Heent Health

8/9/2019 Heent Health

1/71

diannemaydee (tm) 2008

BY:

DIANNE MAYDEE MANDAL RN, USRN, REMT-B, AREMT-B

http://stuffednurse.blogspot.com


2/71


`

thisis a copy of my old supplemental slides

which I used to give to my students from

almost 2 years ago . I don'tuse this at all at mylectures, simply because I don't rely on using

slides during lectures... because lecturers

must know their concepts by heart and must

not read slides nor notes during the actual

lecture presentation.


3/71


ASSESSMENT and

PROCEDURES


4/71


` 1. Normal visual acuity as measured with a Snelleneye chartis 20/20. What does a visual acuity of 20/30indicate?

` A at 20 feet, an individual can only read letterslarge enoughto be read at 30 feet

` B. at 30 feet, an individual can read letters largeenoughto be read at 20 feet

` C. an individual can read 20 out of 30 total letterson the chart

` D. an individual can read 30 out of 50 total letterson the chart at 20 feet


5/71


`

2. Damagetoth

evisu

al area ofth

e occipit

allove of cerebrum, on the leftside, wouldproduce whattype ofvisual loss?

` A. left eye only

` B. right eye only

` C. medial half ofthe right eye and lateralhalf ofthe left eye

` D. medial half ofthe left eye and lateral half

ofthe right


6/71


` 3. Which cranial nerve transmitsvisual

impulses?

` A. I (olfactory)` B. II (optic)

` C. III (oculomotor)

` D. IV (abducens)


7/71


` 4. Intraocular pressure is measured clinicallyby tonometer. Whattonometer reading wouldbe indicative of glaucoma?

` A. pressure of10 mmHg

` B. pressure of15 mmHg

` C. pressure of 20 mmHg

` D. pressure of 25 mmHg


8/71


`

5. A nu

rseis

revi

ewing

the record of

theclient with a disorderinvolving the inner

ear. Which ofthe following would the nurseexpectto see documented as an assessmentfinding in this client?

` A. severe hearing loss` B. complaints ofsevere pain in the affected

ear` C. complaints of burning in the ear

` D. complaints oftinnitus


9/71


` 6. When the nurse preparesthe client orthemyringotomy, the best explanation asto thepurpose forthe proceduresisthatit will:

` A. prevent permanenthearing loss

` B. provide a pathway for drainage

` C. aid in administering medications

` D. maintain motion ofthe ear bones


10/71


` 7. A nurse isinstilling an otic solution into an adultclients left ear. The nurse avoids doing which ofthefollowing as part ofthis procedure?

` A. warming the solution to room temperature` B. placing the clientin a side lying position withthe

ear facing up

` C. pulling the auricle backward and upward

` D. placing the tip ofthe dropper on the edge ofthe

ear canal


11/71


` The cranial nerve thatis responsible forsalivation, tearing,taste, and sensation in the earisthe _____________________

nerve.

` vestibulocochlear` The vestibulocochlear (VII) cranial nerve is responsible forhearing and equilibrium.

` oculomotor` The oculomotor (III) cranial nerve is responsible forthe

musclesthat move the eye and lid, pupillary constriction, andlens accommodation.

` trigeminal` The trigeminal (V) cranial nerve is responsible for facialsensation, corneal reflex, and mastication.

` facial` The facial (VII) nerve controls facial expression and muscle

movement.


12/71


` The cranial nerve thatis responsible for musclesthat move the

eye and lidis

th

e _____________________ nerv

e.

` oculomotor` The oculomotor (III) cranial nerve is also responsible for

pupillary constriction and lens accommodation.

` trigeminal` The trigeminal (V) cranial nerve is responsible for facialsensation, corneal reflex, and mastication.

` vestibulocochlear` The vestibulocochlear (VII) cranial nerve is responsible forhearing and equilibrium.

` facial` The facial (VII) nerve is responsible forsalivation, tearing, taste,

and sensation in the ear.


13/71


` The cranial nerve thatis responsible for facial sensation andcorneal reflex isthe _____________________ nerve.

` trigeminal` The trigeminal (V) cranial nerve is also responsible for

mastication.

