Faculty of Health Sciences

Caring for tomorrow

School of Clinical and Medicinal Care Sciences

Department of Nursing Science

Striving for excellence

COMPREHENSIVE NURSING SCIENCE (VCNS122)

Study Guide 2021

MODULE COORDINATOR
Ms SM Mnwana
Tel: +2741 504 1121
Email: Millicent.Mnwana@mandela.ac.za
Office: Rm 101C, Dept. of Nursing Science, J Block, 1st Floor, North Campus
Consultation Hours: Thursdays 11:00 -13:00 or online by appointment
 CONTENTS
1. INTRODUCTION 3
2. QUALIFICATION 3
3. HEQF/NQF LEVEL 3
4. MODULE NAME 3
5. MODULE CODE 3
6. MODULE CREDITS 3
7. PRESENTERS OF THE MODULE 3
8. PURPOSE OF THE MODULE 4
9. EXIT LEVEL OUTCOMES (EO) FOR THE BACHELOR OF NURSING 5
10. MODULE OUTCOMES 5
11. MODULE LAYOUT 6
12. ANALYSIS OF OUTCOMES COVERED IN VCNS122 6
13. LEARNING ASSUMED TO BE IN PLACE 6
14. MODULE PRESENTATION 7
15. ASSESSMENT OF KNOWLEDGE AND SKILLS 7
16. RESPONSIBILITIES OF THE STUDENT 8
17. PRESCRIBED LEARNING MATERIAL 9
18. RECOMMENDED LEARNING MATERIAL 9
19. UNITS OF LEARNING 10
19.1 UNIT 1: OVERVIEW OF THE MUSCULOSKELETAL AND
INTEGUMENTARY SYSTEMS 10
19.2 UNIT 2: OVERVIEW OF GASTRO-INTESTINAL, HEPATIC AND
BILIARY SYSTEMS 12
19.3 UNIT 3: OVERVIEW OF THE ENDOCRINE SYSTEM 13
19.4 UNIT 4: OVERVIEW OF THE HAEMATOLOGICAL SYSTEM 15
19.5 UNIT 5: OVERVIEW OF THE CENTRAL NERVOUS SYSTEM 16
19.6 UNIT 6: OVERVIEW OF THE SPECIAL SENSES AND THE EYE 17

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The Vision, Mission and Values of the Nursing Science Department

VISION
To be a dynamic nursing education institution recognised for the delivery of cutting-edge
training programmes that will prepare graduates to change the world.

MISSION
To offer innovative, transformative and research-based education to develop
independent, highly skilled, caring and committed nursing graduates who think critically
and who will use their knowledge and skills, in a variety of contexts, to bring about
change and provide or facilitate high-quality comprehensive health care services to
individuals, families and communities.

VALUES

Professionalism
• We encourage dependability, dedication and commitment in delivery of health
care.
• We will adhere to the ethics, rules and regulations that governs our profession.
• We pledge to practice our profession with conscience and dignity.

Respect
• We foster and environment in which diversity is appreciated, respected and
celebrated.
• We acknowledge the uniqueness of the diverse population we engage with and
serve.

Excellence
• We promote excellence in our teaching, research and engagement activities.
• We provide innovative, evidence-based best practices that foster excellence.
• We provide an environment that foster creative, transformative and sustainable
knowledge

Caring

• We promote kindness, concern and compassion amongst students, employees

and the community we serve.
• We share resources, knowledge and expertise amongst colleagues, students,
stakeholders and the community members.

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1. INTRODUCTION
Welcome to Comprehensive Nursing Science II which will be presented in the 2 nd
semester. This module will introduce the student to nursing as a profession and lay the
foundation for essential nursing care practices. This module has been designed to
enable students to relate their knowledge and skills of nursing to biochemical and
biophysical knowledge of bodily systems so that that they can provide holistic,
collaborative, preventive, promotive, curative, and rehabilitative nursing care for all
populations throughout the lifespan. The student must be able to deliver nursing care
to sick or disabled individuals and groups; and promote health.

The study guide includes the necessary information required for these modules. We
wish you well with your studies and we encourage you to please consult your lecturer
timeously should you experience any difficulties in your studies or if you have any
queries or concerns regarding your progress.

