assessment of the eye ear nose mouth and throat n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Assessment of the Eye , Ear , Nose , Mouth and Throat PowerPoint Presentation
Download Presentation
Assessment of the Eye , Ear , Nose , Mouth and Throat

Loading in 2 Seconds...

play fullscreen
1 / 36

Assessment of the Eye , Ear , Nose , Mouth and Throat - PowerPoint PPT Presentation


  • 202 Views
  • Uploaded on

Assessment of the Eye , Ear , Nose , Mouth and Throat. *課程目標: 1. 正確說出眼,耳,口,鼻及喉解剖位置 2. 正確說出各感官器官神經傳導路徑 3. 正確分辨各年齡層眼,耳,口,鼻及喉發展特性 4. 正確運用五官鏡執行眼,耳,口,鼻及喉之檢查技巧 5. 能正確運用學理分析評估結果 6. 能正確運用護理措施處理病患眼,耳,口,鼻及喉各部位之問題. 解 剖 生 理. (一) Eye : sensory organ 1.External Anatomy : . Structure . Gland

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Assessment of the Eye , Ear , Nose , Mouth and Throat


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
assessment of the eye ear nose mouth and throat
Assessment of the Eye,Ear,Nose,Mouth and Throat

*課程目標:

1.正確說出眼,耳,口,鼻及喉解剖位置

2.正確說出各感官器官神經傳導路徑

3.正確分辨各年齡層眼,耳,口,鼻及喉發展特性

4.正確運用五官鏡執行眼,耳,口,鼻及喉之檢查技巧

5.能正確運用學理分析評估結果

6.能正確運用護理措施處理病患眼,耳,口,鼻及喉各部位之問題

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide2
解 剖 生 理

(一)Eye:sensory organ 1.External Anatomy:

.Structure

.Gland

meibomian gland

Lacrimal gland

. tears pathway

.Muscular :

Extraocular muscular : conjugate movement

. nerves control

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide3
解 剖 生 理

2.Internal Anatomy:

.Outer layer :sclera / cornea

. Corneal reflex : afferent n (CNV) / efferent n (CNVII)

.Middle layer : choroid

. vascular pigment

. muscular fiber : pupil

. Lens

.Inner layer :retina (visual receptor)

. nerve : optic disc (optic papilla)

. vessel : artery / vein

. Macula / Fovea centralize

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide4
解 剖 生 理

(二)Ears

1.Exteranl Ear :

. external auditory canal : 1/3 catilage / 2/3 bone S-curve

. Tympanic membrane (eardrum )

2.Middle Ear :

. ear bone : malleus  Bincus  Bstapes

. Eustachian tube : conduct / protect / equalize

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide5
解 剖 生 理

3.Inner Ear :

. bony labyrinth : equilibrium / hearing

semicircular canals / vestibule

4.Fuction :

hearing and equilibrium

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide6
解 剖 生 理

(三)Nose:

1.Bone :

.Superior turbinate

. Middle turbinate

. Inferior turbinate

2.Mucosa / Vibrissae

3.Sinuses :

. Frontal sinuses . Maxillary sinuses

. Ethmoid sinuses . Sphenoid sinuses

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide7
解 剖 生 理

(四)Mouth and Throat:

1.Bone :

. Hard plate . Soft plate

2.Mucous

3.Gland :

. Partied gland

. Submandibular gland

. Sublingual gland

4.Teeth

5.Tonsillar

6.Throat

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide8
各感官器官神經傳導路徑

(一)Eyes:

1.Visual pathway

light (object)corneaaqueous

humorlensvitreous body

 retina  optic nerve( CNII )

 occipital lobe cortex

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide9
各感官器官神經傳導路徑

.image formed :

temporal visual field 

nasal area retina

.optic chiasm :

nasal fiber both temporal visual

field

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide10
各感官器官神經傳導路徑

2.Visual reflexes

(1) Pupillary light reflex :

subcortical reflex arc

 afferent nerve  CNII(optic nerve)

efferent nerve  CNIII(oculomotor nerve)

