Care for patients with alteration in perception and coordination: EENT Disorders

Disease Signs ans Diagnostic Management

Symptoms tests

Eye lid

Blepharitis

-Inflammation of Itchy , red and Slit Lamp Exam Rouitne regimen eyelid care
eyelid margins burning eyes
Warm moist compress
Greasy scales, followed by gentle scrubbing
malforming on with dilute baby shampoo
the eylids and
eye lashes Instruct patient not tu rub
Entropion eyes because this can spread
-inversion of margins
the infection to the other eye
eyelid that structure
results in
eyelashes
rubbing against
the conjunctiva Foreign body Surgery:
- caused by sensation
Pain and tearing Tightening or orbicular muscle
spasm of
Eyelid is turned (moving eyelids to normal
muscles of
inward position) – prevent inward
eyelids as a
Conjunctive may rotation of eylid margin
result of trauma,
chemical or looked inflamed Post op care:
thermal burns Corneal abrasion
irritatiojn in the Instillation of eye drops
eyelids)
Instruct to leave the eye
patch in place

Antibiotics

Surface care- Clean at suture

Ectropion line with cotton swab ( with
-outward the prescribed solution)
sagging and Corneal drying or
ulceration Eye patch:
oversion of
eyelid Outward
Non-pressure- 1 gauze
-caused is deviation of
congenital or eyelid Pressure eye patch- 2 gauze
aging (relaxation
of obicular
muscles); injury
or paralysis of
7th cranial nerve Surgery
Ptosis Post op care:
-drooping of
eyelids, result of Instillation of eye drops
ocular muscle
dysfunction; Antibiotic oitnment
injury to the 3rd
Suture care and leave patch
craniola nerve
in place
External:
Localized
redness, swollen,
tender area is
Hordelium/ noted on the skin
“Stye” surface side of
External- the margin Surgery (appearance is
infection of Internal adversely affected)
sweat glands in Localized Post op care:
eyelid; occure redness usually Asses s/s of infection
near exit of affected one Cool compress after surgery
eyelashes from eyelid Eyeshield
the eyelid Small, beady, Mild analgesics:
Internal- edematous area acetaminophen
infection of on the skin side
eyelid of eyelid Warm compresses 4x a day
sabaceous gland Antibiotic ointment
Causative agent: Remove ointment from the
Staphylococcus Eye fatigue eye before driving or
aureus, Sensitivity to operating machinery
staphylococcus light
epidermidis, Epiphora
streptococcus (excessive
tearing)
Chalazion

Warm compress
Opthalmic ointment
Foreign body Excision when large enough
sensation to affect the risk
Burning and Post op:
Lacrimal itching eye Antibiotic oitment
Kearatoconjuncti Photophobia Non-pressure eyepatch after
vitis sicca Corneal light warm moist compress
-“dry eye reflex distorted
syndrome” Fear film
Eye drops (Hypotecus) –
daytime
Small, well Night lubricating ointment
defined area of
hemorrhage
Conjunctiva appear bright
Painless
Subconjunctival No visual
hemorrhage imnpairement
-break on the Resolves gradually 10-14
subconjunctival Inflammatory s/s: days – no treatment needed
blood vessels Conjunctival
due to increase edema
pressure from Sensation of
sneezing, burning
coughing. Vascular Inflammatory:
Conjunctivitis injection Instillation of vasoconstrictor
Inflammation of Excessive tearing and corticosteroid
conjunctiva and itching (prednisone acetate)
Bacterial s/s: Bacterial:
Marked blood Obtain specimen for culture
vessel dilation Broad spectrum topical
Tearing antibiotic
Discharge is Prevent spread of infection
watery at first Handwashing
Don’t touch the unaffec ted
Tearing eye when washing
Photophobia Avoid sharing washclothes
Trachoma Edema of eyelids
Chronic , Conjunctival
bilateral edema Obtain specimen for culture
scarring form of Follicles form on Prevent spread of infection
conjunctivitis the upper eyelid 4 week course of tetracycline
CA: Chlamydia conjunctiva; or erythromycin
trachomatis eyelid scars
( chief cause of turns inward and
blindness) eylashes abrade
Incubation cornea
period: 5-14
days
Blurred vision
Cornea
Keartoconus
-degenerative
disease that
cause general
thinning and
forward
protrusion of
cornea
Dystrophies
-Abnormal
deposition of
substance in
cornea
Dystrophies
-abnormal
deposition of
substance in
cornea
Keratitis Increase tearing
-Inflammation of Photophobia
cornea
Types:
Exposure
keratitis-
inflammation of General General Management of
cornea by upper manifestations of corneal disorder:
eyelid corneal disorder: Non surgical:
Acantamoeba Increase tearing 1. Drug therapy:
Keratitis Photophobia Ciprofloxacin
-caused by Cloudy/ purulent Gentamicin
protozoa living fluid on eyelid Tobramycin
in h20 and soil Patchy areas on Steroids
Corneal ulcers cornea 2. Vision enhancement
-breaking in the Green coloring of (sun glasses)
corneal cornea
epithelium can Surgical:
provode 1. Keratoplasty/ corneal
entrances for transplant- removal of
bacteria dead corneal tissues
2 approaches:
Lamellar aprroaches
Corneal (partial thickness
disorders keratoplasty) –
superficial- cornea is
removed and replaced
with the donor’s tissue
2. Penetrating
Keratoplasty (full
penetrating
Eyeball appears keratoplasty)clients
pink and purple cornea is removed and
Edema of replaced with the
episclera donor’s tissue
Hyperemia of the
episcleral vessels Post op:
Ocular redness Elevate head 30 degrees of
Pain donor
Lacrimation Monitor v/s, LOC, dressing
Monitor pressure patch
Early:
Blurred vision
Decrease color Topical corticosteroids-
perception dexamethasone
Late:
Sclera Diplopia
Episcleritis Reduced visual
-localized acuity
inflammation of progressing to
sclera usually blindness
close to the Absene of red
corneal margins reflex Extracapsular cataract
Presence of extraction- removal of
white pupil posterior lens only
Intracapsular cataract
Lens extraction- removal of entire
Cataract Decrease visual lens
-opacity of the acuity Phaloemulsification
lens that distorts Vitreous Intraocular lens implantation
the image “floaters”
projected into Black streaks /
the retina tiny black dots

