EENT

LESSON 1: INTRODUCTION TO EENT CONCEPT (EYES, EARS, NOSE, AND THROAT)

EYES EXTERNAL LAYER

 It is a sensory organ, part of the sensory nervous system,  Sclera
that reacts to visible light and allows us to use visual o Opaque white tissue
information for various purposes including seeing things,  Cornea
keeping our balance, and maintaining circadian rhythm. o Dense transparent layer
o The “window” of the eye
PARTS OF THE EYE  Corneoscleral Junction
 Eyelids and eyelashes o Transitional zone through which aqueous humor
 Conjunctiva leaves the eyes.
o Palpebral conjunctiva o Also known as “LIMBUS”
 Pink; lines inner surface of eyelids
o Bulbar conjunctiva MIDDLE LAYER
 White with small blood vessels; covers anterior
 Choroid
sclera
o Dark brown
 Lacrimal Apparatus
o Lines most sclera and is attached to the retina
o Consists of lacrimal glands and ducts
o Contains many blood vessels
 Meibomian glands
 Ciliary body
 Ciliary glands o Connects the choroid with the iris
o Secretes aqueous humor
ANATOMY OF THE EYE  Iris
o Colored portion of the eye
o Located behind the cornea and in front of the lens
o Has a central opening called “PUPIL”
 Pupil
o controls the amount of light that enters the eye
 Dark - dilate (mydriasis)
 Light - constrict (miosis)
o Lens
 Flexible, biconvex, transparent disc, lies behind
the iris
 Bends the rays of light from entering through the
pupil

INNER LAYER
 Retina
o Made of sensory receptors that transmit impulses to
the optic nerve
LAYERS OF THE EYE o Contains blood vessels and 2 types of photoreceptors
 External Layer  Rods
o Sclera - opaque white tissue  work at low light and for peripheral visions
o Cornea - dense transparent layer; the window of the  Cones
eye  active at bright levels and provide color and
o Corneoscleral junction - transitional zone through central visions
which aqueous humor leaves the eyes; also known as  Macula - yellow spot near the center of the retina
“Limbus” (responsible for central vision)
 Problems: astigmatism (mismatch in the curvature  Fovea - small pit; an indentation in the center of
of the eyes) the macula
 Middle Layer  Optic disk - creamy pink to white depressed area
o Choroid in the retina, “blind spot”
 Dark brown  Vitreous humor - jell-like substance that maintains
 Lines most sclera and is attached to the reitan the shape of the eye
 Contains many blood vessels
o Ciliary body MUSCLES OF THE EYE
 connects the choroids with the iris  External Muscles
 Secretes aqueous humor  Rectus muscles (CN 6- abducens) - medial, superior,
 Inner Layer inferior
o Retina o Superior rectus - eyes move up and out (CN 3)
o Lateral rectus - eyes move laterally (CN 6)
o Medial rectus - eyes move medially (CN 3)

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 1

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

 Oblique muscles (CN 4- trochlear) - superior and inferior o Snellen’s Chart

o Superior oblique - down and in (CN 4)  Set patient at 20 ft
o Inferior oblique - up and in (CN 3)  20/20 normal vision
o Note: LR6 SO4; the rest CN 3  20/50 the client is able to read at 20 ft what a
 Levator palpebrae healthy eye can read at 50 ft.
 20/200 legally blind
 If patient cannot see (1st line)
 Set at 10 ft then 5 ft
 E.g. 10/100
 *1 - 20/200 legally blind
 Top - Distance where client stands from the chart
 Bottom - Distance where a normal person could
read the line
 If patient still can't see. Proceed to do:
 Counting fingers (CF) - if (-)
 Hand movement (HM) - if (-)
 Light perception (LP) - if (-), write NLP
(negative light perception)
 Extraocular Muscle Function

NERVES OF THE EYE

 Cranial nerve II - optic nerve
 Cranial nerve III, IV, VI - innervate the muscles around the
eye  Test for Color Vision
o Ishihara Chart
FUNCTIONS OF THE EYE  Use of polychromatic plates
 Refraction - the process of bending light rays to focus an  Each eye is tested separately
image in the brain  Sensitive for the diagnosis of red/green blindness
 Accommodation - ability of the eye to focus specifically for o TEST:
close objects o https://www.color-blindness.com/ishihara-38-plates-
 Pupillary constriction - ability of the pupils of the eye to cvd-
regulate light that enters the eye o RESULT:
https://picassciences.files.wordpress.com/2015/01/ish
ASSESSMENT ihara38.pdf
 Inspection
o Exophthalmos - proptosis; protrusion of the eyeball DIAGNOSTIC TESTS FOR THE EYE
o Enophthalmos - sunken eyeballs, posterior FUNDOSCOPY
displacement of the eye  Used to examine the health of the retina and vitreous humor
o Ptosis - drooping of upper eyelids  Pupils should be dilated prior to the procedure
o Entropion - inversion of the lid margin o Administer pre-meds to dilate eyes (mydriatic agents)
o Ectropion - eversion of the lower lid
 Set ophthalmoscope 6 inches away from the patient’ eyes
o Scleral Icterus - yellowish pigmentation of the sclera
 Look for red reflex that indicates reflection of light in retina
 Pupil
o Check for similarity of shape, size, and reaction
o Isocoria - equal pupil size TONOMETRY
o Anisocoria - 1 pupil larger than the other  Measures IOP by determining the amount of force needed
o PERRLA - Pupil equally round and reactive to light and to the indent a portion of the anterior globe
accommodation  Principle: A soft eye is easier to indent than a hard eye
 Visual Acuity  Normal IOP: 11-21 mmHg
o Measures the client’s distance and near vision

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 2

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

SLIT LAMP  Teach the patient or a family member the correct technique
 Allows examination of the anterior ocular structures under for drug administration
microscopic magnification  Emphasize that patients should never share eye
 Help detect disorders of the anterior portion of the eye medications

