1-8. CARING FOR THE EYES, EARS, AND NOSE
a. General. The eyes, ears, and nose require special attention for cleansing during the patient's bath. The specialist has the responsibility of assisting patients in the care of eyeglasses, contact lenses, artificial eyes, or hearing aids. Assessments must be made of the patient's knowledge and methods used to care for the aids, as well as any problems he might be having with the aids. Patients with limited mobility cannot grasp small objects. Patients that have reduced vision or are seriously fatigued will also require assistance from the specialist.
b. Important Points. The eyes, ears, and nose are sensitive and therefore extra care should be taken to avoid injury to these tissues. Never use bobby pins, toothpicks, or cotton-tipped applicators to clean the external auditory canal. Such objects may damage the tympanic membrane (eardrum) or cause wax (cerumen) to impact within the canal.
(1) Care of the eyes.
(a) Cleansing of the circumorbital (circular area around the eye) area of the eye is usually performed during the bath, and involves washing with a clean washcloth moistened with clear water. Do not use soap because of the possibility of burning and irritation. The eye is cleansed from the inner to outer canthus. A separate section of the washcloth is used each time. This is to prevent spread of infection. Place a damp cotton ball on lid margins to loosen secretions. Never apply direct pressure over the eyeball. Exudate from the eye should be removed carefully, and as often as necessary to keep the eye clean.
(b) The eyelashes, tearing, and split-second blink reflex usually keeps the eyes well protected. An unconscious patient may need frequent special eye care. Secretions may collect along the margins of the lid and inner canthus when the blink reflex is absent or when the eyes do not completely close. The physician may order lubricating eye drops. In some cases, the eyes may be medicated and covered to prevent irritation and corneal drying.
(c) Many patients wear eyeglasses. The specialist will use care when cleaning glasses, and protect them from breaking. Eyeglasses should be stored in the case and placed in the drawer of the bedside stand. Glasses are made of hardened glass or plastic that is impact resistant to prevent shattering, but they can easily be scratched. Plastic glasses require special cleaning solutions and drying tissues. Warm water and a soft dry cloth may be used for cleansing glass lens.
(d) Most patients prefer to care for their own contact lens. A contact lens is a small, round, sometimes colored disk that fits over the cornea. If the patient is unable to remove the lens, the specialist should seek assistance from someone who is familiar with the procedure. The lens should not be reinserted until the patient is capable of caring for the lens himself. It is very important that you care for the patients who are unable to properly take care of their lens. Prolonged wearing of contact lens may cause serious damage to the cornea.
(2) Care of the ears.
(a) The ears are cleaned during the bed bath. A clean corner of a moistened washcloth rotated gently into the ear is used for cleaning. Also, a cotton- tipped applicator is useful for cleansing the pinna.
(b) The care of the hearing aid involves routine cleaning, battery care, and proper insertion techniques. The specialist must assess the patient's knowledge and routines for cleaning and caring for his hearing aid. The specialist will also determine whether the patient can hear clearly with the use of the aid by talking slowly and clearly in a normal tone of voice. Have the patient suggest any additional tips for care of the hearing aid. When not in use, the hearing aid should be stored where it will not become damaged. The hearing aid should be turned off when not in use. The outside of the hearing aid should be cleaned with a clean, dry cloth. Hearing loss is a common health problem with the elderly, and the aid assists in the ability to communicate and react appropriately in the environment.
(3) Care of the nose.
(a) Secretions can usually be removed from the nose by having the patient blow into a soft tissue. The specialist must teach the patient that harsh blowing causes pressure capable of injuring the eardrum, nasal mucosa, and even sensitive eye structures. If the patient is not able to clean his nose, the specialist will assist using a saline moistened washcloth or cotton tipped applicator. Do not insert the applicator beyond the cotton tip.
(b) Suctioning may be necessary if the secretions are excessive. When patients receive oxygen per nasal cannula, or have a nasogastric tube, you should cleanse the nares every 8 hours. Use a cotton-tipped applicator moistened with saline. Secretions are likely to collect and dry around the tube; therefore, you will need to cleanse the tube with soap and water.