Periorbital aching
blurred vision
Photophobia Absorbed slowly witn no
 treatment
Visual Vitreactomy
Glaucoma impairement
Ocular Visual loss
chambers: Irregular shaped
Vitreous of pupil
Hemorrhage Grayish-yellow
-bleeding of patches
vitreous
“copperwire”
arteriole Steroids- prednisone
appearrance Dexamethasone phosphate
Ischemia: Cool or warm compress
Ulgal tract “cotton wool” Darken the room
Anteriror uleitis- spots
inflammation of Vertigo
iris, ciliary body Intraretinal Manage HPN and IOP
or both hemorrhage
Posterior uleitis-
retinitis,
chorioretinitis Laser beams
Vitrectomy
Atrophic Endolaser
Exudative Silicone oil-
(sulfahexaflouroside)
Retina See bright
Hypertensive flashes of light Maximize the use of the
retinopathy Sensation of remaining vision
certain being Alternative strategies (use of
pulled over part books of with large prints)
Diabetic of visual field
retinopathy Cryotherapy
Photocoagulation
Night blindness
well then lead to
total blindness
Macular
degeneration No current therapy

Retinal Bed rest – semi fowler’s

detachment position
No sudden movement of eye
Rhegmatogenou Cycloplegic eye drops
s detachment Eye shield
Traction Resolver 5-7 drops
detachment
Exudative Ice pack is applied
detachment immediately followed
Retinits throught eye examination
pigmensosa
-retinal cells Eye irrigation with normal
degenerate saline solution
Gentle removal of particles
Trauma Eye patch
Hyphema
-presence of Eyelid is closed and a small
blood in the ice pack is applied
anterior Penetrating objects must not
chamber be removed
Antibiotic
-surgery

Contussion-
“black eye” -litmus paper dabbed in
conjunctiva
Foreign body Anesthetic with proparacaine
hcl
Management of four areas:
Orientation
Laceration -converse in normal tone
-caused by - orient to immediate
sharp objects environment
- mealtime: “clock method”
Ambulation
Penetrating -grasp the nurses arm at the
injuries below
-poorest Pain, redness, -arm is kept close to nurses
prognosis edema, itching, body
Chemical burns presence of -cane
exudates, Self-Care
hearing loss, -knocks the door before
Blindness plugged feeling entering
Legally blind – in ear -states the name and reaosn
best visual for visiting
acuity with Senation of Support
corrective lenses fulnnes in the -honest and emphatic
in the better eye ear support
is 20/200 or Hearing loss -positive reinforcement for
decrease Pain each success
Itching
Bleeding from
the ear Topical antibiotics
Corticosteroids
Swelling behind Oral analgesics
the ear Local heat application
Pain and minimal
movement of the Ear irrigation ( h20 with
tragus, pinna or hydrogen peroxide) 50-70 ml
the head solution
Red, dull, thick, Cerumenolytic product
immobile (Cerumenex)
Ear tympanic Steroid ointment
External Otitis/ membrane
swimmer’s ear Tender and
enlarged
postauricular ; Obtain specimen for culture
lymph nodes Antibiotic therapy
Cerumane or Low grade fever, Simple or radical
foreign bodies malaise and mastoidectomy or
anorexia tympanoplasty