CORNEAL STAINING
 Consist of placing fluorescein or other topical dye into
conjunctival sac
 A blue light is directed in the eye
 The dye outlines the corneal irregularities that are not
visible
 Normal eye: green color is uniformly scattered
 Abnormal: green color accumulates on a certain area

COMMON PHARMACOLOGIC AGENTS

MYADRIATIC AGENTS
 Cause pupillary dilation
 Used in conditions requiring pupil to be dilated e.g.
Scopolamine (Isopto Hyoscine); Cyclopentolate (Cyclogyl);
Tropicamide (Mydriacyl); Phenylephrine (AK-Dilate,
Mydfrin)
 Nursing interventions: Wear sunglasses (patient), teach to
administer properly and put pressure on lacrimal sac so that
medication will stay

MIOTIC AGENTS
 Cause intense miosis and contraction of the ciliary muscle
 Decrease intraocular pressure
 Used for treatment of glaucoma
 Eg. Acetylcholine (Miochol); Carbachol (ISO carbachol,
Niostat); Pilocarpine (Pilocar, Isopto Carpine)

OSMOTIC DIURETICS
 Used for reduction of IOP or before ocular surgery
 e.g. Mannitol (Osmitol)l Glycerin (Glycerol)

OPHTHALMIC ANTI-INFECTIVES
 Used for treatment of ophthalmic infections
 Eg. Tobramycin (Tobramycin, Tobrex); Gentamycin
(Garamycin, Genoptic); Bacitracin (AK-Tracin)

OPHTHALMIC STEROID ANTI-INFLAMMATORIES

 To relieve pain; suppress other inflammatory processes of
the conjunctiva, cornea lid, and interior segment of the
globe
 Dexamethasone (Maxidrex, Decadron); Flourometholone
(FML, Flarex)

CARBONIC ANHYDRASE INHIBITORS

 Used in combination regimen to treat glaucoma and
postoperative rise in IOP
 Acetazolamide (Diamox); Methazolamide (Neptazane)

GENERAL CONSIDERATIONS:
 Advise the patient to follow the directions exactly
 If the condition worsens or does not improve, notify the
physician
 If multiple drugs are ordered. Wait 5 minutes between them
 After administering ophthalmic solutions, apply gentle
pressure to inner canthus for approximately 1 minute to
decrease absorption and systemic effects.
 If patient has both an ophthalmic drops and ointment, instill
first the drops before the ointment.

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 3

EENT
LESSON 2: EYE DISORDERS

EYE DISORDERS  Instruct the child to avoid rubbing the eye

 Impairment of health or a condition of abnormal functioning  D/C use of contact lenses and to obtain new lenses to
of the organ of sight. eliminate the chance of re-infection
 Instruct patient that eye make-up should be discarded and
INFECTIOUS AND INFLAMMATORY CONDITIONS OF replaced
THE EYE
CORNEAL DYSTROPHIES
CONJUNCTIVITIS  Rare condition in which the cornea is altered without the
presence of any inflammation, infection or other eye
 Inflammatory disease
o d/t allergens
 Runs in families
o Non contagious
 Types
o Treated with vasoconstrictors / corticosteroids
o Epithelial
 Infectious
o Stromal
o d/t staph, chlamydia, neisseria
o Endothelium
o Contagious
 Signs and symptoms
o Treated with broad spectrum antibiotics
o Cloudy or blurry vision
 S/sx:
o Watery eyes
o Itching
o Dry eyes
o Burning or scratchy eyelids
o Glare
o Redness
o Photophobia
o Conjunctival edema
o Pain
o Excessive tearing
o Foreign body sensation
o Discharge
o Corneal erosions
 Nursing Interventions encourage to wear sunglasses,
 Management
children should not go to school until symptoms have
 Hypertonic eye drops/ ointment
disappeared within 3-7 days, discontinue contact lens use
o Antibiotic
and buy a new pair
o Special contact lenses
 bandage contact lenses
BLEPHARITIS AND HORDEOLUM  Rigid contact lenses
 Blepharitis o Surgery
o Inflammation of the eyelid margins o Corneal transplant
o S/sx: itchy, red, burning eyes, flicking, purulent o Phototherapeutic keratectomy (PTK)
discharges o *slit lamp - used dx test
o Tx: topical/eye drops antibiotics
o Do warm compress EPITHELIAL DYSTROPHIES
 Hordeolum (stye)
 Meesman - occasional “foreign body” sensation
o Chalazion
 Cogan’s - most common type
o Acute suppurative infection of the follicle of an eyelash
o d/t staph  Reis buckler - painful foreign body sensation
o S/sx: redness and pain, lump/swelling of the eyelid,
purulent discharges STROMAL DYSTROPHIES
o Tx: antibiotics. I&D  Granular - greyish dots can be seen through a microscope.
o Do warm compress 4-5x a day Vision may be lost at 50 yrs old
 Macular - irregular, cloudy areas appear in both corneas
KERATITIS which gradually merge together. Light sensitive, sight lost
 Inflammation of the cornea at 20-30 yrs old
 S/Sx: pain, reduced vision, cloudy cornea, photophobia,  Lattice - “foreign body” sensation and a slight deterioration
difficulty opening the eye, abrasion, ulceration on vision. Under a microscope, very fine, overlapping lines
 Tx: Antibiotics, keratoplasty can be seen in the camera.
 Wear pritective eye shield, frequent handwashing …
ENDOTHELIUM DYSTROPHIES
NURSING CONSIDERATIONS:  Innermost layer of the cornea
o Fuch’s
 Instruct infection control measures
 More common in women, unlikely to be inherited
 Administer antibiotic or antiviral
 Begins at 40 painless deteriorations of vision and
 Administer antihistamines glare
 Child should be kept home from school until antibiotic eye  Next stage, painful episodes due to tiny blisters on
drops have been administered for 24 hours the cornea, which will gradually disappear as the
 Instruct in the use of cool compresses vision gets worse
 Wear dark glasses for photophobia

