Assessment and Management of Eye, Ear, and Nose Disorders PDF

‫ﻣﺎذا ﻳﻤ‪‬ﻨﻚ ان ﺗﻔﻌﻞ‬ Assessment and Management of Patients Wit Eye, ear and nose Disorders Prepared by Adult Nursing 1 Staff  Objectives On completion of this lecture, the learner will be able to: 1. Identify significant eye, nose and ear stru...

‫ﻣﺎذا ﻳﻤ‪‬ﻨﻚ ان ﺗﻔﻌﻞ‬ Assessment and Management of Patients Wit Eye, ear and nose Disorders Prepared by Adult Nursing 1 Staff  Objectives On completion of this lecture, the learner will be able to: 1. Identify significant eye, nose and ear structures and describe their functions. 2. Identify causes and risk factors for common eye, nose and ear problems. 3. Discuss clinical features of common eye, nose and ear problem. 4. List the diagnostic assessment and examinations of common eye, nose and ear problem. 5. Discuss medical or surgical management, and patient care for common eye, nose and ear problem. 6. Discuss general discharge instructions for patients with common eye, nose and ear problem.  Out lines 1. Anatomy of eye, nose and ear and their functions. 2. Causes and risk factors of common eye, nose and ear problems. 3. Clinical features of common eye, nose and ear problem. 4. Diagnostic assessment and examinations of common eye, nose and ear problem. 5. Medical, surgical management, and patient care for common eye, nose and ear problem. 6. Discharge instructions for patients with common eye, nose and ear problem. Anatomy of eye Front of eye https://www.ncbi.nlm.nih.gov/books/NBK65754/figure/CDR0000258033__141/  Definitions of term Aqueous humor: The fluid produced in the eye. It provides nutrition to the eye, as well as maintains the eye in a pressurized state Optic nerve: The bundle of nerve fibers at the back of the eye that carry visual messages from the retina to the brain. Retina: The light sensitive layer of tissue that lines the back of the eye. Trabecular meshwork: Spongy tissue located near the cornea through which aqueous humor flows out of the eye. Intraocular pressure(IOP) is a measurement involving the magnitude of the force exerted by the aqueous humor on the internal surface area of the anterior eye. normal rage 10:21 mmhg  Common eye health problems Conjunctivitis Cataract Glaucoma  Common eye health problems 1- CONJUNCTIVITIS It is inflammation of the conjunctiva, the most common ocular disease worldwide. the conjunctiva, a thin, clear tissue that covers the white part of the eye and lines the inner surface of the eyelids. https://www.cdc.gov/conjunctivitis/about/symptoms.html  Manifestations of conjunctivitis uncomfortable with Contact lenses and/or do not stay in place on the eye pus or mucus photophobia Increased tear production  Types of Conjunctivitis it classified according to its cause. Microbial infection (bacteria (eg, Chlamydia), Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Viruses (adenovirus and herpes simplex virus), fungus, and parasites). Allergy conjunctivitis (itching, epiphora, photophbia, mucoid discharge, common in warm weather) Toxic Conjunctivitis from medications, chlorine from swimming pools , common during the summer), exposure to toxic fumes among industrial workers, or exposure to smoke, hair sprays, acids, and alkalis Exogenous infection from respiratory infection as adenovirus  Assessment and Findings of conjunctivit Diagnostic The four main clinical features important to evaluate are Type of discharge (watery, mucoid, purulent, or mucopurulent) Conjunctival reaction (ie, follicular or papillary) Presence of pseudomembranes or true membranes Presence or absence of lymphadenopathy (ie, enlargement of the preauricular and submandibular lymph nodes where the eyelids drain).  Management of conjunctivitis The management depends on the type. Viral conjunctivitis is not responsive to any treatment using Cold compresses may alleviate some symptoms. Mild and viral conjunctivitis are self-limiting may not require treatment and laboratory procedures. Severe cases, topical antibiotics, eye drops, or ointment are prescribed.  Management of conjunctivitis cont., Bacterial conjunctivitis is always self-limiting takes 2-week to resolution of symptoms. Patients with allergic conjunctivitis are usually given corticosteroids in ophthalmic preparations. Decreasing swelling by Using vasoconstrictors as topical epinephrine solution, cold compresses, ice packs, and cool.  