Eye & Ear Pharm and Med Surg Combined

When assessing visual acuity using the Rosenbaum's card, at what length should the card be held from the patient's eyes?

20 feet

What is the criteria to be diagnosed legally blind?

20/200 or less in the best eye with the best possible correction

The preoperative medication sheet identifies that cyclopentolate is prescribed for a client before cataract surgery. The client asks the nurse what the medication is for, and the nurse provides education. Which statement by the client indicates that teaching has been effective? 1. "It lubricates the eye." 2. "It makes my pupils smaller." 3. "It paralyzes the muscles in my eye." 4. "It causes me vessels to become smaller."

3. "It paralyzes the muscles in my eye." Rationale: Cyclopentolate is used for preoperative mydriasis. It is a rapid-acting mydriatic and cycloplegic medication. Cycloplegics are medications that paralyze the ciliary muscle, and mydriatics are medications that dilate the pupil. Cyclopentolate becomes effective in 25 to 75 minutes, and the effects last for 6 to 24 hours. The statements in the remaining options are not actions of this medication.

A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? 1. "The medication will help dilate the eye to prevent pressure from occurring." 2. "The medication will relax the muscles of the eyes and prevent blurred vision." 3. "The medication causes the pupil to constrict and will lower the pressure in the eye." 4. "The medication will help block the responses that are sent to the muscles in the eye."

3. "The medication causes the pupil to constrict and will lower the pressure in the eye." Rationale: Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication? 1. "The medication prevents blurred vision by relaxing the muscles of the eyes." 2. "The medication dilates the eye to prevent increased pressure from occurring." 3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye." 4. "The medication blocks responses that are sent to the brain that direct the actions of the muscles in the eye."

3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye." Rationale: Pilocarpine hydrochloride is a miotic that is used to lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. The statements in the remaining options are incorrect.

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective? 1. "This works to prevent hypertension." 2. "This works to prevent hyperthermia." 3. "This works to decrease intraocular pressure." 4. "This works to maintain an adequate blood pressure for cerebral perfusion."

3. "This works to decrease intraocular pressure." Rationale: Acetazolamide is a carbonic-anhydrase inhibitor used to treat glaucoma. The medication decreases the formation of aqueous humor. The statements in the remaining options are not indicative of the purpose of this medication.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? 1. Doxycycline 2. Atropine sulfate 3. Acetylsalicylic acid 4. Diltiazem hydrochloride

3. Acetylsalicylic acid Rationale: Aspirin is contraindicated for GI bleeding and is potentially ototoxic. The client should be advised to notify the prescribing health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options 1, 2, and 4 do not have effects that are potentially associated with hearing difficulties.

The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride? 1. Disulfiram 2. Cyclopentolate 3. Atropine sulfate 4. Naloxone hydrochloride

3. Atropine sulfate Rationale: Pilocarpine hydrochloride is a cholinergic agent. Atropine sulfate must be available in the event of systemic toxicity from pilocarpine hydrochloride. Pilocarpine toxicity is manifested by vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Disulfiram is an alcohol deterrent used in the management of alcoholism in selected clients. Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication used preoperatively for surgical procedures on the eye. Naloxone hydrochloride is an opioid antagonist used to reverse opioid-induced respiratory depression.

In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 0900 for surgery that is scheduled for 0915. What initial action should the nurse take in relation to the characteristics of the medication action? 1. Provide lubrication to the operative eye prior to giving the eye drops. 2. Call the surgeon, as this medication will further constrict the operative pupil. 3. Consult the surgeon, as there is not sufficient time for the dilative effects to occur. 4. Give the medication as prescribed; the surgeon needs optimal constriction of the pupil.

3. Consult the surgeon, as there is not sufficient time for the dilative effects to occur. Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis, not pupil constriction. The nurse should consult with the surgeon about the time of administration of the eye drops since 15 minutes is not adequate time for dilation to occur.

Betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side and adverse effects of this medication? 1. Assessing for edema 2. Monitoring temperature 3. Monitoring blood pressure 4. Assessing blood glucose level

3. Monitoring blood pressure Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side and adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 2, and 4 are not specifically associated with this medication.

Ear drops are prescribed for an infant with otitis media. Which is the most appropriate method to administer ear drops to an infant? 1. Pull up and back on the pinna, and direct the solution onto the eardrum. 2. Pull down and back on the pinna, and direct the solution onto the eardrum. 3. Pull down and back on the pinna, and direct the solution toward the wall of the canal. 4. Pull up and back on the pinna, and direct the solution toward the wall of the canal.

3. Pull down and back on the pinna, and direct the solution toward the wall of the canal. Rationale: In a child younger than 3 years of age, the pinna is pulled down and straight back. The infant should be turned on the side with the affected ear uppermost. Using the nondominant hand, the person administering the ear drops pulls the pinna down and back. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum. The infant should remain with the affected ear uppermost for 10 to 15 minutes to retain the solution. In an adult or a child older than 3 years of age, the pinna is pulled up and back to straighten the auditory canal.

