Chapter 25 and 26 study guide

otorrhea

An inflammation of the ear with purulent discharge.

Dangers of ototoxic drugs

Assess frequently when receiving a potentially ototoxic drug. Signs of ototoxicity: ringing in the ears, subtle changes in hearing ability, and difficulty in hearing Teach importance of immediate reporting of symptoms.

When a patient is receiving Lasix for a problem with edema, which assessment relative to this drug is important to the patient's health?

Checking for hearing loss

If chemical splashes into the eye, the eye should be treated with

Continuous irregation for at least 30 mins with normal saline or water

Presbyopia

Farsightedness that occurs normally with aging.

After age 40 many people developdecreased visual____ and need glasses

Acuity

After age 70/joe noticed that the ______ of his hearing had decreased

Acuity

Contributing factors to hearing loss

Adequate treatment of severe ear infections helps preserve hearing. Loud noise is a major cause of sensorineural hearing loss, and the use of headphones or earbuds contributes considerably to hearing damage

Cataract surgery is performed when the loss of vision

Affects the persons life

Tuning fork tests measure hearing by_______conduction.

Air or bone

When working with a patient who has a hearing aid the nurse should make certain that the aid

Is turned on and that the battery is working

People who are deaf may __________themselves because of embarrassment and frus tration over difficulty communicating.

Isolate

We asses IOP

In glaucoma

If anforeign objectbis stuck into the eye the best thing to do is to

Leave it in place and patch both eyes and to seek emergency treatment

Symptoms of labyrinthitis are loss of hearing in the affected ear, severe dizziness with nausea and vomiting and

Nystagmus

The patient could hear low sounds but had difficulty hearing sounds with a hieh

Pitch

We give stool softeners before and after surgery to

Prevents IOP

Rehabilitation for Hearing Loss

Specific measures to rehabilitate a patient with hearing loss depend on the age and aptitude of the patient. Adults who have acquired the skills of speech and language before their loss of hearing occurred are better able to pick up language cues and understand what is being said to them, and therefore should have fewer problems with communication by language

A nurse evaluates the visual acuity of a patient using the Snellen chart. Which statement is true regarding the use of the Snellen chart?

The patient reads the letters using one eye at a time.

The teaching plan for the discharged patient who has Ménière's disease and is prescribed meclizine would probably include which information about the drug?

There are antihistamine side effects. They make you sleepy

Things we shouldn't do during ear irrigation

When irrigating an ear canal, the water should be tepid. Cold water and too much irrigation pressure can cause dizziness and nausea as well as pain. Check the temperature of the water each time the syringe or irrigation container is refilled. Drape the patient so that the clothing does not become wet.

The transparent cornea

allows light to hit the lens. It assists with the bending of light rays (refraction), so that the rays will hit the retina in the right location for images to be transmitted to the brain.

Conjunctivitis: Inflammation of the conjunctiva; "pink eye" is a specific type caused by chemical irritants, bacteria, or virus

Varying degrees of pain and discomfort Increased tearing and mucus production Itching; sensation of a foreign body in the eye

Keratitis: Inflammation of the cornea

Varying degrees of pain and discomfort Photophobia; blurred vision if center of cornea is affected

Causes of labyrinthitis include bacterial meningitis, chronic otitis media, or

Viral infections

When eardrops are administered, they should first be ________ or they may cause discomfort or dizziness.

Warmed to room tempurature

Fluorescein angiography (retinal angiography)

To detect tumors of the interior of the eye and to help diagnose and measure the extent of retinopathy, An IV injection of sodium fluorescein is given. A short time later, photographs of the fundus are taken with a special camera, signed consent is necessary for this procedure.

Refraction

To determine amount of lens correction necessary to restore person's vision to as near normal as possible with glasses

Near vision test

To determine status of near vision, The patient is given a Jaeger Test Type card with different sizes of type on it. One eye is occluded while the patient reads the lines of type. Determination of vision status is made on the basis of what a person with normal vision can read.

Visual acuity

To determine status of vision, The Snellen eye chart is used. It is placed 20 feet from the patient; first one eye is occluded, then the other eye is occluded. The person begins reading lines of letters that decrease in size. Visual acuity is expressed as a fraction for each eye. The numerator (first) figure indicates the distance between the patient and the chart. The denominator (second) figure expresses the distance at which the person with 20/20 vision could read the letters in the line correctly. Visual acuity of 20/20 in each eye is normal; vision of 20/200 (with correction) is legally defined as blindness.

