Identify and Manage HEENT disorders.pptx

HEENT disorder

1. Identify and Manage HEENT disorders 1/9/2024 Ibrahim A(BsN) 1

2. Identify and Manage HEENT disorders Cataracts The eye's natural crystalline lens helps us focus on people and things at varying distances. Unfortunately, as we grow older this lens often stiffens and hardens, and without its youthful suppleness it loses its ability to focus, creating vision problems. 1/9/2024 Ibrahim A(BsN) 2

3. This condition — for most, a natural consequence of aging — is called presbyopia. As we age, these changes occurring to the natural crystalline lens can lead to the development of cataracts, or a loss in clarity of the lens. Since the lens is no longer as flexible or as clear as it used to be, the eye can't focus light properly. 1/9/2024 Ibrahim A(BsN) 3

4. Causes While cataracts can occur as a result of other eye diseases, they mostly develop naturally with age. In fact, by age 65, many of us will develop a cataract. There is other, less common causes of cataracts as well, including heredity, birth defects, chronic diseases such as diabetes, excessive use of steroid medications, and certain eye injuries. 1/9/2024 Ibrahim A(BsN) 4

5. Symptoms of Cataracts At first, symptoms may be undetectable or very slight. However, any noticeable change in vision may be cause for concern, and should be brought to the attention of an eye care professional. 1/9/2024 Ibrahim A(BsN) 5

6. Common symptoms of cataracts include: Cloudy or blurred vision Sensitivity to light and glare Frequent prescription changes for glasses or contact lenses Poor night vision Color vision changes and dimming Double vision in a single eye 1/9/2024 Ibrahim A(BsN) 6

7. Treatment for Cataracts While there is no way to prevent cataracts, there are things you can do to slow their formation. Modifiable factors that increase the risk of cataract include smoking, high blood pressure, obesity, and excessive alcohol intake. You may also slow the formation of cataracts by protecting your eyes from direct sunlight. 1/9/2024 Ibrahim A(BsN) 7

8. In the beginning stages of cataracts, vision may be slightly improved using forms of visual correction. However, in the later stages, surgery may be required. Fortunately, surgery has proven to be extremely successful in the removal of cataracts. During cataract surgery, your physician will replace your natural lens with an IOL. 1/9/2024 Ibrahim A(BsN) 8

9. Color Blindness Nearly all people who are “color blind” can see colors but have difficulty distinguishing between certain colors. Not all people who are color blind have trouble with the same colors – most cannot distinguish between reds and greens; some cannot separate blues from yellows; and a very small group have a condition called monochromatism which only allows them to see black and white. Color blindness of various kinds affects roughly 8% of men – and less than 1% of women. 1/9/2024 Ibrahim A(BsN) 9

10. What Causes Color Blindness? Color blindness is a genetic condition caused by a difference in how one or more of the light-sensitive cells found in the retina of the eye respond to certain colors. These cells, called cones, sense wavelengths of light, and enable the retina to distinguish between colors. This difference in sensitivity in one or more cones can make a person color blind. 1/9/2024 Ibrahim A(BsN) 10

11. Symptoms of Color Blindness The symptoms of color blindness are often observed by parents when children are young. In other cases, symptoms are so slight; they may not even be noticed. Common symptoms of color blindness include: Difficulty distinguishing between colors Inability to see shades or tones of the same color 1/9/2024 Ibrahim A(BsN) 11

12. Treatment for Color Blindness There is no known cure for color blindness. Contact lenses and glasses are available with filters to help color deficiencies, if needed. Fortunately, the vision of most color-blind people is normal in all other respects and certain adaptation methods are all that is required. 1/9/2024 Ibrahim A(BsN) 12

13. Crossed Eyes (Strabismus) Crossed eyes (or strabismus) occur when a person’s eyes are not able to align on the same point at the same time, and appear to be misaligned or pointed in different directions. Usually this results from weakness of the muscles in one or both eyes. The weak eye will turn away from the object that it is supposed to be focused on. 1/9/2024 Ibrahim A(BsN) 13

14. The eye that turns off-target may be the same in every incidence, or it could be a different eye at different times. A young child with strabismus will unconsciously reject the image of the improperly aligned eye and the related nerve connections between their eye and brain may fail to develop. This can lead to reduction in vision in the eye - known as amblyopia, or lazy eye . 1/9/2024 Ibrahim A(BsN) 14

15. Crossed eyes develop most often in babies. It is easier to correct when caught early. This is often not a condition babies or children simply outgrow so children with eyes that seem to be misaligned should be examined and treated if necessary. 1/9/2024 Ibrahim A(BsN) 15

