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EENTEENT
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EYESEYES
Anatomy:
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External PartExternal Part
1. Eyelids/Palpebrae
*palpebral fissure
-space between two
lids
*canthi
-corners of the
fissure*meibomian gland
-oil secreting glands
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2. Orbit/eye socket
- surrounds and
protect the most of
the eye3. Conjunctiva
-thin transparent
layer of mucous
tissue that covers
the eyes
- lubricates the eye
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4. Lacrimal system
*lacrimal gland
-found at the upperlid over the outercanthus
-produces tear
*lacrimal ducts- directs flow oftears to thenose
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Internal StructureInternal Structure
1. Outer Layer
*Sclera- white of theeye
- a tough, opaquetissue
-serves as aprotective coat
*cornea
- transparent domed
shape found in frontof the eye
- focus light to theretina
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2. Middle Layer
*Choroid-
-lies between
retina and sclera-supplies blood tothe retina
*Ciliary Body
-lies behind the iris-produces aqueoushumor
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*Iris
- the colored portion
of the eye
-controls level oflight entering the eye
*Pupil
- the opening at thecenter of the iris
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3. Inner Layer
*lens
- located just
behind the iris
-focus light to the
retina
*Canal of schlemm-outflow of
aqueous humor
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*Aqueous humor
- watery fluid that
fills the space
between the corneaand the iris
- nourishes the lens
and cornea
- produced by the
ciliary body
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*Retina
-consistency of a wettissue paper
- contains photo
receptors*rods
*cones
*Macula Lutea
-found at the center ofthe retina
-central vision
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*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
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Extraocular muscles
* Rectus
-horizontal and
vertical movementof the eyes
*Oblique-circular
movement of the
eye
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II. EYE FUNCTION
- light enrgy from an
objectcornea
aqueous h pupilslens vitreous h
retina photoreceptors
converts image to nerve
impulse transmitted tooptic nerve via optic
discoptic chiasm
cerebral cortex
interpretaion as sight
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DIAGNOSTICDIAGNOSTIC
PROCEDURESPROCEDURES
1. Snellens chart
- Test for visual
acuity
- normal readingis 20/20
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2. Ishihara Chart
- test for color vision
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3. Fluorescein Angiography
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DEFINITION
-is an eye test that uses an special
dye and camera to evaluate the
blood circulation in the retina and
choroid.
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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 after20mins
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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
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What to expect during the procedure
- Stinging sensation-nausea and vomiting
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Result shows
macular edema
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4. Fundoscopy
-is an examination of
the back part of
the eyeball(fundus), which
includes the
retina, optic disc,
choroid, and bloodvessels.
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How Test is Performed:
- the patient is asked to sit in a darkened
room
- visualization of the eye using afunduscope
Preparation:
- Midriatic drugs may or may not be given
- Significant other
- Sunglasses
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5. Corneal Staining
- to check for
corneal surface
and corneal injuryusing a dye
Fluorescein
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6. Tonometry
- To check the
intraoccular
pressure.
- Topical anesthetic
is used to numb
the surface
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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 orclosed
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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
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WHAT TO EXPECT
- Painless
- Eye drops used to numbed will
burn a little
- procedure last 5 to 10 mins
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Nursing Considerations:
- tell the client not to rub the eye for
20 mins after the procedure or until
the medication wears off
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8. Opthalmoscopy
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9. Slit-lamp
-The test is used to
examine
the eyelids, thesclera,
conjunctiva, iris,
lens, and the
cornea.
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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
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SPECIAL PREPARATION
*No special preparation
Nursing Consideration
* Sensitivity to light after the
procedure
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EYE DISORDERSEYE DISORDERS
1. Glaucoma
Causes:
- Family
history - Blackrace
- trauma
- myopia
Types:A. open- angle
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B. angle-closure
C. Congenital
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D. Secondary
SIGNS AND SYMPTOMS
A. Open-angle
- Asymptomatic
- insidious visual impairment- loss of peripheral vision
- HALOS around lights
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B. Angle-closure
- Acute ocular pain
- diminished visual acuity
- colored HALOS around lights
- Blurry vision
- Nausea and vomiting
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DIAGNOSTIC EXAMS
- Tonometry
- Gonioscopy
- Opthalmoscopy
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TREATMENT
Medications
Topical Miotics
Topical Epinephrine
Topical Beta-blockers
* contraindicated in pts. w/ asthma.