Intraocular pressure test

To determine the amount of pressure within the eye; aids in diagnosis of glaucoma

Intraocular pressure test

To determine the amount of pressure within the eye; aids in diagnosis of glaucoma, tonometer is used to measure the pressure. This may be a handheld instrument, but it usually is a device that measures pressure by taking a reading while air is directed at the eye by a pneumotonometer. Another type of tonometer is the applanation tonometer. Normal intraocular pressure is 10-21 mm Hg, Explain that this is a test to determine whether a patient might have glaucoma. More than one reading on different days is necessary to confirm a diagnosis of glaucoma. If a diagnosis of glaucoma is made, medication can be prescribed to help control the intraocular pressure and preserve vision

Color vision test

To determine whether the patient has any color blindness, Use the Ishihara chart book, which shows numbers composed of dots of one color within an area of dots of a different color. Ask the patient what she sees on the page for each chart. Test each eye separately. Reading the numbers correctly indicates normal color vision

A tympanoplasty involves surgical reconstruction of the

Tymapanic memebrane and the ossicles to restore middle ear function

Eyelashes

line the edge of the eyelid

The lacrimal glands

located in the upper outer area above the eyes.

keritis

inflammation of the cornea

When assessing a patient who complains of a mild hearing loss, the nurse should first:

inspect the ear canal for cerumen.

Nystagmus

involuntary rhythmic jerking of the eyes

The eyelids

composed of skin, connective tissue, and conjunctiva. The conjunctiva is a thin mucous membrane that lines the eyelid and covers the anterior portion of the eyeball, except for the cornea.

1 Otosclerosis is a hereditary condition which causes sult in profound hearing loss. Treatment for this condition includes: degeneration of bone in the inner ear. This may re- (Select all that apply.)

correction through use of a hearing aid. sodium. surgical correction involving replacing the stapes with a prosthetic device (stapedectomy).

refraction

determination of refractive errors (inability to focus light rays on the retina) and their correction with eyeglasses

When assessing a patient for vision problems, subtle signs of decreasing vision are:

developing a bruise on the shin from the open door to the dishwasher. when using prescribed glasses.

What causes retinal detachment risk factors

diabetic or hypertensive

When administering eardrops to an adult, the nurse would:

draw the pinna upward and toward the back of the head.

The patient who has had a stapedectomy should be instructed to:

sleep with the affected ear up.

Impulses from the equilibrium receptors are transmitted

to the brain via the vestibular branch of the vestibulocochlear nerve (cranial nerve VIII). The cerebellum is important in mediating the sense of equilibrium and balance.

The bones of the middle ear

transmit the sound vibrations to the inner ear

The stapes

transmits the sound vibrations to the oval window, which transfers the motion to the fluid in the inner ear

The biconvex

transparent lens, together with the suspensory ligaments and the ciliary body, forms a partition that divides the interior of the eyeball into two chambers. The anterior chamber between the lens and the cornea is filled with aqueous humor. The posterior chamber, between the lens and the retina, contains vitreous humor.

Retinopathys

two major causes of retinopathy are diabetes mellitus and hypertension

Xanthelasma

soft, raised, yellow areas, sometimes appear on the eyelid after age 50 years

The pinna collects

sound waves and channels them into the auditory meatus

With older age,The joints between the auditory bones become

stiffer; the stiffness interferes with the transmission of sound waves but is not clinically significant by itself

Fluid motion in the inner ear

stimulates the sound receptors in the cochlea and the organ of Corti.

S/S of ototoxicity

ringing in the ears, subtle changes in hearing ability, and difficulty in hearing, should be reported immediately

Retinal detachments commonly occur in people

such as diabetic or hypertensive

The lacrimal gland secretes

tears that moisten, lubricate, and cleanse the surface of the eye.

The malleus transmits

them to the incus, and the incus transmits sound vibrations to the stapes

The fovea centralis

the area of the retina that produces the sharpest image.

Beginning usually around age 40, patients often develop an eye condition known as presbyopia. This condition is when:

the ciliary muscle has less ability to allow the eye to accommodate, resulting in close vision impairment.

The retina

the inner layer of tissue of the eyeball and is found in the posterior portion of it. The retina contains several layers. The layer with rods and cones acts as the receptor for light images

The optic nerve

the nerve that carries neural impulses from the eye to the brain

IOP is determined by

the rate of aqueous production, the resistance encountered by the aqueous humor as it flows out of the passages, and the venous pressure of the episcleral veins that drain into the anterior ciliary vein.