2. QUALIFICATION: BACHELOR OF NURSING AND MIDWIFERY

3. HEQF/NQF LEVEL: 6 (1st year level)

4. MODULE NAME: COMPREHENSIVE NURSING SCIENCE II

5. MODULE CODE: VCNS 122

6. MODULE CREDITS: 10

7. PRESENTERS OF THE MODULE

7.1 Lecturer
Ms S.M Mnwana
Tel: +27 41 504 1121
Cell: +27 82 0921294
E-mail: Millicent.Mnwana@mandela.ac.za
Times: By appointment only or via online arrangement

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 7.2 Lecturer
Ms K. Gerber
Tel: +2741 504 2961
Email: Karin.Gerber@mandela.ac.za
Times: By appointment only or via online arrangement

7.3 Lecturer
Ms J. Blatti
Tel: +2741 504 2961
Email: Jenny.Blatti@mandela.ac.za
Times: By appointment only or via online arrangement

7.4 Lecturer
Ms B. Adams
Tel: +2741 504 3047
Email: Bernardene.Adams@mandela.ac.za
Times: By appointment only or via online arrangement

7.5 Lecturer
Ms J. De Vega
Contact Information:
Tel: 041 504 4338
Email: Jaunita.DeVega@mandela.ac.za
Times: By appointment only or via online arrangement

8. PURPOSE OF THE MODULE:

The module will prepare the student theoretically and provide knowledge of anatomy
and physiology which will meet the requirements for professional health care, and which
will promote effective health care delivery. This module aims to prepare the student
theoretically to render basic scientific nursing care, in particular, for taking a history and
doing a physical examination of a client.

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9. EXIT LEVEL OUTCOMES (EO) FOR THE BACHELOR OF NURSING
• After completion of the programme the student will be able to:

EO1 Apply knowledge of biological and natural sciences, psycho-social sciences

and pharmacology in the provision of safe nursing care, throughout the life
span, in a variety of health care settings and communities in response to
population needs.
EO2 Identify and address ethical and legal issued based on critical reflection on the
suitability of different ethical value (and legal) systems to the nursing and
midwifery practice within the legal framework
EO3 Effectively manage the health care unit and health facility with the
understanding of the roles and relationships within the multi-disciplinary team.
EO4 Access, produce and manage information effectively to a range of audiences
EO5 Utilise research in investigating nursing, midwifery and health-related
problems
EO6 Apply learning strategies effectively to address own and other’s professional
and personal ongoing learning needs in a self-critical manner.
EO7 Apply knowledge of theories, methods and techniques in the practice of safe
clinical nursing and midwifery that is responsive to the needs of the individual,
the family and the community, in accordance with national legislative and
policy frameworks
EO8 Provide safe and quality midwifery and neonatal care in a scientific, integrated
and evidence-based approach in all health care settings.

10. MODULE OUTCOMES:

After completion of this module the student will be able to:

o MO1 Explain how to obtain a comprehensive history of the patient and perform
a comprehensive physical examination based on scientific principles.
o MO2 Differentiate between normal and abnormal findings of the Gastro-
intestinal, Endocrine, Musculoskeletal, Integumentary, Haematological, Central
Nervous, Systems and Special Senses of the human body
o MO3 Describe the provision of health care across the lifespan.

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11. MODULE LAYOUT:

The layout of this module is as follows:

UNIT TOPIC CREDITS PRESENTER
Overview of the Musculoskeletal and SM Mnwana
1 Integumentary systems 3
Overview of Gastro-intestinal, Hepatic 2.5
2 and Biliary systems
Overview of the Endocrine system 1 Ms K Gerber
3

4 Overview of the Hematological 1 Ms J. Blatti

System
5 Overview of the Central Nervous 1 Ms B. Adams
System
6 Overview of the Special Senses of the 1.5 Ms J de Vega
human body

12. ANALYSIS OF OUTCOMES COVERED IN VCNS122

Exit Level
Date Unit Module outcome Outcome
23,30 August Unit 1 MO 1, 2, 3, EO1, 2,4, 7
MO 1, 2, 3,
13, 20 September Unit 2 EO1, 2, 4, 7
MO 1, 2, 3,
04 October Unit 3 EO1, 2, 4, 7
MO 1, 2, 3,
18 October Unit 4 EO1, 2, 4, 7
MO 1, 2, 3,
25 October Unit 5 EO1, 2, 4, 7
MO 1, 2, 3,
08 November Unit 6 EO1, 2, 4, 7

