Week 7 Flashcards
Systematic approach for EENT
General survey and vital signs
-physical appearance
-body structure
-mobility
-behaviours
-across the room look
Subjective data
-open ended questions
-focused questions
-what the pt tells you
Objective Data
-inspection
-Palpation
-percussion
-auscultation
-ippa
Subjective data EENT
-past medical hx
-screening
-family hx: disorders of the eye
-meds
-allergies
-changes in emotional response or coping strategies; personality change
Risk factors for eye diseases
-diabetes, hypertension, smoking, obesity, immunizations, safety: eye protection
Subjective data: Eyes
-headache
-dizziness, syncope (fainting)
-tremors
-seizures
-weakness
-incoordination, involuntary movements
-numbness/tingling
-difficulty swallowing
-change in senses (taste, smell, sensation, hearing)
-vision changes
-changes with concentration, memory, attention
Equipment needed for a physical examination
-strong direct lighting
-small centimetre ruler
-penlight
-tuning fork +/-
-otoscope
-penlight
-tongue blades
-scents
Inspection of the eyes
Symmetry and shape
- brows, lashes, lids, skin
Lacrimal Apparatus
-swelling or tenderness
Spontaneous blinking
Sclera
-smooth, white
Iris
-colour distribution
Discharge
Considerations for the older adult: eyes
- Droop eyelids; eyes sit deeper
-thinner, coarser brows
-smaller pupils and slower pupillary response
-conjunctivae thinner and may appear yellowish
-decrease tearing and visual activity
-decrease accommodation
-decrease night vision and depth perception
-decrease lens transparency - +/- floaters
Common vision concerns related to aging
Macular degeneration
-breakdown of cells in macular of retina; loss of central vision. Lateral vision is unaffected
Cataracts
- lens opacity
Glaucoma
-results from increased intraocular pressure causes damage to the optic nerve and gradual loss of peripheral vision
Diabetic retinopathy
- damage to retinas blood vessels
Subjective data: ears
- headache
-dizziness, syncope (fainting) - tremors
-seizures
-weakness
-incoordination, involuntary movements
-numbness/tingling
-difficulty swallowing
-change in senses (taste, smell, sensation, hearing)
-vision changes
-changes in speech
-changes with concentration, memory, attention
Physical Ear Assessment
-observe for shape, position, and symmetry
-inspect and expect skin tone of face and ears to be uniform
-inspect for lesions, drainage, or redness
-inspect the opening of the ear canal, noting discharge, redness or odour
-palpate and manipulate the external ear and Tagus
-notice any palpable lymph nodes
-palpate behind the ear for lump and tenderness
What is the whisper test
-Evaluates for loss of high frequency sounds
-client plugs the opposite ear
-whisper a two-syllable word 30-40 cm away from the patient and ensure no lip reading
-have the pt repeat the word they hear
-repeat for the opposite ear
What is the webers test
Tests for sensorineural vs conductive hearing loss
- strike the fork then place the base of the fork in the midline high on the pt forehead
-it is important to steady the pt head with your other hand so that reasonably firm pressure can be applied
-then ask the pt “do you hear the sound louder in one ear than the other”
-If so which ear is it louder
Considerations for the older adult: ears
-ears more prominent
-hairs present at meatus
-cilia become coarse and stiff
-decreased hearing
-increased cerumen and drier; leading to impaction (conductive hearing loss)
-presbycusis
-delayed electrical responses
Subjective Data: mouth nose and throat
-Hx of sinusitis, tonsillitis
-family hx
-protection for environmental exposure
-smoking, inhaled drugs, alcohol
-self-care behaviours
- brushing/floss/dentures
-medications: side effects; effects on EENT
(Chronic use of decongestant sprays)
-allergies: nose is common target for inflammatory response
-tobacco use (smoked or smokeless)
-dental care and screening
Objective data: Nose and sinus
-test latency of nostrils
-sense of smell
-view nasal cavities (how should they look?) use a penlight to illuminate
-assess location of septum
-assess any drainage (colour, amount, consistency)
-Palpate for tenderness, lumps, and contour
Abnormal: nose, mouth, throat
-dental caries
-gingivitis
-toothache
-snoring/ sleep apnea
-nasal congestion or discharge
-rhinitis
-epistaxsis
-halitosis
-sore throat
-dysphasia
-voice changes
-oral lesions
-altered smell or taste
-Dry mouth
Objective data: mouth and throat
Lips and Buccal mucosa
-colour, moisture, integrity
Teeth and gingiva
-note breath
Tongue
-texture, colour, movement-cranial nerve
Hard and soft palates and uvula
-AHH-cranial nerve s
Pharynx and tonsils
Observe for signs of difficulty swallowing-gently palpate clients neck during swallow
Palpate lymph nodes
Considerations for older adults: nose and mouth
- coarse nasal hairs (do not filter as well)
- diminished smell and taste
- dental changes
-rhinorhea
-decreased saliva
-teeth and nose appear larger (loss of subcutaneous tissue) - tooth loss and receding gums
Subjective data: skin, hair and nails
- previous history of skin disease (allergies, hives, psoriasis, or eczema)
- changes in pigmentation
-changes in mole (size or colour)
-excessive dryness or moisture
-pruritus
-excessive bruising
-rash or lesion
-medications
-hair loss
-change in nails
-environmental or occupational hazards
-self care behaviours
Objective Data: Skin
Colour
-general pigmentation
-widespread colour change (pallor, erythema, cyanosis, jaundice)
Temperature
-hypothermia/hyperthermia
Moisture
-diaphoresis/dehyrations
Texture and thickness
Edema
Mobility and turgor
Vascularity or bruising
Lesions
-colour and pattern
-elevation
-shape and size
-location and distribution
-exudate
Self examination for moles (ABCDE)
A: Asymmetry
B: Border
C: Color
D: Diameter
E: Evolving
Considerations for older adults: skin
- skin changes
-delay in wound healing
-skin pain
-foot/nail changes
-falling
-diabetes or cardiovascular disease
-skin care
Objective data: hair and nails
Hair
-texture
-distribution
-lesions on scalp
Nails
-shape and contour
-consistency
-colour
-capillary refill
Pressure sores
Appear on the skin over a bony prominence when circulation impaired (confined to bed. Immobilized)
Risk factors
-impaired mobility, thin fragile skin of aging, decreased sensory perception, impaired level of consciousness, moisture from urine or stool incontinence, excessive perspiration or wound drainage, shearing injury, poor nutrition and infection