Primary retinal detachment

the result of spontaneous or degenerative changes in the retina or the vitreous humor

Stool Softeners

may be started a day or two before surgery to prevent constipation and the Valsalva maneuver postoperatively. The Valsalva maneuver can increase IOP

Secondary retinal detachment is associated with

mechanical trauma, inflammation within the eye, or some other ophthalmic disorder, such as diabetic or hypertensive retinopathy

The iris

third part of the middle layer of the eyeball; it is the colored portion of the eye and is a doughnut-shaped diaphragm with the pupil as the central opening. The iris contains two groups of smooth muscles that constrict and dilate the pupil to regulate the entrance of light.

* An intervention for setting up a dinner tray for a blind person would be to:

using the "clock" method describe where each type of food is located

Retinal detachment

not a detachment of the whole retina, but a separation of the sensory layers of the retina from the pigmented epithelial layer, the choroid. Retinal detachment can cause vitreous fluid to leak under the retina, separating a portion of it from the vascular wall and thereby depriving the retina of its blood supply

The ciliary body

part of the middle layer of the eyeball and contains finger-like ciliary processes that produce aqueous humor. The ciliary body helps change eye shape for near and far vision

The choroid

part of the middle layer of the eyeball. It is a highly vascular layer containing brown pigment located between the sclera and the retina.

transparent cornea

part of the wall of the eyeball and covers the anterior one sixth of the eyeball

Sclera

part of the wall of the eyeball, is opaque white and covers the posterior five sixths of the eyeball

A simple hearing test is the_________test.

wnisper

drusen ( risk for macular degeneration )

yellow exudates found beneath the retinal pigment epithelium, representing extracellular debris

A male patient was informed that he would need to wear a pair of corrective lenses for astigmatism. When asked about the condition, the patient demonstrates understanding when he states that:

"Astigmatism is an irregular curvature of the cornea."

When assessing a patient who is complaining of ear pain, the most important question would be:

"Have you had a recent upper respiratory infection?"

Before eye surgery, a patient is instructed to take stool softeners. When asked about the rationale for taking the stool softener, an appropriate response would be:

"The medication reduces the possibility of straining at stool postoperatively."

While looking at a card with a geometric grid of identical squares, a patient is asked to focus on a central dot and to describe any distortions of the surrounding boxes. Which patient statement indicates a need for further diagnostic testing?

"There are wavy lines around the central dot."

A patient returns 1 week after receiving hearing aids and states, "I guess I may as well return these-I just cannot get used to them." What is an appropriate nursing response? (Select all that apply.)

"You have not been able to hear well for a long time. Adjusting to the way you hear the sound through a hearing aid may take quite a bit of time, but it will be worth it!" "In order to adjust to the hearing aids, you must wear them most of the time. Are you able to keep them in most of the time, or do you spend most of your time without them?"

1. Fluorescein angiography is used as an assessment tool by the health care provider. Teaching for the pa- tient about the procedure includes stating:

"dye will be injected intravenously and the blood vessels in the fundus examined."

Ototoxicity

(ear poisoning) is caused by drugs or chemicals that damage the inner ear or the vestibulocochlear nerve, may result in temporary or permanent disturbances of hearing, balance, or both

Community teaching for the prevention of eye problems should include: (Select all that apply.)

1) wearing a hat when outdoors. 2) wearing sunglasses that block UVA and UVB rays when outdoors. 4.obtaining regular glaucoma screening after age 40. 5. eating a diet rich in fruits and vegetables that contain antioxidants.

When administering preoperative mydriatic eyedrops you should wait

5 minutes btw the instillation of one drop and the other

Ms. Jaiswal just had a stapedectomy. She has an IV of D½ NS hanging and there are 660 mL left in the bag. It is prescribed to run at 100 mL/hour. The IV tubing delivers 10 drops per mL. You should set the drip rate at

17 gtts/min

Older adults are more prone to conductive hearing loss and tinnitus because of:

2. hardened cerumen.

The nurse would expect to implement which order for the patient with Ménière's disease?

4. Compazine 25 mg IM q3-4h PRN nausea and vomiting

When eardrops are instilled, the patient should remain in the lateral position for

5-10 minutes

Mr. Schultz has come to the emergency department with severe eye pain. He is diagnosed with closed- 15 minutes. The vial of the drug contains 500 mg in 2 mL. How many mL would be added to the D,W angle glaucoma. The health care provider orders IV Diamox 150 mg in 200 mL of D,W to be given over for this infusion?