13. LEARNING ASSUMED TO BE IN PLACE

• Assumed learning listed below is recommended but not compulsory for
admission
• Communication Skills at NQF Level 4
• Mathematical Literacy at NQF Level 4
• Life Sciences at NQF Level 4
• Computer Literacy at NQF Level 3

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14. MODULE PRESENTATION:

The module will be presented by utilisation of various teaching strategies, e.g. lectures,
informal group presentations, class discussions and peer learning. You will be expected
to do the necessary preparation to participate in these discussions. When allocated to
the clinical area utilise the opportunity to correlate theory and practice and be willing to
share your experiences in class.

Due to the pandemic COVID- 19, this module will be presented by using the university’s
LMS which is Moodle. The student will be expected to view the voice over power points
and watch the videos where applicable on Moodle. Some lecturers may use MS Teams
as an additional platform for discussions to take place. Class attendance even if virtual
is compulsory, taking cognisance of the university rule that states that the student must
have 75% class attendance to have entrance to the exams or final assessments.

15. ASSESSMENT OF KNOWLEDGE AND SKILLS

Your insight and understanding of a topic will be tested. You will be expected to
understand key terms, concepts, facts, and principles of each topic. Once you have
been exposed to clinical practice, your application of knowledge will be tested to assess
if you can solve practical problems with the information you have gained.

15.1 Assessment methods

Assessments will include online tests, case studies, quizzes, assignments, and
informal class presentations of research by groups to assess and encourage
participation in the class as well as introducing students to research. Assessment of
this module will be done in the form of continuous assessment. This implies that all
assessments done throughout the semester will contribute towards your final mark.
You will pass this module if you obtain 50% final mark.

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 15.2 Assessments dates
Date Assessment Weighting Unit
06 September 2021 Test 30% 1
11 October 2021 Test 30% 2&3
01 November 2021 Quiz 25% 4&5
15 November 2021 Quiz 15% 6
22 November 2021 Remedial All

Please also note that dates of assessments might need to be adjusted as we progress
through the academic year. Changes will be made in consultation with the students and
communicated formally in writing.

15.3 Missed assessment

In cases where a student fail to write or submit an assessment on the date specified
(due to illness), the module co-ordinator / lecturer must be contacted within 24 hours
after the assessment was written or submitted and a sick certificate must be handed
in. A medical certificate must be handed in, specifying the reason for absence. In such
cases, you are expected to make prior arrangement with the module coordinator /
lecturer for reassessment. If this is not done, no mark will be allocated to the student.
If an assessment is failed, an appointment with the module coordinator / lecturer must
be made to discuss your progress. A remedial teaching document must be completed.

15.4 Final mark calculation

Final mark will be calculated as follows:
30% Quiz 1 + 30% Quiz 2 + 25% Quiz 3 + 15% Quiz 4

16. RESPONSIBILITIES OF THE STUDENT

The following is expected of the student:
• To log on to the Moodle platform and adhere to the information shared on
Moodle.
• To prepare for each session by ensuring that the preparatory work is done as
set out in the appropriate unit or as indicated on Moodle.
• To utilize the library extensively, attend training session in the library so that

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 you understand how books are categorized and where to get help.
• To read widely and to participate in discussions, debates and critiques.
• To study objectives of each unit for assessment (evaluation) purposes.
• To prepare themselves so that they attain all of the module outcomes.
• To demonstrate skill and knowledge pertaining to each outcome.
• To take ownership for his/her own learning as well as to assist their peers.
• To act in accordance with prescribed organizational and professional ethical
codes of conduct, values, and practices and to seek guidance on ethical and
professional issues where necessary.

17. PRESCRIBED LEARNING MATERIAL

Brooker, C., Waugh, A.; Van Rooyen, D and Jordan, P.J. 2016. Foundations of
Nursing Practice: Fundamentals of Holistic Care: African Edition. 2nd Edition. United
Kingdom: Mosby Elsevier.

Brady, A; McCabes, C; McCann, M. 2014. Fundamentals of Nursing: A systematic

approach. Wiley-Blackwell, UK.

Bickley, L. 2013. Bates’ Guide to Physical Examination and History Taking. Eleventh
edition. Wolters Kluwer Health: Lippincott Williams & Wilkins, Phillidelphia.