Management of conjunctivitis cont., Decreasing swelling by Using vasoconstrictors as topical epinephrine solution, cold compresses, ice packs, and cool. Ask the patient for frequent Hand washing avoiding sharing hand towels, face cloths, and eye drops, Avoid rubbing eye, not touch healthy eye by contaminated hand. Discard Tissues directly into a trash. Comlication of conjunctivitis:- corneal perforation and blindness, meningitis and generalized septicemia.  How to Avoid nosocomial infections 1. Frequent hand hygiene, and Environmental cleaning, 2. Disinfection of eye examination equipment followed each times. 3. Specify areas for treating patients with adenovirus infection to prevent spread. 4. Avoid tonometry unless medically indicated. 5. Infected person not allowed to work or attend school until symptoms have resolved, which can take 3 to 7 days.  Patient education with viral conjunctivitis easily spread from one person to another. The symptoms can be alarming, but they are not serious (red and watery discharge, swollen eye lids, pain, a sandy sensation in the eye, and sensitivity to light, Symptoms resolve after about 1 week). Use light cold compresses over eyes for about 10 minutes four to five times a day to soothe the pain. Use artificial tears for the sandy sensation in the eye and mild pain medications such as acetaminophen (Tylenol).  Patient education with viral conjunctivitis Stay at home. Children must not play outside, may return to work or school after 7 days when the redness and discharge have cleared. Do not share towels, linens, makeup, or toys. hands Wash with soap and water frequently before and after applying artificial tears or cold compresses. Use a new tissue every time wipe the discharge from eye, dampen the tissue with clean water to clean the outside of the eye.  Patient education with viral conjunctivitis cont., wash face and take a shower as normally. Discard all makeup articles, not makeup until the disease is over. Wear dark glasses if bright lights bother you. Return to the health care provider if (yellowish discharge, pus like from eye, changes in vision).  Common eye health problems 2- Cataracts A cataract is a cloudy area in the lens of eye. the lens appears grey or milky on visual inspection. Cataracts are common with older. cataract is the leading cause of blindness in the world Lens is the clear part of the eye that helps to focus light.  Risk Factors for Cataract Formation Aging and family history Associated Ocular Conditions :- Retinitis Myopia Infection Retinal detachment and retinal surgery Toxic Factors:- Deposit of Calcium, copper, iron and mercury in the pupillary area of the lens Alkaline chemical eye burns, poisoning Cigarette smoking Corticosteroids, Nutritional Factors:- Reduced antioxidants Poor nutrition Obesity Physical Factors:- Dehydration, hyperbaric oxygenation Ultraviolet radiation trauma, perforation of the lens, electric shock Systemic Diseases and Syndromes :- Diabetes mellitus Down syndrome Renal disorders Musculoskeletal disorders  Clinical Manifestations of Cataract Painless, blurry vision. The patient perceives that surroundings are dimmer, as if glasses need cleaning. Light scattering Reduced (contrast sensitivity, sensitivity to glare, and reduced visual acuity). Myopic shift, astigmatism, monocular diplopia (ie, double vision),  Clinical Manifestations of Cataract cont., Color shift (the aging lens becomes progressively more absorbent at the blue end of the spectrum) Brunescens (ie, color values shift to yellow-brown) Reduced light transmission Trouble reading or doing other everyday activities. Over time, cataracts can lead to vision loss.  Diagnosis of Cataract Snellen visual acuity test. measures the degree of visual acuity in the patient, assesses the sharpness and clarity of vision. Each eye is tested individually for the ability to see letters of varying sizes. Ophthalmoscopy. used to view the extent of cataract. Slit-lamp biomicroscopic examination. used to establish the degree of cataract formation and Retinal exam Once a cataract diagnosed, the patient should:- examine the eye annually for older than 65, or every two years if younger. Protect the eyes from UV light by wearing sunglasses that block at least 99 percent UV and a hat. Quit Smoking is a key risk factor for cataracts. Use brighter lights for reading and other activities. A magnifying glass useful, too.  