EEN

• Nursing Assessment of Physical Systems

  • EENT - Eyes, Ears, Nose and Throat
• Anatomy of the Eye (Structures and Functions)


  • External and Accessory Structures
  • Internal Structures

  
• Eyelids, eyelashes


  External and accessory structures of the eye

  
• Meibomian glands


  Sebaceous glands which produce oily secretions lubricating the eye

  
• Ciliary glands


  Modified sweat glands of the eyes
• Lacrimal glands


  Continually release dilute salt solution (tears) onto the anterior surface of the eyeball
• Extrinsic eye muscles


  • Lateral Rectus
  • Medial Rectus
  • Superior rectus
  • Inferior rectus
  • Inferior oblique
  • Superior oblique

  
• Eyeball


  Hollow sphere composed of 3 tunics and filled with fluids called humors that help maintain its shape and intraocular pressure

  
• Tunics of the Eyeball

  • Sclera

  
• Sclera


  • Lacerations
• Inspection of the Globe

  • General Appearance
  • Displaced: Medially, Inferiorly
  • Posteriorly (Enophthalmos)
  • Anteriorly (Exophthalmos)
• Inspection of the Eyelid

  • Swelling
  • Ecchymosis
  • Lacerations
  • Stye - infection of a ciliary gland (form of sweat gland on the eyelid) or sebaceous gland (oil-secreting)

  
• Inspection of the Cornea

  • Crystal clear
  • Discoloration
  • Hyphema - collection of blood within anterior chamber of eye
• Inspection of the Conjunctivae

  • Appearance should be transparent (covers sclera)
  • Two types - bulbar and palpebral conjunctivae
  • Subconjunctival Hematoma - leakage of the superficial blood vessels beneath the sclera
  • Examination: Inferior portion - gently pull down on the eyelid, patient looks up
  • Upper portion - gently lift upper eyelid, patient looks down

  
• Inspection of the Sclera

  • Any abnormalities?
  • Appearance of black object - may be inner tissue of eye bulging through a wound
• Inspection of the Iris

  • Iritis - inflammation of iris
• Inspection of the Pupils

  • Normally equal in size and shape
  • Anisocoria - unequal pupil sizes: Benign congenital condition, Secondary to Brain Trauma
  • Teardrop pupil - Serious underlying pathology (corneal laceration, ruptured globe)
• Special Consideration on Assessing

  • Do NOT palpate globe except for superficial bony structures and soft tissue such as: Orbital Margin (circumference of orbital rim), Frontal bone, Nasal Bone, Zygomatic bone
• Vision Assessment


  • Performed on one eye then with both eyes using a Snellen Chart
  • Prescribed glasses/contacts worn during assessment
  • Emmetropia - 20/20 Vision or Ability to read the letters on the 20 ft line of an eye chart when standing 20 ft from the chart
  • Common Abnormal Findings: Diplopia, Blurred vision or Presbyopia ("Old vision"), Myopia (nearsightedness) or Hyperopia (farsightedness)

  
• Pupil Reaction to Light

  • Penlight - shine light into pupil for 1 second from the periphery with opposite eye covered
  • Observe for pupil restriction and dilation
  • Repeated on opposite eye
  • Positive Test suggests: Pupil unresponsive to light, Pupil sluggish compared to opposite side, Indicative of mechanical or neurological deficit of iris (e.g. Head Injury)
• Neurological Testing


  • Cranial Nerve II - Optic: Vision Assessment → Snellen's Chart
  • Cranial Nerve III - Oculomotor Assessment: Pupil reaction to light, Elevation of upper eyelid, Eye adduction and downward rolling
  • Cranial Nerve IV - Trochlear Assessment: Upward eye rolling
  • Cranial Nerve VI - Abducens Assessment: Lateral eye movement

  
• PERRLA


  Pupils Equally Responsive and Reactive to Light and Accommodation
• Anatomy of the Ear(s)


  • Outer (External) Ear
  • Middle ear / Tympanic Cavity

  
• Pinna / Auricle


  Part of the outer (external) ear

  
• External Auditory Canal


  Part of the outer (external) ear

  
• Ceruminous glands


  Secrete a waxy yellow substance called earwax or cerumen
• Tympanic membrane (Eardrum)


  Separates the outer from the middle ear and is continually vibrates with sound waves

  
• Ossicles (3 smallest bones)

  • Hammer (malleus)
  • Anvil (incus)
  • Stirrup(stapes)
• Inspection of the External Ear

  • Inspection and direct palpation for symmetry, deformities, tenderness, lesions, discharges
  • Equipment - tuning forks or otoscope and/or audiometry (for MD use)
  • In severe cases, may find sebaceous cyst and tophi on the pinna
• Assessing Hearing


  • Gross Auditory Acuity: Whispered Voice Test, Watch Tick Test, Weber's Test, Rinne's Test
• Hearing Loss or Presbycusis (in the elderly)

  • Conductive Hearing Loss
  • Sensorineural Hearing Loss
  • Mixed - both conductive and sensorineural deafness
• Mouth and throat


  Comprise the first part of the digestive system and aiding in speech. Cranial Nerves V (trigeminal), VII (facial), IX (glossopharyngeal) and XII (hypoglossal) assist with some of these functions.
• Nose and sinuses (paranasal sinuses)

  Constitute the first part of respiratory functions. Receptors of cranial nerve I (olfactory) are also located in the nose.

  
• Anatomy of the Mouth (or Oral Cavity)

  • Parotid glands
  • Submandibular glands
  • Sublingual glands

  
• Tonsillitis Grading System


  • Grade 1 - The tonsils are behind the tonsillar pillars (Normal)
  • Grade 2 - between the pillars and the uvula
  • Grade 3 - tonsils touch the uvula
  • Grade 4 - one or both tonsils extend to the midline of the oropharynx
• Anatomy of the Nose and Paranasal Sinuses

  • Nose
  • Paranasal sinuses

  
• Assessing Nose and Sinuses Structures and their Functions

  • Equipment - flashlight, nasal speculum, penlight or an otoscope with nasal attachment
  • Methods - Inspection and palpation of the external nose, and appearance and patency of the nasal cavities: Inspect the external nose for any deviations in shape, size, or color and flaring or discharge from the nares, Inspect nasal cavities, Lightly palpate the external nose to determine any areas of tenderness, masses, and displacements, Determine patency of both nasal cavities, Gently palpate facial sinuses then transluminate as necessary with a penlight