Muller, M. 2009. Nursing Dynamics. 4th edition. Cape Town: Heinemann

Weller, B.F. 2009. Bailliere’s Nurses’ Dictionary. 25th edition. London: Bailliere Tindal.

Vasuthevan, S, & Mthembu, S, (eds). 2013. De Haan’s health of Southern Africa.

10th ed. Cape Town: Juta.

18. RECOMMENDED LEARNING MATERIAL

Potter, P.A & Perry, A.G. 2013. Clinical Nursing Skills and Techniques. 8th edition. St
Louis: Elsevier

Wilson, S; Giddens, J. 2013. Health Assessment for Nursing Practice. Fifth Edition.
Elsevier: Mosby, UK.

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19. UNITS OF LEARNING
The following section includes a layout for the units of learning presented in this module.
The learning outcomes, areas of learning and nursing skills pertaining to the unit
objectives are stated. It is recommended that the student consult recommended reading
and electronic journal articles in order to supplement learning in this module.

19.1. UNIT 1: OVERVIEW OF THE MUSCULOSKELETAL AND INTEGUMENTARY

SYSTEMS.
Lecturer: Ms S Mnwana

LEARNING OUTCOMES AREAS OF LEARNING SOURCES

The student must be able to: Overview of anatomy; Brooker, C., Waugh,
physiology of the A.; Van Rooyen, D
Identify structures of the
Musculoskeletal and functions and Jordan, P.J. 2016.
Musculoskeletal and Integumentary
of the Integumentary system Foundations of
system
Nursing Practice:
Common illnesses related to
Summarize the anatomy & Fundamentals of
musculoskeletal and
physiology of the Musculoskeletal Holistic Care. United
integumentary systems
and Integumentary system Kingdom: Mosby
Physical Assessment Elsevier.
Explain how to examine normal
principles of normal anatomy
anatomy and physiology of the Bickley, L. 2013.
and physiology of the
Musculoskeletal and Integumentary Bates’ Guide to
Musculoskeletal and
system/ relate the principles of Physical Examination
Integumentary system
physical examination and History Taking.
History taking regarding the Eleventh edition.
Discuss factors that affect normal
Musculoskeletal and Wolters Kluwer Health:
functioning of the Musculoskeletal
Integumentary system Lippincott Williams &
and Integumentary system
Factors affecting normal Wilkins, Phillidelphia.
Differentiate between normal and
functioning the
abnormal findings
Musculoskeletal and
Integumentary system

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Name and define common illnesses
related to musculoskeletal and
integumentary systems
Explain how to obtain a
comprehensive history of the
patient and perform a
comprehensive physical
examination based on scientific
principles.
Discuss and render health
education related to
musculoskeletal and integumentary
health
Construct at least 3 nursing
diagnosis
Describe the nursing interventions
for patients with mobility and
integumentary problems
Maintaining the
Musculoskeletal and
Integumentary
Health/Preventing the
Musculoskeletal and
Integumentary
Nursing diagnoses related to
Musculoskeletal system
Helping patients mobilize
Patients in wheelchairs
Maintaining healthy bones
and joints
Managing risks of immobility
Maintain and promote skin
integrity
Preventing chest infections
Constipation/elimination
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19.2. UNIT 2: OVERVIEW OF GASTRO-INTESTINAL, HEPATIC AND BILIARY SYSTEMS
Lecturer: Ms K Gerber
LEARNING OUTCOMES AREAS OF LEARNING SOURCES

The student must be able to: Overview of anatomy; Brooker, C., Waugh,
physiology and function of A.; Van Rooyen, D and
Identify structures of the Gastro-
the Gastro-intestinal, Jordan, P.J. 2016.
intestinal, hepatic and biliary systems
hepatic and biliary Foundations of
Summarize the anatomy & physiology of systems Nursing Practice:
the Gastro-intestinal, hepatic and biliary Fundamentals of
Factors affecting normal
systems Holistic Care. United
functioning
Explain how to examine normal Kingdom: Mosby
Physical Assessment Elsevier.
anatomy and physiology of the Gastro-
principles of normal
intestinal, hepatic and biliary systems / Bickley, L. 2013.
anatomy and physiology
relate the principles of physical Bates’ Guide to
of Gastro-intestinal,
examination to the Gastro-intestinal, Physical Examination
hepatic and biliary
hepatic and biliary systems and History Taking.
systems
Discuss factors that affect normal Eleventh edition.
History taking regarding Wolters Kluwer Health:
functioning of Gastro-intestinal, hepatic
Gastro-intestinal, hepatic Lippincott Williams &
and biliary systems
and biliary system Wilkins, Phillidelphia
Name and define common illnesses
Common illnesses related
related to Gastro-intestinal, hepatic and
to Gastro-intestinal,
biliary systems
hepatic and biliary
Explain how to obtain a comprehensive systems
history of the patient and perform a
Maintaining and
comprehensive physical examination
promoting normal
based on scientific principles.
physiology of Gastro-
Differentiate between normal and intestinal, hepatic and
abnormal findings biliary systems