Once a cataract diagnosed, the patient should cont., Limit driving at night once night vision, halos or glare become problems. Take care of other health problems, especially diabetes. Get the right eyeglasses or contact lenses to correct vision. When it becomes difficult to complete regular activities, consider cataract surgery.  Medical Management of Cataract No nonsurgical treatment cures cataracts. intake of antioxidants to slow cataract progression (eg, vitamin C, beta-carotene, vitamin E). In the early stages of cataract, glasses, contact lenses, strong bifocals, or magnifying lenses may improve vision. Reducing glare with proper light can facilitate reading. Mydriatics used to dilate the pupil and allow more light to reach the retina.  Surgical Management of Cataract Lens replacement. There are three lens replacement options: Phacoemulsification. A portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex while the posterior capsule and zonular support are left intact. Extracapsular cataract extraction (ECCE). removes the anterior lens and cortex, leaving the posterior capsule intact. Intracapsular cataract extraction. removes the entire lens within the intact capsule. See video at: https://1733-1680.captiv8online.com/animations/display/t-t-u?player_width=587&player_height=354  Potential Complications of Cataract Surge Immediate Preoperative:- hemorrhage: Intraoperative Complications:- Rupture of the posterior capsule Early Postoperative Complications :-Acute bacterial endophthalmitis by Staphylococcus epidermitus, S. aureus, Pseudomonas and Proteus species Late Postoperative Complications:- -Suture-related problems -Malposition of the IOL -Chronic endophthalmitis Opacification of the posterior capsule  Nursing Diagnosis of Cataract Disturbed visual sensory perception related to altered sensory reception or status of sense organs. Risk for trauma related to poor vision and reduces hand-eye coordination. Anxiety related to threat of permanent loss of vision/ independence. Deficient knowledge regarding ways of coping with altered abilities related to lack of exposure or recall, misinterpretation, or cognitive limitations.  Nursing Care Planning & Goals The major goals for the patient include: Regaining of usual level of cognition. Recognizing awareness of sensory needs. Be free of injury. Identifying potential risk factors in the environment. Appearing relaxed and reporting anxiety is reduced at manageable level. Verbalizing feelings of anxiety. Identifying healthy ways to deal with and express anxiety.  Nursing Interventions of Cataract Care for a patient with cataract includes: Providing preoperative care. Providing postoperative care.  Providing preoperative care of Catara Routine care Patient’s medical history. The nurse assesses the patient’s medical history to determine the preoperative tests to be required. Preoperative tests. The standard preoperative tests as CBC, ECG, and urinalysis according to medical history. Visual acuity test results. Test results from Snellen’s and other visual acuity tests are assessed.  Providing Preoperativecont., Care Recent medication to Reduce the risk for hemorrhage as Aspirin (withheld for 5 to 7 days), nonsteroidal anti-inflammatory medications (NSAIDs) (3 to 5 days) warfarin (until PT reached 1.5). Dilating drops are administered every 10 minutes for four doses at least 1 hour before surgery. Antibiotic, corticosteroid, and NSAID drops used as prophylactic to prevent postoperative infection and inflammation.  Providing Postoperative Care Give verbal and written instruction about (protect the eye, medications, signs of complications, and emergency care. Activities to be avoided. Give analgesic acetaminophen for mild discomfort after surgery as needed. Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively.  Teaching Patients Self-Care of Cataract Prevent accidental rubbing or poking of the eye Wears a protective eye patch for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks. Worn Sunglasses while outdoors during the day because the eye is sensitive to light. The nurse instructs the patient and family in applying and caring for the eye shield.  Teaching Patients Self-Care of Cataract cont Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days. A clean, damp washcloth may be used to remove slight morning eye discharge. Notify the surgeon by retinal detachment symptoms as new floaters (ie, dots) in vision, flashing lights, decrease in vision, pain, or increase in redness occurs (complication of surgery).  