Sensory Function (Exam 1)
Fundus Photography
-Retinal lesions -The fundus of the eye is the interior surface of the eye opposite the lens and includes the retina, optic disc, macula, fovea, and posterior pole
Cataracts
-opacity/cloudiness of the lens
? Nursing Process: Patient undergoing mastoid surgery assessment ?
-Health hx -data related to disorder to the ear, hearing loss, otalgia, otorrhea, and vertigo -duration and intensity, causes and previous tx -medications *physical assessment •Erythema, edema, lesions •Discharge; color and odor •Review audiogram results
What to remember for occular medication?
-Limited size of conjuctival sac (50 mL) -tearing, blinking, drainage can dilute it
What's a treatment for cornea dystrophy?
CROSSLINKING: which films the cornea to stop progression of the disease
What is the leading cause of blindness?
Diabetes
What are the types of corneal dystrophy?
Keratoconus: Hereditary, more women, blurred vision, conical protuberance of the cornea Fuchs Endothelial dystrophy: Slow death of cells in endothelial cornea-women over 50-blurred vision-corneal transplant needed, line in the middle Tx: -PRK (shaving off) -Lasik (Complete removal)
Ménière Disease
Cranial nerve VIII- weber test—sound goes to ear opposite hearing loss—the one affected with Meniere's No salty processed foods, olives, pickles, salted sardines
Conditions of the middle ear
Chronic otitis media Result of recurrent acute otitis media •Chronic infection damages the tympanic membrane, ossicle, and involves the mastoid Treatment •Prevent by treatment of acute otitis •Tympanoplasty, ossiculoplasty, or mastoidectomy
Where do you put the opthalmic ointment for a toddler that has bacterial conjuctivitis?
Conjuctival sac
What are the 3 types of cataracts?
Traumatic Congenital Senile cataract
Why does corticosteroids can affect glaucoma?
it changes the aqueous humor flow which can increase pressure
Treatment for glaucoma
medication therapy (beta blocker - timolol) prevent further optic nerve damage surgery
Myopia
nearsighted
What are the dots in diabetic retinopathy?
necrotic tissue
emmetropia
normal vision
Retinal vein/artery occulsion
occlusion can also cause vision loss from: atherosclerosis, cardiac valvular disease, venous stasis, hypertension, or increased blood viscosity;
Hearing loss
presbycusis (progressive hearing loss, age) •Conductive; caused by external of middle ear problem •Sensorineural; caused by damage to the cochlea or vestibulocochlear nerve •Mixed; both conductive and sensorineural •Functional (psychogenic); caused by emotional problem
Retinal vascular disorders
•Central retina vein occlusion •Branch retinal vein occlusion •Central retinal vein occlusion •Macular degeneration
Age Related MD
**Dry or nonexudative type; most common, 85% to 90% Slow breakdown of the layers of the retina with the appearance of drusen, blockage in retinal capillary arteries **Wet type May have abrupt onset Proliferation of abnormal blood vessels growing under the retina-choroidal revascularization -NO CURE
Q: A 42-year-old woman with Meniere's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan?
- Dim the lights in the patient's room -A darkened, quite room will decrease the symptoms of the acute attack of Meniere's disease.
Glaucoma
African American, CV dx, DM, Family hx glaucoma, migraine syndromes, myopia, old age, eye trauma, steroids, thin cornea chart 63-5 *steroids, addisons disease, asthmatic patients, anyone that's taking corticosteroids
Q: The nurse working in the vision & hearing clinic receives telephone calls from several clients who want appointments in the clinic ASAP. Which client should be seen first?
-71 year old who has noticed increasing loss of peripheral vision -A increasing loss of peripheral vision is characteristic of glaucoma and the patient should be scheduled for an examination as soon as possible.
Q: A nurse is triaging clients in an urgent care clinic. Which of the following clients should the nurse have the provider care for immediately?
-A middle adult male who is diaphoretic and reports epigastric pain -When using the urgent vs. nonurgent approach to client care, the nurse should determine that caring for this client is the highest priority because diaphoresis and epigastric pain are manifestations of an acute myocardial infarction.
