Ears, Nose, Mouth
-
Upload
euscelle-grace-limen -
Category
Documents
-
view
230 -
download
0
Transcript of Ears, Nose, Mouth
-
7/31/2019 Ears, Nose, Mouth
1/45
-
7/31/2019 Ears, Nose, Mouth
2/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Ears and Hearing
Assessment of the ear includes:
Inspection and palpation of the external ear
Inspection of the remaining parts of the ear byan otoscope, and
Determination of auditory acuity
Ears usually assessed during initialphysical examination
-
7/31/2019 Ears, Nose, Mouth
3/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Parts of the Ear
Divided into 3 parts:
-
7/31/2019 Ears, Nose, Mouth
4/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
External Ear Canal
Curved, about 2.5cm (1 inch) long(adult) and ends @ the tympanic
membraneCovered w/ skin, w/ fine hairs, glandand nerve endings
Glands secrete cerumen lubricatesand protects ear canal
Infant and toddler upward curvatureBy age 3 more downward curvature
-
7/31/2019 Ears, Nose, Mouth
5/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Middle Ear
Air-filled cavityContains 3 ossicles (bones of soundconduction):
Malleus (hammer)
Incus (anvil)
Stapes (stirrups)
Eustachian tube stabilizes air pressurebet. external atmosphere and themiddle ear
preventing rupture of tympanic membrane anddiscomfort produced by marked pressuredifference
-
7/31/2019 Ears, Nose, Mouth
6/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Inner Ear
Cochlea
Seashell-shaped structure
Essential for sound transmission and hearing
Vestibule and semicircular canals contains organs of equilibrium
-
7/31/2019 Ears, Nose, Mouth
7/45
Dyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA N
ears and hearing
Chapter 30Chapter 30Chapter 30Chapter 30
(pp. 594(pp. 594(pp. 594(pp. 594 598)598)598)598)
-
7/31/2019 Ears, Nose, Mouth
8/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Sound Transmission
Sound transmission and hearing arecomplex processes
Sound can be transmitted by airconduction or bone conduction.
Air-conducted transmission occurs bythis process:
-
7/31/2019 Ears, Nose, Mouth
9/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Air-conducted transmission occurs bythis process:
A sound stimulusenters the externalcanal and reaches
the tympanicmembrane Sound waves vibratethe tympanic
membrane
reachthe ossicles Opening inner ear(oval window)
Cochlea receives thesound vibrations Stimulus travels auditory nerve (8th
cv) and the cerebralcortex
-
7/31/2019 Ears, Nose, Mouth
10/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Bone-conducted sound transmission
Occurs when skull bones transport thesound directly to the auditory nerve
-
7/31/2019 Ears, Nose, Mouth
11/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Common Hearing Deficit w/ Age
Audiometric evaluations w/c measurehearing @ various decibels
recommended for children and eldersLoss of ability to hear high-frequencysounds such as f, s, sh, and ph
Neurosensory hearing deficit
does not respond well to use of hearing aid
-
7/31/2019 Ears, Nose, Mouth
12/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Common Hearing Deficit w/ Age
Conduction hearing loss
the result of interrupted transmission of sound
waves thru the outer and middle ear structuresCauses: tear in the tympanic membrane or an
obstruction due to swelling or other causes
Sensorineural hearing lossResult of damage to the inner ear, the auditory
nerve, or the hearing center in the brain
Mixed hearing loss
combination
-
7/31/2019 Ears, Nose, Mouth
13/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Assessing the Auricles
Inspect for color, symmetry of size, andposition
Position note the level @ w/c the superioraspect of the auricles attaches to the head inrelation to the eye
N: color same as facial skin; symmetrical;
aligned w/ outer canthus of eye (10 fromvertical)
D: earlobes bluish color; pallor (frostbite);
excessive redness (inflammation/fever); lowset ears (assoc. w/ cong. anomaly, such asDown syndrome
-
7/31/2019 Ears, Nose, Mouth
14/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Assessing the Auricles
Palpate for texture, elasticity, areas oftenderness
Gently pull auricle upward, downward, and backward
fold pinna forward (it shd. recoil)
push in on the tragus
Apply pressure to the mastoid process
N: mobile, firm, and not tender; pinnarecoils after it is folded
D: lesions (cysts); flaky, scaly skin(seborrhea); tenderness when moved orpressed (inflammation or infection of
external ear)
-
7/31/2019 Ears, Nose, Mouth
15/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
External Ear Canal and Tympanic Membrane
Using an otoscope, inspect external earcanal for cerumen, skin lesions, pus,
and bloodAdult: straighten ear canal by pulling the pinna
up and back (superior, posterior)
Children: down and back (inferior, posterior)
Inspect the tympanic membrane forcolor and gloss.