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the health care provider's prescriptions, expecting which type of eye drops to be prescribed? 1. A miotic agent 2. A thiazide diuretic 3. An osmotic diuretic 4. A mydriatic medication

4. A mydriatic medication Rationale: A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the client with a cataract. These medications act by dilating the pupils; they also constrict blood vessels. A miotic medication constricts the pupil. An osmotic diuretic may be used to decrease intraocular pressure. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

Which medication, if prescribed for the client with glaucoma, should the nurse question? 1. Betaxolol 2. Pilocarpine 3. Erythromycin 4. Atropine sulfate

4. Atropine sulfate Rationale: Options 1 and 2 are miotic agents used to treat glaucoma. Option 3 is an antiinfective medication used to treat bacterial conjunctivitis. Atropine sulfate is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)? 1. Hearing acuity 2. Blood glucose level 3. Presence of calf pain 4. Blood pressure and apical pulse

4. Blood pressure and apical pulse Rationale: Betaxolol is an antiglaucoma medication and a β-adrenergic blocker. Systemic effects of this medication are hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea. The client should have the blood pressure monitored for hypotension and the pulse assessed for strength, weakness, irregular rate, and bradycardia. Bowel activity and evidence of heart failure also should be assessed. The other options are incorrect and not associated with this medication.

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops? 1. Irregular pulse 2. Periorbital edema 3. Elevated blood pressure 4. Brown pigmentation of the iris

4. Brown pigmentation of the iris Rationale: Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side/adverse effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation does not progress further once the medication is discontinued but does not regress. The other options are not noted with this medication.

A client with glaucoma is given a prescription for a pilocarpine ocular system. The nurse plans to provide which instruction to the client on how to use the medication? 1. Apply ½ inch into the eye at bedtime. 2. Apply one drop of the solution four times a day. 3. Remove and replace the ocular system every 48 hours. 4. Check the eye each morning to make sure that the system is in place.

4. Check the eye each morning to make sure that the system is in place. Rationale: The pilocarpine ocular system has a bilayered membrane surrounding a reservoir of pilocarpine solution. The tiny unit, which is placed in the conjunctival sac, slowly releases medication. The unit should be changed once a week. Because the unit may fall out during sleep, the client should check the eye each morning for its presence.

The nurse teaching a mother how to administer ear drops to an infant tells the mother to pull the child's ear in which direction? 1. Up and back and direct the solution onto the eardrum 2. Down and forward and direct the solution onto the eardrum 3. Up and forward and direct the solution toward the wall of the canal 4. Down and back and direct the solution toward the wall of the canal

4. Down and back and direct the solution toward the wall of the canal Rationale: The ear is pulled down and straight back in a child younger than 3 years. The infant is turned onto the side, with the affected ear uppermost. The nurse pulls down and back on the earlobe with the nondominant hand while resting the wrist of the dominant hand on the infant's head. The medication is directed toward the wall of the canal rather than onto the eardrum. The infant should lie with the affected ear uppermost for 10 to 15 minutes to retain the solution. In an adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal.

When teaching a client with glaucoma about the effects of a miotic medication, the nurse should tell the client that the medication will produce which effect? 1. Reshape the lens to eliminate blurred vision 2. Dilate the pupil to reduce intraocular pressure 3. Interrupt the drainage of aqueous humor from the eye 4. Lower intraocular pressure and improve blood flow to the retina

4. Lower intraocular pressure and improve blood flow to the retina Rationale: Miotics are used to lower the intraocular pressure, which then increases blood flow to the retina. This in turn decreases retinal damage and loss of vision. Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork. The other options are incorrect.

The nurse is providing instructions to a client who will be self-administering eye drops. To minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action? 1. Eat before instilling the drops. 2. Swallow several times after instilling the drops. 3. Blink vigorously to encourage tearing after instilling the drops. 4. Occlude the nasolacrimal duct with a finger after instilling the drops.

4. Occlude the nasolacrimal duct with a finger after instilling the drops. Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption.

The nurse is teaching a mother to instill drops in her infant's ear. The nurse explains that to give the ear drops correctly, the mother needs to take which action? 1. Pull up and back on the earlobe and direct the solution toward the eardrum. 2. Pull down and back on the auricle and direct the solution toward the eardrum. 3. Pull up and back on the auricle and direct the solution toward the wall of the canal. 4. Pull down and back on the earlobe and direct the solution toward the wall of the canal.

4. Pull down and back on the earlobe and direct the solution toward the wall of the canal. Rationale: The infant should be turned onto the side, with the affected ear uppermost. With the wrist of the nondominant hand resting on the infant's head, the mother pulls down and back on the earlobe and aims the solution at the wall of the canal, rather than directly onto the eardrum. In the adult, the auricle is pulled up and back to straighten the auditory canal.