Continuing Care of Cataract The eye patch is removed after the first follow-up appointment. Patients may experience blurring of vision for several days to weeks. Sutures left in the eye alter the curvature of the cornea, resulting in temporary blurring and some astigmatism. Vision gradually improves as the eye heals. Visual correction is needed for any remaining nearsightedness or farsightedness.  Evaluation of Cataract Regained usual level of cognition. Recognized awareness of sensory needs. Free of injury. Identified potential risk factors in the environment. Appeared relaxed and reporting reduced in anxiety level. Verbalized feelings of anxiety. Identified healthy ways to deal with and express anxiety.  Cataract prevention Protect the eyes from the sun. Wear sunglasses and a hat with a brim to block the sun. Protect the eyes from injury. While doing activities like using power tools or playing certain sports, wear protective eyewear to protect the eyes from getting accidentally injured. Quit smoking & Reduce alcohol use. Eat plenty of healthy foods — like fruits and vegetables, leafy greens, nuts, and whole grains (Antioxidants help maintain the health of eyes). Get a dilated eye exam every 1 to 2 years for Age 60 or older.  Common eye health problems 3- Glaucoma Glaucoma is a group of ocular conditions characterized by optic nerve damage related to the Intra Ocular Pressure (IOP) caused by congestion of aqueous humor in the eye. Glaucoma is one of the leading causes of irreversible blindness in the world Glaucoma is more prevalent among people older than 40 years of age, and the incidence increases with age among men than women 3- Glaucoma  Stages of glaucoma progress stage: 1. Initiating events: precipitating factors include illness, emotional stress, congenital narrow angles, long-term use of corticosteroids stage 2. Structural alterations in the aqueous outflow system stage 3. Functional alterations increased IOP or impaired blood flow stage 4. Optic nerve damage: atrophy of the optic nerve Stage 5. Visual loss: progressive loss of vision  Assessment and Diagnostic Findings of glau Assess the optic nerve damage, and formulate a treatment plan. Ocular and medical history to investigate predisposing factors. Examinations through : 1. tonometry to measure the IOP, 2. ophthalmoscopy to inspect the optic nerve, 3. gonioscopy to examine the filtration angle of the anterior chamber, 4. perimetry to assess the visual fields.  Medical Management of glaucoma The aim is to prevent optic nerve damage through medical therapy, laser or non-laser surgery, or a combination of these approaches. Lifelong therapy because glaucoma cannot be cured. Maintain an IOP within a range to prevent further optic nerve damage. The patient is monitored for the stability of the optic nerve., If there Is evidence of progressive nerve damage lowered IOP until the optic nerve shows stability.  Pharmacologic therapy of glaucoma Systemic and topical ocular medications to lower IOP. Started on the lowest dose of topical medication and then advanced to increased concentrations until the desired IOP level is reached and maintained. Periodic follow-up examinations to monitor IOP, appearance of the optic nerve, visual fields, and side effects of medications.  Pharmacologic therapy of glaucoma cont., One eye is treated first, other eye used to determine the efficacy of the medication once efficacy has been established, treatment of the fellow eye is started. If the IOP is elevated in both eyes, both are treated. Adrenergic agonists , beta-blockers, alpha2-agonists , carbonic anhydrase inhibitors, and prostaglandins increase aqueous outflow, decrease aqueous production  Pharmacologic therapy of glaucoma cont., Cholinergics (ie, miotics) increase the outflow of the aqueous humor Antifibrosis agents such as the antimetabolites fluorouracil (Efudex) and mitomycin (Mutamycin) to inhibit Scarring after surgery. they require special handling procedures before, during, and after the procedure. Fluorouracil can be administered intraoperatively and by subconjunctival injection during follow up; Mitomycin is much more potent and is administered only intraoperatively.  