-
7/31/2019 Ears, Nose, Mouth
16/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Inserting an otoscopeInserting an otoscopeInserting an otoscopeInserting an otoscope Inserting an otoscopeInserting an otoscopeInserting an otoscopeInserting an otoscope
Normal TympanicNormal TympanicNormal TympanicNormal Tympanic
membranemembranemembranemembrane
-
7/31/2019 Ears, Nose, Mouth
17/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Gross Hearing Acuity Tests
Watch Tick testTicking of a watch has a higher pitch than thehuman voice
Tuning Fork TestsWebers test to assess bone conduction by
examining the lateralization (sidewardtransmission) of soundsN: sound heard on both ears or localized @ thecenter of the head = Weber (-)
D: sound is better heard in Impaired ear (boneconductive hearing loss); heard better in ear w/oproblem (sensorineural disturbance) = Weber (+)
-
7/31/2019 Ears, Nose, Mouth
18/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Gross Hearing Acuity Tests
Rinne test to compare air conductionto bone conduction
Normal: Air-conducted (AC) hearing is greaterthan bone-conducted (BC) hearing
AC > BC = (+)Rinne
Deviation: bone-conduction time is equal to orlonger than air-conduction time
BC > AC or
BC = AC(-)Rinne - indicates a conductivehearing loss
-
7/31/2019 Ears, Nose, Mouth
19/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Gross Hearing Acuity Tests
Whisper test
Accurate phrase identification
Client should be able to repeat the phrasescorrectly
Romberg test
Done to detect balance and equilibrium
-
7/31/2019 Ears, Nose, Mouth
20/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Lifespan Considerations
Infants
To assess gross hearing ring a bell from
behind the infant or have the parent call thechilds name to check for a response
Newborns will quiet to the sound and may open
eyes wider3 4 mos. will turn head and eyes toward the
sound
-
7/31/2019 Ears, Nose, Mouth
21/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Children
To inspect ext. canal and tympanicmembrane -
-
7/31/2019 Ears, Nose, Mouth
22/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Elders
Pinna es in width and length; earlobeelongates
Sensorineural hearing loss occursGeneralized hearing loss (prebycusis) occursin all frequencies
1st
Sx: loss of high-frequency sounds(f, s, sh, ph)
-
7/31/2019 Ears, Nose, Mouth
23/45
Dyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA N
Nose andSinuses
Chapter 30Chapter 30Chapter 30Chapter 30
(pp. 600(pp. 600(pp. 600(pp. 600 601)601)601)601)
-
7/31/2019 Ears, Nose, Mouth
24/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Nose and Sinuses
Inspect nasal passagesw/ flashlight
Nasal speculum and a penlight or an
otoscope w/ a nasal attachmentfacilitates examination of the nasalcavity
Assessment includes:Inspection and palpation of the external nose(upper 1/3 of the nose is bone; remainder is
cartilage)Patency of the nasal cavities; and
Inspection of nasal cavities
-
7/31/2019 Ears, Nose, Mouth
25/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Inspection and examination
-
7/31/2019 Ears, Nose, Mouth
26/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Assessment
If client reports difficulty orabnormality in smell, nurse may test
clients olfactory sense by asking clientto identify common odors such ascoffee or mint
Done by asking client to close eyes and placingvials containing the scent under clients nose
-
7/31/2019 Ears, Nose, Mouth
27/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Assessing the Nose and Sinuses
Inspect external nose for any deviations inshape, size, or color and flaring or dischargefrom nares
Lightly palpate to det. any areas of tenderness,masses, displacement of bone and cartilage
Det. patency of both nasal cavitiesClose mouth, exert pressure on one naris and breathe thruthe opposite naris; repeat