What are common causes of cataracts?
-Age related -trauma/foreign body in the eye/ exposure to radiation/ UV light -Toxicity: LT use of corticosteroids, phenotiazine derivatives, BB, miotic medication (contracting) -Comorbidities
Medications for eyes and ears
-Betal blocker -Alpha agonists -Diuretics and anti nausea -Antibiotics -Meclizine
Inner ear conditions
-Dizziness: any altered sense of orientation in space -Vertigo: the illusion of motion or a spinning sensation -Nystagmus: involuntary rhythmic movement of the eyes associated with vestibular dysfunction -Miniere Disease
Q: A nurse is assessing a client who reports ear pain for the past 3 days that has suddenly resolved. The client has a new onset of otorrhea (drainage from the ear). The nurse should recognize the client has manifestations of which of the following conditions?
-Perforated tympanic membrane -The client has manifestations of otitis media with a perforated tympanic membrane (eardrum).
Q: A nurse is caring for a client who has right-sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Which of the following actions should the nurse take?
-Place suction equipment at the client's bedside. -Cranial nerves IX (glossopharyngeal) and X (vagus) innervate the muscles of the soft palate, larynx, and pharynx. Impairment of these nerves places the client at risk for aspiration, making it necessary for the nurse to have access to suction for the client.
Q: The priority nursing diagnosis for a patient experiencing an acute attack with Meniere's disease is?
-Risk for falls related to dizziness -All the nursing diagnoses are appropriate, but because sudden attacks of vertigo can lead to "drop attacks: the major focus of nursing care is to prevent injuries associated with dizziness.
Pt education for eye drops
-Rx eye medication is beneficial uf used q 12 h -instill one drop in each eye twice daily/ wait 5-10 min between eye drops if more than one is prescribed -do not touch top of application bottle to the eye -wash hands after -once instrilled, apply pressure using the punctal occlussion technique (placing pressure on the inner corner of eye)
Q: A nurse has several tasks to delegate to an assistive personnel (AP). Which of the following tasks should the nurse ask the AP to perform first?
-Take an arterial blood gas (ABG) specimen to the laboratory. -When using the urgent vs. nonurgent approach to client care, the nurse should determine the priority action is to take the ABG blood sample to the laboratory. ABG samples are placed on ice and must be transported to the laboratory immediately or the specimen will deteriorate, making any results inaccurate.
Q: Which information about a patient who had a stapedotomy yesterday is most important for the nurse to communicate to the health care provider?
-The patient's oral temperature is 100.8 F (38.1 C) -An elevated temperature may indicate a postoperative infection.
Inner ear conditions
-Tinnitus -Labyrihthitis -Ototoxicity -Benign positional vertigo -Acoustic neuroma: tumor of the VIII cranial nerve *abx, aspirin, mycins*
Q: A nurse is participating in a disaster simulation in which a toxic substance is released into a crowded stadium. Multiple clients are transported to the facility. Which of the following activities would be the lowest priority for the nurse?
-Transferring a client to the discharge location -Nursing care in a disaster setting focuses on essential care. The nurse should recognize nonskilled interventions, such as transferring a client to the discharge location, can be performed by nonmedical personnel.
Patho for inner ear
-deep in the temporal bone -seperated from middle by oval window consist of: -cochlea (hearing organ). -semicircula canals (balance) -CN VII (facial nerve) -CN VIII (vestibulocochlear nerve)
Patho for middle ear
-tympanic membrane -occickes (malleus, incus, stapes) -and connects to the nasopharync via estuchian tube
Post operative care for cataracts
eye shields at night 1st week
Condition of the middle ear
Acute otitis media •Most frequently seen in children •Pathogens are most commonly bacterial or viral •Manifestations include otalgia (ear pain), fever, and hearing loss Treatment •Antibiotic therapy •Myringotomy or tympanotomy
What are the associate risk factors for retinal vein/artery occlussion?