6.6ml

Ms. Messina is scheduled for cataract extraction with intraoccular lens implant of the right eye. Assesment of Ms. Messina during preoperative care would include

A. Degree of retained vision and history of previous hospitilizations, B. Ability to instill eyedrops and perform self-care, C. Ability to understand and follow directions

Post op complications for cataracts

Always wash hands before instilling medication. Check the label of the container to be certain it is the right medication. Do not contaminate the applicator tip of the medication. • Instill only the number of drops ordered; apply pressure at the inner canthus to prevent systemic absorption; close the eye gently (do not squeeze the eye shut). • Change the eye patch dressing at least once a day; change as needed to keep the area clean. • Follow the medication schedule prescribed by the provider exactly. (Send home a written schedule.) • Maintain designated head position and activity restrictions. • Report signs of complications: sudden, increasing pain in the eye, which can indicate hemorrhage; purulent drainage; decreasing vision; or signs of increased IOP, such as brow headache. • Keep the follow-up appointment with the surgeon. • Use caution to prevent getting water in the eye. • Protect the eye during the day with glasses; use sunglasses for outside wear; wear a protective eye shield at night. Patient adherence to the schedule for postoperative medications is critical to prevent complications and promote healing.

When a patient has a hearing loss, it is important that the nurse ______words

Anunciate

sensorineural loss

Approximately 80% of hearing loss is caused by a disorder of the hearing nerve

Drugs used in the treatment of glaucoma act to enhance the flow of

Aqueous humor or decrease production

When irrigating the ear canal to remove cerumen, aim the stream of water above or below the impaction to allow ___________to push out the cerumen.

Back pressure

Uncontrolled glaucoma causes

Blindness

Hereditary deafness is usually due to changes in the

Bones ossicles of the ear and cause conductive hearing loss

For the patient undergoing assessment for a hearing loss, the nurse would explain that electronystag mography is performed in conjunction with:

Caloric testing

How do we respond to a chemical eye injury

Chemical burns should be treated by lengthy, continuous irrigation. If available, an IV bag of normal saline is the preferred solution; otherwise, tap water will suffice. Place the patient supine with his head turned to the affected side. With gloves on, direct the stream of fluid to the inner canthus so that the stream flows across the cornea to the outer canthus, holding the lids apart with your thumb and index finger. Water should be lukewarm. At intervals, stop and have the patient close his eyes to move secretions and particles from the upper eye to the lower conjunctival sac; then begin again. Continue for 15 to 30 minutes. The patient should be seen by a provider as soon as possible.

hearing loss is caused by a problem transmitting sound impulses through the auditory canal, the tympanic membrane, or the bones of the middle ear

Conductive loss

A woman complains of eye itching, tearing, halos around lights, and decreased central vision. Which symptom most clearly relates to macular degeneration

Decreased central vision

Ptosis

Decreased muscle tone and decreased elasticity may cause drooping of the upper lid to a point where it interferes with vision

photophobia

Difficulty tolerating light

When communicating with a hearing-impaired person, it is best to position yourself

Directly in front of the person.

The patient who has just had eye surgery should be positioned with the head

Elevated and should not lie on the affected side

Ectropian

Eversion of the lower lid occurs because of loss of muscle tone and elasticity

hordeolum (stye)

External stye; infected swelling near the lid margin on inside

Cateracts s/s

Hazy, blurred, or double vision (diplopia) Increasing complaints about glare Increasing nearsightedness Complaints that colors are faded or appear yellowish or brownish Desire for increased light by which to read Difficulty with night vision Frequent need for eyeglass prescription change decreased color perception painless patient may have photophobia (intolerance of light)

People with diabetes may face several eye problems and diseases as a complication of their illness. Which of the following can cause severe vision loss or blindness in a person with diabetes? (Select all that apply.)

Glaucoma Retinopathy Glaucoma

Conductive hearing loss can often be helped by a(n)

Hearing aid or corrected with stapendectomy or tympanoplasty

A nurse applies a vibrating tuning fork to the middle of a patient's forehead. What would indicate normal hearing? response

Hearing the sound in the middle of the head.

