EENT

EYES
Anatomy:
 External Part
1. Eyelids/Palpebrae
*palpebral fissure
-space between two
lids
*canthi
-corners of the
fissure
*meibomian gland
-oil secreting glands
2. Orbit/eye socket
- surrounds and
protect the most of
the eye
3. Conjunctiva
-thin transparent
layer of mucous
tissue that covers
the eyes
- lubricates the eye
4. Lacrimal system

*lacrimal gland
-found at the upper
lid over the outer
canthus
-produces tear
*lacrimal ducts
- directs flow of
tears to the nose
 Internal Structure
1. Outer Layer
*Sclera- “white of the
eye”
- a tough, opaque
tissue
-serves as a
protective coat
*cornea
- transparent domed
shape found in front
of the eye
- focus light to the
retina
2. Middle Layer
*Choroid-
-lies between
retina and sclera
-supplies blood to
the retina
*Ciliary Body
-lies behind the iris
-produces aqueous
humor
*Iris
- the colored portion
of the eye
-controls level of
light entering the eye
*Pupil
- the opening at the
center of the iris
3. Inner Layer
*lens
- located just
behind the iris
-focus light to the
retina
*Canal of schlemm
-outflow of
aqueous humor
*Aqueous humor
- watery fluid that
fills the space
between the cornea
and the iris
- nourishes the lens
and cornea
- produced by the
ciliary body
*Retina
-consistency of a wet
tissue paper
- contains photo
receptors
*rods
*cones
*Macula Lutea
-found at the center of
the retina
-central vision
*Optic disc
-also called the
blind spot
*Vitreous Humor
-thick, transparent
substance that
fills the center of
the eye
-comprises 2/3 of
the eye volume
Extraocular muscles
* Rectus
-horizontal and
vertical movement
of the eyes

*Oblique
-circular
movement of the
eye
II. EYE FUNCTION
- light enrgy from an
object→cornea →
aqueous h→ pupils→
lens→ vitreous h→
retina→ photoreceptors
converts image to nerve
impulse→ transmitted to
optic nerve via optic
disc→optic chiasm→
cerebral cortex→
interpretaion as sight
 DIAGNOSTIC
PROCEDURES
1. Snellen’s chart
- Test for visual
acuity
- normal reading
is 20/20
2. Ishihara Chart
- test for color vision
3. Fluorescein Angiography
 DEFINITION
-is an eye test that uses an special
dye and camera to evaluate the
blood circulation in the retina and
choroid.
HOW TEST IS PERFORMED
- Drugs that dilate the pupil is given
- the patient chin is placed at the
chin rest
- 1st photograph is taken
- patient is injected with a dye
“Fluorescein”
- more pictures is taken after 20
mins
Preparation of the test:
1. Have someone to accompany the
patient
2. Check for allergies
3. have an informed consent
4. Ask the patient if pregnant
What to expect during the procedure

- Stinging sensation
-nausea and vomiting
Result shows
macular edema
4. Fundoscopy
-is an examination of
the back part of
the eyeball
(fundus), which
includes the retina
, optic disc,
choroid, and blood
vessels.
How Test is Performed:
- the patient is asked to sit in a darkened
room
- visualization of the eye using a
funduscope
Preparation:
- Midriatic drugs may or may not be given
- Significant other
- Sunglasses
5. Corneal Staining
- to check for
corneal surface
and corneal injury
using a dye
“Fluorescein”
6. Tonometry
- To check the
intraoccular
pressure.

- Topical anesthetic
is used to numb
the surface
7. Gonioscopy
-is an eye
examination to look
at the front part of
your eye (anterior
chamber) between
the cornea and the
iris.
- test if the drainage
angle is open or
closed
How it is Performed:
- topical anesthetic is given
- a special lens is placed in front of
the eye
- the doctor will view the angle
using a slit-lamp
WHAT TO EXPECT
- Painless
- Eye drops used to numbed will
burn a little
- procedure last 5 to 10 mins
Nursing Considerations:
- tell the client not to rub the eye for
20 mins after the procedure or until
the medication wears off
8. Opthalmoscopy
9. Slit-lamp
-The test is used to
examine
the eyelids, the
sclera, conjunctiva
, iris, lens, and the
cornea.
HOW THE TEST IS PERFORMED
- A small strip of paper stained with
dye
- first examination starts
- pupil dilator is placed in the eye
- then repeat examination takes
place after 15-20 mins
SPECIAL PREPARATION
*No special preparation

Nursing Consideration
* Sensitivity to light after the
procedure
 EYE DISORDERS
1. Glaucoma
Causes:
- Family
history - Black
race
- trauma
- myopia
Types:
A. open- angle
B. angle-closure