Diabetes, glaucoma and aging
Types of Cataract Sx
ECCE which uses an ultrasonic device to suction the lens out through a tube lens replacement - after ECCE, surgeon inserts an intraocular lens implant. *may still require glasses
Diuretics and Anti-nausea
For Meniere's Disease
What position do patients that underwent retinal detachment lie?
Prone position
What is the most common type of retinal detachment?
Rhegmatogenous detachment
Q: The nurse is assessing a patient who has recently been treated with amoxicillin for acute otitis media of the right ear. Which finding is a priority to report to the health care provider?
The patient has a temperature of 100.6 F The fever indicates that the infection may not be resolved and the patient might need further antibiotic therapy.
Wide angled glaucoma
bilateral, anterior chamber open/normal
without treatment glaucoma can cause ___________
blindness
Refractive errors
can be corrected by lenses that focuses light rays on the retina ie: myopia, hyperopia
narrow angled glaucoma
complete closure of angle ACUTE=EMERGENCY
Diagnostic findings for cataracts
decreased visual acuity and opacity of the lens by ophthalmoscope, slit lamp, or inspection
Pathophysiology of Menieres Disease
•Abnormal inner ear fluid balance cause by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct •Manifestations include triad of symptoms: episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss. Feeling of pressure, nausea and vomiting
Q: A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first?
-Turn the client's head to the side. -The first action the nurse should take when using the airway, breathing, circulation approach to client care is to turn the client's head to the side. This action keeps the client's airway clear of secretion to prevent aspiration.
Otosclerosis
-hardening of the bony tissue of the middle ear -stapedectomy -Majority of clients experience resolution of conductive hearing loss following surgery, use of sodium fluoride in post op increases success rate
Expected findings of MD
-lack of depth perception -objects appear distorted -blurred vision -LOSS OF CENTRAL VISION -blindness *Opthalmoscopy (examines back part of the retina) & Visual acuity test*
timolol eye drops for glaucoma
-need to be applied on a regular schedule for the rest of clients life -open angle is to continue for rest of the life -abrupt dc can worsen the condition -5 min apart each drops
Q: A nurse is assessing a client who has an acoustic neuroma. Which of the following client manifestations should the nurse expect?
-vertigo -The nurse should expect a client who has an acoustic neuroma, a benign tumor of cranial nerve VIII, to manifest mild to moderate vertigo as time progresses.
Stapedectomy
is a sx procedure of the middle ear in which the stapes is removed and replaced with prothesis. done through external canal and TM done when otosclerosis has developed and the bones of middle ear fuse together
Conjuctivitis and Otitis media
Antibiotcs
Q: A patient who has undergone a left tympanoplasty should be instructed to:
Avoid blowing the nose Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.
Antihistamines
Diphenhydramine/dimenhydrinate NA: observe for urinary retention, sedation, precaution for safe ambulation Education: Dry mouth
Q: A clinic nurse is giving instructions to a mother on the proper technique of applying ophthalmic ointment to her preschool-age child who has conjunctivitis. Which of the following should the nurse include in the instructions?
Discard the first bead of ointment before each application Rationale: contaminated. Eye drops that are stored in the refrigerator should come to room temperature before instillation. The parent should not warm the ointment by placing it in glass of hot water. The parent should clean the eye in a direction from the inside canthus outward in order to prevent contamination of the lacrimal duct or the other eye. Closing the eyes spreads the medication over the eyeball, but squeezing the eyelid shut can force out some of the medication.
Tonometry
IOP screen for and manage glaucoma NI-avoid squeezing the eyelids, holding breath or Valsalva maneuver results in abnormally high IOP
When is cataract sx needed?
If reduced vision interferes with normal activities but if it does not then no need for one
Corneal Dystrophies
Inherited, autosomal dominant 20 y/o and younger men Deposits in corneal layers
How long do corneal transplant improve your vision?
Months to restore vision Vision may not be restored for up to a year after corneal transplant. Because the patient is not experiencing complication of the surgery, an emergency clinic visit is not needed. Because "floaters" are not associated with complications of corneal transplant, the nurse will not need to ask the patient about their presence. Corticosteroid drops, not mydriatic drops are used after corneal transplant surgery.
