NurseReview.Org - Ears Nose Throat Mouth Nursing Lecture

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Information about NurseReview.Org - Ears Nose Throat Mouth Nursing Lecture

Published on April 15, 2008

Author: nclexvideos

Source: slideshare.net

Description

http://NurseReview.Org for more animation and slides.

Ears, Nose, Mouth, Throat

Ears

Summary of any symptom should include PQRSTU P= provocative or palliative Q= quality or quantity R= region or radiation S= severity scale T= timing (onset, duration, frequency) U= understand client’s perception

P= provocative or palliative

Q= quality or quantity

R= region or radiation

S= severity scale

T= timing (onset, duration, frequency)

U= understand client’s perception

Anatomy The ear is responsible for hearing and balance Consists of 3 regions External ear Middle ear Inner ear

The ear is responsible for hearing and balance

Consists of 3 regions

External ear

Middle ear

Inner ear

Structure and Function External Ear – auricle/pinna movable cartilage and skin Mastoid process= important Landmark External Auditory Canal – the opening in the external ear; cul-de-sac 2.5 to 3 cm. Long in adult and ends at the eardrum. Lined with glands that secrete cerumen

External Ear – auricle/pinna

movable cartilage and skin

Mastoid process= important Landmark

External Auditory Canal – the opening in the external ear; cul-de-sac 2.5 to 3 cm. Long in adult and ends at the eardrum.

Lined with glands that secrete cerumen

 

 

 

External Ear 2 types of cerumen Whites and blacks – wet, sticky, and honey colored Asians and Native Americans – dry and flaky Lubricates & protects Moves to meatus with chewing & talking Outer 1/3 of canal is cartilage, inner 2/3 consists of bone covered with skin

2 types of cerumen

Whites and blacks – wet, sticky, and honey colored

Asians and Native Americans – dry and flaky

Lubricates & protects

Moves to meatus with chewing & talking

Outer 1/3 of canal is cartilage, inner 2/3 consists of bone covered with skin

 

External Ear Tympanic membrane (eardrum) separates external and middle ear. Translucent membrane Pearly, gray color Cone of light reflection when using otoscope Oval and slightly concave shape, pulled in at center by malleus

Tympanic membrane (eardrum) separates external and middle ear.

Translucent membrane

Pearly, gray color

Cone of light reflection when using otoscope

Oval and slightly concave shape, pulled in at center by malleus

 

External Ear Malleus (hammer) – one of the middle ear ossicles 3 parts Umbo, manubrium short process, may show through the drum Lymphatic drainage of the external ear flows into Parotid, mastoid, superficial cervical nodes

Malleus (hammer) – one of the middle ear ossicles

3 parts

Umbo, manubrium short process, may show through the drum

Lymphatic drainage of the external ear flows into

Parotid, mastoid, superficial cervical nodes

Middle ear Tiny air–filled cavity in the temporal bone contains: Auditory ossicles (bones) Malleus Incus Stapes Openings to Outer ear covered by tympanic membrane Inner ear = oval and round windows Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)

Tiny air–filled cavity in the temporal bone contains:

Auditory ossicles (bones)

Malleus

Incus

Stapes

Openings to

Outer ear covered by tympanic membrane

Inner ear = oval and round windows

Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)

Middle ear has 3 functions Conducts sound vibration from outer ear to inner ear Protects the inner ear by reducing the amplitude of loud sounds Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes)

Conducts sound vibration from outer ear to inner ear

Protects the inner ear by reducing the amplitude of loud sounds

Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes)

Inner Ear Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium Vestibule Semicircular canals Cochlea (contains the central hearing apparatus)

Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium

Vestibule

Semicircular canals

Cochlea (contains the central hearing apparatus)

Function of hearing 3 levels Peripheral – ear transmits sound and converts its vibrations into electrical impulses that can be analyzed by the brain. The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem Amplitude=loudness Frequency=pitch

3 levels

Peripheral – ear transmits sound and converts its vibrations into electrical impulses that can be analyzed by the brain. The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem

Amplitude=loudness

Frequency=pitch

Sound waves cause the eardrum to vibrate Vibrations travel via the ossicles thru the oval window, the cochlea and are scattered against the round window The basilar membrane of the cochlea contain the organ of Corti receptor hair cells that translate the vibrations to electric impulses The impulses go to the brainstem via Acoustic nerve (VIII)

Sound waves cause the eardrum to vibrate

Vibrations travel via the ossicles thru the oval window, the cochlea and are scattered against the round window