Otosclerosis is generally a(n)

Hereditary degeneration of the Inner ear

The term for inability to see objects close at hand is

Hyperopia

Communicating With a Person Who Is Hearing Impaired

If the person uses a hearing aid, encourage its use and see that it is situated, turned on, and adjusted before beginning speaking. Be certain you have the person's attention before beginning speaking.Sit facing the person with the light on your face rather than from behind you.Ask permission to turn down the volume of or turn off the television or radio.The best distance for speaking to a hearing-impaired person is to 4 feet. Place yourself on eye level with the person. Do not speak directly into the person's ear, because this prevents the person from obtaining visual cues while you are speaking.Do not smile, chew gum, or cover your mouth while speaking. Use short, simple sentences. If the patient does not appear to understand or responds inappropriately, state the message again using different words. Try to limit each sentence to one subject and one verb.Give the person time to respond to questions.Ask for oral or written feedback to make certain your message is understood.Avoid using the intercom system, because it may distort sound.

presbycusis

Impairment of hearing in old age.

An older adult is admitted for cataract extraction. Which sign or symptom is associated with this condition?

Increasing complaints about glare

Blepharitis

Infection of glands and lash follicles along lid margin

Chalazion

Internal stye; infection of meibomian gland

Which nursing action(s) demonstrate(s) appropriate care of a patient who is visually impaired? (Select all that apply.)

Introduce self before touching. Ensure ready access to the call button for assistance. Assist with feeding using the clock method.

Entropion

Inversion of lid margin; eyelids are turned inward toward eyeball so that lashes rub against eyeball

Procedure for irrigation to remove ear wax

Irrigating the external ear canal. Warm water is used to remove cerumen and debris from the canal. Aim the stream of water above or below the impaction to allow back pressure to push it out rather than farther down the canal

Kerititis may be caused by _____

Irritation or infection

When teaching the elderly patient about care of his hearing aid, you would include which action(s)?

Keep the battery in the hearing aid. Never put the hearing aid in water. Open the battery cover when the hearing aid is not in the ear.

Dangers of Ototoxic Drugs

Know the toxic effects of the drugs you administer. Patients should be assessed frequently while receiving a potentially ototoxic drug. Any signs of ototoxicity, such as ringing in the ears, subtle changes in hearing ability, and difficulty in hearing, should be reported immediately. Ototoxicity commonly occurs because patients are taking more than one drug that can be toxic to the ear. Teach patients who are taking daily doses of aspirin or nonsteroidal anti-inflammatory drugs for arthritis or other chronic pain conditions to immediately report the signs of ototoxicity.

Identifying rehab methods for hearing loss

Lip-Reading (Speech Reading), Sign Language, Hearing Aids, cochlear implants, hearing assistive devices

Other rehab for hearing loss

Lip-Reading (Speech Reading), sign language, hearing aids, cochlear implant, hearing assistive devices

Corneal abrasion or ulceration

Moderate to severe pain and discomfort aggravated by blinking History of trauma, contact lens wear

Many people do not know that hearing aids from a reputable dealer usually have a(n)

Money back guarantee trial period

Causes of conductive loss

Obstruction by impacted cerumen, Infection with labyrinthitis, Otosclerosis, Trauma and scarring of the tympanic membrane, Congenital malformation of the outer or middle ear

Early symptoms of macular degeneration are inability to see vividness

Of colors and details

Glaucoma is often unotice until damage

Of vision occurs from IOP and pressure on the optic nerve

A cataractbmakes the lens of the eye

Opaque

Retinopathy is often a disorder that occurs in patients with diabetes mellitus and is either from

Over growth of blood vessels or rupture of blood vessels with bleeding

Common Causes of Sensorineural Hearing Loss

Presbycusis (hearing loss associated with aging) Heredity with congenital loss Ototoxic drugs Loud noise exposure Music and occupational noise Tumor (acoustic neuroma) Ménière's disease Severe infection such as measles, mumps, meningitis Rubella in utero

causes of sensorineural loss

Presbycusis, Heredity with congenital loss, Ototoxic drugs, Loud noise exposure, Tumor (acoustic neuroma), Ménière disease, Severe infection such as measles, mumps, or meningitis, Rubella in utero