Surgical management of glaucoma cont., Laser trabeculoplasty is indicated when IOP is inadequately controlled by medications, it may cause a transient rise in IOP (usually 2 hours after surgery) that may become persistent. Laser iridotomy for pupillary block glaucoma to eliminate the pupillary block. it can cause burns to the cornea, lens, or retina; transient elevated IOP; closure of the iridotomy; uveitis; and blurring.  Surgical management of glaucoma cont., Pilocarpine to prevent closure of the iridotomy. Trabeculectomy is filtering technique to remove part of the trabecular meshwork. It can cause hemorrhage, an extremely low (hypotony) or elevated IOP, uveitis, cataracts, bleb failure, bleb leak, and endophthalmitis. Drainage implants in the anterior chamber.  Nursing Management of glaucoma Teaching patients about glaucoma care 1- The medical and surgical management of glaucoma slows the progression of glaucoma but does not cure it. 2- The need for lifelong therapeutic regimen and importance of adherence to the medication.  Nursing Management of glaucoma cont., Teaching patients about glaucoma care cont., 3- Medication interactions with glaucoma-control medication as acetazolamide has an additive effect on the diuretic effects of other antihypertensive medications and can result in hypokalemia. 4- The effects of glaucoma control medications on vision as Miotics and sympathomimetics result in altered focus; patients need to be cautious in navigating their surroundings.  Continuing glaucoma care at home Referral to rehabilitation services with loss of peripheral vision. Reassurance and emotional support. The family must be integrated into the plan of care. Family members undergo examinations at least once every 2 years to detect glaucoma early. How to instill ocular medication, let the patient redemonstrate the instillation in front of the nurse and correct the mistakes  Patient education managing glaucoma Know intraocular pressure (IOP) measurement and the desired range. Keep a record of eye pressure measurements and visual field test results to monitor own progress. Review all your medications (including over-the-counter and herbal medications) with ophthalmologist, and mention any side effects. Participate in the decision-making process. Keep all follow-up appointments.  Ear problems 1- Otitis media (OM) Is inflammation of the middle ear. It means an infection behind eardrum. It is very common in children but may occur at any age. It can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection.  Types of Otitis media (OM) Acute otitis media (AOM): sudden infection, fluid and pus get trapped under the eardrum. S&S swelling, redness, fever, and pain. Chronic otitis media: ongoing or recurring infection over months to years. S&S painless, involve hearing loss, ear canal drain liquid. Otitis media with effusion follow AOM : After an infection goes away, fluid (effusion) and mucus build up, causing your ear to “feel full.” This can go on for months and may affect hearing. Chronic otitis media with effusion: Fluid (effusion) remains in the middle ear for a long time or builds up repeatedly, without infection. This may also affect hearing.  Common Symptoms Of Infection In Adults Otalgia:-Pain in one or both ears otorrhea:- Drainage from the ear (bus/fluid) Muffled hearing - Fever Sore throat, loss of appetite, Nausea, Vomiting, Diarrhea (common in children) Symptoms of upper respiratory infection. Concurrent or recent symptoms of URI, such as cough, rhinorrhea or sinus congestion is common. Otitis media with effusion include the following: Hearing loss - Tinnitus - Vertigo - Otalgia Balance problems (this is rare), headache -trouble in sleeping  Causes of Otitis media It can be viral, bacterial, or co-infection. Bacterial organisms causing otitis media are , Moraxella catarrhalis, and Haemophilus influenza,Streptococcus pneumoniae, responsible for more than 95% Viral pathogens include the respiratory syncytial virus (RSV), coronaviruses, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses Risk factor of Otitis media Vitamin A deficiency  Diagnosis of Otitis media Patient's history and presenting signs and symptoms. Objective findings on physical exam (otoscopy) diagnostic tools to aid in the diagnosis of otitis media as 1.a pneumatic otoscope:- examination of the external ear and tympanic membrane (TM), examining the entire head and neck region of patients with suspected OM is important. 