Mastoiditis Triad:
- inflammation Tinnitus
of mastoid hair Unilateral /
cells due to sensorineural Tympanic perforation heals in
untreated otitis hearing loss 24 hours
media Vertigo Hearing aids
Surgical reconstitution of the
Conductive ossicles or tympanic
Sensorineural membrane
Mixed Slow head movements
Salt and fluid restrictions
Stop smoking
Anit-histamines
Nasal irritation Anti-emetics
Trauma to Sneezing
tympanic Fatigue
membrane – due Nasal congestion
to rapid change Rhinorrhea
of pressure Itchy, watery
eyes
Meniere’s
Syndrome
Symptomatic treatment
Antihistamine
Decongestants
Antipyretics
Proper rest
Hearing loss Increase fluid intake (2000
ml/day)

Nasal swelling
and congestion
Nose Facial pressure
Rhinitis and pain
-inflammation of Low grade fever
the nasal Purulent / bloody
mucosa nasal drainage
Types:
Acute rhinitis- Broad spectrum antibiotic
allergies, caused Functional endoscopic
by bacteria surgery
Allergic rhinitis-
“Hay fever” –
allergies; Soreness and
sensitivity dryness of the
reaction throat
Chronic/ Pain
Perrenial rhinitis Fever
– present Nasal discharges
intermittent or “Hot potato
continuously voice”
when person is Rest
exposed to Increase fluid intake
certain allergens Mild severe sore Humidification of air
Acute viral throat Direct Analgesics
rhinitis- “Coryza/ Fever Opthalmoscop Warm saline throat gargle
common cold” – Muscle aches y Bacterial- Penicillin V
spread from one Chills Indirect (antibiotic)
person to Dysphagia opthalmoscop
another Anorexia y
Sinusitis- Slit lamp exam Systemic antibiotic
inflammation of Acute Warm saline throat gargle
mucous hoarseness Tonsillectomy
membrane Dry cough Adenoidectomy
Acute sinusitis- Dysphagia
obstruction of aphonia
the flow of
secretions from Voice rest
the sinuses Steam inhalation
which may Increase fluid intake
become infected Antibiotic therapy
Chronic sinusitis- Bronchodilators
permanent Infection prevention:
thickening from Avoidance of alcohol, tobacco
prolonged or and pollutants
repeated Speech therapy
inflammation or
infection
Throat
Pharyngitis
-inflammation of
the pharynx

Tonsillitis
Acute tonsillitis-
lasts 7-10 days
Chronic
tonsillitis-
recurrent
infection

Laryngitis-
inflammation of
the larynx
 Otoscopy
Weber’s tesrt
Rinne’s test
Romberg test

Additional:

EyeS – 17% of sensory receptors are in the eyes

-Extraocular-

Eyebrows, eyelids, and eyelashes - protects the inner structure from foreign
substances

Conjunctiva- lubricates the eye

-Intraocular

Sclera- clear membrane

Cornea- window as light enters the eye

Irirs- controls the light coming in the eyes

Pupils- light enters

Aqueous humor - 10-21 mmHg IOP- nourish the different structures of the eyes

Retina- RODs (dim) and CONS (light) – visualize night and day

Myopia- nearsighted; biconcave lens – Management; Phoreactive Keratotomy; LASIK

Hyperopia- farsighted; biconvex lens

Astigmatism- an irregularity in the curve of the cornea

Presbyopia- farsightedness related to aging

Diagnostic exams;

Snellens’ chart

E-chart- for patient who could not read

Rosenbaum chart- near vision

Strabismus

-deviation from perfect ocular alignment caused by imbalance intraocular muscles.

Assessment:

Esotopia- medial rectus muscle –“turning in”

Exotopia – lateral turning out

Hypertropia – turning up

Hypotropia- turning down

Mangement:

Maintain a safe environment

Put things in the same place and tell the patient about the locations