What cranial nerve transmits sound to the temporal lobes of the cerebral cortex?

8th cranial nerve also called vestibulocochlear nerve

arcus senilis

A benign white or gray opaque ring in the corneal margin of the eye.

What is glaucoma?

A disease in which there's an increase in pressure in the eye damages the optic nerve and thus impairs its ability to transmit visual information from the eye to the brain. It must be treated early or it can lead to blindness. Treatment includes eyedrops

What is a Darwin's Tubercle, would it be concerning?

A downward protrusion of the helix and its a normal finding

eustachian tube

A narrow tube between the middle ear and the throat that serves to equalize pressure on both sides of the eardrum auditory tube

Which physician is an ear specialist? A. Audiologist B. Ophthalmologist C. Optician D. Dermatologist

A. An audiologist is a physician who specializes in treating the ear.

Common otic antibiotics

Acetic acid and aluminum acetate otic (Domeboro Otic) Ofloxacin otic (Floxin) Acetic acid (Vosol)

What are some examples of ototoxic medications?

Amikacin, gentamicin, neomycin, erythromycin, vancomycin, bumetanide, furosemide, hydrochlorothiazide, cisplatin, indomethacin methotrexate

Otic systemic antibiotics

Amoxicillin (Amoxil, Trimox) Amoxicillin and clavulanate potassium (Augmentin) Sulfamethoxazole and trimethoprim (Bactrim, Septra) Cefaclor (Ceclor) Erythromycin and sulfisoxazole (Pediazole)

Ophthalmic Local Anesthetics

Anesthetic before surgery S/E: Stinging, burning Ex: tetracaine proparacaine

What class of drugs is used to treat pinkeye? A.Miotics B.Antibiotics C.Diuretics D.Corticosteroids

B. Antibiotics are used to treat pinkeye.

Which of the following are used to treat edema in the eye? A. Cerumenolytics B. Glucocorticoids C. Mydriatics D. Miotics

B. Glucocorticoids are used to treat edema in the eye.

The category of ophthalmic medication that may alter the color of the iris and change the patient's eye color is called? A.Glucocorticoids B.Prostaglandins C.Antibiotics D.Beta blockers

B. Prostaglandins may change iris color, especially in green or hazel eyes.

Motion sickness medication should be taken? A.1 hour before travel B.1 day before travel C.20 to 60 minutes before travel D.At time of travel

C. 20 to 60 minutes before travel is appropriate.

Scopolamine is given via which route? A.Oral B.Injection C.Transdermal D.Rectal

C. Scopolamine is administered by the transdermal route.

Nerves of the eye

CN II Optic CN III Oculomotor CN IV Trochlear CN V₁ Ophthalmic division of trigeminal CN VI Abducens

What part of vision is lost with macular degeneration?

Central and near vision

How does the nurse assess peripheral vision?

Compares own ability to see peripheral objects with that of the patient. Examiner stands 2ft in front of and facing the patient and instructs the patient to cover one eye. Examiner covers their corresponding eye. Examiner uses the arm opposite the covered eye extends it it to the space midway between the patient and examiner and brings it to toward the eye from 3 directions; superior, inferior, and temporal. Examiner wiggles the finger while moving the arm. Examiner asks patient to look straight ahead and indicate at what point they are able to see examiner's finger. One eye is tested then the other.

What type of hearing loss is helped by using a hearing aid?

Conductive hearing loss cochlear implants for sensorineural loss

Signs of ototoxicity include? A.Tinnitus B.Severe headache C.Ataxia D.All of the above

D. All of the above, plus hearing loss and balance disturbances.

Which drug is used to treat glaucoma? A. Cerumenolytics B. Glucocorticoids C. Mydriatics D. Miotics

D. Miotics are used for glaucoma.

The part of the eye covering the outer eye is called the? A.Iris B.Cornea C.Eyelid D.Sclera

D. The sclera covers the outer eye.

Otic antibiotics used to reduce imflammation

Examples Ciprodex (ciprofloxacin and dexamethasone otic) Cortisporin (hydrocortisone, neomycin, and polymyxin B otic) Vosol H C (hydrocortisone and acetic acid)

Explain proper administration of eye drops

Explain procedure to pt, check medicine for dosage, strength, side effects, contraindications, and expiration date. Perform hand hygiene and apply gloves, instruct pt to tilt head backward and look up toward the ceiling, gently pull lower lid down to form a pocket into which ointment is placed, express ointment directly into exposed palpebral conjunctiva, moving from inner to outer canthus (be careful not to touch pts eye or surrounding structure w/tip of ointment tube. must remain sterile) Release lower eyelid over the ointment

IOP stands for in other places. t or f

False; IOP stands for intraocular pressure.

Aqueous humor is located behind the eardrum. t or f

False; aqueous humor is located in the eye.

Half-angle is a type of glaucoma. t or f

False; open or closed-angle are the two types of glaucoma.