Gastro-intestinal, hepatic
and biliary

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Discuss and render health education Health/Preventing Gastro-
related to gastro-intestinal, hepatic and intestinal, hepatic and
biliary health biliary Tract Infections

Describe the nursing interventions for Principles of nutrition and

patients with gastro-intestinal and liver healthy balanced diet
diseases
Maintaining fluid,
Construct at least 3 nursing diagnosis electrolyte and acid-base
balance

Assessing hydration

Promoting and
maintaining hydration

Nursing skin problems

relating to liver
disease/maintaining and
promoting skin integrity

Promoting normal bowel

elimination

Nursing diagnoses
related to hepatobiliary.

19.3. UNIT 3: OVERVIEW OF THE ENDOCRINE SYSTEM

Lecturer: Ms K Gerber
LEARNING OUTCOMES AREAS OF LEARNING SOURCES

he student must be able to: Bickley, L. 2013.

Bates’ Guide to
Identify structures of the Endocrine Overview of anatomy;
Physical Examination
system physiology of the
and History Taking.
Endocrine system
Summarize the anatomy & physiology of Eleventh edition.
the Endocrine system Wolters Kluwer Health:

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Explain how to examine normal Common disorders Lippincott Williams &
functions of the Endocrine system/ related to Endocrine Wilkins, Phillidelphia
relate the principles of physical systems
examination
-diabetes Mellitus
Discuss factors that affect normal
-hypothyroidism
functioning of the Endocrine system
-hyperthyroidism
Differentiate between normal and
abnormal findings Physical Assessment
principles of normal
Name and define disorders related to
Endocrine system
Endocrine systems
History taking regarding
Explain how to obtain a comprehensive
the Endocrine system
history of the patient and perform a
comprehensive physical examination Factors affecting normal

based on scientific principles. functioning the Endocrine

system
Discuss and render health education
related to Endocrine health Maintaining the
Endocrine
Construct at least 3 nursing diagnosis
Health/Preventing

Nursing diagnoses
related to Endocrine
system

Nursing interventions of
Describe the nursing interventions for
patients with endocrine
patients with Endocrine disorders
disorders