C. Congenital
 D. Secondary

• SIGNS AND SYMPTOMS

A. Open-angle
- Asymptomatic
- insidious visual impairment
- loss of peripheral vision
- HALOS around lights
B. Angle-closure
- Acute ocular pain
- diminished visual acuity
- colored HALOS around lights
- Blurry vision
- Nausea and vomiting
DIAGNOSTIC EXAMS
- Tonometry
- Gonioscopy
- Opthalmoscopy
• TREATMENT
Medications
Topical Miotics
Topical Epinephrine
Topical Beta-blockers
– * contraindicated in pt’s. w/ asthma.
Oral Carbonic Anhydrase Inhibitors
Glycerin
Mannitol
Surgical procedures
1. Laser
trabeculoplasty
- A laser is being
used to improve
the drainage at the
tubercular
meshwork
- Treatment for open
angle glaucoma
2. Trabeculectomy
- The drainage
angle of the eye is
removed creating a
new drainage
- the new opening
is being covered by
a part of the sclera
3. Iridectomy
-Removal of a
portion of the iris
to enhance the out
flow of aqeous
humor
- Close angle
glaucoma
NURSING MGT
• Pre-op:
• Admin. prescribed meds.
• Routine pre-op procedure
• Post-op:
• Position accdg. to physician’s orders
• Admin. eyedrops/meds as ordered
• Orient pt. to environment
• Avoid activities that may raise IOP
• Observe for complications
2. CATARACT
- Progressive and
gradual
development of
opacity in the
lens/lens capsule
that results in loss
of vision.
CAUSES
- Aging Process
- Inherited
- Injury
- Endocrine Disorders
SIGNS AND SYMPTOMS
- Gradual loss of vision
- Photophobia
- Opaque or cloudy white pupil
- Decrease visual acuity

DIAGNOSTIC TEST
- Slit lamp
- Opthalmoscopic examination
 SLIT-LAMP
EXAMINATION

Cataract Lens Normal Lens

TREATMENT
• Surgery – treatment of choice
1. ICCE (intracapsular cataract
extraction)

2. ECCE (extracapsular cataract

extraction)
3. Phacoemulsification
- a small incision in
the cornea is done
- Special instrument
is inserted to break
the cataract into
fragments and
suction the small
fragments
Pre-op preparation:
- Assess vision for the affected eye
- Administer pre-op meds
- Instruct post-op measure to
prevent increase in IOP
Visual restoration post-op
• Aphakic Eyeglasses
• Contact Lens
• IOL Implant
• Post-op complications:
Infection
Hemorrhage – pt may verbalize
sudden pain in the eye.
Retinal detachment
• NURSING MGT
1. Orient pt to environment.
2. Prevent activities that increase
IOP.
3. Instruct not to touch/rub the eye.
4. Use stool softener.
5. Side-rails up.
6. Use sunglasses when patch is
removed.
3. MACULAR DEGENERATION
Degeneration of the macular area of
the retina in the eye. The most
common type is age-related macula
degeneration (ARMD).

CUASE:
- Aging
TYPES
• Atrophic (dry)

• Exudative (wet)
SIGNS AND
SYMPTOMS
• Loss of central
vision “scotoma”

• Pale yellow spots

“drusen” appear on
the macula
• Visual distortion
• Difficulty with activities requiring
close central vision
TREATMENT
1. Laser
photocoagulation
- Uses laser to seal
of damage blood
vessel in the retina
- destroys
abnormal blood
vessels
2. Photodynamic
therapy
- light-activated
drug known as
Verteporfin is
injected into the
patient's
bloodstream
- Produces clot on
the abnormal
blood vessels
NURSING MGT
• Early referral for ophthalmologist.
• Reassure that loss of central does
not progress to loss of peripheral
vision.
• Institute safety measures to prevent
injury.
4. RETINAL
DETACHMENT
-Separation of the
sensory layer of
the retina from the
choroid.
CAUSES:
- aging
- cataract surgery
- myopia
- trauma
- tumor
• SIGNS AND SYMPTOMS
- blurred vision
- floaters
- flashes of light
- curtain vision
• Floaters are blood cells released
into the vitreous humor by the
detachment
TREATMENT
• Bed rest
• Tranquilizers
• Scleral buckling
• Pneumatic
retinopexy
Laser
photocoagulation/
cryosurgery
• NURSING MGT
• 1. Provide bed rest.
• 2. Maintain eye patch.
• 3. Speak to a client before
approaching.
• 4. Avoid jerky movements.
• 5. Protect client from injury.
 EYE
INFECTION/INFLAMMATION
Blepharitis -
inflammation of
the eyelid margin
glands and lash
follicles.
Hordoleum (sty) -
infection of Zeis or
Moll gland.
Chalazion
-cyst of one ore
more meibomian
glands
Conjuctivitis (Pink
eye, red eye, sore
eyes) - infection
and inflammation
of conjuctiva by
allergen or
bacteria.
Keratitis -
inflammation of
cornea.