Pinkeye is an injury occurring from surgery. t or f

False; pinkeye is an eye infection caused by viruses or bacteria.

The stapes is located in the inner ear. t or f

False; stapes is in the middle ear.

How can the nurse communicate effectively to a patient that has presbycusis?

Get the person's attention before beginning to speak, face and stand close to the person, maintain eye contact, avoid standing in the glare of bright sunlight or other bright lights, speak clearly at normal rate and volume, use short sentences and assess for understanding, allow extra time for listener to respond, ensure optimum environment, encourage nonverbal communication such as touch or gestures as appropriate, don't smile, chew gum, or cover mouth when talking, ensure listening device is working properly, use written communication

What family history would put a patient at risk of developing a vision problem?

Glaucoma, diabetes, blindness, and cataracts

What are signs and symptoms of Cataracts?

Halos around lights difficulty reading fine print or seeing in bright light increased sensitivity to glare double or hazy vision decreased color vision

How can you prevent the spread of conjunctivitis?

Hand hygiene

A patient who has acute angle glaucoma is prescribed Atropine, what should the nurse do?

Hold medicine/clarify w/Dr.

Ophthalmic antibiotics

INDICATIONS FOR USE: Infection SIDE EFFECTS: Burning sensation in the eyes, conjunctivitis Ex: gentamicin ophthalmic, bacitracin/polymyxin B, Polysporin

Ophthalmic anti-inflammatories

INDICATIONS FOR USE: Inflammation and pain in eye, chronic dry eye SIDE EFFECTS: Burning, stinging, irritation Ex: diclofenac 0.1% solution (step up from Ibuprofen)

Immunomodulators

INDICATIONS FOR USE: Used to increase tear production SIDE EFFECTS: burning, itching Ex: Cyclosporine (Restasis 0.05% emulsion) SHOULD KNOW FOR THE N-CLEX

Ophthalmic corticosteroids

INDICATIONS OF USE: Inflammation and pain resulting from injury or surgery SIDE EFFECTS: If used for prolonged period: immunosuppression Ex: dexamethasone, prednisolone ophthalmic, Pred Forte

Explain where and what purpose the vitreous humor has in the eye

In the posterior cavity of the lying posterior to the lens. Helps keep the eyeball from collapsing

Prostaglandins

Increase outflow of aqueous humor by dilating blood vessels Side effect: Change in pigmentation of iris (color of eye) Examples Bimatoprost (Lumigan) Lantanoprost (Xalatan) Travoprost (Travatan Z)

Miotics

Increase the outflow of aqueous humor Constrict the pupil Some are cholinergic agonists, decrease I O P Examples: Pilocarpine H C L (Isopto Carpine, Pilocarpine H C L Ophthalmic Solution U S P), carbachol (Isopto Carbachol), and pilocarpine H C L gel 4% (Pilopine H S Gel)

Ophthalmic Corticosteriods

Inflammation and pain resulting from injury or surgery. S/E: If used for prolonged periods: immunosuppression Ex: Dexamethasone, predisolone ophthalmis (omnipred, Pred Forte, Prednisol)

What is IOP?

Intraocular pressure

Glaucoma

Leading cause of blindness due to an increase in pressure in the eye causing damage to the optic nerve

Medications for cerumen

Mineral oil, cerumenolytics, and hydrogen peroxide used to decrease amount of wax

What are some medications that treat glaucoma?

Miotic Medications, -pilocarpine HC1 -carbachol -pilocarpine HC1 4% And Prostaglandin Medications, -bimatoprost(Lumigan) -latanoprost(Xalatan) -travoprost(Travatan Z)

What is a normal finding on a Snellen Chart test?

Normal vision 20/20 meaning patient can read at 20 ft what the normal eye can read at 20 ft

How does the nurse assess visual muscle balance and movement?

Observe patient's gait by having patient walk away and back to examiner. Romberg's test instruct the patient to stand with ft together first w/eyes open then w/eye closed normally pt doesn't have trouble maintaining standing position w/only minimal swaying

What is the therapeutic action of pilocarpine?

Opens the aqueous flow by administering pilocarpine to constrict the pupil. WHen pupil is constricted the iris pulls away from the drainage canal so the aqueous fluid can flow freely

What positioning would be best for a patient after having a stapedectomy?

Operative ear is placed upward when lying down

What are normal findings on the Weber test and what would indicate abnormal findings?

Patient can hear the tuning for fork sound the same in both ears. Abnormal findings sound heard louder in affected ear (conductive hearing loss), sound heard louder in better ear (sensorineural hearing loss), no sound heard

Antivertigo Agents

Prevention and treatment of motion sickness S/E: Blurred vision, confusion, extrapyramidal symptoms, restlessness, sedation, hypotension, rash, dry mouth Ex: Meclizine (Anti-Vert) Diphenhydramine (benedryl) Scopolamine (transderm-scop transdermal patch)

What is one side effect of prostaglandins?

