LESSON SIX. Skin, Eyes, Ears, Nose and Throat Assessment
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1 LESSON SIX Skin, Eyes, Ears, Nose and Throat Assessment Introduction The ability to see, hear, smell, taste and interact with others helps us to connect with the world and enjoy life. Assessment of the eyes, ears, nose, throat and mouth is essential to understanding how to best meet the needs of your clients. It is also important in order to keep them safe and involved in their care. The following covers a basic assessment, which includes obtaining a detailed health history and inspection skills. Advanced skills are within the scope of the Registered Nurse, but do require extra education beyond this course. Remember to elicit help from other members of the health care team if you suspect the client needs further assessment in one of these areas. This lesson also contains the basic skills needed by a Registered Nurse to perform a thorough skin assessment. Given the nature of the role of the nurse, we are in an excellent position to monitor skin integrity and promote healthy skin care. Learning Outcomes 1. Discuss the information to gather during a comprehensive ears, nose and throat (ENT) health history. 2. Describe the meaning and assessment of subjective data such as vision difficulty, pain, redness, swelling, watering, and discharge. 3. Explain the significance of inspecting the external structures of the eye. 4. Describe the meaning and assessment of subjective data such as ear pain, ear discharge, and hearing loss. 5. Describe the normal appearance/findings and assessment of the nose, mouth, and throat. 6. Describe the meaning and assessment of subjective data such as nasal discharge, colds, sinus pain, nasal trauma, epistaxis, allergies, altered smell, mouth and throat lesions, sore throat, bleeding gums, toothache, hoarseness, dysphagia and altered taste. 7. Describe a basic skin assessment. 8. Understanding abnormal findings in a skin assessment. 9. Discuss how to use the Braden scale in skin assessment. August 2011 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 1
2 Required Readings See required reading list. August 2011 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 2
3 ENT Health History The following outlines the key symptoms and related information that you should ask about when conducting a focused ears, nose and throat health history. Ears Changes in hearing. Use of hearing aid and its effectiveness. Itching. Earache. Discharge. Tinnitus (ringing in ears). Vertigo. Ear trauma. Q-tip use (a Q-tip is the brand name of small cotton swab used for cosmetics, but also commonly used to clean ears- see picture to left). Nose Nasal discharge or postnasal drip. Epistaxis (nosebleed). Obstruction of airflow. Sinus pain. Itching. Anosomia (loss of sense of smell). Trauma. Mouth and Throat Oral lesions. Dental health. Bleeding gums. Sore throat. Dysphagia (difficulty swallowing). Hoarseness or recent voice change. Neck pain, swelling or enlarged glands Health History (specific to ENT) Frequent ear or throat infections. Sinusitis. ENT or head trauma/surgery. Hearing tests. Smoking. August 2011 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 3
4 Personal and Social History Seasonal allergies. Others at home with similar symptoms. Asthma. Hearing loss. Menieres disease. ENT cancer. Frequent exposure to water. Use of foreign object to clean ear. Use of ear protection. Crowded living conditions. Dental hygiene habits. Exposure to respiratory toxins (such as smoke). Recent air travel. Occupational exposure to toxins or loud noise. Please Read: Lesson Six: Required Reading 1 and 2 SKIN ASSESSMENT The skin is the body s largest organ; it guards the body from environmental stress, provides us with the sense of touch, and helps us to cope with external factors such as temperature. Illnesses, especially those that result in prolonged bed rest, puts the client at a high risk for impaired skin integrity. For this course skin assessment is incorporated in the inspection phase of each focused assessment. It is important to review some common skin problems, as well as a simple assessment tool to help you to gauge your client s risk of skin breakdown. Please Read: Lesson Six: Required Reading 3 and 4 August 2011 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 4
5 Conclusion In order to effectively communicate with your client and promote his/her health it is necessary to assess his/her ability to see and hear. Hidden problems with vision and auditory abilities can impact nursing interventions such as teaching. Problems with the nose, mouth and throat can affect appetite, and one s ability to speak, chew and swallow. This can have a major impact on the client s quality of life and ability to cope with health issues. Thus, basic assessment of the ears, eyes, nose and throat is important for all clients. Skin cancer is on the rise in North America, as a result, diligent assessment and health teaching should be a priority for nurses. Monitoring skin integrity and promoting health of the integumentary system is an important part of the role of the clinical nurse at the bedside. August 2011 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 5
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Ambulatory Care & Local Networks Cheekbone (isolated zygomatic arch) fracture surgery Information for patients You have been treated in the Emergency Department for a broken (fractured) cheekbone. This