Inspect nasal cavities using flashlight or nasalspeculum
Observe for presence of redness, swelling,growths, discharges
Inspect nasal septum bet. nasal chambers
-
7/31/2019 Ears, Nose, Mouth
28/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Lifespan Considerations
Infants
Speculum usually not necessary
Ethmoid and maxillary sinuses present @birth
Frontal sinuses begin to develop by 1 2
years of ageSphenoid sinuses develop later
Have fewer sinus problem than older children
and adolescents
-
7/31/2019 Ears, Nose, Mouth
29/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Lifespan Considerations
Children
Speculum not necessary cause child to be
apprehensiveEthmoid sinuses develop by age 6
Pre-adolescent cough and runny nose
common signs of sinusitisAdolescents may have headaches, facial
tenderness, and swelling (similar signs to adults)
-
7/31/2019 Ears, Nose, Mouth
30/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Lifespan Considerations
Elders
Sense of smell markedly diminishes - in the
no. of olfactory nerve fiber and atrophy ofremaining fibers
Less able to identify and discriminate odors
Nosebleeds may result from hypertensivedse. Or other arterial vessel changes
-
7/31/2019 Ears, Nose, Mouth
31/45
Dyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA N
Mouth andOropharynx
Chapter 30Chapter 30Chapter 30Chapter 30
(pp. 601(pp. 601(pp. 601(pp. 601 605)605)605)605)
-
7/31/2019 Ears, Nose, Mouth
32/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Structures of the Mouth and Oropharynx
LipsInner and buccalmucosa
Tongue and thefloor of the mouthTeeth and gums
Hard and softpalateUvulaSalivary glands
Tonsillar pillarstonsils
-
7/31/2019 Ears, Nose, Mouth
33/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Problems affecting the Teeth
Dental Caries (cavities)Periodontal dse. (pyorrhea)
Plaqueinvisible soft film that adheres to the enamelsurface of the teeth; consists of bacteria,molecules of saliva, remnants of epithelial cells
and leukocytes
Tartar (dental calculus)Visible, hard deposit of plaque and deadbacteria that forms @ the gum lines
Can alter the fibers that attach the teeth to thegum and eventually disrupt bone tissue
-
7/31/2019 Ears, Nose, Mouth
34/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Problems affecting the Teeth
Pl
-
7/31/2019 Ears, Nose, Mouth
35/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Plaque
P bl ff i h T h
-
7/31/2019 Ears, Nose, Mouth
36/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Problems affecting the Teeth
P i d t l di ( h )
-
7/31/2019 Ears, Nose, Mouth
37/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Periodontal disease (pyorrhea)
P i d t l d
-
7/31/2019 Ears, Nose, Mouth
38/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Periodontal dse.
P i d t l Di
-
7/31/2019 Ears, Nose, Mouth
39/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Periodontal Disease
GingivitisRed, swollen gingiva (gums)
Bleeding, receding gum lines, and
Formation of pockets bet. teeth and gums
Advanced periodontal dse. teeth are
loose and pus evident when gums arepressed
-
7/31/2019 Ears, Nose, Mouth
40/45
Other problems:
-
7/31/2019 Ears, Nose, Mouth
41/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Other problems:
Other deviations:
-
7/31/2019 Ears, Nose, Mouth
42/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Other deviations:
TonsillitisTonsillitisTonsillitisTonsillitis
Bifid uvulaBifid uvulaBifid uvulaBifid uvula
Other deviations
-
7/31/2019 Ears, Nose, Mouth
43/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Other deviations
Cleft lip andCleft lip andCleft lip andCleft lip and
PalatePalatePalatePalate
Dentures
-
7/31/2019 Ears, Nose, Mouth
44/45
D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN
Dentures
Video Presentation
-
7/31/2019 Ears, Nose, Mouth
45/45
D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN
Video Presentation