Retinal detachment post op

Restrict activity according to the provider's instructions. Bed rest with bathroom privileges for the first few days is common. The head may need to be positioned to the left or right most of the time. A head-down or semiprone position to the right or left will be required for most of the time if a gas bubble was injected into the eye. • The following activities are allowed immediately after discharge unless a gas bubble has been injected into the eye as part of the procedure: • Watching television from a distance of at least 10 feet. • Tub bath or shower, using extreme care not to get soap or water into the eyes. Take care to prevent a fall. • Walking outdoors with the guidance of a companion. • Reading for brief periods. • Gentle shampooing of hair with head tilted backward and care not to get soap or water into the eyes. • Riding in a car as a passenger. Eye Care • The operated eye is to be patched at all times and protected by an eye shield or glasses until you are told you may leave the eye uncovered. A patch or shield may still be recommended for use while sleeping. The eye patch is removed only to administer eyedrops or ointment. The eyelid may be cleansed with cotton or gauze moistened with irrigating solution. Each time the patch is changed, check the movement of the eyeballs under the lids. Gently retract the upper lid, and look down as far as possible. Next, look up while retracting the lower lid. This helps break adhesions of the eyeball to the lids. • The following are expected and should not cause alarm: tearing, a small amount of blood on the eye patch, a scratchy sensation, blurred vision, unusual visual images, a few light flashes, and floaters. Call the provider if these symptoms significantly increase after discharge. • Have someone else administer the eye medications. Assume a reclining position for eyedrop or eye ointment placement. Pull down the lower lid and, with the patient looking up, place the correct number of drops into the center of the conjunctival sac. Let the lid gently close. The patient should try not to squeeze the eye shut or blink excessively. Wait 3 to 5 minutes between types of eyedrops so that they do not wash each other out and dilute the intended effect. Patch the eye after each set of drops or ointment is administered. If a shield is to be used, it is placed on top of the taped-down eye pad. Comfort • Take a prescribed analgesic or extra-strength acetaminophen to relieve pain. A cool washcloth or ice pack to the forehead may provide comfort. Report pain that grows markedly worse or is accompanied by nausea and vomiting. Precautions • In case of cough, take cough syrup. Do not try to hold back sneezes. Do not strain at stool; take a stool softener or milk of magnesia if needed to prevent this. Restrictions • Avoid driving a car until visual acuity is 20/40 or better; your provider will tell you when you may resume driving. • Avoid lifting heavy objects (those over 20 lb) for at least 4 months. • Refrain from work for 2 to 6 weeks (depending on type of work); your provider will tell you when you may return to work. Light housework that does not require bending over or vigorous scrubbing may be resumed within 1 to 2 weeks depending on the type of surgery performed. • Avoid vigorous or strenuous activity for 4 months. • Do not bend with your head down; keep the head upright, and bend at the knees. • Avoid sports for 3 to 4 months.

The sudden occurrence of flashes of colored light is a sign of

Retinal detachment

Exposure to environmental loud noise causes a(n) ______________hearing loss that is of ten not correctable,

Sensory neural

The characteristic signof narrow angle glacoma is

Servere eye pain

After eye surgery, a patient is instructed to avoid movements that increase the venous pressure in the head, neck, and eyes. Which movement(s) increase(s) venous pressure? (Select all that apply.)

Straining Bending Strenuous exercises

Tobacco and Alcohol and Macular Degeneration

Teaching people to quit smoking and to abstain from immoderate drinking (four or more alcoholic drinks a day) can decrease the incidence of AMD. Smoking is believed to double the risk of AMD

We position pts after eye surgery

The head is positioned so that the area repaired is dependent, preventing the pull of gravity from disrupting the surgical site. The designated position for the head also is calculated to position the oil or gas bubble—if one was used—in the best place to apply pressure to the retina. Position the patient according to the provider's orders

A cateract causes a blurring of vision because

The lens becomes cloudy and opaque

Six muscles attach to the eyeball and allow for movement

The muscles come from the bones of the orbit and insert on the outer layer of the eyeball.

How to admin ear drops to a pt

The patient should be positioned in a supine lateral position so that the affected ear is uppermost. The medication should be at room temperature. Cold eardrops may cause discomfort or dizziness. For adults and children 3 years of age and older, the ear canal is straightened by drawing the pinna upward and toward the back of the head (Figure 25-12). For a child younger than 3 years, the pinna is pulled down and back. Following the "Six Rights" of medication administration, draw up the correct amount of medication. Insert the tip of the dropper into the external ear canal and instill the medication Place cotton in the external meatus to prevent the medication from escaping. Have the patient remain in the lateral position for 5 to 10 minutes.

To of retnopathy

Tight control of blood glucose levels (100 to 115 mg/dL) is very important to prevent excessive diabetic retinopathy. There is no other known way to halt the process

Topical dye (corneal staining)

To detect abrasions of the cornea or the presence of a foreign body on the cornea, Fluorescein dye drops are administered to the affected eye. The dye remains on the injured tissue or surrounds a foreign body. Such areas usually appear as green spots, Warn that the drops may sting slightly for a few minutes. Give the patient a tissue to absorb the excess drops, because they may stain clothing.