Oral Carbonic Anhydrase InhibitorsGlycerin
Mannitol
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Surgical procedures
1. Laser
trabeculoplasty
- A laseris beingusedtoimprove
thedrainageat the
tubercular
meshwork- Treatment foropen
angleglaucoma
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2. Trabeculectomy
- The drainage
angle of the eye is
removed creating anew drainage
- the new opening
is being covered by
a part of the sclera
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3. Iridectomy
-Removal of a
portion of the iris
to enhance the outflow of aqeous
humor
- Close angle
glaucoma
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NURSING MGT Pre-op:
Admin. prescribed meds.
Routinepre-opprocedure Post-op:
Position accdg. tophysicians orders
Admin. eyedrops/meds as ordered
Orient pt. toenvironment Avoid activities that may raiseIOP
Observe forcomplications
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2. CATARACT
- Progressive and
gradual
development ofopacity in the
lens/lens capsule
that results in loss
of vision.
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CAUSES
- Aging Process
- Inherited
- Injury
- Endocrine Disorders
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SIGNS AND SYMPTOMS
- Gradual loss of vision
- Photophobia
- Opaque or cloudy white pupil
- Decrease visual acuity
DIAGNOSTIC TEST
- Slit lamp
- Opthalmoscopic examination
SLITSLIT LAMPLAMP
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SLITSLIT--LAMPLAMP
EXAMINATIONEXAMINATION
Cataract Lens Normal Lens
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TREATMENT
Surgery treatment ofchoice
1. ICCE (intracapsular cataract
extraction)
2. ECCE (extracapsular cataract
extraction)
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3. Phacoemulsification
- a small incision in
the cornea is done
- Special instrumentis inserted to break
the cataract into
fragments and
suction the smallfragments
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Pre-oppreparation:
- Assess visionfortheaffectedeye
- Administerpre-opmeds
- Instruct post-opmeasure to
prevent increaseinIOP
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Visualrestorationpost-op
Aphakic Eyeglasses
Contact Lens
IOL Implant
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Post-op complications:
Infection
Hemorrhage pt may verbalize
sudden pain in the eye.
Retinal detachment
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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 isremoved.
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3. MACULAR DEGENERATION
Degeneration of the macular area of
the retina in the eye. The most
common type is age-related maculadegeneration (ARMD).
CUASE:
- Aging
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TYPES
Atrophic (dry)
Exudative (wet)
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SIGNS AND
SYMPTOMS
Loss of central
vision scotoma
Pale yellow spots
drusen appear
on the macula
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Visual distortion
Difficulty with activities requiring
close central vision
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TREATMENT
1. Laser
photocoagulation
- Uses laser to sealof damage blood
vessel in the retina
- destroys
abnormal bloodvessels
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2. Photodynamic
therapy
- light-activated
drug known asVerteporfin is
injected into the
patient's
bloodstream- Produces clot on
the abnormal
blood vessels
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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.
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4. RETINAL
DETACHMENT
-Separation of the
sensory layer ofthe retina from the
choroid.
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CAUSES:
- aging
- cataract surgery
- myopia
- trauma
- tumor
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SIGNS AND SYMPTOMS
- blurred vision
- floaters
- flashes of light
- curtain vision
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Floaters are blood cells released
into the vitreous humor by the
detachment
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TREATMENT
Bed rest
Tranquilizers
Scleral buckling Pneumatic
retinopexy
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Laser
photocoagulation/
cryosurgery
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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.
EYEEYE
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INFECTION/INFLAMMATIONINFECTION/INFLAMMATION
Blepharitis -inflammation of
the eyelid margin
glands and lash
follicles.
Hordoleum (sty) -
infection of Zeis or
Moll gland.
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Chalazion-cyst of one oremore meibomianglands
Conjuctivitis (Pinkeye, red eye, soreeyes) - infectionand inflammation
of conjuctiva byallergen orbacteria.
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Keratitis -inflammation of
cornea.
Uveitis -
inflammation of
uveal tract.
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MANAGEMENT
Medication therapy with
topical/systemic antibiotics,
antivirals, antihistamine,corticosteroid.
Promote infection control.
Reduce pain or discomfort.