` oculomotor` The oculomotor (III) cranial nerve is responsible forthe

musclesthat move the eye and lid, pupillary constriction, andlens accommodation.

` vestibulocochlear` The vestibulocochlear (VII) cranial nerve is responsible for

hearing and equilibrium.

` facial` The facial nerve is responsible forsalivation, tearing, taste, andsensation in the ear.


14/71


GLAUCOMA


15/71


` 1. Among the following, the patient with

glaucoma would most likely manifest:

` A. Halos around light` B. Blurring ofvision

` C. Curtainsin the visual field

` D. Floaters


16/71


` 2. A clienthasundergone surgery forglaucoma. The nurse provides whichdischarge instructionsto the clients?

` A. wound healing usually takes12 weeks

` B. expected the vision will be permanentlyimpaired

` C. a shield or eye patchshould be worn toprotectthe eye

` D. the sutures are removed after1 week


17/71


` 3. A nurse is assigned to care for a clientwho has justundergone eye surgery. Thenurse plansto instructthe clientthat whichofthe following activitiesis permitted in thepostoperative period?

` A. reading

` B. watching television

` C. bending over

` D. lifting objects


18/71


` 4. Which assessment findings provide the bestevidence that a client with acute angle-closureglaucoma is responding to drug therapy?

` A. swelling ofthe eyelids decreases

` B. redness ofthe sclera is reduced` C. eye pain is reduced or eliminated

` D. peripheral vision is diminished


19/71


` 5. Glaucoma is conservatively managed withmiotic eye drops. Mydriatic eye drops are

contraindicated for glaucoma. Which ofthe

following drugsis a mydriatic?

` A. neostigmine

` B. pilocarpine

` C. physostigmatine

` D. atropine


20/71


` 6.G

lau

coma may requi

resu

rgicaltreatment. Preoperatively, the client would be

taughtto expect which ofthe following

postoperatively?

` A. cough and deep-breathing qh.

` B. turn only to the unaffected side

` C. medication forsevere eye pain

` D. restriction of fluids forthe first 24hours


21/71


` 7. W

hen

insti

lling eye drop

sfor a cl

ien

twith

glaucoma, what procedure would the nurse follow?

` A. place the medication in the middle ofthe lowerlid, and put pressure on the lacrimal ductafter instillation.

` B. Instill the drug to the outer angle ofthe eye, haveclienttilthead back

` C. instill the drug atthe innermost angle; wipe withcotton away from inner aspect

`

D.insti

ll medica

tion

in m

iddle eye,

have cl

ien

tblinkfor better absorption


22/71


` Pathology: impaired outflow of aqueous chamberthroughthe trabecular meshwork and canal ofschlemm resultingfrom narrowed angle between the pupil and lateralcornea IOP, maybe acute or chronic.

` Risk: aging, diabetes, family history

` Dx: tonometry and gonioscopy

` Cardinal sign: severe eye pain, halos, tunnel vision,dilated pupil non reactive to light.

` DOC: Timolol ( to decrease production of aqueoushumor); Pilocarpine ( constriction of pupil); acetazolamide( reduce production of aqueoushumor)


23/71


` Nurse concern: Blindness can occurin acute angle if

IIOP persist for 24-48hours; annual eye exam by age 40;

Avoid mydriatrics ( dilates) like Atropine Sulfate; safety

precautions; IEC on meds compliance and systemic

effect of opthalmic beta blocker.

` Surgical operation to drain aqueoushumorin close angle

glaucoma: trabeculectomy, iridectomy, iridotomy


24/71


CATARACT


25/71


` 1. A cataractis:

` A. an opacity ofthe lens

` B. a thin film overthe cornea` C. A crystallization ofthe pupil

` D. an increase in the density ofthe

conjunctiva


26/71


` 2. after a clienthas cataractsurgery, thenurse should:

` A. teachthe client coughing and deepbreathing exercises.

` B. encourage eye exercisesto strengthenthe ocular musculature

` C. keep the clientin supine position withthehead immobilized

` D. advise the clientto refrain from vigorous

brushing ofteeth and hair


27/71


` Pathology: progressive opacity ofthe lens from cellular

debris.