Amsler grid test

To detect macular degeneration, Using a handheld card printed with a grid of black lines similar to graph paper, the patient fixates on a center dot and records abnormalities of the grid lines, Test should be performed every week or two. Instruct the patient to record seeing wavy or missing lines or distorted areas

Ultrasonography

To evaluate the characteristics of a lesion and its size and growth over time, or to determine the presence of a foreign body, probe is placed directly on the eyeball. Sound waves are transmitted into the eye, bounce back off the various tissues, and are collected by a receiver and amplified on an oscilloscope screen.

Visual fields test (confrontation test)

To examine the patient's visual fields, detecting problems with peripheral vision, The examiner faces the patient and asks her to look directly into his eyes. The examiner covers his right eye, and the patient covers her left eye. Then the examiner's finger is moved from an area outside of the peripheral vision into the line of vision. The patient should detect the finger about the same time as the examiner. The test is repeated with the other eye covered.

Slit-lamp biomicroscopic examination

To examine the surface of the eye, A beam of light is reduced to a narrow slit that illuminates only a small section of the eye, allowing examination of a thin section of the eye structures at a time, Explain that this device helps detect "floaters" in the vitreous humor, and abnormalities of the cornea and other structures of the eye. The eyes may be dilated with mydriatic drops for this test.

Ophthalmoscopy (retinoscopy)

To inspect the fundus (back portion) of the eyeball to detect abnormalities of the retina, macula, optic disc, and retinal vessels

Optical coherence tomography (OCT)

To record images of retinal structures To differentiate the anatomic layers within the retina and allow measurement of retinal thickness To detect macular holes, epiretinal membranes, cystoid macular edema, and other pathologies Focused beams of light are directed into the eye that scan the structural features of the retina. A cross-sectional image similar to a topographic map is produced, The patient's eyes must be dilated. Tell the patient that she will be looking into a machine. The test takes 10-20 min.

Extraocular muscle function test

To test the function of the extraocular muscles, Ask the patient to hold her head still and to move her eyes to follow a small object such as a pen to each of the six cardinal points: right; upward and right; downward and right; left; upward and left; downward and left, Observe for parallel eye movements and any deviation of movement. Nystagmus is a normal finding for the far lateral gaze. Record your findings.

Electroretinography

To test the functional integrity of the retina; evaluates degeneration of the photoreceptor cells, Electrodes embedded into a contact lens are placed directly on the anesthetized eye. A light stimulus is introduced. The change in electrical potential of the eye caused by the flash of light is measured, Instruct the patient that she must fixate on the target and not move her eyes during the test.

When hearing loss occurs, it is often the_______ that are most difficult to hear

Tones

Which instruction must be included in the discharge teaching of a patient who has undergone corneal transplant?

Wear an eye shield when in close contact with children or pets.

The macula lutea

a yellow spot just lateral to the optic disc that allows for visual detail.

How do meds like aspirin and Lasix effect our ears

a very high dose of the drug is given or if it is given incorrectly, Aspirin and other salicylates can produce loss of hearing of high frequencies and ringing in the ears (tinnitus), they cause ototoxicity

What is astigmatism?

a visual defect that results from a warped lens or an irregular curvature of the cornea; either condition will prevent the horizontal and vertical rays from focusing at the same point on the retina

The order of sound transmission from the outer ear to the brain is

a. pinna b. tympanic membrane с. middle ear d. organ of Corti e. vestibulocochlear nerve f. medulla oblongata

Meclizine (Antivert) is a drug that is used for patients with Ménière's disease. This drug is used to re- duce dizziness and is a(n):

antihistamine.

Receptors responsible for equilibrium (balance)

are located in the inner ear, within the bony vestibule and at the base of the semicircular canals

While ambulating, a patient with Ménière disease complains of dizziness and vertigo. An immediate nursing action would be to:

assist the patient to supine position.

The lacrimal ducts and canals

carry tears from the eye to the nose

Cataracts eventually

cause blindness if they are not removed

The nurse's most important evaluation criterion for interventions to prevent complications of glaucoma surgery is:

checking the degree of eye pain.

The suspensory ligaments

connect the ciliary body to the lens

Tears

contain an enzyme that helps destroy bacteria and prevent infections.

The therapeutic response expected of dorzolamide (Trusopt) is:

decreased production of aqueous humor.

The older you get The number of nerve fibers in the vestibulocochlear nerve

decreases, contributing to hearing loss and sometimes affecting balance and equilibrium.