Uveitis -
inflammation of
uveal tract.
• MANAGEMENT
• Medication therapy with
topical/systemic antibiotics,
antivirals, antihistamine,
corticosteroid.
• Promote infection control.
• Reduce pain or discomfort.
 REFRACTIVE ERRORS
MYOPIA
Management:
BICONCAVE LENS

HYPEROPIA /
HYPERMETROPIA
Management:
BICONVEX LENS
PRESBYOPIA
Management:
Biconvex lens

ASTIGMATISM
Management:
Astigmatic lens
EARS
I. Anatomy
1.External
Auricle/Pinna
- Collects sound
waves from the
environment
Auditory canal
- Relays sound
waves to the ear
drum
2. Middle
Eustachian tube
-connected to the
nasopharynx
-Maintains pressure
in the inner ear
Tympanic Membrane
-conducts vibration
from external
canal to middle
ear
Ossicles
a. Malleus
b. Incus
c. Stapes
Mastoid bone
- Part of the temporal
lobe bone, found at
the back of the ear

Window membranes
Oval- where the sound
vibration enters
Round- sound
vibration exits
3. Inner (Labyrinth)
Bony Labyrinth-
proctects the
membranous
labyrinth
Semicircular Canals-
resposible for
balance
Cochlea – Organ of
Corti(organ of
hearing)
Fluids
• Perilymph- fluid at the bony
labyrinth
• Endolymph- fluid that fills the
membranous labyrinth,
- responsible for balance
EAR FUNCTION
• Hearing

• Sense of Balance
 DAIGNOSTIC
PROCEDURES

a. Otoscopic
examination
Child

Adult
NORMAL TYMPANIC
MEMBRANE
b. Tuning Fork tests

Rinne test

Weber test
 Sensorineural hearing loss Conductive hearing loss
Criteria

Anatomical Inner ear, cranial nerve VIII, or Middle ear (ossicular chain),
Site central processing centers; tympanic membrane, or external
irreversible ear; reversible

Weber Test Sound is heard in normal ear Sound is heard in the affected ear
(ear with conductive loss)

Rinne Test Positive Rinne; Air conduction > Negative Rinne; Bone Conduction >
Bone conduction Air Conduction (Bone/Air Gap)
c. Whisper Voice Test

d. Audiometry

f. Tympanogram-
measures middle ear
muscles reflex to
sound stimulation
and compliance of
tympanic membrane
 Severity of Hearing loss
Loss in Decibels Interpretation
>15 Normal hearing
>15-25 Slight hearing loss
>25-40 Mild
>40-50 Moderate
>55-70 Moderate-severe
>70-90 Severe
>90 Profound
g. Romberg’s Test-
test for balance
 EAR DISORDERS
• CONDUCTIVE HEARING LOSS

• SENSORINEURAL HEARING LOSS

OTOSCLEROSIS
Hardening of the inner
ear in which repeated
resorption and
redeposition of abnormal
bone growth gradually
leads to fixation of the
footplate of the stapes.
• RISK FACTORS
- Familial Tendency
- Women
- Caucasian
SIGNS AND SYMPTOMS
- Gradual, progressive hearing loss
- Constant tinnitus
- Schwartze’s sign- reddish or pinkish
tympanic membrane
- (-) Rinne’ test
TREATMENT
Hearing aids
Stapedectomy
NURSING MGT (Stapedectomy)
- watch for signs of infx
- Antibiotics for prophylaxis
- Bed rest
- Do not blow nose for at least 2
weeks
OTITIS MEDIA
• Usually begins in childhood that
results from the spread of
microorganisms from the
Eustachian tube to the middle ear
during upper respiratory infections.
• May be acute or chronic.
SIGNS AND SYMPTOMS
• Hearing loss
• Feeling of fullness within the ear
• Pain
• Drainage from the ear that may
be foul-smelling
• Bulging or perforation of the
eardrum
TREATMENT
• Systemic antibiotics
• Antibiotic eardrops
• Symptomatic relief with
analgesics
• Gentle irrigations to cleanse
the ear
• Myringotomy
• Tympanoplasty
TYMPANOPLASTY
MASTOIDITIS
• Infection of the
mastoid process
SIGNS AND SYMPTOMS