The basilar membrane of the cochlea contain the organ of Corti receptor hair cells that translate the vibrations to electric impulses

The impulses go to the brainstem via Acoustic nerve (VIII)

Brain stem – function is binaural interaction – permits identification of sound and locating the direction of a sound in space. The acoustic nerve (Cranial nerve VIII) sends signals from each ear to both sides of the brain stem. Brainstem is sensitive to intensity & timing from the ears depending on head position

Brain stem – function is binaural interaction – permits identification of sound and locating the direction of a sound in space. The acoustic nerve (Cranial nerve VIII) sends signals from each ear to both sides of the brain stem. Brainstem is sensitive to intensity & timing from the ears depending on head position

Cerebral cortex – interprets the meaning of the sound and begins the appropriate response

Cerebral cortex – interprets the meaning of the sound and begins the appropriate response

Pathways of hearing Air conduction (AC)– normal pathway of hearing, the most efficient Bone conduction (BC)– bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve

Air conduction (AC)– normal pathway of hearing, the most efficient

Bone conduction (BC)– bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve

 

Hearing loss Conductive – mechanical dysfunction of the external or middle ear resulting in partial hearing loss (if ↑ amplitude to reach nerve elements in inner ear, person can hear) Causes= impacted cerumen, FB, perforated eardrum, pus/bld in the middle ear, otosclerosis

Conductive – mechanical dysfunction of the external or middle ear resulting in partial hearing loss (if ↑ amplitude to reach nerve elements in inner ear, person can hear)

Causes= impacted cerumen, FB, perforated eardrum, pus/bld in the middle ear, otosclerosis

Hearing loss Sensorineural ( perceptive) – pathology of the inner ear, acoustic nerve or auditory areas of the cerebral cortex. ↑ amplitude may not help Causes= Presbycusis, a nerve degeneration due to aging (50yrs) or ototoxic drugs Equilibrium – labyrinth feeds info to the brain about the body’s position in space, inflammation causes vertigo.

Sensorineural ( perceptive) – pathology of the inner ear, acoustic nerve or auditory areas of the cerebral cortex. ↑ amplitude may not help

Causes= Presbycusis, a nerve degeneration due to aging (50yrs) or ototoxic drugs

Equilibrium – labyrinth feeds info to the brain about the body’s position in space, inflammation causes vertigo.

Subjective data Earaches Infections- otitis media Discharge Hearing loss Environmental noise Tinnitus- ototoxic: ASA, Aminoglycosides (gentamicin) etc. Vertigo Self care behaviors

Earaches

Infections- otitis media

Discharge

Hearing loss

Environmental noise

Tinnitus- ototoxic: ASA, Aminoglycosides (gentamicin) etc.

Vertigo

Self care behaviors

Objective data External ear = Inspect and Palpate Size and shape Skin condition Tenderness- pinna & tragus; mastoid process External auditory meatus- cerumen

External ear = Inspect and Palpate

Size and shape

Skin condition

Tenderness- pinna & tragus; mastoid process

External auditory meatus- cerumen

Inspect using Otoscope Pull pinna up & back for adult/older child Pinna down for infant & ↓ 3yrs. Maintain hold on pinna until exam is complete. Avoid inner, bony section of canal= sensitive to pain Can angle otoscope towards nose

Pull pinna up & back for adult/older child

Pinna down for infant & ↓ 3yrs. Maintain hold on pinna until exam is complete.

Avoid inner, bony section of canal= sensitive to pain

Can angle otoscope towards nose

Inspect using Otoscope External canal Color Swelling Lesions Discharge ; color and odor. Clean or change speculum before examining other ear.

External canal

Color

Swelling

Lesions

Discharge ; color and odor. Clean or change speculum before examining other ear.

 

Perform the otoscope exam prior to hearing tests.

Perform the otoscope exam prior to hearing tests.

The following slide show a furuncle which is an infected hair follicle

The following slide show a furuncle which is an infected hair follicle

 

Tympanic membrane Color – normal is shiny, translucent, pearl-grey Characteristics – landmarks; umbro, manubrium, and short process Position – flat, slightly pulled in at the center and flutters when person holds nose and swallows Integrity of membrane – intact? Scarring = dense white patch

Color – normal is shiny, translucent, pearl-grey

Characteristics – landmarks; umbro, manubrium, and short process

Position – flat, slightly pulled in at the center and flutters when person holds nose and swallows

Integrity of membrane – intact? Scarring = dense white patch

Hearing tests Begins with the history-Conversational tone The following tests may indicate the presence of hearing loss but not the degree.

