Inspection of ENT organs
Rules for the use of the frontal reflector
Inspection of ENT organs is effective only with the help of reflected light and provided that the direction of the light beam coincides with the visual axis of the researcher. Inspection in daylight is considered to be of little informative. For effective research, a light bulb of 150-200 W is used as the light source;the reflector is a round,
slightly concave mirror with a diameter of 8-9 cm with a focal length of 20 cm. The light source is placed at the level of the patient's head on the right and somewhat backward. Reflector should be strengthened on the explorer's head before the left eye so that the eye, the hole in the reflector and the area under investigation are on a straight line. In the study of young children, the presence of an assistant is required. The child is seated in the arms of an assistant, and he holds the child's head firmly with one hand, pressing it to his chest, and holding the other hand with his other hand. The legs of the child should be sandwiched between the legs of the assistant.
Nasal cavity examination( rinsoscopy)
Nasal cavity examination is performed under artificial illumination using a frontal reflector and a nasal dilator( Hartmann's mirror).The nasal dilator held in the left arm is carefully inserted in the closed state into the patient's nose, then gradually expanding the jaws, widening the nostril and lifting it slightly upward. Inspection should be done carefully, so as not to press the expander on the nasal septum, as this causes pain and can cause nosebleeds. On examination, the lower and middle nasal concha, the lower and middle nasal passages and the anterior part of the nasal septum are seen. To examine various parts of the nasal cavity, the patient needs to change the position of the head. Inspection of the inferior nasal concha can be carried out at the usual position of the patient's head, to examine the middle nasal conch the patient needs to tilt his head back somewhat. With the help of lateral movements of the head, the results of the study are refined.
Inspection of the oral cavity and pharynx( pharyngoscopy)
To investigate the oral cavity and the middle part of the pharynx, a light source of artificial light, a frontal reflector is needed. When examining the oral cavity, pay attention to the condition of the tongue, teeth, hard and soft palate. Further, the palatine tonsils and the posterior pharyngeal wall are examined. When examining a child, you do not need to recommend sticking out your tongue, as this is not right. To ensure a free inspection of the oral cavity, the tongue should remain in the mouth without any tension and in a flattened state. The spatula is slightly pressed against the front third of the tongue, without touching the root of the tongue, so as not to induce a vomiting reflex.
Ear examination( otoscopy)
After examining the auricle and entering the external auditory meatus, it is necessary to take the ear funnel over the enlarged part with the thumb and forefinger. Carefully, with gentle rotational movements, insert it into the ear canal to a depth of 1-1.25 cm, if possible, without touching the bone. At the same time, to straighten the ear canal, the auricle is pulled upward and posteriorly, and in young children - down and back. With the help of light movements of the inner part of the ear funnel, the inner sections of the auditory canal and the whole surface of the tympanic membrane are examined in parts.
Carrying out of medical procedures
Care of patients with ear diseases consists in cleaning of an ear and introduction in it of various medicinal substances. Often before the examination of the tympanic membrane it is required to clean the external auditory canal from sulfur, pus or crusts.
Cleaning the external ear canal
Cleaning the external ear canal is one of the stages of ear treatment. It is carried out in a wet or dry way. A wet cleaning method( ear washing) is performed in those cases of acute or chronic purulent inflammation of the middle ear, when the suppuration is so abundant that the removal of pus by drying with cotton can not be complete or takes a long time.
Ear wash
Ear flushing is done with a 100-gram ear syringe or an ordinary rubber balloon with a plastic tip. The ear is washed with warm disinfectant solutions, usually 3% solution of boric acid. The patient himself holds the kidney-shaped basin tightly pressing it to the side of the neck. For a better cleansing of the ear canal in adults, pull the left hand backwards and upwards, with the right hand the tip of the balloon is injected into the ear of the patient, but not deeper than 1 cm. The nurse must direct a stream of warm water in separate portions with moderate strength along the back wall of the auditory canal. When filling a rubber cylinder with liquid, all air should be removed from it, since air bubbles, mixing with water, cause a noise unpleasant for the patient during washing. After washing, the patient's head is tilted sideways so that the water will flow out of the ear. Remains of water from the depth of the ear canal are removed with cotton wool wrapped around the probe. This method of cleaning the ear canal requires accuracy and caution, since during washing it is possible to drift into the ear of a secondary infection.
Dry ear cleaning
As dry cleaning, drying or wiping the ear canal with cotton wool is used. This method is used to remove pus from the ear canal in cases where pyustin is small or when washing is contraindicated due to irritation of the skin of the auditory canal( for example, with dermatitis, eczema, furuncle).