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 1

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY
o Keratoconus
 Conical or cone-shaped cornea  Nursing Management
 Rarely appears until puberty or older o Assess how visual impairment can affect normal
 Cornea becomes stretched and thins at its center functioning
o Provide emotional support for recent visual impairment
AMETROPIA o Orient to the environment
 A state where refractive error is present or when distant o Sight guide technique (eg. contact and grasp)
points are no longer focused properly to the retina
 Etiology: corneal curvature, length of the eye, strength of CATARACTS
the lens  Is an opacity or cloudiness of the normally transparent
 Types of Refractive Errors crystalline lens
o Myopia  Lens protein dried out and forms crystals
o Hyperopia  Causes
o Astigmatism o Senile - associated with aging
o Presbyopia o Congenital - may be hereditary
 Surgical Management o Traumatic - associated with injury
o Lasik o Secondary - sequelae of systemic disease, drug
 Laser in situ Keratomileusis ingestion
 Uses an excimer laser to cut/reshape the cornea  Diagnostic Exams
o ICR Intrastromal Corneal Ring o Standard ophthalmic exam
 are small devices implanted to correct vision o Visual acuity test
o Phacik Intraocular Lens o Eye movement and peripheral vision
 Lens that are made of plastic/silicone; implanted o Color blindness
permanently o Pupil dilation
o Tonometry
MYOPIA o Slit-lamp exam
 Near-sightedness  Medical Examination
 Has excessive refractive strength o Extracapsular cataract extraction (ECCE)
 Focuses light in front of the retina  Manual expression
 Treat with concave lens  Phacoemulsification
o Intracapsular cataract extraction (ICCE)
HYPEROPIA  Lens is removed through it capsule by incision to correct the
vision of patient
 Far-sightedness
 Focuses light at the back of the retina Nursing Management
 Treat with CONVEX LENS  Pre-op Nursing Care
 Clear sa malayo, blurry sa malapit o Instruct measures to prevent increased IOP
 Administer pre-op eye medication including
ASTIGMATISM mydriatics and cycloplegics as prescribed (e.g.
 Unequal curvature of the cornea Atropine)
 Treat with special lenses o No carrying of heavy objects
o No bending below the waist
PRESBYOPIA o Don't read
 Post-op Nursing Care
 Old sight
o CATARATA
 Inability to accommodate for near vision due to loss of  Clean post-operative eye
elasticity of the crystalline lens  Analgesics
 Treat with bifocal lens  TobraDex (Tobramycin/dexamethasone)
 Avoid lying on operative side
BLINDNESS  Report complications
 A condition of lacking visual perception  Avoid bending and stooping
 Defined ad a BCVA (Best Corrected Visual Acuity) of  The use of eyeshield
20/400 to no light perception  Advise hygiene
 Types Of Blindness o Turn the client to the back or inoperative side
o Total blindness - no light perception and no usable o Give antibiotic-steroids (tobradex and acetaminophen)
vision o No aspirin due to clotting effects
o Functional blindness- has light perception but no o Instruct measures to prevent or decrease IOP
usable vision o Wear glasses during the day until the pupils responds
o Legally blindness - central vision acuity for distance of to light
20/20 o Eye shield at night or while sleeping
 Etiology o For minor pain; use ice or heat as prescribed
o Common to adult 40 yrs old and above o Shower or bathing is allowed
o Diabetic retinopathy o Care of the dressings
o Macular degeneration o Stool softeners
o Glaucoma o Instruct to report pain with nausea and vomiting
o Cataract

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 2

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

GLAUCOMA  Signs and Symptoms

 A group of disorder that all have IOP, leading to damage to o Early
the optic nerve structure with resulting visual field loss.  Elevated IOP
 Maybe caused by ocular inflammation or injury, trauma,  Diminished accommodation
infection, hereditary predisposition o Late
 Progressive loss of peripheral vision ”tunnel -
 Normal IOP: 12-20 mmHg (determined by the rate of the
vision” followed by loss of central vision
aqueous production)
 Vision worsening in the evening with difficulty
 Two types:
adjusting to dark rooms
o Open-Angle Glaucoma
 Blurred vision
 Aka: chronic simple or wide-angle glaucoma
 Halos around white lights
 Most common
 Frontal headaches
 Bilateral and asymptomatic in early stage
 Photophobia
 Reduced outflow of AH
 Increased lacrimation
 The fluid cannot leave the eye at the same time it
 Diagnostic Tests
is produced, IOP gradually increases
o Tonometry,
 First s/sx is cloudy vision, lessened
o Ophthalmoscopy,
accommodation, loss of peripheral vision
o Visual field testing,
o Closed-Angle Glaucoma
o Gonioscopy (it checks the drainage angle)
 AKA: Narrow-angle glaucoma or acute glaucoma
 Less common  Management
 Movement of the iris against the cornea narrows o For acute glaucoma: treat as medical emergency
or closes the chamber angle, o Administer medications as prescribed to lower IOP
 obstructing the outflow of the AH causing sudden  Miotics (e.g. Pilocarpine) - constrict the pupils,
onset of unilateral eye pain with when it is constricted there will be contraction of
 BOV and possibly nausea and vomiting. ciliary muscle so increase outflow of aqueous
 IOP of 40-65 mmHg humor
 Largest chance that the patient will get blind  Carbonic anhydrase inhibitors (e.g.
 Less Common Acetazolamide) - decreased the production of
aqueous humor
 Beta-blockers (e.g. Timolol, betaxolol ) - use
cautiously to patient with asthma and CHF,
decreases the production of aqueous humor
 Sympathomimetics (drug of choice to patient with
asthma and CHF; e.g, epinephrine) - reduce
aqueous humor output
o Surgery: peripheral iridectomy, trabeculectomy,
iridotomy
 Peripheral Iridectomy- typically a laser
procedure that allows aqueous humor to flow from
the posterior to anterior chamber through an
excision of a small part of the iris.
 Trabeculectomy- Partial thickness scleral
resection with small part of trabecular meshwork
removed.
 Laser Iridotomy- Multiple laser incisions to the iris
to create openings for aqueous humor flow.
o Nursing Management
 Monitor on CBR
 Administer meds as ordered
 Assist according to degree of visual impairment
 Provide emotional support
 Avoid mydriatics
 Prepare patient for surgery

