NURS 3120 Lecture 4: Week 4- HEENT

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7 Feb 2017
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HEENT
HEENT Health History/Present
(ave there been any changes to …
o Eyes
o Ears
o Nose
o Mouth/throat
Any chronic conditions of HEENT system
Current meds?
Visions issues cataracts etc.…
Migraines
Hearing loss
Thyroid dysfunction
Oral cancers?
Co-morbidities?
o HTN
o DM
General Health/Past Medical History
Any injuries to ears, eyes, mouth or neck?
If yes, what problems exist from injury?
Any surgeries?
What surgeries?
Do you smoke?
Any chronic infections of eyes, ears, sinus infections issues with tonsils/adenoids?
Dental issues?
Own teeth or dentures? Eating issues? Regular dental care visits?
General Family History
H/O cancer in family?
Who? Kinds of cancer (illustration of squamous cell carcinoma)
Family members with vision/hearing or thyroid issues?
Patient/Client Problem Based History
Note the MOST COMMON problems R/T this system include …
o Headache/dizziness
o Visional impairments
o Hearing loss
o Tinnitus/ringing in ears
o Nasal infections
o Sore throats
o Dry mouth syndrome
o Oral lesions
How long does issue last? What helps? Aggravates issue?
Headache Assessment
Headaches
o Cluster headaches: occur more than 1x/day & last 1-2 hours. Are unilateral
Pain is in or around one eye
o Migraines: periodic intervals & last from a few hours to 1-3 days. Also unilateral
Pain, nausea and visual changes are typical of classic form
o IDENTIFICATION of patterns and triggers important ! Foods/stress
Headache types
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o Sinus: cause tenderness
Pain is behind brow bone and cheekbones
o Tension: front/back of head
Pain is like a band squeezing the head
o Cluster: pain over eye, temples, forehead & cheeks
o Tension: throbbing pain, may have burning/stabbing sensation behind eyes
Common Problem: Headaches
Most common reason for seeking medical attention
Chronic or primary = recurring headaches
Classification occurs based on S/S & history
Common Problems: Migraines
2nd most common headache
May occur in any age group most frequently in young women
Occurs due to vasospasm on intracranial arteries
Accompanied by depression, stress, light sensitivity (photophobia), N&V
Can last from several hours to days
Common Problems: Cluster Headaches
Most painful type
Seen mostly in teens to middle aged adults
Pain is usually intense, one-sided described as burning, pounding
Duration less than 1 hour, reoccur
Common Problems: Tension Headaches
Common in people B/T 20-40 years old
Usually bilateral
Confined to one location of head
Onset may be gradual, lasting for days
Tightness noted in face & jaw
Post Traumatic Headaches
Occur secondary to head injuries
Occur with concussions
Most commonly seen after a motor vehicle accident
S/S’s include …
o Generalized/dull pain
o Difficult to concentrate
o Feelings of dizziness
o Blurred vision
o Staring off
Hydrocephalus
Infants obstruction of CSF drainage
o Increase in ICP with bigger head, fontanels bulge & dilated scalp veins
o )f pressure builds, it won’t allow their brains to grow
o Newborns have very fragile heads
Clots that block CSF
o Pseudotumor cerebri: pressure in the skull
Adults obstruction, increased production or decreased absorption
Increased ICP in adults alterations in mental status, unrelieved headaches
Adult skulls cannot expand like newborns/toddlers
Newborn with Shunt
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Tube that empties the fluid to the neck and be absorbed that way
Dizziness and Vertigo
Have patient/client describe sensation
Begins when, how often, duration
Does dizziness lead to faintness
Sensation of room spinning around (vertigo)
Have you fallen?
Does your sensation interfere with ADL or work?
Safe to drive/operate machinery?
Trial of treatments? Document these tx’s
Difficulty with Vision/Eyes
Type of difficulty?
Sudden or gradual, does it affect one or both eyes?
Both eyes usually lean towards a systemic issue
If one eye is involved leans towards local problem
Visual disturbances
Common Problems of the Eyes
Hordeolum (Stye): acute infection in sebaceous gland found in eyelids
o Usually pussing
o Comes to a head like a pimple
o Warm washcloth relieves pain
Chalazion; cyst in eyelid (usually upper lid) blocked Meibomian gland
Eye Conditions/Conjunctivitis (Pink Eye)
Inflammation of palpebral or bulbar conjunctiva
Infections usually caused by bacteria/viruses, allergic reactions or chemical irritation
Eyes are red, sticky/thick discharge worse in mornings after sleeping
Eye Conditions/Corneal Abrasions
Abrasion or ulcer of corneal epithelium
Caused by infections, lacrimal gland dysfunction, foreign bodies, contact lens
S/S’s: intense pain, redness, tearing, photophobia
Eye Conditions/Strabismus
Abnormal ocular alignment
o Non-paralytic: muscle weakness
o Paralytic: motor imbalance caused by extraocular muscle paralysis
ESOTROPIA: inward turning eye, seen in infants commonly
o Cross eyes
o Common in premature babies
EXOTROPIA: outward eye turning
Eye Conditions/Cataracts
Opacity (cloudiness) of lens
Causes: congenital/trauma, aging
S/S’s: cloudy/blurred vision, headlight glare, night vision, changes in prescriptions
Exam reveals cloudy lens
Absence of red reflex light cannot penetrate the opacity of the lens
Common Conditions/Diabetic Retinopathy
Changes in vision due to DM with retinal capillary alterations
Leads to blindness
S/S’s: decrease in vision, exudate around macula
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