For wiping and drying the ear use thin probes with a screw thread at the end. Smooth and buttoned probes are not suitable for this purpose. Before the procedure, the nurse should thoroughly wash her hands with soap, tightly wrap the cotton in the probe, and cover the sharp end of the probe with cotton so that the walls of the ear canal or the tympanic membrane are not injured. Vat should be used hygroscopic sterile. Ear wiping should be done by the following mechanism: with the left hand, hold the ear funnel and pull the auricle back and forth, and the right one gently insert the probe from the vat at the end of the cotton wool to a depth of 2.5 cm or to the tympanic membrane. Light rotational movements of the probe contribute to better absorption of moisture by cotton wool. Wiping of the ear is repeated until the wool removed from the ear is completely dry. Only with complete dryness of the ear canal, if necessary, let in droplets.
Introduction of ear pads
The introduction of ear pads is performed according to the following scheme:
• to straighten and widen the auditory canal with the left hand, pull the auricle back and forth;
• with crank tweezers grasp the end of the ear swab, which is a narrow gauze specially folded strip no longer than 5 cm, gently propel it along the ear canal to a depth of not more than 2.5 cm;
• taking out the tweezers, again grasp the gauze swab, for 1 - 1.5 cm away from its end, and gently move until it touches the tympanic membrane.
Ear tampons stacked in the auditory canal loosened so as not to cause a delay of pus in the depths. When copious hypotension, ear pads should be changed 5-6 times a day, when ungrowing or lean - 1-2 times a day. To prevent the development of complications or the introduction of secondary infection, all receptions for ear care should be performed gently, with the strictest asepsis.
Flushing of sulfuric plug
Washing the sulfur plug with warm water( 37 ° C) to avoid irritation of the vestibular apparatus and associated unpleasant sensations for the patient( dizziness, nausea, vomiting, etc.).To wash the ear, use a 100 ml syringe. The jet of liquid is pushed along the back wall of the ear canal, pulling the auricle back and forth. To avoid damaging the walls of the ear canal and the tympanic membrane with the tip of the syringe, it is necessary to create a syringe support to prevent the tip from suddenly entering the ear canal. With sufficient strength of the jet, the sulfur plug is washed out entirely or in parts by individual small lumps. After washing, the ear canal should be dried with cotton wool wrapped around the probe. If, after repeated washing, the sulfur plug does not leave, soften it. To do this, for 2-3 days for 10-15 minutes in the ear filled alkaline drops. After the infusion of drops as a result of cork swelling, an even more pawning of the ear may occur, which should be warned of the patient.
Ear blowing
Ear blowing according to the method of the Politorzer is carried out with the aid of a rubber cylinder( 300-500 ml capacity) connected to a rubber tube ending with an olive. The olive is introduced into this or that nostril( or both), the fingers of the left hand tightly press both wings of the nose( one to the olive, the other to the nasal septum).This ensures the fixation of the olive and the necessary tightness. Then the patient is asked to take a sip of water, or an empty sip, or utter a word( "steamer", "cuckoo") to raise the soft palate, and at the moment of swallowing or uttering the word it is necessary to gently squeeze the balloon with his right hand. With successful blowing, the patient feels a blowing noise, the sensation of ear congestion disappears and hearing is restored.
The use of medicinal substances in diseases of the ear
Drugs for diseases are applied in the form of drops, ointments and powders. The most common treatment procedure for ear disorders is the droplet in the ear. If there is a purulent discharge in the ear canal, then carefully remove the drops before it is allowed to enter by repeated wiping with cotton wool wrapped around the probe. All drops must be preheated to body temperature, so as not to cause irritation of the vestibular apparatus. When the droplets are allowed to enter the ear, the patient should tilt the head in the opposite direction. Pulling the auricle with his left hand back and forth, the nurse drops 5-10 drops of the medicine with a pipette. Drops are allowed to enter the ear 2-3 times a day, each time holding them for 10-15 minutes, then tilt the head towards the diseased ear in order for the drops to drain out. After removing the drops, the ear canal should be dried and, when the doctor prescribes, it is difficult to tampon it with a sterile gauze pad.
Smearing with ointment is used only for diseases of the external ear canal and auricle( dermatitis, eczema).The walls of the auditory canal are smeared with ointment using cotton wool tied to the probe. Sometimes a tampon with ointment is left in the ear canal for 15-30 minutes.
Injection of powdered drugs
The injection of powder must be preceded by a thorough cleaning of the ear canal from the existing pus in a dry or wet way. Inflammation produces a different kind of powder blowers( insufflators).Blowing up the powder, it is necessary to straighten the ear canal, pulling the auricle back and forth, and make sure that the powder lies in a thin, even layer, without forming lumps that can prevent the outflow of pus. The application of warming compresses on the ear, a rubber bag with ice on the mastoid process, ear dressings are carried out according to the general rules of patient care.
Lubrication of the pharyngeal mucosa with medicinal substances
Lubricate the pharyngeal mucosa with a cotton swab dipped in the medicinal solution prescribed by the doctor. This procedure should be carried out under the control of vision using a frontal reflector. The tongue is pressed with a spatula. Cotton swab should be quickly lubricated first front palatine arch, then palatine tonsils, then the back wall of the pharynx. When urge to vomit, you should stop the procedure and let the patient calm down, and then continue lubricating the pharyngeal mucosa.