RETINAL DETACHMENT
 Occurs when the layers of the retina separate because of
accumulation of fluid between them
 Also occurs when both retinal layers elevate away from the
choroid as a result of a tumor.
 Types:
o Partial Retinal Detachment
 Initial detachment may be localized but without
rapid treatment
 initial detachment that may be localized but
without rapid treatment

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 3

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY
o Complete Retinal Detachment
 The entire retina may be detached; a serious eye  Forms of AMD
condition needing immediate diagnosis and often o Dry (non-exudative)
urgent eye surgery (*entire retinal detachment*).  Abnormal accumulation of yellowish colored
 Causes: extracellular deposits “drusen” in the retinal
o Degenerative changes in the retina or vitreous. pigment of epithelium
o Trauma, inflammation, tumor  Slow onset
o Diabetic Nephropathy  Macular cells start to atrophy
o Myopia and loss of lens from a cataract  Drusen= Are small yellow deposits of fatty proteins
 Signs and Symptoms (lipids) that accumulate under the retina
o Sense of curtain (eye detachment) being drawn o Wet (exudative)
o Flashes of light  Growth of new blood vessels from the choroid to
o - Black spots or floaters retinal epithelium
o - Blurred vision  Rapid onset
o - Loss of a portion of the visual field  Development of abnormal blood vessels around
 Diagnostic Exams the macula
o Ophthalmoscopy  Manifestations
o Slit-Lamp Exam o Blurred or darkened vision
 Slit Lamp is a microscope with a bright light used o Scotomas (blind spots in visual fields)
during an eye exam. It gives the ophthalmologist a o Metamorphospia (distortion of vision)
closer look at the different structures at the front of  Diagnostic Exam
the eye and inside the eye. It is a key tool in o Amster grid test: a diagnostic test that aids in detection
determining the health of the eyes and detecting of central visual disturbance; …
eye disease. o A pattern of intersecting lines with a black dot in the
o Gonioscopy middle. The central black dot is used for fixation (a
 A painless exam your ophthalmologist uses to place for the eye to stare of)
check a part of your eye called the drainage angle.  Management
 Immediate Nursing Care o Laser macular photocoagulation
o Provide bedrest o Photodynamic therapy (PDT)
o Cover both eyes with patches to prevent further o Pegaptanib
detachment o Ranibizumab
o Speak to the client before approaching o Green leafy vegetables with lutein (spinach…)
o Position the client’s head as prescribed  Nursing Interventions
o Protect the client from injury o Discuss strategies/modifications to carry out usual
o Avoid jerky head movements activities
o Minimize eye stress o Assist with self-care activities
o Prepare the client for surgical procedure as prescribed o Engage support people in assistance with patient
 Goal: To prevent injury through further detachment activity
 Surgical Management o Advise patient to memorize environment while some
o Sealing retinal breaks by cryosurgery vision is intact
 A cold probe applied to the sclera to stimulate an o Use side rails as needed and make sure that patient
inflammatory response leading to adhesions can call help if needed
o Diathermy o Rest eyes as needed
 the use of electrode needle & heat through the
sclera to stimulate an inflammatory response STRABISMUS
leading to adhesions  Called “Squint Eye” or “crossed eye”
o Laser Therapy  A condition in which the eyes are not aligned because of
 to stimulate an inflammatory response to seal lack of muscle coordination of the extraocular muscles
small retinal tears before the detachment occurs  Manifestations
o Scleral Buckling o Crossed eyes
 to hold the choroid and retina together with a splint o Double vision
until scar tissue forms closing the tear o Uncoordinated eye movements
o Loss of depth perception
MACULAR DEGENERATION
 Age-related macular degeneration CAUSES:
o Is a medical condition that results in loss of vision in the  Children
center of the visual fields (the macula) because of o Unknown
damage to the retina o Congenital rubella
o The most common cause of irreversible central vision o Cerebral palsy
loss in persons over 60 o Retinopathy of prematurity
 Risk Factors o Traumatic brain injury
o Related to retinal aging o Hemangioma near the eye
o Affected by genetics  Adults
o Long term exposure to UV lights o Diabetes
o Hyperopia o Traumatic brain injury
o Cigarette smoking o Injury to the eye
o Stroke

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 4

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

DIAGNOSTICS & TREATMENT CHEMICAL BURNS

 Diagnostic Exams  Immediately flush eye with water, normal saline or
o Retinal exam ophthalmic irrigation solution for a minimum of 15-20
o Ophthalmic exam minutes
o Visual acuity  Using fingers to keep eye open as wide as possible
o Neurological exam
 Treatment FOREIGN BODIES
o Glasses  Never rub a speck or particle in the eye
o Eye patch  Have the client look upward, expose the lower lid, wet a
o Eye muscles exercise cotton-tipped applicator with sterile normal saline and
o Surgery gently twist the swab over the particle and remove it.
OCULAR MELANOMA HYPHEMA
 is a rare type of eye cancer that affects vision specifically
the choroid, ciliary body, and the iris. Choroidal melanoma  is a pooling or collection of blood inside the anterior
is the most common. It is often discovered on a retinal chamber of the eye
examination and can be mistaken as a nevus/mole in its  Management bedrest is semi fowler’s position
early stage; primarily occurs in adults.  Avoid sudden movements for 3-5 days
 Melanocytes produce the dark-colored pigment melanin  Eye patch and shields
 Found in the places in our body, including the skin, hair and  If may resolve in 5-7 days
lining of the internal organs including the eye.  Cycloplegic medications to rest the eye injured
 Etiology
o Unknown
o Ultraviolet rays
o Dysplasic naevus syndrome
 a condition that causes abnormal moles
o Ocular melanocytosis
 a rare condition that causes crease and abnormal
pigmentation of the eye and skin around the eye.