` Risk: aging, tobacco smoking, alcoholism, UV rays,

oculartrauma, family history, downssyndrome, rubella,

DM, drugs( corticosteroids, thorazine)

` Dx: slit lamp ( lens opacity and loss of red reflex)

` Cardinal sign: blurred vision, glaring, white or gray

opacity.


28/71


Cataracts: causes

CATARAct:

Congenital

Aging

Toxicity (steroids, etc)Accidents

Radiation

Abnormal metabolism (DM, Wilsons, etc)


29/71


` DOC: post op meds: analgesics and antiinflammatory

` Surgeries:

Extracapsular extraction: removal of lens nucleus and

cortex

Phacoemulsification: use ofsound wavesto break up lens

Cryoextraction: use of forcep orsuper cooled probestoextract lens

Intracapsular Extraction: removal of entire lens and

capsule.

Las

er removal of len

s.

` Nurse concern: surgical procedures are done in OPD

basis; safety precautions; avoid night driving priorto

surgery


30/71


EYE INJURY


31/71


` Pathology: injury to part ofthe eye: abrasion, blunt,penetrating, burns.

` Risk: environmental hazards, vehicular accidents, sportsinjuries, physical assault

` Dx: Eye exam, flourescein staining, facial CT scan` Cardinal sign:

Abrasion: photophobia, tearing pain

Blunt:ecchymosis ( black eye)

Penetrati

ng:pain, lo

ssof

vision, lo

ssof eye con

ten

ts

Burns: pain, swollen eyelids, decrease vision withsloughing of conjunctiva


32/71


` DOC:

Abrasion: opthalmic ABx

Blunt:acetazolamide

Penetrating: Narcotic analgesics, antiemetics, ABx

Burns: topical anesthetic and ABx

`

Nu

rs

e concerns:Semi Fowlers position

Patch affected eye or bothto decrease movements

Immobilize foreign body with eye shields/paper cups

For chemical burns, irrigate with copious amount ofsterile

water.


33/71


MACULARDEGENERATION


34/71


` Pathology: gradual failure ofthe outer layer ofthe retinaleading to photoreceptors lost and accumulation of waste

products and toxinsin subretinal spaces: atrophic( dry);

exudative( wet)

` Risk: aging, family history

` Dx: ERG, visual acuity test

` Cardinal sign: loss of central vision; pale yellow spots;

distorted images.

` DOC: N/A

` Tx: laser photocoagulation for wet MD, No Tx for dry MD` Nurse concern: Enhance vision and promote safety at

home; large print books and newspaper.


35/71


RETINAL

DETACHMENT


36/71


` 1. Atthe time of retinal detachment, a clientmost likely describes whichsymptoms?

` A. a seeing flashes of light

` B. being unable to see light` C. feeling discomfortin light

` D. seeing poorly in daylight


37/71


` Pathology: separation ofsensory layer ofthe retinaleading to vitreous fluidsseepage and retinal neuronsischemia and deaths.

`

Ris

k: aging,

trau

ma

` Dx:Opthalmoscope exam

` Cardinal sign: 3Fs: floaters, flashes, folds

` DOC: ABx and anti-inflammatories


38/71


` Tx Modalities:

Scleral buckling ( silicon): to produce adhesions

Pneumatic retinopexy: injecting airto vitreousto

force the detached retina back in contact with choroid.

Laser photocoagulation/ cryothermy: creating areas

ofinflammations and adhesion.Surgical manipulations: for detached retina pulled

back in contact with choroid.

` Nurse concern: head is positioned with detached area in

dependent position; avoid bending orsudden head

movement; Patchthe eye; protect from injury.


39/71


SENSORINEURAL

HEARINGIMPAIRMENT


40/71


` 1. Nerve deafness would most likely result

from an injury or an infection that damaged

the:

` A. Vagus nerve

` B. Cochlear nerve

` C. Vestibular nerve

` D. Trigeminal nerve


41/71


` Pathology: damage and degeneration ofhair cells oftheorgan of cortiin the cochlea resulting to hearing loss (initially high pitched tones and conversational speech,then lowertones)

` Risk: aging, ototoxic medications, persistent exposure toloud noise

`

Dx: audiometry; weber and rinne tests` Cardinal sign: deafness and tinnitus` DOC: NA` Tx Modality: cochlearimplants` Nurse concern: hearing aids are nothelpful; avoidshouting, speak in low tone voice withvisual contact;alternative way of communication; use ofshortsentences; home safety; preventsocial isolation.