Prostaglandins change the pigmentation of the iris and thus the color of the eye

What does PERRLA stand for?

Pupils equal, round, reactive to light, accommodation

What recommendations can be made to prevent further vision loss with open-angle glaucoma?

Regular eye exams, proper medication administration,, refer patients to support services that provide adaptive visual devices

When assessing the patient's pupils what type of lighting would you have in the room?

Slightly darkened room

What can chronic otitis media lead to?

Spontaneous perforation of the tympanic membrane, cholesteatoma, tympanosclerosis, mastoiditis

whisper test

Test in which an examiner whispers a sentence and asks the patient to repeat it to evaluate loss of high-frequency sounds. Tests auditory nerve

Cornea

The clear structure that covers the iris, the pupil, and the anterior chamber

What causes motion sickness?

The ear's inability to determine the body's position relative to its motion.

How would you explain the finding of a patient's vision of 20/100?

The patient can read at 20 ft what the normal eye can read at a 100 ft

Vitreous Humor

Thick liquid found in the posterior chamber of the eye

Aqueous Humor (fluid)

Thin, watery fluid contained in the anterior chamber of the eye

How does the ophthalmologist determine intraocular pressure?

Tonometer uses a puff of air to make an indentation in the cornea to measure pressure

How is vertigo treated?

Treated with an anticholinergic drug, Meclizine (Antivert)

Otic Antibiotics

Treatment of ear infection S/E: Irritation of ear Ex: Acetic acid and aluminum acetate otic ofloxacin otic (floxin) acetic acid (vosol)

Otic combination drugs

Treatment of ear infection with inflammation S/E: unusual taste in mouth Ex: Ciprofloxacin and dexamethasone otic (ciprodex) Hydrocortisone, neomycin, and polymyxin B Otic (vosolHCL)

Ophthalmic alpha blockers

Treatment of eye irritation. S/E: Hypertension, somnolence, oral dryness, ocular hyperemia, eye buring or stinging. Ex: Alphagan P (brimonidine tartrate) Epifrin (epinephrine)

Miotics

Treatment of glaucoma S/E: Coneal edema, clouding, stinging, burning, tearing, headache. Ex: Carbachol (Isoptp carbachol) Pilocarpine HCL ( isopto carpine)

Carbonic anhydrase inhibitors

Treatment of glaucoma S/E: Ocular burning or stinging, blurred vision, bitter taste Ex: Brinzolamide ophthalmic suspension (azopt) Dorzolamide HCL (trusopt)

Osmotic Diuretic

Treatment of glaucoma, decrease intra-ocular pressure S/E: Dizziness, drymouth, fluid and electrolyte imbalances, headache, tremors, nausea, vomiting, disorientation, confusion. Ex: Glycerin osmoglyn (ophthalgan solution)

Ophthalmic Prostaglandin Agonist

Treatment of open angle glaucoma and ocular hypertenstion. S/E: Ocular hyperemia, decreased visual acuity, eye discomfort, eye discoloration. Ex: Bimatoprost (lumigan) Latanprost (xalatan solution) Travoprost (travatan 2)

Ophthalmic beta blockers

Treatment of open-angle glaucoma S/E: Headache, depression, arrhythmia, syncope, nausea, keratitis, visual disturbances, bronchospasm Ex: Betaxolol (betoptic S) Timol

The Schlemm canal is located in the eye. t or f

True; Schlemm's canal is located in the eye.

Cerumen is another name for earwax. t or f

True; cerumen is earwax.

Mydriatics are used to examine the inner eye. t or f

True; mydriatics are used to examine the inner eye.

what characteristics of communication would clue the nurse in to the patient experiencing hearing loss?

Turns volume up on TV or radio, frequently asks what did you say, leans forward or turns head to one side during conversation, cups hand around ear, speaks in an unusually quiet or loud voice, answers questions inappropriately or not at all, difficulty hearing high frequency consonants, avoids group activities, shows loss of sense of humor, has strained or serious look on face during conversation, appears to ignore people or in aloof, reports a ringing, buzzing, or roaring noise in the ears, mentions that people are talking slowly or mumbling

Ophthalmic Anti-inflammatories

Tx for Inflammation and pain in the eye, chronic dry eye S/E: Burning, stinging, irritation, corneal edema, risk for increased bleeding. Ex: Diclofenac 0.1% solution (cambia voltaven) Ketorolac tromethamine 0.5% solution (acular)

Ophthalmic Antibiotics

Use for infection S/E: Burning sensation in the eyes, conjuntivitis, hypersensitivity reactions, rash, uticaria Ex: Gentmycin tobramycin azithromycin polysporin ophthalmic neomycin/polymyxin B

Immunomodulators

Used to increase tear production. S/E: Burning, itching, discharge, red eyes, blurred vision, over flow of tears. Ex: Cyclosporine (restasis 0.05% emulsion)

What are the triad of symptoms in Meniere's disease?

