Week 7: EENT Flashcards
Which nerves innervates and controls motor activities of eye?
Eye: Occulomotor CN III
Trochlear CN IV
Abducens CN VI
Optic CN II
Face: Trigeminal CN V
Facial nerve CN VIII
EENT assessment
Involves Inspection and Palpation of systems
Acute Assessment
- Eye injuries
- Acute eye assessment
- Rapid assessment
- Immeidate assessment: penetrating injury, orbital bone fracture, loss of vision.
- Foreign boides, blood lacerations, visual acuity
Subjective Data Collection
History of past medical diagosis
Screening
Family History of eyes
Meds/allergies
Changes in emotional coping
Risk factors dieases: diebetic, hypertension, smoking, obeisty, stress, inactivity
Immunizations and safety
Eye Assessment
- PQRSTUV
- Redness, swelling
- Vision issues
- DIscharge, pain
- Light sensitive
- ADL’s
Objective EENT Assessment
I-P
- Prepare pt comfort and dignity
- Wear gloves if signs for infection, clean equipment, assess infected eyes last.
- Accomodations
- Test for visual fields
- Static confrontation and kinetic confrontation
1. Assessment of visual acuity: Distance, near, peripheral and color vison
2. Extra ocular movements: Conreal light relfex, cover test, cardinal direction
–> Assessments of the eyes provides data about CNS as well
Components to Eye Assessment
- General Survey: physical apperance, body structure, mobility, behavior
- Inspection: Distribution of brows, symmetry of eye position, palerbal fissures, skin, spont. blinking
- Cornea: inspcted using light aimed at eyes both nasally and temporally. Note clarity and transluence.
- Inspect lacrimal appratus
- Genelty life eyelids ask to look down note color and swelling
- Sclear ( white) and conjuctiva
- Iris color distrubution
- Pupils ( Perrla: round regualr reactive equal 3-5mm - Palpation: gently palpate lacrminal sacs, eyelids, eyeballs for tender or swelling.
Visual Acuity
Distance, peripheral, near, color
- Snellen Charts
- Visual Acuity test
- 20 feet awat at eye level
- Cover one eye and leave lens on
- Normal visionn: 20/20
- Read largest to smallest 20/15 means can read something at 20 feet what most could read at 15ft
- Snellen chart assess for distant vision
- Near vision
- For pt older than 40
–> Using a screener instruct pt to hold card from eye , test each eye with glassess on Normal range is 14/14 each eye - Colored bars
- Ishihara Chart ( color vision)
- Jager pocket screener
- Viusal Fields
- Eveyrthing that is visble when eye focused on object
- Confrontation Test: inferior, sup., temporal, nasal
–> Static Confrontation: arm away, eye level–> cover pt l eye and close my right eye. pt looks at your opened eye. Show fingers in eac quadrant testing periphery
–> Kinetic Confrontation: wiggling fingers from pt and move towards the center of each quadrant.
Expectation: is pt sees objects as you do, idenifies how many without direct look.
- Extraoccular Eye Movement
- Corneal light, cover test, cardinal directions
1. Corneal Light Test: tests for any strabisum - Note pupillary response to light and accomodation
- Check where light reflects on cornea shine light on pt nose
- Note symmetry
2. Cover Test: gaze should remain steady and fixed. Ask pt to focus on nose, cover one eye and inspect for any gaze.
3. Cardinal Directions: Assessing for symmetrical movements of the eye. Extraoccualr muscle functions - Pt hold head steady and follow finger with eyes
- Focus on 6 directions to follow eyes
- Parallel eye tracking of the object
Occular Abnormalities
- Nystagmus: fined oscilating movement on iris
- Anisocoria: different size of pupils
-Myopia ( nearsightedness) - Hyperopia: Farsighted ness
- Presbyopia: decreased ability to focus near
- Astiagmatsim: blurred vision
- Macular Degeneration: breakdown of cells in retinal macula, loss central focus
- Cataracts: less opiacty
- Glaucoma: increased intraocular pressure, damage to peripheral vision
- Diabetic retinopathy: retina vessle damage
Perrla Assessment
Assessment for CN III
- Pupils Equal, round 2-5mm, reactive to direct and consensual, light and accomodation
- Accomodation: Far vison pupils should dialte and closer pupils constrict.
- Bring distant object closer after 30s holding still
Older Adult Considerations
- Loss of elatsicity
- Loss fat
-Conjuctiva thinning
Lens - Poor accomodation
Cultural Considerations
- Palperbal fissures
- Sclera colors
- Snellen
Occular Health Promotion
- Diabeteic control
- Eye protection
- Nutrition
- Vision check ups
- Primary, secondary, teritary
Ears
External ear: Ends at TM and functions to guide sound into meatus
Middle Ear: TM-Eustachain tubes- funnels sound into the inner ear. The eutachain tubes are crucial for pressure regulation of middle ear and equalize pressure,
Inner Ear: translates sound to CN VIII and balance
Hearing Issues
- Conductive Loss: caused by impacted cerumen (earwax) , peforated ear drum in middle ear.
- Senosineural loss: also known as perceptive hearing loss is a gradual nerve degeneration presbycusis , middle/inner cortex.
- Tinnitus: rining/buzzing in ears
- Cerumen ( earwax)
Conducting a Acute Assessment On Ears
Note any foreign objects, drainage, ear trama. Assessment preparation: penlight, gloves, fork
Inspection and palption of ears and involves some common or more advanced techniques.
1. Inspection
2. Palpation
3. Hearing tests ( whisper, rinne, weber)
Subjective Ear Assessment
- Personal history
- Medications
- Family
- Allergies
- Protection from loud noises and sun
- Aids
- Infections, trama
- Hearing aids
- Screening
- Self-care
- Dizzyness
- Tinnitus/Ear rinning
- Dischrage
–> Note signs of hearing loss such as leaning foward, lip reading, loud voice, repetive
Objective IPP Assessment
- Whisper test
- Rinne test
- Weber
- Otoscope examiantion
- OPQRSTUV Pain
Ear Inspection
Inspection: Observe for position, symmetry
- Top ear line with outer eye canthus
- Lesions, drainage, redness
- Behind ear
- Inspect opening of ear canal, note discharge and redness
Ear Palpation
Palpate external ear and tragus, palpate mastoid process behind ear note tenderness and lumps
