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Action Figure 3 Removing hard contact lenses.

Procedure guideline 9.5 Contact lens removal: soft lenses

Essential equipment

Sterile dressing pack

Contact lens solution

Low-linting or lint-free swabs

Optional equipment

Sterile/non-sterile powder-free gloves

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their consent (NMC 2008a, C).

2 Wash hands thoroughly using bactericidal soap. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

Procedure

3 Wearing gloves, gently pinch the lens between the thumb and index finger (see Action Figure 3). To encourage the lens to fold together, allowing air to enter underneath the lens for easy removal. E

4 Store lenses in the appropriate solution as recommended by the manufacturer and ensure lenses are placed in the correct left and right storage pots. To prevent deterioration and contamination (Stollery et al. 2005, E).

5 Refer to manufacturer’s instructions for further storage information, particularly if patient will not be using the lenses for a lengthy period of time. To prevent deterioration and growth of organisms. E

6 Make the patient comfortable.

Postprocedure

7 Remove and dispose of equipment. To keep area clean and reduce risk of cross-infection (Fraise and Bradley 2009, E).

8 Wash hands with bactericidal soap and water. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

9 Complete the patient’s recording chart and other hospital and/or legally required documents. To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment (NMC 2009, C).

Action Figure 3 (a) Moving a soft lens down the interior part of the sclera. (b) Removing a soft lens by pinching it between the pads of the thumb and index finger.

Ear care

Definition

Ear care encompasses the assessment and cleaning of the ears, including the instillation of prescribed ear drops. The monitoring and maintenance of hearing and patient education are also included.

Anatomy and physiology

The ears capture sounds for hearing and maintain balance for equilibrium (Nigam and Knight 2008). The ear has three parts: external, middle and inner (Figure 9.6).

Figure 9.6 Internal structure of the ear.

External ear

The external ear is a protective funnel made up of the cartilaginous pinna and external acoustic canal and the eardrum (Figure 9.6). The external acoustic canal is lined with small hairs and next to it lie the ceruminous glands which produce cerumen or ear wax. The amalgamation of cerumen and hairs prevents foreign objects from entering the ear. As the cerumen dries, it usually falls out of the ear canal but in some circumstances the wax can become impacted (Tortora and Derrickson 2009).

The pinna collects sound waves and delivers them via the external acoustic canal to the tympanic membrane or eardrum which vibrates in harmony (Nigam and Knight 2008, Richardson 2007). The eardrum separates the external and middle ear; it has a slight cone shape and the pointed end sits within the inner ear to assist the funnelling of sounds.

Middle ear

The middle ear is an air-filled chamber. It contains the three smallest bones in the body, the malleus, incus and stapes, collectively known as the auditory ossicles. To one side, it has a thin bony partition that holds two small membrane-covered apertures which are the oval and round windows (Tortora and Derrickson 2009). The auditory ossicles receive vibrations from the tympanic membrane. Vibrations are passed on to the oval window and through to the cochlea in the inner ear; within this process the sound waves are magnified (Alexander et al. 2007, Richardson 2007).

At the bottom of the chamber lies the eustachian tube which connects to the nasopharynx and regulates the pressure in the ear. It is usually closed but yawning or swallowing briefly opens it, allowing air to enter