Q: A nurse is caring for a client who is postoperative following a left corneal transplant. The nurse observes purulent drainage from the affected eye. Which of the following actions is the nurse's priority?
Notify the Surgeon Purulent draining is a manifestation of infection and should be reported to the surgeon immediately.
Q: A nurse is talking with a client who is scheduled for surgery to repair retinal detachment. Which of the following preoperative instructions should the nurse include?
RESTRICT HEAD MOVEMENT The client should restrict head and eye movement to prevent further detachment prior to surgery. With retinal detachment, the client should wear an eye patch over the affected eye to limit its movement. Topical medications are administered preoperatively to prevent pupil constriction and accommodation. Retinal detachment is painless, so there is no need for comfort measures like cool compresses.
Tympanoplasty
Reconstruction of the tympanic membrane *Middle ear procedure
Glaucoma
SILENT THIEF unaware of condition until significant visual loss peripheral vision loss, blurring, halos, unable to focus, difficulty in adjusting eyes to low lighting aching/discomfort around eyes, headache
Visual acuity
SNELLEN chart - distance, 20 feet back ROSENBAUM pocket screener - near
Surgical tx for retinal detachment
Scleral buckle - compresses sclera Vitrectomy - intraocular procedure, gas bubble, silicone oil, perfluorocarbon and liquids may be injected into vitreous cavity, a cavity is removed to provide better access to retina
Condition of the middle ear
Serous otitis media: fluid in the middle ear w/o evidence of infection
Post cataract surgery nursing intervention
if pt complain of pain then notify provider right away eye pain after sx may indicate IOP/hemorrage wear glasses should have immediate return of regular vision so educate pt to protect eyes
Photodynamic Therapy for MD (age related)
The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. {verteporfin (Visudyne) medication collects in the abnormal blood vessels under the macula. Laser light then activates the medication to form clots that block the abnormal vessels} There are no restrictions on the use of facial lotions, medications to keep the pupils dilated would increase the risk for damage caused by the treatment.
Procedure of visual acuity
The right eye is tested followed by the left eye, then both eyes are tested 20 ft distance
Note for Wet MD
This can occur at any age *new abnormal proliferation of vessels
Diagnostic for Glaucoma
Tonometry Opthalmoscopy (to inspect the optic nerve disc inside the eye)
Conditions of the middle ear
Tympanic membrane perforation Otoscopic exam shows redness, bulging of tympanic membrane, inability to visualize usual landmarks
Meclizine
Vertigo NA: observe for sedation and take appropriate precaution for safe ambulation Education: Avoid driving or operating heavy machinery
myringotomy
incision into the tympanic membrane to drain fluid from the middle ear to prevent ear drum perforation in otitis media.
Diabetic Retinopathy
•Diabetic retinopathy is caused by damage to the blood vessels in the tissue at the back of the eye (retina). Poorly controlled blood sugar is a risk factor. •Early symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors. Blindness can occur. •Mild cases may be treated with careful diabetes management. Advanced cases may require laser treatment or surgery.
Risk Factors of MD
-Smoking -Hypertension -Female -Short body -Family Hx -Diet lacking carotene and V E
Intervention from mastoid sx
-analgesics -safety measure when ambulating -antiemetics/antivertigo meds -patient education -decrease anxiety
What med is used for cataracts?
-atropine 1% (anticholinergic), dilates eye
Glaucoma
-damaged to the optic nerve -IOP d/t congestion of aqueous humor
*Ocular medication administration *SATA*
1.Hand hygiene 2.Remove contacts 3.Have client sit down and tile head slightly backward 4.Gently pull the tissue underneath the eye downward to expose the lower conjunctival sac 5.Hold the dropper and stabilize your hand on the client forehead 6.Have client look up while you instill the number of prescribed drops 7.Gently press on the puncta with the eyes closed
Patient education for cataracts
•Provide written and verbal instructions •Instruct patient to call physician immediately if vision changes; continuous flashing lights appear; redness, swelling, or pain increase; type and amount of drainage increases; or significant pain is not relieved by acetaminophen
Ossiculoplasty
•Reconstruction of the bones of the middle ear •Prostheses are used to reconnect the ossicles to reestablish sound conduction *Middle ear surgery
If transplant is needed for corneal dystrophy, where do they get it?