• Tenderness over the mastoid

process
• Headache and ear pain
• Vertigo
• Swelling over the mastoid
process
TREATMENT
Medication
Antibiotics
Surgical Intervention
Mastoidectomy
Tympanoplasty
MENIERE’S DISEASE
• Disorder of the inner ear in which
there is excessive accumulation of
endolypathic fluid in the
membranous labyrinth.
• Also known as Endolymphatic
hydrops.
• Incidence is higher between 35-
60 y.o.
CAUSES:
- Unknown
- maybe related to:
- Hypernatremia
- Allergic reactions
- Emotional disturbaces
SIGNS AND SYMPTOMS
Triad of symptoms:
-Tinnitus
- Vertigo
- Hearing loss
Warning Sign of Impending Attack:
TREATMENT
Medications
Diuretics
Antihistamines
Atropine SO4
Antivertigo- meclizine
Antiemetics- phenergan
Surgical procedures
-Endolymphatic
decompression
-Vestibular
neurectomy
-Labyrinthectomy
-Cochlear implant
NURSING MGT
• Instruct pt to avoid moving abruptly.
• Protect pt from injury.
• Keep the pt on bed rest is has severe
vertigo.
• Explain that Bell’s palsy may occur
post-op but will subside within few
months.
• Teach pt to avoid foods high in salt.
PRESBYCUSSIS
Hearing loss among elderly.

IMPACTED CERUMEN
Having excessive thick or dry
cerumen.
TREATMENT
Irrigation
Instilling otic solution
a. Warm the solution before
instilling to the affected ear.
b. Let the solution flow towards
the side of the ear and NOT
directly in the tympanic
membrane
OTOTOXICITY
Detrimental effect of certain medications
on the cranial nerve VIII or hearing
structures.

Examples of ototoxic drugs:

• Salicylates
• Loop diuretics
• Quinidine
• Antibiotics
 BURN
A traumatic injury to the skin and
underlying tissues caused by heat,
electricity, radiation, chemical, or
inhalation
CAUSES
a. Thermal – flame, hot fluids, hot
objects
b. Chemical – strong acids, alkali or
organic compounds
c. Electrical – faulty electrical wiring
or high voltage power lines, lightning
d. Radiation – sunburn, prolonged
exposure to UV rays
e. Inhalation – smoke or gases, direct
injury to the lungs
CLASSIFICATION
a. 1st degree-
epidermis, reddish,
painful

b. 2nd degree-
dermis, moist
surface with
vesicles, painful
c. 3rd degree- subcutaneous layer,
connective tissues, pearly white
with no pain

d. 4th degree- muscles, bones,

blackish or charred, no pain
 STAGES OF BURNS
1st stage
Shock/ Fluid Accumulation Phase
(Emergent stage)
First 24-48 h
Intervascular space (IVS)
-interstitial space (ISS)
Generalized dehydration
Hypovolemia
Hemoconcentration, oliguria
HyperK, Hypo Na
 2 nd
stage
Diuretic/Fluid Remobilization Phase
(Acute stage)

After 48 h
ISS-IVS
Hypervolemia
Hemodilution
Diuresis
Hypo K, Hypo Na
 3 stage
rd

Recovery (Rehabilitation
stage)

5th day onwards

HypoCa, HypoNa
TREATMENT
Medical Mgt
a. Initial First Aid Intervention
“STOP THE BURNING PROCESS!”
Remember: R.A.C.E
R- escue the patient
A- larm
C- onfine
E- xtinguish
b. Promote respiratory Function
c. Assess burn severity
Rule of nines – quickest way to
assess TBSA

d. Promoting fluid-electrolyte, acid-

base balance
Parkland/Baxter formula
 FORMULA
Parkland – GIVE Lactated Ringer’s
solution
4ml x kg x % of burn =
Example: What volume of fluids is
required for a client who weighs
100lbs and has acquired 36% TBSA.
ANSWER: 6480 mL
Brooke – lactated ringers
2ml x kg x % burn = ___ ml

Example: A man sustained 27% burn

and currently weighs 145 lbs. Using
Brooke’s formula, how much LR
should be given?
ANSWER: 3564 ml
e. Promoting comfort; relief of pain
Morphine So4
Meperidine (Demerol)

f. Prevent Infection
Topical IV antibiotics
Reverse or protective isolation
g. Maintaining adequate nutrition
High-CHON diet, CHO, fats and
minerals
- TPN
 Wound Management
Open method- wound is uncovered
and exposed to air
Closed-method- wound is covered
with thick layer of sterile gauze
or with occlusive dressings.
Antimicrobial Therapy
Silver NO3
Silver sulfadiazine
Mafenide acetate- drug of choice
 Surgical Management

Debridement-
removal of
necrotic tissue.

Escharotomy- An
incision into the
eschar to relieve
pressure on the
affected area.
 SKIN GRAFTING
Purpose:
 Lessen the potential for infection.
 Minimize fluid loss by evaporation.
 Promotes growth of epithelial tissue
 Reduce scarring
 Prevent loss of function.
 TYPES
Isograft – donor from identical twin
Autograft- from self

Homograft – from another human

being

Heterograft/xenograft- from the

animal, e.g. pigskin