2. tympanometry:- measures changes in acoustic impedance of the tympanic membrane /middle ear system with air pressure changes in the external auditory canal 3. Acoustic reflectometry, measures reflected sound from the TM  Complications of Otitis media Facial paralysis Delayed speech and language development: Muffled hearing in children Torn eardrum: About 5% to 10% of children. Often, the tear heals on its own. If not the child may need surgery. Spread of the infection: to the bone behind ear (mastoiditis). Or to the membranes surrounding brain and spinal cord (meninges) and cause meningitis. Brain abscess, Lateral sinus thrombophlebitis  of Otitis media Management Antibiotics, taken by mouth or as ear drops (high-dose amoxicillin or a second-generation cephalosporin are first-line agents) Medication for pain (Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen) Decongestants, antihistamines, or nasal steroids An ear tube (for chronic otitis media with effusion) Autoinsufflation:- helps adjust the pressure in the ear. pinch the nose and gently exhale, forcing air back through the eustachian tube.  of Otitis media Management cont., Myringotomy:- placing a small tube at the opening of the eardrum to keep fluid from building up, help to hear. The tubes usually fall out on their own after six months to a year. Nursing management of otitis media It includes patient education to improve their understanding of the condition and its management, including the importance of completing the full course of antibiotics, managing pain, and avoiding activities that can exacerbate symptoms. Nursing management of otitiscont., media Assess Vital signs may be febrile, Assess the lymph nodes of the neck for enlargement (Peri-auricular and anterior cervical nodes enlarged and tender) Pneumatic Otoscopy to examine tympanic membrane (red, dull, bulging) Assess Bony Landmarks. Discharge (Purulent discharge if drum perforated) Assess hearing (whisper, Rinne & Weber test) &, speaking ability  Assessment of OM cont., Hearing acuity, by observing the client’s conversation with others and by performing the whisper test and the Weber and Rinne tuning fork tests Whisper Test Whisper in each ear one word and observe for deafness, while blocking opposite ear and stand one foot away from patient  Comparison of Weber and Rinne Tests HEARING WEBER RINNE STATUS Normal hearing Sound is heard equally in Air conduction is audible both ears longer than bone conduction. Conductive hearing Sound heard best in Sound heard as long or longer loss affected ear (hearing loss). in affected ear (hearing loss). Sensorineural Sound heard best in Air conduction is audible hearing loss normal hearing ear. longer than bone conduction in affected ear  Nursing diagnosis of OM Acute pain related to inflammation and increased pressure from fluid accumulation in the middle ear Impaired verbal communication due to the pain or hearing impairment Disturbed sleep pattern related to pain and discomfort Anxiety related to the illness, especially if there are repeated episodes Imbalance in Nutrition: Less than body requirements related to Decrease in Appetite:  Nursing Interventions of OM The nurse should assess the pain level regularly and provide appropriate pain relief measures, such as ibuprofen or acetaminophen. The nurse should administer antibiotics, if ordered. The nurse should also assess the vital signs and pain level. Providing comfort measures, as applying a warm compress to the ear to relieve pain. Encourage drinking plenty of fluids and provide nutritious snacks can promote healing.  Nursing Interventions of OM cont., Provide emotional support and reassurance to patient and family. Removed Wax and other debris from the ear canal before Otoscopy to allow a clear view of the tympanic membrane. the cerumen may be removed by gently irrigating the external canal with warm water. If adherent cerumen is present, a small amount of mineral oil or over-the-counter cerumen softener may be instilled within the ear canal Teach the patient about instillation of ear medication  Family education about the ear tube with childre reading The eustachian tubes will come out on their own in 6-12 months. Keep water out of the tubes place Put a cotton ball coated in petroleum jelly in the ear while bathing to keep any water from entering and causing infection. Keep the child in an upright position with