Transcript Eyes, Ears, Nose & Throat

Eyes, Ears, Nose & Throat
PN 2
Summer Semester
Eyes
Infants and Children:
• At birth eyes symmetrical; pupils equal and
respond to light
• Iris is brown or slate gray-blue
• By 3 months colour changes
• Eyelids edematous; little or no tears which begin
a 4 weeks
• Vision in both eyes begin at 6 weeks
• Eyes fully grown at age 8
• Red reflex at birth
Eyes
Pregnant Female:
• May c/o dry eyes (contact lenses)
• Visual changes d/t shifting fluid in cornea
• Blurriness or distortion of vision can occur
because of temporary changes in shape of
eye in last trimester and first 6 weeks post
partum.
Eyes
Older Adults:
• Age 45 lens looses elasticity; ciliary muscle
becomes weaker = near vision become a
problem (presbyopia)
• Droopy eye lids d/t decrease fat
• Decrease tear formation
• Cornea cloudy
• Light reflex slower
• Cateracts; macular degeneration
• Narrow blood vessels
Considerations
Cultural and environmental:
• Blindness in poorer countries
• Excessive sun exposure
• Vitamin A deficiency
• Discard makeup after 3 mos
• Trauma in the workplace
• Excessive sun may lead to cataracts
Doing the Eye Assessment
•
•
•
•
•
•
General questions
Questions r/t illness or infection
Questions r/t symptoms or behaviours
Questions r/t to pain
Questions r/t to age
Questions r/t occupations/environment
Physical Assessment
• Provide specific clear instructions
• If you ask someone to read
something…make sure they can read.
• Place card over “closed” eye; do not
actually close or apply pressure
• Lighting in room should be adjustable
• Need at least 20 feet of space
• Use standard precautions
Snellen Eye Chart
• Results recorded as fractions
• Numerator=distance from chart
• Denominator=distance where ct with normal
vision can read line
• Normal 20/20
• 20/30 = at 20 ft ct can read what normal person
reads at 30 ft.
• If ct is unable to read ½ of line, record the
number of line above
• Smaller the fraction=worse vision
• 20/200 is legal blindness
Visual tests
• We will do these when we do cranial nerve
assessment
• Visual fields
• 6 cardinal fields of gaze
• Corneal light reflex
• Cover test
• Pupillary response
Eye lids
•
•
•
•
•
•
•
•
Conjunctiva
Sclera
Skin cancer
Eye lid inflammation
Cataract
Conjunctiva
Ectropian/entropion
Trauma
Ears, Nose and Throat
Infants and Children:
• Auditory canal is short with upward curve
• Children (age 3) have horizontal tube
• Nose of child is too small to really examine
• Salivation begins at 3 months
• Drooling occurs until baby learns to
swallow
ENT
Pregnant Female:
• Estrogen levels cause increase vascularity
• Vessels change in middle ear
• Increase blood flow in sinuses
• Sense of smell increases
• Edema of vocal cords
• Sometimes over growth of gums
ENT
Older Adult
• Hair in ears
• Ears become more prominent
• Tympanic membrane paler and thicker
• Lips and buccal mucosa become thinner and
less vascular
• More fissures on tongue; decreased taste, saliva
• Gums recede and tooth decay
Psychosocial Considerations
• Stress = mouth ulcers and lip biting
• Clenching or grinding of teeth
Cultural and Environmental
Considerations
• Teeth size and decay
• Occupation and hearing
• Finances/health care insurance
Interview
General questions
Questions r/t illness and infection
Questions r/t to symptoms and behaviour
Questions r/t pain
Questions r/t environment
Questions r/t age
Questions r/t nose and sinus; mouth and
throat
Physical Assessment
• Inspection; palpation; percussion; trans
illumination of sinuses
• Tuning fork, otoscope and nasal speculum
Ear/hearing
• Binaural hearing
• Ears symmetrical in size, shape, colour and
configuration
• External auditory canal is patent and free of
drainage
• External ear and mastoid process are free of
lesions and tragus is movable
• When viewing through otoscope the external ear
is open, non tender, free of lesions, inflammation
and F/O’s
• Cerumen is soft and small amt.
Ear/hearing
• Tympanic membrane is flat, gray and
translucent
• Malleolar process and reflected light are
visible on tympanic membrane
• TM flutters with Valsalva
• During hearing test, air conduction is
longer than bone conduction
• Adults are able to maintain balance
Hearing loss
• Noise induced hearing loss from exposure
to loud music or machinery common
cause of hearing loss in adult aged 20 to
40
• Hearing loss in older adults common and
is either senorineural or conductive loss
• Presbycosis: occurs around age 50 and
gets worse
Nose/Sinuses
• Infants: obligatory nose breathers
• Nose is only external organ of the resp
track
• Nasal mucosa is rich in blood supply and
filters inspired air.
• Olfactory cells are in roof of nose
• Sinuses are mucous lined, air-filled
cavities that warm, filter and moisten air
Mouth and Throat
• Teeth, lips, gums (buccal mucosa),
cheeks, tongue, hard and soft palate,
uvula, manibular arch and maxillary arch
• Tongue: check for adhesions; taste
• Palate: check for cleft
• Throat: tonsils