42/71


CONDUCTIVE

HEARINGIMPAIRMENT


43/71


` 1. A cl

ien

twith

a condu

cti

onh

earing lo

ssasksthe nurse how a hearing aid improves

hearing. The nurse most accurately informs

the clientthat a hearing aid:

` A. amplifiessound heard

` B. makessoundssharper and clearer

` C. produces more distinct, crisp, speech

` D. eliminates garbled background sounds


44/71


` Pathology: interruption ofsound wavesin external ear;with otosclerosisstapes becomesimmobilize againsttheoval window thus decreasing transmission ofsoundstoinner ear.

` Risk: otosclerosis, eartrauma, earinfection, impacted

cerumen, foreign objects, neoplasm, edema ofthe canallining.

` Dx: tympanometry; weber and rinne test

` Cardinal sign: loss ofsound at all frequencies

` DOC: NA

` Tx Modality: hearing aids; stapedectomy

` Nurse concern: Avoid earinjury while swimming orcleaning ear.


45/71


OTITIS MEDIA


46/71


` 1.Which of the following management strategiesexplains the purpose of ear tubes in clients withchronic otitis media who have undergonemyringotomy/

` A. to administer antibiotics

` B. to flush the middle ear

` C. to increase pressure

` D. to drain fluid


47/71


` Pathology: infection of middle ear leading to impaired equalization ofair pressure: serous, acute

` Risk:

serous: URTI, allergies, edematous eustachian tube

Acute: streptococcal pneumonia/pyrogens; Haemophilusinfluenza

`

Dx: PE andhist

ory` Cardinal sign:

Serous: snapping or popping sound, hearing loss, vertigo

Acute: severe ear pain, pulling of ear by kids, fevertenderness ofmastoid area.

` DOC: Decongestants, ABx, antipyretics, analgesics` Nurse concern: Tympanocentesis; myringotomy ( if withtympanostomy tube, avoid airtravel, swimming or diving); hydrate;complete the ABx therapy


48/71


MENIERES DISEASE


49/71


` Situation: Irene P is being treated in theemergency room for an acute attack ofMenieressyndrome

` 1. The nurse should recognize thatthe triadofsymptoms associated with Menieres

syndrome is` A. nystagmus, arthralgia, and vertigo

` B. nausea, vomiting, and arthralgia

` C. syncope, headache, and hearing loss

` D. hearing loss, vertigo, and tinnitus


50/71


` 2. Patientteaching for Mrs. P includeshelping hertorecognize that

` A. Menieressyndrome is psychogenic and is

brought on by stress` B. most patients can be successfully treated with

a low-salt diet and diuretics

` C. acute infection can precipitate an attack

` D. a labyrinthectomy isthe preferred treatment

for relieving symptoms and restoring hearing


51/71


`

3. Nursing intervention during an acute attackincludes:

` A. encouraging the patient to walk

` B. placing the patient in a semi-Fowlersposition

` C. Having the patient lie flat

` D. placing the patient in Trendelenburgsposition


52/71


` 4. You are caring for a patient with adiagnosis of Meniere's Disease. Which ofthe following would NOT be an appropriatenursing intervention forthis patient?

` 1. Restrictsaltintake` 2. Give vasodilating drugssuch as

Priscoline or Banthine

` 3. Give diuretics

` 4. Increase carbohydrate intake


53/71


` Pathology: overaccumulation of endolymph( fluids) inmembranous labyrinth ofthe inner ear resulting todilation of lymphatic channel and labyrinth dysfunction.

` Risk: middle age, family history

` Dx: Caloric ice watertest, auditory dehydration test, ENG,weber and rinne tests.