16. Causes There are many different causes for crossed eyes and it does seem to run in families. In some cases, it may be caused by severe farsightedness that has been left untreated. Significant head trauma may also cause crossed eyes, as it can affect the portion of the brain that controls eye muscles. 1/9/2024 Ibrahim A(BsN) 16

17. Signs of Crossed Eyes The most obvious sign of crossed eyes is when the eyes appear to be pointed in different directions. There are, however, more signs of crossed eyes that can most often be observed in children, including: Eyes that do not move together Unsymmetrical points of reflection in each eye Tilting the head to one side Inability to gauge depth Squinting with only one eye 1/9/2024 Ibrahim A(BsN) 17

18. Treatments for Crossed Eyes In order to improve vision, the weakened muscles in the affected eye or eyes must be put to work. Several treatments may be used alone or in combination, depending on the type, severity, and cause of strabismus, including: Eyeglasses or contact lenses – this method may help people who have crossed eyes due to an uncorrected farsightedness 1/9/2024 Ibrahim A(BsN) 18

19. Medication (eye drops) – In some cases, as an alternative to patching, eye drops are used in the stronger (good) eye to temporarily blur the vision in the good eye. This forces use of the weaker eye. Surgery – straightens and realigns muscles in the eyes; this method has a high success rate although it is expensive and involves more risk than other options. Patching or covering the better-seeing eye – similar to eye drops, this method works to strengthen the weakened eye. 1/9/2024 Ibrahim A(BsN) 19

20. Glaucoma The term glaucoma is used to refer to a group of ocular conditions characterized by optic nerve damage. In the past, glaucoma was seen more as a condition of elevated intraocular pressure (IOP) than of optic neuropathy. Increasingly, that is no longer the case. There is no doubt that increased IOP damages the optic nerve and nerve fiber layer, but the degree of harm is highly variable. 1/9/2024 Ibrahim A(BsN) 20

21. The optic nerve damage is related to the IOP caused by congestion of aqueous humor in the eye. Most cases are asymptomatic until extensive and irreversible damage has occurred. 1/9/2024 Ibrahim A(BsN) 21

22. Glaucoma affects people of all ages but is more prevalent with increasing age (above 40 years). Others at risk are patients with diabetes, African Americans, those individuals with a family history of glaucoma, and people with previous eye trauma or surgery or those who have had long-term steroid treatment. There is no cure for glaucoma, but the disease can be controlled. 1/9/2024 Ibrahim A(BsN) 22

23. Classification of Glaucoma There are several types of glaucoma. Current clinical forms of glaucoma are identified as open-angle glaucoma, angle-closure glaucoma (also called pupillary block), congenital glaucoma, and glaucoma associated with other conditions. 1/9/2024 Ibrahim A(BsN) 23

24. Glaucoma can be primary or secondary, depending on whether associated factors contribute to the rise in IOP. The two common clinical forms of glaucoma encountered in adults are primary open angle glaucoma (POAG) and angle-closure glaucoma, which are differentiated by the mechanisms that cause impaired aqueous outflow. 1/9/2024 Ibrahim A(BsN) 24

25. Clinical Manifestations Most patients are unaware that they have the disease until they have experienced visual changes and vision loss. Symptoms may include blurred vision or “halos” around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache. Pallor and cupping of the optic nerve disc; as the optic nerve damage increases, visual perception in the area is lost. 1/9/2024 Ibrahim A(BsN) 25

26. Assessment and Diagnostic Methods Ocular and medical history (to investigate predisposing factors) Diagnostic tests include tonometry (measures IOP), ophthalmoscopy (to inspect the optic nerve), gonioscopy (to examine the filtration angle of the anterior chamber), and perimetry (visual fields assessment) are major diagnostic tests. 1/9/2024 Ibrahim A(BsN) 26

27. Medical Management The aim of all glaucoma treatment is prevention of optic nerve damage. Lifelong therapy is almost always necessary because glaucoma cannot be cured. Treatment focuses on pharmacologic therapy, laser procedures, surgery, or a combination of these approaches, all of which have potential complications and side effects. 1/9/2024 Ibrahim A(BsN) 27

28. The objective is to achieve the greatest benefit at the least risk, cost, and inconvenience to the patient. Although treatment cannot reverse optic nerve damage, further damage can be controlled. The goal is to maintain an IOP within a range unlikely to cause further damage. 1/9/2024 Ibrahim A(BsN) 28

29. Pharmacologic Therapy Medical management of glaucoma relies on systemic and topical ocular medications that lower IOP. Periodic follow-up examinations are essential to monitor IOP, the appearance of the optic nerve, the visual fields, and side effects of medications. 1/9/2024 Ibrahim A(BsN) 29

