CARE OF THE EYES, NOSE AND EARS

CARE OF THE EYES, NOSE AND EARS

UPDATED 2024

The eyes,
nose and ears are important organs which require no special care in daily life.
Hygienic care of these organs is always done as part of the general bathing
procedure. Hygienic care of the eyes, ears and nose prevents infection and
helps to maintain their functions. 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

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

Essential Steps in Eye, Ear and Nose

Eyes are cleaned from the inner to
the outer cantus
During a bath, each eye is cleaned
with a separate portion of the wash cloth
Excessive accumulation of secretions
make patient sniff or blow the nose
The patients who cannot remove
secretions needs assistance to clear the congestion and protect from nasal
mucosa
Babies and small children a wisp of
cotton moistened with warm water or oil, introduced into the anterior nares and
rotated gently, cleanses the nostrils

Common Problems of Neglected Care

Poor eye,
ear causes debris may accumulate behind the ear and in the anterior aspect of
the external ear. This can lead to ulceration of the skin. Collection of
cerumen or ear wax, in the external auditory canal cause difficulty in hearing

Purpose

To maintain the cleanliness of eye,
ear and nose
To prevent infection
To keep the organ in normal
functioning
To prevent obstruction

Factor Affecting

Systemic disease condition (diabetes
and hypertension)
Acute illness (viral or bacterial
infection)
Trauma (blow or foreign bodies)
Medication (toxic drugs)
Allergic substances
Congenital anomalies

Common Problems

Eye: conjunctivitis (burning, itching, red-watery and painful eyes with increased secretions) cataracts, glaucoma, strabismus and squint

Ear: otitis media, impacted cerumen and foreign bodies

Nose: mechanical irritation and obstruction

General Instructions

Eye

Unconscious patients are at risk for
eye injury. Daily swabbing of eye with wet sterile cotton is important
Cleaning is done from the inner
canthus of eye to the outer canthus of the eye
Use normal saline to remove the crust
During bath, each eye is cleaned with
a separate portion of the wash cloth
When sterile procedure is required,
each eye cleaned with separate swabs, swabbing each once only

Ear

Do not use pins or slides to clean
ears. Only use clean buds to clean ears
Poor hygiene of ear, debris may
accumulate behind the ear and in the anterior aspect of the external ear

Nose

Observation of nose for signs of
discharge, lesions, edema and deformity is required
External crusted secretions can be
removed with a wet wash cloth or a cotton applicator moistened with oil, normal
saline or water
Foreign bodies and small children a
wisp of cotton moistened with water or oil, introduced into the anterior flares,
and rotated gently cleanse the nostrils

Preliminary Assessment

Check

Patients diagnosis
Doctors order for specific
instructions
Assess the general condition
Self-care ability
Articles available in the unit

Preparations of the Patient and Environment

Explain the procedure
Arrange the articles at the bedsides
Place the patient in flat if the
condition permits
Protect the pillow and the bed with a
Mackintosh and towel under the head

Eye Care

Eye care is
carried out for a number of reasons: to clean the eye of discharge and crusts;
prior to eye drop installation; to soothe eye irritation; to prevent corneal
damage/abrasion in the unconscious/sedated patient

Equipment Needed

Clean trolley
Sterile dressing pack containing a
gallipot, gauze swabs and disposable towel
Sterile 0.9% sodium chloride
Sterile gloves
Appropriate eye ointment/drops (as
prescribed)
Good light source
Disposable bag for rubbish

The patient
should be sitting or lying with their head tilted backwards and chins pointing
upwards. This allows for easy access to the eyes and is a good position for
patient comfort.

Procedure:
explain to the patient what you are about to do even if the patient is
unconscious. Make sure the bed area is clear of any obstructions to enable you
to move around the bed freely, and that you have all the equipment-ensuring you
are prepared means you will not have to leave the patient unnecessarily during
the procedure

Make sure that the patient is in a
comfortable position and that there is a good light source
Ensure patients privacy
Make an assessment of the patients
eyes
Wash hands, put on gloves and open
sterile pack
Place disposable towel around the
patient’s neck
Ask the patient to close their
eyelids, to avoid damage to the cornea
With a gauze swab dampened in the
saline 0.9% gently swab from the inner aspect (nasal corner) of the eye
outwards. Use a new swab each time until all discharge has been removed
Repeat the procedure for both eyes
Dry the patient’s eyelids gently to
remove excess fluid
Dispose of equipment
Ensure that patient is comfortable
Wash hands thoroughly
At this point, if required, eye
ointment/drops are instilled
The medicine prescription should be
checked against the label on the eye ointment/drops prior to cleaning patient’s
eyes. The expiry date should also be checked on the medication
Check the patient’s prescription
sheet for the date and time of administration
Make sure that you have the correct
eye ointment/drop for each eye
Ensure the patient is in a
comfortable position head titled back and supported
The patient should be warned if the
medication is likely to cause side effects, such as blurred vision

After Care

Instill any medications that are
ordered
Remove the Mackintosh and towel from
under the patient head
Adjust the position of the patient
Replace the articles to the utility
room
Wash hand thoroughly
Record and report the procedure in
the nurse’s record

Care of the Ears

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
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

Care of the Nose

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 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