. direct light reflex

. consensual light reflex

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide11
各感官器官神經傳導路徑

2.Visual reflexes

(2) Fixation :

strong conscious control fix image to fovea centralize

(3) Accommodation :

eyeball convergence and pupillary constriction

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide12
各感官器官神經傳導路徑

(二)Ears:

1.Hearing

NoiseTympanic membraneear boneoval

windowcochlearound windowbasilar

membrane Cortic organ(hair cells)

CNVIII  temporal lobe cortex

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide13
各感官器官神經傳導路徑

2. Hearing pathway :

.Air conduction(AC)

.Bone conduction(BC)

3.Hearing loss :

conductive loss :

mechanical dysfunction of external or middle ear

sensorineural loss :

inner ear , CNVIII , auditory area cortex damage

mixed loss

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide14
各感官器官神經傳導路徑

(三)Nose:

1.Smelling

Smellolfactory receptor (hair cells )

nasal cavity roof and upper 1/3 nasal

septum  CNI temporal lobe

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide15
各感官器官神經傳導路徑

(四)Mouth:

1.Taste

Tongue :

sweet

salt

sour

bitter

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide16
三.各年齡層眼,耳,口,鼻及喉發展特性

四.眼,耳,口,鼻及喉各系統評估技巧

(一)資料收集

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide17
檢 查 步 驟

1.用物準備 :

視力表.筆燈

五官鏡(檢眼鏡.耳窺鏡.鼻窺鏡)

瞳孔尺.棉籤

壓舌板.嗅覺測試用具

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide18
檢 查 步 驟

Eyes ( Inspect )

◎External Ocular Structures

1).General :

move around the room

2).Eyebrows :

bilaterally ; symmetrically ; scare ; lesion

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide19
檢 查 步 驟

3).Eyelids and Lashes :

no redness ; swelling ; discharge

upper lids overlap the superior part of the

iris

4).Eyeballs :

no protrusion or sunken

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide20
檢 查 步 驟

5).Conjunctiva and Sclera :

moist / glossy / color

6).Lacrimal apparatus :

Inspect / pressing

身體檢查與評估 長庚大學護理學系 楊翠雲老師

anterior eyeball structure
◎Anterior Eyeball Structure

1).Cornea and Lens :

smooth / clarity(oblique view)

2).Iris and Pupil :

flat / round regular shape / color / equal size

pupillary light reflex(pupils rest size=3~5mm)

. direct light reflex:construct of the same sided pupil

. consensual light reflex:construct the other pupil

. accommodation :pupillary construction and convergence

eyes axes

身體檢查與評估 長庚大學護理學系 楊翠雲老師

the ocular fundus
◎The Ocular Fundus

1).Inspect :

optic disc / retinal vessel /general background / macula

2).Optic disc :

locate on nasal side of retina 『disc diameter (DD)』

color / shape / margins / cup-disc ratio

3).Retinal vessels

4).Macula : locate on temporal side of retina(1DD)

身體檢查與評估 長庚大學護理學系 楊翠雲老師

snellen eye chart near vision
◎Snellen Eye Chart ( Near Vision )

.place at eye level

.20 feet from chart ; hold the card about 35 cm

.normal visual : 20/20 ( 14/14 )

◎Visual field

.Confrontation Test :

. eye level with person about 2 ft

. cover the same eyes

. each eyes test 6 range of peripheral vision

身體檢查與評估 長庚大學護理學系 楊翠雲老師

extraocular muscle function
◎Extraocular Muscle Function

1).Corneal Light Reflex :

. assess the parallel alignment of eye axes

. light about 30 cm on the corneas

* if asymmetry of the light  Cover test

2).Cover test :

. interrupt the two eyes parallel to detect small degree

of deviated alignment

 Phoria  Tropia

3).Diagnostic Positions Test :

. six cardinal position . distance 12 inch

身體檢查與評估 長庚大學護理學系 楊翠雲老師

ears inspect and palpate
Ears (Inspect and Palpate)