Begins with the history-Conversational tone

The following tests may indicate the presence of hearing loss but not the degree.

Hearing tests Voice– place a finger on the tragus of one ear and while rapidly pushing it in and out of the meatus, place your head 1 –2 feet from your client’s other ear, shield your lips and whisper a 2 syllable word. Repeat on the opposite ear using another word, have the client identify the words (Used to detect high-tone loss)

Voice– place a finger on the tragus of one ear and while rapidly pushing it in and out of the meatus, place your head 1 –2 feet from your client’s other ear, shield your lips and whisper a 2 syllable word. Repeat on the opposite ear using another word, have the client identify the words (Used to detect high-tone loss)

Normal Response to Voice test Correct identification of whispered words bilaterally

Normal Response to Voice test

Correct identification of whispered words bilaterally

Tuning fork tests- measure hearing by AC and BC To activate the tuning fork, hold it by the stem and strike the tines softly on the back of the hand Weber test – used when hearing is reported as better in one ear than other (bone conduction)

Tuning fork tests- measure hearing by AC and BC

To activate the tuning fork, hold it by the stem and strike the tines softly on the back of the hand

Weber test – used when hearing is reported as better in one ear than other (bone conduction)

Normal finding for the Weber test is Tone heard = loud bilaterally If sound lateralizes to one ear it indicates conductive or sensorineural loss.

Normal finding for the Weber test is

Tone heard = loud bilaterally

If sound lateralizes to one ear it indicates conductive or sensorineural loss.

Rinne test – compares bone conduction and air conduction Normally sound is heard 2X as long by air conduction as by bone conduction Normal response ; positive Rinne Test = AC>BC Bilaterally Sound is heard longer by BC with a conductive loss.

Rinne test – compares bone conduction and air conduction

Normally sound is heard 2X as long by air conduction as by bone conduction

Normal response ; positive Rinne Test = AC>BC Bilaterally

Sound is heard longer by BC with a conductive loss.

Weber test Rinne test

Nose, Throat and Mouth

Nose First segment of the respiratory system Warms, moistens and filters inhaled air Sensory organ for smell

First segment of the respiratory system

Warms, moistens and filters inhaled air

Sensory organ for smell

External parts Bridge Tip Nares Vestibule -nares widen in to vestibule Columella divides the nares Ala –lateral outside wing of the nose bilaterally Upper 1/3 nose is bone; rest is cartilage

Bridge

Tip

Nares

Vestibule -nares widen in to vestibule

Columella divides the nares

Ala –lateral outside wing of the nose bilaterally

Upper 1/3 nose is bone; rest is cartilage

Internal Nasal cavity, extends back over the roof of the mouth Nasal hair, ciliated mucous membrane – red due to ↑ bld supply Septum-divides cavity into 2 passages

Nasal cavity, extends back over the roof of the mouth

Nasal hair, ciliated mucous membrane – red due to ↑ bld supply

Septum-divides cavity into 2 passages

Internal Superior, middle, inferior turbinates- 3 parallel bony projections on lateral walls of each cavity Meatus- cleft underlying each turbinate. The sinuses drain into the middle, tears from the nasolacrimal duct drain into the inferior

Superior, middle, inferior turbinates- 3 parallel bony projections on lateral walls of each cavity

Meatus- cleft underlying each turbinate. The sinuses drain into the middle, tears from the nasolacrimal duct drain into the inferior

 

Internal Olfactory receptors- in roof of the nasal cavity & upper part of septum. Merge into the olfactory nerve (I) goes to the temporal lobe of the brain

Olfactory receptors- in roof of the nasal cavity & upper part of septum. Merge into the olfactory nerve (I) goes to the temporal lobe of the brain

 

Foreign Body

 

Paranasal sinuses- air- filled pockets in the cranium Purpose ↓ wt. of the skull Serve as resonators for sound Provide mucous for the nasal cavity Sinus openings are narrow = susceptible to occlusion resulting in inflammation/sinusitis

Paranasal sinuses- air- filled pockets in the cranium

Purpose

↓ wt. of the skull

Serve as resonators for sound

Provide mucous for the nasal cavity

Sinus openings are narrow = susceptible to occlusion resulting in inflammation/sinusitis