REFRACTIVE ERRORSREFRACTIVE ERRORS
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REFRACTIVE ERRORSREFRACTIVE ERRORS
MYOPIA
Management:
BICONCAVE LENS
HYPEROPIA /
HYPERMETROPIA
Management:
BICONVEX LENS
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PRESBYOPIA
Management:
Biconvex lens
ASTIGMATISM
Management:
Astigmatic lens
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EARSEARS
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EARSEARS
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I. Anatomy
1.External
Auricle/Pinna
- Collects soundwaves from the
environment
Auditory canal
- Relays sound
waves to the ear
drum
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2. MiddleEustachian tube
-connected to the
nasopharynx
-Maintains pressure
in the inner ear
Tympanic Membrane
-conducts vibrationfrom external
canal to middle
ear
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Ossicles
a. Malleus
b. Incus
c. Stapes
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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
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3. Inner (Labyrinth)Bony Labyrinth-
proctects themembranous
labyrinthSemicircular Canals-
resposible forbalance
Cochlea Organ ofCorti(organ ofhearing)
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Fluids
Perilymph- fluid at the bony
labyrinth
Endolymph- fluid that fills themembranous labyrinth,
- responsible for balance
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EAR FUNCTION
Hearing
Sense of Balance
DAIGNOSTICDAIGNOSTIC
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PROCEDURESPROCEDURES
a. Otoscopic
examination
Child
Adult
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NORMAL TYMPANIC
MEMBRANE
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b. Tuning Fork tests
Rinne test
Weber test
Criteria
Sensorineural hearing loss Conductive hearing loss
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Anatomical
Site
Innerear, cranial nerve VIII, or
central processing centers;
irreversible
Middle ear(ossicular chain),
tympanic membrane, orexternal
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 >
Bone conduction
Negative Rinne; Bone Conduction >
Air Conduction (Bone/Air Gap)
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c. Whisper Voice Test
d. Audiometry
f. Tympanogram-measures middle ear
muscles reflex tosound stimulationand compliance oftympanic membrane
Severity of Hearing loss
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Severity of Hearing loss
Loss in DecibelsInterpretation
>15 Normal hearing
>15-25 Slight hearing loss
>25-40 Mild
>40-50 Moderate
>55-70 Moderate-severe
>70-90 Severe
>90 Profound
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g. Rombergs Test-test for balance
EAR DISORDERSEAR DISORDERS
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EAR DISORDERSEAR DISORDERS
CONDUCTIVE HEARING LOSS
SENSORINEURAL HEARING LOSS
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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.
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RISK FACTORS
- Familial Tendency
- Women
- Caucasian
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SIGNS AND SYMPTOMS
- Gradual, progressive hearing loss
- Constant tinnitus
- Schwartzes sign- reddish or pinkish
tympanic membrane
- (-) Rinne test
TREATMENT
Hearing aids
Stapedectomy
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NURSING MGT (Stapedectomy)
- watch for signs of infx
- Antibiotics for prophylaxis
- Bed rest
- Do not blow nose for at least 2
weeks
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OTITIS MEDIA
Usually begins in childhood that
results from the spread of
microorganisms from theEustachian tube to the middle ear
during upper respiratory infections.
May be acute or chronic.
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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
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TREATMENT
Systemic antibiotics
Antibiotic eardrops
Symptomatic relief withanalgesics
Gentle irrigations to cleanse
the ear
Myringotomy
Tympanoplasty
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TYMPANOPLASTY
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MASTOIDITIS Infection of the
mastoid process
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SIGNS AND SYMPTOMS
Tenderness over the mastoid
process
Headache and ear pain
Vertigo
Swelling over the mastoidprocess
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TREATMENTMedication
Antibiotics
SurgicalIntervention
Mastoidectomy
Tympanoplasty
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MENIERES DISEASE
Disorder of the inner ear in which
there is excessive accumulation of
endolypathic fluid in themembranous labyrinth.
Also known as Endolymphatic
hydrops. Incidence is higher between 35-
60 y.o.
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CAUSES:
- Unknown
- maybe related to:
- Hypernatremia
- Allergic reactions
- Emotional disturbaces
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SIGNS AND SYMPTOMS
Triadofsymptoms:
-Tinnitus
- Vertigo
- Hearingloss
Warning SignofImpending Attack:
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TREATMENT
Medications
Diuretics
Antihistamines
Atropine SO4
Antivertigo- meclizine
Antiemetics- phenergan
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Surgicalprocedures-Endolymphatic
decompression
-Vestibular
neurectomy
-Labyrinthectomy
-Cochlearimplant
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NURSING MGT Instruct pt to avoid moving abruptly.
Protect pt from injury.
Keep the pt on bed rest is has severevertigo.