Vertigo hearing loss and tinnitus

What vitamin can help a patient who experiences night blindness?

Vitamin A

amblyopia

a dimness of vision or the partial loss of sight, especially in one eye, without detectable disease of the eye lazy eye

carbuncle

a necrotizing infection of skin and subcutaneous tissue composed of a cluster of boils

meniere's disease

a recurrent and usually progressive group of symptoms including progressive deafness, ringing in the ears, dizziness, and a sensation of fullness or pressure in the ears

iris

a ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening

cerumen

a waxy substance secreted by glands located throughout the external canal ear wax

strabismus

abnormal deviation of the eye Esotropia: Strabismus in which there is deviation of the visual axis of one eye toward that of the other eye, resulting in diplopia. Also called cross-eyed. Exotropia: Abnormal turning outward of one or both eyes; divergent strabismus.

photophobia

abnormal vision intolerance to light

macular degeneration

age-related breakdown of the macular area of the retina of the eye

furuncle

an acute circumscribed inflammation of the subcutaneous layers of the skin or of a gland or hair follicle

miotics

an agent that causes the pupil to contract

astigmatism

an error of reaction in which a ray of light is not sharply focused on the retina but is spread over a more or less diffuse area

hyphema

blood in the anterior chamber of the eye

otosclerosis

condition characterized by chronic, progressive deafness, especially for low tones

presbyopia

diminution of accommodation of the lens of the eye occurring normally with aging and usually resulting in hyperopia or farsightedness

retinopathy

disease of retina of the eye

Schlemm canal

drainage tube in the eye that drains aqueous humor

ptosis

drooping, sagging, prolapse drooping of eyelid Increased ptosis occurs if MG is present. Myasthenia gravis (MG) means "grave muscle weakness" commonly seen in stroke patients.

stapedectomy

excision of the stapes to improve hearing, especially in cases of otosclerosis

What ear infection can occur in someone who frequently swims?

external otitis

hyperopia

farsightedness

What part of the eye detects color?

fovea centralis--cones

glaucoma

group of eye diseases characterized by increased intraocular pressure.

Ototoxicity

having a detrimental effect on the eighth nerve or organs of hearing

sensorineural

hearing loss caused by impairment of a sensory nerve

conductive hearing loss

impaired transmission of sound waves through the external ear canal to the bones of the middle ear

ophthalmoscope

instrument used to examine the interior of the eye

What are symptoms of an inner ear disorder?

labyrinthitis-vertigo, tinnitus, and sensorineural hearing loss. Inner ear tumor-progressive unilateral sensorineural hearing loss of high pitched sounds, unilateral tinnitus and intermittent vertigo. Meniere's disease-vertigo, hearing loss, and tinnitus

blindness

lack or loss of ability to see

What are age related changes with vision?

lens may become totally opaque, loses its elasticity and most people become farsighted, depth perception decreases and glare intensifies, color vision fades with less discrimination of blue, green and violet colors. Red, yellow, and orange colors are best visible. Depth perception losses may occur

cataract

opacity of the lens of the eye

Parts of the ear

outer ear, middle ear, inner ear, ear canal, ear drum, anvil, stirrup, cochlea, auditory nerve, semicircular canal, and hammer

otalgia

pain in the ear

enucleation

removal of an organ or other mass intact from its supporting tissues as of the eyeball from the orbit

myringoplasty

surgical reconstruction of the tympanic membrane

myopia

the error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina; nearsightedness

Retina

the light-sensitive inner surface of the eye, containing the receptor rods and cones plus layers of neurons that begin the processing of visual information

Sclera

white of the eye

Common eye disorders

-Glaucoma - Conjunctivitis -Macular Degeneration -Keratitis -Chalazion -Cataracts

Symptoms of ototoxicity

-Tinnitus: Ringing in the ears -Hearing loss -Severe headache -Ataxia -Balance disturbances

eye anatomy

-outermost layer "sclera and cornea" -middle layer "choroid, ciliary body, and iris" -inner layer "retina, macula lutea, fovea centralis, optic disc"

The nurse is reviewing the instillation technique for both eye ointment and eye drops with the parent of a pediatric client diagnosed with bacterial conjunctivitis. Which statement made by the parent would indicate that learning has taken place? 1. "I will be careful not to touch the eye or eyelid during administration." 2. "I will place my child on the left side to administer drops in the right eye." 3. "I will administer the eye ointment and then wait 5 minutes and administer the eye drops." 4. "I will have my child blink after the instillation to encourage thorough distribution of the eye drops."

1. "I will be careful not to touch the eye or eyelid during administration." Rationale: Touching the eye or eyelid during medication administration can contaminate the dropper and cause eye injury. The child should be placed in a supine position with the neck slightly hyperextended for administration. Eye drops should be administered before eye ointment is administered. Blinking will increase the loss of medication.

