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
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