Examination of the earThis includes an assessment of hearing as well as the appearance of the ear. Show
History[1]The following issues should be included:
Inspecting the external ear[2]Inspect the external ear before examination with an otoscope/auriscope. Swab any discharge and remove any wax. Look for obvious signs of abnormality.
Inspecting the ear canal and eardrumA modern electric otoscope/auriscope with its own light source is primarily used to examine the ear. An otoscope also has its own magnification, which gives a good view of the tympanic membrane (TM). Batteries need to be fully operational to allow optimal light during examination. The examination technique involves grasping the pinna and pulling it up and backwards (posteriorly and superiorly), which helps to straighten the ear canal and for inspection of the TM. (In infants, only pull the pinna posteriorly not superiorly for examination.) Hold the otoscope near to the eyepiece rather than at the end; this helps to reduce the patient's discomfort due to hand movements, which are exaggerated in the ear. Modern otoscopes are designed to use a disposable speculum. It is necessary to fit the correct size of speculum to achieve the best view; it is tempting to use a small piece for ease of insertion, but this simply restricts the image available. Note the condition of the canal skin, and the presence of wax, foreign tissue, or discharge. The mobility of the eardrum can be evaluated using a pneumatic speculum, which attaches to the otoscope. The drum should move on squeezing the balloon. Inspecting the tympanic membrane[2]Move the otoscope in order to see several different views of the drum; it is not always possible to see the whole drum in one single view using an otoscope. The drum is roughly circular (~1 cm in diameter). In a normal drum the following structures can be identified:
Occasionally, in a healthy, thin drum, it is possible to see the following:
Common pathological conditions related to the ear include:
Check facial nerve function if ear pathology is serious. Basic hearing tests[2]Detailed hearing tests are usually performed in audiology clinics. A patient with normal hearing should hear equally as well in both ears.
Examination of the nose[2]Full nose examinations assess the function, airway resistance and occasionally sense of smell. It includes looking into the mouth and pharynx. Common symptoms of nasal disease include:
HistoryThe following issues should be covered:
Inspection of the noseFirst look at the external nose. Ask the patient to remove any glasses. Look at the nose from the front and side for any signs of the following:
The nose can be inspected from the front to examine the anterior nares by lifting the tip of the nose up and looking inside without a speculum. Check patency of each side and ask the patient to sniff. To assess the nasal airway hold a cold metal tongue compressor under the nose while the patient exhales and note the condensation under both nostrils, or occlude one nostril whilst the patient sniffs to give a reasonable idea of airway patency. Most otolaryngologists now use endoscopy rather than the traditional method. However, the traditional method of head mirror or illuminated spectacles with a Thudichum speculum to open up the nose, allows examination of the nasal cavity with excellent specificity and is more suited to primary care. It does not have high sensitivity, however, and is therefore unsuitable for screening[4]. Holding the instrument comfortably can take practice at first. Insert the Thudichum speculum gently, and identify the nasal septum medially; turbines laterally; inferior turbinate (nearly always possible to see); and the middle turbinate - often difficult to see as it is small. Check for inflammation (rhinitis), position of the septum, and presence of polyps (touch to check sensitivity; it should be insensitive to touch). A foreign body, usually accompanied by an offensive unilateral discharge, may be seen inside the nose of a child. A mirror and headlight or an endoscope instrument are used to view the nasopharynx (the postnasal space, which contains the Eustachian tube orifices and pharyngeal recess (of Rosenmüller) and may contain adenoids or nasopharyngeal cancer), but this is not always possible during a routine examination. Finally, examine the palate. Look for large nasal polyps and tumours arising from the soft palate. Examination of the throat[2]This includes a thorough examination of the oral cavity. HistoryGeneral history, plus ask the patient about tobacco or alcohol use and dental history. InspectionAsk the patient to remove any dentures, and examine their mouth systemically (use a bright torch): tongue, hard and soft palate, tonsillar fossa, gingivolabial/gingivobuccal sulci, floor of mouth/undersurface of tongue as follows:
What are the 4 techniques in health assessment?WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation.
Which examination method would be used for the nose ears and eyes?A HEENT examination is a portion of a physical examination that principally concerns the head, eyes, ears, nose, and throat.
What are the things and techniques that you used in assessing the head and neck?Inspect the skull and face. Inspect the skin and scalp. Palpate skull (especially if patient complains of tenderness or recent trauma). Assess facial sensation and motor function.
Which techniques can the nurse use for collecting patient assessment data?A structured physical examination allows the nurse to obtain a complete assessment of the patient. Observation/inspection, palpation, percussion and auscultation are techniques used to gather information.
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