MANIFESTATIONS
 Blurred vision
 Flashing lights and shadows
 Change in iris color
 Red and painful eye
 Loss of peripheral vision

DIAGNOSTIC EXAMS
 Ophthalmoscopy
 Ultrasound
 MRI/CT scan

MANAGEMENT
 Radiotherapy
 Surgery (Enucleation)
o Removal of the entire eye part of the optic nerve.
o An artificial ocular eye prosthesis can be created which
will maintain the contour of the eye
 Transpupillary thermotherapy
o Is a method of delivering heat through the dilated pupil
into the posterior segment of the eye using a diiodide
laser.

OCULAR EMERGENCIES
 An eye emergency is defined as a condition requiring
prompt medical attention due to a sudden change in ocular
health or vision. Eye trauma, foreign objects in the eye,
chemical exposure to the eyes, and ocular infections are all
considered eye emergencies and should be treated
immediately.

BLOW TO THE EYE

 Apply cold compress for about 15 minutes to reduce
swelling and pain and help prevent bleeding.

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 5

EENT
LESSON 3: EARS
o Normal: sound is heard equally in both ears
EAR o Conductive hearing loss: affected ear
• It is a sensory organ that is responsible for hearing and o Sensorineural hearing loss: unaffected ear
equillibrium. ▪ * if malakas both ears (normal)
• *left conductive deafness (mas malakas si left ear)
DIVISION OF THE EAR • *left sensorineural deafness (mas malakas si right
OUTER (EXTERNAL) EAR ear)
• *right conductive deafness (malakas right ear)
• Auricle (Pinna)- collects sound waves
• *right sensorineural deafness (malakas si left)
• External Auditory Canal
• * weber’s right or left
o Glands secrete cerumen which provides protection
o Transmits sound waves to tympanic membrane. • *check for the lateralization; identify kong ano ang
o Tympanic Membrane side na mas malakas
▪ Barrier between external ear and middle ear • *N: same ang sound
▪ Transmit vibrations to middle ear • *Affected ear: yun yung mas malakas so it means
pt has conductive hearing loss
MIDDLE EAR *unaffected ear: mas malakas so si pt kay may
sensorineural hearing loss.
• Ossicles • Rinne Test
o Contains 3 small bones: o Useful in distinguishing between conductive and
▪ Malleus (hammer) sensorineural hearing loss
▪ Incus (anvil) ▪ (+) rinne test = air conduction > bone conduction
▪ Stapes (Stirrup) (normal)
• Oval window: an opening between the middle and inner ear ▪ (-) rinne test = bone conduction > air conduction
• Eustachian tube ▪ (+) conductive hearing loss
o Connects nasopharynx and middle ear ▪ *rinne under the pinne (pinna; mastoid)
o Equalizes pressure on both sides of the eardrum; ▪ * dapat mas malakas si bone conduction kesa sa
drainage channel air conduction
▪ *distinguish which is louder, either air or bone
INNER EAR conduction (normally mas loud si air conduction)
• Filled with perilymph and endolymph ▪ *(-) rinne test: conductive hearing loss (N: (+)
• Vestibule hearing loss)
o Entrance space next to oval window
• Cochlea IVESTIBULAR ASSESSMENT OF THE EAR
o Has the organ of corti, the receptor and organ of • Romberg’s test
hearing o Is a screening test for balance
o Contains hair cells that detect vibration from sound and ▪ (-) romberg: clent remains erect with slight
stimulate the 8th cranial nerve swaying
o Hearing ▪ (+) romberg: presence of significant swaying
• Semicircular canals • *let pt stand and close the eyes: if pt sway
o Organ of balance a lot (+) romberg’s test
o Bony tubes that form the inner part of the ear
o Balance DIAGNOSTIC TESTS
AUDIOMETRY
ASSESSMENTS
• Measure hearing acuity
VOICE TEST (WHISPER TEST) o The patient wears earphones and signals to the
• Ask the client to block one external canal audiologist when a tone is heard
• The examiner stands 1-2 ft away and quickly whispers a o Audiometric evaluations are performed in a soundproof
statement room
• The client is asked to repeat the whispered statement o Responses are plotted on a graph known as an
• Each ear is tested separately audiogram
o Mechanical Sound Transmission (middle ear function)
WATCH TEST o Neural Sound Transmission (cochlear function)
o Speech Discrimination (central integration)
• A ticking watch is used to test high-frequency sounds
• The examiner holds a ticking watch about 5 inches from
each ear and asks the client if the ticking is heard OTOSCOPIC EXAM
• Guidelines:
TUNING FORK TEST o The speculum is never blindly introduces into the
external canal
• Weber Test
o Tilt the head slightly away and golf the otoscope upside
o Uses bone conduction to test lateralization of sound
down as if it were a large pen
o Useful in detecting unilateral hearing loss

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 1

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY
o Visualize the external canal while slowly inserting the
speculum • Manifestations
o Normal: o Sound is perceived as distant or faint (decreased
▪ External canal - colored, intact, without lesions sensitivity)
▪ Eardrum - shiny, transparent, opaque or pearly o Complain that hearing is worse while eating crisp or
gray; mobile crunchy foods
• Diagnostic Tests:
ELECTRONYSTAGMOGRAPHY (ENG) o Weber test = lateralization on affected ear
o Electroencephalographic recording of eye movements o Rinne test = BC > AC
that provide objective documentation of induced and
spontaneous nystagmus SENSOURINAL HEARING LOSS
o Used to evaluate the oculomotor and vestibular • Results from damage to the inner ear and/or auditory nerve
systems to differentiate the cause of • Sensitivity to sounds/discrimination to sounds are impaired
o vertigo, tinnitus, and hearing loss of unknown origin • Irreversible
o C/I if patient has had prior neck injury • Etiology
o Exposure to nose
NURSING CONSIDERATIONS o Presbycusis
• Avoid a heavy meal before the procedure o Meningitis
• Avoid caffeine and/or alcohol - 48 hours before the o Ototoxic drugs (Aminoglycosides, Loop diuretics)
procedure o Acoustic neuroma
• Medications that may affect the vestibular system o Syphilis
(sedatives, anti anxiety agents, antihistamines, and o Diabetes mellitus
medications ordered for dizziness) - w/held for up to 5 days o Meniere’s disease
before the procedure. o Acoustic trauma
o Barotrauma/Ear Squeeze
EAR DISORDERS o Vascular diseases
• Manifestations
HEARING LOSS o Sound is distorted and faint
• Hearing loss is any degree of impairment of the ability to o Sounds “f” “s” and “z” are not heard
apprehend sound o High tones are less audible
• Disruption of the wave path • Diagnostic Tests
• Decibel (DB) - unit of measuring loudness o Weber test = lateralization on unaffected ear
• Types of hearing loss o Rinne test = AC > BC in affected ear
o Conductive
o Sensorineural MIXED HEARING LOSS
o Mixed • Client has both sensorineural and conductive hearing loss
o Presbycusis • Etiology
o Encephalitis
o Stroke
o Neoplasm in the brain