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19.4. UNIT 4: OVERVIEW OF THE HAEMATOLOGICAL SYSTEM
Lecturer: Ms J. Blatti
LEARNING OUTCOMES
The student must be able to:
Identify different constituents
of blood.
Summarize the functions of
blood
Name and Define the different
blood disorders: Leukaemia,
Neutropenia
Differentiate between normal
and abnormal findings
Explain how to obtain a
comprehensive history of the
patient and perform a
comprehensive physical
examination based on
scientific principles when
assessing for anaemia.
Discuss and render health
education related to Blood
disorders.
Construct at least 3 nursing
diagnosis
AREAS OF LEARNING SOURCES
Overview of the structure and Bickley, L. 2013.
functions of blood. Bates’ Guide to
Physical Examination
Blood groups
and History Taking.
Classifications of blood disorders Eleventh edition.
according to the causative factors: Wolters Kluwer Health:
Lippincott Williams &
-Cardiovascular shock
Wilkins, Phillidelphia
-Anaemia (iron deficiency &
haemorrhagic)
-Malaria
-Thrombocytopenia
-Genetic (Haemophilia & sickle cell
anaemia)
-Polycythaemia
Physical Assessment principles of
normal haematological system:
assessing for anaemia
History taking of Haematological
system
Brief introduction to HIV
Nursing diagnoses related to
haematological system
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19.5. UNIT 5: OVERVIEW OF THE CENTRAL NERVOUS SYSTEM
Lecturer: Ms B. Adams
LEARNING OUTCOMES
The student must be able to:
Identify structures of the Central
Nervous system
Summarize the anatomy &
physiology of the Central Nervous -haemorrhage/stroke
system
Discuss factors that affect normal
functioning of the Central
Nervous system
Differentiate between normal and
abnormal findings
Name and define common
conditions related to Central
Nervous systems
Understand how to assess
general mental status of a patient
i.e orientation to time; place;
person and general mood
Explain how to obtain a
comprehensive history of the
patient and perform a
comprehensive physical
examination based on scientific
principles.
Construct at least 3 nursing
diagnosis
AREAS OF LEARNING SOURCES
Overview of anatomy; physiology Brooker, C., Waugh,
of the Central Nervous system A.; Van Rooyen, D
and Jordan, P.J.
Common conditions affecting the
2016. Foundations
Central Nervous system
of Nursing Practice:
Fundamentals of
Holistic Care. United
-encephalitis and infective
conditions Kingdom: Mosby
Elsevier.
-epilepsy
Bickley, L. 2013.
-congenital conditions
Bates’ Guide to
Neurological Assessment Physical Examination
principles of normal anatomy and and History Taking.
physiology Assessing motor and Eleventh edition.
sensory function Wolters Kluwer
Health: Lippincott
-assessing level of
Williams & Wilkins,
consciousness
Phillidelphia
-assessing general mental status
i.e orientation to time; place;
person and general mood
History taking of Central Nervous
system
Factors affecting normal
functioning the Central Nervous
system
-hypertension
-atherosclerosis
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Describe the nursing
interventions for unconscious and
stroke patients
19.6. UNIT 6: OVERVIEW OF THE SPECIAL SENSES AND THE EYE
Lecturer: Ms J. De Vega
LEARNING OUTCOMES
The student must be able to:
Identify structures of the Ear;
Nose; Throat and Eye
Summarize the anatomy &
physiology of the Ear; Nose;
Throat and Eye
Explain how to examine
normal anatomy and
physiology of the Ear; Nose;
Throat and Eye / relate the
principles of physical
-lifestyle (smoking; alcohol;
drugs)
-age and gender
-metabolic conditions
-environmental factors
-genetic
-nutritional
-stress
Maintaining health of the Central
Nervous system
Nursing diagnoses related to
CNS
Nursing the unconscious patient
AREAS OF LEARNING SOURCES
Overview of anatomy; physiology Brooker, C., Waugh,
of the Ear; Nose; Throat and Eye A.; Van Rooyen, D
and Jordan, P.J. 2016.
Physical Assessment principles of
Foundations of
normal anatomy and physiology of
Nursing Practice:
the Ear; Nose; Throat and Eye
Fundamentals of
Factors affecting normal Holistic Care. United
functioning the Ear; Nose; Throat Kingdom: Mosby
and Eye Elsevier.
Common illnesses related to Ear; Bickley, L. 2013.
Nose; Throat and Eye Bates’ Guide to
Physical Examination
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examination to the Ear; Nose;
Throat and Eye
Discuss factors that affect
normal functioning of the Ear;
Nose; Throat and Eye
Differentiate between normal
and abnormal findings
Name and define common
conditions and disorders
related to Ear; Nose; Throat
and Eye
Explain how to obtain a
comprehensive history of the
patient and perform a
comprehensive physical
examination based on
scientific principles.
Discuss and render health
education related to Ear; Nose;
Throat and Eye
Construct at least 3 nursing
diagnosis
Describe the nursing
interventions for patients with
Ear; Nose; Throat and Eye
problems
-common infections of the Ear; and History Taking.
Nose and throat (otitis media; Eleventh edition.
pharyngitis; laryngitis; tonsillitis; Wolters Kluwer Health:
rhinitis; sinusitis) Lippincott Williams &
Wilkins, Phillidelphia
-Epistaxis
-congenital infections/conditions of
the eye
-refractive errors
-retinopathy
-squinting
-cataracts
Maintaining the Health/Preventing
of conditions of the Ear; Nose;
Throat & Eye
Preventing blindness/ causes of
blindness
History taking regarding the Ear;
Nose; Throat and Eye
Nursing diagnoses related to
special senses and eye
Nursing interventions of ear, nose,
throat & eye conditions
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