Explain that Bells palsy may occur
post-op but will subside within few
months. Teach pt to avoid foods high in salt.
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PRESBYCUSSIS
Hearing loss among elderly.
IMPACTED CERUMEN
Having excessive thick or dry
cerumen.
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TREATMENTIrrigation
Instilling otic solution
a. Warm the solution beforeinstilling to the affected
ear.
b. Let the solution flow towards
the side of the ear and NOTdirectly in the tympanicmembrane
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OTOTOXICITYDetrimental effect of certain medicationson the cranial nerve VIII or hearingstructures.
Examples of ototoxic drugs:
Salicylates
Loop diuretics
Quinidine
Antibiotics
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BURNBURN
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A traumatic injury to the skin andunderlying tissues caused by heat,
electricity, radiation, chemical, or
inhalation
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CAUSESa. Thermal flame, hot fluids, hotobjects
b. Chemical strong acids, alkali ororganic compounds
c. Electrical faulty electrical wiringor high voltage power lines,lightning
d. Radiation sunburn, prolonged
exposure to UV rayse. Inhalation smoke or gases, direct
injury to the lungs
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CLASSIFICATIONa. 1st degree-
epidermis, reddish,
painful
b. 2nd degree-
dermis, moist
surface withvesicles, painful
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c. 3rd degree- subcutaneous layer,connective tissues, pearly whitewith no pain
d. 4th degree- muscles, bones,blackish or charred, no pain
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STAGES OF BURNSSTAGES OF BURNS
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11stst stagestageShock/ Fluid Accumulation Phase
(Emergent stage)
First 24-48 h
Intervascular space (IVS) -interstitial space (ISS)
Generalized dehydration
HypovolemiaHemoconcentration, oliguria
HyperK, Hypo Na
22ndnd stagestage
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Diuretic/Fluid Remobilization Phase(Acute stage)
After48 h
ISS-IVS
Hypervolemia
Hemodilution
Diuresis
Hypo K, Hypo Na
33rdrd stagestage
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Recovery (Rehabilitationstage)
5th day onwards
HypoCa, HypoNa
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TREATMENTMedical Mgt
a. Initial First AidIntervention
STOP THE BURNING PROCESS!
Remember: R.A.C.E
R- escue the patient
A- larmC- onfine
E- xtinguish
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b. Promote respiratory Functionc. Assess burn severity
Rule of nines quickest way to
assess TBSA
d. Promoting fluid-electrolyte, acid-
base balanceParkland/Baxter formula
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FORMULAFORMULA
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Parkland GIVE Lactated Ringerssolution
4ml x kg x % of burn =
Example: What volume of fluids isrequired for a client who weighs
100lbs and has acquired 36% TBSA.
ANSWER: 6480 mL
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Brooke lactated ringers2ml x kg x % burn = ___ ml
Example: A man sustained 27% burnand currently weighs 145 lbs. Using
Brookes formula, how much LR
should be given?ANSWER: 3564 ml
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e. Promoting comfort; relief of painMorphine So4
Meperidine (Demerol)
f. Prevent Infection
Topical IV antibiotics
Reverse or protective isolation
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g. Maintaining adequate nutritionHigh-CHON diet, CHO, fats and
minerals
- TPN
WoundManagementWoundManagement
8/9/2019 EENT JEPTA
154/160
Openmethod- wound is uncovered
andexposed toair
Closed-method- wound is covered
with thick layerof sterilegauze
or with occlusivedressings.
Antimicrobial Therapy
Silver NO3
Silver sulfadiazine
Mafenideacetate- drugof choice
SurgicalManagementSurgicalManagement
8/9/2019 EENT JEPTA
155/160
Debridement-removalof
necrotic tissue.
Escharotomy- An
incisioninto the
escharto relieve
pressureon the
affected area.
SKIN GRAFTINGSKIN GRAFTING
8/9/2019 EENT JEPTA
156/160
Purpose: Lessen the potential for infection.
Minimize fluid loss by evaporation.
Promotes growth of epithelial tissue
Reduce scarring
Prevent loss of function.
8/9/2019 EENT JEPTA
157/160
8/9/2019 EENT JEPTA
158/160
TYPESTYPES
8/9/2019 EENT JEPTA
159/160
Isograft donor from identical twinAutograft- from self
Homograft from another humanbeing
Heterograft/xenograft- from theanimal, e.g. pigskin
8/9/2019 EENT JEPTA
160/160