PESBYCUSIS
• Associated with aging
• Leads to degeneration or atrophy of the ganglionic cells in
the cochlea and a loss of elasticity of the basilar
membranes
• Leads to compromise of the vascular supply to the inner ear
• Bilateral hearing loss especially high frequency tones
• Etiology
o Age related changes
o Lifelong exposure to loud noises
o Ototoxic drugs
CONDUCTIVE HEARING LOSS o Disease process
• Occurs when sound waves are blocked to the inner ear • Common Manifestations:
fibers because of external ear or middle ear disorders o Complaints that their hearing is good but others
• Reversible mumble
• Etiology : o Leaning of turning one ear toward the speaker
o Otosclerosis o May fail to follow directions, speak while others are
o Changes in eardrum such as bulging speaking, or turn the radio/TV up very loud.
o Obstructed external ear canal o Irritability and even hostility not unusual
o Perforated tympanic membrane o Some become very suspicious of other because they
o Dislocated ossicle cannot hear what is being said
o Otitis media o Otalgia (ear pain), dizziness, and tinnitus with certain
o Otitis externa types of disorders

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 2

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

MANAGEMENT MANAGEMENT
• Hearing aids - are battery operated instruments that make • E - Ear wicking
sounds louder • X - Surgery; debridement
o B - battery check • T - Thorough cleaning
o U - u have to clean the earpiece • E - Steroids
o N - not in use turn it off • R - Relieve edema
o G - go away from high or extreme temperature • N - NSAID’s
o O - oil cosmetics are CI • A – Antibiotics
o L - lowest setting adjustment • Showering or swimming use an ear plug (one that is
• Cochlear implants - permits direct neural stimulation of designed to keep water out), or use
auditory nerve, bypassing damaged hair cells • cotton with Vaseline on the outside.
• Surgery • Cotton swabs should be avoided
o Tympanoplasty: reconstruction of diseased or
• Hearing aids should be left out as much as possible until
deformed middle ear components
swelling and discharge stops.
o Stapedectomy: removal of footplate of stapes and
• Suctioning of the ear canal helps to keep it open, remove
insertion of graft or prosthesis.
debris, and decrease bacterial counts.
POSTOPERATIVE NURSING MANAGEMENT
OTITIS MEDIA
• Antibiotic as prescribed • Infection of the middle ear occurring as a result of a blocked
• Bed rest may be maintained for the first 24 hours or longer eustachian tube, which prevents normal drainage.
• Analgesics, antiemetics, and antihistamines are given as • A common complication of an acute respiratory infection
needed • Primary causative agents: H. Influenzae, Strep, Staph,
• The patient is positioned to promote drainage but maintain E.coli
some immobility • Infants and children are more prone
• Elevate head of bed • Main Causes:
• Encourage the patient to move slowly o Allergy
• Wash hands before ear care, and instruct patient not to o Infection
touch ear o Blockage of the eustachian tube and nutritional
• Take care not to get dressing or ear wet deficiency
• Packing may be removed up to 6 days postoperatively
• Report and teach patient to report any manifestations of SIGN AND SYMPTOMS:
infections • Bulging and immobile tympanic membrane
• Fullness in the ear
OTITIS EXTERNA • With slight hearing loss
• Ineffective inflammatory or allergic responses involving the • Vertigo
strictures of the external auditory canal or the auricles.
• Pain: usually the first symptom
• Swimmer’s ear”
• Fever
• More common in children and adolescents
o primary cause: ear pain
MANAGEMENT
o *cause: bacteria
• M - Measures to open eustachian tube/ Myringotomy
CAUSES • E - Eradicate the case
• D - Decongestant and antihistamine
• Causative agents: bacteria (Pseudo, proteus, E.coli, staph)
and Fungi (candida and aspergillus) • I - Instruct to avoid colds and barotraumas
• “Swimmer’s ear” : water collects in the ear canal • A - Analgesics (for pain)
• Cuts or abrasions in the lining of the ear canal (e.g. cotton
swab injury) NURSING CARE
• Dermatologic conditions (seborrhea, eczema, and contact • Apply heat locally for 20 minutes 3x a day
dermatitis) • Administer analgesics, antipyretics, antibiotics (Amoxicillin,
• *NOTE: moisture and irritation will prolong the course of the Clarithromycin, Cefuroxime)
problem • Ears should be kept clean and dry
• Use earplugs for swimming
SIGNS AND SYMPTOMS • Instruct the client that irritating agents such as hair products
• First symptom: the ear will feel full, and it may itch or headphones should be discontinued
• Pain • Prepare for myringotomy
• Skin becomes red, swollen and tender
• Yellowish discharge MASTOIDITIS
• Fever • Infection of the mastoid air cells
• Lymphadenopathy • Secondary disorder resulting from untreated otitis media
• Excessive swelling of the canal lead to conductive hearing • Caused by strep, pneumoniae and H. Influenzae
loss • Most often affects children

