor for sudden, sharp eye pain (notify the MD stat) Avoid sudden head movements or anything that increases IOP Administer eye medications as prescribed

POST OP NURSING INTERVENTIONS:

Instruct the client to limit reading for 3-5 weeks avoid squinting, straining & constipation, lifting heavy objects & bending from the waist Instruct to wear dark glasses during the day & an eye patch at night Follow-up care because of the danger of recurrence or occurrence in the other eye

 An adult male is receiving cryotherapy for repair of detached retina. When taking history from the patient, which symptoms should the nurse expect him to have?

1. Diplopia 2. Severe eye pain 3. Sudden blindness 4. Bright flashes of light

 The nurse is explainin cryotherapy to a client who has detached retina. The nurse should explain that the major purpose of cryotherapy is to:

1. Disintegrate debris in the eye 2. Freeze small blood vessels 3. Halt secretions of the lacrimal duct 4. Create a scar that promotes healing

DISEASES OF THE EAR

OUTER EAR

The OUTER EAR collects sound, whose pressure is amplified through the middle ear

MIDDLE EAR
MIDDLE EAR includes the eardrum (also called tympanic membrane) and ossicles. a.) Ear osssicle 1. Hammer-malleus 2. Anvil -Incus for bone conduction disorder conductive hearing loss 3. Stirrups-stapes b. Eustachian tube - Opens to allow equalization of pressure on both ears - Yawn, chew, and swallow

INNER EAR
INNER EAR also called labyrinth, It consists of two parts: 1. Cochlea - the organ of hearing; filled with water 2. Vestibular System responsible for balance.

WEBER TEST
Lateralization test that compares right & left ear NEGATIVE NORMAL Sound heard in both ears POSITIVE ABNORMAL Heard better in bad ear = conductive hearing loss Heard better in good ear = sensorineural hearing loss

RINNE TEST
Compares air conduction with bone conduction POSITIVE NORMAL Air conduction is > than bone conduction NEGATIVE ABNORMAL Bone conduction is = or longer than air conduction (Conductive Hearing Loss)

OTITIS EXTERNA
inflammatory or allergic responses involving the structure of the external auditory canal or the auricles more common in children & termed as SWIMMERS EAR

OTITIS MEDIA
Inflammation of the MIDDLE ear Etiologic Factors: Strep pneumonia Hemophilus influenzae Moraxela catarrhalis

OTITIS MEDIA
ASSESSMENT:
 Fever  Rolling of head from side to side  Pulling on or rubbing the ear  Signs of hearing loss  Purulent ear drainage  Red, opaque, bulging tympanic membrane

Complications: Conductive Hearing loss Abscess Meningitis Mastoiditis

OTITIS MEDIA
INTERVENTIONS: feed infants in an upright position avoid chewing during the acute period Provide local heat & have the child lie with affected ear down clean drainage with sterile cotton swabs administer of analgesics or antipyretics & antibiotics as prescribed

OTOSCLEROSIS
Formation of spongy bone in the labyrinth Fixation of stapes No transmission of auditory vibration to inner ear

OTOSCLEROSIS
ASSESSMENT: Progressive conductive hearing loss Tinnitus

OTOSCLEROSIS
MANAGEMENT: STAPEDECTOMY Removal of diseased portion of stapes Replaced with a prosthesis to conduct vibrations

MENIERES SYNDROME
ENDOLYMPHATIC HYDROPS dilation of the endolympathic system by either 1.overproduction or 2. decreased reabsorption of endolymphatic fluid

MENIERES SYNDROME
characterized by: Tinnitus unilateral sensorineural hearing loss vertigo

MENIERES SYNDROME
INTERVENTIONS: Preventing injury during vertigo attacks Bed rest in a quiet environment Instruct the client to move the head slowly to prevent worsening of vertigo Initiate Na & fluid restrictions

MENIERES SYNDROME
Administer Nicotinic acid (Niacin) vasodilating effect Administer antiemetics

Administer tranquilizers & Administer sedatives antihistamines - to calm client & - reduce of histamine allow rest, control production & the vertigo, N&V inflammation

 Which nursing diagnosis takes highest priority for a client admitted for evaluation for Menieres disease?

1. Acute pain related to vertigo 2. Imbalance nutrition: less than body requirements related to nausea & vomiting 3. Risk for deficient fluid volume related to vomiting 4. Risk for injury related to vertigo

 A nurse admitting a client who reports vision loss. To determine if a client has glaucoma or a detached retina, the nurse understands that a client with glaucoma will report

A. Seeing floating spots B. Eye pain C. Seeing flashing lights D. Sudden loss of vision

 A client has just been diagnosed with early glaucoma. During health teaching, the nurse should

A. teach about intraocular lens cleaning. B. demonstrate eyedrop instillation. C. assess the client's visual acuity. D. Provide instructions on eye patching

 Audiometry confirms a client progressive chronic hearing loss. Further investigation shows ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called a

A. Functional hearing loss B. fluctuating hearing loss. C. sensorineural hearing loss. D. conductive hearing loss

 A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?

1. External ear 2. Middle ear 3. Inner ear 4. Tympanic membrane

 The nurse correctly tells the client that the priority goal in the treatment for Menieres disease is to

1. Maintain sodiumfree diet 2. Eliminate environmental noise 3. Preserve the remaining hearing 4. Promote a quiet environment