30. Therapy takes into account the patient’s health and stage of glaucoma. Patient is usually started on the lowest dose of topical medication and then advanced to increased concentrations until the desired IOP level is reached and maintained. 1/9/2024 Ibrahim A(BsN) 30

31. One eye is treated first, with the other eye used as a control in determining the efficacy of the medication. Several types of ocular medications are used to treat glaucoma, including miotic (medications that cause papillary constriction), adrenergic agonists (i.e., sympathomimetic agents), beta-blockers, alpha2-agonists (i.e., adrenergic agents), carbonic anhydrase inhibitors, and prostaglandins. 1/9/2024 Ibrahim A(BsN) 31

32. Surgical Management Laser trabeculoplasty or iridotomy indicated when IOP is inadequately controlled by medications. Filtering procedures : an opening or a fistula in the trabecular meshwork; trabeculectomy is standard technique. Drainage implant or shunt surgery may be performed. Trabectome surgery is reserved for patients in whom pharmacologic treatment and/or laser trabeculoplasty do not control the IOP sufficiently. 1/9/2024 Ibrahim A(BsN) 32

33. Nursing Management Create a teaching plan regarding the nature of the disease and the importance of strict adherence to the medication regimen to help ensure compliance. Review the patient’s medication program, particularly the interactions of glaucoma-control medications with other medications. 1/9/2024 Ibrahim A(BsN) 33

34. Explain effects of glaucoma-control medications on vision (e.g., miotics and sympathomimetics result in altered focus; Provide reassurance and emotional support. Integrate patient’s family into the plan of care, and because the disease has a familial tendency, encourage family members to undergo examinations at least once every 2 years to detect glaucoma early. 1/9/2024 Ibrahim A(BsN) 34

35. Otitis Acute otitis media is an acute infection of the middle ear, usually lasting less than 6 weeks. The pathogens that cause acute otitis media are usually Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1/9/2024 Ibrahim A(BsN) 35

36. which enter the middle ear after eustachian tube dysfunction caused by obstruction related to upper respiratory infections, inflammation of surrounding structures (e.g., rhinosinusitis, adenoid hypertrophy), or allergic reactions (e.g., allergic rhinitis 1/9/2024 Ibrahim A(BsN) 36

37. Clinical Manifestations Symptoms vary with the severity of the infection; usually unilateral in adults. Pain in and about the ear (otalgia) may be intense and relieved only after spontaneous perforation of the eardrum or after myringotomy. Fever; drainage from the ear, hearing loss. Tympanic membrane is erythematous and often bulging. Conductive hearing loss due to exudate in the middle ear. Even if the condition becomes subacute (3 weeks to 3 months) with purulent discharge, permanent hearing loss is rare. 1/9/2024 Ibrahim A(BsN) 37

38. Complications Perforation of the tympanic membrane may persist and develop into chronic otitis media. Secondary complications involve the mastoid (mastoiditis),meningitis, or brain abscess (rare). 1/9/2024 Ibrahim A(BsN) 38

39. Management With early and appropriate broad-spectrum antibiotic therapy, otitis media may clear with no serious sequelae. If drainage occurs, an antibiotic otic preparation may be prescribed. Outcome depends on efficacy of therapy (the prescribed dose of an oral antibiotic and the duration of therapy), the virulence of the bacteria, and the physical status of the patient. 1/9/2024 Ibrahim A(BsN) 39

40. Otitis Media, Chronic Chronic otitis media results from repeated episodes of acute otitis media, causing irreversible tissue pathology and persistent perforation of the tympanic membrane. Chronic infections of the middle ear cause damage to the tympanic membrane, can destroy the ossicles, and can involve the mastoid. 1/9/2024 Ibrahim A(BsN) 40

41. Clinical Manifestations Symptoms may be minimal, with varying degrees of hearing loss and a persistent or intermittent foul-smelling otorrhea (discharge). Pain may be present if acute mastoiditis occurs; when mastoiditis is present, postauricular area is tender; erythema and edema may be present. 1/9/2024 Ibrahim A(BsN) 41

42. Cholesteatoma (sac filled with degenerated skin and sebaceous material) may be present as a white mass behind the tympanic membrane visible through an otoscope. If untreated, the cholesteatoma continues to grow and destroys structures of the temporal bone, possibly causing damage to the facial nerve and horizontal canal and destruction of other surrounding structures. Auditory tests often show a conductive or mixed hearing loss. 1/9/2024 Ibrahim A(BsN) 42