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 3

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY
• Endolymphatic drainage and Insertions of the Shunt (First-
SIGNS AND SYMPTOMS line surgical approach)
• Dull, post-auricular pain swelling • Labyrinthectomy (for severe, or inability to make use of the
• Cellulitis of area involved organ)
• Low grade fever
• Anorexia NURSING CARE
• Tender and enlarged lymph nodes • Help patients recognize the aura so the patient has time to
prepare for an attack.
DIAGNOSTIC EXAMS • Encourage the patient to lie down during attack, in a safe
place, and lie still.
• Otoscopic exam: reddened, dull, thick, immobile tympanic
membrane with OR without perforation • Place a pillow on each side of head.
• Xray: shows bone destruction • Have patients close eyes if this lessens symptoms.
• Management • Teach about the medication therapy
o Antibiotics • Assist patient to identify specific triggers to control attacks
o Surgery (Myringotomy; Mastoidectomy) • Remind the patient to move slowly
• Complications: • Avoid noises and glaring, bright lights
o Facial Nerve Injury • If there is a tendency to allergic reactions to foods, eliminate
o Meningitis those foods from the diet.
o Brain Abscess
o Labyrinthitis OTOSCLEROSIS
• Is a genetic disorder in which repeated reabsorption
LABYRINTHITIS • More common in women; 15-45 y/o
• An infection of the inner ear structure called labyrinth
• Causes MANIFESTATIONS
o Usually follows a viral illness • Progressive hearing loss
o Trauma or injury to the head or ear • Paracusis willisii (patient hears better in a noisy
o Bacterial infection (otitis media) environment
o Allergies • w/ or w/out tinnitus
o Alcohol abuse • Pinkish discoloration (schwartze’s sign) of the tympanic
o A benign tumor of the middle ear membrane
o Certain medications taken in high doses … • Rinne’s test: BC better that AC
• Manifestations • Weber’s test: increased sound in affected ear
o Common Symptoms:
• Audiometry: conductive hearing loss or mixed loss
▪ Vertigo
▪ Tinnitus
▪ Sensorineural hearing loss MANAGEMENT:
o Other symptoms • Medical therapy
▪ Nystagmus o Sodium fluoride therapy for 1-2 years
o Calcium gluconate and Vit. D
NURSING CARE • Amplification - hearing aid
• Nursing Care (PRIORITY: SAFETY) • Surgery - partial stapedectomy or complete stapedectomy
• Avoid turning the head with prosthesis (fenestration)
• Place on bed rest
• Assist to cope with anxiety that may be present because of ACOUSTIC NEUROMA
the frustration surrounding hearing loss or loss of work • Slow-growing tumor of the nerve that connects the ear to
• Priority: Patient’s safety = side rails up, if blind, be there for the brain. This nerve is located behind the ear.
the patient, if patient wants to pee, put on a wheelchair. • - Non-cancerous
Avoid injuries and further injuries (complications) • - Vestibular Schwannoma
• - Affects both men and women
MENIERE’S SYNDROME • Etiology
• Manifestations o Genetics (neurofibromatosis type 2) in which the tumor
o Traid: tinnitus, unilateral sensorineural hearing loss forms on the nerves (brain or spine).
and vertigo
o Nausea and vomiting MANIFESTATIONS
o Depression • Common Symptoms
o Headache o Hearing loss (progressive)
• Management o Tinnitus
o Treatment o Vertigo
▪ Sodium restricted diet • Less Common
▪ Diuretics: hydrochlorothiazide to decrease o Difficulty understanding speech
pressure o Headache
▪ Vestibular suppressants: antihistamine, o Numbeness in face or one ear
tranquilizers, and anticholinergics o Pain in the face or one ear
▪ Avoid alcohol, caffeine and smoking o Sleepiness
▪ Stress therapy o Vision problems
o Weakness of the face

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 4

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

DIAGNOSTIC EXAMS MANIFESTATIONS

• Head CT • Lacerations
• Audiogram • Contusion
• Auditory Brainstem Response • Hematoma
• Caloric test • Abrasion
• Erythema
MANAGEMENT • Blistering
• Surgical removal of the tumor (preserve the facial nerve) • Conductive hearing loss
• Stereotactic radiosurgery (focus on high powered x rays on • Repeated trauma to the ear can cause hypertrophy, also
the small area) (pts unable to perform brain surgery and for known as cauliflower ear (common with boxers)
small tumors) • Numbness, pain, and paresthesia of the auricle

IMPACTED CERUMEN DIAGNOSTIC EXAMS

• A condition wherein earwax has built up in the ear canal and • Imaging studies
cause blockage. • Audiometric
• The air conduction would be equal to the bone conduction • Whisper test
or bone conduction ang mas malakas • Rinne and weber test

RISK FACTORS NURSING DIAGNOSIS

• Improper cleaning • Acute pain related to inflammation or trauma
• Older adult • Disturbed sensory perception: auditory related to altered
• Patients with hearing aids sensory reception
• Bony growths secondary to osteophyte or osteoma • Risk for injury related to self-cleaning of external ear
• • Deficient knowledge related to the lack of information on
MANIFESTATIONS preventive ar care
• Hearing loss
• A feeling of fullness, or blocked ear if cerumen has become
impacted
• Tinnitus
• Otoscopic examination reveals cerumen blocking the ear
canal

DIAGNOSTIC EXAMS
• Audiometric testing
• Hearing activity
• Whisper Voice

FOREIGN BODIES
• Anything that may be lodged in the ear canal intentionally
or accidentally
• High risks (Adults: insects; 9 months and up children: small
objects)
• Managements
o Of object is visible: use tweezers
o If insect: instill 2 drops of mineral oil
o If not insect do not instill mineral oil
o Irrigation in contraindicated if eardrum is perforated;
foreign vegetable bodies; insects
• Don’ts
o Do not push finger into the ear when you suspect some
foreign body in the ear
o Do not put out into the ear unless you are sure the
foreign body is insect
o Do not shake the head of the child who has foreign
body in the ear
o Do not attempt to clean your ears with cotton swabs
sticks or the match sticks