During a provider visit, a 65-year-old man complains of pain in his right eye associated with excessive tearing. The nurse notes that the eye is red with lashes rubbing against the cornea. A likely condition would be:

entropion.

Ménière disease

exact cause is unknown, occurs most commonly in people who have had chronic ear disorders and allergic symptoms involving the upper respiratory tract. There is a genetic link, and approximately 50% of those with the disorder have family members who are also afflicted. An increase of endolymph within the spaces of the labyrinth, with swelling and congestion of the mucous membranes of the cochlea, occurs. Resultant pressure in the labyrinth of the inner ear results in permanent damage to both the cochlear and vestibular structures. The disorder is usually unilateral. Long-term stress may be a factor

The hairs and cerumen in the canal help prevent

foreign objects from reaching the tympanic membrane.

The optic disc

formed by the axons of the ganglion cells of the retina.

Eye Disorders

genetic predisposition, Diabetes mellitus, hypertension, Untreated glaucoma, Macular degeneration.

S/S of retinal detachment

gradual or sudden, depending on the cause and extent of the detachment and the location of the area involved flashes of colored light accompanied by showers of floaters (black spots) or may feel as if a curtain has been drawn over a portion of the visual field Later, cloudy vision or loss of central vision is noticed. In severe cases, there may be complete loss of vision.

With older age Cerumen becomes

harder, containing less moisture, and its buildup within the ear may contribute to a hearing loss in the low-frequency range

The eustachian tube

helps equalize pressure in the middle ear.

The organ of Corti transmits

impulses to the cochlear branch of the vestibulocochlear nerve (cranial nerve VIII). This nerve carries the impulses to the medulla oblongata, the thalamus, and then to the temporal lobe of the brain, which contains the auditory cortex.

smoking has a direct link

incidence of macular degeneration

The nurse emphasizes safety precautions to a 60-year-old female Hispanic patient with Ménière disease. An appropriate nursing approach would be to:

include family members in instructions.

As you get older The tympanic membrane

loses elasticity

Decreases in hearing often occur with aging because of: (Select all that apply.)

loss of elasticity of the tympanic membrane. nerve cell atrophy in the ear and brain. arteriosclerosis and decreased blood flow.

Dietary considerations for Ménière's disease

low-sodium diet, his fluid intake may be restricted

The priority measures a diabetic patient must take following surgery for diabetic retinopathy are: (Select all that apply.)

maintain strict control of blood glucose levels. 3 maintain blood pressure within a normal range.

Things putting you at risk for macular degeneration

occurs with aging and is the most common cause of visual loss in older adults, Inflammation, Chlamydia pneumoniae has been found in the eye tissue of some people with the wet form of AMD, genetic tendency, diabetes and hypertension are associated risk factors.

Macular degeneration

occurs with aging and is the most common cause of visual loss in older adults. Inflammation may be a factor; Chlamydia pneumoniae has been found in the eye tissue of some people with the wet form of AMD. There is a genetic tendency for the disease, and diabetes and hypertension are associated risk factors. Wearing sunglasses regularly when outdoors may help protect against AMD. Certain vitamins, minerals, and antioxidants seem to help prevent or slow AMD.

With aging There is a gradual loss

of the receptor cells in the organ of Corti after age 40 years.

The sebaceous glands secrete

oily fluid that lubricates the lids

cataract

opacity of the lens that produces an effect similar to one a person would experience when looking through a sheet of falling water, causes a blurring of vision because the lens, which is normally transparent, becomes cloudy and opaque

AIDS can cause blindness as a result of

opportunistic infections

Planning for safety needs for a patient with a right cataract extraction and intraocular lens implant in the immediate postoperative period would include: (Select all that apply.)

placing the call light cord and console on her left side. medicating quickly if she becomes nauseous from anesthea

The most important nursing intervention in the recovery period before discharge from the day surgery unit to ensure success of eye surgery is:

positioning the patient per orders.

Exopthalmus

protrusion of the eyeball

hearing loss caused by a disorder of the hearing nerve

sensorineural loss

When communicating with a patient who is hearing impaired, the nurse should: (Select all that apply.)

sit at eye level facing the patient. enunciate clearly. use simple, short sentences.

Sebaceous glands

situated with the eyelashes.

Common causes of external otitis media

staphylococci

Besides difficulty hearing, ear problems and deafness are often accompanied by

tinnitus which can cause considerable fatigue in the person.

The tympanic membrane

vibrates when sound waves hit it; the sound vibrations are conducted to the malleus.

The Romberg test is performed by having the person stand

w/Feet togther arms out to the side; and eyes open