A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate eye drops as prescribed. The client asks the nurse why this medication is needed, and the nurse provides education. Which statement by the client indicates that teaching has been effective? 1. "The medication dilates the pupil of the operative eye." 2. "The medication constricts the pupil of the operative eye." 3. "The medication is needed for the initiation of miosis in the operative eye." 4. "The medication provides the necessary lubrication to the nonoperative eye."

1. "The medication dilates the pupil of the operative eye." Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication that is used preoperatively to dilate the eye. It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. The statements in the other options are incorrect.

A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. Administer the eye drop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eye drop. 3. Administer the eye drop, wait 15 minutes, and administer the eye ointment. 4. Administer the eye ointment, wait 15 minutes, and administer the eye drop.

1. Administer the eye drop first, followed by the eye ointment. Rationale: When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the health care provider (HCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the HCP before the home visit for which reason? 1. Clarify the prescription for the atropine sulfate. 2. Clarify the prescription for the pilocarpine hydrochloride. 3. Determine the date of the scheduled follow-up HCP visit. 4. Determine the extent of the intraocular pressure caused by the glaucoma.

1. Clarify the prescription for the atropine sulfate. Rationale: Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and cause increased intraocular pressure in the eye. Pilocarpine hydrochloride is a miotic agent used in the treatment of glaucoma. It is unnecessary to contact the HCP regarding the date for follow-up treatment. In fact, the client may know this date, which the nurse can ask about during the home care visit. It is unnecessary to know the extent of the intraocular pressure caused by the glaucoma in planning care for the client.

A client being discharged to home with a prescription for eye drops to be given in the left eye has received instructions regarding self-administration of the drops. The nurse determines that the client needs further instruction if, on return demonstration, the client takes which action? 1. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid 2. Lies supine, pulls down on the lower lid, and puts the drop in the lower lid 3. Tilts the head back, pulls down on the lower lid, and puts the drop in the lower lid 4. Lies with head to the right, puts the drop in the inner canthus, and slowly turns to the left while blinking

1. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid Rationale: It is correct procedure for the client to lie down or sit with his or her head tilted back. The thumb or finger is used to pull down on the lower lid. The client holds the bottle like a pencil (tip facing downward) and squeezes the bottle so that one drop falls into the sac. The client then gently closes the eye. An alternative method for clients who blink very easily is to place the client in the supine position with the head turned to one side. The eye to be used is uppermost. With the eye closed, the client squeezes the drop onto the inner canthus of the eye. The client turns from this side to the other while blinking. Surface tension and gravity then cause the drop to move into the conjunctival sac.

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action? 1. Monitoring body weight 2. Assessing the glucose level 3. Assessing peripheral pulses 4. Monitoring body temperature

1. Monitoring body weight Rationale: This medication is an antiglaucoma medication and a β-adrenergic blocker. The nurse assesses for evidence of heart failure manifested by dizziness, night cough, peripheral edema, and distended neck veins. Intake greater than output, weight gain, and decreased urine output also may indicate heart failure. Hypotension (manifested as dizziness), nausea, diaphoresis, headache, fatigue, and constipation or diarrhea also are potential systemic effects of the medication. Nursing interventions include monitoring body weight; periodically evaluating blood pressure for hypotension; and assessing the apical or radial pulse for strength, weakness, irregular heart rate, and bradycardia.

Betaxolol eye drops have been prescribed for a client with glaucoma. The nurse monitoring this client for side/adverse effects of the medication would place highest priority on which assessment? 1. Pulse rate 2. Blood glucose 3. Respiratory rate 4. Oxygen saturation

1. Pulse rate Rationale: Betaxolol is a beta-blocking agent as well as an antiglaucoma medication. Nursing assessments include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. The nurse also assesses for evidence of heart failure as manifested by dizziness, night cough, peripheral edema, and distended neck veins.

The nurse prepares a client for ear irrigation as prescribed by the health care provider. Which action should the nurse take when performing the procedure? 1. Warm the irrigating solution to 98.6°F (37.0°C) . 2. Position the client with the affected side up following the irrigation. 3. Direct a slow, steady stream of irrigation solution toward the eardrum. 4. Assist the client to turn his or her head so that the ear to be irrigated is facing upward.

1. Warm the irrigating solution to 98.6°F (37.0°C) . Rationale: Before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6°F (37.0°C) because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal.

The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply. 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone. 5. Instruct the client to squeeze the eyes shut after instilling the eye drop. 6. Instruct the client to tilt the head forward, open the eyes, and look down.

1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone. Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

The nurse would question the health care provider if which medication were prescribed for a client with glaucoma? 1. Carbachol 2. Atropine sulfate 3. Pilocarpine nitrate 4. Pilocarpine hydrochloride

2. Atropine sulfate Rationale: Pilocarpine and carbachol are examples of miotic agents used in the treatment of glaucoma. Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated for use in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity? 1. Anorexia 2. Bradycardia 3. Tachycardia 4. Hypertension

2. Bradycardia Rationale: Systemic absorption of pilocarpine hydrochloride can produce toxicity, manifested as vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Atropine sulfate is the antidote for systemic reactions that occur with pilocarpine.