Frontal sinuses Maxillary sinuses Ethnoid sinuses Sphenoid sinuses Frontal & Maxillary sinuses are accessible to examination

Frontal sinuses

Maxillary sinuses

Ethnoid sinuses

Sphenoid sinuses

Frontal & Maxillary sinuses are accessible to examination

 

 

Mouth First segment of the digestive system Airway for the respiratory system ORAL CAVITY Lips Palate Hard Soft Uvula – hangs down from the soft palate

First segment of the digestive system

Airway for the respiratory system

ORAL CAVITY

Lips

Palate

Hard

Soft

Uvula – hangs down from the soft palate

Cheeks- side walls of cavity Tongue Papillae- rough, bumpy elevations on dorsal Frenulum Taste buds Teeth – 32 permanent

Cheeks- side walls of cavity

Tongue

Papillae- rough, bumpy elevations on dorsal

Frenulum

Taste buds

Teeth – 32 permanent

 

Salivary glands Parotid- largest of the glands, located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa Submandibular- walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum Sublingual –smallest, almond shape, under tongue

Salivary glands

Parotid- largest of the glands, located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa

Submandibular- walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum

Sublingual –smallest, almond shape, under tongue

 

Throat Area behind the mouth & nose Oropharynx – separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars Tonsils – lymphoid tissue behind pillars

Area behind the mouth & nose

Oropharynx – separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars

Tonsils – lymphoid tissue behind pillars

Posterior pharyngeal wall located behind the tonsils Nasopharynx continues from the oropharynx but it is above it and behind the nasal cavity. It holds the adenoids and the eustachian tube openings.

Posterior pharyngeal wall located behind the tonsils

Nasopharynx continues from the oropharynx but it is above it and behind the nasal cavity. It holds the adenoids and the eustachian tube openings.

Subjective data Nose Discharge Frequent colds Sinus pain Trauma Epistaxis Allergies Altered smell

Discharge

Frequent colds

Sinus pain

Trauma

Epistaxis

Allergies

Altered smell

Subjective data Mouth and Nose Sores, lesions Sore throat Bleeding gums Toothache Hoarseness Dysphagia Altered taste

Sores, lesions

Sore throat

Bleeding gums

Toothache

Hoarseness

Dysphagia

Altered taste

Smoking Alcohol intake Self care behaviors

Smoking

Alcohol intake

Self care behaviors

Objective behavior Nose – Inspect and palpate INSPECT for: Symmetry, deformity Inflammation Skin lesions Color If injury – palpate gently

Nose – Inspect and palpate

INSPECT for:

Symmetry, deformity

Inflammation

Skin lesions

Color

If injury – palpate gently

Test for Patency Test for Sense of Smell – Cranial nerve I (olfactory)

Test for Patency

Test for Sense of Smell – Cranial nerve I (olfactory)

Inspect nasal cavity/ septum Deviated septum? Can see middle & inferior turbinates

Inspect nasal cavity/ septum

Deviated septum?

Can see middle & inferior turbinates

Inspect and palpate Paranasal Sinuses Press thumbs over frontal & maxillary sinuses Transillumination for sinus inflammation Frontal & Maxillary sinuses Darken room

Inspect and palpate Paranasal Sinuses

Press thumbs over frontal & maxillary sinuses

Transillumination for sinus inflammation

Frontal & Maxillary sinuses

Darken room

 

 

Mouth - Inspect Use gloves, tongue depressor, light Lips Teeth Gums Tongue Buccal mucosa –Stenson’s duct (parotid) Palate

Use gloves, tongue depressor, light

Lips

Teeth

Gums

Tongue

Buccal mucosa –Stenson’s duct (parotid)

Palate

 

 

Throat - Inspect Tonsils Grade size 1+ visible …………… .2+ ½ way b/t tonsillar pillars and uvula …………… .3+ touching the uvula …………… .4+ touching each other Posterior pharyngeal wall Gag reflex cranial nerves IX = glossopharyngeal and X = Vagus Cranial nerve XII = hypoglossal- stick out tongue Halitosis – Due to ????

Tonsils

Grade size 1+ visible

…………… .2+ ½ way b/t tonsillar pillars and uvula

…………… .3+ touching the uvula

…………… .4+ touching each other

Posterior pharyngeal wall

Gag reflex cranial nerves IX = glossopharyngeal and X = Vagus

Cranial nerve XII = hypoglossal- stick out tongue

Halitosis – Due to ????

 

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