feeding so that the head is higher than the stomach. in a horizontal position, the feeding can flow back into the child’s eustachian tubes and lead to infection. Encourage Breastfed children are less likely to get ear infections due to the presence of antibodies in the breast milk. Family education about the ear tube with children Avoid the Recurrent use of unnecessary antibiotics can lead to antibiotic resistance. Typically antibiotics are started after three days of non- resolution. Parents should keep the child’s ears dry, especially after swimming as a way to prevent acute otitis media. Children should stay current on all recommended vaccines. A warm compress on the outside of the ear help to relieve pain.  Family education about the ear tube with children cont., Away from Things that can lead to acute otitis media are secondhand smoke and being around individuals who are infectious with bacterial or viral infections. Provide smoking cessation education as needed seeking medical care when fever above 39-degrees C (102.2F), drainage from the ear, symptoms that don’t improve after 2-3 days or get worse, or any signs of hearing loss. Teach parents that mild infections will often clear on their own in a few days.  Nose problems 1- A deviated septum  Nose problems 1- A deviated septum Introduction The nasal septum is the part of the nose that separates the two airways and the nostrils. A deviated septum is when there is shift from the midline or center position. Nasal deviation is common physical disorder of the nose, involving a displacement of the nasal septum to the one side. It is an important cause of nasal obstruction. A deviated septum occurs when a nasal septum (the thin wall) that separates right and left nasal passages — is displaced to one side resulting in partial airway obstruction.. Deviated septum - Symptoms & causes - Mayo Clinic  Clinical manifestation of deviated sept Breathing impairment with a mildly deviated septum. Blockage of one or both nostrils Nasal congestion, sometimes one sided Repetitive sneezing Frequent sinus infections At times, facial pain, headaches, postnasal drip Snoring:- Noisy breathing during sleep. Frequent nosebleeds Mild to sever loss of smell Dry mouth, due to chronic mouth breathing in sever case ( American Academy of Otolaryngology Head and Neck Surgery ,2011)  Causes & Risk factors of deviated sept A condition present at birth (during fetal development unequal growth skull base& palate/injury during childbirth. Mass in opposite nasal cavity Injury to the nose (during childbirth, accidents, Playing contact sports ) Not wearing seat belt while riding in a motorized vehicle Swelling and irritation of the nasal cavities or sinus cavities because of an infection (further narrow the nasal passage and result in nasal obstruction).  Diagnosis of deviated septum History taking. Physical examination using a pen torch (Signs and symptoms, Examine inside the nose use a bright light before and after applying a decongestant spray.. Check farther back nose with a long tube-shaped scope with a bright light at the tip. X-ray CT scan  Treatment of deviated septum a. Medical management for patient symptoms:- Decongestants:- it reduce nasal tissue swelling to keep the airways on both sides of the nose open (a pill or a nasal spray with caution SE it increase blood pressure and heart rate ). Antihistamines :- it prevent allergy symptoms- Some antihistamines cause SE drowsiness, affect driving. Nasal steroid sprays:- it reduce swelling in the nasal passage and help with drainage, it takes from 1 to 3 weeks to reach the maximal effect.  SE: side effect  Treatment of deviated septum cont., b. Surgical repair:- If medical therapy not effective as:- 1. Septoplasty:- the nasal septum is straightened and repositioned in the center of the nose. after that nasal septal splint made of plastic is inserted , then the nose packed for several days 2. Rhinoplasty:- cosmetic surgery for correcting and reconstructing the form, restoring the functions, is performed at the same time as septoplasty. b. Surgical repair cot., 3. Rhinoseptoplaasty:- combined cosmetic and septal corrective surgery NB. avoid aspirin or ibuprofen for two weeks before and after the surgery, it increase the risk for bleeding. - stop smoking can interfere with healing.  