◎The External Ear

1).Size and shape :

bilaterally equal size , no swelling , thickening

2).Skin condition :

intact , no lump or lesion

3).Tenderness :

move the pinna and push the tragus

4).The external auditory meatus :

size / swelling / redness / discharge

身體檢查與評估 長庚大學護理學系 楊翠雲老師

the otoscopic examination
◎The Otoscopic Examination

1).Using the Otoscope :

a. choose the largest speculum

b. head toward the opposite shoulder

c. pull adult ear : pinna upper and back

pull infant and child ( <3 age ) : pinna down

身體檢查與評估 長庚大學護理學系 楊翠雲老師

the otoscopic examination1
◎The Otoscopic Examination

d. hold the otoscope : upside down

* The External Canal :

redness / swelling / lesion / foreign body / discharge

* Tympanic Membrane :

color / character / perforation

shiny , translucent , pearl-gray color

Cone-shaped light reflex

visible : Umbo ;Manubrium ;short process

身體檢查與評估 長庚大學護理學系 楊翠雲老師

hearing acuity
Hearing Acuity :

(1) Voice Test

. test one ear at a time

. 30 ~ 60 cm ; whisper slowly

 unable to hear whisper  high tone loss

身體檢查與評估 長庚大學護理學系 楊翠雲老師

2 tuning fork test
(2) Tuning Fork Test :

Weber test :

.place a vibrating tuning fork in the midline skull

.the same sound in both ears

Rinne test :

.compares air conduction ( AC ) and bone conduction( BC )

.mastoid  near ear cana

.AC : BC≒ 2 : 1 or(AC > BC)

身體檢查與評估 長庚大學護理學系 楊翠雲老師

slide30
臨床情境:

Hearing lossWebber testRinne test

Conductive loss 聲音偏向較差一側 AC<BC

Sensorineural loss 聲音偏向較好一側 AC>BC

身體檢查與評估 長庚大學護理學系 楊翠雲老師

nose inspect and palpate
Nose ( Inspect and Palpate )

◎Eternal Nose

1).symmetric , in the midline , skin lesion ,

pain

2).nastril patency :

each time test one nasal (CNI)

身體檢查與評估 長庚大學護理學系 楊翠雲老師

nasal cavity
◎Nasal Cavity

1).nasal speculum : insert 1 cm

2).short wide-tipped speculum

. normal red color and smooth moist surface

. note swelling , discharge , bleeding , foreign

body

. nasal septum deviation

. turbinate : middle and inferior (red color)

身體檢查與評估 長庚大學護理學系 楊翠雲老師

sinus areas
◎Sinus Areas :

Palpate:

1).frontal sinus below the eyebrow

2).maxillary sinus  below cheekbones

 chronic allergy and acute infection (sinusitis)  pain

Transillumination:R/O sinusitits

1).frontal sinus  under thesuperior orbital

2).maxillary sinus  inside the mouth on the hard palate

normal light up symmetrically

身體檢查與評估 長庚大學護理學系 楊翠雲老師

mouth inspect and palate
Mouth (Inspect and Palate)

◎Mucosa

1).lip :

color , moisture , crack , lesion

2).Teeth and Gums :

teeth number and alignment / gum color , bleeding , swelling

3).Tongue :

color , surface character , moisture , nodule, ulcer , lesion

身體檢查與評估 長庚大學護理學系 楊翠雲老師

mouth inspect and palate1
Mouth (Inspect and Palate)

4).Buccal Mucosa :

color , nodule , lesion

※ Stensen‘s duct  open the parotid salivary(upper

second molar)

5).Palate :

pink , smooth , upwardly movable

. uvula : in the midline (CN X)

身體檢查與評估 長庚大學護理學系 楊翠雲老師

throat inspect and palate
◎Throat (Inspect and Palate)

1).Tonsils :

color , small plugs , size

Tonsils grade : (p.395)

1+ : visible

2+ : halfway between tonsillar pillars and uvula

3+ : touching the uvula

4+ : touching each other

(2+ , 3+ , 4+  Acute Infection)

身體檢查與評估 長庚大學護理學系 楊翠雲老師