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur early with the use of this medication? 1. Fatigue 2. Diuresis 3. Headache 4. Loss of libido

2. Diuresis Rationale: Diuresis is an early side effect of acetazolamide that usually subsides with continued treatment. This is because the medication is also a weak diuretic, although it is no longer prescribed for that purpose. Fatigue, headache, and loss of libido are common side effects of therapy, but these may not subside spontaneously.

What are risk factors for developing Cataracts?

Age ultraviolet radiation (sunlight) diabetes smoking steroids nutritional deficiencies alcohol consumption intraocular infections trauma congenital defects

Cycloplegic Mydriatics

Dialation of pupil in inflammatory conditions or for diagnostic or surgical procedures. S/E: Increased IOP, transient burning/stinging, blurred vision, dry mouth, dry skin Ex: Pilocarpine (isopto carpine solution) Scopolamine (scopace)

Prior to doing an indocyanine green angiography test, what should the nurse assess for?

Dye allergies

What recommendation can be made to prevent further vision loss with diabetic retinopathy?

Early detection and treatment; Yearly comprehensive eye exams to detect changes for treatment

Antimicrobials

Gentamicin Tobramycin Erythromycin

What is the leading cause of blindness?

Glaucoma

caloric test

Test the function of the eighth cranial nerve and assess vestibular reflexes of the inner ear that control balance.

Local Anesthetics

Tetracaine (Pontocaine 0.5% solution) Proparacaine (Ophthaine, Ophthetic 0.5 % solution)

Cornea

The transparent layer forming the front of the eye.

Glaucoma can occur suddenly or gradually over time. t or f

True; glaucoma can occur gradually over time or with a sudden increase in IOP.

The pinna functions by funneling sound through the outer ear canal. t or f

True; the pinna protects the inner and middle ears as well as capturing and funneling sound toward the tympanic membrane.

What examinations can be provided using a tuning fork?

Rinne test, Weber test

Rods and cones

Rods-Retinal receptors that detect black, white, and gray (night vision) Cones-(photoreceptor) in the retina of the eye that provides color vision and sharp central vision.

Cerumenolytics

Softening of ear wax ( cereum) S/E: None Ex: Cabamide peroxide solution (Auro, debrox)

What are age related changes with hearing?

cumulative damage to hair cells in the organ of Corti, ability to hear high frequencies (presbycusis), more difficult to filter out background noises

conjunctivitis

inflammation of the conjunctiva of the eye

external otitis

inflammation of the external ear

blepharitis

inflammation of the glands and lash follicles along the margin of the eyelids

otitis media

inflammation of the middle ear

Tonometer

instrument for measuring tension or pressure

Tinnitis

ringing in the ears

What part of the eye detects only presence of light?

rods

chalazion

small eyelid mass resulting from chronic inflammation of a meibomian gland.

hordeolum

sty

A stye is caused by? A.Bacteria B.Fungus C.Parasite D.Virus

A. Bacteria cause sties.

Antivertigo agents

INDICATIONS FOR USE: Prevention and treatment of motion sickness SIDE EFFECTS: sedation, dry mouth Ex: meclizine, dimenhydrinate, scopolamine

Cerumenolytics

INDICATIONS FOR USE: Softening of earwax (cerumen) Ex: carbamide peroxide solution

Otic antibiotics

INDICATIONS FOR USE: Treatment of ear infection INTERACTIONS: Other ear drops Ex: ofloxacin otic

Otic combination drugs

INDICATIONS FOR USE: Treatment of ear infection with inflammation INTERACTIONS: Other ear drops Ex: ciprofloxacin, neomycin, polymyxin B otic

Carbonic anhydrase inhibitors

INDICATIONS FOR USE: Treatment of glaucoma Ex: dorzolamide HCI (Trusopt)

Miotics

INDICATIONS FOR USE: Treatment of glaucoma SIDE EFFECTS: stinging, burning, tearing Ex: pilocarpine HCI

What are signs and symptoms of Astigmatism?

Blurred vision w/distortion

Osmotic diuretics

INDICATIONS FOR USE: treatment of glaucoma; decreases intraocular pressure

Ophthalmic prostaglandin agonists

INDICATIONS FOR USE: treatment of open of open-angle glaucoma and ocular hypertension Ex: bimatoprost, latanoprost

myringotomy

incision of the tympanic membrane, usually performed to relieve pressure and allow for drainage of either serous or purulent fluid in the middle ear behind the tympanic membrane

presbycusis

progressive bilaterally symmetrical perceptive hearing loss occurring with age; usually after age 50 and is caused by structural changes in the organs of hearing

otorrhea

purulent drainage from the ear

What is one side effect of prostaglandins?

They change the pigmentation of the iris and thus the color of the eye.