Complication of deviated septum Infection Bleeding Perforation of the septum/changing of nose shape persistence in problems even after the surgery decreased sense of smell temporary numbness in upper gums and teeth septal hematoma (mass of blood)  Nursing Management of deviated septum The priority is to maintain an open patent airway. Close monitoring to Respiratory status (vital sigs, pulse oximetry, and breath sounds). Monitor for respiratory distress, swelling, and bruising. Assessment for swelling that impairs the client’s breathing is important and frequently performed. Assess for pain, shortness of breath, dyspnea, cyanosis, anxiety, and level of consciousness. headache, facial pain, discomfort, nausea, and nasal congestion.  Nursing diagnosis of deviated septum Ineffective airway clearance related to presence of backing and excessive mucus Ineffective self-health management related to lack of knowledge about care at home Acute pain related to surgical tissue injury Impaired verbal communication related to pain ,presence of nasal surgery Risk for infection Risk for bleeding  Nursing Management of deviatedcont septum., Pain management to promote healing and a positive client outcome. Apply cold compresses as ordered. Observe dressing for drainage noting the color and amount when removing and inserting nasal packing. Assess for signs of infection such as fever, ↑WBCs or purulent drainage Assess the signs of hemorrhage (excessive blood on nasal dressing, bright red vomitus, repeated swallowing, rapid pulse). Provide the patient with written and verbal discharge instructions regarding pain management, dressing changes, signs and symptoms of infection, and follow-up appointments. How to use nasal inhaler Remove the cap and shake the bottle. Hold the inhaler between the thump ad forefinger Prime the bottle by spraying 1 time to get it ready. Gently blow the nose to clear the mucous Tilt the head forward until the chin is about halfway to the chest. Insert the nozzle into one nostril ad close the other. Point the nozzle slightly toward the side of nostril, away from the middle of the nose.  Technique for nasal inhaler Remove cap Prime the bottle blow nose applicator tip Press the spray once, slightly outwards breath in slowly How to use nasal inhaler cont., Squeeze the bottle or push down on the top to spray the medicine into nostril. breathe in through nose slowly (to prevent too much medicine quickly. Ask the patient to hold the breath for few seconds then breath out slowly through mouth. Withdraw the inhaler from the nostril Repeat these steps for the other nostril. wipe the applicator tip with a clean tissue or cloth and put on the dust cap. Cautions While Using The Nasal Spray Do not Tilt the head backward or Try to breath in strongly and quickly while inhalation to prevent the medication from going into throat Use the nasal spray as directed by professional. If the patient experience nosebleed, stop using the nasal spray for a few days and use saline nasal spray. If the bleeding continues, please seek medical attention. Do not sneeze or blow nose until a few minutes after using the nasal spray. References Suzanna.S.C. , Brenda.B.G., Janice.H.L, kerry.C.H. Brunner and suddarths textbook of medial surgical nursing,2021 Ear infection available at: https://my.clevelandclinic.org/health/ diseases/8613-ear-infection-otitis-media. Retrieved at 2/11/2023 Ear infection available at: https://www.cdc.gov/antibiotic-use/ear infection.html https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms- causes/syc-20351616 the American Academy of Otolaryngology Head and Neck Surgery (2011) How to use nasal spray. Available at: http://www.myhealth.gov.my/ en/how-to-use-nasal-spray/  https://emedicine.medscape.com/article/994656-differential?form=fpf Ear Infection (Otitis Media): Symptoms, Causes & Treatment (clevelandclinic.org) Danishyar A & John V (2023). Acute Otitis Media. Availble at: Acute Otitis Media - StatPearls - NCBI Bookshelf (nih.gov) Otitis Media (Secretory) - Ear, Nose, and Throat Disorders - MSD Manual Consumer Version (msdmanuals.com) Cataract surgery. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye- conditions-and-diseases/cataracts/cataract-surgery. Machiele. R, Motlagh M ,& Bhupendra C.(2022) intraocular pressure, national library of medicine. Available at: https://www.ncbi.nlm.nih.gov/ BELLEZA, M (2023) OTITIS MEDIA. AVAILABLE AT: HTTPS://NURSESLABS.COM/OTITIS- MEDIA/  Thank you Any question