` Cardinal sign: endolymphatic hydrops( vertigo, tinnitus,

hearing loss); and,nystagmus, ear fullness andhypotension during acute attack


54/71


` DOC: Dramamine

Du

ring ac

ute a

ttack

atrop

ine, d

iazepam, compaz

ine,diphenhydramine, and ABx

Between attacks diureticsOther Tx: Labyrinthectomy, vestibular nerve resection,

endolymphatic sac decompression and shunting.` Nurse concern: Ensure safety during attacks; sodium restricted diet;

avoid substancesthat causesvasoconstriction; If attacks becomes frequent, ensure hydration and

nutrition Signs ofimpending attack: feeling of ear fullness;increa

sing

tinn

itus,verti

go, naus

ea andvom

iting Attack triggers: stress, fatigue, blinking lights, loud noise,

jerky or quick body movements Relaxation techniques


55/71


EPISTAXIS


56/71


` Gary isseen in the emergency room withthediagnosis of epitaxis.

` 1. Itisunlikely thatGaryshistory willincl

ude:

` A. minortrauma to the nose

` B. a deviated septum

` C. acute sinusitis

` D. hypotension


57/71


` 2. Which nursing action is best forcontrolling the clients nosebleed?

` A. have the client lay down slowly and

swallow frequently` B. have the client lay down and breathethroughhis mouth

` C. have the client lean forward and applydirect pressure

` D. have the client lean forward and clenchhisteeth


58/71


` 3. Which ofthe following medications would

be used within orderto promote

vasoconstriction and control bleeding?

` A. epinephrine

` B. lidocaine

` C. pilovarpine

` D. cylospentolate


59/71


` 4. The physician decidesto insert nasal packing. Of

the following nursing actions, which would have thehighest priority?

` A. encourage Gary to breaththroughhis mouth,because he may feel panicky afterthe insertion.

`

B. advi

ceG

aryto expec

tora

teth

e bloodinth

enasopharynx gently and notto swallow it` C. periodically check the position ofthe nasal

packing, because airway obstruction can occurif the packing accidentally slip out of place

` D. take rectal temperature, because he must rely on

mouth breathing and would be unable to keep hismouth closed on the thermometer.


60/71


` 5. Upon his discharge, the nurse instructsGary on

the use ofvasoconstrictive nose drops and cautionshim to avoid too frequent, and excessive use tothese drugs, which ofthe following providesthebest rationale forthis caution?

` A. A rebound effect occursin whichstuffnessworsens after eachsuccessive dose

` B. cocaine, a frequentingredientin nose drops, maylead to psychological addiction

` C. these medications may be absorbed

systematically, causing severe hypotension` D. persistentvasoconstriction ofthe nasal mucosa

can lead to alterationsin the olfactory nerve


61/71


` Pathology: ruptured vessels of Kiesselbach area in anterior nasalspectrum.

` Risk: nasal trauma, cocaine, URTI, allergies, smoking, use of oxygen,climates and altitude extremes, nasal polyps, deviated nasal septum,HTN, diabetes, blood dyscrasias.

` Dx: PE and History

` Cardinal sign: nose bleeding

` DOC: vasoconstrictors( Neo-Synephrine, adrenaline); analgesics

` Nurse concern: assess respiratory distress; situpright withheadti

lted forward; apply pre

ssure by p

inc

hing

the no

se for 5-

10m

inut

es;encourage to expectorate the blood gently to prevent aspiration;

Caldwell-Luc procedure is cauterization and ligation ofvessels. Afternasal packing, Monitor VS, assess drainage, oral care and humidifierand O2 at bedside.


62/71


SINUSITIS


63/71


` Pathology: inflammation with resulting infection ofmucous membrane of paranasal sinuses: acute( 3mos)

` Risk: allergies, immunocompromised, viral rhinitis

` Dx: PE, cultures nasal endoscopy

` Cardinal sign: severe pain over affected sinuses, nasaldischarges, malaise.

` DOC: Intranasal corticosteroids, ABx, analgesics

` Surgery: endoscopic nasal surgery, Externalsphenoethmoidectomy, and Caldwell-Luc procedure.

` Nurse concern: Complete the ABx therapy; Comfortmeasures; hazards of decongestants; hydrate client;avoid strenuous activity


64/71


OTHER DISORDERS


65/71


` 1. Ofthe following terms, which describes a condition characterizedby abnormal spongy bone formation around the stapes?