43. Medical Management Careful suctioning and cleansing of the ear are done under microscopic guidance. Antibiotic drops are instilled or antibiotic powder is applied to treat purulent discharge. Tympanoplasty procedures (myringoplasty and more extensive types) may be performed to prevent recurrent infection, reestablish middle ear function, close the perforation, and improve hearing. 1/9/2024 Ibrahim A(BsN) 43

44. Oculoplastic may be done to reconstruct the middle ear bones to restore hearing. Mastoidectomy may be done to remove cholesteatoma, gain access to diseased structures, and create a dry (noninfected) and healthy ear. 1/9/2024 Ibrahim A(BsN) 44

45. Headache Headache (cephalgia) is one of the most common of all human physical complaints. Headache is actually a symptoms rather than a disease entity and may indicate organic disease (neurologic), a stress response, vasodilation (migraine), skeletal muscle tension (tension headache), or a combination of these factors. 1/9/2024 Ibrahim A(BsN) 45

46. A primary headache is one for which no organic cause can be identified. These types of headache include migraine, tension-type, and cluster headaches. 1/9/2024 Ibrahim A(BsN) 46

47. A secondary headache is a symptoms associated with organic causes, such as a brain tumor or aneurysm, subarachnoid hemorrhage, stroke, severe hypertension, meningitis, and head injury. Examples of secondary headaches include the following: Miscellaneous headaches associated with structural lesions Headache associated with head trauma Headache associated with vascular disorders 1/9/2024 Ibrahim A(BsN) 47

48. 1.7.1 Migraine Headache Migraine is a complex of symptoms characterized by periodic and recurrent attacks of severe headache. The cause of migraine has not been clearly demonstrated, but it is primarily a vascular disturbance that occurs more commonly in women and has strong familial tendencies. Onset typically occurs in puberty, and the incidence is 18% in women and 6% in men. 1/9/2024 Ibrahim A(BsN) 48

49. Clinical Manifestations Headache often begins in early morning (headache on awakening). The classic migraine attack can be divided into four phases: prodrome, aura, headache, and recovery. 1/9/2024 Ibrahim A(BsN) 49

50. Prodrome Phase Present in 60% of patients with migraine headache. Symptoms may occur consistently hours to days before onset of migraine. Depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea, or constipation may be noted with each migraine 1/9/2024 Ibrahim A(BsN) 50

51. Aura Phase Occurs in a minority of patients and lasts less than 1 hour. Focal neurologic symptoms, predominantly visual disturbances (light flashes), occur and may be hemianoptic (occurring in half of the visual field). Numbness and tingling of lips, face, or hands; mild confusion; slight weakness of an extremity; and drowsiness and dizziness may be present. 1/9/2024 Ibrahim A(BsN) 51

52. Headache Phase This phase, occurring in 60% of patients, involves a unilateral, throbbing headache that intensifies over several hours. Pain is severe and incapacitating, often associated with photophobia, nausea, and vomiting. Duration varies from about 4 to 72 hours.. 1/9/2024 Ibrahim A(BsN) 52

53. Recovery Phase (Termination and Postdrome) Pain gradually subsides. There is a period of muscle contraction in the neck and scalp with associated muscle ache and localized tenderness, exhaustion, and mood changes. Any physical exertion exacerbates the headache pain. Patient may sleep for an extended period 1/9/2024 Ibrahim A(BsN) 53

54. Assessment and Diagnostic Methods Physical assessment of head and neck Neurologic examination Detailed health and headache assessment and history; medication history Cerebral angiography, computed tomography (CT), or magnetic resonance imaging (MRI) if abnormalities on neurologic examination 1/9/2024 Ibrahim A(BsN) 54

55. Electromyography (EMG) and laboratory tests (complete blood cell [CBC] count, electrolytes, glucose, creatinine, erythrocyte sedimentation rate, electrolytes, glucose, creatinine, and thyroid hormone levels) 1/9/2024 Ibrahim A(BsN) 55

56. Medical Management Therapy is divided into abortive (symptomsatic) and preventive approaches. Abortive approach is used for frequent attacks and is aimed at relieving or limiting a headache at onset or while in progress. Preventive approach is used for those who have frequent attacks at regular or predictable intervals and may have medical conditions that preclude abortive therapies. 1/9/2024 Ibrahim A(BsN) 56

57. Nursing Management Relieving Pain Attempting to abort headache early. Provide comfort measures (e.g., a quiet, dark environment); elevate the head of bed 30 degrees. Administer medications If non pharmacologic measures are ineffective. Provide symptomsatic treatment, such as antiemetics, as indicated. 1/9/2024 Ibrahim A(BsN) 57

58. END THANKS FOR YOUR ATTENTION 1/9/2024 Ibrahim A(BsN) 58