EAR TRAUMA
• A blow to the head
o Automobile accidents
o Burns
o Foreign bodies lodged in the ear canal
o Cold temperatures

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 5

EENT
LESSON 4: NOSE AND THROAT

NOSE & THROAT MANAGEMENT

 Consists of bone and cartilages; air enters through 2  Antihistamines
opening/nostrils (nares)  Antipyretics
 Functions  Nasal decongestants
o Olfaction - (CN1) smelling  Rest and hydration
o Air-conditioning - controlling air temperature and  Desensitization (gradual exposure to triggers)
humidity; removing particles before air enters into the
trachea, bronchi.
SINUSITIS
 Inflammation of the mucous membrane of 1 or more
ANATOMY OF THE SINUSES
sinuses
PARANASAL SINUSES  May accompany or follow rhinitis
 frontal, sphenoid, maxillary, ethmoid  Caused by Diplococcus, Strep, H. Influenzae
 Air-filled cavities lined with mucous membranes  Acute (if <4 weeks)
 Functions
o Reduce the weight of the skull MANIFESTATIONS
o To produce mucus
 Nasal swelling
o To influence voice quality (resonating chambers)
 Purulent nasal discharge
 Fever
ANATOMY OF THE PHARYNX AND LARYNX
 Facial pain
 Pharynx
o Commonly called the throat  Fatigue
o Divided into 3 regions- nasopharynx, oropharynx,  Congestion
laryngopharynx.  Headache
o Functions:  Cough
 Respiratory function - receives air from the nasal  Ear pain
cavity  Anosmia
 Digestive function - receives air, food and fluids
from the oral cavity MANAGEMENT
 Larynx  Antibiotics (amoxicillin, sulfamethoxazole, azithromycin,
o Commonly called the voice box/glottis clarithromycin, ciprofloxacin)
o Passageway for air bet. The pharynx above and the  Decongestants
trachea below  Antihistamines
 Function: essential in human speech  Antral irrigation: Caldwell-Luc procedure - permanent
opening for drainage
DISORDERS OF THE NOSE
NURSING CARE
RHINITIS
 Methods to promote drainage:
 Inflammation of the nasal mucosa
o Inhaling steam, Increase fluid intake, and Applying
 Types
local heat
o Acute viral rhinitis or common colds
 Stress the importance of following the recommended
 Due to rhinovirus, parainfluenza virus,
antibiotic regimen
coronavirus, respiratory syncytial virus (RSV),
influenza virus, and adenovirus  Discourage swimming and diving while patient has URTI
o Allergic Rhinitis (hay fever)  Avoid people who has URTI
 Is the most common form of respiratory allergy  Maintain strict hand washing habits
presumed to be mediated by an immediate
immunologic reaction EPISTAXIS
 Maybe seasonal (pollens from grass, trees,  A.K.A. Nosebleeding
flowers) or perennial (domestic animal, hair, wool,  Causes:
house dust, foods, newspaper, tobacco, etc.) o Trauma, HPN, blood dyscrasias, tumor, inflammatory
 Manifestations reactions, otic barotrauma, nasal sprays, vigorous
o Edema nose blowing and nose picking
o Headache  Types
o Swelling of the nasal mucosa o Anterior - easier to treat
o Congestion o Posterior - more severe bleeding
o Fever MANAGEMENT
o Sneezing  Apply direct pressure (Kiesselbach’s area)
o Rhinorrhea  Cautery
o Cough and Itching
 Nasal Packing
o Mucus production
 Cotton Ball with epinephrine

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 1

 3rd CONCEPT: OPHTHALMOLOGY AND OTORHINOLARYNGOLOGY

NURSING MANAGEMENT LARYNGITIS

 Monitor vital signs and assist with control of bleeding  Inflammation of the mucous membrane of the larynx
 Provides tissues and an emesis basin to allow the patient  Caused by viruses, exposure to irritating inhalants,
to expectorate ant excess blood pollutants, chemical agents, alcohol smoke, overuse of
 Review ways to prevent epistaxis; avoiding forceful nose voice
blowing, straining, high altitudes.  Manifestations
 Adequate humidification to prevent drying of the nasal o Acute hoarseness
passages o Dry cough
 Instruct the patient how to apply direct pressure to the nose o Dysphagia
in the case of a recurrent nosebleed o Aphonia (voice loss)
 If recurrent bleeding cannot be stopped, the patient is o Fever
instructed to seek additional medical attention.  Management
o Voice rest
o Steam inhalation
NASAL POLYPS
o Hydration
 Benign, grape like clusters of mucous membrane and loose
o Lozenges
connective tissue
o Antibiotics
 Most often seen in patients with allergic rhinitis
 Forms gradually from recurrent swelling of the nasal
mucosa
 Complication: airway obstruction
 Manifestations
o Nose feeling blocked
o Anosmia
o Runny nose
o Headache or pain
o Rhinoscopy shows a grayish grape like mass in the
nasal cavity
o CT scan of the sinuses will show opaque (cloudy) spots
where the polyps are
 Management
o Cortisone therapy
o Polypectomy
o Note: nasal polyps may recur (so avoid nasal blowing)

DISORDERS OF THE THROAT

TONSILITIS
 Inflammation and infection of the tonsils
 d/t strep, staph, H. influenzae
 Prone to rheumatic fever

MANIFESTATIONS
 Difficulty swallowing
 Ear pain
 Fever, chills
 Headache
 Sore throat
 Tenderness of the jaw and throat
 Redness and swelling of the tonsils and surrounding tissues
with patches upon inspections
 Voice changes, loss of voice

MANAGEMENT
 Antibiotic therapy, warm saline gargles, analgesics,
antipyretics
 Apply ice collar to severe sore throat
 Oral care
 Soft/liquid diet, hydration
 Discourage spicy/sweet foods
 Bed rest with increase OFI
 Tonsillectomy

BORROMEO, CUTA, DANGO, GELIG, MAGNANAO, SADAVA, VERAQUE | BSN 3A (21-22) 2