` A. Otosclerosis

` Otosclerosisis more common in femalesthan males and is frequentlyhereditary.

` B. Middle ear effusion

`

A middle ear eff

usion

isdeno

ted by fl

uidinth

e middle ear w

ithout

evidence ofinfection.

` C. Chronic otitis media

` Chronic otitis media is defined as repeated episodes of acute otitismedia causing irreversible tissue damage and persistenttympanicmembrane perforation.

` D. Otitis externa

` Otitis externa refersto inflammation ofthe external auditory canal.


66/71


` 2. Ossiculoplasty is defined as:

` A. surgical reconstruction ofthe middle ear bones.` Ossiculoplasty is performed to restore hearing.

` B. surgical repair ofthe eardrum.` Surgical repair ofthe eardrum istermed tympanoplasty.

` C. incision into the tympanic membrane.` Tympanotomy or myringotomy isthe term used to refertoincision into the tympanic membrane.

` D. incision into the eardrum.` Tympanotomy or myringotomy isthe term used to refertoincision into the tympanic membrane.


67/71


` 3. Which ofthe following terms refersto surgical repair ofthe

tympanic membrane?

` A. Tympanoplasty` Tympanoplasty may be necessary to repair a scarred eardrum.

` B. Tympanotomy

` A tympanotomy is an incision into the tympanic membrane.

` C. Myringotomy` A myringotomy is an incision into the tympanic membrane.

` D. Ossiculoplasty

` An ossiculoplasty is a surgical reconstruction ofthe middle earbonesto restore hearing.


68/71


` 4. Ofthe following terms, which refersto the progressivehearing loss associated with aging?

` A. Presbycusis` Both middle and inner ear age-related changes resultinhearing loss.

` B. Exostoses

` Exostoses refersto small, hard, bony protrusionsin the lowerposterior bony portion ofthe ear canal.

` C. Otalgia` Otalgia refersto a sensation of fullness or pain in the ear.

` D. Sensorineural hearing loss` Sensorineural hearing lossis loss ofhearing related to damage

ofthe end organ forhearing and/or cranial nerve VIII.


69/71


` 5. When the nurse reviewsthe physician's progress notes forthe patient who hassustained a head injury and seesthatthephysician observed Battle'ssign when the patient wasin the

Emergency Department, the nurse knowsthatthe physicianobserved:

` A. an area of bruising overthe mastoid bone.` Battle'ssign may indicate skull fracture.

` B. a bloodstain surrounded by a yellowishstain on the headdressing.

` A bloodstain surrounded by a yellowishstain on the headdressing is referred to as a halo sign and ishighly suggestiveof a cerebrospinal fluid leak.

` C. escape of cerebrospinal fluid (CSF) from the patient's ear.` Escape ofCSF from the patient's earistermed otorrhea.

` D. escape of cerebrospinal fluid (CSF) from the patient's nose.` Escape ofCSF from the patient's nose istermed rhinorrhea.


70/71


` 6. The nurse assessesthe dressing of a patient with a basalskull fracture and seesthe halo sign - a blood stain surroundedby a yellowishstain. The nurse knowsthatthissign :

` A. ishighly suggestive of a cerebrospinal fluid (CSF) leak.` The halo sign - a blood stain surrounded by a yellowishstain ishighly suggestive of a cerebrospinal fluid (CSF) leak.

` may indicate a subdural hematoma..

` The halo sign ishighly suggestive of a cerebrospinal fluid(CSF) leak.

` ishighly suggestive of a cerebral contusion.` The halo sign ishighly suggestive of a cerebrospinal fluid

(CSF) leak.

` normally occurs within 24hours following a basal skullfracture.

` The halo sign ishighly suggestive of a cerebrospinal fluid(CSF) leak.


71/71

di d (t ) 2008

` DIANNE MAYDEE MANDAL RN, USRN, REMT-B, AREMT-B

` http://stuffednurse.blogspot.com

` [email protected]

` [email protected]

`

Note: this is a copy of my supplemental reviewslides of 2008, I do not use this during my actual

lecture

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