Cadavers
Condition of the external ear
External otitis - outer portion •by bacteria Staphylococcus or Pseudomonas, or fungal infection from Aspergillus •Manifestations include pain and aural tenderness, discharge, edema, erythema, pruritus, hearing loss, feelings of fullness in the ear •Therapy is aimed at reducing discomfort, reducing edema, and treating the infection •A wick may be inserted in the canal to keep it open and facilitate medication administration
Angiography
Macular edema macular capillary nonperfusion & neovascularization NI-ck BUN/Cr due to contrast, pt well hydrated, may turn urine yellow or orange x 24h encourage fluids after
Timolol (BB)
decreases IOP when used as an eye drop
Brimonidine, combigan ( Alpha Agonists )
decreases aquaous humor, allows better fluid drainage from within the eye
What are the four diseases that can cause blindness?
diabetes retinopathy, glaucoma, trauma, macular degeneration
Astigmatism
distortion caused by irregularity of the cornea
When irrigating external ear d/t cerumen impaction or foreign bodies what type of water should be use?
warm water cold can projectile vomitting
Treatment for Meniere Disease
•Low-sodium diet; 1,000-1,500 mg/day •Meclizine (Antivert); tranquilizers-valium, antiemetics-promethazine, and diuretics may also be used •Surgical management to eliminate attacks of vertigo; endolymphatic sac decompression, middle and inner ear perfusion, and vestibular nerve sectioning
Conditions of the external ear
•Malignant external otitis: rare, progressive infection that affects the external auditory canal, surrounding tissues, and skull
Intervention for preventing infection
•Monitor for signs and symptoms of infection •Administer antibiotics as ordered •Prevent contamination of ear with water from showers, washing hair, and so on
Note: Improving communication and hearing
•Note: Hearing may reduce for several weeks after surgery because of edema, accumulation of blood and fluid in the middle ear, and dressings and packings •Use measures to improve hearing and communication as discussed in "Communicating with Hearing Impaired Persons."
patient education for undergoing mastoid sx
•Occasional sharp, shooting pans may occur as the eustachian tube opens and allows air into the middle ear. Constant throbbing pain and fever may indicate infection
Clinical manifestation of cataracts
•Painless, blurry vision, surroundings dimmer •Sensitivity to glare •Reduced visual acuity •Other effects include myopic shift; astigmatism; diplopia (double vision); and color shifts, including brunescens (color value shift to yellow-brown)
Photodynamic Therapy for slowing progression of MD
•Patient must avoid exposure to sunlight or bright light for 5 days after treatment to avoid activation of dye in vessels near the surface of the skin •Light-sensitive verteporfin dye is injected into vessels. A laser then activates the dye, shutting down the vessels without damaging the retina •The result is to slow or stabilize vision loss
Mastoidectomy
•Removal of diseased bone, mastoid air cells, and cholesteatoma to create a noninfected, healthy ear •Cholesteatoma: benign tumor, an ingrowth of skin that causes persistently high pressure in the middle ear, which causes hearing loss and neurologic disorders and destroys structures
Enucleation
•Removal of the eyeball (globe) from the orbit •Evisceration-removal of contents through and incision •Exenteration-removal of entire contents
Expected findings of retinal detachment
•Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as: •The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision •Flashes of light in one or both eyes (photopsia) •Blurred vision •Gradually reduced side (peripheral) vision •A curtain-like shadow over your visual field
Retinal detachment
•Separation of the sensory retina and the RPE (retinal pigment epithelium) •Manifestations: sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, sudden onset of floaters
Enucleation: Ocular prosthesis
•Will have large ocular pressure dressing removed after a week •Ophthalmic topical antibiotic ointment is applied in the socket three times daily •Client has loss of depth perception, extra caution with ambulation •Client is advised conformers may accidentally fall out of the socket, if this happens wash, dry, place back in
